Non-compliance amongst adolescents with asthma: listening to what they tell us about self-management.
BACKGROUND: Non-compliance with prescribed anti-asthma medication is considered to be a major problem. The reasons why adolescents may fail to comply with their regimen are poorly understood. OBJECTIVES: This study set out to understand better the reasons for non-compliance in adolescents with asthma. METHODS: In-depth interviews were conducted with a sample of 49 adolescents, aged 14-20 years, diagnosed as asthmatic more than a year previously and attending a hospital asthma clinic in Greater Glasgow. The interviews focused on young people's feelings about their illness and on their illness-related behaviour, including self-management. RESULTS: Most of the young people interviewed admitted that they had not always complied with their self-care regimens. Reasons given for non-compliance with prescribed medication in the past or at present were: forgetfulness, belief that the medication is ineffective, denial that one is asthmatic, difficulty using inhalers, inconvenience, fear of side effects, embarrassment and laziness. CONCLUSION: Most of those interviewed believed that compliance with prescribed medication was extremely important, with many having formed this belief following a negative experience which they attributed to their non-compliance. Nevertheless, barriers exist which mean that optimum self-care is not always achieved. It is suggested that future health care initiatives in this area be designed to provide practical information which aids the surmounting of these barriers and helps children and adolescents to be sufficiently aware of their own vulnerability at an early stage of their career as asthmatics. Peer education initiatives may meet these objectives, and more thought should be given to their development and optimum form. (+info)
Psychosocial characteristics of literate blinds: a study.
Blindness leaves a person in a state of physical, psychosocial and economic dependence. Aberrant mental attitudes and even frank mental illnesses can develop among the aged blinds. The present study shows that acceptance towards their disability was much higher (in 68.75% cases) among the aged blinds in group 'A' (mean age 42.2 years) than the younger student (in 47% cases) in group 'B' (mean age 17.6 years) All the younger blinds were found to be optimistic for their future but the level for this mental attitude among older subjects was relatively lower (in 68.75% cases). The aberrant mental attitude like rejection, guilt and aggressiveness which reflected negative attitude towards life were more prevalent among students. Older blinds were found to be relatively more shameful for their disability (in 43.75% cases). The negative attitude towards life was evaluated to be present among 12.5% cases in group 'A' and among 76.5% cases in group 'B'. Anxiety and depression were the mental illnesses evaluated among blind and were displayed by 6.25% and 0% cases in group 'A' i.e. the group of teachers and trained workers and in 35.3% and 43.7% cases among group 'B' i.e. the group of blind students respectively. Aberrant mental attitudes have shown no definite relation with the age at the onset of blindness or otherwise they appeared to change with age. (+info)
Psychological therapies for post-traumatic stress disorder.
BACKGROUND: After exposure to traumatic stressors, a subgroup of survivors (20-30%) will develop post-traumatic stress disorder (PTSD). AIMS: Since the incidence and prevalence rates for PTSD in the community are significant, it is important that general practitioners and psychiatrists be familiar with possible therapeutic options. In this review we shall look at the published evidence about the effectiveness of psychological treatments for PTSD. METHOD: The psychopathological mechanisms involved in PTSD are discussed. Studies of the effectiveness of different psychological therapies are reviewed. RESULTS: The review suggests that persistent fear or shame reactions are key aspects of PTSD. Evidence from systematic reviews suggests that psychotherapeutic treatments are effective in the therapy of reactions based on fear, and may increase the effectiveness of pharmacological therapy. There is less systematic evidence for the efficacy of interventions for symptoms based on shame. CONCLUSIONS: Although a proportion of patients with complex or chronic PTSD may require specialist interventions, most patients can be treated effectively by a general psychiatric service which can offer both pharmacological and psychological interventions. (+info)
Relationships of stigma and shame to gonorrhea and HIV screening.
OBJECTIVES: The purpose of this study was to assess the relationships between stigma and shame associated with seeking treatment for sexually transmitted diseases (STDs) and undergoing testing for gonorrhea and HIV. METHODS: Participants were 847 males and 1126 females (mean age: 24.9 years) in 7 cities. Two scales assessed STD-related stigma and STD-related shame. RESULTS: Rates of stigma and shame were higher among participants without a gonorrhea test in the past year and among those without an HIV test. Sex, age, health service use, previous suspicion of gonorrhea, and low levels of stigma were independently associated with gonorrhea testing. Age, enrollment site, use of health services, gonorrhea testing, and low levels of stigma were independently associated with HIV testing. CONCLUSIONS: Shame is part of the experience of seeking STD-related care, but stigma may be a more powerful barrier to obtaining such care. (+info)
Pushing the profession: how the news media turned patient safety into a priority.
