Impact of provision of cardiovascular disease risk estimates to healthcare professionals and patients: a systematic review.

OBJECTIVE: To systematically review whether the provision of information on cardiovascular disease (CVD) risk to healthcare professionals and patients impacts their decision-making, behaviour and ultimately patient health. DESIGN: A systematic review. DATA SOURCES: An electronic literature search of MEDLINE and PubMed from 01/01/2004 to 01/06/2013 with no language restriction and manual screening of reference lists of systematic reviews on similar topics and all included papers. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: (1) Primary research published in a peer-reviewed journal; (2) inclusion of participants with no history of CVD; (3) intervention strategy consisted of provision of a CVD risk model estimate to either professionals or patients; and (4) the only difference between the intervention group and control group (or the only intervention in the case of before-after studies) was the provision of a CVD risk model estimate. RESULTS: After duplicates were removed, the initial electronic search identified 9671 papers. We screened 196 papers at title and abstract level and included 17 studies. The heterogeneity of the studies limited the analysis, but together they showed that provision of risk information to patients improved the accuracy of risk perception without decreasing quality of life or increasing anxiety, but had little effect on lifestyle. Providing risk information to physicians increased prescribing of lipid-lowering and blood pressure medication, with greatest effects in those with CVD risk >20% (relative risk for change in prescribing 2.13 (1.02 to 4.63) and 2.38 (1.11 to 5.10) respectively). Overall, there was a trend towards reductions in cholesterol and blood pressure and a statistically significant reduction in modelled CVD risk (-0.39% (-0.71 to -0.07)) after, on average, 12 months. CONCLUSIONS: There seems evidence that providing CVD risk model estimates to professionals and patients improves perceived CVD risk and medical prescribing, with little evidence of harm on psychological well-being.BS was supported by the European Commission Framework 7, EPIC-CVD: Individualised CVD risk assessment: tailoring targeted and cost-effective approaches to Europe's diverse populations, Grant agreement no: 279233. JUS was supported by a National Institute of Health Research (NIHR) Clinical Lectureship.This is the final version of the article. It first appeared from BMJ via http://dx.doi.org/10.1136/bmjopen-2015-00871

Perspectives on strengths-based approaches: social workers, commissioners and managers

Innovation in care models is seen as a key mechanism for addressing demographic and financial challenges facing the care system. One such recent development are strengths based approaches to social care and social work. A previous systematic review of the literature conducted by the Adult Social Care Research Unit (ASCRU) showed that little is known about the development and implementation of strengths-based approaches in adult social care and social work. The present study builds on existing evidence and the literature review noted above

Responses to provision of personalised cancer risk information: a qualitative interview study with members of the public.

Background It is estimated that nearly 600,000 cancer cases in the UK could have been avoided in the past five years if people had healthier lifestyles. A number of theories of behaviour change suggest that before people will change health behaviours, they must accept that a risk applies to them. This study aimed to explore the views of the public on receiving personalised cancer risk information and the potential for that information to motivate behaviour change. Methods We conducted 27 interviews with members of the public (mean age 49 ± 23 years). Each participant completed a questionnaire to allow calculation of their risk of developing the most common cancers (10 for women, 8 for men). During the interviews we presented their risk using a web-based tool developed for the study and discussions covered their views on receiving that information. Each interview was audio-recorded and then analysed using thematic analysis. Results Participants generally viewed the concept of personalised cancer risk positively. The first reaction of almost all when presented with their 10-year risk of an individual cancer without any further context was that it was low and not concerning. Views on what constituted a high risk ranged widely, from 0.5 to 60%. All felt seeing the impact of changes in lifestyle was helpful. For some this led to intentions to change behaviour, but reductions in risk were not always motivating as the risks were considered low and differences small. Conclusions Provision of personalised cancer risk was well received and may be a useful addition to other cancer prevention initiatives. Further work is needed in particular to develop ways to present cancer risk that reflect the general perception of what constitutes a risk high enough to motivate behaviour change and help patients contextualise a less well known health risk by providing a frame of reference

Strengths-based Approaches—Perspectives from Practitioners

Despite its popularity, relatively little is known about strengths-based approaches in adult social work. In order to explore how strengths-based models and approaches are developed and implemented in social work and social care in England, and how these models are impacting practice, a two-stage project was conducted between December 2020 and October 2021. An online survey was completed by thirty-two respondents and a sub-sample of ten semi-structured interviews were conducted with social work and social care professionals involved in organising, managing, delivering or commissioning strengths-based approaches. The majority of participants were social workers. A range of positive outcomes were reported including improved reported well-being and satisfaction for people accessing services and enriched interactions (greater empathy, trust, better rapport), particularly for social workers. Challenges included incompatibility of systems and organisational structures; workload pressures and a depleted workforce; limited resources and applying the model at crisis point. The principles and values associated with adopting a strengths-based approach appear consistent with providing high-quality social work. The challenge for researchers—and to some extent practitioners—is how to meaningfully capture the nuanced impact of such a multi-dimensional approach. The challenge for policy is how to operationalise and replicate the benefits

