Exploring the uptake and use of electronic cigarettes provided to smokers accessing homeless centres: a four-centre cluster feasibility trial

Background: Smoking prevalence is extremely high in adults experiencing homelessness, and there is little evidence regarding which cessation interventions work best. This study explored the feasibility of providing free electronic cigarette starter kits to smokers accessing homeless centres in the UK. / Objectives: Seven key objectives were examined to inform a future trial: (1) assess willingness of smokers to participate in the study to estimate recruitment rates; (2) assess participant retention in the intervention and control arms; (3) examine the perceived value of the intervention, facilitators of and barriers to engagement, and influence of local context; (4) assess service providers’ capacity to support the study and the type of information and training required; (5) assess the potential efficacy of supplying free electronic cigarette starter kits; (6) explore the feasibility of collecting data on contacts with health-care services as an input to a main economic evaluation; and (7) estimate the cost of providing the intervention and usual care. / Design: A prospective cohort four-centre pragmatic cluster feasibility study with embedded qualitative process evaluation. / Setting: Four homeless centres. Two residential units in London, England. One day centre in Northampton, England. One day centre in Edinburgh, Scotland. / Intervention: In the intervention arm, a single refillable electronic cigarette was provided together with e-liquid, which was provided once per week for 4 weeks (choice of three flavours: fruit, menthol or tobacco; two nicotine strengths: 12 or 18 mg/ml). There was written information on electronic cigarette use and support. In the usual-care arm, written information on quitting smoking (adapted from NHS Choices) and signposting to the local stop smoking service were provided. / Results: Fifty-two per cent of eligible participants invited to take part in the study were successfully recruited (56% in the electronic cigarette arm; 50.5% in the usual-care arm; total n = 80). Retention rates were 75%, 63% and 59% at 4, 12 and 24 weeks, respectively. The qualitative component found that perceived value of the intervention was high. Barriers were participants’ personal difficulties and cannabis use. Facilitators were participants’ desire to change, free electronic cigarettes and social dynamics. Staff capacity to support the study was generally good. Carbon monoxide-validated sustained abstinence rates at 24 weeks were 6.25% (3/48) in the electronic cigarette arm compared with 0% (0/32) in the usual-care arm (intention to treat). Almost all participants present at follow-up visits completed measures needed for input into an economic evaluation, although information about staff time to support usual care could not be gathered. The cost of providing the electronic cigarette intervention was estimated at £114.42 per person. An estimated cost could not be calculated for usual care. / Limitations: Clusters could not be fully randomised because of a lack of centre readiness. The originally specified recruitment target was not achieved and recruitment was particularly difficult in residential centres. Blinding was not possible for the measurement of outcomes. Staff time supporting usual care could not be collected. / Conclusions: The study was associated with reasonable recruitment and retention rates and promising acceptability in the electronic cigarette arm. Data required for full cost-effectiveness evaluation in the electronic cigarette arm could be collected, but some data were not available in the usual-care arm. / Future work: Future research should focus on several key issues to help design optimal studies and interventions with this population, including which types of centres the intervention works best in, how best to retain participants in the study, how to help staff to deliver the intervention, and how best to record staff treatment time given the demands on their time. / Trial registration: Current Controlled Trials ISRCTN14140672; the protocol was registered as researchregistry4346. / Funding: This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 7. See the NIHR Journals Library website for further project information

Women’s experiences of receiving care for pelvic organ prolapse: a qualitative study

Background Pelvic organ prolapse is a common urogenital condition affecting 41–50% of women over the age of 40. To achieve early diagnosis and appropriate treatment, it is important that care is sensitive to and meets women’s needs, throughout their patient journey. This study explored women’s experiences of seeking diagnosis and treatment for prolapse and their needs and priorities for improving person-centred care. Methods Twenty-two women receiving prolapse care through urogynaecology services across three purposefully selected NHS UK sites took part in three focus groups and four telephone interviews. A topic guide facilitated discussions about women’s experiences of prolapse, diagnosis, treatment, follow-up, interactions with healthcare professionals, overall service delivery, and ideals for future services to meet their needs. Data were analysed thematically. Results Three themes emerged relating to women’s experiences of a) Evaluating what is normal b) Hobson’s choice of treatment decisions, and c) The trial and error of treatment and technique. Women often delayed seeking help for their symptoms due to lack of awareness, embarrassment and stigma. When presented to GPs, their symptoms were often dismissed and unaddressed until they became more severe. Women reported receiving little or no choice in treatment decisions. Choices were often influenced by health professionals’ preferences which were subtly reflected through the framing of the offer. Women’s embodied knowledge of their condition and treatment was largely unheeded, resulting in decisions that were inconsistent with women’s preferences and needs. Physiotherapy based interventions were reported as helping women regain control over their symptoms and life. A need for greater awareness of prolapse and physiotherapy interventions among women, GPs and consultants was identified alongside greater focus on prevention, early diagnosis and regular follow-up. Greater choice and involvement in treatment decision making was desired. Conclusions As prolapse treatment options expand to include more conservative choices, greater awareness and education is needed among women and professionals about these as a first line treatment and preventive measure, alongside a multi-professional team approach to treatment decision making. Women presenting with prolapse symptoms need to be listened to by the health care team, offered better information about treatment choices, and supported to make a decision that is right for them

