Capability, Opportunity, and Motivation Model for Behavior Change in People With Asthma: Protocol for a Cross-Sectional Study.

BACKGROUND: Asthma is a common lung condition that cannot be cured, but it can usually be effectively managed using available treatments. Despite this, it is widely acknowledged that 70% of patients do not adhere to their asthma treatment. Personalizing treatment by providing the most appropriate interventions based on the patient's psychological or behavioral needs produces successful behavior change. However, health care providers have limited available resources to deliver a patient-centered approach for their psychological or behavioral needs, resulting in a current one-size-fits-all strategy due to the nonfeasible nature of existing surveys. The solution would be to provide health care professionals with a clinically feasible questionnaire that identifies the patient's personal psychological and behavioral factors related to adherence. OBJECTIVE: We aim to apply the capability, opportunity, and motivation model of behavior change (COM-B) questionnaire to detect a patient's perceived psychological and behavioral barriers to adherence. Additionally, we aim to explore the key psychological and behavioral barriers indicated by the COM-B questionnaire and adherence to treatment in patients with confirmed asthma with heterogeneous severity. Exploratory objectives will include a focus on the associations between the COM-B questionnaire responses and asthma phenotype, including clinical, biological, psychosocial, and behavioral components. METHODS: In a single visit, participants visiting Portsmouth Hospital's asthma clinic with a diagnosis of asthma will be asked to complete a 20-minute questionnaire on an iPad about their psychological and behavioral barriers following the theoretical domains framework and capability, opportunity, and motivation model. Participants' data are routinely collected, including demographics, asthma characteristics, asthma control, asthma quality of life, and medication regime, which will be recorded on an electronic data capture form. RESULTS: The study is already underway, and it is anticipated that the results will be available by early 2023. CONCLUSIONS: The COM-B asthma study will investigate an easily accessible theory-based tool (a questionnaire) for identifying psychological and behavioral barriers in patients with asthma who are not adhering to their treatment. This will provide useful information on the behavioral barriers to asthma adherence and whether or not a questionnaire can be used to identify these needs. The highlighted barriers will improve health care professionals' knowledge of this important subject, and participants will benefit from the study by removing their barriers. Overall, this will enable health care professionals to use effective individualized interventions to support improved medication adherence while also recognizing and meeting the psychological needs of patients with asthma. TRIAL REGISTRATION: ClinicalTrials.gov NCT05643924; https://clinicaltrials.gov/ct2/show/NCT05643924. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44710.

A Different Conversation: Psychological Research and the Problem of Self in Autism.

Observations about peculiarities in the autistic population concerning type and frequency of references to subjective states, and lack of perspective taking, have been on the whole referred to as the paradox of the autistic self, i.e. a co-presence of ego-centeredness and weak self-referentiality (Lombardo & Baron Cohen 2010). Prevalent approaches in autism ascribe these peculiarities to high order disfunctions caused by neurological factors, such as defective self-encoding processes. Two narratives told by an adult man with Asperger during counselling are examined with Conversation Analysis; the analysis identifies features that may lead to descriptions like the paradox of autistic self, but also reveals competences related to perspective-taking and narrative construction. Drawing on Bruner's narrative theory, as well on recent interactional research on autism and the psychology of self, it is suggested that a relatively limited practice with narrative co-construction might be at the origin of the peculiarities observed. A socio-developmental approach to the understanding of autism not only can provide explanations compatible with first and second person accounts of life with autism, but can also open new paths for researching ways of self-construction that are less reliant on social interaction. The article finally challenges assumptions in psychological research about the ability of humans to access their internal states, and discusses how such assumptions can deter understanding of atypical populations.

Rethinking Intrusiveness: Exploring the Sequential Organization in Interactions Between Infants and Mothers.

