• The incompatibility of system and lifeworld understandings of food insecurity and the provision of food aid in an English city

      Power, M.; Small, Neil A.; Doherty, B.; Pickett, K.E. (2020)
      We report qualitative findings from a study in a multi-ethnic, multi-faith city with high levels of deprivation. Primary research over 2 years consisted of three focus groups and 18 semi-structured interviews with food insecurity service providers followed by focus groups with 16 White British and Pakistani women in or at risk of food insecurity. We consider food insecurity using Habermas’s distinction between the system and lifeworld. We examine system definitions of the nature of need, approved food choices, the reification of selected skills associated with household management and the imposition of a construct of virtue. While lifeworld truths about food insecurity include understandings of structural causes and recognition that the potential of social solidarity to respond to them exist, they are not engaged with by the system. The gap between system rationalities and the experiential nature of lay knowledge generates individual and collective disempowerment and a corrosive sense of shame.
    • Independent non-medical prescribing in children's hospices in the UK: a practice snapshot

      Tatterton, Michael J. (2017-08)
      Background: Non-medical prescribing is well established within the British health service, with increasing numbers of nurses practicing within children’s hospices. Aim: To identify the context of non-medical prescribing in children’s hospices in the UK, focusing on the perceived benefits and challenges. Method: Internet-based questionnaires were sent to 55 UK children’s hospices, exploring the practice and context of prescribing. Results: Of the 55 invited, 20 children’s hospices responded to the questionnaire, 14 of which employed a total of 39 non-medical prescribers (NMPs). Sixteen individual NMPs responded, of which half (50%) prescribed to enable the continuation of existing medicines, 37.5% prescribed independently surrounding symptom management and control and 31.3% in end-of-life care. Perceived benefits of prescribing included timely access to medicines, increased efficiency and accuracy in the admissions process and medicine reconciliation and the increased ability to offer choice in the place of palliative and hospice care. Perceived barriers to prescribing surrounded opportunities to develop confidence, defining the scope of practice and the time required to assess, diagnose and treat. Conclusion: NMPs are making a significant contribution to the prescribing workforce within hospices; however, a number of challenges need to be addressed to enable hospices to realise the benefits.
    • Individual goal-oriented cognitive rehabilitation to improve everyday functioning for people with early-stage dementia: a multi-centre randomised controlled trial (the GREAT trial)

      Clare, L.; Kudlicka, A.; Oyebode, Jan R.; Jones, R.W.; Bayer, A.; Leroi, I.; Kopelman, M.D.; James, I.A.; Culverwell, A.; Pool, J.; et al. (2019)
      Objectives: To determine whether individual goal-oriented cognitive rehabilitation (CR) improves everyday functioning for people with mild-to-moderate dementia. Design and methods: Parallel group multi-centre single-blind randomised controlled trial (RCT) comparing CR added to usual treatment (CR) with usual treatment alone (TAU) for people with an ICD-10 diagnosis of Alzheimer’s, vascular or mixed dementia and mild-to-moderate cognitive impairment (MMSE score ≥ 18), and with a family member willing to contribute. Participants allocated to CR received ten weekly sessions over three months and four maintenance sessions over six months. Participants were followed up three and nine months post-randomisation by blinded researchers. The primary outcome was self-reported goal attainment at three months. Secondary outcomes at three and nine months included informant-reported goal attainment, quality of life, mood, self-efficacy, and cognition, and study partner stress and quality of life. Results: We randomised (1:1) 475 people with dementia; 445 (CR=281) were included in the intention to treat analysis at three months, and 426 (CR=208) at nine months. At three months there were statistically-significant large positive effects for participant-rated goal attainment (d=0.97, 95% CI 0.75 to 1.19), corroborated by informant ratings (d=1.11, 0.89 to 1.34). These effects were maintained at nine months for both participant (d=0.94, 0.71 to 1.17) and informant ratings (d=0.96, 0.73 to 1.2). The observed gains related to goals directly targeted in the therapy. There were no significant differences in secondary outcomes. Conclusions: Cognitive rehabilitation enables people with early-stage dementia to improve their everyday functioning in relation to individual goals targeted in the therapy.
    • Inequalities in living well with dementia-The impact of deprivation on well-being, quality of life and life satisfaction: Results from the improving the experience of dementia and enhancing active life study

