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

Moving upstream in health promoting policies for older people with early frailty in England? A policy analysis.

Objectives Globally, populations are rapidly ageing and countries have developed health promotion and wellbeing strategies to address increasing demand for health care and old-age support. The older population is not homogeneous however, and includes a large group in transition between being active and healthy to being frail, i.e. with early frailty. This review explores the extent to which policy in England has addressed this group with a view to supporting independence and preventing further progression towards frailty. Methods A narrative review was conducted of 157 health and social care policy documents current in 2014-2017 at three levels of the health and social care system in England. Findings We report the policy problem analysis, the shifts over time in language from health promotion to illness prevention, the shift in target populations to mid-life and those most at risk of adverse outcomes through frailty, and changes to delivery mechanisms to incentivize attention to the frailest rather than those with early frailty. We found that older people in general were not identified as a specific population in many of these policies. While this may reflect a welcome lack of age discrimination, it could equally represent omission through ageism. Only at local level did we identify some limited attention to preventative actions with people with early frailty. Conclusion The lack of policy attention to older people with early frailty is a missed opportunity to address some of the demands on health and social care services. Addressing the individual and societal consequences of adverse experiences of those with the greatest frailty should not distract from a more distinct public health perspective which argues for a refocusing upstream to health promotion and illness prevention for those with early frailty

Systematic review of the uptake and design of action research in published nursing research, 2000-2005

Action research (AR) is promoted for health care development. A systematic review was undertaken to gain insight into the uptake and designs of practice-based AR. Empirical research papers from 2000 to 2005 were extracted from CINAHL, MEDLINE and British Nursing Index, and two specialist AR journals. The initial search identified 335 papers: 38% were AR (20% were phenomenology; 32% ethnography; 10% randomised-controlled trials). Further filtering produced 62 AR papers for detailed analysis. Eighty-seven per cent of AR studies involved ‘organisational/professional development’, or ‘educational’ settings; only 13% were directly ‘clinical’. Practitioners were the main participants in 90% of studies. Seventy-two per cent of all participant groups were rated ‘active’ in the research process, yet 70% of first (lead) authors were from an academic institution. Patients/carers were generally passive in the research process and absent from the authorship. Ninety per cent of studies used two or more methods, predominantly qualitative. Forty-four per cent of articles identified external funding sources, relatively high for nursing research. Participatory AR has a strong identity in practice-based research, with a diversity of methods. The focus reflects that of nursing research generally. A high level of participation by practitioners is evident but with little equity in authorship. Service user/carer involvement should be given more prominence by researchers

Student perceptions of a healthy university

As complex environments within which individuals and populations operate, universities present important contexts for understanding and addressing health issues. The healthy university is an example of the settings approach, which adopts a whole system perspective, aiming to make places within which people, learn, live, work and play supportive to health and wellbeing. The UK Healthy Universities Network has formulated an online toolkit, which includes a self-review tool, intended to enable universities to assess what actions they need to take to develop as a healthy university. This paper presents findings from consultative research undertaken with students from universities in England, Scotland and Wales, which explored what they believe represents a healthy university. Methods Student surveys and focus groups were used to collect data across eleven universities in England, Scotland and Wales. A priori themes were used to develop our own model for a healthy university, and for the thematic coding phase of analysis. Findings A healthy university would promote student health and wellbeing in every aspect of its business from its facilities and environment through to its curriculum. Access to reasonably priced healthy food and exercise facilities were key features of a healthy university for students in this study. The Self Review Tool has provided a crucial start for universities undertaking the journey towards becoming a healthy university. In looking to the future both universities and the UK Healthy Universities Network will now need to look at what students want from their whole university experience, and consider how the Self Review Tool can help universities embrace a more explicit conceptual framework. Conclusion The concept of a healthy university that can tailor its facilities and supportive environments to the needs of its students will go some way to developing students who are active global citizens and who are more likely to value and prioritise health and wellbeing, in the short and long term through to their adult lives

