A cross-sectional study exploring levels of physical activity and motivators and barriers towards physical activity in haemodialysis patients to inform intervention development

Purpose. To describe physical activity (PA) levels and motivators and barriers to PA among haemodialysis patients and to identify an appropriate approach to increasing their PA. Methods. A cross sectional mixed methods study conducted in a tertiary and satellite haemodialysis unit. 101 participants aged 18 years and over, receiving regular haemodialysis for at least four months, were recruited. Patients with recent hospital admission or acute cardiac event were excluded. Participants completed health status (EQ-5D-3L™) and activity (Human Activity Profile) questionnaires. A subgroup were invited to wear accelerometers and wearable cameras to measure PA levels and capture PA episodes, to inform subsequent semi-structured interviews on motivators and barriers. Semi-structured interviews were analysed using the Framework Method informed by constructs of the Health Belief Model. Results. 98/101 completed the study (66 male, 32 female). For 68/98 participants, adjusted activity scores from the Human Activity Profile indicated ‘impaired’ levels of Physical Activity; for 67/98 participants, the EQ-5D-3L indicated problems with mobility. Semi-structured interviews identified general (fear of falls, pain) and disease specific barriers (fatigue) to PA. Motivators included tailored exercise programmes and educational support from health care professionals. Conclusions. Participants indicated a need for co-development with healthcare professionals of differentiated, targeted exercise interventions

Exploration of dietary patterns and alcohol consumption in pregnant women in the UK: A mixed methods study

Backgroundfetal Alcohol Spectrum Disorders is a term used to describe a range of physical, cognitive and behavioural deficits in the offspring of women who drank alcohol during pregnancy. A growing body of evidence suggests alcohol consumption in the presence of poor maternal nutrition may increase the risk of harm to the developing fetus.Objectiveto investigate relationships between maternal dietary patterns and alcohol consumption, and explore which factors influence women's decisions about what to eat and drink during pregnancy.Designa mixed methods study comprising a questionnaire (paper-based and online) and semi-structured, in-depth interviews with a sub-sample of women who completed the questionnaire.Participantswomen were eligible for inclusion if they were ≥16 years of age, pregnant and living in the UK and were recruited through antenatal clinics, specialist substance misuse antenatal clinics or via social media platforms; 350 women completed a questionnaire and a sub-sample of 6 women participated in an interview.Methodsthe questionnaire comprised the Alcohol Use Disorders Identification Test Consumption to measure alcohol consumption patterns and a Food Frequency Questionnaire to measure dietary intake. Dietary pattern analysis was conducted using Principle Components Analysis and linear regression models were used to explore relationships between dietary pattern scores and alcohol consumption. Analyses were adjusted for socio-demographic and lifestyle characteristics. Semi-structured, in-depth interviews were conducted face-to-face and analysed thematically.Findingstwo key dietary patterns were derived. Women who reported frequent alcohol consumption before and during pregnancy were more likely to adhere to the ‘Prudent’ dietary pattern compared to those who abstained. No relationships were observed between alcohol consumption and adherence to the ‘Cafeteria’ dietary pattern. Six key themes were identified through the qualitative analysis: (1) pregnancy as a time to review behaviour; (2) listen to your body – it will tell you what you need; (3) treats are still important – on special occasions; (4) social and cultural expectations constrain behaviour; (5) inconsistent or ambiguous information creates uncertainty; and 6) confidence increases following a successful pregnancy.Conclusionsthose who drink low levels of alcohol during pregnancy may have better quality diets compared to women who report no alcohol consumption. The reasons for this are complex and influenced by social context and previous pregnancy experience, which should be considered when healthcare professionals provide advice during this period

