• Recovering from Psychosis: Empirical Evidence and Lived Experience

      Williams, Stephen (2016-10)
      The use of first-hand service user accounts of mental illness is still limited in the professional literature available. This is, however, beginning to change, with a new ‘recovery’ focus in mental health services meaning that the voices of service users are finally being heard. Recovering from Psychosis: Empirical Evidence and Lived Experience synthesises a narrative approach alongside an evidence-based review of current treatment by including Stephen Williams’ own personal experience as it relates to psychosis, recovery and treatment. A mental health professional himself, the author’s account of his own recovery from severe mental health difficulties, without sustained intervention, challenges the orthodoxy of representation of service users in mental health. Recovering from Psychosis critically explores and reviews the current state of the art of research and knowledge about the nature and treatment of psychosis. Working simultaneously from empirical, lived experience and philosophical perspectives,Stephen Williams: Evaluates political and power related issues in professional understanding, knowledge-creation and treatment of people with psychosis; Introduces the current ‘recovery movement’, unpacking its origins and implications for the future development of ‘recovery oriented services’; Reviews, summarizes and critiques the current state of ‘recovery’ research, looking at the advantages and disadvantages of such an approach, examining how this is influencing the transformation of UK mental health services; Analyses the difficulties in organisational implementation of recovery approaches, summarises the most empirically robust approaches to practice, personal and service delivery measurement; Reviews current ‘models’ of psychosis and how various professional scientific groups explain the experience and nature of psychosis; Uses lived-experience accounts taken from the scientific literature, portraying the nature of such experiences and analysing them in the face of contemporary psychological models. Recovering from Psychosis is an essential comprehensive guide for mental health professionals, psychologists, social workers and carers, who are working with people with severe and enduring mental health difficulties diagnosed as psychosis. It addresses the practical implications of working with such difficult conditions and serves as a hopeful story of recovery for service users.
    • Recruitment of older adults to three preventative lifestyle improvement studies

      Chatters, R.; Newbould, L.; Sprange, K.; Hind, D.; Mountain, Gail; Shortland, K.; Powell, L.; Gossage-Worrall, R.; Chater, T.; Keetharuth, A.; et al. (2018-02)
      Background: Recruiting isolated older adults to clinical trials is complex, time-consuming and difficult. Previous studies have suggested querying existing databases to identify appropriate potential participants. We aim to compare recruitment techniques (general practitioner (GP) mail-outs, community engagement and clinician referrals) used in three randomised controlled trial (RCT) studies assessing the feasibility or effectiveness of two preventative interventions in isolated older adults (the Lifestyle Matters and Putting Life In Years interventions). Methods: During the three studies (the Lifestyle Matters feasibility study, the Lifestyle Matters RCT, the Putting Life In Years RCT) data were collected about how participants were recruited. The number of letters sent by GP surgeries for each study was recorded. In the Lifestyle Matters RCT, we qualitatively interviewed participants and intervention facilitators at 6 months post randomisation to seek their thoughts on the recruitment process. Results: Referrals were planned to be the main source of recruitment in the Lifestyle Matters feasibility study, but due to a lack of engagement from district nurses, community engagement was the main source of recruitment. District nurse referrals and community engagement were also utilised in the Lifestyle Matters and Putting Life In Years RCTs; both mechanisms yielded few participants. GP mail-outs were the main source of recruitment in both the RCTs, but of those contacted, recruiting yield was low (< 3%). Facilitators of the Lifestyle Matters intervention questioned whether the most appropriate individuals had been recruited. Participants recommended that direct contact with health professionals would be the most beneficial way to recruit. Conclusions: Recruitment to the Lifestyle Matters RCT did not mirror recruitment to the feasibility study of the same intervention. Direct district nurse referrals were not effective at recruiting participants. The majority of participants were recruited via GP mail-outs, which may have led to isolated individuals not being recruited to the trials. Further research is required into alternative recruitment techniques, including respondent-driven sampling plus mechanisms which will promote health care professionals to recruit vulnerable populations to research.
    • Reducing emergency hospital admissions: A population health complex intervention of an enhanced model of primary care and compassionate communities

