[Show abstract][Hide abstract] ABSTRACT: Body dissatisfaction can be significantly detrimental to wellbeing. Little is known about older adults' body image, despite the fact that ageing causes unique bodily changes and that sociocultural pressures to resist these changes abound. We conducted six focus groups with a UK community sample of White British and South Asian older adults aged 65-92 years. Thematic analysis highlighted four themes: appearance indicates capability and identity; physical ability trumps appearance; felt pressures to age 'gracefully' while resisting appearance changes; and gender and cultural differences. These findings suggest that older adults' body image can have important implications for their wellbeing and merits researchers' attention.
Journal of Health Psychology 04/2014; · 1.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Breast cancer is one of the most common forms of cancer in the UK, and affects women of all ethnic groups. The psychosocial impact of breast cancer has been well documented. However, research conducted in this area has been primarily focused on white women. There is very little work within the breast cancer literature that captures the experiences of black and minority ethnic (BME) women. The aim of this qualitative study was to explore the experiences of breast cancer diagnosis and treatment in black and South Asian women living in the UK. Individual semi-structured interviews were conducted with 22 English-speaking breast cancer survivors (11 black and 11 South Asian women). Thematic analysis of the data revealed five key themes, namely social support, spirituality, body image concerns, healthcare experiences and life after cancer. The findings showed that although the BME women shared similar concerns to white women, their experiences were also influenced by cultural specific concerns. This study has implications for healthcare professionals and recognises the need to provide culturally sensitive care and support to BME women, tailored specifically to their values and beliefs.
Diversity and Equality in Health and Care. 01/2014; 11(2).
[Show abstract][Hide abstract] ABSTRACT: To explore the day-to-day experience of young people living with neurofibromatosis type 1 in the UK, focusing on the role that appearance plays in this experience.
neurofibromatosis type 1 is a genetic condition, which is highly variable and unpredictable. It can result in varying degrees of visible difference (disfigurement). Both the effect of NF1 on appearance and its uncertainty can prove particularly difficult for those affected. However, very little research to date has investigated the psychosocial impact of neurofibromatosis type 1 on young people or their experiences of managing it.
Exploratory qualitative interview study.
Nine young people aged 14-24, with a confirmed diagnosis of neurofibromatosis type 1, took part in semi-structured interviews between March-September 2011. Interview transcripts were thematically analysed.
Three key themes were identified from the data: (1) 'Different things to different people' reflecting the variability in the condition; (2) 'Relationships and reactions' relating to individuals' social experience; and (3) 'Understanding and misunderstanding' reflecting participants' experiences with organizations and social structures.
Findings suggest a need for further research to explore young people's adaptation and management of neurofibromatosis type 1. In particular, raising awareness and understanding of the condition among professionals and in the general public was an important issue for young people. In addition, access to trustworthy information about neurofibromatosis type 1 and practical advice to support adjustment to an altered appearance and managing stigma experiences are highlighted as areas to be considered further.
Journal of Advanced Nursing 11/2013; · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Psychosocial difficulties have been reported in head and neck cancer (HNC) patients, yet only few studies have assessed the impact of altered appearance following HNC treatment using theoretically selected measures of appearance-related distress. This study investigated appearance-related adjustment following HNC, and demographic and socio-cognitive predictors of adjustment. HNC patients (n = 49) completed baseline questionnaires and a nine-month postal follow-up (n = 20). Participants showed considerable variation in appearance-related adjustment, with females reporting higher levels of appearance-related distress (derriford appearance scale [DAS-24]) than females in the general population and male HNC survivors. Depression scores on the hospital anxiety and depression scale were higher than UK norms whilst anxiety was similar to UK norms. There were no significant differences between baseline and follow-up data. Fear of negative evaluation (a central feature of social anxiety) was a significant predictor of appearance-related adjustment at baseline, whilst dispositional optimism was a significant predictor of appearance-related adjustment at baseline and follow-up. Qualitative responses showed themes of appearance and disability, and coping strategies. Findings suggest that appearance-related adjustment post-HNC varies considerably and psychosocial services working with HNC patients should consider this broad pattern of response. Future research to examine the role of socio-cognitive predictors of appearance-related adjustment could progress development of effective psychological interventions.
