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Ali Y, Rennick-Egglestone S, Llewellyn-Beardsley J, Ng F, Yeo C, Franklin D, Perez Vallejos E, Ben-Zeev D, Kotera Y, Slade M. Perception and appropriation of a web-based recovery narratives intervention: qualitative interview study. Front Digit Health 2024; 6:1297935. [PMID: 38419807 PMCID: PMC10899698 DOI: 10.3389/fdgth.2024.1297935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Mental health recovery narratives are widely available to the public, and can benefit people affected by mental health problems. The NEON Intervention is a novel web-based digital health intervention providing access to the NEON Collection of recovery narratives. The NEON Intervention was found to be effective and cost-effective in the NEON-O Trial for people with nonpsychosis mental health problems (ISRCTN63197153), and has also been evaluated in the NEON Trial for people with psychosis experience (ISRCTN11152837). We aimed to document NEON Intervention experiences, through an integrated process evaluation. Methods Analysis of interviews with a purposive sample of intervention arm participants who had completed trial participation. Results We interviewed 34 NEON Trial and 20 NEON-O Trial participants (mean age 40.4 years). Some users accessed narratives through the NEON Intervention almost daily, whilst others used it infrequently or not at all. Motivations for trial participation included: exploring the NEON Intervention as an alternative or addition to existing mental health provision; searching for answers about mental health experiences; developing their practice as a mental health professional (for a subset who were mental health professionals); claiming payment vouchers. High users (10 + narrative accesses) described three forms of appropriation: distracting from difficult mental health experiences; providing an emotional boost; sustaining a sense of having a social support network. Most participants valued the scale of the NEON Collection (n = 659 narratives), but some found it overwhelming. Many felt they could describe the characteristics of a desired narrative that would benefit their mental health. Finding a narrative meeting their desires enhanced engagement, but not finding one reduced engagement. Narratives in the NEON Collection were perceived as authentic if they acknowledged the difficult reality of mental health experiences, appeared to describe real world experiences, and described mental health experiences similar to those of the participant. Discussion We present recommendations for digital health interventions incorporating collections of digital narratives: (1) make the scale and diversity of the collection visible; (2) provide delivery mechanisms that afford appropriation; (3) enable contributors to produce authentic narratives; (4) enable learning by healthcare professionals; (5) consider use to address loneliness.
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Affiliation(s)
- Yasmin Ali
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Caroline Yeo
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Department of Architecture and Built Environment, Faculty of Engineering, University of Nottingham, Nottingham, United Kingdom
| | - Donna Franklin
- NEON Lived Experience Advisory Panel, Nottingham, United Kingdom
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Elvira Perez Vallejos
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
- School of Computer Science, University of Nottingham, Nottingham, United Kingdom
| | - Dror Ben-Zeev
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Yasuhiro Kotera
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Center for Infectious Disease Education and Research, Osaka University, Osaka, Japan
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Faculty of Nursing and Health Sciences, Health, and Community Participation Division, Nord University, Namsos, Norway
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Nolan HA, Roberts L. Trigger warnings as tools for learning-theorising an evolving cultural concept. Med Educ 2024; 58:185-195. [PMID: 37528527 DOI: 10.1111/medu.15172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND While definitions of trigger warnings vary, it is generally accepted that they caution about potential reactions arising from exposure to distressing material. Controversy surrounds use of warnings in education, with concerns noted regarding impacts on academic freedom, "coddling", thereby undermining resilience, reinforcement of traumatised identity and enablement of avoidance. Proponents of warnings position them as accommodations for those affected by trauma, enhancing inclusion, and suggest warnings empower choice and enable informed engagement in learning. A recent meta-analysis of warnings' efficacy demonstrated no effect on affective responses or comprehension. Findings regarding avoidance suggested warnings may increase engagement with material. Synthesis of heterogeneous results relating to context of warning application necessitates cautious interpretation of findings. Furthermore, controlled experimental designs do not reflect complex ecologies of social learning environments. METHODS Evidence relating to warnings in healthcare professions education remains limited. We undertake a narrative review and synthesis of evidence regarding the role and functions of trigger warnings from a range of disciplines, to inform healthcare education practice. We apply this evidence in considering how warnings may act within a range of theoretical frameworks for healthcare professionals educations including andragogy, self-directed learning and, ultimately, transformative learning. Tensions between exposure to emotionally stimulating learning episodes and the necessity of emotion for learning while simultaneously attending to learners' needs and fulfilling educators' responsibilities are explored. We probe gaps and contentions in existing theoretical frameworks for learning, and consider implications of recognised limitations with reference to warnings. We summarise by proposing a conceptual model for the role of warnings that considers wider salient factors for fostering effective learning. DISCUSSION AND CONCLUSIONS Difficulties associated with deriving contextually-relevant evidence and conclusions relating to warnings as an evolving cultural concept are highlighted. We propose warnings as tools to enable critical reflection and emotional literacy, to curate effective learning environments and support humanistic healthcare professional identity formation, within wider trauma-informed pedagogies and educator practice.
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