The tasks of self-managing hepatitis C: The significance of disclosure

The narratives of those with hepatitis C were viewed through the lens of Corbin and Strauss’ [Corbin, J., & Strauss, A. (1988). Unending work and care: Managing chronic illness at home. The Jossey-Bass health series and The Jossey-Bass social and behavioral science series. San Francisco, CA: Jossey-Bass.] self-management model for chronic illness, using qualitative methodology. Fifteen Australian hepatitis C positive interviewees described the challenges and turning points in adjusting to their diagnosis. The data were analysed using open- and closed-coding methods. Support was found for a self-management model encompassing medical, emotional and life role facets for those adjusting to life with hepatitis C. Unique challenges emerged beyond those described by Corbin and Strauss (1988 Corbin, J and Strauss, A. 1988. Unending work and care: Managing chronic illness at home, The Jossey-Bass health series and The Jossey-Bass social and behavioral science series San Francisco, CA: Jossey-Bass.  [Google Scholar]), namely that disclosure impacted both positively and negatively on the tasks of self-management. It was concluded that self-management may be compromised by disclosure, particularly distress derived from hepatitis C-related stigma. The self-management tasks described contribute to broadening clinicians’ understanding of the challenges faced by those living with hepatitis C.     

A telehealth intervention for veterans on antiviral treatment for the hepatitis C virus

The standard treatment for chronic hepatitis C (pegylated interferon and ribavirin) causes challenging physical and psychological side effects. The current pilot study evaluated the efficacy of a brief, telephone-based, cognitive-behavioral self-management intervention designed to address mood and quality of life within a sample of veterans on antiviral treatment for hepatitis C. Results from this pilot study support the feasibility of this telehealth intervention, showing that veterans were highly satisfied with the content of the intervention and compliant with the telephone calls. Findings further indicate that symptoms of depression and anxiety and mental health quality of life either remained stable or improved in those participants who received the brief telephone intervention, while those receiving usual care showed significant declines in mood and mental health quality of life. The findings from this study provide evidence that a brief, clinician-administered phone intervention may help individuals on antiviral therapy for hepatitis C to cope more effectively with the negative treatment side effects.     

糖尿病自我管理的面面观

糖尿病是慢性终身性疾病。糖尿病患者的自我管理处于中等或偏低的水平,导致患者出现各种急慢性并发症,严重影响了患者的生活质量。患者的自我效能影响患者的自我管理行为。因此,有必要介绍糖尿病自我管理理论及研究现状,为提高糖尿病患者的自我管理水平提供参考资料。     

Adaptive Tasks in Multiple Sclerosis: Development of an Instrument to Identify the Focus of Patients' Coping Efforts

Objective : Adaptive tasks, referring to the subjective evaluation of disease-related stressors in relation to personal concerns, have been neglected in the extensive literature on coping with chronic disease. In this study, the development of an instrument for measuring adaptive tasks is described: the Questionnaire Adaptive Tasks in Multiple Sclerosis (QuAT-MS). Method : The QuAT-MS is based on a bottom-up categorization of patients' statements on the losses, threats, and challenges brought about by their disease, and employs 10 scales to measure the importance attached to particular disease-related stressors. Validity and reliability of this bottom-up categorization were established in a sample of MS patients ( N = 259) by examining their associations with related concepts relevant in adaptation to disease, such as coping (CISS), coping resources (LOT, self-efficacy), and quality of life (SIP). We also investigated whether patients' backgrounds and disease characteristics were related to adaptive tasks. Results : Adaptive tasks are more closely related with concepts relevant for adaptation (coping and coping resources) than with physical functioning (SIP) and disease-related characteristics (illness duration). Adaptive tasks are also associated with gender and level of education. Conclusion : It is concluded that adaptive tasks can be distinguished from related concepts like coping and quality of life. Furthermore, the QuAT-MS offers a reliable and patient-centred instrument for measuring the tasks which MS patients identify in their adaptation process.     

Getting one's thoughts straight: a dialogical analysis of women's accounts of poorly controlled type 2 diabetes

Type 2 diabetes is a metabolic disorder characterised by chronically elevated blood glucose and a high risk of cardiovascular and other complications. Self-management is central to diabetes care and includes taking regular exercise, low-fat/sugar diet and blood glucose monitoring. However, little is understood about how people with diabetes make sense of self-management. Our aim, therefore, is to explore the process of 'getting one's thoughts straight' in relation to illness self-management for women with poorly controlled type 2 diabetes. Eight women were recruited from two hospitals in the North of England. Each was interviewed using a biographic-narrative method. Narratives were analysed using a dialogical approach. We use Bakhtin's concepts of voice, official and unofficial truth, and internally persuasive discourse to explore how participants considered, struggled with, and, sometimes, acted upon self-management. We demonstrate how the truth by which participants lived shifted as they encountered new perspectives and experiences. The accounts revealed tension between official, authoritative voices, typically concerned with optimal illness control and unofficial voices that speak at a lived, embodied level. In conclusion, we suggest moving beyond the notion of self-management towards a conceptualisation of life with chronic illness that includes personal goals, values and embodied experience in context.     

