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The COVID-19 pandemic created stressors and uncertainty, particularly for women. This international study explored whether the impact of the COVID-19 pandemic on women’s stressful experiences and future expectations is associated with Hofstede’s cultural dimension of femininity/masculinity, which refers to the cultural constructions of gender role differences. In total, 1218 women from 15 countries varying in cultural femininity/masculinity provided narrative data by answering open-ended questions via an online survey. Data were analysed using mixed methods, starting with thematic content analysis followed by logistic regression analyses. The findings from the regression analysis indicate that many stresses and expectations that were mentioned in the narratives were unrelated to the cultural femininity/masculinity. However, women from masculine cultures more often expressed disorientation, while women from feminine cultures more often wrote about negative emotions. Additionally, women from masculine cultures had more future expectations regarding daily activities, while women from feminine cultures had more expectations regarding social activities, work and economic revival, and universal social issues. The pandemic seems to confront women in both types of culture with similar challenges. The differences between women from feminine versus masculine cultures indicate that increased societal participation and responsibilities of women in feminine cultures was associated with negative affect during the pandemic, but they also propelled plentiful expectations for the future “after COVID-19”.

Background: The global COVID-19 pandemic has had a significant impact on the physical and mental health of people everywhere. The aim of the study is to understand how people living in 15 countries around the globe experience an unexpected crisis which threatens their health and that of loved ones, and how they make meaning of this disruption in their narratives.Methods: Data were collected through an anonymous online survey during May–September 2020, which was during or just after the first wave of the COVID-19 pandemic, depending on the country. The questionnaire included demographic and three open-ended questions as prompts for stories about experiences during the initial months of the pandemic. The text was analyzed through inductive thematic content analysis and quantified for full sample description, demographic and subsequently international comparisons.Results: The final qualitative dataset included stories from n = 1685 respondents. The sample was 73.6% women and 26.4% men. The mean age of participants was 39.55 years (SD = 14.71). The identified four groups of overarching themes were: The presence and absence of others; Rediscovering oneself; The meaning of daily life; Rethinking societal and environmental values. We discuss the prevalence of each theme for the sample as a whole and differences by demographic groups. The most prevalent theme referred to disruptions in interpersonal contacts, made meaningful by the increased appreciation of the value of relationships, present in (45.6%) of stories. It was more prevalent in the stories of womencompared to men (χ² = 24.88, p = .001).Conclusions: The paper provides a detailed overview of the methodology, the main themes identified inductively in the stories and differences according to select demographic variables. We identify several major ways of making meaning of the pandemic. The pandemic has impacted many aspects of people’s lives which give it meaning, no matter where they live.

Objective The process of reflexivity is used to critically examine the experience of conducting qualitative research with functionally diverse older adults in a post disaster context. Methods The design of the study began with an interpretative phenomenological framework, using in-depth interviews. Fifteen individuals with functional and access needs living in Puerto Rico were interviewed regarding their experiences after Hurricane María of 2017. Findings In the field, it was necessary to expand the initial design, and adjust to participants’ preferences and needs, as well as situational characteristics, without compromising ethical standards of practice. The methodology transformed because of the need for flexibility requiring humility from the researchers. A more relational form of inquiry was warranted, which acknowledged the intersubjectivity of human experience. This entailed adapting to community involvement, building rapport with community leaders functioning as gatekeepers, and integrating family or friends in interviews. Discussion The reflexive approach allowed for a better understanding of the researcher’s positionalities and how they influence the ability or inability to develop trust (e.g. insider/ outsider status, Puerto Rican/ US, with functional and access needs/ without functional and access needs). Conclusions Given the shift toward relational inquiry and due to the challenges faced while carrying out the study, we suggest that post-disaster qualitative research would benefit from further including principles of indigenous decolonizing methodologies, which can be incorporated into studies using interpretative phenomenological analysis.

Older adults were uniquely affected during the COVID-19 pandemic, given that they were most at risk of serious complications and death if infected. Numerous preventative measures were abruptly mandated, including stay at home orders and social distancing that led to social isolation. Given this context, the aim of this qualitative study is to explore the lived experiences, perceived challenges, and mechanisms for resilience of older adults during the first wave of the pandemic. Our sample (n=50), derived from a larger international study with data from 15 countries, includes individuals 60 or older in Puerto Rico and mainland United States. Following thematic analysis of responses from an online survey, three themes were identified: resilience through reflection and adaptation, resilience through critique of systemic problems and injustices, and resilience through reaffirmation of values. Findings support various recommendations for improving support to older adults in future crises.

