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1.  Obesity treatment—more than food and exercise: a qualitative study exploring obese adolescents' and their parents' views on the former's obesity 
The aim of this study was to explore obese adolescents’ and their parents’ views on the former's obesity; especially to gain knowledge about barriers and motivational factors that influence obese adolescents’ ability to lose weight. This is a qualitative study involving field observation and semi-structured interviews with obese adolescents and their parents. The analysis takes a phenomenological–hermeneutic approach. Fifteen obese adolescents aged 13–16 years and their parents/grandparents participated in this study (one father, seven mothers, five sets of parents and two sets of grandparents). The results showed that obese adolescents’ are aware that they have unhealthy eating habits and they wish they were able to attain to a healthier diet. Although in poor physical shape, obese adolescents perceive their daily level of exercise as moderate. Obese adolescents blame themselves for being obese and blame their parents for an unhealthy diet, and for being unsupportive regarding exercise. Parents blame their obese child of lacking will power to change eating and exercise habits. As a consequence, the homely atmosphere is often characterised by quarrels and negative feelings. The conclusion is that despite obese adolescents’ intention of reducing weight, underlying issues interfere with this goal. This is particularly related to quarrels with parents, self-blame and misguided understanding of eating and exercising habits. These matters need to be addressed when treating obesity among adolescents.
doi:10.3402/qhw.v5i2.5073
PMCID: PMC2875969  PMID: 20640019
Adolescents; blame; phenomenological–hermeneutic study; obesity; views on obesity
2.  Extraordinary exposed in early motherhood - a qualitative study exploring experiences of mothers with type 1 diabetes 
BMC Women's Health  2011;11:10.
Background
Women with type 1 diabetes face several challenges during pregnancy, childbirth and in relation to breastfeeding. It is therefore of utmost importance to consider their need for specific support, early postpartum as well as in daily life after discharge from maternity care. Few studies have investigated these aspects of healthcare. The aim of this study was to explore experiences after childbirth regarding breastfeeding, glycemic control, support and well-being in women with type 1 diabetes.
Methods
A hermeneutic reflective life world research approach was used in this qualitative study. Data was gathered through audio-recorded focus group discussions and individual interviews with 23 women with type 1 diabetes, 6-24 months after childbirth. After verbatim transcription, the text was analyzed in order to identify themes of meaning and a conclusive interpretation of the explored phenomenon.
Results
Experiences of extraordinary exposure challenged the women with type 1 diabetes in their transition to early motherhood. The exposure included a struggle with breastfeeding, although with a driving force to succeed. Everyday life was filled with uncertainty and unpredictability related to one's own unstable glycemic control and the women down-prioritized their own needs in favor of the child. A feeling of being disconnected from professional care further contributed to the experiences of extraordinary exposure.
Conclusion
In early motherhood women with type 1 diabetes have a great need for support in managing daily life postpartum, which requires contemporary approaches to overlap insufficient linkage between health care professionals in maternity and child health care, and diabetes care.
doi:10.1186/1472-6874-11-10
PMCID: PMC3079679  PMID: 21473755
3.  Being hospitalized with a newly diagnosed chronic illness—A phenomenological study of children's lifeworld in the hospital 
The impact of a hospital environment on children has rarely been investigated. Recently, however, the perspective of hospitalized children has been taken into account. Being hospitalized and facing an illness represent a dramatic change in a child's daily life, and the quality of the environment may influence the child's experiences. The aim of this study was to investigate the experiences of children being hospitalized with newly diagnosed type 1 diabetes and to obtain an increased understanding of the environmental influences on the children's lifeworld. The study used a hermeneutic phenomenological approach. The design is a combination of observation of the participant, interviews, and photographs. Nine children, aged between 7 and 12 years, participated in the study. The data were collected between October 2008 and February 2010 and analysed in accordance with thematic analysis as described by van Manen. The children experienced change through recognition and adaptation. They perceived the environment as strange but still comfortable because of the “child-friendly” atmosphere, close contact with their relatives, and access to private space. The children were gradually able to adapt to their new life; they perceived their illness through bodily changes and developed practical skills and understanding. The findings underscored the necessity for an emphasis on the mutual relationship between the body and its environment. Bodily changes that occur during illness may lead to changes in one's perception of the environment. Children seem to be particularly affected when the body appears alien and the hospital environment is unfamiliar. A well-adapted environment, active involvement, and the incorporation of new habits are significant elements of gradually returning to a more familiar life. However, the child's new life requires alertness to the body's signals and acclimation to a demanding diabetes treatment regime. All these factors remind children of their body's needs and experiences and influence their lifeworld.
doi:10.3402/qhw.v7i0.18694
PMCID: PMC3422725  PMID: 22901338
Hospitalized children; lived experience; hospital environment; type 1 diabetes; bodily changes; hermeneutic phenomenological method
4.  First time pregnant women's experiences in early pregnancy 
Background
There are few studies focusing on women's experiences of early pregnancy. Medical and psychological approaches have dominated the research. Taking women's experiences seriously during early pregnancy may prevent future suffering during childbirth.
