Research into practice : collaboration for leadership in applied health research and care (CLAHRC) for Nottinghamshire, Derbyshire, Lincolnshire (NDL)

To address the problem of translation from research-based evidence to routine healthcare practice, the Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire, and Lincolnshire (CLAHRC-NDL) was funded by the National Institute for Health Research as one of nine CLAHRCs across England. This paper outlines the underlying theory and its application that CLAHRC-NDL has adopted, as a case example that might be generalised to practice outside the CLAHRC, in comparison to alternative models of implementation

A mixed-methods study of challenges and benefits of clinical academic careers for nurses, midwives and allied health professionals

Objectives: The clinical academic trajectory for doctors and dentists is well-established, with research embedded in their career development. Recent years have also seen a burgeoning interest and push for nurses, midwives and allied health professionals (NMAHPs) to pursue a clinical academic career. However, the NIHR 10 year review suggested that there may be problems with progression post Master’s degree level for this group, with nurses and midwives receiving less NIHR funding than AHPs. This study responds to these concerns, tracking the progression and exploring experiences of NMAHPs in the East Midlands region of England. Design: An online survey and in-depth interviews were used to capture a wide range of experiences.Participants: 67 NMAHPs who were pursuing a clinical academic career were surveyed, supplemented by 16 semi-structured in-depth interviews.Results: Three themes emerged during data analysis: Embarking on a clinical academic career; overcoming barriers; and benefits.Conclusions: NMAHPs are motivated to pursue a clinical academic career by a drive to improve services for the benefit of patients and the NHS more widely, as well as for personal development and career progression. People working in these roles have opportunities to explore possible solutions to issues that they encounter in their clinical role through academic study. Findings reveal benefits emanating from the individual level through to (inter)national levels, therefore academic study should be encouraged and supported. However, investment is needed to establish more clinical academic roles to enable NMAHPs to continue to utilise their experience and expertise post-PhD, otherwise the full extent of their value will not be recognised

An analysis of the research team–service user relationship from the service user perspective: a consideration of ‘The Three Rs’ (roles, relations, and responsibilities) for healthcare research organisations

Background This article debates interview data from service users who engaged with the work of a Collaboration for Leadership in Applied Health Research and Care (CLAHRC). The evidence base, to date, concerning the nature of CLAHRC work at the frontline (i.e. What is it actually like to do CLAHRC work?) is meagre; thus, this article represents an original contribution to that literature. Further, this article analyses service users' participation in research – as members of the research team – and so contributes to the body of developing literature regarding involvement too. Objective This article explores the nature of the Research Team–Service User relationship, plus associated roles, relations and responsibilities of collaborative health research. Design Qualitative social science research was undertaken in a health-care research organization utilizing interview method and a medical sociology and organizational sociology theoretical framework for analysis. Data utilized originate from a larger evaluation study that focuses on the CLAHRC as an iterative organization and explores members' experiences. Results There can be a disparity between initial expectations and actual experiences of involvement for service users. Therefore, as structured via ‘The Three Rs’ (Roles, Relations and Responsibilities), aspects of the relationship are evaluated (e.g. motivation, altruism, satisfaction, transparency, scope, feedback, communication, time). Regarding the inclusion of service users in health research teams, a careful consideration of ‘The Three Rs’ is required to ensure expectations match experiences

Genetically exceptional?: women's experiences of being at risk of hereditary breast and ovarian cancer

This thesis questions whether the experiences of women at-risk of hereditary breast and ovarian cancer (HBOC) might be genetically exceptional. Using a combination of retrospective in-depth interviews with women at-risk and observations of consultations carried out at a regional specialist centre, this research questions the genetic exceptionalism thesis and the argument that the experiences and decisions that women at-risk of HBOC make, are unique and thus different compared to those of women diagnosed with non-genetic, sporadically developing breast or ovarian cancer. In examining the arguments for and against genetic exceptionalism, this thesis revisits the medical sociological literature on the doctor-patient relationship and discusses the difficulty in establishing who should be recognised to be the patient within the genetic consultation, the decision to undergo genetic testing and the decision to have risk-reducing, prophylactic surgery. The resulting analysis recognises the data to be moral accounts, constructed by research participants so that their utterances would be perceived in a particular manner. For example, while justifying their reported actions, participants were attempting to portray themselves as moral, responsible citizens, mothers, patients and women. In addressing these four aspects of women’s HBOC experiences, this thesis concludes that there is little unfamiliar to medical sociologists about the experiences described and the rationales given by the participants. Such data lends itself to the position where the notion of genetic exceptionalism cannot be supported. Consequently, the thesis concludes that the experiences of women at-risk of HBOC seem to be little different from other, non-genetic health experiences

The propagation of Standard Language Ideology: exploring how a Grade One teacher in an urban, linguistically diverse, English-medium primary school conceptualises language