The COVID-19 pandemic has imposed on people the need to find meaning in many unprecedented ways. The aim of this qualitative study was to explore how the general Italian population dealt with government restrictions and to understand personal experiences connected with the first wave of the pandemic in light of the personal construct theory (PCT) framework. One hundred and sixteen people (over 18 years old) completed an online survey between May and June 2020. Two independent researchers ran inductive thematic content analysis on data using a specifically developed international codebook. Five major themes were identified in the participants’ narrations: difficulties, emotions, coping with lockdown measures, going back to normal, and change. The results, interpreted within the PCT transitions, showed that the pandemic represented a threat to participants’ life plans, beliefs, and certainties. Some coped with it mainly by waiting for the pandemic to end and remaining firm in their beliefs and certainties, whereas others coped by trying to find alternative ways of giving sense to this experience and reconstructing personal meanings, claiming a change in their life and in society. Differentiating personal experiences of the COVID-19 pandemic is fundamental for designing personalised strategies to promote well-being.

Persistent drug shortages introduce challenges to clinicians and health care systems. We describe an exploratory qualitative study of key informants' perspectives, discourse, and experiences in confronting drug shortages. Semi-structured interviews were conducted with pharmacy directors and bedside clinicians at urban academic medical centers and surrounding community hospitals. Focused coding, reflexive review, and thematic analyses informed by constructionist grounded theory were employed. For some participants, the unpredictability of drug shortages created a siege mentality. Recognition of potentially related patient safety deficits also led to moral distress. Participants were often unprepared to make explicit allocation decisions nor openly discuss drug substitutions with patients. Despite these struggles; participants displayed resilience, and inter-professional teamwork, which eclipsed role constraints and medical hierarchical authority. Varied perspectives and responses are described.

Background Discrimination and social inequity increase risk for alcohol use disorders among Latinxs. An alcohol intervention trial that led to significant reductions in alcohol-related consequences also produced significant reductions in mental health symptoms for Latinx heavy drinkers. In the current qualitative study, we explore this trial's mental health effect by examining participants' perspectives on the social context of immigration, i.e., structural barriers, and associations among the immigrant experience, stigma, depressive/anxiety symptomatology, and alcohol consumption. Methods Study participants were eligible if they completed the clinical trial, exhibited levels of depressive and anxiety symptoms that exceeded the range for clinical depression (≥18, CES-D) and anxiety (≥12, BAI) at baseline, and demonstrated significant declines in depression and anxiety symptoms 12 months following their completion of the trial. The study coded 24 participant transcripts using ATLAS.ti and thematic analysis. Results Participants reported their responses to structural barriers (e.g., a lack of educational supports, difficulties accessing safety net programs). Reported experiences of exclusion and discrimination were associated with depressive and anxiety symptoms. Stigmatization processes included feeling isolated and contributed to poor mental health. Participants reported drinking to cope with low mood. Conclusions Structural barriers are exclusionary because they limit full participation and communicate who does/does not belong along race/ethnic lines, i.e., structural racism. Feeling stigmatized for being different was associated with feelings of anxiety and depression among our immigrant participants. Future interventions must focus on stressors associated with the constraints of being an immigrant. Understanding how structural barriers and structural racism impact health behavior can enrich the design and impact of interventions for socially disadvantaged Latinx individuals.

The study used mixed-methods to illustrate the complexity of the interplay between the contexts in Bulgaria and Romania and women’s attitudes and behaviors related to screening. A secondary analysis of quantitative data from Romanian (n = 1053) and Bulgarian (n = 1099) women and qualitative interviews ( n = 30 Romanian, n = 35 Bulgarian) was performed. Low rates of screening attendance were found in both countries. Regression analysis illustrates that attitudes and social norms significantly predicted intentions and screening behavior in both countries. Thematic analysis revealed that systemic barriers and cultural meanings were relevant to women’s decisions to attend screening or avoid contact with the health-care system.