      Wu, Y.-T.; Clare, L.; Jones, I.R.; Martyr, A.; Nelis, S.M.; Quinn, Catherine; Victor, C.R.; Lamont, R.A.; Rippon, I.; Matthews, F.E.; et al. (2018-12)
      Area level factors, such as deprivation and urban/rural settings, have been associated with variation in local resources and services and health inequality in later life. The aim of this study is to investigate the potential impact of deprivation and urban/rural areas on capability to live well with dementia and to examine whether availability of informal carers modified the associations. The analysis was based on a large cohort study of 1547 community-dwelling people with dementia across Great Britain. Quality of life, life satisfaction, and well-being were measured as indices of "living well." Multivariate modelling was used to investigate differences in living well measures across deprivation quintiles and urban/rural areas adjusting for sociodemographic factors and number of comorbidities and stratifying by three groups: those living with a carer, those with a noncoresident carer and those without a carer. Negative dose-response relationships between deprivation and measures of quality of life (-2.12; 95% CI: -3.52, -0.73), life satisfaction (-1.27; 95% CI: -2.70, 0.16), and well-being (-5.24; 95% CI: -10.11, -0.36) were found in participants living with a carer. The associations were less clear in those with a noncoresident carer and those without a carer but these two groups generally reported lower scores on living well indicators than participants living with a carer. There was no urban/rural difference. The findings suggest inequalities in living well with dementia according to levels of deprivation. Additional resources are needed to improve postdiagnostic care in highly deprived areas and support those who have no informal carer.
    • Inequality, exclusion and infant mortality: listening to bereaved mothers

      Small, Neil A.; Fermor, K.; Mir, G.; HOPE Group (2016-02-16)
      This chapter will examine issues of social justice by focussing on social exclusion and infant mortality. Infant mortality is defined as the death of a live born child before its first birthday. Social exclusion and infant mortality are both important areas of policy debate in the UK and globally (1).We will examine how far they are linked and will focus on ethnic minority populations with higher than average rates of infant mortality. The chapter continues by considering a small group of women who have experienced the death of an infant and who have come together in a group called HOPE. We ask how their experience might inform our understanding of the needs of women at the time of childbirth and in the weeks immediately following it. Their experiences illuminate how feelings of exclusion, and injustice, can be manifest in and through the structures and processes of engaging with health care professionals. The potential to promote social justice and enhance inclusion via listening to the voices of those who have had this experience of loss is considered
    • Influence of ethnicity on acceptability of method of blood pressure monitoring: a cross-sectional study in primary care.

      Wood, S.; Greenfield, S.M.; Haque, M.S.; Martin, U.; Gill, P.S.; Mant, J.; Mohammed, Mohammed A.; Heer, G.; Johal, A.; Kaur, R.; et al. (2016)
      Background: Ambulatory and/or home monitoring are recommended in the UK and North America for the diagnosis of hypertension but little is known about acceptability. Aim: To determine the acceptability of different methods of measuring blood pressure to people from different ethnic minority groups. Design and setting : Cross sectional study with focus groups in primary care. Methods: People with and without hypertension of different ethnicities were assessed for acceptability of clinic, home and ambulatory blood pressure measurement using completion rate, questionnaire and focus groups. Results: 770 participants were included comprising white British (n=300), South Asian (n=241) and African Caribbean (n=229). White British participants had significantly higher successful completion rates across all monitoring modalities compared to the other ethnic groups, especially for ambulatory monitoring: white British (277 completed, 92%[89-95%]) vs South Asian (171, 71%[65-76%], p<0.001 and African Caribbean (188, 82%[77-87%], p<0.001) respectively. There were significantly lower acceptability scores for minority ethnic participants across all monitoring methods compared to white British. Focus group results highlighted self-monitoring as most acceptable and ambulatory monitoring least without consistent differences by ethnicity. Clinic monitoring was seen as inconvenient and anxiety provoking but with the advantage of immediate professional input. Conclusions: Reduced acceptability and completion rates amongst minority ethnic groups raise important questions for the implementation and interpretation of blood pressure monitoring in general and ambulatory monitoring in particular. Selection of method for blood pressure monitoring should take into account clinical need and patient preference as well as consideration of potential cultural barriers to monitoring.
    • Influence of positive aspects of dementia caregiving on caregivers' well-being: a systematic review

