Development of self-help groups for caregivers of children with disabilities in Kilifi, Kenya: Process evaluation

Background: Caring for a child with disabilities in a resource-poor setting brings many challenges to the caregiver. We examined the development of self-help groups for caregivers in a rural part of Kenya. Objectives: To conduct a process evaluation on the development of self-help groups during a 10-month set-up period, focusing on implementation and mechanisms associated with their functional status. Methods: Using a realist evaluation design, we set up 20 self-help groups for 254 caregivers. An evaluation was conducted to investigate implementation and mechanisms of impact. Implementation focused on caregiver registration, community group support and monitoring visit compliance. Data were collected from group registers, records of meetings and field notes. Mechanisms of impact employed a framework of strengths-weaknesses-opportunities-threats to review the groups at the end of the 10-month set-up period. Results: Recruitment resulted in registration of 254 participants to 18 groups-two groups disbanded early. Post-evaluation included 11 active and 7 inactive groups. Compliance with the monitoring visits was consistent across the active groups. All groups engaged in 'merrygo-round' activities. The active groups were characterised by strong leadership and at least one successful income generation project; the inactive had inconsistent leadership and had dishonest behaviour both within the group and/or externally in the community. Mediators associated with functional status included the following: available literacy and numeracy skills, regular meetings with consistent attendance by the members, viable income generating projects, geographical proximity of membership and strong leadership for managing threats. Conclusion: Self-help groups have the potential to progress in resource-poor settings. However, critical to group progression are literacy and numeracy skills amongst the members, their geographical proximity, regular meetings of the group, viable income generating projects and strong leadership

The meaning and importance of dignified care: Findings from a survey of health and social care professionals

This article is available through the Brunel Open Access Publishing Fund. Copyright © 2013 Cairns et al.; licensee BioMed Central Ltd.There are well established national and local policies championing the need to provide dignity in care for older people. We have evidence as to what older people and their relatives understand by the term 'dignified care' but less insight into the perspectives of staff regarding their understanding of this key policy objective.This research was supported by the Dunhill Medical Trust [grant number: R93/1108]

Seed system security assessment: Southern Sudan

A Seed System Security Assessment (SSSA) was carried out across Southern Sudan in November–December 2010. It reviewed the functioning of the seed systems farmers use, both formal and informal, and assessed whether farmers could access seed of adequate quantity and quality in the short and medium term. The work covered 8 states and 16 counties, chosen to anticipate the range of possible seed security constraints. Field research encompassed 885 farmer interviews, seed/grain market analysis, interviews with 70 traders, over 25 focus group discussions (including discussions with women’s groups), and key-informant sessions. Background papers were also commissioned on: a) the formal breeding sector’s structures and processes; b) the formal seed sector’s structures and processes; and c) current decentralized seed multiplication and distribution initiatives. This is among the more comprehensive agricultural and seed security assessments carried out nationwide, across Southern Sudan, in many decades

Why are relatives of care home residents reluctant to ‘rock the boat’? Is there a culture of acceptance?

Purpose - The purpose of this paper is to explore whether relatives of care home residents are best placed to act as ‘champions’ or advocates for their family members, as is often the expectation. Design/methodology/approach - Focus groups and interviews were conducted with 25 relatives of residents in four care homes for older people in the South East of England. Two rounds of focus groups were held in each participating care home: the first was to discuss any issues arising from the care received, or concerns about the home itself; the second was to enable a deeper exploration of the key themes that arose from the first round and explore why relatives, in this case, failed to complain. Findings - Thematic analysis revealed a complex range of emotions experienced by relatives that contributed to a conflict between what they believed to be the correct response and how they behaved in reality, which led to a culture of acceptance. Analysis revealed some relatives were reluctant to ‘interfere’ for fear of possible negative repercussions, thus they downplayed issues in an attempt not to ‘rock the boat’. Originality/value - This paper discusses the flaws in the policy emphasis on personalisation and the reliance on family members as advocates, and concludes with suggestions on how care homes may foster an environment where relatives, and indeed residents, feel comfortable to raise issues and concerns

Strategic argumentation: A game theoretical investigation

Argumentation is modelled as a game where the payoffs are measured in terms of the probability that the claimed conclusion is, or is not, defeasibly provable, given a history of arguments that have actually been exchanged, and given the probability of the factual premises. The probability of a conclusion is calculated using a standard variant of Defeasible Logic, in combination with standard probability calculus. It is a new element of the present approach that the exchange of arguments is analysed with game theoretical tools, yielding a prescriptive and to some extent even predictive account of the actual course of play. A brief comparison with existing argument-based dialogue approaches confirms that such a prescriptive account of the actual argumentation has been almost lacking in the approaches proposed so far

Seed system security assessment : Southern Sudan : November-December 2010

Juba, South Suda

Can Fire and Rescue Services and the National Health Service work together to improve the safety and wellbeing of vulnerable older people? Design of a proof of concept study

Older adults are at increased risk both of falling and of experiencing accidental domestic fire. In addition to advanced age, these adverse events share the risk factors of balance or mobility problems, cognitive impairment and socioeconomic deprivation. For both events, the consequences include significant injury and death, and considerable socioeconomic costs for the individual and informal carers, as well as for emergency services, health and social care agencies.Secondary prevention services for older people who have fallen or who are identifiable as being at high risk of falling include NHS Falls clinics, where a multidisciplinary team offers an individualised multifactorial targeted intervention including strength and balance exercise programmes, medication changes and home hazard modification. A similar preventative approach is employed by most Fire and Rescue Services who conduct Home Fire Safety Visits to assess and, if necessary, remedy domestic fire risk, fit free smoke alarms with instruction for use and maintenance, and plan an escape route. We propose that the similarity of population at risk, location, specific risk factors and the commonality of preventative approaches employed could offer net gains in terms of feasibility, effectiveness and acceptability if activities within these two preventative approaches were to be combined

Active Residents in Care Homes (ARCH) : study protocol to investigate the implementation and outcomes of a whole-systems activity programme in residential care homes for older people

OBJECTIVES: To evaluate the effectiveness, acceptability and costs of Active Residents in Care Homes, ARCH - a programme aiming to increase opportunities for activity in older care home residents. DESIGN: Feasibility study. SETTING: Residential care homes for older people. PARTICIPANTS: 10-15 residents, staff and family members will be recruited in each of the three participating care homes. INTERVENTION: ARCH is a 12-month 'whole-systems' programme implemented by occupational therapists and physiotherapists. They will conduct a comprehensive assessment of each care home, considering the physical environment, working practices and organisation structure as well as residents' individual needs, and recommend ways to address barriers and increase residents' activity levels. The therapists will then work with staff to improve understanding of the issues, instigate training, environmental, organisational and working practice changes as necessary. MAIN OUTCOME MEASURES: Residents' activity levels, health and quality of life will be tested using several measures to see which are practicable and appropriate for this population in this context. This includes: Assessment of Physical Activity in Frail Older People; Pool Activity Level Checklist; Dementia Care Mapping observations; and EQ-5D-5L. Residents will be assessed prior to programme implementation then 4- and 12-months post-implementation. Semi-structured interviews will explore the experiences of residents, staff, family members and therapists. CONCLUSIONS: Providing evidence of effectiveness and acceptability of ARCH, and documenting factors that impede/facilitate implementation will help us identify ways to enhance the care and quality of life of older people in residential care, and our understanding of how to implement them