Kiara Lewis

Women's experiences of coping with pain during childbirth: A critical review of qualitative research

OBJECTIVE to identify and analyse qualitative literature exploring womens experiences of coping with pain during childbirth. DESIGN critical review of qualitative research. FINDINGS ten studies were included, conducted in Australia, England, Finland, Iceland, Indonesia, Iran and Sweden. Eight of the studies employed a phenomenological perspective with the remaining two without a specific qualitative methodological perspective. Thematic analysis was used as the approach for synthesising the data in this review. Two main themes emerged as the most significant influences upon a womans ability to cope with pain: (i) the importance of individualised, continuous support and (ii) an acceptance of pain during childbirth. This review found that women felt vulnerable during childbirth and valued the relationships they had with health professionals. Many of the women perceived childbirth pain as challenging, however, they described the inherent paradox for the need for pain to birth their child. This allowed them to embrace the pain subsequently enhancing their coping ability. KEY CONCLUSIONS womens experience of coping with pain during childbirth is complex and multifaceted. Many women felt the need for effective support throughout childbirth and described the potential implications where this support failed to be provided. Feeling safe through the concept of continuous support was a key element of care to enhance the coping ability and avoid feelings of loneliness and fear. A positive outlook and acceptance of pain was acknowledged by many of the women, demonstrating the beneficial implications for coping ability. These findings were consistent despite the socio-economic, cultural and contextual differences observed within the studies suggesting that experiences of coping with pain during childbirth are universal. IMPLICATIONS FOR PRACTICE the findings suggest there is a dissonance between what women want in order to enhance their ability to cope with pain and the reality of clinical practice. This review found women would like health professionals to maintain a continuous presence throughout childbirth and support a social model of care that promotes continuity of care and an increasing acceptance of pain as part of normal childbirth. It is suggested future research regarding the role of antenatal provision for instilling such a viewpoint in preparation of birth be undertaken to inform policy makers. The need for a shift in societal norms is also suggested to disseminate expectations and positive or negative views of what the role of pain during childbirth should be to empower women to cope with childbirth and embrace this transition to motherhood as part of a normal process.

Pupils' and teachers' experiences of school-based physical education: a qualitative study

Objectives To explore pupils’ and teachers’ experiences of physical education (PE). Study design A qualitative investigation employing semistructured interviews. Self Determination Theory was used as a guiding theory and Template Analysis was used to analyse the data. Setting A secondary school in the North East of England. Participants 14 pupils (aged 13 and 14, boys and girls) with a range of self-perceived competencies regarding PE and four PE teachers of the pupils (3 male, 1 female). Primary and secondary outcomes (1) Attitudes and perceptions of PE pupils regarding their experiences of compulsory school PE lessons. (2) PE teachers’ experiences of teaching PE. Results Key results from pupils and teachers suggest pupils enjoy participation in PE when they feel competent, in control and supported by others. Feeling competent depended on (1) the activity within PE and (2) the pupils perceived physical capabilities/aptitude. Feeling in control related to (1) having a choice of activities, (2) being able to set exertion levels and (3) control over clothes worn while taking part. Relationships within pupil groups and between pupils and teachers were perceived as important. Teachers could positively influence their pupils’ enjoyment by understanding and supporting their personal goals, as opposed to dictating and controlling what they did and for how long, and by promoting a non-threatening atmosphere between pupils. Conclusions Rising obesity levels and concerns over the fitness of children and young people has returned the focus of PE to its potential as a vehicle for promoting health. This study suggests schools and PE teachers in particular can positively influence the PE experience of both boys and girls by providing more choice of activities and letting pupils make their own decisions based on their personal needs.

Person-centred phenomenology: service user experiences of exercise

Purpose The purpose of this paper is to explore the lived experience of sport and exercise amongst a group of mental health service users. Participants were recruited from a north of England NHS mental health trust that was piloting a sport and exercise intervention for adults with mental health needs. Design/methodology/approach In depth semi-structured interviews were conducted with five mental health service users. The chosen phenomenological methodology was collaborative and interpretive. Findings Two essential themes were highlighted: “Intermittent health breaking through heavy clouds of illness” and “The cycle of recovery”. In addition, this person-centred research identified a number of intervention benefits beyond those relating to the impact of physical activity on mental health and wellbeing. The main findings are expressed using visual imagery which participants found expressed their perceptions and experiences better than written prose. This includes the way day-to-day illness impacts on the journey of health for people with mental health problems. Research limitations/implications The intervention looked to help the transition between leaving mental health services and developing a regular routine to promote recovery. The study illuminates the voices of service users and identifies that sport and exercise for mental health service users can be beneficial for recovery and feelings of belonging which can strengthen perceptions of the self. Originality/value Few studies have approached this methodological approach. This study demonstrates the value of phenomenological research with a collaborative, person-centred or indeed an involved patient focus. This collaborative approach enabled a shared understanding of the phenomena.

