Cathrin Martin

Learning as Longitudinal Interactional Change : From Other-Repair to Self-Repair in Physiotherapy Treatment

The aims of this article are to address how learning is constituted and can be studied as a phenomenon in interaction and to discuss how teaching and learning are related. Theoretically, the article argues for and discusses constraints and affordances for relating sociocultural understandings of learning as changing participation to conversation analysis understandings of participation. The data material consists of longitudinal video recordings of authentic physiotherapist–patient encounters. This study traces the progressional change in the formation of movement behavior through detailed analysis of repair and correction practices. The results show a change in participation over time through capturing changes in the repair and correction organization participants use to resolve troubles with understanding and movement performance. In sum, there is a successive change for the patient from other- to self-initiated repair and correction, and from other- to self-repair and correction. The findings relate to the notion of educational scaffolding and have implications for teaching professions.

Relevance of Situational Context in Studying Learning as Changing Participation

Seemingly small situational problems with understanding and changes in the environment can constitute critical aspects in learning a task. I will describe and discuss through a detailed analysis of correction practices in interaction how learning in a situation influences a learners ability to distinguish and handle continuity and change in related situations. Correction is “an understanding‐display device” by which participants in interaction can check and correct problems occurring in activity. The socio‐cultural understanding of learning as changing participation is the point of departure. The data material consists of longitudinal video recordings from naturally occurring physiotherapist‐patient encounters focussing the interplay between talk, gaze, gesture, body orientation, and artefacts. Through an integrated interactional exploration of smaller alternating cycles of changes from other to self regarding who is responsible for detecting and solving problems, the findings show how a learners capability to notice similarities and differences develops in progressive situations. The analysis contributes empirically to expanding the understanding of some generative aspects of learning related to the issue of transfer in educational science.

Affordances for Participation: Children's Appropriation of Rules in a Reggio Emilia School

This study explores how young children appropriate school rules and what opportunities for active participation are afforded in a Reggio Emilia elementary classroom with particular interest in the interactional and communicative competences children display in situated practice. An ethnographic and microanalytic approach is used to study how the material environment and multimodal resources are mobilized in the activity. The analysis is based on video-recorded sequences in which 6- to 7-year-old children participate in a school project about rules for the schoolyard. The detailed analysis demonstrates how the children plan, reflect, enact, and discuss how to apply their own co-constructed rules in locally relevant ways in the playground. Overall, the findings shed light on how opportunities for childrens active participation are situated within and also afforded by the particular Reggio Emilia educational practice that is also shaped by the learning process itself.

From Clinical Expert to Guide: Experiences From Coaching People With Rheumatoid Arthritis to Increased Physical Activity

Background Physical activity levels in people with rheumatoid arthritis are lower than what are recommended for a healthful lifestyle. To support physical activity, health care professionals may use behavioral change techniques based on a biopsychosocial perspective. Investigating the implementation process may be relevant for understanding how these techniques translate to practice. Objectives The study objective was to explore the experiences of physical therapists using behavioral change techniques to coach people with rheumatoid arthritis to health-enhancing physical activity in a 2-year trial, the Physical Activity in Rheumatoid Arthritis 2010 study. Design This was an exploratory study with qualitative content analysis. Methods Semistructured interviews were conducted with all 12 physical therapists in the study. They were asked about their experiences with an educational program and with their delivery of a health-enhancing physical activity intervention. Codes, subcategories, categories, and an overarching theme were derived from the transcribed interviews by use of qualitative content analysis. Results The overarching theme (from clinical expert to guide) was based on 3 main categories: challenges in the coaching role, growing into the coaching role, and coach education and support. Early in the process, the physical therapists encountered challenges that needed to be addressed for a smoother transition into their coaching role. Assisted by education and support, they gradually adopted practices that facilitated their use of behavioral change techniques and promoted growth into the role of coach. Conclusions Adapting to a new role is a challenging process for health care professionals; it requires relevant education and support. The experiences identified in the present study may inform future educational programs targeting the skills of health care professionals in promoting various health-related behaviors.

Older Adults' Perceptions of Exercising in a Senior Gym

This qualitative study investigated what factors influenced older adults to start and continue to exercise in a senior gym. Eight individuals, ages 65–81, were interviewed. The interviews were analyzed by manifest content analysis. Exercising at their own pace and finding peers, competent staff, and accessible machines were all positive factors for continuing to exercise in a senior gym. Initially, training was something to do to take control of life, physically or time-wise. Later, training became a health investment and a social activity. The found factors can be used as strategies for changing physical activity behavior in older adults.

Development of a Web-Based and Mobile App to Support Physical Activity in Individuals With Rheumatoid Arthritis: Results From the Second Step of a Co-Design Process

Background Long-term adherence to physical activity recommendations remains challenging for most individuals with rheumatoid arthritis (RA) despite evidence for its health benefits. Objective The aim of this study was to provide basic data on system requirement specifications for a Web-based and mobile app to self-manage physical activity. More specifically, we explored the target user group, features of the future app, and correlations between the system requirements and the established behavior change techniques (BCTs). Methods We used a participatory action research design. Qualitative data were collected using multiple methods in four workshops. Participants were 5 individuals with RA, a clinical physiotherapist, an officer from the Swedish Rheumatism Association, a Web designer, and 2 physiotherapy researchers. A taxonomy was used to determine the degree of correlation between the system requirements and established BCTs. Results Participants agreed that the future Web-based and mobile app should be based on two major components important for maintaining physical activity: (1) a calendar feature for goal setting, planning, and recording of physical activity performance and progress, and (2) a small community feature for positive feedback and support from peers. All system requirements correlated with established BCTs, which were coded as 24 different BCTs. Conclusions To our knowledge, this study is the first to involve individuals with RA as co-designers, in collaboration with clinicians, researchers, and Web designers, to produce basic data to generate system requirement specifications for an eHealth service. The system requirements correlated to the BCTs, making specifications of content and future evaluation of effectiveness possible.

