Dietetics, Nutrition and Biological Sciences
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Item Focus group methodology: Some ethical challenges(Springer, 2019-07-16) Sim, Julius; Waterfield, JackieFocus group methodology generates distinct ethical challenges that do not correspond fully to those raised by one-to-one interviews. This paper explores, in both conceptual and practical terms, three key issues: consent; confidentiality and anonymity; and risk of harm. The principal challenge in obtaining consent lies in giving a clear account of what will take place in the group, owing to unpredictability of the discussion and interaction that will occur. As consent can be seen in terms of creating appropriate expectations in the participant, this may therefore be hard to achieve. Moreover, it is less straightforward for the participant to revoke consent than in one-to-one interviews. Confidentiality and anonymity are potentially problematic because of the researcher’s limited control over what participants may subsequently communicate outside the group. If the group discussion encourages over-disclosure by some participants, this problem becomes more acute. Harm in a focus group may arise from the discussion of sensitive topics, and this may be amplified by the public nature of the discussion. A balance should be struck between avoiding or closing down potentially distressing discussion and silencing the voices of certain participants to whom such discussion may be important or beneficial. As a means of addressing the above issues, we outline some strategies that can be adopted in the consent process, in a preliminary briefing session, during moderation of the focus group, and in a subsequent debriefing, and suggest that these strategies can be employed synergistically so as to reinforce each other.Item A mixed methods exploration of physiotherapist’s approaches to analgesic use among patients with hip osteoarthritis(Elsevier, 2018-08-17) Holden, Melanie Ann; Whittle, Rebecca; Waterfield, Jackie; Chesterton, Linda; Cottrell, Elizabeth; Quicke, Jonathan George; Mallen, Christian DavidObjective To explore how physiotherapists currently address analgesic use among patients with hip osteoarthritis, and their beliefs about the acceptability of prescribing for these patients.Item How do UK physiotherapists address weight loss among individuals with hip osteoarthritis? A mixed‐methods study(Wiley, 2019-01-21) Holden, Melanie Ann; Waterfield, Jackie; Whittle, Rebecca; Bennell, Kim; Quicke, Jonathan George; Chesterton, Linda; Mallen, Christian DavidBackground Weight loss is recommended as a core treatment for individuals with hip osteoarthritis who are overweight or obese. Physiotherapists play an important role in managing patients with hip osteoarthritis, but little is known about how they address weight. We aimed to explore how UK‐based physiotherapists currently address weight loss among individuals with hip OA.Item The sample size debate: Response to Norman Blaikie(Informa UK Limited, 2018-03-27) Sim, Julius; Saunders, Benjamin; Waterfield, Jackie; Kingstone, TomIn his detailed response to our paper on sample size in qualitative research, Norman Blaikie raises important issues concerning conceptual definitions and taxonomy. In particular, he points out the problems associated with a loose, generic application of adjectives such as 'qualitative' or 'inductive'. We endorse this concern, though we suggest that in some specific contexts a broad categorization may be more appropriate than a more nuanced distinction - provided that it is clear in which sense the terms are employed. However, other concepts, such as saturation, do not lend themselves to generic use, and require a more detailed conceptualization. Blaikie's analysis also makes it clear that meaningful discussion of sample size in qualitative research cannot occur with reference to an undifferentiated conception of the nature of qualitative research; clear distinctions need to be made within this approach in terms of methodology, ontological and epistemological assumptions and broader research paradigms.Item Can sample size in qualitative research be determined a priori?(Informa UK Limited, 2018-03-27) Sim, Julius; Saunders, Benjamin; Waterfield, Jackie; Kingstone, TomThere has been considerable recent interest in methods of determining sample size for qualitative research a priori, rather than through an adaptive approach such as saturation. Extending previous literature in this area, we identify four distinct approaches to determining sample size in this way: rules of thumb, conceptual models, numerical guidelines derived from empirical studies, and statistical formulae. Through critical discussion of these approaches, we argue that each embodies one or more questionable philosophical or methodological assumptions, namely: a nave realist ontology; a focus on themes as enumerable 'instances', rather than in more conceptual terms; an incompatibility with an inductive approach to analysis; inappropriate statistical assumptions in the use of formulae; and an unwarranted assumption of generality across qualitative methods. We conclude that, whilst meeting certain practical demands, determining qualitative sample size a priori is an inherently problematic approach, especially in more interpretive models of qualitative research.Item Cultural aspects of pain: A study of Indian Asian women in the UK(Wiley-Blackwell, 2018-01-12) Holt, Stephanie; Waterfield, JackieObjectives: Culture and ethnicity are acknowledged as important factors in the context of the biopsychosocial model. They may contribute to explaining the experience of pain, therapeutic encounters within healthcare, and the strategies that individuals use to cope with pain. The present study explored these issues in a sample of Indian Asian women in the UK. Methods: Based on a phenomenological approach, 17 women participated in five semi-struc tured group interviews. Data were analysed using qualitative content analysis, so as to identify core themes and subthemes inductively from the data. Results: Six themes were identified: meaning of pain; personal experience of pain; causes of pain; coping strategies; family and friends; experience of healthcare. Pain was conceptualized in both physical and mental terms, and its experience was explained largely in terms of functional consequences. The causes of pain offered suggested externalized beliefs, relating to events in participants' lives, rather than being expressed in biomedical terms. Alongside culture-specific therapies, the women spoke of coping strategies based on rest and activity. Although satisfaction with healthcare appeared to be high overall, problems due to communication - sometimes related to a language barrier - were voiced by some participants. Conclusions: Greater attention to cultural aspects of the pain experience may assist health professionals in communicating with and managing patients with pain from ethnic minority backgrounds.Item Physical Therapists' Views and Experiences of Pregnancy-Related