Joanna L. McParland

It's not fair: An Interpretative Phenomenological Analysis of discourses of justice and fairness in chronic pain

Quantitative research suggests that perceiving injustice can impact negatively upon physical and psychological health in chronic pain. However, little is known about the experience and perceptions of injustice in this context. This study examines the phenomenology of justice and injustice in chronic pain. Fifteen chronic pain sufferers recruited from General Practices in upper, middle and lower socioeconomic areas participated in one of three focus group discussions. Semi-structured interviews were conducted to interrogate justice-related conceptions. All discussions were observed, audio-recorded, transcribed verbatim and subjected to Interpretative Phenomenological Analysis. The dominant theme of the upper socioeconomic group was ‘seeking equality’. For the middle socioeconomic group the dominant theme was ‘battle for quality of life’ and for the lower socioeconomic group the dominant theme was ‘the unfair advantage of others’. It is concluded that this group of chronic pain sufferers prioritize justice-related issues in terms of what is dominant to their social concerns and personal needs.

“It’s Not Fair” Social Justice Appraisals in the Context of Chronic Pain

Social justice appraisals refer to evaluations about fairness. These judgments are particularly pertinent in the experience of an undeserved fate, such as the suffering caused by a chronic health complaint. Published research examining the implications of these appraisals for adjustment to long-term painful conditions has emerged only recently, focused in two areas of investigation. One area shows that perceived injustice for pain may be a vulnerability factor that can block adjustment. The second area shows that maintaining some sense of justice in life, despite personal adversity, might protect psychological health when people are in pain. The review discusses this research and identifies key reactions to perceived injustice in the context of chronic pain. We call for investigations to synthesize this research, specifically to establish mediators and moderators of varied justice appraisals, to examine the relationships between core justice beliefs and injustice appraisals, and to identify drivers of responses to injustice. Finally, we consider interventions for those pain sufferers struggling to cope with perceived injustice.

Just world beliefs moderate the relationship of pain intensity and disability with psychological distress in chronic pain support group members

The impact of pain beliefs on coping and adjustment is well established. However, less is known about how beliefs unrelated to pain might impact upon this experience. In particular, just world beliefs could impact upon and be influenced by chronic pain, given that pain is not experienced in a vacuum but instead is experienced in a social context where justice issues are potentially salient. The focus of this study was the ability of personal and general just world beliefs to moderate the relationships psychological distress held with pain intensity and disability in chronic pain. The sample (N = 95) was recruited from members of arthritis and fibromyalgia support groups to investigate these social beliefs in a controlled community pain context. A cross‐sectional, questionnaire design was adopted. The personal just world belief was endorsed significantly more than the general just world belief, and endorsement of the personal just world belief was negatively correlated with pain intensity, disability and psychological distress, while the general just world belief was unrelated to these variables. When interaction terms relating to personal and general just world beliefs were entered simultaneously into regression analyses, the personal just world belief did not predict psychological distress. However, pain intensity positively predicted psychological distress at low but not high levels of the general just world belief, while disability predicted psychological distress at low and high levels of this belief. This suggests that a strong general just world belief has implications for psychological well‐being in chronic pain, and as such this belief may occupy a potential coping function in this context.

An investigation of constructions of justice and injustice in chronic pain: a Q-methodology approach.

This study used Q-methodology to explore justice-related accounts of chronic pain. Eighty participants completed the Q-sorting procedure (33 chronic pain sufferers and 47 non-pain sufferers). Analysis revealed five main factors. Three factors blame: society for poor medical and interpersonal treatment; the chronic pain sufferer for indulging in self-pity and unempathic healthcare workers for ignoring patients. A fourth factor acknowledges the unfairness of pain and encourages self-reliance. The fifth factor rejects injustice in the chronic pain discourse. Overall, there is a shared view that chronic pain brings unfair treatment, disrespect and a de-legitimization of pain. Future research ideas are suggested.

A thematic analysis of attributions to others for the origins and ongoing nature of pain in community pain sufferers

Research suggests that pain sufferers can attribute their pain to others. However, this work is scarce, lacking in detail and does not focus on any particular time during the pain experience. To understand how these attributions operate in pain, this study sought to examine as an exclusive focus the types, context of, and rationale for attributions made to others for the origins and ongoing nature of pain. A community pain sample was voluntarily recruited into the study to gain a comprehensive understanding of these attributions and minimise potential group-specific bias. Sixty-two participants were interviewed using semi-structured questions about cause, responsibility and blame for pain. Data were analysed using a thematic analysis. Attributions to others emerged across interview questions. Acquaintances, professionals and strangers were implicated in pain onset for reasons including negligence, accident and attack. Few additional attributions were made for pain now. Those made were mostly to medical professionals for perceived poor treatment of an original pain condition encompassing issues related to compliance, diagnosis and treatment and searching for alternative pain solutions. This research provides insight into the social context in which pain attributions to others are reported, and provides the basis for research into largely untapped areas including the implications particular attributions have for adjustment to pain and relationships with others.