Aim
To describe and understand women's first time experiences of early pregnancy.
Method
Qualitative study using a phenomenological hermeneutic approach. Data were collected via tape-recorded interviews in two antenatal care units in Sweden. Twelve first time pregnant women in week 10–14, aged between 17 and 37 years participated.
Results
To be in early pregnancy means for the women a life opening both in terms of life affirming and suffering. The central themes are: living in the present and thinking ahead, being in a change of new perspectives and values and being in change to becoming a mother.
Conclusions
The results have implications for the midwife's encounter with the women during pregnancy. Questions of more existential nature, instead of only focusing the physical aspects of the pregnancy, may lead to an improvement in health condition and a positive experience for the pregnant woman.
doi:10.3402/qhw.v6i2.5600
PMCID: PMC3077216  PMID: 21499449
Early pregnancy; midwifery and pregnancy; maternity care; experiences of pregnancy; phenomenological hermeneutic
5.  Caring for People at the End of Life: Iranian Oncology Nurses' Experiences 
Indian Journal of Palliative Care  2009;15(2):141-147.
Aim:
To explore the meaning of Iranian oncology nurses' experiences of caring for people at the end of life.
Materials and Methods:
A phenomenological hermeneutic approach was applied. Fifteen nurses working in oncology units were interviewed in 2007 regarding their experiences of caring for people at the end of life.
Results:
Participants experienced caring for people at the end of life as sharing space and time to be lost within an organizational context. This main theme was divided into three subthemes including being attentive to the dying persons and their families, being cared for by the dying persons and their families, and being faced with barriers.
Conclusion:
The study suggests that the nurses' success in caring for people at the end of life is reliant on their interpersonal caring relationship. Facilitating such relationship requires the establishment of palliative care unit, incorporation of palliative care into undergraduate nursing studies, and cultural preparation through public education.
doi:10.4103/0973-1075.58461
PMCID: PMC2902116  PMID: 20668594
Caring for dying people; Lived experience; Iran; Oncology nurses; Palliative care
6.  South African managers in public service: On being authentic 
South African managers in public service consistently face challenges related to managing a well-adjusted and productive diverse workforce. Following the notion that leadership authenticity fosters positive psychological employee capacity, the aim of this study was to explore the meaning essence of authenticity as lived in the work–life experiences of senior managers in public service. Five senior managers in public service were purposefully selected based on their articulated challenges with being authentic at work, whilst attending a diversity sensitivity workshop. From a hermeneutic phenomenological perspective, in-depth interviews were used, and an interpretative phenomenological analysis yielded two predominant themes offering a description of what it means to be authentic. Authenticity is experienced as an affective state that results from a continuous self-appraisal of the extent to which expression of self is congruent with a subjective and socially constructed expectation of self in relation to others. Authenticity seems to develop through a continuous process of internal and external adaptation, and it leads to ultimately building a differentiated yet integrated identity of self. A reciprocal dynamic between feeling authentic and self-confidence alludes to the potential importance of authenticity dynamics in identity work.
doi:10.3402/qhw.v9.20630
PMCID: PMC3895260  PMID: 24434054
Authenticity; authentic leadership; identity work; psychological well-being; interpretative phenomenology; hermeneutic phenomenology
7.  Childbirth experience questionnaire (CEQ): development and evaluation of a multidimensional instrument 
Background
Negative experiences of first childbirth increase risks for maternal postpartum depression and may negatively affect mothers' attitudes toward future pregnancies and choice of delivery method. Postpartum questionnaires assessing mothers' childbirth experiences are needed to aid in identifying mothers in need of support and counselling and in isolating areas of labour and birth management and care potentially in need of improvement. The aim of this study was to develop and evaluate a questionnaire for assessing different aspects of first-time mothers' childbirth experiences.
Methods
Childbirth domains were derived from literature searches, discussions with experienced midwives and interviews with first-time mothers. A draft version of the Childbirth Experience Questionnaire (CEQ) was pilot tested for face validity among 25 primiparous women. The revised questionnaire was mailed one month postpartum to 1177 primiparous women with a normal pregnancy and spontaneous onset of active labor and 920 returned evaluable questionnaires. Exploratory factor analysis using principal components analysis and promax rotation was performed to identify dimensions of the childbirth experience. Multitrait scaling analysis was performed to test scaling assumptions and reliability of scales. Discriminant validity was assessed by comparing scores from subgroups known to differ in childbirth experiences.
Results
Factor analysis of the 22 item questionnaire yielded four factors accounting for 54% of the variance. The dimensions were labelled Own capacity, Professional support, Perceived safety, and Participation. Multitrait scaling analysis confirmed the fit of the four-dimensional model and scaling success was achieved in all four sub-scales. The questionnaire showed good sensitivity with dimensions discriminating well between groups hypothesized to differ in experience of childbirth.
