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Kenning C, Usher-Smith JA, Jamison J, Jones J, Boaz A, Little P, Mallen C, Bower P, Park S. Impact of research activity on performance of general practices: a qualitative study. BJGP Open 2024:BJGPO.2024.0073. [PMID: 38649161 DOI: 10.3399/bjgpo.2024.0073] [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] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND There is evidence that engaging in research is directly associated with better performance. If this relationship is to be strengthened, it is necessary to understand the mechanisms which might underlie that relationship. AIM To explore the perspectives of staff and wider stakeholders about mechanisms by which research activity might impact on the performance of general practices. DESIGN & SETTING Qualitative study using semi-structured interviews with general practice professionals and wider stakeholders in England. METHOD Individual interviews with 41 purposively sampled staff in 'research ready' or 'research active' general practices and 21 other stakeholders. Interviews were independently coded by three researchers using a Framework approach. RESULTS Participants described potential 'direct' and 'indirect' impacts on their work. 'Direct' impacts included research changing practice work (eg, additional records searches for particular conditions), bringing in additional resources (eg, access to investigations or staff) and improving relationships with patients. 'Indirect' impacts included job satisfaction (eg, perception of practice as a centre of excellence and innovation, and the variety afforded by research activity reducing burnout) and staff recruitment (increasing the attractiveness of the practice as a place to work). Respondents identified few negative impacts. CONCLUSIONS Staff and stakeholders identified a range of potential impacts of research activity on practice performance, with impacts on their working lives most salient. Negative impacts were not generally raised. Nevertheless, respondents generally discussed potential impacts rather than providing specific examples of those impacts. This may reflect the type of research activity conducted in general practice, often led by external collaborators.
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Affiliation(s)
- Cassandra Kenning
- Centre for Primary Care and Health Services Research, The University of Manchester 6 Floor, Williamson Building, Oxford Road, Manchester, United Kingdom
| | - Juliet A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, East Forvie Building, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - James Jamison
- Division of Psychiatry, University College London, London, United Kingdom
| | - Jennifer Jones
- Department of Population Health Sciences, University of Leicester, University Road, Leicester, United Kingdom
| | - Annette Boaz
- NIHR Health and Social Care Workforce Research Unit, Policy Institute, Virginia Woolf Building, Kingsway, King's College London, London, United Kingdom
| | - Paul Little
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
| | | | - Peter Bower
- Centre for Primary Care and Health Services Research, The University of Manchester 6 Floor, Williamson Building, Oxford Road, Manchester, United Kingdom
| | - Sophie Park
- Research Dept of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill St., Hampstead, United Kingdom
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Farmer AJ, Allen J, Bartlett YK, Bower P, Chi Y, French DP, Gudgin B, Holmes E, Horne R, Hughes DA, Jones L, Kenning C, Locock L, McSharry J, Miles L, Newhouse N, Rea R, Robinson S, Tarassenko L, Velardo C, Williams N, Yu LM. Supporting people with type 2 diabetes in effective use of their medicine through mobile health technology integrated with clinical care (SuMMiT-D pilot): results of a feasibility randomised trial. Pilot Feasibility Stud 2024; 10:15. [PMID: 38273420 PMCID: PMC10809651 DOI: 10.1186/s40814-023-01429-5] [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: 01/30/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The purpose of this 6-month intervention pilot feasibility randomised trial was to test sending brief messages using mobile phones to promote self-management through taking medication as prescribed to people with type 2 diabetes. This was to inform the design and conduct of a future large-scale United Kingdom-based clinical trial and establish the feasibility of recruitment, the technology used, follow-up, and data collection. METHODS A multicentre individually randomised, controlled parallel group trial in primary care, recruiting adults (≥ 35 years) with type 2 diabetes in England. Consenting participants were randomly allocated to receive short message system text messages up to four times a week, or usual care, for a period of 6 months; messages contained behavioural change techniques targeting medication use. The primary outcome was the rate of recruitment to randomisation of participants to the trial with a planned rate of 22 participants randomised per month. The study also aimed to establish the feasibility of follow-up at 6 months, with an aim of retaining more than 80% of participants. Data, including patient-reported measures, were collected at baseline and the end of the 6-month follow-up period, and a notes review was completed at 24 months. RESULTS The trial took place between 26 November 2018 and 30 September 2019. In total 209 participants were randomly allocated to intervention (n = 103) or usual care (n = 106). The maximum rate of monthly recruitment to the trial was 60-80 participants per month. In total, 12,734 messages were sent to participants. Of these messages, 47 were identified as having failed to be sent by the service provider. Participants sent 2,864 messages to the automated messaging system. Baseline data from medical records were available for > 90% of participants with the exception of cholesterol (78.9%). At 6 months, a further HbA1c measurement was reported for 67% of participants. In total medical record data were available at 6 months for 207 (99.0%) of participants and completed self-report data were available for 177 (84.7%) of participants. CONCLUSION The feasibility of a large-scale randomised evaluation of brief message intervention for people with type 2 diabetes appears to be high using this efficient design. Failure rate of sending messages is low, rapid recruitment was achieved among people with type 2 diabetes, clinical data is available on participants from routine medical records and self-report of economic measures was acceptable. TRIAL REGISTRATION ISCTRN ISRCTN13404264. Registered on 10 October 2018.
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Affiliation(s)
- Andrew J Farmer
- University of Oxford, Oxford, UK.
- Nuffield Department of Primary Care Health Sciences, Woodstock Road, Oxford, OX2 6GG, UK.
| | | | | | | | - Yuan Chi
- University of Oxford, Oxford, UK
| | | | | | | | | | | | | | | | | | | | - Lisa Miles
- University of Manchester, Manchester, UK
| | | | - Rustam Rea
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Kenning C, Bower P, Small N, Ali SM, Brown B, Dempsey K, Mackey E, McMillan B, Sanders C, Serafimova I, Van der Veer SN, Dixon WG, McBeth J. Users' views on the use of a smartwatch app to collect daily symptom data in individuals with multiple long-term conditions (Multimorbidity): A qualitative study. J Multimorb Comorb 2024; 14:26335565231220202. [PMID: 38223165 PMCID: PMC10785716 DOI: 10.1177/26335565231220202] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/27/2023] [Indexed: 01/16/2024]
Abstract
Introduction Long-term conditions are a major burden on health systems. One way to facilitate more research and better clinical care among patients with long-term conditions is to collect accurate data on their daily symptoms (patient-generated health data) using wearable technologies. Whilst evidence is growing for the use of wearable technologies in single conditions, there is less evidence of the utility of frequent symptom tracking in those who have more than one condition. Aims To explore patient views of the acceptability of collecting daily patient-generated health data for three months using a smartwatch app. Methods Watch Your Steps was a longitudinal study which recruited 53 patients to track over 20 symptoms per day for a 90-day period using a study app on smartwatches. Semi-structured interviews were conducted with a sub-sample of 20 participants to explore their experience of engaging with the app. Results In a population of older people with multimorbidity, patients were willing and able to engage with a patient-generated health data app on a smartwatch. It was suggested that to maintain engagement over a longer period, more 'real-time' feedback from the app should be available. Participants did not seem to consider the management of more than one condition to be a factor in either engagement or use of the app, but the presence of severe or chronic pain was at times a barrier. Conclusion This study has provided preliminary evidence that multimorbidity was not a major barrier to engagement with patient-generated health data via a smartwatch symptom tracking app.
