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  • Exercise and physical activity in asylum seekers in Northern England; using the theoretical domains framework to identify barriers and facilitators

    Haith-Cooper, Melanie; Waskett, Catherine; Montague, Jane; Horne, M. (2018)
    Background: Many asylum seekers have complex mental health needs which can be exacerbated by the challenging circumstances in which they live and difficulties accessing health services. Regular moderate physical activity can improve mental health and would be a useful strategy to achieve this. Evidence suggests there are barriers to engaging black and minority ethnic groups in physical activity, but there is little research around asylum seekers to address the key barriers and facilitators in this group. Methods: A two stage qualitative study used semi-structured interviews underpinned by the Theoretical Domains Framework. The interviews were conducted in voluntary sector groups in four towns/ cities in Northern England. Purposive sampling recruited 36 asylum seekers from 18 different countries. Interviews were audio recorded, transcribed verbatim and subject to framework analysis. Stage two involved a nominal group technique with five key stakeholders including asylum seekers and those that work with them. They followed a four stage process to rank and reach consensus on the key barrier to undertaking physical activity/ exercise that could be addressed locally through a future intervention. Results: A number of barriers and facilitators were identified including a lack of understanding of the term physical activity and recommended levels but knowledge of the health benefits of physical activity/ exercise and the motivation to increase levels having engaged with activities back home. Living as an asylum seeker was considered a barrier due to the stress, poverty and temporary nature of living in an unfamiliar place. The outcome of the nominal group technique was that a lack of knowledge of facilities in the local area was the prevailing barrier that could be addressed. Conclusions: Public health practitioners could develop interventions which capitalise on the motivation and knowledge of asylum seekers to encourage an increase in physical activity which may in turn reduce the breadth and depth of mental health needs of this group.
  • Embedding consultant radiographer roles within radiology departments: A framework for success

    Nightingale, J.; Hardy, Maryann L.; Snaith, Beverly (2018)
    Objectives: Many organisations struggle to clearly differentiate the radiographer consultant role from advanced or specialist practice, with newly appointed consultant practitioners often illprepared for working at this level. This article discusses the design, implementation and validation of an outcomes framework for benchmarking competencies for trainee or new-in-post consultant radiographers. Methods: Five experienced radiographers from different clinical specialisms were seconded to a twelve month consultant trainee post, guided by a locally-devised outcomes framework. A longitudinal qualitative study explored, from the radiographers' perspective, the impact of the outcomes framework on the transition to consultant practice and beyond. Data collection included semi-structured interviews (months 1, 6 and 12), validation via a focus group (month 18) and a group interview (5 years). Results: Early interactions with framework objectives were mechanistic, but as participants better understood the role more creative approaches emerged. Despite diverse clinical expertise, the framework facilitated parity between participants, promoting transparency and credibility which was important in how the consultant role was perceived. All participants achieved all framework outcomes and were subsequently appointed to substantive consultant radiographer positions. Conclusion This outcomes framework facilitates experienced radiographers to successfully transition into consultant radiographers, enabling them to meet multiple non-clinical targets while continuing to work effectively within a changing clinical environment. It is the first validated benchmarking tool designed to support the transition to radiographer consultant practice. Adoption of the tool will provide a standardised measure of consultant radiographer outcomes that will promote inter-organisational transferability hitherto unseen in the UK.
  • An Evaluation of Image Acquisition Techniques, Radiographic Practice, and Technical Quality in Neonatal Chest Radiography

