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Dorey RB, Theodosiou AA, Read RC, Vandrevala T, Jones CE. Qualitative interview study exploring the perspectives of pregnant women on participating in controlled human infection research in the UK. BMJ Open 2023; 13:e073992. [PMID: 38151279 PMCID: PMC10753751 DOI: 10.1136/bmjopen-2023-073992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 12/11/2023] [Indexed: 12/29/2023] Open
Abstract
INTRODUCTION Pregnant women have been historically excluded from interventional research. While recent efforts have been made to improve their involvement, there remains a disparity in the evidence base for treatments available to pregnant women compared with the non-pregnant population. A significant barrier to the enrolment of pregnant women within research is risk perception and a poor understanding of decision-making in this population. OBJECTIVE Assess the risk perception and influences on decision-making in pregnant women, when considering whether to enrol in a hypothetical interventional research study. DESIGN Semistructured interviews were undertaken, and thematic analysis was undertaken of participant responses. PARTICIPANTS Twelve pregnant women were enrolled from an antenatal outpatient clinic. RESULTS Participants were unanimously positive about enrolling in the proposed hypothetical interventional study. Risk perception was influenced by potential risks to their fetus and their previous experiences of healthcare and research. Participants found the uncertainty in quantifying risk for new research interventions challenging. They were motivated to enrol in research by altruism and found less invasive research interventions more tolerable. CONCLUSION It is vital to understand how pregnant women balance the perceived risks and benefits of interventional research. This may help clinicians and scientists better communicate risk to pregnant women and address the ongoing under-representation of pregnant women in interventional research.
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Affiliation(s)
- Robert B Dorey
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Anastasia A Theodosiou
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Robert C Read
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Tushna Vandrevala
- Centre for Applied Health and Social Care Research, Kingston University and St George's University of London, London, UK
| | - Christine E Jones
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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2
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Heaton-Shrestha C, Hanson K, Quirke-McFarlane S, Delaney N, Vandrevala T, Bearne L. Exploring how members of the public access and use health research and information: a scoping review. BMC Public Health 2023; 23:2179. [PMID: 37936117 PMCID: PMC10629152 DOI: 10.1186/s12889-023-16918-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Making high-quality health and care information available to members of the general public is crucial to support populations with self-care and improve health outcomes. While attention has been paid to how the public accesses and uses health information generally (including personal records, commercial product information or reviews on healthcare practitioners and organisations) and how practitioners and policy-makers access health research evidence, no overview exists of the way that the public accesses and uses high quality health and care information. PURPOSE This scoping review aimed to map research evidence on how the public accesses and uses a specific type of health information, namely health research and information that does not include personal, product and organisational information. METHODS Electronic database searches [CINAHL Plus, MEDLINE, PsycInfo, Social Sciences Full Text, Web of Science and SCOPUS] for English language studies of any research design published between 2010-2022 on the public's access and use of health research or information (as defined above). Data extraction and analysis was informed by the Joanna Briggs Institute protocol for scoping reviews, and reported in accordance with the PRISMA extension for scoping reviews. RESULTS The search identified 4410 records. Following screening of 234 full text studies, 130 studies were included. One-hundred-and-twenty-nine studies reported on the public's sources of health-research or information; 56 reported the reasons for accessing health research or information and 14 reported on the use of this research and information. The scoping exercise identified a substantial literature on the broader concept of 'health information' but a lack of reporting of the general public's access to and use of health research. It found that 'traditional' sources of information are still relevant alongside newer sources; knowledge of barriers to accessing information focused on personal barriers and on independent searching, while less attention had been paid to barriers to access through other people and settings, people's lived experiences, and the cultural knowledge required. CONCLUSIONS The review identified areas where future primary and secondary research would enhance current understanding of how the public accesses and utilises health research or information, and contribute to emerging areas of research.
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Affiliation(s)
- Celayne Heaton-Shrestha
- Kingston University, Faculty of Health, Science, Social Care and Education, Kingston-upon-Thames, KT27LB, UK
| | - Kristin Hanson
- Kingston University, Faculty of Health, Science, Social Care and Education, Kingston-upon-Thames, KT27LB, UK
| | | | - Nancy Delaney
- Guy's and St Thomas' NHS Foundation Trust, Department of Physiotherapy, London, SE1 7EH, UK
| | - Tushna Vandrevala
- Kingston University, Faculty of Health, Science, Social Care and Education, Kingston-upon-Thames, KT27LB, UK
| | - Lindsay Bearne
- Kingston University, Faculty of Health, Science, Social Care and Education, Kingston-upon-Thames, KT27LB, UK.
- St George's, University of London, Population Health Research Institute, 1st Floor Jenner Wing, Cranmer Terrace, London, SW17 0RE, UK.
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3
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Crawshaw AF, Kitoko LM, Nkembi SL, Lutumba LM, Hickey C, Deal A, Carter J, Knights F, Vandrevala T, Forster AS, Hargreaves S. Co-designing a theory-informed, multicomponent intervention to increase vaccine uptake with Congolese migrants: A qualitative, community-based participatory research study (LISOLO MALAMU). Health Expect 2023; 27:e13884. [PMID: 37831054 PMCID: PMC10726157 DOI: 10.1111/hex.13884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/11/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Disparities in the uptake of routine and COVID-19 vaccinations have been observed in migrant populations, and attributed to issues of mistrust, access and low vaccine confidence. Participatory research approaches and behaviour change theory hold the potential for developing tailored vaccination interventions that address these complex barriers in partnership with communities and should be explored further. METHODS This study used a theory-informed, community-based participatory research approach to co-design a culturally tailored behaviour change intervention aimed at increasing COVID-19 vaccine uptake among Congolese migrants in London, United Kingdom (2021-2022). It was designed and led by a community-academic partnership in response to unmet needs in the Congolese community as the COVID-19 pandemic started. Barriers and facilitators to COVID-19 vaccination, information and communication preferences, and intervention suggestions were explored through qualitative in-depth interviews with Congolese migrants, thematically analysed, and mapped to the theoretical domains framework (TDF) and the capability, opportunity, motivation, behaviour model to identify target behaviours and strategies to include in interventions. Interventions were co-designed and tailored in workshops involving Congolese migrants. RESULTS Thirty-two Congolese adult migrants (24 (75%) women, mean 14.3 (SD: 7.5) years in the United Kingdom, mean age 52.6 (SD: 11.0) years) took part in in-depth interviews and 16 (same sample) took part in co-design workshops. Fourteen barriers and 10 facilitators to COVID-19 vaccination were identified; most barrier data related to four TDF domains (beliefs about consequences; emotion; social influences and environmental context and resources), and the behavioural diagnosis concluded interventions should target improving psychological capability, reflective and automatic motivations and social opportunities. Strategies included culturally tailored behaviour change techniques based on education, persuasion, modelling, enablement and environmental restructuring, which resulted in a co-designed intervention comprising community-led workshops, plays and posters. Findings and interventions were disseminated through a community celebration event. CONCLUSIONS Our study demonstrates how behavioural theory can be applied to co-designing tailored interventions with underserved migrant communities through a participatory research paradigm to address a range of health issues and inequalities. Future research should build on this empowering approach, with the goal of developing more sensitive vaccination services and interventions which respond to migrant communities' unique cultural needs and realities. PATIENT OR PUBLIC CONTRIBUTION Patient and public involvement (PPI) were embedded in the participatory study design and approach, with community members co-producing all stages of the study and co-authoring this paper. An independent PPI board (St George's Migrant Health Research Group Patient and Public Involvement Advisory Board) comprising five adult migrants with lived experience of accessing healthcare in the United Kingdom were also consulted at significant points over the course of the study.
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Affiliation(s)
- Alison F. Crawshaw
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
| | | | | | | | | | - Anna Deal
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical MedicineLondonUK
| | - Jessica Carter
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
| | - Felicity Knights
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
| | - Tushna Vandrevala
- Centre for Applied Health and Social Care Research, Faculty of Health, Science, Social Care and EducationKingston University LondonLondonUK
| | | | - Sally Hargreaves
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
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4
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Forbes L, Armes J, Shafi S, Mohamed A, Mustafa R, Dar O, Vandrevala T, Amlôt R, Hayward A, Asaria M, Pirani T, Weston D, Shah S, Zumla A, Ala A. Novel intervention to promote COVID-19 protective behaviours among Black and South Asian communities in the UK: protocol for a mixed-methods pilot evaluation. BMJ Open 2023; 13:e061207. [PMID: 37041047 PMCID: PMC10105914 DOI: 10.1136/bmjopen-2022-061207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
INTRODUCTION Culturally appropriate interventions to promote COVID-19 health protective measures among Black and South Asian communities in the UK are needed. We aim to carry out a preliminary evaluation of an intervention to reduce risk of COVID-19 comprising a short film and electronic leaflet. METHODS AND ANALYSIS This mixed methods study comprises (1) a focus group to understand how people from the relevant communities interpret and understand the intervention's messages, (2) a before-and-after questionnaire study examining the extent to which the intervention changes intentions and confidence to carry out COVID-19 protective behaviours and (3) a further qualitative study exploring the views of Black and South Asian people of the intervention and the experiences of health professionals offering the intervention. Participants will be recruited through general practices. Data collection will be carried out in the community. ETHICS AND DISSEMINATION The study received Health Research Authority approval in June 2021 (Research Ethics Committee Reference 21/LO/0452). All participants provided informed consent. As well as publishing the findings in peer-reviewed journals, we will disseminate the findings through the UK Health Security Agency, NHS England and the Office for Health Improvement and Disparities and ensure culturally appropriate messaging for participants and other members of the target groups.
