Positive Experiences and Adjustment to Living with a Visible Difference - Case Study Example

RESEARCH CRITIQUE TO INVESTIGATE POSITIVE EXPERIENCES AND ADJUSTMENT TO LIVING WITH A VISIBLE DIFFER­ENCE The research was about the experience of positive adjustment of people with a visible physical appearance. The study involved a group interview of 12 individuals they identified four themes that is, personal growth, coping strategies, importance of appearance and interaction with others. The findings provided insight into behaviors, personal outlooks that contributed to adaptive coping, had implications for future research and interventions aimed at those individuals who exhibit poor adjustment to visible difference. The title “a qualitative study of the experiences of people who identify themselves as having adjusted positively to a visible difference” its broad based, in assuming that every individual participate indeed adjusted positively, there was no proper criteria used, besides these participates involved in an earlier research study, which makes them biased and not ideal for the study because they were aware of what was expected of them. Introduction The evaluation of body image concerns in people with disfiguring conditions appears daunting in view of the many different types and body sites, the variability in severity and visibility, the numerous personal, social, situational characteristics that contribute to body image and adjustment. (Rumsey, 2002a, 2002b) A study by (Brown et al 1988) involving 260 burn-affected individuals hinted at the complexity of variables involved in adjustment, and the role of gender. RESEARCH CRITIQUE And in this study it is not clear as to the criteria used to assess the positive adjustments to visible appearances. Much of the available research evidence confirms that a visible disfigurement leads to lowered self-confidence and negative self-image across the lifespan. While the present study does not indicate exactly how the participants were able to overcome their negative emotions, and if they attended any support groups or they did it on their own. (Turner et al 1997) Aims To investigate positive experiences and adjustment to living with a visible differ­ence specifically: What are the positive consequences of living with a visible difference? What facilitates these positive experiences? The aims are clear though too restricting hence not all inclusive and it is not easy to account for differences in body image and adjustment due to factors such as race, culture, gender, social class, and age. (Strauss 1985) Methodology Methods Researchers have blamed insufficient sample sizes and methodological shortcomings for the reported levels of psychological problems and dysfunction. (Eiserman 2001) Prevailing focus on individuals who encounter the health care system and leaving those who fail to come out in the open or contact self-help groups or support organizations. We know little about those who do not actively seek treatment. The recent interest in resilience and positive outcomes suggest a focus on this group in future research. RESEARCH CRITIQUE A focus group interview was the primary means of data collection since they encourage participants to evoke memories and attitudes from each other. (Frith 2000) This method could have hindered the individual experiences which, participates may have deemed to be embarrassing hence not sharing them in the group interviews. Data collection was mainly via group interviews alone. However, due to a small number of participants and logistical difficulties with arranging group interviews additional, more accessible forms of qualitative data collection adopted. This would have had an impact of collected data, which may not entirely reflect the true experiences of individuals especially the ones in-group interviews. They had also provided consent to be contacted again about possible participation in further research. Hence, there was a targeted approach to the recruitment strat­egy in the current study. Thirty-eight potential participants who met the criteria invited, which clearly stated that this research was focusing on positive adjustment and coping. Sampling method was askew towards individuals who already identified themselves, as having adjusted positively to the physical appearance difference, should have been more inclusive with some individuals who have not participated in any study. All partici­pants were over the age of 18, had a self reported visible difference of some kind and had previously taken part in an appearance related study in which they had self reported that they considered that they ‘coped well with their visible difference’. They had also provided consent to be contacted again about possible participation in further research. Hence, there was a targeted approach to the recruitment strat­egy in the current study. RESEARCH CRITIQUE Thirty-eight potential participants who met the criteria invited to the study, which clearly stated that this research was focusing on positive adjustment and coping. A few people did contact the first author to explain that they did not feel eligible to take part in this research now that is did not feel they were currently coping well. Two participants failed to attend a planned focus group interview. One individual explained that this was because they decided at the last minute that they did not want to reflect on the past in case it would influence negatively on their current positive state. Twelve people (nine female) aged between 31 and 80 years (mean age 56.7 years) chose to take part. Self-reported visible differences were psoriasis, port wine stain, scarring, amputations, burn injuries, impact of thyroid eye disease, mastec­tomy, alopecia and altered appearance of their hands or nose. The majority of research in this area is cross-sectional and correlational. There is a pressing need for longitudinal research to explore the dynamic nature of adjustment to disfigurement across the lifespan and the impact of treatments and interventions. Patient-centered measures ascertaining participants’ strengths and abilities in addition to difficulties would give a more balanced view of life with a disfigurement and would be a valuable resource for planning policy and care provision. (Cash and Fleming 2002) Data collection The first