    Pedersen, C.C.E.; Hardy, Maryann L.; Blankholm, A.D. (2018)
    Background Neonatal chest radiography is a frequently performed diagnostic examination, particularly in preterm infants where anatomical and/or biochemical immaturity impacts on respiratory function. However, the quality of neonatal radiographic images has been criticized internationally and a prevailing concern has been that radiographers (radiologic technologists) fail to appreciate the unique nature of neonatal and infant anatomical proportions. The aim of this study was to undertake a retrospective evaluation of neonatal chest radiography image acquisition techniques against key technical criteria. Methods Hundred neonatal chest radiographs, randomly selected from all those acquired in 2014, were retrospectively evaluated. Inclusion criteria for radiographs acquisition were as follows: anterior-posterior supine; within 30 days of birth; and with all preprocessed collimation boundaries visible. Image evaluation was systematically undertaken using an image assessment tool. To test for statistical significance, Student's t-test, χ2 test, and logistic regression were undertaken. Results Only 47% of the radiographs were considered straight in both upper and lower thoraces. The cranial collimation border extended beyond the upper border of the third cervical vertebra in 30% of cases, and the caudal border extended below the lower border of the first lumbar vertebra in 20% of cases, suggesting high possibility of neonatal overirradiation. Upper thorax rotation was significantly associated with head position (χ2 = 10.907; P < .001) as has been stated in many published textbooks internationally, but arm position had no apparent influence on rotation of the upper thorax (χ2 = 5.1260; P = .275). Birth weight was associated with accurate midline centering of central ray (logistic regression; OR = 1.0005; P = .009; CI, 1.00139–1.000957) with greater accuracy observed in images of neonates with higher birth weight. Conclusion This study has highlighted areas for neonatal chest radiography improvement. Importantly, the findings bring into question commonly advocated radiographic techniques relating to arm positioning and assessment of rotation while confirming the importance of other technical factors. These findings begin the work toward developing the evidence base to underpin neonatal chest radiograph acquisition, but further prospective work and multicenter/multinational data comparison are required to confirm the findings.
  • Effects of water and land based exercise programmes on women experiencing pregnancy-related pelvic girdle pain: a randomized controlled feasibility study

    Scott, K.L.; Hellawell, Michael (2018-06)
    This study aimed to address whether a water exercise programme improves pain and quality of life in pregnant patients with Pelvic Girdle Pain (PGP) compared to a land-based exercise programme and the feasibility of undertaking a large-scale research programme. Twenty-three participants with diagnosed PGP, recruited at St George’s Hospital London, were randomised into two groups (water or land exercise). Each group received, four, once-weekly exercise sessions on land or water. Exercise effects on PGP were measured using the Pelvic Girdle Pain Questionnaire (PGPQ) (primary outcome), Visual Analogue Scale (VAS), Patient Specific Functional Score (PSFS) and Active Straight Leg Raise (ASLR). Quality of life was measured using the Subjective Exercise Experience Scale (SEES). Outcomes were assessed at baseline and post four weeks exercise. Results showed there was a clinically significant improvement shown in all outcome measures in the water group, compared to the land group. A statistical difference between groups was shown for ASLR (p=0.036), Positive Well-Being (p=0.000) and Fatigue levels (p=0.011). No statistical difference was shown for PGPQ (p=0.056), PSFS (p=0.530) and Psychological Distress (p=0.712) scores. Exercise in water appears to offer a clinical benefit for patients experiencing PGP compared to a land exercise, particularly with Fatigue, Positive Well-Being and ASLR scores. Statistical differences between groups are limited by small sample size and that no power calculation was used in this study. Methodology and results provide support for a larger study on this topic to provide more definitive conclusions to support the use of water-based therapy for PGP.
  • Impact of a specialist mental health pharmacy team on medicines optimisation in primary care for patients on a severe mental illness register: a pilot study

