Consultation and consequences: A view on the services experienced by some young people and six families

Reports the views of some young people and 6 families on services received from social care professionals. Summarises the main themes that emerged and emphasises the issue of professional reliability as articulated in these 2 small, but in depth, studies. The views of both sets of interviewees contributed to the creation of a course for front line managers drawing from user and worker consultations. Draws on the interviews to shed light on various aspects of professional relationships with services users and what they said they wanted. Discussion sets this in the context of policy agenda

Merging current health care trends: Innovative perspective in aging care

Current trends in health care delivery and management such as predictive and personalized health care incorporating information and communication technologies, home-based care, health prevention and promotion through patients’ empowerment, care coordination, community health networks and governance represent exciting possibilities to dramatically improve health care. However, as a whole, current health care trends involve a fragmented and scattered array of practices and uncoordinated pilot projects. The present paper describes an innovative and integrated model incorporating and “assembling” best practices and projects of new innovations into an overarching health care system that can effectively address the multidimensional health care challenges related to aging patient especially with chronic health issues. The main goal of the proposed model is to address the emerging health care challenges of an aging population and stimulate improved cost-efficiency, effectiveness, and patients’ well-being. The proposed home-based and community-centered Integrated Healthcare Management System may facilitate reaching the persons in their natural context, improving early detection, and preventing illnesses. The system allows simplifying the health care institutional structures through interorganizational coordination, increasing inclusiveness and extensiveness of health care delivery. As a consequence of such coordination and integration, future merging efforts of current health care approaches may provide feasible solutions that result in improved cost-efficiency of health care services and simultaneously increase the quality of life, in particular, by switching the center of gravity of health delivery to a close relationship of individuals in their communities, making best use of their personal and social resources, especially effective in health delivery for aging persons with complex chronic illnesse

Framework for better living with HIV in England

1 Introduction and overview 1.1 The goal, purpose and scope of the framework This framework is the first of its kind in the UK. It describes the shared aspirations of a group of agencies for the lives of people diagnosed with HIV in England. The overarching goal of the framework is: All people with HIV are enabled to have the maximum level of health, well-being, quality of life and social integration. This is no less than the majority of people in the country expect for themselves. However, numerous obstacles prevent people with HIV from achieving this goal. These obstacles are not about having the virus but about how people with the virus are treated. This overarching goal is the situation we want to bring about. We detail this goal in seventeen subsidiary goals (what we want to happen). Each of these has a number of related aims and target groups (what we want individuals and groups to do to bring about the goal). The framework starts with the individual and seeks to bring about the conditions most favourable to individual self-determination and self-empowerment. The purpose of the framework is to: • Promote and protect the rights and well-being of all people with HIV in England. • Maximise the capacity of individuals and groups of people with HIV to care for, advocate and represent themselves effectively. • Improve and protect access to appropriate, effective and sufficient information, social support and social care services. • Minimise social, economic, governmental and judicial change detrimental to the rights and well-being of people with HIV. • Build consensus among those with a responsibility for promoting the well-being and rights of people with HIV. • Provide benchmarks against which the activities of a range of key stakeholders can be assessed, critiqued and coordinated. The framework does not describe all the activities of the organisations represented in the Framework Development Group (see section 1.4). Nor can these organisations undertake all the interventions necessary within the framework. Rather, the framework seeks to mobilise and coordinate the actions of a broad range of individuals and groups, from people with HIV themselves to government ministers. The framework primarily seeks to benefit people with diagnosed HIV infection. It is concerned with the health and well-being of those diagnosed with HIV and not those with undiagnosed HIV or those who might become infected (HIV prevention).As we are concerned with the lives of people with HIV after diagnosis, this framework is not focused on increasing HIV testing or HIV diagnosis nor does it attend to the needs of the broader population affected by HIV except where they relate to people with diagnosed HIV

Social and environmental factors influencing in-prison drug use

Purpose – There is a strong political imperative to regard the prison as a key social setting for health promotion, but evidence indicates that drug misuse continues to be a significant issue for many prisoners. This paper aims to examine the social and environmental factors within the setting that influence individuals' drug taking. Design/methodology/approach – Focus groups and interviews were conducted with prisoners and staff in three male training prisons in England. The sampling approach endeavoured to gain “maximum variation” so that a broad based understanding of the prison setting could be gathered. The data were analysed in accordance with Attride-Stirling's thematic network approach. Findings – The findings suggest a myriad of social and environmental factors influencing drug use. While staff recognised the scale of the drugs problem, they struggled to cope with creative inmates who were not perturbed by taking risks to gain their supplies. Fellow prisoners played a major role in individuals' decision making, as did the boredom of institutional life and Mandatory Drug Testing (MDT) policies within the institutions. Practical implications – Drug treatment is an essential component of prison healthcare, but it only forms a small part of creating a health-promoting setting. If the health-promoting prison is to be fully realised, a more radical, upstream and holistic outlook is required. Originality/value – The settings approach is an important theoretical and practical approach in health promotion. In comparison to other settings (such as schools), however, there has been limited research on the prison as a health-promoting environment

Tackling health inequalities in primary care: an exploration of GPs’ experience at the frontline

