Optimizing preoperative expectations in cardiac surgery patients is moderated by level of disability: the successful development of a brief psychological intervention

Patients’ expectations have shown to be a major psychological predictor of health outcome in cardiac surgery patients. However, it is unclear whether patients’ expectations can be optimized prior to surgery. This study evaluates the development of a brief psychological intervention focusing on the optimization of expectations and its effect on change in patients’ expectations prior to cardiac surgery. Ninety patients scheduled for coronary artery bypass graft were randomly assigned to (1) standard medical care, (2) additional expectation manipulation intervention (EMI), and (3) additional attention control group. Therapists’ fidelity to intervention manuals and patients satisfaction with the intervention were assessed for both active intervention conditions. Patients’ expectations about post-surgical disability, treatment control, personal control, and disease duration were assessed before and after the psychological intervention. Demographical, medical, and psychosocial characteristics and disability were assessed at baseline. Treatment fidelity and patient satisfaction was very high in both intervention conditions. Only patients receiving EMI developed higher personal control expectations and longer (more realistic) expectations of disease duration. The effect of intervention group on patients’ disability expectations and patients’ personal control expectations was moderated by patient’s level of disability. EMI patients with low to moderate disability developed positive expectations whereas patients with high disability did not. This study shows the successful development of a short psychological intervention that was able to modify patients’ expectations, especially in those with low to moderate disability. Given the robust association of expectations and surgery outcome, such an intervention might offer the opportunity to enhance patients’ health following cardiac surgery.     

‘You have to treat the person,not the mouth only’: UK dentists’ perceptions of communication in patient consultations

Effective communication between patients and health professionals is a key component of patient-centred care. Although there is a large body of literature focusing on doctor-patient communication, there has been limited research related to dentist-patient communication, especially presented from the dentists’ perspective. The aim of our study was to explore UK dentists’ perceptions of communication in their consultations, and the factors they perceive may influence this. We conducted semi-structured interviews with eight dentists in UK dental NHS practices. Thematic analysis revealed three themes (‘Treating the whole person’, ‘Barriers to patient-centred communication’ and ‘Mutuality of communication’), which reflected the dentists’ perceptions of their own communication during consultations, the patients’ interaction skills, attitudes (and characteristics that may affect them), and external factors, such as time constraints, that can influence dentist-patients’ encounters. These in-depth accounts are valuable, in that we see what dentists perceive is important, obstructive and facilitative. They report using a patient-centred approach in their everyday dental practice; however this is often difficult due to factors such as time constraints. Although they emphasized that the patient has an active role to play in the communication process, it may be the case that they also need to play their part in facilitating this.     

Increasing Positive Health Behaviors in Adolescents with Nutritional Goals and Exercise

Research has documented that low-income urban youth are at risk for obesity and related health problems. Our goal was to develop a brief, developmentally informed intervention to increase positive health behaviors (e.g., diet and exercise) among low-income, minority adolescents. Our study was designed to examine the feasibility and potential impact of our single session intervention that was delivered in a primary care setting. The participants were 100 adolescents from an urban adolescent medicine clinic who were randomly assigned to one of two conditions: a) a 3–5?min goal-only session or b) a 15–20?min motivationally enhanced intervention. Health behaviors and individual characteristics (i.e., autonomous motivation, self-efficacy) were assessed at baseline and re-assessed at follow-up 1 month later with 53?% of the youth completing the follow-up assessment. Those in the enhanced intervention group were more likely to participate in the follow-up as were those who reported higher baseline motivation and self-efficacy. Both groups reported statistically significant health behavior improvements over time and older adolescents reported more improvements. The two conditions did not significantly differ in reported health improvements. Self-efficacy predicted improvements in self-reported fruit and vegetable intake at follow-up. Results support that a brief “chat” with adolescents about their personal goals and values appears to have the potential to increase their positive health behaviors and appears to be useful as a preparatory intervention for weight management efforts for urban teens. The study demonstrates the feasibility and potential efficacy of implementing this 20?min intervention into primary care settings, thereby helping urban youth focus on their individualized goals, values, and motivations for health.     

Mental health and well-being of black women: Toward strategies of empowerment

This review of the literature on Black women's mental health has three goals: 1) to describe the mental health issues, needs, and adaptive behaviors of Black women; 2) to discuss the research, intervention, and public policy efforts of mental health professionals and Black women's groups to address the multiple needs of this population; and 3) to identify effective strategies by which community psychologists can improve the mental health status of Black women through efforts to reduce their environmental stressors, to increase their resources and access to services, and to facilitate their empowerment in American society. The authors propose a number of recommendations to improve Black women's mental health, including changes in research paradigms, changes in education and training programs, and the development of culturally competent service delivery systems.     