Psychology Health and Medicine 11/2013; · 1.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract Purpose: This study investigates experiences of dating and intimate relationships amongst women who use a below-knee prosthesis. Method: Four women took part in semi-structured online interviews. Transcripts were subject to interpretative phenomenological analysis (IPA). Results: Five themes were identified: Revealing and Exposing: Disclosing the Amputation and Prosthesis; Judging and Judged: Internal Fears and Self-Doubt; Trusting and Accepting: Good Guy/Bad Guy Elimination; Taking it Further: The Need for Depth; and Realisation: Accepting and Feeling Accepted. Participants described how, despite negative feelings towards their appearance and body image, they chose not to conceal their prosthesis when dating. Rather, it was used as a means of screening potential partners in their search for deep and meaningful relationships. Realising that others were not prejudiced towards people who use a prosthetic had helped them become more comfortable with their own prosthesis. Conclusion: These findings suggest that facilitating contact with other below-knee amputees and, in some cases specialist support, could help those who are struggling with the challenges they face regarding dating and intimate relationships. They also highlight the need for researchers and clinicians to give more attention to these important aspects of amputees' lives. Implications for Rehabilitation Amputation can have a significant psychosocial impact for those affected. The relative invisibility of below-knee amputation and prostheses can present particular challenges for amputees looking to establish romantic and intimate relationships, particularly around when and how to disclose the limb loss to potential partners. Developing a sense of resilience to the reactions of other people can help those who have undergone below-knee amputation. Support for people affected by below-knee amputation should routinely consider their needs and concerns in relation to new and established relationships, offer specialist psychosocial input when needed and provide opportunities for support from other amputees.
Disability and Rehabilitation 05/2013; · 1.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study evaluated an adapted version of 'Happy Being Me', a school-based body image intervention, with girls and boys aged 10-11 years. Forty-three children participated in a three-week intervention, and 45 children formed a control group. Both groups completed measures of body satisfaction, risk factors for negative body image, eating behaviors, self-esteem, and intervention topic knowledge, at baseline, post-intervention, and three month follow-up. For girls, participation in the intervention resulted in significant improvements in body satisfaction, appearance-related conversations, appearance comparisons, eating behaviors and intervention topic knowledge at post-intervention, although only the change in body satisfaction was maintained. There was also a significant decrease in internalization of cultural appearance ideals from baseline to follow-up. For boys, participation in the intervention resulted in significant improvements in internalization and appearance comparisons at post-intervention; however, neither of these changes were sustained at follow-up. There were no improvements in the control group over time.
[Show abstract][Hide abstract] ABSTRACT: Some people who have a visible difference (disfigurement) experience psychosocial adjustment problems that can lead to social anxiety and isolation. The aim of this study was to assess the effectiveness of a new computerised CBT-based intervention (Face IT) in reducing anxiety and appearance-related distress for individuals with visible differences. Face IT was tested against a non-intervention control group and standard CBT-based face-to-face delivery. Eighty-three participants were assessed at four time points using the Hospital Anxiety and Depression Scales, Derriford Appearance Scale-24, Body Image Quality of Life Inventory and Fear of Negative Evaluation (FNE). The findings indicate a significant reduction in anxiety and appearance-related distress in both the Face IT intervention and the face-to-face condition. Similar findings were reported for depressive symptoms and FNE. Results at the three and six months follow-up demonstrate increased improvements in psychological functioning with both interventions. This new online psychosocial intervention has been found to be effective at reducing anxiety, depression and appearance concerns amongst individuals with disfigurements, whilst increasing positive adjustment. A remote-access, computer-based intervention offers the potential to provide psychosocial support more easily and in a cost-effective manner to adults with appearance-related distress.
