‘Out of the Blue’ A qualitative evaluation of the Home-Start Perinatal Mental Health Project

Commissioned piece of research and report for the Home-Start Hertfordshire charityFinal Published versio

Evaluating technology for elders : towards a measure of attitudes

Technology is ubiquitous in modern day society and has the potential to enhance one's quality of life. Numerous innovative assistive technologies are designed to aid elderly people in every day activities and enable them to maintain a measure of independence longer. One such assistive technology was the PAM-AID walking aid: a robotic walking aid designed to provide frail, visually impaired elders with the physical support of a rollator, coupled with the navigational assistance necessary for safe, independent mobility. A user-centred design approach was integral to the design and development of PAM-AID and the first part of this thesis, details the research undertaken to ensure that, as far as possible, PAM-AID met the needs of potential users. Studies were conducted with carers and elders to establish elders' requirements for PAM-AID. The results of these studies directly influenced the functional specification of the first PAM-AID prototype. Following an iterative design life cycle, further studies were conducted to evaluate the usability of the first and second prototypes and the results of these studies enabled informed design decisions could be made. Therefore, elders were involved at every stage of the design process, to ensure that PAM-AID was an efficient and acceptable technology to this user group. However, throughout this preliminary work, an interesting discrepancy in elders' attitudes began to emerge. It became evident that although elders thought that PAM-AID was a useful walking aid for other frail elderly people, they did not think that PAM-AID was beneficial for them personally. In other words, elders' attitudes indicated that they might not use or accept PAM-AID, even though they would clearly benefit from this innovative technology. Indeed, other research has shown that many assistive technologies are often under utilised or discarded by elders, even when the potential benefits of the technology are clearly evident. This was a pivotal point in the research programme, as it highlighted the importance of monitoring elders' attitudes to predict future use of and acceptance of assistive technology. Since no applicable tool exists for measuring individuals' attitudes to technologies such as PAM-AID, the main empirical work of this research programme involved the development of a psychometric scale: the Attitudes to Technology Scale (ATS). The inductive approach to development of this scale involved: the generation of items, the reduction of the items into meaningful subscales, as well as the demonstration of the scale's reliability and validity. Throughout its development, the scale was applied to a number of different types of technology such as ATMs, computers, microwaves, mobile phones, VCRs and the Internet. The scale has been used to investigate the effect of age and sex differences in terms of attitudes to technology. Thus, the ATS is unique in that it has been developed for use with ID1 types of technology and with individuals of ~ ages. The limitations of the scale have been noted and further work is needed to address these limitations. It is hoped that this scale will have both academic and commercial research applications, but above all, the ATS could be applied to continually monitor users' attitudes during the design and development of new technologies. It is proposed that the measurement of users' attitudes should be an integral part of the design life cycle, resulting in more useable and acceptable technology

Multimorbidity and frailty in people with dementia

This document is the Author's Accepted Manuscript version. The final, published version is available online at doi: DOI: https://doi.org/10.7748/ns.30.1.45.e9816. Published by the Royal College of Nursing.Many people with dementia have other complex health needs, including comorbidity and frailty. Most models of care focus on single diseases and do not take into account the needs of those with comorbidities and dementia. Integration, continuity of care and personalisation are particularly important for this vulnerable group. It is also important to recognise potential barriers to accessing care so that these can be addressed. Issues around providing health care for people with dementia and complex health needs are considered in this article, including management and organisation of care, access to care, models of care, role of the family carer, and prevention of dementia, frailty and long-term conditionsPeer reviewe

Police referrals for domestic abuse before and during the first COVID-19 lockdown: An analysis of routine data from one specialist service in South Wales.

BACKGROUND: COVID-19 lockdown measures may have led to more, and increasingly severe, domestic abuse. This study examines police referrals to a specialist domestic abuse service in Wales, UK before and during the first lockdown. METHODS: Routine data relating to 2292 police referrals for female adult victim-survivors from December 2019 until July 2020 were analysed and presented in the form of descriptive statistics to monitor changes in referral rates and the profile of those referrals. RESULTS: There was little increase in the overall volume of police referrals during lockdown, but the proportion assessed as high risk increased, and children became the primary source of third-party referrals, with a higher proportion of reports made by other third parties as restrictions eased. Police reports for cases of Child/Adolescent to Parent Violence (C/APV) occurred almost exclusively during lockdown. CONCLUSIONS: The increase in risk level despite less clear increase in volume may suggest unmet need, with victims less likely to seek help during lockdown other than for more severe instances. Increased reports by children suggest increased exposure of children to domestic abuse during school closure. Unmet need for women and children may have been made visible to services, and acquaintances, as measures began to ease.National Institute for Health Research via the Public Health Research funding committee (NIHR127793)

Developing a Web-Based App to Assess Mental Health Difficulties in Secondary School Pupils: Qualitative User-Centered Design Study.

