Overcoming barriers to engaging socio-economically disadvantaged populations in CHD primary prevention: a qualitative study

<p><b>Background:</b> Preventative medicine has become increasingly important in efforts to reduce the burden of chronic disease in industrialised countries. However, interventions that fail to recruit socio-economically representative samples may widen existing health inequalities. This paper explores the barriers and facilitators to engaging a socio-economically disadvantaged (SED) population in primary prevention for coronary heart disease (CHD).</p> <p><b>Methods:</b> The primary prevention element of Have a Heart Paisley (HaHP) offered risk screening to all eligible individuals. The programme employed two approaches to engaging with the community: a) a social marketing campaign and b) a community development project adopting primarily face-to-face canvassing. Individuals living in areas of SED were under-recruited via the social marketing approach, but successfully recruited via face-to-face canvassing. This paper reports on focus group discussions with participants, exploring their perceptions about and experiences of both approaches.</p> <p><b>Results:</b> Various reasons were identified for low uptake of risk screening amongst individuals living in areas of high SED in response to the social marketing campaign and a number of ways in which the face-to-face canvassing approach overcame these barriers were identified. These have been categorised into four main themes: (1) processes of engagement; (2) issues of understanding; (3) design of the screening service and (4) the priority accorded to screening. The most immediate barriers to recruitment were the invitation letter, which often failed to reach its target, and the general distrust of postal correspondence. In contrast, participants were positive about the face-to-face canvassing approach. Participants expressed a lack of knowledge and understanding about CHD and their risk of developing it and felt there was a lack of clarity in the information provided in the mailing in terms of the process and value of screening. In contrast, direct face-to-face contact meant that outreach workers could explain what to expect. Participants felt that the procedure for uptake of screening was demanding and inflexible, but that the drop-in sessions employed by the community development project had a major impact on recruitment and retention.</p> <p><b>Conclusion:</b> Socio-economically disadvantaged individuals can be hard-to-reach; engagement requires strategies tailored to the needs of the target population rather than a population-wide approach.</p&gt

Evaluation of Glasgow Housing Association’s Youth Diversionary Programme

An evaluation of three youth diversionary initiatives: Operation Reclaim, Jedworth Avenue and P8. These youth programmes were part-funded by GHA and run in collaboration with other partners

GoWell Briefing Paper 9: Youth Diversionary Programme Evaluation

Aston, E., Thomson, H., Scoular, A., & Kearns, A. (2010). GoWell Briefing Paper 9: Youth Diversionary Programme Evaluation. Glasgow: Glasgow Housing Association (GHA). https://www.gowellonline.com/assets/0000/0551/Briefing_Paper_9.pd

GoWell Briefing Paper 9: Youth Diversionary Programme Evaluation

Aston, E., Thomson, H., Scoular, A., & Kearns, A. (2010). GoWell Briefing Paper 9: Youth Diversionary Programme Evaluation. Glasgow: Glasgow Housing Association (GHA). https://www.gowellonline.com/assets/0000/0551/Briefing_Paper_9.pd

Evaluation of Glasgow Housing Association’s Youth Diversionary Programme

An evaluation of three youth diversionary initiatives: Operation Reclaim, Jedworth Avenue and P8. These youth programmes were part-funded by GHA and run in collaboration with other partners

Partner notification in HIV-1 infection: a population based evaluation of process and outcomes in Scotland

Objectives: To evaluate the process and outcomes of HIV partner notification (PN) activity in Scotland. Design: Retrospective population based study. Subjects: 114 adults newly diagnosed with HIV infection (index patients) in Scotland between September 1995 and August 1996. Setting: Healthcare settings in which all 114 new HIV diagnoses were made: 42 (37%) from genitourinary medicine; 32 (28%) infectious diseases; 18 (16%) general practice; and 22 (19%) from other sites. Main outcome measures: Number of partners notified and tested up to 9 months after initial diagnosis. Results: Of 114 index patients (IPs), information on current partners was available for 102 (89%). PN was not appropriate for 47 of the 102 IPs. The remaining 55 IPs identified 63 current partners at risk, of whom 51 were notified: 44 underwent HIV testing, which yielded 11 new HIV positive diagnoses. Information on previous partners was available for only 56 IPs (49%). PN was not appropriate for 30 of the 56 IPs; the remaining 26 IPs identified 46 previous partners at risk, of whom 12 were notified: four were tested, but yielded no new diagnoses. Conclusions: Notification of current partners was performed well and was an effective strategy for identification of HIV positive individuals at a presymptomatic stage. Notification of previous partners was limited. Partner notification was attempted in a wide range of healthcare settings. Given the clinical effectiveness of antiretroviral therapy, partner notification as a tool towards early diagnosis of HIV disease deserves renewed attention. Key Words: HIV; contact tracin

Screening and the construction of scepticism: the case of Chlamydia

Screening for disease is an integral component of UK preventative health policy, and there are proposals to introduce a screening programme for the sexually transmitted infectionChlamydia trachomatis. In recent years, however, debates over screening have been characterized by increasing scepticism about the individual benefits of participating in such initiatives. This article explores factors that may contribute to this scepticism, in the context of a study that investigated the experience of women who had been diagnosed with chlamydia. We employ Bury's concept of 'risk to meanings' to understand better the social process of the development of uncertainty in relation to a positive diagnosis. Three themes related to uncertainty and the 'risk to meaning' are explored here - the threat to self-image, disclosing diagnosis and anxiety about future health status. The implications for the proposed UK chlamydia screening programme are discussed, and the article suggests that the development and construction of scepticism occurs in the space between expectations stimulated by public health discourses of screening and the lived experience of individuals

Estimation of the risk of tubal factor infertility associated with genital chlamydial infection in women : a statistical modelling study

Using a statistical modelling approach, our study aim is to determine reliable age-related estimates of the risk of all-cause tubal factor infertility (TFI) following past or current chlamydial infection in women in Scotland. Using data from several sources, a Markov-Chain Monte Carlo model was used to estimate the age-related risk of TFI given genital chlamydia infection at any time. The analysis is based on the probability of a woman ever having chlamydial infection, ever having TFI and ever having a previous chlamydial infection given a diagnosis of TFI. The model was programmed and evaluated using WinBugs14. By the age 44 years, the overall risk of a woman having at least a single chlamydial infection is estimated at 42.9% (95% credible interval 30.0, 59.0%). The risk of a woman having TFI increased from 0.5% in those aged 16–19 years to 0.8% in those aged 40–44. The overall estimated probability of TFI, based on lifetime infertility, given a past or current chlamydial infection, is relatively consistent across all five age groups from 16–44 years, being 0.9% among those aged 25–29 and 1.4% in those aged 35–39; The estimates were found to be sensitive to the definition of infertility, with the estimate increasing from 1.3% in the youngest age group to 2.8% and 4.5% for 24-month primary infertility and primary or secondary infertility, respectively