Informing the development of services supporting self-care for long term mental health conditions: A mixed method study of community based mental health initiatives in England

Background Supporting self-care is being explored across health care systems internationally as an approach to improving care for long term conditions in the context of ageing populations and economic constraint. UK health policy advocates a range of approaches to supporting self-care, including the application of generic self-management type programmes across conditions. Within mental health, the scope of self-care remains poorly conceptualised and the existing evidence base for supporting self-care is correspondingly disparate. This paper aims to inform the development of support for self-care in mental health by considering how generic self-care policy guidance is implemented in the context of services supporting people with severe, long term mental health problems. Methods A mixed method study was undertaken comprising standardised psychosocial measures, questionnaires about health service use and qualitative interviews with 120 new referrals to three contrasting community based initiatives supporting self-care for severe, long term mental health problems, repeated nine months later. A framework approach was taken to qualitative analysis, an exploratory statistical analysis sought to identify possible associations between a range of independent variables and self-care outcomes, and a narrative synthesis brought these analyses together. Results Participants reported improvement in self-care outcomes (e.g. greater empowerment; less use of Accident and Emergency services). These changes were not associated with level of engagement with self-care support. Level of engagement was associated with positive collaboration with support staff. Qualitative data described the value of different models of supporting self-care and considered challenges. Synthesis of analyses suggested that timing support for self-care, giving service users control over when and how they accessed support, quality of service user-staff relationships and decision making around medication are important issues in supporting self-care in mental health. Conclusions Service delivery components – e.g. peer support groups, personal planning – advocated in generic self-care policy have value when implemented in a mental health context. Support for self-care in mental health should focus on core, mental health specific qualities; issues of control, enabling staff-service user relationships and shared decision making. The broad empirical basis of our research indicates the wider relevance of our findings across mental health settings

Perceptions of childhood immunization in a minority community: Qualitative study

This is the author's accepted manuscript. The final published article is available from the link below. Published article copyright @ The Royal Society of Medicine.Objective - To assess reasons for low uptake of immunization amongst orthodox Jewish families. Design - Qualitative interviews with 25 orthodox Jewish mothers and 10 local health care workers. Setting - The orthodox Jewish community in North East London. Main outcome measures - Identification of views on immunization in the orthodox Jewish community. Results - In a community assumed to be relatively insulated from direct media influence, word of mouth is nevertheless a potent source of rumours about vaccination dangers. The origins of these may lie in media scares that contribute to anxieties about MMR. At the same time, close community cohesion leads to a sense of relative safety in relation to tuberculosis, with consequent low rates of BCG uptake. Thus low uptake of different immunizations arises from enhanced feelings of both safety and danger. Low uptake was not found to be due to the practical difficulties associated with large families, or to perceived insensitive cultural practices of health care providers. Conclusions - The views and practices of members of this community are not homogeneous and may change over time. It is important that assumptions concerning the role of religious beliefs do not act as an obstacle for providing clear messages concerning immunization, and community norms may be challenged by explicitly using its social networks to communicate more positive messages about immunization. The study provides a useful example of how social networks may reinforce or challenge misinformation about health and risk and the complex nature of decision making about children's health.City and Hackney Teaching Primary Care Trus

Severe primary immune thrombocytopenia in Pregnancy UK Obstetric Surveillance System (UKOSS) Study

This is the largest reported population cohort of severe ITP in pregnancy. Current incidence of severe ITP in the UK is approximately 0.1/1000 pregnancies. With current treatment strategies the incidence of serious maternal and neonatal outcomes is extremely low

Bearing witness and being bounded; the experiences of nurses in adult critical care in relation to the survivorship needs of patients and families

