Search

Objectives: Rigorous photoprotection is the only means to prevent skin cancer in people with the rare condition of xeroderma pigmentosum (XP). We conducted a qualitative process evaluation of patient experiences and responses to a highly personalized, multi‐component intervention, 'XPAND', designed to influence the psychosocial determinants of inadequate photoprotection among adults with XP. Design: Qualitative study of 15 patients following participation in a RCT. Methods: Semi‐structured interviews explored acceptability, changes in photoprotection and attributions for behavioural changes. Analysis followed a framework approach. Results: Participants were overwhelmingly positive in their views of the quality and range of components of XPAND and the relevance to their personal photoprotection barriers. All participants reported improved adherence to at least one photoprotection activity and nearly two‐thirds of participants noted improvements across multiple activities. Participants believed improvements in their photoprotection behaviours were influenced by different change mechanisms. Sunscreen application, was mainly facilitated by habit formation, prompted by text messages, whereas the wearing of a photoprotective face buff was influenced by strategies, learnt during one‐to‐one sessions, to overcome worry about looking different. Enhancement of general self‐confidence and perceived support from XPAND described by participants facilitated change more broadly. Conclusions: Exploration of responses to XPAND is required in the international XP population, followed by adaptation and evaluation to see if it could benefit other patient groups at higher risk of skin cancer. Implications for approaches to behaviour change include the acceptability of complex multidimensional interventions, the importance of dynamic personalization and the interactive nature of behaviour change mechanisms. [ABSTRACT FROM AUTHOR]

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-9566.2010.01247.x Byline: Katharine Daneski (1), Paul Higgs (2), Myfanwy Morgan (3) Keywords: prevention; moral; stroke; obesity; public health Abstract: Abstract Current UK medical guidance on the management of stroke includes advice on reducing behavioural factors that place people at risk of the disease. This paper explores the historical background to the construction of this risk; it starts by investigating the connections made between individual behaviours and the causation of apoplexy in the medical discourse during the 18.sup.th and 19.sup.th centuries described in English medical textbooks from the 1700s. In outlining the emergence of a biomedical discourse around apoplexy and stroke, we note how a number of judgemental and moral concerns are articulated particularly around diet and exercise. While different in emphasis and starting point these discourses have their echo in contemporary approaches to the prevention of stroke. We seek to show that many of the themes common in current health promotion and public health strategies can be seen as continuities of earlier concerns regarding people's health; albeit now operating against the backdrop of a somatic society rather than a broader sense of moral regulation. We also hope to show how the understanding and prevention of stroke feeds into the moral discourse of the 'obesity crisis' confronting the affluent nations of North America and Europe. Author Affiliation: (1)School of Human and Health Sciences, Swansea University (2)Unit of Behavioural Medicine, Division of Research Strategy, University College London Medical School (3)Department of Primary Care and Public Health Sciences, King's College London Article note: Address for correspondence: Katharine Daneski, School of Human and Health Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP, e-mail: K.A.Daneski@swansea.ac.uk

Purpose: An individual's lack of social connections and social isolation is often associated with feelings of loneliness which is regarded as having a negative effect on health. This paper describes the development and assessment of a 10 item 'Personal Sociability and Connections Scale' (PeSCS) to measure individual's disposition and accompanying skills to seek out companionship and engage in interpersonal relations. Methods: The study was conducted at a rural primary care unit in Northern Greece. A total of 199 attenders were recruited over a 6-week period in 2020 and questionnaires completed. This informed the 10-items PeSCS that comprises Social, Behavioral, and Emotional components focusing on the expression of social comfort, willingness to share experiences, stories and concepts, and feelings of similarity at first contact. Reliability of the PeSC scale was assessed and the relationship with scale scores examined as an indicator of convergent validity. A multivariate linear regression analysis was performed to examine the relationship of PeSC scale score with the characteristics of participants. Results: Assessment of reliability of PeSC scale produced a Cronbach's alpha of 0.809. The relationship between components and the total PeSCS scores identified significant correlations (p <.001). At a multivariate level, male gender was the sample characteristic with a significant association with scale levels (p <.05) and higher annual income with Social component (p <.05). Otherwise the distribution of sociability dispositions was similar across population groups. Conclusion: The 10-item PeSC scale forms a simple and quick to complete measure whose overall reliability was rated as 'meritorious'. The PeSC instrument may be a useful tool for assessing the causes and appropriate responses to the negative health effects of loneliness and social isolation. [ABSTRACT FROM AUTHOR]

The study aimed to synthesise qualitative studies of lay experiences of medicine taking. Most studies focused on the experience of those not taking their medicine as prescribed, with few considering those who reject their medicines or accept them uncritically. Most were concerned with medicines for chronic illnesses. The synthesis revealed widespread caution about taking medicines and highlighted the lay practice of testing medicines, mainly for adverse effects. Some concerns about medicines cannot be resolved by lay evaluation, however, including worries about dependence, tolerance and addiction, the potential harm from taking medicines on a long-term basis and the possibility of medicines masking other symptoms. Additionally, in some cases medicines had a significant impact on identity, presenting problems of disclosure and stigma. People were found to accept their medicines either passively or actively, or to reject them. Some were coerced into taking medicines. Active accepters might modify their regimens by taking medicines symptomatically or strategically, or by adjusting doses to minimise unwanted consequences, or to make the regimen more acceptable. Many modifications appeared to reflect a desire to minimise the intake of medicines and this was echoed in some peoples' use of non-pharmacological treatments to either supplant or supplement their medicines. Few discussed regimen changes with their doctors. We conclude that the main reason why people do not take their medicines as prescribed is not because of failings in patients, doctors or systems, but because of concerns about the medicines themselves. On the whole, the findings point to considerable reluctance to take medicine and a preference to take as little as possible. We argue that peoples' resistance to medicine taking needs to be recognised and that the focus should be on developing ways of making medicines safe, as well as identifying and evaluating the treatments that people often choose in preference to medicines. Keywords: Medicines; Qualitative; Synthesis

Interest in how qualitative health research might be used more widely to inform health policy and medical practice is growing. Synthesising findings from individual qualitative studies may be one method but application of conventional systematic review methodology to qualitative research presents significant philosophical and practical challenges. The aim here was to examine the feasibility of synthesising qualitative research using qualitative methodology including a formative evaluation of criteria for assessing the research to be synthesised. Ten qualitative studies of adult patients' perspectives of diabetes were purposefully selected and questions proposed by the critical appraisal skills programme (CASP) adapted and used to assess papers prior to synthesis. Each study was reviewed independently by two experienced social scientists. The level of agreement between reviewers was determined. Three papers were excluded: one because it turned out not to be qualitative research, one because the quality of the empirical work was poor and one because the qualitative findings reported were also recorded in another paper already included. The synthesis, which had two distinct elements, was conducted using the recta-ethnographic method. Firstly, four papers containing typologics of patient responses to diabetes were synthesised. Secondly, six key concepts were identified from all seven papers as being important in enabling a person with diabetes to achieve a balance in their lives and to attain a sense of well-being and control. These included: time and experience, trust in self, a less subservient approach to care providers, strategic non-compliance with medication, effective support from care providers and an acknowledgement that diabetes is serious. None of the studies included in the synthesis referenced any of the early papers nor did they appear to have taken account of or built upon previous findings. This evaluation confirmed that recta-ethnography can lead to a synthesis and extension of qualitative research in a defined field of study. In addition, from it a practical method of qualitative research assessment evolved. This process is promising but requires further testing and evaluation before it could be recommended for more widespread adoption. Keywords: Qualitative research; Meta-ethnography; Patient perspectives; Diabetes mellitus