Encompassing experience: Meanings and methods in health psychology

Abstract

Health psychology is limited by its almost exclusive use of a positivist quantitative research paradigm, and the adoption and use of qualitative methods by health psychologists will provide increased understandings of health and illness. Qualitative methods provide a means to incorporate the social world into our research, and furnish ways to investigate the meanings of health and illness experience. We present a brief consideration of the qualitative paradigm and some important underlying issues related to its use. We describe three qualitative approaches - grounded theory, narrative analysis, and discourse analysis - chosen for their relevance and diversity. We provide illustrations of the use of each in health research, and suggest how these approaches could be utilised by health psychologists to enrich understanding in the health field. We conclude that health psychologists have a great deal to gain from joining other social science health researchers in adopting qualitative approaches in their research.     

Untapped Potential: Psychologists Leading Research in Clinical Practice

Enhancing the capacity of allied health professionals to engage in research is central to improving healthcare delivery. Psychologists have research skills given their training focus that emphasises the scientist‐practitioner model. We aimed to investigate among psychologists the link between individual research capacity and their current level of research activity, how this compares with other allied health professions, and the role of team and organisation research capacity. Psychologists (n = 60) working in clinical roles in a large metropolitan public health setting completed an online survey consisting of the validated Research Capacity and Culture tool, and questions related to current research activities, barriers, and motivators. The results indicated that psychologists reported relatively high individual research capacity, higher than both team and organisation levels, and greater individual research capacity compared with studies of dietitians and a mixed group of allied health. Preliminary findings suggested that team research capacity mediated the link between individual research capacity and the level of current research activity. Finally, barriers and motivators to research activity were similar compared with studies of other allied health professions. Overall, a multi‐strategy approach that focuses on and facilitates practice‐based and interdisciplinary research, and enhances the leadership skills of psychologists in research, as well as broader efforts from an organisational perspective to build a strong and sustainable research culture, may contribute to the rapid use of research skills in clinical practice and improve health and healthcare delivery.     

Ethical implications in the allocation of scarce medical resources in Poland

The health care system in Poland is undergoing major change and it is possible that these changes could affect clinical research. Therefore, the situation of funding of health care is important for the future of medical research in this country. Some questions relevant in this field will be addressed. Since funds for health care and scientific research remain inadequate, their allocation raises moral, economic, legal and organisational dilemmas. The clinical aspects of resource allocation also include physicians’ responsibilities towards their patients. Scientific research, clinical medicine, and clinical research have a common denominator: they rely on trust. The physician should be a fiduciary of the patient as well as being a researcher for the benefit of the patient and for society. Some physicians and researchers, despite unethical conduct, escape disclosure and punishment, but decision-makers who wrongly allocate funds for health care and research are never held accountable for their actions. An earlier version of this paper was presented at a symposium, Scientific Misconduct: An International Perspective, organised by The Medical University of Warsaw, 16 November, 1998.     

Psychologie communautaire et recherche : l’exemple du projet EMILIA

The development of community psychology has also had significant implications in the area of evaluation and research methodology. The empowerment principle, that is, giving users the means to control their health and to make their own health decisions, has important implications for the choice of evaluation strategies for both individual therapeutic acts as well as for public health programmes. If the user's potential expertise in the health area is to be fully acknowledged, how is this to be done with regard to research? How can users become not only actors of their own health, but also play an active role in research and health evaluation? The article gives an overview of research strategies based on community psychology principles, with a particular emphasis on action research and participative-action research. The example of a multisite European project on empowering mental-health service users to access life-long learning and employment, currently underway in Paris, is presented to illustrate these community research methods.     

Governance of Transnational Global Health Research Consortia and Health Equity

Global health research partnerships are increasingly taking the form of consortia of institutions from high-income countries and low- and middle-income countries that undertake programs of research. These partnerships differ from collaborations that carry out single projects in the multiplicity of their goals, scope of their activities, and nature of their management. Although such consortia typically aim to reduce health disparities between and within countries, what is required for them to do so has not been clearly defined. This article takes a conceptual approach to explore how the governance of transnational global health research consortia should be structured to advance health equity. To do so, it applies an account called shared health governance to derive procedural and substantive guidance. A checklist based on this guidance is proposed to assist research consortia determine where their governance practices strongly promote equity and where they may fall short.     

