Suicide in Northern Ireland: epidemiology, risk factors, and prevention

The rates of suicide and self-harm in Northern Ireland are high, and have increased from 143 registered suicides in 1996 to 313 in 2010 and 318 in 2015. This Review summarises the epidemiology of suicidal behaviour, as well as the evidence from a small number of studies that have identified risk factors associated with high suicide rates in Northern Ireland. These risk factors were mental illness, trauma, exposure to the conflict known as the Troubles, deprivation, relationship problems, employment difficulties, financial difficulties, being LGBT, childhood adversities, and alcohol or drug use. We highlight the key challenges and opportunities for suicide prevention, emphasising a so-called lifespan approach. More needs to be done to address the relationship between substance misuse and suicide. Future research and prevention efforts should also focus on the transgenerational effect of the conflict, youth suicide, suicide prevention in minority groups, and the criminal justice context. The provision of and access to suicide-specific psychosocial interventions need to be prioritised, more support for people in crisis is required, as well as interventions for mental illness. Protect Life 2, the national suicide prevention strategy, needs to be implemented in full. Given the legacy of conflict in Northern Ireland, all suicide prevention efforts should be trauma informed

"Connecting research, policy, and practice": Knowledge translation in the context of child and family early intervention and prevention-based research in Ireland.

This multi-method research was carried out as part of a large, six-year research programme called ENRICH which assessed the effectiveness and cost-effectiveness of two early years service models developed to support young children and families in Ireland. The overarching aims of the research were twofold: (1) to explore how research evidence relevant to child and family services and policies is disseminated in the field of public health; and (2) to increase visibility and understanding of, and engagement with, the evidence emerging from the ENRICH programme through a series of strategies targeted at KUs within child and family services in Ireland. The research comprised there separate but related phases including an evidence synthesis using realist principles; a documentary analysis; and a KT-D case study. The results from Phase One showed that the facilitation of engagements and relationship-building are important KT-D strategies across a range of contexts. A combination of KT-D strategies is likely to achieve multiple positive outcomes. More specifically, research summaries and social media are effective at increasing awareness, promoting engagement, and/or enhancing understanding. The results from Phase Two showed that research evidence was found to play an increasingly significant role (but is not the only factor involved) in the decision-making processes relating to child and family well-being policy and practice in Ireland. Phase Three of the research involved professionals working in child and family services/research in Ireland (N=162 ) (research n=57, practice n=67, policy n=9, other (funder, intermediary organisations) n=29) who completed a Research Dissemination Survey designed to explore a range of perspectives, experiences and views on research dissemination. Thirty-seven one-to- one interviews were completed to explore the barriers and facilitators to research dissemination and to amplify the survey findings (research n=7, practice n=7, policy n=12, other (funder, intermediary organisation) n=3, and parents n=8). Two focus groups were also carried out with parents (n=8) and with members of the ENRICH research team (n=3). The qualitative data were analysed using standard thematic analysis and the quantitative data were analysed using appropriate descriptive and inferential statistics; and online tracking analytics. The main factors influencing the dissemination of evidence, as identified by the participants were: a lack of resources; an under-developed understanding of research use and dissemination; insufficient collaboration and communication; and conflicting stakeholder priorities. The ENRICH research programme was also found to benefit from a multi- component KT plan, as guided by the Knowledge Translation Planning Template (Barwick, 2008, 2013, 2019). The case study was the first of its kind to provide important insights for stakeholders in Ireland and elsewhere, about how to improve the research dissemination process. Exploring the KT planning process resulted in more efficient and targeted dissemination of research findings, thereby delivering a better return on research investment and producing positive outcomes from research outputs

"Connecting research, policy, and practice": Knowledge translation in the context of child and family early intervention and prevention-based research in Ireland.