Are incremental changes in physical activity and sedentary behaviours associated with improved employee health? : A 12-month prospective study in five organisations

Purpose – The workplace offers an ideal setting for facilitating physical activity and reducing sedentary behaviours. Understanding employees’ current health behaviours is required to inform appropriate, tailored, health promotion interventions. The purpose of this paper is to compare the physical activity and sedentary behaviours over 12 months of employees within and across five UK organisations. The paper also explores the association of these health behaviours with objective and self-reported health outcomes; and investigates the association between physical activity and sedentary behaviours. Design/methodology/approach – Self-reported physical activity and sedentary behaviours were recorded at four time points (baseline, three, six, 12 months). BMI, per cent body fat, waist circumference, blood pressure and resting heart rate were collected in health checks (baseline, 12 months). Well-being and health were collected via questionnaire. Findings – Low physical activity and high sedentariness were evide...

‘It’s not mind blowing really….it’s about keeping people happy’: the perceptions of player welfare managers in Rugby Super League

Abstract At a time when the welfare needs of individuals within powerful organisations, such as professional sport, are being scrutinised it is appropriate to look at what is being done to support athletes and what more may be needed. The RFL, in recognition of the need for welfare support, introduced player welfare managers to all Super League clubs in 2011. Using an interpretivist approach, we report the findings from a series of semi-structured interviews with player welfare managers (PWMs) that explored the PWMs’ perceptions of player welfare, what impact they believe they are having on player welfare, and what else is needed to enhance the service. The PWMs perceive that they have been an important resource for players, independent of the club and coaches, which has allowed players to seek support for a range of issues. The use of the services provided by PWMs increased over the time between interviews, this, it is thought, is due in part to a change of culture within the sport. The PWMs felt the head coach, along with the backing of the club, and the RFL structure were important in the services being accessible and accepted. The PWMs were struggling to meet the demands of their job roles, which were largely part time. However, since the results of this and other studies were made accessible to the RFL, large-scale changes to welfare provision have been made, including making the PWMs’ posts full-time. This is seen as an important contribution and commitment to players’ welfare needs.

Social Physique Anxiety and physical activity behaviour of male and female exercisers

Abstract Despite females consistently reporting greater social physique anxiety (SPA), previous literature has yet to demonstrate whether SPA gender differences are linked to the way males and females perform physical activity. This study investigated an association between SPA and physical activity frequency, history of exercise, and physical activity intensity. Participants were represented by currently active users (N = 33 males; N = 31 females) of an on-campus university-run gym and completed a background physical activity questionnaire and the nine-item Social Physique Anxiety Scale. Participants also performed an exercise session at a self-selected level of exertion, with the intensity of each session measured via heart rate monitor. SPA was not associated with physical activity frequency, history of exercise (length of gym membership), or intensity for male and female exercisers. With respect to male participants, females reported higher SPA and a preference for performing higher intensity physical activity. Females and males also indicated a preference for performing aerobic and anaerobic physical activity respectively. Our findings suggest the experience of SPA does not deter body-conscious individuals from the performance of regular physical activity. Findings also suggest the discrepancy in male and female SPA is not linked to differences in the way physical activity is performed.

Breast cancer survivors’ perceptions of participating in a supervised exercise intervention: an exploratory review of the literature

ABSTRACT Background. Despite the reported beneficial effects of physical activity (PA) during and after cancer diagnosis, current research data suggest that the percentages of breast cancer survivors who adhere to PA recommendations are low. The objective of the present systematic, critical review was to identify, analyze, and provide a summary of qualitative literature findings, which have explored breast cancer survivors’ experiences of participating in an exercise/PA intervention after cancer treatment. Methods. A systematic search was conducted using CINAHL, PsychINFO, PubMed, and Scopus electronic databases to search for qualitative literature published during 2000–2016. A total of six studies that met the inclusion criteria were reviewed. Thematic synthesis, following Thomas and Harden’s methods, were used to analyze the data. Findings. Seven descriptive themes were developed: control, focus, transitioning phase, regaining a sense of confidence, enhanced spirits, social support, and safe environment. The findings suggested that participation in supervised exercise interventions enhanced the self-confidence and mood of breast cancer survivors. It allowed them to regain control and provide a focus, thereby allowing them to move forward in their lives. Conclusion. The results of this systematic critical review indicated that the supervised exercise was a positive experience for breast cancer survivors.