Aim: To discern and understand the responses of nurses to the survivorship needs of patients and family members in adult critical care units. Background: The critical care environment is a demanding place of work which may limit nurses to immediacy of care, such is the proximity to death and the pressure of work. Design: A constructivist grounded theory approach with constant comparative analysis. Methods: As part of a wider study and following ethical approval, eleven critical care nurses working within a general adult critical care unit were interviewed with respect to their experiences in meeting the psychosocial needs of patients and family members. Through the process of constant comparative analysis an overarching selective code was constructed. EQUATOR guidelines for qualitative research (COREQ) applied. Results: The data illuminated a path of developing expertise permitting integration of physical, psychological and family care with technology and humanity. Gaining such proficiency is demanding and the data presented reveals the challenges that nurses experience along the way. Conclusion: The study confirms that working within a critical care environment is an emotionally charged challenge and may incur an emotional cost. Nurses can find themselves bounded by the walls of the critical care unit and experience personal and professional conflicts in their role. Nurses bear witness to the early stages of the survivorship trajectory but are limited in their support of ongoing needs. Relevance to Clinical Practice: Critical care nurses can experience personal and professional conflicts when caring for both patients and families. This can lead to moral distress and may contribute to compassion fatigue. Critical care nurses appear bounded to the delivery of physiological and technical care, in the moment, as demanded by the patient's acuity. Consequentially this limits nurses’ ability to support the onward survivorship trajectory. Increased pressure and demands on critical care beds has contributed further to occupational stress in this care setting

Medicines adherence: Involving patients in decisions about prescribed medicines and supporting adherence

It is thought that between a third and a half of all medicines1 There are many causes of non-adherence but they fall into two overlapping categories: intentional and unintentional. Unintentional non-adherence occurs when the patient wants to follow the agreed treatment but is prevented from doing so by barriers that are beyond their control. Examples include poor recall or difficulties in understanding the instructions, problems with using the treatment, inability to pay for the treatment, or simply forgetting to take it. prescribed for long-term conditions are not taken as recommended. If the prescription is appropriate, then this may represent a loss to patients, the healthcare system and society. The costs are both personal and economic. Adherence presumes an agreement between prescriber and patient about the prescriber’s recommendations. Adherence to medicines is defined as the extent to which the patient’s action matches the agreed recommendations. Non-adherence may limit the benefits of medicines, resulting in lack of improvement, or deterioration, in health. The economic costs are not limited to wasted medicines but also include the knock-on costs arising from increased demands for healthcare if health deteriorates. Non-adherence should not be seen as the patient’s problem. It represents a fundamental limitation in the delivery of healthcare, often because of a failure to fully agree the prescription in the first place or to identify and provide the support that patients need later on. Addressing non-adherence is not about getting patients to take more medicines per se. Rather, it starts with an exploration of patients’ perspectives of medicines and the reasons why they may not want or are unable to use them. Healthcare professionals have a duty to help patients make informed decisions about treatment and use appropriately prescribed medicines to best effec

Utilising implementation intentions to promote healthy eating in adolescents

Objectives: This study evaluated a school-based behaviour change intervention for adolescents to address unhealthy eating habits that may otherwise “track” into adulthood. Design: A behaviour change intervention was conducted utilising implementation intention formation (or if-then planning) for adolescents to achieve two healthy eating goals: (1) including fruit and vegetable in each daily meal, and (2) replacing unhealthy snacks with healthy choices. Methods: Participants (N = 107) aged between 16 and 18 years were randomised to intervention, active control and passive control conditions. Intervention participants formed implementation intentions for achieving the healthy eating goals; participants in the active control condition completed health-related tasks; and passive control participants read health information. Eating habits and intentions were measured at baseline and 5-month follow-up. Results: Findings showed that the intervention was not effective in achieving the healthy eating goals. Conclusions: Our findings give some indication that implementation intentions alone may not be a powerful enough means of changing eating behaviour in this age group. We reflect in detail upon the elements of the intervention that may have prevented its success in changing behaviour, for example, its failure to raise motivation, and the target of potentially unsuitable self-regulatory goals. We also discuss our findings, for example, on forming multiple plans and the role of intentions, within the context of current literature