The problem of patient safety has been repeatedly identified in the medical literature since the mid 1950s, but regular revelations about patient deaths and injuries resulting from treatment have had almost no effect on the actual practice of medicine. Only very recently has the medical profession made a systematic effort to reduce or eliminate the many preventable deaths and injuries that occur in hospitals each year. This review traces the diffusion of innovation in medical error reduction to the public shaming of the profession that occurred as a result of stories that appeared in the news media. The focus is on the USA, but news stories about patient safety are sparking a similar process throughout the western world. (+info)
Attitudes about sexual disclosure and perceptions of stigma and shame.
OBJECTIVES: To determine the association between stigma and shame about having a sexually transmitted disease and adolescents' past STD related care seeking; between stigma, shame, and perceptions about disclosure of sexual behaviours to a doctor or nurse; and whether the association of stigma, shame, and care seeking was moderated by perceptions about disclosure. METHODS: A household sample of 142 sexually active African-American youths, 13-19 years old, was questioned about STD related stigma (alpha = 0.89), STD related shame (alpha = 0.90), and perceptions about disclosure of sexual behaviours to a doctor or nurse (alpha = 0.81). RESULTS: Among females, stigma was associated with increased anticipation of negative reactions to disclosure of sexual behaviours to a doctor or nurse (odds ratio (OR) = 0.319; 95% confidence interval (CI) =0.12 to 0.85) while shame was not. Stigma was also independently associated with STD related care seeking in the past year (OR = 0.296; 95% CI = 0.09 to 0.94) while shame was not. There was no association between stigma and shame with perceptions about disclosure or past care seeking in males. Perceived outcomes of disclosing sexual behaviours did not moderate the association of stigma, shame, and past STD related care seeking. CONCLUSIONS: Stigma about STDs may influence how female adolescents perceive reactions to disclosure of their sexual behaviour to healthcare providers. It may also be an important factor in their decision seek to STD related care. Perceptions about disclosure of sexual behaviour to a doctor or nurse do not change the relation of stigma or shame to past STD related care seeking. (+info)
Stigma, shame, and blame experienced by patients with lung cancer: qualitative study.
OBJECTIVES: To draw on narrative interviews with patients with lung cancer and to explore their perceptions and experience of stigma. DESIGN: Qualitative study. SETTING: United Kingdom. PARTICIPANTS: 45 patients with lung cancer recruited through several sources. RESULTS: Participants experienced stigma commonly felt by patients with other types of cancer, but, whether they smoked or not, they felt particularly stigmatised because the disease is so strongly associated with smoking. Interaction with family, friends, and doctors was often affected as a result, and many patients, particularly those who had stopped smoking years ago or had never smoked, felt unjustly blamed for their illness. Those who resisted victim blaming maintained that the real culprits were tobacco companies with unscrupulous policies. Some patients concealed their illness, which sometimes had adverse financial consequences or made it hard for them to gain support from other people. Some indicated that newspaper and television reports may have added to the stigma: television advertisements aim to put young people off tobacco, but they usually portray a dreadful death, which may exacerbate fear and anxiety. A few patients were worried that diagnosis, access to care, and research into lung cancer might be adversely affected by the stigma attached to the disease and those who smoke. CONCLUSION: Patients with lung cancer report stigmatisation with far reaching consequences. Efforts to help people to quit smoking are important, but clinical and educational interventions should be presented with care so as not to add to the stigma experienced by patients with lung cancer and other smoking related diseases. (+info)
Characterizing perceived police violence: implications for public health.
Despite growing recognition of violence's health consequences and the World Health Organization's recent classification of police officers' excessive use of force as a form of violence, public health investigators have produced scant research characterizing police-perpetrated abuse. Using qualitative data from a study of a police drug crackdown in 2000 in 1 New York City police precinct, we explored 40 injection drug using and 25 non-drug using precinct residents' perceptions of and experiences with police-perpetrated abuse. Participants, particularly injection drug users and non-drug using men, reported police physical, psychological, and sexual violence and neglect; they often associated this abuse with crackdown-related tactics and perceived officer prejudice. We recommend that public health research address the prevalence, nature, and public health implications of police violence. (+info)