'I'd like to know what causes it, you know, anything I've done?' Are we meeting the information and support needs of patients with macular degeneration? A qualitative study

Objective: To examine patients' experiences of information and support provision for age-related macular degeneration (AMD) in the UK. Study design: Exploratory qualitative study investigating patient experiences of healthcare consultations and living with AMD over 18 months. Setting: Specialist eye clinics at a Birmingham hospital. Participants: 13 patients diagnosed with AMD. Main outcome measures: Analysis of patients' narratives to identify key themes and issues relating to information and support needs. Results: Information was accessed from a variety of sources. There was evidence of clear information deficits prior to diagnosis, following diagnosis and ongoing across the course of the condition. Patients were often ill informed and therefore unable to self-advocate and recognise when support was needed, what support was available and how to access support. Conclusions: AMD patients have a variety of information needs that are variable across the course of the condition. Further research is needed to determine whether these experiences are typical and identify ways of translating the guidelines into practice. Methods of providing information need to be investigated and improved for this patient group.

Exploring the experiences of nurses who care for children who have Acute Life Threatening Events (ALTE) in hospital

This thesis presents a program of work designed to explore and describe what the experience of caring for a child who has an Acute Life Threatening Event (ALTE) is like for the nurses. An ALTE may include a cardiac arrest, respiratory arrest or unplanned admission for a ward to the Paediatric Intensive Care unit. Using the MRC framework for the development of complex interventions, this information was then coupled with theory to develop the PREPARE and SUPPORT interventions. Given the wide-ranging and exploratory nature of this research, a pragmatic, mixed design approach was used to address the aims and objectives of the thesis. The mixed design approach included: a systematic literature review; international survey of practice; interviews with nurses and doctors using Interpretative Phenomenological Analysis; development, refinement and evaluation of interventions during a feasibility study. Two studies were identified through the systematic review which aimed to evaluate the effectiveness of debriefing. The studies did not provide evidence to support the use of these interventions within healthcare. The international survey of practice demonstrated hospitals were using interventions to both prepare and support nurses for these events. The preparatory interventions were clinically focused and the majority of the supportive interventions included a debrief. The interventions were not being evaluated for effectiveness. The interviews conducted with nurses and doctors provided insight into what that experience was like for the participants. Using the MRC framework, this evidence was coupled with theory to develop the PREPARE and SUPPORT interventions. A multidisciplinary working party used an iterative process to refine and evaluate the interventions and study procedures were explored through a feasibility study. The pragmatic, mixed design approach demonstrated how the empirical evidence was coupled with theory and clinical expertise to develop interventions for use within the healthcare environment.

Hypnotic induction is followed by state-like changes in the organization of EEG functional connectivity in the theta and beta frequency bands in high-hypnotically susceptible individuals

Altered state theories of hypnosis posit that a qualitatively distinct state of mental processing, which emerges in those with high hypnotic susceptibility following a hypnotic induction, enables the generation of anomalous experiences in response to specific hypnotic suggestions. If so then such a state should be observable as a discrete pattern of changes to functional connectivity (shared information) between brain regions following a hypnotic induction in high but not low hypnotically susceptible participants. Twenty-eight channel EEG was recorded from 12 high susceptible (highs) and 11 low susceptible (lows) participants with their eyes closed prior to and following a standard hypnotic induction. The EEG was used to provide a measure of functional connectivity using both coherence (COH) and the imaginary component of coherence (iCOH), which is insensitive to the effects of volume conduction. COH and iCOH were calculated between all electrode pairs for the frequency bands: delta (0.1-3.9 Hz), theta (4-7.9 Hz) alpha (8-12.9 Hz), beta1 (13-19.9 Hz), beta2 (20-29.9 Hz) and gamma (30-45 Hz). The results showed that there was an increase in theta iCOH from the pre-hypnosis to hypnosis condition in highs but not lows with a large proportion of significant links being focused on a central-parietal hub. There was also a decrease in beta1 iCOH from the pre-hypnosis to hypnosis condition with a focus on a fronto-central and an occipital hub that was greater in high compared to low susceptibles. There were no significant differences for COH or for spectral band amplitude in any frequency band. The results are interpreted as indicating that the hypnotic induction elicited a qualitative change in the organization of specific control systems within the brain for high as compared to low susceptible participants. This change in the functional organization of neural networks is a plausible indicator of the much theorized "hypnotic-state". © 2014 Jamieson and Burgess.

