A qualitative examination of affect and ideology within mass media interventions to increase HIV testing with gay men garnered from a systematic review

OBJECTIVES

Increasing appropriate HIV testing among men who have sex with men (MSM) is crucial to HIV prevention. Mass media interventions are effective in promoting testing, but to date, there has been little examination of their active content.

DESIGN

We conducted a qualitative analysis of intervention materials (n = 69) derived from a systematic review of mass media interventions designed to improve testing with MSM.

METHODS

Visual data were analysed for their affective and ideological content using a novel method drawing on concepts from semiotics (i.e., broadly speaking, the analysis of signs).

RESULTS

Whilst affect was not explicitly theorized or examined in any of the studies, there are clearly identifiable affective elements implicitly at play in these interventions. Four thematic categories of affect/ideology were identified including (1) sexual desire and the 'pornographication' of the gay/bisexual male subject; (2) narratives of romance and love; (3) fear, threat, and regret; and (4) 'flattened' affect.

CONCLUSIONS

This is the first study to examine and detail the affective and ideological aspects of intervention content in this field. Using analytic techniques such as those reported here, in addition to approaches that focus on the manner in which intervention content address more proximal determinants of behaviour, can provide a rich and potentially more useful evidence base to assist with future interventions.

The Psychology of Puppy Play: A Phenomenological Investigation

This article presents a phenomenological investigation into the experience of engaging in a sexual practice known as "puppy play," where participants role-play being puppies or handlers (those that look after or own puppies), often within a dominance/submission sexual context. Only one previous study has been conducted on this phenomenon, and the present study sought to provide new knowledge about the meaning of this practice for participants. We conducted a qualitative analysis of data derived from 68 individual experience descriptions and 25 semi-structured interviews with puppies and handlers. Through the use of a phenomenological methodology focused on experience, we identified the key constituents that comprise this phenomenon and help make sense of peoples' desire to participate. The five themes include: (1) sexual pleasure; (2) relaxation, therapy, and escape from self; (3) adult play and vibrant physicality; (4) extending and expressing selfhood; and (5) relationships and community. We discuss this practice/identity in the context of enjoyment of the dominant/submissive sexual element, the perceived benefits of a form of mindful adult play, the opportunity to explore aspects of selfhood, and the value of relationships and community membership.

Effectiveness of interventions to improve the public's antimicrobial resistance awareness and behaviours associated with prudent use of antimicrobials: a systematic review

Background

A global antimicrobial resistance (AMR) awareness intervention targeting the general public has been prioritized.

Objectives

To evaluate the effectiveness of interventions that aim to change AMR awareness and subsequent stewardship behaviours amongst the public.

Methods

Five databases were searched between 2000 and 2016 for interventions to change the public's AMR awareness and/or antimicrobial stewardship behaviours. Study designs meeting the Cochrane Effective Practice and Organization of Care (EPOC) criteria, non-controlled before-and-after studies and prospective cohort studies were considered eligible. Participants recruited from healthcare settings and studies measuring stewardship behaviours of healthcare professionals were excluded. Quality of studies was assessed using EPOC risk of bias criteria. Data were extracted and synthesized narratively. Registration: PROSPERO international prospective register of systematic reviews (PROSPERO 2016: CRD42016050343).

Results

Twenty studies were included in the review with nine meeting the EPOC criteria. The overall risk of bias was high. Nineteen studies were conducted in high-income countries. Mass media interventions were most common (n = 7), followed by school-based (n = 6) and printed material interventions (n = 6). Seventeen studies demonstrated a significant effect on changing knowledge, attitudes or the public's antimicrobial stewardship behaviours. Analysis showed that interventions targeting schoolchildren and parents have notable potential, but for the general public the picture is less clear.

Conclusions

Our work provides an in-depth examination of the effectiveness of AMR interventions for the public. However, the studies were heterogeneous and the quality of evidence was poor. Well-designed, experimental studies on behavioural outcomes of such interventions are required.

Understanding the relationship between pet owners and their companion animals as a key context for antimicrobial resistance-related behaviours: an interpretative phenomenological analysis

Objectives: Drivers of antimicrobial resistance (AMR) are diffuse and complex including a range of interspecies behaviours between pet owners and their animals. We employed interpretative phenomenological analysis (IPA) to explore the relationship between pet owners and their companion animals in relation to AMR. Design: Cross sectional, qualitative study. Methods: Semi-structured interviews were conducted with twenty-three British pet owners, transcribed verbatim and subjected to Interpretative Phenomenological Analysis (IPA). Results: Three, inter-related Superordinate themes are presented 1) 'They're my fur babies': unconditional love and anthropomorphism; 2) 'They share everything with you': affection and transmission behaviours; and 3) 'We would err on the side of caution': decision making and antibiotic use'. Conclusions: Affectionate behaviours between companion animals and their owners pose a risk for AMR transmission but they are so deeply treasured that they are unlikely to be amenable to change. In contrast, the promotion of appropriate antibiotic stewardship for pet owners and vets may offer a viable pathway for intervention development, benefitting from synergies with other interventions that target prescribers.

