Improving the psychological evaluation of exercise referral: psychometric properties of the Exercise Referral Quality of Life Scale

There is a growing need to assess the psychological outcomes of exercise referral and the National Institute of Health and Care Excellence has called for the routine assessment of life-quality. However, a quality of life scale specific to the requirements of exercise referral is currently unavailable. Therefore, the aim of this study was to produce a quality of life measure for this purpose. The Exercise Referral Quality of Life Scale is a 22-item measure comprising three domains: mental and physical health, injury pain and illness and physical activity facilitators. Exploratory factor analysis determined the initial factor structure and was subsequently confirmed by confirmatory factor analysis. Additional scale properties were also assessed. The scale contributes to the global need for improved consistent psychological outcome assessment of exercise referral

Ethnic Minorities and their Health Needs: Crisis of Perception and Behaviours

There is considerable evidence to suggest that racial and ethnic disparities exist in the provision of emergency and wider healthcare. The importance of collecting patient ethnic data has received attention in literature across the world and eliminating ethnic and racial health equalities is one of the primary aims of healthcare providers internationally. The poor health status of certain racial and ethnic groups has been well documented. The improvement of racial and ethnic disparities in healthcare is at the forefront of many public health agendas. This article addresses important policy, practice, and cultural issues confronted by the pre-hospital emergency care setup. This aspect of care plays a unique role in the healthcare safety net in providing a service to a very diverse population, including members of ethnic and racial minorities. Competent decision making by the emergency care practitioners requires patient-specific information and the health provider's prior medical knowledge and clinical training. The article reviews the current ethnicity trends in the UK along with international evidence linking ethnicity and health inequalities. The study argues that serious difficulties will arise between the health provider and the patient if they come from different backgrounds and therefore experience difficulties in cross-cultural communication. This adversely impacts on the quality of diagnostic and clinical decision making for minority patients. The article offers few strategies to address health inequalities in emergency care and concludes by arguing that much more needs to be done to ensure that we are hearing the voices of more diverse groups, groups who are often excluded from engagement through barriers such as language or mobility difficulties

Fat, Queer, Dead: ‘Obesity’ and the Death Drive

That contemporary discourses of the ‘obesity epidemic’ are engaged in the construction of fatness as pathological, immoral and socially undesirable has been the subject much recent critical inquiry within Fat Studies. This paper contributes to that literature with a re-reading of obesity discourse via what queer theorist Lee Edelman (2004) has called ‘reproductive futurism’. Edelman contends that queerness figures the social order's death drive, and is thus abjected in order to assure the reproduction of that social order. This paper argues that, like the queer, fatness is increasingly being figured as anti-social and as that which must be eliminated in the name of a viable future. Framing obesity in this way makes possible an analysis of the presumed ‘threat’ of obesity, frequently referred to, but seldom unpacked, in the existing literature. A comparative analysis of the UK government's Change 4 Life (2009) public health campaign and nineteenth century theories of degeneracy is used to illustrate the cultural anxieties about immorality, disease, civilization and death that undergird both discourses. This analysis suggests the centrality of rationality and self-control, understood as moral, to the reproduction of the social order. Furthermore, reading the ‘obesity epidemic’ as couched in the logic of reproductive futurism opens up potential alternative approaches to fat politics. In the light of Samantha Murray's (2008) critique of the liberal humanist underpinnings of fat activist discourse, this paper considers whether Edelman's advocacy of ‘future-negating’ for queers, offers a productive trajectory for fat politics

On self-neglect and safeguarding adult reviews: diminishing returns or adding value?