This multi-method research was carried out as part of a large, six-year research programme called ENRICH which assessed the effectiveness and cost-effectiveness of two early years service models developed to support young children and families in Ireland. The overarching aims of the research were twofold: (1) to explore how research evidence relevant to child and family services and policies is disseminated in the field of public health; and (2) to increase visibility and understanding of, and engagement with, the evidence emerging from the ENRICH programme through a series of strategies targeted at KUs within child and family services in Ireland. The research comprised there separate but related phases including an evidence synthesis using realist principles; a documentary analysis; and a KT-D case study. The results from Phase One showed that the facilitation of engagements and relationship-building are important KT-D strategies across a range of contexts. A combination of KT-D strategies is likely to achieve multiple positive outcomes. More specifically, research summaries and social media are effective at increasing awareness, promoting engagement, and/or enhancing understanding. The results from Phase Two showed that research evidence was found to play an increasingly significant role (but is not the only factor involved) in the decision-making processes relating to child and family well-being policy and practice in Ireland. Phase Three of the research involved professionals working in child and family services/research in Ireland (N=162 ) (research n=57, practice n=67, policy n=9, other (funder, intermediary organisations) n=29) who completed a Research Dissemination Survey designed to explore a range of perspectives, experiences and views on research dissemination. Thirty-seven one-to- one interviews were completed to explore the barriers and facilitators to research dissemination and to amplify the survey findings (research n=7, practice n=7, policy n=12, other (funder, intermediary organisation) n=3, and parents n=8). Two focus groups were also carried out with parents (n=8) and with members of the ENRICH research team (n=3). The qualitative data were analysed using standard thematic analysis and the quantitative data were analysed using appropriate descriptive and inferential statistics; and online tracking analytics. The main factors influencing the dissemination of evidence, as identified by the participants were: a lack of resources; an under-developed understanding of research use and dissemination; insufficient collaboration and communication; and conflicting stakeholder priorities. The ENRICH research programme was also found to benefit from a multi- component KT plan, as guided by the Knowledge Translation Planning Template (Barwick, 2008, 2013, 2019). The case study was the first of its kind to provide important insights for stakeholders in Ireland and elsewhere, about how to improve the research dissemination process. Exploring the KT planning process resulted in more efficient and targeted dissemination of research findings, thereby delivering a better return on research investment and producing positive outcomes from research outputs

The Tudor Turn: The Poetics and Politics of Englishness in Contemporary Historical Novels

This thesis investigates the interrelationship between contemporary Englishness and historical fictions. It responds to two coeval elements of English culture that started to emerge around the beginning of the present century: a revival of national consciousness that arguably underpinned the 2016 vote to leave the European Union, and a turn towards fiction set in the world of Henry VIII. Through a close reading of six Henrician texts by Philippa Gregory, C.J. Sansom and Hilary Mantel, all of whom are leading authors in the field, it aims to establish the reasons for this setting’s prevalence and commercial success in the English historical fiction of the pre-Brexit period, and to determine what this might tell us about the nature of English identity at this time. Drawing on theories of nationhood and postmodernism, my analysis of the ways in which these texts write England applies a postcolonial reading of English identity and explores their interplay with nationalist discourses by mapping their themes and preoccupations to contemporaneous polemical texts on the state of the nation. In so doing, I identify a common focus on loss, melancholia, grievance and decline, and find that in their re-writing of each other the novels illuminate the divisions and competing instincts that have characterised English society before and since the EU referendum. In taking this cultural materialist approach to a corpus of texts that re-work the same elements of England’s past in different ways, the project contributes significantly to the understanding of how fiction, cultural memory and politics intersect, highlighting the ways in which they reflect, reinforce, or indeed undermine, the construction of national identity. My work demonstrates how these multiple re-imaginings of this specific historical period function as the ‘mirror and the light’ of the contemporary nation and draws attention to the particularities of the English imaginary