    Raynsford, Justine; Dada, C.; Stansfield, D.; Cullen, T. (2018)
    Objective Medication arrangements for patients with severe mental illness (SMI), including schizophrenia and bipolar disorder, can be complex. Some have shared care between primary and secondary services while others have little specialist input. This study investigated the contribution a specialist mental health clinical pharmacy team could make to medicines optimisation for patients on the SMI register in primary care. Research shows that specialist mental health pharmacists improve care in inpatient settings. However, little is known about their potential impact in primary care. Method Five general practice surgeries were allocated half a day per week of a specialist pharmacist and technician for 12 months. The technician reviewed primary and secondary care records for discrepancies. Records were audited for high-dose or multiple antipsychotics, physical health monitoring and adherence. Issues were referred to the pharmacist for review. Surgery staff were encouraged to refer psychotropic medication queries to the team. Interventions were recorded and graded. Results 316/472 patients on the SMI register were prescribed antipsychotics or mood stabilisers. 23 (7%) records were updated with missing clozapine and depot information. Interventions by the pharmacist included clarifying discharge information (12/104), reviewing high-dose and multiple antipsychotic prescribing (18/104), correcting errors (10/104), investigating adherence issues (16/104), following up missing health checks (22/104) and answering queries from surgery staff (23/104). Five out of six interventions possibly preventing hospital admission were for referral of non-adherent patients. Conclusion The pharmacy team found a variety of issues including incomplete medicines reconciliation, adherence issues, poor communication, drug errors and the need for specialist advice. The expertise of the team enabled timely resolution of issues and bridges were built between primary and secondary care.
  • Cardiology patients' medicines management networks after hospital discharge: A mixed methods analysis of a complex adaptive system

    Fylan, Beth; Tranmer, M.; Armitage, Gerry R.; Blenkinsopp, Alison (2018)
    Introduction: The complex healthcare system that provides patients with medicines places them at risk when care is transferred between healthcare organisations, for example discharge from hospital. Consequently, under-standing and improving medicines management, particularly at care transfers, is a priority.Objectives: This study aimed to explore the medicines management system as patients experience it and determine differences in the patient-perceived importance of people in the system.Methods: We used a Social Network Analysis framework, collecting ego-net data about the importance of people patients had contact with concerning their medicines after hospital discharge. Single- and multi-level logistic regression models of patients' networks were constructed, and model residuals were explored at the patient level.This enabled us to identify patients' networks with support tie patterns different from the general patterns suggested by the model results. Qualitative data for those patients were then analysed to understand their differing experiences.Results: Networks comprised clinical and administrative healthcare staff and friends and family members.Networks were highly individual and the perceived importance of alters varied both within and between patients. Ties to spouses were significantly more likely to be rated as highly important and ties to community pharmacy staff (other than pharmacists) and to GP receptionists were less likely to be highly rated. Patients with low-value medicines management networks described having limited information about their medicines and alack of understanding or help. Patients with high-value networks described appreciating support and having confidence in staff.Conclusions: Patients experienced medicines management as individual systems within which they interacted with healthcare staff and informal support to manage their treatment. Multilevel models indicated that there are unexplained variables impacting on patients' assessments of their medicines management networks. Qualitative exploration of the model residuals can offer an understanding of networks that do not have the typical range of support ties.
  • Gait termination on a declined surface in trans-femoral amputees: Impact of using microprocessor-controlled limb system

    Abdulhasan, Z.M.; Scally, Andy J.; Buckley, John G. (2018-08)
    Background: Walking down ramps is a demanding task for transfemoral-amputees and terminating gait on ramps is even more challenging because of the requirement to maintain a stable limb so that it can do the necessary negative mechanical work on the centre-of-mass in order to arrest (dissipate) forward/downward velocity. We determined how the use of a microprocessor-controlled limb system (simultaneous control over hydraulic resistances at ankle and knee) affected the negative mechanical work done by each limb when transfemoral-amputees terminated gait during ramp descent. Methods: Eight transfemoral-amputees completed planned gait terminations (stopping on prosthesis) on a 5-degree ramp from slow and customary walking speeds, with the limb's microprocessor active or inactive. When active the limb operated in its ‘ramp-descent’ mode and when inactive the knee and ankle devices functioned at constant default levels. Negative limb work, determined as the integral of the negative mechanical (external) limb power during the braking phase, was compared across speeds and microprocessor conditions. Findings: Negative work done by each limb increased with speed (p < 0.001), and on the prosthetic limb it was greater when the microprocessor was active compared to inactive (p = 0.004). There was no change in work done across microprocessor conditions on the intact limb (p = 0.35). Interpretation: Greater involvement of the prosthetic limb when the limb system was active indicates its ramp-descent mode effectively altered the hydraulic resistances at the ankle and knee. Findings highlight participants became more assured using their prosthetic limb to arrest centre-of-mass velocity.
  • Palliative curriculum re-imagined: A critical evaluation of the UK Palliative Medicine Syllabus