BACKGROUND: Secondary schools are an ideal setting to identify young people experiencing mental health difficulties such as anxiety or depression. However, current methods of identification rely on cumbersome paper-based assessments, which are lengthy and time-consuming to complete and resource-intensive for schools to manage. Artemis-A is a prototype web app that uses computerized adaptive testing technology to shorten the length of the assessment and provides schools with a simple and feasible solution for mental health assessment. OBJECTIVE: The objectives of this study are to coproduce the main components of the Artemis-A app with stakeholders to enhance the user interface, to carry out usability testing and finalize the interface design and functionality, and to explore the acceptability and feasibility of using Artemis-A in schools. METHODS: This study involved 2 iterative design feedback cycles-an initial stakeholder consultation to inform the app design and user testing. Using a user-centered design approach, qualitative data were collected through focus groups and interviews with secondary school pupils, parents, school staff, and mental health professionals (N=48). All transcripts were thematically analyzed. RESULTS: Initial stakeholder consultations provided feedback on preferences for the user interface design, school administration of the assessment, and outcome reporting. The findings informed the second iteration of the app design and development. The unmoderated usability assessment indicated that young people found the app easy to use and visually appealing. However, school staff suggested that additional features should be added to the school administration panel, which would provide them with more flexibility for data visualization. The analysis identified four themes relating to the implementation of the Artemis-A in schools, including the anticipated benefits and drawbacks of the app. Actionable suggestions for designing mental health assessment apps are also provided. CONCLUSIONS: Artemis-A is a potentially useful tool for secondary schools to assess the mental health of their pupils that requires minimal staff input and training. Future research will evaluate the feasibility and effectiveness of Artemis-A in a range of UK secondary schools.Medical Research Council Confidence in Concept award (MC_PC_18042)

Landscape Transformation During Ceramic Age and Colonial Occupations of Barbuda, West Indies

This research documented the history of landscape transformation on the island of Barbuda in the Lesser Antilles, Caribbean through cross-disciplinary research approaches. Excavations confirmed a human presence for the seasonal exploitation of conch meat and other mollusks during the Archaic Age (c.3000–500 BC), but more substantial impacts to terrestrial ecosystems likely began during the Ceramic Age (c.500 BC–AD 1500). Our combined sedimentary and charcoal records revealed that human-induced environmental transformations began with Ceramic Age peoples as they cleared vegetation for settlements and gardens with intentional burning. Sedimentary charcoal indicated a dramatic decline in fire during post-Ceramic Age abandonment, continuing through the Colonial Period, as the dominant human activities shifted to herding, farming, and selective wood harvesting. Historical sources showed that during the Colonial Period (post-1492), the island was intermittently settled until the mid-seventeenth century, while the Codrington family of Antigua held the lease to the island from 1681 to 1870. They used the island for farming and stock-rearing, exporting meat and draught animals along with lime, timber, and subsistence crops. Macrocharcoal recovered from Colonial Period archaeological sites reflect the use of a variety of local species and wood imported to the island or harvested from shipwrecks

Dementia case-finding in hospitals: a qualitative study exploring the views of healthcare professionals in English primary care and secondary care.

OBJECTIVES: In 2012-2013, the English National Health Service mandated hospitals to conduct systematic case-finding of people with dementia among older people with unplanned admissions. The method was not defined. The aim of this study was to understand current approaches to dementia case-finding in acute hospitals in England and explore the views of healthcare professionals on perceived benefits and challenges. DESIGN: Qualitative study involving interviews, focus groups and thematic content analysis. SETTING: Primary care and secondary care across six counties in the East of England. PARTICIPANTS: Hospital staff involved in dementia case-finding and primary care staff in the catchment areas of those hospitals. RESULTS: We recruited 23 hospital staff and 36 primary care staff, including 30 general practitioners (GPs). Analysis resulted in three themes: (1) lack of consistent approaches in case-finding processes, (2) barriers between primary care and secondary care which impact on case-finding outcomes and (3) perceptions of rationale, aims and impacts of case-finding. The study shows that there were variations in how well hospitals recorded and reported outcomes to GPs. Barriers between primary care and secondary care, including GPs' lack of access to hospital investigations and lack of clarity about roles and responsibilities, impacted case-finding outcomes. Staff in secondary care were more positive about the initiative than primary care staff, and there were conflicting priorities for primary care and secondary care regarding case-finding. CONCLUSIONS: The study suggests a more evidence-based approach was needed to justify approaches to dementia case-finding. Information communicated to primary care from hospitals needs to be comprehensive, appropriate and consistent before GPs can effectively plan further investigation, treatment or care. Follow-up in primary care further requires access to options for postdiagnostic support. There is a need to evaluate the outcomes for patients and the economic impact on health and care services across settings.NIH

