Health Experiences Of People Research Articles

Psoriasis today: experiences of healthcare and impact on quality of life in a major UK cohort.

To establish how people with psoriasis in the United Kingdom today experience living with their condition including diagnosis, treatment, healthcare provision and impact on daily life. Psoriasis is a debilitating long-term inflammatory skin disease which can result in severe itching, discomfort and soreness, and may be associated with problems beyond the specific symptoms related to the skin. For many it is accompanied by difficult-to-manage treatment regimes, emotional distress and a negative impact on their quality of life and psychosocial functioning. To date there is little published information about the health experiences of people in the United Kingdom with psoriasis. A postal self-administered questionnaire was completed by members of the Psoriasis Association and the responses analysed (n = 1564). The findings suggest some similarities to surveys in other nations, but specifically highlighted that patients feel under-informed and are dissatisfied with current treatment regimes. Responses provided an insight into aspects of the condition that treatments should be targeting. Specific areas of negative impact on psychosocial functioning were identified, including the lack of available support for those experiencing emotional distress. The research provides important information about how the care of patients with psoriasis can be improved, especially at primary care level. This includes: improved training in psoriasis knowledge and awareness at general practitioner level and greater use of dermatology specialist nurses in primary care settings; more effective and manageable treatment regimes that target visible areas and general well-being; greater support for emotional distress and psychosocial functioning.

Internet Gamblers: A Latent Class Analysis of Their Behaviours and Health Experiences

In order to learn about the behaviours and health experiences of people who gamble on the Internet, we conducted an international online survey with respondents recruited via gambling and gambling-related websites. The mean (SD) age of the 4,125 respondents completing the survey was 35.5 (11.8) years, with 79.1% being male and 68.8% UK residents. Respondents provided demographic details and completed validated psychometric screening instruments for problem gambling, mood disturbances, as well as alcohol and substance misuse, and history of deliberate self harm. We applied latent class analysis to respondents' patterns of regular online gambling activities, and identified subgroups of individuals who used the Internet to gamble in different ways (L (2) = 44.27, bootstrap P = 0.07). We termed the characteristic profiles as 'non-to-minimal gamblers'; 'sports bettors'; 'casino & sports gamblers'; 'lottery players'; and 'multi-activity gamblers'. Furthermore, these subgroups of respondents differed on other demographic and psychological dimensions, with significant inter-cluster differences in proportion of individuals scoring above threshold for problem gambling, mood disorders and substance misuse, and history of deliberate self harm (all Chi (2)s > 23.4, all P-values <0.001). The 'casino & sports' and 'multi-activity-gamblers' clusters had the highest prevalence of mental disorder. Internet gamblers appear to be heterogeneous but composed of several subgroups, differing markedly on both demographic and clinical characteristics.

Participatory action research to understand and reduce health disparities

Participatory action research (PAR) is an excellent way to systematically learn about the conditions under which people experience health disparities, what it is like from the perspective of those experiencing such disparities and, even more importantly, how to ameliorate this major public health problem and create a more equitable and effective health care system. This article describes the method of PAR, supports the appropriateness of PAR to learn about and reduce health disparities, and then presents some specific examples of research projects that have employed or are planning to employ PAR. These examples are from the work of several authors of this article, who are members of an interdisciplinary working group that serves as a forum for discussion of issues related to qualitative research methods and facilitates the development of qualitative studies. All of the authors of this article are part of a task force of this working group that is focusing specifically on community outreach with the goal of reducing health disparities within specific communities.

Interactive drama: teaching aboriginal health medical education

Context and setting Approximately 100 students attended this attitudinal learning activity designed for a Year 1 undergraduate medical education course on cultural diversity. The learning activity took place in an urban community with approximately 30 000 aboriginal people. Why the idea was necessary While lip-service is often given to the proverbial 3-legged stool in medical education (attitudes, knowledge and skills), most medical teaching institutions are perched precariously on a wobbly 2 legs at best. Attitude-oriented courses are typically perceived as being ‘soft’ and unimportant compared to more science-oriented courses. Most curricula squeeze in a mere hour or so for introspection and self-reflection, leaving students unaware of the importance that their attitudes have on their clinical interaction. Learning about aboriginal people's health tends to be limited to a knowledge-focused approach. Learning must illustrate the complex interaction of cultures (aboriginal, learner's natal and medical) and then offer tools to help negotiate and bridge the complexities. This learning activity was designed to provide an opportunity for students to explore cultural perspectives, reflect on attitudes toward aboriginal people, and learn ideational frameworks through which local aboriginal people experience health care. What was done An interactive genre called Forum Theatre encouraged students to move from being passive observers to active participants within a play consisting of a series of scenarios between an aboriginal elder, her granddaughter, her doctor and a medical student. The play wove together themes of relationship, culture and conflict within a health care setting. Students observed the play once. Following this, the play was run through a second time; however, this time students were instructed to shout out ‘Stop!’ when they felt that the medical student could engage with her preceptor or aboriginal patient differently. The audience member who shouted ‘Stop!’ would then take the place of the actor in the play and attempt to mitigate the conflict scenario. Thus, the students could practise and learn from alternative interventions. The activity created space for discussion around intervention effectiveness and diversity of cultural perspectives and preferences. Key issues that arose were: accepting gifts and conflict of interest, negotiating student−preceptor disagreements, intergenerational conflict, the role of the chart, medical professionalism, racism, gaining trust, and eliciting the patient's worldview without imposing assumptions based on ethnicity. Evaluation of results and impact Following this activity, students were asked to complete a mixed qualitative and quantitative evaluation. Student feedback included: ‘It made me realise how many issues I wouldn’t have answers for.' Students expressed their particular enjoyment in being involved and participating in ‘real life examples’: ‘It was fantastic to be able to “test out” alternate approaches or tactics and see how they work.’ The play fostered exploration of vital covert and overt issues, rarely dealt with in a traditional teaching setting. It was apparent that this activity enabled students to connect mentally, physically, spiritually and emotionally with the content and begin to develop an appropriate approach towards interacting with aboriginal patients.

