Financial capability, health and disability

BACKGROUND: It has been suggested that improving people’s ability to deal with their finances, their financial capability, will directly improve their wellbeing and indirectly their health. To this end, financial capability initiatives have been funded by statutory and charitable health bodies, sometimes as part of a practice termed ‘social prescribing’. DISCUSSION: This paper examines financial capability from the perspective of the Capability Approach to welfare and justice. It argues that the Approach shows current conceptions of financial capability to be flawed in that they focus on it as a personal quality in isolation from the socioeconomic environment. Using the Capability Approach as applied to disability the paper argues that financial capability is best viewed as a ‘conversion factor’ rather than a capability, that is, something necessary to convert resources, particularly money, into something of value to an individual, such as an adequate pension. Often, those judged as lacking financial capability are poor and this fact is at the heart of their inability to, say, plan a pension; by contrast, those who are not poor may find it relatively easy to do so and thus be deemed financially capable. Hence there are two distinct types of financial capability: i) in poverty and ii) not in poverty. To be able to plan a pension or make ends meet in poverty requires distinct and perhaps rare skills in an individual. However, some environmental or social changes may help individuals to improve their financial capability without calling on them to develop extraordinary abilities. Given the potential of such work to improve people’s health, making such changes can reasonably be described as Public Health work. The article concludes with a defence of this use of the Capability Approach against possible criticism. SUMMARY: The Capability Approach enables analysis of financial capability that is theoretically important to and has practical implications for Public Health

Parental experiences of raising a child with medium chain Acyl-CoA Dehydrogenase deficiency

Newborn screening enabling early diagnosis of medium chain acyl-CoA dehydrogenase deficiency (MCADD) has dramatically improved health outcomes in children with MCADD. Achieving those outcomes depends on effective management by parents. Understanding parental management strategies and associated anxieties and concerns is needed to inform provision of appropriate care and support. Semi structured interviews were conducted with a purposive sample of parents of children aged two to twelve years. Thematic analysis identified two main themes. Managing dietary intake examined how parents managed day-to-day dietary intake to ensure adequate intake and protection of safe fasting intervals. Managing and preventing illness events explored parental experiences of managing illness events and their approach to preventing these events. Management strategies were characterised by caution and vigilance and influenced by a lack of confidence in others to manage the condition. The study identifies the need for increased awareness of the condition, particularly in relation to emergency treatment

Barriers to effective communication between doctors at shift handover.

Shift handover is a process during which doctors can exchange information, authority and primary responsibility for patient care. The level of handover standardisation may vary across departments and hospitals, and handover may be affected by the context in which it occurs. If during handover communication doctors do not transfer information pertinent to a patient's care delivery, it may lead to unintended negative consequences.An explanatory, mixed-methods study, using the principles of critical realism was conducted to investigate whether or not similar barriers to effective shift handover communication between doctors identified in hospitals around the world are identified by doctors working in hospitals in the Czech Republic and to develop hypotheses regarding how various individual performance-, work environment- and system-related factors may collectively contribute to ineffective shift handover communication between doctors. In accordance with the principles of critical realism the study included theory-testing phases: (i) a critical review of literature; (ii) a cross-sectional questionnaire survey; and (iii) semi-structured interviews with doctors.The results of the study show that doctors working in hospitals in the Czech Republic identify similar barriers to effective shift handover communication between doctors identified in hospitals around the world. However, handover between the Czech Republic doctors has its own specific characteristics. The inadequacies of the social, systemic and environmental features that make up different contexts in which handover is conducted collectively contribute to ineffective shift handover communication. For example, a systemic feature (e.g. the absence of training), may lead to specific doctors' beliefs (e.g. handover is meaningless), which in turn trigger certainbehaviours (e.g. doctors go home without communicating either verbally or in writing the work carried out during the previous shift), that tend towards a particular kind of outcome (e.g. the absence of handover). Consequently, the division of barriers to handover into one-dimensional categories such as 'the individual performance', 'the system' or 'the social environment', has emerged as superficial as it does not adequately reflect the reality of the context and process of handover communication. Any interventions and programmes, which aim to enhance communication between doctors at shift handover, may need therefore to address the multidimensional nature of handover communication

