Developing a measure of informed choice in cancer screening

The principle of informed choice has recently become incorporated into cancer screening policy. However, there has been limited empirical or theoretical work on informed choice in this particular context. The main aim of this thesis is to develop an instrument/approach that could be used to measure informed choice in both research and service settings. The principal research question is, 'What are the key domains of informed choice in cancer screening, and how best can they be measured?'Systematic reviews were undertaken to identify the relevant qualitative and quantitative studies. A qualitative study (nine focus groups and 15 individual interviews) was undertaken with people who had different experiences of screening (for breast, cervical or colorectal cancer). The purpose of the study was to identify the key domains of informed choice. Data from the qualitative study were used to define the items in the questionnaire. The questionnaire was piloted initially by sending it to a sample of 150 screening invitees and 54 replied (36%). It was then further refined and sent to 1292 people who had been invited to participate in one of the three types of screening. Of these, 553 returned a completed questionnaire (43%).Findings from the systematic reviews suggested that lay people define and conceptualise informed choice differently from researchers and policy makers. These findings were substantiated in the data from the qualitative study. The study also found that information on the disease was as important to people as information on the risks and limitations of screening. However, information may have little part to play in the choices people make. It may have more impact on outcomes such as satisfaction and anxiety. Analysis of the questionnaire data found that people had limited knowledge of the risks and consequences of screening. In addition, perceived informedness was strongly predicted by attitudes rather than the knowledge of the risk and benefits. High levels of knowledge were not a predictor of the level of choice people had.The main policy reason for promoting informed choice is to enhance autonomy and to prevent people being deceived or coerced. However, this research shows that the provision of evidence-based information alone does not necessarily mean that an informed choice is made. People may not read, want, or understand the information, and, additionally, people may not be able to carry out their intended choice. For example, people may feel that they do not have the choice to refuse screening, even though they might wish to do so. Moreover, there may be personal barriers, such as physical or mental health problems and language, or organisational barriers, such as the availability of the service/intervention and access. This research identifies the complexity of the relationship between information and choice, revealing a number of reasons why the concept of 'informed choice' requires more subtle understanding in the context of cancer screening

An Evaluation of the Impact of Sight and Hearing Support Services: Western Isles Sensory Project

This report presents an evaluation of the Western Isles Sensory Centre (WISC). The Centre provides advice, assessment, referrals and practical interventions to people with sensory impairments who live in the Western Isles. The report details the evaluation findings from a survey and in-depth interviews carried out with WISC clients and their carers. The views of clients and experience of the service offered by the WISC was explored initially by the use of a postal survey (n=49). Following this, a number of in-depth interviews (n=12) were conducted with clients that further explored the impact that attending the Centre had on their impairment. The views of WISC staff who support service provision for people with sensory impairments were also sought. Additionally, perspectives about the service were sought from health, social care and third sector professionals who are involved in the care and support of people with sensory impairments

Using evaluability assessment to assess local community development health programmes: a Scottish case-study

Background Evaluation of the potential effectiveness of a programme’s objectives (health or otherwise) is important in demonstrating how programmes work. However, evaluations are expensive and can focus on unrealistic outcomes not grounded in strong theory, especially where there is pressure to show effectiveness. The aim of this research was to demonstrate that the evaluability assessment (a cost-effective pre-evaluation tool that primarily gives quick, constructive feedback) can be used to help develop programme and outcome objectives to improve programmes while they run and to assist in producing more effective evaluations. This was done using the example of a community development programme aiming to improve health and reduce health inequalities in its target population. Methods The setting was Glasgow, Scotland, UK and focused on the Health Issues in the Community programme. Data were collected from documents and nine individual stakeholder interviews. Thematic analysis and a realist approach were used to analyse both datasets and, in conjunction with a workshop with stakeholders, produce a logic model of the programme theory and related evaluation options to explore further.  Results Five main themes emerged from the analysis: History; Framework; Structure and Delivery of the Course; Theory of Action; and Barriers to Delivery and Successful Outcomes. These themes aided in drafting the logic model which revealed they key programme activities (e.g. facilitating group learning) and 23 potential outcomes. The majority of these outcomes (16) were deemed to be short-term outcomes (more easily measured within the timeframe of an individual being involved in the programme) e.g. increased self-esteem or awareness of individual/community health. The remaining 6 outcomes were deemed longer-term and included outcomes such as increased social capital and individual mental health and wellbeing.  Conclusions We have shown that the evaluability assessment tool can be applied to the evaluation of community health programmes, providing short- and long-term outcomes that could be evaluated to demonstrate effectiveness and avoid unnecessary or poorly designed full-scale evaluations. This type of pre-evaluation method is already a useful resource for national policy evaluations, but could be a valuable evaluation tool for other regional or community health programmes

