Negative Personal Experiences Research Articles

Person-centered versus disease-centered narratives among mental health providers in Kuwait: A critical and qualitative analysis of iatrogenesis and .global medical discourse in action

This article uses bioethical and cross-cultural lenses to examine the narratives of 11 mental health professionals (psychiatrists, psychologists, and counselors) regarding their perceptions of, and experiences in providing mental health services in Kuwait. Given that there is no legal ethical body governing mental health service delivery in Kuwait, and that there have been recent reports of negative personal experiences with mental health professionals, this study sought to understand the types of narratives and treatment approaches that may contribute to inadequate service delivery. This study drew on interpretive phenomenological analysis (IPA) and critical discourse analysis in its analysis. The analyses indicated that ideology (either patient-centered or disease-centered) can be shaped by educational background and professional experiences, which can, in turn, shape how mental health professionals deliver mental health services to the Kuwaiti community. Findings also indicate that mainstream western medical discourses are actively transforming the landscape of mental health care in Kuwait; while this western transformation is welcomed (and even imposed) by some clinicians, it is critiqued by others who feel that: a) indigenous forms of healing are beginning to wane; and b) local clinicians can be pressured to assimilate to North American standards of mental health care. Research limitations and directions for clinical education and practice are also discussed.

Graduate social work students’ perceptions and attitude toward mental illness: implications for practice in developing countries

ABSTRACTMental health stigma is an integral part of the problems faced by individuals diagnosed with mental illness in developing countries. Though Ghana enacted a new Mental Health Law (Act 846) in 2012 with emphasis on community-based care, concerns persist as social workers tend to distance themselves from the field. For CBC to succeed, social workers must opt for a career in the mental healthcare field. The question that arises is how willing social work students are to pursue a career in mental health. The paper explores the perceptions and attitudes of Graduate Social Work students towards mental illness and people living with mental illness. Socio-cultural and religious beliefs about mental illness continue to dominate perceptions about mental illness and fuel stigma. Many social work students are reluctant or unwilling to work with persons living with mental illness due to such beliefs and negative personal experiences. Opportunities to engage positively with persons living with mental illness, and inclusion of core courses in mental health in social work curricular could pave the way for minimising stigma and getting more professionals interested in a career in mental health.

Consumer Perspectives on Access to Direct-to-Consumer Genetic Testing: Role of Demographic Factors and the Testing Experience.

Policy Points: The policy context of direct‐to‐consumer personal genomic testing (DTC‐PGT) has been evolving over the last decade, with little empirical data available about consumers’ perspectives. A majority of consumers of DTC‐PGT supported expanded access to services and their integration into the medical context and opposed more governmental regulation. Consumers’ attitudes about access to services and regulation did not vary based on the specific genetic risk information they received from companies, but may vary based on whether consumers perceived their DTC experience negatively. ContextWhile policymakers have been considering the appropriateness of direct‐to‐consumer personal genomic testing (DTC‐PGT) for more than a decade, there is little empirical data on consumers’ views regarding the regulation of these products. No research has assessed whether consumers’ personal experience with testing is related to their views about access to and regulation of DTC tests.MethodsData were analyzed from the PGen Study, a longitudinal prospective cohort of DTC‐PGT customers of 23andMe (n = 564) and Pathway Genomics (n = 377; total N = 941). Consumers were sent an electronic survey before receiving genetic test results and again 6 months after receipt of results.FindingsAt the 6‐month follow‐up, more than 80% of participants believed that people have a right to access genetic information directly, that parents should be able to get DTC‐PGT testing for their children, and that genetic information should be kept private. Participants supported health insurance coverage of PGT (60%), wider availability of PGT (68%), and inclusion of genetic information in medical records (63%). Participants were less supportive of government regulation (28%) and restricting testing to clinical settings (14%). Conservative political ideology was associated with less support for government regulation (P < 0.001), as was feeling more confident in one's genetic knowledge (P < 0.05). Participants’ level of computed genetic risk for common diseases, as indicated by their actual test results received from companies, showed no relationship with attitudes. However, those who perceived that they had received elevated risk results expressed lower support for expanded availability and incorporation of PGT into health care (P < 0.01). Those who reported being upset by their genetic test results were less likely to endorse access to DTC products without a medical professional (P < 0.01).ConclusionsPGT consumers supported expanded access to these services and opposed additional regulation. Users who had a negative personal experience with PGT testing were less supportive of expanded availability without a medical professional.