Patients experience of fatigue in advanced heart failure

Aims: To explore the experience of fatigue and living with fatigue in persons with advanced heart failure. Design: Single-setting, qualitative interview study. Methods: In-depth in-person interviews were conducted with participants from November 2012 to June 2013. Participant responses to open-ended questions were analysed using thematic content analysis. Inclusion criteria were: 18 years and older, diagnosis of New York Heart Association class III-IV heart failure with reduced ejection fraction by a consultant cardiologist, and able to participate in conversational-style interviews in their own language. Major exclusion criteria was cognitive deficit identified by Abbreviated Mental Test Score. Twenty-three adults participated in the study. Results: Participants (age 72.5 ± 9.5 years, 10/23 female, 17/23 New York Heart Association class III, and 6/23 class IV) identified experiencing fatigue almost daily with over 14/23 reporting it as their worst symptom or combined worst symptom with breathlessness. 9/23 identified fatigue as their second-worst symptom. Three key themes were identified: fatigue as a physical barrier, psychological response to fatigue, and living with fatigue as a part of daily life. The three themes however combine to influence a patients well-being and we suggest need to be acknowledged when planning self-care management. Conclusion: As heart failure progresses fatigue influences patients’ daily life and may negatively affect self-care abilities however patients strive to adapt to these limitations. Understanding the patient experience of fatigue and living with fatigue is important to optimize health management strategies

Women's experience of motherhood: A Study of Women with Pre-School Children

This thesis describes the way 50 women in London experienced motherhood. It is based on in-depth interviews with 25 working-class and 25 middle-class women, living with their husbands, with 2, 3 or 4 children, at least one of whom was under 5. First, the views on motherhood of biological perspectives (psychoanalysis and ethology) and social perspectives (sociology and social anthropology) are critically reviewed and the framework and methods for the empirical study are spelled out. Central to this framework is the distinction between two dimensions of experience:i mmmediate response (enjoyment or irritation) to caring for children and sense of meaning and purpose which may or may not be experienced in such care. The main body of the thesis is a description of the women's experience in terms of these two dimensions. Successive chapters outline the irritation which the women expressed with the demanding nature of preschool children; with the organization and setting of child care; and with the sense of loss of individuality felt in motherhood. A following chapter describes the sense of meaning and purpose which the women conveyed as arising from feeling needed and wanted by their children and from investing hopes, dreams and ambitions in them. From these accounts, a four-fold typology of experiences of motherhood is developed. The influence of a husband's practical help and emotional support on a woman's experience is also examined. Throughout, social class differences are a particular focus of attention. A third dimension of experience, satisfaction with maternity, is then distinguished and the limitations of conventional measures of satisfaction are drawn out by a comparison of the interviewer and self-reported assessments. Finally, an attempt is made to place the women's experience in a cross-cultural perspective which highlights the difficult and demanding circumstances in which they cared for their children.<p

The workforce delivering translational and applied health research: A cross sectional survey of their characteristics, studies and responsibilities

Background. Translational and applied health research, and the workforce needed to deliver it, have grown substantially in the last 10 years and this growth is likely to continue. However, there are few good empirical studies of the workforce and only limited evidence on which to base future policy and practice. Aim. To provide a better understanding of the workforce that delivers translational and applied health research by exploring who delivers studies, what types of studies are delivered and what delivering them entails and whether this varies across employment contexts. Methods. A link to an on-line questionnaire was sent to 280 non-medical researchers in England funded by the National Institute for Health Research to deliver translational and applied health research; 168 (60%) responded. Responses were analysed quantitatively. Findings. Participants were from 11 occupational groups, with nurses (77%) the most common. Most (82%) had worked on clinical trials and almost as many (73%) on observational studies. A fifth had conducted studies outside hospital settings. Participants recruited from Community sites more often reported taking a medical history (p=0.022) and carrying out initial assessments (p=0.028) and less often reported managing other staff (p=0.036). Those recruited through the University Hospital more often reported contributing to development of new studies (p=0.000); to research governance (p=0.001) and protocols (p=0.000); and to writing publications (p=0.005). Discussion. There is greater diversity in the workforce than previously identified, more variation in types of studies delivered and a wider range of settings. Responsibilities vary across employment contexts. Conclusions. This diversity needs to be acknowledged in educational, training and career planning to sustain capacity for delivering translational and applied health research in the future

Development of an e-health app to support women prescribed adjuvant endocrine therapy after treatment for breast cancer