Health and wellness coaching (HWC) for lifestyle behavior change is emerging as a practice, role, and profession, in diverse health care, employee wellness, and community settings. Health care professionals apply HWC as a behavior change methodology for the prevention and treatment of diabetes, hypertension, hyperlipidemia, heart disease, cancer, and other chronic disorders. The purpose of this systematic review was to provide a comprehensive and organized compendium of HWC literature. To date, extant HWC literature remains scattered with no meaningful summary accessible. Lack of comprehensive summary stems from lack of consensus on HWC definition and standards. We applied a recently proposed, standardized definition of HWC to determine compendium inclusion criteria for peer-reviewed, data-based literature from relevant search engines (ie, PubMed, PsychInfo, and CINAHL). A systematic review process was executed and ultimately yielded 219 articles meeting HWC inclusion criteria. Of these, 150 were data-based and the remainder were expert opinion or review-style articles. A summary of results generally reveals HWC as a promising intervention for chronic diseases though further research is needed in most categories. The resulting HWC compendium organizes and describes the quantity and quality of available literature for the use and benefit of HWC practitioners and researchers.

Identity among Puerto Ricans of the diaspora on the U.S. mainland is fluid, fragmented, multifocal, and nuanced. We explore Puerto Rican identity through the use of poetry, by presenting I-poems of adult Puerto Ricans living in the Greater Boston area, which we extract from qualitative interviews from the Boston Puerto Rican Health Study. I-poems are presented in conjunction with published poetry of Puerto Rican poets, with the aim of underscoring resonating sentiments and experiences. Poetry allows us to bring voice to the ambiguity of transnational and diasporic identity that is not as accessible and perceptible through other methodology.

Puerto Rican adults who moved from Puerto Rico to the U.S. mainland during their youth and have been living in the mainland for several decades provide a multifaceted case for analyzing cultural identity. Our article focuses on a group of Puerto Ricans living in Boston and their discussions of their own cultural identity, including their sense of belonging and home. The current study is based on semistructured interviews with a subsample of 26 participants from a large longitudinal cohort study of 1,500 respondents. We analyzed data collected through in-depth interviews and use dialogical self theory (DST) as a framework for understanding the multiple discourses in their responses. Three main I-positions that we identify include I-as-Puerto Rican, I-as-realist, and I-as-other. The dialogical process of these I-positions demonstrates the complex connections participants had to place. Findings can inform future studies of acculturation and assimilation among older Puerto Ricans of the diaspora.

Taking medications are complex symbolic acts, infused with diverse meanings regarding body and identity. This article focuses on the meanings of medications for older Puerto Ricans living on the United States mainland, a population experiencing stark health disparities. We aim to gain an understanding of the way multiple cultural and personal meanings of medications are related to and integrated in identity, and to understand how they are situated within Puerto Rican culture, history and circumstance on the US mainland. Data is drawn from thirty qualitative interviews, transcribed and translated, with older Puerto Ricans living on mainland United States. Thematic Analysis indicated four prevalent themes: embodiment of medication use; medications redefining self through the fabric of daily life; healthcare experience defined through medication; and medicine dividing the island and the mainland. While identity is impacted by experience of chronic illness, the experience of medication prescription and consumption is further related to the construction of the sense of self in distinct ways. For these individuals, medication use captures the dilemma of immigration. While cultural belonging and well-being remains on the island of Puerto Rico, the mainland hosts both easier access to and excess reliance on medication.

The special issue on Women’s Reproductive Health in Cultural Context covers multiple dimensions of women’s reproductive health and how it might be shaped by cultural meanings, social and gender inequities, and power differentials, employing a variety of methodological approaches. On the one hand, it aims to bring to the forefront the conversation about how women’s health is uniquely experienced and constructed in local settings, and on the other hand, it aims to draw broader conclusions from a perspective of interconnectedness of women and the shared issues that they face. The special issue was initiated through a call for submissions and includes ten articles on the topic of women’s reproductive health in cultural context. The articles provide many insights into how the context in which they live can disadvantage women and endanger their health, as well as offer perspectives on women’s resistance to disempowering and stigmatizing discourses and practices. It aims to be of interest to scholars in behavioral medicine, psychology, and other social sciences

Building on the existing foundation of research, this chapter examines two distinctive case studies, the Nepal earthquake of 25 April 2015 and the mixed migration flows through the Western Balkans between spring 2015 and spring 2016. It assesses whether these extraordinary situations indeed led to an increase in trafficking and exploitation and determines the extent to which counter-trafficking efforts were incorporated into overarching response measures. In both cases, the chapter identifies promising practices and challenges in mainstreaming counter-trafficking measures. The biggest ongoing challenge for protection actors in Nepal is to provide vulnerable populations in the districts with critical protection-related information on human trafficking and exploitation. In some countries along the Western Balkan route, meeting the immediate needs of migrants transiting through their territory proved such a challenge during the peak of the movements that only a partial response to vulnerable groups could be ensured for a number of months.