Applying outcomes in community-based social care practice in England

Context. Social care outcomes (the effect of services on the quality of life of people with support needs and unpaid carers) have been proposed as a way of improving the quality and effectiveness of care. Outcomes have also been proposed as a way of re-conceptualising ‘needs’ that has application in needs assessment, care planning, evaluation and care practice. Objectives. The study aimed to provide insights into social care professionals’ experiences and views on the collection and application of outcomes data in practice, and what they believe are the benefits, challenges and barriers to implementation. Methods. Interviews were conducted with 25 social care professionals in England and analysed using a framework approach. Findings. Participants reported perceived benefits of using outcomes data, especially to focus effort on improving the wellbeing of people with support needs and carers. Perceived challenges include requirements for data collection set by funders/commissioners; the volume of data collected; difficulties in separating non-service-related influences on outcomes; and the format of collection. Participants felt a more flexible approach might facilitate more meaningful conversations, rather than a ‘tick-box’ exercise. Limitations. The study sample was purposive, based on established connections. It only included professionals from London, South East and Central England. Implications. Although outcomes are perceived as important in helping to improve people’s lives, social care professionals identified a number of challenges. Further research to understand and address these challenges is needed

Happy to Share Cards

Happy to Share Cards (HtSC) are a simple, low-cost initiative aimed at reducing loneliness in the community. By placing a card on their table, a customer can indicate they are happy to share their table with someone else. The present study explores the use of HtSC among early adopters of this initiative and is the first evaluation of their use. An online survey was distributed to businesses known to use HtSC, to ask questions about why they chose to join the initiative, how staff and customers had been interacting with the cards (what was and was not working well), and how/whether they plan to engage with the cards following the Covid-19 pandemic

Information and Risk Modification Trial (INFORM): design of a randomised controlled trial of communicating different types of information about coronary heart disease risk, alongside lifestyle advice, to achieve change in health-related behaviour

Abstract Background Cardiovascular disease (CVD) remains the leading cause of death globally. Primary prevention of CVD requires cost-effective strategies to identify individuals at high risk in order to help target preventive interventions. An integral part of this approach is the use of CVD risk scores. Limitations in previous studies have prevented reliable inference about the potential advantages and the potential harms of using CVD risk scores as part of preventive strategies. We aim to evaluate short-term effects of providing different types of information about coronary heart disease (CHD) risk, alongside lifestyle advice, on health-related behaviours. Methods/Design In a parallel-group, open randomised trial, we are allocating 932 male and female blood donors with no previous history of CVD aged 40–84 years in England to either no intervention (control group) or to one of three active intervention groups: i) lifestyle advice only; ii) lifestyle advice plus information on estimated 10-year CHD risk based on phenotypic characteristics; and iii) lifestyle advice plus information on estimated 10-year CHD risk based on phenotypic and genetic characteristics. The primary outcome is change in objectively measured physical activity. Secondary outcomes include: objectively measured dietary behaviours; cardiovascular risk factors; current medication and healthcare usage; perceived risk; cognitive evaluation of provision of CHD risk scores; and psychological outcomes. The follow-up assessment takes place 12 weeks after randomisation. The experiences, attitudes and concerns of a subset of participants will be also studied using individual interviews and focus groups. Discussion The INFORM study has been designed to provide robust findings about the short-term effects of providing different types of information on estimated 10-year CHD risk and lifestyle advice on health-related behaviours. Trial registration Current Controlled Trials ISRCTN17721237 . Registered 12 January 2015

A cross-sectional study during COVID-19 of the social care-related quality of life of people with dementia and their carers in England

Objective: The study aimed to establish the factors related to the social care-related QoL of people living with dementia (proxy-report) and their carers (self-report). Methods: An online/postal survey of 313 carers in England was conducted from January 2020 to April 2021. Carers were eligible if they supported someone living with dementia, who lived at home, was unable to self-complete a questionnaire (even with help), and used community-based long-term care. Multiple regression was applied to establish the factors related to the social care-related quality of life (SCRQoL) of carers (self-report, using ASCOT-Carer) and people with dementia (proxy-report, using ASCOT-Proxy). Findings: Factors related to carers’ SCRQoL were their own health, financial difficulties associated with caring, and satisfaction with long-term care services. Inadequate home design was significantly negatively associated with SCRQoL for people living with dementia. The latter stages of pandemic-related restrictions in England (specifically, the tier system from 2nd December 2020 to study end, April 2021) were associated with significantly worse SCRQoL for PLWD, but not for carers. Conclusion: The study offers insight into the factors associated with SCRQoL of people with dementia and their carers. The findings highlight the importance of adequate home design and environment for people with dementia. Satisfactory long-term care support and limiting any adverse financial impact of caring are important for carers. The findings indicate that there was a negative effect of COVID restrictions on SCRQoL of people with dementia