      Quinn, Catherine; Toms, G. (2019-10)
      Background and Objectives: There is a growing evidence base that informal caregivers can identify positive aspects of providing care and that this may have a beneficial influence on their well-being. The aim of this systematic review was to explore how positive aspects of caregiving (PAC) affects the well-being of caregivers of people with dementia. Research Design and Methods: We searched electronic databases for quantitative studies exploring the association between PAC and caregiver well-being. Studies were included if they involved informal (unpaid) caregivers of people with dementia, at least 75% of whom had to be residing in the community. A narrative synthesis was used to explore patterns within the data. Results: Fifty-three studies were included in the narrative synthesis. Most studies utilized a cross-sectional design. The majority of samples consisted primarily of spouses and female caregivers. Twenty different PAC measures were employed and studies referred to a variety of constructs, such as satisfactions, gains, meaning, and rewards. PAC was associated with lower depressive symptoms and burden. Conversely, PAC was associated with better mental health, quality of life, satisfaction with life, and competence/self-efficacy. PAC was not associated with self-rated health or personal strain/stress. Discussion and Implications: The findings suggest that identifying PAC is associated with better caregiver well-being, although further longitudinal studies are required to explore how this relationship changes over time. Interventions that enable caregivers to gain a more positive experience of caregiving could be beneficial for their well-being.
    • The influence of subliminal crosstalk in dementia narratives

      Chatwin, John; Capstick, Andrea (2019-07-01)
      Ethnographic audio-visual research data recorded in a busy dementia care environment were initially considered to be ‘contaminated’ by unwanted background noise. This included a variety of elements: ambient sound, mechanical noise, non-narrative vocalisation and narrative fragments from parallel conversation. Using the methodological lens of conversation analysis, we present an exploration of the striking temporal and sequential resonances between the narrative of one man with dementia and a group of care staff holding a separate conversation some distance away. We suggest that in this and similar settings, where random and intrusive background sounds and conversation form a ubiquitous backdrop, the presence of such ‘noise’ can have a detectable influence on the content and direction of situated narratives. We argue that rather than attempting to filter out these apparently intrusive sounds from micro-interactional data, interference elements can usefully be incorporated into the analysis of interactions.
    • Influences on uptake of a community occupational therapy intervention for people with dementia and their family carers

      Field, B.; Coates, E.; Mountain, Gail (2018)
      Living well with dementia is promoted nationally and internationally (Department of Health, 2009: Global Action Against Dementia, 2013). UK health policy recommends post-diagnostic support to enable people to live well in the community for as long as possible (Department of Health, 2015; NHS England, 2017; Scottish Government, 2017; Welsh Government, 2017). This is important given that a cure for dementia is not imminent. A growing evidence base demonstrates that psychosocial interventions can benefit people with mild to moderate dementia, by improving cognition, performance in valued activities or daily living skills, maintaining quality of life or carer coping. (Clare et al., 2011;2017; Graff et al.,2006,2007; Streater et al.,2016). Occupational therapists offer interventions to people living with mild to moderate dementia and family carers (Swinson et al.,2016;Streater et al.,2016;Yuill and Hollis,2011). The National Institute for Clinical Excellence and Social Care Institute for Excellence (2006) recommended occupational therapists provide skills training for activities of daily living. Also, the Memory Services National Accreditation Programme recommends people with dementia have access to occupational therapy and other psychosocial interventions such as reminiscence, life story work or cognitive stimulation therapy, for the cognitive, emotional, occupational and functional aspects of dementia (Hodge et al.,2016). Such interventions can be delivered by occupational therapists. The focus on the benefits of non-pharmacological interventions provides occupational therapists with an opportunity, to deliver services that improve lives and the experience of dementia (Collier and Pool, 2016). Understanding what may influence uptake of such interventions is important if people with dementia and their carers are to benefit from what occupational therapists can offer. Yet what supports the uptake of such interventions, specifically by people with mild to moderate dementia and their family carers, living in the community is poorly understood and limited research about this topic exists. ‘Uptake’, in this paper, is defined as initial acceptance of an offer, of intervention, support or services, rather than continued engagement or adherence to an intervention over time.
    • Initial evaluation of a university dementia awareness initiative

