BACKGROUND: The incidence of chronic disease is increasing worldwide which, in turn, increases the demand for healthcare services. To meet these demands, healthcare systems are adapting their services in order to reduce treatment costs and ensure coherence for patients with multiple diseases. One form of adaptation is shared outpatient consultations between internal medical specialties. However, little is known about how patients interact with multiple clinicians in shared consultations.
OBJECTIVE: This project aimed to explore how patients with diabetes and chronic kidney disease interact with multiple clinicians in a shared outpatient setting.
METHODS: We performed a qualitative ethnographic study, combining focused participant observations with informal field interviews. We included 17 participants, nine males and eight females with a mean age of 67.3 in the project. The data analysis was guided by Braun and Clarke\'s reflexive thematic analysis and Arthur Kleinman\'s theory of illness and disease.
RESULTS: We found one over-arching theme: \'A consultation which encompassed both illness and disease\' and four subthemes: (1) \'The medical focal point\' pertained to the focus on physiological measurements in dialogue between patients and clinicians. (2) \'The possibility of negotiations\' illustrated how decisions about dialysis and pharmacological treatment were based on negotiations. (3) \'Speaking different languages\' displayed how patients used alternative illness-based explanations whereas clinicians tended to use biomedical language. (4) \'Perceptions of everyday life\' concerned what patients considered was best for them when managing their illness and everyday lives.
CONCLUSIONS: Patients present information on how they balance life with physiological and psychosocial challenges. When clinicians employ a biomedical perspective, opportunities to gain information on patients\' illness behaviours or cues to negotiate are missed. Patients prioritise functioning on a daily level over following treatment regimes. These findings are tenuous and require verification in similar studies in similar settings.
UNASSIGNED: Shared Outpatient Clinic, Patient-clinician interactions.

Established research supports collaborative patient-clinician communication as a means of improving pain management and decreasing opioid use by patients with chronic pain. However, much of this scholarship emphasises clinicians\' capacities to shape and improve communication; limited research investigates patients\' roles in this process. Drawing on 40 ethnographic observations of patient-clinician interactions, clinical spaces and case conferences within one specialist pain clinic in Brisbane, Australia, this paper investigates how and why patients present themselves in particular ways within consultations. Our theoretical lens combines concepts from Goffman on patienthood and stigma with Foucauldian theories of pastoral and disciplinary power. Findings suggest that elements of the clinical environment - namely posters - usher patients towards presenting in what we conceptualise as the \'good pain patient\' role. In this role, patients demonstrate that they are moral, responsible, and contributing members of society. Yet, such a role is problematic to opening communication, with the role constraining what is socially acceptable for patients with chronic pain to say, do, or feel. In recognising how clinical contexts facilitate problematic good pain patient presentations, this paper directs attention to the spatial and relational nature of implicit clinical expectations and constrained good pain patient presentations.

BACKGROUND: Despite the fact that joint bleeds (haemarthrosis) frequently occur in people with haemophilia (PwH) with invalidating arthropathies as result, the clinical pain experience has received only limited attention. A sudden increase in pain intensity can be linked to a bleed, but in most cases, no acute bleed is confirmed. Nevertheless, a patient\'s perception of an acute bleed as cause of the pain might impact the patients\' behaviour in response to pain. It is therefore essential to gain more insight into pain coping strategies seen in PwH.
OBJECTIVE: This systematic review aims to identify the range of pain coping behaviour strategies used among PwH and the factors associated with pain coping behaviour.
METHODS: This review was reported according to the Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines (PRISMA). PubMed and Web of Science were systematically screened for relevant literature using keyword combinations related to adult PwH, pain and pain coping behaviour strategies. Risk of bias was assessed with the modified Newcastle-Ottowa Scale.
RESULTS: Eleven full text articles (nine cross-sectional and two comparative studies) consisting of 1832 PwH met the inclusion criteria. Due to the heterogeneity of the study samples, quality of evaluation instruments and varying risk of bias, it was difficult to draw conclusions regarding the used pain coping behaviour strategies and associated factors.
CONCLUSIONS: Literature on pain coping behaviour strategies and associated factors in PwH is still scarce and describes heterogenous results. Validated haemophilia-specific instruments are warranted to inventory pain coping behaviour in a standardized way.

Adolescents and young adults with type 1 diabetes must manage a demanding chronic condition in their daily lives, but adequate self-management remains a major challenge. In this article, we explore the logics invoked in shaping daily type 1 diabetes self-management among adolescents and young adults and propose an analytical view of self-management as a matter of \'calibrating logics\'. Drawing on Annemarie Mol\'s concept of logic, our analysis of in-depth interviews with 21 adolescents and young adults with type 1 diabetes suggested that three main logics collectively shaped their self-management: biomedical, embodied and social. Biomedical logics appeared in the form of routinised insulin therapy, frequent blood glucose testing, and carbohydrate counting, all of which emphasise controlling blood glucose levels. Embodied logics emerged as refined practices such as \'thinking insulin units\' and \'listening\' to blood glucose fluctuations. Finally, social logics were at play when discreet or postponed self-management practices were used to adjust to social situations. While these logics may complement each other, study participants invoked how these logics often competed in daily life, generating tensions. We therefore propose viewing self-management as a matter of calibrating logics in which often-competing logics are at play. This can provide nuanced insights into the effort and challenges related to the daily self-management of type 1 diabetes for adolescents and young adults, in contrast to the prevailing dichotomy of adherence versus nonadherence to prescribed treatment regimens.