In Scotland, life expectancy and health outcomes are strongly tied to socioeconomic status. Specifically, socioeconomically deprived areas suffer disproportionately from high levels of premature multimorbidity and mortality. To tackle these inequalities in health, challenges in the most deprived areas must be addressed. One avenue that merits attention is the potential role of general medical practitioners (GPs) in helping to address health inequalities, particularly due to their long-term presence in deprived communities, their role in improving patient and population health, and their potential advocacy role on behalf of their patients. GPs can be seen as what Lipsky calls ‘street-level bureaucrats’ due to their considerable autonomy in the decisions they make surrounding individual patient needs, yet practising under the bureaucratic structure of the NHS. While previous research has examined the applicability of Lipsky’s framework to the role of GPs, there has been very little research exploring how GPs negotiate between the multiple identities in their work, how GPs ‘socially construct’ their patients, how GPs view their potential role as ‘advocate’, and what this means in terms of the contribution of GPs to addressing existing inequalities in health. Using semi-structured interviews, this study explored the experience and views of 24 GPs working in some of Scotland’s most deprived practices to understand how they might combat this growing health divide via the mitigation (and potential prevention) of existing health inequalities. Participants were selected based on several criteria including practice deprivation level and their individual involvement in the Deep End project, which is an informal network comprising the 100 most deprived general practices in Scotland. The research focused on understanding GPs’ perceptions of their work including its broader implications, within their practice, the communities within which they practise, and the health system as a whole. The concept of street-level bureaucracy proved to be useful in understanding GPs’ frontline work and how they negotiate dilemmas. However, this research demonstrated the need to look beyond Lipsky’s framework in order to understand how GPs reconcile their multiple identities, including advocate and manager. As a result, the term ‘street-level professional’ is offered to capture more fully the multiple identities which GPs inhabit and to explain how GPs’ elite status positions them to engage in political and policy advocacy. This study also provides evidence that GPs’ social constructions of patients are linked not only to how GPs conceptualise the causes of health inequalities, but also to how they view their role in tackling them. In line with this, the interviews established that many GPs felt they could make a difference through advocacy efforts at individual, community and policy/political levels. Furthermore, the study draws attention to the importance of practitioner-led groups—such as the Deep End project—in supporting GPs’ efforts and providing a platform for their advocacy. Within this study, a range of GPs’ views have been explored based on the sample. While it is unclear how common these views are amongst GPs in general, the study revealed that there is considerable scope for ‘political GPs’ who choose to exercise discretion in their communities and beyond. Consequently, GPs working in deprived areas should be encouraged to use their professional status and political clout not only to strengthen local communities, but also to advocate for policy change that might potentially affect the degree of disadvantage of their patients, and levels of social and health inequalities more generally

Silent voices : supporting children and young people affected by parental alcohol misuse

Main table of contents: • Summary of Key Messages and Recommendations • Section One: Background • Section Two: Methodology • Section Three: Consultation with children and young people • Section Four: Review Findings • Research Question One: What is known about the experiences of children and families where there is parental alcohol misuse and to what extent is this informed by the views of children and young people themselves? • Research Question Two: What are the key wider issues associated with PAM (e.g. unemployment, domestic abuse, mental health) and how do they relate to risk/protective factors for children and families? • Research Question Three: What is known about protective factors and processes in this population and how they can minimise risk/negative outcomes? • Research Question Four: What is known about services, and their delivery, and the impact/benefit of such services for children (and families) where there is PAM and to what extent is this informed by the views of children and young people themselves? • Research Question Five: What is the current policy context for children and families where there is PAM and how might it be improved? • Research Question Six: Thinking about questions 1 to 5 above, what are the gaps in our knowledge about children affected by PAM and services for these children

Self-management of type 2 diabetes : processes for setting up a diabetes and pre-diabetes support intervention in socioeconomically disadvantaged communities in Sweden

Background: Type 2 diabetes and pre-diabetes are major public health challenges, disproportionately affecting disadvantaged populations worldwide. The high burden of Type 2 diabetes (T2D) contributes significantly to disability, reduced quality of life, and increased use of health care services, impacting heavily on both individuals and health systems. Potentially effective interventions for the prevention and management of T2D exist and self-management is a core strategy. However, there is limited knowledge on the processes and actors required for the provision of adequate self-management support to compliment routine primary care, especially for disadvantaged populations. Aim: The overall aim is to understand the self-management support processes for type 2 diabetes and pre-diabetes in socioeconomically disadvantaged communities in Stockholm, Sweden. Specific research questions in turn focus on perceptions about self-management and pre-diabetes, the role of the community in the provision of self-management support and the opportunities for improving community involvement. Methods: The thesis comprises of four sub-studies, with studies I to III focusing on the individuals, the community and primary care in Sweden. A range of qualitative data collection methods were applied including: individual interviews, natural group discussions, and observations followed by thematic and content analysis. In study IV, a case-study approach was used, including synthesis and triangulation of data from Sweden, South Africa and Uganda, and informed by a self-management framework. Results: Patients and providers experienced dilemmas in their daily dealings with selfmanagement practices. Whilst patients struggled to adapt to recommended lifestyle changes, providers were ill equipped to manage the cultural diversity of their patients when attempting to empower them to self-manage through education (Study I). Pre-diabetes is not recognized as a diagnosis and persons at risk are uncertain of its significance in everyday life (Study II). Community was perceived as living in close proximity and sharing common resources. Interaction between communities and local and regional stakeholders was limited for health promotion and prevention activities including for T2D (Study III). In comparison to Uganda and South Africa, Sweden has established primary care routines for T2D management but self-management strategies are not adequately tailored to patients’ needs, particularly considering the diversity in the target population. In comparison to South Africa and Uganda, Swedish primary care has no established processes to engage communities in self-management support activities. Examples of this in South Africa and Uganda include integrated care through community health workers and other tailored peer or professional-led support initiatives. (Study IV). Conclusions: Self-management support is a complex process involving multiple actions and actors. The findings of this thesis highlighted: the mismatches in patient-provider perceptions of self-management; the barriers to recognizing pre-diabetes as the focus of a prevention strategy; the need to redefine the role of communities in the provision of selfmanagement support; and that strengthened ties between communities and primary care, as seen in other settings, has the potential to improve self-management. This further highlights the significance of a contextualized response to the demands of a changing population to ensure that no one is left behind