      Abel, J.; Kingston, H.; Scally, Andy J.; Hartnoll, J.; Hannam, G.; Thomson-Moore, A.; Kellehear, Allan (2018-11)
      Background: Reducing emergency admissions to hospital has been a cornerstone of health care policy. There is little evidence of systematic interventions which achieved this aim across a population. We report the impact on unplanned admissions to hospital through a complex intervention over a 44 month period in Frome, Somerset. Aim: A population health complex intervention of an enhanced model of primary care and compassionate communities to improve population health and reduce emergency admissions to hospital Design: A cohort retrospective study of a complex intervention on all emergency admissions in Frome compared to Somerset from April 2013 to December 2017. Setting: Frome Medical Practice, Somerset Methods: Patients were identified using broad criteria including anyone with cause for concern. Patient centred goal setting and care planning combined with a compassionate community social approach was implemented broadly across the population of Frome. Results: There was a progressive reduction, by 7.9 cases per quarter (95% CI: 2.8, 13.1; p=0.006) in unplanned hospital admissions across the whole population of Frome, over the study period from April 2014 to December 2017. At the same time, there was sharp increase in the number of admissions per quarter, within the Somerset, with an increase in the number of unplanned admissions of 236 per quarter (95% CI: 152, 320; p<0.001). Conclusion: The complex intervention in Frome was associated with highly significant reductions in unplanned admissions to hospital with reduction of healthcare costs across the whole population of Frome
    • Reducing image interpretation errors – Do communication strategies undermine this?

      Snaith, Beverly; Hardy, Maryann L.; Lewis, Emily F. (2014-08)
      Errors in the interpretation of diagnostic images in the emergency department are a persistent problem internationally. To address this issue, a number of risk reduction strategies have been suggested but only radiographer abnormality detection schemes (RADS) have been widely implemented in the UK. This study considers the variation in RADS operation and communication in light of technological advances and changes in service operation. A postal survey of all NHS hospitals operating either an Emergency Department or Minor Injury Unit and a diagnostic imaging (radiology) department (n = 510) was undertaken between July and August 2011. The questionnaire was designed to elicit information on emergency service provision and details of RADS. 325 questionnaires were returned (n = 325/510; 63.7%). The majority of sites (n = 288/325; 88.6%) operated a RADS with the majority (n = 227/288; 78.8%) employing a visual ‘flagging’ system as the only method of communication although symbols used were inconsistent and contradictory across sites. 61 sites communicated radiographer findings through a written proforma (paper or electronic) but this was run in conjunction with a flagging system at 50 sites. The majority of sites did not have guidance on the scope or operation of the ‘flagging’ or written communication system in use. RADS is an established clinical intervention to reduce errors in diagnostic image interpretation within the emergency setting. The lack of standardisation in communication processes and practices alongside the rapid adoption of technology has increased the potential for error and miscommunication.
    • Reducing senility to 'bare life': are we heading for a new Holocaust at mid-C21?

      Capstick, Andrea (04/12/2013)
      The tradition of the oppressed teaches us that the 'state of emergency' in which we live is not the exception but the rule. We must attain to a conception of history that is in keeping with this insight¿.The current amazement that the things we are experiencing are 'still' possible in the twentieth century is not philosophical. This amazement is not the beginning of knowledge, unless it is the knowledge that the view of history which gives rise to it is untenable. (Benjamin, 1940: 248-249) The German-Jewish critical theorist Walter Benjamin (1892-1940) wrote these lines shortly before his death in exile whilst fleeing from the agents of fascism. They seem particularly relevant to a healthcare policy conference with the title ¿Condition Critical¿ taking place almost 70 years later. In this paper one of the things I hope to do is outline how Benjamin¿s concept of the permanent state of emergency relates to health and social care provision for older people with dementia today. Benjamin believed that the Holocaust came about because of the 'amnestic' view of history as an unbroken, linear process of scientific achievement, including the belief in human perfectibility. He suggested that in order to see history stripped of this ideological myth of progress, we need to wake from a collective 'dream history', from our usual somnolent acceptance of surface appearances (Cohen 1993: 5). Similarly it can be argued today that the 20th century 'dream history' of linear progress away from a never-to-be-repeated Holocaust is a myth. My strong claim in this paper is that present day demographic panic related to the economic 'burden of care' for an ageing population is leading to proposed solutions analogous to the ideological killing of psychiatric patients, the physically disabled, Jews and other victims of Nazism in the mid-20th century. Such 'solutions' are fuelled by media propaganda, the profit motives of what has been described as the 'medical-industrial complex' (Bond et al 2004) and a reductive, medicalised, biological determinist model of the cognitive changes of ageing.
    • Reducing spinal injuries in rugby: Is rugby league the solution?