Background. Adjuvant endocrine therapy (AET) is prescribed to women for 5–10 years after treatment for estrogen receptor positive (ER+ve), early-stage breast cancer. AET has proven effectiveness in reducing the risk of recurrence of breast cancer and mortality. However, adherence is known to be suboptimal with around 20% discontinuing by 2 years and up to 50% discontinuing by 5 years. Interventions are needed to support women taking AET after breast cancer. The aim of this study was to develop and pilot test an e-health app for this population. Methods. Two focus groups (n=15) and five interviews were conducted with women following treatment for early-stage breast cancer to assess the likely acceptability of an e-health app and to inform the content (Phase I). Following development of a prototype e-health app, a simple heuristic usability test was completed by five women in order to identify any design usability problems (Phase II). A further 18 women used the app for 1 month between July and August 2016, after which they were interviewed by telephone to collect their experiences and views of the app (Phase III). Results. The prototype e-health app included evidence-based information on effectiveness of AET, an electronic side-effects diary, a peer support forum, a repeat prescription reminder, suggested strategies for facilitating adherence and managing any side effects that occur, and a link to further evidence and useful organizations for further information and support. The app was received positively by women. Women found the app useful as it emphasized the importance of taking AET, helped them manage their side effects and provided details of support organizations, while offering empathy and exchange of suggestions for self-management strategies through the peer support forum. Conclusion. Overall, findings suggest that this novel e-health app has potential as a feasible medium for promoting adherence to AET. Future research should evaluate the efficacy of the app in supporting women and promoting adherence

Dismantling the present and future threats of testicular cancer: a grounded theory of positive and negative adjustment trajectories

Testicular cancer commonly affects men in the prime of their lives. While survival rates are excellent, little previous research has examined men’s experiences of adjustment to survivorship. We aimed to explore this issue in younger testicular cancer survivors

Experiences of fatigue in daily life of people with acquired brain injury: A qualitative study

Purpose. To develop an in-depth understanding of how survivors of acquired brain injury (ABI) experience fatigue and how fatigue affects everyday life. Materials and methods. We conducted semi-structured in-depth interviews with 16 adults with ABI fatigue, recruited from support groups in south east UK. Interviews were analysed using the frameworks method. Results. We developed four themes: experiencing fatigue in the context of everyday activities, struggling to make sense of fatigue, coping with fatigue, adjusting social participation in the context of fatigue. Fatigue was comprised of mental, physical, generalised and motivational fatigue. Balancing fatigue against participation in daily activities was influenced by coping strategies and social support. Opportunities to socialize or participate in meaningful activities provided incentives for participants to push through their fatigue. Conclusions. This study highlights complex interactions that potentially mitigate the impact of fatigue on everyday life. Educational and self-management approaches to fatigue need to account for different types of fatigue in the contexts of an individual’s daily activity. Assessment of fatigue should capture in- the- moment experiences of different types of fatigue and activity. Social support and participation in meaningful activities may help individuals to break the negative cycle of fatigue and inactivity

Adjuvant endocrine therapy after breast cancer: a qualitative study of factors associated with adherence.

INTRODUCTION: Despite evidence of the efficacy of adjuvant endocrine therapy (AET) in reducing the risk of recurrence and mortality after treatment for primary breast cancer, adherence to AET is suboptimal. This study aimed to explore factors that influence adherence and nonadherence to AET following breast cancer to inform the development of supportive interventions. METHODS: Interviews were conducted with 32 women who had been prescribed AET, 2-4 years following their diagnosis of breast cancer. Both adherers (n=19) and nonadherers (n=13) were recruited. The analysis was conducted using the Framework approach. RESULTS: Factors associated with adherence were as follows: managing side effects including information and advice on side effects and taking control of side effects, supportive relationships, and personal influences. Factors associated with nonadherence were as follows: burden of side effects, feeling unsupported, concerns about long-term AET use, regaining normality, including valuing the quality of life over length of life, and risk perception. CONCLUSION: Provision of timely information to prepare women for the potential side effects of AET and education on medication management strategies are needed, including provision of timely and accurate information on the efficacy of AET in reducing breast cancer recurrence and on potential side effects and ways to manage these should they arise. Trust in the doctor-patient relationship and clear patient pathways for bothersome side effects and concerns with AET are important. Training and education on AET for GPs should be considered alongside novel care pathways such as primary care nurse cancer care review and community pharmacist follow-up