Using social media to engage nurses in health policy development

Aims: To explore nurses' views on future priorities for the profession and to examine social media as an engagement tool to aid policy discussion and development.Background: Nurses are often not directly involved in policy creation and some feel it is a process they cannot easily influence.Methods: A descriptive mixed methods study of a Twitter chat hosted by the Chief Nursing Officer for Scotland was undertaken. Data were gathered using an analytics platform and NCapture software. The framework approach aided thematic analysis to draw out themes.Results: Sixty-four people took part in the Twitter chat (#CNOScot) and posted 444 tweets. Nurses called for investment in technology, nursing research, education and mental health. Primary care and advanced practice roles to support older adults with complex health and social care needs were also seen as vital to develop further.Conclusion: Social media can help reach and engage nurses in policy discussion and ensure there is better continuity between policy and practice but some groups risk being excluded using this digital medium.Implications for Nursing Management: Nursing leaders should consider social media as one of many engagement strategies to ensure nurses and other stakeholders participate in policy debate that informs health strategy development

Exploring eHealth implementation: understanding factors affecting engagement and enrolment in consumer digital health

Introduction At the dawn of the 21st century, ageing populations combined with rising numbers of people with chronic conditions are placing burdens on patients, carers, professionals, and health systems worldwide. Digital health interventions (DHIs) such as mobile, online, wearable and sensor technologies are being used to promote healthy lifestyles and encourage self-management of disease in an effort to address some of these global health challenges. However, these kinds of electronic tools can be difficult to implement. Engaging patients, the public and health professionals in digital health and getting them signed up to these technologies can be challenging in real-world settings. Aim The primary aim of this thesis is to examine the barriers and facilitators affecting engagement and enrolment in consumer digital health interventions. It examines these complex processes from the perspective of three key stakeholder groups: 1) patients and the public; 2) health professionals; and 3) those implementing the technologies. The secondary aim is to identify the strategies used to engage and enrol individuals in consumer DHIs. Methods An exploratory, multi-method qualitative study design was adopted. This included a qualitative systematic review and collection and analysis of primary and secondary qualitative data, gathered as part of a large (£37 million) digital health innovation programme called Delivering Assisted Living Lifestyles at Scale (dallas). The dallas programme deployed a wide range of digital health products and services in the United Kingdom ranging from telehealth and telecare systems through to mobile health applications, personal electronic medical records, and online health and wellbeing portals. These were deployed among patients with chronic illness and healthy people providing an ideal opportunity to study engagement and enrolment in DHIs. The systematic review explored the experiences of patients and the public when engaging with or signing up to DHIs. Primary data collection during the dallas programme consisted of fourteen interviews and five focus groups with patients, carers, clinicians, and those implementing the various technologies. Secondary analysis was undertaken of forty-seven baseline, midpoint, and endpoint interviews with stakeholders implementing the DHIs during the dallas programme. All analyses followed the framework approach to identify key themes and subthemes. This was underpinned by Normalization Process Theory (NPT) to synthesise the findings and develop a conceptual model of digital health engagement and enrolment. Findings A wide range of factors affected engagement and enrolment in DHIs for the three stakeholder groups. Where patients or the public were concerned, four themes emerged from the systematic review. These were; 1) personal agency and motivation, 2) personal lifestyle and values, 3) engagement and enrolment approach, and 4) quality of the DHI. A preliminary Digital Health Engagement Model (DIEGO) was developed along with an initial catalogue of engagement and enrolment strategies. The results of the dallas programme expanded on the barriers and facilitators influencing patient and public engagement and enrolment in digital health. The main themes that arose were; 1) personal perceptions and agency, 2) personal lifestyle and values, 3) digital accessibility, 4) implementation strategy, and 5) quality of the DHI. For health professionals, three overarching themes came to light; health professional role, health service organisation and culture, and digital infrastructure. Those implementing digital health products and services were slightly different as two main themes, each of which has several subthemes, appeared to affect engagement and enrolment in DHIs. These were organisation of engagement and enrolment, and implementation strategy. Hence, the conceptual model highlighting key issues affecting patient and public engagement and enrolling in DHIs was refined and developed further based on the findings from the dallas programme. In addition, the initial catalogue of engagement and enrolment strategies was extended. Conclusion This thesis provides new insights into the digital health implementation process, in particular the early phases of engagement and enrolment. A preliminary conceptual framework of digital health engagement and enrolment, the DIEGO model, was developed which summarises key issues that need to be considered during the earliest stages of implementing digital health products and services. This new framework could help researchers, clinicians, businesses, and policy makers appreciate the dynamics of deploying digital interventions in healthcare. This work suggests that educating patients, the public, and health professionals about the benefits, risks, and limitations of health technology is needed, while supporting research that describes engagement and enrolment strategies for consumer digital health and examines their effectiveness. Implementation teams could benefit from building strategic partnerships with marketing specialists and third sector agencies, and having clear business plans and budgets to enhance the reach and impact of engagement and enrolment in digital health. A positive digital health culture also needs to be cultivated in the health service, with leaders that champion the appropriate use of technology. National policies and funding that supports health informatics education, digital literacy for citizens, and digital infrastructure may also be necessary to enable people to sign up for DHIs. These recommendations may help support implementation and improve uptake to digital health products and services in the future

