[Digitalization and care relationships of people living alone in old age: a critical analysis of policy documents]. / Digitalisierung und Sorgebeziehungen von Alleinlebenden im Alter: eine kritische Analyse politischer Dokumente.

Digitalization is transforming social life and relationships. New cultural ideas of care, cooperation and reciprocity are emerging that can create challenges for older people. These are particularly poignant for older people living alone, who use digital devices less frequently and rely on support to manage the increasing number of digital tasks (appointments, bookings, financial matters). This article explores the relationship between digitalization and care relationships among older people living alone using a critical document analysis approach according to Bacchi. This approach makes it possible to look at the understanding behind the terms living alone, care relationships, and digitalization, each in relation to older people and in interaction as well as to render gaps visible. The analysis of laws and social policies as well as of political and civil society orientated documents leads to two key findings: Firstly, an individual responsibility to deal with needs arising from gaining access to and handling of digitalization is expected of older people and their social networks. This is striking as digitalization is presented as a means of dealing with the large-scale social challenges, such as demographic change and shortage of care staff. Secondly, the analysis shows that legal documents that set out the structure for policies do not focus on digitalization in later life. With older people not being a target group of policy of digitalization, fewer strategies are put into practice.

Negotiating vulnerability and attractiveness through dress.

BACKGROUND: The ageing female body is particularly exposed to the social gaze. While it should remain fit and durable as well as attractive and desirable, there is the danger of ridicule through supposedly too youthful or too outlandish performance. Women's clothing practices can conform to social expectations, can circumvent them, can actively protest against them, and possibly change social demands. In every part of the process, i.e., the experience of bodily changes, the experience of social expectations, consumer choices, the practices of clothing and reactions to clothing choices, the body and getting dressed becomes a site of new feelings of vulnerability. OBJECTIVE: This article asks how these vulnerabilities are presented in the clothing practices of older women, are expressed in the materiality of clothes and in the practices of getting dressed. MATERIAL AND METHODS: Data from a study that followed a situational analysis methodology and used semi-structured interviews and photo elicitation, were re-examined through the lens of vulnerability. RESULTS: Different aspects to vulnerability are presented in this article. Interviewees had to come to terms with bodily changes and made arrangement to the way they dressed that in turn could collide with subjective and social expectations of normative femininity. In this process of acquiescing, new vulnerabilities were produced; however, interviewees developed clothing strategies that provided them with experiences of their own attractiveness. They also had to adapt to changing circumstances to present themselves as fashionable and attractive due to age. CONCLUSION: Practitioners can address feelings of vulnerabilities when talking about gendered clothing practices, for example through biographical work.

[Research questions in participatory projects. Critical reflections from the project "Longing in later life"]. / Forschungsfragen in partizipativen Projekten. Kritische Reflexionen aus dem Projekt "Sehnsüchte im Alter".

BACKGROUND: A central component of participatory research is the collaborative, nonhierarchical work of co-researchers and academic researchers. The development of a research question has a special importance as it entails different meanings for those involved. For academic researchers the research question is focussed on gaining knowledge and is developed at an early stage of the project. For co-researchers the development and the finding of answers to a question are less important than the possibility of jointly changing their social reality. OBJECTIVE: This article investigates how these different interests influence the collaborative development of a research question and which factors can enhance the process. MATERIAL AND METHODS: Based on experiences from the participatory action research project "Longing in later life" and critical reflections, this article unpacks the different roles of the participants in the project and the process of co-creation. CONCLUSION: A joint development of a research question is time consuming and depends on the extent of shared experiences and the degree of marginalization among the group of co-researchers.

Digital (in)equalities and user emancipation: Examining the potential of Adorno's maxim of Mündigkeit for critical intergenerational learning.

The widespread use of mobile technologies has penetrated the lives of people across all age groups with the usage of smartphones and wearables appearing "natural" and without alternatives. The digitalisation of everyday life means that communication and negotiation of social and societal meanings are co-constructed by users and mobile technologies thereby blurring the boundary between on- and off-line as well as social and private spheres. At the same time, the global-market logic that has driven the extent and speed of this social transformation raises questions as to how individuals retain influence and agency over the digital technologies that have come to define both social and private spheres and that surround them at all times. Against this backdrop, this theoretical paper discusses the role of Adorno's maxim of emancipation toward autonomy (Mündigkeit) for education (Erziehung) and critical learning about and living with digital technologies. The paper suggests a way forward through intergenerational learning as a didactical method of enhancing emancipation among younger and older generations of "users" in their joint efforts of becoming critical agents in an age of digitally enhanced data markets.