An exploration of the meaning of physical activity for working adults and their reluctance to reduce sedentary behaviour

An active pregnancy encompasses benefits that apply to both mother and baby. However, before investing resources in interventions aimed at changing or supporting expectant mothers’ physical activity behaviours, it is necessary to have a greater fundamental understanding of the modifiable factors influencing women’s decisions during this time. Therefore, the main purpose of this study was to investigate the socio-cognitive determinants of physical activity during pregnancy. A mixed methods research approach using a multiphase design framed by the Theory of Planned Behaviour (TPB; Ajzen, 1991, Organizational Behavior and Human Decision Processes, 50, 179-211) guided the investigation. Following ethical approval and permission to carry out the study, participants were recruited from randomly selected antenatal clinics in the East Kent region of England. Application of the TPB required both qualitative and quantitative cross-sectional data to be collected. Study One (n = 18) involved the elicitation of pregnant women’s beliefs towards being physically active. The modal salient behavioural, normative and control beliefs were used to inform the development of a TPB questionnaire which was implemented during the next phase of the investigation. Study Two (n = 78) examined the predictive utility of the TPB in explaining pregnant women’s physical activity intentions and behaviour and scrutinised the role of past behaviour within this context. Finally, Study Three (n = 10) comprised semi-structured interviews involving community midwives. Meta-inferences maintained the function of improving the validity of the study and advancing the overall aim of the research project. Specifically, triangulation was used to ascertain convergence, corroboration, and correspondence of findings between studies. Whilst results of the individual studies hold merit, meta-inferences point towards the development of three main themes: (1) pregnant women lack access to the necessary information that would allow them to make informed decisions regarding their engagement in physical activities; (2) a co-ordinated effort involving interprofessional collaboration is required to support pregnant women in overcoming barriers associated with regular physical activity participation; and (3) profiling pregnant women according to motivation and behaviour status could serve as a useful and manageable starting point for intervening to produce positive changes in pregnant women’s physical activity behaviour. In normalising physical activity during pregnancy and achieving better health outcomes for mothers and babies, it is necessary to consider the modifiable factors involved in behaviour change, identify opportune moments to intervene, and involve a network of professionals in facilitating and supporting pregnant women’s engagement with physical activities.Life skills are defined as a range of transferrable skills needed for everyday life (Jones and Lavallee, 2009, Psychology of Sport and Exercise, 10, 159-167). According to Benson and Saito’s (2001, In P.L. Benson & K.J. Pittman (Eds.), Trends in youth development: Visions, realities and challenges (pp. 135-154). London, UK: Kluwer Academic Publishers) framework for youth development theory and research, life skills impact upon young people’s academic performance, health and well-being. Thus, the aim of this study was to explore the relationships between university sports degree students’ life skills (teamwork, goal setting, time management, emotional skills, interpersonal communication, social skills, leadership, and problem solving & decision making) and their academic self-efficacy, predicted academic performance, health-related quality of life (physical, emotional, social, and work/school functioning), and flourishing. With institutional ethics approval, 423 sports degree students (male = 236, female = 187, mean age = 20.42 ± 2.56 years) completed a survey assessing the main study variables. Standard multiple regression analyses revealed that time management (B = .51, P < .001), problem solving & decision making (B = .23, P < .01), and goal setting (B = .15, P < .05) contributed significantly to students’ academic self-efficacy. Time management was the only significant contributor to students’ predicted academic performance (B = 2.23, P < .001). In terms of health-related quality of life, emotional skills (B = .23, P < .001) were the only significant contributor to students’ emotional functioning, social skills (B = .18, P < .001) were the only contributor to students’ social functioning, and both time management (B = .25, P < .001) and problem solving & decision making (B = .14, P < .05) contributed significantly to students’ work/school functioning. Finally, five life skills contributed significantly to students’ flourishing: social skills (B = .27, P < .001), leadership (B = .26, P < .01), emotional skills (B = .20, P < .001), goal setting (B = .14, P < .01), and time management (B = .13, P < .01). Interpretation of the results suggest that university degree programmes and staff (e.g., lecturers or learning services) should help sports degree students develop these life skills which contribute to their academic performance, health-related quality of life, and flourishing. In practice, staff could provide specific learning sessions during the degree