More Than Mental Illness: Experiences of Associating with Stigma of Mental Illness for Chinese College Students

From existing empirical research, we identified that Chinese college students commonly experience stigma surrounding mental illness and found some factors that support them in resisting the stigma and achieving psychological health. However, less research provides qualitative data involving individual experiences and insights on mental illness within this group of college students. This study, based on ACE-LYNX (an internationally cooperative research-sharing project between China and Canada), was conducted in Shandong, Jinan, and aims to promote the mental health of college students by empowering interdisciplinary professionals and students. Through the research project, this study analyzed the materials from 24 focus groups, explored the understanding of mental illness and prevalence of mental illness stigma in Chinese colleges at the present time, administered a background questionnaire, and provided statistical support for some revealed themes. The final themes are as follows: mental illness is stereotyped as “severe, pathetic, and complicated”; the misconception of “visiting a psychological counselor is scary”; from public stigma to self-stigma; barriers deterring students from seeking help or accessing services; two sides of the same coin: peer support versus peer pressure.

Identifying correlates of salt reduction practices among rural, middle-aged Muslim Indonesians with hypertension through structural equation modeling

Background: In 2016, the World Health Organization recommended salt reduction strategies. In most low- and middle-income countries, little is known about what causes people to reduce their salt intake. Aim: In rural West Java, Indonesia, we conducted a cross-sectional survey to describe self-reported salt reduction practices among middle-aged Muslims with hypertension (n = 447) and to identify correlates of salt reduction. Methods: We developed a questionnaire with Likert scales to measure self-reported frequency of efforts to reduce salt intake, and degree of agreement/disagreement with 51 statements about variables hypothesized to influence salt reduction practices. We compared groups using t-tests and one-way ANOVAs. Through one-factor confirmatory factor analysis and structural equation modeling, we identified correlates of salt reduction practices. Results: About 45% of participants reported regularly reducing their salt intake; only 12.8% reported never attempting. Men reported higher social barriers, while women reported higher family support and spiritual support. Overall, we found that participants’ frequency of effort to reduce their salt intake was associated with a constellation of six correlates. Salt reduction practices were directly positively associated with prior health/illness experiences (β = 0.25), and by seeking health information (β = 0.24). Seeking health information was in turn positively associated with prior health/illness experiences (β = 0.34), receiving support from health professionals (β = 0.23) and Islamic spiritual practice (β = 0.24). Salt reduction practices were negatively associated with environmental barriers to healthful eating practices (β = -0.14). Conclusion: In this population, reinforcing positive correlates identified in this study and mitigating against negative correlates may foster salt reduction practices.

Taking phenomenology beyond the first-person perspective: conceptual grounding in the collection and analysis of observational evidence

Phenomenology has been adapted for use in qualitative health research, where it’s often used as a method for conducting interviews and analyzing interview data. But how can phenomenologists study subjects who cannot accurately reflect upon or report their own experiences, for instance, because of a psychiatric or neurological disorder? For conditions like these, qualitative researchers may gain more insight by conducting observational studies in lieu of, or in conjunction with, interviews. In this article, we introduce a phenomenological approach to conducting this kind of observational research. The approach relies on conceptual grounding to focus a study on specific aspects of the participants’ experiences. Moreover, the approach maintains the openness to novel discoveries that qualitative research requires while also providing a structured framework for data collection and analysis. To illustrate its practical application, we use examples of hemispatial neglect—a neurologic disorder in which patients characteristically lack awareness of their own illness and bodily capacities. However, the approach that we describe can be applied more broadly to the study of complex illness experiences and other experiential alterations.

Stroke and COVID-19: The Value of Narrative Medicine

Stroke and COVID-19 are both traumatic and life-altering experiences that are marked by uncertainty, fear, and medical intervention. The devastation that stroke and COVID-19 oppress on an individual and a population is well established, and these traumas are potently magnified in the troughs of the COVID-19 pandemic. Furthermore, stroke has been shown to be a potential complication of COVID-19 infection, and while there is global controversy regarding this finding, it is undeniable that there are patients across the world presenting with both conditions concurrently. Thus, the topic of isolated stroke and the co-occurrence of stroke and COVID-19 amidst the pandemic both warrant considerable investigation on both a basic science level and a humanistic level. This opinion article advocates for a narrative medicine approach to better explicate the intertwining of stroke and COVID-19. Interviewing patients who presented with both stroke and COVID-19 as well as patients who present with stroke during the pandemic will provide the opportunity to gather and juxtapose individual illness experiences, including encounters with the health care system, relationship with care teams and care takers, recovery, and insights into the future. Creating, analyzing, and comparing such an anthology of illness narratives of the 2 patient populations will offer a unique understanding into the experience of different, yet over-lapping, medical traumas in an unprecedented time. With this deeper appreciation of patient accounts, the health care system can better recognize how to provide for future patients who present specifically with stroke or stroke and COVID-19. However, more broadly, this study can also afford insight into how the health care system can better provide for and support patients who present with complex diagnoses in the context of a complex healthcare system, which most probably will operate under the effects of the pandemic for time to come as well as other, future complicating factors.