Evaluation intégrée des mesures agro-environnementales territorialisées à enjeu "qualité des eaux" sur la période 2007 à 2011 : le projet MAEVEAU

The MAEVEAU project has developed an approach for an integrated assessment of effectiveness of regionalized Agro-Environmental Measures (MAET) intended to preserve water quality in relation to pesticides. This approach investigates the concept of efficiency through a triple analysis: the impact (net effects), the environmental cost-effectiveness and the role of organizational factors in the contracting process. The impact is assessed by a quasi-experimental approach by counterfactuals and examines adaptation of the matching method to the regionalized MAET. Cost-effectiveness analysis is based on integrated modeling spatially distributed coupling the agro-hydrological SWAT model, pesticides pressure indicators and a bio-economic model optimizing gross margin. The effectiveness of organizational factors focuses on transaction costs, the role of collective action and preferences for alternative contracts.La recherche conduite dans le projet MAEVEAU a développé une démarche d'évaluation intégrée de l'efficacité des Mesures Agro-Environnementales Territorialisées (MAET) à enjeu préservation de la qualité de l'eau vis-à-vis des pesticides sur la période 2007 à 2011. La question scientifique traite le concept d'efficacité de la politique en s'appuyant sur une triangulation des approches: une évaluation de l'impact (c'est-à-dire des effets propres de la politique), une évaluation coût-efficacité environnementale et une évaluation du rôle des facteurs organisationnels dans le processus d'adhésion. L'impact est évalué par une approche quasi-expérimentale par contrefactuel et questionne l'adaptation de la méthode du matching à la territorialisation des MAET. L'analyse coût-efficacité s'appuie sur une modélisation intégrée spatialisée couplant modèle agro-hydrologique, indicateurs pesticides spatialisés et optimisation économique des marges brutes. L'efficacité des facteurs organisationnels s'est intéressée aux coûts de transaction, au rôle de l'action collective et aux préférences pour des contrats alternatifs

Exploring the uptake and use of electronic cigarettes provided to smokers accessing homeless centres: a four-centre cluster feasibility trial

Background Smoking prevalence is extremely high in adults experiencing homelessness and there is little evidence regarding which cessation interventions work best. This study explored the feasibility of providing free e-cigarette (EC) starter kits to smokers accessing homeless centres in the UK Objectives Seven key objectives were examined to inform a future trial. 1: Assess willingness of smokers to participate in the study to estimate recruitment rates. 2: Assess participant retention in the intervention and control groups. 3: Examine the perceived value of the intervention, facilitators and barriers to engagement and influence of local context. 4: Assess service providers’ capacity to support the study and the type of information and training required. 5: Assess the potential efficacy of supplying free EC starter kits. 6: Explore the feasibility of collecting data on contact with health care services as an input to a main economic evaluation. 7: Estimate the cost of providing the intervention and usual care. Design A prospective cohort four-centre pragmatic cluster feasibility study with embedded qualitative process evaluation. Setting Four homeless centres. Two residential units in London, England. One day centre in Northampton, England. One day centre in Edinburgh, Scotland. Intervention Intervention arm: A single refillable EC was provided with e-liquid provided once a week for four weeks (choice of three flavours: fruit, menthol, tobacco and two nicotine strengths: 12mg/mL or 18mg/mL). Written information for EC use and support. Usual care arm: Written information on quitting smoking (adapted from NHS Choices) and signposting to the local stop smoking service (SSS). Results Fifty-two percent of eligible participants invited to take part in the study were successfully recruited (56% in the EC arm; 50.5% in the UC arm; total N=80). Retention rates were 75%, 63% and 59% respectively at 4, 12 and 24 weeks. The qualitative component found perceived value of the intervention was high. Barriers were participant’s personal difficulties and cannabis use. Facilitators were participants’ desire to change, free EC and social dynamics. Staff capacity to support the study was generally good. Carbon Monoxide (CO) validated sustained abstinence rates at 24 weeks were 6.25% (3/48) in the EC arm vs. 0/32 (0%) in the UC arm (intention to treat). Almost all participants present at follow-up visits completed measures needed for input into an economic evaluation although information about staff time to support UC could not be gathered. The cost of providing the EC intervention was estimated to be £114.42 per person. Estimated cost could not be completed for UC. Limitations Clusters could not be fully randomised due to lack of centre readiness. The originally specified recruitment target was not achieved and recruitment was particularly difficult in residential centres. Blinding was not possible for the measurement of outcomes. Staff time supporting UC could not be collected. Conclusions The study was associated with reasonable recruitment and retention rates and promising acceptability in the EC arm. Data required for full cost-effectiveness evaluation in the EC arm could be collected but some data was not available in the UC arm. Future work: Future research should focus on several key issues to help design optimal studies and interventions with this population, including: which types of centres the intervention works best in; how best to retain participants in the study; how to help staff to deliver the intervention and how best to record staff treatment time given the demands on their time