Case finding for dementia during acute hospital admissions: a mixed-methods study exploring the impacts on patient care after discharge and costs for the English National Health Service

Abstract Objective: Between 2012 and 2017 dementia case-finding was routinely carried out on people aged 75 and over with unplanned admissions to acute hospitals across England. The assumption was that this would lead to better planning of care and treatment for patients with dementia following discharge from hospital. However, little is known about the experiences of patients and carers or the impacts on other health services. This study explored the impact of dementia case-finding on older people and their families and on their use of services. Design: Thematic content analysis was conducted on qualitative interview data and costs associated with service use were estimated. Measures included the Mini-Mental State Examination (MMSE), the EuroQol (EQ-5D-5L) quality of life scale and a modified Client Service Receipt Inventory (CSRI). Setting: Four counties in the East of England. Participants: People aged ≥75-years who had been identified by case-finding during an unplanned hospital admission as warranting further investigation of possible dementia and their family carers. Results: We carried out 28 interviews, including 19 joint patient-carer(s), 5 patient only and 4 family carer interviews. Most patients and carers were unaware that memory assessments had taken place, with many families not being informed or involved in the process. Participants had a variety of views on memory testing in hospital and had concerns about how hospitals carried out assessments and communicated results. Overall, case-finding did not lead to general practitioner (GP) follow up after discharge home or lead to referral for further investigation. Few services were initiated because of dementia case-finding in hospital. Conclusions: This study shows that dementia case-finding may not lead to increased GP follow up or service provision for patients after discharge from hospital. There is a need for a more evidence-based approach to the initiation of mandatory initiatives such as case-finding that inevitably consume stretched human and financial resources

Studying Mental Health in Schools: A Participatory Action Research (PAR) Approach in Public Mental Health

Despite a rising prevalence of mental health difficulties in the young, existing prior to, but also exacerbated by the current COVID-19 pandemic, mental health needs in this population remain unmet even in economically wealthy countries. Increasingly, supportive school environments have been suggested as having a significant impact on young people's mental health. The idea of health- promoting schools, initiated by the World Health Organisation (WHO), highlights the ongoing need for both health education via the curriculum but also a school environment that is conducive to students' health and emotional well-being. Despite this promising public health measure, existing studies into mental health- related interventions delivered in schools have been found to have a small or no effect. One explanation for this is that previous studies did not sufficiently address or focus on the school environment, which may in itself pose barriers to acceptability and successful implementation of mental health interventions. This paper will highlight a novel methodological approach to public mental health research - Participatory Action Research (PAR). The PAR method is unique in enabling study participants to become co-researchers of their own experiences in a specific context. A growing body of educational PAR research suggests that this method can also generate collaborative and participative processes foundational to positive school culture and mental health outcomes. This paper will provide an overview of such outcomes, as well as outline methodological strengths and challenges common to the PAR approach in educational mental health settings

Studying Mental Health in Schools: A Participatory Action Research (PAR) Approach in Public Mental Health

Despite a rising prevalence of mental health difficulties in the young, existing prior to, but also exacerbated by the current COVID-19 pandemic, mental health needs in this population remain unmet even in economically wealthy countries. Increasingly, supportive school environments have been suggested as having a significant impact on young people's mental health. The idea of health- promoting schools, initiated by the World Health Organisation (WHO), highlights the ongoing need for both health education via the curriculum but also a school environment that is conducive to students' health and emotional well-being. Despite this promising public health measure, existing studies into mental health- related interventions delivered in schools have been found to have a small or no effect. One explanation for this is that previous studies did not sufficiently address or focus on the school environment, which may in itself pose barriers to acceptability and successful implementation of mental health interventions. This paper will highlight a novel methodological approach to public mental health research - Participatory Action Research (PAR). The PAR method is unique in enabling study participants to become co-researchers of their own experiences in a specific context. A growing body of educational PAR research suggests that this method can also generate collaborative and participative processes foundational to positive school culture and mental health outcomes. This paper will provide an overview of such outcomes, as well as outline methodological strengths and challenges common to the PAR approach in educational mental health settings