The Test–Retest Reliability and Predictive Validity of a Battery of Newly Developed Occupational Performance Assessments

The Canadian Occupational Performance Measure was used as a tool to compare goals for intervention identified by seven clients living in a long-term residential program and diagnosed with schizophrenia, with their goals as identified by the occupational therapist. In-depth interviews were conducted in conjunction with the use of the Canadian Occupational Performance Measure. Data analysis revealed an overarching theme that described the clients' concerns as, “I want to accomplish goals outside of the residence program.” During the analysis, however, the data revealed that the occupational therapist primarily focused her attention on goals to be achieved within the residence program, emphasizing programming and symptom management as each client's priorities for intervention, rather than community involvement. The findings reveal how data from the Canadian Occupational Performance Measure was used to reveal client/therapist disconnect in goal setting and the need to continue to examine client-centered practices in mental health settings.     

‘Use what God has given me’: Difference and disparity in breast reconstruction

African-American women are significantly less likely to undergo postmastectomy breast reconstruction compared to white women in the USA. These observed differences have been interpreted as evidence of a healthcare disparity. The current study examines breast reconstruction decision-making among African-American women, locating reconstruction decisions in a context of culture, racial inequality and biomedicalisation. Semi-structured interviews were conducted with 27 African-American women who underwent mastectomy for breast cancer to add patient-centred perspectives to existing conceptualisations of racial/ethnic differences in reconstruction. Participants were socio-demographically diverse, and resided in the New York metropolitan area. Data analysis was informed by grounded theory. Spiritually and culturally informed body ethics often guided surgery decisions. Participants expressed reservations about breast implants, preferring autologous procedures that use ‘what God has given’. For some, breast reconstruction restored a sense of normalcy after cancer; others challenged an imperative to reconstruct. Several participants redirected our focus on access to reconstruction toward access to alternatives, noting the low reimbursement for prostheses, or their unavailability in patients’ skin tones. We suggest that a framework of ‘stratified biomedicalization’ better addresses the complexities of race, class and gender that inform preference, access and recommendations for breast reconstruction, and focuses attention on access to high and low-tech interventions.     

Your goals or mine? Women’s personal and vicarious eating regulation goals and their partners’ perceptions of support,well-being,and relationship quality

This research examined the types of eating regulation goals that women have for themselves as well as for their romantic partner, and how these relate to their interpersonal style toward their partner, and to their partner’s psychological and relational well-being. Participants were 131 heterosexual couples. Results show that the eating regulation goals that women have for their partner (health or appearance oriented) reflect the type of goals that they personally pursue. Furthermore, women who have health-focused eating goals for their partner are perceived as more autonomy-supportive, which is associated with the partner’s report of higher relationship quality. Conversely, women who have appearance-focused eating goals for their partner are more likely to be perceived as controlling, which negatively predicts the partner’s psychological and relational well-being. These results attest to the importance of considering women’s personal eating regulation goals for a better understanding of the type of goals they have for their partners and how these relate to their partners’ well-being and relationship quality.     

'Please don't put the whole dang thing out there!': a discursive analysis of internet discussions around infant feeding

The promotion of breastfeeding is an important focus of intervention for professionals working to improve infant health outcomes. Literature in this area focuses largely on 'choices' and 'barriers to breastfeeding'. It is our argument, however, that women's cultural context plays a key role in infant feeding 'choices'. In this article, we explore contested representations of infant feeding and infant feeding choices in public debates conducted on a large British parenting website. To sample dominant representations of infant feeding circulating in UK culture, two threads were chosen from the debating board of a busy online parenting community (105 and 99 individual posts, respectively). Participants on the threads were largely women. A feminist informed Foucauldian discourse analysis was used to deconstruct the intersecting constructions of gender, childhood and motherhood implicit in public discussions about infant feeding choices. We identify dominant constructions of women who breastfeed or bottle feed, social representations of both forms of infant feeding, and explore the relationship between constructions of infant feeding choices and constructions of 'good' or 'bad' motherhood. This analysis functions to trouble the individualist assumptions underpinning the notion of infant feeding 'choices', considering the cultural context within which British mothers 'choose' how to feed their babies.     