Socio-demographic and cognitive determinants of xenophobia among the GCC citizens

IntroductionXenophobia has been referred to as a global phenomenon, linked to the globalization process and noted in countries undergoing transition. It comes from the perceived threat of foreigners’ impact on the citizens’ identity or individual rights. Although the Gulf countries host a large number of migrants from several different cultures and ethnicity, so far no study has examined the conceptualization and pervasiveness of Xenophobia and counter strategies to such phenomenon.ObjectivesExploring Xenophobia in the Gulf context. Exploring socio-demographic and cognitive factors affecting xenophobia.AimsValidating a measure of Xenophobia in the Gulf cultural context. Examining the gender differences in Xenophobia among the GCC individuals. Studying socio-demographic and cognitive predictors of Xenophobia.MethodsA sample of 513 individuals from the GCC countries completed several measures of socio-demographic and cognitive variables. Likert-type scale of xenophobia was developed and validated on a large sample of Qatari citizens that showed trustworthy indications of validity and reliability and delivered via internet survey.ResultsThe findings showed that Xenophobia negatively correlated with age, parents’ level of education, and varied subject to the type of father's job. The females showed Xenophobia more indications than males. Participants from the six GCC countries showed different levels of Xenophobia indicators. Bad experience with expatriates fully mediated the relationship between the socio-demographic of subjects and the number of Xenophobia indicators. Cognitive factors were also good predictors of Xenophobia across all cultures and gender.ConclusionsXenophobia in the Gulf region is influenced by several cognitive and socio-demographic factors that is mediated by, but not limited to, negative personal experiences and their cultural backgrounds.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Perceptions of interprofessional collaboration of general practitioners and community pharmacists - a qualitative study

BackgroundDespite numerous evidences for the positive effect of community pharmacists on health care, interprofessional collaboration of pharmacists and general practitioners is very often limited. Though highly trained, pharmacists remain an underutilised resource in primary health care in most western countries. This qualitative study aims at investigating pharmacists’ and general practitioners’ views on barriers to interprofessional collaboration in the German health care system.MethodsA total of 13 narrative in-depth interviews, and two focus group discussions with 12 pharmacists and general practitioners in Mecklenburg-Western Pomerania, a predominantly rural region of North-Eastern Germany, were conducted. The interviews aimed at exploring general practitioners’ and pharmacists’ attitudes, views and experiences of interprofessional collaboration. At a second stage, two focus group discussions were performed. Fieldwork was carried out by a multi-professional team. All interviews and focus group discussions were audio taped and transcribed verbatim. The constant comparative method of analysis from grounded theory was applied to the data.ResultsThere are three main findings: First, mutual trust and appreciation appear to be important factors influencing the quality of interprofessional collaboration. Second, in light of negative personal experiences, pharmacists call for a predefined, clear and straightforward way to communicate with physicians. Third, given the increasing challenge to treat a rising number of elderly patients with chronic conditions, general practitioners desire competent support of experienced pharmacists.ConclusionsOn the ground of methodological triangulation the findings of this study go beyond previous investigations and are able to provide specific recommendations for future interprofessional collaboration. First, interventions and initiatives should focus on increasing trust, e.g. by implementing multi-professional local quality circles. Second, governments and health authorities in most countries have been and still are reluctant in advancing political initiatives that bring together physicians and pharmacists. Proactive lobbying and empowerment of pharmacists are extremely important in this context. In addition, future physician and pharmaceutical training curricula should focus on comprehensive pharmacist-physician interaction at early stages within both professional educations and careers. Developing and fostering a culture of continued professional exchange and appreciation is one major challenge of future policy and research.

“Ethnicity moderates the outcomes of self-enhancement and self-improvement themes in expressive writing”: Correction to Tsai et al. (2015).