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Affiliation(s)
- Cassandra Kenning
- Centre for Primary Care and Health Services Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Peter Bower
- Centre for Primary Care and Health Services Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Nicola Small
- Centre for Primary Care and Health Services Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Syed Mustafa Ali
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Benjamin Brown
- Centre for Primary Care and Health Services Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Katherine Dempsey
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Elaine Mackey
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Brian McMillan
- Centre for Primary Care and Health Services Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Caroline Sanders
- Centre for Primary Care and Health Services Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Ilina Serafimova
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Sabine N Van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - William G Dixon
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - John McBeth
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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Bower P, Gibson J, Kenning C. The relationship between research activity and quality of care in English general practice: a mixed methods study. Br J Gen Pract 2023; 73:bjgp23X734133. [PMID: 37479306 DOI: 10.3399/bjgp23x734133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND There is evidence showing that healthcare organisations that take part in research demonstrate better performance. However, most evidence derives from hospital settings and these findings may not extend to general practice. The relationships between research activity and outcomes across general practices in England were explored. AIM To assess whether levels of research activity in general practice are associated with a range of organisational and patient-reported outcomes, and to explore possible mechanisms that might explain those associations. METHOD Analysis of national data on research activity and outcomes (including QoF, GPPS, prescribing, GP retention, and hospital utilisation) between 2008 and 2019 from practices in England, combined with qualitative interviews with general practice staff, patients, and wider stakeholders. RESULTS In cross-sectional analyses, research activity was associated with a number of outcomes, including clinical quality of care, patient-reported experience, and hospital use. The associations were generally modest in magnitude. However, longitudinal analyses did not generally support a causal relationship. Practice staff reported that the most likely benefits of research activity would be on professional wellbeing. CONCLUSION Similar to hospital settings, general practice research activity is associated with a range of positive outcomes, although it is difficult to claim that research is causing those improvements. This study identified no negative impacts, suggesting that research activity is something that high-quality practices are able to deliver alongside their core responsibilities. There is a need to explore ways by which additional impacts of research can be maximised.
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Butler K, Bartlett YK, Newhouse N, Farmer A, French DP, Kenning C, Locock L, Rea R, Williams V, Mc Sharry J. Implementing a text message-based intervention to support type 2 diabetes medication adherence in primary care: a qualitative study with general practice staff. BMC Health Serv Res 2023; 23:614. [PMID: 37301867 DOI: 10.1186/s12913-023-09571-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 05/16/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The Support through Mobile Messaging and digital health Technology for Diabetes (SuMMiT-D) project has developed, and is evaluating, a mobile phone-based intervention delivering brief messages targeting identified behaviour change techniques promoting medication use to people with type 2 diabetes in general practice. The present study aimed to inform refinement and future implementation of the SuMMiT-D intervention by investigating general practice staff perceptions of how a text message-based intervention to support medication adherence should be implemented within current and future diabetes care. METHODS Seven focus groups and five interviews were conducted with 46 general practice staff (including GPs, nurses, healthcare assistants, receptionists and linked pharmacists) with a potential role in the implementation of a text message-based intervention for people with type 2 diabetes. Interviews and focus groups were audio-recorded, transcribed and analysed using an inductive thematic analysis approach. RESULTS Five themes were developed. One theme 'The potential of technology as a patient ally' described a need for diabetes support and the potential of technology to support medication use. Two themes outlined challenges to implementation, 'Limited resources and assigning responsibility' and 'Treating the patient; more than diabetes medication adherence'. The final two themes described recommendations to support implementation, 'Selling the intervention: what do general practice staff need to see?' and 'Fitting the mould; complementing current service delivery'. CONCLUSIONS Staff see the potential for a text message-based support intervention to address unmet needs and to enhance care for people with diabetes. Digital interventions, such as SuMMiT-D, need to be compatible with existing systems, demonstrate measurable benefits, be incentivised and be quick and easy for staff to engage with. Interventions also need to be perceived to address general practice priorities, such as taking a holistic approach to care and having multi-cultural reach and relevance. Findings from this study are being combined with parallel work with people with type 2 diabetes to ensure stakeholder views inform further refinement and implementation of the SuMMiT-D intervention.
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Affiliation(s)
- Karen Butler
- Health Behaviour Change Research Group, School of Psychology, University of Galway, University Road, Galway, Ireland
| | - Yvonne Kiera Bartlett
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK
| | - Nikki Newhouse
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - David P French
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK
| | - Cassandra Kenning
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Rustam Rea
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Veronika Williams
- Faculty of Education and Professional Studies, School of Nursing, Nipissing University, North Bay, Canada
| | - Jenny Mc Sharry
- Health Behaviour Change Research Group, School of Psychology, University of Galway, University Road, Galway, Ireland.
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Bartlett YK, Farmer A, Newhouse N, Miles L, Kenning C, French DP. Effects of Using a Text Message Intervention on Psychological Constructs and the Association Between Changes to Psychological Constructs and Medication Adherence in People With Type 2 Diabetes: Results From a Randomized Controlled Feasibility Study. JMIR Form Res 2022; 6:e30058. [PMID: 35486430 PMCID: PMC9107060 DOI: 10.2196/30058] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/10/2021] [Accepted: 10/24/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Poor adherence to oral medications is common in people with type 2 diabetes and can lead to an increased chance of health complications. Text messages may provide an effective delivery method for an intervention; however, thus far, the majority of these interventions do not specify either a theoretical basis or propose specific mechanisms of action. This makes it hard to determine how and whether an intervention is having an effect. The text messages included in the current intervention have been developed to deliver specific behavior change techniques. These techniques are the "active ingredients" of the intervention and were selected to target psychological constructs identified as predictors of medication adherence. OBJECTIVE There are 2 aims of this study: (1) to assess whether a text message intervention with specified behavior change techniques can change the constructs that predict medication adherence behaviors in people with type 2 diabetes and (2) to assess whether changes to psychological constructs are associated with changes in self-reported medication adherence. METHODS We conducted a randomized controlled, 6-month feasibility trial. Adults prescribed oral medication for type 2 diabetes (N=209) were recruited from general practice and randomized to either receive a text message-based intervention or care as usual. Data were analyzed with repeated measures analysis of covariance and Spearman rho correlation coefficients. RESULTS For 8 of the 14 constructs that were measured, a significant time-by-condition interaction was found: necessity beliefs, intention, maintenance self-efficacy, recovery self-efficacy, action control, prompts and cues, social support, and satisfaction with experienced consequences all increased in the intervention group compared to the control group. Changes in action self-efficacy, intention, automaticity, maintenance self-efficacy, and satisfaction with experienced consequences were positively associated with changes in self-reported medication adherence. CONCLUSIONS A relatively low-cost, scalable, text message-only intervention targeting medication adherence using behavior change techniques can influence psychological constructs that predict adherence. Not only do these constructs predict self-reported medication adherence, but changes in these constructs are correlated with changes in self-reported medication adherence. These findings support the promise of text message-based interventions for medication adherence in this population and suggest likely mechanisms of action. TRIAL REGISTRATION ISRCTN Registry ISRCTN13404264; https://www.isrctn.com/ISRCTN13404264.