Conclusion
The CEQ measures important dimensions of the first childbirth experience and may be used to measure different aspects of maternal satisfaction with labour and birth.
doi:10.1186/1471-2393-10-81
PMCID: PMC3008689  PMID: 21143961
8.  Experiences of professional support during pregnancy and childbirth – a qualitative study of women with type 1 diabetes 
Background
Women with type 1 diabetes are at high risk of complications during both pregnancy and childbirth. Stringent monitoring of blood sugar is required in order to improve the chance of giving birth to a healthy child; however, this increases the incidence of severe hypoglycaemia. The aim of this study was to explore the need for and experience of professional support during pregnancy and childbirth among women with type 1 diabetes.
Methods
The study has a lifeworld research approach. Six focus groups and four individual interviews were conducted with 23 women, 6–24 months after delivery. The participants were encouraged to narrate their experiences of pregnancy and childbirth in relation to glycaemic control, well-being and provided care. Data analysis was directed towards discovering qualitative meanings by identifying and clustering meaning units in the text. Further analysis identified eight themes of meaning, classified under pregnancy or childbirth, forming a basis for a final whole interpretation of the explored phenomenon.
Results
The women felt worry about jeopardizing the baby's health and this was sometimes made worse by care providers' manner and lack of competence and support. The increased attention from care providers during pregnancy was experienced as related to the health of the unborn child; not the mothers. Women who during pregnancy received care in a disconnected diabetes organisation were forced to act as messengers between different care providers.
Conclusion
Clarity in terms of defining responsibilities is necessary during pregnancy and childbirth, both among care providers and between the woman and the care provider. Furthermore, a decision must be made concerning how to delegate, transfer or share diabetes responsibility during labour between the care providers and the parents-to-be.
doi:10.1186/1471-2393-9-27
PMCID: PMC2725032  PMID: 19575789
9.  Action ethical dilemmas in surgery: an interview study of practicing surgeons 
BMC Medical Ethics  2005;6:7.
Background
The aim of this study was to describe the kinds of ethical dilemmas surgeons face during practice.
Methods
Five male and five female surgeons at a University hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of physicians and nurses about ethically difficult situations in surgical units. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation.
Results
No gender differences were found in the kinds of ethical dilemmas identified among male and female surgeons. The main finding was that surgeons experienced ethical dilemmas in deciding the right treatment in different situations. The dilemmas included starting or withholding treatment, continuing or withdrawing treatment, overtreatment, respecting the patients and meeting patients' expectations. The main focus in the narratives was on ethical dilemmas concerning the patients' well-being, treatment and care. The surgeons narrated about whether they should act according to their own convictions or according to the opinions of principal colleagues or colleagues from other departments. Handling incompetent colleagues was also seen as an ethical dilemma. Prioritization of limited resources and following social laws and regulations represented ethical dilemmas when they contradicted what the surgeons considered was in the patients' best interests.
Conclusion
The surgeons seemed confident in their professional role although the many ethical dilemmas they experienced in trying to meet the expectations of patients, colleagues and society also made them professionally and personally vulnerable.
doi:10.1186/1472-6939-6-7
PMCID: PMC1182373  PMID: 15996268
10.  Being old and living alone in urban areas: the meaning of self-care and health on the perception of life situation and identity 
Background
Living alone in urban areas when getting old is an important and necessary field for research as the growth of the urban population worldwide increases, and due to the fact that people live longer. How older people manage their self-care and health, and how this might influence their identity and life situation may be very important to understand when planning for a new, upcoming older generation. The aim of this study was to elucidate the meaning of self-care and health for the perception of life situation and identity among single-living older individuals in urban areas in southern Norway.
Methods
A phenomenological–hermeneutic approach inspired by Ricoeur was applied. Nine single-living older persons in urban areas, 70–82 years of age, and identified to be in good health were interviewed. The interviews were audiotaped, transcribed verbatim, and analyzed using a phenomenological–hermeneutic method.
Results
Strength and a time dimension characterized the meaning of self-care and health for the perception of life situation and identity as narrated by the group of single-living older individuals in urban areas in southern Norway. The informants were, as older individuals, caring, autonomous, and robust characters, who had gone through difficult times in life, and in a resilient way moved towards a new future. They valued and were grateful for what they had learned in their lives and could go forward and still experience and explore.
Conclusion
Self-care is significant in the perception of life situation and identity among single urban older people in this study, and characterized by strength, temporality, gratitude, autonomy, and natality. Society needs to acknowledge the strengths and capabilities of older people to a greater extent.
doi:10.2147/PRBM.S46329
PMCID: PMC3704551  PMID: 23847434
aged; health promotion; phenomenological; hermeneutic method; salutogenesis; time
11.  Stories from the road of recovery – How adult, female survivors of childhood trauma experience ways to positive change 
Nordic Psychology  2013;65(1):3-18.