programme, that target the development of key life skills at what is a critical developmental period of young adulthood.This abstract was published in Journal of Sports Sciences : BASES Conference 2017 – Programme and Abstracts on 24 November 2017 (online) available at http://dx.doi.org/10.1080/02640414.2017.1378421Reactive strength index (RSI) has been described as an individual’s ability to change quickly from an eccentric to a concentric contraction (Young, 1995, New Studies in Athletics, 10, 825-833). RSI has been used in the practical strength and conditioning setting and exercise science literature as a means of quantifying stretch-shortening cycle performance (Flanagan and Comyns, 2008, Strength and Conditioning Journal, 30, 32-38). A drop jump test has been used extensively to assess an athlete’s RSI capabilities. Recently, RSI has been derived from the average of the best 5 jumps obtained from a series of 10 maximal repeated bilateral hops (10/5 repeated jump test (RJT)) (Harper, Hobbs and Moore, 2011, BASES Student Conference). Limited research exists on the interday reliability and usefulness (ability to detect the smallest worthwhile change) of the 10/5 RJT with no reported research for a female population. This study aimed to assess the reliability and usefulness of RSI derived from the 10/5 RJT for an amateur female field sport population. With institutional ethical approval, 15 female participants (mean age: 21.1 ± 0.9 years; stature: 1.65 ± 0.73 m; body mass: 62.0 ± 5.1 kg) (mean ± s) completed 2 trials of the 10/5 RJT with 60 s rest after a specific warm-up protocol on two testing sessions separated by a minimum of 48 hours. A 10/5 RJT technique familiarisation session preceded the two testing sessions. For all 10/5 RJT trials the participants were instructed to minimise ground contact time and maximise jump height. The best trial from each testing day was used for the interday reliability and usefulness analysis. Acceptable reliability was determined at an ICC ≥ 0.8 and a CV ≤ 10% (Hopkins, 2000, Sports Medicine, 30, 1-15). The reported ICC for RSI was 0.91 (95% CI; 0.76 to 0.97) and the CV was 7.3%. In order to assess the usefulness of the test the typical error (TE) was compared to the smallest worthwhile change (SWC). The SWC for RSI in the 10/5 RJT test was 0.09 units (SWC%: 7.0%), while the TE was 0.14 units. Therefore the usefulness of this test for this female population is rated as ‘marginal’ (Hopkins, 2004, Sportscience, 8, 1-7). The results suggest that the 10/5 RJT is a reliable test for RSI as both criteria for acceptable reliability were satisfied but the ability of the test to detect the SWC is marginal.Metacognition refers to our ability to control, modify, and interpret cognitive activity (Wells & Cartwright-Hatton, 2004, Behaviour Research and Therapy, 42, 385–396). Research suggests dysfunctional metacognitive beliefs can be an important factor in the development and maintenance of mental health problems (Cotter, Yung, Carney, & Drake, 2017, Behaviour Research and Therapy, 90, 25–31). Mental toughness represents a collection of personal resources that may act as a positive indicator of mental health (Gucciardi et al., 2016, Journal of Science and Medicine in Sport, 20, 307–311). Therefore the purpose of our study was to assess whether an inverse relationship existed between mental toughness and metacognitive factors associated with psychopathology. Following institutional ethical approval 60 undergraduate university students (mean age: 21.07 ± 4.19 years) studying various sport science related degree programmes voluntarily consented to participate in the current study. Participants completed the Metacognitions Questionnaire-30 (Wells & Cartwright-Hatton, 2004, Behaviour Research and Therapy, 42, 385–396) and Mental Toughness Index (Gucciardi et al., 2015, Journal of Personality, 83, 26–44). Questionnaires were counterbalanced to reduce order effects with participants on average taking nine minutes to complete both questionnaires. A Pearson bivariate correlation recorded significant negative relationships between the mental toughness index, total MCQ-30 (r = –.334, P < 0.01, BCa 95% CI: –.639–.084) scores, positive beliefs about worry (r = –.329, P = < 0.01, BCa 95% CI: –.652–.010), and negative beliefs about thoughts concerning uncontrollability and danger (r = –.330, P = <0.05, BCa 95% CI: –.652–.109) subscale scores. Our investigation suggests that mental toughness is a state-like psychological resource that may contribute to people being less likely to adopt metacognitive beliefs, judgements, and monitoring tendencies associated with the development and maintenance of psychological disorders. More specifically, mental toughness scores were negatively associated with positive beliefs about worry suggesting that participants were unlikely to consider worrying as a means to cope and avoid problems in the future. In addition, responses to items indicative of persistent worrying thoughts that can be accompanied with unpleasant somatic effects were also inversely associated with mental toughness scores. Practitioners may wish to consider developing higher levels of mental toughness as a means of mitigating against the adoption of negative metacognitive processing and in doing so minimise the emergence of negative mental health symptoms (e.g., depression, anxiety).Despite extensive research exploring the psychological phenomenon of flow in performance contexts for