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Affiliation(s)
- Lindsay Forbes
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Jo Armes
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Shuja Shafi
- Mass Gatherings and Global Health Network, Harrow, UK
| | - Amran Mohamed
- Department of Access and Medicine, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Reham Mustafa
- Department of Access and Medicine, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Osman Dar
- Global Public Health Directorate, UK Health Security Agency, London, UK
| | - Tushna Vandrevala
- Centre for Applied Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston University, London, UK
| | - Richard Amlôt
- Epidemiological and Behavioural Sciences Directorate, UK Health Security Agency, London, UK
| | - Andrew Hayward
- Epidemiology and Public Health, University College London, London, UK
| | - Miqdad Asaria
- Department of Health Policy, London School of Economics, London, UK
| | - Tasneem Pirani
- Department of Critical Care Medicine, King's College Hospital NHS Foundation Trust, London, UK
- School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Dale Weston
- Epidemiological and Behavioural Sciences Directorate, UK Health Security Agency, London, UK
| | | | - Alimuddin Zumla
- Infection and Immunity, University College London, London, UK
| | - Aftab Ala
- Gastroenterology and Hepatology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Institute of Liver Studies, King's College Hospital, London, UK
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5
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Crawshaw AF, Hickey C, Lutumba LM, Kitoko LM, Nkembi S, Knights F, Ciftci Y, Goldsmith LP, Vandrevala T, Forster AS, Hargreaves S. Codesigning an intervention to strengthen COVID-19 vaccine uptake in Congolese migrants in the UK (LISOLO MALAMU): a participatory qualitative study protocol. BMJ Open 2023; 13:e063462. [PMID: 36639215 PMCID: PMC9842599 DOI: 10.1136/bmjopen-2022-063462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Migrants positively contribute to host societies yet experience barriers to health and vaccination services and systems and are considered to be an underimmunised group in many European countries. The COVID-19 pandemic has highlighted stark inequities in vaccine uptake, with migrants facing access and informational barriers and lower vaccine confidence. A key challenge, therefore, is developing tailored vaccination interventions, services and systems which account for and respond to the unique drivers of vaccine uptake in different migrant populations. Participatory research approaches, which meaningfully involve communities in co-constructing knowledge and solutions, have generated considerable interest in recent years for those tasked with designing and delivering public health interventions. How such approaches can be used to strengthen initiatives for COVID-19 and routine vaccination merits greater consideration. METHODS AND ANALYSIS LISOLO MALAMU ('Good Talk') is a community-based participatory research study which uses qualitative and coproduction methodologies to involve adult Congolese migrants in developing a tailored intervention to increase COVID-19 vaccine uptake. Led by a community-academic coalition, the study will involve (1) semistructured in-depth interviews with adult Congolese migrants (born in Democratic Republic of Congo, >18 years), (2) interviews with professional stakeholders and (3) codesign workshops with adult Congolese migrants. Qualitative data will be analysed collaboratively using reflexive thematic analysis, and behaviour change theory will be used in parallel to support the coproduction of interventions and make recommendations across socioecological levels. The study will run from approximately November 2021 to November 2022. ETHICS AND DISSEMINATION Ethics approval was granted by the St George's University Research Ethics Committee (REC reference: 2021.0128). Study findings will be disseminated to a range of local, national and international audiences, and a community celebration event will be held to show impact and recognise contributions. Recommendations for implementation and evaluation of prototyped interventions will be made.
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Affiliation(s)
- Alison F Crawshaw
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Caroline Hickey
- Hackney Refugee and Migrant Forum, Hackney Council for Voluntary Service, London, UK
| | | | | | - Sarah Nkembi
- Hackney Congolese Women Support Group, London, UK
| | - Felicity Knights
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | | | - Lucy Pollyanna Goldsmith
- Institute for Infection and Immunity and Population Health Research Institute, St George's, University of London, London, UK
| | - Tushna Vandrevala
- Faculty of Health, Science, Social Care and Education, Centre for Applied Health and Social Care Research, Kingston University, Kingston, UK
| | | | - Sally Hargreaves
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
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6
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Jones CE, Bailey H, Bamford A, Calvert A, Dorey RB, Drysdale SB, Khalil A, Heath PT, Lyall H, Ralph KMI, Sapuan S, Vandrevala T, Walter S, Whittaker E, Wood S. Managing challenges in congenital CMV: current thinking. Arch Dis Child 2022:archdischild-2022-323809. [PMID: 36442957 DOI: 10.1136/archdischild-2022-323809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/06/2022] [Indexed: 11/29/2022]
Abstract
Congenital human cytomegalovirus (CMV) infection is the most common congenital infection, affecting around 1 in 200 infants in high-income settings. It can have life-long consequences for up to one in four children, including sensorineural hearing loss and neurodisability. Despite the frequency of congenital CMV and the severity for some children, it is a little-known condition by pregnant women, families and healthcare providers. Timely diagnosis of CMV infection in pregnancy is important to facilitate consideration of treatment with valaciclovir, which may reduce the risk of transmission to the fetus or reduce the severity of the outcomes for infected infants. Recognition of features of congenital CMV is important for neonatologists, paediatricians and audiologists to prompt testing for congenital CMV within the first 21 days of life. Early diagnosis gives the opportunity for valganciclovir treatment, where appropriate, to improve outcomes for affected infants. Further research is urgently needed to inform decisions about antenatal and neonatal screening, long-term outcomes for asymptomatic and symptomatic infants, predictors of these outcomes and optimal treatment for women and infants.
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Affiliation(s)
- Christine E Jones
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK .,Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Heather Bailey
- Institute for Global Health, University College London, London, UK
| | - Alasdair Bamford
- Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Infection, Immunity and Inflammation Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Anna Calvert
- Centre for Neonatal and Paediatric infection, St George's, University of London, London, UK
| | - Robert B Dorey
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Simon B Drysdale
- Centre for Neonatal and Paediatric infection, St George's, University of London, London, UK
| | - Asma Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK.,Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Paul T Heath
- Centre for Neonatal and Paediatric infection, St George's, University of London, London, UK
| | - Hermione Lyall
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
| | | | - Shari Sapuan
- Centre for Neonatal and Paediatric infection, St George's, University of London, London, UK
| | - Tushna Vandrevala
- Centre for Applied Health and Social Care Research, Faculty of Health, Science, Social Care and Education, Kingston University, Kingston-Upon-Thames, UK
| | - Simone Walter
- Department of Audiovestibular Medicine, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Elizabeth Whittaker
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
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7
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Vandrevala T, Hendy J, Hanson K, Alidu L, Ala A. Unpacking
COVID
‐19 and conspiracy theories in the
UK
black community. Br J Health Psychol 2022; 28:482-498. [PMID: 36397650 DOI: 10.1111/bjhp.12636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Conspiracy theories are associated with significant COVID-19 health consequences including lower engagement with protective behaviours. This study uses sensemaking theory, a process of constructing meanings through interpersonal exchanges that enable people to interpret their world to explain the theoretical process underlying the development of conspiratorial beliefs around COVID-19 within Black African and Caribbean communities in the UK. DESIGN Qualitative, in-depth interviews were used. METHODS Twenty-eight members of the communities were recruited: semi-structured interviews were analysed using grounded theory. RESULTS Our findings provide an explanation of how an environment of crisis combined with current and historical mistrust, perceived injustice and inequality provided a context in which alternative conspiracy narratives could thrive. The nature of these conspiratorial beliefs made more sense to many of our respondent's than institutional sources (such as the UK Government). Critically, these alternative beliefs helped respondents shape their decision-making, leading to non-engagement with COVID protective behaviours. CONCLUSIONS We conclude that the uncertainty of the pandemic, combined with historical and contemporary perceived injustice and mistrust, and a lack of specific identity-aligned messaging, created a perfect environment for conspiratorial sense-making to thrive. This alternative sensemaking was inconsistent with the health-protection messaging espoused by the Government. To ensure all groups in society are protected, and for health promotion messages to take purchase, the experiences of different target audiences must be taken into account, with sensemaking anchored in lived experience.
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Affiliation(s)
- Tushna Vandrevala
- Centre for Applied Health and Social Care Research, Faculty of Health, Science, Social Care and Education Kingston University London UK
| | - Jane Hendy
- Brunel Business School Brunel University London London UK
| | | | - Lailah Alidu
- Centre for Applied Health and Social Care Research, Faculty of Health, Science, Social Care and Education Kingston University London UK
| | - Aftab Ala
- Department of Access and Medicine Royal Surrey County Hospital NHS Foundation Guildford UK
- Department of Clinical and Experimental Medicine University of Surrey Guildford UK
- Institute of Hepatology Studies King's College Hospital London London UK
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8
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Goldsmith LP, Rowland-Pomp M, Hanson K, Deal A, Crawshaw AF, Hayward SE, Knights F, Carter J, Ahmad A, Razai M, Vandrevala T, Hargreaves S. Use of social media platforms by migrant and ethnic minority populations during the COVID-19 pandemic: a systematic review. BMJ Open 2022; 12:e061896. [PMID: 36396309 PMCID: PMC9676419 DOI: 10.1136/bmjopen-2022-061896] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Migrants and ethnic minority groups have been disproportionately impacted by COVID-19 and have lower levels of vaccine uptake in some contexts. We aimed to determine the extent and nature of social media use in migrant and ethnic minority communities for COVID-19 information, and implications for preventative health measures including vaccination intent and uptake. DESIGN A systematic review of published and grey literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched databases including Embase, Web of Science, PubMed NIH, CINAHL, facilitated through the WHO Global Research on COVID-19 database from 31 December 2019 to 9 June 2021. ELIGIBILITY CRITERIA FOR STUDY SELECTION Research reporting the use of social media by migrants and/or ethnic minority groups in relation to COVID-19. DATA EXTRACTION We extracted data on key outcomes, study design, country, population under study and sample size. RESULTS 1849 unique records were screened, and 21 data sources were included, including populations in the UK, USA, China, Jordan, Qatar and Turkey. We found evidence of consistent use of a range of social media platforms for COVID-19 information in some migrant and ethnic minority populations (including WeChat, Facebook, WhatsApp, Instagram, Twitter, YouTube), which may stem from difficulty in accessing COVID-19 information in their native languages or from trusted sources. Some evidence suggested circulating misinformation and social media use may be associated with lower participation in preventative health measures, including vaccine intent and uptake, findings which are likely relevant to multiple population groups. CONCLUSIONS Social media platforms are an important source of information about COVID-19 for some migrant and ethnic minority populations. Urgent actions and further research are now needed to better understand effective approaches to tackling circulating misinformation, and to seize on opportunities to better use social media platforms to support public health communication and improve vaccine uptake. REGISTRATION This study has been registered with PROSPERO (CRD42021259190).
