Integrating mobile-phone based assessment for psychosis into people\u27s everyday lives and clinical care: a qualitative study

Background: Over the past decade policy makers have emphasised the importance of healthcare technology in the management of long-term conditions. Mobile-phone based assessment may be one method of facilitating clinically- and cost-effective intervention, and increasing the autonomy and independence of service users. Recently, text-message and smartphone interfaces have been developed for the real-time assessment of symptoms in individuals with schizophrenia. Little is currently understood about patients\u27 perceptions of these systems, and how they might be implemented into their everyday routine and clinical care. Method: 24 community based individuals with non-affective psychosis completed a randomised repeated-measure cross-over design study, where they filled in self-report questions about their symptoms via text-messages on their own phone, or via a purpose designed software application for Android smartphones, for six days. Qualitative interviews were conducted in order to explore participants\u27 perceptions and experiences of the devices, and thematic analysis was used to analyse the data. Results: Three themes emerged from the data: i) the appeal of usability and familiarity, ii) acceptability, validity and integration into domestic routines, and iii) perceived impact on clinical care. Although participants generally found the technology non-stigmatising and well integrated into their everyday activities, the repetitiveness of the questions was identified as a likely barrier to long-term adoption. Potential benefits to the quality of care received were seen in terms of assisting clinicians, faster and more efficient data exchange, and aiding patient-clinician communication. However, patients often failed to see the relevance of the systems to their personal situations, and emphasised the threat to the person centred element of their care. Conclusions: The feedback presented in this paper suggests that patients are conscious of the benefits that mobile-phone based assessment could bring to clinical care, and that the technology can be successfully integrated into everyday routine. However, it also suggests that it is important to demonstrate to patients the personal, as well as theoretical, benefits of the technology. In the future it will be important to establish whether clinical practitioners are able to use this technology as part of a personalised mental health regime

Patterns of Sedentary Behaviour in Female Office Workers

Background: Prolonged sedentary behaviour is associated with poor health outcomes. Office workers often engage in excessive sedentary behaviour, however limited research reports on how this sedentary behaviour is accumulated. This study examines objectively measured patterns of prolonged sedentary behaviour in female office workers during weekdays and weekend days and across time of day. Methods: Full time female office workers from a Scottish University participated (N = 27 mean age 43.0 ± 11.5 yrs; BMI 25.8 ± 4.1 kg/m2). Participants wore an activPAL™ for 7 days and completed a diary of waking and working hours. Average week and weekend time sitting, standing and stepping was calculated and also expressed as a proportion of waking day. Average week and weekend daily step count and sit to stand transitions were calculated. Continuous bouts of sedentary behaviour were categorised as: 20–40, 40–60 and > 60 minutes and compared between week and weekend days and across time of day. Results: Average weekday sitting time and proportion was higher (P 0.05) on weekdays vs weekend days. The pattern of sedentary behaviour bouts was different between week and weekend days. Week days were dominated by a consistent pattern of shorter (20–40 mins) sedentary behaviour bouts. The longest continuous sedentary behaviour bouts occurred in the evening, particularly at weekends. Conclusions: In office workers the most prolonged sedentary behaviour occurred in the evening, particularly at weekends. Interventions need to target these highly saturated periods of sedentary behaviour

Risk work in dental practices: an ethnographic study of how risk is managed in NHS dental appointments

Ideas about disease risk underpin many preventive health strategies. These have assumed even greater importance in recent years as health policies place a growing emphasis on personal responsibility. This is reflected in new national contracts for National Health Service (NHS) dentistry that emphasise informing patients on their oral health risk status to persuade them to be accountable for their health. Thus, ‘risk’ is now central to the practice of dentistry, particularly primary care delivery. An ethnographic study in dental practices in England looked at how risk is acted on in dental settings. 368 dental appointments were observed in five dental practices over a year. The analysis shows three interrelating forms of risk work. Dentists position risk work as administrative to gain consent, translate risk through temporality to encourage action, whilst protecting rapport and their professional reputation through interactional risk work. This qualitative study demonstrates that the everyday nature of risk work in NHS dental practices is often implicit, defensive and focused on social interaction rather than the explicit discussions of individual lifestyle risks that policymakers assume. The study contributes to the literature on ‘risk work’ by illustrating how health professionals use risk to manage situationally sensitive contexts

Can conditional health policies be justified? A policy analysis of the new NHS dental contract reforms

Conditional policies, which emphasise personal responsibility, are becoming increasingly common in healthcare. Although used widely internationally, they are relatively new within the UK health system where there have been concerns about whether they can be justified. New NHS dental contracts include the introduction of a conditional component that restricts certain patients from accessing a full range of treatment until they have complied with preventative action. A policy analysis of published documents on the NHS dental contract reforms from 2009 to 2016 was conducted to consider how conditionality is justified and whether its execution is likely to cause distributional effects. Contractualist, paternalistic and mutualist arguments that reflect notions of responsibility and obligation are used as justification within policy. Underlying these arguments is an emphasis on preserving the finite resources of a strained NHS. We argue that the proposed conditional component may differentially affect disadvantaged patients, who do not necessarily have access to the resources needed to meet the behavioural requirements. As such, the conditional component of the NHS dental contract reform has the potential to exacerbate oral health inequalities. Conditional health policies may challenge core NHS principles and, as is the case with any conditional policy, should be carefully considered to ensure they do not exacerbate health inequities