Anita Melander-Wikman

Participatory and appreciative action and reflection (PAAR) – democratizing reflective practices

The paper introduces a new approach to reflecting and acting called participatory and appreciative action and reflection (PAAR). It explores its potential to enable individuals and groups to move forward, to improve their working practices and lives in particular communities and contexts. The paper situates PAAR in the historical context of participatory and action research and reflective learning. It suggests that using PAAR requires four strategic ‘turns’. By turn we mean a change in direction from one way of thinking and practising to another. The four turns are: (i) away from a preoccupation with changing behaviours in order to solve problems, with ‘fixing’ things and an engagement in deficit‐based discourses, towards the development of appreciative insight, understanding the root causes of success and sustaining strengths‐based discourses in order to amplify those things that will help build a better future from the positive present; (ii) away from self‐learning (individualism and isolation) and towards collective learning through interconnectedness, appreciative knowledge sharing and the use of new forms of communications technology which enable simultaneous action in dispersed geopolitical spaces; (iii) away from one way of knowing and one perspective on truth to an acceptance of more pluralistic view of ways of knowing, of understanding human experience and putting this knowing to good use; (iv) away from reflective cycles and spirals and towards the use of a reflective learning (r‐learning) framework comprising four mutually supportive processes. They are those of developing an appreciative ‘gaze’, of reframing lived experience, of building practical wisdom and of achieving and moving forward.

Patient empowerment in rehabilitation: “Somebody told me to get rehabilitated”

Within healthcare, there is a growing interest in patient influence and participation. The aim of this study is to describe patients’ experience of participation in and influence on rehabilitation with the focus on physiotherapy. Interviews with patients from three different primary healthcare centres were conducted. The result indicated low patient participation in and influence on the rehabilitation process within the hospital. The informants trusted the competence of the caregivers and tried to be as compliant as possible. Their experiences were that training must be supported and followed up. Information about rights was requested. The informants felt that they were listened to and confirmed by the physiotherapists. The positive attitude was combined with low demands and a great feeling of gratitude as a matter of course. Using information and support from the physiotherapist, together with friends and next of kin, the informants had learned to cope with the new situation. In this paper, these results are understood and described in terms of the parallel process of rehabilitation, based on traditional and individual models, and implying that the patient copes with the situation by shifting between being compliant and adopting more self-regulatory behaviour, for example. Attitudes are changing in society and this study reflects the patient of today, and is confirmed by recent studies.

Reflections on an appreciative approach to empowering elderly people, in home healthcare

This is a reflective account of aspects of our collective concern about developing and sustaining ways that might enable elderly people to feel more empowered to exercise their right of self‐determination. This work has been undertaken in the context of home healthcare in northern Sweden. In this paper we put three espoused values ‘under pressure’ from client, professional (homecare staff) and research perspectives. We also explore three aspects of the pictorial landscape of homecare (see Figure 1). They are the notions of client participation, empowerment and ICT. The living data for this paper is drawn from two days of workshop activities with 35 homecare staff working in the municipality of Luleå, Sweden. The workshop was one outcome of the e‐Home Health Care @ North Calotte (eHHC) Project of 2003–2005. We conclude with some collective reflections about: (a) the practice of participation (dialogue) and an intention of it (empowerment) in the context of clients accelerating service change; (b) how to reframe traditional views of the relationships between research and practice and, as a consequence, open up new possibilities for understanding how elderly people’s lived experiences can be a positive force for service improvement; and (c) the use of storyboards as an appreciative approach to enable frontline staff to reflect on their work, share and learn together. Figure 1 A pictorial version of our abstract

Gender perspectives on views and preferences of older people on exercise to prevent falls: a systematic mixed studies review

BackgroundTo offer fall prevention exercise programs that attract older people of both sexes there is a need to understand both women’s and men’s views and preferences regarding these programs. This paper aims to systematically review the literature to explore any underlying gender perspectives or gender interpretations on older people’s views or preferences regarding uptake and adherence to exercise to prevent falls.MethodsA review of the literature was carried out using a convergent qualitative design based on systematic searches of seven electronic databases (PubMed, CINAHL, Amed, PsycINFO, Scopus, PEDro, and OTseeker). Two investigators identified eligible studies. Each included article was read by at least two authors independently to extract data into tables. Views and preferences reported were coded and summarized in themes of facilitators and barriers using a thematic analysis approach.ResultsNine hundred and nine unique studies were identified. Twenty five studies met the criteria for inclusion. Only five of these contained a gender analysis of men’s and women’s views on fall prevention exercises. The results suggests that both women and men see women as more receptive to and in more need of fall prevention messages. The synthesis from all 25 studies identified six themes illustrating facilitators and six themes describing barriers for older people either starting or adhering to fall prevention exercise. The facilitators were: support from professionals or family; social interaction; perceived benefits; a supportive exercise context; feelings of commitment; and having fun. Barriers were: practical issues; concerns about exercise; unawareness; reduced health status; lack of support; and lack of interest. Considerably more women than men were included in the studies.ConclusionAlthough there is plenty of information on the facilitators and barriers to falls prevention exercise in older people, there is a distinct lack of studies investigating differences or similarities in older women’s and men’s views regarding fall prevention exercise. In order to ensure that fall prevention exercise is appealing to both sexes and that the inclusion of both men and women are encouraged, more research is needed to find out whether gender differences exists and whether practitioners need to offer a range of opportunities and support strategies to attract both women and men to falls prevention exercise.

