Conocimientos, actitudes y prácticas sobre métodos de prevención de embarazo en las adolescentes del colegio Ismael Pérez Pazmiño de la ciudad de Machala, año 2003

En la provincia de El Oro el embarazo en adolescentes corresponde al 19.6 menor que menor que ENDEMAN 99), problemática que motivó a realizar este estudio en uno de los colegios de mayor afluencia de adolescentes del sexo femenino, del cantón Machala, con el objetivo de determinar que conocimientos, actitudes y prácticas sobre métodos anticonceptivos posee. El estudio es descriptivo, cuantitativo, transversal, en una muestra aleatoria de 285 adolescentes del civlo diversificado del Colegio Ismael Pérez Pazmiño. Los datos se recolectaron mediante un cuestionario previamente validado. La edad promedio de las encuestadas es 16.4 +- 1.3 años, el 12.6ha iniciado actividad sexual, motivadas por amor, curiosidad y presión de pareja; el 3.2tiene antecedente de embarazo. El conocimiento de como se usa, actúan y seguridad de los métodos anticonceptivos es adecuado en el 23, inadecuado el 21y desconocen el 56de los adolescentes; los más conocidos son la píldora, inyecciones y condón. La actitud frente a los anticonceptivos es positiva, sin embargo al pregunárseles qué método usarían esta tendencia notablemente, solo el 39.6señala un método; el 37de las adolescentes con antecedente de embarazo los usan

Mielenterveys- ja päihdepotilaiden palveluketjujen ongelmien havainnointi ja analysointi – Case: Turun kaupungin hyvinvointitoimialan Palvelumuotoilulla Parempia Palveluita Riskiryhmille (PPPR) - projekti

Mielenterveys- ja päihdeongelmat ovat yhä suuremman kansanterveydellisen huomion kohteena. Näihin ongelmiin liittyvät suorat ja epäsuorat kustannukset ovat kansantaloudellisesti huomattavia. Mielenterveys- ja päihdepalvelut ovat toisistaan erillään hajanaisessa palvelu¬järjestelmässä, mikä vaikeuttaa palveluihin pääsyä ja toisaalta edesauttaa putoamista pois hoidon piiristä. Palvelumuotoilulla parempia palveluita riskiryhmille -projektin (PPPR) tavoitteena on kehittää sosiaali- ja terveyspalveluita vastaamaan paremmin palveluiden suur¬kuluttajien, erityisesti päihde- ja mielenterveysasiakkaiden tarpeita. Projektin yhtenä tavoitteena on luoda uusia palvelumalleja, jotka tarjoavat asiakkailla matalan kynnyksen palveluita moniammatillisena yhteistyönä. Tämän tutkimuksen tarkoituksena on havainnoida ja analysoida mielenterveys- ja päihdeasiakkaiden palveluketjujen ongelmia ja selvittää, millä mekanismeilla projektissa luodut uudet palvelumallit voivat parantaa palveluketjujen kustannustehokkuutta ja -vaikuttavuutta. Tutkimuskysymykset ovat rajattu koskemaan vain PPPR-projektin kohderyhmän asiakkaita ja heidän palveluketjujaan. Tutkimuksen tulosten pohjalta voidaan kuitenkin tehdä joitain yleistyksiä myös muiden sosiaali- ja terveydenhuollon asiakkaiden palveluketjujen ongelmista ja niiden syistä. Tutkimus suoritettiin kvalitatiivisena tapaustutkimuksena ja aineistona käytettiin PPPR-projektissa luotuja oikeisiin asiakastapauksiin pohjautuvia esimerkkitapauksia. Aineisto analysoitiin tutkimuksessa esitellyn teoreettisen viitekehyksen avulla. Suurimpia havaittuja palveluketjun ongelmia olivat mm. henkilöstön kapea näkökulma, kannusteiden puute, standardoitujen menettelytapojen puute, yksikköjen välisen johtajuuden puute, asiakkaiden huono sitoutuminen hoitoon, asiakkaiden liian suuri vastuu oman hoitonsa etenemisestä sekä hoidon vaikuttavuuden ennustamattomuus ja palveluketjun suorituskyvyn mittaamisen moniselitteisyys. Tutkimuksen tulosten perusteella PPPR-projektin uudet palvelumallit korjaavat melko hyvin kohderyhmän asiakkaiden palveluketjuissa havaittuja ongelmia. Palvelumalleilla ei vaikuteta kaikkiin havaittuihin ongelmiin, mutta sillä on potentiaalia parantaa palveluketjujen kustannus¬tehokkuutta ja -vaikuttavuutta niin lyhyellä kuin pitkälläkin aikavälillä. PPPR-projektin ongelmat liittyvät siihen, että se ei käytännössä vaikuta, eikä voikaan vaikuttaa ongelmien taustalla oleviin tekijöihin. Lisäksi se vaatii erityisen poikkihallinnollisen toimintatavan, jonka ylläpitäminen muuten funktionaalisesti organisoidussa palvelujärjestelmässä vaatii erityistä huomiota. Nämä ongelmat voivat aiheuttaa sen, että muutoksesta tulee lyhytkestoista. PPPR -projektissa luodut uudet palvelu¬mallit voidaan myös tulkita yritykseksi taivuttaa funktionaalinen palvelujärjestelmä suorittamaan sellaisia asioita, joita se ei luonnostaa tee hyvin.