Lessons learned from the London Exercise and Pregnant (LEAP) Smokers randomised controlled trial process evaluation: implications for the design of physical activity for smoking cessation interventions during pregnancy.

BACKGROUND: The challenges of delivering interventions for pregnant smokers have been poorly documented. Also, the process of promoting a physical activity intervention for pregnant smokers has not been previously recorded. This study describes the experiences of researchers conducting a randomised controlled trial of physical activity as an aid to smoking cessation during pregnancy and explores how the effectiveness of future interventions could be improved. METHODS: Two focus groups, with independent facilitators, were conducted with six researchers who had enrolled pregnant smokers in the LEAP trial, provided the interventions, and administered the research measures. Topics included recruitment, retention and how the physical activity intervention for pregnant smokers was delivered and how it was adapted when necessary to suit the women. The focus groups were audio-recorded, transcribed verbatim and subjected to thematic analysis. RESULTS: Five themes emerged related to barriers or enablers to intervention delivery: (1) nature of the intervention; (2) personal characteristics of trial participants; (3) practical issues; (4) researchers' engagement with participants; (5) training and support needs. Researchers perceived that participants may have been deterred by the intensive and generic nature of the intervention and the need to simultaneously quit smoking and increase physical activity. Women also appeared hampered by pregnancy ailments, social deprivation, and poor mental health. Researchers observed that their status as health professionals was valued by participants but it was challenging to maintain contact with participants. Training and support needs were identified for dealing with pregnant teenagers, participants' friends and family, and post-natal return to smoking. CONCLUSIONS: Future exercise interventions for smoking cessation in pregnancy may benefit by increased tailoring of the intervention to the characteristics of the women, including their psychological profile, socio-economic background, pregnancy ailments and exercise preferences. Delivering an effective physical activity intervention for smoking cessation in pregnancy may require more comprehensive training for those delivering the intervention, particularly with regard to dealing with teenage smokers and smokers' friends and family, as well as for avoiding post-natal return to smoking. TRIAL REGISTRATION: ISRCTN48600346 , date of registration: 21/07/2008.

Giving hope, ticking boxes or securing services? A qualitative study of respiratory physiotherapists' views on goal-setting with people with chronic obstructive pulmonary disease.

OBJECTIVE: To explore respiratory physiotherapists' views and experiences of using goal-setting with people with chronic obstructive pulmonary disease in rehabilitation settings. PARTICIPANTS: A total of 17 respiratory physiotherapists with ⩾12 months current or previous experience of working with patients with chronic obstructive pulmonary disease in a non-acute setting. Participants were diverse in relation to age (25-49 years), sex (13 women), experience (Agenda for Change bands 6-8) and geographic location. METHOD: Data were collected via face-to-face qualitative in-depth interviews (40-70 minutes) using a semi-structured interview guide. Interview locations were selected by participants (included participants' homes, public places and University). Interviews followed an interview guide, were audio-recorded and transcribed verbatim. DATA ANALYSIS: Data were analysed using thematic analysis; constant comparison was made within and between accounts, and negative case analysis was used. RESULTS: Three themes emerged through the process of analysis: (1) 'Explaining goal-setting'; (2) 'Working with goals'; and (3) 'Influences on collaborative goal-setting'. Goal-setting practices among respiratory physiotherapists varied considerably. Collaborative goal-setting was described as challenging and was sometimes driven by service need rather than patient values. Lack of training in collaborative goal-setting at both undergraduate and postgraduate level was also seen as an issue. CONCLUSION: Respiratory physiotherapists reflected uncertainties around the use of goal-setting in their practice, and conflict between patients' goals and organisational demands. This work highlights a need for wider discussion to clarify the purpose and implementation of goal-setting in respiratory rehabilitation.

Negotiating roles in pharmacy practice: interactions across linguistic and cultural barriers.

There has been relatively little discussion of the effects of cultural and linguistic differences on communication in consultations. Moreover, communication in community pharmacy is largely under-researched. This study explores interactions between pharmacists, pharmacy assistants and patients conducted across cultural and linguistic barriers. We drew on a data set collected in a pharmacy in London. The data consisted of 12 video recorded consultations in which patients spoke in Sylheti (a dialect of Bengali), the pharmacists spoke in English and pharmacy assistants used both languages. These data were supplemented with focus groups. Despite the fact that the pharmacy assistant was the only person able to follow all the interactions, pharmacists worked to fulfil their legal and professional duties. It could be argued that the very existence of cultural and linguistic barriers prompted the pharmacists to engage to ensure that the patient understood how to use their medicine. There was no acknowledgement that the pharmacy assistants were fulfilling an additional role. It is likely that explicit negotiation of a flexible and adaptive communicative model would lead to a more satisfying encounter for all participants.