Towards sustainable business models from healthcare technology research

As demographic ageing impacts across the world, health and welfare organisations are seeking new paradigms of care that address peoples needs as well as being inherently more scalable than the incumbent processes and services. The aim of this paper is to describe the current situation in Europe with information on service provision, before signposting some possible new ways to develop sustainable business models that support care models. The paper uses a case study approach to examine the issues in the introduction of such business models, from a perspective of the translation of research proof of concepts into business services and from the perspective of developing innovations from research that address unmet or poorly considered needs of user. The paper shows how several innovative European projects are anticipating the need for service change and are designing their research outcomes to match the needs of service commissioners more fully. The conclusion discusses several different approaches before drawing together strands of the work and providing tentative recommendations on the way forward to develop new inclusive technology-enhanced services in health and social care.

The concept of palpation of the shoulder – A basic element of physiotherapy practice: A focus group study with physiotherapists

Although palpation is frequently used in physiotherapy examinations, a limited amount of research has been done to clarify this concept. The aim of this study was to describe physiotherapists’ experiences of shoulder palpation with the intention of obtaining detailed descriptions of the concept of palpation. Three focus group interviews were conducted, including a total of seven physiotherapists who had experience of patients with shoulder disability built up over a long period. A qualitative content analysis of the interviews was carried out. The findings showed how palpation can be perceived as a skill that could be described from two different perspectives: Manual and technical palpation and Palpation being dependent on the relationship between the physiotherapist and the patient. Palpation requires time, and the knowledge and experience of palpating built up over time. We also found how the two “perspectives” of palpation were inseparable from each other. The ability to perform manual and technical palpation and the relationship between the physiotherapist and the patient can be considered an interactive learning situation where the physiotherapist and the patient develop mutual knowledge of the body.

Gender Perspective on Older People's Exercise Preferences and Motivators in the Context of Falls Prevention : A Qualitative Study

Background Several factors have previously been identified to positively influence the uptake and adherence for fall prevention exercise programmes. There is, however, a lack of studies investigating if men and women differ in their views and preferences for fall prevention exercises. Aim To explore exercise preferences and motivators of older community-dwelling women and men in the context of falls prevention from a gender perspective. Methods Workshops including multistage focus group discussions were conducted with 18 older community-dwelling people with and without history of falls. Participants were purposively selected and divided into two groups. Each group met on six occasions over a period of five months. Participatory and Appreciative Action and Reflection methodology was used to guide the discussions. A qualitative content analysis approach was used in the analysis. Results Older participants had many diverse preferences and confirmed that individually tailored exercise, in terms of mode, intensity, challenge, and social context, is important. Moreover, important factors for exercise adherence and maintenance included the experience of individual confirmation; different spirit lifters to increase enjoyment; and personal tricks to maintain exercise routines. The individual differences within genders were more diverse than the differences between women and men. Conclusion Exercise interventions to prevent falls should be individually tailored, based on the specific needs and preferences of the older participant, and do not appear to require gender specific approaches. To increase adherence, intrinsic motivation for exercise may be encouraged by competence enhancing confirmations, energizing spirit lifters, and practical tips for exercise maintenance. The study provides an awareness about womens and mens preferences for fall prevention exercises, and this information could be used as guidance in designing inclusive exercise interventions.

Improving health and safety for elderly people through an ethic-of-appreciation

IntroductionThis paper uses data from My Health @ Age (2008-2010), an EU, Northern Periphery funded project. Its aim is to offer the rapidly ageing population in the northern periphery regions of E ...Age and ageing related humour expressed in birthday cards has been suggested to support negative attitudes towards aged people. Little attention has been paid to how retired people themselves exper ...It is well known that reduced ability to perform activities of daily living (ADL) and declining mobility are both related to advanced age. This relation is also valid for low quality-of-life. It is ...The HPA-1 polymorphism of alphaIIbbeta3 arises from a Leu to Pro exchange at residue 33 of the beta3 subunit resulting in HPA-1a (Leu33) or HPA-1b (Pro33). We have documented that patients with coronary artery disease who are carriers of HPA-1b experience their myocardial infarction 5.2 years earlier than HPA-1a/1a patients (JTH 2005; 3: 1522). Based on these observations, it has been postulated that HPA-1b is a prothrombotic variant of alphaIIbbeta3. To explore the molecular nature of this phenotype, we have now generated a model overexpressing fluorescent proteins fused with alphaIIbbeta3 in transfected HEK293 cells. The yellow (YFP) and the cyan fluorescent protein (CFP) were cloned to the C-termini of the beta3 and alphaIIb subunits prior to transfection of HEK293 cells, subsequently expressing the fusion proteins of both HPA-1 isoforms. Using flow cytometry, Western blotting and specific antibodies directed against alphaIIb or beta3, we identified 12 HPA-1a and 11 HPA-1b positive clones expressing equal amounts of fluorescent fusion proteins, i.e. a 140 kD alphaIIb-CFP and a 113 kD beta3-YFP. Functional integrity of both integrin variants and proper membrane insertion were documented by intact activation through G protein-coupled receptors with organic acid, PMA-induced activation of protein kinase C and by specific binding of Alexa647 fibrinogen to alphaIIbbeta3. In the presencence of pertussis toxin or abciximab, activation or ligand binding of alphaIIbbeta3 were completely (> 98%) inhibited in both isoforms. Analysis of Src, a tyrosine kinase associated with alphaIIbbeta3, revealed that activation of the phosphotyrosine motif at residue 418 was higher in adherent HPA-1b than HPA-1a cells (P < 0.01). Upon activation of alphaIIbbeta3, analysis by FRET showed equal kinetics with signal disappearance of 40 5% in both HPA-1 variants. We therefore conclude that the postulated prothrombotic phenotype of HPA-1b (Pro33) is related to increased outside-in signaling rather than to allosteric changes of the C-terminal cytoplasmic tails of alphaIIbbeta3. Disclosure of interest: none declared.