Estudio de factibilidad para la ampliación de las instalacciones del Colegio de Mejicanos, ubicado en el municipio de Mejicanos, departamento de San Salvador.

El presente estudio de factibilidad nace a partir de la necesidad del Colegio de Mejicanos, ubicado en el municipio de Mejicanos, departamento de San Salvador, de expandir la cobertura de mercado y asegurar su sustentabilidad a largo plazo. Adicionalmente, las condiciones actuales de inseguridad presentes en la sociedad salvadoreña ponen en riesgo la integridad física de los educandos, especialmente la de aquellos que asisten a Centros Escolares Públicos, situación que motivó al propietario de la institución a incorporar el segundo ciclo de educación básica (cuarto, quinto y sexto grado) con el objetivo de impartir educación integral de calidad a través de condiciones que garanticen el bienestar físico del alumno y del personal humano a su disposición, complementando dicho proyecto con un catálogo de servicios escolares que contribuirán a mejorar el programa de enseñanza del ente educativo. A partir de los factores antes mencionados, el grupo de investigación decidió realizar el estudio con los siguientes propósitos: Objetivo general Elaborar una propuesta de inversión que se adecúe a las necesidades y que favorezca el crecimiento operacional del Colegio de Mejicanos. Objetivos específicos Recopilar información bibliográfica que sirva de base para la elaboración del marco teórico sobre la formulación y evaluación del proyecto. Construir el estudio de mercado a partir del cual se defina el segmento de clientes, la oferta, demanda y mezcla de comercialización para la inversión. Establecer la rentabilidad del proyecto a través del estudio económico-financiero, haciendo uso de indicadores que permitan su aceptación o rechazo. El procedimiento que se siguió para elaborarlo implicó hacer uso del método científico, en donde el análisis permitió separar las partes del todo para estudiarlas individualmente; mientras que la síntesis contribuyó a interpretar e integrar dichos elementos. En el mismo sentido, se empleó una investigación correlacional y un diseño no experimental, con los cuales se midieron las relaciones existentes entre las variables en estudio sin ser sometidas a manipulación por parte del grupo de investigación. Por otra parte, para elaborar el diagnóstico de la situación actual se recurrieron a fuentes primarias; en primer lugar, los directores de los colegios privados ubicados en el municipio de Mejicanos; en segundo lugar, los padres de familia con edades entre los 30 y 49 años con un ingreso superior a los trescientos dólares mensuales y que posean hijos en edad escolar para cursar el cuarto, quinto y sexto grado de educación básica; por último, al propietario de la institución en estudio; todos a los cuales se les aplicaron instrumentos de recolección de información para identificar las ventajas y desventajas a considerar en caso de que se decida llevar a cabo la propuesta de inversión. Al término del estudio de factibilidad se concluyó lo siguiente: La mayor parte de los padres de familia consultados poseen hijos en primero y segundo ciclo de educación básica, lo que confirma la existencia de un mercado potencial para los servicios educativos que la institución en estudio oferta actualmente y aquellos que proyecta implementar. La mayoría de los indagados han inscrito a sus hijos en el sector educativo público, pero estarían dispuestos a cambiarlos al privado buscando incrementar la seguridad del infante o aprovechar la calidad educativa, condiciones que deberán ser aportadas en la inversión que se planifica realizar. La mayor parte de las instituciones educativas privadas del municipio de Mejicanos solo imparten clases en horario matinal, lo que deja al turno vespertino como un mercado desatendido que la institución en estudio puede incorporar en la nueva oferta educativa con el fin de incrementar sus ingresos operativos y su cobertura de mercado. A partir de las conclusiones se construyeron las siguientes recomendaciones: Se sugiere ampliar la cobertura de mercado de la institución a través de la incorporación del segundo ciclo de educación básica, considerando la demanda para dicho nivel existente en el municipio de Mejicanos, además se debe promover los servicios educativos disponibles con el objetivo de asegurar en el largo plazo la matrícula de alumnos y la rentabilidad de la inversión a realizar. Se recomienda incorporar en la inversión a realizar variables que contribuyan a incrementar la seguridad de los alumnos dentro de las ampliaciones a efectuar así como aumentar la calidad educativa para volver a la institución más atractiva, enfocándose tanto a clientes actuales como potenciales del sector público. Se propone evaluar la rentabilidad del turno vespertino en la inversión a realizar en el Colegio de Mejicanos con el objetivo de aumentar el número de estudiantes matriculados, especialmente los que provienen del sector público donde el turno de la tarde es una jornada normal.