In the context of unequal access to quality education in South Africa in a first language, and policy that relies upon outdated, inaccurate conceptions of language, this study looks at how a Grade One educator at an urban English-medium school (attended by a linguistically diverse cohort of mostly non-English home language speakers) in Cape Town thinks about and talks about language in her teaching practices. The central question it attempts to answer is: how does Ms L, a Grade One educator at South Star Primary School, conceptualise language in her teaching practices? In other words, what is language for Ms L? With an eye to answering this question, I examine the language practices of Ms L alongside the assumptions implicit in her interactions with learners about (what counts as legitimate) language use and language speakers. I draw on current sociolinguistic theory which posits that language is a situated social practice, and contrast this with the conception of language as an identifiable bounded entity that is ubiquitous in policy and curriculum statements. Using concepts from sociolinguistics and applied linguistics, I analysed transcriptions from two weeks of lesson recordings in Ms L's classroom. Ms L's teaching practices pointed to a conception of language as a system of parts, as a measurable skill, and languages as separable objects. Analysis of her language practices showed the use of mainly one named language, English, except during Afrikaans lessons where she attempted to use only Afrikaans, occasionally drawing on English linguistic resources for specific purposes. Learners were strongly discouraged from using more than one language at a time, and use of different languages were strictly demarcated according to the lesson being taught. Aside from this evidence pointing to a conception similar to that evident in policy - of language as an autonomous entity, and languages as distinct and distinguishable objects - many of the ways in which Ms L spoke about language also pointed to a standard language ideology. This is incompatible with multilingualism and is a symbolic devaluing of non-standard varieties and speakers

From admission to discharge in mental health services: a qualitative analysis of service user involvement

Background: User involvement and recovery are now widely used terms within the mental health policy, research and practice discourse. However, there is a question mark about the impact these ideas have in everyday practice. Of interest is the degree of involvement in key transitions of care. In particular admission to and discharge from acute inpatient mental health wards. Objective: To explore the nature of service user involvement in the admission and discharge process into and out of acute inpatient mental health care. Design: A qualitative study using focus groups. Setting and Participants: One acute, inpatient mental health ward was the focus of the study. Seven uni-professional focus group interviews were conducted with ward staff, community staff and service users (total number of participants = 52). Conventional, thematic qualitative techniques were used to analyse the data. Results: The data analysed and presented in this article relates to the loss of the service user voice at the key transition points into and out of acute inpatient care. Due to the lack of resources (inpatient beds and community care follow up) the role service users could play was diminished. In their narratives clinical staff associated the person with the process and used language which dehumanised the individual. Conclusion: Service users experience numerous care transitions into and out of hospital. As there is the potential for these encounters to have a lasting negative effect, the importance of ensuring service users have a voice in what is happening to them is crucial

The Acceptability and Usability of Digital Health Interventions for Adults With Depression, Anxiety, and Somatoform Disorders: Qualitative Systematic Review and Meta-Synthesis

The prevalence of mental health disorders continues to rise, with almost 4% of the world population having an anxiety disorder and almost 3.5% having depression in 2017. Despite the high prevalence, only one-third of people with depression or anxiety receive treatment. Over the last decade, the use of digital health interventions (DHIs) has risen rapidly as a means of accessing mental health care and continues to increase. Although there is evidence supporting the effectiveness of DHIs for the treatment of mental health conditions, little is known about what aspects are valued by users and how they might be improved. This systematic review aimed to identify, appraise, and synthesize the qualitative literature available on service users' views and experiences regarding the acceptability and usability of DHIs for depression, anxiety, and somatoform disorders. A systematic search strategy was developed, and searches were run in 7 electronic databases. Qualitative and mixed methods studies published in English were included. A meta-synthesis was used to interpret and synthesize the findings from the included studies. A total of 24 studies were included in the meta-synthesis, and 3 key themes emerged with descriptive subthemes. The 3 key themes were initial motivations and approaches to DHIs, personalization of treatment, and the value of receiving personal support in DHIs. The meta-synthesis suggests that participants' initial beliefs about DHIs can have an important effect on their engagement with these types of interventions. Personal support was valued very highly as a major component of the success of DHIs. The main reason for this was the way it enabled individual personalization of care. Findings from the systematic review have implications for the design of future DHIs to improve uptake, retention, and outcomes in DHIs for depression, anxiety, and somatoform disorders. DHIs need to be personalized to the specific needs of the individual. Future research should explore whether the findings could be generalized to other health conditions. [Abstract copyright: ©Shireen Patel, Athfah Akhtar, Sam Malins, Nicola Wright, Emma Rowley, Emma Young, Stephanie Sampson, Richard Morriss. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 06.07.2020.

Industry perceptions of barriers to commercialization of regenerative medicine products in the UK

Aims Regenerative medicine is an emerging field with the potential to provide widespread improvement in healthcare and patient well-being via the delivery of therapies which can restore, regenerate or repair damaged tissue. As an industry, it could significantly contribute to economic growth if products are successfully commercialized. However, to date, relatively few products have reached the market due to a variety of barriers, including a lack of funding and regulatory hurdles. The present study analyzes industry perceptions of the barriers to commercialization which currently impede the success of the regenerative medicine industry in the UK. Materials & Methods The analysis is based on twenty interviews with leading industrialists in the field. Results The study revealed that scientific research on regenerative medicine is thriving in the UK. Unfortunately, lack of access to capital, regulatory hurdles, lack of clinical evidence leading to problems with reimbursement, as well as the culture of the NHS do not provide a good environment for the commercialization of RM products. Conclusions Policy interventions, including increased translational government funding, a change in NHS and NICE organisation and policies as well regulatory clarity would likely improve the general outcomes for the regenerative medicine industry in the UK