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Affiliation(s)
- Yvonne Kiera Bartlett
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Nikki Newhouse
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Lisa Miles
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Cassandra Kenning
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - David P French
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
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Farmer A, Jones L, Newhouse N, Kenning C, Williams N, Chi Y, Bartlett YK, Plumpton C, McSharry J, Cholerton R, Holmes E, Robinson S, Allen J, Gudgin B, Velardo C, Rutter H, Horne R, Tarassenko L, Williams V, Locock L, Rea R, Yu LM, Hughes D, Bower P, French D. Supporting People With Type 2 Diabetes in the Effective Use of Their Medicine Through Mobile Health Technology Integrated With Clinical Care to Reduce Cardiovascular Risk: Protocol for an Effectiveness and Cost-effectiveness Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e32918. [PMID: 35188478 PMCID: PMC8902673 DOI: 10.2196/32918] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Type 2 diabetes is a common lifelong condition that affects over 400 million people worldwide. The use of effective medications and active self-management can reduce the risk of serious complications. However, people often have concerns when starting new medications and face difficulties in taking their medications regularly. Support provided by brief messages delivered through mobile phone-based SMS text messages can be effective in some long-term conditions. We have identified promising behavior change techniques (BCTs) to promote medication adherence in this population via a systematic review and developed SMS text messages that target these BCTs. Feasibility work has shown that these messages have fidelity to intended BCTs, are acceptable to patients, and are successful in changing the intended determinants of medication adherence. We now plan to test this intervention on a larger scale in a clinical trial. OBJECTIVE The aim of this trial is to determine the effectiveness and cost-effectiveness of this intervention for reducing cardiovascular risk in people with type 2 diabetes by comparing it with usual care. METHODS The trial will be a 12-month, multicenter, individually randomized controlled trial in primary care and will recruit adults (aged ≥35 years) with type 2 diabetes in England. Consenting participants will be randomized to receive short SMS text messages intended to affect a change in medication adherence 3 to 4 times per week in addition to usual care. The aim is to test the effectiveness and cost-effectiveness of the intervention when it is added to usual care. The primary clinical outcome will be a composite cardiovascular risk measure. Data including patient-reported measures will be collected at baseline, at 13 and 26 weeks, and at the end of the 12-month follow-up period. With 958 participants (479 in each group), the trial is powered at 92.5% to detect a 4-percentage point difference in cardiovascular risk. The analysis will follow a prespecified plan. A nested quantitative and qualitative process analysis will be used to examine the putative mechanisms of behavior change and wider contextual influences. A health economic analysis will be used to assess the cost-effectiveness of the intervention. RESULTS The trial has completed the recruitment phase and is in the follow-up phase. The publication of results is anticipated in 2024. CONCLUSIONS This trial will provide evidence regarding the effectiveness and cost-effectiveness of this intervention for people with type 2 diabetes. TRIAL REGISTRATION ISRCTN Registry ISRCTN15952379; https://www.isrctn.com/ISRCTN15952379. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/32918.
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Affiliation(s)
- Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Louise Jones
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Nikki Newhouse
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Cassandra Kenning
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
| | - Nicola Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Yuan Chi
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Y Kiera Bartlett
- Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
| | - Catrin Plumpton
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Rachel Cholerton
- Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
| | - Emily Holmes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | - Stephanie Robinson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Julie Allen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Bernard Gudgin
- Patient Advocate, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Carmelo Velardo
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
- Sensyne Health plc, Oxford, United Kingdom
| | - Heather Rutter
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Rob Horne
- Centre for Behavioural Medicine, University College London, London, United Kingdom
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | | | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Rustam Rea
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | - Peter Bower
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
| | - David French
- Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
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Bartlett YK, Kenning C, Crosland J, Newhouse N, Miles LM, Williams V, McSharry J, Locock L, Farmer AJ, French DP. Understanding acceptability in the context of text messages to encourage medication adherence in people with type 2 diabetes. BMC Health Serv Res 2021; 21:608. [PMID: 34182988 PMCID: PMC8240254 DOI: 10.1186/s12913-021-06663-2] [Citation(s) in RCA: 8] [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: 01/29/2021] [Accepted: 05/11/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Acceptability is recognised as a key concept in the development of health interventions, but there has been a lack of consensus about how acceptability should be conceptualised. The theoretical framework of acceptability (TFA) provides a potential tool for understanding acceptability. It has been proposed that acceptability measured before use of an intervention (anticipated acceptability) may differ from measures taken during and after use (experienced acceptability), but thus far this distinction has not been tested for a specific intervention. This paper 1) directly compares ratings of anticipated and experienced acceptability of a text message-based intervention, 2) explores the applicability of the TFA in a technology-based intervention, and 3) uses these findings to inform suggestions for measuring acceptability over the lifespan of technology-based health interventions. METHODS Data were obtained from a quantitative online survey assessing anticipated acceptability of the proposed text messages (n = 59) and a 12-week proof-of-concept mixed methods study assessing experienced acceptability while receiving the text messages (n = 48). Both quantitative ratings by return text message, and qualitative data from participant interviews were collected during the proof-of-concept study. RESULTS The quantitative analysis showed anticipated and experienced acceptability were significantly positively correlated (rs > .4). The qualitative analysis identified four of the seven constructs of the TFA as themes (burden, intervention coherence, affective attitude and perceived effectiveness). An additional two themes were identified as having an important impact on the TFA constructs (perceptions of appropriateness and participants' role). Three suggestions are given related to the importance of appropriateness, what may affect ratings of acceptability and what to consider when measuring acceptability. CONCLUSIONS The high correlation between anticipated and experienced acceptability was a surprising finding and could indicate that, in some cases, acceptability of an intervention can be gauged adequately from an anticipated acceptability study, prior to an expensive pilot or feasibility study. Directly exploring perceptions of appropriateness and understanding whether the acceptability described by participants is related to the intervention or the research - and is for themselves or others - is important in interpreting the results and using them to further develop interventions and predict future use.