      Beck, Jamie J.W. (2016-02-22)
      Sport as a whole has recently been under greater scrutiny over the safety of its participants. The tragic death of Australian Test Cricketer Philip Hughes brought into stark focus the risk of head injury but there has also been greater awareness of hypertrophic cardiomyopathy, concussion and use of performance enhancing drugs. Much of the research around concussion arises from what could be described as “collision” sports such as American football and ice hockey. The catalyst for discussions around concussion has tended to originate from these American sport. The significance of this increased awareness of safety has not been lost on the sport of rugby which has caused changes in practice in terms of concussion management but what appears not to have been fully appreciated is the additional risk of cervical spine injury associated with the sport.
    • A reference database for the Stratec XCT-2000 peripheral quantitative computed tomography (pQCT) scanner in healthy children and young adults aged 6–19 years

      Ashby, R.L.; Ward, K.A.; Roberts, S.A.; Edwards, Lisa; Mughal, M.Z.; Adams, Jenny E. (2009-08)
      Summary We have produced paediatric reference data for forearm sites using the Stratec XCT-2000 peripheral quantitative computed tomography scanner. These data are intended for clinical and research use and will assist in the interpretation of bone mineral density and bone geometric parameters at the distal and mid-shaft radius in children and young adults aged between 6–19 years. Introduction Peripheral quantitative computed tomography (pQCT) provides measurements of bone mineral content (BMC), density (BMD) and bone geometry. There is a lack of reference data available for the interpretation of pQCT measurements in children and young adults. The aim of this study was to provide reference data at the distal and midshaft radius. Methods pQCT was used to measure the 4% and 50% sites of the non-dominant radius in a cohort of healthy white Caucasian children and young adults aged between 5 and 25 years. The lambda, mu, sigma (LMS) technique was used to produce gender-specific reference centile curves and LMS tables for calculating individual standard deviations scores. Results The study population consisted of 629 participants (380 males). Reference centile curves were produced; total and trabecular BMD for age (distal radius) and for age and height, bone area (distal and mid-shaft radius), cortical area, cortical thickness, BMC, axial moment of inertia, stress– strain index and muscle area (mid-shaft radius). Conclusions We present gender-specific databases for the assessment of the distal and mid-shaft radius by pQCT. These data can be used as control data for research studies and allow the clinical interpretation of pQCT measurements in children and young adults by age and height.
    • Reflecting team processes in family therapy: A search for research

      Willott, S.; Hatton, T.; Oyebode, Jan R. (2012-05)
      Tom Andersen's Reflecting Team approach is widely (and creatively) employed in family therapy. Despite continuing enthusiasm for the practice, however, there are few journal articles reporting empirical research and only one (now dated) review of the literature. After defining reflecting team processes through practices that are embedded in particular approaches to knowledge construction and theoretical interpretation, we offer an overview of the empirical research found in our search of the literature. In the second half of this article we ask why there is so little existing research in this area. Various possible explanations are explored and future directions proposed. We conclude that a dialogue around the complex interweaving of practice, theory and research (that is, praxis) would be a helpful overall stance to adopt in relation to future work in this area.
    • Reflections on PPI from the ‘Action on Living Well: Asking You’ advisory network of people with dementia and carers as part of the IDEAL study

      Litherland, R.; Burton, J.; Cheeseman, M.; Campbell, D.; Hawkins, M.; Hawkins, T.; Oliver, K.; Scott, D.; Ward, J.; Nelis, S.M.; et al. (2018-11-01)
      This article describes the work of the ‘Action on Living Well: Asking You’ group – an involvement group of people with dementia and carers attached to the IDEAL research study. The article describes the work of the group, the methods that have helped them to stay involved and people’s perspectives on their experiences of being involved and the impact it has had, for themselves and others. The article has been written following a reflective piece of work with the ‘Action on Living Well: Asking You’ group to review and remember the work of the past four years. An accompanying film brings to life the work and activities of the group, available at www.idealproject.org.uk/mclass/
    • Reframing challenging behaviour as cultural resistance: The refusal of bare life in long-term dementia care.