author using an open-ended interview schedule based on previous literature on positive adjustment conducted three group interviews and four one-to-one interviews (one face-to-face and three telephone interviews) although research indicates focus groups should ideally contain four to eight participants. (Wilkinson 2003) it was felt that smaller groups would be preferable since participants be easy in RESEARCH CRITIQUE discussing a highly personal and complex topic; thus it was probable that they would have plenty to discuss on the matter and this would allow for the development of rich data. Analysis Transcripts analyzed using an inductive thematic analysis; it was felt that its flexibility and potential to yield rich data was most appropriate to reflect the reality of participants’ experiences. (Braun and Clarke, 2006) Results Four main themes emerged importance of appearance, personal growth, relationships with others, coping Importance of appearance participants and others’ views on appearance. Participants described how they place little significance on appearance, value other characteristics and qualities highly. Many participants referred to the importance attached to appearance in society, made specific reference to media and cosmetic surgery. They also discussed how they tried to overcome the stigma associated with being vis­ibly different by talking about it openly and not camouflaging or covering up their disfigure­ment … “if you are just yourself with it, you are not kind of hiding away or being embarrassed by it, if you can just be confident in yourself … then maybe it’s showing something” (Jane). For this information to be credible they ought to have discussed what their initial reactions was when they discovered to have a visible disfigurement, how they overcame those negative emotions, in order to have a clear indication of the challenges each went through. RESEARCH CRITIQUE Discussion The current findings support assertion that individuals with high levels of resilience tend to use positive emotions. One could speculate, therefore, that individuals who display poor adaptation to their visible difference are low in resilience and dis­play more negative emotions. Participants valued benefits of supportive friends and family. This is in line with previous research findings that positive perceptions of social support related to a reduced impact of appearance concerns on lifestyle and that social support may increase acceptance through mainte­nance of self-esteem. Furthermore, demonstrated that social sup­port was a strong predictor of post-traumatic growth among people with burn injuries and found that social support helped participants cope with other peo­ple’s reactions to their visible difference. In the present study the researchers there is no indication of the amount of support each member received to enable them live positively, and what happened to those who did live positively without much support how did they overcome the challenges that came there way? This study is biased and is not all-inclusive. Telephone interviews previously criticized, first for the participants becoming distracted when in their own environment and second, as telephone conversations lack the non-verbal communication that contributes to the rich­ness of data. Because of the differences in methods used, the information obtained from participants who took part in telephone interviews might be noticeably different from that gained from face-to-face or group interviews. High­lighted a need for the development of high qual­ity psychosocial interventions to support people who are experiencing difficulties because of a visible difference, by RESEARCH CRITIQUE providing an insight into the experiences of people who consider them­selves to have adjusted positively to a visible difference, the current study can usefully inform the development of such interventions. For example, cognitive- behavioral therapy interventions could use examples from this study to encourage individuals to identify posi­tive consequences and not to attribute other problems to their visible difference, while online discussion forums might offer access to support from others who report positive experi­ences because of a disfigurement. Conclusions Whereas a small amount of existing research in this field has examined positive aspects of disfigurement among individuals with spe­cific conditions, the current study explored the experiences of individuals with a variety of visible differences and highlighted simi­larities in positive consequences, effective coping and adjustment across this group. It demonstrated the effective use of both group and individual interviews in this area and the utility of taking a positive as opposed to prob­lem-focused approach when considering the psychosocial impact of visible difference. There is more research needed to give insight into a broad range of mechanisms intended for use as part of positive adjustment to visi­ble difference. These findings to inform both the provision of care to all individuals affected, including the develop­ment of interventions to promote positive adjustment, and further research aiming to help individuals who experience difficulty adjusting to a visible difference. RESEARCH CRITIQUE Reference list Brown B, Roberts J, Browne G, Byrne C, Love B, & Streiner D (1988) Gender differences in variables associated with psychosocial adjustment to burn injury. Research on Nursing Health, 11, 23–30. Cash F, & Fleming E. C (2002) Body image and social relations. Clinical practice (pp. 277–286) Eiserman W (2001) Important outcomes and positive contributions associated with facial difference: Cleft Palate Craniofacial Journal, 38(3), 236–244. Frith H (2000) Focusing on Sex: Using Focus Groups in Sex Research. Sexualities 3(3): 275–297. Rumsey N (2002a) Body image & congenital conditions with visible differences, research and clinical practice. (pp. 226–233) Rumsey N (2002b) Optimizing body image in disfiguring congenital conditions research, and clinical practice. (pp. 431–439) Strauss R P (1985) Culture, rehabilitation and facial birth defects. Cleft Palate Journal, 22(1), 56–62. Turner S, Dowell T, Sandy J, Rumsey N, and Thomas P, (1997) Psychological outcomes amongst cleft patients and their families. Journal of Plastic Surgery, 50, 1–9. Read More