Purpose: One purpose is to update the core data set of self-neglect serious case reviews and safeguarding adult reviews, and accompanying thematic analysis. A second purpose is to respond to the critique in the Wood Report of serious case reviews commissioned by Local Safeguarding Children Boards by exploring the degree to which the reviews scrutinised here can transform and improve the quality of adult safeguarding practice. Design/Methodology/approach: Further published reviews are added to the core data set from the web sites of Safeguarding Adults Boards and from contacts with SAB Independent Chairs and Business Managers. Thematic analysis is updated using the four domains employed previously. The findings are then further used to respond to the critique in the Wood Report of serious case reviews commissioned by Local Safeguarding Children Boards, with implications discussed for Safeguarding Adult Boards. Findings: Thematic analysis within and recommendations from reviews have tended to focus on the micro context, namely what takes place between individual practitioners, their teams and adults who self-neglect. This level of analysis enables an understanding of local geography. However, there are other wider systems that impact on and influence this work. If review findings and recommendations are to fully answer the question “why”, systemic analysis should appreciate the influence of national geography. Review findings and recommendations may also be used to contest the critique of reviews, namely that they fail to engage practitioners, are insufficiently systemic and of variable quality, and generate repetitive findings from which lessons are not learned. Research limitations/implications: There is still no national database of reviews commissioned by SABs so the data set reported here might be incomplete. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. This makes learning for service improvement challenging. Reading the reviews reported here against the strands in the critique of serious case reviews enables conclusions to be reached about their potential to transform adult safeguarding policy and practice. Practical implications: Answering the question “why” is a significant challenge for safeguarding adult reviews. Different approaches have been recommended, some rooted in systems theory. The critique of serious case reviews challenges those now engaged in safeguarding adult reviews to reflect on how transformational change can be achieved to improve the quality of adult safeguarding policy and practice. Social implications: Originality/value: The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice. The paper also contributes new perspectives to the process of conducting safeguarding adult reviews by using the analysis of themes and recommendations within this data set to evaluate the critique that reviews are insufficiently systemic, fail to engage those involved in reviewed cases and in their repetitive conclusions demonstrate that lessons are not being learned

Problematising parent–professional partnerships in education

The value of, and need for, parent–professional partnerships is an unchallenged mantra within policy relating to ‘special educational needs’. In spite of this, partnerships continue to be experienced as problematic by both parents and professionals. This paper brings together the different perspectives of two disability researchers: one a parent of a disabled child while the other was a teacher for 20 years of children with the label autism. The paper deconstructs the concept of partnership and then, drawing on the expertise of parents, suggests how enabling and empowering parent–professional relationships might be achieved

Problematising parent–professional partnerships in education

The value of, and need for, parent–professional partnerships is an unchallenged mantra within policy relating to ‘special educational needs’. In spite of this, partnerships continue to be experienced as problematic by both parents and professionals. This paper brings together the different perspectives of two disability researchers: one a parent of a disabled child while the other was a teacher for 20 years of children with the label autism. The paper deconstructs the concept of partnership and then, drawing on the expertise of parents, suggests how enabling and empowering parent–professional relationships might be achieved

Gaining consensus on family carer needs when caring for someone dying at home to develop the Carers' Alert Thermometer (CAT): a modified Delphi study

Aim To report a multi-phase modified Delphi study conducted with carers and professionals to identify the priority areas for inclusion in an alert screening tool for carers providing support to someone dying at home. Background Internationally, there is a growing emphasis on increasing choice for patients who wish to die at home which relies heavily on care provided by the unpaid family carers. Family carers can have high levels of unmet needs comprising their psychological and physical health and their ability to provide effective care and support. Development of an alert tool to identify carers' needs in everyday practice required identification and consensus of the priority areas of need for inclusion. Design Multi-phase modified Delphi study and instrument development. Method Qualitative and quantitative data collection took place between 2011–2013 with 111 carers and 93 professionals to identify carers' needs and gain consensus on the priority areas for inclusion in the alert tool. An expert panel stage and final evidence review post-Delphi were used. Results The Delphi panels had high levels of agreement and consensus. Ten areas of carer need across two themes of ‘the current caring situation’ and ‘the carer's own health and well-being’ were prioritized for inclusion in the alert tool. An optional end-of-life planning question was included following the final stages. Conclusions The results provide evidence of carers' needs to be assessed, areas for consideration in the education of those who support carers and someone dying at home and targeting of services, while demonstrating the usefulness and adaptability of the Delphi method