The roles of dispositional coping style and social support in helping people with respiratory disease cope with a breathlessness crisis

© 2019 John Wiley & Sons Ltd Aim: To explore the role of coping moderators in self-management of breathlessness crises by people with advanced respiratory disease. Design: A secondary analysis of semi-structured interview data. Methods: Interviews with patients who had advanced respiratory disease, chronic breathlessness and at least one experience where they considered presenting to Emergency but self-managed instead (a “near miss”). Participants were recruited from New South Wales, Queensland, Victoria, South Australia or Tasmania. Eligible caregivers were those who contributed to Emergency-related decision-making. Interviews were coded inductively and then deductively against the coping moderators social support and dispositional coping style, defined by the Transactional Model of Stress and Coping. Results: Interviews were conducted between October 2015 - April 2016 with 20 patients and three caregivers. Social networks offered emotional and practical support but also had potential for conflict with patients' ‘hardy’ coping style. Patient hardiness (characterized by a sense of ‘commitment’ and ‘challenge’) promoted a proactive approach to self-management but made some patients less willing to accept support. Information-seeking tendencies varied between patients and were sometimes shared with caregivers. An optimistic coping style appeared to be less equivocally beneficial. Conclusion: This study shows that social support and coping style may influence how people self-manage through their breathlessness crises and identified ways coping moderators can facilitate or hinder effective self-management. Impact: This study confers insights into how social-support and coping style can be supported and optimized to facilitate breathlessness self-management. Acknowledging coping moderator interactions is beneficial for developing resources and strategies that recognise patient mastery

Systematic review of interventions to promote the performance of physical distancing behaviours during pandemics/epidemics of infectious diseases spread via aerosols or droplets

Objectives Physical-distancing (i.e., keeping 1-2m apart when co-located) can prevent cases of infectious-diseases spread by droplets/aerosols (i.e. SARS-COV2). Distancing is a recommendation/requirement in many countries. This systematic-review aimed to determine which interventions and behaviour change techniques (BCTs) are effective in promoting adherence to physical-distancing and through which potential mechanisms of action (MOAs). Methods Six databases were searched for studies of physical-distancing interventions. A narrative synthesis included any design that included a comparator (e.g., pre-intervention versus post-intervention; randomised controlled trial), for any population and year. Risk-of-bias was assessed using the Mixed Methods Appraisal Tool. BCTs and potential MoAs were identified in each intervention.. Results Six papers of moderate/high quality indicated that distancing interventions could successfully change MoAs/behaviour. Successful BCTs (MoAs) included feedback on behaviour (e.g., motivation); information about/ salience of health consequences (e.g., beliefs about consequences) and demonstration (e.g., beliefs about capabilities) and restructuring the physical environment (e.g., environmental context and resources). The most promising interventions were proximity buzzers, directional systems and posters with loss-framed messages that demonstrated the behaviours. Conclusions High quality RCTs that measure behaviour, have representative samples and specify/test a larger range of BCTs /MoAs are needed

A national survey of the prevalence of overweight and obesity in Greece: the Greco study

The aim of the present paper from the Greek Childhood Obesity (GRECO) study is to provide current national data on overweight and obesity prevalence in preadolescent schoolchildren (aged 10-12 years old) in Greece, and to evaluate the quality of children’s diet by assessing the degree of adherence to the Mediterranean diet

The role of digital communication in patient-clinician communication for NHS providers of specialist clinical services for young people [the Long-term conditions Young people Networked Communication (LYNC) study]: a mixed-methods study

