Failing to meet expectations:the meaning of intimate partner violence for Pakistanis

Background: Intimate Partner Violence (IPV) is a major social and public health problem affecting people across cultures, religions and societies. Much research has been undertaken to offer understanding and explanations of this phenomenon, its determinants, and its consequences in developed countries around the world. However, there is still a paucity of research on IPV in many areas of the developing world such as Pakistan. Although various studies have been conducted to demonstrate the prevalence of IPV in the country, none of the studies have tried to explore the meaning of IPV from the perspective of Pakistani people. Aim: This study aimed to explore understandings of Pakistani men and women of IPV. It aimed to develop a theory to explain the meaning of IPV and the process through which it occurs, from the perspective of Pakistani people. Methods: The study utilised a qualitative approach with constructivist grounded theory methods and analysis techniques. Data was collected from Karachi, Pakistan and Sheffield, UK. Forty one people (20 from Pakistan and 21 from UK) participated in the study. Findings: The participants identified IPV as a serious concern. Although verbal abuse is often included in definitions of IPV, the participants did not consider shouting, raising the voice or scolding as a type of violence. Hitting, beating, pushing, throwing objects, and pulling hair were identified as acts of physical violence, and non-consensual sex was identified as a form of sexual abuse. Participants identified failure to meet role expectations of a husband or wife as a key contributor to the development of conflict between partners which could lead to IPV. Examples of various expectations from a wife include completing household chores, looking after husband, looking after children, looking after in laws, respecting and adjusting to in-law's customs and traditions. Important expectation from a husband include provision of finances, acting as a bridge, maintaining a balance between his wife and other family members particularly his mother and sisters, and taking the responsibility for his wife and children. Failure to meet these expectations could contribute to conflict and subsequent violence. This appeared to be shaped by cultural issues such as common use of arranged marriages, the rarity of divorce and the centrality of the extended family to the intimate partnership. Implications: Any interventions aimed at reducing IPV in Pakistani people must consider the meaning and causes of IPV from the perspective of that group.

Attachment anxiety and friendship group identification under attachment threat:the moderating role of priming support network expectations

We examined the role of priming participants' own network expectations on their subsequent identification with their friendship group. We examined this prime alongside attachment anxiety and attachment threat, as predictors of friendship group identification. Previous research has suggested that attachment anxiety is associated with negative network expectations. In this study, we extended this work to show that when a network expectation prime was absent, higher attachment anxiety was associated with lower group identification under attachment threat, compared to a control condition. However, when expectations of support network were primed, attachment threat no longer affected group identification, so that only attachment anxiety predicted group identification. This suggests that priming participants who are high in attachment anxiety with their own network expectancies (which are negative), results in participants dis-identifying with their friendship group, regardless of whether or not they have experienced attachment threat. © 2012 Elsevier Ltd.

Physicians' perceptions, attitudes and expectations regarding the role of hospital-based pharmacists in the West Bank, Palestine

Objective - To evaluate the perceptions, expectations and experiences of physicians with regard to hospital-based pharmacists in the West Bank, Palestine. Methods - A self-administered questionnaire was distributed to 250 physicians practising in four general hospitals in the West Bank, Palestine. The main sections of the questionnaire comprised a series of statements pertaining to physicians' perceptions, expectations and experiences with pharmacists. Key findings - One hundred and fifty seven questionnaires were completed and returned (response rate, 62.8%). The majority of respondents were most comfortable with pharmacists detecting and preventing prescription errors (76.4%; 95% confidence interval (CI) 69.5–81.2%) and patient education (57.9%; CI 51.2–63.4%) but they were not comfortable with pharmacists suggesting the use of prescription medications to patients (56.7%; CI 49.8–62.4%). Most physicians (62.4%; CI 56.8–69.1%) expected the pharmacist to educate their patients about the safe and appropriate use of their medication. However, approximately one-third (31.7%; CI 26.0–39.6%) did not expect pharmacists to be available for consultation during rounds. Physicians' experiences with pharmacists were less favourable; whereas 77% (CI 70.2–81.5%) of the physicians agreed that pharmacists were always a reliable source of information, only 11.5% (CI 6.2–16.4%) agreed that pharmacists appeared to be willing to take responsibility for solving any drug-related problems. Conclusion -The present study showed that hospital physicians are more likely to accept traditional pharmacy services than newer clinical services for hospital-based pharmacists in the West Bank, Palestine. Pharmacists should therefore interact more positively and more frequently with physicians. This will close the gap between the physicians' commonly held perceptions of what they expect pharmacists to do and what pharmacists can actually do, and gain support for an extended role of hospital-based pharmacists in future patient therapy management.