Older Puerto Ricans of the diaspora live with evident health and socioeconomic disparities, heightening their need for support. They also provide a unique transnational case in which to explore the exchange of support. This study aims to understand the informal social support experiences of older Puerto Ricans with disabilities. Data are based on the translated transcripts of 25 interviews with Spanish-speaking, Island-born Puerto Ricans living in Boston. We identify four themes through thematic analysis: (a) making sense of responsibility within valued familial relationships, (b) conceptualizing friends as family, (c) finding resolve and meaning despite isolation, and (d) (not) asking for help. These themes delineate an incongruence between their beliefs and their lived experiences of social support, as well as how this contradiction is sometimes harmonized. Whereas some older Puerto Ricans with disabilities have support to rely on, others are isolated and lack support to address the challenges of functional impairment.

This study addresses criminal victimization and contact with police among older Puerto Ricans living in Northeastern United States. Framing their experiences within the context of immigration, we assess the role that acculturation and perceived stress play on Puerto Rican crime and victimization. Data from the Boston Puerto Rican Health Study (BPRHS; N = 1,504) were analyzed using multiple logistic regressions. The experience of criminal victimization by Puerto Ricans is associated with higher educational attainment, increased perceived stress, and also with psychological acculturation. Contact with police is associated with linguistic, but not psychological, acculturation. Our findings give strength to the argument that exposure to crime and the criminal justice system increases with acculturation and that this argument is relevant to Puerto Ricans. Thus, the association between acculturation, criminal victimization, and police contact depends on the conceptualization of acculturation used. The relationship between stress, acculturation, and crime among Latinos is complex and warrants further assessment.

Psychological Thought, 2014, Vol. 7(1), 102–105, doi:10.5964/psyct.v7i1.94 Published (VoR): 2014-04-30. *Corresponding author at: P.O. Box 238 1113 Sofia, Bulgaria. E-mail: ilgt1@comcast.net This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Puerto Ricans are the second largest Hispanic group in the U.S. and older adults have significant health disparities. Educational programs that address heart disease risk for this population have rarely been developed and implemented.To address this gap, the Heart Healthy Initiative for Puerto Rican adults is being developed. To develop it as a participatory program, the community members were asked about their perspectives.Five focus groups with 28 participants, aged 45-60, were conducted, transcribed and analyzed using Thematic Analysis. In-depth analysis of meanings of health promoting behaviors, in the context of cultural beliefs and values was carried out.The following themes were identified: Health as balance and integration; Health as connection of self, connection with others; Cultural meanings of lifestyle choices; Stresses and struggles. Participants suggested that the program should have significant variety and a holistic perspective, be sensitive to different needs and motivations, stimulate mutual understanding and shared cultural meanings.The program needs to support lifestyle changes which maximally preserve traditions and to introduce multi-level changes.The identified cultural meanings of diet, physical activity and relationships were taken into account to develop the educational curriculum.

Puerto Rican adults in the United States mainland live with socioeconomic and health disparities. To understand their contextual experience of aging, we interviewed participants in the Boston Puerto Rican Health Study. Through a Thematic Analysis we identify themes and tensions: normalization and acceptance of aging; gratitude; the importance of aging within social networks; longing to return to Puerto Rico at older age. We address the tensions between ‘acceptance’ and fatalismo as a cultural belief, and a function of structural barriers. The experience of aging is discussed in the context of Puerto Rico’s history and continued dependence on the United States.

New preventive technologies such as vaccines offer insight into psychological, social, and cultural landscapes. Providers have a key role in parents' decisions for vaccinating their children. Yet, perspectives from providers regarding the human papillomavirus (HPV) vaccine, or vaccination in general, are rarely sought Our objective in this paper is to understand how the HPV vaccine is perceived by health care providers and the multiple contextual meanings it elicits. We conducted interviews with 20 health care professionals in Bulgaria about their attitudes and practices related to HPV vaccination and their recommendations for policies. The verbatim-transcribed interviews were analyzed through narrative analysis, with a special focus on language. We illustrate providers' contradictory and contextualized constructions of the vaccine and the narrative strategies they use to manage any uncertainty it elicits. These include being advocates and missionaries for preventive health, confirming their trust in the medical profession and professional organizations, challenging patients' concerns with rational explanations, normalizing the risk of medical innovations, and avoiding the sexual nature of HPV transmission. The introduction of a vaccine to prevent HPV infection, and by implication, possibly cervical and other cancers, created hope, and at the same time, intensified confusion and uncertainty. Providers have been frustrated for years with the rising mortality from cervical cancer in Bulgaria, and their perceived powerlessness in affecting this. HPV vaccination, on the other hand, seems relatively simple and “taming uncertainty” positions them as instrumental in limiting (or even eliminating) morbidity and mortality in future generations.

