Implications for Research Methods When Conducting Studies With the Users of Online Health Communities

Bournemouth Universit

End of Life Care Education: A Service evaluation

EXECUTIVE SUMMARY Introduction and scope of report Following a successful pilot programme which combined End of Life Care (EoLC) education with leadership skills, St Wilfred’s Hospice Chichester, in partnership with Sue Nash from Action Learning Teams were awarded a grant from the Frances and Augustus Newman Foundation to fund a follow-up programme and independent evaluation. The action learning and education development programme for care home leaders focused on improving End of Life Care provision in a care home setting and was delivered over one year. Bournemouth University (BU) undertook the independent service evaluation on behalf of the project team. This report concerns the evaluation element of the project. Evaluation questions Following consultation with the education facilitators, two questions were determined to guide the evaluation: • What are the care home managers’ perceptions of the impact of the educational programme on their leadership role in the provision of end of life care in their workplace? • Has confidence and competence in delivering and facilitating the delivery of end of life care changed over the course over the programme? Evaluation design As the evaluation questions sought to explore the effectiveness of learning as well as the relevance of the action learning approach, the evaluation was designed on the basis of a mixed methods approach. Quantitative methods utilised three questionnaires to explore; • Demographic data • Assessment of Training Needs using the Hennessey & Hicks Training Needs Analysis (TNA) Tool (with permission). • Assessment of Confidence using an adapted questionnaire developed by the Advanced Connected Advanced Communication Skills Programme offered under the auspices of the NHS End of Life Care Programme. Scores from competency documents were also collated. Qualitative methods involved focus groups, a type of group interview that stimulates interaction between participants in order to generate data. A member of the BU team acted as a facilitator using prepared trigger questions with the goal of eliciting perceptions and attitudes about the programme and its impact on participants’ practice. Participants were encouraged to share their views, to expand on these and others invited to comment. The interaction was audio-recorded (with permission). Data Analysis Completed questionnaires were managed and analysed using SPSS (V18.0) for Windows and descriptive statistical analysis was utilised. Reliability analysis (Cronbach’s Alpha) was used to screen the TNA and Confidence elements (and sub-categories) ahead of generating scores for these domains. The threshold for reliability was set at 0.7 or above. The focus groups were analysed using a process of thematic and content analysis. This technique is used with qualitative data and involves a process of systematically searching for themes or patterns in the data related to the evaluation questions. Subsequently, these themes are able to provide small thematic case study examples of how the professional development programme has impacted on practice. Findings - questionnaires TNA tool (n=6) The integration of the EoLC competencies indicates the tool has good internal face and content validity. Overall there was an improved perception of performance in role but the results are limited given the numbers of participants and the very slight degree of change evident. However, the results were confirmed and elaborated upon within the focus group data. Confidence questionnaire (n=6) Use of the confidence questionnaire indicates that the managers’ perceptions of confidence in a range of their abilities related to EoLC increased in all sections. However, given the managers’ desire to undertake the programme, perceived confidence in their knowledge and skills pre-programme was surprisingly high. An over-assessment of abilities seems likely resulting in a smaller extent of change post-programme. This conclusion is supported by the frequency and strength of comments concerning increased levels of knowledge and confidence as a result of the programme captured within the focus group data. Competency profile document (n=5) The competency profile appeared to be a very useful educational tool as it was so closely linked to the programme content. From the perspective of the evaluation however it yielded limited information. Nevertheless, the competency rating provides confirmation of the scores related to the corresponding areas of the confidence questionnaire. Findings – focus groups The perceptions of the focus group participants indicates that the programme offered a valuable opportunity for the development of interpersonal and management skills related to EoLC. Three themes emerged. First communication abilities in terms of leading and managing staff in the provisions of informed EoLC were reported to have significantly developed, alongside an increased sense of self-confidence. Second the style of the programme, which used action learning, resulted in the sharing of practice knowledge and a valuing of actively engaging in support networks. These ways of working were new to the participants. Finally the data indicated that the programme resulted in a sustainable model of education for this particular professional group, firstly perceived more effective management of staff to cascade best practice; second, the skills taught in action learning motivated the participants to continue to meet and share experiences post-programme on a self-managed basis. Discussion The evaluation has indicated increased confidence in care home managers knowledge and skills related to end of life care via a number of measures: the confidence questionnaire (CQ), the competency profile and the focus group feedback. The TNA questionnaire also showed some positive movement towards perceived increase in role performance in most domains. As the TNA, CQ and competency profile were linked with the EoLC competencies (DoH, 2009), it is reasonable to assume that improved confidence and perception of competence will have positively impacted on EoLC for residents. In addition, the focus groups provide examples and case studies of improved inter-professional liaison, cascading of knowledge and more proactive communication with residents and families when making decisions about EoLC. This data also indicates that for most participants this educational experience has been both personally and professionally effective, and even for some, life changing. The evaluation provides support for the link between excellent communication skills, effective leadership ability and better quality provision (Shaw et al, 2007; Thomas and Noble, 2007; King et al, 2008; Shaw et al, 2010; Seymour et al, 2011; Badger et al, 2012). The findings show that this educational strategy appeared to have a positive influence on communication both within the specialty and in general teams when working with colleagues and residents. Further the link between evidence-based care and confidence to deliver has emerged as very significant factor (Badger et al, 2012). The action-learning model appeared to be a sustainable approach as participants carried on appreciating the benefits of this, with the only cost being staff time. However, the programme length and small group size could be perceived as expensive. Conclusions In order to enable high quality EoLC, professional development should equip participants to be able to positively influence not just the individual’s immediate team, but also resident’s family members, care home owners, and other external stakeholders such as general practitioners (GP) and emergency departments in hospitals. This evaluation provides compelling evidence that an action learning approach to EoLC education can be used to empower middle managers to have positive impacts on EoLC provision through not only increasing specialist knowledge but also enhancing their capability to engage in a confident and informed manner with a diverse range of stakeholders. Recommendations Evidence from this evaluation suggests that • Expertly taught EoLC knowledge and skills is essential for care home managers to fulfil their role effectively • An action learning approach enables the embedding of specialist knowledge in practice through the enhancement of leadership skills linked to increased self-confidence. • The EoLC action learning education model leads to sustainable educational outcome

