Impact of the government's restrictions and guidance in relation to "social distancing" on the lives of ethnic minority populations: A mixed methods study.

Background and Aims: The impacts of the COVID-19 pandemic have not been equal, with a disproportionate impact among ethnic minority communities. Structural inequalities in social determinants of health such as housing and employment have contributed to COVID-19's impact on deprived communities, including many ethnic minority communities. To compare (1) how the UK government's "social distancing" restrictions and guidance were perceived and implemented by ethnic minority populations compared to white populations, (2) the impact of restrictions and guidance upon these groups. Methods: An explanatory sequential mixed methods study incorporated a quantitative survey and qualitative semi-structured interviews to explore individual perceptions and experiences of COVID-19 and the national restrictions. Survey participants (n = 1587) were recruited from North West England; 60 (4%) participants were from ethnic minority communities. Forty-nine interviews were conducted; 19 (39%) participants were from ethnic minority communities. Interviews were transcribed verbatim and analysed using a thematic approach. Data collection was between April and August 2020. Results: Significant differences in demographics and household overcrowding were observed between white vs ethnic minority survey respondents, who were also significantly less confident in their knowledge of COVID-19, less likely to be high-risk drinkers, and marginally more likely to have experienced job loss and/or reduced household income. There were no group differences in wellbeing, perceptions, or nonfinancial impacts. Two inter-related themes included: (1) government guidance, incorporating people's knowledge and understanding of the guidance and their confusion/frustration over messaging; (2) the impacts of restrictions on keyworkers, home-schooling, working from home and changes in lifestyle/wellbeing. Conclusions: Further research is needed on the long-term impacts of COVID-19 on ethnic minority communities. If policy responses to COVID-19 are to benefit ethnic minority communities, there is a need for future studies to consider fundamental societal issues, such as the role of housing and economic disadvantage.

The role of uncertainty intolerance in adjusting to long-term physical health conditions: A systematic review.

Long-term physical health conditions (LTPHCs) are associated with poorer psychological well-being, quality of life, and longevity. Additionally, individuals with LTPHCs report uncertainty in terms of condition aetiology, course, treatment, and ability to engage in life. An individual's dispositional ability to tolerate uncertainty-or difficulty to endure the unknown-is termed intolerance of uncertainty (IU), and may play a pivotal role in their adjustment to a LTPHC. Consequently, the current review sought to investigate the relationship between IU and health-related outcomes, including physical symptoms, psychological ramifications, self-management, and treatment adherence in individuals with LTPHCs. A systematic search was conducted for papers published from inception until 27 May 2022 using the databases PsycINFO, PubMed (MEDLINE), CINAHL Plus, PsycARTICLES, and Web of Science. Thirty-one studies (N = 6,201) met the inclusion criteria. Results indicated that higher levels of IU were associated with worse psychological well-being outcomes and poorer quality of life, though impacts on self-management were less clear. With the exception of one study (which looked at IU in children), no differences in IU were observed between patients and healthy controls. Although findings highlight the importance of investigating IU related to LTPHCs, the heterogeneity and limitations of the existing literature preclude definite conclusions. Future longitudinal and experimental research is required to investigate how IU interacts with additional psychological constructs and disease variables to predict individuals' adjustment to living with a LTPHC.

Readability of online health information pertaining to migraine and headache in the UK.

An estimated 46% of the worldwide adult population live with an active headache disorder, and it is thought that there is a proportion of headache and migraine sufferers who do not attend for medical care, instead choosing to manage their symptoms at home. The internet continues to act as a source of online health information for self-management, however, it is important that this information can be understood by the user. Research indicates that most health information online is written at a level too difficult for much of the UK population to understand. The aim of this study was to investigate the readability of online health information pertaining to headache and migraine for a UK-based internet user accessing the top four search engines. Searches for 'headache' and 'migraine' were performed on each search engine and results from the first page were selected for analysis. Five validated readability tests were used to analyse readability; Flesch-Kincaid Grade Level, Flesch Reading Ease, Gunning Fog Index, Coleman-Liau Index and Simple Measure of Gobbledygook Index. We found that the majority of online health information about migraine and headache is too difficult for the UK adult population to read. Findings highlight work is required to ensure that information from a wider variety of sources is easier to comprehend for much of the population in order for individuals to make informed decisions about health seeking and self-management of headache and migraine. Health information providers should weave readability analysis into their content design process, incorporating shorter sentences and simpler words in their description of conditions and treatment.

Using a randomised controlled trial (RCT) methodology in CAM research with gynaecological cancer patients: A commentary on the perks and pitfalls.