Abstract
The aim of this study was to explore how female survivors of childhood trauma who have sought treatment experience ways to positive change. Little knowledge exists regarding the first-person perspective of the recovery process following childhood trauma, and getting access to this perspective might contribute to better understanding of these processes, hence offering opportunities for health promotion. All clients (31, including 3 who dropped out) from six stabilization groups for women exposed to human-inflicted traumas were invited to participate in the study. Experiences of the recovery process were not restricted to the period of receiving treatment, and all clients who volunteered were included in the study. Qualitative, in-depth interviews with 13 consenting clients were carried out shortly after completion of the group treatment. All interviews were transcribed verbatim, and a hermeneutical-phenomenological approach to analysis was applied. The analysis resulted in five interrelated, but distinct main themes: finding new ways to understand one's emotions and actions, moving from numbness toward vital contact, becoming an advocate of one's own needs, experiencing increased sense of agency, and staying with difficult feelings and choices. The themes support, yet supplement trauma theory, by underlining the relationship between emotional contact and meaning-making, while downplaying the necessity of symptom elimination in the experience of recovery. The findings also underline that the active role trauma survivors play in their processes of recovery.
doi:10.1080/19012276.2013.796083
PMCID: PMC3892724  PMID: 24443662
childhood trauma; recovery; client perspective; qualitative interviews; stabilization group
12.  Factors affecting the motivation of healthcare professionals providing care to Emiratis with type 2 diabetes 
JRSM Short Reports  2013;4(2):14.
Objective
We aimed to identify facilitators of and barriers to healthcare professionals' motivation in a diabetes centre in the United Arab Emirates (UAE).
Design
A qualitative research approach was employed using semistructured interviews to assess perception of and attitudes regarding healthcare professionals' motivation in providing good quality diabetes care.
Setting
A diabetes centre located in Abu-Dhabi, UAE.
Participants
Healthcare professionals including specialist physicians, dieticians, podiatrists, health educators and nurses were recruited through purposive sampling.
Main outcome measures
After data collection, the audiotaped interviews were transcribed verbatim and subjected to content analysis.
Results
Nine semistructured interviews were conducted with healthcare professionals of various professional backgrounds. Important facilitators and barriers related to patient, professional, organization and cultural factors were identified. Barriers that related to heavy workload, disjointed care, lack of patient compliance and awareness, and cultural beliefs and attitudes about diabetes were common. Key facilitators included the patient's role in achieving therapeutic outcomes as well as compliance, cooperation and communication.
Conclusion
This qualitative study provides some unique insights about factors affecting healthcare professionals' motivation in providing good quality care. To improve the motivation of healthcare professionals in the management of diabetes and therefore the quality of diabetes care, several steps are needed. Importantly, the role of primary care should be reinforced and strengthened regarding the management of type 2 diabetes mellitus, privacy of the consultation time should be highly protected and regulated, and awareness of the Emirate culture and its impact on health should be disseminated to the healthcare professionals providing care to Emirates with diabetes. Also, greater emphasis should be placed on educating Emiratis with diabetes on, and involving them in, the management of their condition.
doi:10.1177/2042533313476419
PMCID: PMC3591689  PMID: 23476735
13.  Infanticide secrets 
Canadian Family Physician  2008;54(12):1716-1717.e5.
ABSTRACT
OBJECTIVE
To explore thoughts of infanticide that did not lead to the act among mothers with postpartum depression.
DESIGN
A phenomenologic hermeneutic study in which women were invited to share their experiences of having thoughts of infanticide.
SETTING
Community setting in a large metropolitan city, Brisbane, Australia.
PARTICIPANTS
Fifteen women who had been diagnosed as clinically depressed with postpartum onset whose babies were 12 months of age or younger.
METHOD
Audiotaped, in-depth interviews were transcribed verbatim. Thematic analysis commenced immediately after the first interview, and data collection continued until saturation was achieved. A questioning approach that reflected hermeneutics was facilitated by use of journals by the researchers.
MAIN FINDINGS
Six themes emerged from the data: imagined acts of infanticide, the experience of horror, distorted sense of responsibility, consuming negativity, keeping secrets, and managing the crisis.
CONCLUSION
Women who experienced nonpsychotic depression preferred not to disclose their thoughts of infanticide to health professionals, including trusted general practitioners or psychiatrists. These women were more likely to mention their suicidal thoughts than their infanticidal thoughts in order to obtain health care. General practitioners and other health professionals should directly ask about whether a woman has been experiencing thoughts of harming herself or her baby, regardless of the reason why she has presented.
PMCID: PMC2602639  PMID: 19074717
14.  Qualitative analysis of stroke patients' motivation for rehabilitation 
BMJ : British Medical Journal  2000;321(7268):1051-1054.
Objective
To explore the attitudes and beliefs of stroke patients identified by professionals as having either “high” or “low” motivation for rehabilitation.
Design
Qualitative study with semistructured interviews.
Setting
The stroke unit of an inner city teaching hospital.
Participants
22 patients with stroke who were undergoing rehabilitation; 14 with high motivation for rehabilitation and eight with low motivation.
