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  • Risks and benefits of ventilation tubes and hearing aids from the perspective of parents of children with cleft palate.

    29 June 2018

    OBJECTIVE: To understand parents' experiences of treatment of otitis media with effusion (OME) for children with cleft palate. METHODS: Qualitative interviews with parents of 37 children who had non-syndromic cleft palate (with or without cleft lip). They were recruited from two cleft centres in northern England. Participants talked about choices, information, decision-making and satisfaction with ventilation tubes (VTs) and/or hearing aids (HAs). Interviews were recorded and transcribed verbatim. Themes were developed using Framework Analysis. RESULTS: VTs and HAs were not considered as equal treatments by interviewees, due to physical risks associated with the former and social consequences with the latter. The inequality was explained within three main themes: (1) treatment recommendations - most parents did not recall being offered options when OME was first treated; VTs tended to be presented initially followed by HAs if VTs had been inserted more than once. Treatment recommendations came from medical specialists, although participants could also be influenced by other parents' stories; (2) beliefs about mechanisms of treatments - interviewees believed VTs could address the underlying cause of OME by draining fluid. Some parents felt HAs signified a deterioration in hearing and an escalation of care. Improvements in hearing were reported by interviewees with VTs and HAs; (3) demands on parents - participants often saw the insertion of VTs as opportunistic, alongside another procedure (e.g. palatal closure). They could feel disappointed when VTs fell out or were perceived to have caused ear infections. Parental involvement was on-going for HAs (e.g. ordering batteries and tubes). Parents expressed fears about the potential for social stigma of HAs, although none reported significant teasing of children because they wore HAs. CONCLUSIONS: Parents' views about treatment for OME were shaped by differing perceptions about anticipated risks and benefits. VTs may have been seen as a simple fix, inserted alongside another procedure, but some interviewees had concerns about possible physical consequences. Others were more worried about anticipated social stigma associated with HAs. However, parents of children who wore a HA described them as easy to manage and well tolerated, at least until children got older and started to comment on their appearance.

  • What are the barriers and facilitators to exercise and physical activity uptake and adherence among South Asian older adults: a systematic review of qualitative studies.

    29 June 2018

    OBJECTIVE: The objective of this study is to synthesise views and experiences of South Asian (SA) older adults in relation to exercise and physical activity (PA). It was anticipated that this work would identify barriers and facilitators that could inform interventions aimed at promoting PA among this population. METHOD: A systematic review of qualitative research was conducted. Six electronic databases were searched for relevant papers published from January 2000 to October 2011. Studies were appraised and data extracted by two reviewers. A synthesis was undertaken using framework analysis. Of 26 papers read in full, 11 were included in the review. RESULTS: An overriding concept derived from the synthesis was the influence of empowering and disempowering contexts on PA levels of SA participants. It was supported by the following themes: communication (e.g. relying on relatives for translation of information, lack of understanding); relationships (e.g. social support from family, friends, community), beliefs (e.g. not culturally appropriate to exercise, fatalism) and environment (e.g. lack of accessible recreational areas/facilities). CONCLUSIONS: Drawing on community resources to generate group norms appears to be important when trying to increase exercise and PA among SA older adults. Implications of the results for PA promotion and provision are discussed.

  • What influences physical activity in people with heart failure?: a qualitative study.

    29 June 2018

    BACKGROUND: Research has highlighted the benefits of physical activity for people with stable heart failure in improving morbidity and quality of life. However, adherence to exercise among this patient group is low. Barriers and enablers to sustained physical activity for individuals with heart failure have been little investigated. OBJECTIVES: To explore reasons why people with heart failure do and do not engage in regular physical activity. DESIGN: A qualitative, interview-based investigation. SETTINGS: Three heart failure clinics held at hospitals in the UK. PARTICIPANTS: Purposive sampling was adopted to provide maximum variation in terms of gender, age, heart failure duration and severity, and current activity levels. Twenty two patients (7=female) were interviewed, aged between 53 and 82 years. METHODS: Semi-structured interviews were conducted via telephone. These were recorded and transcribed verbatim. Framework analysis was applied to collected data. RESULTS: Interviewees' narratives suggested that adopting positive health behaviours was complex, affected by internal and external factors. This was reflected in the four themes identified during analysis: fluctuating health; mental outlook; others' expectations; environmental influences. Failure to exercise arose because of symptoms, co-morbidities, poor sense of self as active and/or lack of perceived benefit. Likewise, encouragement from others and inclement weather affected exercising. CONCLUSIONS: Areas identified during interviews as influencing activity levels relate to those commonly found in behavioural change theories, namely perceived costs and benefits, self-efficacy and social support. These are concepts that practitioners may consider when devising interventions to assist patients with heart failure in undertaking and maintaining regular exercise patterns.

