Embodying sexual subjectivity after cancer: A qualitative study of people with cancer and intimate partners

Research has increasingly recognised the profound impact that cancer can have upon embodied subjectivity. However, there has been little acknowledgement of the centrality of sexuality to subjectivity, and marginalisation of the experiences of intimate partners of people with cancer. This Australian qualitative study explores the post-cancer experiences of embodied sexual subjectivity for 44 people with cancer (23 women and 21 men) and 35 partners of people with cancer (18 women and 17 men) across a range of cancer types and stages. Semi-structured interviews were analysed with theoretical thematic analysis, guided by a post-structuralist approach to sexual subjectivity as a dynamic process of becoming that can change over time, and by Williams’ [(1996). The vicissitudes of embodiment across the chronic illness trajectory. Body and Society, 2, 23–47] framework on post-illness embodiment. Participants took up the following post-cancer subject positions: ‘dys-embodied sexual subjectivity’ – characterised by bodily betrayal, sexual loss, lack of acceptance, depression, and anxiety; ‘re-embodied sexual subjectivity’ – characterised by greater sexual confidence, acceptance, the exploration of non-coital sexual practices and increased relational closeness; and ‘oscillating sexual subjectivity’ – involving a shift between states of sexual dys-embodiment and sexual re-embodiment. The findings point to the importance of focusing on the sexual health of people with cancer and partners across the cancer trajectory.     

‘I feel better when…’: An analysis of the memory-experience gap for peoples’ estimates of the relationship between health behaviours and experiences

Objective: People often overestimate how strongly behaviours and experiences are related. This memory-experience gap might have important implications for health care settings, which often require people to estimate associations, such as “my mood is better when I exercise”. This study examines how subjective correlation estimates between health behaviours and experiences relate to calculated correlations from online reports and whether subjective estimates are associated with engagement in actual health behaviour.

Design: Seven-month online study on physical activity, sleep, affect and stress, with 61 online assessments.

Main Outcome Measures: University students (N = 168) retrospectively estimated correlations between physical activity, sleep, positive affect and stress over the seven-month study period.

Results: Correlations between experiences and behaviours (online data) were small (r = ?.12–.14), estimated correlations moderate (r = ?.35–.24). Correspondence between calculated and estimated correlations was low. Importantly, estimated correlations of physical activity with stress, positive affect and sleep were associated with actual engagement in physical activity.

Conclusion: Estimation accuracy of relations between health behaviours and experiences is low. However, association estimates could be an important predictor of actual health behaviours. This study identifies and quantifies estimation inaccuracies in health behaviours and points towards potential systematic biases in health settings, which might seriously impair intervention efficacy.     

Understanding behavioural clusters: Identifying differences between clusters of health behaviours on key constructs

Objective: To uncover the rationale underlying the perceived distinction between clusters of health behaviours by identifying cognitive constructs that differentiate among them, and creating a ‘cognitive profile’ for each behavioural cluster. Thus, different determinants and characteristics of health behaviours (e.g. ‘perceived behavioural control’, ‘impact on health’, ‘effort’, ‘non-health rewards’, ‘habit’) were used to compare health behaviour meta-clusters (physical and psychosocial) and clusters (e.g. nutrition behaviours, substance abuse, medical practices).

Methods: A sample of lay people (N = 1956) judged items representing behavioural clusters delineated in the Health Behaviour Taxonomy on 14 constructs.

Results: Significant differences emerged between the physical and psychosocial meta-clusters, as well as among their sub-clusters. For example, physical behaviours were higher on ‘perceived behavioural control’ and ‘impact on health’ compared to psychosocial behaviours, and nutrition was perceived highest on ‘effort’ and ‘non-health rewards’ compared to the other clusters of the physical meta-cluster.

Conclusion: The findings increase our understanding of the logic underlying lay people’s cognitive schema of health behaviour clusters. ‘Cognitive profiles’ that explain differences between the clusters were identified, which can be used to design health messages and interventions targeting multiple health behaviours.     

Men’s strategies for preserving emotional well-being in advanced prostate cancer: An interpretative phenomenological analysis

Objective: This study explores men with advanced prostate cancers’ own practices for promoting and maintaining emotional well-being using Interpretative Phenomenological Analysis.

