Measuring the psychosocial burden in women with low-grade abnormal cervical cytology in the TOMBOLA trial: psychometric properties of the Process and Outcome Specific Measure (POSM).

Background: There is a need for an instrument to measure the psychosocial burden of receiving an abnormal cervical cytology result which can be used regardless of the clinical management women receive.Methods: 3331 women completed the POSM as part of baseline psychosocial assessment in a trial of management of low grade cervical cytological abnormalities. Factor analysis and reliability assessment of the POSM were conducted.Results: Two factors were extracted from the POSM: Factor 1, containing items related to worry; and Factor 2 containing items relating to satisfaction with information and support received and change in the way women felt about themselves. Factor 1 had good reliability (Cronbach's alpha 0.769), however reliability of the Factor 2 was poorer(0.482). Data collected at four subsequent time points demonstrated that the factor structure was stable over time.Conclusion: This study demonstrates the presence and reliability of a scale measuring worries within the POSM. This analysis will inform its future use in this population and in other related contexts.

REFINE (REducing Falls in In-patieNt Elderly) using bed and bedside chair pressure sensors linked to radio-pagers in acute hospital care: a randomised controlled trial.

BACKGROUND: falls in hospitals are a major problem and contribute to substantial healthcare burden. Advances in sensor technology afford innovative approaches to reducing falls in acute hospital care. However, whether these are clinically effective and cost effective in the UK setting has not been evaluated. METHODS: pragmatic, parallel-arm, individual randomised controlled trial of bed and bedside chair pressure sensors using radio-pagers (intervention group) compared with standard care (control group) in elderly patients admitted to acute, general medical wards, in a large UK teaching hospital. Primary outcome measure number of in-patient bedside falls per 1,000 bed days. RESULTS: 1,839 participants were randomised (918 to the intervention group and 921 to the control group). There were 85 bedside falls (65 fallers) in the intervention group, falls rate 8.71 per 1,000 bed days compared with 83 bedside falls (64 fallers) in the control group, falls rate 9.84 per 1,000 bed days (adjusted incidence rate ratio, 0.90; 95% confidence interval [CI], 0.66-1.22; P = 0.51). There was no significant difference between the two groups with respect to time to first bedside fall (adjusted hazard ratio (HR), 0.95; 95% CI: 0.67-1.34; P= 0.12). The mean cost per patient in the intervention group was £7199 compared with £6400 in the control group, mean difference in QALYs per patient, 0.0001 (95% CI: -0.0006-0.0004, P= 0.67). CONCLUSIONS: bed and bedside chair pressure sensors as a single intervention strategy do not reduce in-patient bedside falls, time to first bedside fall and are not cost-effective in elderly patients in acute, general medical wards in the UK. TRIAL REGISTRATION: isrctn.org identifier: ISRCTN44972300.

'Practising under your own Pin'- a description of the transition experiences of newly qualified midwives.

AIM: Transition experiences of newly qualified midwives were examined in depth during the third phase of a UK evaluation study of midwifery education. BACKGROUND: The fitness to practise and the retention of newly qualified nursing and midwifery graduates are pressing concerns for health care managers. The advantages of preceptorship are reported in the literature but the content and timing of schemes remain unclear. METHODS: A semi-structured diary was kept for up to 6 months by 35 newly qualified midwives in 18 work sites covering all countries in the UK. The preceptor and supervisor of midwives for each newly qualified midwife completed short questionnaires about their preceptee's performance, and a further sub-sample of newly qualified midwives and preceptors participated in a semi-structured interview. Data were analysed to elicit aspects of newly qualified midwives transition experiences. RESULTS: Findings confirm that structured preceptorship schemes are not widely available. Newly qualified midwives primarily obtained transition support from members of the midwifery team. CONCLUSION: Although perceived as competent, there is no demarcation point in becoming confident to practise as a registered practitioner. Implications for managers include the importance of a supportive culture within clinical teams for successful transition and the introduction of structured preceptorship schemes facilitated by appropriate rotation patterns.

The impact of injuries study. multicentre study assessing physical, psychological, social and occupational functioning post injury--a protocol.