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Affiliation(s)
- Lucy Pollyanna Goldsmith
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- Population Health Research Institute, St George's University of London, London, UK
| | - May Rowland-Pomp
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Kristin Hanson
- Faculty of Health, Social Care and Education, Kingston University, Kingston-Upon-Thames, London, UK
| | - Anna Deal
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Alison F Crawshaw
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Sally E Hayward
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Felicity Knights
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- Population Health Research Institute, St George's University of London, London, UK
| | - Jessica Carter
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Ayesha Ahmad
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
| | - M Razai
- Population Health Research Institute, St George's University of London, London, UK
| | - Tushna Vandrevala
- Faculty of Health, Social Care and Education, Centre for Applied Health and Social Care Research, Kingston University, Kingston, Surrey, UK
| | - Sally Hargreaves
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
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9
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Hargreaves S, Goldsmith LP, Rowland-Pomp M, Hanson K, Deal A, Crawshaw AF, Ahmad A, Razai M, Vandrevala T. The use of social media platforms by migrant populations during the COVID-19 pandemic. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The rapid expansion of internet and social media use has meant that both useful and potentially harmful health information can spread rapidly. Groups experiencing barriers to health systems may be more reliant on social media as a source of health information. We did a systematic review to determine the extent and nature of social media use in migrant and ethnic minority communities for COVID-19 information, and implications for preventative health measures including vaccination intent and uptake.
Methods
We reviewed published and grey literature following PRISMA guidelines (PROSPERO registered CRD42021259190). Global research was included that reported on the use of social media by migrants and/or ethnic minority groups in relation to COVID-19.
Results
1849 unique records were screened, and 21 data sources included in our analysis involving studies from the UK, US, China, Jordan, Qatar, and Turkey. We found evidence of consistent use of a range of social media platforms for COVID-19 information in some migrant and ethnic minority populations (including WeChat, Facebook, WhatsApp, Instagram, Twitter, YouTube), which may stem from difficulty in accessing COVID-19 information in their native languages or from trusted sources. There were positive and negative associations with social media use reported, with some evidence suggesting circulating misinformation and social media use may be associated with lower participation in preventative health measures, including vaccine intent and uptake, findings of which are likely relevant to multiple population groups.
Conclusions
Urgent actions and further research are now needed to better understand the use of social media platforms for accessing health information by groups who may be marginalised from health systems, effective approaches to tackling circulating misinformation, and to seize on opportunities to make better use of social media platforms to support public health communication.
Key messages
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Affiliation(s)
- S Hargreaves
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - LP Goldsmith
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - M Rowland-Pomp
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - K Hanson
- Faculty of Health, Social Care and Education, Kingston University & St George’s , London, UK
| | - A Deal
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - AF Crawshaw
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - A Ahmad
- Population Health Research Institute, St George's University of London , London, UK
| | - M Razai
- Population Health Research Institute, St George's University of London , London, UK
| | - T Vandrevala
- Faculty of Health, Social Care and Education, Kingston University & St George’s , London, UK
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10
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Crawshaw AF, Hickey C, Lutumba LM, Kitoko LM, Nkembi SL, Knights F, Ciftci Y, Vandrevala T, Forster AS, Hargreaves S. Co-developing a tailored vaccination intervention with Congolese migrants: a participatory study. Eur J Public Health 2022. [PMCID: PMC9594176 DOI: 10.1093/eurpub/ckac131.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Disparities in vaccination uptake among migrant populations are well documented. WHO and ECDC have sought renewed focus on participatory research that engages migrants in co-producing tailored initiatives to address vaccination inequities and increase coverage. Methods This community-based participatory research study aims to engage Congolese migrants in co-developing a tailored approach to increase vaccine uptake. Phase 1 used poster walls and in-depth interviews with Congolese migrants (n = 32) to explore COVID-19 vaccination beliefs, experiences, and preferred information sources and communication methods, analysed iteratively and thematically in NVivo. Preliminary results Institutional distrust has shaped this population’s interpretation of the pandemic response and enabled vaccine misinformation and conspiracy theories to take hold. We found complex information networks and preference for Francophone, African and social media. Limited English proficiency and preference for the oral tradition restricted engagement with official public health messaging. Suspicion of government motives, low knowledge, and culturally specific perceptions about vaccination contributed to belief that breakthrough infections and need for COVID-19 boosters imply the vaccine is not effective. The population felt coerced by vaccination reminders and mandates, and were resultantly more hesitant to accept COVID-19 vaccination. Conclusions The population’s specific characteristics suggest that existing and trusted interpersonal networks and oral communication in first languages should be harnessed to spread credible information and encourage vaccine uptake, and mandate policies are unlikely to be effective. Training local role models to facilitate vaccination dialogues and myth-bust may be effective at changing behaviour. The next phases will gather more information from key stakeholders and engage migrants in workshops to co-design insight-driven, tailored interventions. Key messages • Global policy-setting organisations have called urgently for participatory research that engages migrants in the co-production of tailored initiatives to address vaccination inequalities. • Populations with strong interpersonal networks and low trust in public institutions may be receptive to tailored, community-centred dialogue approaches using local messengers and role models.
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Affiliation(s)
- AF Crawshaw
- Institute for Infection and Immunity, St George’s, University of London , London, UK
| | - C Hickey
- Hackney Refugee and Migrant Forum, Hackney CVS , London, UK
| | - LM Lutumba
- Hackney Congolese Women Support Group , London, UK
| | - LM Kitoko
- Hackney Congolese Women Support Group , London, UK
| | - SL Nkembi
- Hackney Congolese Women Support Group , London, UK
| | - F Knights
- Institute for Infection and Immunity, St George’s, University of London , London, UK
| | - Y Ciftci
- Doctors of the World UK , London, UK
| | - T Vandrevala
- Faculty of Health, Social Care and Education, Kingston and St George’s, University of London , London, UK
| | | | - S Hargreaves
- Institute for Infection and Immunity, St George’s, University of London , London, UK
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11
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Crawshaw AF, Hickey C, Lutumba LM, Kitoko LM, Nkembi SL, Knights F, Ciftci Y, Vandrevala T, Forster AS, Hargreaves S. A community-based participatory approach to engaging Congolese migrants in intervention co-design. Eur J Public Health 2022. [PMCID: PMC9594374 DOI: 10.1093/eurpub/ckac129.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Issue The World Health Organization has called for tailored, community-based interventions to address disparities in vaccination uptake affecting migrant and minoritised populations, however few exist. This study directly responds to global calls for community-centred and participatory approaches to engaging migrants in routine and COVID-19 vaccination. Problem description Black and African migrants are known to be at risk of under-immunisation and have lower COVID-19 vaccine uptake rates in high-income countries. This UK study will use community-based participatory approaches to engage Congolese migrants in co-developing a tailored intervention to increase vaccine uptake. A community-academic coalition will lead the study. Community members will be trained as peer researchers and financially compensated. The final output will be an intervention strategy tailored to and embedded within the Congolese migrant community. Preliminary results The coalition held 20 hours of planning meetings and peer researcher training in 2021 and co-developed a phased study involving 1) community days with poster walls and qualitative in-depth interviews with Congolese migrants, 2) interviews and workshops with local stakeholders, and 3) co-design workshops with Congolese migrants. Following outreach and pre-engagement, approximately 80 migrants attended the community days, with more than 50 interviews and 100% left positive feedback (including: felt valued, welcomed, Congolese language recognised). Lessons Community-academic partnerships are resource-intensive but can be an effective means to build and maintain trust required to deliver a community-based research study. Academic partners should support community partners in understanding the research process to help manage expectations and provide financial compensation for their time and effort. This study offers an innovative engagement model and study design that can be adapted to other underserved populations. Key messages • Global policy-setting organisations have called urgently for participatory research that engages migrants in the co-production of tailored initiatives to address vaccination inequalities. • This study uses a novel, theory-driven, participatory approach to engage with and identify barriers to vaccination in Congolese migrants and co-design a tailored strategy to increase uptake.
