Individual's experiences of adjusting to changes in body image after spinal cord injury: a literature review and thematic synthesis.

PURPOSE: To understand how individuals experience and adjust to changes in body image after spinal cord injury (SCI). METHODS: A systematic search using four databases identified eleven articles that met the inclusion criteria. The studies were critically appraised to determine quality. Interpretative thematic synthesis was used to explore adults' experiences of adjusting to changes in body image after SCI. RESULTS: Three themes described the influence of sociocultural factors on body image: 'Sociocultural influences', 'Responses of others' and 'Experience of rehabilitation'. Six themes described individuals' experiences of body image. 'Loss and threat of difference', 'Discomfort and disconnection' and 'Resistance' negatively influenced body image. 'Reconnecting with the body and re-negotiating identity', 'Support network' and 'Challenging beliefs about disability' promoted positive body image. Adjustment was a dynamic process, influenced by interactions between individual, relational and sociocultural factors. CONCLUSIONS: The physical impacts of SCI, individual's perceptions, relationships and sociocultural discourses influenced body image. Rehabilitation professionals could support adjustment to changes in body image by considering individual, relational and systemic influences. Furthermore, it is important to include an individual's support network within their care as social factors influenced body image experiences. Peer support could promote hope and challenge negative sociocultural beliefs about disability.IMPLICATIONS FOR REHABILITATIONFollowing spinal cord injury (SCI) individuals described a dynamic process of adjustment to changes in their body image, which can include positive and negative body image experiences.Rehabilitation environments and interactions with clinicians can influence individuals' body image experiences.Multidisciplinary interventions which consider sociocultural, relational and individual influences on body image may promote positive body image experiences and the renegotiation of identity after SCI.

Switching antipsychotics to support the physical health of people with severe mental illness: a qualitative study of healthcare professionals' perspectives.

OBJECTIVES: The side effects of antipsychotic medications (APs) can increase the risk of developing physical health conditions. Some APs pose a higher risk than others. Evidence suggests switching to lower risk APs can support physical health outcomes. We sought to explore the views of healthcare professionals about switching antipsychotics to support physical health in people with severe mental illness (SMI). DESIGN: A qualitative study with semi-structured interviews conducted with general practitioners (GPs), psychiatrists and mental health nurses. The main focus was to explore participants' views on the physical health of people with SMI, the impact of APs and decision-making about switching medication to support physical health. Data were analysed thematically using principles of constant comparison. SETTINGS: Participants recruited through primary care and one mental health trust in the West Midlands. PARTICIPANTS: Interviews were conducted with 9 GPs, 10 psychiatrists and 4 mental health nurses. RESULTS: Awareness and knowledge of AP side-effects and risk profiles varied considerably between primary and secondary care clinicians. GPs reported limited awareness, while psychiatrists and nurses demonstrated a comprehensive understanding of AP risk profiles and side-effects. Mental health and control of symptoms were prioritised. Switching to promote physical health was considered as a reactive intervention, once side-effects or complications developed. There were a range of views over where responsibility lay for monitoring physical health and consideration of switching. Collaboration between primary and secondary care was identified as a way to address this. CONCLUSIONS: This study presents multidisciplinary perspectives on awareness, decision making, perceived responsibility and barriers to switching APs to support physical health. Collaborative approaches that involve liaison between primary and secondary care, but tailored to the individual patient, may support switching, and present an opportunity to intervene to address the physical health inequalities experienced by individuals with SMI.

Healthcare professionals' perspectives on identifying and managing perinatal anxiety: a qualitative study.

BACKGROUND: Perinatal mental health problems are those that occur during pregnancy or up to 12 months postpartum, and affect up to 20% of women. Perinatal anxiety (PNA) is at least as common as depression during the perinatal phase and can adversely impact on both mother and child. Despite this, research into anxiety has received less attention than depression. The National Institute for Health and Care Excellence guidance on perinatal mental health has identified PNA as a research priority. AIM: To explore the perspectives and experiences of healthcare professionals (HCPs) in the identification and management of PNA. DESIGN AND SETTING: This was a qualitative study in primary and secondary care set in the West Midlands from February 2017 to December 2017. METHOD: Semi-structured interviews (n = 23) with a range of HCPs. Iterative approach to data generation and analysis, using principles of constant comparison. Patient and Public Involvement and Engagement (PPIE) group was involved throughout the study. RESULTS: Twenty-three HCPs interviewed: 10 GPs, seven midwives, five health visitors, and one obstetrician. Four themes were uncovered: PNA as an 'unfamiliar concept'; reliance on clinical intuition and not clinical tools; fragmentation of care; and opportunities to improve care. CONCLUSION: Awareness and understanding of PNA among HCPs is variable, with debate over what is 'normal' anxiety in pregnancy. HCPs suggested that PNA can be challenging to identify, with mixed views on the use and value of case-finding tools. Opportunistic identification was noted to be significant to aid diagnosis. Care for women diagnosed with PNA was reported to be fragmented and interprofessional communication poor. Potential solutions to improve care were identified.