Julie Hepworth

An Interpretative Phenomenological Analysis of Participation in a Pro-anorexia Internet Site and Its Relationship with Disordered Eating

Pro-anorexia Internet sites aim to promote, support and discuss anorexia nervosa. Media coverage has raised concerns that sites may increase the level of eating disorders. This research examines the meaning of participation in a pro-anorexia Internet site and its relationship with disordered eating by using an interpretative phenomenological analysis of fifteen separate message ‘threads’ followed over a six-week period. Four themes were identified: (1) tips and techniques; (2) ‘ana’ v. anorexia nervosa; (3) social support; and (4) need for anorexia. Findings suggest participation was multi-purpose, providing a coping function in relation to weight loss, and the contribution of sites to increased levels of eating disorders is not inevitable.

A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia, New Zealand, and the United Kingdom

OBJECTIVE The aim of this study was to examine the prevalence of overweight and obesity and the association with demographic, reproductive work variables in a representative cohort of working nurses and midwives. DESIGN A cross sectional study of self reported survey data. SETTINGS Australia, New Zealand and the United Kingdom. METHODS Measurement outcomes included BMI categories, demographic (age, gender, marital status, ethnicity), reproductive (parity, number of births, mothers age at first birth, birth type and menopausal status) and workforce (registration council, employment type and principal specialty) variables. PARTICIPANTS 4996 respondents to the Nurses and Midwives e-Cohort study who were currently registered and working in nursing or midwifery in Australia (n=3144), New Zealand (n=778) or the United Kingdom (n=1074). RESULTS Amongst the sample 61.87% were outside the healthy weight range and across all three jurisdictions the prevalence of obesity in nurses and midwives exceeded rates in the source populations by 1.73% up to 3.74%. Being overweight or obese was significantly associated with increasing age (35-44 yrs aOR 1.71, 95% CI 1.41-2.08; 45-55 yrs aOR 1.90, 95%CI 1.56-2.31; 55-64 aOR 2.22, 95% CI 1.71-2.88), and male gender (aOR 1.46, 95% CI 1.15-1.87). Primiparous nurses and midwives were more likely to be overweight or obese (aOR 1.37, 95% CI 1.06-1.76) as were those who had reached menopause (aOR 1.37, 95% CI 1.11-1.69). Nurses and midwives in part-time or casual employment had significantly reduced risk of being overweight or obese, (aOR 0.81, 95% CI 0.70-0.94 and aOR 0.75, 95% CI 0.59-0.96 respectively), whilst working in aged carried increased risk (aOR 1.37, 95% CI 1.04-1.80). CONCLUSION Nurses and midwives in this study have higher prevalence of obesity and overweight than the general population and those who are older, male, or female primiparous and menopausal have significantly higher risk of overweight or obesity as do those working fulltime, or in aged care. The consequences of overweight and obesity in this occupational group may impact on their workforce participation, their management of overweight and obese patients in their care as well as influencing their individual health behaviours and risks of occupational injury and chronic disease.

Hepatitis C: A Socio-cultural Perspective on the Effects of a New Virus on a Community's Health.

Since the emergence of diagnostic medical tests in Australia in 1990, hepatitis C (HCV) has been shown to account for over 90 percent of all non-A non-B hepatitis, revealing it to be a widespread and major public health problem. The diagnosis of HCV involves a diverse range of issues for affected persons, introducing identity and lifestyle changes, which are commonly articulated through psychological concepts. In this article we argue that it is important to examine the broader social and cultural contexts that contribute to the experiences of persons affected by HCV. The thematic analysis of qualitative data from six individuals diagnosed with HCV is included to exemplify some of the processes that are involved in the changing identity of a person following a positive diagnosis. The theoretical framework for the interpretation of these processes is interpretive interactionism. In this research, we are attempting to extend the understanding of the effects of HCV diagnoses beyond internal, psychological processes by examining how these diagnoses transform some of the processes of self-formation and expression. The participants’ experiences indicate that there are at least four dimensions of self that were significant to their changing sense of self: relationship of self to others; the emotional self; self-stories and identity; and self-scrutiny and relationships. We conclude that a socio-cultural perspective contributes to the explanation of the transition period following a HCV-positive diagnosis and the redefinition of self towards a HCV status.

The emergence of critical health psychology: can it contribute to promoting public health?

The purpose of this article is twofold: first to provide an overview of the emergence of critical health psychology for those working in the related social and health sciences and as a review of its major developments for health psychology; and second to discuss critically the potential for critical health psychology to contribute to promoting public health with specific reference to the directives espoused by Prilleltensky (2003) and Murray and Campbell (2003). The identification of three philosophical phases of the emergence of critical health psychology is used to examine the directions of the field and the challenges facing critical health psychology in order to contribute to public and global health.

Public Health Psychology: A Conceptual and Practical Framework

Increasingly, the development of public health infrastructures requires psychology to reevaluate its contribution to public health at local, national and global levels. Already familiar to some psychologists, particularly those in community psychology and health promotion, the expansion of public health has implications for psychology in terms of knowledge/practice and working differently in multidisciplinary settings. In this article, I provide a critical overview of the implications of the historical and international development of health psychology and the changing nature of public health to strengthen the establishment of public health psychology. A conceptual and practical framework is proposed in which public health psychology theory, methods and practice are considered as well as its relevance to the health social sciences more generally.