Low Back Pain and the Role of Acupuncture: Qualitative Exploration(Oxford, 2015-09-01) Waterfield, Jackie; Bartlam, Bernadette; Bishop, Annette; Holden, Melanie A.; Barlas, Panos; Foster, Nadine E.Background Low back pain is often accepted as a normal- part of pregnancy. Despite research suggesting that quality of life for women who are pregnant is adversely affected, most are advised to self-manage. Although the use of acupuncture for the management of persistent nonspecific low back pain has been recommended in recent UK national guidelines, its use in the management of pregnancy-related low back pain remains limited. Objectives This study aimed to explore the perceptions and experiences of physical therapists involved in treating women who are pregnant and have low back pain with the objective of informing the pretrial training program for a pilot randomized trial (Evaluating Acupuncture and Standard care for pregnant womEn with Back pain [EASE Back]). Design A qualitative phenomenological method with purposive sampling was used in the study. Methods Three focus groups and 3 individual semistructured interviews were undertaken, and an iterative exploratory thematic analysis was performed. To ensure transparency of the research process and the decisions made, an audit trail was created. Results Twenty-one physical therapists participated, and emergent issues included: a lack of experience in treating pregnancy-related complaints, mixed messages from previous acupuncture education, a mistrust of the current evidence for acupuncture safety and effectiveness, and personal and professional fear of causing harm. Conclusions The findings suggest that UK physical therapists are reluctant to use acupuncture in the management of pregnancy-related low back pain. The explanations for these findings include perceived lack of knowledge and confidence, as well as a pervasive professional culture of caution, particularly fears of inducing early labor and of litigation. These findings have been key to informing the content of the training program for physical therapists delivering acupuncture within the pilot EASE Back trial.Item The Understanding of Pain by Older Adults Who Consider Themselves to Have Aged Successfully(2014-12-03) Collis, David; Waterfield, JackieObjectives: Despite an ageing population and an increased prevalence of chronic pain, the relationship between chronic pain and the concept of successful ageing is unclear. The aim of the present research was to explore older people's views on past and present experiences of pain, and its management, and how these experiences relate to their perceptions of successful ageing. Methods: Semi-structured interviews with six participants, aged 75 years or older, who considered themselves to have aged successfully, explored what this concept meant to them and their experiences of pain. Data analysis used methods drawn from grounded theory. The themes reported in this article are 'understanding of pain' and 'perceptions of ageing'. Results: None of the participants recalled painful experiences that were not attributable to physical trauma. They believed that pain is part of life and a natural consequence of the ageing process. While some accepted this with little resistance, others felt frustration at what they considered a dismissive attitude towards older people experiencing pain from healthcare practitioners. The concept of successful ageing was previously unfamiliar to participants, and their conceptualization of ageing derived from comparing themselves with their peers. Conclusions: The findings of the present study suggest that predictable experiences of pain as one ages may contribute to an acceptance of pain as a biomedical certainty, a belief reinforced both by health professionals and society. However, one may have chronic pain and yet consider oneself to have aged successfully, and it should therefore be recognized that there is a distinction between having pain and having a problem with pain.Item Evaluating Acupuncture and Standard carE for pregnant women with Back pain (EASE Back): a feasibility study and pilot randomised trial(NIHR Journals Library, 2016-04-01) Foster, Nadine E.; Bishop, Annette; Bartlam, Bernadette; Ogollah, Reuben; Barlas, Panos; Holden, Melanie A.; Ismail, Khaled M. K.; Jowett, Sue; Kettle, Christine; Kigozi, Jesse; Lewis, Martyn; Lloyd, Alison; Waterfield, Jackie; Young, JulieBackground: Many pregnant women experience low back pain. Acupuncture appears to be a safe, promising intervention but evidence is needed about its clinical effectiveness and cost-effectiveness. Objectives: To assess the feasibility of a future large randomised controlled trial (RCT) testing the additional benefit of adding acupuncture to standard care (SC) for pregnancy-related back pain.Item Preparing to manage patients in pain. The student perspective: a pilot(Ingenta, 2015-12-01) Etherton, Jo; Waterfield, JackieObjectives: This pilot study aims to explore the experience of preparing to manage patients in pain, from a student perceptive. Specifically: Do physiotherapy students consider themselves 'prepared' for practice with patients in pain and what has contributed to this sense of 'preparedness'? Design: A phenomenological approach was taken to provide a rich description of the student experience. Data was collected via semi structured, one to one interviews with the researcher. Setting: Data collection occurred in a neutral room on the University of East Anglia (UEA) campus. Participants: Inclusion criteria were: final year about to qualify and consented to participate. Three UEA BSc Physiotherapy students were interviewed. Results: Six themes were identified within the data: time, confidence, relationships, professionalism, theory - practice gap and team working. Key findings included: student's personal experiences with patients informed their perceptions of preparedness; students have greater confidence in working with a bio-medical compared to a bio-psychosocial model; preparing to manage patients in pain includes developing understanding of professional responsibility, which equated to reducing a patients pain; students have theoretical understanding of patient-centered and bio-psychosocial care, but experiences in application of these principles are varied and clinical educators actively 'gate keep' opportunities for students to work with patients in pain. Conclusions: Findings from the three themes presented here suggest physiotherapy students did not always perceive themselves prepared to manage patients in pain. However, comments were made without awareness that the shared examples indicated a lack preparedness. This perception is primarily informed by situated learning and experiences with patients in relatively acute pain. Opportunities for contextualisation of theoretical knowledge for managing persistent and chronic pain states during placement could be limited, perhaps by clinical educators actively 'gate-keeping' opportunities for students to work with certain 'types' of patients with pain.