individuals, there is a paucity in literature with regards to the experience of group flow in team sports. Whilst group flow has received attention in predominantly non-sporting domains, only a limited amount of research has explicitly explored group flow experiences of athletes (Bakker et al., 2011, Psychology of Sport and Exercise, 12, 442–450). As such, the aim of this study was to investigate perceptions of group flow experience of athletes that competed in team sports, applying a qualitative framework. A particular emphasis was placed on exploring the characteristics involved in group flow and the factors that facilitate or disrupt this experience. With institutional ethical approval, semi-structured interviews were conducted with eight (N = 8) athletes (mean age: 24.0 ± 3.96, years’ experience playing their sport 9.9 ± 2.17) from a variety of standards (ranging from national to recreational), and sports (including soccer, rugby, tennis doubles, camogie, and handball). The trustworthiness of the data was established through peer debriefs, critical peer review, and member checking. Subsequent data analysis included both inductive and deductive analysis, based on Sparkes and Smith’s (2013, Qualitative research methods in sport, exercise and health: From process to product. London: Routledge) recommendations. Inductive analysis created higher order themes from the raw data, and these themes were deductively coded into Csikszentmihalyi’s (2002, Flow: The classic work on how to achieve happiness. 2nd ed. London. Rider Books) model of flow, producing eight characteristics describing the experience of group flow. When athletes experienced group flow they also perceived an enhancement in team performance, and shared understanding with teammates. In particular, a perceived shared understanding between teammates was associated with heightened automaticity of movement and decisions. Group flow was reported to be facilitated by high levels of confidence within the team at both an individual and collective level, and by positive team play and interactions. Group flow disruptors included negative interactions from team-mates, such as criticism. The current study provides a detailed understanding of athletes’ perceptions of group flow in relation to current flow theories, with considerations outlined for theoretical development and practical application of developing group flow.It is hypothesised that the human unconscious consists of two layers: the personal unconscious and collective unconscious (Jung, 1959, The archetypes and the collective unconscious. London: Routledge). Personal experience is theorised to define the former while inherent behavioural patterns, dubbed archetypes, form the latter, these being universal to all human minds. Previous studies reveal that individuals exhibiting mature archetypes, specifically the warrior archetype, can enhance development and performance in sport. (Moore & Gillete, 1990, King, warrior, magician, lover: rediscovering the archetypes of the mature masculine. San Francisco: Harper Collins Publishers). The psychosocial journey from immature hero to mature warrior is conceptualised as a complex interweaving between an individual’s collective unconscious, inherited self, and environment that is yet to be contextualised. Therefore, the aims of this study on talent development and performance in English football academies are to explore the implications of the immature and mature archetypes called the hero and the warrior, and their bipolar counterparts the bully and the coward, and the sadist and the masochist. This is with a view to exploring the impact of various talent development environments and coaching methods on the psychosocial development of football players. Following ethical approval, a two stage ethnographic study was conducted using an interpretist approach. Stage one was comprised of eight field observations (four per team) of an under nine and under ten team in a category three English football academy. In stage two semi-structured interviews with key academy staff members concerning their experiences with and perceptions of the participants and the club’s talent pathway to establish major and minor themes. Results indicate that although they are considered psychosocially immature, participants were accessing the warrior/hero and their bipolar archetypes numerous times during one session/ game. Participants who displayed behaviours of the warrior and hero archetypes regularly were perceived by academy staff to be developing and performing more effectively in comparison to participants habitually accessing the bipolar archetypes. Results also show a potential link between the use of planned traumas in a situational based approach underpinned by a warrior/hero-based culture and effective development of these archetypes. Further research is required to fully comprehend the psychosocial maturation process from the immature to the mature warrior archetype and the mediators to psychosocial growth before stronger conclusions are made. Correspondingly, the researcher recommends that practitioners in English football academies identify the archetypes that an athlete is displaying and facilitate appropriate experiences to enhance development and performance.This abstract was published in Journal of Sports Sciences : BASES Conference 2017 – Programme and Abstracts on 24 November 2017 (online) available at http://dx.doi.org/10.1080/02640414.2017.1378421