Der Zusammenhang der Theorie des geplanten Verhaltens mit der selbstberichteten Individualisierungspraxis von Lehrpersonen

Einstellungen stellen als Teil der professionellen Handlungskompetenz von Lehrpersonen eine wichtige handlungsleitende Determinante des Unterrichtsgeschehens dar. Hierzu wird auf Basis der Theorie des geplanten Verhaltens ein Erwartungs-mal-Wert-theoretisches Einstellungsinstrument faktoriell validiert und der Zusammenhang der inklusiven Einstellung, Normvorstellung und Lehrerselbstwirksamkeitsüberzeugung mit der selbstberichteten Individualisierungspraxis von Lehrpersonen betrachtet. Die Ergebnisse einer exploratorischen Faktorenanalyse zeigen in Studie I drei Einstellungsfaktoren, die in Studie II konfirmatorisch bestätigt wurden. Studie III zeigt, dass die selbstberichtete Individualisierungspraxis durch die Normvorstellung und die Intention, sich den Herausforderungen eines inklusiven Unterrichtes anzunehmen, vorhergesagt werden kann. Die Intention mediiert dabei den Zusammenhang der selbstberichteten Individualisierungspraxis mit der Einstellung vollständig und mit der Normvorstellung partiell. Die Lehrerselbstwirksamkeitsüberzeugung sagt demgegenüber die selbstberichtete Individualisierungspraxis weder direkt noch indirekt vorher. (DIPF/Orig.)

”Täytyy miettii koko elämä ihan uudestaan” – Nuorten mielenterveyskuntoutujien kokemukset mielenterveyskuntoutuksen onnistumiseen vaikuttavista tekijöistä