BACKGROUND: Large numbers of people are killed or severely injured following injuries each year and these injuries place a large burden on health care resources. The majority of the severely injured are not fully recovered 12-18 months later. Psychological disorders are common post injury and are associated with poorer functional and occupational outcomes. Much of this evidence comes from countries other than the UK, with differing health care and compensation systems. Early interventions can be effective in treating psychological morbidity, hence the scale and nature of the problem and its impact of functioning in the UK must be known before services can be designed to identify and manage psychological morbidity post injury. METHODS/DESIGN: A longitudinal multi-centre study of 680 injured patients admitted to hospital in four areas across the UK: Nottingham, Leicester/Loughborough, Bristol and Surrey. A stratified sample of injuries will ensure a range of common and less common injuries will be included. Participants will complete a baseline questionnaire about their injury and pre-injury quality of life, and follow-up questionnaires 1, 2, 4, and 12 months post injury. Measures will include health and social care utilisation, perceptions of recovery, physical, psychological, social and occupational functioning and health-related quality of life. A nested qualitative study will explore the experiences of a sample of participants, their carers and service providers to inform service design. DISCUSSION: This study will quantify physical, psychological, social and occupational functioning and health and social care utilisation following a range of different types of injury and will assess the impact of psychological disorders on function and health service use. The findings will be used to guide the development of interventions to maximise recovery post injury.

Ethnicity and participation in cancer self-help groups.

OBJECTIVES: Investigations of the benefits of membership of a cancer self-help group have suggested that it leads to improved sense of support, increased ability to deal with life-events, and decreased anxiety, confusion, depression and helplessness. However, some evidence suggests that people from black and ethnic groups are less likely to join a cancer self-help group. The main aims of the reported study were: to explore possible reasons why people from some ethnic groups have not participated in self-help to the same extent as the rest of the community; and to identify ways in which participation of people from ethnic groups can be increased. METHODS: A qualitative interview-based study of 68 people active in self-help was carried out as a partnership between an academic institution and a community organisation. RESULTS: A thematic analysis of the interview transcripts identified three main aspects of the value of being a member of a self-help group, regardless of interviewees' self-identified ethnicity: forming a sense of togetherness, learning from one other, and developing mutuality. We identify a number of reasons that discourage or encourage people from black and ethnic groups to join cancer self-help groups. CONCLUSION: We discuss some limits, identified by interviewees, that affect development of feelings of togetherness and mutuality and we conclude with some brief recommendations about widening participation in cancer self-help.

Using self-efficacy theory to develop interventions that help older people overcome psychological barriers to physical activity: a discussion paper.

BACKGROUND: Only a fifth of older people undertake a level of physical activity sufficient to lead to health benefit. Misconceptions about the ageing process and beliefs about the costs and benefits of exercise in late life may result in unnecessary self-imposed activity restriction. Thus, adhering to a physical activity can be difficult particularly when the benefits of exercise are often not immediate. Many of the barriers to engaging in physical activity among older people are attitudinal. It is therefore important to take account of the non-physical aspects of physical activity intervention programmes, such as increasing confidence. Self-efficacy is a widely applied theory used to understand health behaviour and facilitate behavioural modification, such as the increase of physical activity. AIM: This paper aims to examine the ways in which self-efficacy theory might be used in intervention programmes designed to overcome psychological barriers for increasing physical activity among older people. CONCLUSION: A number of studies have demonstrated that exercise self-efficacy is strongly associated with the amount of physical activity undertaken. Evidence from some trials supports the view that incorporating the theory of self-efficacy into the design of a physical activity intervention is beneficial. Physical activity interventions aimed at improving the self perception of exercise self-efficacy can have positive effects on confidence and the ability to initiate and maintain physical activity behaviour. There are a number of ways for nurses to facilitate older people to draw on the four information sources of self-efficacy: performance accomplishments, vicarious learning, verbal encouragement, and physiological and affective states. Research challenges that future studies need to address include the generalisability of exercise setting, the role of age as an effect modifier, and the need for more explicit reporting of how self-efficacy is operationalised in interventions.