Results
All patients thought rehabilitation was important for recovery. High motivation patients were more likely to view rehabilitation as the most important means of recovery and to accord themselves an active role in rehabilitation. These patients were also more likely to understand rehabilitation and in particular to understand the specialist role of the nursing staff. Many patients reported independence at home as a personal goal, though few low motivation patients related this goal to success in rehabilitation. Information from professionals about rehabilitation, favourable comparisons with other stroke patients, and the desire to leave hospital had a positive effect on motivation. Conversely, overprotection from family members and professionals, lack of information or the receipt of “mixed messages” from professionals, and unfavourable comparisons with other patients had a negative effect.
Conclusions
There are some differences in beliefs between stroke patients identified as having low or high motivation for rehabilitation. These beliefs seem to be influenced by the environment in which the patient is rehabilitated. Professionals and carers should be made aware of the ways in which their behaviour can positively and negatively affect motivation.
PMCID: PMC27512  PMID: 11053175
15.  Work-aged stroke survivors’ psychosocial challenges narrated during and after participating in a dialogue-based psychosocial intervention: a feasibility study 
BMC Nursing  2013;12:22.
Background
Studies point to the lack of psychosocial support and rehabilitation services that are adjusted to the work-aged stroke survivors’ specific needs in order to promote psychosocial well-being. The aim of the study was to illuminate the psychosocial challenges work-aged participants (i.e. aged 18–67 years) thematised during and after participating a dialogue-based psychosocial intervention during the first year following a stroke.
Methods
The study was a feasibility study guided by the UK Medical Research Council Framework for developing and evaluating complex interventions. Qualitative data from in-depth interviews with fourteen stroke-survivors aged 33–66 years, researcher field notes and log notes written during the intervention were analysed applying a hermeneutic-phenomenological approach.
Results
The stroke and its consequences had a substantial impact on family and work life. Their experiences were summarised in the two themes The threat of becoming marginalised in family life and The threat of becoming marginalised in work life.
Conclusion
Life as a work-aged stroke survivor was experienced as challenging and created a threat of becoming marginalised in family and work life. The study highlights the need to understand the specific psychosocial challenges and needs facing work-aged stroke survivors’ in order to promote their psychosocial well-being. More research is needed concerning specific life-span challenges amongst work-aged stroke survivors in order to further develop appropriate interventions that helps address this issue.
doi:10.1186/1472-6955-12-22
PMCID: PMC3849869  PMID: 24066840
Stroke; Work-aged stroke survivors; Marginalisation; Feasibility study; Complex intervention; Qualitative method; Hermeneutic-phenomenological; Rehabilitation
16.  Reshaping maternal services in Nigeria: any need for spiritual care? 
Background
High maternal and perinatal mortalities occur from deliveries conducted in prayer houses in Nigeria. Although some regulatory efforts have been deployed to tackle this problem, less attention has been placed on the possible motivation for seeking prayer house intervention which could be hinged on the spiritual belief of patients about pregnancy and childbirth. This study therefore seeks to determine the perception of booked antenatal patients on spiritual care during pregnancy and their desire for such within hospital setting.
Method
A total of 397 antenatal attendees from two tertiary health institutions in southwest Nigeria were sampled. A pretested questionnaire was used to obtain information on socio-demographic features of respondents, perception of spiritual care during pregnancy and childbirth; and how they desire that their spiritual needs are addressed. Responses were subsequently collated and analyzed.
Results
Most of the women, 301 (75.8%), believe there is a need for spiritual help during pregnancy and childbirth. About half (48.5%) were currently seeking for help in prayer/mission houses while another 8.6% still intended to. Overwhelmingly, 281 (70.8%) felt it was needful for health professionals to consider their spiritual needs. Most respondents, 257 (64.7%), desired that their clergy is allowed to pray with them while in labour and sees such collaboration as incentive that will improve hospital patronage. There was association between high family income and desire for collaboration of healthcare providers with one’s clergy (OR 1.82; CI 1.03-3.21; p = 0.04).
Conclusion
Our women desire spiritual care during pregnancy and childbirth. Its incorporation into maternal health services will improve hospital delivery rates.
doi:10.1186/1471-2393-14-196
PMCID: PMC4057573  PMID: 24902710
Pregnancy; Childbirth; Hospital; Spiritual care
17.  Stress is dominant in patients with depression and chronic low back pain. A qualitative study of psychotherapeutic interventions for patients with non-specific low back pain of 3–12 months’ duration 
Background
There is continuing uncertainty in back pain research as to which treatment is best suited to patients with non-specific chronic low back pain (CLBP). In this study, Gestalt therapy and the shock trauma method Somatic Experiencing® (SE) were used as interventions in parallel with the usual cross-disciplinary approach. The aim was to investigate how these treatments influence a patient’s capacity to cope with CLBP when it is coupled with depression.
Methods
In this qualitative explorative study, a phenomenological–hermeneutic framework was adopted. Patients were recruited on the basis of following criteria: A moderate depression score of 23–30 according to the Beck Depression Inventory Scale and a pain score of 7–10 (Box scale from 0–10) and attendance at five- six psychotherapeutic sessions. Six patients participated in the study. The data was comprised of written field notes from each session, which were subsequently analysed and interpreted at three levels: naive reading, structural analysis and critical interpretation and discussion.
