How Person-Centred Is Cardiac Rehabilitation in England? Using Bourdieu to Explore Socio-Cultural Influences and Personalisation.

The National Health Service (NHS) cardiac rehabilitation patient care pathway has remained largely unchanged for many years despite, on average, half of all eligible patients declining to engage. To investigate reasons for non-engagement, we explored the experiences of ten cardiac patients who participated in cardiac rehabilitation, dropped out, or declined, as well as experiences of seven people deemed significant others by participants. Our ethnographic study involved participant observations, repeat in-depth semi-structured interviews, and reflexive journaling. Reflexive thematic analysis was conducted, focusing on participants' lived experiences. Utilising Bourdieusian concepts of habitus, capital, and field, this article highlights how personal biography, material conditions, and dispositional inclinations combine to make cardiac health care decision-making individual and complex. Despite this, health professionals were not always attuned to specific circumstances arising from differences in patients' experiences and lifeworlds. By considering service improvement recommendations that acknowledge socio-cultural influences, cardiac rehabilitation can work towards providing patients and their significant others with more appropriate, personalised, and person-centred support.

Older adults' and service providers' experiences of a settings-based health promotion initiative in English football.

The study was undertaken to explore the experiences of older adults and service providers in a settings-based health promotion initiative in a football club. We conducted semi-structured interviews with 10 older adults attending an 'Extra Time Hub' (ETH) and two staff delivering the initiative. Our reflexive thematic analysis generated six themes. Findings revealed the brand of the sports club attracted some to join the ETH, but through partnerships with local agencies, the initiative was also successful in widening participation beyond older adults with an interest in football. Participants perceived that the ETH was beneficial for their mental health, helped them develop social connections, and promoted positive physical activity experiences. Moreover, the variety of pleasures derived from participation were also discussed. Our findings also illustrate the central role of staff in older adults' experiences of this form of health promotion. Overall, this study contributes to understandings of settings-based health promotion activities in sports clubs, and also demonstrates the potential for sports clubs to widen engagement with the local community through health promotion for older adults.

"I'd got self-destruction down to a fine art": a qualitative exploration of relative energy deficiency in sport (RED-S) in endurance athletes.

Relative Energy Deficiency in Sport (RED-S) is a syndrome of impaired health and performance that occurs as a result of low energy availability (LEA). Whilst many health effects associated with RED-S have been widely studied from a physiological perspective, further research exploring the psychological antecedents and consequences of the syndrome is required. Therefore, the aim of this study was to qualitatively explore athlete experiences of RED-S. Twelve endurance athletes (female n= 10, male n= 2; M age = 28.33 years) reporting past or current experiences of RED-S, associated with periods of LEA, took part in semi-structured interviews designed to explore: contexts and mechanisms underpinning the onset of RED-S; the subjective experience of RED-S; and contexts and mechanisms influencing "recovery" from RED-S. Regardless of how RED-S was initiated, all athletes experienced a multitude of physiological impairments, accompanied by significant psychological distress. This paper contributes novel understanding of the complex interplay between physiological and psychological components of RED-S from the perspective of information-rich cases. The findings suggest that system-wide educational prevention and awareness interventions are vital for athletes and support personnel, such as coaches, parents, dieticians, psychologists, and sports medicine staff.

The Thin Line: A Phenomenological Study of Mental Toughness and Decision Making in Elite High-Altitude Mountaineers.

Mental toughness (MT) is a key psychological variable related to achievement in performance domains and perseverance in challenging circumstances. We sought to understand the lived experiences of mentally tough high-altitude mountaineers, focusing primarily upon decisions to persevere or abort summit attempts. Phenomenological interviews were conducted with 14 mountaineers including guides, expedition leaders, and doctors (Mage = 44 years). A content analysis was employed to identify key themes in the data. Participants emphasized the importance of MT in extreme environments and described rational, flexible, and vigilant decision-making. Turning around without summiting was the toughest decision reported, with recognition of the thin line between persevering and overstretching. In contrast to much MT literature, mountaineers accepted limits, demonstrated restraint, and sacrificed personal goals to aid others. Costly perseverance was also reported with some mountaineers described as "too tough": overcompetitive, goal-obsessed, and biased decision-makers. These findings revealed both benefits and dangers of MT in mountaineering.

"It Gives Me My Freedom": Technology and Responding to Bodily Limitations in Motor Neuron Disease.

People living with motor neuron disease (MND) experience profound and rapidly progressing impairment. In order to maintain their physical and social functioning, people so affected employ a range of technologies and technological aids (body auxiliaries) to enhance their life and maintain well-being. Using a phenomenological study design, we explored the experiences of 42 men and women who had been diagnosed with MND. Although many participants initially resisted the adoption of aids (often-electronic devices that enabled continued participation in daily life) or tools (the instruments that allowed achievement of specific tasks), such technologies offered a way for people with MND to overcome, to some extent, the limitations posed by their physical degeneration. Through generating a sense of 'normality,' these kinds of 'enabling' technologies promoted social engagement and the maintenance of valued relationships or activities. Technologies can provide people with MND with some positive experiences within a way of being-in-the-world that has become so difficult and challenging.

Using a Narrative Approach to Enhance Clinical Care for Patients With Asthma.

There are currently > 230 million people in the world with asthma, and asthma attacks result in the hospitalization of someone every 7 min. The National Heart, Lung, and Blood Institute outlines four components of clinical practice guidelines for the diagnosis and management of asthma, which tend to take a biomedical focus: (1) measures of assessment and monitoring, obtained by objective tests, physical examination, patient history, and patient report, to diagnose and assess the characteristics and severity of asthma and to monitor whether asthma control is achieved and maintained; (2) education for a partnership in asthma care; (3) control of environmental factors and comorbid conditions that affect asthma; and (4) pharmacologic therapy. Many national guidelines include providing patients with asthma with (1) written action plans, (2) inhaler technique training, and (3) structured annual reviews. Although current guidelines help improve clinical processes of care for asthma, there is also a need to improve self-care of asthma by empowering individuals to take more control of their condition. There is a growing appreciation that a narrative approach with patients with asthma, which focuses on the illness experience and aims to enhance patient-clinician understanding, might improve self-care. We explore how a framework for clinicians to listen to patients' stories, developed from research on individuals with asthma, might enhance communication, improve patient-clinician relationship, and foster better patient self-care. The article closes with the implications of this approach for clinical practice and future research.

Touching moments: phenomenological sociology and the haptic dimension in the lived experience of motor neurone disease.

Currently, there is a relative research lacuna in phenomenological research into the lived experience of motor neurone disease. Based on a sociological research project in the UK, involving 42 participants diagnosed with MND, this article explores the potential of a phenomenological sociology for analysing experiences of this drastically life-limiting neurological disorder. Calls have been made for sociological researchers to analyse more fully and deeply the sensory dimension of the lived body, and this article also contributes to this newly developing body of literature. While the social sciences have been accused of a high degree of ocularcentrism, here we take forward the literature by specifically focusing upon the haptic dimension, given that touch - and particularly the loss of key elements of the haptic dimension- emerged as salient in MND patients' accounts. To illustrate the potential of our phenomenologically inspired theoretical perspective, we consider two specific haptic themes: (i) being out of touch: the loss of certain forms of touch within MND and (ii) unwelcome touch by medical staff.