Reports an error in "Ethnicity moderates the outcomes of self-enhancement and self-improvement themes in expressive writing" by William Tsai, Anna S. Lau, Andrea N. Niles, Jordan Coello, Matthew D. Lieberman, Ahra C. Ko, Christopher Hur and Annette L. Stanton (Cultural Diversity and Ethnic Minority Psychology, 2015[Oct], Vol 21[4], 584-592). In this article, there were three errors in the Results section. Each are described in the erratum alongside the correct results. The interpretations of the findings remain the same. (The following abstract of the original article appeared in record 2014-32908-001.) The current study examined whether writing content related to self-enhancing (viz., downward social comparison and situational attributions) and self-improving (viz., upward social comparison and persistence) motivations were differentially related to expressive writing outcomes among 17 Asian American and 17 European American participants. Content analysis of the essays revealed no significant cultural group differences in the likelihood of engaging in self-enhancing versus self-improving reflections on negative personal experiences. However, cultural group differences were apparent in the relation between self-motivation processes and changes in anxiety and depressive symptoms at 3-month follow-up. Among European Americans, writing that reflected downward social comparison predicted positive outcomes, whereas persistence writing themes were related to poorer outcomes. For Asian Americans, writing about persistence was related to positive outcomes, whereas downward social comparison and situational attributions predicted poorer outcomes. Findings provide evidence suggesting culturally distinct mechanisms for the effects of expressive disclosure. (PsycINFO Database Record

Caffeine consumption patterns and determinants among adolescents in Serbia.

The number of adolescents who use caffeine is constantly increasing. As juvenile age is vulnerable, it is reasonable to expect that they will differently perceive reason and react to caffeine use than adults, and be more prone to unwanted physiological and psychological consequences of its consumption. Analysis of the scope and pattern of caffeine consumption among adolescents in Serbia. The cross-sectional survey was implemented in the study population of 191 Serbian adolescents during 2010. The median daily intake of caffeine was 95.6 mg. The major source of caffeine was brewed coffee, and the most common reasons for caffeine intake were leisure, peer influence, or habit. Only 57.6% of the subjects were aware that caffeine is present in consumed beverages. Sex affected the pattern, but not the overall level, of caffeine consumption. No association between caffeine consumption and smoking status, frequency of caffeine use in the family, or negative personal experience with caffeine effects was observed. Our investigation provides first and rather detailed insight into caffeine-containing beverage consumption scope and pattern among Serbian adolescents. For accurate estimation and analysis of caffeine intake in this population, randomized studies with prospective longitudinal design, caffeine content measurement, and more subjects involved are warranted.

Personal experiences of people with serious mental illness when seeking, obtaining and maintaining competitive employment in Queensland, Australia.

High non-participation in the labour force and unemployment remain challenging for adults with serious mental illness. This study examined the personal experiences of people with serious mental illness when seeking, obtaining and maintaining competitive employment. The aim was to increase understanding of personal experiences of employment and how these experiences can be used to inform the assistance provided in support of clients' competitive employment goals. Qualitative data from a two-year period were thematically analysed from one participating site in a multi-site trial of employment services integrated with public funded community mental health treatment and care. Both positive and negative themes arose. Positive themes included: Aspirations for a better life, receiving feedback on good job performance, employment displacing preoccupation with illness, and employment improving self-esteem and reducing financial stress. Negative themes included stigma experiences, stress, and health difficulties. Both positive and negative experiences did not depend on type of employment service assistance nor key client characteristics such as age, sex, and diagnostic category. Despite its many benefits, employment can also increase the risk of negative personal experiences. These findings suggest that employment service providers could do more to assist people who commence employment, to reduce the risk of negative personal experiences and to enhance the benefits of competitive employment.

Childhood adversities and risk for problematic alcohol use

The findings from studies exploring the relationship between childhood adversities (CAs) and adolescent and adult drinking problems are inconclusive – some researchers have found strong effects, others virtually none. In this study, we sought to examine the associations between 23 types of retrospectively reported CAs and adult problematic alcohol use in two samples, one drawn from Germany, the other from Poland. A total sample of 1008 participants was recruited via the internet: 500 in Germany and 508 in Poland. They completed a set of questionnaires including questions regarding various types of CA, and also the CAGE tool for the identification of problem drinking. CAs were grouped into four categories: Negative Personal Experience, Family Adversities, Parental Disorders, Parent-Child Relationships; this last category included role reversal. Separate logistic regression analyses were performed, with age, gender and country as potential confounders. The probability of having an alcohol problem was higher in men, and higher in Poland than in Germany. Of the risk factors tested, three displayed a significant association with problematic alcohol use. The risk factors concerned were Regular Arguments Between the Parents, plus two types of adversities from the Parent-Child Relationships cluster: Maternal Control and Maternal Role Reversal. The results serve to underline the importance of examining links between childhood risk factors and problematic alcohol use, and also suggest that certain less visible symptoms of a disordered parent-child (particularly mother-child) relationship, such as parentification, may constitute important risk factors for the development of drinking problems in later life.