Results
Three areas of focus emerged: the significance of previous experiences, restrictions in everyday life and restoration of inner resources during the therapy period. The study revealed a diversity of psychological stressors that related to loss and sorrow, being let down, violations, traumatic events and reduced functioning, which led to displays of distress, powerlessness, reduced self-worth, anxiety and discomfort.
Overall, the sum of the stressors together with pain and depression were shown to trigger stress symptoms. Stress was down-played in the psychotherapeutic treatment and inner resources were re-established, which manifested as increased relaxation, presence, self-worth, sense of responsibility and happiness. This, in turn, assisted the patients to better manage their CLBP.
Conclusions
CLBP is a stress factor in itself but when coupled with depression, they can be regarded as two symptom complexes that mutually affect each other in negative ways. When pain, stress and depression become overwhelming and there are few internal resources available, stress seems to become prominent. In this study, Gestalt therapy and the SE-method may have helped to lower the six patients’ level of stress and restore their own internal resources, thereby increasing their capacity to cope with their CLBP.
doi:10.1186/1471-2474-13-166
PMCID: PMC3495206  PMID: 22950571
Psychotherapy; Chronic low back pain; Chronic pain; Depression; Stress; Qualitative method; Gestalt therapy; Somatic Experiencing® method
18.  The Meaning of Awaiting Bariatric Surgery Due to Morbid Obesity 
Background:
The understanding of the association between the objective conditions of health and the subjective perceptions of morbidly obese patients appears to be poor. The use of objective indicators alone produces results totally unrelated to the feelings and experiences of the bariatric patients studied. No study has approached the bariatric patient from both an inside and a preoperative perspective.
Purpose:
The aim of this study was to investigate the meaning of awaiting bariatric surgery due to morbid obesity. Method: Twenty-three patients admitted to a Swedish University Hospital for bariatric surgery were included. Data were collected by interviews and the analysis was performed using the phenomenological hermeneutics method developed by Lindseth and Norberg.
Main Findings:
Two structural thematic analyses revealed six main themes: experiencing food as a complex element in life, feeling hopeless regarding weight loss, living in fear of future sickness and death, living a restricted life, being ignored by health care professionals and hoping for control and opportunities. The informants experienced addiction to food and dependence on others for managing their daily life, which constituted an infringement of their freedom. Loss of control meant giving in to the desire for food, but also being subjected to stigmatizing remarks from persons in their environment or uncaring approaches from health care professionals.
Conclusion:
Being scheduled for bariatric surgery meant developing an awareness of how completely dependent they were on surgery for their survival and prospective health. The scheduled bariatric surgery constituted tangible confirmation that weight loss and restored health were possible.
doi:10.2174/1874434601105010001
PMCID: PMC3109523  PMID: 21660178
Morbid obesity; awaiting surgery; inside perspective; phenomenological hermeneutics method.
19.  A Model of Goal Directed Vegetable Parenting Practices 
Appetite  2011;58(2):444-449.
The aim of this study was to explore factors underlying parents’ motivations to use vegetable parenting practices (VPP) using the Model of Goal Directed Vegetable Parenting Practices (MGDVPP) (an adaptation of the Model of Goal Directed Behavior) as the theoretical basis for qualitative interviews.
In-depth interviews with parents of 3–5-year-old children were conducted over the telephone by trained interviewers following a script. MGDVPP constructs provided the theoretical framework guiding script development. Audio-recordings were transcribed and analyzed, with themes coded independently by two interviewers. Fifteen participants completed the study. Interviews elicited information about possible predictors of motivations as they related to VPP, and themes emerged related to each of the MGDVPP constructs (attitudes, positive anticipated emotions, negative anticipated emotions, subjective norms, and perceived behavioral control). Parents believed child vegetable consumption was important and associated with child health and vitality. Parents described motivations to engage in specific VPP in terms of emotional responses, influential relationships, food preferences, resources, and food preparation skills. Parents discussed specific strategies to encourage child vegetable intake. Interview data suggested parents used diverse VPP to encourage child intake and that varied factors predicted their use. Understanding these factors could inform the design of interventions to increase parents’ use of parenting practices that promote long-term child consumption of vegetables.
doi:10.1016/j.appet.2011.12.011
PMCID: PMC3288949  PMID: 22210348
eating behavior; food parenting practices; behavioral theories; Model of Goal Directed Behavior; preschooler nutrition
20.  HIV/AIDS PREVENTION PRACTICES AMONG RECENT-IMMIGRANT JAMAICAN WOMEN 
Ethnicity & disease  2008;18(2 Suppl 2):S2-175-8.
Introduction
The HIV/AIDS pandemic continues to affect people in the United States and around the world at a profound rate, and African Americans are disproportionately affected.