Background Young people (age 16-25 years) with long term health conditions tend to disengage from health services resulting in poor health outcomes. They are prolific users of digital communications. Innovative UK National Health Service (NHS) clinicians use digital communication with these young people. The NHS plans to use digital communication with patients more widely. Objectives To explore how health care engagement can be improved using digital clinical communication; understand effects, impacts, costs and necessary safeguards; provide critical analysis of its use, monitoring and evaluation. Design Observational mixed methods case studies; systematic scoping literature reviews; assessment of patient reported outcome measures; public and patient involvement (PPI); consensus development through focus groups. Setting Twenty NHS specialist clinical teams from across England and Wales, providing care for 13 different long term physical or mental health conditions. Participants 165 young people aged 16-25 years living with a long term health condition; 13 parents; 173 clinical team members; 16 Information Governance Specialists. Interventions Clinical teams and young people variously used: mobile phone calls, text messages, email, Voice over Internet Protocol. Main outcome measures Empirical work: thematic and ethical analysis of qualitative data; annual direct costs; Did Not Attend, Accident and Emergency Attendance and Hospital Admissions rates plus clinic specific clinical outcomes. Scoping reviews: patient, health professional and service delivery outcomes and technical problems. Patient reported outcome measures: scale validity, relevance and credibility. Data sources Observation, interview, structured survey, routinely collected data, focus groups, peer reviewed publications. Results Digital communication enables access for young people to the right clinician when it makes a difference for managing their health condition. This is valued as additional to traditional clinic appointments. This access challenges the nature and boundaries of therapeutic relationships but can improve them, increase patient empowerment and enhance activation. Risks include increased dependence on clinicians, inadvertent disclosure of confidential information and communication failures, but clinicians and young people mitigate these risks. Workload increases, and staff time is the main cost. Clinical teams had not evaluated impact of their intervention, and analysis of routinely collected data did not identify any impact. There are no currently used generic outcome measures but the Patient Activation Measure and the Physician Humanistic Behaviour Questionnaire are promising. Scoping reviews suggest digital clinical communication is acceptable to young people but with no clear evidence of benefit except for mental health. Limitations Qualitative data was mostly from clinician enthusiasts. No interviews were achieved with young people who do not attend clinics. Clinicians struggled to estimate workload. Only eight full sets of routine data were available. Conclusions Timely digital clinical communication is perceived as making a difference to health care and health outcome for young people with long term conditions but this is not supported by evidence that measures health outcome. Such communication is challenging and costly to provide but valued by young people. Future work Future development should distinguish digital communication replacing traditional clinic appointments and additional timely communication. Evaluation is needed that uses relevant generic outcomes

The role of digital communication in patient-clinician communication for NHS providers of specialist clinical services for young people [the Long-term conditions Young people Networked Communication (LYNC) study]: a mixed-methods study

Background Young people (age 16-25 years) with long term health conditions tend to disengage from health services resulting in poor health outcomes. They are prolific users of digital communications. Innovative UK National Health Service (NHS) clinicians use digital communication with these young people. The NHS plans to use digital communication with patients more widely. Objectives To explore how health care engagement can be improved using digital clinical communication; understand effects, impacts, costs and necessary safeguards; provide critical analysis of its use, monitoring and evaluation. Design Observational mixed methods case studies; systematic scoping literature reviews; assessment of patient reported outcome measures; public and patient involvement (PPI); consensus development through focus groups. Setting Twenty NHS specialist clinical teams from across England and Wales, providing care for 13 different long term physical or mental health conditions. Participants 165 young people aged 16-25 years living with a long term health condition; 13 parents; 173 clinical team members; 16 Information Governance Specialists. Interventions Clinical teams and young people variously used: mobile phone calls, text messages, email, Voice over Internet Protocol. Main outcome measures Empirical work: thematic and ethical analysis of qualitative data; annual direct costs; Did Not Attend, Accident and Emergency Attendance and Hospital Admissions rates plus clinic specific clinical outcomes. Scoping reviews: patient, health professional and service delivery outcomes and technical problems. Patient reported outcome measures: scale validity, relevance and credibility. Data sources Observation, interview, structured survey, routinely collected data, focus groups, peer reviewed publications. Results Digital communication enables access for young people to the right clinician when it makes a difference for managing their health condition. This is valued as additional to traditional clinic appointments. This access challenges the nature and boundaries of therapeutic relationships but can improve them, increase patient empowerment and enhance activation. Risks include increased dependence on clinicians, inadvertent disclosure of confidential information and communication failures, but clinicians and young people mitigate these risks. Workload increases, and staff time is the main cost. Clinical teams had not evaluated impact of their intervention, and analysis of routinely collected data did not identify any impact. There are no currently used generic outcome measures but the Patient Activation Measure and the Physician Humanistic Behaviour Questionnaire are promising. Scoping reviews suggest digital clinical communication is acceptable to young people but with no clear evidence of benefit except for mental health. Limitations Qualitative data was mostly from clinician enthusiasts. No interviews were achieved with young people who do not attend clinics. Clinicians struggled to estimate workload. Only eight full sets of routine data were available. Conclusions Timely digital clinical communication is perceived as making a difference to health care and health outcome for young people with long term conditions but this is not supported by evidence that measures health outcome. Such communication is challenging and costly to provide but valued by young people. Future work Future development should distinguish digital communication replacing traditional clinic appointments and additional timely communication. Evaluation is needed that uses relevant generic outcomes