Lay theories of anorexia nervosa: a discourse analytic study.

Previous studies on lay theories of anorexia nervosa have examined the ‘accuracy’ of lay knowledge, and the identification of factors by family and friends that would encourage early interventions (Huon, Brown, & Morris, 1988, 7, 239–252; Murray, Touyz, & Beumont, 1990, 9, 87–93). In contrast to these approaches, we examine lay theories of anorexia nervosa using a critical psychology perspective. We argue that the use of a discourse analysis methodology enables the examination of the construction of lay theories through dominant concepts and ideas. Ten semi-structured interviews with five women and five men aged between 15 and 25 years were carried out. Participants were asked questions about three main aspects of anorexia nervosa: aetiology, treatment and relationship to gender. Each interview was analysed in terms of the structure, function and variability of discourse. Three discourses: sociocultural, individual and femininity, are discussed in relation to the interview questions. We conclude that, in this study, lay theories of anorexia nervosa were structured through key discourses that maintained a separation between sociocultural aspects of anorexia nervosa and individual psychology. This separation exists in dominant psychomedical conceptualizations of anorexia nervosa, reinforcing the concept that it is a form of psychopathology.

Nurses' role in caring for people with a comorbidity of mental illness and intellectual disability: A literature review

This article examines literature on the role of the nurse caring for people with a dual disability (DD) of intellectual disability and mental illness. A search of the literature between 2000 and 2010 resulted in a total of 21 articles that met the inclusion criteria. Seven key categories of the role of the nurse were identified: (i) advocacy/health promotion (including working with family); (ii) assessment/case management; (iii) behavioural interventions; (iv) communication; (v) leadership and the nurses role within the multidisciplinary team; (vi) functions regarding medication administration; and (vii) safety/risk management. There is a paucity of research about the role of nurses working with people with DD, although a number of opinion-based articles exist. This article identifies a need for the role of the nurse working in DD to be more clearly articulated and for the development of evidence to guide best practice.

Research participation by people with intellectual disability and mental health issues: An examination of the processes of consent

Balancing the demands of research and ethics is always challenging, and even more so when recruiting vulnerable groups. Within the context of current legislation and international human rights declarations, it is strongly advocated that research can and must be undertaken with all recipients of health-care services. Research in the field of intellectual disability presents particular challenges in regards to consenting processes. This paper is a reflective overview and analysis of the complex processes undertaken, and events that occurred in gaining informed consent from people with intellectual disability to participate in a study exploring their experiences of being an inpatient in mental health hospitals within Aotearoa/New Zealand. A framework based on capacity, information, and voluntariness is presented, with excerpts from the field provided to explore consenting processes. The practical implications of the processes utilized are then discussed in order to stimulate debate regarding clearer and enhanced methods of gaining informed consent from people with intellectual disability.

Narrative review of changing medical and feminist perspectives on menopause: From femininity and ageing to risk and choice

Meanings and descriptions of menopause have shifted focus over the past century and a half; more particularly the past sixty years has seen a shift from descriptions of hormone decline and its relation to ageing, femininity and symptoms of menopause since the 1960s to the possibility for preventive medicine afforded by menopause. Medicine is not a static field in its construction of menopause. It has changed, not least by its engagement (positively or negatively) with critique from both within (epidemiological) and without (feminist and social sciences). In this review we identify three recent changes: (1) Increasing concern with womens decision-making. (2) The emergence from within medicine of the rejection of the use of language which defines menopause as a condition of deficiency. (3) New insights from postmodern and poststructural analyses of menopause that examine the epistemological foundations of medical and feminist concepts of menopause and contest fixed descriptions of the experience of menopause. Key aspects of a ‘medical menopause’ nevertheless remain constant: menopause is a loss of hormones that results in predictable effects and risks and may be ameliorated by hormone replacement therapy. A question therefore emerges about how and to what effect medical practitioners have engaged with critiques of the medical menopause?

A qualitative systematic review of maternal infant feeding practices in transitioning from milk feeds to family foods

Abstract Evidence supports the establishment of healthy feeding practices early in life to promote lifelong healthy eating patterns protective against chronic disease such as obesity. Current early childhood obesity prevention interventions are built on extant understandings of how feeding practices relate to infants cues of hunger and satiety. Further insights regarding factors that influence feeding behaviors in early life may improve program designs and outcomes. Four electronic databases were searched for peer‐reviewed qualitative studies published between 2000 to 2014 with transitional infant feeding practice rationale from developed countries. Reporting transparency and potential bias was assessed using the Consolidated Criteria for Reporting Qualitative Research quality checklist. Thematic synthesis of 23 manuscripts identified three themes (and six sub‐themes): Theme 1. Infant (physical cues and behavioural cues) focuses on the perceived signs of readiness to start solids and the feeding to influence growth and “health happiness.” Theme 2. Mother (coping strategies and knowledge and skills) focuses on the early survival of the infant and the family and the feeding to satisfy hunger and influence infant contentment, and sleep. Theme 3. Community (pressure and inconsistent advice) highlights the importance of generational feeding and how conflicting feeding advice led many mothers to adopt valued familial or culturally established practices. Overall, mothers were pivotal to feeding decisions. Satisfying infants needs to reach “good mothering” status as measured by societal expectations was highly valued but lacked consideration of nutrition, obesity, and long term health. Maternal interpretation of healthy infant feeding and successful parenting need attention when developing strategies to support new families.