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Affiliation(s)
- AF Crawshaw
- Institute for Infection and Immunity, St George's, University of London , London, UK
| | - C Hickey
- Hackney Refugee and Migrant Forum, Hackney CVS , London, UK
| | - LM Lutumba
- Hackney Congolese Women Support Group , London, UK
| | - LM Kitoko
- Hackney Congolese Women Support Group , London, UK
| | - SL Nkembi
- Hackney Congolese Women Support Group , London, UK
| | - F Knights
- Institute for Infection and Immunity, St George's, University of London , London, UK
| | - Y Ciftci
- Doctors of the World UK , London, UK
| | - T Vandrevala
- Faculty of Health, Social Care and Education, Kingston and St George's, University of London , London, UK
| | | | - S Hargreaves
- Institute for Infection and Immunity, St George's, University of London , London, UK
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12
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Hammond J, Davies N, Morrow E, Ross F, Vandrevala T, Harris R. "Raising the curtain on the equality theatre": a study of recruitment to first healthcare job post-qualification in the UK National Health Service. Hum Resour Health 2022; 20:57. [PMID: 35804352 PMCID: PMC9264517 DOI: 10.1186/s12960-022-00754-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND UK equality law and National Health Service (NHS) policy requires racial equality in job appointments and career opportunities. However, recent national workforce race equality standard (WRES) data show that nearly all NHS organisations in the UK are failing to appoint ethnically diverse candidates with equivalent training and qualifications as their white counterparts. This is problematic because workforce diversity is associated with improved patient outcomes and other benefits for staff and organisations. AIM To better understand the reasons behind underrepresentation of ethnically diverse candidates in first NHS healthcare jobs post-qualification and to identify any structural or systemic barriers to employment for such groups. METHODS The study was informed by critical theory and the authors' interdisciplinary perspectives as educators and researchers in the healthcare professions. Data collected from semi-structured face-to-face interviews with 12 nurse and physiotherapy recruiting managers from two NHS trusts in London were analysed using a healthcare workforce equity and diversity conceptual lens we developed from the literature. Using this lens, we devised questions to examine six dimensions of equity and diversity in the interview data from recruiting managers. RESULTS Recruiting managers said they valued the benefits of an ethnically diverse workforce for patients and their unit/organisation. However, their adherence to organisational policies for recruitment and selection, which emphasise objectivity and standardisation, acted as constraints to recognising ethnicity as an important issue in recruitment and workforce diversity. Some recruiting managers sense that there are barriers for ethnically diverse candidates but lacked information about workforce diversity, systems for monitoring recruitment, or ways to engage with staff or candidates to talk about these issues. Without this information there was no apparent problem or reason to try alternative approaches. CONCLUSION These accounts from 12 recruiting managers give a 'backstage' view into the reasons behind ethnic inequalities in recruitment to first healthcare job in the UK NHS. Adherence to recruitment and selection policies, which aim to support equality through standardisation and anonymisation, appear to be limiting workforce diversity and creating barriers for ethnically diverse candidates to attain the jobs that they are trained and qualified for. The Healthcare Workforce Equity + Diversity Lens we have developed can help to 'raise the curtain on the equality theatre' and inform more inclusive approaches to recruitment such as contextualised recruitment or effective allyship between employers and universities.
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Affiliation(s)
- John Hammond
- Centre for Allied Health, St George’s University of London, Cranmer Terrace, Tooting, London, SW17 0RE UK
| | - Nigel Davies
- College of Health, Medicine and Life Sciences, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH UK
| | | | - Fiona Ross
- Emerita Professor, Health and Social Care, Kingston University and St George’s University of London, Cranmer Terrace, Tooting, London, SW17 0RE UK
| | - Tushna Vandrevala
- Centre for Health and Social Care Research, Kingston University and St George’s University of London, Cranmer Terrace, Tooting, London, SW17 0RE UK
| | - Ruth Harris
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
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13
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Vandrevala T, Alidu L, Hendy J, Shafi S, Ala A. 'It's possibly made us feel a little more alienated': How people from ethnic minority communities conceptualise COVID-19 and its influence on engagement with testing. J Health Serv Res Policy 2022; 27:141-150. [PMID: 34978500 PMCID: PMC8948536 DOI: 10.1177/13558196211054961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The cultural beliefs, practices and experiences of ethnic minority groups, alongside structural inequalities and the political economy play a critical, but overlooked role in health promotion. This study aimed to understand how ethnic minority groups in the United Kingdom conceptualised COVID-19 and how this influenced engagement in testing. METHOD Black (African and Caribbean) and South Asian (Indian, Pakistani and Bangladeshi) community members were purposefully recruited from across the UK. Fifty-seven semi-structured interviews were conducted and analysed using principles of grounded theory. RESULTS We found that people of Black and South Asian ethnicity conceptualised COVID-19 as a disease that makes them visible to others outside their community and was seen as having more severe risk and suffering worse consequences, resulting in fear, stigmatisation and alienation. Views about COVID-19 were embedded in cultural beliefs, relating to culturally specific ideas around disease, such as ill-health being God's will. Challenges brought about by the pandemic were conceptualised as one of many struggles, with the saliency of the virus contextualised against life experiences. These themes and others influenced engagement with COVID-19 testing. Testing was less about accessing timely and effective treatment for themselves and more about acting to protect the family and community. Testing symbolised a loss of income, anxiety and isolation, accentuated by issues of mistrust of the system and not being valued, or being treated unfairly. CONCLUSION Health communications should focus on counterbalancing the mistrust, alienation and stigmatisation that act as barriers to testing, with trust built using local credible sources.
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Affiliation(s)
- Tushna Vandrevala
- Centre for Applied Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston University and St George’s University of London, Kingston-Upon-Thames, UK
| | - Lailah Alidu
- Centre for Applied Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston University and St George’s University of London, Kingston-Upon-Thames, UK
| | - Jane Hendy
- Brunel Business School, Brunel University London, Uxbridge, Middlesex, UK
| | - Shuja Shafi
- Mass Gatherings and Global Health Network, London, UK
| | - Aftab Ala
- King’s College Hospital and University of Surrey, Royal Surrey County Hospital NHS Foundation, Guildford, Surrey, UK
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14
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Vallée-Tourangeau G, Wheelock A, Vandrevala T, Harries P. Peer reviewers' dilemmas: a qualitative exploration of decisional conflict in the evaluation of grant applications in the medical humanities and social sciences. Humanit Soc Sci Commun 2022; 9:s41599-022-01050-6. [PMID: 36530545 PMCID: PMC7613955 DOI: 10.1057/s41599-022-01050-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/12/2022] [Indexed: 06/17/2023]
Abstract
Independent evaluations of grant applications by subject experts are an important part of the peer-review system. However, little is known about the real-time experiences of peer reviewers or experts who perform reviews of a grant application independently. This study sought to gain insight into this stage of the grant evaluation process by observing how experts conduct an independent review in near real time. Using the think aloud approach and Critical Decision Method of interviewing, in-depth interviews were conducted with 16 peer reviewers from a range of roles and disciplines within the medical humanities and social sciences. Participants were asked to think aloud while reviewing applications to different grant schemes from a single prestigious funder. The analysis shows reviewers encountered five dilemmas during the evaluation process. These dilemmas were related to whether or not one should (1) accept an invitation to review, (2) rely exclusively on the information presented in the application, (3) pay attention to institutional prestige, (4) offer comments about aspects that are not directly related to academics' area of expertise, and (5) to take risks and overlook shortcomings rather than err on the side of caution. In order to decide on the appropriate course of action, reviewers often engaged in a series of deliberations and trade-offs-varying in length and complexity. However, their interpretation of what was 'right' was influenced by their values, preferences and experiences, but also by relevant norms and their understanding of the funder's guidelines and priorities. As a result, the way reviewers approached the identified dilemmas was idiosyncratic and sometimes diametrically opposed to other reviewers' views, which could lead to variation in peer-review outcomes. The dilemmas we have uncovered suggest that peer reviewers engage in thoughtful considerations during the peer-review process. We should, therefore, be wary of reducing the absence of consensus as resulting from biased, instinctive thinking. Rather, these findings highlight the diversity of values, priorities and habits and ways of working each reviewer brings to the fore when reviewing the applicants and their project proposals and call for further reflection on, and study of, this "invisible work" to better understand and continue to improve the peer-reviewing process.
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Affiliation(s)
| | - Ana Wheelock
- Kingston Business School, Kingston University, Kingston upon Thames, UK
| | - Tushna Vandrevala
- Centre for Applied Health and Social Care Research, Kingston University and St. George’s, University of London, London, UK
| | - Priscilla Harries
- Centre for Applied Health and Social Care Research, Kingston University and St. George’s, University of London, London, UK
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15
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Ahmed A, Vandrevala T, Hendy J, Kelly C, Ala A. An examination of how to engage migrants in the research process: building trust through an 'insider' perspective. Ethn Health 2022; 27:463-482. [PMID: 31722534 DOI: 10.1080/13557858.2019.1685651] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 10/16/2019] [Indexed: 06/10/2023]
Abstract
Introduction: Ensuring all members of society can equally participate in research and the provision of services is a challenging goal. Increased migration has been mirrored by media narratives of social threat, leaving many migrants feeling differentiated and distrustful of mainstream society.Objectives: We explore how migrant and ethnic minority populations can be given the opportunity to participate in the research process. In this work, we iteratively and jointly developed a range of engagement strategies that adopt an 'insider' approach; seeking to eliminate feelings of differentiation and 'otherness' by establishing mutual trust.Design: Recruitment activities were carried out with 8 focus groups of first-generation South Asian migrants (the largest ethnic minority group in England). Our analysis was grounded in the broad principles of action research with reflective evaluation of our recruitment process using field observations and relevant focus group data; asking whether we tackled barriers to engagement.Results: Our findings show that 'otherness' can be reduced by establishing a trustworthy researcher-community relationship, but also that this relationship is complex, and needs to acknowledge residual mistrust. Alongside, researchers need to enable opportunities for empowered interaction, with flexible strategies to negotiate potential power divides.Conclusions: We can successfully create opportunities for engagement but there is no 'one size fits all'. Engagement requires tailored approaches that embrace flexibility, and position both engagement and non-engagement as positive and empowered choices.
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Affiliation(s)
- Ayesha Ahmed
- Brunel Business School, Brunel University London, London, UK
| | - T Vandrevala
- Department of Psychology, School of Social and Behavioural Sciences, Kingston University, Kingston-Upon-Thames, UK
| | - J Hendy
- Brunel Business School, Brunel University London, London, UK
| | - C Kelly
- Department of Gastroenterology and Hepatology, The Royal Surrey County Hospital NHS Foundation Trust Guildford, Guildford, UK
| | - A Ala
- Department of Gastroenterology and Hepatology, The Royal Surrey County Hospital NHS Foundation Trust Guildford, Guildford, UK
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Institute of Liver Studies, King's College Hospital London, London, UK
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16
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Crawshaw AF, Farah Y, Deal A, Goldsmith LP, Carter J, Rustage K, Campos-Matos I, Vandrevala T, Forster AS, Hargreaves S. Analysing drivers of routine and COVID-19 vaccination in migrants to develop tailored interventions. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Migrants in Europe are at risk of under-immunisation and may also have lower COVID-19 vaccination intent and uptake. There is an urgent need to better understand the drivers of uptake in these groups to inform the development of migrant-sensitive interventions for COVID-19 vaccination and routine vaccination beyond the pandemic.