Getting one's thoughts straight: A dialogical analysis of women's accounts of poorly controlled type 2 diabetes

Type 2 diabetes is a metabolic disorder characterised by chronically elevated blood glucose and a high risk of cardiovascular and other complications. Self-management is central to diabetes care and includes taking regular exercise, low-fat/sugar diet and blood glucose monitoring. However, little is understood about how people with diabetes make sense of self-management. Our aim, therefore, is to explore the process of ‘getting one's thoughts straight’ in relation to illness self-management for women with poorly controlled type 2 diabetes. Eight women were recruited from two hospitals in the North of England. Each was interviewed using a biographic-narrative method. Narratives were analysed using a dialogical approach. We use Bakhtin's concepts of voice, official and unofficial truth, and internally persuasive discourse to explore how participants considered, struggled with, and, sometimes, acted upon self-management. We demonstrate how the truth by which participants lived shifted as they encountered new perspectives and experiences. The accounts revealed tension between official, authoritative voices, typically concerned with optimal illness control and unofficial voices that speak at a lived, embodied level. In conclusion, we suggest moving beyond the notion of self-management towards a conceptualisation of life with chronic illness that includes personal goals, values and embodied experience in context.     

A developmental-contextual model of couples coping with chronic illness across the adult life span

A developmental-contextual model of couples coping with chronic illness is presented that views chronic illness as affecting the adjustment of both the patient and the spouse such that coping strategies enacted by the patient are examined in relation to those enacted by the spouse, and vice versa. The developmental model emphasizes that dyadic coping may be different at various phases of the life span, changing temporally at different stages of dealing with the illness as well as unfolding daily as spouses interact around dyadic stressors. In addition, couples engaged in dyadic coping are affected by broad sociocultural factors (culture and gender) as well as more proximal contextual factors (quality of the marital relationship and the specific demands of the chronic illness). The model provides a framework for understanding how couples coping with chronic illness may together appraise and cope with illness during adulthood and for determining when spousal involvement is beneficial or harmful to both patient and spousal adjustment. The developmental-contextual model to dyadic appraisal and coping has numerous research implications for the field, and the authors conclude with specific recommendations for future research.     

Illness disclosure and mental health among women with HIV/AIDS

The current study examines two contrasting models of the relationship between illness disclosure and mental health among an ethnically‐diverse group of women with HIV/AIDS. In the first, and commonly accepted model, illness disclosure predicts enhanced mental health status. In the second or alternate model, based on the stigmatization that accompanies HIV/AIDS infection, illness disclosure predicts poorer mental health. We also explore an alternate interpretation for this second model, namely that the mental health status of participants is predictive of their levels of disclosure. A total of 176 women from three major ethnic groups were interviewed and assessed during the baseline visit for a comprehensive longitudinal study. Results showed that these women constituted a highly‐disclosed population; over one‐third of them had disclosed their HIV status to their entire social networks. Contrary to expectation, disclosure was unrelated to mental health among the African‐American (n = 72) and European‐American (n = 47) women. Among the Latina women (n = 57), however, greater disclosure was related to higher levels of depression, psychological distress, and reported pain. Regression analyses controlling for age, education, and illness severity showed that disclosure makes a small but independent contribution to the prediction of mental health status. Thus, among the Latinas, the data were consistent with both the stigma model and the hypothesis that greater distress predicts wider disclosure. General patterns of disclosure are described and possible explanations for the inconsistent relationships found between disclosure and mental health among the three ethnic groups are considered. Copyright © 2000 John Wiley & Sons, Ltd.     

乳腺癌患者自我管理行为与生活质量的相关性研究

探讨乳腺癌患者自我管理行为、生活质量及两者之间的相关性.应用慢性病自我管理研究测量表中的自我管理行为量表、乳腺癌患者生活质量测定量表调查260例乳腺癌患者的自我管理行为和生活质量.乳腺癌患者自我管理行为及生活质量现状均不理想,自我管理行为与生活质量呈正相关（P＜0.05）.乳腺癌患者自我管理行为与生活质量间有密切关系,临床护理工作中可对患者进行护理干预来增强其自我管理行为,进而提高生活质量.     