Knowledge and Expectations of Women Undergoing Cancer Genetic Risk Assessment: A Qualitative Analysis of Free-Text Questionnaire Comments

Individuals undergoing cancer genetic risk assessment have been found to have a poor understanding of the process, which may affect how well they cope with learning their risk. This paper reports free-text data from questionnaires completed by women undergoing a randomised controlled trial of a psychological intervention. Of the 268 women undergoing genetic assessment for familial breast/ovarian cancer risk who were invited to take part in the trial, 157 women returned research questionnaires. Of these, 97 women provided free-text comments upon referral to a cancer genetics clinic, 62 provided comments whilst waiting for risk information (average, moderate or high), and 36 women provided comments following notification of risk. This paper reports a thematic analysis of the free-text data. Themes reflected individuals’ poor knowledge and uncertainty about genetic risk assessment. How well individuals responded to learning their risk depended upon whether expectations had been met. Regardless of risk, individuals undergoing cancer genetic risk assessment are likely to benefit from increased information about its process and timescales, and access to increased psychological support. Free-text comments can provide valuable data about individuals’ expectations and knowledge of genetics services.     

The associations of illness perceptions and self-efficacy with psychological well-being of patients in preparation for joint replacement surgery

Patient well-being on referral to surgery likely affects their surgical experience yet few studies examine pre-surgical correlates of well-being. Guided by the Common Sense Model of Self-Regulation and Social Cognitive theory, this study examined whether illness and emotional representations, general and domain self-efficacy were associated with pre-surgical well-being. The pre-surgical assessment of a three-wave prospective study is reported. Fifty-four hip and knee replacements patients (mean age = 69.33; SD = 8.57) were recruited in the pre-surgery educational clinic at a UK general hospital. Patients completed a questionnaire-pack including the Revised Illness Perceptions Questionnaire, the General Self-Efficacy Scale, the Self-Efficacy for Rehabilitation Outcome Scale, the Falls-Efficacy Scale, and the Short Form of Psychological Well-Being Index. Multiple hierarchical regression analyses showed that above and beyond demographic and clinical characteristics, negative emotional representations were associated with lower psychological well-being while strong general self-efficacy beliefs were positively related to psychological well-being. Independent of demographic and clinical characteristics, joint replacement patients’ psychological well-being was associated with their cognitions and emotional reactions to their condition before surgery. Early interventions could potentially target these modifiable factors to improve pre-surgical well-being in this group of patients, with potential for additional post-surgical benefit.     

“I Don't Think Anorexia Is the Way Out”: Reconstruction of Meaning in Women's Narratives of Anorexia Nervosa over 10 Years

This article explores how a group of nine Australian women who identified their past or present experiences as anorexia nervosa ascribed meaning to their experiences and negotiated their identities longitudinally over 10 years. A critical discursive analysis of their narratives found anorexia to be a troubled, socially constructed category. Within the discursive context of talk not confined to the dominant vocabulary of illness, the women negotiated and, over time, renegotiated alternative ways of speaking to depict their experiences, including through use of metaphor and a lexicon of values. The findings challenge health professionals to take greater accountability for the problematic effects of speaking only in the dominant medical paradigm and to recognize the transformative potential of privileging the voices of people who experience anorexia nervosa, including prioritizing their terms and engaging with their values.     

UNDERSTANDING THE SEXUALITY OF MEXICAN-BORN WOMEN AND THEIR RISK FOR HIV/AIDS

Participants in this study were 300 Mexican women of rural origin who were born and raised in villages of that country and who belong to one of three groups: married and living with their husbands in Los Angeles, California ( n = 100), married to migrant workers but living in Mexico ( n = 100), and living in Mexico with their spouses ( n = 100). Trained female professionals conducted face-to-face interviews in Spanish, in Mexico and in the United States. The purpose of this study was to identify specific sexual practices, coping strategies in sex-related situations, and fears and concerns regarding sexual intercourse. This article analyzes how these elements place Mexican ruralorigin women at risk for HIV/AIDS. It discusses the need to design intervention strategies to prevent HIV/AIDS that take into consideration the limited power of women in traditional societies and the cultural precepts that promote gender roles characterized by male dominance and female submissiveness in the sexual arena.     

Intimate partner abuse of educated,employed black South African women: sociocultural factors

This study aimed to explore the influence of African culture and tradition on the abuse experiences of Black South African women who are educated and employed. Interviews were conducted with seven Black South African women (age range 38 to 47) who are college educated and employed. All participants were married for seven or more years and self-reporting to be in an abusive relationship. Interviews were transcribed verbatim and analysed using thematic content analysis. The results indicate sociocultural factors such as patriarchal values within their culture as an underlying reason for their husbands’ abusive behaviour. Abuse seemed likely when the women perceived gender roles that were in conflict with their husband's gender role expectations of them. The cultural expectation that women should not leave a marriage appeared to play an implicit role in their staying in an abusive relationship.     