A Mobile App Delivering a Gamified Battery of Cognitive Tests Designed for Repeated Play (OU Brainwave): App Design and Cohort Study

BACKGROUND

Mobile phone and tablet apps are an increasingly common platform for collecting data. A key challenge for researchers has been participant "buy-in" and attrition for designs requiring repeated testing.

OBJECTIVE

The objective of this study was to develop and assess the utility of 1-2 minute versions of both classic and novel cognitive tasks using a user-focused and user-driven mobile phone and tablet app designed to encourage repeated play.

METHODS

A large sample of app users (N=13,979 at first data collection) participated in multiple, self-paced sessions of classic working memory (N-back), spatial cognition (mental rotation), sustained attentional focus (persistent vigilance task), and split attention (multiple object tracking) tasks, along with the implementation of a comparatively novel action-learning task. The "OU Brainwave" app was designed to measure time-of-day variation in cognitive performance and did not offer any training program or promise any cognitive enhancement. To record participants' chronotype, a full Morningness-Eveningness questionnaire was also included, which measures whether a person's circadian rhythm produces peak alertness in the morning, in the evening, or in between. Data were collected during an 18-month period. While the app prompted re-engagement at set intervals, participants were free to complete each task as many times as they wished.

RESULTS

We found a significant relationship between morningness and age (r=.298, n=12,755, P<.001), with no effect of gender (t_13,539=-1.036, P=.30). We report good task adherence, with ~4000 participants repeatedly playing each game >4 times each-our minimum engagement level for analysis. Repeated plays of these games allowed us to replicate commonly reported gender effects in gamified spatial cognition (F_1,4216=154.861, P<.001, η²_ρ=.035), split attention (F_1,4185=11.047, P=.001, η²_ρ=.003), and sustained attentional focus (F_1,4238=15.993, P<.001, η²_ρ=.004) tasks. We also report evidence of a small gender effect in an action-learning task (F_1,3988=90.59, P<.001, η²_ρ=.022). Finally, we found a strong negative effect of self-reported age on performance, when controlling for number of plays, in sustained attentional focus (n=1596, F_6,1595=30.23, P<.001, η²=.102), working memory (n=1627, F_6,1626=19.78, P<.001, η²=.068), spatial cognition (n=1640, F_6,1639=23.74, P<.001, η²=.080), and split attention tasks (n=1616, F_6,1615=2.48, P=.02, η²=.009).

CONCLUSIONS

Using extremely short testing periods and permitting participants to decide their level of engagement-both in terms of which gamified task they played and how many sessions they completed-we were able to collect a substantial and valid dataset. We suggest that the success of OU Brainwave should inform future research oriented apps-particularly in issues of balancing participant engagement with data fidelity.

A visual affective analysis of mass media interventions to increase antimicrobial stewardship amongst the public

Objectives

In an innovative approach to improve the contribution of health psychology to public health we have analysed the presence and nature of affect within the visual materials deployed in antimicrobial stewardship interventions targeting the public identified through systematic review.

Design

A qualitative analysis focused on the affective content of visual materials garnered from a systematic review of antibiotic stewardship (k = 20).

Methods

A novel method was devised drawing on concepts from semiotics to analyse the affective elements within intervention materials.

Results

Whilst all studies examined tacitly rely on affect, only one sought to explicitly deploy affect. Three thematic categories of affect are identified within the materials in which specific ideological machinery is deployed: (1) monsters, bugs, and superheroes; (2) responsibility, threat, and the misuse/abuse of antibiotics; (3) the figure of the child.

Conclusions

The study demonstrates how affect is a present but tacit communication strategy of antimicrobial stewardship interventions but has not – to date – been adequately theorized or explicitly considered in the intervention design process. Certain affective features were explored in relation to the effectiveness of antimicrobial resistance interventions and warrant further investigation. We argue that further research is needed to systematically illuminate and capitalize upon the use of affect to effect behaviour change concerning antimicrobial stewardship.

What are the 'active ingredients' of interventions targeting the public's engagement with antimicrobial resistance and how might they work?

Objectives

Changing public awareness of antimicrobial resistance (AMR) represents a global public health priority. A systematic review of interventions that targeted public AMR awareness and associated behaviour was previously conducted. Here, we focus on identifying the active content of these interventions and explore potential mechanisms of action.

Methods

The project took a novel approach to intervention mapping utilizing the following steps: (1) an exploration of explicit and tacit theory and theoretical constructs within the interventions using the Theoretical Domains Framework (TDFv2), (2) retrospective coding of behaviour change techniques (BCTs) using the BCT Taxonomy v1, and (3) an investigation of coherent links between the TDF domains and BCTs across the interventions.