Explanatory models, illness, and treatment experiences of patients with psychosis using the services of traditional and faith healers in three African countries: Similarities and discontinuities

As part of formative studies to design a program of collaborative care for persons with psychosis, we explored personal experience and lay attributions of illness as well as treatment among persons who had recently received care at traditional and faith healers’ (TFHs) facilities in three cultural groups in Sub-Saharan Africa. A purposive sample of 85 individuals in Ibadan (Nigeria), Kumasi (Ghana), and Nairobi (Kenya) were interviewed. Data was inductively explored for themes and analysis was informed by the Framework Method. Across the three sites, illness experiences featured suffering and disability in different life domains. Predominant causal attribution was supernatural, even when biological causation was also acknowledged. Prayer and rituals, steeped in traditional spiritual beliefs, were prominent both in traditional faith healing settings as well as those of Christianity and Islam. Concurrent or consecutive use of TFHs and conventional medical services was common. TFHs provided services that appear to meet the therapeutic goals of their patients even when harmful treatment practices were employed. Cultural and linguistic differences did not obscure the commonality of a core set of beliefs and practices across these three groups. This similarity of core worldviews across diverse cultural settings means that a collaborative approach designed in one cultural group would, with adaptations to reflect differences in context, be applicable in another cultural group. Studies of patients’ experience of illness and care are useful in designing and implementing collaborations between biomedical and TFH services as a way of scaling up services and improving the outcome of psychosis.

Enacting Woundedness and Compassionate Care for Recurrent Metastatic Breast Cancer

This analysis integrates Arthur Frank’s timeless revelations about woundedness within the communication context of an oncology interview. A Patient whose life is threatened by recurrent metastatic breast cancer claims personal knowledge and visibly demonstrates impacts from illness experiences. Conversation Analysis (CA) was conducted on a video recorded and transcribed case study involving a Patient, her husband, and co-present oncologists. By focusing on narratives as talk-in-interaction, grounded exemplars are provided of primary interactional achievements: How woundedness gets displayed and responded to with empathy and compassionate witnessing; Patient’s flooding out with emotion and potential embarrassment; attempting to regain control and resume talking about her condition; and the serial organization of crying and laughter when managing noticeably delicate moments. In this interview, woundedness is not discounted or dismissed but recognized as legitimate suffering meriting shared commiseration. Understanding how to enact humane and communicatively competent skills during emotionally uncertain moments can enhance medical education.

Transplant Tourism: New Zealand Residents Deciding on Commercial Transplantation Overseas

<p>The demand for organs exceeds supply in almost every country, including New Zealand. As such, scholars have argued that this has contributed to a rise in illegal kidney purchase and commercial transplantation. Taking into account the likelihood that patients in New Zealand have been involved, this research considers the factors that motivate these patients to circumvent the transplant opportunities here in favour of a commercial transplant overseas. In addition, this project examines the ethical concerns that arise for medical professionals who suspect or become aware of a patient’s intention to procure an organ outside of New Zealand. Interviews were conducted with eight medical professionals working in the field of kidney donation and transplantation, two key informants (stakeholder and academic), and two patients. The patients have previously undergone a kidney transplant in New Zealand and have both — to varying degrees — considered transplant tourism. Using narrative thematic analysis, the data was organised into three predominant themes; The Desire for Health, Transplant Tourism: An Uncommon Phenomenon, and The Healthcare Response. Numerous insights were generated from this analysis. While transplant tourism is considered by many patients in New Zealand, it is pursued infrequently and arguably only by those with connections to common destination countries. When such instances occur, medical professionals in New Zealand encounter a variety of ethical, legal, and professional dilemmas that affect their ability to prevent transplantrelated crimes. This research concludes that patients (regardless of whether or not they pursue transplant tourism) experience feelings of frustration and hopelessness as a result of their illness experiences along with the current healthcare infrastructures. Assisting patients in setting realistic expectations of their treatment options, as well as increasing the transparency of the deceased donor waiting list is recommended. Moreover, it is suggested that transplant professionals at all levels are offered education about organ trafficking and transplant tourism, and a policy statement on organ trafficking and transplant tourism should be developed to clarify the rights and obligations of medical professionals in relation to organ purchase and offer guidance on how they can interact with patients who travel or plan to travel abroad for a transplant.</p>

