Prof Andrew R Thompson

Childhood skin conditions can affect the quality of life of children, adolescents, and families. As such, paediatric dermatological conditions have been the focus of a number of qualitative studies and there is now a need to integrate the findings. A meta-ethnography was carried out with the existing 12 studies, which included nine studies examining parental experiences and three studies of child experiences. Meta-ethnographic analysis of the studies identified themes focused on the child’s… Show more

Childhood skin conditions can affect the quality of life of children, adolescents, and families. As such, paediatric dermatological conditions have been the focus of a number of qualitative studies and there is now a need to integrate the findings. A meta-ethnography was carried out with the existing 12 studies, which included nine studies examining parental experiences and three studies of child experiences. Meta-ethnographic analysis of the studies identified themes focused on the child’s sense of stigmatisation and the challenges for families that arose from this. Common experiences across studies were feelings of difference relating to the appearance of the skin. The results highlight that children and adolescents can experience negative social reactions and that parents may struggle with some aspects of the physical management of the condition. The studies indicate the need to examine in more detail the psychosocial aspects of childhood skin conditions and the role played by stigmatisation. Show less

Objectives: Although many traumatic incidents result in changes to appearance, little research has
examined the experience of individuals distressed by such changes in connection with psychological
processes involved in posttraumatic stress disorder (PTSD). This study aimed to examine how PTSD and appearance concern associated with burn injury are experienced when both difficulties co-occur.
Method: The qualitative method of interpretative phenomenological analysis (IPA) was used to… Show more

Objectives: Although many traumatic incidents result in changes to appearance, little research has
examined the experience of individuals distressed by such changes in connection with psychological
processes involved in posttraumatic stress disorder (PTSD). This study aimed to examine how PTSD and appearance concern associated with burn injury are experienced when both difficulties co-occur.
Method: The qualitative method of interpretative phenomenological analysis (IPA) was used to provide a
framework for building nuanced accounts of individual experience. In-depth analysis was conducted with interview data obtained from 8 women, who were purposively selected on the basis of being distressed in relation to burn scarring, and having symptoms of PTSD. Results: Participants described how changes in appearance were experienced as maintaining a sense of threat through social stigma, and acting as a trigger for re-experiencing the traumatic incident that had caused the burn injury. As such, appearance concern and PTSD symptomatology appeared intertwined within the participants’ accounts of their postburn injury recovery. Conclusions: This is the first study to consider some of the processes through which PTSD and appearance concern might be mutually maintained. The results suggest that psychosocial interventions need to be tailored to simultaneously address processes related to concerns about change in appearance and also with traumatic re-experiencing. Show less

Background

Mindfulness, defined as purposively and non-judgementally paying attention in the present moment, could be used within psychosocial interventions to reduce the distress associated with social anxiety and avoidance found in many skin conditions. However, little is known about the relationship between naturally occurring levels of mindfulness and distress in dermatology patients.
Objective

This study sought to examine the relationship between mindfulness and… Show more

Background

Mindfulness, defined as purposively and non-judgementally paying attention in the present moment, could be used within psychosocial interventions to reduce the distress associated with social anxiety and avoidance found in many skin conditions. However, little is known about the relationship between naturally occurring levels of mindfulness and distress in dermatology patients.
Objective

This study sought to examine the relationship between mindfulness and psychosocial distress in a dermatological sample. It was hypothesised that higher levels of mindfulness would be associated with lower levels of social anxiety, anxiety, depression, and skin shame, and with better quality of life.
Method

Adult dermatology outpatients (N=120) from one hospital completed items assessing subjective severity, skin shame, fear of negative evaluation (BFNE), anxiety and depression (HADS), quality of life (DLQI), and levels of mindfulness (FFMQ).
Results

Considering depression, 14% reported mild, 5% moderate and 2.5% severe symptoms. For anxiety, 22% reported mild, 23% moderate and 6% severe symptoms. In addition, 33.4% reported clinically significant social anxiety. After controlling for subjective severity, mindfulness explained an additional 19% of the variance in depression, 39% in anxiety, 41% in social anxiety, 13% in skin shame, and 6% in dermatological quality of life. One specific facet of mindfulness (acting with awareness) was found to be the most consistent predictor of distress.
Conclusions