Understanding the views of parents of children with special needs about the nursing care their child receives when in hospital: a qualitative study.

This article reports a qualitative study designed to explore parents' views on how their child with additional needs had been cared for by hospital nursing staff, focusing on how well their own and their child's needs had been identified and met. Twelve interviews with parents of children with additional needs and a thematic analysis of the interview data was conducted. Four themes were developed to provide an insight into parents' views about their experiences: their prior experiences of hospital care, including the process of being told the original diagnosis; communication with staff; nurse-parent relationships; and perceptions of nurses and nursing care. It concludes that parents experience some difficulties in developing a trusting relationship with the nurses caring for their child with additional needs. Parents perceive that nurses are not always able to recognize and respond to their needs when caring for their child. Failure to address these needs can interfere with the development of effective nurse-parent relationships.

Ethnic minority participation in an East Midlands Sure Start.

This paper draws on evidence from a local Sure Start evaluation of low participation rates among ethnic minority families. It reflects national concerns regarding the low use of children's services among ethnic minority families. The evaluation aimed to improve understanding of the factors that affect families' participation in Sure Start services. A sample of 34 ethnic minority parents, six Sure Start outreach workers and four community workers from allied local agencies were interviewed in 2006. The interviews revealed an unexpected disparity between the views of the majority of the workers and those of local, Sure Start-eligible parents. The workers felt that the main factor discouraging participation was too little focus on multiculturalism. However, parents focused on practical barriers, concerns around age and the perceived indiscipline of some Sure Start families. Parents generally saw their own ethnic culture as being compatible with Sure Start values. While most workers viewed minority communities as having homogeneous needs, parents discussed the heterogeneity of' communities. .Ethnicity and cultural factors do not have a simple or straightforward impact on people's decisions over whether to access Sure Start services.

The construction of people with mental health problems as risk objects: Findings of a case study inquiry.

WHAT IS KNOWN ON THE SUBJECT?: Risk assessment and management in mental health services are contested and perceived as problematic by both professionals and service users. There is substantial emphasis on risk as a core component of professional practice. However, recovery for people with mental health problems emphasizes self-determination which seems to conflict with risk management. A critique is emerging of risk assessment and management. However, there is a lack of empirical evidence which seeks to explore how professionals manage the conflicts between recovery orientated practice and risk management. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper reports on qualitative research which highlights people with mental health problems are objectified and frequently associated with the potential for harm. Risk dominates the work of mental health professionals and undermines individualized care. Service users are subject to increased surveillance and medication as a result. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Service users' subjective experiences need to be prioritized in mental health care by renewed focus on the relationship between professionals and service users. Mental health professionals should question the centrality of risk to their practice. ABSTRACT: Introduction The emergence of recovery, alongside significant focus on risk management, creates potential for conflicting influences in mental health care. Although evidence has critiqued risk assessment, there is a lack of research that seeks to explore how professionals make decisions within these apparently incompatible agendas. Aim To explore how practitioners, experience potential tensions arising from delivering recovery-orientated care and enforcing containment. Method This paper reports on a case study inquiry, using interviews with mental health professionals and observations in an acute ward and an assertive outreach team. Results Risk governed the practice of mental health professionals to such an extent it defined how service users were understood and treated. Service users were constructed as objects of risk, first by being objectified and secondly by creating a link between that object and harm. Discussion Hilgartner's (1992, Organizations, uncertainties and risk (pp. 39-53). Boulder, CO: Westview Press) theory of risk explains how risk dominates the identity of people with mental health problems at the cost of recovery. This results in increased monitoring, surveillance and medication to enact control. Implications for practice To undermine the dominance of risk, professionals should reconnect with the subjective experiences of people with mental health problems and challenge the acceptance of risk as central to their role.

Therapeutic relationships, risk, and mental health practice.