This paper provides a commentary on several challenges faced by researchers when conducting randomised controlled trials (RCTs) utilising complementary therapies with cancer patients. Several factors, such as research design and recruitment to the intervention are discussed. Examples are drawn from an RCT conducted by the lead author regarding the use of yoga to improve the quality of life of gynaecological cancer patients undergoing treatment for their cancer. This paper gives methodological insights into some of the difficulties experienced when conducting research with cancer patients, and provides a number of recommendations based on the available evidence and practical application of these methods.

Involvement in rehabilitative care and wellbeing for partners of people with an amputation.

The present research aimed to determine if partners' involvement in the rehabilitative care of people who have undergone an amputation predicted their wellbeing using a quantitative, cross-sectional design. Partners of people with an amputation were contacted through amputation-related advocacy groups and asked to complete an online questionnaire. Full data were collected from 66 participants who completed demographic information and measures of perceived social support, involvement in partner's rehabilitative care, depression and posttraumatic growth. Predictors into the two regression models were chosen based on their zero-order correlations with the outcome variables. Only time since amputation and degree of prosthesis use were correlated with posttraumatic growth. Time since amputation, time in relationship and partner's involvement in rehabilitative care were negatively correlated with depression. Both models (posttraumatic growth and depression) were significant. Involvement in partner's care was an independent significant predictor for depression. More involvement in partners' rehabilitative care was a significant predictor of less depression for partners of people with an amputation. The present research provides tentative evidence in support of the planned inclusion of partners by amputation rehabilitation services. Future research is needed to determine how robust this finding is.

"Look and feel your best": representations of artificial limb users in prosthetic company advertisements.

PURPOSE: Artificial limbs (prosthetics) are considered important for keeping the person physically active and avoiding an array of negative health outcomes associated with non-use. Increasingly, the potential users of these limbs are the focus of commercial prosthetic company advertisements. It has been argued that it is important to examine such media representations, not least because people's beliefs regarding health and illness are often forged from the discourses and constructions available to them in such material, but because these representations mediate individual lived experience. METHOD: This article provides a thematic analysis, drawing upon discourse analysis and semiotics, of textual-pictorial representations of artificial limb users in the advertisements of prosthetic companies. The data set was comprised of advertisements that appeared over a 2-year period in inMotion, an international magazine produced and distributed by a major amputee advocacy group. RESULTS: The findings indicate that dominant societal constructions of work, gender and family are drawn on in depicting artificial limb users. These offer generally positive representations that draw on socially pervasive stereotypes. CONCLUSIONS: The findings are discussed in relation to literature concerning the experience and meaning of prosthesis use, and the implications for health professionals working with this group are set out. Implications for Rehabilitation People who lose a limb are increasingly being exposed to advertisements from prosthetic companies. Such advertisements have the potential to foster unrealistic expectations regarding rehabilitation following amputation. Healthcare professionals need to be mindful of how these advertisements mediate lived experience and impact on rehabilitation when planning personal care plans.

New, normative, English-sample data for the Short Form Perceived Stress Scale (PSS-4).

This article provides population norms for the Short Form Perceived Stress Scale (PSS-4) and investigates the relationship between PSS-4 scores and sociodemographic variables. The PSS-4 was administered to an English sample (n = 1568) and was found to have acceptable psychometric properties. Sociodemographic variables explained 19.5% of variance in PSS-4 scores, and mean PSS-4 scores were significantly different from the mean scores reported in Cohen and Williamson's original study. Greater levels of perceived health status, greater levels of social support, being male and being older were predictive of lower PSS-4 scores. Norm values for interpreting PSS-4 scores are presented.

Self-care in primary care: findings from a longitudinal comparison study.

AIM: To examine the effects of self-care training workshops for primary healthcare workers on frequently attending patients. BACKGROUND: Interventions to promote self-care in frequent users of primary care services have had mixed results. This paper reports an evaluation of a self-care initiative that aimed to develop a practice-based strategy to support self-care. METHODS: A 12-month longitudinal-matched comparison study was carried out in seven intervention and four comparison practices. The intervention was a multidisciplinary training package delivered to Primary Care Trusts (PCTs) and practice staff in three workshops, over a three- to six-month period. Twenty-one managers, health professionals and other staff from participating practices and PCTs and 1454 patients were involved in the study. 'Frequently attending' patients were defined as having visited the practice more than eight times in the previous year, and were identified from practice registers and recruited by letter. Three sets of data were obtained: psychometric scores and other data from structured questionnaires; routinely collected data on use of healthcare services; and self-care beliefs and behaviour from qualitative interviews. Findings Study recruitment rate was 20% and retention rate 75%. Of those recruited 66% were female and the majority (94.8%) were White. There was poor uptake of the training programme within the participating practices, with few changes agreed or implemented. Few healthcare professionals consented to take part in the evaluation. No significant changes were seen in patients' use of health services, psychometric scores or self-care beliefs or behaviour. CONCLUSION: The initiative did not show any effects during its pilot phase. Uptake and implementation were adversely affected by competing pressures for time and resources in primary care, coupled with a lack of engagement from primary health care professionals.