The findings indicate that higher levels of mindfulness are associated with lower distress. This suggests that facilitating mindfulness may be helpful in reducing distress in dermatology patients and the use of mindfulness techniques warrants further investigation. Show less

Despite good physical prognosis, patients who receive a diagnosis of
non-cardiac chest pain (NCCP) may experience persistent pain and
distress. While cognitive-behavioural interventions have been found
to be effective for this group, they are difficult to deliver in busy
emergency department (ED) settings. Addressing the acceptability
and relevance of self-help interventions is an important initial step in
addressing this need. This study sought to examine the… Show more

Despite good physical prognosis, patients who receive a diagnosis of
non-cardiac chest pain (NCCP) may experience persistent pain and
distress. While cognitive-behavioural interventions have been found
to be effective for this group, they are difficult to deliver in busy
emergency department (ED) settings. Addressing the acceptability
and relevance of self-help interventions is an important initial step in
addressing this need. This study sought to examine the acceptability
and relevance of an evidence-based self-help intervention for ED
patients with persistent NCCP and anxiety. Patient (interviews:
N
= 11) and specialist chest pain nurse (focus group:
N
= 4) views on
acceptability and feasibility were examined. Data were analysed using
thematic analysis. Patients and nurses reported that there was a need
for the intervention, as stress and anxiety are common among patients
with NCCP, and provision of psychosocial support is currently lacking.
Both patients and nurses reported that the intervention was relevant,
acceptable, and potentially useful. Some changes to the intervention
were suggested. Nurses reported that the intervention could be used
within the existing staff resources available in an ED setting. This study
represents an important first step towards developing a brief self-help
intervention for ED patients with NCCP and anxiety. Further research
should seek to determine the efficacy of the intervention in a pilot
trial Show less

Research corner. Article summarizing three recent studies relevant to psychodermatology

Objectives This study aimed to understand the experiences and expectations of people seeking bariatric surgery in England and identify implications for behavioural and self-management interventions.

Design A qualitative study using modified photovoice methods, triangulating photography with semistructured indepth interviews analysed using framework techniques.

Setting Areas served by two bariatric surgery multidisciplinary teams in the north of England.

Participants… Show more

Objectives This study aimed to understand the experiences and expectations of people seeking bariatric surgery in England and identify implications for behavioural and self-management interventions.

Design A qualitative study using modified photovoice methods, triangulating photography with semistructured indepth interviews analysed using framework techniques.

Setting Areas served by two bariatric surgery multidisciplinary teams in the north of England.

Participants 18 adults (14 women and 4 men) who accepted for bariatric surgery, and were aged between 30 and 61 years. Participants were recruited through hospital-based tier 4 bariatric surgery multidisciplinary teams.

Results The experiences of participants indicates the nature and extent of the burden of obesity. Problems included stigmatisation, shame, poor health, physical function and reliance on medications. Participants expected surgery to result in major physical and psychological improvement. They described how this expectation was rooted in their experiences of stigma and shame. These feelings were reinforced by previous unsuccessful weight loss attempts. Participants expected extreme and sometimes unrealistic levels of sustained weight loss, as well as improvements to physical and mental health. The overall desire and expectation of bariatric surgery was of ‘normality’. Participants had received previous support from clinicians and in weight management services. However, they reported that their expectations of surgery had not been reviewed by services, and expectations appeared to be unrealistic. Likewise, their experience of stigmatisation had not been addressed.

Conclusions The unrealistic expectations identified here may negatively affect postoperative outcomes. The findings indicate the importance of services addressing feelings of shame and stigmatisation, and modifying patient's expectations and goals for the postoperative period.
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Editorial

Background

Despite the worthy intentions of international health partnerships between high-income countries and countries with developing economies, the tangible benefits are rarely evaluated, limiting the assessment of the achievements of such collaborations.
Methods

The present study used longitudinal qualitative methods to examine the individual and organisational benefits of a partnership between a National Health Service (NHS) mental health Trust in the United Kingdom… Show more

Background

Despite the worthy intentions of international health partnerships between high-income countries and countries with developing economies, the tangible benefits are rarely evaluated, limiting the assessment of the achievements of such collaborations.
Methods