Teachers' conceptions of their role

An analysis is made of the conceptions which serving teachers have of their role, though no attempt is made to relate this to their practice of teaching. A series of role items was collected to afford a description of the teacher's role in terms of school and society expectations as well as classroom behaviours. These were taken from the literature and from interviews with teachers, and confirmed in a preliminary survey. Presented as a questionnaire, replies to the main investigation were made by 881 teachers, working in a variety of schools from nurseries to comprehensives. Two attempts have been made to construct a role model. The first, depending on the judgement of items fitting theoretically derived roles, failed, due to diffuseness in the role of teacher. The second used factor analysis; six factors were extracted which represent meaningful and distinct areas of role. The analysis has depended largely on examination of scores taken from these factors. Teachers in all types of school have similar conceptions of discipline. Nursery-infant and junior staff generally agree on the other areas investigated, but the concepts of secondary teachers are distinct. They are more conservative and less child-centered. When the class being taught is held constant, few differences in role conception are found to be related to sex, being a parent, graduate status, or personality, as measured in terms of the extrovert and neurotic dimensions. The first few years of teaching bring considerable changes in role conception, and further changes occur with prolonged experience. Deputy heads in junior schools and nursery nurses have quite distinct role conceptions; those of all other teachers, including those holding senior posts in secondary schools, are similar. The perception of school climate influences the role conception of primary teachers directly, but it does not influence that of secondary teachers. The greatest variation in role conception is related to scores on the radical scale of Oliver and Butcher. Primary school teachers experience little constraint, but that reported by secondary school teachers is considerable, especially that coming from the head. Despite difficulties caused by the wide division between primary and secondary education, teachers have an accurate perception of the roles their colleagues adopt. A few misunderstandings may be due to a feeling of idealism amongst nursery and infant teachers. There is evidence in their conception of role that would enhance the professional standing of teachers, but this is not in a form which is likely to be recognised by the public.

Employee perceptions of interpersonal justice:the moderating role of attachment and cultural values

This study investigated the moderating role of national culture in the relationship between attachment orientations and employee perceptions of interpersonal justice. Three hundred and forty individuals from countries categorized (by GLOBE) as either low collectivistic ‘Anglo’ (e.g. UK, Australia, US; N = 205) or high collectivistic ‘South Asian’ (e.g. India, Malaysia, Indonesia; N = 135), responded to an online questionnaire. Attachment anxiety and avoidance were negatively related to perceptions of interpersonal justice, as expected, but against expectations the direct relationship between attachment orientations and interpersonal justice did not differ between cultures. However, supplementary analysis revealed a significant 3-way interaction. When attachment anxiety was high, avoidance was a stronger predictor of interpersonal justice perceptions but the direction of this association differed by culture. The findings suggest the importance of fit between employee attachment orientations and cultural relational values in the workplace. Practical and theoretical implications are discussed.