Chlamydia trachomatis prevalence in undocumented migrants undergoing voluntary termination of pregnancy: a prospective cohort study

BACKGROUND: Chlamydia trachomatis infection (CTI) is the most frequent sexual transmitted disease (STI) in Switzerland but its prevalence in undocumented migrants is unknown. We aimed to compare CTI prevalence among undocumented migrants undergoing termination of pregnancy (ToP) to the prevalence among women with residency permit. METHODS: This prospective cohort study included all pregnant, undocumented women presenting from March 2005 to October 2006 to the University hospital for ToP. The control group consisted of a systematic sample of pregnant women with legal residency permit coming to the same hospital during the same time period for ToP. RESULTS: One hundred seventy five undocumented women and 208 women with residency permit (controls) were included in the study. Mean ages were 28.0 y (SD 5.5) and 28.2 y (SD 7.5), respectively (p = 0.77). Undocumented women came primarily from Latin-America (78%). Frequently, they lacked contraception (23%, controls 15%, OR 1.8, 95% CI 1.04;2.9). Thirteen percent of undocumented migrants were found to have CTI (compared to 4.4% of controls; OR 3.2, 95% CI 1.4;7.3). CONCLUSION: This population of undocumented, pregnant migrants consisted primarily of young, Latino-American women. Compared to control women, undocumented migrants showed higher prevalence rates of genital CTI, which indicates that health professionals should consider systematic screening for STI in this population. There is a need to design programs providing better access to treatment and education and to increase migrants' awareness of the importance of contraception and transmission of STI

A methodological systematic review of meta-ethnography conduct to articulate the complex analytical phases

Background: Decision making in health and social care requires robust syntheses of both quantitative and qualitative evidence. Meta-ethnography is a seven-phase methodology for synthesising qualitative studies. Developed in 1988 by sociologists in education Noblit and Hare, meta-ethnography has evolved since its inception; it is now widely used in healthcare research and is gaining popularity in education research. The aim of this article is to provide up-to-date, in-depth guidance on conducting the complex analytic synthesis phases 4 to 6 of meta-ethnography through analysis of the latest methodological evidence. Methods: We report findings from a methodological systematic review conducted from 2015 to 2016. Fourteen databases and five other online resources were searched. Expansive searches were also conducted resulting in inclusion of 57 publications on meta-ethnography conduct and reporting from a range of academic disciplines published from 1988 to 2016. Results: Current guidance on applying meta-ethnography originates from a small group of researchers using the methodology in a health context. We identified that researchers have operationalised the analysis and synthesis methods of meta-ethnography – determining how studies are related (phase 4), translating studies into one another (phase 5), synthesising translations (phase 6) and line of argument synthesis - to suit their own syntheses resulting in variation in methods and their application. Empirical research is required to compare the impact of different methods of translation and synthesis. Some methods are potentially better at preserving links with the context and meaning of primary studies, a key principle of meta-ethnography. A meta-ethnography can and should include reciprocal and refutational translation and line of argument synthesis, rather than only one of these, to maximise the impact of its outputs. Conclusion: The current work is the first to articulate and differentiate the methodological variations and their application for different purposes and represents a significant advance in the understanding of the methodological application of meta-ethnography

A Qualitative Study of Factors Influencing Adherence among Pregnant Women Taking Part in a Trial of E-Cigarettes for Smoking Cessation.

Use of e-cigarettes (vaping) has potential to help pregnant women stop smoking. This study explored factors influencing adherence among participants in the vaping arm of the first trial of vaping for smoking cessation in pregnancy. We conducted semi-structured telephone interviews (n = 28) with women at three-months postpartum. Interviews were analysed using thematic analysis, informed by the Theoretical-Domains Framework, Necessity-Concerns Framework and Perceptions and Practicalities Approach. Interviewees generally reported high levels of vaping. We found that: (1) intervention adherence was driven by four necessity beliefs-stopping smoking for the baby, and vaping for harm reduction, smoking cessation or as a last resort; (2) necessity beliefs outweighed vaping concerns, such as dependence and safety; (3) adherence was linked to four practicalities themes, acting as barriers and facilitators to vaping-device and e-liquid perceptions, resources and support, whether vaping became habitual, and social and environmental factors; and (4) intentional non-adherence was rare; unintentional non-adherence was due to device failures, forgetting to vape, and personal circumstances and stress. Pregnant smokers provided with e-cigarettes, and with generally high levels of vaping, had positive beliefs about the necessity of vaping for smoking cessation which outweighed concerns about vaping. Non-adherence was mainly due to unintentional factors