”Medialle pitäis kertoa positiivisiakin asioita eikä vaan niitä kamalia ja huonoja” : lastensuojeluun liittyviä mielikuvia, niiden taustaa ja tulevaisuutta

Tämän opinnäytetyön tarkoituksena oli selvittää ihmisten mielikuvia ja tietämystä lastensuojelusta sekä tietämystä viime vuonna voimaan tulleesta uudesta sosiaalihuoltolaista. Lisäksi tarkoituksena oli kartoittaa mistä lähteestä saatuun tietoon heidän mielikuvansa lastensuojelusta heidän omasta mielestään perustuvat sekä miten lastensuojelun tulisi toimia, jotta se heidän mielikuvissaan toimisi kaikilta osin hyvin. Työssä haluttiin vielä selvittää, mitä ajatuksia sosiaalihuoltolain muutokset ihmisissä herättävät sekä miten heidän mielestään lastensuojelusta ja lakimuutoksista tiedottaminen tulisi hoitaa. Tutkimusotteena käytettiin laadullista tutkimusta. Tutkimusaineisto kerättiin haastattelemalla ihmisiä Tampereen keskustassa ja lähialueilla huhti-toukokuussa 2016. Haastatteluita tehtiin kaksikymmentä, joista saatu aineisto analysoitiin aineistolähtöisen sisällönanalyysin keinoin. Opinnäytetyön teoreettinen viitekehys käsittelee lastensuojelua sekä mielikuvia. Opinnäytetyön tulosten mukaan sellaiset ihmiset, joilla ei ole lastensuojelusta henkilökohtaista kokemusta, eivät tiedä alalla tehtävästä käytännön työstä tai lakimuutoksesta paljoakaan. Mielikuvat lastensuojelusta ovat rakentuneet hyvin vahvasti median kautta tai muista arjen tietolähteistä, kuten muiden ihmisten puheista, saadun informaation perusteella. Faktatietoa lastensuojelun toiminnasta tai edes sen tehtävistä yhteiskunnassa ei ihmisillä juurikaan ole. Tulosten mukaan lastensuojelutyöhön kaivataan lisää avoimuutta ja läpinäkyvyyttä sekä positiivista julkisuutta. Mielikuvat lastensuojelusta olisivat paremmat, mikäli työssä olisi enemmän ja tehokkaammin kohdistettuja resursseja, siinä panostettaisiin enemmän ennaltaehkäisevään työhön ja apua olisi helpommin ja nopeammin saatavilla. Lakimuutokset herättivät ihmisissä positiivisia ajatuksia, ja he kokivat, että ne vievät työtä oikeaan suuntaan. Lastensuojeluun liittyvistä asioista tiedottamisessa haastatellut toivoivat käytettävän monipuolisesti eri medioita sekä muun muassa kouluja ja neuvoloita. Johtopäätöksenä voidaan todeta, että median rooli lastensuojeluun liittyvän tiedon jakamisessa ja siihen liittyvien mielikuvien parantamisessa on keskeinen. Sosiaalihuoltolain muutokset ovat viemässä työn painopistettä oikeaan suuntaan, ja tämän positiivisen muutoksen tukemisessa tarvitaan paitsi riittäviä resursseja, myös panostusta tiedottamiseen sekä avoimeen ja positiiviseen julkisuuteen työntekijätahon puolelta.The purpose of was to collect data on people's knowledge and mental image regarding Child welfare services, and their knowledge and opinion about changes in Social welfare law that came into effect last year. Also the purpose was to find out from what source they have gotten the information their mental image is founded on, how Child welfare services should change to make people's mental image better, and how municipalities should inform public about these matters. The study was qualitative in nature and the data were collected interviewing people in Tampere center and nearby areas. The data were content analysed. The results show that people not in contact with Child welfare services in their everyday life do not know many facts about their function, nore about the changes in Social welfare law. Mental images people have are founded on information from the media or ordinary life sources like other people's stories. Child welfare services should be more transparent, have more positive visibility in media, have better resources and invest more to preventive work. Interviewees found that the changes in Social welfare law take this line of work to the right direction. As sources of information they thought that different medias, schools and child health centers would be most efficient. The conclusion was that media has a central role in sharing information and improving the mental image concerning Child welfare. Changes in the Social welfare law are taking the focus of Child welfare services to the right direction. Supporting this positive change requires not only sufficient resources but also investment from workers in providing more information and taking part in positive publicity