Psychology Health and Medicine 02/2012; 17(5):565-77. · 1.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This paper is a report of a descriptive qualitative study of the evolution of women's perceptions and experiences of ductal carcinoma in situ from the period near to diagnosis to 1 year later.
Ductal carcinoma in situ is a non-invasive breast condition where cancer cells are detected but confined to the ducts of the breast. With treatment, the condition has a positive prognosis but ironically patients undergo treatment similar to that for invasive breast cancer. There is a lack of longitudinal qualitative research studying women's experiences of ductal carcinoma in situ, especially among newly diagnosed patients, and how experiences change over time.
Forty-five women took part in an initial interview following a diagnosis of ductal carcinoma in situ and 27 took part in a follow-up interview 9-13 months later. Data were collected between January 2007 and October 2008. Transcripts were analysed using a hybrid approach to thematic analysis.
Women's early perceptions of ductal carcinoma in situ merged and sometimes conflicted with their lay beliefs of breast cancer. Perceptions and experiences of the condition shifted over time. These overriding aspects were evident in four themes identified across the interviews: (i) perceptions of ductal carcinoma in situ vs. breast cancer, (ii) from paradox to acceptance, (iii) personal impact, and (iv) support and interactions with others.
This study represents one of the few longitudinal qualitative studies with newly diagnosed patients, capturing women's initial and shifting experiences and perceptions of the condition. The issues identified need to be recognized in clinical practice and supported appropriately.
Journal of Advanced Nursing 07/2011; 68(4):856-67. · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This experimental study examined whether a brief video intervention identifying the artificial nature of media images could protect adolescent girls from negative media exposure effects and body dissatisfaction.
A 2 (intervention condition)×2 (exposure condition) between-groups design was used.
Participants were 127 British girls aged between 10 and 13 recruited from two secondary schools. Girls were assigned to one of four experimental conditions. An intervention video was shown to half of the girls immediately before they viewed ultra-thin models or control images. The video was developed by Dove's Self-Esteem Fund and has the benefits of being professionally produced and freely available through the Internet.
In the absence of the intervention video, viewing thin idealized models was associated with lower state body satisfaction and lower state body esteem than exposure to control images. However, viewing the video intervention immediately before exposure prevented this negative exposure effect.
The results suggest that, in the short term, this widely available video prevents girls from making damaging social comparisons with media models. Although this study only examined short-term effects, the findings add to the growing evidence that media literacy interventions may be useful tools in protecting young girls from body dissatisfaction.
British Journal of Health Psychology 05/2011; 16(Pt 2):396-403. · 2.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 127 women who had previously undergone surgical nipple reconstruction completed self-report questionnaires to assess body image, anxiety, depression, information preference, and satisfaction with surgical outcome, information provision, and the decision to undergo the procedure. Whilst most women were satisfied with the outcome of surgery and of their decision to have nipple reconstruction, this study highlights the importance of information provision that meets patients' needs at the time of decision-making, in particular information about likely nipple sensation after surgery.
Journal of Plastic Reconstructive & Aesthetic Surgery 04/2011; 64(4):494-9. · 1.44 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Individual and group interviews explored experiences of positive adjustment among 12 people with a range of visible differences. Thematic analysis identified four main themes: importance of appearance; personal growth; relationships with others; and coping (factors in the coping theme considered to be paramount to positive adjustment were inner strength and positivity, active coping techniques, downward social comparisons, taking things day-by-day, spirituality and humour). The findings provide insight into behaviours and personal outlooks that may contribute to adaptive coping and have implications for future research and interventions aimed at those who exhibit poor adjustment to visible difference. The article reflects on the use of both individual and group interviews for research in this field.
Journal of Health Psychology 02/2011; 16(5):739-49. · 1.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: No previous research has explored the impact of the many appearance changes that can occur in patients following bone marrow transplantation (BMT).