Information and behavioural instruction along the health-care pathway:the perspective of people undergoing hernia repair surgery and the role of formal and informal information sources

Provision of information and behavioural instruction has been demonstrated to improve recovery after surgery. However, patients draw on a range of information sources and it is important to establish which sources patients use and how this influences perceptions and behaviour as they progress along the surgical pathway. In this qualitative, exploratory and longitudinal study, the use of information and instruction were explored from the perspective of people undergoing inguinal hernia repair surgery. Seven participants undergoing inguinal hernia repair surgery were interviewed using semi-structured interviews 2 weeks before surgery and 2 weeks and 4 months post-surgery. Nineteen interviews were conducted in total. Topic guides included sources of knowledge, reasons for help-seeking and opting for surgery and factors influencing return to activity. Data were analysed thematically according to Interpretative Phenomenological Analysis. Participants sought information from a range of sources, focusing on informal information sources before surgery and using information and instruction from health-care professionals post-surgery. This information influenced behaviours including deciding to undergo surgery, use of pain medication and returning to usual activity. Anxiety and help-seeking resulted when unexpected post-surgical events occurred such as extensive bruising. Findings were consistent with psychological and sociological theories. Overall, participants were positive about the information and instruction they received but expressed a desire for more timely information on post-operative adverse events.

Cognitive systems associated with the hippocampus of the human brain and their role in behaviour and neurodegenerative disease

Cognitive systems research involves the synthesis of ideas from natural and artificial systems in the analysis, understanding, and design of all intelligent systems. This chapter discusses the cognitive systems associated with the hippocampus (HC) of the human brain and their possible role in behaviour and neurodegenerative disease. The hippocampus (HC) is concerned with the analysis of highly abstract data derived from all sensory systems but its specific role remains controversial. Hence, there have been three major theories concerning its function, viz., the memory theory, the spatial theory, and the behavioral inhibition theory. The memory theory has its origin in the surgical destruction of the HC, which results in severe anterograde and partial retrograde amnesia. The spatial theory has its origin in the observation that neurons in the HC of animals show activity related to their location within the environment. By contrast, the behavioral inhibition theory suggests that the HC acts as a ‘comparator’, i.e., it compares current sensory events with expected or predicted events. If a set of expectations continues to be verified then no alteration of behavior occurs. If, however, a ‘mismatch’ is detected then the HC intervenes by initiating appropriate action by active inhibition of current motor programs and initiation of new data gathering. Understanding the cognitive systems of the hippocampus in humans may aid in the design of intelligent systems involved in spatial mapping, memory, and decision making. In addition, this information may lead to a greater understanding of the course of clinical dementia in the various neurodegenerative diseases in which there is significant damage to the HC.

An examination of the UK community pharmacist's role in facilitating patient self-management of cardiovascular disease through lifestyle behaviours

The progression of cardiovascular disease (CVD) is largely modifiable through lifestyle behaviours. UK pharmacists are contractually obliged to facilitate patient self-management of chronic conditions such as CVD. Pharmacists are easily accessible health professionals who are well placed to identify “at risk” patients through medication regimes. Research has identified varying attitudes towards and levels of involvement in pharmacist-led health promotion activity. Given the diverse and exploratory nature of the work, a pragmatic, mixed methods approach was used to explore community pharmacists’ role in facilitating patient self-management of CVD. The thesis presents four studies: a qualitative study with pharmacists; a cross sectional questionnaire of community pharmacists; a systematic review and a qualitative study with patients with CVD. The qualitative study with pharmacists gave an insight into pharmacists’ experiences of giving patients with CVD lifestyle advice and the factors underpinning commonly cited barriers to providing public health services. This informed the development of the cross-sectional questionnaire which identified the predictors of pharmacists’ intentions to give two different types of advice to facilitate patient self-management. The systematic review identified a small number of interventions to prepare pharmacists to facilitate patient lifestyle behaviour change and evaluated the theories and behaviour change techniques used in successful interventions; however due to poor study quality and poor reporting of the interventions limited conclusions about the efficacy of the interventions could reliably be drawn. Finally, the qualitative study gave an insight into the experiences of patients with CVD using community pharmacy services and their expectations of the service they receive from community pharmacists. Recommendations about changes to pharmacy policy and practice in order to support pharmacists’ provision of CVD self-management advice are made.