Methods
This exploratory, descriptive, and phenomenological study explored the meaning of HIV/AIDS safer sex practices among 20 single, heterosexual women, 18–30 years old, who emigrated from Jamaica in the last 12 years. The study described the participants’ HIV/AIDS prevention knowledge, behaviors, health-beliefs, and social and cultural factors that influenced their behaviors. The Health Belief Model guided the study, and the maximum variation criterion sampling technique was used to select participants. In-depth interviews, journal entries, and field notes were used to collect data. Diekelmann, Allen, and Tanner’s seven-stage process of Heideggarian hermeneutics data analysis was used to produce rich descriptions of shared practices and common meanings.
Results
Participants in this study acknowledged that HIV/AIDS was serious, but most women did not perceive themselves as susceptible to the disease. Women in this study did not use condoms. These women expressed lack of condom negotiation skills, fear of losing their relationship, and fear of physical or mental abuse from their significant other as barriers to using condoms.
Discussion
Most women were knowledgeable about HIV/AIDS prevention but have religious beliefs and cultural practices that were deeply embedded in their health practices. Many women were not sure of a mutually monogamous relationship, and talking about sexual issues was viewed as taboo. This research provides the foundation for the development of culturally appropriate interventions to decrease HIV/AIDS and improve health disparities among immigrant women.
PMCID: PMC2864647  PMID: 18646344
HIV/AIDS; Immigrants; Jamaican Women; Cultural Practices
21.  The association between antenatal anxiety and fear of childbirth in nulliparous women: a prospective study 
BACKGROUND:
This study aimed to examine the association of state and trait anxiety with fear of childbirth to explore whether there was any support for the hypothesis that state and trait anxiety are risk factors for the fear of childbirth or not.
METHODS:
In this prospective study, 156 pregnant women referred to the health centers of Qom. The study samples selected using simple random sampling method. Anxiety and fear of the childbirth in nulliparous women were measured using Spielberger's state-trait anxiety inventory and childbirth attitudes questionnaire (CAQ) at gestational age of 28 and 38 weeks respectively. The data were analyzed using Pearson correlation, t-test, logistic regression and software SPSS16.
RESULTS:
Pearson correlation test indicated a positive and statistically significant association between fear of childbirth scores and state and trait anxiety (p < 0.05). Logistic regression analysis showed that state and trait anxiety at gestational age of week 28th increased the risk of fear of childbirth (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.69-4.35) (p = 0.03) ([OR] 2.8, 95% [CI] 1.17-6.80) (p = 0.02) respectively. It also indicated that state and trait anxiety increased the risk of fear of childbirth at gestational age of week 38th ([OR] 2.7, 95% [CI] 1.03-6.80) and ([OR] 5.4, 95% [CI] 1.75-16.76) (p = 0.04) (p = 0.003) respectively.
CONCLUSIONS:
The results support this possibility that state and trait anxiety could be considered as risk factors for the fear of childbirth. Hence, considering other included biological and medical factors, measurement and control of psychological factors in pregnancy is recommended.
PMCID: PMC3249768  PMID: 22224102
Anxiety; fear; childbirth; pregnancy; women
22.  Attitudes toward depression among Japanese non-psychiatric medical doctors: a cross-sectional study 
BMC Research Notes  2012;5:441.
Background
Under-recognition of depression is common in many countries. Education of medical staff, focusing on their attitudes towards depression, may be necessary to change their behavior and enhance recognition of depression. Several studies have previously reported on attitudes toward depression among general physicians. However, little is known about attitudes of non-psychiatric doctors in Japan. In the present study, we surveyed non-psychiatric doctors’ attitude toward depression.
Methods
The inclusion criteria of participants in the present study were as follows: 1) Japanese non-psychiatric doctors and 2) attendees in educational opportunities regarding depression care. We conveniently approached two populations: 1) a workshop to depression care for non-psychiatric doctors and 2) a general physician-psychiatrist (G-P) network group. We contacted 367 subjects. Attitudes toward depression were measured using the Depression Attitude Questionnaire (DAQ), a 20-item self-report questionnaire developed for general physicians. We report scores of each DAQ item and factors derived from exploratory factor analysis.
Results
We received responses from 230 subjects, and we used DAQ data from 187 non-psychiatric doctors who met the inclusion criteria. All non-psychiatric doctors (n = 187) disagreed with "I feel comfortable in dealing with depressed patients' needs," while 60 % (n = 112) agreed with "Working with depressed patients is heavy going." Factor analysis indicated these items comprised a factor termed "Depression should be treated by psychiatrists" - to which 54 % of doctors (n = 101) agreed. Meanwhile, 67 % of doctors (n = 126) thought that nurses could be useful in depressed patient support. The three factors derived from the Japanese DAQ differed from models previously derived from British GP samples. The attitude of Japanese non-psychiatric doctors concerning whether depression should be treated by psychiatrists was markedly different to that of British GPs.