      Capstick, Andrea (2017-04-28)
      This paper considers the situation of people with dementia who are living in long-term care from two rarely-applied theoretical perspectives. The first, Agamben’s theory of biopolitical life versus bare life, demonstrates that the situation of people with dementia living in care homes or hospitals approximates to that of prisoners, internees and refugees, deprived of full citizenship or biopolitical life. In popular imagery people with dementia are frequently referred to, first in terms of numbers, as a ‘rising tide’, in a way that has historically been used to justify discrimination and social exclusion. In many, care environments it is, moreover, still the case that people with dementia are reduced to a condition of ‘bare life’ only: given little choice, having few rights, lacking freedom of movement, and subjected to almost constant surveillance. In other contexts, such treatment is known to cause or exacerbate many of the problems which – following a biomedical model – are constructed as ‘symptoms of dementia’, such as disorientation in time and space, sleep disturbance, hallucinations and repetitive movement. The second body of theory is Bakhtin’s work on cultural resistance. This demonstrates that many of the so-called ‘challenging behaviours’ manifested by people with dementia, can better be understood as coping, sense-making and self-determining strategies adopted in order to survive within prevailing organisational cultures. Based on a series of studies carried out in intermediate and long-term care since 2009, the paper draws on a range of narrative and film-based examples to demonstrate the ‘courage, humour, fortitude and cunning’ with which, as Walter Benjamin noted, the oppressed have always met the conditions of their oppression. In the process, ‘challenging behaviour’ is given political and ideological meaning, as protest, perpetrated by people who are struggling against extreme odds to be reinstated as full citizens.
    • The relation between mood, activity, and interaction in long-term dementia care

      Beerens, H.C.; Zwakhalen, S.M.G.; Verbeek, H.; Tan, F.E.S.; Jolani, S.; Downs, Murna G.; de Boer, B.; Ruwaard, D.; Hamers, J.P.H. (2018)
      Objective: The aim of the study is to identify the degree of association between mood, activity engagement, activity location, and social interaction during everyday life of people with dementia (PwD) living in long-term care facilities. Method: An observational study using momentary assessments was conducted. For all 115 participants, 84 momentary assessments of mood, engagement in activity, location during activity, and social interaction were carried out by a researcher using the tablet-based Maastricht Electronic Daily Life Observation-tool. Results: A total of 9660 momentary assessments were completed. The mean age of the 115 participants was 84 and most (75%) were women. A negative, neutral, or positive mood was recorded during 2%, 25%, and 73% of the observations, respectively. Positive mood was associated with engagement in activities, doing activities outside, and social interaction. The type of activity was less important for mood than the fact that PwD were engaged in an activity. Low mood was evident when PwD attempted to have social interaction but received no response.
    • Relationship between artificially sweetened and sugar-sweetened cola beverage consumption during pregnancy and preterm delivery in a multi-ethnic cohort: analysis of the Born in Bradford cohort study.

      Petherick, E.S.; Goran, M.I.; Wright, J. (2014-02)
      The aim of this study was to investigate the relationship between the intake of sugar-sweetened (SS) and artificially sweetened (AS) cola beverages during pregnancy and the risk of preterm delivery (PTD). At baseline (2007–2010), 8914 pregnant women were recruited to the Born in Bradford birth cohort study at 24–28 weeks of pregnancy. Women completed a questionnaire describing their health and lifestyle behaviours, including their consumption of AS and SS cola beverages reported as cups per day, which were then linked to maternity records. The relationship between SS and AS cola beverage consumption was examined using logistic regression analyses. No relationship was observed between daily AS cola beverage consumption and PTD. Women who drank four cups per day of SS cola beverages had higher odds of a PTD when compared with women who did not consume these beverages daily. We conclude that high daily consumption of SS cola beverages during pregnancy is associated with increases in the rate of PTD.
    • The relationship between perceived functional difficulties and the ability to live well with mild-to-moderate dementia: Findings from the IDEAL programme.