    Abel, J.; Kellehear, Allan (2018-05)
    The UK Palliative Medicine Syllabus is critically evaluated to assess its relationship and relevance to contemporary palliative care policy and direction. Three criteria are employed for this review: (1) relevance to non-cancer dying, ageing, caregivers, and bereaved populations; (2) uptake and adoption of well-being models of public health alongside traditional illness and disease models of clinical understanding; and (3) uptake and integration of public health insights and methodologies for social support. We conclude that the current syllabus falls dramatically short on all 3 criteria. Suggestions are made for future consultation and revision.
  • Initial evaluation of a university dementia awareness initiative

    Parveen, Sahdia; Haunch, K.; Kerry, F.; Oyebode, Jan R. (2018)
    Purpose: This paper describes a study which explored the knowledge and attitudes of university students towards people living with dementia, and developed and tested a dementia awareness workshop, Dementia Detectives: University edition, designed to improve knowledge and foster positive attitudes to dementia in students. Design/methodology/approach: Dementia Detectives: University edition was launched during Dementia Awareness Week and five workshops were delivered to university students. Forty-two participants attended and completed a knowledge and attitude measure before and after the workshop, as well as rating the workshop with regards to satisfaction, relevance, understanding and whether they would recommend the workshop to friends. Findings: Students perceived living with dementia to be a negative and stigmatised experience. The workshop scored highly in terms of satisfaction, relevance and understanding and all students stated they would recommend the workshop to others. Paired t-tests found significant improvements in self-assessed dementia knowledge. Research Limitations: This was a pilot evaluation and further testing with larger samples is required. Practical implications: The workshop meets the requirements for tier 1 dementia education and training as outlined in the Dementia Core Skills and Knowledge Framework published by the Department of Health. Social implications: The workshop has the potential to increase knowledge, change attitudes, improve empathy and contribute to the development of a dementia aware workforce through undergraduate education. Originality/value: Dementia Detectives: University edition is a novel interactive method of dementia education and training.
  • Optimum positioning for anteroposterior pelvis radiography: A literature review

    Alzyoud, K.; Hogg, P.; Snaith, Beverly; Flintham, K.; England, A. (2018)
    Aim: Pelvic radiography is used for the identification of hip joint changes, including pathologies such as osteoarthritis. Several studies have recommended that the position for this radiological procedure should be standing, not supine, to reflect the functional appearances of the hip joint. The aim of this review was to evaluate pelvis radiography positioning with respect to the image appearances and information provided for clinical decision-making. Aside from this, potential recommendations to the radiographic technique for an erect pelvis projection will be considered. Method: A literature search was performed using databases/abstract systems (ScienceDirect, Web of Science, PubMed, and MEDLINE). Only articles written in English were included. Results: Twenty-five articles were identified. Findings from the review describe the effect of repositioning from supine to erect on a series of specific hip measurements. These include pelvic tilt, joint space width, and the acetabular component. Conclusion: Evidence within the literature illustrates that in several studies, there were differences when repositioning from supine to standing for a number of pelvic metrics. Standing positioning is promoted by some authors since this may facilitate the early diagnosis of hip joint pathology and assist in the planning of surgical interventions. Literature is very limited on how to optimally perform erect pelvis radiography, and this should be an area for future research.
  • Is a nurse consultant impact toolkit relevant and transferrable to the radiography profession? An evaluation project