Trust and power in adults: an investigation using Rogers' Science of Unitary Human Beings.

Trust is a critical element in establishing a therapeutic nurse-client relationship that can help to change people's health experiences and quality of life. This study's purpose was to examine the relationship between trust and power using Rogers' science of unitary human beings and Barrett's theory of power. A national sample, comprised of 189 women and men, aged 21 to 60, completed Barrett's Power as Knowing Participation in Change Test that measured power and Gibb's TORI Self-Diagnosis Scale that measured trust, trust of self, and trust of others. Correlation analyses revealed support for the three hypotheses stated which predicted a positive relationship between power and trust, trust of self, and trust of others. Findings support the conceptualization of trust and power.

Valuing Health for All: PCTs and the Health of People with Learning Disabilities

Findings and good practice are reported from a project promoting engagement of PCTs with the health experiences of people with learning disabilities. Project work was most successful where it linked into mainstream NHS priorities, using good information and specialists' expertise to support mainstream practitioners.

“It's your whole way of life really”: negotiating work, health and gender

Recent discussions in contemporary geographies of health have highlighted the need to understand the social contexts in which people experience health and illness. Qualitative and mixed method studies have been shown to be invaluable to such research, especially where investigations seek to understand the circumstances and responses surrounding particular conditions. In this paper, we move beyond biomedical approaches to combine methods in health research and gain insights into the complex contexts and relations affecting men's and women's respiratory health. Drawing on three literatures and past work on respiratory disease in selected primary industries, we report on qualitative research conducted with men and women horse trainers and vegetable growers working in southern New Zealand. We note the gendered work differences that could be affecting contrasting disease rates and focus on notions of ‘metaphor’ and ‘place’ to analyse the narratives trainers and growers construct about their health. We report that men and women negotiate a “whole way of life” that involves both specific workplaces and social relations that shape their work and health experiences.

Job satisfaction and health experience of people with a lower-limb amputation in comparison with healthy colleagues

Schoppen T, Boonstra A, Groothoff JW, de Vries J, Göeken LN, Eisma WH. Job satisfaction and health experience of people with a lower-limb amputation in comparison with healthy colleagues. Arch Phys Med Rehabil 2002;83:628-34. Objectives: To describe indicators of job dissatisfaction among amputee employees and to compare job satisfaction and health experience of working amputee employees with that of control subjects. Design: A cross-sectional study, mailed questionnaire. Setting: Patients were recruited by the orthopedic workshops of the Netherlands. Participants: One hundred forty-four patients who had an acquired unilateral major amputation of the lower limb at least 2 years before, were aged 18 to 60 years (mean age, 43y), and were living and working in the Netherlands. One hundred forty-four control subjects matched for age, gender, and type of job. Interventions: Not applicable. Main Outcome Measures: Statistical analysis of responses to a questionnaire regarding patient characteristics and amputation-related factors, amputee patients' opinions about their work and the social atmosphere at work, and their general health (RAND 36-Item Health Survey [RAND-36]). Results: People with an amputation had greater job satisfaction (70%) than did the able-bodied control group (54%). The wish for (better) modifications in the workplace and the presence of comorbidity were significantly related to job dissatisfaction in people with limb loss. Amputee employees were less often hindered by the failures of others and by fluctuations in temperature. People with limb loss showed a worse physical health experience than controls on the RAND-36. Conclusions: The vocational satisfaction of people with limb loss may be improved by better workplace modifications, depending on the functional capabilities of the person and the functional demands of the job; improvement may also be achieved by vocational rehabilitation programs, especially for those with an amputation in combination with other morbidity. Despite experiencing more health problems, the amputee group expressed greater job satisfaction than the able-bodied group, reflecting a great appreciation of job reintegration by people with a lower-limb amputation. © 2002 by the American Congrees of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Embodied risk: My body, myself?

Risk has become a dominant way to interpret who gets sick and why. A distinction has been drawn between two categories of risk: those arising from the environment, and those resulting from an individual's lifestyle. We identify a third category that might be called corporeal or embodied risk which has received little scholarly attention. Embodied risks are so called because they are located in the body of the person said to be “at risk”. Environmental risks are due to something that happens to a person; lifestyle risks occur because of something a person does or does not do, while embodied risks say something about who the person is. To investigate how people experience health risks—especially risks identified as characteristics of their bodies—we conducted detailed interviews with 29 women who were told they had an abnormal Pap smear. All health risks pose problems for people who are diagnosed as “at risk”: They must translate probabilistic statements about populations into terms that have personal meaning; they must cope with uncertainty; they must consider what it means to be in danger of developing an illness even though most have no symptoms; and they must mobilise appropriate surveillance and perhaps risk reduction. However, limiting attention to environmental and lifestyle risk (and the distinction between them) neglects the additional challenges posed by corporeal risks: the simultaneous presence of disease now and the possibility of more consequential disease in the future; the necessity to submit to ongoing medical surveillance; a tendency to exacerbate the cartesian split between body and self; and the absence of medical or popular discourses through which to interpret and respond to embodied risk. We call upon medicine and public health practitioners to work together with people who are at risk to formulate languages and approaches that can reflect both scientific accuracy (as it is currently understood), and the needs of people to integrate health threats into their daily personal lives.