激励发展中国家的卫生研究——再思考与研讨新策略时代正在兴起

发展中国家需要更清晰地明确其卫生研究面临的优先项目,即国家应共同分担全球性研究项目,增强激励和纳入研究轨道的国家能力,把循证决策人微言轻政策决策的基础,加强国家与国际合作问题是卫生研究中的中心议题。     

Innovations in the Identification and Referral of Mothers at Risk for Depression: Development of a Peer-to-Peer Model

This paper describes a feasibility study of a peer-delivered prevention intervention to identify mothers at high risk for depression and facilitate engagement in mental health services for their emotional health. Sixteen family peer advocates and their supervisors partnered with academic researchers over a period of 6 months to develop a four-session intervention that focused on identifying symptoms of depression, providing education about depression and treatment, actively linking caregivers to treatment for their own emotional health, and assisting caregivers in becoming active participants in their mental health care. Collaborating with peers to develop the model enhanced its perceived relevance and utility, and resulted in an intervention that was complimentary to their roles and the mission of peer-delivered support services. Peer/professional partnerships may be beneficial for enhancing the feasibility and acceptability of research efforts; the impact of peers’ participation in the current project and the need for future research to develop and study peer-delivered models is discussed.     

The effects of health frame and target relevance in appearance social comparisons

Social comparison powerfully influences on appearance self‐evaluations, but previous research has not examined the combined impact of target frame and relevance on appearance comparison outcomes. The present study examined the effect of target relevance and health frame in body‐ideal images on self‐evaluations in a mixed‐gender university‐based sample from the United States (N = 176; 58% female). Participants were randomly assigned to one of four conditions in which they viewed a body‐ideal image of a same‐sex target that varied in target relevance (peer or model) and health frame (extreme behaviors described as being healthy or unhealthy). We did not find evidence that comparisons with models or peers are different in their effects. And, consistent with hypotheses, the health frame of a comparison target’s eating and exercise behaviors influenced how participants perceived themselves and their health. Participants were more likely to take health advice from the target described as healthy, and felt better about their own health when comparing to healthy targets. We also found gender differences such that men were more satisfied with their physical health but women were more satisfied with their appearance. Overall, this research supports the importance of addressing peer comparisons and health literacy in body image interventions, which has long‐term implications for the prevention of eating and exercise pathology.     

Health Care Behaviours and Beliefs in Hasidic Jewish Populations: A Systematic Review of the Literature

Cultural issues impact on health care, including individuals’ health care behaviours and beliefs. Hasidic Jews, with their strict religious observance, emphasis on kabbalah, cultural insularity and spiritual leader, their Rebbe, comprise a distinct cultural group. The reviewed studies reveal that Hasidic Jews may seek spiritual healing and incorporate religion in their explanatory models of illness; illness attracts stigma; psychiatric patients’ symptomatology may have religious content; social and cultural factors may challenge health care delivery. The extant research has implications for clinical practice. However, many studies exhibited methodological shortcomings with authors providing incomplete analyses of the extent to which findings are authentically Hasidic. High-quality research is required to better inform the provision of culturally competent care to Hasidic patients.     

An investigation of self-assessment bias in mental health providers

Previous research has consistently found self-assessment bias (an overly positive assessment of personal performance) to be present in a wide variety of work situations. The present investigation extended this area of research with a multi-disciplinary sample of mental health professionals. Respondents were asked to: (a) compare their own overall clinical skills and performance to others in their profession, and (b) indicate the percentage of their clients who improved, remained the same, or deteriorated as a result of treatment with them. Results indicated that 25% of mental health professionals viewed their skill to be at the 90th percentile when compared to their peers, and none viewed themselves as below average. Further, when compared to the published literature, clinicians tended to overestimate their rates of client improvement and underestimate their rates of client deterioration. The implications of this self-assessment bias for improvement of psychotherapy outcomes are discussed.     

