Does the professional and working context of United Kingdom clinicians predict if they use practices to support patients with long term conditions to self manage?

INTRODUCTION: Our study examines how the professional and employment context may influence clinicians' practice self management support for patients with long term conditions (LTC). MATERIAL AND METHODS: We surveyed clinicians working with patients with depression, chronic obstructive pulmonary disorder (COPD), chronic musculo skeletal pain and diabetes. RESULTS: Clinicians most frequently endorsed items on a scale concerned with patient centeredness, and less frequently endorsed items concerned with clinical and organizational self management support. The most important factors predicting these latter activities were the intensity of working experience with patients with LTC and attending professional training addressing the principles and practice of self management support. Practicing patient centeredness was endorsed by nearly all respondents, and so was not sensitive to variation on work variables. CONCLUSIONS: The interaction of training and intensity of work with patients with LTC seems to have the most powerful effect on undertaking clinical and organizational self management support practices. To facilitate clinicians' practice of self management support for patients with LTC it is very important to provide relevant professional training and to build specialized patient care teams with professionals having complimentary skills

A randomised controlled trial of the effectiveness of a breastfeeding training DVD on improving breastfeeding knowledge and confidence among healthcare professionals in China.

Background: Despite almost all babies being breastfed initially, the rates of exclusive breastfeeding rate at six months is only 30% in China. Improving professionals' knowledge and practical skill is a key government strategy to increase breastfeeding rates. This study aimed to test the effectiveness of a breastfeeding DVD training method for clinicians on improving their knowledge and confidence in breastfeeding support skills of teaching mothers Positioning and Attachment (P & A) and Hand Expression (HE). Methods: A randomised controlled trial was conducted in three hospitals in Zhejiang province, China in 2014. Participants were recruited before their routine breastfeeding training course and randomly allocated to intervention group (IG) and control group (CG). The 15 minute "Breastfeeding: Essential Support Skills DVD" was the intervention for IG and vaginal delivery DVD was used for CG. All participants completed questionnaires of job information, knowledge and confidence in the two skills before (baseline) and immediately after viewing the DVD (post DVD). Results: Out of 210 participants, 191 completed knowledge assessments before and after watching the DVD (IG n=96, CG n=95), with the response rate of 91.0%. At baseline, there are no significant differences in job variables, knowledge scores and confident scores. The total knowledge score significantly increased post-DVD for IG (pre-DVD: M=5.39, SD=2.03; post-DVD: M=7.74, SD=1.71; t (95) =-10.95, p<0.01), but no significant change in total knowledge score for CG between pre- and post-DVD (pre-DVD: M=5.67, SD=1.70; post-DVD: M=5.56, SD=1.63; t (94) =0.85). The total confidence scores were significantly higher post-DVD than pre-DVD in IG (pre-DVD: M=66.49, SD=11.27; post- DVD: M=71.81, SD=9.33; t (68) =-4.92, p<0.01), but no significant difference was seen in CG between pre- and post-DVD total confidence scores (pre-DVD: M=68.33, SD=11.08; post-DVD: M=68.35, SD=11.40; t (65) =-0.25). Personal and job variables did not mediate these effects. Conclusions: The breastfeeding training DVD improved professionals' knowledge and confidence of the two breastfeeding support skills. However, the effect on professionals' practice and on breastfeeding outcomes needs to be examined in the future

Web-based self-management for young cancer survivors: consideration of user requirements and barriers to implementation.

PURPOSE: As the population of young cancer survivors increases, there is a need to develop alternative ways of providing post-treatment support. Online systems potentially offer self-management and e-learning support following cancer treatment. This research aims to explore the self-management support needs of teenage and young adult cancer survivors and consider whether those needs can be met through a web-based self-management resource. METHODS: A mixed methods approach was adopted including an online survey (n = 24), focus groups and interviews with teenage and young adult cancer survivors (n = 7) and interviews with parents of survivors (n = 6), information technology specialists (n = 8) and clinical, nursing and social work professionals (n = 11). RESULTS: All stakeholders were supportive of web-based self-management to meet information and support needs that would supplement continued direct interaction with clinical staff. Barriers to implementation were identified in terms of risks to young people, governance issues and the challenges of providing a long-term service. CONCLUSION: Computer access and use amongst teenagers and young adults is commonplace, and there is an expectation that self-management needs will be met at least partially online in the future. There is a desire for online social support through peer interaction as well personal developmental and clinical management. These elements may need to be run through different systems to cater for governance requirements. IMPLICATIONS FOR CANCER SURVIVORS: An online self-management system could provide support at a number of different levels. The barriers to implementation should be addressed, to ensure that survivors can be supported in this way in the future

The Relational Impact of Multiple Sclerosis: An Integrative Review of the Literature Using a Cognitive Analytic Framework

This integrative literature review uses cognitive analytic therapy (CAT) theory to examine the impact of a chronic illness, multiple sclerosis (MS), on relationships and mental health. Electronic searches were conducted in six medical and social science databases. Thirty-eight articles met inclusion criteria, and also satisfied quality criteria. Articles revealed that MS-related demands change care needs and alter relationships. Using a CAT framework, the MS literature was analysed, and five key patterns of relating to oneself and to others were identified. A diagrammatic formulation is proposed that interconnects these patterns with wellbeing and suggests potential “exits” to improve mental health, for example, assisting families to minimise overprotection. Application of CAT analysis to the literature clarifies relational processes that may affect mental health among individuals with MS, which hopefully will inform how services assist in reducing unhelpful patterns and improve coping. Further investigation of the identified patterns is needed