Reasons for Frequent Emergency Department Use by Medicaid Enrollees: A Qualitative Study.

The Affordable Care Act initiated several care coordination programs tailored to reduce emergency department (ED) use for Medicaid-enrolled frequent ED users. It is important to clarify from the patient's perspective why Medicaid enrollees who want to receive care coordination services to improve primary care utilization frequently use the ED. We conducted a qualitative data analysis of patient summary reports obtained from Medicaid enrolled frequent ED users who agreed to participate in a randomized control trial (RCT) evaluating the impact of patient navigation intervention compared with standard of care on ED use and hospital admissions. We defined frequent ED users as those who used the ED four to 18 times in the past year. The study was conducted at an urban, teaching hospital ED with approximately 90,000 visits per year. The research staff conducted interviews (~30-40minutes), regarding the patient's medical history, reasons for ED visits, health care access issues, and social distresses. The aforementioned findings were summarized in a 1- to 2-page report and presented to the RCT's project team (social worker, emergency medicine physician, primary care physician, and patient navigators) on a weekly basis to further understand the needs of this patient population. A diverse team of researchers (program staff and physicians) coded all reports and reached consensus using reflexive team analysis. We reconciled differences in code interpretations and generated themes. One-hundred patients enrolled in the RCT from March 2013 to February 2014, and all 100 patient summary reports were evaluated. We identified three key themes associated with Medicaid enrollee frequent ED use: 1) negative personal experiences with the healthcare system, 2) challenges associated with having low socioeconomic status, and 3) significant chronic mental and physical disease burden. Medicaid frequent ED users engaged in receiving patient navigation services with the goal to reduce ED use and hospital admissions describe barriers that go beyond timely primary care access issues. These include sociodeterminants of health, lack of trust in primary care providers, and healthcare system.

Zorgcoöperaties: een wetenschappelijke verkenning vanuit drie perspectieven

Zorgcoöperaties: een wetenschappelijke verkenning vanuit drie perspectieven

Russian Lawyers

The article analyzes the Russian lawyers community in order to assess its potential for collective action in an imperfect institutional environment, its potential for joint efforts to monitor compliance with professional ethics, to improve the quality of legal education, and to represent the interests of the professional group at the state level. Two hypotheses are tested: (1) lawyers with high ethical standards impose a higher demand for collective action; (2) negative personal experience in confronting violations of clients' rights by law enforcement officers bodies may also prompt lawyers to engage in joint action. The conclusion is that with the support of the “healthy core” of the lawyers community it is possible to create an instrument for competent and independent assessment of the state of the law enforcement system in Russia.

Ethnicity moderates the outcomes of self-enhancement and self-improvement themes in expressive writing.

The current study examined whether writing content related to self-enhancing (viz., downward social comparison and situational attributions) and self-improving (viz., upward social comparison and persistence) motivations were differentially related to expressive writing outcomes among 17 Asian American and 17 European American participants. Content analysis of the essays revealed no significant cultural group differences in the likelihood of engaging in self-enhancing versus self-improving reflections on negative personal experiences. However, cultural group differences were apparent in the relation between self-motivation processes and changes in anxiety and depressive symptoms at 3-month follow-up. Among European Americans, writing that reflected downward social comparison predicted positive outcomes, whereas persistence writing themes were related to poorer outcomes. For Asian Americans, writing about persistence was related to positive outcomes, whereas downward social comparison and situational attributions predicted poorer outcomes. Findings provide evidence suggesting culturally distinct mechanisms for the effects of expressive disclosure. (PsycINFO Database Record

How perceptions and personal contact matter: The individual-level determinants of trust in police in Hungary