      Parveen, Sahdia; Haunch, K.; Kerry, F.; Oyebode, Jan R. (2018-09)
      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.
    • Innovation in teaching and learning in health higher education - literature review.

      Dearnley, Christine A.; McClelland, Gabrielle T.; Irving, Donna (2013)
      The landscape for health professional education is changing. The higher education (HE) sector faces the challenge of delivering high quality education at a time of financial constraint and increased emphasis on the student as a consumer. But universities also face new expectations from a health sector that is increasingly recognising both the interdependency between the quality of health care and the quality of education and training and the potential for education to support innovation. Although the differences in the HE and health policy context across the four UK home nations are increasingly significant, these are common challenges for all 85 members of the UK Council of Deans of Health. ... The literature review throws up many interesting findings. It is striking that there is relatively little research evidence on assessment or practice oriented innovative teaching and learning interventions, nationally or internationally. So too, the gaps revealed in the evidence base around the culture of innovation are something that we will pursue as a project group with a further literature review in 2014. However, the literature review reveals a rich body of research, covering areas as diverse as simulation, social media, drama and peer learning. Our hope is that the findings will help colleagues across the UK to track down the research evidence behind existing innovative practice and that it will stimulate many new ideas as we seek to continually improve the way we teach. Professor Brian J. Webster, Assistant Dean, Edinburgh Napier University and Chair, Innovation Project Advisory Group.
    • Innovations to reduce demand and crowding in emergency care; a review study

      Mason, S.; Mountain, Gail; Turner, J.; Arain, M.; Revue, E.; Weber, E.J. (2014-09-11)
      Emergency Department demand continues to rise in almost all high-income countries, including those with universal coverage and a strong primary care network. Many of these countries have been experimenting with innovative methods to stem demand for acute care, while at the same time providing much needed services that can prevent Emergency Department attendance and later hospital admissions. A large proportion of patients comprise of those with minor illnesses that could potentially be seen by a health care provider in a primary care setting. The increasing number of visits to Emergency Departments not only causes delay in urgent care provision but also increases the overall cost. In the UK, the National Health Service (NHS) has made a number of efforts to strengthen primary healthcare services to increase accessibility to healthcare as well as address patients’ needs by introducing new urgent care services. In this review, we describe efforts that have been ongoing in the UK and France for over a decade as well as specific programs to target the rising needs of emergency care in both England and France. Like many such programs, there have been successes, failures and unintended consequences. Thus, the urgent care system of other high-income countries can learn from these experiments.
    • Innovative changes in a UK midwifery education programme

      Porter, Jan; Meddings, Fiona S. (2007)
      At the University of Bradford, the midwifery team have developed an innovative approach to the delivery of their midwifery programme. This includes the use of a spiral curriculum that is underpinned by problem based learning. A spiral curriculum is one that facilitates an iterative revisiting of topics, subjects or themes throughout the programme. The approach is not simply one of repetition but one that enables the student to achieve deeper knowledge with each turn of the spiral.
    • INSPIRE (INvestigating Social and PractIcal suppoRts at the End of life): Pilot randomised trial of a community social and practical support intervention for adults with life-limiting illness

