A profiling exercise of childhood immunisation services in Edinburgh: A qualitative report.

BACKGROUND:Childhood immunisation is a complex area in the research literature with a number of contributing influences. Within Edinburgh Community Health Partnership (CHP), recent figures indicated that there was great geographical variety for immunisations and uptake rates. While initial primary immunisations were high, uptake of measles, mumps and rubella (MMR) did not always meet expected targets (e.g. Health Protection Newsletter, April, 2008).AIMS OF EXERCISE:- To review the current literature on childhood immunisations.- To explore the views and experiences of relevant stakeholders (parents, health staff and key management) for current childhood immunisation services across Edinburgh.- To identify potential facilitators and barriers towards childhood immunisations that may affect uptake rates.KEY MESSAGES AND RECOMMENDATIONS:- Lay beliefs about immunisation could be addressed- Communication and rapport for immunisation is important- There is conflict between public health issues versus the financial model in current services- Increased parental choice about immunisation services delivery is needed- Developing confidence and skills in health staff is necessary for the delivery of childhood immunisations after informed consent- Greater public health campaigns are needed concerning the value of vaccinations- Greater support was requested by health staff for complex schedules- Government policies and vaccine shortages were held to be unsatisfactory amongst health staff- From a local Edinburgh context, this work has wider relevance for the national immunisation campaigns

Transition to parenthood in the neonatal care unit: a qualitative study and conceptual model designed to illuminate parent and professional views of the impact of webcam technology

Background: Complications during pregnancy, childbirth and/or the postnatal period may result in the admission of a baby to a neonatal unit (NNU). While the survival and long-term prospects of high-risk infants are enhanced by admission, the enforced separation of the parent and child may have psychological consequences for both. There is a need to develop and evaluate interventions to help parents ‘feel closer’ to their infants in circumstances where they are physically separated from them. In this paper we present findings from an in-depth, theoretically-driven, evaluation of a technological innovation designed to address this need. The study sought to explore parent and professional views of the impact of the technology, which transmits real-time images of the baby via a webcam from the NNU to the mother’s bedside in the post-natal care environment.Methods: A qualitative approach was adopted, guided by a critical realist perspective. Participants were recruited purposively from a NNU located in East-central Scotland. Thirty-three parents and 18 professionals were recruited.Data were collected during individual, paired and small group interviews and were analys ed thematically. Following the initial analysis process, abductive inference was used to consider contextual factors and mechanisms of action appearing to account for reported outco mes.Results: Views on the technology were overwhelmingly positive. It was perceived as a much needed and important advancement in care delivery. Benefits centred on: enhanced feelings of closeness and responsiveness; emotional wellbeing; physical recovery; and the involvement of family/friends. These benefits appeared to function as important mechanisms in supporting the early bonding process and wider transition to parenthood. However, for a small number of the parents, use of the technology had not enhanced their experience and it is important, as with any intervention, that professionals monitor the parents’ response and act accordingly.Conclusions: With a current global increase in premature births, the technology appears to offer an important solution to periods of enforced parent-infant separation in the early post-natal period. The current study is one of a few world-wide to have sought to evaluate this form of technology in the neonatal care environment

Development of a cross-cultural HPV community engagement model within Scotland

Objective To examine cultural barriers and participant solutions regarding acceptance and uptake of the Human Papillomavirus (HPV) vaccine from the perspective of Black African, White-Caribbean, Arab, Indian, Bangladeshi and Pakistani young people.Methods Forty young people from minority ethnic communities in Scotland took part in a qualitative study, involving seven focus groups and four paired interviews, to explore their views and experiences of the HPV vaccine. Using critical discursive psychology, the analysis focussed on young people’s accounts of the barriers and enablers to information, access and uptake of the HPV vaccination programme.Results Participants suggested innovative strategies to tackle intergenerational concerns, information design and accessibility, and public health communications across diverse contexts. A cross-cultural community engagement model was developed, embracing diversity and contradiction across different ethnic groups. This included four inter-related strategies: providing targeted and flexible information for young people; vaccine provision across the life-course; intergenerational information and; specific cross-cultural communications.Conclusion This is the first HPV cross-cultural model inductively derived from accounts of young people from different ethnic communities. We recommend public health practitioners and policymakers consider utilising the processes and strategies illustrated within this model in order to increase dialogue around public engagement, awareness and receptivity towards the HPV vaccination