A desztináció menedzsment szerepe a desztinációs versenyképességben – Hazai és dán tapasztalatok tükrében = The role of destination management in the destinations’ competitiveness – Hungarian and Danish experiences

A desztináció menedzsment valamennyi desztinációs versenyképesség modell középponti eleme, és „csodaszerként” jelenik meg, különösen azokban az országokban, amelyek a desztináció menedzsment eszközrendszerét a közelmúltban vezették be, annak érdekében, hogy a desztinációk lépést tudjanak tartani a versenytársaikkal, mint ahogyan ez hazánkban is történt. Jelen tanulmány alapját a témában írt PhD Értekezésem (Sziva, I. (2010)) adja, amelynek fókuszában a desztinációs versenyképesség értelmezése, az ex ante oldali tényezők feltárása állt. A téziskutatás során feltárt tényezők, és a Bírálóim konstruktív fejlesztési javaslatai a téma továbbkutatására ösztönöztek. Mindezért tartottam elengedhetetlennek, hogy a tézisemben összefoglalt hazai és osztrák kutatások legfontosabb eredményeit további nemzetközi színtéren, ezúttal Dániában vizsgáljam, jelen esetben a fókuszt a desztináció menedzsment tényezőire, és annak kiemelt kontextusaira helyezve. Jelen tanulmány legfontosabb célja az, hogy egyrészt összefoglalást adjon a desztináció menedzsment szerepéről a desztinációs versenyképesség elméleti megközelítéseit tekintve. Továbbá, hogy a hazai tapasztalatok összevetésre kerüljenek a szakértői interjúk során megismert dán tapasztalatokkal és további kutatási irányok kerüljenek meghatározásra. Ezúton szeretném megköszönni dániai kutatásom interjú-alanyainak részvételét és a Budapesti Corvinus Egyetem TÁMOP 4.2.1.B-09/1/KMR-2010-0005 projekt keretében nyújtott támogatását! _________ Destination management is the central element of the model concerning destinations’ competitiveness, and appears as „wonder medicine”, particularly in those countries, where the tools of destination management was introduced in the near past, as it happened in Hungary. The baseline of this study is given by my PhD Dissertation (Sziva, I. (2010)), which was focusing on interpretation and the ex ante factors of destinations’ competitiveness. The factors identified during my thesis research, and the constructive recommendations of my Reviewer gave the motivation for further analysis. That is why was it important to make further researchers based on the results identified in the Hungarian and Austrian cases of my thesis research, and add further international, this time Danish context to the research, by focusing on destination management among the factors of competitiveness. The aim of the article is to give a summary about the theoretical approach of destination management and compare the Hungarian experiences with that of the results of the Danish research based on experts’ interviews. Hereby I would like to thank my interviewees their participation, and the support of Corvinus University Budapest in the framework of TÁMOP 4.2.1.B-09/1/KMR-2010-0005 project.

Academic and nonacademic experiences that affect first-generation college student attrition

The purpose of this qualitative study was to explore the academic and nonacademic experiences of self-identified first-generation college students who left college before their second year. The study sought to find how the experiences might have affected the students' decision to depart. The case study method was used to investigate these college students who attended Florida International University. Semi-structured interviews were conducted with six ex-students who identified themselves as first-generation college students. The narrative data from the interviews were transcribed, coded, and analyzed. Analysis was informed by Pascarella, Pierson, Wolniak, and Terenzini's (2004) theoretical framework of important college academic and nonacademic experiences. An audit trail was kept and the data was triangulated by using multiple sources to establish certain findings. The most critical tool for enhancing trustworthiness was the use of member checking. I also received ongoing feedback from my major professor and committee throughout the dissertation process. The participants reported the following academic experiences: (a) patterns of coursework; (b) course-related interactions with peers; (c) relationships with faculty; (d) class size; (e) academic advisement; (f) orientation and peer advisors; and (e) financial aid. The participants reported the following nonacademic experiences; (f) on- or off- campus employment; (g) on- or off-campus residence; (h) participation in extracurricular activities; (i) noncourse-related peer relationships; (j) commuting and parking; and (k) FIU as an HSI. Isolationism and poor fit with the university were the most prevalent reasons for departure. The reported experiences of these first-generation college students shed light on those experiences that contributed to their departure. University administrators should give additional attention to these stories in an effort to improve retention strategies for this population. All but two of the participants went on to enroll in other institutions and reported good experiences with their new institutions. Recommendations are provided for continued research concerning how to best meet the needs of college students like the participants; students who have not learned from their parents about higher education financial aid, academic advisement, and orientation.