Design: Five men with advanced prostate cancer participated in face-to-face, semi-structured, in-depth interviews.

Results: Within rich narratives of lost and regained well-being, two super-ordinate themes emerged – ‘living with an imminent and uncertain death’ and ‘holding on to life.’ Well-being was threatened by reduced sense of the future, isolation and uncertainty. Yet, the men pursued well-being by managing their emotions, striving for the future whilst enjoying life in the present, taking care of their families and renegotiating purpose. Running through participant’s accounts was a preference for taking action and problem-solving. Sense of purpose, social connectedness, and life engagement were revealed as concepts central to improving well-being, indicating areas which practitioners could explore with men to help them re-establish personal goals and life purpose.

Conclusions: The findings also add weight to the evidence base for the potential value of psychological interventions such as cognitive behaviour therapy and mindfulness in men with prostate cancer.     

The experiences and understandings of obesity: Families’ decisions to attend a childhood obesity intervention

Objectives: This study investigated the families’ experiences of a childhood obesity intervention and sought to understand factors that influence attendance and lifestyle behaviours.

Design: Eleven semi-structured interviews were conducted and analysed using Interpretative Phenomenological Analysis.

Results: Four themes emerged highlighting the differences and similarities between attendees and non-attendees perceptions of childhood obesity, perceptions of the intervention, practical barriers and overcoming hurdles to attending and, availability and suitability of local facilities.

Conclusions: The findings relate to identity and health communication. For some families attending an obesity intervention may challenge social and individual identities, which may have an impact on subsequent behavioural decisions. Those who attend the obesity intervention may experience a shift in identity, which may or may not initially be perceived as a positive outcome. Public Health and those involved in treatment interventions should aim to bridge the gap between people’s in-group identities and those associated with particular lifestyle behaviours. In order to be effective, services must meet the needs of their clients and address any preconceived negative perceptions by carefully considering how health information is presented, how it is understood and most importantly how identity may affect motivation to engage in, and sustain, new behaviours.     

Prospective associations between unforgiveness and physical health and positive mediating mechanisms in a nationally representative sample of older adults

Objective: This study examined the prospective association between unforgiveness and self-reported physical health and potential positive psychological mediators of this association.

Design: Participants were a national sample of 1024 USA’s adults of ages 66 years and older. Data were collected at two time points separated by three years.

Main Outcome Measures: Measures of trait unforgiveness, self-rated physical health, socio-demographics, health behaviours and positive psychological traits (e.g. life satisfaction, self-esteem) were included in a comprehensive survey known as the ‘Religion, Aging, and Health Survey.’

Results: The results indicated that unforgiveness was prospectively associated with declines in self-reported physical health three years later, and poor initial self-reported health status did not predict increases in unforgiveness across time. Furthermore, the prospective association of unforgiveness with self-reported health was mediated by a latent positive psychological traits variable.

Conclusion: These results confirm cross-sectional findings suggesting that unforgiveness is related to health. The present study also suggests that unforgiveness has a prospective, but not reciprocal, association with self-reported physical health. Unforgiveness may have its association with self-reported physical health through its interruption of other positive traits that typically confer health benefits.     

Living with Hereditary Haemorrhagic Telangiectasia: stigma,coping with unpredictable symptoms,and self-advocacy

Abstract

Objective: Hereditary Haemorrhagic Telangiectasia (HHT) is a genetic condition causing frequent nose bleeds, skin lesions (telangiectasia) and arteriovenous malformations. Approximately, 50% of people experience life-threatening HHT symptoms including haemorrhages in the brain, lungs and liver. This study aimed to gain a qualitative understanding of the psychosocial impact of HHT over time. Design: Using a phenomenological framework, a rigorous narrative analysis was performed on 20 semi-structured interviews with individuals with HHT aged 20s–60s. Main outcome measures: Qualitative themes explaining life experiences prior to and following a clinical diagnosis of HHT. Results: Narratives highlighted four psychosocial themes: (i) the psychological impact of visible symptoms was significant and related to experiences of social stigma, (ii) individuals struggled to identify triggers of symptoms in order to reduce unpredictability, (iii) an illness identity was rejected by minimising HHT when talking about the present self, and by positive reframing as ‘lucky’ and (iv) self-advocacy was necessitated due to lack of expert coordinated care. Conclusion: HHT has a demanding impact on social, physical and psychological well-being. These findings have significant implications for health care, as narratives about interactions with health professionals often used the terms ‘frustrating’ and ‘not being heard’.     