Despite significant changes to mental health services, nurses remain the professional group most likely to be in close contact with people who experience mental health problems. A core part of the contemporary identity of the mental health nurse is one who is able to provide acceptance and support for an individual's recovery through the therapeutic relationship. Yet there have always been some tensions with the mental health nursing role that can appear to challenge this relational focus. An increasing prominence of risk management in mental health care can position mental health nurses as responsible for enacting restrictions and has reignited interest in the role of mental health professionals in social control. This paper reports on one part of a multiple case study, which aimed to explore mental health professionals' experiences of such tensions in the context of decision-making. Interviews and observations were undertaken in acute ward and assertive outreach settings. Findings suggested that risk dominated decision-making to such an extent it defined the way service users were understood and treated. A distant relationship between professionals and service users helped to create and maintain this situation. There needs to be a greater focus on service users' subjective experiences in the decision-making process to challenge the definition of people with mental health problems as risky.

Why do women participate in the English cervical cancer screening programme?

The vast majority of women in England attend for cervical cancer screening. Conventional economic theorising fails to explain why and its predictions are inconsistent with the evidence. Using questionnaire data, we analyse directly motivations for screening attendance. We conclude that regular attendance at screening is driven primarily by a search for reassurance, a sense of duty and herd signalling. It is evident that recognisable sub-groups of attenders exist, in which the configurations of motivational factors differ. Being motivated to attend by physicians is less significant that is widely supposed and is more frequently associated with irregular attendance.

Health beliefs of African-Caribbean people with type 2 diabetes: a qualitative study.

BACKGROUND: There is evidence that African-Caribbean people with diabetes have poorer outcomes than other individuals with diabetes. It is not fully understood why this happens. AIM: To gain an understanding of how health beliefs influence the way African-Caribbean people with diabetes manage their illness. DESIGN OF STUDY: Qualitative study using one-to-one interviews. SETTING: Inner-city Nottingham during 2003-2004. METHOD: A purposive sample of 16 African-Caribbean people with type 2 diabetes. Participants took part in semi-structured in-depth interviews which were audio-taped recorded and transcribed. Transcripts were analysed for emergent themes and validity was checked by an independent researcher and through discussion with a local community group. Data were managed using NVivo software. RESULTS: Participants were strongly influenced by memories of growing up in the Caribbean, migration to the UK, and friends' and families' accounts of diabetes, as well as their own experiences of the illness. Knowledge and understanding of diabetes was sometimes poor. There was some mistrust in the value of advice and treatment offered by professionals and a preference for natural treatments. Health professionals were generally praised but some interviewees felt that the NHS did not cater properly for black people. Insulin treatments were feared and diet- or tablet-controlled diabetes was seen by some as a mild form that did not warrant serious concern. CONCLUSIONS: These findings have implications for how some people manage their diabetes and how diabetes care is delivered to the African-Caribbean community.

The perceptions of statutory service providers of a local Sure Start programme: a shared agenda?

Sure Start is the UK government's flagship scheme for providing services to children and their families in deprived areas. This study aimed to examine the perceptions of statutory service providers about their experience of working with Sure Start professionals in one Nottinghamshire (UK) Sure Start programme, and to explore the extent to which there was a shared agenda and successful collaboration. A purposive sample of 18 statutory providers working within existing mainstream health, education and social care services were interviewed, between January and March 2005. Data were analysed through thematic content analysis. We found that although interviewees welcomed the additional input provided by Sure Start for the most vulnerable families, a number of tensions arose over key divergences between the philosophical positions of statutory providers and Sure Start. The most important tension was over Sure Start's philosophy of targeting resources on an entire geographical area. This was seen as antithetical to statutory providers' case-by-case approach, and raised questions about access and equity for families living outside Sure Start's boundaries. Sure Start's concentration on young children, and the time-limited nature of their services and activities, frustrated statutory providers who had a broader family focus, and a longer term perspective. The perceived under-resourcing of statutory services in comparison to Sure Start, and statutory providers' responsibility for 'selling' Sure Start services, strained a sense of equality between agencies and professionals, and undermined a sense of a shared agenda. We conclude that successful collaboration and a shared agenda depends upon a mutual understanding of the basic philosophy of service provision. The government's commitment to developing interprofessional collaboration will be furthered significantly by placing Sure Start services under the umbrella of statutory provision, and ensuring that the differing service philosophies are reconciled.