Results

Of 20 studies included, only four reported an explicit theoretical basis to their intervention. However, TDF analysis revealed that nine of the 14 TDF domains were utilized, most commonly ‘Knowledge’ and ‘Environmental context and resources’. The BCT analysis showed that all interventions contained at least one BCT, and 14 of 93 (15%) BCTs were coded, most commonly ‘Information about health consequences’, ‘Credible source’, and ‘Instruction on how to perform the behaviour’.

Conclusions

We identified nine relevant TDF domains and 14 BCTs used in these interventions. Only 15% of BCTs have been applied in AMR interventions thus providing a clear opportunity for the development of novel interventions in this context. This methodological approach provides a useful way of retrospectively mapping theoretical constructs and BCTs when reviewing studies that provide limited information on theory and intervention content.

Statement of contribution

What is already known on this subject?

Evidence of the effectiveness of interventions that target the public to engage them with AMR is mixed; the public continue to show poor knowledge and misperceptions of AMR.

Little is known about the common, active ingredients of AMR interventions targeting the public and information on explicit theoretical content is sparse.

Information on the components of AMR public health interventions is urgently needed to enable the design of effective interventions to engage the public with AMR stewardship behaviour.

What does this study add?

The analysis shows very few studies reported any explicit theoretical basis to the interventions they described.

Many interventions share common components, including core mechanisms of action and behaviour change techniques.

The analysis suggests components of future interventions to engage the public with AMR.

Recovery From Heart Attack, Biomedicalization, and the Production of a Contingent Health Citizenship

In this article, I explore the experience of recovery from a heart attack through an analytic autoethnography. I discuss the tensions inherent in biomedical subjectivities of health and ill-health during cardiac recovery through three key themes: (a) the transfer of responsibility and becoming a subject "at risk," (b) technologies of biomedicine and the disciplining of subjectivities, and (c) the transformation of a body toward a new pharmaceuticalized bodily normal. Through an analysis driven by the biomedicalization thesis of Clarke, alongside work on biopower and the governmentality of health by Foucault, Rose, and Rabinow, I seek to provide new insights into the process of cardiac recovery and the relationship between individual experience and broader socio-political processes. Key to this analysis is a focus on the contingent subjectivities brought into being through biomedicalization that constitute a new form of health citizenship that is otherwise not accounted for in narratives of recovery.

Ideology and Utopia

In recent years we have witnessed a number of new developments in social psychology that set out to offer an alternative to the dominant social cognitive paradigm. Whilst there is undoubtedly growing interest in these alternatives, they have not had the impact that many might have hoped. In this paper, I outline Paul Ricoeur’s work on the social imaginary, ideology and utopia, and use this as a critical hermeneutic to understand the failure of ‘new movements’ within social psychology to move the discipline forward. The social imaginary is the ensemble of stories possessed by all societies that serve to mediate human reality. Ricoeur uses this concept to understand and conceptualize the distinction between ideology and utopia. Ideology and utopia are reconceptualized by Ricoeur as integration/identity and rupture/critique, respectively. I argue that social psychology vacillates between these two positions and, as yet, has not been able to engage dialectically with both.

Offending the other: Deconstructing narratives of deviance and pathology

Narratives of homophobia and the repathologization of gay men now emerge and coalesce in often unconsidered ways. Within this paper, we present a deconstructive analysis of a recent paper published within the British Journal of Social Psychology (Crossley, 2004) and highlight how a narrative of repathology emerges through the selective appropriation of particular textual sources. By employing pathological constructions of sexual conduct between men; focusing upon singular homogenized constructions of gay men and simplistic constructions of health promotion and through a process of reconstructing HIV as a gay plague and it is possible to embroider a moral tale which constitutes a further deviant 'othering' of gay men. We contend that by employing (functional) discourses of 'unconscious motivation', together with a constellation of disclaimers, caveats and tokenistic pluralization, it becomes possible for psychologists to engage in homophobic knowledge production whilst maintaining an identity as a (dis)interested professional. Our analysis raises issues pertinent to all social psychologists engaged in 'suspicious' research on 'the other'. To this end, we expand our critique by employing ideas from Ricoeur's hermeneutic phenomenology to provide more general discussion of ethical and constructive ways of engaging in textual analyses of persons outside one's own tradition.

The fundamental attribution error: a phenomenological critique

The fundamental attribution error (Heider, 1958; Ross, 1977) has been extensively researched and explanations sought within a social cognitive framework. This work is reviewed, and it is noted that there is no unifying theory to account for the extensive catalogue of experimental work. Social cognitive explanations have proposed distinctions between perceptual, inferential and motivational functions within the person to account for the phenomenon. A phenomenological critique of this approach is then advanced. Drawing on the thought of Merleau-Ponty (1962) it is argued that our understanding of the phenomenon is enhanced by focusing not 'inside' people, but on interactions between them. In many ways, this brings us back to the project of Gestalt psychology, Heider's original framework for studying attribution.