Cranberries for treating urinary tract infections

Background Cranberries (particularly in the form of cranberry juice) have been used widely for several decades for the prevention and treatment of urinary tract infections (UTIs). The aim of this review is to assess the effectiveness of cranberries in treating such infections. Objectives To assess the effectiveness of cranberries for the treatment of UTIs. Search strategy The search strategy developed by the Cochrane Renal Group was used. Also, companies involved with the promotion and distribution of cranberry preparations were contacted; electronic databases and the Internet were searched using English and non English language terms; reference lists of review articles and relevant studies were also searched. Date of last search: December 2007 Selection criteria All randomised controlled trials (RCTs) or quasi-RCTs of cranberry juice or cranberry products for the treatment of UTIs. Studies of men, women or children were included. Data collection and analysis Titles and abstracts of studies that were potentially relevant to the review were screened by one author, RJ, who discarded studies that were clearly ineligible but aimed to be overly inclusive rather than risk losing relevant studies. Authors RJ and LM independently assessed whether the studies met the inclusion criteria. Further information was sought from the authors where papers contained insufficient information to make a decision about eligibility. Main results No studies were found which fulfilled all of the inclusion criteria. Two studies were excluded because they did not have any relevant outcomes and two studies are currently being undertaken. Authors' conclusions After a thorough search, no RCTs which assessed the effectiveness of cranberry juice for the treatment of UTIs were found. Therefore, at the present time, there is no good quality evidence to suggest that it is effective for the treatment of UTIs. Well-designed parallel group, double blind studies comparing cranberry juice and other cranberry products versus placebo to assess the effectiveness of cranberry juice in treating UTIs are needed. Outcomes should include reduction in symptoms, sterilisation of the urine, side effects and adherence to therapy. Dosage (amount and concentration) and duration of therapy should also be assessed. Consumers and clinicians will welcome the evidence from these studies.Output Type: Revie

Optimising workplace health programmes using organisational culture:Post-COVID perspectives from managers and workplace health experts from the UK contact centre industry

Contact centre workers experience disproportionately low physical activity levels and high sedentary behaviour levels, as well as an increased risk of negative occupational health outcomes such as anxiety and depression. Organisational culture factors such as strict work schedules and pressure to maintain productivity often impede the effectiveness of programmes to reduce these health risks. Despite its significance, organisational culture is often overlooked during the development and implementation of workplace health programmes due to its conceptually complex nature. The COVID-19 pandemic further complicated organisational culture-related associations to workplace health programmes in contact centres. This study investigated how organisational culture influences the existence and effectiveness of workplace health programmes in contact centres and if/how COVID-19 disrupted these associations. Fifteen interviews were conducted with contact centre managers and workplace health experts between February and June 2021. Findings indicate that employee well-being is increasingly being prioritised within contact centres, especially post-pandemic, and that there is a legacy of COVID-19 to learn from the spotlight that was placed on employee well-being during the pandemic to improve workplace conditions for contact centre employees. Further, to maximise effectiveness and support positive organisational culture change, these findings should be considered during well-being programme planning, delivery, implementation and evaluation.</p

Risk Perceptions of Environmental Hazards and Human Reproduction: A Community Based Survey

Objectives: We have investigated the Australian public’s perceived risks on human reproductive health from a number of identified environmental hazards. Methods: A sample of 1261 subjects were interviewed. This interview included specific questions related to perceived risks of certain environmental hazards to human reproductive health. Results: Women were almost twice as likely to rank all hazards as harmful or very harmful to human reproduction than men. Age also influenced perceived risk with those in the 35 and older age groups more likely to rank lead as a harmful hazard when compared with the 18-34 group. Pesticides were identified by 84.5% of the sample as the most harmful environmental hazard to human reproduction. Conclusions: Similar to other environmental hazards, different groups of people in the general population perceive hazards relating to reproductive health differently. This information is important for both policy makers and health professionals dealing with reproductive environmental health issues

Assessing the unintended health impacts of road transport policies and interventions: translating research evidence for use in policy and practice

Background: Transport and its links to health and health inequalities suggest that it is important to assess both the direct and unintended indirect health and related impacts of transport initiatives and policies. Health Impact Assessment (HIA) provides a framework to assess the possible health impacts of interventions such as transport. Policymakers and practitioners need access to well conducted research syntheses if research evidence is to be used to inform these assessments. The predictive validity of HIA depends heavily on the use and careful interpretation of supporting empirical evidence. Reviewing and digesting the vast volume and diversity of evidence in a field such as transport is likely to be beyond the scope of most HIAs. Collaborations between HIA practitioners and specialist reviewers to develop syntheses of best available evidence applied specifically to HIA could promote the use of evidence in practice. Methods: Best available research evidence was synthesised using the principles of systematic review. The synthesis was developed to reflect the needs of HIA practitioners and policymakers. Results: Aside from injury reduction measures, there is very little empirical data on the impact of road transport interventions. The possibility of impacts on a diverse range of outcomes and differential impacts across groups, make it difficult to assess overall benefit and harm. In addition, multiple mediating factors in the pathways between transport and hypothesised health impacts further complicate prospective assessment of impacts. Informed by the synthesis, a framework of questions was developed to help HIA practitioners identify the key questions which need to be considered in transport HIA. Conclusion: Principles of systematic review are valuable in producing syntheses of best available evidence for use in HIA practice. Assessment of the health impacts of transport interventions is characterised by much uncertainty, competing values, and differential or conflicting impacts for different population groups at a local or wider level. These are issues pertinent to the value of HIA generally. While uncertainty needs explicit acknowledgement in HIA, there is still scope for best available evidence to inform the development of healthy public policy