Interview with Elaine Hartley from Down to Earth Natural Foods

Elaine Hartley talks about growing up and her job at Down to Earth Foods.https://digital.kenyon.edu/elfs_interviews/1051/thumbnail.jp

Interview with Elaine Hartley regarding Down to Earth

Elaine Hartley talks about food options and consumption in Mt. Vernon.https://digital.kenyon.edu/elfs_interviews/1010/thumbnail.jp

Gateway to health: promoting the physical and psychosocial wellbeing of older adults and people with long-term conditions

The ageing population and predicted increase in the number of people with long-term conditions (LTCs) presents a challenge to healthcare systems when faced with demands to provide more cost-effective and sustainable services. Optimising citizens’ health and wellbeing (HWB) could offer an efficient way to provide holistic care; however, it is not clear as to how to achieve this. This thesis demonstrates how my publications have helped to contribute to knowledge within the HWB arena for older adults and people with LTCs, and, specifically, to gain more understanding of their physical and psychosocial health needs and models of care that can promote their HWB. To offer context to these publications, this thesis provides a critical review of the relevant theory. This includes an appraisal of healthcare policy to highlight the issues faced by current health services, drivers for change and approaches to models of care. The concept of HWB has also been deliberated including a critical evaluation of its role in relation to healthy ageing and the wellbeing agenda. Six publications are contained within this thesis and, as a collective, reflect a mixed methods research design as they involve interviews, a focus group and surveys. The final publication, a theoretical paper, is an amalgamation of all the research findings discussed within the context of a critical review of the literature and linked explicitly to the physiotherapist’s role in long-term condition management. The findings of the publications are from insights gained from the perspectives of people with LTCs, though, mainly from those with neuromuscular disorders and mental ill-health, as well as older adults. The publications’ findings demonstrate the capacity of voluntary, community and social enterprises (VCSE) to provide integrated care that meets the holistic needs of those who access them whilst, potentially, addressing the social determinants of health. They also highlight the necessity for supporting people with LTCs to improve their life circumstances through their own personal empowerment. This includes the ability to facilitate their readiness to take on the responsibility with partnership working between the individual and the healthcare worker and psychological support when needed being identified as key. Developing the person’s social skills and aptitude to build interdependent relationships have been determined as the ultimate goal to enhance capacity for community engagement and further access to HWB resources. The publications’ findings also show that capitalising on the power of social networks to foster older adults’ adherence to community physical activity (PA) groups may promote HWB and, thus, the ability to age healthily. It was also found that if older adults become embedded within the PA group’s network they could shape the environment to fulfil their own needs. In addition, the findings advocate the necessity for a transformation in physiotherapy practice including enhancing the physiotherapists’ role as health promoters. It is proposed that only by doing so; they can remain contemporary and continue to support the optimisation of the HWB of older adults and people with LTCs. Further to the publications, this thesis comprises a critical commentary that includes how VCSE can support healthcare services by promoting the HWB of people with LTCs and older adults. Finally, this thesis culminates in a critical discussion of the implications, for practice and policy, of the findings from my publications, with recommendations for further research

Physical activity counselling among junior doctors in the UK: A qualitative study

Background: Evidence supporting physical activity (PA) as an effective modality in the prevention and management of non-communicable diseases is robust. Medical doctors are ideally placed to translate this into practice; however, realising this has proved challenging. To ensure doctors are well prepared, the training of medical students to be proficient in PA counselling seems essential. This study aimed to explore the PA counselling practice of junior doctors, to gain insight into how undergraduate training might influence their future practice. Methods: Interviews were conducted with 11 junior doctors recruited by purposive sampling from across seven different medical schools. All junior doctors were currently undertaking their post-graduate training in North-West England. Interviews were digitally recorded, transcribed verbatim and analysed using thematic analysis. Results: Themes developed from the data were PA attitudes and practices, and barriers and facilitators to PA counselling in clinical practice. Conclusion: The PA counselling practice of junior doctors was found to be inadequate, and attitudes towards PA promotion were particularly discouraging while in the hospital setting. Lack of training in PA counselling at both the undergraduate and postgraduate level and lack of support from consultants were major hindrances. However, unexplored opportunities exist for junior doctors to incorporate PA counselling into primary and secondary care and thus transform the practice of the next generation of doctors

Views and experiences of non-medical prescribing: a national survey of prescribing physiotherapists