A comparison of specific positive future expectancies and global hopelessness as predictors of suicidal ideation in a prospective study of repeat self-harmers

Background. Hopelessness and the lack of positive future expectancies have been related to suicidality. This is the first study to compare the power of positive future expectancies and global hopelessness in the prediction of suicidal ideation. In short, are specific positive expectancies or global hopelessness attitudes more closely related to suicidality? Method. One hundred and forty four adults hospitalized following a suicidal self-harm episode completed a range of clinical and psychological measures in hospital and were followed up approximately 2.5 months after discharge. All participants reported at least one other self-harm episode in addition to the index episode. Results. Hierarchical regression analyses confirmed that specific positive future expectancies were better predictors of Time 2 suicidal ideation than global hopelessness. In addition, as hypothesized, negative future thinking was not independently associated with suicidal ideation. Limitations. Short-term follow-up. Conclusions. Specific, idiographic expectancies for positive events (i.e., positive future thinking) are more important predictors of suicidal ideation than global attitudes of hopelessness. Unlike global hopelessness, they provide more options for intervention (e.g., identifying life goals and plans). These findings are particularly noteworthy given the widespread use of measures of global hopelessness. The theoretical and clinical implications are discussed

Engaging in large-scale digital health technologies and services. What factors hinder recruitment?

Implementing consumer oriented digital health products and services at scale is challenging and a range of barriers to reaching and recruiting users to these types of solutions can be encountered. This paper describes the experience of implementers with the roll-out of the Delivering Assisted Living Lifestyles at Scale (dallas) programme. The findings are based on qualitative analysis of baseline and midpoint interviews and project documentation. Eight main themes emerged as key factors which hindered participation. These include how the ..

The misuse and overuse of non-sterile gloves: application of an audit tool to define the problem

Background: The use of non-sterile gloves (NSG) has become routine in the delivery of health care, often for procedures for which they are not required; their use may increase the risk of cross contamination and is generally not integrated into hand hygiene audit. This paper describes a small-scale application and validation of an observational audit tool devised to identify inappropriate use of NSG and potential for cross contamination. Methods: Two observers simultaneously observed the use of NSG during episodes of care in an acute hospital setting. The inter-rater reliability (IRR) of the audit tool was measured corrected for chance agreement using Kappa. Results: A total of 22 episodes of care using NSG were observed. In 68.6% (24/35) of procedures there was no contact with blood/body fluid; in 54.3% (19/35) NSG-use was inappropriate. The IRR was 100% for eight of 12 components of the tool. For hand hygiene before and after NSG removal it was 82% (Kappa = 0.72) and 95% (Kappa = 0.87). Conclusions: In this small-scale application of a glove-use audit tool we demonstrated over-use and misuse of NSG and potential for cross transmission on gloved hands. The audit tool provides an effective mechanism for integrating glove use into the audit of hand hygiene behaviour