Exploration of the stress phenomena within public health

Background: The connection between stress and health is one that has been documented extensively. In recent years, significant investments have been made into health improvement and public health initiatives across the NHS (e.g. preventing cardiovascular disease). However, studies have exemplified that stress is often a barrier for health-related behaviour change (e.g. smoking cessation, physical activity) (Ali, 2010; Heslop et al., 2001; Louis et al., 2009; Kalsi, 2012, 2013; Ng & Jeffery, 2003), an increased levels of stress can impact upon health outcomes. Despite this connection, minimal support is currently offered, in terms of stress management within public health services, failing to address the holistic health needs of patients (Goodrick et al., 2005). Aims: Two studies were undertaken to (1) explore the lived experience of stress, and (2) to explore healthcare professionals (HCPs) experiences of patient reported stress. The aims of study 1 were to (a) gain insight into participants’ experiences of stress and their coping strategies, and (b) explore participants’ views on stress and coping, in light of their personal experiences. The aims of study 2 were to (a) gain insight into HCPs’ experiences of working with patients reporting stress, (b) explore HCPs’ perceptions of stress management and their narrative accounts concerning stress management advice in their consultations with their patients, and (c) explore how the experiences of dealing with patient reported stress has an impact on HCPs stress levels and their experience of that. Methodology: A qualitative methodology was employed for both studies due to the explorative nature of the study aims. A combination of mini-focus groups and one-toone interviews were conducted with individuals who self-reported themselves to be highly stressed, and HCPs (e.g. G.P.s, pharmacists, and health improvement practitioners). A total of sixteen participants took part in the six mini-focus groups conducted. Ten HCPs took part in the four mini-focus and two of the one-to-one interviews. The data generated from both studies was analysed by thematic phenomenological analysis. Results: Study one exemplified the subjectivity associated with stress. Various stress definitions and coping strategies were used by the participants (e.g. increased smoking, aggressive behaviours, increased acceptance and tolerance). Segmentation highlighted differences between the age and gender groups (i.e. coping styles). Study two revealed that patient-reported stress was a common feature in all the HCPs patient consultations (Goodrick et al., 2005; Verhaak et al., 2005); often eliciting feelings of anxiety and uncertainty as they felt ill-equipped in, (a) talking about stress, (b) assessing stress levels, (c) making the distinction between depression and stress, (d) and advising patients about stress management. Issues surrounding professional remit and management of stress disclosure were identified. Inclusion of various HCP groups exemplified variances in the patient reported stress experiences. Stress appears to pose a fundamental concern for public health, as it not only influences patients’ wellbeing; it also places additional demands on frontline healthcare providers (Goodrick et al., 2005). There is a need for greater stress management services, and the provision of HCP training on patient reported stress. Recommendations: The author proposes a series of tailored training programmes and presents a holistic model of health improvement, which centres around integrated stress management services.