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The purpose of this paper is to explore the relationship of two distinct variants of dispositional shame (internal and external shame) with collaborative, purpose-driven aspects of the patient–provider relationship (working alliance) and patient satisfaction. The aim of this research was to conduct a preliminary investigation into the relevance of dispositional shame in a general healthcare population.

In total, 127 community members (mean age 25.9 years) who reported that they had regularly seen a GP over the past year were recruited at an Australian university. Participants were asked to reflect on their relationship with their GP, and completed instruments assessing various domains of shame, as well as working alliance and patient satisfaction.

Non-parametric correlations were examined to determine the direction and strength of relationships, as well as conducting mediation analyses where applicable. Small, negative correlations were evident between external shame and working alliance. Both external and internal shame measures were also negatively correlated with patient satisfaction. Finally, the relationship of external shame to patient satisfaction was partially mediated by working alliance.

Both the reported quality of patient–provider working alliance, and level of patient satisfaction are related to levels of dispositional shame in patients, and working alliance may act as a mediator for this relationship.

The findings from this preliminary study suggest that internal and external shame are important factors to consider in the provision of medical care to maximise the quality of patient experience and working alliance.

Purpose: Miscarriage is commonly understood as an involuntary, grieve-able pregnancy outcome. Abortion is commonly understood as a voluntary, if stigmatized, pregnancy outcome that people do not typically grieve. This chapter examines a nexus of the involuntary and voluntary: how people who chose abortion following observation of a serious fetal health issue make sense of their experience and process associated emotions.

Design: The author draws on semi-structured interviews with cisgender women who had an observed serious fetal health issue and chose to terminate their pregnancy.

Findings: Findings highlight an initial prioritization of medical knowledge in pregnancy decision-making giving way, in the face of the inherent limits of medical knowability, to a focus on personal and familial values. Abortion represented a way to lessen the prospective suffering of their fetus, for many, and felt like an explicitly moral decision. Respondents felt relief after the abortion as well as a sense of loss. They processed their post-abortion emotions, including grief, in multiple ways, including through viewing – or intentionally not viewing – the remains, community rituals, private actions, and no formalized activity. Throughout respondents’ experiences, the stigmatization of abortion negatively affected their ability to obtain the care they desired and, for some, to emotionally process the overall experience.

Originality/Value: This chapter offers insight into the understudied experience of how people make sense of a serious fetal health issue and illustrates an additional facet of the stigmatization of abortion, namely how stigmatization may complicate people’s pregnancy decision-making process and their post-abortion processing.

The purpose of this study explores the perspective of key informants (educators, preceptors and former students) of the Kintampo Project, on the perceived effectiveness, gains and challenges in delivering this large-scale training innovation in Ghana. The problem of mental health care neglect in Ghana is gradually improving. The Kintampo Project which trained mental health workers in Ghana has played a critical role in increasing access to mental health care.

This qualitative study explored participants' perspectives on the Kintampo Project in three broad areas: perceived effectiveness, gains and challenges. In all, 17 interviews were conducted with former students, preceptors and educators from the project. The interviews were digitally audio-recorded, transcribed, coded and analysed using deductive and thematic methods.

The participants perceived the project to have been successful in increasing the number of mental health workers in Ghana. The project provided a route for career progression for those involved. However, the Kintampo Project faced accreditation issues, low recognition, improper integration and remuneration of trained staff in the Ghana Health Service. This study points to the fact that the sustainability of mental health training in Ghana can be obstructed, because of this career path being less attractive. Further research is needed to explore how best to achieve sustainability of similar mental health innovations.

This paper shares the views of participants in the Kintampo Project.

