Predictable pathways? : An exploration of young women's perceptions of teenage pregnancy and early motherhood

While young women from relatively affluent backgrounds tend to abort their pregnancies, young women from relatively deprived backgrounds tend to keep theirs. It has been suggested that this socio-economic-pregnancy outcome relationship is due to some form of subcultural acceptance of teenage motherhood existing among disadvantaged groups. The aim of this thesis was to assess how young, never pregnant women from diverse social and economic backgrounds perceive teenage pregnancy and early motherhood, and to consider whether these perceptions could, at least in part, explain this relationship. 248 women (mean age 15.6) completed a questionnaire which requested information on their lives, experiences, expectations about their futures, and their views of teenage pregnancy and early motherhood. Six discussion groups were then held with selected sub-groups of these women to explore their views in greater detail. As the thesis had an additional aim of exploring the process embarked upon by women following the confirmation of a teenage pregnancy, semi-structured interviews were conducted with eight women who were currently pregnant, had recently entered motherhood, or had an abortion. It was evident that young women from relatively deprived backgrounds may be more likely than their relatively affluent peers to predict they would keep a teenage pregnancy, and may anticipate early motherhood as having fewer implications for their current situation and futures. It was also evident that young women may view this role as beneficial and plan their pregnancies. However, it was clear that young women from diverse backgrounds may view early motherhood in a predominately negative light, and a range of factors may influence the outcome of a teenage pregnancy. Thus, whilst there was evidence to support the subcultural acceptance hypothesis, it did appear that this acceptance is one which would maintain a young woman on the pathway to motherhood rather than encouraging her to enter this role

Mothers’ views of their preschool child’s screen-viewing behaviour:a qualitative study

Abstract Background Research on screen-viewing in preschool children has predominantly focused on television viewing. The rapid development of mobile devices (e.g. tablets, smart phones and e-readers) and the increase in their use by preschool children means there is a need to understand how and why these devices are used by this age group. The aim of this study was to explore mothers’ views of their preschool children’s screen viewing behaviour (including mobile devices) and investigate how preschool children use different screen-viewing devices. Methods One-to-one, semi-structured interviews with mothers of preschool children (aged between 2 and 4 years old). Mothers were recruited through preschools, nurseries, and mother and toddler groups located within four areas of varying socio-economic status within Bristol, UK. Data were analysed thematically using a framework approach. Results Twenty-six mothers were interviewed. Mobile devices were regularly used as a form of screen-viewing for most children but were used on an ad hoc basis rather than being a habitual activity. The reasons and influences of mobile device use described by mothers were similar to that of television viewing. However, the portability of mobile devices meant that they were often used outside of the home as a distraction tool. Their multi-functionality meant that they could be used as a portable television, or for purposeful learning through educational games and applications. Some mothers showed concerns over mobile device use by their child, whilst others felt it was an important and useful educational tool. Although the majority of mothers felt they needed to set rules and restrictions for mobile device use, many mothers felt that they are also a necessary and unavoidable part of life. Conclusions Mothers in this study suggested that mobile device use by preschool children is common. More research is needed to determine the impact of mobile device use in preschool children, how much time preschool children spend using mobile devices and which activities their use may be replacing

Feasibility study of eye movement desensitisation and reprocessing (EMDR) in people with an at-risk mental state (ARMS) for psychosis:study protocol

Introduction Trauma can play an important role in the development of psychosis, yet no studies have investigated whether a trauma-focused psychological therapy could prevent the onset of psychosis in people at high risk of developing this condition. This study aims to establish whether it would be feasible to conduct a multicentre randomised controlled trial (RCT) to investigate the clinical and cost-effectiveness of eye movement desensitisation and reprocessing (EMDR) therapy to prevent the onset of psychosis in people with an at-risk mental state (ARMS). Methods/analysis This is a single-arm trial with a nested qualitative study where all participants (target n=20) will be offered EMDR. Eligible participants are those who meet criteria for ARMS; have experienced a traumatic event before the onset of ARMS symptomatology; and have at least one symptom of post-traumatic stress disorder (PTSD). Participants will be followed up at 4, 8 and 12 months after the baseline assessment. The primary outcome measure is transition to psychosis, and secondary outcome measures include severity of psychotic symptoms, PTSD, depression, anxiety, impaired functioning, health status and resource use. The analysis will aim to establish the rates of recruitment and retention for a large-scale RCT. Interviews with therapists and patients will explore their views of the study and their experiences of delivering or receiving EMDR. Ethics and dissemination This protocol has been approved by the South West-Cornwall and Plymouth Research Ethics Committee (Reference 18/SW/0037). Findings will be disseminated through journal publications, conference presentations and meetings with service users, their families, mental health professionals and commissioners. Trial registration number ISRCTN31976295