      McLoughlin, K.; Rhatigan, J.; McGilloway, S.; Kellehear, Allan; Lucey, M.; Twomey, F.; Conroy, M.; Herrera-Molina, E.; Kumar, S.; Furlong, M.; et al. (2015)
      BACKGROUND: For most people, home is the preferred place of care and death. Despite the development of specialist palliative care and primary care models of community based service delivery, people who are dying, and their families/carers, can experience isolation, feel excluded from social circles and distanced from their communities. Loneliness and social isolation can have a detrimental impact on both health and quality of life. Internationally, models of social and practical support at the end of life are gaining momentum as a result of the Compassionate Communities movement. These models have not yet been subjected to rigorous evaluation. The aims of the study described in this protocol are: (1) to evaluate the feasibility, acceptability and potential effectiveness of The Good Neighbour Partnership (GNP), a new volunteer-led model of social and practical care/support for community dwelling adults in Ireland who are living with advanced life-limiting illness; and (2) to pilot the method for a Phase III Randomised Controlled Trial (RCT). DESIGN: The INSPIRE study will be conducted within the Medical Research Council (MRC) Framework for the Evaluation of Complex Interventions (Phases 0-2) and includes an exploratory two-arm delayed intervention randomised controlled trial. Eighty patients and/or their carers will be randomly allocated to one of two groups: (I) Intervention: GNP in addition to standard care or (II) Control: Standard Care. Recipients of the GNP will be asked for their views on participating in both the study and the intervention. Quantitative and qualitative data will be gathered from both groups over eight weeks through face-to-face interviews which will be conducted before, during and after the intervention. The primary outcome is the effect of the intervention on social and practical need. Secondary outcomes are quality of life, loneliness, social support, social capital, unscheduled health service utilisation, caregiver burden, adverse impacts, and satisfaction with intervention. Volunteers engaged in the GNP will also be assessed in terms of their death anxiety, death self efficacy, self-reported knowledge and confidence with eleven skills considered necessary to be effective GNP volunteers. DISCUSSION: The INSPIRE study addresses an important knowledge gap, providing evidence on the efficacy, utility and acceptability of a unique model of social and practical support for people living at home, with advanced life-limiting illness. The findings will be important in informing the development (and evaluation) of similar service models and policy elsewhere both nationally and internationally. TRIAL REGISTRATION: ISRCTN18400594 18(th) February 2015.
    • Institutional use of National Clinical Audits by healthcare providers

      McVey, Lynn; Alvarado, Natasha; Keen, J.; Greenhalgh, J.; Mamas, M.; Gale, C.; Doherty, P.; Feltbower, R.; Elshehaly, Mai; Dowding, D.; et al. (2021-02)
      Healthcare systems worldwide devote significant resources towards collecting data to support care quality assurance and improvement. In the United Kingdom, National Clinical Audits are intended to contribute to these objectives by providing public reports of data on healthcare treatment and outcomes, but their potential for quality improvement in particular is not realized fully among healthcare providers. Here, we aim to explore this outcome from the perspective of hospital boards and their quality committees: an under-studied area, given the emphasis in previous research on the audits' use by clinical teams. Methods: We carried out semi-structured, qualitative interviews with 54 staff in different clinical and management settings in five English National Health Service hospitals about their use of NCA data, and the circumstances that supported or constrained such use. We used Framework Analysis to identify themes within their responses. Results: We found that members and officers of hospitals' governing bodies perceived an imbalance between the benefits to their institutions from National Clinical Audits and the substantial resources consumed by participating in them. This led some to question the audits' legitimacy, which could limit scope for improvements based on audit data, proposed by clinical teams. Conclusions: Measures to enhance the audits' perceived legitimacy could help address these limitations. These include audit suppliers moving from an emphasis on cumulative, retrospective reports to real-time reporting, clearly presenting the “headline” outcomes important to institutional bodies and staff. Measures may also include further negotiation between hospitals, suppliers and their commissioners about the nature and volume of data the latter are expected to collect; wider use by hospitals of routine clinical data to populate audit data fields; and further development of interactive digital technologies to help staff explore and report audit data in meaningful ways.
    • Integrating research and system-wide practice in public health to enhance the evidence-base of interventions: lessons learnt from Better Start Bradford

      Dickerson, J.; Bird, P.K.; Bryant, M.; Dharni, N.; Bridges, S.; Willan, K.; Ahern, S.; Dunn, A.; Nielsen, D.; Uphoff, E.P.; et al. (2018-11)