Objective: The aim of this study was to describe the prevalence of forgoing care and forgoing sick leave among primary care physicians (PCPs) in Switzerland and to investigate associated factors. Methods: A random sample of 1,000 PCPs in French-speaking regions of Switzerland (participation rate: 50%) was asked whether they had forgone care and sick leave during the last year. Sociodemographic, personal and occupational characteristics were recorded. Logistic regressions were performed to study these behaviours. Results: 37% of respondents reported at least one episode of forgoing care and 29% reported an episode of forgoing sick leave. No associations were found between individual characteristics and forgoing care. A heavy workload was the most common reason evoked for forgoing care. Coming to work when sick (presenteeism) was associated with female sex, younger age, having a chronic illness, working in a suburban area and working full-time. Conclusion: A high proportion of PCPs in Switzerland is forgoing own care and continues to work despite sickness. New generations of PCPs should require careful monitoring, and specific solutions should be sought to reduce these harmful behaviours.

The aim of this ethnographic study was to explore how a group of nine Danish people with schizophrenia managed physical health issues as they naturally occurred in everyday life. Qualitative methods were used to generate of data. Thematic analysis led to the description of two typical strategies used by participants to manage debilitating physical health issues in everyday life. Modifying everyday life to manage discomfort was a strategy employed to manage potential or actual discomfort associated with ongoing poor physical health, while retreating from everyday life to recover was a strategy used by participants who experienced recurring discrete episodes of poor physical health characterized by fast deterioration. Both management strategies were inexpedient as they failed to produce any positive progress in terms of the participants regaining health. The social context of participants\' everyday life was characterized by a lack of interactions with others about their prevailing and ongoing physical health issues. Repeated use of these inexpedient strategies to manage physical health caused potential worsening rather than improvements to physical health. There is a need for future research that explores aspects of beneficial management of physical health issues among people with severe mental illness. Relevant foci of such research include enhancing self-management of physical health, active help-seeking behaviours, and opportunities to engage in interactions with others about physical health issues.

People experiencing traumatic brain injury or multitrauma will often live with problems in functioning for a profound period in life. A situation of great complexity emerges involving both the experience of an impaired body and the experience of a changed social position. This article addresses the intricate relations between the altered body, personal ambitions, and social surroundings in the first 2-3 years after an injury. The conceptual framework centers around the process of change, applying concepts such as the unexpected other and biographical reconstruction. Twenty-one people of working age were interviewed two times. All interviewees had experienced traumatic brain injury or multitrauma. A thematic narrative analysis was applied. Consequences of the injury took place at a carnal level where fatigue is something completely different from becoming exhausted and where elimination of body waste takes place through practices novel to the injured person. Living with impairment also took place at the level of social interaction. Here, family relations, shame, and establishing a new identity seemed profoundly important. This article makes two novel contributions. First, it emphasizes more than previous studies do that the daily management of altered body functions is more important for independence and wellbeing. Second, the article identifies the narrative about the accident as an important issue for injured people to settle.

Atrial fibrillation is a complex condition associated with a broad spectrum of symptoms, coupled with variability in the frequency, duration and severity of symptoms. Early treatment seeking is important to reduce the risk of stroke, heart failure and dementia. Despite the increasing prevalence, there remains a limited understanding of the symptom experience prior to an atrial fibrillation diagnosis, and how these experiences influence treatment-related decisions and time frames.
This qualitative study aimed to explore the symptom experiences of patients receiving an early diagnosis of less than 48 hours and a late diagnosis of 48 hours or more after symptom awareness.
Twenty-six adults were interviewed guided by the symptom experience model. The symptom checklist was used to probe patient\'s symptoms further. Data were analysed using a two-step approach to thematic analysis utilising concepts from the symptom experience model.
The two groups differed in their perception, evaluation and response to symptoms. The early diagnosis group (n = 6) experienced traumatic, severe and persistent symptoms, evoking concern and urgent treatment seeking. Conversely, the late diagnosis group (n = 20) reported more vague, paroxysmal symptoms that were readily ignored, self-theorised as non-illness related, and engaged in non-treatment strategies. Healthy self-perceptions, past experiences, atrial fibrillation knowledge and healthcare provider interactions influenced early or late treatment seeking.
For many, the atrial fibrillation pre-diagnosis was a tumultuous period, requiring prolonged periods to recognise symptoms and formulate treatment-seeking responses. This study may promote future research and strategies aimed at facilitating the early identification and response to symptoms among atrial fibrillation patients.