    Snaith, Beverly; Williams, S.; Taylor, K.; Tsang, Y.; Kelly, J.; Woznitza, N. (2018-08)
    Introduction: Consultant posts were developed to strengthen strategic leadership whilst maintaining front line service responsibilities and clinical expertise. The nursing profession has attempted to develop tools to enable individuals to evaluate their own practice and consider relevant measurable outcomes. This study evaluated the feasibility of transferring such a nursing ‘toolkit’ to another health profession. Method: This evaluation was structured around a one-day workshop where a nurse consultant impact toolkit was appraised and tested within the context of consultant radiographic practice. The adapted toolkit was subsequently validated using a larger sample at a national meeting of consultant radiographers. Results: There was broad agreement that the tools could be adopted for use by radiographers although several themes emerged in relation to perceived gaps within the nursing template, confirming the initial exercise. This resulted in amendments to the original scope and a proposed new evaluation tool. Conclusion: The impact toolkit could help assess individual and collaborat ive role impact at a local and national level. The framework provides consultant radiographers with an opportunity to understand and highlight the contribution their roles have on patients, staff, their organisation and the wider profession.
  • Using birth cohort data to assess the impact of the UK 2008-2010 economic recession on smoking during pregnancy

    Uphoff, E.P.; Small, Neil A.; Pickett, K.E. (2018)
    Introduction Despite the well-known link between stress and smoking, evidence for associations between economic recession, financial stress and smoking is contradictory. In this study we assess whether women were more likely to continue smoking during pregnancy if they were exposed to the UK 2008-2010 economic recession during pregnancy than those who were unexposed, and whether this relationship is mediated by financial stress. Methods We used cross-sectional data on 2775 pregnant women who were regular smokers before pregnancy and who were enrolled in the UK Born in Bradford cohort study between March 2007 and December 2010. The cut-off date for exposure to recession was set at August 1, 2008, based on local and national economic data. Multivariable logistic regression analysis included potential confounders: maternal age, parity, cohabitation, ethnicity and maternal age. The mediating role of financial stress was analysed using ‘worse off financially’ and a ‘difficult financial situation’ as indicators of financial stress in Sobel-Goodman mediation tests with bootstrap resampling. Results After taking into account potential confounders, exposure to recession was associated with continued smoking during pregnancy (OR 1.19, 95% CI 1.01; 1.41, p=0.03). A worse financial situation and difficult financial situation were identified as mediators, explaining 8.4% and 17.6%, respectively, of the relationship between exposure to recession and smoking during pregnancy. Conclusions Smoking during pregnancy is associated with exposure to the UK 2008-2010 economic recession during pregnancy, and this relationship is partly mediated by financial stress.
  • What sources of bereavement support are perceived helpful by bereaved people and why? Empirical evidence for the compassionate communities approach

    Aoun, S.M.; Breen, L.J.; White, I.; Rumbold, B.; Kellehear, Allan (2018)
    Aims: To determine who provides bereavement support in the community, what sources are perceived to be the most or least helpful and for what reason, and to identify the empirical elements for optimal support in developing any future compassionate communities approach in palliative care. Design: A population-based cross-sectional investigation of bereavement experiences. Sources of support (informal, community and professional) were categorised according to the Public Health Model of Bereavement Support; most helpful reasons were categorised using the Social Provisions Scale, and least helpful were analysed using inductive content analysis. Setting and participants: Bereaved people were recruited from databases of funeral providers in Australia via an anonymous postal survey (2013–2014). Results: In total, 678 bereaved people responded to the survey. The most frequently used sources of support were in the informal category such as family, friends and funeral providers. While the professional category sources were the least used, they had the highest proportions of perceived unhelpfulness whereas the lowest proportions of unhelpfulness were in the informal category. The functional types of helpful support were Attachment, Reliable Alliance, Social Integration and Guidance. The five themes for least helpful support were: Insensitivity, Absence of Anticipated Support, Poor Advice, Lack of Empathy and Systemic Hindrance. Conclusion: A public health approach, as exemplified by compassionate communities policies and practices, should be adopted to support the majority of bereaved people as much of this support is already provided in informal and other community settings by a range of people already involved in the everyday lives of those recently bereaved. This study has provided further support for the need to strengthen the compassionate communities approach, not only for end of life care for dying patients but also along the continuum of bereavement support.
  • Nurses’ attitudes to supporting people who are suicidal in emergency departments

