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Coping and Help Seeking Behaviour in Women with Pelvic Floor Dysfunction : the Emic Perspective

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Coping and Help Seeking Behaviour in Women with Pelvic Floor Dysfunction : the Emic Perspective City Research Online City, University of London Institutional Repository Citation: Theresa, P. (2010). Coping and help seeking behaviour in women with Pelvic Floor Dysfunction : the emic perspective. (Unpublished Doctoral thesis, City University London) This is the accepted version of the paper. This version of the publication may differ from the final published version. Permanent repository link: https://openaccess.city.ac.uk/id/eprint/8612/ Link to published version: Copyright: City Research Online aims to make research outputs of City, University of London available to a wider audience. Copyright and Moral Rights remain with the author(s) and/or copyright holders. URLs from City Research Online may be freely distributed and linked to. Reuse: Copies of full items can be used for personal research or study, educational, or not-for-profit purposes without prior permission or charge. Provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way. City Research Online: http://openaccess.city.ac.uk/ [email protected] Porrett, Theresa (2010). Coping and help seeking behaviour in women with Pelvic Floor Dysfunction – the emic perspective. (Unpublished Doctoral thesis, City University London) City Research Online Original citation: Porrett, Theresa (2010). Coping and help seeking behaviour in women with Pelvic Floor Dysfunction – the emic perspective. (Unpublished Doctoral thesis, City University London) Permanent City Research Online URL: http://openaccess.city.ac.uk/1164/ Copyright & reuse City University London has developed City Research Online so that its users may access the research outputs of City University London's staff. Copyright © and Moral Rights for this paper are retained by the individual author(s) and/ or other copyright holders. All material in City Research Online is checked for eligibility for copyright before being made available in the live archive. URLs from City Research Online may be freely distributed and linked to from other web pages. Versions of research The version in City Research Online may differ from the final published version. Users are advised to check the Permanent City Research Online URL above for the status of the paper. Enquiries If you have any enquiries about any aspect of City Research Online, or if you wish to make contact with the author(s) of this paper, please email the team at [email protected]. ‘Coping and help seeking behaviour in women with Pelvic Floor Dysfunction – the emic perspective’ Theresa Porrett MSc, RGN Thesis submitted for the degree of Doctor of Philosophy (PhD) CITY UNIVERSITY, London Department of Applied Biological Sciences School of Community and Health Sciences June 2010 1 TABLE OF CONTENTS Page Table of Contents 2-10 Index to Figures 11 Index to Tables 12 Index to Appendices 13 Acknowledgements 14 Declaration 15 Watermark of conceptual model 16 Abstract 17 Chapter 1: Introduction 18-24 1.0 Rational for the area of study 18 1.1 Definition of Pelvic Floor Dysfunction 18 1.1.1 Pelvic Floor Dysfunction as a concept 19 1.2.1 The emic and etic perspective in PFD 20 1.2 Incidence and demographics of PFD 21 1.3 Symptomatology spectrum in PFD 22 1.4 Help seeking behaviour in PFD 23 1.5 Aims and objectives of the study 23 1.6 Summary 24 Chapter 2: Explication and critique of the theoretical frameworks underpinning 25-43 this study 2.0 Introduction 25 2.1 Rationale for the utilisation of Culture Care Theory to 25 underpin this study 2.1.1 The importance of Culture Care Theory in nursing 26 2.2 Culture Care Theory 27 2.3 The evolution of Culture Care Diversity and Universality: 27 a theory of nursing 2 Page 2.4 Description of the Theory of Culture Care and the Sunrise 28 Enabler 2.5 Analysis and evaluation of the Theory of Culture Care 31 Diversity and Universality 2.5.1 Scope of the Theory 31 2.5.2 Context of the Theory 32 2.5.3 Philosophical Claims 32 2.5.4 Conceptual Model 33 2.5.5 Antecedent Knowledge 33 2.5.6 Content of the Theory 34 2.5.7 Relational Propositions 36 2.6 The application of the Theory of Culture Care 37 Diversity and Universality to nursing practice 2.6.1 Variety of settings in which Culture Care Theory 39 has been utilised in published studies 2.7 Rationale for the utilisation of Shaw’s Framework for the 39 study of Coping 2.7.1 The importance of the Coping Framework 40 2.7.2 The Coping Framework 41 2.7.3 Methodology employed to develop the framework 41 2.7.4 Framework assumptions 42 2.7.5 Analysis and evaluation of the Coping Framework 42 2.8 Summary 42 Chapter 3: Coping and Help Seeking Behaviour – a review of the literature 44-66 3.0 Introduction 44 