The feasibility of identifying health inequalities in social prescribing referrals and declines using primary care patient records.

Background: Social prescribing (SP) is part of universal personalised care and available to everyone in the UK National Health Service. However, emerging evidence suggests access disparities in social prescribing. This study aimed to investigate the feasibility of using primary care records to access and analyse data on social prescribing. Our secondary aim was to compare characteristics of patients who are offered referral, referred to or decline referral for social prescribing to explore possible inequalities in access to social prescribing. Methods: Patient records (n=3086) were extracted from 11 GP practices across Northwest England for accepted, offered and declined social prescribing referrals. Patient demographics collected included sex, age, ethnicity, mental and physical health diagnoses. Patient characteristics in social prescribing referrals were compared to the overall practice population (practice information from Public Health England). Referral and decline rates were compared by group (e.g. male/female decline rates). Results: GP referral data showed inconsistent recording of wider determinants of health. Patient age, sex and mental and physical health conditions were consistently recorded. Other variables (marital status, interpreter need, education, disability, sexual orientation, non-English language, nationality) were recorded only sporadically and could not be used for analysis. Practices varied in referral patterns. Our preliminary findings identified under-referring of younger age groups and Asians, and higher declined referrals among individuals with physical health diagnoses. Conclusions: Recording discrepancies meant that many patient factors could not be used to identify trends in social prescribing referrals and declines and assess equity. Primary care data recording must be consistent to understand SP referral trends and inequalities relating to the wider determinants of health. Preliminary results suggest some patient groups may be underrepresented in SP referrals, however this requires further investigation.

Sustaining Resilience of Healthcare Workers and Leaders during a Pandemic: A Protocol to Support Coping during the COVID-19 Pandemic.

Objective: One way healthcare organisations can support their staff is through supervision. Supervision is typically defined as a process in which professionals receive support and guidance from more experienced colleagues. In this brief review we propose a tailored protocol for supporting support workers during a pandemic. Method: We collected narrative data from difference sources including a systematic meta ethnography and used expert advise in order to tailor the protocol. Results: This protocol can be used by management teams (e.g., senior support workers, team leaders, registered managers, and operation managers) without any prior experience of supervision. The protocol suggested includes a template with easy-to-follow instructions. Conclusions: It provides an easy step-by-step guide that simplifies the process whilst maintaining the depth needed to ensure effective supervision.

UK healthcare support workers and the COVID-19 pandemic: an explorative analysis of lived experiences during the COVID-19 pandemic.

Support workers are an underrepresented profession that receives less attention with a high degree of responsibilities. The aim of this study was to explore the lived experiences of healthcare support workers within the care sector during the COVID-19 pandemic. This is a qualitative semi-structured interview study using an interpretative phenomenology (IP) framework. Fifteen (15) support workers were interviewed while all COVID-19 restrictions from the government were still in place. We identified five main themes: (1) challenging experiences; (2) coping mechanisms; (3) emotions and behaviors arising from the COVID-19 pandemic; (4) external interest on support worker's health; (5) take-home message from the COVID-19 pandemic. The organization selected for the research is a good representative of how care organizations operate within the UK both in terms of policies and staff selection.

Healthcare support workers' lived experiences and adaptation strategies within the care sector during the COVID-19 pandemic. A meta-ethnography review.

Support workers are an "invisible" part of the health sector often working during pandemics to support clients. This meta-ethnography screened 167 articles out of 211 results identifying 4 qualitative studies that explored the support worker's experiences during the COVID-19 pandemic. "Redundancy approach" was used to map non-essential criteria and the analysis was informed by the interpretative meta-ethnography method. Eight key themes identified from studies in UK and USA. The themes identified are: (1) job role; (2) marginalized profession; (3) impact of work; (4) concerns surrounding PPE; (5) transportation challenges; (6) level of support and guidance; (7) a higher calling and self sacrifice; (8) adaptation strategies. Adaptation strategies include purchasing their own masks, to policy and agency adaptation, cleaning, talk walks, meetings with colleagues or within the company. The adaptation strategies aim at tackling emotional distress and raise the level of appreciation that society or organizations show to the support workers.

Predictors of dental care utilization in north-central Appalachia in the USA.