Pro gradu- tutkielmassa on tarkasteltu nuorten 20–45-vuotiaiden mielenterveyskuntoutujien henkilökohtaisia kokemuksia mielenterveyskuntoutuksen onnistumiseen positiivisesti ja negatiivisesti vaikuttaneista tekijöistä. Tutkielma tuo esiin mielenterveyskuntoutuksen onnistumiseen vaikuttavien tekijöiden monipuolisuuden, ja erityisesti muiden kuin lääkinnällisten kuntoutustoimien roolin kuntoutumisen edistymisessä. Tutkielmassa on tarkasteltu suomalaisen yhteiskunnan tarjoaman kuntoutusjärjestelmän toimivuutta sekä sen ongelmia. Tutkielman teoreettiset lähtökohdat pohjaavat hulluuden, mielenterveyden ja – sairauden sekä mielenterveyskuntoutuksen historian ja nykypäivän sosiologiseen tarkasteluun. Tutkielmassa mielenterveysongelmat mielletään sosiaalisiksi konstruktioiksi, joiden määrittely ja ylläpitäminen tapahtuvat yhteiskunnallisissa käytännöissä ja suhteissa kielen, tiedon ja vallan avulla. Mielenterveyden ongelmien tarkastelu perustuu tutkielmassa sosiologian antipsykiatristen tutkijoiden näkemyksiin hulluudesta ja mielisairaudesta sosiaalisesti rakentuneina kontrollin keinoina ja sosiaalisen leimaamisen ja moraalisen tuomitsemisen välineinä. Pro gradu- tutkielma on toteutettu laadullisin tutkimusmenetelmin. Tutkielman aineistona on yhdeksän nuoren mielenterveyskuntoutujan teemahaastattelua, ja aineiston analyysi on toteutettu temaattisella verkostoanalyysilla. Mielenterveyskuntoutuksen onnistumiseen vaikuttivat tutkielmaan osallistuneiden mielenterveyskuntoutujien kokemusten perusteella positiiviset ja negatiiviset kokemukset perusterveydenhuollon ja psykiatrisen sairaanhoidon palveluista sekä lääkehoidosta. Psykoterapia, vertaistuki, läheisten tuki, opiskelu ja työnteko edistivät kuntoutumista terveydenhuollon ulkopuolella. Yksilön oma aktiivisuus kuntoutuksessa, omien voimavarojen ja niiden rajojen tunnistaminen sekä sairauteen suhtautuminen vaikuttivat mielenterveyskuntoutuksen edistymiseen. Tutkielma tuo esiin yhteiskunnan palvelujärjestelmien toimimattomuuden tarkasteltaessa perusterveydenhuollon palveluita, hoitoon pääsyä, rahallisten tukien saantia sekä kouluttautumiselle ja työn teolle asetettuja säännöksiä mielenterveyskuntoutujien näkökulmasta. Rakenteellisen joustamattomuuden purkaminen, mielenterveysongelmien leimaavuuden poistaminen, sosiaalisten kuntoutusmuotojen lisääminen ja psykiatriseen avohoitoon panostaminen auttaisivat tutkielman löydösten perusteella toimivamman mielenterveyspalvelujärjestelmän rakentamista.

Rapport entre les méthodes pédagogiques et les indicateurs de motivation scolaire chez des étudiantes et des étudiants en Soins infirmiers