Learning lessons from the analysis of patient complaints relating to staff attitudes, behaviour and communication, using the concept of emotional labour

Objectives: This paper explores the content of letters of complaint by patients and carers about the behaviour, attitudes and communication of healthcare staff.Background: The most common focus of patient complaints in the UK and other high-income countries is staff attitudes, behaviour and communication. There is a move to learn lessons from patient complaints which can be used to improve patient care and experience.Methods: Fifty letters of complaint made by patients and carers relating to the behaviour, attitudes and communication of healthcare staff were analysed thematically.Results: Poor attitudes, behaviours and communication have significant negative impact on the emotional wellbeing of patients and carers. Many patients and carers have heightened sensitivities due to both health related stresses and also other factors. The health care role is expected to include compassion and kindness. The concept of emotional labour is useful in explaining the skills and effort required of staff in this often invisible and undervalued aspect of health care.Conclusions: Given the increasing focus on patient experience, it is important that the importance of good staff attitudes, behaviours and communication is understood and that the emotional labour associated with this is recognised. Key words: emotional labour, patient experience, qualitative method

‘Just that Little Bit of Doubt’: Scottish Parents', Teenage Girls' and Health Professionals' Views of the MMR, H1N1 and HPV Vaccines

Background Parental decision making about childhood vaccinations is complex and the vaccination schedule everchanging. Vaccination may be controversial even in countries with historically high vaccination rates such as Scotland. Health behaviour models have aided understanding of individual vaccine intentions for specific vaccines. These are limited in explaining actual behaviours and are divorced from the impact of socio-cultural contexts on vaccination decision making.Purpose To explore vaccination views in Scotland amongst parents, teenage girls and health professionals across three controversial vaccines: the Measles, Mumps, Rubella (MMR), the Human Papilloma virus (HPV) and the Influenza A (H1N1) vaccine.Method We used qualitative interviews and focus group discussions in a purposive sample of health professionals(n =51), parents (n =15) and teenage girls aged 12–15 years (n =8) about their views of these vaccines. Discussionswere analysed using thematic analysis.Results Two main themes are highlighted: ‘vaccine risks revisited’ in which we explored how the MMR legacy resurfaced and how worries about vaccine safety permeated the data. ‘Vaccine responsibilities’ indicated tensions regarding roles and responsibilities for vaccines. An overarching notion of ‘just that little bit of doubt’ referred to lingering doubts and uncertainties interwoven across the vaccines.Conclusions Public health authorities should remain alert towards pervasive vaccine concerns. It is important for authorities to clarify vaccine roles and responsibilities in the face of new and existing vaccines and to acknowledge public concerns regarding vaccine safety

Professional boundary work in the face of change to generalist working in community nursing in Scotland

Aim.  The present study explored how community nurses and managers constituted changes towards generalist working.Background.  Following international trends moving from acute care towards community care, changes within community nursing in the United Kingdom have been subject to debate in recent years. Sociological insights into ‘boundary work’ in professional disciplines are informative for understandings about proposed new roles in community nursing. Recently, radical changes to the role of the community nurse from specialist disciplines to a generalist community health nurse model were proposed in Scotland and tested in four health boards.Methods.  Focus group discussions were held with 27 community nurses and semi-structured interviews with three managers during January–March 2009 in a purposive sample from one health board. Discussions were audio-recorded and transcribed verbatim. Initial thematic analysis was used to highlight key themes from the data and later a discursive analysis focused on the rhetorical strategies used by participants.Findings.  Four key themes were identified along with the rhetorical devices associated with these including: the undermining of the generalist model through the ‘jack of all trades, master of none' metaphor through associations of loss of specialisms; how the re-establishment of specialist discipline boundaries occurred; how current roles were validated and how managers and nurses accounted for future changes to the profession.Conclusion.  The qualitative study explored here has implications for discussions about future role change debates within community nursing as well as the specialist–generalist debate internationally. Managers and policy-makers involved in organizational changes are required to give greater credence to the perceived professional status of community nursing