Chaplaincy and Mental Health Care in Aotearoa New Zealand: An Exploratory Study

This paper summarizes an initial exploratory study undertaken to consider the ministry of New Zealand chaplaincy personnel working within the mental health care context. This qualitative research (a first among New Zealand mental health care chaplains) was not concerned with specific health care institutions per se, but solely about the perspectives of chaplains concerning their professional contribution and issues they experienced when trying to provide pastoral care to patients, families, and clinical staff involved in mental health care. Data from a single focus group indicated that chaplains were fulfilling various WHO-ICD-10AM pastoral interventions as a part of a multidisciplinary and holistic approach to mental health care; however, given a number of frustrations identified by participants, which either impeded or thwarted their professional role as chaplains, a number of improvements were subsequently identified in order to develop the efficiency and effectiveness of chaplaincy and thus maximize the benefits of pastoral care to patients, families, and clinical staff. Some implications of this exploratory study relating to mental health care chaplaincy, ecclesiastical organizations, health care institutions, and government responsibilities and the need for further research are noted.     

Emotions and cognitions in consumer health behaviors: insights from chronically ill patients into the effects of hope and control perceptions

The lack of compliance to medical advice is a widely recognized healthcare concern with important implications to consumer well‐being. Through an in‐depth examination of the narratives provided by chronically ill patients, this study contributes to transformative consumer research by offering a better understanding of patients' compliance or lack of compliance with medical advice. The narratives are examined with a focus on two potential antecedents: hope and perceptions of control over health outcomes. Findings suggest that although control perceptions play a crucial role in compliance, chronically ill patients often feel that they have no control over their health outcomes. The narratives reveal that the positive emotion of hope is a motivator for positive health behaviors. Additionally, the lived experiences accounts suggest a possible relationship between hope and control perceptions: patients' belief in their ability to manage their chronic illness facilitates hope but might not be essential to it. The importance of healthcare providers' role in cultivating hope and customizing their interactions with patients is discussed. The implications also indicate that health initiatives aimed at increasing treatment compliance should consider alternatives to messages calling for patients to take control of their health. Instead, future research on health behavior should look beyond social cognition models of health behavior and focus on the role of positive emotions such as hope. Copyright © 2015 John Wiley & Sons, Ltd.     

Developing preventive mental health interventions for refugee families in resettlement

In refugee resettlement, positive psychosocial outcomes for youth and adults depend to a great extent on their families. Yet refugee families find few empirically based services geared toward them. Preventive mental health interventions that aim to stop, lessen, or delay possible negative individual mental health and behavioral sequelae through improving family and community protective resources in resettled refugee families are needed. This paper describes 8 characteristics that preventive mental health interventions should address to meet the needs of refugee families, including: Feasibility, Acceptability, Culturally Tailored, Multilevel, Time Focused, Prosaicness, Effectiveness, and Adaptability. To address these 8 characteristics in the complex environment of refugee resettlement requires modifying the process of developmental research through incorporating innovative mental health services research strategies, including: resilience framework, community collaboration, mixed methods with focused ethnography, and the comprehensive dynamic trial. A preventive intervention development cycle for refugee families is proposed based on a program of research on refugees and migrants using these services research strategies. Furthering preventive mental health for refugee families also requires new policy directives, multisystemic partnerships, and research training.     

A Social Ecological Conceptual Framework for Understanding Adolescent Health Literacy in the Health Education Classroom

With the rising concern over chronic health conditions and their prevention and management, health literacy is emerging as an important public health issue. As with the development of other forms of literacy, the ability for students to be able to access, understand, evaluate and communicate health information is a skill best developed during their years of public schooling. Health education curricula offer one approach to develop health literacy, yet little is known about its influence on neither students nor their experiences within an educational context. In this article, we describe our experience applying a social ecological model to investigating the implementation of a health education curriculum in four high schools in British Columbia, Canada. We used the model to guide a conceptual understanding of health literacy, develop research questions, select data collection strategies, and interpret the findings. Reflections and recommendations for using the model are offered.     