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Affiliation(s)
- Y Kiera Bartlett
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Coupland 1 Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Cassandra Kenning
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jack Crosland
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Coupland 1 Building, Oxford Road, Manchester, M13 9PL, UK
| | - Nikki Newhouse
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lisa M Miles
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Coupland 1 Building, Oxford Road, Manchester, M13 9PL, UK
| | | | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, Republic of Ireland
| | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Andrew J Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - David P French
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Coupland 1 Building, Oxford Road, Manchester, M13 9PL, UK
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Waheed W, Mirza N, Waheed MW, Blakemore A, Kenning C, Masood Y, Matthews F, Bower P. Recruitment and methodological issues in conducting dementia research in British ethnic minorities: A qualitative systematic review. Int J Methods Psychiatr Res 2020; 29:e1806. [PMID: 31808215 PMCID: PMC7051842 DOI: 10.1002/mpr.1806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 07/05/2018] [Revised: 07/11/2019] [Accepted: 08/16/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Identifying existing recruitment and methodological issues within dementia research conducted in UK studies that included ethnic minorities. METHODS We searched for and included any publication detailing dementia research in the UK that included any ethnic minority. The search results and all titles and abstracts were screened according to the inclusion criteria followed by screening of the full texts. We extracted data regarding the recruitment and methodological issues faced by the researchers. This data was combined and listed, and related issues were grouped into overarching themes and subthemes. RESULTS Of 52 publications suitable for analysis, 33 provided data collated into six themes: attitudes and beliefs about dementia in ethnic minority communities, recruitment process, data collection issues, practical issues, researcher characteristics, and lack of published research and normative data. These themes allowed us to identify three areas responsible for addressing these recruitment and methodological issues: community and patient education, health services, and researchers' training. CONCLUSIONS This is the first review identifying recruitment and methodological issues within UK dementia research that included ethnic minorities. We now have a compilation of reported existing issues and a framework of areas responsible for addressing them and devising solutions.
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Affiliation(s)
- Waquas Waheed
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Nadine Mirza
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | | | - Amy Blakemore
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Cassandra Kenning
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Yumna Masood
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Fiona Matthews
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Peter Bower
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
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Farmer A, Allen J, Bartlett K, Bower P, Chi Y, French D, Gudgin B, Holmes EA, Horne R, Hughes DA, Kenning C, Locock L, McSharry J, Miles L, Newhouse N, Rea R, Riga E, Tarassenko L, Velardo C, Williams N, Williams V, Yu LM. Supporting people with type 2 diabetes in effective use of their medicine through mobile health technology integrated with clinical care (SuMMiT-D Feasibility): a randomised feasibility trial protocol. BMJ Open 2019; 9:e033504. [PMID: 31888938 PMCID: PMC6937131 DOI: 10.1136/bmjopen-2019-033504] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/30/2019] [Accepted: 12/04/2019] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Type 2 diabetes is common, affecting over 400 million people worldwide. Risk of serious complications can be reduced through use of effective treatments and active self-management. However, people are often concerned about starting new medicines and face difficulties in taking them regularly. Use of brief messages to provide education and support self-management, delivered through mobile phone-based text messages, can be an effective tool for some long-term conditions. We have developed messages aiming to support patients' self-management of type 2 diabetes in the use of medications and other aspects of self-management, underpinned by theory and evidence. The aim of this trial is to determine the feasibility of a large-scale clinical trial to test the effectiveness and cost-effectiveness of the intervention, compared with usual care. METHODS AND ANALYSIS The feasibility trial will be a multicentre individually randomised, controlled trial in primary care recruiting adults (≥35 years) with type 2 diabetes in England. Consenting participants will be randomised to receive short text messages three times a week with messages designed to produce change in medication adherence or non-health-related messages for 6 months. The aims are to test recruitment methods, retention to the study, the feasibility of data collection and the mobile phone and web-based processes of a proposed definitive trial and to refine the text messaging intervention. The primary outcome is the rate of recruitment to randomisation of participants to the trial. Data, including patient reported measures, will be collected online at baseline and the end of the 6-month follow-up period. With 200 participants (100 in each group), this trial is powered to estimate 80% follow-up within 95% CIs of 73.8% to 85.3%. The analysis will follow a prespecified plan. ETHICS AND DISSEMINATION Ethics approval was obtained from the West of Scotland Research Ethics Committee 05. The results will be disseminated through conference presentations, peer-reviewed journals and will be published on the trial website: www.summit-d.org (SuMMiT-D (SUpport through Mobile Messaging and digital health Technology for Diabetes)). TRIAL REGISTRATION NUMBER ISRCTN13404264.
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Affiliation(s)
- Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Julie Allen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kiera Bartlett
- The Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - Peter Bower
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Yuan Chi
- The Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - David French
- The Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | | | - Emily A Holmes
- School of Health Sciences, Bangor University, Bangor, UK
| | - Robert Horne
- UCL School of Pharmacy, University College London, London, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Cassandra Kenning
- Institute of Population Health, The University of Manchester, Manchester, UK
| | - Louise Locock
- Health Service Research, University of Aberdeen, Aberdeen, UK
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Lisa Miles
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | | | - Rustam Rea
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Evgenia Riga
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lionel Tarassenko
- The Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Carmelo Velardo
- The Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Nicola Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Veronika Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Kenning C, Blakemore A, Bower P, Safari M, Cuijpers P, Brown JS, Hann M, Lidbetter N, Muñoz RF, Waheed W. Preventing depression in the community by voluntary sector providers (PERSUADE): intervention development and protocol for a parallel randomised controlled feasibility trial. BMJ Open 2019; 9:e023791. [PMID: 31585966 PMCID: PMC6797240 DOI: 10.1136/bmjopen-2018-023791] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Depression is now the most common illness worldwide affecting more than 300 million people. Studies modelling the impact of depression interventions have shown that the burden of depression cannot be minimised by more than 35% with existing treatments. There is a need to develop better preventative interventions. The overall aim of this programme of work is to develop interventions to reduce depression symptom scores and prevent development of depression in people with subthreshold depression. The objectives are to adapt a low intensity community-based depression prevention intervention, establish the acceptability and uptake of this model and conduct a parallel randomised controlled feasibility trial to inform a full-scale trial. METHODS AND ANALYSIS Focus groups will be run with members of the public, voluntary sector providers and researchers to inform the adaptation of an existing depression prevention course. Sixty-four people with subthreshold depression, as represented by a score of between 5 and 9 on the Patient Health Questionnaire-9 depression measure, will be recruited to take part in the feasibility trial. Participants will be randomised equally to the intervention or usual care control groups. Participants in the intervention group will receive the new revised manual and attend a 1-day workshop delivered by voluntary sector service providers. Outcome measures will be completed 3 months after baseline. Quantitative data on recruitment, randomisation, attendance, retention, questionnaire completion rates will be collected. Primary analyses will be descriptive and a process evaluation will be conducted to assess the processes involved in implementing the intervention. Interviews will be conducted to explore acceptability and framework analysis will be used to analyse the data. ETHICS AND DISSEMINATION The study has been reviewed and approved by NHS Research and Ethics Committee: NW-Greater Manchester East. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media, the internet and community engagement activities. TRIAL REGISTRATION NUMBER ISRCTN23278208;Pre-results.