OBJECTIVES: Dental utilization is an important determinant of oral health and well-being. The aim of this study was to evaluate potential associations between a variety of biopsychosocial factors and dental utilization in north-central Appalachia, USA, a region where oral health disparities are profound. METHODS: This study used household-based data from the Center for Oral Health Research in Appalachia (COHRA1) study in north-central Appalachia, including 449 families with 868 adults. The generalized estimating equation (GEE) approach was used to determine the best-fitting predictor model for dental utilization among adult family members. RESULTS: On average across West Virginia and Pennsylvania, having dental insurance was associated with greater dental utilization over a 3-year time period (OR = 2.20, 95% CI = 1.54, 3.14). When stratified by state, the association held for only West Virginia (OR = 2.41, 95% CI = 1.54, 3.79) and was nonsignificant for Pennsylvania residents (OR = 1.50, 95% CI = 0.80, 2.79). Individuals from Pennsylvania were more likely to utilize dental care and participants from West Virginia less so (2.31, 95% CI = 1.57, 3.40). Females from Pennsylvania were more likely than males to regularly seek dental care (OR = 1.44, 95% CI = 1.00, 2.05), and a higher income was associated with greater frequency of regular dental visits (OR = 1.21, 95% CI = 1.09, 1.34) in West Virginia. Individuals from Pennsylvania who scored higher on the Physiological Arousal subscale of the Dental Fear Survey were more likely to attend routine care visits (OR = 1.18, 95% CI = 1.03, 1.35). Across both states, more fatalistic beliefs related to oral health care also predicted less routine care (OR = 0.87, 95% CI = 0.81, 0.94), and more investment in or more positive attitudes towards one's oral health also was associated with higher utilization (OR = 1.18, 95% CI = 1.13, 1.23). CONCLUSIONS: Overall, the findings of this study suggest state residency, sex, insurance, income, fatalistic beliefs, health values, and aspects of dental care-related anxiety and fear predicted dental care utilization in north-central Appalachia. These findings reinforce the need to address insurance and other economic factors affecting utilization and to consider how individual-level fatalistic beliefs and oral health values may affect utilization of routine oral health care.

Subjective well-being in dentists: the role of intrinsic aspirations.

OBJECTIVES: To take a motivational approach, testing an idea derived from self-determination theory (SDT) that the pursuit of intrinsic life and professional aspirations is associated with enhanced subjective well-being. METHODS: A cross-sectional survey of a cluster sample of 583 dentists in England provided data on the subjective importance of their intrinsic and extrinsic aspirations and their perceived likelihood of achieving those aspirations. The dependent variable was a four-domain measure of subjective well-being. RESULTS: Controlling measures of core self-evaluations and trait emotional intelligence, the perceived importance and likelihood of achieving intrinsic aspirations were uniquely related to positive affect; the perceived likelihood of achieving intrinsic aspirations was uniquely related to job and life satisfaction and positive affect, and the perceived likelihood of achieving extrinsic aspirations was uniquely related to life satisfaction. No aspiration variables uniquely predicted negative affect. CONCLUSIONS: These findings lend support to self-determination theory and provide a platform for the future development of interventions that can promote and maintain well-being in dentists.

The impact of changes in incentives and governance on the motivation of dental practitioners.

Recent changes to the system of remuneration and contracting arrangements with Primary Care Trusts (PCTs) has meant that dental practitioners in the UK have experienced several types of incentive and governance arrangements. This paper uses data from a qualitative study of 20 dental practitioners to examine the influence of different systems of incentives and governance on their motivational system. Results show that a perceived reduction in autonomy was the least acceptable aspect of the health reforms. The study also suggests that conflict between self-interested and altruistic motives may occur where medical professionals operate as independent contractors in a small business environment. Whilst dentists appeared to show altruistic motives towards their patients, priorities towards running an autonomous business enterprise meant that PCT managerial requirements, for example, to widen access were not welcomed, because of their impact on managerial autonomy. Moreover, whilst dentists' professional ethos appeared geared towards achieving technically high quality standards of work, this produced tensions against a background of cost containment in a fee-per-item system of remuneration. The paper raises issues such as the person-system interaction associated with professional and individual autonomy and the importance of reciprocity and fair payment.

Implementing intentions to drink a carbohydrate-electrolyte solution during exercise.

In this study, we examined the effectiveness of a theory-based psychological implementation intention strategy on the volume and frequency of intake of a carbohydrate-electrolyte solution by participants engaged in submaximal exercise. Thirty-five participants were randomly assigned to an implementation intention or control condition. Participants assigned to the implementation intention condition were required to write down when and where they would carry out their intention to drink a sports drink in the upcoming exercise trial. Participants completed self-report measures of intentions, the psychological antecedents of intentions, and past behaviour for sports drink use and physical activity before and after receiving the experimental manipulation. Participants then engaged in a one-hour submaximal exercise trial on a cycle ergometer and had free access to a carbohydrate-electrolyte solution throughout. The frequency and volume of sports drink consumed by participants over the course of the trial was recorded. Participants also provided pre- and post-trial urine samples, which were tested for osmolality. Experimental participants imbibed a significantly greater volume of sports drink and had significantly higher urine osmolality than controls. The intervention had no effects on psychological variables. Results support the use of implementation intentions to effectively promote sports drink intake among sports participants.