Methods
We did a systematic review (PROSPERO: CRD42020219214) following PRISMA guidelines to explore factors influencing vaccine uptake in migrants in the EU/EEA and identify determinants of under-immunisation. We also held 3 participatory workshops with multinational migrant community leaders (n = 23) in London, to explore solutions and approaches to strengthen COVID-19 vaccine roll-out.
Results
We included 66 papers reporting data on 262,761 migrants in the review. Numerous access-related factors (e.g. government policy, communication barriers) influenced uptake. Vaccine hesitancy was attributed to lack of information, concerns about side-effects, and cultural beliefs/stigma around specific vaccinations. Migrants who had recently arrived, were older, female or of African and Eastern Mediterranean origin were at risk for under-immunisation for key vaccine-preventable diseases. Migrant community leaders reported considerable hesitancy towards COVID-19 vaccination in their communities and misinformation circulating via social media. Leaders requested support in producing simple COVID-19 guidance that could be translated and adapted locally, alongside more meaningful engagement and partnership-working.
Conclusions
Access barriers and vaccine hesitancy may affect vaccine uptake in some migrant populations in Europe, which needs to be urgently addressed for COVID-19 vaccine roll-out but also beyond the pandemic to strengthen uptake of routine vaccinations. Actively involving migrant communities in the planning, co-production and implementation of tailored and targeted approaches will be essential.
On behalf of ESGITM.
Key messages
Access barriers and vaccine hesitancy (from information gaps, cultural factors) contribute to low vaccine uptake in some migrant populations in the EU/EEA, with implications for COVID-19 vaccination. Meaningful engagement and co-production of tailored approaches with under-immunised migrants are urgently needed to ensure their inclusion in COVID-19 and routine vaccination programmes.
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Affiliation(s)
- AF Crawshaw
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Y Farah
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - A Deal
- Institute for Infection and Immunity, St George's, University of London, London, UK
- Faculty of Public Health and Policy, LSHTM, London, UK
| | - LP Goldsmith
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - J Carter
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - K Rustage
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - I Campos-Matos
- Health Improvement Division, Public Health England, London, UK
- UCL Collaborative Centre for Inclusion Health, University College London, London, UK
| | - T Vandrevala
- Department of Psychology, Kingston University London, London, UK
| | - AS Forster
- Department of Behavioural Science and Health, University College London, London, UK
| | - S Hargreaves
- Institute for Infection and Immunity, St George's, University of London, London, UK
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17
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Calvert A, Vandrevala T, Parsons R, Barber V, Book A, Book G, Carrington D, Greening V, Griffiths P, Hake D, Khalil A, Luck S, Montague A, Star C, Ster IC, Wood S, Heath PT, Jones CE. Changing knowledge, attitudes and behaviours towards cytomegalovirus in pregnancy through film-based antenatal education: a feasibility randomised controlled trial of a digital educational intervention. BMC Pregnancy Childbirth 2021; 21:565. [PMID: 34407771 PMCID: PMC8375137 DOI: 10.1186/s12884-021-03979-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Congenital cytomegalovirus (CMV) is the most common congenital infection globally, however information about CMV is not routinely included in antenatal education in the United Kingdom. This feasibility study aimed to gather the essential data needed to design and power a large randomised controlled trial (RCT) to investigate the efficacy of a digital intervention in reducing the risk of CMV acquisition in pregnancy. In order to do this, we carried out a single-centre RCT, which explored the knowledge, attitudes and risk reduction behaviours in women in the intervention and treatment as usual groups, pre- and post-intervention. METHODS CMV seronegative women living with a child less than four years old, receiving antenatal care at a single UK tertiary centre, were randomised to the digital intervention or 'treatment as usual' groups. Participants completed questionnaires before the digital intervention and after and at 34 gestational weeks, and responses within groups and between groups were compared using tailored randomisation tests. CMV serology was tested in the first trimester and at the end of pregnancy. RESULTS Of the 878 women screened, 865 samples were analysed with 43% (n = 372) being CMV seronegative and therefore eligible to take part in the RCT; of these, 103 (27.7%) women were enrolled and 87 (84%) of these completed the study. Most participants (n = 66; 64%) were unfamiliar with CMV at enrolment, however at 34 gestational weeks, women in the intervention group (n = 51) were more knowledgeable about CMV compared to the treatment as usual group (n = 52) and reported engaging in activities that may increase the risk of CMV transmission less frequently. The digital intervention was highly acceptable to pregnant women. Overall, four participants seroconverted over the course of the study: two from each study group. CONCLUSIONS A large multi-centre RCT investigating the efficacy of a CMV digital intervention is feasible in the United Kingdom; this study has generated essential data upon which to power such a study. This single-centre feasibility RCT demonstrates that a digital educational intervention is associated with increase in knowledge about CMV and can result in behaviour change which may reduce the risk of CMV acquisition in pregnancy. TRIAL REGISTRATION Clinicaltrials.gov, NCT03511274 , Registered 27.04.18, http://www.Clinicaltrials.gov.
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Affiliation(s)
- Anna Calvert
- Paediatric Infectious Diseases Research Group, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
- St George's University Hospitals NHS Foundation Trust, London, UK.
| | - Tushna Vandrevala
- Department of Psychology, Kingston University, Kingston-Upon-Thames, UK
| | - Robin Parsons
- Paediatric Infectious Diseases Research Group, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Victoria Barber
- Department of Psychology, Kingston University, Kingston-Upon-Thames, UK
| | - Alex Book
- Parent Caring for a Child With Congenital CMV Infection, London, UK
| | - Gayle Book
- Parent Caring for a Child With Congenital CMV Infection, London, UK
| | - David Carrington
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Vanessa Greening
- Paediatric Infectious Diseases Research Group, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Paul Griffiths
- University College London, Medical School, Institute of Immunity and Transplantation, London, UK
| | - Danielle Hake
- Paediatric Infectious Diseases Research Group, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Asma Khalil
- Paediatric Infectious Diseases Research Group, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Suzanne Luck
- Paediatric Infectious Diseases Research Group, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
- Kingston Hospital NHS Foundation Trust, Kingston-Upon-Thames, UK
| | - Amy Montague
- Department of Psychology, Kingston University, Kingston-Upon-Thames, UK
| | | | - Irina Chis Ster
- Institute of Infection and Immunity, St George's University of London, London, UK
| | | | - Paul T Heath
- Paediatric Infectious Diseases Research Group, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Christine E Jones
- Paediatric Infectious Diseases Research Group, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, and NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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18
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Drury J, Mao G, John A, Kamal A, Rubin GJ, Stott C, Vandrevala T, Marteau TM. Behavioural responses to Covid-19 health certification: a rapid review. BMC Public Health 2021; 21:1205. [PMID: 34162364 PMCID: PMC8221819 DOI: 10.1186/s12889-021-11166-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/27/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Covid-status certification - certificates for those who test negative for the SARS-CoV-2 virus, test positive for antibodies, or who have been vaccinated against SARS-CoV-2 - has been proposed to enable safer access to a range of activities. Realising these benefits will depend in part upon the behavioural and social impacts of certification. The aim of this rapid review was to describe public attitudes towards certification, and its possible impact on uptake of testing and vaccination, protective behaviours, and crime. METHOD A search was undertaken in peer-reviewed databases, pre-print databases, and the grey literature, from 2000 to December 2020. Studies were included if they measured attitudes towards or behavioural consequences of health certificates based on one of three indices of Covid-19 status: test-negative result for current infectiousness, test-positive for antibodies conferring natural immunity, or vaccination(s) conferring immunity. RESULTS Thirty-three papers met the inclusion criteria, only three of which were rated as low risk of bias. Public attitudes were generally favourable towards the use of immunity certificates for international travel, but unfavourable towards their use for access to work and other activities. A significant minority was strongly opposed to the use of certificates of immunity for any purpose. The limited evidence suggested that intention to get vaccinated varied with the activity enabled by certification or vaccination (e.g., international travel). Where vaccination is seen as compulsory this could lead to unwillingness to accept a subsequent vaccination. There was some evidence that restricting access to settings and activities to those with antibody test certificates may lead to deliberate exposure to infection in a minority. Behaviours that reduce transmission may decrease upon health certificates based on any of the three indices of Covid-19 status, including physical distancing and handwashing. CONCLUSIONS The limited evidence suggests that health certification in relation to COVID-19 - outside of the context of international travel - has the potential for harm as well as benefit. Realising the benefits while minimising the harms will require real-time evaluations allowing modifications to maximise the potential contribution of certification to enable safer access to a range of activities.
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Affiliation(s)
- John Drury
- School of Psychology, University of Sussex, Brighton, UK
| | - Guanlan Mao
- School of Psychology, University of Sussex, Brighton, UK
| | - Ann John
- Swansea University, Population Data Science, Swansea, UK
| | - Atiya Kamal
- Department of Psychology, Birmingham City University, Birmingham, UK
| | - G. James Rubin
- Department of Psychological Medicine, King’s College London, London, UK
| | | | - Tushna Vandrevala
- Department of Psychology, Kingston University, Kingston upon Thames, UK
| | - Theresa M. Marteau
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
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Hanson K, O'Dwyer E, Chaudhuri S, Silva Souza LG, Vandrevala T. Mitigating the identity and health threat of COVID-19: Perspectives of middle-class South Asians living in the UK. J Health Psychol 2021; 27:2147-2160. [PMID: 34154436 PMCID: PMC9353968 DOI: 10.1177/13591053211027626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The recognition and representation of BAME community as 'high risk' of Covid-19 in the UK presents both a health and an identity threat to this ethnic group. This study employed thematic analysis to explore response to these threats as related by a sample of 13 middle class members of the South Asian community. This work advances both health and identity psychological theory by recognising the affinity between expressions of health efficacy and identity. Our findings identify South Asian intragroup stigmatisation and commonalities that have implications for the promotion of health behaviour and health communications for minority groups.