Personality research often has focused on how people change in response to the work environment, given that work constitutes a significant portion of the daily life of adults. However, most research has failed to consider the effect of the work context on purpose in life. This omission is surprising given that purpose research involves several characteristics that align well with the occupational psychology and organizational behavior literatures. The current research considers how one feature of the work context, work stress, may (or may not) facilitate the purpose development process. We put forth a Purpose and Work Stress (PAWS) model which explains why understanding whether work stress is perceived as harmful or challenging to employees can provide significant insight into whether that occupation is aligned with the individual’s purpose in life. Furthermore, the model highlights that the ability to monitor and interpret work stress may help an individual identify and cultivate their purpose. Implications of the PAWS model are described, including how it may help us understanding the roles for retirement and job crafting on purpose.

The purpose of this paper is to examine the psychometric characteristics of male offenders who joined a democratic therapeutic community and their relationship to attrition.

Residents who left therapy prematurely during the assessment phase (N = 46) and residents who left therapy prematurely during core therapy (N = 202) were compared to residents who completed therapy (N = 52) on two psychometric measures: Raven’s Standard Progressive Matrices and The Blame Attribution Inventory.

A multinomial logistic regression analysis showed higher levels of external blame can predict attrition during therapy; those with higher levels of external attribution are significantly more likely to leave therapy prematurely, including both during the assessment phase and during core therapy. Raven's Standard Progressive Matrices score did not significantly predict whether an individual left therapy prematurely.

Support was found for existing research within the academic evidence base. The findings have both empirical and clinical utility, suggesting during the assessment phase of therapy, practitioners can identify residents that may require additional support to maintain engagement, minimising the potential for premature departure. The implications of the findings are discussed, with suggestions made for future research.

International students commonly need to adjust to an unfamiliar environment while at the same time juggling with their education without traditional family support. Intercultural adjustment is often stressful for these students, thus contributing to a higher risk of a vulnerable mental and emotional state. The relocation to a foreign country presents a case of temporary migration during the time that they are away. This chapter looks at the challenges international students faced during relocation and adaptation. The study will also discuss how international students cope with mental health issues and the important role educational institutions have in mental health care. Interview data will be drawn on to present the perspectives of a group of international Singaporean university students in Melbourne, Australia, aged between 20 and 25 years old. However, the discussion about mental health issues cannot be assumed to be directly related to the challenges of relocation. Interview data will only represent the perspective of a group of international students and cannot be made generalisable to all international students. Similar to other studies, findings from this chapter reinforced the challenges international students face from their migration. While they acknowledged the importance of mental health care services, there are still barriers to seeking professional help. Future studies could look into how universities can continue to bridge this gap.

The purpose of this paper was to gain a qualitative view of the participant experience of using home-based transcranial direct current stimulation (tDCS). Acceptability impacts patient preference, treatment adherence and outcomes. However, acceptability is usually assessed by rates of attrition, while multifaceted constructs are not reflected or given meaningful interpretations. tDCS is a novel non-invasive brain stimulation that is a potential treatment for major depressive disorder (MDD). Most studies have provided tDCS in a research centre. As tDCS is portable, the authors developed a home-based treatment protocol that was associated with clinical improvements that were maintained in the long term.

The authors examined the acceptability of home-based tDCS treatment in MDD through questionnaires and individual interviews at three timepoints: baseline, at a six-week course of treatment, and at six-month follow-up. Twenty-six participants (19 women) with MDD in a current depressive episode of at least moderate severity were enrolled. tDCS was provided in a bifrontal montage with real-time remote supervision by video conference at each session. A thematic analysis was conducted of the individual interviews.

Thematic analysis revealed four main themes: effectiveness, side effects, time commitment and support, feeling held and contained. The themes reflected the high acceptability of tDCS treatment, whereas the theme of feeling contained might be specific to this protocol.

Qualitative analysis methods and individual interviews generated novel insights into the acceptability of tDCS as a potential treatment for MDD. Feelings of containment might be specific to the present protocol, which consisted of real-time supervision at each session. Meaningful interpretation can provide context to a complex construct, which will aid in understanding and clinical applications.

This paper explores how ethnicity is implicated in an etic–emic understanding through day-to-day practices and how such practices meet external accountability demands. Addressing the broader question of how ethnicity presents in an accounting situation, it examines the mundane level responses to those accountability demands manifesting an operationalisation of the ethnicity of the people who make those responses.