“Like a Family”: Perspectives of Doctoral Students from Traditionally Under-represented Populations on Cohorts

This study examined the experiences of special education doctoral students from minority populations and investigated the perceptions of students in the cohort experience. Three themes emerged: The cohort was a (a) family for bonding and support, (b) motivator for academic success and retention, and an (c) inhibitor of educational growth.

Experiences of Internalized and Enacted Stigma among Women with Obstetric Fistula in Tanzania

Background: Obstetric fistula is the development of a necrosis between the bladder and the vagina and/or the bladder and the rectum as a result of prolonged obstructed labor, resulting in urinary or fecal incontinence. In Tanzania surgical repair for obstetric fistula is provided freely by the government but it is estimated that there are over 25,000 women living with an untreated fistula. These women experience high degrees of psycho-social stresses exacerbated by the stigma surrounding their condition. There is a dire need to explore stigma within this population in order to better understand its impact, as stigma affects both treatment seeking behavior as well as long term recovery of those who access surgical repair.

Study Aims: This study aims to understand the experiences of stigma among women with obstetric fistulas by examining both internalized and enacted stigma, and by identifying pertinent correlates of internalized stigma.

Methods: This mixed-methods study utilized both quantitative and qualitative data collected in two related studies at a single hospital in Moshi, Tanzania. All study participants were women receiving surgical repair for an obstetric fistula. In the quantitative portion, cross-sectional survey data were collected from 52 patients. The primary outcome was fistula-related stigma, measured using an adaptation of the HASI-P stigma scale, which included constructs of both internalized and enacted stigma. In the qualitative portion, 45 patients participated in a semi-structured in-depth interview, which explored topics such as stressors caused by the fistula, coping mechanisms, and available support. The transcripts were analyzed using analytic memos and an iterative process of thematic coding using the framework of content analysis.

Results: Expressions of internalized stigma were common in the sample, with a median score of 2.1 on a scale of 0 – 3. Internalized was significantly correlated with negative religious coping, social participation, impact of incontinence and enacted stigma. Qualitative analysis was consistent and demonstrated widespread themes of shame and embarrassment. Experiences of enacted stigma were not as common (median score of 0), although some items, like those pertaining to mockery and blame, were endorsed by up to 25% of the study sample. Themes of anticipated stigma (isolation and non-disclosure due to the possibility of stigmatization) were also evident in the qualitative sample and may explain the low enacted stigma scores observed.

Conclusion: In this sample of women receiving surgical repair for an obstetric fistula, stigma was evident, with internalized stigma resulting in psychological impacts for patients. Experiences of both anticipated and enacted stigma were also observed. There is a need to explore interventions that would decrease stigma while also increasing support for these women, as stigma may be a barrier towards accessing surgical repair and reintegration following surgery.

Keywords: Tanzania, obstetric fistula, stigma, maternal health

“I am in a constant state of insecurity trying to make ends meet, like our service users”: Shared austerity reality between social workers and service users: Towards a preliminary conceptualization

This article introduces the concept of an emerging shared austerity reality, which refers to the socio-economic context of austerity that is shared both by social workers and service users, albeit to different degrees. Traditionally, the concept of the shared reality has been utilized to encompass the experiences of welfare professionals working in situations where both they and service users are exposed to the adverse effects of a natural disaster, war or terrorist attack. Here, the concept of shared reality is expanded through the introduction of the context of austerity. Drawing on 21 in-depth interviews with public sector social work practitioners in Greece it discusses, among other things, social anxieties about their children’s future, and their inability to take care of their elderly relatives that suggest an emerging shared austerity reality, reflecting the deterioration of socio-economic conditions. The paper ends with a discussion about the possibilities of alliance and division that emerge from the concept and future research directions. Moreover, it concludes with a reflection on the role of the social work profession and recent political developments in Greece in anti-austerity struggles.