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20
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Crawshaw AF, Deal A, Rustage K, Forster AS, Campos-Matos I, Vandrevala T, Würz A, Pharris A, Suk JE, Kinsman J, Deogan C, Miller A, Declich S, Greenaway C, Noori T, Hargreaves S. What must be done to tackle vaccine hesitancy and barriers to COVID-19 vaccination in migrants? J Travel Med 2021; 28:6189154. [PMID: 33772312 PMCID: PMC8083646 DOI: 10.1093/jtm/taab048] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/16/2021] [Accepted: 03/23/2021] [Indexed: 01/21/2023]
Abstract
Migrants have been disproportionately impacted by COVID-19 and emerging evidence suggests they may face barriers to COVID-19 vaccination. Participatory approaches and engagement strategies are urgently needed to strengthen uptake, alongside innovative delivery mechanisms and sharing of best practice, to ensure migrants are better consider within countries’ existing vaccine priority structures.
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Affiliation(s)
- Alison F Crawshaw
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, SW17 0RE London, UK
| | - Anna Deal
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, SW17 0RE London, UK.,Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, WC1E 7HT London, UK
| | - Kieran Rustage
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, SW17 0RE London, UK
| | - Alice S Forster
- Department of Behavioural Science and Health, University College London, WC1E 6BT London, UK
| | - Ines Campos-Matos
- Health Improvement Division, Public Health England, SE1 8UG London, UK and UCL Collaborative Centre for Inclusion Health, University College London, WC1E 6BT London, UK
| | - Tushna Vandrevala
- Department of Psychology, Kingston University London, Kingston KT2 7LB, UK
| | - Andrea Würz
- Disease Programmes (AW, AP, JK, CD, TN); Public Health Functions (JES), European Centre for Disease Prevention and Control, Stockholm SE-Solna, Sweden
| | - Anastasia Pharris
- Disease Programmes (AW, AP, JK, CD, TN); Public Health Functions (JES), European Centre for Disease Prevention and Control, Stockholm SE-Solna, Sweden
| | - Jonathan E Suk
- Disease Programmes (AW, AP, JK, CD, TN); Public Health Functions (JES), European Centre for Disease Prevention and Control, Stockholm SE-Solna, Sweden
| | - John Kinsman
- Disease Programmes (AW, AP, JK, CD, TN); Public Health Functions (JES), European Centre for Disease Prevention and Control, Stockholm SE-Solna, Sweden
| | - Charlotte Deogan
- Disease Programmes (AW, AP, JK, CD, TN); Public Health Functions (JES), European Centre for Disease Prevention and Control, Stockholm SE-Solna, Sweden
| | - Anna Miller
- Policy & Advocacy Division, Doctors of the World UK, part of the Médicins du Monde network, E14 5AA London, UK
| | - Silvia Declich
- National Centre for Global Health, Istituto Superiore di Sanità, 00161 Roma RM, Italy
| | - Chris Greenaway
- Department of Medicine, McGill University Montreal, H3A 1A1 Quebec, Canada
| | - Teymur Noori
- Disease Programmes (AW, AP, JK, CD, TN); Public Health Functions (JES), European Centre for Disease Prevention and Control, Stockholm SE-Solna, Sweden
| | - Sally Hargreaves
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, SW17 0RE London, UK
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21
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Kelly C, Pericleous M, Ahmed A, Vandrevala T, Hendy J, Shafi S, Skene SS, Verma S, Edge C, Nicholls M, Gore C, de Lusignan S, Ala A. Improving uptake of hepatitis B and hepatitis C testing in South Asian migrants in community and faith settings using educational interventions-A prospective descriptive study. Int J Infect Dis 2020; 100:264-272. [PMID: 32861830 DOI: 10.1016/j.ijid.2020.08.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/19/2020] [Accepted: 08/22/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic viral hepatitis (CVH) is a leading contributor to the UK liver disease epidemic, with global migration from high prevalence areas (e.g., South Asia). Despite international guidance for testing high-risk groups in line with elimination targets, there is no consensus on how to achieve this. The objectives of this study were to assess the following: (1) the feasibility of recruiting South Asian migrants to view an educational film on CVH, (2) the effectiveness of the film in promoting testing and increasing knowledge of CVH, and (3) the methodological issues relevant to scale-up to a randomized controlled trial. METHODS South Asian migrants were recruited to view the film (intervention) in community venues (primary care, religious, community), with dried blood spot CVH testing offered immediately afterwards. Pre/post-film questionnaires assessed the effectiveness of the intervention. RESULTS Two hundred and nineteen first-generation migrants ≥18 years of age (53% female) were recruited to view the film at the following sites: religious, n = 112 (51%), community n = 98 (45%), and primary care, n = 9 (4%). One hundred and eighty-four (84%) underwent CVH testing; hepatitis B core antibody or hepatitis C antibody positivity demonstrated exposure in 8.5%. Pre-intervention (n = 173, 79%) and post-intervention (n = 154, 70%) questionnaires were completed. CONCLUSIONS This study demonstrated the feasibility of recruiting first-generation migrants to view a community-based educational film promoting CVH testing in this higher risk group, confirming the value of developing interventions to facilitate the global World Health Organization plan for targeted case finding and elimination, and a future randomized controlled trial. We highlight the importance of culturally relevant interventions including faith and culturally sensitive settings, which appear to minimize logistical issues and effectively engage minority groups, allowing ease of access to individuals 'at risk'.
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Affiliation(s)
- Claire Kelly
- Department of Gastroenterology and Hepatology, Royal Surrey NHS Foundation Trust, Guildford, Surrey, UK; Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Marinos Pericleous
- Department of Gastroenterology and Hepatology, Royal Surrey NHS Foundation Trust, Guildford, Surrey, UK; Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Ayesha Ahmed
- Brunel Business School, Brunel University, London, UK
| | | | - Jane Hendy
- Brunel Business School, Brunel University, London, UK
| | - Shuja Shafi
- Research and Documentation Committee, The Muslim Council of Britain, London, UK
| | - Simon S Skene
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Sumita Verma
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School and Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospital, Brighton, UK
| | - Chantal Edge
- Institute of Epidemiology and Health Care, UCL, London, UK
| | | | | | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Royal College of General Practitioners Research and Surveillance Centre, London, UK
| | - Aftab Ala
- Department of Gastroenterology and Hepatology, Royal Surrey NHS Foundation Trust, Guildford, Surrey, UK; Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
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Vandrevala T, Barber V, Mbire-Chigumba E, Calvert A, Star C, Khalil A, Griffiths P, Book AS, Book GM, Heath P, Jones CE. Parenting a child with congenital cytomegalovirus infection: a qualitative study. BMJ Paediatr Open 2020; 4:e000844. [PMID: 33225083 PMCID: PMC7662527 DOI: 10.1136/bmjpo-2020-000844] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Congenital cytomegalovirus (CMV) is the most common infectious cause of congenital disability, which can cause lifelong impairments including sensorineural hearing loss and developmental delay. This study aimed to explore the experiences of parenting a child with congenital CMV and the impact this has on families. METHODS Ten parents living with a child with congenital CMV in the UK participated in semistructured interviews and data were analysed using thematic analysis. RESULTS The findings illustrate that delays in making the diagnosis of congenital CMV are associated with parental distress and lack of knowledge about CMV among medical professionals can exacerbate this distress. Parents expressed frustration about not knowing about CMV infection during their pregnancies and therefore not having the opportunity to take measures to reduce their risk of acquiring CMV while pregnant. The uncertainty about the long-term outcomes of children with congenital CMV adds additional emotional burden for parents. Family and wider societal networks have the potential to facilitate coping and alleviate stress, but the lack of awareness of CMV acts as a barrier to receiving support from family and friends. CONCLUSIONS There is a need to increase awareness of CMV among medical professionals, pregnant women and wider society to improve the diagnostic process and to provide better support for families caring for children with congenital CMV infection.
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Affiliation(s)
| | - Victoria Barber
- Psychology, Kingston University, Kingston-Upon-Thames, London, UK
| | | | - Anna Calvert
- Institute of Infection and Immunity, St George's, Unite, London, UK
| | | | - Asma Khalil
- Fetal Medicine Unit, St George's University Hospital, London, UK
| | | | | | - Gayle M Book
- Parent of child with congenital CMV infection, London, UK
| | - Paul Heath
- University of London Saint George's, London, UK
| | - Christine E Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
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23
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Vandrevala T, Barber V, Calvert A, Star C, Khalil A, Griffiths P, Heath PT, Jones CE. Understanding pregnant women's readiness to engage in risk-reducing measures to prevent infections during pregnancy. J Health Psychol 2019; 26:1728-1740. [PMID: 31686538 DOI: 10.1177/1359105319884609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to develop a conceptual understanding of women's readiness to engage in behaviours to reduce the risk of acquiring infections during pregnancy, using cytomegalovirus, the most common congenital infection as a case. Thirty-three pregnant women participated in semi-structured interviews. The findings illustrate that for behavioural change to become viable, it is necessary for individuals to consider barriers or facilitators at the individual, inter-personal and system levels. By widening the theoretical lens beyond individual cognitive determinants, the model places sufficient emphasis on factors, such as collective identity, support networks, interaction with the healthcare system and wider community, relevant to pregnant women.