An exploration of adjustment to pain: interactions with attribution and individual difference variables

This study explored the nature of and the interactions between self-defined adjustment to pain, attributions, and individual difference variables. Sixty-two pain sufferers were interviewed using a semi-structured measure to allow them to define psychological, physical and social adjustment. Changes in psychological adjustment were also examined, using retrospective and current reports. Responsibility and blame were measured to determine the adaptive nature of attributions to the self and others, using these outcomes. The main results indicated the following. Individual differences in adjustment emerged. Various physical and social limitations of pain were reported, and they were frequently reported by participants aged 60 years and over. Additionally, adjustment outcomes not measured by more structured adjustment measures emerged, including positive statements. These were frequently reported by arthritis sufferers, and people with pain for over nine years’ duration. Descriptive analyses suggested that positive statements along with negative emotions changed for different times in the pain experience, in terms of their nature and frequency. Other-responsibility attributions were positively associated with negative psychological adjustment (p<0.05). Implications of these findings for future research are discussed.

An experimental investigation of the role of perceived justice in acute pain.

Emerging research suggests that perceiving injustice can compound the suffering of chronic pain, while perceiving justice serves as a positive psychological resource in this context. However, little more is currently known about the function of justice beliefs, particularly in the context of acute pain. The present study undertook this investigation, using cold pressor methodology to investigate whether trusting in the fairness of the world would help someone to cope with short‐term pain.

Effectiveness of interventions to improve the public’s antimicrobial resistance awareness and behaviours associated with prudent use of antimicrobials: a systematic review

Background A global antimicrobial resistance (AMR) awareness intervention targeting the general public has been prioritized. Objectives To evaluate the effectiveness of interventions that aim to change AMR awareness and subsequent stewardship behaviours amongst the public. Methods Five databases were searched between 2000 and 2016 for interventions to change the publics AMR awareness and/or antimicrobial stewardship behaviours. Study designs meeting the Cochrane Effective Practice and Organization of Care (EPOC) criteria, non-controlled before-and-after studies and prospective cohort studies were considered eligible. Participants recruited from healthcare settings and studies measuring stewardship behaviours of healthcare professionals were excluded. Quality of studies was assessed using EPOC risk of bias criteria. Data were extracted and synthesized narratively. Registration: PROSPERO international prospective register of systematic reviews (PROSPERO 2016: CRD42016050343). Results Twenty studies were included in the review with nine meeting the EPOC criteria. The overall risk of bias was high. Nineteen studies were conducted in high-income countries. Mass media interventions were most common (n = 7), followed by school-based (n = 6) and printed material interventions (n = 6). Seventeen studies demonstrated a significant effect on changing knowledge, attitudes or the publics antimicrobial stewardship behaviours. Analysis showed that interventions targeting schoolchildren and parents have notable potential, but for the general public the picture is less clear. Conclusions Our work provides an in-depth examination of the effectiveness of AMR interventions for the public. However, the studies were heterogeneous and the quality of evidence was poor. Well-designed, experimental studies on behavioural outcomes of such interventions are required.

The effects of a recalled injustice on the experience of experimentally induced pain and anxiety in relation to just-world beliefs

A growing field of investigation into social justice cognitions and pain suggests perceived injustice has a negative impact on pain, but little is known about individual variation in the impact of a perceived injustice. One published study found that individuals with a strong rather than a weak just‐world belief reported greater pain from the cold pressor task after experiencing a perceived injustice, but an overt measure of perceived unfairness is needed to investigate this relationship.

Nine lessons and recommendations from the conduct of focus group research in chronic pain samples.

PURPOSE  The view of the patient is central to their care. Focus group methodology has been used in health psychology to capture patient views on health and illness. However, the process of conducting focus group research with patient groups has received scarce attention. The purpose of this paper was to highlight lessons learned from the conduct of focus groups in psychological research with chronic pain samples. METHODS  Lessons were taken from three structured focus groups containing participants recruited from General Practice. Each group contained five, four, and six chronic pain sufferers from upper, middle and lower socioeconomic areas, respectively. RESULTS  Nine lessons were learned about the conduct of focus group research in general, and also with chronic pain sufferers in particular. The lessons relate to (1) translating study interest into group attendance, (2) ensuring the environment maximizes the opportunity to learn from participants, (3) understanding participant motivations for attendance as well as (4) what participants take from the group, (5) ensuring adequate question specificity, accommodating the needs of particular groups in (6) moderation style and (7) discussion time scales, (8) considering the function of conflict in the group and (9) paying due attention to simultaneous dialogue. Recommendations for addressing the lessons are made. CONCLUSION  Patient groups have specific requirements and the conduct of focus groups should be driven by these needs to maximize inclusion and quality contributions in the group. Time, resources, and flexibility are needed to ensure the successful transition of these groups into focus group research.