Talking about sex after cancer: A discourse analytic study of health care professional accounts of sexual communication with patients

There is consistent evidence that health care professionals (hcps) are not addressing the sexual information and support needs of people with cancer. Thirty-eight Australian hcps across a range of professions working in cancer care were interviewed, to examine constructions of sexuality post-cancer, the subject positions adopted in relation to sexual communication, and the ways in which discourses and subject positions shape information provision and communication about sexuality. Participants constructed sexual changes post-cancer in physical, psychological and relational terms, and positioned such changes as having the potential to significantly impact on patient and partner well-being. This was associated with widespread adoption of a discourse of psychosocial support, which legitimated discussion of sexual changes within a clinical consultation, to alleviate distress, dispel myths and facilitate renegotiation of sexual practices. However, this did not necessarily translate into patient-centred practice outcomes, with the majority of participants positioning personal, patient-centred and situational factors as barriers to the discussion of sex within many clinical consultations. This included: absence of knowledge, confidence and comfort; positioning sex as irrelevant or inappropriate for some people; and limitations of the clinical context. In contrast, those who did routinely discuss sexuality adopted a subject position of agency, responsibility and confidence.     

‘Please don’t put the whole dang thing out there!’: A discursive analysis of internet discussions around infant feeding

The promotion of breastfeeding is an important focus of intervention for professionals working to improve infant health outcomes. Literature in this area focuses largely on ‘choices’ and ‘barriers to breastfeeding’. It is our argument, however, that women's cultural context plays a key role in infant feeding ‘choices’. In this article, we explore contested representations of infant feeding and infant feeding choices in public debates conducted on a large British parenting website. To sample dominant representations of infant feeding circulating in UK culture, two threads were chosen from the debating board of a busy online parenting community (105 and 99 individual posts, respectively). Participants on the threads were largely women. A feminist informed Foucauldian discourse analysis was used to deconstruct the intersecting constructions of gender, childhood and motherhood implicit in public discussions about infant feeding choices. We identify dominant constructions of women who breastfeed or bottle feed, social representations of both forms of infant feeding, and explore the relationship between constructions of infant feeding choices and constructions of ‘good’ or ‘bad’ motherhood. This analysis functions to trouble the individualist assumptions underpinning the notion of infant feeding ‘choices’, considering the cultural context within which British mothers ‘choose’ how to feed their babies.     

‘They’ve invited me into their world’: a focus group with clinicians delivering a behaviour change intervention in a UK contraceptive service

Although teenage conceptions rates in the United Kingdom (UK) have seen a downward trend recently, it remains imperative that contraceptive services for young people continue to improve. To ensure that evidence-based interventions are sustained in clinical practice, it is useful to assess the experiences of those delivering them. This study explores the experiences of sexual health clinicians who were trained to deliver a one-to-one behaviour change intervention aiming to improve contraceptive use in young women. The intervention was set in a UK NHS contraceptive and sexual health service and involved clinicians’ facilitating (within one-to-one consultations) the formation of implementation intentions (or ‘if-then’ plans) that specified when, where and how young women would use contraception. A focus group was conducted with seven clinicians who had delivered the intervention. A thematic analysis of the focus group revealed three overall themes: (1) How the intervention worked in practice; (2) barriers and benefits to delivering the intervention; and (3) positive changes to individual consultation style and wider ‘best practice’ within the clinic. Our findings show that, with support, clinical staff would be in favour of incorporating if-then planning as a strategy to help promote contraceptive adherence in young women.     

Juggling roles and expectations: dilemmas faced by women talking to relatives about cancer and genetic testing

Health professionals do not inform their patients’ kin about BRCA1/2 test results or genetic testing without their written consent. Thus, the onus is on women attending genetic counselling to talk to relatives about the family history and their potential increased risk. This communication process within the family is largely unexplored and provides the focus of the present study. Fifteen healthy women attending a genetics clinic for predictive testing were interviewed prior to receiving their test result and again 6 months later. A grounded theory approach was used. Findings illustrate the dilemmas women faced in juggling social roles and expectations, which had an impact on communication within the family in the context of predictive genetic testing. Tensions between responsibilities towards themselves and others and their fulfilment of social roles had an impact on who women informed and on how they did so. These factors should be considered when assigning patients the role of information provider.     

Gender differences in applying social cognitive career theory in engineering students

This study tested Social Cognitive Career Theory (SCCT) in predicting engineering interest and major choice goals among male and female college students. Participants were 579 sophomore engineering students who completed measures of self-efficacy beliefs, outcome expectations, interests, goals and social supports and barriers. Findings confirmed that the SCCT model produced a good fit to the data across gender. The findings also corroborated that women have less self-efficacy beliefs and interest than men. However, there are no statistically significant differences in measures relating to outcome expectations and goals. Moreover, women are more likely to perceive support, especially from peers and family, while men are more likely to perceive family barriers than women. For other supports and barriers there are no gender differences. Implications for future research and practice are discussed.