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Affiliation(s)
| | | | - Anna Calvert
- St George's University of London, and St George's University Hospitals NHS Trust, UK
| | | | - Asma Khalil
- St George's University of London, and St George's University Hospitals NHS Trust, UK
| | | | - Paul T Heath
- St George's University of London, and St George's University Hospitals NHS Trust, UK
| | - Christine E Jones
- University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
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24
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Hendy J, Vandrevala T, Ahmed A, Kelly C, Gray L, Ala A. Feeling misidentified: Understanding migrant's readiness to engage in health care screening. Soc Sci Med 2019; 237:112481. [DOI: 10.1016/j.socscimed.2019.112481] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 07/22/2019] [Accepted: 08/03/2019] [Indexed: 02/07/2023]
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25
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Yeh IL, Samsi K, Vandrevala T, Manthorpe J. Constituents of effective support for homecare workers providing care to people with dementia at end of life. Int J Geriatr Psychiatry 2019; 34:352-359. [PMID: 30430628 DOI: 10.1002/gps.5027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 11/03/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The aim of this study was to enhance understanding about homecare workers providing care to people with dementia at end of life by exploring homecare workers' perceptions of challenges and the support they needed and sometimes received. METHODS Qualitative semi-structured interviews were conducted with 29 homecare workers and 13 homecare managers in England. Framework analysis was used to analyse the data. FINDINGS Four overarching challenges were identified: working with clients with dementia, including clients' sometimes unpredictable responses, communication difficulties, and mood changes; caring for the dying; conflict with family members; and working alone, which often left homecare workers at risk of exhaustion, fatigue, and a sense of isolation. When their work entailed high levels of emotion, such as a client's death or getting embroiled in a client's family conflict, they felt emotionally drained, under-prepared, and overwhelmed. Supportive elements include receiving encouragement and learning from experienced peers and their feelings being acknowledged by managers at their employing homecare agency. Some workers were offered time off or encouraged to attend the client's funeral as a means of supporting the process of bereavement. CONCLUSIONS Peer and manager support are essential and effective in coping with work pressures. There is a need to develop models of effective support to alleviate staff's practical, emotional, and interpersonal pressures. However, due to the isolating nature of homecare work, managers may not recognise early signs of their staff finding stress unmanageable and miss the opportunity to mitigate these negative effects.
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Affiliation(s)
| | - Kritika Samsi
- Social Care Workforce Research Unit, King's College London, London, UK
| | | | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
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26
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Wilcox CR, Bottrell K, Paterson P, Schulz WS, Vandrevala T, Larson HJ, Jones CE. Influenza and pertussis vaccination in pregnancy: Portrayal in online media articles and perceptions of pregnant women and healthcare professionals. Vaccine 2018; 36:7625-7631. [PMID: 30401620 PMCID: PMC6263273 DOI: 10.1016/j.vaccine.2018.10.092] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 10/05/2018] [Accepted: 10/29/2018] [Indexed: 11/13/2022]
Abstract
Introduction Online media may influence women’s decision to undergo vaccination during pregnancy. The aims of this mixed-methods study were to: (1) examine the portrayal of maternal vaccination in online media and (2) establish the perceived target of vaccine protection as viewed by pregnant women and maternity healthcare professionals (HCPs). Methods Online media articles on maternal vaccination (published July-December 2012 or November 2015-April 2016) were identified through the London School of Hygiene & Tropical Medicine’s Vaccine Confidence Database and thematically analysed. Questionnaires for pregnant women and HCPs were distributed within four English hospitals (July 2017-January 2018). Results Of 203 articles identified, 60% related to pertussis vaccination, 33% to influenza and 6% both. The majority positively portrayed vaccination in pregnancy (97%), but inaccurate, negative articles persist which criticize pertussis vaccination’s safety and efficacy. Positively-worded articles about pertussis tended to focus on infant protection and highlight examples of recent cases, whereas positively-worded articles about influenza focused on maternal protection. These themes were reflected in questionnaire responses from 314 pregnant women and 204 HCPs, who perceived pertussis vaccination as protecting the baby, and influenza vaccination as protecting the mother, or mother and baby equally. A minority of the pregnant women surveyed intended to decline influenza (22%) or pertussis (8%) vaccination. Conclusions The majority of online articles support pertussis and influenza vaccination during pregnancy. The portrayal of pertussis vaccination as primarily benefiting the child, using real-examples, may influence its higher uptake compared with influenza. This approach should be considered by HCPs when recommending vaccination. HCPs should be prepared to provide advice to women hesitant about vaccination, including addressing any negative media, and consider educational strategies to counteract inaccurate information. Future studies should directly assess the influence of media on vaccine decision-making and establish which media platforms are typically used by pregnant women to gather information.
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Affiliation(s)
- Christopher R Wilcox
- NIHR Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Kathryn Bottrell
- Paediatric Infectious Diseases Research Group, St George's, University of London, UK
| | - Pauline Paterson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - William S Schulz
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Heidi J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Christine E Jones
- Paediatric Infectious Diseases Research Group, St George's, University of London, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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27
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Kelly C, Pericleous M, Hendy J, de Lusignan S, Ahmed A, Vandrevala T, Ala A. Interventions to improve the uptake of screening across a range of conditions in Ethnic Minority Groups: a systematic review. Int J Clin Pract 2018; 72:e13202. [PMID: 29920875 DOI: 10.1111/ijcp.13202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 04/15/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Screening programmes are well established in cancer, and are now being implemented in other conditions. An effective screening programme leads to early disease detection and improved outcomes but its impact is dependent on the quality of the test and the proportion of the target population participating. A further consideration is that uptake of screening by minority groups is low. PURPOSE To determine which interventions have successfully increased screening uptake amongst minorities. DATA SOURCES Medline, Cochrane database and the grey literature were searched from 1990 to 1st March 2016. STUDY SELECTION Fifty-five English language studies that assessed uptake of screening in any minority population in the country of study aged over 18 years and that included a comparison arm. DATA EXTRACTION Independent data extraction was undertaken by two researchers (CK and MP), using a predesigned data extraction form (DEF) which assisted retrieval of the core contents of each study and the organisation of material. DATA SYNTHESIS Evidence was organised by screening test and type of intervention. Two authors (CK and MP) extracted data into evidence tables to enable comparison of study characteristics and findings. The heterogeneity of methods precluded a meta-analysis thus results are descriptive. Evidence was also assessed, using the Cochrane Collaboration risk of bias tables. RESULTS This systematic review appraises data from international studies on a variety of minority groups, interventions and screening programmes providing a narrative review of their success and limitations.
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Affiliation(s)
- Claire Kelly
- Department of Gastroenterology and Hepatology, Royal Surrey County Hospital, Guildford, Surrey, UK
- Department of Clinical and Experimental Medicine, FHMS, University of Surrey, Guildford, Surrey, UK
| | - Marinos Pericleous
- Department of Gastroenterology and Hepatology, Royal Surrey County Hospital, Guildford, Surrey, UK
- Department of Clinical and Experimental Medicine, FHMS, University of Surrey, Guildford, Surrey, UK
| | - Jane Hendy
- Brunel Business School, Brunel University, London, UK
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, FHMS, University of Surrey, Guildford, Surrey, UK
| | - Ayesha Ahmed
- Brunel Business School, Brunel University, London, UK
| | | | - Aftab Ala
- Department of Gastroenterology and Hepatology, Royal Surrey County Hospital, Guildford, Surrey, UK
- Department of Clinical and Experimental Medicine, FHMS, University of Surrey, Guildford, Surrey, UK
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28
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D'Astous V, Abrams R, Vandrevala T, Samsi K, Manthorpe J. Gaps in Understanding the Experiences of Homecare Workers Providing Care for People with Dementia up to the End of Life: A Systematic Review. Dementia (London) 2017; 18:970-989. [PMID: 28358269 DOI: 10.1177/1471301217699354] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This systematic review of the literature explores the perspectives and experiences of homecare workers providing care for people with dementia living at home up to the end of life. A search of major English language databases in 2016 identified 378 studies on the topic, of which 12 met the inclusion criteria. No empirical research was identified that specifically addressed the research question. However, synthesis of the findings from the broader literature revealed three overarching themes: value of job role, emotional labour and poor information and communication. The role of homecare workers supporting a person with dementia up to the end of life remains under-researched, with unmet needs for informational, technical and emotional support reported. The effective components of training and support are yet to be identified.
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Affiliation(s)
| | - Ruth Abrams
- School of School of Social and Behavioural Sciences, Faculty of Arts & Social Sciences, Kingston University, UK
| | - Tushna Vandrevala
- School of School of Social and Behavioural Sciences, Faculty of Arts & Social Sciences, Kingston University, UK
| | - Kritika Samsi
- Social Care Workforce Research Unit, King's College London, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, UK
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29
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Vandrevala T, Samsi K, Rose C, Adenrele C, Barnes C, Manthorpe J. Perceived needs for support among care home staff providing end of life care for people with dementia: a qualitative study. Int J Geriatr Psychiatry 2017; 32:155-163. [PMID: 26988707 DOI: 10.1002/gps.4451] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 01/16/2016] [Accepted: 01/26/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of the current exploratory study was to investigate the impact on care home staff when working with people with dementia at the end of life and to explore how they cope with this aspect of their work. With UK policy encouraging death in the place of residence, rather than hospital, more people with dementia are dying in care homes. METHOD A qualitative approach was employed; 20 care home staff working in five English care homes were interviewed. Thematic Analysis was used to analyse the data. RESULTS Care home staff found the external demands on them and difficulties associated with interacting with people with dementia sometimes challenging, stressful and anxiety-provoking, particularly as residents approached end of life. Emotional aspects of caring for dying residents were sometimes heightened by close attachments with residents and their families. Staff were able to recognise these unmet needs and identified a need for further training and emotional support to manage these stressors. CONCLUSIONS This study revealed rich and complex understandings of the practice dimensions of caring for people with dementia at the end of life and the impact these have on staff. There is a need to develop effective psychosocial interventions that focus on emotional support for care home staff. There will be challenges in providing this in employment settings that are generally low paid, low status, have high turnover and are reliant on temporary or migrant staff, where training is not rewarded, mandatory or culturally valued. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - K Samsi
- Social Care Workforce Research Unit, King's College London, UK
| | - C Rose
- Kingston University London, UK
| | | | | | - J Manthorpe
- Social Care Workforce Research Unit, King's College London, UK
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30
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Vandrevala T, Coyle A, Walker V, Cabrera Torres J, Ordoña I, Rahman P. 'A good method of quitting smoking' or 'just an alternative to smoking'? Comparative evaluations of e-cigarette and traditional cigarette usage by dual users. Health Psychol Open 2017; 4:2055102916684648. [PMID: 28680694 PMCID: PMC5298535 DOI: 10.1177/2055102916684648] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The development of e-cigarettes was initially hailed as a resource in facilitating a reduction in or cessation of cigarette smoking. Many users of e-cigarettes are ‘dual users’, smoking traditional cigarettes and e-cigarettes. The present qualitative study examines the factors that a group of 20 dual users considered to have been influential in their decisions to use e-cigarettes and their comparative evaluations of e-cigarettes and traditional cigarettes. Health concerns were not found to be sole motivators. Participants pointed to financial and contextual considerations, particularly peer influence on uptake and continued usage of e-cigarettes. E-cigarettes were evaluated as comparable to cigarettes in some ways but not in other important respects such as sensation and satisfaction. Different social evaluations of cigarette and e-cigarette usage were discerned which influenced how participants identified as smokers, ‘vapers’ or neither. Findings are discussed in relation to social representations, identity and implications for continued e-cigarette usage among dual users.