Factors affecting participation in Sure Start programmes: a qualitative investigation of parents' views.

The objectives of the present study were to examine the factors that parents identify as promoting or hindering participation in Sure Start programmes, and to identify methods for enhancing parents' engagement with Sure Start. A qualitative, in-depth interview study was conducted with parents registered with two local Sure Start programmes based in the East Midlands, UK, and located in inner city areas with a range of health and social problems associated with social exclusion and disadvantage. Sixty parents, guardians or carers of children living in both Sure Start areas were recruited during autumn of 2004 on the basis of whether they were identified as a 'frequent user' or 'non-frequent user' of Sure Start services. The data were analysed using a thematic approach supported by NVivo computer software, and explanatory themes were subsequently tested for completeness and adequacy. The results of the study indicated that parents who used Sure Start services were positive about the benefits that they obtained for themselves and their children, in particular in overcoming a sense of isolation. Parents who were non-frequent users identified a number of practical reasons that prevented them using Sure Start services, although parents also recognised a loss of confidence and trust in the local communities summarised in the phrase 'keeping myself to myself'. Parents' awareness of the targeted nature of Sure Start can also lead to stigma and reluctance to use services. It is concluded that continued investment of time and effort in maintaining communication networks between Sure Start staff and local parents is vital if parents and children are to make the best use of Sure Start services.

Psychosocial and economic aspects of a trial of management of mild and borderline cervical abnormalities (TOMBOLA).

TOMBOLA is a randomized controlled trial to determine (a) the most effective and efficient management strategy for women with borderline or mildly dyskaryotic cervical smear results, and (b) the most appropriate treatment for women with abnormalities detected following colposcopy. This paper outlines the trial's psychosocial and economic protocol, and explains how TOMBOLA can provide detailed evidence on the psychosocial and economic impact of alternative management options and follow-up. This protocol has been developed in parallel with the clinical protocol, thereby offering the opportunity for the development of a type-specific outcome measure and detailed piloting of all instruments. The multi-disciplinary approach to TOMBOLA allows the combination of clinical outcomes with both generic and specific psychosocial and health-related quality of life measures. The convergent validity between these measures will be assessed, with a view to developing a specific utility index for the future assessment of cervical screening modalities.

Do we need methodological theory to do qualitative research?

Positivism is frequently used to stand for the epistemological assumption that empirical science based on principles of verificationism, objectivity, and reproducibility is the foundation of all genuine knowledge. Qualitative researchers sometimes feel obliged to provide methodological alternatives to positivism that recognize their different ethical, ontological, and epistemological commitments and have provided three theories: phenomenology, grounded theory, and ethnography. The author argues that positivism was a doomed attempt to define empirical foundations for knowledge through a rigorous separation of theory and evidence; offers a pragmatic, coherent view of knowledge; and suggests that rigorous, rational empirical investigation does not need methodological theory. Therefore, qualitative methodological theory is unnecessary and counterproductive because it hinders critical reflection on the relation between methodological theory and empirical evidence.

The MINT project--an evaluation of the impact of midwife teachers on the outcomes of pre-registration midwifery education in the UK.

OBJECTIVE: to explore the contribution of midwife teachers in preparing student midwives for competent practice. DESIGN: a three phase design using qualitative and quantitative approaches. Phase one involved UK wide on-line questionnaire surveys, phase two was a case study method in six UK approved education institutions and phase three was a diary study with newly qualified midwives. PARTICIPANTS: phase one included all UK Lead Midwives for Education (LMEs), midwife teachers and Local Supervising Authority Midwifery Officers; phase two participants were three year and shortened programme student midwives, midwife teachers, LMEs and programme leads from each of the four countries; and phase three included a sample of newly qualified midwives graduating from the case study sites and their preceptors and supervisors of midwives. FINDINGS: midwife teachers were valued for their unique and crucial role in supporting the application of knowledge to midwifery practice. Visibility and credibility were two key concepts that can explain the unique contribution of midwife teachers. These concepts included being able to support skills acquisition, understanding of contemporary midwifery practice, having a role in practice contexts and able to offer personal support. Visibility of teachers in practice was vital for students and mentors to assist students put their learning into practice and monitor learning and assessment decisions. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: given the complexity of midwifery education a team approach is essential in ensuring the effectiveness of these programmes. This requires a sufficient differentiation of midwife teacher roles to deliver the pre-registration curriculum. A set of resource quality indicators is proposed to support midwife teacher teams achieving sufficient clinical and academic expertise to deliver effective education programmes.