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Affiliation(s)
- Cassandra Kenning
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, Greater Manchester, UK
| | - Amy Blakemore
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, Manchester, UK
| | - Peter Bower
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, Greater Manchester, UK
| | - Melina Safari
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, Greater Manchester, UK
| | - Pim Cuijpers
- Faculty of Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - June Sl Brown
- Department of Psychology, Kings College London, London, UK
| | - Mark Hann
- Centre for Biostatistics and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Ricardo F Muñoz
- Institute for International Internet Interventions for Health, Palo Alto University, Palo Alto, California, USA
| | - Waquas Waheed
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, Greater Manchester, UK
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Blakemore A, Kenning C, Mirza N, Daker-White G, Panagioti M, Waheed W. Dementia in UK South Asians: a scoping review of the literature. BMJ Open 2018; 8:e020290. [PMID: 29654029 PMCID: PMC5898329 DOI: 10.1136/bmjopen-2017-020290] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/24/2018] [Accepted: 03/02/2018] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Over 850 000 people live with dementia in the UK. A proportion of these people are South Asians, who make up over 5% of the total UK population. Little is known about the prevalence, experience and treatment of dementia in the UK South Asian population. The aim of this scoping review is to identify dementia studies conducted in the UK South Asian population to highlight gaps in the literature which need to be addressed in future research. METHOD Databases were systematically searched using a comprehensive search strategy to identify studies. A methodological framework for conducting scoping reviews was followed. An extraction form was developed to chart data and collate study characteristics and findings. Studies were then grouped into six categories: prevalence and characteristics; diagnosis validation and screening; knowledge, understanding and attitudes; help-seeking; experience of dementia; service organisation and delivery. RESULTS A total of 6483 studies were identified, 27 studies were eligible for inclusion in the scoping review. We found that studies of prevalence, diagnosis and service organisation and delivery in UK South Asians are limited. We did not find any clinical trials of culturally appropriate interventions for South Asians with dementia in the UK. The existing evidence comes from small-scale service evaluations and case studies. CONCLUSIONS This is the first scoping review of the literature to identify priority areas for research to improve care for UK South Asians with dementia. Future research should first focus on developing and validating culturally appropriate diagnostic tools for the UK South Asians and then conducting high-quality epidemiological studies in order to accurately identify the prevalence of dementia in this group. The cultural adaptation of interventions for dementia and testing in randomised controlled trials is also vital to ensure that there are appropriate treatments available for the UK South Asians to access.
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Affiliation(s)
- Amy Blakemore
- Division of Nursing, Social Work and Midwifery, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Cassandra Kenning
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Nadine Mirza
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Gavin Daker-White
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Maria Panagioti
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Waquas Waheed
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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13
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Kenning C, Lovell K, Hann M, Agius R, Bee PE, Chew-Graham C, Coventry PA, van der Feltz-Cornelis CM, Gilbody S, Hardy G, Kellett S, Kessler D, McMillan D, Reeves D, Rick J, Sutton M, Bower P. Collaborative case management to aid return to work after long-term sickness absence: a pilot randomised controlled trial. Public Health Res 2018. [DOI: 10.3310/phr06020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BackgroundDespite high levels of employment among working-age adults in the UK, there is still a significant minority who are off work with ill health at any one time (so-called ‘sickness absence’). Long-term sickness absence results in significant costs to the individual, to the employer and to wider society.ObjectiveThe overall objective of the intervention was to improve employee well-being with a view to aiding return to work. To meet this aim, a collaborative case management intervention was adapted to the needs of UK employees who were entering or experiencing long-term sickness absence.DesignA pilot randomised controlled trial, using permuted block randomisation. Recruitment of patients with long-term conditions in settings such as primary care was achieved by screening of routine records, followed by mass mailing of invitations to participants. However, the proportion of patients responding to such invitations can be low, raising concerns about external validity. Recruitment in the Case Management to Enhance Occupational Support (CAMEOS) study used this method to test whether or not it would transfer to a population with long-term sickness absence in the context of occupational health (OH).ParticipantsEmployed people on long-term sickness absence (between 4 weeks and 12 months). The pilot was run with two different collaborators: a large organisation that provided OH services for a number of clients and a non-profit community-based organisation.InterventionCollaborative case management was delivered by specially trained case managers from the host organisations. Sessions were delivered by telephone and supported use of a self-help handbook. The comparator was usual care as provided by participants’ general practitioner (GP) or OH provider. This varied for participants according to the services available to them. Neither participants nor the research team were blind to randomisation.Main outcome measuresRecruitment rates, intervention delivery and acceptability to participants were the main outcomes. Well-being, as measured by the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), and return-to-work rates were also recorded.ResultsIn total, over 1000 potentially eligible participants were identified across the sites and invited to participate. However, responses were received from just 61 of those invited (5.5%), of whom 16 (1.5%) were randomised to the trial (seven to treatment, nine to control). Detailed information on recruitment methods, intervention delivery, engagement and acceptability is presented. No harms were reported in either group.ConclusionsThis pilot study faced a number of barriers, particularly in terms of recruitment of employers to host the research. Our ability to respond to these challenges faced several barriers related to the OH context and the study set up. The intervention seemed feasible and acceptable when delivered, although caution is required because of the small number of randomised participants. However, employees’ lack of engagement in the research might imply that they did not see the intervention as valuable.Future workDeveloping effective and acceptable ways of reducing sickness absence remains a high priority. We discuss possible ways of overcoming these challenges in the future, including incentives for employers, alternative study designs and further modifications to recruitment methods.Trial registrationCurrent Controlled Trials ISRCTN33560198.FundingThis project was funded by the NIHR Public Health Research programme and will be published in full inPublic Health Research; Vol. 6, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Cassandra Kenning
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Mark Hann
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Raymond Agius
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - Penny E Bee
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | | | | | | | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | - Gillian Hardy
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Stephen Kellett
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - David Kessler
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK
| | - David Reeves
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Joanne Rick
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Matthew Sutton
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Peter Bower
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
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Kenning C, Daker-White G, Blakemore A, Panagioti M, Waheed W. Barriers and facilitators in accessing dementia care by ethnic minority groups: a meta-synthesis of qualitative studies. BMC Psychiatry 2017; 17:316. [PMID: 28854922 PMCID: PMC5577676 DOI: 10.1186/s12888-017-1474-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [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: 04/12/2017] [Accepted: 08/22/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND It is estimated that there are about 25,000 people from UK ethnic minority groups with dementia. It is clear that there is an increasing need to improve access to dementia services for all ethnic groups to ensure that everyone has access to the same potential health benefits. The aim was to systematically review qualitative studies and to perform a meta-synthesis around barriers and facilitators to accessing care for dementia in ethnic minorities. METHODS Databases were searched to capture studies on barriers and facilitators to accessing care for dementia in ethnic minorities. Analysis followed the guidelines for meta-ethnography. All interpretations of data as presented by the authors of the included papers were extracted and grouped into new themes. RESULTS Six hundred and eighty four papers were identified and screened. Twenty eight studies were included in the meta-synthesis. The analysis developed a number of themes and these were incorporated into two overarching themes: 'inadequacies' and 'cultural habitus'. CONCLUSIONS The two overarching themes lend themselves to interventions at a service level and a community level which need to happen in synergy. TRIAL REGISTRATION The review was registered with PROSPERO: CRD42016049326 .