  • Treading the tightrope between motherhood and an eating disorder: a qualitative study.

    29 June 2018

    BACKGROUND: Pregnancy is a life event that involves a change in appearance, during which the eating behaviour and body of childbearing women is scrutinised by others. The impact this has on the thoughts and behaviours of individuals who have or have had an eating disorder has been little investigated. OBJECTIVES: A qualitative project to provide a deeper understanding of the views of women with an eating disorder history about pregnancy and the early stages of motherhood. METHODS: Semi-structured interviews were conducted with eight women who were or had recently been pregnant. All had an eating disorder history. It explored how becoming a mother impacted on thoughts and practices relating to weight, using framework analysis. RESULTS: Interviews lasted approximately 80min. The overriding concept identified through analysis was the divided loyalties participants experienced between putting their child first and disregarding the eating disorder. Interpretation of data resulted in the identification by the research team of four main themes: fear of failure, transforming body and eating, uncertainties about child's shape and emotional regulation. CONCLUSIONS: Three types of women were identified among interviewees; those that seemed to be 'cured' of their eating disorder through motherhood, those that seemed able to put their condition on hold during pregnancy and those that seemed unable to relinquish dangerous behaviours. Issues relating to control, identity and perfectionism may impede some women's ability to enjoy pregnancy and motherhood if they have an eating disorder history.

  • Living with the anorexic voice: a thematic analysis.

    29 June 2018

    OBJECTIVES: A factor said to drive the behaviours of people with the eating disorder anorexia nervosa is the inner voice some recount hearing. However, little systematic examination has been made of this entity. The study aimed to investigate experiences of and reflections on living with an anorexic voice. DESIGN: A qualitative approach was used because the study sought to establish the perspectives of those with anorexia who identified with the concept of living with an anorexic voice. METHOD: Individuals from three self-help organizations were invited to write about their life with an anorexic voice in the form of a poem, a reflection, a letter, or a descriptive narrative. Recruitment continued until data saturation was reached. Thematic analysis was employed by two researchers. RESULTS: Written contributions were provided by 21 participants. These data underlined the positive and negative attributes individuals bestowed upon their anorexic voice; the former appeared stronger during the early stages of their eating disorder, the latter coming into force as it developed. In spite of their voice's harsh and forceful character, participants felt an affiliation towards it. DISCUSSION: The bond between individuals and their anorexic voice could explain their ambivalence to change. Therapists must persist in their endeavours to penetrate this tie, whilst acknowledging the hold this entity has over those with anorexia. Interventions that address this component of the eating disorder could prove fruitful in helping people towards recovery.

  • Sputum issues as defined by patients with cystic fibrosis: a qualitative investigation.

    29 June 2018

    OBJECTIVES: Patients with cystic fibrosis (CF) are asked to provide a sputum sample at clinic to test for potentially harmful pathogens. However, some appear to struggle with this request. Research into the difficulties experienced by these patients is lacking. This study set out to explore this issue in depth, using a qualitative research approach. METHODS: Semi-structured interviews were conducted with 18 patients identified as having difficulties with sputum by the physiotherapists involved in their care. Framework analysis was applied to collected data. RESULTS: An overarching concept derived from the interview material was a concern about sputum coming to be a defining feature of identity. This was reflected in the following four themes: (1) being seen as dirty because sputum is socially vilified as thus; (2) sputum exposing an invisible condition; (3) sputum acting as a reminder of having CF; (4) being seen as sputum producers by practitioners. DISCUSSION: Patients' difficulties with expectorating sputum were multifaceted and included psychosocial and physical factors. Practitioners need to appreciate that for some people, a request for sputum can cause significant discomfort. Individualized interventions to assist these patients may prove helpful.