Informed consent in randomised controlled trials: development and preliminary evaluation of a measure of participatory and informed consent (PIC)

Background Informed consent (IC) is an ethical and legal prerequisite for trial participation, yet current approaches evaluating participant understanding for IC during recruitment lack consistency. No validated measure has been identified that evaluates participant understanding for IC based on their contributions during consent interactions. This paper outlines the development and formative evaluation of the Participatory and Informed Consent (PIC) measure for application to recorded recruitment appointments. The PIC allows the evaluation of recruiter information provision and evidence of participant understanding. Methods Published guidelines for IC were reviewed to identify potential items for inclusion. Seventeen purposively sampled trial recruitment appointments from three diverse trials were reviewed to identify the presence of items relevant to IC. A developmental version of the measure (DevPICv1) was drafted and applied to six further recruitment appointments from three further diverse trials to evaluate feasibility, validity, stability and inter-rater reliability. Findings guided revision of the measure (DevPICv2) which was applied to six further recruitment appointments as above. Results DevPICv1 assessed recruiter information provision (detail and clarity assessed separately) and participant talk (detail and understanding assessed separately) over 20 parameters (or 23 parameters for three-arm trials). Initial application of the measure to six diverse recruitment appointments demonstrated promising stability and inter-rater reliability but a need to simplify the measure to shorten time for completion. The revised measure (DevPICv2) combined assessment of detail and clarity of recruiter information and detail and evidence of participant understanding into two single scales for application to 22 parameters or 25 parameters for three-arm trials. Application of DevPICv2 to six further diverse recruitment appointments showed considerable improvements in feasibility (e.g. time to complete) with good levels of stability (i.e. test-retest reliability) and inter-rater reliability maintained. Conclusions The DevPICv2 provides a measure for application to trial recruitment appointments to evaluate quality of recruiter information provision and evidence of patient understanding and participation during IC discussions. Initial evaluation shows promising feasibility, validity, reliability and ability to discriminate across a range of recruiter practice and evidence of participant understanding. More validation work is needed in new clinical trials to evaluate and refine the measure further

Opportunistic and systematic screening for chlamydia: a study of consultations by young adults in general practice

BACKGROUND: Opportunistic screening for genital chlamydia infection is being introduced in England, but evidence for the effectiveness of this approach is lacking. There are insufficient data about young peoples' use of primary care services to determine the potential coverage of opportunistic screening in comparison with a systematic population-based approach. AIM: To estimate use of primary care services by young men and women; to compare potential coverage of opportunistic chlamydia screening with a systematic postal approach. DESIGN OF STUDY: Population based cross-sectional study. SETTING: Twenty-seven general practices around Bristol and Birmingham. METHOD: A random sample of patients aged 16–24 years were posted a chlamydia screening pack. We collected details of face-to-face consultations from general practice records. Survival and person-time methods were used to estimate the cumulative probability of attending general practice in 1 year and the coverage achieved by opportunistic and systematic postal chlamydia screening. RESULTS: Of 12 973 eligible patients, an estimated 60.4% (95% confidence interval [CI] = 58.3 to 62.5%) of men and 75.3% (73.7 to 76.9%) of women aged 16–24 years attended their practice at least once in a 1-year period. During this period, an estimated 21.3% of patients would not attend their general practice but would be reached by postal screening, 9.2% would not receive a postal invitation but would attend their practice, and 11.8% would be missed by both methods. CONCLUSIONS: Opportunistic and population-based approaches to chlamydia screening would both fail to contact a substantial minority of the target group, if used alone. A pragmatic approach combining both strategies might achieve higher coverage