La réussite scolaire est affaire de capacité, mais aussi de motivation. Viau (2009) définit la motivation comme: un état dynamique qui a ses origines dans les perceptions qu’une étudiante ou un étudiant a de lui-même et de son environnement et qui l’incite à choisir une activité, à s’y engager et à persévérer dans son accomplissement afin d’atteindre un but. La motivation, c’est ce moteur qui nous fait avancer pour atteindre un idéal. Tout enseignante ou enseignant doit favoriser la motivation des étudiantes et des étudiants et mettre en place des conditions nécessaires pour leur permettre de trouver eux-mêmes le sens qu’ils souhaitent donner à leur démarche. En effet, si les étudiantes et les étudiants choisissent leur programme d’étude et parfois certains cours, il en revient à l’enseignante et à l’enseignant de contribuer à susciter l’intérêt pour le cours, d’aider la clientèle étudiante à percevoir son utilité et surtout à se réaliser dans ses apprentissages. Si l’enseignante ou l’enseignant n’a pas le choix sur le contenu du cours, il a cependant le choix des méthodes pédagogiques à utiliser. Certaines méthodes pédagogiques vont susciter un dynamisme qui caractérise les interactions entre les étudiantes et les étudiants, et entre ces derniers et l’enseignante ou l’enseignant. Ce dynamisme contribue à motiver la clientèle étudiante. Dans cet essai, la chercheure s’est intéressée sur l’effet des stratégies d’enseignement sur les étudiantes et étudiants en Soins infirmiers. Le premier chapitre aborde l’APC et le vent de changement suscité par cette approche sur les méthodes pédagogiques, mais aussi sur le rôle des enseignantes et des enseignants. On y aborde en conséquence la problématique ainsi que les raisons qui ont motivé la chercheure à vouloir conduire cette étude. Le deuxième chapitre est le cadre de référence de cette étude. Les méthodes pédagogiques et la motivation scolaire sont au coeur de ce cadre conceptuel. On y retrouve entre autres la classification, la définition et la description de huit méthodes pédagogiques, soit les plus populaires selon Chamberland, Lavoie et Marquis (1995). Par la suite, la motivation scolaire est abordée en discutant entre autres des facteurs liés à la classe, des trois déterminants, les perceptions attributionnelles, la perception de sa compétence, la perception de l’importance de la tâche ainsi que deux indicateurs de la motivation scolaire: l’engagement cognitif et la participation. Barbeau (1994) a élaboré un modèle de la motivation qui regroupe cinq grandes variables de la motivation dans un ensemble dynamique. Ce modèle est présenté dans ce chapitre. Le troisième chapitre élabore la méthodologie utilisée pour la réalisation de cette étude. L’approche méthodologique de type qualitatif est présentée de même que le paradigme interprétatif. L’approche méthodologique, les participantes et les participants à la recherche, le déroulement de la recherche et les instruments de collecte de données sont expliqués. Cette étude a fait appel à trois outils de collectes de données soit un entretien semi-dirigé avec les enseignantes et les enseignants, l’observation en classe et le questionnaire passé aux étudiantes et aux étudiants. Le quatrième chapitre comprend l’interprétation des résultats obtenus. Les résultats sont présentés à partir des données recueillies par les différents instruments de collecte. Ces derniers font ressortir que les étudiantes et les étudiants semblent plus motivés si les méthodes pédagogiques utilisées sont plus actives. La conclusion de cette recherche présente pour sa part un résumé de l’étude, les retombées de la recherche et différentes avenues qui pourraient être développées.

An interpretative phenomenological analysis of the lived experience of suicidal behaviour

Background: In Scotland, suicide prevention is a major public health challenge, with two people, on average, dying every day due to suicide. Any efforts to prevent suicide should be aided by research. Existing research on suicide is dominated by quantitative research that has largely focused on providing explanatory accounts of suicidal phenomena. Research providing rich and detailed accounts of suicidal behaviour among individuals who have directly experienced it is growing but remains relatively embryonic. This study sought to supplement existing understanding of attempted suicide specifically by exploring the processes, meaning and context of suicidal experiences among individuals with a history of attempted suicide. Methods: The study used a retrospective qualitative design with semi-structured in-depth interviews. Participants were patients (n=7) from a community mental health service in Glasgow, Scotland who had attempted suicide within the previous 12-month period. The interviews were transcribed verbatim and were analysed for recurrent themes using interpretative phenomenological analysis (IPA). Results: Three super-ordinate themes, each with inter-related sub-themes, emerged from the analysis. 1) “Intentions”: This theme explored different motives for suicide, including providing relief from upsetting feelings; a way of establishing control; and a means of communicating with others. 2) “The Suicidal Journey”: This theme explored how individuals’ thinking can change when they are suicidal, including feeling overwhelmed by a build-up of distress and a narrowing of their perspective. 3) “Suicidal Dissonance”: This theme explored how people can feel conflicted about suicide and can be fearful of the consequences of their suicidal behaviour. Conclusion: Participants’ accounts were dominated by experience of significant adversity and psychological suffering. These accounts provided valuable insights into the suicidal process, highlighting implications for clinical practice and future research.