Parenting in youth tennis: Understanding and enhancing children's experiences

ObjectiveThe overall purpose of this study was to develop a grounded theory of optimal parental involvement in youth tennis.DesignA Straussian grounded theory methodology (Corbin and Strauss, 2008, Strauss and Corbin, 1998) was used. Semi-structured interviews and focus groups were conducted with 90 youth tennis players, ex-youth players, parents, and coaches from the United Kingdom. Data were analyzed through a process of open and axial coding, and theoretical integration. Through this process data were broken down into smaller units (concepts), relationships between concepts were identified, and a substantive grounded theory was developed.ResultsThe grounded theory of optimal parental involvement in tennis was built around the core category of ‘understanding and enhancing your child's tennis journey.’ The core category was underpinned by three categories: (a) Share and communicate goals, which referred to the need for parents and children to have the same aims for the child's tennis involvement; (b) develop an understanding emotional climate, which accounted for the need for parents to continually seek to foster an environment in which children perceived parents understand their experience, and; (c) engage in enhancing parenting practices at competitions, which denoted the specific behaviors parents should display in relation to competitive tennis.ConclusionThe theory predicts that consistency between goals, emotional climate, and parenting practices will optimize parenting in youth tennis.     

Retraction Note: Globalization and vulnerable populations in times of a pandemic: A Mayan perspective

Understanding representations of disease in various art genres provides insights into how patients and health care providers view the diseases. It can also be used to enhance patient care and stimulate patient self-management. This paper reviews how cardiovascular diseases are represented in novels, films, and paintings: myocardial infarction, aneurysm, hypertension, stroke, heart transplantation, Marfan’s disease, congestive heart failure. Various search systems and definitions were used to help identify sources of representations of different cardiovascular diseases. The representations of the different diseases were considered separately. The Common Sense Model was used a theoretical model to outline illness perceptions and self-management in the various identified novels, films, and paintings. Myocardial infarction followed by stroke were the most frequently detailed diseases in all three art genres. This reflects their higher prevalence. Representations ranged from biomedical details through to social and psychological consequences of the diseases. Artistic representations of cardiovascular diseases reflect cognitions, emotions, and images of prevalent disease. These representations shape views and behaviour of ill and healthy persons regarding heart diseases. As these representations are amenable to change, they deserve further research, which may be instrumental in improving the quality of life of persons struck by cardiovascular diseases. Changing illness perceptions appears to be a method to improve self-management and thereby quality of life in patients with various cardiovascular diseases.     

The common sense of counseling psychology: introducing the Common-Sense Model of self-regulation

Abstract

The goal of therapy is typically to improve clients’ self-management of their problems, not only during the course of therapy but also after therapy ends. Although it seems obvious that therapists are interested in improving clients’ self-management, the psychotherapy literature has little to say on the topic. This article introduces Leventhal’s Common-Sense Model of Self-Regulation, a theoretical model of the self-management of health, and applies the model to the therapeutic process. The Common-Sense Model proposes that people develop illness representations of health threats and these illness representations guide self-management. The model has primarily been used to understand how people self-manage physical health problems, we suggest it may also be useful to understand self-management of mental health problems. The Common-Sense Model’s strengths-based perspective is a natural fit for the work of counseling psychologists. The model has important practical implications for addressing how clients understand mental health problems over the course of treatment and self-manage these problems during and after treatment.     

Mental illness disclosure in organizations: defining and predicting (un)supportive responses

Employees with a mental illness regularly encounter situations where they must make decisions regarding the extent to which they discuss their stigma. Past research has found links between positive disclosure experiences and positive well-being and job-related outcomes for the individual disclosing. However, research on stigma disclosure has not yet defined what differentiates a supportive response from an unsupportive one, and there is evidence to suggest that people are unsure of how to best respond to a disclosure. In a series of three studies, we sought to develop a better understanding of mental illness disclosure at work. First, we created a typology of supportive and unsupportive responses to disclosure via critical incidents gathered from working adults with a mental illness. Second, we surveyed working adults with and without a mental illness to examine if they perceive the supportiveness of responses differently. Third, in an experimental study, we examined which methods of disclosure are most effective in eliciting a supportive response. This work identifies several types of supportive (e.g., providing emotional support) and unsupportive (e.g., denial of symptoms) responses to mental illness disclosure and finds that individuals without a mental illness have a reasonable understanding of what an individual with a mental illness would also identify as supportive/unsupportive responses. We also find that downplaying one’s mental illness will likely lead to a less supportive response.

