published_or_final_version / Community Medicine / Master / Master of Philosophy

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In this thesis I explore women's engagement with body, weight and eating from a socio-cultural perspective. I discuss the limitations of current research on body dissatisfaction and propose that women's negative appraisal of their body needs to be understood as an active engagement with their social context. Research that focuses on the interaction of ethnic/cultural differences and body dissatisfaction seeks to clarify the interrelationship between femininity, gender and culture and suggests that women's dissatisfaction with their body is linked to levels of global Westernisation. My criticism of this research is that it conceptualises culture and social knowledge in a simplistic way. I propose social representations theory and the principles of dialogicality as an alternative research paradigm and argue that such an approach can overcome the dichotomy of individual and social, inner and outer. In order to explore the interaction of the subjective with the social in relation to the negative and positive appraisal of the body an interview study was conducted in two distinct cultural contexts. In depth interviews were conducted with 14 women in the UK and 12 women in Tobago, WI. The thema recognition/disrespect was used as an interpretative frame. The results show that the meanings that were assigned to the body interlinked with socially enacted representations of self, other and femininity. While the thema recognition/disrespect could be seen to be problematised through contradictory conditions of worth in the UK, it was the notion of 'disrespect' in interrelation with representations of others that was foregrounded in women's reflections in Tobago. In both research locations women negotiated constraining or contradictory demands of femininity and 're-presented' themselves through the construction of alternative identities.

Aim: The overall aim of this thesis was to describe and explore how sexuality, body image and HRQoL were affected in patients treated for hematologic malignancies, and their need for support. A further aim was to describe nurses’ conceptions of dialogues about sexuality. Methods: Ten nurses in cancer care (I) and twelve patients were interviewed (II). Data were analysed according to phenomenography (I-II). Data were also collected from patients (≥45 years) included consecutively: at baseline (n=32), one month (n=25; III-IV) and six months (n=20; IV) after treatment. Three instruments were used: SAQ-S, BIS and EORTC QLQ-C30. The data were analysed statistically. Main findings: The nurses (I) conceived that they should talk about sexuality with cancer patients, but usually did not due to their own attitudes, lack of knowledge about sexuality, communication skills and environmental conditions. The patients (II) experienced negative effects on sexual function and sexual relationship due to affected strength and sexual desire. The patients’ sexuality, body image and HRQoL were affected during (II-III) and one month after treatment (III-IV). Patients recovered with regard to these issues within six months, except for sexual relationship (IV). However, when the disease and side effects were experienced as severe, thoughts about and interest in sexuality were overshadowed, and the need or wish for support related to this issue was low (II). Sexuality and body image seemed to influence changes in HRQoL (IV). Conclusion: Patients above the age of 45 treated for hematologic malignancies with chemoimmunotherapy experienced problems related to sexuality, body image and HRQoL. However, as sexuality was found to be of low priority due to concerns for life when the disease and side effects were severe, support must be timely and individualized. Patient-centered care, with patients continuously meeting a nurse guided by the idea of holistic individual nursing care throughout the care trajectory, is suggested. / Sexuality is to a large extent seen as a private and sensitive topic by both patients and nurses in cancer care. The patients in this thesis were above the age of 45 and treated with chemo- or chemoimmunotherapy for hematologic malignancies. They experienced affected sexuality, body image and HRQoL during and after treatment. The importance of sexuality was low and sexuality seemed to be overshadowed when the disease and side effects were experienced as severe. Few patients described that information might have been helpful.  In order to avoid violating patients’ integrity, one challenge is to identify patients who ascribe importance to sexuality and who also want support regarding sexuality. One way is to organize care in a patient-centered way, with patients continuously meeting a nurse guided by the idea of holistic individual nursing care throughout the care trajectory. Furthermore, nurse educators’ need to acknowledge this area and the health care leaders should provide nurses opportunities to discuss attitudes and personal barriers to sensitive issues such as sexuality

Research supports a link between poor body esteem, depression, and sexual dysfunction among childhood sexual abuse (CSA) survivors. Though the interplay of these factors also impacts nonabused women, it is possible that the impact is differentially affects these populations. The present study examined the degree to which body esteem may act as psychological mechanism through which CSA impacts adult sexuality, while controlling for the effects of depression – a problem that affects many abuse survivors. Data were collected from 108 women, 73 of who reported CSA. Women with CSA reported poorer body esteem, lower sexual functioning, less sexual satisfaction, and higher depression than women without CSA. Multivariate regression analysis revealed that body esteem significantly predicted sexual functioning and sexual satisfaction and there were significant interactions between body esteem and abuse history, and among body esteem and marital status. Depressive symptom severity was not a moderator in the relationship between body esteem and sexual functioning-satisfaction. These findings suggest that treatments for CSA survivors with sexual difficulties might benefit from addressing body esteem concerns. / text