Experiences of care and adjustment to change in caregivers of children with autoimmune encephalitis: an interpretative phenomenological analysis

Background: Autoimmune encephalitis (AE) occurs in response to an antibody-mediated central nervous system disease and can lead to significant neurodisability. Prior research on family adjustment has described a reciprocal relationship between caregiver functioning, distress and clinical outcome in parents and children with encephalitis. There has been no previous research exploring the experiences of caregivers with a child with AE. Aims: To explore the perspectives of parents and/or caregivers with a child diagnosed with AE regarding (i) their own adjustment from hospital admission to post-discharge, and (ii) their experiences of care and service provision. Methods: A purposive sampling approach was used. Five parents of children with AE participated in a semi-structured interview exploring their experiences of caring for their child and service provision during acute care and post-discharge. Interpretative Phenomenological Analysis (IPA) was used to analyse the transcripts. Main findings and conclusions: Four shared super-ordinate themes with related subthemes emerged: (a) uncertainty, (b) managing our recovery, (c) changes in my child, (d) experiences of service provision. Participants reported emotional distress, often underpinned by recurrent experiences of uncertainty, and ‘loss’ of the previous child, and mediated by coping strategies and social support. While an overall positive experience of inpatient services was reported, parents often perceived post-discharge services as lacking in co-ordination, communication and formal follow-up, resulting in unmet support needs. Implications and recommendations for services, practitioners and future research are discussed.

Balancing the demands of two tasks: an investigation of cognitive-motor dual-tasking in relapsing remitting multiple sclerosis

Background: People with relapsing remitting MS (PwRRMS) suffer disproportionate decrements in gait under dual-task conditions, when walking and a cognitive task are combined. There has been much less investigation of the impact of cognitive demands on balance. This study investigated whether: (1) PwRRMS show disproportionate decrements in postural stability under dual-task conditions compared to healthy controls; (2) dual-task decrements are associated with everyday dual-tasking difficulties. In addition, the impact of mood, fatigue and disease severity on dual-tasking were also examined. Methods: 34 PwRRMS and 34 matched controls completed cognitive (digit span) and balance (movement of centre of pressure on a Biosway, on stable and unstable surfaces) tasks under single and dual-task conditions. Everyday dual-tasking was measured using the DTQ. Mood was measured by the HADS. Fatigue was measured via the MFIS. Results: No differences in age, gender, years of education, estimated pre-morbid IQ or baseline digit span between the groups. Compared to healthy controls, PwRRMS showed a significantly greater decrement in postural stability under dual-task conditions on an unstable surface (p=0.007), but not a stable surface (p=0.679). PwRRMS reported higher levels of everyday dual-tasking difficulties (p<0.001). Balance decrement scores were not correlated with everyday dual-tasking difficulties, or with fatigue. Stable surface balance decrement scores were significantly associated with levels of anxiety (rho=0.527, p=0.001) and depression (rho=0.451, p=0.007). Conclusion: RRMS causes difficulties with dual-tasking, impacting balance, particularly under challenging conditions, which may contribute to an increased risk of gait difficulties and falls. The striking relationship between anxiety/depression and dual-task decrement suggests that worry may be contributing to dual-task difficulties.

Legal disclosure of childhood sexual abuse: what can professionals tell us?

ABSTRACT: Purpose: This study explores how the decision to disclose Childhood Sexual Abuse (CSA) to the legal setting for adult victims is perceived by key informants, specifically factors that are believed to facilitate or prevent legal disclosure from occurring. Background: Prevalence rates of CSA are high (Pereda, Guilera, Forns & Gomez-Benito, 2009) and the negative consequences caused by the abuse acknowledged (Filipas & Ullman, 2006). Disclosure of this crime is understood to be complex and delayed disclosure recognised (Arata, 1998) but little is known about disclosure to the legal system. Rates of legal disclosure of CSA remain low and the attrition rates high (London, Bruck, Ceci & Shuman, 2005), but investigation and understanding of the contributory factors is rare. Disclosure of CSA to the legal system enables prosecution of the abuser and protection of the victim and others. Method: 10 “key informants” consisting of specialised clinicians working with adult victims of CSA were interviewed. Each informant completed an indepth interview exploring their beliefs about factors that facilitated or prevented adult victims of CSA from disclosing their experience to the legal system. Interviews were transcribed and the qualitative data subjected to Thematic Analysis. Conclusions: Two super-ordinate themes (Legal Disclosures Are Rare: “Why would they do that?” and The Anomalies: Acknowledging that this is a crime) and four sub-ordinate themes emerged from the analysis and an analytical narrative constructed. Themes emphasised the rarity of legal disclosure and the significant number of barriers adult victims of CSA perceive. Implications for clinical practice and future research are outlined.