Stroke patients' perceptions of home blood pressure monitoring: a qualitative study.

BACKGROUND: Stroke is the leading cause of adult disability in the UK. Hypertension is the leading modifiable risk factor for stroke. There is increasing interest n home blood pressure monitors for self-monitoring, but no published research on the experiences of stroke patients who do self-monitor. AIM: To explore stroke patients' experiences of self-monitoring with nurse-led support. DESIGN AND SETTING: A qualitative study of 26 (66%) patients from the first 39 participants to complete the intervention arm of a community-based randomised controlled trial (RCT) of home blood pressure monitoring in 381 patients recruited from hospital stroke clinics in south London. METHOD: Semi-structured face-to-face interviews were conducted with 26 patients. Interviews were digitally recorded and transcribed, and a thematic analysis of the data was undertaken. RESULTS: Participants were highly motivated to avoid a further stroke and developed a strong focus on blood pressure control and attaining a 'good result'. Only a minority reported anxiety about their blood pressure. Participants gained a welcome sense of empowerment and control over managing their health; some felt confident and 'experimented' with their medication doses. Eight patients required physical help to self-monitor and there was uncertainty about where responsibility lay for such help. Patients who lived alone and were functionally impaired had the least positive experience. Active engagement with the home blood pressure monitoring process by GPs was variable. CONCLUSION: Patients in this study generally reported increased knowledge and empowerment about blood pressure control and avoiding further strokes. The technique is overall welcome, acceptable, and successful, even in patients with disabilities. Since home blood pressure monitoring can also lead to improved blood pressure control, this simple, pragmatic intervention might be more widely used.

Review: Taking care of yourself in later life: a qualitative study into the use of non-prescription medicines by people aged 60+.

The last 40 years have witnessed substantial changes to the experience of later life. Health and life expectancy have improved and the emergence of a putative third age has allowed post-working life to move beyond being a residual social category to become an arena in which later life lifestyles can be constructed. Greater emphasis is now placed on expectations of self-agency and choice. Allied to this is the growing role of consumerism as a way of organizing key aspects of social life. Not only do these changes place increased emphasis on individual responsibility for health, but they also engage individuals in various forms of health consumerism.This study draws on these aspects of contemporary society to provide an explanatory framework for understanding older people's engagement with, and consumption of non-prescription medicines. We present a qualitative study in which we interviewed 22 men and women aged 60 plus who were purchasing or interested in purchasing non-prescription medicines, including complementary and alternative medicines. Our findings suggest that the use of non-prescription medicines is both pluralistic and makeshift. Moreover, while this pluralism led to tensions with conventional bio-medicine, conventional bio-medicine still maintained the legitimacy of its knowledge base. Self-care using non-prescription medicines appeared more governed by hope than by evidence or knowledge of the treatments concerned.We conclude that such pluralism of approach reflects the growing consumerism in health and self-care and that older people may in fact be similar to other age groups in terms of their approach to such commodification.

Over-the-counter medicines: professional expertise and consumer discourses.

Ideas of participation and partnership in health care consultations have attracted increasing attention in recent years; however the consequences in terms of the necessary shifts in existing relationships are often overlooked. We examine how pharmacists work to maintain their professional expertise against the rise of health-care consumerism. We draw on the following data from a UK study of consultations for over-the-counter (OTC) medicines in two pharmacies: (i) an outline of the pharmacy owners' views of their practice model, (ii) data from observations and tape recorded consultations (iii) interviews with customers and pharmacists and (iv) views expressed in two feedback sessions discussing vignettes developed from observational and interview-based fieldwork. There was no suggestion that attempts to engage customers in discussions about their treatment necessitated a diminution of the importance of pharmaceutical expertise. Indeed, both pharmacists and customers acknowledged the importance of the asymmetry of knowledge between pharmacists and customers. Pharmaceutical expertise was however not always perceived to be necessary and transactions in pharmacies may be treated like those in any other retail environment. Further research using a larger dataset to investigate problems in interactions resulting from tensions between pharmaceutical expertise and consumerism is indicated.