This research aimed to explore in depth patients' experiences of appearance changes following allogeneic BMT to address the lack of knowledge in this area.
Semistructured interviews were conducted with 6 men and women who had received an allogeneic BMT within the previous 6 months to 2 years. Interviews were analyzed using interpretative phenomenological analysis.
The findings illustrated that appearance changes had an impact on participants' confidence. It was also found that participants appeared to prioritize and view their appearance changes in the context of having a life-threatening treatment and experiencing many adverse effects. Appearance changes were a low priority until the immediate dangers of treatment had subsided and participants were returning to their former roles. In addition, it was also found that the isolation that participants experienced while recovering from transplant seemed to lessen the effects of appearance changes by limiting their exposure to the reactions and perceptions of others.
The effects of appearance changes on confidence may become problematic if individuals are still experiencing an altered appearance when returning to former roles.
This study highlights the need to identify and support those with long-term appearance changes.
Cancer nursing 11/2010; 34(4):315-21. · 1.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Individuals with visible differences can experience social anxiety in relation to their appearance. Social skills-based psychosocial interventions have to date shown only limited effectiveness at addressing their concerns.
To incorporate user perspectives in the development of an online psychosocial intervention, known as Face IT.
Study one consisted of a needs assessment with 12 individuals with a visible difference and six health professionals in order to identify the difficulties experienced by those with visible difference and obtain feedback on the proposed content of Face IT. The findings demonstrated support for the social skills model and the use of an online intervention. Study two consisted of an empirical usability evaluation of Face IT with 14 potential users and 14 health professionals. Based on feedback from the participants, changes were made to the graphics and navigation of the programme. The clinical content has been made more acceptable.
The findings indicate support for the importance of social skills-based psychosocial interventions for addressing the needs of those with a visible difference, and have allowed modifications to be made to Face IT ahead of a randomized controlled trial of effectiveness.
Behavioural and Cognitive Psychotherapy 10/2010; 38(5):577-96. · 1.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Breast reconstruction (BR) is undertaken to improve cosmetic outcomes, but how this is optimally assessed is uncertain. This review summarises current methods for assessing cosmesis after reconstructive surgery and makes recommendations for future practice.
A comprehensive systematic review identified all studies with 20 or more participants that evaluated the cosmetic outcome of BR. Four evaluation criteria (reporting of study inclusion criteria, type and timing of BR and timing of assessment) were used to assess study quality. Articles reporting at least three of the four criteria were considered robust and further summarised to report methods of cosmetic assessment, assessor details and the scoring systems used.
122 primary papers assessed cosmesis in 11,308 women with median follow-up of 28.8 months (range 18.0-42.9 months). Cosmesis was assessed by either healthcare professionals or patients in 33 (27.1%) and 37 studies (30.3%), respectively, and by both professionals and patients in 52 (42.6%). Professional assessments included 43 (40.2%) clinical, 49 (45.8%) photographic and 13 (12.1%) geometric assessments conducted by between 1 and 26 observers. Surgeons were most frequently involved in assessments (n = 71, 67.6%), but in 38 (36.1%) papers the assessor's profession was not reported. Twenty-seven (25.7%) papers used previously published assessment scale. Patients' views were assessed in 89 studies, using questionnaires (n = 63) or interviews (n = 12); 14 (15.7%) did not report how patients' views were obtained.
Current methods for assessing the cosmetic outcome of BR vary widely. A valid patient-centred assessment method is required to fully understand the outcomes of BR and to inform decision-making.
Annals of Surgical Oncology 10/2010; 18(3):813-23. · 4.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: As survival rates increase, many people have to adjust to life after cancer. This includes adjusting to life after surgery. While previous research suggests that patients commonly strive to be 'normal' after mastectomy and reconstructive surgery, research surrounding individual perceptions of normality is lacking.
