Promoting and implementing self care: a mixed methods study of offshore workers and remote healthcare practitioners.

The oil and gas industry is a vital contributor to the global economy and a key source of employment within oil-producing countries. Oil production is largely dependent on a skilled population who are adept in coping with the demands of an offshore environment. Due to the high risk nature of work offshore, it is a requisite that personnel engage in health promoting behaviours. The research aimed to identify aspects of offshore workers self care which required behaviour change and the behavioural determinants which were associated with engagement in self care. A mixed methods design was utilised to generate novel data and original findings. Phase 1 used a quantitative cross-sectional online survey to assess offshore workers (n=352, 53.6% response rate) health, quality of life, mental wellbeing and self care status. The findings highlighted key areas of concern, as indicated by negative scoring across measures, relating to: overweight/obesity; medication adherence; absenteeism (with regard to travelling offshore); medical evacuation; lack of adherence to 5-a-day fruit and vegetable guidelines; physical activity; smoking; hazardous alcohol use, and insomnia. Phase 2 used qualitative theory-based telephone interviews to explore self care behaviours from the perspective of offshore workers (n=16). Offshore workers who had completed a survey and indicated they would like to receive further information on the interviews were invited to participate. Both the interview schedule and data analysis were informed by the Theoretical Domains Framework (TDF). Healthy eating and physical activity were the behaviours most frequently discussed by offshore workers and identified as areas requiring behaviour change. TDF domains representing both behaviours included: beliefs about capabilities; beliefs about consequences; intentions; goals; memory, attention and decision processes; environmental context and resources; social influences; emotion, and behavioural regulation. Phase 3 used qualitative theory-based telephone interviews to explore offshore workers (n=13) self care behaviours from the perspective of remote healthcare practitioners. Both the interview schedule and data analysis were informed by TDF. Healthy eating and harmful/hazardous alcohol use were the behaviours most frequently discussed by remote healthcare practitioners and identified as areas requiring behaviour change. TDF domains representing both behaviours included: knowledge; environmental context and resources; social influences; emotion, and behavioural regulation. The findings, when triangulated suggest that offshore workers may benefit from the implementation of a self care intervention which targets healthy eating, physical activity and alcohol consumption. It is advised that the intervention target multiple self care behaviours and that development is underpinned by behaviour change theory to ensure effectiveness. The intervention may be tailored in accordance with the TDF domains identified in this research as determinants of healthy eating, physical activity and alcohol use behaviours

Affordability, inclusivity and justice : threats to the sustainability of the medical workforce in an economic crisis

Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.Peer reviewedPublisher PD

Opening up the black box of a Gateway to Medicine programme : a realist evaluation

Acknowledgements We would like to thank all our study participants for their valuable input into the study and all those who set up and supported the programme. In particular, thank you to Professor Rona Patey, Professor Stephen Davies, Dr Wendy Dollery, Anna Johnston, Dr Christine Kay, Professor Colin Lumsden, Dr Pietro Marini, Dr Sally Middleton, Sarah Miller, Gwen Smith, Laura Young. In addition, we would like to thank Pat Maclennan for all administrative support and Scottish Government for granting the funding. Funding The programme and work was supported by Scottish Goverment.Peer reviewedPublisher PD

Offshore workers and health behaviour change: an exploration using the Theoretical Domains Framework

Background: Previous research has identified the importance of promoting behaviour change within theoffshore workforce. This qualitative study sought to: identify self-care behaviours perceived to require behaviourchange within the offshore workforce, and explore perceived potential behavioural determinants.Materials and methods: This study included the perspectives of both offshore workers (OWs, n = 16) andhealthcare practitioners (HCPs, n = 12) from the global workforce. Telephone interviews were conducted,recorded electronically and transcribed. Transcripts were analysed independently by two researchers usinga Framework Approach and the Theoretical Domains Framework (TDF) to support coding.Results: Healthy eating and alcohol intake were behaviours perceived by OWs and HCPs to require changewithin the offshore workforce. Knowledge (e.g. availability of nutritional knowledge), intentions (e.g. role ofmotivation), memory, attention and decision process (e.g. effect of boredom), environmental context andresources (e.g. influence of environmental stressors), social influences (e.g. influence of others), emotion(e.g. influence of emotional state) and behavioural regulation (e.g. influence of willpower). TDF domainswere reported by both OWs and HCPs in relation to OWs’ healthy eating and physical activity behaviours.Conclusions: The determinants identified as mechanisms of behaviour may be targeted in future interventionswhich aim to promote engagement in self-care within the offshore workforce

"For us, whatever we do is wrong, until we do something really good" : a qualitative study of the lived experiences of doctors from minority ethnic backgrounds in Scotland