A universally delivered CBT based intervention in a Scottish secondary school: a pilot feasibility study

Objectives: To evaluate the feasibility of a universally delivered CBT-based programme for pupils within a Scottish secondary school setting. Design: A pre-post, within and between groups design was utilised. Setting: Religious Moral Citizenship and Education (RMCE) classes in a Scottish secondary school. Participants: Four (n = 103) classes of third year secondary school pupils were arbitrarily allocated to two conditions: RMCE-as usual (RMCE-AU) controls, and LLTTF intervention. Intervention: Living Life to the Full (LLTTF) is a series of Cognitive Behavioural Therapy (CBT)-based booklets and accompanying 8 classes to improve coping skills. An adolescent version of LLTTF was recently developed. This was delivered over nine weeks by school teachers trained in the approach. Outcome measures: The Strengths and Difficulties Questionnaire, Rosenberg Self-Esteem scale, General Self-Efficacy Scale, and Locus of Control scale were administered at baseline and 9 week follow-up. To determine acceptability and utility of the materials course feedback was gathered weekly from the intervention group and a focus group (n=5) was conducted at 3 month follow up. Results: Outcome measures showed no significant improvement in overall wellbeing of those in the intervention group compared with that of the control group. Weekly feedback suggested that the majority of pupils found the materials useful and relevant. Focus group feedback suggested that pupils found the intervention useful, had utilised strategies in everyday life and would welcome recurring provision of such interventions within the school setting. Conclusions: Universally delivered CBT intervention is acceptable and feasible within the secondary school environment. However, objective measurement using standardised tools does not adequately corroborate qualitative feedback from pupils. Issues relating to measurement, study design and implementation of future interventions are discussed.

Mindfulness-Based Cognitive Therapy for older people in a community setting: a mixed methods feasibility study

Rationale: In line with complex intervention development, this research takes a systematic approach to examining the feasibility and acceptability of delivering Mindfulness-Based Cognitive Therapy (MBCT) to older people who experience symptoms of depression. Methods: A mixed methods approach was adopted in line with recommendations made by the MRC Complex Intervention Development framework. Quantitative and qualitative methods were combined by administering questionnaires as well as conducting post intervention interviews. A number of trial feasibility factors were examined such as recruitment and attrition rates. Qualitative data was analysed using Braun and Clarke’s thematic analysis framework. Results: Nine participants started the MBCT intervention and six completed the 8-week programme. The results suggest that MBCT for older people is feasible and acceptable. Participants reported improved mindfulness skills. Participants responded positively to being asked to take part in research and appeared to particularly value the group delivery format of the intervention. Conclusions: MBCT is both feasible and acceptable for older people experiencing symptoms of depression. Further research is required with larger sample sizes to allow for more robust statistical exploration of outcome measures, including mechanisms of change.

Negative symptoms of schizophrenia and psychosocial treatment: thematic analysis of stakeholders’ perspectives

Objectives. Recent literature indicates variance in psychosocial treatment preferences for negative symptoms of schizophrenia. Attempts at defining therapeutic aims and outcomes for negative symptoms to date have not included major stakeholder groups. The aim of the present study was to address this gap through qualitative methods. Design. Thematic Analysis was applied to qualitative semi-structured interview data to gather the opinions of people who experience negative symptoms, carers, and healthcare professionals. Participants were recruited from two mental health sites (inpatient/community) to increase generalisability of results. Ten people participated in the research. Methods. Semi-structured interview scripts were designed utilising evidence from the review in Chapter 1 of effective psychosocial intervention components for specific negative symptoms. Interviews were audio recorded and transcribed verbatim. Thematic analysis was employed to analyse data. Results. A common theme across groups was the need for a personalised approach to intervention for negative symptoms. Other themes indicated different opinions in relation to treatment targets and the need for a sensitive and graded approach to all aspects of therapy. This approach needs to be supported across systemic levels of organisation with specific training needs for staff addressed. Conclusions. There is disparity in treatment preferences for negative symptoms across major stakeholders. The findings suggest an individualised approach to intervention of negative symptoms that is consistent with recovery. Implementation barriers and facilitators were identified and discussed. There remains a need to develop a better understanding of treatment preferences for patients.