Insights from the experiences of older people with hearing impairment in the United Kingdom: recommendations for nurse-led rehabilitation.

AIMS AND OBJECTIVES: This study aims to explore, and develop a greater understanding of the experience of living with age-related hearing impairment from the perspectives of older people themselves to highlight possible recommendations for the improvement of hearing aid (HA) services and rehabilitation. BACKGROUND: Hearing impairment (HI) is one of the most common chronic conditions affecting older people. HI can have a huge impact on a wide variety of life factors including physical, mental and social health and can lead to a reduction in quality of life. With the current ageing population, the numbers living with hearing impairment in old age is likely to increase. Currently, the diagnosis of hearing impairment in older people can be slow with individuals living with hearing impairment for around 10 years before being diagnosed. METHODS: The research utilises a descriptive qualitative method in the form of descriptive thematic analysis. Findings are reported from semi-structured interviews with nine participants with self-reported HI, aged 61-93. RESULTS: Themes include; the loss itself, communication, using HAs, isolation, and coping strategies. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The results highlight the need for early diagnosis of HI and the development of nurse-led rehabilitation strategies and support services that address the felt stigma and potentially isolating experiences of older people with HI.

The experience of amputation and prosthesis use for adults: a metasynthesis.

PURPOSE: To identify and synthesize qualitative literature on the experience of amputation and prosthesis use for adults, and to make recommendations based on these findings for rehabilitation services. METHODS: A systematic search of three databases for qualitative research exploring the experience of amputation and prosthesis use for adults was undertaken. Included papers were evaluated using the Critical Appraisal Skills Programme (CASP) quality guidelines. Data were extracted and themes synthesized in accordance with accepted procedures for qualitative metasyntheses. RESULTS: From the 15 papers (13 studies) included in there view, five concepts were identified: (i) Becoming an amputee and facing prosthesis use; (ii) Adjustment to and coping with amputation and prosthesis use; (iii) The role of valued relationships in recovery; (iv) Amputation and prosthesis use in social interaction; and (v) Prosthetically enabled identities. CONCLUSIONS: The findings provide a base from which to make suggestions regarding the provision of health rehabilitation services for this population. It is recommended that such services make greater use of psychological interventions and education, include patients' social support networks, use psychotherapy to support and develop positive coping strategies, and facilitate peer support from those who have already made positive adjustments to amputation and prosthesis use.

Indoor Tanning within UK Young Adults: An Extended Theory of Planned Behaviour Approach.

The indoor tanning industry poses a long-term public health risk. Despite the adverse health effects, indoor tanning seems to be gaining considerable popularity. The study examined indoor tanning intentions and behaviour within UK young adults using an extended theory of planned behaviour model, which included variables on "appearance reasons to tan," "perceived susceptibility to damaging appearance," "perceived susceptibility to health consequences," and "tanning knowledge." The model was successful in predicting indoor tanning intentions and behaviour (explained 17% and 71%, resp.). An interesting outcome was the magnitude of the variable "appearance reasons to tan." A current tanned appearance therefore seemed to outweigh any adverse future appearance or health consequences caused by indoor tanning. Appearance-focused interventions to reduce such behaviour may now prove to be efficacious within a UK sample.

Lifestyle risk factors of students: a cluster analytical approach.

OBJECTIVE: Unhealthy lifestyle behaviours have been identified as a problem amongst students. This present study investigated the prevalence and clustering of five lifestyle risk factors within a UK Higher Education (HE) institution during the period of April-May in 2008. METHOD: In a cross-sectional design, 410 students completed a 'health and lifestyle' survey. Data was collected on psychological stress, physical activity (PA), fruit and vegetable intake, binge drinking, smoking, and demographic factors. RESULTS: Three subgroups emerged from the cluster analysis: 'unhealthy/high risk', 'moderately healthy/moderate risk' and 'healthy/low risk' group. The groups were cross-tabulated by demographics and the resulting clusters provided an insightful indication of how behaviours interact. Data on the whole sample revealed that the prevalence of three lifestyle risk factors were high; 70% did not meet the recommended guidelines of PA, 66% ate less than the recommended servings of fruit and vegetables per day, and 56% reported binge drinking at least once in a seven-day period. Psychological stress was also high amongst the sample, with females experiencing greater psychological stress than males. CONCLUSION: Students' health lifestyles are of concern. The tendency for specific health lifestyle factors to aggregate in clusters has important implications for health promotion within this environment.