In established democracies perceptions about police effectiveness and procedural fairness are the main individual-level determinants of trust in police. However, very little is known about whether this is also the case in different circumstances. By analysing trust in police in Hungary, in an East Central European context, the paper finds that the same micro-level factors have a similar relationship with trust in police there as in established democracies. Both the perceptions of police performance and fairness are significant contributors to trust as well as individual judgements about the country's current affairs. However, people attribute different salience to distinct aspects of procedural fairness: Hungarians are sensitive to police corruption, but less so to discriminative police behaviour. Finally, the overall effect of personal contact with the police on trust is negative, but distinguishing those who reported negative personal experiences from those who were satisfied with how the police treated them shows that only bad contacts have a detrimental effect on trust. Our findings suggest that while positive personal experiences with the police do not improve trust judgements, negative ones damage people's perceptions about the police in virtually every dimension.

Non-invasive Prenatal Diagnosis for BRCA Mutations - a Qualitative Pilot Study of Health Professionals' Views.

Non-invasive prenatal diagnosis (NIPD) is a rapidly advancing approach that allows diagnostic testing based on analysis of cell free DNA in maternal plasma. This study aimed to explore the views of health professionals regarding the use of NIPD for BRCA1/2 mutations. Qualitative semi-structured interviews were conducted with eight participants. Whilst participants viewed NIPD in general as a positive step forward in prenatal testing, they were cautious about its use for BRCA testing. Significant ethical concerns emerged regarding testing prenatally for an adult onset condition, that is not fully penetrant, and the possibility of abrogating the rights of the future child to genetic autonomy. Nevertheless, participants did identify some situations whereby the test might be beneficial, such as for individuals with very negative and traumatic personal experiences of cancer desiring reassurance or wanting to prevent passing on the condition. NIPD was also seen as having benefits over invasive testing and pre-implantation genetic diagnosis, the only other options currently available to test prenatally for this condition. Exploring the views of a wider range of clinical specialties as well as patients at risk of hereditary breast cancer would be beneficial.

The Impact of Stigma and Personal Experiences on the Help-Seeking Behaviors of Medical Students With Burnout.

Because of the high prevalence of burnout among medical students and its association with professional and personal consequences, the authors evaluated the help-seeking behaviors of medical students with burnout and compared their stigma perceptions with those of the general U.S. population and age-matched individuals. The authors surveyed students at six medical schools in 2012. They measured burnout, symptoms of depression, and quality of life using validated instruments and explored help-seeking behaviors, perceived stigma, personal experiences, and attitudes toward seeking mental health treatment. Of 2,449 invited students, 873 (35.6%) responded. A third of respondents with burnout (154/454; 33.9%) sought help for an emotional/mental health problem in the last 12 months. Respondents with burnout were more likely than those without burnout to agree or strongly agree with 8 of 10 perceived stigma items. Respondents with burnout who sought help in the last 12 months were twice as likely to report having observed supervisors negatively judge students who sought care (odds ratio [OR] 2.06 [95% confidence interval (CI) 1.25-3.39], P < .01). They also were more likely to have observed peers reveal a student's emotional/mental health problem to others (OR 1.63 [95% CI 1.08-2.47], P = .02). A smaller percentage of respondents would definitely seek professional help for a serious emotional problem (235/872; 26.9%) than of the general population (44.3%) and age-matched individuals (38.8%). Only a third of medical students with burnout seek help. Perceived stigma, negative personal experiences, and the hidden curriculum may contribute.

A comparison of breastfeeding women's, peer supporters' and student midwives' breastfeeding knowledge and attitudes

In the United Kingdom over 90% of women do not breastfeed for as long as they would like, despite widespread knowledge of the benefits of breastfeeding. Negative attitudes and low levels of knowledge in staff supporting breastfeeding may be a contributing factor. This paper reports on the breastfeeding knowledge and attitudes in two key workforce groups; student midwives (n = 19) and Breastfeeding Network peer supporters (n = 36) and compares them with breastfeeding women (n = 23). All three groups had high knowledge and attitude scores, but peer supporters had significantly higher levels than student midwives or breastfeeding women. Student midwives' knowledge of breastfeeding was higher than breastfeeding women's but they had similar breastfeeding attitude scores. The higher knowledge and attitude scores in peer supporters may be attributed to the effectiveness of their training, which includes challenging their existing breastfeeding attitudes and debriefing their personal breastfeeding experience. It is suggested that midwives' breastfeeding attitudes are affected by their community culture and their personal experience of breastfeeding. It is proposed that midwifery training should continue to embrace a biopsychosocial model, including training to improve breastfeeding attitudes, particularly for professionals from areas where breastfeeding is not the cultural norm, or who have had negative personal breastfeeding experiences.