Conclusions
Japanese non-psychiatric doctors believe that depression care is beyond the scope of their duties. It is suggested that educational programs or guidelines for depression care developed in other countries such as the UK are not directly adaptable for Japanese non-psychiatric doctors. Developing a focused educational program that motivates non-psychiatric doctors to play a role in depression care is necessary to enhance recognition and treatment of depression in Japan.
doi:10.1186/1756-0500-5-441
PMCID: PMC3434090  PMID: 22894761
23.  A qualitative study of the learning processes in young physicians treating suicidal patients: from insecurity to personal pattern knowledge and self-confidence 
Background
Little empirical work has been done in studying learning processes among newly educated physicians in the mental health field.
The aim of the study was to shed light on the meaning of newly educated physicians' lived experiences of learning processes related to treating suicidal patients.
Methods
Thirteen newly educated physicians narrated their learning experiences while treating suicidal patients in their own practice. The interview texts were transcribed and interpreted using a phenomenological-hermeneutical method inspired by Ricoeur's philosophy.
Results
There was one main theme, four themes and eleven sub themes. The main theme was: Being in a transitional learning process. The themes and sub themes were: Preparing for practice (Getting tools and training skills, Becoming aware of one's own attitudes); Gaining experience from treating patients (Treating and following up patients over time, Storing memories and recognizing similarities and differences in patients); Participating in the professional community (Being an apprentice, Relating clinical stories and receiving feedback, Sharing emotions from clinical experiences, Receiving support from peers); and Developing personal competence (Having unarticulated awareness, Having emotional knowledge, Achieving self-confidence). The informants gave a detailed account of the learning process; from recognising similarities and differences in patients they have treated, to accumulating pattern knowledge, which then contributed to their personal feelings of competence and confidence. They described their personal competence with cognitive and emotional elements consisting of both articulated and less articulated knowledge. The findings are interpreted in relation to different learning theories that focus on both individual factors and the interaction with the learning environment.
Conclusion
This study provides additional information about learning experiences of young physicians during the critical transition phase from medical school to early professional life. Peers are used for both learning and support and might represent a more powerful resource in the learning process than previously recognized. Emotional experiences do not seem to be adequately focused upon in supervision, which obviously has relevance both for learning and for the well-being of young professionals. The study indicates some areas of the educational system that could profitably be expanded including stimulating more systematically to critical reflection on and in practice, attention to feelings in the reflective process and provision of more performance feedback to young physicians.
doi:10.1186/1472-6920-7-21
PMCID: PMC1950702  PMID: 17612413
24.  Awareness and Attitudes Towards Face and Organ Transplant in Kumasi, Ghana 
Ghana Medical Journal  2013;47(1):30-34.
Summary
Objectives
This study aimed to determine the level of awareness and attitudes towards face and organ transplant among the people of Kumasi, Ghana.
Design
An observational study was employed, where participants were randomly selected for the study.
Participants
The respondents were commuters waiting to board public vehicles at the Kejetia lorry station, Bantama/Komfo Anokye Teaching Hospital taxi station, Buokrom Estate F-line lorry station, traders, and residents of Adum and Bantama, all in Kumasi.
Methods
The descriptive study was conducted from 1st February to 30th April 2009. An interview-based questionnaire was used for the convenient sample of respondents. Data obtained included: demographic profile and items covering awareness, attitudes and beliefs towards face and organ transplant.
Results
Out of the 1020 respondents, females (53.2%) outnumbered males. The age of respondents ranged from 10 to 89 years; mean was 27.50± 2.98 years; majority (72.3%) was Christians, whilst 61.8% had gone through tertiary education. Few (33.5%) of the respondents were aware of face transplant; 70.0% and 62.1% were willing to receive a face if their face was disfigured or donate their face when dead respectively. Also, 50.6% were aware of organ transplant, whiles 59.1% would receive/donate an organ when required. Multiple regression analysis shows statistical significant association between attitudes, awareness and demographic variables listed.
Conclusion
Face and organ transplant were found to have a relatively low and high awareness level respectively. However, an affirmative attitude was recorded for face and organ transplant. More education on face and organ donations is needed.
PMCID: PMC3645184  PMID: 23661853
Face; Organ; Transplant; Awareness; Attitudes
25.  Trait Dissociation and the Subjective Affective, Motivational, and Phenomenological Experience of Self-Defining Memories 
Journal of Personality  2011;79(5):939-963.
The present research reports two studies that examine the relation between non-pathological trait dissociation and the subjective affect, motivation, and phenomenology of self-defining memories. In Study 1 (N=293), participants retrieved and rated the emotional and motivational experience of a general and a positive and negative achievement-related memory. Study 2 (N=449) extended these ratings to relationship-related memories and the phenomenological experience of the memory. Dissociation was associated with incongruent affect in valenced memories (e.g., positive affect in a negative memory) and memories that were visually incoherent and saturated with power motivation, hubristic pride, and shame, regardless of valence or domain. The present findings demonstrate that autobiographical memories, which integrate emotional, motivational, and phenomenological components, reflect the emotional and motivational processes inherent to dissociation.
doi:10.1111/j.1467-6494.2010.00708.x
PMCID: PMC3111868  PMID: 21204840
Dissociation; Autobiographical Memory; Emotion; Phenomenology

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