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Affiliation(s)
- Cassandra Kenning
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, 5th floor, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Gavin Daker-White
- 0000000121662407grid.5379.8Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, 5th floor, Williamson Building, Oxford Road, Manchester, M13 9PL UK
| | - Amy Blakemore
- 0000000121662407grid.5379.8Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, 5th floor, Williamson Building, Oxford Road, Manchester, M13 9PL UK
| | - Maria Panagioti
- 0000000121662407grid.5379.8Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, 5th floor, Williamson Building, Oxford Road, Manchester, M13 9PL UK
| | - Waquas Waheed
- 0000000121662407grid.5379.8Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, 5th floor, Williamson Building, Oxford Road, Manchester, M13 9PL UK
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Adeniji C, Kenning C, Coventry PA, Bower P. What are the core predictors of 'hassles' among patients with multimorbidity in primary care? A cross sectional study. BMC Health Serv Res 2015; 15:255. [PMID: 26137932 PMCID: PMC4489210 DOI: 10.1186/s12913-015-0927-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 06/19/2015] [Indexed: 11/10/2022] Open
Abstract
Background A limitation of service delivery in primary care in the United Kingdom is that services are often organised to manage discrete long-term conditions, using guidelines related to single conditions, and managed in clinics organised around single conditions. However, many older patients have more than one condition (so called multimorbidity). Qualitative research suggests that these patients experience ‘hassles’ in their care, including multiple appointments, poor co-ordination, and conflicting recommendations. However, there is limited quantitative evidence on the ‘hassles’ that patients with multimorbidity experience, or factors predicting ‘hassles’ in patients with multimorbidity. Methods We conducted a cross sectional study, mailing questionnaires to 1460 patients with multimorbidity identified from the disease registers of four general practices in the UK. Patients were asked to complete a range of self-report measures including measures of multimorbidity, measures of their experience of multimorbidity and service delivery. Data were analysed using regression modelling to assess the factors predicting ‘hassles’ in patients with multimorbidity. Results In total 33 % (n = 486) of patients responded to the baseline survey. The ‘hassles’ most often reported by patients related to lack of information about conditions and treatment options, poor communication among health professionals, and poor access to specialist care. There was a significant relationship between numbers of conditions, and reports of ‘hassles’. In multivariate analysis, 5 variables predicted more ‘hassles’: more long-term conditions, symptoms of anxiety and depression, younger age, being in paid employment, and not having a discussion with their GP in the last 12 months. Conclusion Hassles are frequently reported by patients with multimorbidity in primary care. A priority for future research should be on the development of new models of care that better cater for these patients. This research highlights core hassles that need to be addressed, and the patient groups that are most at risk, which may aid in the design of these new models.
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Affiliation(s)
- Charles Adeniji
- *NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Williamson Building, Manchester, M13 9PL, UK. .,NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK.
| | - Cassandra Kenning
- NIHR Collaboration for Applied Health Research and Care, Greater Manchester (GM-CLAHRC), Manchester Academic Health Science Centre (MAHSC), University of Manchester, Williamson Building, Manchester, M13 9PL, UK.
| | - Peter A Coventry
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK.
| | - Peter Bower
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK.
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Kenning C, Coventry PA, Gibbons C, Bee P, Fisher L, Bower P. Does patient experience of multimorbidity predict self-management and health outcomes in a prospective study in primary care? Fam Pract 2015; 32:311-6. [PMID: 25715962 PMCID: PMC4445135 DOI: 10.1093/fampra/cmv002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There is a need to better understand the mechanisms which lead to poor outcomes in patients with multimorbidity, especially those factors that might be amenable to intervention. OBJECTIVE This research aims to explore what factors predict self-management behaviour and health outcomes in patients with multimorbidity in primary care in the UK. METHODS A prospective study design was used. Questionnaires were mailed out to 1460 patients with multimorbidity. Patients were asked to complete a range of self-report measures including measures of multimorbidity, measures of their experience of multimorbidity and service delivery and outcomes (three measures of self-management: behaviours, Self-monitoring and Insight and medication adherence; and a measure of self-reported health). RESULTS In total, 36% (n = 499) of patients responded to the baseline survey and 80% of those respondents completed follow-up. Self-management behaviour at 4 months was predicted by illness perceptions around the consequences of individual conditions. Self-monitoring and Insight at 4 months was predicted by patient experience of 'Hassles' in health services. Self-reported medication adherence at 4 months was predicted by health status, Self-monitoring and Insight and 'Hassles' in health services. Perceived health status at 4 months was predicted by age and patient experience of multimorbidity. CONCLUSIONS This research shows that different factors, particularly around patients' experiences of health care and control over their treatment, impact on various types of self-management. Patient experience of multimorbidity was not a critical predictor of self-management but did predict health status in the short term. The findings can help to develop and target interventions that might improve outcomes in patients with multimorbidity.
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Affiliation(s)
- Cassandra Kenning
- Institute of Population Health, NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC),
| | - Peter A Coventry
- Institute of Population Health, NIHR Collaboration for Applied Health Research and Care, Greater Manchester (GM-CLAHRC), Manchester Academic Health Science Centre (MAHSC)
| | - Chris Gibbons
- Institute of Population Health, NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC)
| | - Penny Bee
- Institute of Population Health, School of Nursing, Midwifery and Social Work and
| | - Louise Fisher
- Institute of Population Health, NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC)
| | - Peter Bower
- Institute of Population Health, NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
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Kenning C, Protheroe J, Gray N, Ashcroft D, Bower P. The potential for using a Universal Medication Schedule (UMS) to improve adherence in patients taking multiple medications in the UK: a qualitative evaluation. BMC Health Serv Res 2015; 15:94. [PMID: 25888725 PMCID: PMC4359545 DOI: 10.1186/s12913-015-0749-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 02/17/2015] [Indexed: 12/04/2022] Open
Abstract
Background Poor adherence to prescribed medication has major consequences. Managing multiple long-term conditions often involves polypharmacy, potentially increasing complexity and the possibility of poor adherence. As a result of the globally recognised problems in supporting adherence to medication, some researchers have proposed the use of reminder charts. The main aim of the research was to explore the need for and perceptions around the ‘Universal Medication Schedule’ (UMS). Looking at ways in which pharmacists and General Practitioners (GPs) could use the UMS in NHS settings. Methods Semi-structured interviews were carried out with 10 GPs, 10 community pharmacists and 15 patients. Patients were aged 65 years and over, had multiple long-term conditions and were prescribed at least 5 medications. Interviews were recorded and transcribed and thematic analysis was conducted, using a framework approach to manage the data. Results Attitudes towards the UMS were mixed with stakeholders seeing benefits and limitations to the chart. Practitioners proposed a number of existing services where they thought the UMS could easily be integrated but there was evidence of role conflict with GPs feeling it may be best placed with pharmacists and vice versa. The potential for the UMS to be used as a tool to aid communication between the different services involved in a patient’s care was a key theme. Conclusions The UMS chart provides consolidated medicines information that might help to improve patients’ knowledge and health literacy, which may or may not improve adherence but could help patients in making informed decisions about their treatment. One of the key benefits of using the UMS in practice is that it could be introduced across services. In this way it may aid in medicines reconciliation between healthcare settings to ensure continuity of message, improve patient experience and create more joined up working between services. Further research is needed to test implementation in different services and to assess outcomes on patient understanding and adherence. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0749-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cassandra Kenning
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor, Williamson Building, Oxford Road, M13 9PL, Manchester, UK.
| | - Joanne Protheroe
- Institute of Primary Care and Health Sciences, Keele University, Keele, UK.
| | - Nicola Gray
- Independent Pharmacist Researcher and Director- Green Line Consulting Ltd, Manchester, UK.
| | - Darren Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety Research, Manchester Pharmacy School, NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, UK.
| | - Peter Bower
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK.