OBJECTIVE: The Self-Care Self-Efficacy Scale (SCSES) was newly developed as a self-report measure for self-care self-efficacy for chronic illness. This study investigated its measurement equivalence (ME) in different cultural groups, including United States, China (Hong Kong), Italy, and Brazil.
METHODS: A multi-national study for cross-cultural validation of the Scale.
METHODS: From January 2015 - December 2018, investigators recruited 957 patients (United State: 200; Hong Kong: 300; Italy: 285; and Brazil: 142) with chronic illness from inpatient and outpatient settings. The SCSES was administered and clinical and demographic data were collected from participants. Based on the Meredith framework, multi-group confirmatory factor analysis evaluated the configural, metric, scalar, and strict invariance of the scale across the four populations through a series of nested models, with evaluation of reliability and coherence of the factor solution.
RESULTS: The mean ages of the groups ranged from 65-77 years, 56.4% was male. The Cronbach\'s alpha coefficients of the single-factor SCSES were 0.93, 0.89, 0.92, and 0.90 for the United States, China (Hong Kong), Italy, and Brazil, respectively. Three of the four levels of ME were partially or totally supported. The highest level achieved was partial scalar invariance level (χ2 [52] = 313.4, p < 0.001; RMSEA = 0.067; 95% CI = 0.056-0.077; CFI = 0.966; TLI = 0.960, SRMR = 0.080).
CONCLUSIONS: Patients from the four countries shared the same philosophical orientation towards scale items, although some of the items contributed differently to represent the concept and participants shared the same schemata for score interpretation.
CONCLUSIONS: Self-efficacy is important in producing effective and sustainable self-care behavioural changes. Cultural ideation shapes the ways individuals interpret and report their self-care self-efficacy. The study findings support cross-cultural and cross-national utility of the SCSES for research on self-care across United States, China (Hong Kong), Italy, and Brazil.
目的: 自我护理自我效能量表(SCSES)是一种最新制定的对慢性病自我护理自我效能的自我报告测量方法。本研究调查了其在美国、中国(香港)、意大利、巴西等不同文化群体的测量等效性(ME)。 设计: 量表跨文化验证的跨国研究。 方法: 自2015年1月至2018年12月,研究员招募了957位患有慢性病的住院患者和门诊患者(美国:200;香港:300;意大利:285;以及巴西:142)进行了自我护理自我效能量表测量,并收集了参与者的门诊和人口数据。基于Meredith框架,多组验证性因素分析通过一系列嵌套模型评估了这四类人群的量表构型、度量、标量以及严格等值,并评估了因素解决方案的可靠性和一致性。 结果: 各组的平均年龄为65岁至77岁,其中男性占总参与者人数的56.4%。美国的单因素自我护理自我效能量表的克隆巴赫系数为0.93、中国(香港)为0.89、意大利为0.92、巴西为0.90。测量等效性的四个等级中的三个得到了部分或全部支持。达到的最高等级为部分标量不变性等级。(χ2  [52] = 313.4、 p < 0.001、 RMSEA = 0.067、95% CI = 0.056-0.077、CFI = 0.966、TLI = 0.960、SRMR = 0.080) 结论: 尽管部分项目不同(观念不同),但是来自四个国家的患者在思想上对量表项目有着相同的选择,并且参与者有着相同的评分解读图解。 影响: 在有效并持续改变自我护理行为时,自我效能非常重要。文化观念的形成塑造了个人解释和报告其自我护理自我效能的方式。研究调查结果支持在美国、中国(香港)、意大利和巴西的自我护理研究中采用跨文化跨国的自我护理自我效能量表。.

If illness behaviour is to be fully understood, the social and behavioural sciences must work together to understand the wider forms in which illness is experienced and communicated with individuals and society. The current paper synthesised literature across social and behavioural sciences exploring illness experience and communication through physical and mental images. It argues that images may have the capacity to embody and influence beliefs, emotions, and health outcomes. While four commonalities exist, facilitating understandings of illness behaviour across the fields (i.e., understanding the importance of the patient perspective; perception of the cause, sense of identity with the illness, consequences, and level of control; health beliefs influencing illness experience, behaviours, and outcomes; and understanding illness beliefs and experiences through an almost exclusive focus on the written or spoken word), we will focus on exploring the fourth commonality. The choice to focus on the role of images on illness behaviour is due to the proliferation of interventions using image-based approaches. While these novel approaches show merit, there is a scarcity of theoretical underpinnings and explorations into the ways in which these are developed and into how people perceive and understand their own illnesses using image representations. The current paper identified that the use of images can elucidate patient and practitioner understandings of illness, facilitate communication, and potentially influence illness behaviours. It further identified commonalities across the social and behavioural sciences to facilitate theory informed understandings of illness behaviour which could be applied to visual intervention development to improve health outcomes.