    Briggs, Amanda (2018-05-10)
    The aim of this study is to determine emergency nurses’ knowledge about, and perceived ability to support, people who are suicidal. A questionnaire consisting of 34 questions was sent out to 113 adult emergency nurses employed in two emergency departments. A total of 38 responded. Findings highlight differences in attitudes and show a correlation between suicide prevention training and nurses’ perceived competence to triage people who are suicidal. The article makes recommendations for future research, as well as nurse education and training on suicide prevention, to improve attitudes and increase emergency nurses’ ability to respond effectively to people who are suicidal.
  • Research Review of: Singleton breech presentation at term: review of the evidence and international guidelines for application to the New Zealand context

    Firth, Amanda (2018-06-01)
    This paper focuses on vaginal breech birth of singleton babies in New Zealand using a review of international literature to inform discussion on the care of women presenting at term with an uncomplicated breech presentation.
  • What are meaningful psychosocial interventions for people with dementia and how can they be captured in research? Report of a pan-European consultation

    Øksnebjerg, L.; Diaz-Ponce, A.; Gove, A.; Moniz-Cook, E.; Mountain, Gail; Chattat, R.; Woods, B. (2018)
  • Predictors of self-reported adherence to antihypertensive medicines: A multinational, cross-sectional survey

    Morrison, V.L.; Holmes, E.A.F.; Parveen, Sahdia; Plumpton, C.O.; Clyne, W.; de Geest, S.; Dobbels, F.; Vrijens, B.; Kardas, P.; Hughes, D.A. (2015-03)
    Background Nonadherence to antihypertensive medicines limits their effectiveness, increases the risk of adverse health outcome, and is associated with significant health care costs. The multiple causes of nonadherence differ both within and between patients and are influenced by patients’ care settings. Objectives The objective of this article was to identify determinants of patient nonadherence to antihypertensive medicines, drawing from psychosocial and economic models of behavior. Methods Outpatients with hypertension from Austria, Belgium, England, Germany, Greece, Hungary, The Netherlands, Poland, and Wales were recruited to a cross-sectional online survey. Nonadherence to medicines was assessed using the Morisky Medication Adherence Scale (primary outcome) and the Medication Adherence Rating Scale. Associations with adherence and nonadherence were tested for demographic, clinical, and psychosocial factors. Results A total of 2595 patients completed the questionnaire. The percentage of patients classed as nonadherent ranged from 24% in The Netherlands to 70% in Hungary. Low age, low self-efficacy, and respondents’ perceptions of their illness and cost-related barriers were associated with nonadherence measured on the Morisky Medication Adherence Scale across several countries. In multilevel, multivariate analysis, low self-efficacy (odds ratio = 0.73; 95% confidence interval 0.70–0.77) and a high number of perceived barriers to taking medicines (odds ratio = 1.70; 95% confidence interval 1.38–2.09) were the main significant determinants of nonadherence. Country differences explained 11% of the variance in nonadherence. Conclusions Among the variables measured, patients’ adherence to antihypertensive medicines is influenced primarily by their self-efficacy, illness beliefs, and perceived barriers. These should be targets for interventions for improving adherence, as should an appreciation of differences among the countries in which they are being delivered.
  • Development and initial validation of the Influences on Patient Safety Behaviours Questionnaire