Introduction of a non-ported peripheral intravenous catheter with multi-use blood control septum offers improvements in the overall efficiency of the procedure and is clinically well accepted

Financial challenges that the National Health Service (NHS), England, faces may jeopardise its future. This study evaluated the direct cost of using two different safety peripheral intravenous cannulae (SPIVC) with and without a blood control septum, including the cost of device and clinician time. Observation of 103 cannulations demonstrated a 54 second (29%) time reduction per cannulation with the non-ported SPIVC with multi-use blood control septum (Introcan Safety® 3 B Braun), compared to the standard ported SPIVC (Vasofix® Safety B Braun) (P<0.05). The direct cost analysis, including clinician time, demonstrated that the introduction of SPIVC with multi-use blood control septum could offer time efficiency savings equivalent to a reduction in average cannulation costs by 25%. Eighty two per cent of users perceived the insertion of SPIVC with multi-use blood control septum to be easy to use; 82% would choose to use it in clinical practice

Prevention and lifestyle behaviour change : a competence framework

Prevention, Health and Wellbeing and Health Inequalities are key national and regional priorities for the future of our nation and for the NHS. This was highlighted in recent ‘Fair Society, Healthy Lives’ Marmot review. The ‘Prevention and Lifestyle Behaviour Change: A Competence Framework’, has been developed to support NHS Yorkshire and the Humber’s key Public Health strategy ‘Making Every Contact Count’, to which there has already been an excellent response. Delivery on this subject has always been challenging and with this in mind we are aiming to support all involved in every way possible. The Framework will support all staff and organisations in the delivery of this important agenda. This framework will enable a common approach across all elements as everyone will be able to use the same base. We would encourage everyone in the workforce to engage with this framework to establish their current knowledge and skills on this subject. This will in turn support Service and Education commissioners and Education and Service providers with the measurable base line of their current workforce and identify what additional learning, new ways of working or service redesign may be required and what services can be commissioned now and in the future. We would like to thank the Faculty of Health and Wellbeing at Sheffield Hallam University. The development of this Framework has also been supported by collaboration with NHS Yorkshire and the Humber and the staff and organisations within Yorkshire and the Humber who have given of their time and knowledge to deliver this excellent product

Understanding the experience of initiating community-based group physical activity by people with serious mental illness: a systematic review using a meta-ethnographic approach

Background People living with serious mental illness (SMI) experience debilitating symptoms that worsen their physical health and quality of life. Regular physical activity (PA) may bring symptomatic improvements and enhance wellbeing. When undertaken in community-based group settings, PA may yield additional benefits such as reduced isolation. Initiating PA can be difficult for people with SMI and so PA engagement is commonly low. Designing acceptable and effective PA programmes requires a better understanding of the lived experiences of PA initiation among people with SMI. Methods This systematic review of qualitative studies used the meta-ethnography approach by Noblit and Hare (1988). Electronic databases were searched from inception to November 2017. Eligible studies used qualitative methodology; involved adults (≥18 years) with schizophrenia, bipolar affective disorder, major depressive disorder or psychosis; reported community-based group PA; and captured the experience of PA initiation, including key features of social support. Study selection and quality assessment was performed by four reviewers. Results Sixteen studies were included in the review. We identified a ‘journey' that depicted a long sequence of phases involved in initiating PA. The journey demonstrated the thought processes, expectations, barriers and support needs of people with SMI. In particular, social support from a trusted source played an important role in getting people to the activity, both physically and emotionally. Discussion The journey illustrated that initiation of PA for people with SMI is a long complex transition. This complex process needs to be understood before ongoing participation in PA can be addressed

Integrating physical activity into the treatment of depression in adults: a qualitative enquiry