Adapting to a team of host culture domination: Experiences of Finnish and British expatriates

International teams are permanent features of the global market, and multinational companies cannot ignore them. This thesis discusses an individual’s adaptation to a team of host culture domination by looking at the experiences of Finnish and British expatriates. The research question is: How does a foreigner adapt to a Finnish-British team where all the other members are from the local culture? The theoretical framework of this thesis consists of theories on multicultural teamwork and Finnish and British cultures. Based on theories, the impact of diversity on teamwork and whether it improves or deteriorates a team’s performance is unclear but the idea of multicultural teams is not just to live with cultural differences but to use and benefit of them. The main differences between Finnish and British cultures are in management styles and level of hierarchy. Still, these two cultures seem to be very similar. This is a qualitative study and expert interviews were used as a method for data collection. The results of the empirical research showed that Finns and Brits have differences in decision-making, level of hierarchy and communication. None of the informants saw the challenges that they have faced to result from being the only representative of a foreign culture – they only perceived them resulting from the characteristics of the host culture. In addition, all the informants had to change their habits and behaviour in the host culture in order to fit into the new culture and to become a part of the team. However, all the informants saw advantages in cross-cultural teams. Based on this thesis, team members from the host culture do not value cultural differences and they seem to be an issue only for the team member from the minority culture. It seems that a Finn or a Brit adapts to a Finnish-British team where the host culture dominates by changing their own behaviour in order to become a part of the team – even though people often see their own culture’s methods and habits as the right ones. Finnish and British cultures seem to be similar in fundamental issues like views and attitudes, which could mean that it is fairly easy for a Finn to get used to working in a British team and vice versa. Even though there are many challenges in cross-cultural and bi-cultural teams, there are even more advantages.

Men's experiences of receiving objective feedback on physical activity and other indicators of health risk, within the context of a gender-sensitised weight loss intervention

Receiving personalised feedback on body mass index and other health risk indicators may prompt behaviour change. Few studies have investigated men’s reactions to receiving objective feedback on such measures and detailed information on physical activity and sedentary time. The aim of my research was to understand the meanings different forms of objective feedback have for overweight/obese men, and to explore whether these varied between groups. Participants took part in Football Fans in Training, a gender-sensitised, weight loss programme delivered via Scottish Professional Football Clubs. Semi-structured interviews were conducted with 28 men, purposively sampled from four clubs to investigate the experiences of men who achieved and did not achieve their 5% weight loss target. Data were analysed using the principles of thematic analysis and interpreted through Self-Determination Theory and sociological understandings of masculinity. Several factors were vital in supporting a ‘motivational climate’ in which men could feel ‘at ease’ and adopt self-regulation strategies: the ‘place’ was described as motivating, whereas the ‘people’ (other men ‘like them’; fieldwork staff; community coaches) provided supportive and facilitative roles. Men who achieved greater weight loss were more likely to describe being motivated as a consequence of receiving information on their objective health risk indicators. They continued using self-monitoring technologies after the programme as it was enjoyable; or they had redefined themselves by integrating new-found activities into their lives and no longer relied on external technologies/feedback. They were more likely to see post-programme feedback as confirmation of success, so long as they could fully interpret the information. Men who did not achieve their 5% weight loss reported no longer being motivated to continue their activity levels or self-monitor them with a pedometer. Social support within the programme appeared more important. These men were also less positive about objective post-programme feedback which confirmed their lack of success and had less utility as a motivational tool. Providing different forms of objective feedback to men within an environment that has intrinsic value (e.g. football club setting) and congruent with common cultural constructions of masculinity, appears more conducive to health behaviour change.