Social-class indicators differentially predict engagement in prevention vs. detection behaviours

Objective: Few systematic studies have examined the contexts in which social-class variables will predict engagement in health-relevant behaviours. The current research examined whether the impact of social-class on health behaviours depends upon how social-class is assessed and the category of health behaviour under consideration.

Method: Our sample was drawn from the Health Information National Trends Survey in 2012 (N = 3959). Participants reported their income and education as well as their engagement in a variety of prevention and detection behaviours.

Results: Consistent with our hypothesised framework, we found that income predicted engagement in a variety of detection behaviours above and beyond education, whereas education predicted engagement in a variety of prevention behaviours above and beyond income.

Conclusions: Our findings suggest that income and education operate on health behaviours via different pathways and have implications for public health policy and intervention.     

Narrative, identity and mental health: How men with serious mental illness re-story their lives through sport and exercise

ObjectivesIt has been suggested that mental illness threatens identity and sense of self when one's personal story is displaced by dominant illness narratives focussing on deficit and dysfunction. One role of therapy, therefore, is to allow individuals to re-story their life in a more positive way which facilitates the reconstruction of a meaningful identity and sense of self. This research explores the ways in which involvement in sport and exercise may play a part in this process.DesignQualitative analysis of narrative.MethodWe used an interpretive approach which included semi-structured interviews and participant observation with 11 men with serious mental illness to gather stories of participants’ sport and exercise experiences. We conducted an analysis of narrative to explore the more general narrative types which were evident in participants’ accounts.FindingsWe identified three narrative types underlying participants’ talk about sport and exercise: (a) an action narrative about “going places and doing stuff”; (b) an achievement narrative about accomplishment through effort, skill or courage; (c) a relationship narrative of shared experiences to talk about combined with opportunities to talk about those experiences. We note that these narrative types differ significantly from—and may be considered alternatives to—dominant illness narratives.ConclusionThis study provides an alternative perspective on how sport and exercise can help men with serious mental illness by providing the narrative resources which enabled participants to re-story aspects of their lives through creating and sharing personal stories through which they rebuilt or maintained a positive sense of self and identity.     

Interpersonal effects of parents and adolescents on each other’s health behaviours: a dyadic extension of the theory of planned behaviour

Objective: Interpersonal relationships are important predictors of health outcomes and interpersonal influences on behaviours may be key mechanisms underlying such effects. Most health behaviour theories focus on intrapersonal factors and may not adequately account for interpersonal influences. We evaluate a dyadic extension of the Theory of Planned Behaviour by examining whether parent and adolescent characteristics (attitudes, subjective norms, perceived behavioural control and intentions) are associated with not only their own but also each other’s intentions/behaviours.

Design: Using the Actor-Partner Interdependence Model, we analyse responses from 1717 parent-adolescent dyads from the Family Life, Activity, Sun, Health, and Eating study.

Main Outcome Measures: Adolescents/parents completed self-reports of their fruit and vegetable consumption, junk food and sugary drinks consumption, engagement in physical activity, and engagement in screen time sedentary behaviours.

Results: Parent/adolescent characteristics are associated with each other’s health-relevant intentions/behaviours above the effects of individuals’ own characteristics on their own behaviours. Parent/adolescent characteristics covary with each other’s outcomes with similar strength, but parent characteristics more strongly relate to adolescent intentions, whereas adolescent characteristics more strongly relate to parent behaviours.

Conclusions: Parents and adolescents may bidirectionally influence each other’s health intentions/behaviours. This highlights the importance of dyadic models of health behaviour and suggests intervention targets.     

