Young people’s images of cigarettes, alcohol and drugs.

To meet their aim of reducing the acceptability of psychoactive substances to young people, the designers of drug prevention programmes need to have a thorough understanding of the personal views already held by their audience with respect to the object of attitude and behavioural change. However, few studies involving younger adolescents have collated participant-generated impressions of a range of legal and illegal substances. The present study used a word association methodology to explore adolescents' impressions of cigarette smoking, drinking alcohol and taking a range of illegal drugs. In total, 3571 images were generated which were placed into 24 categories on the basis of content analysis. The predominance of negative imagery was of note, particularly for cigarette smoking and drug taking and there was little evidence of a simplistic generic attitude to substance use. Images of alcohol, especially alcopops, were markedly more positive and were much less likely to contain reference to specific health problems than the images of cigarette smoking. However, there was less differentiation between 'hard' and 'soft' illegal drugs than has been found with older adolescents in other studies and many of the images relating to illegal drugs were poorly defined, revealing vague notions of danger and risk. The present methodology is proposed as a useful tool for assessing attitudes both prior to and following prevention programmes and it is suggested, based on the wide variation in images elicited, that successful prevention dialogues with young people may need to vary their message according to the particular substance targeted

Using audio-diaries to capture lived experience in health psychology: technological, methodological and epistemological issues

Although diary methods have a long tradition of use within psychology and appear to have considerable potential in researching health-related processes and experiences, the use of unstructured diary methods to generate detailed phenomenological accounts within contemporary health psychology has thus far been limited. In this poster presentation, we describe a recently completed British study in which a sample of first-time mothers used voice-recording technology to make daily diary entries about their infant feeding experiences. We present a consideration of the benefits and challenges of this approach to data collection. In particular, we focus on ethical and epistemological issues, drawing on the accounts of both participants and members of the research team. We also explore the most suitable ways of analysing data derived from diaries and consider the practical advantages and limitations of using audio-diaries. Finally, some of the implications for developing the use of audio-diaries in health psychologists' research and practice are considered

Becoming a breastfeeding mother: An interactionist perspective

Understanding the establishment of breastfeeding by focussing on the mother-child dyad offers only a limited perspective. Instead, breastfeeding can be understood as becoming established or breaking down within broader networks of relationships (e.g. Dykes, 2006; Tiedje et al., 2002). Quantitative research has suggested that support from various others (lay and professional) can be an important factor in sustaining breastfeeding (Sikorski et al., 2003). However, those around the mother may orientate to breastfeeding in various ways. For example, fathers play a key role in decisions about infant feeding and in supporting breastfeeding, and yet need to define and adjust to their new parenting role and changed relationship with their partner in a way that accommodates breastfeeding (Bar-Yam & Darby, 1997). From the perspective of the mother, breastfeeding can be an important aspect of the transition to motherhood. However, becoming a mother is not an individual project but one that involves redefining roles and relationships with others (Mercer, 2004; Nelson, 2003), and negotiating mothering practices such as breastfeeding in the context of others’ expectations and cultural prescriptions for motherhood (McBride-Henry, 2010). The present research aims to extend understanding of how breastfeeding mothers experience their relations with others and how these are implicated in their experiences of breastfeeding and their developing relationship with their infant. The data discussed here have been taken from a longitudinal qualitative study of 22 new mothers in the UK who expressed an intention to breastfeed and were interviewed during the first week following birth and one month later. At each time point they were also asked to keep an audio-diary of their experiences of feeding their baby for one week. The analysis discussed here draws on symbolic interactionism and other theoretical perspectives which emphasise the relational nature of the self and assume that relations with others are part of, rather than external to, lived experience and mediate more distal cultural influences. The themes explored include the women’s sense of duty to balance what they saw as the needs of their baby, their own needs and the needs, demands and sensibilities of others, and the ways in which they negotiated these. We also discuss the way in which, as the participants were developing their new identities as breastfeeding mothers, others with expertise in breastfeeding or perceived to have knowledge regarding related norms and expectations took on a particular significance in the women’s lives. As such, these "experts" were experienced by the participants as in a powerful position to provide either validation or invalidation of them as breastfeeding mothers. We discuss (i) the implications of our analysis for facilitating supportive interactions between health professionals and breastfeeding mothers and their immediate networks and (ii) the implications for breastfeeding promotion of viewing ongoing engagement with the practices of infant feeding as mutually negotiated and enabled, rather than as the choice of individual women

Expressing yourself: A feminist analysis of talk around expressing breast milk

Recent feminist analyses, particularly from those working within a poststructuralist framework, have highlighted a number of historically located and contradictory socio-cultural constructions and practices which women are faced with when negotiating infant feeding, especially breastfeeding, within contemporary western contexts. However, there has been little explicit analysis of the practice of expressing breast milk. The aim of this article is to explore the embodied practice of expressing breast milk. This is done by analysing, from a feminist poststructuralist perspective, discourse surrounding expressing breast milk in sixteen first time mothers’ accounts of early infant feeding. Participants were recruited from a hospital in the South Midlands of England. The data are drawn from the first phase of a larger longitudinal study, during which mothers kept an audio diary about their breastfeeding experiences for seven days following discharge from hospital, and then took part in a follow-up interview. Key themes identified are expressing breast milk as (i) a way of managing pain whilst still feeding breast milk; (ii) a solution to the inefficiencies of the maternal body; (iii) enhancing or disrupting the ‘bonding process’; (iv) a way of managing feeding in public; and (v) a way to negotiate some independence and manage the demands of breastfeeding. Links between these and broader historical and socio-cultural constructions and practices are discussed. This analysis expands current feminist theorising around how women actively create the ‘good maternal body’. As constructed by the participants, expressing breast milk appears to be largely a way of aligning subjectivity with cultural ideologies of motherhood. Moreover, breastfeeding discourses and practices available to mothers are not limitless and processes of power restrict the possibilities for women in relation to infant feeding