3.1 Literature Search Strategy 45 3.1.1 Findings 45 3.2 PFD as a Stressor 45 3.2.1 The impact of PFD on Quality of Life 46 3.2.2 The stigma, embarrassment and feelings of 48 disgrace associated with PFD 3.3 Coping mechanisms 49 3.3.1 Primary Appraisal – Event 50 3.3.1.1 Beliefs about the illness 51 3.3.1.2 Cognitive processes 51 3 Page 3.3.1.3 Health beliefs and Locus of Control 52 3.3.1.4 Emotional processes 53 3.3.1.5 Group differences and Socio-Economic 53 factors 3.3.2 Primary Appraisal – Situation 55 3.3.2.1 Perceived severity of illness 55 3.3.2.2 Raised Awareness 57 3.3.3 Secondary Appraisal – Condition 57 3.3.3.1 Emotions 58 3.3.3.2 Social Support 58 3.3.4 Coping behaviour 58 3.3.5 Secondary Appraisal – Cue 59 3.3.5.1 Barriers to help seeking 59 3.3.5.1.1 Evidence with respect to 63 women who do not seek help 3.3.5.2 Factors which promote help seeking 63 3.4 Summary 65 Chapter 4: Methodology 67 - 82 4.0 Introduction 67 4.1 Research question 67 4.1.1 Study aims 67 4.1.2 Study assumptions 67 4.1.3 Inclusion criteria 68 4.1.4 Exclusion criteria 68 4.2 Rationale for the use of Leininger’s Culture Care Diversity 68 and Universality: a theory of nursing and ethnographic methods to underpin the study 4.3 Rational for the use of Shaw’s Framework of coping 70 4.4 Dual role of nurse and researcher 71 4.5 Research Study Phases 72 4.5.1 Phase One – One Life Health Care History 72 4.5.1.1 Sampling methods for Phase 1 73 4.5.1.2 Data Analysis methods used throughout 74 the study 4.5.1.2.1 Life Health Care History 75 4.6 Modification of Shaw’s Framework of Coping 75 4.7 Modification of Leininger’s Sunrise Enabler 75 4.8 Phase Two – Semi-structured interviews 76 4 Page 4.8.1 Thematic development of questions and question 76 format 4.8.2 Sampling methods for Phase Two 78 4.8.3 Data Analysis 78 4.9 Phase Three Focus Groups – the emic perspective of 78 women with PFD from diverse cultures 4.9.1 Sampling methods for Phase Three 79 4.9.2 Thematic development of Focus Group questions 79 and question format 4.9.3 Data Analysis 79 4.10 Qualitative Criteria for trustworthiness used throughout the 79 Study 4.10.1 Credibility 80 4.10.2 Confirmability 80 4.10.3 Dependability 81 4.10.4 Transferability 81 4.11 Ethical considerations 81 4.11.1 Data Protection 82 4.12 Summary 82 Chapter 5: Results Phase One 83-101 5.0 Life Health Care History 83 5.1 Background history of the Life Health Care Informant 83 5.2 Ethnography – ‘Juggling with aspects of my life to cope 83 with PFD’ 5.3 Themes extrapolated from the Life Health Care History 87 5.3.1 Kinship and Social Factor 89 5.3.1.1 Kinship – Knowledge 89 5.3.1.2 Kinship – Social Support 89 5.3.1.3 Societal Pressure 89 5.3.2 Political and Legal Factors 89 5.3.3 Cultural Values, Beliefs and Lifeways 90 5.3.3.1 Women in society 90 5.3.3.2 Role and status of women 90 5.3.4 Religious and Philosophical Factors 91 5.3.4.1 Religious beliefs and health 91 5 Page 5.3.5 Personality Factors 91 5.3.5.1 Personality traits 91 5.3.5.2 Emotions 91 5.3.5.3 Permission 91 5.3.5.4 Coping Mechanisms 92 5.3.6 Educational Factors 92 5.3.6.1 Knowledge 92 5.3.6.2 Communication and language 93 5.3.6.3 Perception of the problem 93 5.3.7 Technological Factors 93 5.3.7.1 Health Beliefs 93 5.3.7.2 Knowledge of services 94 5.3.8 Socio-Economic Factors 94 5.3.9 Care Influencers 94 5.3.9.1 Trigger to help seeking 94 5.3.9.2 Barrier to help seeking 94 5.3.9.3 Facilitator of help seeking 95 5.3.10 Summary of thematic analysis 95 5.4 Expositional Analysis 96 5.4.1 Sunrise Enabler 96 5.4.2 Shaw’s Framework of Coping 99 5.5 Conclusion 101 Chapter 6: Results of Phase Two 102-128 6.0 Introduction 102 6.1 Demographics 102 6.2 Thematic analysis of interview transcripts 103 6.2.1 Synthesis of Primary and Secondary Appraisal 107 6.3 Thematic Exposition 107 6.3.1 Kinship and Social factors 108 6.3.1.1 Kinship – Knowledge 108 6.3.1.2 Kinship - Social Support 108 6.3.1.3 Social – Societal Pressure 109 6.3.2 Political and Legal Factors 111 6.3.3 Cultural Values, Beliefs and Lifeways 111 6.3.3.1 Women in Society 111 6.3.3.2 Role and status of women 112 6.3.4 Religious and Philosophical Factors 112 6.3.4.1 Religious beliefs and health 112 6 Page 6.3.5 Personality Factors 113 6.3.5.1 Personality traits 113 6.3.5.2 Emotions 114 6.3.5.3 Permission 114 6.3.5.4 Coping strategies 115 6.3.6 Educational Factors 115 6.3.6.1 Knowledge 116 6.3.6.2 Communication and Language 117 6.3.6.3 Perception of the problem 118 6.3.7 Technological Factors 118 6.3.7.1 Health Beliefs 118 6.3.7.2 Knowledge of services 119 6.3.8 Socio-Economic Factors 120 6.3.9 Care Influences 120 6.3.9.1 Trigger to help seeking 121 6.3.9.2 Barriers to help seeking 121 6.3.9.3 Facilitator of help seeking 122 6.3.10 Ideal world comments 124 6.3.10.1 Aids to help seeking 124 6.3.10.2 Service improvement 124 6.3.11 Summary of thematic analysis
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