To date, studies investigating maternal postpartum depression (PPD) have mainly focused on identifying failures in interactions of postpartum depressed mothers and their infants, often attributed to single dysfunctional maternal behaviors. Intrusiveness has been identified as a dysfunctional behavior characterizing mothers suffering from PPD. However, this research does not consider the co-constructed and sequential nature of social interactions, in which single behaviors cannot be conceived as isolated or disconnected units. The aim of the work presented in this paper was to explore the interactional dynamics underlying maternal behaviors previously identified as intrusive by mainstream literature on postpartum depression. Through a conversation analytical approach, we analyzed filmed interactions between mothers with and without postpartum depression and their 3-months-old infants. The analyses of 4 selected episodes illustrate similar dyadic activities, yet presenting different levels of mutuality and affective attunement. Results showed two normative features of social interactions that contributed to the different quality in the mutual adjustment of the partners: interactional rhythm and preliminaries. Interactional rhythm refers to the structuring of infants' spontaneous activity into a turn sequence, whereas preliminaries consist of verbal or nonverbal moves that anticipate following action. As evident from our analytical observations, what seems to be hindering the mutual coordination (previously labeled as "intrusive") is not based on specific individual behaviors but on the absence or violation of such interactional norms. Adopting an interactive and dynamical framework, we shifted the focus from maternal behaviors considered as dysfunctional to observing the unfolding of interactional aspects contributing to better or poorer sequential structuring. We argue that these aspects shape the possibilities for the infant's participation. Finally, we discuss the theoretical and methodological implications of adopting a conversation analytical approach for a better understanding of the relational dynamics related to clinical and non-clinical interactions.

Find the Hidden Object. Understanding Play in Psychological Assessments.

Standardized psychological assessments are extensively used by practitioners to determine rate and level of development in different domains of ability in both typical and atypical children. The younger the children, the more likely the trials will resemble play activities. However, mode of administration, timing and use of objects involved are constrained. The purpose of this study is to explore what kind of play is play in psychological assessments, what are the expectations about children's performance and what are the abilities supporting the test activities. Conversation Analysis (CA) was applied to the videorecording of an interaction between a child and a practitioner during the administration of the Bayley Scale of Infant and Toddler Development, III edition. The analysis focuses on a 2'07″ long sequence relative to the administration of the test item "Find the hidden object" to a 23 months old child with Down syndrome. The analysis of the sequence shows that the assessor promotes the child's engagement by couching the actions required to administer the item in utterances with marked child-directed features. The analysis also shows that the objects constituting the test item did not suggest to the child a unique course of action, leading to the assessor's modeling of the successful sequence. We argue that when a play frame is activated by an interactional partner, the relational aspect of the activity is foregrounded and the co-player becomes a source of cues for ways in which playing can develop. We discuss the assessment interaction as orienting the child toward a right-or-wrong interpretation, leaving the realm of play, which is inherently exploratory and inventive, to enter that of instructional activities. Finally, we argue that the sequential analysis of the interaction and of the mutual sense-making procedures that partners put in place during the administration of an assessment could be used in the design and evaluation of tests for a finer understanding of the abilities involved.

Planting the seeds of change: Directionality in the narrative construction of recovery from addiction.

OBJECTIVE: The dominant theoretical perspective that guides treatment evaluations in addiction assumes linearity in the relationship between treatment and outcomes, viewing behaviour change as a 'before and after event'. In this study we aim to examine how the direction of the trajectory of the process from addiction to recovery is constructed in personal narratives of active and recovering users. DESIGN: 21 life stories from individuals at different stages of recovery and active use were collected and analysed following the principles of narrative analysis. RESULTS: Personal trajectories were constructed in discontinuous, non-linear and long lasting patterns of repeated, and interchangeable, episodes of relapse and abstinence. Relapse appeared to be described as an integral part of a learning process through which knowledge leading to recovery was gradually obtained. CONCLUSION: The findings show that long-term recovery is represented as being preceded by periods of discontinuity before change is stabilised. Such periods are presented to be lasting longer than most short-term pre-post intervention designs can capture and suggest the need to rethink how change is defined and measured.

Asking 'What about' questions in chronic illness self-management meetings.

OBJECTIVES: This study investigates 'What about' questions asked by patients in the course of diabetes self-management groups led by nurses, and explores their functions in these empowerment-informed settings. METHODS: Conversation Analysis of 24 video-recorded sessions of a Start Insulin Group Programme for patients with type 2 diabetes, in a diabetes centre in the South of England. The groups included 2-7 patients and were led by 5 nurses, all of whom had received training in the empowerment approach. RESULTS: The analysis revealed a prevalence of single-unit 'Whatabout X' questions and found that they were used to embed requests for information in current or just closed activities. The nurses always provided the information, but could ask patients to specify the content of the question and collaborate to the answer. CONCLUSION: The analysis suggests that the short form of the question may be adapting to the nurses' restraint in giving recommendations or immediate responses to information seeking-questions. PRACTICE IMPLICATIONS: When healthcare communication practices are shaped in observance to a theoretical approach, such as empowerment, it is recommendable that practitioners monitor not only what they do, but also how patients change their habitual forms of speech in response.

Do We Really Want a Future as Qualitative Psychologists?