The study followed ethnomethodology principles whereby one of the researchers acted both as an active member and as a researcher within a Salvation Army congregation in Manchester (UK), while the others acted as post-fieldwork reflectors.

The conceivers and guardians of an accountability system relating to the Zimbabwean-Mancunian Salvationist congregation see account giving practices as they appear (etic), not as they are thought and interiorised (emic). An etic–emic misunderstanding on both sides occurs in the situation of a practice variation in a formal accountability system. This is due to the collision of one ethnic group's emics with the emics of conceivers. Such day-to-day practices are thus shaped by ethnic orientations of the participants who operationalise the meeting of accountability demands. Hence, while ethnicity is operationalised in emic terms, accounting is seen as an etic construct. Possible variations between etic requirements and emic practices can realise this operationalisation.

The authors’ findings were based on one ethnic group's emic construction of accountability. Further research may extend this to multi-ethnic settings with multiple etic/emic combinations.

This study contributed to the debate on both epistemological and methodological issues in accountability. As it is ill-defined or neglected in the literature, the authors offer a working conceptualisation of ethnicity – an operating cultural unit being implicated in both accounting and accountability.

Japanese lesson study (LS) is a professional development (PD) approach in which teachers collaboratively plan a lesson, observe it being taught and then discuss what they have learned. LS's popularity as an approach to teacher PD in the UK is growing, and it is used in both special and mainstream settings. This study explores whether LS is perceived and operationalized in the same way across special and mainstream settings.

This study arose as a result of collaboration between UCL Institute of Education academics (principle investigators) and three special school leaders using LS in their own schools (practitioner co-investigators), who together formed the research team. The team first explored the literature base for LS in special education. They then investigated special and mainstream schools using LS for teacher PD. Research tools included semi-structured interviews and an online survey. Participants were obtained through opportunistic sampling via the networks of schools available to the researchers.

There were several key differences between LS in special and mainstream settings. Special teachers felt LS had a more positive impact on subject knowledge than mainstream teachers, and this impact extended to support staff. Special teachers were more likely to carry out multiple research cycles than mainstream colleagues and to quickly build LS into the existing timetable. Mainstream teachers focused on individual pupils in LS to seek learning about pedagogy more generally, whereas general learning about pedagogy was seen as a secondary benefit to special teachers.

One of the limitations of the research is that participants are more positively inclined toward LS than the general population of their school, since those not interested in LS would be unlikely to take the time to engage with the research. It will be important to conduct more research into the use of LS in mainstream schools, as this study is one of very few exploring LS in this special context.

The ease with which special schools can align LS to current practice due to greater flexibility of timetables and larger staff teams seems to result in a greater appreciation and “valuing” of the process in mainstream schools, where teachers seemed to feel their senior leadership teams had gone to extra lengths to enable LS to happen. LS seems to offer a framework within which senior leaders can prioritize such learning experiences for teachers, leading to positive benefits for pupils, teachers and the school, and is therefore a process worth considering both for special and mainstream school leaders.

The literature review found a limited number of studies of LS in a special educational needs and disability (SEND) context, all of which took place in the UK and focused on the impact of teacher participation in LS on teacher practice and pupil learning. All three studies show a positive impact and suggest that LS might have wider applications for both special schools and mainstream schools supporting SEND pupils. There has been no exploration of the different ways in which mainstream and special school teachers and pupils might experience or construct LS in their own contexts.

The purpose of this study was to explore the phenomenon of leadership development as experienced by non-government organization (NGO) executive leaders in international agricultural development. Data were collected from twelve executive NGO leaders through in-depth interviews to understand the textural and structural essences of the participants’ lived experiences of leadership development. Findings indicated the integral role of mentoring in leadership development prior to obtaining an executive leadership role and supported the conceptual model inclusive of mentoring as a mediating factor of efficacious leadership development. The study provided implications and future research recommendations for executive leaders in international agricultural development, as well as for leadership educators and practitioners.