Background: Physiotherapy non-medical prescribing (NMP) is a contemporary development whereby physiotherapists can prescribe medications within their scope of practice. Despite institutional and professional support for its implementation, data regarding physiotherapists’ views and experiences of NMP is limited. Objectives: To explore the views and experiences of NMP for UK prescribing physiotherapists. Design: Cross-sectional study, using an anonymous, online survey. Methods: Recruitment involved non-probability sampling targeting UK physiotherapists with a NMP qualification. Data was gathered about the role, scope, and activity of prescribing physiotherapists via closed and open-ended questions. Descriptive statistics and inductive content analysis were undertaken. Results: Of the 552 respondents, most worked in FCP roles (122/552, 22%) and 82% (450/552) prescribed medication. NSAIDs were the most prescribed drug class (267/450, 59%). Perceived benefits were enhanced patient care, reduced burden on other prescribers, and improved medication access. Challenges included restrictions on prescribing or deprescribing controlled drugs (CDs), limited scope of practice, and inadequate CPD. Themes identified to improve physiotherapy NMP were increasing the CDs that physiotherapists can independently prescribe and deprescribe, improving CPD and supervision, and increasing awareness amongst the public and healthcare professionals. Conclusions: This study provides novel findings of the perceived benefits, challenges, and development areas for physiotherapy prescribing. There is a need to review and potentially expand the drug formulary for physiotherapists. Improving education and supervision is crucial for the sustainable growth of physiotherapy NMP. Increasing the awareness amongst the public and healthcare professionals may enhance the acceptance of physiotherapy prescribing. Contribution of the paper: - This study provides novel insights into physiotherapy NMP in the UK and highlights future development needs. - The survey identifies that NMP physiotherapists perceive a need to review and expand the current drug formulary to allow physiotherapists to independently prescribe and deprescribe more CDs within their scope of practice. - Physiotherapy prescribing is rapidly increasing across the UK, improving the education, supervision, and awareness of physiotherapy NMP should be considered to enhance future practice

Future-proofing the Profession: Physiotherapists’ perceptions of their current and emerging role

Objectives As healthcare systems continue to modernise, physiotherapists are required to transform their practice to remain contemporary and meet future population needs. The study aims to gain an insight into physiotherapists’ perceptions of their current and emerging future role. The intention is to develop an understanding of the physiotherapist’s role and how it can continue to evolve to support populations’ needs in more sustainable and innovative ways. Design A qualitative design using semi-structured interviews was undertaken informed by Gadamerian hermeneutic philosophy. Participants Participants were gained from a postgraduate physiotherapy programme in Northwest England that recruits physiotherapists from across the UK; via the research teams’ professional networks and using snowball sampling. Interviews were digitally recorded and transcribed verbatim. Thematic analysis was undertaken. Ethical approval and informed consent was obtained. Results 23 participants (15 female). 4 themes were identified: ‘An underpinning philosophy of practice’ that promotes holistic care and supports patient wellbeing. An ‘evolving role broadening the scope of practice’ with many ‘agents of change shaping the profession’. When ‘preparing the future workforce and their transition into practice’, graduates were seen as more adaptable and resilient. However, more affiliation between the university and placement providers to enhance learning environments is needed. Conclusions Physiotherapists need to re-evaluate their role so a clear vision for the future can be co-created to ensure they remain contemporary and continue to optimise their potential. An emerging role that re-envisages a holistic approach that incorporates health promotion as fundamental to this role could support physiotherapists’ transformation in practice

Moving anticoagulation initiation and monitoring services into the community:Evaluation of the Brighton and hove community pharmacy service