Physical activity in sleep apnea and obesity : personal incentives, challenges, and facilitators for success

The purpose of this study was to explore aspects of engagement in physical activity in persons with obstructive sleep apnea and overweight. Seven women and 8 men were interviewed, and transcribed data were analyzed according to qualitative content analysis. Two themes evolved reflecting influences on engagement in physical activity: (a) incentives strong enough and (b) facilitators for success and challenges to overcome. Strong incentives to change seem crucial for engagement in physical activity. The identified challenges and facilitators concerned a spectrum of emotional and contextual aspects, as well as diseases and physical symptoms. Exploring the patients expectations on physical activity behavior change and the perceived facilitators and barriers for engagement may be helpful when tailoring behavioral support strategies.

“I Don't Know What You're Looking for”: Professional Vision in Swedish Agricultural Extension on Nature Conservation Management

Abstract The article addresses how farmers learn to appropriate the gaze of the ‘new farmer’, by describing how farmers and advisers in the field discursively construct farmland under scrutiny for inclusion in government support schemes. Based on the findings, recommendations for successful agricultural extension are presented. The methodological perspective is an interaction analysis based on video recordings of advisory encounters. The analysis is focused on the professional vision of the participants. The results show how the participants manifest different professional visions when they walk through the same piece of land. Despite an interest in contributing to the encounter, insufficient access to relevant resources is an obstacle for the farmer. Due to asymmetries between the participants, the professional vision of the adviser becomes the dominating and acknowledged one, but the prerequisites are insufficient to afford learning by the farmer. To overcome this dilemma, we encourage reflection on the role of the adviser by challenging the frames for participation in extension encounters.

Facilitators and barriers for eating behaviour changes in obstructive sleep apnoea and obesity - a qualitative content analysis.

Abstract Purpose: Obesity is a major risk factor for obstructive sleep apnoea syndrome, a condition known causing lack of sleep continuity and daytime sleepiness. Weight loss interventions are recommended, however knowledge on what facilitate and impede eating behaviour change is lacking for this particular population. The aim of this study was to identify personal conceptions of prerequisites for eating behaviour change. Method: A qualitative study on 15 patients with obstructive sleep apnoea syndrome (OSAS; apnoea-hypopnoea index >15) and obesity (Mean body mass index 38.2). Semi-structured interviews were conducted and data were transcribed and analysed using qualitative content analysis with researcher triangulation for trustworthiness. Results: Data were organised according to barriers and facilitators for changing eating behaviour. Identified barriers were desire and reward, cravings and emotional control, low self-confidence, insufficient support, taxing behaviours, cost, lack of knowledge about healthy eating strategies, perceived helplessness and low susceptibility. Identified facilitators were positive expectations, fear of negative consequences, experience of success, support and follow-up, accessibility, applied skills for healthy eating, personal involvement and challenged self-image. Conclusion: This study adds knowledge on important barriers and facilitators of eating behaviour change according to individuals with obesity and OSAS. Information used to inform a tailored behavioural medicine intervention targeting eating behaviours. Implications for Rehabilitation Patients with obstructive sleep apnoea syndrome (OSAS) benefit from weight loss and eating behaviour changes are recommended. Patients’ views on prerequisites for eating behaviour change are important to plan, conduct and tailor behaviour change interventions. These aspects have hitherto not been elaborated in patients with OSAS. Considerations on patient’s self-image and perceived susceptibility along with providing strategies for controlling the desire and rewarding feeling associated with eating are emphasised.

Physical therapists’ assessments, analyses and use of behavior change techniques in initial consultations on musculoskeletal pain: direct observations in primary health care

BackgroundBehavioral medicine (BM) treatment is recommended to be implemented for pain management in physical therapy. Its implementation requires physical therapists (PTs), who are skilled at performing functional behavioral analyses based on physical, psychological and behavioral assessments. The purpose of the current study was to explore and describe PTs’ assessments, analyses and their use of behavioral change techniques (BCTs) in initial consultations with patients who seek primary health care due to musculoskeletal pain.MethodsA descriptive and explorative research design was applied, using data from video recordings of 12 primary health care PTs. A deductive analysis was performed, based on a specific protocol with definitions of PTs’ assessment of physical and psychological prognostic factors (red and yellow flags, respectively), analysis of the clinical problem, and use of BCTs. An additional inductive analysis was performed to identify and describe the variation in the PTs’ clinical practice.ResultsRed and yellow flags were assessed in a majority of the cases. Analyses were mainly based on biomedical assessments and none of the PTs performed functional behavioral analyses. All of the PTs used BCTs, mainly instruction and information, to facilitate physical activity and improved posture. The four most clinically relevant cases were selected to illustrate the variation in the PTs’ clinical practice. The results are based on 12 experienced primary health care PTs in Sweden, limiting the generalizability to similar populations and settings.ConclusionRed and yellow flags were assessed by PTs in the current study, but their interpretation and integration of the findings in analyses and treatment were incomplete, indicating a need of further strategies to implement behavioral medicine in Swedish primary health care physical therapy.