    Taylor, N.; Parveen, Sahdia; Robins, V.; Slater, B.; Lawton, R. (2013)
    Background: Understanding the factors that make it more or less likely that healthcare practitioners (HCPs) will perform certain patient safety behaviors is important in developing effective intervention strategies. A questionnaire to identify determinants of HCP patient safety behaviors does not currently exist. This study reports the development and initial validation of the Influences on Patient Safety Behaviors Questionnaire (IPSBQ) based on the Theoretical Domains Framework. Methods: Two hundred and thirty-three HCPs from three acute National Health Service Hospital Trusts in the United Kingdom completed the 34-item measure focusing on one specific patient safety behavior (using pH as the first line method for checking the position of a nasogastric tube). Confirmatory factor analysis (CFA) was undertaken to generate the model of best fit. Results: The final questionnaire consisted of 11 factors and 23 items, and CFA produced a reasonable fit: χ2 (175) = 345.7, p < 0.001; CMIN/DF = 1.98; GFI = 0.90 and RMSEA = 0.06, as well as adequate levels of discriminant validity, and internal consistency (r = 0.21 to 0.64). Conclusions: A reliable and valid theoretically underpinned measure of determinants of HCP patient safety behavior has been developed. The criterion validity of the measure is still unknown and further work is necessary to confirm the reliability and validity of this measure for other patient safety behaviors.
  • Adherence of patients to long-term medication: a cross-sectional study of antihypertensive regimens in Austria

    Lotsch, F.; Auer-Hackenberg, L.; Groger, M.; Rehman, K.; Morrison, V.; Holmes, E.; Parveen, Sahdia; Plumpton, C.; Clyne, W.; de Geest, S.; Dobbels, F.; Vrijens, B.; Kardas, P.; Hughes, D.; Ramharter, M. (2015-05)
    Objective The objective of this study was to evaluate adherence and causes for non-adherence to antihypertensive therapy in Austrian patients. A special focus was placed on social parameters and behavioural theories. Methods Patients were invited via advertisements in community pharmacies in Austria to complete an online survey. Inclusion criteria were an age of 18 years or older, a diagnosis of arterial hypertension and a current prescription of antihypertensive medication. Adherence was measured by the four-item Morisky scale. Non-adherence was defined by at least one point in the Morisky scale. Several demographic, social and behavioural parameters were analysed as potential co-variables associated with adherence. Results A total of 323 patients completed the online survey, of which 109 (33.7 %) met the criteria for nonadherence. In a multivariable model, self-efficacy and age were associated with adherence, whereas intention and barriers were linked to non-adherence; 56 patients (17.3 %) were classified as intentionally non-adherent. Conclusion This study demonstrates that non-adherence affects an important proportion of patients in the treatment of arterial hypertension. Young age was a particularly important risk factor for non-adherence, and this patient population is, therefore, in need of special attention. Modifiable risk factors were identified that could help improving the treatment of arterial hypertension and potentially other chronic conditions.
  • Development of the Adolescent Attitudes towards Dementia Scale (A‐ADS)

    Griffiths, Alys W.; Parveen, Sahdia; Shafiq, Saba; Oyebode, Jan R. (2018-08)
    Objective: There has been an increasing interest in establishing dementia friendly communities leading to the development and delivery of various dementia awareness initiatives. These initiatives have generally been aimed at adults, however to sustain dementia friendly communities, the involvement of young people is imperative. Very few dementia awareness initiatives exist for young people and none have been independently evaluated to establish their impact. This research aimed to design and develop a scale to measure adolescents’ attitudes towards dementia to allow such initiatives to be evaluated. Methods: The Adolescent Attitudes toward Dementia Scale (A-ADS) was developed in two stages. Firstly, cognitive interviews were conducted with 15 young people and secondly, a new scale (based on items from two existing scales) was piloted with 262 young people, recruited through schools. Results: A scale consisting of 23 items was developed. Exploratory factor analysis demonstrated that this captured three factors; perceptions of dementia, personal sacrifice and empathy with people living with dementia. The three sub-scales showed adequate internal consistency (>.60), correlated with the original scales (r = .79-.91, p <.001) and correlated with an existing measure of attitudes towards older people at a similar level to the original scales (r = .47, p < .001). Discussion: The scale will allow the evaluation of educational initiatives for young people and provide a validated and standardised measure to establish adolescents’ attitudes towards dementia.

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