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Gibbons CJ, Kenning C, Coventry PA, Bee P, Bundy C, Fisher L, Bower P. Development of a multimorbidity illness perceptions scale (MULTIPleS). PLoS One 2013; 8:e81852. [PMID: 24376504 PMCID: PMC3869652 DOI: 10.1371/journal.pone.0081852] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 10/18/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Illness perceptions are beliefs about the cause, nature and management of illness, which enable patients to make sense of their conditions. These perceptions can predict adjustment and quality of life in patients with single conditions. However, multimorbidity (i.e. patients with multiple long-term conditions) is increasingly prevalent and a key challenge for future health care delivery. The objective of this research was to develop a valid and reliable measure of illness perceptions for multimorbid patients. METHODS Candidate items were derived from previous qualitative research with multimorbid patients. Questionnaires were posted to 1500 patients with two or more exemplar long-term conditions (depression, diabetes, osteoarthritis, coronary heart disease and chronic obstructive pulmonary disease). Data were analysed using factor analysis and Rasch analysis. Rasch analysis is a modern psychometric technique for deriving unidimensional and intervally-scaled questionnaires. RESULTS Questionnaires from 490 eligible patients (32.6% response) were returned. Exploratory factor analysis revealed five potential subscales 'Emotional representations', 'Treatment burden', 'Prioritising conditions', 'Causal links' and 'Activity limitations'. Rasch analysis led to further item reduction and the generation of a summary scale comprising of items from all scales. All scales were unidimensional and free from differential item functioning or local independence of items. All scales were reliable, but for each subscale there were a number of patients who scored at the floor of the scale. CONCLUSIONS The MULTIPleS measure consists of five individual subscales and a 22-item summary scale that measures the perceived impact of multimorbidity. All scales showed good fit to the Rasch model and preliminary evidence of reliability and validity. A number of patients scored at floor of each subscale, which may reflect variation in the perception of multimorbidity. The MULTIPleS measure will facilitate research into the impact of illness perceptions on adjustment, clinical outcomes, quality of life, and costs in patients with multimorbidity.
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Affiliation(s)
- Chris J. Gibbons
- NIHR Collaboration for Leadership in Applied Health Research and Care for Greater Manchester, University of Manchester, Manchester, United Kingdom
- NIHR School for Primary Care Research, NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, United Kingdom
- * E-mail:
| | - Cassandra Kenning
- NIHR School for Primary Care Research, NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, United Kingdom
| | - Peter A. Coventry
- NIHR Collaboration for Leadership in Applied Health Research and Care for Greater Manchester, University of Manchester, Manchester, United Kingdom
- NIHR School for Primary Care Research, NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, United Kingdom
| | - Penny Bee
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom
| | - Christine Bundy
- Manchester Centre for Health Psychology, Institute of Inflammation and Repair, University of Manchester, Manchester, United Kingdom
| | - Louise Fisher
- NIHR School for Primary Care Research, NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, United Kingdom
| | - Peter Bower
- NIHR School for Primary Care Research, NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, United Kingdom
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Kenning C, Fisher L, Bee P, Bower P, Coventry P. Primary care practitioner and patient understanding of the concepts of multimorbidity and self-management: A qualitative study. SAGE Open Med 2013; 1:2050312113510001. [PMID: 26770690 PMCID: PMC4687771 DOI: 10.1177/2050312113510001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [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: 02/01/2023] Open
Abstract
OBJECTIVES The aim of this article is to offer insight into how professionals and patients understand and experience multimorbidity and how these accounts differ, and how they affect attitudes and engagement with self-management. METHODS Semi-structured interviews with 20 primary healthcare practitioners and 20 patients with at least 2 long-term conditions (including coronary heart disease, diabetes, osteoarthritis, chronic obstructive pulmonary disease and depression). Thematic analysis was used, and themes were identified using an open-coding method. RESULTS Practitioners associated multimorbidity with complexity and uncertainty in the clinic, leading to emotional strain and 'heart sink'. Patient accounts differed. Some described multimorbidity as problematic when it exacerbated their symptoms and caused emotional and psychological strain. Others did not perceive multimorbidity as problematic. Self-management was seen by practitioners and patients to be a key element of managing multiple conditions, but drivers for prompting and engaging in self-management differed between patients and practitioners. CONCLUSION This study suggests that recommendations for clinical practice for multimorbid patients should take into account the gap in perceptions between practitioner and patients about experiences of multimorbidity. Not least, practice would need to reflect the tension between practitioners' and patients' accounts about the role and benefits of self-management in the presence of multimorbidity.
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Affiliation(s)
- Cassandra Kenning
- NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
| | - Louise Fisher
- NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Penny Bee
- Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK; School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
| | - Peter Coventry
- Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK; NIHR Collaboration for Applied Health Research and Care for Greater Manchester (GM-CLAHRC), University of Manchester, Manchester, UK
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Coventry PA, Bower P, Keyworth C, Kenning C, Knopp J, Garrett C, Hind D, Malpass A, Dickens C. The effect of complex interventions on depression and anxiety in chronic obstructive pulmonary disease: systematic review and meta-analysis. PLoS One 2013; 8:e60532. [PMID: 23585837 PMCID: PMC3621386 DOI: 10.1371/journal.pone.0060532] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 02/26/2013] [Indexed: 11/18/2022] Open
Abstract
Background Depression and anxiety are very common in people with chronic obstructive pulmonary disease (COPD) and are associated with excess morbidity and mortality. Patients prefer non-drug treatments and clinical guidelines promote non-pharmacological interventions as first line therapy for depression and anxiety in people with long term conditions. However the comparative effectiveness of psychological and lifestyle interventions among COPD patients is not known. We assessed whether complex psychological and/or lifestyle interventions are effective in reducing symptoms of anxiety and depression in patients with COPD. We then determined what types of psychological and lifestyle interventions are most effective. Methods and Findings Systematic review of randomised controlled trials of psychological and/or lifestyle interventions for adults with COPD that measured symptoms of depression and/or anxiety. CENTRAL, Medline, Embase, PsychINFO, CINAHL, ISI Web of Science and Scopus were searched up to April 2012. Meta-analyses using random effects models were undertaken to estimate the average effect of interventions on depression and anxiety. Thirty independent comparisons from 29 randomised controlled trials (n = 2063) were included in the meta-analysis. Overall, psychological and/or lifestyle interventions were associated with small reductions in symptoms of depression (standardised mean difference −0.28, 95% confidence interval −0.41 to −0.14) and anxiety (standardised mean difference −0.23, 95% confidence interval −0.38 to −0.09). Multi-component exercise training was the only intervention subgroup associated with significant treatment effects for depression (standardised mean difference −0.47, 95% confidence interval −0.66 to −0.28), and for anxiety (standardised mean difference −0.45, 95% confidence interval −0.71 to −0.18). Conclusions Complex psychological and/or lifestyle interventions that include an exercise component significantly improve symptoms of depression and anxiety in people with COPD. Furthermore, multi-component exercise training effectively reduces symptoms of anxiety and depression in all people with COPD regardless of severity of depression or anxiety, highlighting the importance of promoting physical activity in this population.