Acknowledgments We remain very grateful to all the participants for giving us their time and sharing their thoughts and experiences with us. Funding The study received a research grant from the Scottish Medical Education Research Consortium (SMERC).Peer reviewedPublisher PD

A qualitative study of the perspectives of older people in remote Scotland on accessibility to healthcare, medicines and medicines-taking

Acknowledgements The authors wish to acknowledge the input of: Melissa Davidson, Lucie Donaldson, Katie Milne and Samantha Moodie to data collection; Anna Marie McGregor, Katie MacLure, Alpana Mair, Gary Todd, Martin Wilson and Kay Wood to interview schedule review; and all interviewees.Peer reviewedPublisher PD

Perceived roles and barriers in caring for the people who are homeless:a survey of UK community pharmacists

Background: Community pharmacists can be an accessible source for advice and support for the people who are homeless, given their utilisation of a variety of currently available services such as dispensing of medicines, drugs and alcohol services. Objective: To determine community pharmacists’ training, experiences and behavioural determinants in counselling and management of homeless population. Setting: UK community pharmacies. Method: A questionnaire based on literature and theoretical domains framework was mailed to randomly sampled community pharmacies in England and Scotland (n = 2000). Data were analysed using descriptive and inferential statistics. Main outcome measures: Pharmacists’ perspectives, pharmacists’ training, pharmacists’ experiences and behavioural determinants. Results: A total of 321 responses (RR 16.1%) were received. Respondents indicated lack of knowledge, skills, intentions as well as contextual factors such as lack of guidelines impacted on their counselling and management of homeless patients. Less than a third (n = 101, 32.2%) indicated that they knew where to refer a homeless patient for social support. Broaching the subject of homelessness was outside their comfort zone (n = 139, 44.3%). Only four (1.2%) respondents could correctly answer all knowledge assessment questions. Conclusions: Community pharmacist identified lack of education, training opportunities and guidelines in counselling and management of homeless patients. Targeting community pharmacists’ knowledge, skills and intention to provide care to the homeless patients may enable addressing health inequality through community pharmacy

Remote communities: promoting engagement in self-care.

Behaviour change interventions which promote engagement in self-care may be utilised as a means to increase the reach of healthcare and reduce health inequality by targeting those populations deemed harder to reach. The remote and rural community and offshore workforce in the United Kingdom may be regarded as hard to reach and accordingly, may benefit from implementation of a self-care behaviour change intervention. Such interventions may foster resilience and wellbeing within these communities, and increase quality of life. However, traditional face-to-face methods of delivery may prove challenging to implement within remote communities. Accordingly, digital means of delivery may proffer a unique opportunity to engage those that are harder to reach. In addition, digital interventions may assist in overcoming some of the barriers that are typically associated with face-to-face methods. For example, they may assist in reducing the stigma that is often associated with seeking help. Strategies such as self-monitoring, whereby an individual monitors their own health data, may prove beneficial in promoting self-care. It is advocated, in an effort to best ensure sustained behaviour change, that digital interventions are developed in accordance with theory. The use of theory enables intervention developers to match determinants of behaviour to intervention content. Such mapping is proposed to increase the effectiveness of interventions. This paper is based on an essay which was submitted to the International Self-Care Foundation and Self-Care Journal Prize Essay Competition 2015, and was awarded a runner-up prize

Medical evacuations and absences from work in offshore personnel employed in the oil and gas industry

BACKGROUND: Absenteeism and medical evacuation (medevac) has a significant impact on offshore operations, and individual health and wellbeing. OBJECTIVES: The research aimed to estimate the prevalence of medevac and work absences due to health-related problems in global offshore workers. DESIGN: A cross-sectional survey utilising an electronic questionnaire, comprising closed questions, was developed to identify the prevalence of medevac and absenteeism, pre-tested with an expert panel and piloted (n=9). Global oil and gas industry employees (n=776) attending a 1-day course at a training facility in Aberdeen, Scotland, were recruited on a daily basis. Consenting participants received an invitation email containing a link to an online questionnaire. RESULTS: A total of 352 questionnaires were returned (45.4% response rate). One fifth (n=70, 20.1%) of respondents stated that, over the course of their career, they were unable to travel offshore for work due to their health-related problems. Absence was primarily due to: injury (n=30, 39.0%); short-term illness (n=19, 24.7%), or long-term illness (n=4, 5.2%). Over the course of their offshore careers, approximately one tenth (n=42, 12.1%) had required medevac of which most resulted from either injury (n=15, 34.1%) or short/long-term illness (n=14, 31.8%). A significant association between absenteeism and medical evacuation was identified (p= 0.002). CONCLUSIONS: The findings support the need for further preventative measures to be taken as a means of reducing the incidence of medevacs and absences in the offshore industry. The development of interventions that enable offshore workers to maintain their own health and wellbeing may be of benefit