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Konstantara E, Vandrevala T, Cox A, Creagh-Brown BC, Ogden J. Balancing professional tension and deciding upon the status of death: Making end-of-life decisions in intensive care units. Health Psychol Open 2016; 3:2055102915622928. [PMID: 28070383 PMCID: PMC5193261 DOI: 10.1177/2055102915622928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This study investigated how intensivists make decisions regarding withholding and withdrawing treatment for patients at the end of their lives. This involved completing in-depth interviews from two sites of the South of England, United Kingdom by twelve intensivists. The data collected by these intensivists were analysed using thematic analysis. This resulted in the identification of three themes: intensivists' role, treatment effectiveness, and patients' best interest. Transcending these were two overarching themes relating to the balance between quantity and quality of life, and the intensivists' sense of responsibility versus burden. The results are considered in terms of making sense of death and the role of beliefs in the decision-making process.
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King W, Teare J, Vandrevala T, Cartwright S, Mohammed KB, Patel B. Evaluation of a novel Surgicric® cricothyroidotomy device for emergency tracheal access in a porcine model. Anaesthesia 2015; 71:177-84. [PMID: 26572240 DOI: 10.1111/anae.13275] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2015] [Indexed: 12/21/2022]
Abstract
A can't intubate, can't ventilate scenario can result in morbidity and death. Although a rare occurrence (1:50 000 general anaesthetics), it is crucial that anaesthetists maintain the skills necessary to perform cricothyroidotomy, and are well-equipped with appropriate tools. We undertook a bench study comparing a new device, Surgicric(®) , with two established techniques; the Melker Emergency Cricothyroidotomy, and a surgical technique. Twenty-five anaesthetists performed simulated emergency cricothyroidotomy on a porcine model, with the primary outcome measure being insertion time. Secondary outcomes included success rate, tracheal trauma and ease of use. The surgical technique was fastest. The median (IQR [range]) was 81 (62-126 [37-300]) s, followed by the Melker 124 (100-217 [71-300]) s, and the Surgicric 127 (68-171 [43-300]), p = 0.003. The Surgicric device was the most traumatic, as evaluated by a blinded Ear, Nose and Throat surgeon. Subsequently, the authors contacted the device manufacturer, who has now modified the kit in the hope that its clinical application might be improved. Further studies are required to evaluate the revised model.
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Affiliation(s)
- W King
- Surrey Peri-operative Anaesthesia Critical Care Collaborative Research Group, Anaesthetic Department, Royal Surrey County Hospital, Guildford, Surrey, UK
| | - J Teare
- Surrey Peri-operative Anaesthesia Critical Care Collaborative Research Group, Anaesthetic Department, Royal Surrey County Hospital, Guildford, Surrey, UK
| | - T Vandrevala
- Research Design Service, Kingston Hospital, Surrey, UK
| | - S Cartwright
- ENT Department, Guy's and St Thomas' Hospitals, London, UK
| | - K B Mohammed
- Research and Development Department, The Royal Marsden Hospital, London, UK
| | - B Patel
- Surrey Peri-operative Anaesthesia Critical Care Collaborative Research Group, Anaesthetic Department, Royal Surrey County Hospital, Guildford, Surrey, UK
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Affiliation(s)
| | - Kritika Samsi
- Social Care Workforce Research Unit, King's College London
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London
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Uchil D, Vandrevala T. Quality of Life after Hysteroscopic Myomectomy: A Prospective Observational Study. J Minim Invasive Gynecol 2014. [DOI: 10.1016/j.jmig.2014.08.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jones C, Kelliher L, Dickinson M, Riga A, Worthington T, Scott MJ, Vandrevala T, Fry CH, Karanjia N, Quiney N. Randomized clinical trial on enhanced recovery versus standard care following open liver resection. Br J Surg 2013; 100:1015-24. [PMID: 23696477 DOI: 10.1002/bjs.9165] [Citation(s) in RCA: 197] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Enhanced recovery programmes (ERPs) have been shown to reduce length of hospital stay (LOS) and complications in colorectal surgery. Whether ERPs have the same benefits in open liver resection surgery is unclear, and randomized clinical trials are lacking. METHODS Consecutive patients scheduled for open liver resection were randomized to an ERP group or standard care. Primary endpoints were time until medically fit for discharge (MFD) and LOS. Secondary endpoints were postoperative morbidity, pain scores, readmission rate, mortality, quality of life (QoL) and patient satisfaction. ERP elements included greater preoperative education, preoperative oral carbohydrate loading, postoperative goal-directed fluid therapy, early mobilization and physiotherapy. Both groups received standardized anaesthesia with epidural analgesia. RESULTS The analysis included 46 patients in the ERP group and 45 in the standard care group. Median MFD time was reduced in the ERP group (3 days versus 6 days with standard care; P < 0·001), as was LOS (4 days versus 7 days; P < 0·001). The ERP significantly reduced the rate of medical complications (7 versus 27 per cent; P = 0·020), but not surgical complications (15 versus 11 per cent; P = 0·612), readmissions (4 versus 0 per cent; P = 0·153) or mortality (both 2 per cent; P = 0·987). QoL over 28 days was significantly better in the ERP group (P = 0·002). There was no difference in patient satisfaction. CONCLUSION ERPs for open liver resection surgery are safe and effective. Patients treated in the ERP recovered faster, were discharged sooner, and had fewer medical-related complications and improved QoL. REGISTRATION NUMBER ISRCTN03274575 (http://www.controlled-trials.com).
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Affiliation(s)
- C Jones
- Department of Anaesthesia, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK.
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Abstract
BACKGROUND Recent government policy has highlighted the needs of family and friends who provide support to mental health service users. Carers of assertive outreach (AO) service users may be particularly in need of support. However, little is known about their experiences and how services can support them. AIM To explore the experiences of carers of individuals receiving an AO service. METHOD Ten participants were interviewed using a semi-structured interview schedule. Interviews were transcribed and analysed using interpretative phenomenological analysis. RESULTS Participants were positive about the service they and their relatives received from AO teams. They described the service as flexible and responsive to their needs and they had developed close collaborative relationships with AO workers. AO workers were considered by carers to be an extension of their family system. AO interventions helped their relatives to regain independence and enabled participants to feel less burdened by their caring role, thereby improving the carer's quality of life. CONCLUSIONS The unique way in which AO teams engage and work alongside service users and their families is greatly valued by carers.
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Affiliation(s)
- Helen Hughes
- Sussex Partnership NHS Foundation Trust, Sussex, UK.
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Arber S, Vandrevala T, Daly T, Hampson S. Understanding gender differences in older people's attitudes towards life-prolonging medical technologies. J Aging Stud 2008. [DOI: 10.1016/j.jaging.2008.05.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Garnett D, Vandrevala T, Hampson SE, Daly T, Arber S. Family members' perspectives on potential discussions about life prolongation for their older relatives. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/13576270701783124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Vandrevala T, Hampson SE, Daly T, Arber S, Thomas H. Dilemmas in decision-making about resuscitation—a focus group study of older people. Soc Sci Med 2006; 62:1579-93. [PMID: 16182420 DOI: 10.1016/j.socscimed.2005.08.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Indexed: 11/17/2022]
Abstract
Cardiopulmonary resuscitation (CPR) may be used by default on patients suffering a cardiac arrest in hospital in the UK unless there is an order that specifies otherwise in the patient's notes. Guidelines recommend that the decision involves competent and willing patients or, in the case of incapacitation, their families. In practice, patient autonomy is often compromised. Ideally, discussion of preferences for end-of-life care should take place prior to hospitalisation. The majority of research on this topic has been conducted on hospitalised patients, so little is known about the views of older, but healthy, people about resuscitation decision-making. The present study was designed to address this gap. A series of eight focus groups involving a total of 48 participants over the age of 65 was conducted to explore people's views about the factors guiding resuscitation decision-making. A qualitative analysis, which emphasised the dilemmatic nature of resuscitation decision-making, identified two broad thematic dilemmas that subsumed six specific themes which contribute to resolving the dilemmas: quality of life (medical condition, mental versus physical incapacity, age and ageing, and burden), and the involvement of others (doctors and families) versus loss of autonomy. The dilemma underlying quality of life is that an acceptable quality of life after CPR cannot be assured. The dilemma underlying the involvement of others is that individual autonomy may be lost. The themes and subthemes provide the basis for guiding these difficult discussions in advance of serious illness.
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Vandrevala T, Hampson S, Chrysanthaki T. Breaking the death taboo — Older people's perspectives on end‐of‐life decisions. Quality Ageing Older Adults 2002. [DOI: 10.1108/14717794200200020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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