Understanding the prevalence and correlates of implicit theories of weight in the United States: Insights from a nationally representative sample

Objectives: The primary aim of this research is to understand how mindsets about weight controllability in the United States relate to population health. We examined the distribution of people’s implicit theories of weight, from an incremental (controllable) to an entity (not controllable) mindset, in a nationally representative sample, as well as their relation to: sociodemographic factors, beliefs about behaviour and genetics as causes of obesity and engagement in weight management-relevant behaviours.

Methods: We report data from the National Cancer Institute’s Health Information National Trends Survey 4.

Results: A majority of respondents endorsed an incremental mindset of body weight, but endorsement of this mindset was stronger among younger, white respondents, and those with a higher income and more educational attainment. A stronger incremental mindset was related to stronger behaviour and weaker genetic causal beliefs about obesity, as well as a tendency to report increased engagement in weight management-relevant behaviours.

Conclusions: Our research provides evidence that although incremental mindsets are more common overall and associated with engagement in health behaviours that can contribute to or detract from population health, incremental mindsets are less common among individuals from more marginalised groups.     

Mediation,moderation, and context: Understanding complex relations among cognition,affect, and health behaviour

Objective: Researchers have historically treated cognition and affect as separate constructs in motivating health behaviour. We present a framework and empirical evidence for complex relations between cognition and affect in predicting health behaviour.

Main Outcome, Design and Results: First, affect and cognition can mediate each other’s relation to health behaviour. Second, affect and cognition can moderate the other’s impact. Third, context can change the interplay of affect and cognition. Fourth, affect and cognition may be indelibly fused in some psychological constructs (e.g. worry, anticipated regret and reactance). These four propositions in our framework are not mutually exclusive.

Conclusion: Examination of the types of complex relations described here can benefit theory development, empirical testing of theories and intervention design. Doing so will advance the understanding of mechanisms involved in regulation of health behaviours and the effectiveness of interventions to change health behaviours.     

The Long and Winding Road: An Autobiographic Study of an Elite Athlete Mother’s Journey to Winning Gold

Within sport psychology, researchers have explored elite athlete mothers’ experiences. More work is needed to understand the nuanced psychosocial aspects of their athletic journeys. Studying autobiographical narratives is useful toward understanding the psychosocial nuances of motherhood and athletics in sociocultural context. Within the present study we sought to extend this understanding through studying one elite athlete’s—British runner Jo Pavey—journey as an athlete mother within her autobiography This Mum Runs (26 chapters totaling 253 pages). Thematic narrative analysis of key chapters focusing on pregnancy and motherhood in relation to training and competition allowed for the identification of a central theme—discovery narrative–reconfiguring the performance narrative—along with two subthemes: go with the flow and best of both worlds. The subthemes are used to illustrate the navigation of tensions in relation to an athlete mother identity grounded in family relationships to facilitate training and competition goals, within a discovery narrative. Applied sport psychology recommendations are made using narrative theory in relation to key findings. Recommendations focused on athlete stories and narrative resources as concrete entry points to encourage compatible athlete mother identities and sport career engagement. This study adds to sport psychology work that has used autobiography as theoretical, analytical, and applied resources to expand understanding of marginalized and/or hard to access topics in elite sport. This is the first autobiographic study to focus on elite athlete mother identities, furthering understanding of nuanced identity negotiation and experiences over time.

Lay Summary: Understanding of elite athlete mother's negotiation of identity and athletic career is expanded through studying published/public autobiographical narratives. A discovery narrative grounded in personal growth and family relationships facilitates strategies that facilitate training and competition goals.     

The impact of valence framing on response expectancies of side effects and subsequent experiences: a randomised controlled trial

Abstract

Objective: Pre-treatment side effect expectancies often influence subsequent experiences; however, expectancy-based reduction strategies are lacking. We explored whether framing information about adverse responses (in positive or negative formats) altered expectancies and experiences of a cold pressor task. We further investigated associations between expectancies and experiences, to inform potential interventions.

Design: Healthy volunteers (N?=?134), randomised to receive positively- or negatively-framed pre-cold pressor task information, self-rated 12 expectancies for cold pressor experiences, emotional state and coping style.