This article aims to initiate a critical reconstruction of theory and research on reasoning and personal epistemology prompted by socio-philosophical critiques of rationalism and by a theoretical perspective according to which both discourses of knowledge and modes of thought are constituted in a power-infused sociocultural order structured materially and discursively by gender, ‘race,’ and socioeconomic class. A new qualitative methodology is introduced, particularizing participants in terms of their social location and modes of thought while also formulating cross-sectional analytical constructs. New analytical constructs for characterizing epistemic resources ostensibly brought into reasoning are interpretively induced from data through a quasi-inductive process informed by critical philosophical perspectives on knowledge. Theoretical implications point to the functional interplay of dominant and subversive discourses of knowledge in the constitution of thought, the complex assemblage of discursive resources flexibly deployed in reasoning, and the social constitution and biographical particularity of reasoners as epistemic agents.

Self-rated health (SRH) is an important indicator of overall health, predicting morbidity and mortality. This paper investigates what individuals incorporate into their self-assessments of health and how acculturation plays a part in this assessment. The relationship of acculturation to SRH and whether it moderates the association between indicators of health and SRH is also examined.The paper is based on data from adults in the Boston Puerto Rican Health Study, living in the greater Boston area (n=1357) mean age 57.2 (SD = 7.6). We used multiple regression analysis and testing for moderation effects.The strongest predictors of poor SRH were the number of existing medical conditions, functional problems, allostatic load and depressive symptoms. Poor SRH was also associated with being female, fewer years of education, heavy alcohol use, smoking, poverty, and low emotional support. More acculturated Puerto Rican adults rated their health more positively, which corresponded to better indicators of physical and psychological health. Additionally, acculturation moderated the association between some indicators of morbidity (functional status and depressive symptoms) and SRH.Self-assessments of overall health integrate diverse indicators, including psychological symptoms, functional status and objective health indicators such as chronic conditions and allostatic load. However, adults' assessments of overall health differed by acculturation, which moderated the association between health indicators and SRH. The data suggest that when in poor health, those less acculturated may understate the severity of their health problems when rating their overall health, thus SRH might thus conceal disparities. Using SRH can have implications for assessing health disparities in this population.

Objectives Health care reform in Bulgaria has been ongoing for two decades. Since 1990, it has been transforming from a socialized system of medical care with free access, to one which is decentralized, includes private health care services, the general practitioner model and a National Health Insurance Fund. In this context, we are conducting an international EC Framework 7 project: ‘Improving quality and safety in the hospital: The link between organizational culture, burnout, and quality of care’. We focus on health professionals’ perceptions of organizational hierarchies in Bulgarian hospitals and how doctors and nurses connect these to organizational justice. Methods We conducted seven focus groups and four interviews, with a total of 42 participants (27 nurses, 15 physicians and medical residents) in three hospitals. Data were analysed through thematic analysis and discourse analysis with Atlas.ti. Results From the perspective of health professionals, health reform has intensified traditional hierarchies and inequalities and has created new ones in Bulgarian hospitals. These hierarchies are continuously (re)constructed through language and practices and also destabilized through resistance. The health professionals protest fact that these hierarchies are permeated with unfairness and silence voices. All health professions (nurses, doctors, residents) in our study experience being unjustly positioned and disempowered in various hierarchies. They connect these experiences to stress and anxiety. Conclusions Participatory action research needs to address multiple dimensions of organizational relationships in Bulgarian hospitals, including hierarchical relationships and ways of promoting organizational justice. Statement of Contribution What is already known on this subject? Health care organizations are hierarchically organized. Organizational injustice can contribute to burnout in health professionals. There is a high level of stress and burnout for health professionals in Bulgaria. What does this study add? This study adds understanding of changing hierarchies in hospitals during health care reform in the post-socialist period. Illuminates how health professionals' discourse sustains and resists hierarchical relationships in Bulgarian hospitals. Adds understanding of health professionals' perspectives on implications of injustice for their well-being.

Much has changed in health psychology since Rethinking Methods in Psychology (Smith, Harre, & Langenhove, 1995) was published 15 years ago. Today, this shift in stance in health psychology research...