      Martyr, A.; Nelis, S.M.; Quinn, Catherine; Rusted, J.M.; Morris, R.G.; Clare, L. (2019)
      Objectives: The objectives of the study are to investigate how different levels of functional ability relate to quality of life, well‐being, and satisfaction with life, conceptualised as reflecting capability to “live well” in people with dementia. Methods/design: Participants were 1496 people with mild‐to‐moderate dementia and 1188 informants who completed baseline assessments in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort study. Total selfrated and informant‐rated scores on the Functional Activities Questionnaire were split into six ability levels to monitor how poorer functioning impacts the ability to live well. We also investigated the potential influence of sociodemographic and diagnostic variables, depression, cognition, and carer stress. Results: Multivariate multiple regression models found that people with dementia who had the greatest functional impairment according to self‐ratings and informant ratings had poorer living well scores than those with the least functional impairment. Sociodemographic and diagnostic factors and cognition had little impact on effect sizes. For self‐ratings, depression attenuated the relationship between functional ability and living well, whereas carer stress attenuated informant ratings. Conclusions: People with dementia with the least functional impairments had greater capability to live well than those with the most functional impairment. Even subtle perceived difficulties in functional ability had a detrimental effect on the ability of people with dementia to live well. Depression in people with dementia and carer stress in informants influenced these associations, and therefore, these factors should be routinely included in future research studies and clinical assessments.
    • Relationship continuity and emotional well-being in spouses of people with dementia

      Riley, J.A.; Evans, L.; Oyebode, Jan R. (2016-11)
      Objectives: Qualitative research has suggested that spousal experiences of discontinuity in their relationship with a person who has dementia (i.e. the relationship is experienced as radically changed) may contribute to heightened feelings of burden, entrapment, isolation, guilt and intolerance of behaviours that challenge. By contrast, continuity in the relationship may contribute to a greater sense of achievement and gratification from providing care. The present study served as a quantitative test of these suggestions. Method: A convenience sample of 71 spouses of people with dementia completed three questionnaires - the Zarit Burden Interview (ZBI), the Positive Aspects of Caregiving measure (PAC) and the Birmingham Relationship Continuity Measure (BRCM). Results: In accordance with the hypotheses, the experience of greater relationship continuity (higher BRCM scores) was correlated with fewer negative emotional reactions to caregiving (lower ZBI scores; rho = −.795) and more positive emotional reactions (higher PAC scores; rho = .764). Conclusions: The study provided some quantitative support for suggestions arising from qualitative research about how perceptions of continuity/discontinuity in the relationship may impact on the caregiving spouse's emotional well-being. Helping couples to maintain a sense of continuity and couplehood may assist their emotional adjustment to dementia.
    • Relatives' Experiences of Frontal-Variant Frontotemporal Dementia

      Oyebode, Jan R. (2013)
      In this article we address how relatives of people with frontal-variant frontotemporal dementia (fvFTD) experience the illness and how it impacts their lives. We interviewed 6 participants and carried out interpretative phenomenological analysis. We report on 11 themes that reflect distinctive challenges. Five themes relate to witnessing bizarre and strange changes: changed appetites and drives, loss of planning ability, loss of inhibition leading to social embarrassment, risky behavior, and communication problems. Four relate to managing these changes and two to the impact on the person and his or her relationships. Relatives must live with unusual changes in the person with fvFTD and the stigma this carries in social settings. They learn to act assertively for their relatives and put effort into promoting quality of life, using strategies adapted for fvFTD. Relatives grieve the loss of the person with fvFTD and their mutual relationship, but nonetheless find sources of solace and hope.
    • Relaxation and chronic pain: A critical review

      Jeffrey, Sarah; McClelland, Gabrielle T.; Carus, Catherine; Graham, Claire (2016-06)
      Chronic non-malignant pain is a global condition with a complex biopsychosocial impact on the sufferers. Relaxation skills are commonly included as part of a pain management programme, which is currently the recommended evidence-based intervention for this group of patients. However, there is little evidence behind the choice of relaxation method implemented, or their effectiveness. The aim of this study was to investigate the effectiveness of relaxation skills in the management of chronic non-malignant pain, related to pain intensity and health-related quality of life. A systematic literature review was conducted using MEDLINE, CINAHL, AMED, PEDro and PsycARTICLES. The Cochrane, DARE and Trip databases were also accessed, and searches were carried out using the terms (relaxation OR relaxation therapy OR relaxation training) AND (pain OR chronic pain). Following critical appraisal, ten studies met the inclusion criteria. Three studies reported a decrease in pain intensity as a result of the relaxation intervention, whilst only one study reported an improvement in health-related quality of life. Progressive muscle relaxation was the most commonly implemented method throughout, although its method of delivery differed between studies. There is little evidence for the use of relaxation as a stand-alone intervention for pain intensity and health-related quality of life for patients with musculoskeletal chronic non-malignant pain. More research is needed to determine its effectiveness.
    • Reliability of 2-Dimensional Video Assessment of Frontal-Plane Dynamic Knee Valgus During Common Athletic Screening Tasks