Abstract Background As part of the NHS desire to move services closer to where people live, and provide greater accessibility and convenience to patients, Brighton and Hove Clinical Commissioning Group (CCG) underwent a review of their anticoagulation services during 2008. The outcome was to shift the initiation and monitoring service in secondary care for non-complex patients, including domiciliary patients, into the community. This was achieved via a procurement process in 2008 resulting in the Community Pharmacy Anticoagulation Management Service (CPAMs) managed by Boots UK (a large chain of community pharmacies across the United Kingdom). Methods This evaluation aims to review the outcomes (International Normalised Ratio [INR] readings) and experiences of those patients attending the anticoagulation monitoring service provided by community pharmacists in Brighton and Hove. All patients on warfarin are given a target INR range they need to achieve; dosing of and frequency of appointment are dependent on the INR result. Outcome measures for patients on the CPAM service included percentage INR readings that were within target range and the percentage time the patient was within therapeutic range. Data collected from 2009 to 2016 were analysed and results compared to the service targets. Patient experience of the service was evaluated via a locally developed questionnaire that was issued to patients annually in the pharmacy. Results The evaluation shows that community pharmacy managed anticoagulation services can achieve outcomes at a level consistently exceeding national and local targets for both percentage INR readings in therapeutic target range (65.4%) compared to the recommended minimum therapeutic target range of 60.0% and percentage time in therapeutic range (72.5%, CI 71.9–73.1%) compared to the national target of 70.0%. Patients also indicated they were satisfied with the service, with over 98.6% patients rating the service as good, very good or excellent. Conclusion The Brighton and Hove CPAM service achieved above average national target management of INR and positive patient feedback, demonstrating that community pharmacy is ideally placed to provide this service safely and deliver enhanced clinical outcomes and positive patient experience

Suffix interference and processing speed effects in young and older adults' visual feature binding

There is debate regarding whether or not working memory for bound visual objects is more age-sensitive than that for individual visual features. To investigate this potential ‘age-related binding deficit’, we administered a visual recognition task to young and healthy older adults. In experiment 1, coloured shapes were sequentially presented, either with or without a subsequent, to-be-ignored, coloured shape (suffix). Performance was generally better with the individual shape memory test relative to binding (coloured shape test), although a greater binding deficit was found in older than young adults, regardless of whether or not a suffix had been presented. Additional analyses identified that the deficit was only observable within the lure (test probe absent) trials, suggesting that it is more likely to be observed in circumstances that encourage overwriting of bound objects at test. A second experiment will also be presented, which was aimed at assessing the potential role of processing speed in visual binding. Both age groups performed the task at relatively slow and fast encoding speeds, tailored to each group, allowing us to explore the circumstances that may lead to binding deficits and/or serial position curves in both young and older adults

COVID-19 and the role of Voluntary, Community, and Social Enterprises in northern England in responding to the needs of marginalised communities: a qualitative focus group study

Background: The Voluntary Community and Social Enterprise sector has a crucial role in supporting the health and wellbeing of people who are marginalised or who have multiple complex needs. We aimed to understand perceptions of those working in the sector and examine the short-term, medium-term, and long-term effects of COVID-19 on Voluntary Community and Social Enterprise organisations in northern England as they respond to the needs of marginalised communities. This research formed one component of a regional multiagency Health Inequalities Impact Assessment. Methods: We conducted qualitative focus groups with staff and volunteers from five organisations between March and July, 2021, via a video conferencing platform. Eight of nine focus groups were audio-recorded and transcribed verbatim. One focus group was not recorded due to concerns raised over anonymity and safeguarding, but non-ascribed fieldnotes were taken. Focus group transcripts were analysed using framework analysis. Findings: One organisation supported children and young people; two organisations supported vulnerable women, young people, and families; one organisation supported refugees and asylum seekers, and one organisation supported disadvantaged individuals to improve their mental and physical health and wellbeing. Three central themes were identified: the exacerbation of pre-existing inequalities, adversity, and challenges for vulnerable and marginalised populations; the cost of being flexible, innovative, and agile for Voluntary Community and Social Enterprise staff and volunteers; and the voluntary sector as a lifeline (organisational pride and resilience). Interpretation: The considerable expertise, capacity, and resilience of Voluntary Community and Social Enterprise organisations and the crucial role they have in supporting marginalised communities has been clearly shown in their response to the COVID-19 pandemic. The Voluntary Community and Social Enterprise sector therefore has an essential role in the post-COVID levelling-up agenda. The implications of these findings for service provision are that the Voluntary Community and Social Enterprise sector must be recognised as an integral partner within any effectively functioning local health system and, as such, adequately resourced to safeguard sustainability and to ensure that attempts to involve the sector in addressing the social determinants of health are not jeopardised. Funding: National Institute for Health and Care Research (Applied Research Collaboration North East and North Cumbria (grant reference NIHR200173) and Public Health England. SSo is supported by a Health Education England and National Institute for Health and Care Research Integrated Clinical Academic Lecturer award (reference CA-CL-2018-04-ST2-010) and Research Capability Funding, National Health Service North of England Care System Support. VJM is funded by the National Institute for Health and Care Research School for Public Health Research (grant reference PD-SPH-2015)