The present study used longitudinal qualitative methods to examine the individual and organisational benefits of a partnership between a National Health Service (NHS) mental health Trust in the United Kingdom and a mental health referral hospital in Northern Uganda. Benefits to UK staff and organisational development were benchmarked against an existing framework of healthcare competencies.
Results

Partnership involvement was beneficial to UK staff, by increasing awareness of diversity, and in enhancing ability to work flexibly and as a team. There were clear benefits expressed with regards to the partnership having the potential to enhance organisational reputation and staff morale.
Conclusions

The findings from this study demonstrate that international partnerships are experienced as being of tangible value for healthcare staff from high-income countries, providing opportunities for the development of recognised healthcare competencies. In this study there was also some evidence that staff involvement might also provide wider organisational benefits.
Keywords: International health partnerships; Mental health; Qualitative methods; Thematic analysis; Africa Show less

Sheffield Health and Social Care NHS Foundation Trust (SHSC) is a UK provider of mental health services in themNorth of England that has formed a partnership with mental health services in Gulu, Northern Uganda. Violent/aggressive behaviour has been reported as being prevalent on the Mental Health Ward at the Regional Referral
Hospital in Gulu. Similar to other regional referral hospitals across Uganda, staffi ng levels are low. As part of the partnership, staff working on the Mental Health… Show more

Sheffield Health and Social Care NHS Foundation Trust (SHSC) is a UK provider of mental health services in themNorth of England that has formed a partnership with mental health services in Gulu, Northern Uganda. Violent/aggressive behaviour has been reported as being prevalent on the Mental Health Ward at the Regional Referral
Hospital in Gulu. Similar to other regional referral hospitals across Uganda, staffi ng levels are low. As part of the partnership, staff working on the Mental Health Ward attended training that focuses on the prevention/management of violence/aggression (RESPECT Training). SHSC commissioned this evaluation with the aim of examining staff perspectives on the usefulness of RESPECT training provided in Gulu. Semi-structured interviews were conducted with eleven staff. Qualitative data was analysed using Thematic Analysis. The majority of respondents described
implementing the RESPECT training. Staff generally reported feeling more equipped to manage aggressive behaviour. There was a perceived reduction in aggression on the ward and some respondents reported feeling safer. However, several respondents also alluded to not feeling confi dent in implementing specifi c techniques, and feeling unsafe. This may refl ect lack of resources, but there also appeared to be limited opportunity to practice and maintain skills, or to learn from incidents. There was a unanimous request for further training. This evaluation highlighted some benefi ts but also some areas of diffi culty in implementing RESPECT on the Mental Health Ward in Gulu. Further training and the recording and reviewing of incidents is required for staff to maintain their skills, and
to further embed RESPECT into ward culture. Key Words: Violence, Aggression, Mental ward, Uganda Show less

Aims and objectives
To examine patients' perceptions and experiences of noncardiac chest pain, within the framework of the common sense model.

Background
Patients with noncardiac chest pain have good physical prognosis, but frequently suffer prolonged pain and psychological distress. The common sense model may provide a good framework for examining outcomes in patients with noncardiac chest pain.

Design
Qualitative thematic analysis with semi-structured… Show more

Aims and objectives
To examine patients' perceptions and experiences of noncardiac chest pain, within the framework of the common sense model.

Background
Patients with noncardiac chest pain have good physical prognosis, but frequently suffer prolonged pain and psychological distress. The common sense model may provide a good framework for examining outcomes in patients with noncardiac chest pain.

Design
Qualitative thematic analysis with semi-structured interviews.

Methods
In 2010, participants recruited from an emergency department (N = 7) with persistent noncardiac chest pain and distress were interviewed using a semi-structured schedule, and data were analysed using thematic analysis.

Results
Seven themes were identified; six of which mapped onto core dimensions of the common sense model (identity, cause, timeline, consequences, personal control, treatment control). Contrary to previous research on medically unexplained symptoms, most participants perceived psychological factors to play a causal role in their chest pain. Participants' perceptions largely mapped onto the common sense model, although there was a lack of coherence across dimensions, particularly with regard to cause.

Conclusion
Patients with noncardiac chest pain lack understanding with regard to their condition and may be accepting of psychological causes of their pain.

Relevance to clinical practice
Brief psychological interventions aimed at improving understanding of the causes of noncardiac chest pain and providing techniques for managing pain and stress may be useful for patients with noncardiac chest pain. Show less