Influence of faith-based organisations on HIV prevention strategies in Africa: A systematic review

Background: The HIV/AIDS epidemic remains of global significance and there is a need to target sub-Saharan Africa since it is the hardest hit region worldwide. Religion, and more specifically faith-based organisations, can have an effect on socio-cultural factors that increase or decrease the risk of infection in society; and offer preventative interventions to their followers or the wider community. Objective: To understand the influence of faith-based organisations on HIV prevention in Africa. Method: The Bournemouth University (UK) the main search engine of a British university ‘mysearch’ was used as this incorporates all relevant databases. Studies were also retrieved by searches within Google scholar, PubMed, the British Library and reference lists of included papers and citations in key papers were hand searched. The authors assessed the relevance of each article separately against the inclusion criteria. The data extraction form was piloted by the first author and the other two authors cross-checked the extracted data and necessary amendments were made after discussions. Results: Seven studies met all inclusion criteria and were reviewed. Five were qualitative, one systematic and one of quantitative methodology. Seven individual themes were identified. However, for the purposes of focus within this paper only two themes will be focused on. Conclusion: Given the accessibility of FBOs and the coverage of religion among the population, FBOs are potentially important players in HIV prevention and are often in the forefront of responding to the HIV/AIDS epidemic. Therefore, more resources and support should be given to support their strategies to deliver health promotion messages

Human platelets and their capacity of binding viruses: Meaning and challenges?

Blood platelets are first aimed at ensuring primary hemostasis. Beyond this role, they have been acknowledged as having functions in the maintenance of the vascular arborescence and, more recently, as being also innate immune cells, devoted notably to the detection of danger signals, of which infectious ones. Platelets express pathogen recognition receptors that can sense bacterial and viral moieties. Besides, several molecules that bind epithelial or sub-endothelial molecules and, so forth, are involved in hemostasis, happen to be able to ligate viral determinants, making platelets capable of either binding viruses or even to be infected by some of them. Further, as platelets express both Fc-receptors for Ig and complement receptors, they also bind occasionally virus-Ig or virus-Ig-complement immune complexes. Interplays of viruses with platelets are very complex and viral infections often interfere with platelet number and functions. Through a few instances of viral infections, the present review aims at presenting some of the most important interactions from pathophysiological and clinical points of view, which are observed between human viruses and platelets.Fil: Chabert, Adrien. Universite Lyon 2; FranciaFil: Hamzeh Cognasse, Hind. Universite Lyon 2; FranciaFil: Pozzetto, Bruno. Universite Lyon 2; FranciaFil: Cognasse, Fabrice. Universite Lyon 2; FranciaFil: Schattner, Mirta Ana. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Gomez, Ricardo Martin. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Biotecnología y Biología Molecular. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Biotecnología y Biología Molecular; ArgentinaFil: Garraud, Olivier. Universite Lyon 2; Franci

Influence of faith-based organisations on HIV prevention strategies in Africa: a systematic review

Background: The HIV/AIDS epidemic remains of global significance and there is a need to target sub-Saharan Africa since it is the hardest hit region worldwide. Religion and more specifically faith-based organisations can have an effect on socio-cultural factors that increase or decrease the risk of infection; and offer preventative interventions to the wider community.Objective: To understand the influence of faith-based organisations on HIV prevention in Africa.Method: The main search engine of a British university ‘mysearch’ was used as this incorporates all relevant databases. Studies were also retrieved by searches within Google scholar, PubMed and reference lists of included papers were hand searched. The authors assessed the relevance of each article separately against the inclusion criteria. The data extraction form was piloted by the first author and cross-checked by the other authors.Results: Seven studies met all inclusion criteria and were reviewed. Seven individual themes were identified. However, for the purposes of focus within this paper only two themes were focused on.Conclusion: Given the accessibility of faith-based organisations (FBOs) and the coverage of religion among the population, FBOs are potentially important players in HIV prevention. Therefore, more resources and support should be given to support their health promotion strategies.Keywords: Faith-based organisations, HIV prevention strategies, systematic revie

A Comparative Study on Nutritional Problems in Preschool Aged Children of Nepal

Objectives: Measure the level of knowledge, attitudes & beliefs about nutritious food for children amongst poor rural and urban mothers. Methods: Quantitative questionnaire study. Results: The study included more urban mothers (56%) than rural mothers (44%). Major barriers to recommending nutritious foods included: lack of knowledge (15%); high market prices (19%); and cultural influences or beliefs (6%). The study shows nearly 55% children are providing fruit once in week. Similarly nearly 15% of families never give salad to their children. Nearly 16% of mothers cannot choose nutritious food from the grocery store. Likewise 12% respondents lacked food. Nearly 57% children had been taken at least once to a spiritual healer and 16% on multiple occasions for the treatment. Nearly 20% of mother believed eating green leafy vegetables and fruits during illness affect child health. Nearly 8% respondent feed meat, fish, egg and milk during times of illness to their children but 92% do not. Conclusions: Knowledge and attitudes towards nutritious food of rural and urban mothers are still poor in both societies. Beliefs about food practice are still strongly embedded in Nepal. Urban mother had better food recommendation, whereas rural mother experienced huge barriers. Meat, fish, egg and dairy products are not provided to children due to cultural influences. Mothers from both communities have high faith in spiritual healers