The use of Acceptance and Commitment Therapy to address psychological distress experienced by caregivers: a randomised controlled feasibility trial

Background: An extensive research literature has documented the impact of caring for an individual with acquired brain injury (ABI) on caregivers and family members, including role adjustment, psychological distress, social isolation, family tension and coping with the cognitive and behavioural difficulties of the injured person. Given these findings it is important this population have access to services and supports. Acceptance and Commitment Therapy (ACT) is an intervention that helps individuals to accept difficult experiences and commit to behaviour that is consistent with their values. Research into the effectiveness of ACT to support caregivers is at a preliminary stage. Aim: To investigate the feasibility of using ACT to reduce psychological distress and increase psychological flexibility in ABI caregivers. A secondary aim was to gain an understanding of the experience of caregivers in this context and how this can inform the development and delivery of interventions for this population. Method: Phase one was a randomised controlled feasibility trial of an ACT intervention for use with ABI caregivers. The parameters of this study were formulated around the PICO (population, intervention, control, and outcome) framework. Eighteen carers were recruited and randomised to ACT or an enhanced treatment as usual (ETAU) group. ACT was implemented over 3 sessions; and ETAU was implemented over 2 sessions. The General Health Questionnaire, Valuing Questionnaire, Acceptance and Action Questionnaire, Experiential Avoidance of Caregiving Questionnaire and the Flexibility of Responses to Self-Critical Thoughts Scale were administered to both groups at baseline and following the final session. Phase two used a retrospective qualitative design that involved conducting semi-structured interviews with four participants from phase one. Results: ACT and control participants were successfully recruited. Positive feedback was obtained from ACT participants suggesting that the intervention was acceptable. There were no significant differences between the ACT and ETAU groups on outcome measures. However, there were challenges retaining participants and the overall attrition rate was high (44.44%). Therefore a number of participants did not complete the full complement of sessions, which may have impacted on this result. Qualitative results illustrated the challenges this population face including significant adjustments in their life, the emotional impact of having a loved one with a brain injury and trying to adapt to the changes in the injured person. In addition, findings elucidated the types of support that this population would find helpful and the barriers to accessing same. Conclusions: Findings from this study highlight factors that will help the development of this intervention further for a caring population. Recommendations for future implementation include completing some preparatory work with carers before beginning the intervention, consideration of a larger sample and wider recruitment strategy from local services, barriers to attending interventions and the possibility of holding groups in local venues.

‘Breaking good news’: neurologists’ experiences of discussing SUDEP with patients in Scotland

Since the findings of a Fatal Accident Inquiry (FAI) in 2010, clinicians working in Scotland have been advised to discuss the risk of Sudden Unexpected Death in Epilepsy (SUDEP) with patients immediately or soon after a diagnosis of epilepsy is made. A thematic analysis was used to describe the experiences discussing SUDEP of 10 clinicians (six Consultant Neurologists and four Neurology Registrars) working in Scotland. Five themes were found: Clinicians employ a ‘SUDEP protocol’, suggesting there is a standardised way of discussing SUDEP with patients and all clinicians routinely discuss SUDEP with newly diagnosed epilepsy patients; The FAI has diffused into practice through meetings and discussions with colleagues; ‘Breaking Good News’ refers to the ambivalence clinicians feel about discussing SUDEP; ‘Falsely anticipating anxiety’ refers to clinicians anticipating a distressed response from patients despite this very rarely occurring; Clinicians suggest that ‘pressure hinders effective communication’ to patients – suggesting that the pressure to discuss SUDEP early after diagnosis may have an emotional impact on patients and affect the amount of information they can take in. Implications for guideline development are discussed.