Beyond the therapeutic: A Habermasian view of self-help groups' place in the public sphere.

Self-help groups in the United Kingdom continue to grow in number and address virtually every conceivable health condition, but they remain the subject of very little theoretical analysis. The literature to date has predominantly focused on their therapeutic effects on individual members. And yet they are widely presumed to fulfil a broader civic role and to encourage democratic citizenship. The article uses Habermas' model of the public sphere as an analytical tool with which to reconsider the literature on self-help groups in order to increase our knowledge of their civic functions. In doing this it also aims to illustrate the continuing relevance of Habermas' work to our understanding of issues in health and social care. We consider, within the context of current health policies and practices, the extent to which self-help groups with a range of different forms and functions operate according to the principles of communicative rationality that Habermas deemed key to democratic legitimacy. We conclude that self-help groups' civic role is more complex than is usually presumed and that various factors including groups' leadership, organisational structure and links with public agencies can affect their efficacy within the public sphere.

Final year students' perceptions of learning to be a midwife in six British universities.

Midwifery education in the UK has been delivered through the University sector since the mid-1990s, with the requirement to create safe, effective clinicians who are equipped to engage with research and evidence based practice. This paper presents an in-depth analysis of focus group data from 120 senior midwifery students at six British universities to explore the experience of learning to be a midwife. Thematic analysis of the data suggests the following themes pertain to the experience of a number of students: 'teach yourself midwifery', knowing it all, right way of doing things, the importance of physical skills. These themes suggest a dissonance for some students between the andragogical methods of learning espoused by universities, and the expectations of students, who express the belief that there is a fixed and finite body of knowledge, without which they feel disempowered, anxious and ill-prepared for clinical practice. This paper argues that there are unresolved tensions between the perceived demands of practice environments and regulatory bodies and the philosophical stance of universities. For some students the concept of a broad discursive education is a distraction from training in discrete clinical skills.

The contribution of self-help/mutual aid groups to mental well-being.

This article explores the contribution of self-help/mutual aid groups to mental well-being. Self-help/mutual aid groups are self-organising groups where people come together to address a shared a health or social issue through mutual support. They are associated with a range of health and social benefits, but remain poorly understood. This article draws on data from stage one of ESTEEM, a project which runs from 2010 to 2013. Stage one ran from 2010 to 2011 and involved participatory, qualitative research carried out in two UK sites. Twenty-one groups were purposively selected to include a range of focal issues, longevity, structures and ethnic backgrounds. Researchers carried out 21 interviews with group coordinators and twenty group discussions with members to explore the groups' purpose, nature and development. Preliminary analysis of the data suggested that mental well-being was a common theme across the groups. Subsequently the data were re-analysed to explore the groups' contribution to mental well-being using a checklist of protective factors for mental well-being as a coding framework. The findings showed that groups made a strong contribution to members' mental well-being by enhancing a sense of control, increasing resilience and facilitating participation. Group members were uplifted by exchanging emotional and practical support; they gained self-esteem, knowledge and confidence, thereby increasing their control over their situation. For some groups, socio-economic factors limited their scope and threatened their future. The article provides an evidence-base which illustrates how self-help/mutual aid groups can enhance mental well-being. If supported within a strategy for social justice, these groups enable people with varied concerns to develop a tailored response to their specific needs. The authors suggest that policy-makers engage with local people, investing in support proportionate to the needs of different populations, enabling them to develop their own self-help/mutual aid groups to enhance their sense of mental well-being.