Around 246 million people globally suffer from depression. Physical activity (PA) can reduce the risk of depression by 30% and is recognised as an effective treatment for mild‐to‐moderate depression (MMD). However, a high proportion of patients with MMD are currently inactive and the implementation of PA as an adherent treatment for MMD is not well understood. This study contributes to a growing body of research exploring how to support people who are experiencing MMD to increase their PA levels (i.e. initiation and maintenance). It investigated which factors individuals with MMD perceived to be important for integrating PA into the treatment of depression in adults. In‐depth interviews were carried out with individuals with MMD (N = 6), and data were analysed using thematic analysis. Two main theories of social capital that of Bourdieu and Putnam informed the discussion of findings. The initiation and maintenance of PA were linked to individual factors including health (i.e. nature of depression; comorbidities); abilities and tastes; socioeconomic status (e.g. financial position) and positive encouragement. In addition, maintenance emerged as dependent upon the choice, enjoyment, and meaningfulness of PA itself, and, for those who engaged in group PA, on social capital. PA interventions need to be personalised. This goes beyond a simple exercise prescription based on functional ability, but instead takes into account the needs, desires and capabilities of the whole person. The nature of MMD, the wider physical and socio‐economic context and the social capital that is available to the individual also need to be harnessed

Developing a model to estimate the potential impact of municipal investment on city health

This article summarizes a process which exemplifies the potential impact of municipal investment on the burden of cardiovascular disease (CVD) in city populations. We report on Developing an evidence-based approach to city public health planning and investment in Europe (DECiPHEr), a project part funded by the European Union. It had twin objectives: first, to develop and validate a vocational educational training package for policy makers and political decision takers; second, to use this opportunity to iterate a robust and user-friendly investment tool for maximizing the public health impact of 'mainstream' municipal policies, programs and investments. There were seven stages in the development process shared by an academic team from Sheffield Hallam University and partners from four cities drawn from the WHO European Healthy Cities Network. There were five iterations of the model resulting from this process. The initial focus was CVD as the biggest cause of death and disability in Europe. Our original prototype 'cost offset' model was confined to proximal determinants of CVD, utilizing modified 'Framingham' equations to estimate the impact of population level cardiovascular risk factor reduction on future demand for acute hospital admissions. The DECiPHEr iterations first extended the scope of the model to distal determinants and then focused progressively on practical interventions. Six key domains of local influence on population health were introduced into the model by the development process: education, housing, environment, public health, economy and security. Deploying a realist synthesis methodology, the model then connected distal with proximal determinants of CVD. Existing scientific evidence and cities' experiential knowledge were 'plugged-in' or 'triangulated' to elaborate the causal pathways from domain interventions to public health impacts. A key product is an enhanced version of the cost offset model, named Sheffield Health Effectiveness Framework Tool, incorporating both proximal and distal determinants in estimating the cost benefits of domain interventions. A key message is that the insights of the policy community are essential in developing and then utilising such a predictive tool

Interventions to increase physical activity and reduce sedentary behaviour in severe mental ill health: How effective are they?’- A systematic review.

Background People with severe mental ill health experience a mortality gap of 15–20 years and one of the main reasons for this is due to preventable physical health conditions. Physical activity can reduce the risk of developing physical health conditions such as diabetes and cardiovascular disease yet people with severe mental ill health are less physically active and more sedentary than the general population. Methods A systematic review was conducted to investigate the effectiveness of interventions aimed at increasing physical activity and reducing sedentary behaviour in people with severe mental ill health. The protocol was published with PROSPERO (CRD42021277579). Randomised controlled trials conducted in any country in any setting and published in English with an aim of increasing physical activity or reducing sedentary behaviour were included. Results Eleven unique studies were identified for inclusion. Due to the variability between interventions, outcome measures, and time points, it was not possible to conduct a meta-analysis. Effect estimates suggested that three of the interventions were effective at increasing physical activity. However, the certainty of the evidence was rated as low using the GRADE approach. Conclusions The evidence on interventions to increase activity shows promise but is insufficiently robust for an intervention to be recommended in clinical guidelines. More high-quality and statistically powered trials are needed to guide best practice and policy