False Consensus and False Uniqueness in Estimating the Prevalence of Health-Protective Behaviors

The degree to which people perceive that their health-relevant behaviors are also performed by their peers may influence whether they continue these practices or are susceptible to change. The present paper examined estimates of social consensus for health-relevant behaviors. It was hypothesized that respondents would perceive their own behaviors to be relatively more common than do people not performing them, the so-called False Consensus Effect. However, in terms of the accuracy of consensus estimates, people who behave in undesirable ways will tend to overestimate the actual number of others who behave similarly. In contrast, people who behave in desirable ways will underestimate the actual number of people who behave like themselves (false uniqueness). A group of college-aged males were asked to report about their performance of a series of health-relevant behaviors and to estimate the frequency of each behavior among their peers. The findings strongly supported the first two hypotheses and provided some support for the third. One practical implication of the results is that persons with unhealthy practices may resist public health campaigns and other interventions by overestimating consensus for their own behaviors. Also, individuals who think their undesirable health behaviors are relatively common may believe that they involve few health risks for them. The research suggests the need for further research on social cognitions about health, illness, and health-protective behaviors.     

Improvements in Depression and Mental Health After Acceptance and Commitment Therapy are Related to Changes in Defusion and Values-Based Action

Acceptance and commitment therapy (ACT) has been found to be effective for various mental health disorders but the processes through which it affects change remain unclear. Much process research in the area is on physical rather than mental health, and focuses on the broad concept of psychological flexibility with little research on specific mechanisms identified in theory such as fusion and values. This study explored whether there was a relationship between two of the main ACT processes (cognitive defusion and values) and levels of depression and distress. Thirty-three participants completed questionnaires at the start and end of their treatment measuring general mental health and distress, depression, levels of cognitive fusion and how much they were living in line with their values and how important their values were to them. Results showed reductions in levels of fusion and increases in values-based action were significantly related to reductions in distress and depression. There was no correlation between changes in values importance and changes in distress or depression. This study therefore suggests decreased defusion and increased values-based action is an important mechanism in the efficacy of ACT in those with depression and mental health problems. The study is however limited by a small sample size and future research with a sample large enough for mediation analysis would be beneficial.     

Parent-adolescent health conversations as action: Theoretical and methodological issues

Abstract

A qualitative research method based on action theory is proposed and illustrated for use in health psychology and health promotion research. Action refers to the goal-directed and intentional behaviors of individual and groups. Action theory has the advantage of using the perspectives provided by manifest behavior, internal processes, and social meaning in the analysis of action. In this article, the actions under consideration are the health-related conversations of parents and their adolescent children. The approach is premised on an understanding of health promotion as a family task constructed through actions such as conversations between family members. Health conversations in two parent-adolescent dyads are used to illustrate the method. The analysis includes the identification of goals, functional steps, and elements and their relation to the family health promotion project. Specific attention is paid to data gathering and analysis issues and their implications for health promotion research.     

Ethical issues for psychologists in hospital-based research and practice

Psychologists are increasingly viewing hospital-based practice with problems of physical health and illness as an area of both needed and appropriate involvement. Indeed, a wide array of research findings underscores the importance of psychological factors in maintaining physical health and preventing illness. However, the increasing involvement of psychologists, and broader acceptance of the practice contributions they can make, may lead to their experiencing ethical dilemmas in research and in practice. This article considers some ethical issues of confidentiality and informed consent in areas of research and practice with hospital-based patients.     

An overview of issues in research on consumer satisfaction with child and adolescent mental health services

Research that focusses on consumer satisfaction with child and adolescent mental health services is reviewed. Satisfaction is broadly conceived to include any study where the perspectives of children, adolescents or their parents about mental health services were gathered and presented. Important conceptual issues in research on consumer satisfaction with children's mental health services are discussed. Some of the general methodological issues that have faced satisfaction researchers are also considered. The wide range of methodological variations that have been used to investigate this topic area are outlined. The most significant findings of previous research are presented and critiqued. In conclusion, suggestions are made about the most fruitful directions for future research.