In this article I pick up some threads from the contributions in the previous special issue of IPSB dedicated to the future of qualitative psychology, and elaborate on them around two main points. The first is the status of qualitative psychology as a social and institutional category; the second is what we mean by experience. As concerns the first point, I argue that using the label of qualitative psychology may separate us from the rest of psychology, also creating a false impression of homogeneity among qualitative approaches and a false opposition with quantitative methods. Implications for teaching as well as research are discussed. The second issue has to do with experience as the object of qualitative psychology investigations. I propose three ways of formulating experience in research which would prevent naïve assumptions about accessing it directly through language. These are 1) experience as experience of the researcher, 2) experience as situated intersubjectivity, and 3) experience as expression. I discuss how being clearer about definitions of experience and going towards engaged forms of research could safeguard the integrity of both researcher and participants.

Not Just Being Lifted: Infants are Sensitive to Delay During a Pick-Up Routine.

In the present study we observed whether infants show online adjustments to the mother's incipient action by looking at their sensitivity to changes as the pick-up unfolded. Twenty-three 3-month-old infants and their mothers were observed in the lab, where mothers were instructed (1) to pick-up their infants as they usually did (normal pick-up), and then (2) to delay the pick-up for 6 s after placing their hands on the infants' waist (delayed pick-up). In both Normal and Delayed conditions infant's body tension, affective displays and gaze shifts were coded during three phases: Approach, Contact, and Lift. Additionally, a measure of infants' head support in terms of head lag at the beginning and end of Lift was computed. Results showed that during normal pick-up infants tensed up their body during the Approach phase and increased their tension during contact, maintaining it through Lift; their head was also supported and in line with their body during Lift. When the pick-up was delayed, infants also tensed their body during Approach, yet this tension did not increase during the Contact phase and was significantly lower at Lift. Their head support was also lower in the Delayed condition and they shifted their gazes away from their mothers' face more often than in the Normal condition. These results suggest that infants are sensitive to changes of the timing of the pick-up sequence, which in turn may have affected their contribution to the interaction.

We can work it out: an enactive look at cooperation.

The past years have seen an increasing debate on cooperation and its unique human character. Philosophers and psychologists have proposed that cooperative activities are characterized by shared goals to which participants are committed through the ability to understand each other's intentions. Despite its popularity, some serious issues arise with this approach to cooperation. First, one may challenge the assumption that high-level mental processes are necessary for engaging in acting cooperatively. If they are, then how do agents that do not possess such ability (preverbal children, or children with autism who are often claimed to be mind-blind) engage in cooperative exchanges, as the evidence suggests? Secondly, to define cooperation as the result of two de-contextualized minds reading each other's intentions may fail to fully acknowledge the complexity of situated, interactional dynamics and the interplay of variables such as the participants' relational and personal history and experience. In this paper we challenge such accounts of cooperation, calling for an embodied approach that sees cooperation not only as an individual attitude toward the other, but also as a property of interaction processes. Taking an enactive perspective, we argue that cooperation is an intrinsic part of any interaction, and that there can be cooperative interaction before complex communicative abilities are achieved. The issue then is not whether one is able or not to read the other's intentions, but what it takes to participate in joint action. From this basic account, it should be possible to build up more complex forms of cooperation as needed. Addressing the study of cooperation in these terms may enhance our understanding of human social development, and foster our knowledge of different ways of engaging with others, as in the case of autism.

Changing the game: exploring infants' participation in early play routines.

Play has proved to have a central role in children's development, most notably in rule learning (Piaget, 1965; Sutton-Smith, 1979) and negotiation of roles and goals (Garvey, 1974; Bruner et al., 1976). Yet very little research has been done on early play. The present study focuses on early social games, i.e., vocal-kinetic play routines that mothers use to interact with infants from very early on. We explored 3-month-old infants and their mothers performing a routine game first in the usual way, then in two violated conditions: without gestures and without sound. The aim of the study is to investigate infants' participation and expectations in the game and whether this participation is affected by changes in the multimodal format of the game. Infants' facial expressions, gaze, and body movements were coded to measure levels of engagement and affective state across the three conditions. Results showed a significant decrease in Limbs Movements and expressions of Positive Affect, an increase in Gaze Away and in Stunned Expression when the game structure was violated. These results indicate that the violated game conditions were experienced as less engaging, either because of an unexpected break in the established joint routine, or simply because they were weaker versions of the same game. Overall, our results suggest that structured, multimodal play routines may constitute interactional contexts that only work as integrated units of auditory and motor resources, representing early communicative contexts which prepare the ground for later, more complex multimodal interactions, such as verbal exchanges.