Alcohol-Specific Parenting as a Mechanism of Parental Drinking and Alcohol Use Disorder Risk on Adolescent Alcohol Use Onset

The primary aim of the current study was to examine three dimensions of alcohol-specific parenting (anti-alcohol parenting strategies, parental legitimacy in regulating adolescent drinking, and parental disclosure of negative alcohol experiences) as mechanisms in the prospective relations between parental drinking and alcohol use disorder (recovered, current, and never diagnosed) and adolescent alcohol use initiation. Participants were from an ongoing longitudinal study of the intergenerational transmission of alcoholism. Structural equation modeling was used to test a maternal model (n = 268 adolescents and their mothers) and a paternal model (n = 204 adolescents and their fathers) of alcohol-specific parenting. Results indicated that higher levels of drinking among mothers and current alcohol use disorder among fathers were related to more frequent parental disclosure of personal negative experiences with alcohol. Maternal disclosure of negative alcohol experiences mediated the effect of maternal drinking on adolescent onset of alcohol use such that more disclosure predicted a greater likelihood of adolescent drinking initiation at follow-up over and above general parenting. In addition, currently alcoholic mothers were perceived as having less legitimate authority to regulate adolescent drinking, and low levels of legitimacy among fathers was predictive of drinking onset among adolescents. Alcohol-specific parenting is a distinct and influential predictor of adolescent alcohol use initiation that is partially shaped by parents' own drinking experiences. Moreover, parental conversations about their own personal experiences with alcohol may not represent a form of parent-child communication about drinking that deters adolescent drinking.

Immunizing health care workers against influenza: A glimpse into the challenges with voluntary programs and considerations for mandatory policies

Vaccination of health care workers (HCWs) is an important patient safety initiative. It prevents influenza infection among patients and reduces staff illness and absenteeism. Despite these benefits, HCW influenza immunization uptake is low. Therefore, strategies to achieve high immunization coverage in HCWs, barriers to uptake, and perceptions of mandatory influenza immunization policies were discussed in key informant interviews with influenza immunization program planners. We conducted telephone interviews with 23 influenza immunization program planners from 21 organizations (7 acute care hospitals, 6 continuing care facilities, and 8 public health organizations) across Canada. We used content analysis to identify themes from the interviews. Participants used a variety of promotional and educational activities, and many vaccine delivery approaches, to support HCW immunization programs. Barriers to achieving high coverage in HCWs included misconceptions about the safety and effectiveness of the influenza vaccine, negative personal experiences associated with the vaccine, and antivaccine sentiments. Participants mentioned mandatory influenza immunizations as a solution to low coverage. However, they identified challenges with this approach such as obtaining support from stakeholders, enforcement, and limiting personal autonomy. Participants believed immunization coverage in health care organizations will continue to be suboptimal using existing program strategies. Although participants discussed mandatory immunization as a way to improve uptake, potential obstacles will need to be addressed for this to be implemented successfully.

Personal experience and reputation interact in human decisions to help reciprocally

There is ample evidence that human cooperative behaviour towards other individuals is often conditioned on information about previous interactions. This information derives both from personal experience (direct reciprocity) and from experience of others (i.e. reputation; indirect reciprocity). Direct and indirect reciprocity have been studied separately, but humans often have access to both types of information. Here, we experimentally investigate information use in a repeated helping game. When acting as donor, subjects can condition their decisions to help recipients with both types of information at a small cost to access such information. We find that information from direct interactions weighs more heavily in decisions to help, and participants tend to react less forgivingly to negative personal experience than to negative reputation. Moreover, effects of personal experience and reputation interact in decisions to help. If a recipient's reputation is positive, the personal experience of the donor has a weak effect on the decision to help, and vice versa. Yet if the two types of information indicate conflicting signatures of helpfulness, most decisions to help follow personal experience. To understand the roles of direct and indirect reciprocity in human cooperation, they should be studied in concert, not in isolation.