Breastfeeding works: the role of employers in supporting women who wish to breastfeed and work in four organizations in England

An important factor influencing duration of breastfeeding is mother's employment status. The main aim of this study was to determine the experience and views of employees (n = 46) in four large public sector organizations concerning breastfeeding support at work. Participants were recruited if they were employed by one of four public service employers and if they were planning to go on maternity leave in the next 6 months, on maternity leave or within 6 months of return from maternity leave. They completed a questionnaire anonymously. Almost 80 of women wanted to continue breastfeeding after returning to work. However, 90 of all respondents were not aware of any employer policy nor offered any information concerning support to enable breastfeeding after returning to work, despite two organizations having a range of maternity- and breastfeeding-related policies in development and some facilities in place. Almost 90 of respondents stated the employers should do more to support breastfeeding. This should include providing pregnant staff with information about breastfeeding support that they should expect and could therefore plan to use, including access to facilities to express and to store breast milk, to enable them to work flexible hours and to take rest breaks during working hours. Recommendations are made for employers. © The Author 2006, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved

A training needs survey of doctors' breastfeeding support skills in England

The study examined the training needs of paediatricians and general practitioners (GPs). Respondents rated their competence on 23 breastfeeding support skills, importance of update in the next 2 years, actual and potential helpfulness of different forms of professional updates, and accessibility in the next 2 years. The perception of organizational barriers to breastfeeding support and practitioners'knowledge of policies and guidance on breastfeeding were also examined. The sample comprised 120 paediatricians and 57 GPs. Response rates were estimated as between 4% and 29%, depending upon the method of recruitment. Although both groups rated themselves as fairly competent in most of the skill areas, they welcomed training in key areas of practice. Paediatricians identified more areas for update than GPs (t = 3.44; d.f. = 178; P r = 0.35; P <0.00001). Practical forms of training were most often welcomed. Only 47% of GPs and 62.5% of paediatricians had access to a local breastfeeding policy. There were evident gaps in knowledge on key aspects of public health policy, which could influence local practice; for example, 50.8% of GPs and 47.5% of paediatricians identified a younger age for introducing solids than the minimum according to current government guidance. Organizational barriers to breastfeeding support were experienced by all respondents. Recommendations include purposively targeting training to those least likely to seek training, and developing effective self-study and observational methods of learning. All training should be evaluated and implemented alongside breastfeeding policies and clinical leadership to improve the practice of all healthcare practitioners

A qualitative study of the childbearing experience of women living with multiple sclerosis

Purpose: Although at any time in the UK, there are about 20,000 women with MS who may be considering having children, healthcare system often fails to provide them with information and support they need to make informed decisions about their health and pregnancy management. The aim of this paper is to explore the childbearing experience of women with MS to determine what support and information may be useful to this target group. Method: Interviews were conducted with women with MS (n = 9). Transcripts were analysed using thematic analysis. Results: Three major themes emerged from the interviews with women living with MS. We found women were concerned about both medical and practical issues associated with having children. Limited access to information about relationships between MS and childbearing and receiving conflicting or wrong information was recounted. Opinions of family members and clinicians regarding having children in the context of MS impacted on women's experience of making decision about having children and childbearing. Conclusions: Women with MS can benefit from having access to comprehensive, structured sources of information about MS and childbearing. Healthcare professionals and family members 'support could be channelled more appropriately to enhance their experience of making choices about childbearing

Development and psychometric properties of a self report measure to assess clinicians’ practices in self management support for patients with long term conditions

Objective: This paper presents a process of developing practices in self management support (PSMS) – a measure assessing clinicians’ self reported use of self management support practices in clinical consultations for patients with long term conditions (LTCs). Methods: The development process comprised the following steps: literature review to define what skills clinicians need to effectively support patients to self manage, review of existing measures of SMS practices, construction of an initial pool of items, E Delphi study pilot survey to select items for final measure, data collection to confirm the factor structure and internal consistency of the final measure. Results: The PSMS comprises three subscales: Clinical SMS (14 items), Patient Centeredness (4 items) and Organizational SMS (7 items). All subscales have very good internal reliability (Cronbach α: 0.94, 0.78 and 0.85; all item-total correlations above 0.50). Conclusions and practice implications: We believe PSMS measure is suitable for both research and programme evaluation in UK clinical settings. To complete the process of measure development we are now planning to conduct further analyses to establish the validity of PSMS measure in UK and non UK healthcare settings and test the validity of PSMS measure on a wider range of other LTC groups

A process evaluation using a Self Determination Theory measure of the co-delivery of self management training by clinicians and by lay tutors

Objective: To evaluate the co-delivery style of lay and clinician co-tutors of courses for patients, and courses for clinicians to support their patients' self-management skills. Methods: Motivational style of course delivery was assessed in 37 patient course sessions and 14 clinician workshops by independent observers using four Self Determination Theory rating scales and ethnographic notes. Forty-five tutors and 35 attendees were interviewed about their experience of co-delivered courses. Results: Lay and clinician tutors had similar motivational styles, with significant differences between the four motivational style scales; patient courses (F(3, 216)=3.437, p=.018); and clinician courses (F(3, 78)=3.37, p=.025). The courses were experienced as co productive in style as suggested during interviews, but adherence to manuals limited the tutors' contributions. Lay and clinician tutors scored higher on providing structure and engaging participants than they scored on supporting autonomous decision making and involvement. Conclusion: Co-delivery was a successful model, affording opportunities to demonstrate co-production skills. Practice implications: There is more scope to enable lay and clinician tutors to use their respective expertise in supporting self-management, and for tutor training to encourage a less didactic delivery style