Maggie Evans

Objectives: The study objective was to develop methodology for observational research within traditional acupuncture consultations in community-based practice, and to explore how traditional acupuncturists communicate with patients about lifestyle and self-care. Design: This was a mixed-method qualitative study, using audio-recording of consultations followed by telephone interviews of patients. The study was nested within a cooperative inquiry. As co-researchers, group members participated in framing the research questions, deciding methods to be used, and discussing the emergent findings. Settings: Four (4) experienced traditional acupuncture practitioners, registered with the British Acupuncture Council, contributed to the cooperative enquiry and recorded consultations in three clinics in Somerset. Subjects: Subjects comprised a convenience sample of patients attending 21 consultations. A purposive sub-sample of patients was selected for interview. Results: Audio-recording was challenging to some practitioners who felt that it might result in infrequent, but nevertheless worrying, withholding of personal information by patients. Patients, however, reported that they were generally positive about the audio-recording. Each consultation was analyzed as a trajectory in which eight categories of talk interwove with each other and with periods of physical examination, needling, and silence. Trajectories showed where talk about self-care (''self-care talk'') appeared in the consultations, the content of such talk, and who initiated it. The data confirmed that self-care advice arises from, and is explained in terms of, each person's individual Chinese Medicine diagnosis. The identification of different types of talk and the way that ''self-care talk'' is interwoven throughout the consultation emphasized the integral nature of self-care support and advice in the practice of traditional acupuncture. Some patients had difficulty putting self-care advice into practice, even when they were intellectually committed to it, suggesting that practitioners may need to follow up more carefully on the advice they have given. Conclusions: Self-care in traditional acupuncture consultations is integral, interactive, and individualized. This study has mapped out a potential agenda for research into self-care in traditional acupuncture consultations and illustrates the exciting opportunities that open up when observational and interview data are combined.

Programmes of research which combine related studies are commonplace, including in the field of Intimate Partner Violence (IPV). Whereas the systematic synthesis of published qualitative data is now well established, the synthesis of qualitative data that make up a programme of work is rare. A Programme of Research on Violence in Diverse Domestic Environments (PROVIDE) is a UK NIHR funded programme. The five studies associated with PROVIDE are sited in general practice, sexual health clinics, mental health services and 3rd sector IPV agencies. Synthesising the data from across the studies offered an opportunity to highlight variations in help-seeking strategies according to gender and sexual orientation and identify variations in help-seeking across different contexts. The approach to the synthesis was meta-ethnography. The synthesis identified 23 2nd order constructs in relation to helpseeking. Findings show gender and sexuality influences how help-seeking in different contexts is viewed. Disclosure of IPV to mental health services was rare. Women favour help-seeking from primary care which is familiar and where they are known, whilst gay men favour help-seeking from GUM clinics where there is a taken for granted acknowledgement of sexual identity. These differences suggest an intersectional approach to providing support services for IPV is needed.