Racism and discrimination can have significant implications for health, through complex biopsychosocial interactions. Latino groups, and particularly Puerto Ricans, are an understudied population in the United States in terms of the prevalence of discrimination and its relevance to health. Participants in our study were 45- to 75-year-old (N = 1122) Puerto Ricans. The measures were perceived discrimination, depressive symptomatology (CES-D), perceived stress (PSS), self-rated health, medical conditions, blood pressure, smoking and drinking behaviours, demographics. Our findings show that 36.9 per cent of participants had at some time experienced discrimination, with men, those with more years of education, currently employed and with higher incomes being more likely to report it. Experiences of discrimination were associated with increased levels of depressive symptoms and perceived stress. When controlling for covariates, perceived discrimination was predictive of the number of medical conditions, of ever having smoked and having been a drinker, and having higher values of diastolic pressure. Depressive symptoms are a mediator of the effect of perceived discrimination on medical conditions, confirmed by the Sobel test: z = 3.57, p < 0.001. Mediating roles of perceived stress, smoking and drinking behaviours were not confirmed. Increased depressive symptoms might be the main pathway through which perceived discrimination is associated with a greater number of medical diagnoses.

The incidence of cervical cancer in Eastern Europe has been on the rise, in contrast to the reduction in incidence in most countries of Western Europe. The objectives of the paper are to delineate the inequalities in cervical cancer screening in Romania and Bulgaria and identify explanations for these inequalities.Representative samples of women - 1,099 in Bulgaria and 1,053 in Romania, were interviewed through a structured questionnaire.We found multiple dimensions of inequalities in cervical cancer prevalence and prevention, including disparities in comparison to other countries, disparities due to socioeconomic status, education, residency and ethnicity, as well as differential barriers faced by women in access to screening and in relationships with providers. We identified mediators of the effects of socio-economic status on screening history.The study concludes that the effect of SES on screening is mediated mainly by the structural barriers in accessing the healthcare system, as well as women's perceptions of the multiple costs of the smear. These conclusions are relevant to the development of national screening programs and health promotion in the two countries.

The European Health Psychology Society: History and Prospects - In this paper we present the history of the establishment of the European Health Psychology Society (EHPS) in 1986, its development during the last two decades and its future prospects. We focus on the membership and the countries who are involved in EHPS activities, on the society’s conferences, research and training initiatives, international collaborations and publications. The upcoming 23rd conference of the EHPS will take place in Pisa, Italy in September 2009. Key words: health psychology, EHPS, research issues.

Within an underlying health-impairing process, work stressors exhaust employees’ mental and physical resources and lead to exhaustion/burnout and to health problems, with health-impairing behaviors being one of the potential mechanisms, linking burnout to ill health. The study aims to explore the associations between burnout and fast food consumption, exercise, alcohol consumption and painkiller use in a multinational sample of 2623 doctors, nurses and residents from Greece, Portugal, Bulgaria, Romania, Turkey, Croatia and Macedonia, adopting a cross-national approach. Data are part of the international cross-sectional quantitative ORCAB survey. The measures included the Maslach Burnout Inventory and the Health Behaviors Questionnaire. Burnout was significantly positively associated with higher fast food consumption, infrequent exercise, higher alcohol consumption and more frequent painkiller use in the full sample, and these associations remained significant after the inclusion of individual differences factors and country of residence. Cross-national comparisons showed significant differences in burnout and health behaviors, and some differences in the statistical significance and magnitude (but not the direction) of the associations between them. Health professionals from Turkey, Greece and Bulgaria reported the most unfavorable experiences. Burnout and risk health behaviors among health professionals are important both in the context of health professionals’ health and well-being and as factors contributing to medical errors and inadequate patient safety. Organizational interventions should incorporate early identification of such behaviors together with programs promoting health and aimed at the reduction of burnout and work-related stress.

The current rise of immigration to the United States is being accompanied by a dramatic increase of newly arrived immigrant children to American schools. Therefore, there is a clear need to gain an understanding of the way in which the children themselves conceptualize achievement and how they attribute success and failure in their new unfamiliar surroundings. We examined immigrant children's narratives elicited by a modified version of the Thematic Apperception Test (TAT) (C. Suarez-Orozco & Suarez-Orozco) collected in two separate studies. The first study, Transformations: Immigration, Family Life, and Achievement Motivation Among Latino Adolescents (C. Suarez-Orozco & Suarez-Orozco, 1995) is archived in the Murray Research Archive, Harvard–MIT Data Center, Harvard University. The second study from which we drew data is the Longitudinal Immigrant Student Adaptation Study (LISA) (C. Suarez-Orozco, Suarez-Orozco, & Todorova, in press). In this combination of current and archival data, we applied a unified...