Main Outcome Measures: Self-reports of the same 12-experiences (recorded during and after the experiment) were assessed.

Results: Framing had minimal impact on expectancies and experiences; however, discomfort threshold (p?=?.08, d?=?0.22) showed a trend in the expected direction. Hierarchical regressions revealed expectancies uniquely, significantly predicted 6–23% of the variance for 11 subsequent experiences. Following a popular charity event (Ice Bucket Challenge), all participants showed higher ‘discomfort thresholds’ (p?=?.001, d?=?0.59), and those in the negative frame reported more overall ‘discomfort’ (p?=?.01, d?=?0.60) than participants in the positive condition.

Conclusion: Expectancies uniquely influenced subsequent cold pressor experiences. Framing had minimal impact in this ‘analogue’ medical setting, only influencing ‘discomfort threshold’. ‘Discomfort threshold’ and overall ‘discomfort’ were also impacted by a social media challenge, highlighting a potential area for intervention.     

Growth: A Journey from Experience to Higher Perception Among Iranian Muslim CPR Survivors

Several studies have been conducted among cardiopulmonary resuscitation (CPR) survivors. Some studies have shown that positive and negative experiences coexist. Emotional distress and psychopathology in CPR survivors are related to the urgent need to make growth. Understanding the meaning of CPR survivors’ lived experiences of growth may facilitate their growth. The aim of the study was to illuminate the meaning of CPR survivor’s lived experiences of growth in southeast Iran. A qualitative design using a phenomenological hermeneutic approach influenced by Ricoeur was used in 12 CPR survivors. Three main themes emerged including: (1) opening up a new horizon in the meaning of life, (2) opening up a new horizon in the meaning of interpersonal connections and (3) opening up a new horizon in the meaning of God and spirituality. The interpreted comprehensive understanding conveyed a meaning that CPR survivors’ experience of growth seems to be like opening the doors of perception to the higher reality. The finding may assist other CPR survivors to learn from participants in this study. Exposure to suitable narratives under health care provider supervision could develop profound learning. Training sessions with an emphasis on meditation education and how to use connecting to God in the adaptation process may approve the quality of life of CPR survivors.

     

Marital Functioning and Physical Health: Implications for Social and Personality Psychology

Marriage – the most important adult relationship in most people’s lives – has been theorized to affect biological processes, physical health, and mortality. This article highlights key findings in marriage and health research, focusing on the interpersonal processes through which marriage has been proposed to affect health. A model of marriage and health is presented that incorporates both main and stress-moderating effects of negative marital experiences –marital strain– and positive marital experiences –marital strength. Although many more studies have investigated marital strain than marital strength, current evidence suggests that both have potent effects on biology and health. The article concludes with a discussion of implications of this research for social and personality psychology, focusing on insights that may be gained from basic relationship science. Examples of three areas of relationship research – intimacy processes, commitment processes, and dyadic analysis – and their potential relevance for marriage and health research are presented.     

Structure and content of affective associations with health behaviours: Is the behaviour ‘good OR bad’ or ‘good AND bad’

Objective: The feelings and emotions individuals associate with health-related behaviours influence engagement in those behaviours. However, the structure and the content of these affective associations have not been examined. The studies reported here examined competing hypotheses about the structure (unidimensional or bidimensional) and content (generalised affect or specific emotions) of affective associations with two health-related behaviours: physical activity and fruit/vegetable consumption.

Design: For each behaviour, participants (fruit and vegetable consumption n = 149; physical activity n = 199) completed an assessment of the association of 40 positive and 51 negative affect concepts with the behaviour.

Main outcome measures: Ratings of affective associations with each behaviour.

Results: Confirmatory factor analyses comparing unidimensional and bidimensional affect structure models showed that the structure of individuals’ affective associations was bidimensional for both behaviours – positive and negative affective associations were shown to be separate and distinct constructs. Exploratory factor analyses supported a model of affective associations as generalised affect for both behaviours.

Conclusion: Affective associations with both physical activity and with fruit/vegetable consumption consist of separate positive and negative dimensions of generalised affect. These findings lead to recommendations for research and intervention development based on the implications for how affective associations might operate to influence behavioural decision-making.