The aim of this study was to explore concepts of normality within a sample of breast cancer patients eligible for reconstructive surgery following mastectomy.
A total of 35 semi structured interviews, with women who had undergone or were about to undergo breast reconstructive surgery following breast cancer, were analysed using thematic analysis.
Four main themes emerged from the data. Women referred to looking normal (appearance); being able to fulfil everyday activities (behaviour); adapting to a new normal (reconstructing normality); and not being ill (health). The importance placed on each area of normality differed between patients. Additionally, patients used different standards to anchor concepts of normality. These included individual standards, social standards and clinical standards.
The results indicate that although there are commonalities between patients' concepts of normality, it is important for health care professionals to recognise potential individual differences. This may usefully aid communication and help to manage expectations among patients considering surgical options.
[Show abstract][Hide abstract] ABSTRACT: DCIS is a non-invasive breast cancer, increasingly detected through routine breast screening. Patients are reassured that the condition is early and not life-threatening but they undergo surgery similar to that used in the treatment of invasive breast cancer (IBC). Little research has explored the psychosocial impact of DCIS, especially in the UK. A longitudinal, prospective study was therefore conducted to address this gap. Fifty women newly diagnosed with DCIS were followed over the first year post-diagnosis. Anxiety and depression significantly reduced from baseline to 6 months. Body image distress was relatively stable, but extensive for some women. Those undergoing mastectomy with immediate reconstruction experienced significantly greater body image concerns. This study highlights that DCIS patients can experience psychosocial distress that is often transient but in some cases extensive and prolonged. Appropriate psychosocial support is needed to help DCIS patients adjust to the diagnosis, its treatment and long-term implications.
Breast (Edinburgh, Scotland) 04/2010; 19(5):382-7. · 2.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Research suggests that rheumatoid arthritis (RA) can have a negative psychosocial impact on partners, as well as patients. However, until now there has been very little in-depth qualitative research in this area. The aim of this study was to explore the experiences of partners of people with RA.
Semi-structured interviews were conducted with a heterogeneous sample of eight partners of people with RA (six men, two women, age range 48-73 years). Transcripts were analysed thematically.
Five overarching themes emerged: psychological burden in partners was substantial, as they experienced frustration and distress at watching their partner suffer and tried to protect their spouse from emotional and physical distress. 'It's a restricted life': partners reported having to cut back on previously enjoyable shared activities and had difficulty making future plans. Adjusting lives: partners had to make considerable adjustments to many aspects of their lives, and had adopted practical and psychological ways to cope. 'It's a joint approach': many partners discussed adopting a joint approach to managing the RA. Met and unmet support needs varied considerably, and many partners felt that a joint approach to treatment taken by health professionals is needed, which involves and recognizes their role.
Partners of people with RA are vital to the patients' disease management, but the data show that many carry a substantial psychosocial burden. Healthcare professionals should be aware of this, so that couples coping with RA can be better supported.
[Show abstract][Hide abstract] ABSTRACT: Using combined qualitative data from multiple case study interviews and an online survey, this study explored the impact of appearance change on 22 adolescents receiving cancer treatment aged 13 to 18 years and six of their parents. Data were analyzed using template analysis. Appearance changes were a major concern. Adolescents typically struggled to adapt to new experiences and concerns related to this highly sensitive issue. Many felt anxious and self-conscious and were reluctant to reveal appearance changes in public. These feelings were compounded by the negative reactions of others (e.g., staring, teasing, and inappropriate questioning), which sometimes lead to avoidance of social activity and threats of noncompliance. Parents of these children felt ill-prepared to manage appearance-related anxieties. Adolescents wanted support to develop the practical and social skills necessary to maintain a "normal" appearance and manage the negative responses of others. However, some adolescents showed resilience and, with support from friends and family, developed strategies to manage their altered appearance and its social consequences. These strategies are explored, which can inform interventions to support adolescents and parents.