Transplant Tourism: New Zealand Residents Deciding on Commercial Transplantation Overseas

<p>The demand for organs exceeds supply in almost every country, including New Zealand. As such, scholars have argued that this has contributed to a rise in illegal kidney purchase and commercial transplantation. Taking into account the likelihood that patients in New Zealand have been involved, this research considers the factors that motivate these patients to circumvent the transplant opportunities here in favour of a commercial transplant overseas. In addition, this project examines the ethical concerns that arise for medical professionals who suspect or become aware of a patient’s intention to procure an organ outside of New Zealand. Interviews were conducted with eight medical professionals working in the field of kidney donation and transplantation, two key informants (stakeholder and academic), and two patients. The patients have previously undergone a kidney transplant in New Zealand and have both — to varying degrees — considered transplant tourism. Using narrative thematic analysis, the data was organised into three predominant themes; The Desire for Health, Transplant Tourism: An Uncommon Phenomenon, and The Healthcare Response. Numerous insights were generated from this analysis. While transplant tourism is considered by many patients in New Zealand, it is pursued infrequently and arguably only by those with connections to common destination countries. When such instances occur, medical professionals in New Zealand encounter a variety of ethical, legal, and professional dilemmas that affect their ability to prevent transplantrelated crimes. This research concludes that patients (regardless of whether or not they pursue transplant tourism) experience feelings of frustration and hopelessness as a result of their illness experiences along with the current healthcare infrastructures. Assisting patients in setting realistic expectations of their treatment options, as well as increasing the transparency of the deceased donor waiting list is recommended. Moreover, it is suggested that transplant professionals at all levels are offered education about organ trafficking and transplant tourism, and a policy statement on organ trafficking and transplant tourism should be developed to clarify the rights and obligations of medical professionals in relation to organ purchase and offer guidance on how they can interact with patients who travel or plan to travel abroad for a transplant.</p>

“I put a stone on my heart and kept going”: An explanatory model of how distress is generated and regulated among Indian women from slums reporting gender-based violence

Clinical variation in the expression of panic disorder, depression and anxiety, and posttraumatic stress disorder (PTSD) has have been documented across cultures. However, local (emic) cultural models that explain how people make sense of their illness experiences remain relatively understudied in India among trauma-exposed populations. Further, the integration of emic findings into clinical care is limited, underscoring the need for emic perspectives following trauma to improve the development or adaptation of trauma-focused treatments in India. This study describes an emic explanatory model of distress, which includes idioms of distress, perceived causes of distress, and coping/help-seeking behaviors among Indian women from slums reporting gender-based violence. This explanatory model can be used as a culturally grounded way to develop clinical case conceptualizations to adapt and deliver psychological treatments for this under-served population.

‘Walking in the shoes of our patients’: a scoping review of healthcare professionals learning from the simulation of patient illness experiences

Background Health professionals who have experienced ill-health appear to demonstrate greater empathy towards their patients. Simulation can afford learners opportunities to experience aspects of illness, but to date, there has been no overarching review of the extent of this practice or the impact on empathic skills. Objective To determine from the evidence—what is known about simulation-based learning methods of creating illness experiences for health professions and the impact on their empathic skills. Study selection Arksey and O’Malley’s methodological framework informed our scoping review of articles relevant to our research question. Three databases (MEDLINE, Embase and Web of Science) were searched, and a sample of 516 citations was screened. Following review and application of our exclusion criteria, 77 articles were selected to be included in this review. Findings Of the 77 articles, 52 (68%) originated from the USA, 37 (48%) of studies were qualitative based and 17 (22%) used a mixed-methods model. Of all the articles in our scope, the majority (87%) reported a positive impact and range of emotions evoked on learners. However, some studies observed more negative effects and additional debriefing was required post-simulation. Learners were noted to internalise perceived experiences of illness and to critically reflect on their empathic role as healthcare providers. Conclusions A diverse range of simulation methods and techniques, evoking an emotional and embodied experience, appear to have a positive impact on empathy and could be argued as offering a complementary approach in healthcare education; however, the long-term impact remains largely unknown.