Socially sensitive lactation: Exploring the social context of breastfeeding

Many women report difficulties with breastfeeding and do not maintain the practice for as long as intended. Although psychologists and other researchers have explored some of the difficulties they experience, fuller exploration of the relational contexts in which breastfeeding takes place is warranted to enable more in-depth analysis of the challenges these pose for breastfeeding women. This article is based on qualitative data collected from 22 first-time breastfeeding mothers through two phases of interviews and audio-diaries which explored how the participants experienced their relationships with significant others and the wider social context of breastfeeding in the first five weeks postpartum. Using a thematic analysis informed by symbolic interactionism, we develop the overarching theme of 'Practising socially sensitive lactation' which captures how participants felt the need to manage tensions between breastfeeding and their perceptions of the needs, expectations and comfort of others. We argue that breastfeeding remains a problematic social act, despite its agreed importance for child health. While acknowledging the limitations of our sample and analytic approach, we suggest ways in which perinatal and public health interventions can take more effective account of the social challenges of breastfeeding in order to facilitate the health and psychological well-being of mothers and their infants

Making use of expertise: A qualitative analysis of the experience of breastfeeding support for first-time mothers

There is now a body of research evaluating breastfeeding interventions and exploring mothers’ and health professionals’ views on effective and ineffective breastfeeding support. However, this literature leaves relatively unexplored a number of questions about how breastfeeding women experience and make sense of their relationships with those trained to provide breastfeeding support. The present study collected qualitative data from 22 breastfeeding first-time mothers in the UK on their experiences of, and orientation towards, relationships with maternity care professionals and other breastfeeding advisors. The data were obtained from interviews and audio-diaries at two time points during the first five weeks post-partum. We discuss a key theme within the data of ‘Making use of expertise’ and three subthemes which capture the way in which the women’s orientation towards those assumed to have breastfeeding expertise varied according to whether the women (i) adopted a position of consulting experts versus one of deferring to feeding authorities (ii) experienced difficulty interpreting their own and their baby’s bodies and (iii) experienced the expertise of health workers as empowering or disempowering. Although sometimes mothers felt empowered by aligning themselves with the scientific approach and ‘normalising gaze’ of healthcare professionals, at other times this gaze could be experienced as objectifying and diminishing. The merits and limitations of a person-centred approach to breastfeeding support are discussed in relation to using breastfeeding expertise in an empowering rather than disempowering way

Empowerment or regulation? Exploring the implications of women's perspectives on pumping and expressing breast milk

The feminist literature on pumping and expressing breast milk has highlighted contradictory theorisation of these practices. On the one hand they have been argued to represent a form of ‘control’ placed upon breastfeeding in that they offer a way of managing future expectations about returning to ‘normal’ activities. Additionally, the use of breast pumps has been theorised as contributing to the commercialisation, medicalisation and mechanisation of breastfeeding. On the other hand, it has been noted that these practices have the potential to be empowering, in that they allow for greater paternal involvement in infant feeding and increased freedom for women. In this paper we report on an analysis of first-time mothers’ reasons for pumping and expressing breast milk drawn from a recent British qualitative study. Our analysis suggests that these practices were employed for a myriad of complex, multi-layered reasons which can be seen as potentially both empowering and disempowering. For instance, they were used as a way of managing breastfeeding difficulties and the perceived inefficiencies of the maternal body thus ensuring the continued provision of adequate breast milk. They were also constructed as practices which could be used to manage the realities of modern motherhood including facilitating shared parenting, feeding in public and managing returning to work. We illustrate this complexity by drawing on detailed case studies of women who used these practices extensively. Implications for public health theory and practice which have the potential to support women in their infant feeding choices are discussed

Applying clinical decision aids for the assessment and management of febrile infants presenting to emergency care in the UK and Ireland: Febrile Infant Diagnostic Assessment and Outcome (FIDO) Study protocol.

INTRODUCTION: Febrile infants 90 days and younger are at risk of invasive bacterial infections (bacteraemia and meningitis) and urinary tract infections. Together this is previously termed serious bacterial infection with an incidence of approximately 10-20%. The National Institute for Health and Care Excellence guidance advocates a cautious approach with most infants requiring septic screening, parenteral broad-spectrum antibiotics and hospital admission. Internationally, variations exist in the approach to febrile infants, with European and North American guidance advocating a tailored approach based on clinical features and biomarker testing. None of the available international clinical decision aids (CDAs) has been validated in the UK and Irish cohorts. The aim of the Febrile Infant Diagnostic Assessment and Outcome (FIDO) Study is to prospectively validate a range of CDAs in a UK and Irish population including CDAs that use procalcitonin testing. METHODS AND ANALYSIS: The FIDO Study is a prospective multicentre mixed-methods cohort study conducted in UK and Irish hospitals. All infants aged 90 days and younger presenting with fever or history of fever (≥38°C) are eligible for inclusion. Infants will receive standard emergency clinical care without delay. Clinical data and blood samples will be collected, and consent will be obtained at the earliest appropriate opportunity using research without prior consent methodology. The performance and cost-effectiveness of CDAs will be assessed. An embedded qualitative study will explore clinician and caregiver views on different approaches to care and perceptions of risk. ETHICS AND DISSEMINATION: This study was reviewed and approved by the Office for Research Ethics Committees Northern Ireland-Health and Social Care Research Ethics Committee B, Public Benefit and Privacy Panel for Health and Social Care Scotland, and Children's Health Ireland Research and Ethics Committee Ireland. The results of this study will be presented at academic conferences and in peer-reviewed publications. TRIAL REGISTRATION NUMBER: NCT05259683