Bröstcancer och mastektomi kan leda till sexuella svårigheter för kvinnor. Sexualitet och intimitet är av betydelse för livskvaliteten, och vårdpersonalen behandlar inte eller är obekväma med att vårda patienter med sexuella problem.  Syftet med denna litteraturstudie var att beskriva faktorer som kan påverka kvinnans upplevelse av sin sexualitet efter en mastektomi. Arton vetenskapliga artiklar analyserades och resultatet visar att förändringar av kroppens utseende, sociodemografiska skillnader och den psykiska och fysiska hälsan är faktorer som påverkar sexualiteten efter en mastektomi. Kvinnor som genomgår bröstbevarande kirurgi upplever en bättre sexuell hälsa än de som genomgår mastektomi. Bröstvårts- och vårtgårdsområdet bör om möjligt bevaras då den är viktig för sexualiteten.  Relationen till partnern spelar betydande roll för sexualiteten. En stödjande och förstående partner leder till att kvinnor blir tillfredsställda med sin sexualitet efter en mastektomi. Åldern är även en betydande faktor för sexualiteten. Yngre kvinnors sexualitet är ofta sämre än för äldre kvinnor efter en mastektomi. Kroppsbilden är betydelsefull för äldre kvinnor, men yngre kvinnor har större problem med den efter en mastektomi. Den psykologiska hälsan försämras efter en mastektomi, vilket leder till en försämrad sexualitet. Obehag och smärta vid beröring samt vaginal torrhet kan uppkomma efter en mastektomi, vilka också leder till en försämrad sexualitet.  Hälso- och sjukvården bör utforma rutiner för att patienter med en förändrad sexualitet inte skall förbigås, och vidare forskning inom sexualitet vore önskvärt. / Breast cancer and mastectomy can lead to sexual difficulties. Sexuality and intimacy is of great importance to the quality of life, and health care professionals are either not comfortable with or do not deal with sexual problems among patients. The aim of this literature review was to describe factors that may affect women’s experience of their sexuality after a mastectomy. Eighteen scientific articles were analyzed and the results show that changes of the body, socio-demographic differences, the psychological and physical health are factors that affect the sexuality after a mastectomy. Women who undergo breast conserving therapy experience a better sexual health than those who undergo mastectomy. Nipple-Areolacomplex is significant to sexuality and should be preserved if possible. The relationship with the partner plays a significant role in a woman’s sexuality. A supportive and understanding partner results in women being satisfied with their sexuality after a mastectomy. Age is also an important factor. Young women’s’ sexuality is often worse than for older women. Body image is important to older women, although younger women experience greater difficulties with their body image. The psychological health worsens after a mastectomy, which leads to a deteriorated sexuality. Pain and discomfort when being touched and vaginal dryness can occur after a mastectomy, this can also lead to a worsened sexuality. Health care should develop procedures so that patients with an altered sexuality won’t be ignored, and further research would be desirable.

This study explored adult women’s lived experiences with body dissatisfaction. Using a multi-methods qualitative approach incorporating in-depth semi-structured interviews and arts-based projects, women between the ages of 20-39 engaged in a critical exploration of their body experiences in order to deepen understanding of the psychological construct of body dissatisfaction and its ongoing influence in their lives. Ten women from diverse social and ethnocultural backgrounds took part in the study, completing 1-2 interviews, an in-session drawing exercise, and a creative project. Interview transcripts, drawings, and creative projects were analyzed for themes using an hermeneutic phenomenological approach. Four core categories emerged from the data. The first category contained the women’s understanding of the experience and meaning of body dissatisfaction. The second category captured the external reinforcement of body dissatisfaction and related body beliefs. The third emergent category delineated the impact of body dissatisfaction on daily life, including body-self relationships and interpersonal relationships. The final category captured the difficulties the women encountered as they attempted to overcome their feelings of body dissatisfaction and their negative body beliefs. This research highlighted the complex and multidimensional meaning of body dissatisfaction in adult women’s lives.

The primary objective of this thesis was to investigate body image at both the behavioural and neural levels. We describe three studies aimed at: (1) developing a novel digital methodology with which to assess perceptual aspects of body image during adolescence; (2) investigating perceptual accuracy and sensitivity to changes in the size/shape of body images among healthy adolescents; and (3) identifying the neural mechanisms of body perception using functional magnetic resonance imaging (fMRI). A novel library of digital images of adolescent bodies was created and used to characterize natural covariations in body size and shape using principal components analysis. Identified principal components were used to morph body images in a realistic manner to generate larger or smaller bodies. These morphed body-image stimuli were then used in a behavioural investigation of self body-image perception among adolescents. Male and female adolescents overestimated the size of their bodies. When compared with males, females overestimated their body size to a greater extent and showed greater sensitivity in detecting changes in body size. Overestimation of body size and detection sensitivity increased with subject age. Detection sensitivity decreased as a function of subjects' body mass index (BMI). In order to identify the underlying neural mechanisms of these effects, functional block-design and fMR-adaptation experiments were completed in healthy young adults. During both experiments, females, and not males, showed greater fMR signal in the right versus left hemisphere in the extrastriate body area (EBA) and fusiform body area (FBA). During the block-design experiment, females also demonstrated greater right EBA response compared with males. Observer BMI modulated the EBA hemispheric effect in both experiments. A significant recovery from adaptation was found in EBA and FBA with body-image morphing, indicating that both regions were sensitive to body-size changes. Ultimately, we demonstrated the successful use of a novel body-morphing method for the assessment of body image, established that sex, age, and BMI modulate accuracy of self body-size estimation and detection of changes in body size, and described evidence of EBA and FBA as the likely neural substrates of these behavioural effects.

Darbe nagrinėjama studenčių požiūris į savo kūno svorio kontrolę ir jai taikomas priemones,studenčių požiūrį į savo kūno vaizdą ir fizinį patrauklumą. Bus nustatomos sąsajos tarp objektyvių fizinio išsivystymo rodiklių ir subjektyvaus kūno vaizdo vertinimo. / The main of this study is to analise viewpoint of students to theyr body-weight control and mains applied, viewpoint to the view and attractiveness of theyr own body. Relations between objective physical development index and subjective body view assessment will be defined.