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Affiliation(s)
- Peter A Coventry
- Collaboration for Leadership in Applied Health Research and Care for Greater Manchester, Centre for Primary Care, and Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
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Chitsabesan P, Rothwell J, Kenning C, Law H, Carter LA, Bailey S, Clark A. Six years on: a prospective cohort study of male juvenile offenders in secure care. Eur Child Adolesc Psychiatry 2012; 21:339-47. [PMID: 22427059 DOI: 10.1007/s00787-012-0266-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 03/05/2012] [Indexed: 10/28/2022]
Abstract
Longitudinal studies are helpful in understanding developmental trajectories and recognising opportunities for early intervention. This paper describes the long-term needs and mental health of an initial sample of male juvenile offenders, now adults 6 years after their index admission to secure care. In this prospective cohort study of 97 male juvenile offenders admitted to secure, offenders were assessed initially on admission, 2 and 6 years later. Interviews were conducted with 54 offenders at the 6-year follow-up and included an assessment of psychosocial need, mental health and psychopathy. Outcome data on offending behaviour were collected on a total of 71 offenders. Persistent offenders have needs in multiple domains as they transition into adulthood. The majority of offenders were single and about a half were in neither employment nor training. Almost nine out of ten offenders had a substance misuse disorder and a similar number met the criteria for a diagnosis of antisocial personality disorder. Substance misuse in adolescence was strongly correlated with later substance misuse in adulthood, emphasising the importance of early intervention. A diagnosis of antisocial personality disorder and living with friends and family were both significantly associated with persistent offending behaviour. Many offenders continued to reoffend despite receiving offence-related interventions and custodial care. Interventions currently aimed at reducing recidivism in more severe offenders appear to be ineffective. Persistent offenders would benefit from a multi-modal approach based on individual needs, rather than receiving generic interventions.
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Affiliation(s)
- Prathiba Chitsabesan
- Child and Family Service (Stepping Hill Hospital), Pennine Care NHS Foundation Trust, Manchester, UK.
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Kenning C, Cooper J, Short V, Shaw J, Abel K, Chew-Graham C. Prison staff and women prisoner's views on self-harm; their implications for service delivery and development: A qualitative study. Crim Behav Ment Health 2010; 20:274-284. [PMID: 20603816 DOI: 10.1002/cbm.777] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Rates of self-harm are high among women in prison in the UK. This is the first study to compare the views and attitudes of prison staff and women prisoners and to look at the effects of these attitudes on prisoner/staff relationships. AIMS To explore understanding of self-harm among women prisoners, prison officers and health-care staff and how their perceptions might influence service provision and development. METHOD Semi-structured interviews were conducted with women prisoners who self-harm and with staff at a women's prison. Data were analysed thematically. RESULTS Prison officers often attributed motives to self-harm such as 'manipulation' and 'attention-seeking', whereas descriptions by women prisoners, prison governors and health-care staff suggested explanations in affect regulation or self-punishment. CONCLUSIONS Differences between prison officers and other staff working in the prison in their understanding of self-harm by women prisoners may lie in training differences, but there may be other explanations such as self-protection/coping strategies. More training and support for officers may result in improved staff-prisoner relationships and thus, safer service provision.
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Affiliation(s)
- Cassandra Kenning
- Centre for Women's Mental Health Research, University of Manchester, Manchester, UK
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Mitchell P, Smedley K, Kenning C, McKee A, Woods D, Rennie CE, Bell RV, Aryamanesh M, Dolan M. Cognitive behaviour therapy for adolescent offenders with mental health problems in custody. J Adolesc 2010; 34:433-43. [PMID: 20673994 DOI: 10.1016/j.adolescence.2010.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 05/24/2010] [Accepted: 06/25/2010] [Indexed: 11/30/2022]
Abstract
Many studies have identified high levels of mental health problems among adolescents in custody and there is increasing evidence that mental health problems in this population are associated with further offending and mental health problems into adulthood. Despite recent improvements in mental health provision within custodial settings there is little evidence of structured interventions being offered or of their effectiveness being evaluated. A cognitively based intervention was developed and offered to adolescents with a variety of mental health problems in different secure settings, and the outcomes compared with a control group. Although this small-scale study did not identify significant differences in outcomes for the two groups, both recruitment and retention in therapy were good, and potential candidates were not excluded on the basis of learning difficulties or co-morbidity. The study demonstrated the viability of a delivering cognitively based intervention for common mental health problems within secure settings.
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Affiliation(s)
- Paul Mitchell
- Greater Manchester West Mental Health NHS Foundation Trust, Research Office, Gardener Unit, Bury New Road, Prestwich, Manchester, M25 3BL, United Kingdom.
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Abstract
BACKGROUND Research has revealed high levels of mental health needs in young offenders but many studies have been small, focusing on specific populations. AIMS To evaluate the mental health and psychosocial needs of a nationally representative sample of juvenile offenders in England and Wales, including female offenders and those from Black and minority ethnic groups. METHOD A cross-sectional survey of 301 young offenders, 151 in custody and 150 in the community, was conducted in six geographically representative areas across England and Wales. Each young person was interviewed to obtain demographic information, mental health and social needs, and psychometric data. RESULTS Young offenders were found to have high levels of needs in a number of different areas including mental health (31%), education/work (36%) and social relationships (48%). Young offenders in the community had significantly more needs than those in secure care and needs were often unmet. One in five young offenders was also identified as having a learning disability (IQ<70). CONCLUSIONS Needs for young offenders were high but often unmet. This emphasises the importance of structured needs assessment within custody and community settings in conjunction with a care programme approach that improves continuity of care.
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Affiliation(s)
- Prathiba Chitsabesan
- Research Room, Gardner Unit, Bolton, Trafford and Salford Mental Health Trust, Bury New Road, Manchester M25 3BL, UK.
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Abstract
BACKGROUND The full costs of accommodating and supporting young people in the criminal justice system are unknown. There is also concern about the level of mental health needs among young offenders and the provision of appropriate mental health services. AIMS To estimate the full cost of supporting young people in the criminal justice system in England and Wales and to examine the relationship between needs, service use and cost. METHOD Cross-sectional survey of 301 young offenders, 151 in custody and 150 in the community, conducted in six geographically representative areas of England and Wales. RESULTS Mental health service use was low despite high levels of need, particularly in the community. Monthly costs were significantly higher among young people interviewed in secure facilities than in the community (pound 4645 v. pound 1863; P<0.001). Younger age and a depressed mood were associated with greater costs. CONCLUSIONS Young people in the criminal justice system are a significant financial burden not only on that system but also on social services, health and education. The relationship between cost and depressed mood indicates a role for mental health services in supporting young offenders, particularly those in the community.
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Affiliation(s)
- Barbara Barrett
- Centre for the Economics of Mental Health, Box PO24, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.
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Kenning C. Course of action. Nurs Times 1994; 90:52. [PMID: 8115259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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