     

Military Veterans' Experiences with Suicidal Ideation: Implications for Intervention and Prevention

We sought to understand Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans' experiences with suicidal ideation. Semi‐structured interviews with 34 OEF/OIF veterans addressed circumstances leading up to disclosure of suicidal ideation during brief clinical assessments. We used an iterative, inductive and deductive thematic analysis approach. Results revealed three pervasive, persistent domains that reinforce the uniqueness of veteran suicidal thoughts: military culture, difficult deployment experiences, and postdeployment adjustment challenges. Within postdeployment, we identified four themes that serve as intervention targets: adjusting to civilian culture, changes to sense of self, feeling overwhelmed by stressors, and lacking life purpose or meaning.     

Medical family therapy: an emerging arena for family therapy

This paper describes an important recent development in American family therapy. Medical family therapy uses a biopsychosocial systems model to work with families who have a member with a chronic illness or disability. The authors maintain that family therapy has tended to embrace the mind–body split and to view itself too narrowly as a mental health specialty. Medical family therapists work collaboratively with physicians and other health professionals to help families achieve a sense of agency and communion in facing some of the greatest challenges that life brings.     

Feminist Developmental Theory: Implications for Counseling

This article discusses the importance of counseling guided by a life-span development model. Major developmental tasks across the life span are outlined from an Eriksonian perspective. This is contrasted with the feminist development theory of S. Conarton and L. Kreger-Silverman (1988). Issues covered include the call by C. Gilligan (1991) for counselors to assist women to reclaim their intuitive voice and the importance of connectedness for women's development in Western society. Implications for counseling are explored with reference to borderline personality disorder and anorexia nervosa.     

Extended network learning error: A new way of conceptualising chronic fatigue syndrome

Abstract

The cause of chronic fatigue syndrome (CFS) is controversial: psychological, hypothalamic and immune mechanisms have been proposed as well as the possibility of some form of interaction between these mechanisms. Patients' own conceptual models vary and sometimes adversely affect self-management. This paper suggests an interactional way of conceptualising CFS using developments in complexity theory (networks, parallel processing or connectionism). I propose that the neurological, immune and endocrine systems are pan of a single, self-regulatory, extended brain-body network. Furthermore, that CFS is caused by self-organisational change in this extended network created by normally adaptive error-sensitive learning rules that malfunction when physiological and psychological challenges coincide. This psychoneuroimniunoendocrinological model shows how previously proposed mechanisms could interact to cause CFS. explains the heterogeneity of the presentation of the disease, and provides a conceptual model that may be acceptable to patients but is also consistent with effective self-management.     

Improving accuracy in an error detection task via task sequence

The intent of this study was to determine whether performance on an error detection task and a series of cognitive search and memory tasks would be affected if performed serially. Fifty-six participants were assigned into two experimental groups, defined by whether they performed the error detection task or the cognitive tasks first. Measures of hit rates and false alarms were taken for the error detection task, and the perceived workload of both tasks was measured immediately following completion. In the group that did the cognitive tasks first, a significant relationship between perceptions of mental demand on the cognitive tasks and subsequent performance on the error detection task was found. Also, false alarms in error detection were correlated with perceptions of time pressure and frustration measured after the error detection task. These results suggest that a mentally demanding initial task may facilitate performance in a subsequent cognitively-based task. Parts of this paper were presented at the American Psychological Society's annual convention in Atlanta, GA in June 2003. The author thanks Abbie Woodruff and Brandon Corbin for their work on the original presentation and their help in data collection, and Blaine Browne for helpful editorial comments.     

Planning a Stigmatized Nonvisible Illness Disclosure: Applying the Disclosure Decision-Making Model

This study applied the disclosure decision-making model (DD-MM) to explore how individuals plan to disclose nonvisible illness (Study 1), compared to planning to disclose personal information (Study 2). Study 1 showed that perceived stigma from the illness negatively predicted disclosure efficacy; closeness predicted anticipated response (i.e., provision of support) although it did not influence disclosure efficacy; disclosure efficacy led to reduced planning, with planning leading to scheduling. Study 2 demonstrated that when information was considered to be intimate, it negatively influenced disclosure efficacy. Unlike the model with stigma (Study 1), closeness positively predicted both anticipated response and disclosure efficacy. The rest of the hypothesized relationships showed a similar pattern to Study 1: disclosure efficacy reduced planning, which then positively influenced scheduling. Implications of understanding stages of planning for stigmatized information are discussed.