The article discusses the experiences of women facing infertility and infertility treatment in Bulgaria with a focus on identity construction. A theoretical framework invoking an understanding of identity as a social and contextual phenomenon, contingent upon local interpersonal relations and cultural meanings, informs our study. We use semi-structured interviews, which are analyzed using Interpretative Phenomenological Analysis. Using this method, we have identified the following overarching themes: Identity as Incomplete, Absent or Invisible; Identity as Present but Separate; Identity Shifts Through Dis/Embodiment; Identity as Nurtured and Nurturing. The study delineates the contextual identity shifts in the social and medical settings and the extent to which the women we interviewed experienced themselves as separate, autonomous and agentic. We discuss some of the possible interpretations of these findings, invoking the meanings and metaphors of the individual and the relational available in Bulgarian ...

This introductory chapter uses a detailed case study to illustrate the interconnection of multiple social influences on one particular youth's path of migration. It further identifies some of the major influences on immigrant youth development, including the stresses of migration, separations and reunifications, changing networks of relations, poverty and segregation, and identity formation.

The article discusses the way in which culturally available discourses of the expected transition to motherhood are negotiated in women's narratives of living with involuntary childlessness in Bulgaria. We follow the meanings that the situation holds for the women and the ways in which they creatively appropriate, transform, and resist culturally available discourses in the process of constructing their narratives and identities. For the purpose of this analysis, we use the Listening Guide Method of interviewing and interpretation of interview transcripts. For the women we interviewed in Bulgaria, both subtle and explicit forms of resistance were evident. They protest stigma and mistreatment through voicing their anger, and they also appeal to social change through organized action. Childless women in Bulgaria are slowly changing the available cultural images of infertility, as well as the models of womanhood, introducing more societal options.

On behalf of the European Health Psychology Society, I would like to extend a warm welcome to all delegates at this, the 23rd Conference of our Society, in collaboration with the Italian Heath Psyc...

BACKGROUND: Following international trends, the HPV (human papilloma virus) vaccine was introduced in Europe for protection against infection from common strands of the HPV virus which can lead to cervical cancer. Young women aged 18-26 years are at greatest risk of infection by the HPV virus yet have been neglected in research, policy, and practice.PURPOSE: To explore young women's constructions of the HPV vaccine in four European countries with different implementation policies ranging from national school-based programmes, regarded as the gold standard, to regional on-demand and private provision.METHOD: Qualitative methods comprising 11 focus group discussions with 54 young women aged 18-26, in Scotland (n = 10), Spain (n = 25), Serbia (n = 9) and Bulgaria (n = 10). A discursive analysis was conducted, following an initial thematic analysis.RESULTS: Two competing discursive constructions were considered: the 'responsible young woman' discourse was constructed as someone with individual rights to health, choice and discretion along with responsibilities to protect health and make rational decisions. In 'the HPV vaccine: a discourse of exclusion', access to the vaccine, wider health promotion and knowledge was controlled by others which had the potential to undermine the young woman's health. We consider how young women managed this tension through recourse to being health vigilant.CONCLUSION: Qualitative, cross-cultural research highlighted common concerns amongst young European women towards being responsible citizens in the face of their health and highlighted socio-cultural constraints to knowledge and resources. We highlight cross-cultural implications particularly between Western and Eastern European contexts.

The Human Papilloma Virus (HPV) is the most common sexually transmitted infection (STI) and can cause cervical cancer. Two vaccines are available to protect against the most common strands of the virus. Vaccination programs differ across Europe but most neglect young adults, who are the group with the highest risk of contracting STIs. Our aim was to explore the views of young women from four European countries-Scotland, Spain, Serbia, and Bulgaria - about the HPV vaccine communication strategy. These countries are characterized by different cervical cancer prevalence and vaccine implementation policies. We conducted focus group discussions with young women (aged 18-26) with various vaccination histories in a purposive sample. We subjected the data to thematic analysis with the purpose of identifying themes related to communication about the HPV vaccine. We recorded the information sources mentioned by participants. Participants discussed numerous sources of vaccine-related information. They approached information critically rather than naively and questioned the sources’ trustworthiness and motives. Participants desired transparent information about the risks of the virus and the risks and benefits of the vaccine. These risks and benefits were individualized in view of personal and external factors. Particular aspects of the vaccine and the way information was communicated resulted in feelings of uncertainty. There were notable cross-cultural differences in experiences with HPV vaccine communication. Our results suggest that transparent risk communication about the HPV vaccine is valued by young women. In addition, both individual and culturally-dependent factors influenced experiences with, and preference for information.