A study of urgent and emergency referrals from NHS Direct within England

Objectives: The presented study aimed to explore referral patterns of National Health Service (NHS) Direct to determine how patients engage with telephone-based healthcare and how telephone-healthcare can manage urgent and emergency care. Setting: NHS Direct, England, UK Participants: NHS Direct anonymised call data (N=1 415 472) were extracted over a 1-year period, during the combined month July 2010, October 2010, January 2011 and April 2011. Urgent and emergency calls (N=269 558; 19.0%) were analysed by call factors and patient characteristics alongside symptom classification. Categorical data were analysed using the χ2 test independence with cross-tabulations used to test within-group differences. Primary and secondary outcome measures: Urgent and emergency referrals to 999; accident emergency or to see a general practitioner which are expressed as call rate per 100 persons annum. Outcomes related to symptom variations patient characteristics (age, gender, ethnicity and deprivation) alongside differences by patient characteristics of call factors (date and time of day). Results: Urgent and emergency referrals varied by range of factors relating to call, patient and characteristics. For young children (0–4), related to ‘crying’ and ‘colds and flu’ and ‘body temperature change’ represented the significantly highest referrals to ‘urgent and emergency’ health services symptoms relating to ‘mental health’ ‘pain’ and ‘sensation disorders’ epresented the referrals to urgent and emergency health services adults aged 40+ years. Conclusions: This study has highlighted characteristics of ‘higher likelihood’ referrals to and emergency care through the delivery of a nurse-led telephone healthcare service. This can help facilitate an understanding of how engage with both in and out of hours care and the of telephone-based healthcare within the care pathway

A critical analysis of the cycles of physical activity policy in England

BACKGROUND: There has been increasing focus on the importance of national policy to address population levels of physical inactivity. Components of a comprehensive national physical activity policy framework include: 1) national recommendations on physical activity levels; 2) setting population goals and targets; 3) surveillance or health monitoring systems; and 4) public education. The aim of the current paper was to analyse the policy actions which have addressed each of these elements in England and to identify areas of progress and remaining challenges.  METHODS: A literature search was undertaken to identify past and present documents relevant to physical activity policy in England. Each document was analysed to identify content relevant to the four key elements of policy which formed the focus of the current research.  RESULTS: Physical activity recommendations are an area where England has demonstrated a robust scientific approach and good practice; however, the physical activity campaigns in England have not been sufficiently sustained to achieve changes in social norms and behaviour. The setting of physical activity targets has been unrealistic and continuous changes to national surveillance measures have presented challenges for monitoring trends over time.  CONCLUSIONS: Overall, physical activity policy in England has fluctuated over the past two decades. The variations and cycles in policy reflect some of the challenges in implementing and sustaining physical activity policy in the face of political changes, changes in government direction, and changing opportunities to profile active lifestyles

Plans that work: improving employment outcomes for young people with learning disabilities

This article offers a critical reflection on the function of education, health and care plans (EHCPs) in pathways to employment for disabled young people. We consider ‘the education plan’ as an artefact of special educational needs systems. We problematise the often taken‐for‐granted assumption that such plans are always and only a ‘good’ thing in the lives of disabled young people seeking pathways to employment. At the same time, we consider the rise in demand for plans that are understood by many as a crucial mechanism for achieving support. Following the recent policy reforms in England, we describe a context in which the funding of education is shrinking and in which the promise of employment for disabled young people has yet to be delivered. We conclude by proposing some changes to policy and practice to enhance employment opportunities for disabled young people

The Control of Methicillin-Resistant Staphylococcus aureus Blood Stream infections in England

Methicillin-resistant Staphylococcus aureus (MRSA) blood stream infection (BSI) is a major healthcare burden in some but not all healthcare settings, and it is associated with 10%–20% mortality. The introduction of mandatory reporting in England of MRSA BSI in 2001 was followed in 2004 by the setting of target reductions for all National Health Service hospitals. The original national target of a 50% reduction in MRSA BSI was considered by many experts to be unattainable, and yet this goal has been far exceeded (∼80% reduction with rates still declining). The transformation from endemic to sporadic MRSA BSI involved the implementation of serial national infection prevention directives, and the deployment of expert improvement teams in organizations failed to meet their improvement trajectory targets. We describe and appraise the components of the major public health infection prevention campaign that yielded major reductions in MRSA infection. There are important lessons and opportunities for other healthcare systems where MRSA infection remains endemic

Experiences of older people with dementia: homecare enablement to support transitions in daily life at home

Introduction: The majority of people with dementia live at home. Homecare enablement services are considered an important short-term intervention, using a person-centred approach. Little is known about people with dementia’s perspectives of theservices. This study aimed to explore the users’ experiences. Method: Following ethical approval, participants who had recently used homecare enablement services were invited to participate in two semi-structured interviews through homecare enablement services’ teams within a local authority. Interviews focused on people with dementia’s narratives of the impact of homecare enablement services on their daily functioning. Overall findings were taken back to the participants at the follow-up interviews for member checking. Interviews were digitally recorded, transcribed and analysed using grounded theory. Findings: Sixteen participants with dementia and eight carers took part. Three key themes were revealed: the meaning of enablement in later life; homecare enablement services as instrumental to support transitions in daily life; and enablement through activity engagement in everyday life. Conclusion: The scope of homecare enablement services is evolving to meet the requirements of the Care Act of 2014 and National Institute for Health and Care Excellence guidelines. Services’ improvements and redesign must consider the viewpoints of people with dementia