      Munro, Allan G.; Herrington, L.C.; Carolan, M. (2012)
      Context: Two-dimensional (2D) video analysis of frontal-plane dynamic knee valgus during common athletic screening tasks has been purported to identify individuals who may be at high risk of suffering knee injuries such as anterior cruciate ligament tear or patellofemoral pain syndrome. Although the validity of 2D video analysis has been studied, the associated reliability and measurement error have not. Objective: To assess the reliability and associated measurement error of a 2D video analysis of lower limb dynamic valgus. Design: Reliability study. Participants: 20 recreationally active university students (10 women age 21.5 ± 2.3 y, height 170.1 ± 6.1 cm, weight 66.2 ± 10.2 kg, and 10 men age 22.6 ± 3.1 y, height 177.9 ± 6.0 cm, weight 75.8 ± 7.9 kg). Main Outcome Measurement: Within-day and between-days reliability and measurement-error values of 2D frontal-plane projection angle (FPPA) during common screening tasks. Interventions: Participants performed single-leg squat and drop jump and single-leg landings from a standard 28-cm step with standard 2D digital video camera assessment. Results: Women demonstrated significantly higher FPPA in all tests except the left single-leg squat. Within-day ICCs showed good reliability and ranged from .59 to .88, and between-days ICCs were good to excellent, ranging from .72 to .91. Standard error of measurement and smallest detectable difference values ranged from 2.72° to 3.01° and 7.54° to 8.93°, respectively. Conclusions: 2D FPPA has previously been shown to be valid and has now also been shown to be a reliable measure of lower extremity dynamic knee valgus. Using the measurement error values presented along with previously published normative data, clinicians can now make informed judgments about individual performance and changes in performance resulting from interventions.
    • Reliability of measurements with digital radiographs ¿ a myth.

      Varghese, B.; Muthukumar, N.; Balasubramaniam, M.; Scally, Andy J. (2011)
      The purpose of this study was to assess the accuracy of digital radiographs and hence their effectiveness in templating. The methodology involved a retrospective study of post operative radiographs of patients with hemiarthroplasty of the hip. Three observers made observations blinded to each other¿s measurements. A statistical analysis of the data highlights magnification varying from 6 to 31 percent. There is a statistically significant relationship between the size of the error (size measured on radiograph minus implant size, i.e. magnification) and the implant size (p = 0.005) but the percentage error (error/implant size x 100) is independent of implant size (p = 0.505). It is our impression that digital radiographs and templating on the digital radiographs should not be considered a precise process.
    • Remote health care provision in care homes in England: an exploratory mixed methods study of Yorkshire and the Humber

      Newbould, L.; Mountain, Gail; Ariss, S.; Hawley, M.S. (2019-02-15)
      An increasing demand for care homes in the UK, has necessitated the evaluation of innovative methods for delivering more effective health care. Videoconferencing may be one way to meet this demand. However, there is a lack of literature on the provision of videoconferencing in England. This mixed-methods study aimed to map current attitudes, knowledge and provision of videoconferencing in the Yorkshire and Humber region of England. Qualitative interviews with care home managers, a scoping review and field notes from a Special Interest Group (SIG) informed the development of a descriptive convenience survey which was sent out to care home managers in the Yorkshire and Humber region of England. The survey had a 14% (n = 124) response rate. Of those who responded, 10% (n = 12) reported using videoconferencing for health care; with over 78% (n = 97) of respondents’ care homes being based in urban areas. Approximately 62% (n = 77) of the 124 respondents had heard of videoconferencing for health care provision. Of those who reported not using videoconferencing (n = 112), 39% (n = 48) said they would consider it but would need to know more. The top ranked reason for not introducing videoconferencing was the belief that residents would not be comfortable using videoconferencing to consult with a healthcare professional. The main reason for implementation was the need for speedier access to services. Those already using videoconferencing rated videoconferencing overall as being very good (50%) (n = 6) or good (42%) (n = 5). Those who were not using it in practice appeared sceptical before implementing videoconferencing. The main driver of uptake was the home’s current access to and satisfaction with traditionally delivered health care services.