The need to improve quality of care represents a major goal of all health care systems. The objective of this series is to illuminate how the contextual factors of hospitals from eight European countries, and the well-being of their healthcare professionals, contribute to either construct or degrade quality of care. The studiesreported here provide an important bottom-up perspective on quality of care, andthe way that burnout and organizational culture are intertwined within it. Overall, thecollected studies represent an in-depth examination through focus groups of theexperiences of 153 physicians, 133 nurses, and 46 patients from Greece, Portugal,Bulgaria, Romania, Ireland, Turkey, Croatia, and the Republic of Macedonia. Eachpaper makes a unique contribution to the understanding of how institutionalcontexts, organizational management, and job characteristics impose constrains, bothon the capacity of health workers for better treatment decisions and choices, butalso on their day-to-day professional satisfaction and quality of life. Taken as a whole,the papers make an even greater contribution, by pointing out the underlyingsimilarities and differences across these eight European countries.

This study examined correlates of patterns of priority in careers, anchored at the extremes by career-primary and career-family orientations, among 218 managerial and professional women in Bulgaria. Data were collected using anonymously completed questionnaires to replicate similar research conducted in Canada. Career-family women were more likely to be married, have more children, work fewer extra hours per week, been with a present employer for a longer period of time and reported less job involvement than did career-primary women. There were no differences on job and career satisfaction or on measures of psychological well-being. Many of the relationships present in the Canadian sample were absent in the Bulgarian sample.

This research examined correlates of three career priority patterns – career‐primary, modified career‐family, and career‐family – among 218 managerial and professional women in Bulgaria. Data were collected using questionnaires completed anonymously. It attempted to replicate similar research conducted in Canada. Although career‐family women worked fewer hours per week, and were less involved with their jobs than were career‐primary women, many of the differences observed in the Canadian sample were absent in the Bulgarian sample. Offers possible explanations for the differences in the two studies.

Over 600 industrial managers in Bulgaria were individually interviewed to determine their ecological awareness and their attitudes towards the environment. The interviews took place at an unusual time in 1990 when these managers were beginning to move from a position of government control and interference, but were becoming affected by a situation of increasing economic difficulties. Various specific profiles of environmental awareness of the managers were registered, depending on the technologies used by their industrial enterprise, the degree to which the labour force was acquainted with the environmental hazards, and the pressures from the ecological movements and legislature.

The aim of this article is to investigate the role of social network support in ameliorating the psychological impact of life stressors that are prevalent for the older Puerto Rican population.Social support was measured through the Norbeck Social Support Questionnaire, and psychological distress through the Center for Epidemiological Studies Depression Scale and the Perceived Stress Scale. We describe the life stressors (Norbeck Life Events) faced by Puerto Ricans and their implications for psychological distress. We present associations between depression, perceived stress, social support, and socio-demographic indicators. The role of social network support-emotional and instrumental-in buffering the effect of negative events is examined. Attention is given to the interacting effect of gender and the type of support.The analysis shows that dimensions of social support, particularly emotional support, are generally protective of psychological health. However, when delineating the moderating effects of gender, social support is beneficial for men, but manifestly less so for women. Emotional, tangible support and duration of social contacts show a moderate effect on the impact of life stressors on psychological distress which, however, is in a direction opposite to that proposed by the buffering hypothesis.Social ties are generally protective, but may also be contributing, particularly for women, to increased psychological distress in the face of stressful life events.

The social and institutional context of health-care reform in Eastern Europe has important implications for cervical cancer screening and prevention. The incidence and mortality from cervical cancer in Bulgaria and Romania have risen, which is in sharp contrast to the steady decline in most other countries in Europe during the last 2 decades. To analyze these dynamics we conducted a multi-component study of health systems and psychosocial aspects of cervical cancer screening in Bulgaria and Romania. Following the disappearance of organized preventive programs, the initiative for cervical cancer screening has shifted to providers and clients and depends on the way they perceive their responsibility and interpret their own and each other's roles in prevention. We focus on how providers construct women and their role in prevention of cervical cancer through their accounts. The analysis identified several discourses and themes in providers' constructions of women's responsibility for prevention of disease. These include responsible women as 'intelligent' and 'cultured'; non-attenders as 'irresponsible' and 'negligent'; women as needing monitoring and sanctioning; and women as 'victims' of health-care reform. We discuss the implications for health-care reform and health promotion.