Shared decision making in consultations for hypertension:Qualitative study in general practice

Abstract Background Hypertension is mainly managed in primary care. Shared decision making is widely recommended as an approach to treatment decision making. However, no studies have investigated; in detail, what happens during primary care consultations for hypertension. Aim To understand patients’ and clinicians’ experience of shared decision making for hypertension in primary care, in order to propose how it might be better supported. Design Longitudinal qualitative study. Setting Five general practices in south‐west England. Method Interviews with a purposive sample of patients with hypertension, and with the health‐care practitioners they consulted, along with observations of clinical consultations, for up to 6 appointments. Interviews and consultations were audio‐recorded and observational field notes taken. Data were analysed thematically. Results Forty‐six interviews and 18 consultations were observed, with 11 patients and nine health‐care practitioners (five GPs, one pharmacist and three nurses). Little shared decision making was described by participants or observed. Often patients’ understanding of their hypertension was limited, and they were not aware there were treatment choices. Consultations provided few opportunities for patients and clinicians to reach a shared understanding of their treatment choices. Opportunities for patients to engage in choices were limited by structured consultations and the distribution of decisions across consultations. Conclusion For shared decision making to be better supported, consultations need to provide opportunities for patients to learn about their condition, to understand that there are treatment choices, and to discuss these choices with clinicians. Patient or Public Contribution A patient group contributed to the design of this study

Feasibility trial evaluation of a physical activity and screen-viewing course for parents of 6 to 8 year-old children : Teamplay

Background: Many children spend too much time screen-viewing (watching TV, surfing the internet and playing video games) and do not meet physical activity (PA) guidelines. Parents are important influences on children’s PA and screen-viewing (SV). There is a shortage of parent-focused interventions to change children’s PA and SV. Methods: Teamplay was a two arm individualized randomized controlled feasibility trial. Participants were parents of 6–8 year old children. Intervention participants were invited to attend an eight week parenting program with each session lasting 2 hours. Children and parents wore an accelerometer for seven days and minutes of moderate-to-vigorous intensity PA (MVPA) were derived. Parents were also asked to report the average number of hours per day that both they and the target child spent watching TV. Measures were assessed at baseline (time 0) at the end of the intervention (week 8) and 2 months after the intervention had ended (week 16). Results: There were 75 participants who provided consent and were randomized but 27 participants withdrew post-randomization. Children in the intervention group engaged in 2.6 fewer minutes of weekday MVPA at Time 1 but engaged in 11 more minutes of weekend MVPA. At Time 1 the intervention parents engaged in 9 more minutes of weekday MVPA and 13 more minutes of weekend MVPA. The proportion of children in the intervention group watching ≥ 2 hours per day of TV on weekend days decreased after the intervention (time 0 = 76%, time 1 = 39%, time 2 = 50%), while the control group proportion increased slightly (79%, 86% and 87%). Parental weekday TV watching decreased in both groups. In post-study interviews many mothers reported problems associated with wearing the accelerometers. In terms of a future full-scale trial, a sample of between 80 and 340 families would be needed to detect a mean difference of 10-minutes of weekend MVPA. Conclusions: Teamplay is a promising parenting program in an under-researched area. The intervention was acceptable to parents, and all elements of the study protocol were successfully completed. Simple changes to the trial protocol could result in more complete data collection and study engagement

Parental modelling, media equipment and screen-viewing among young children : cross-sectional study

Objective: To examine whether parental screenviewing, parental attitudes or access to media equipment were associated with the screen-viewing of 6-year-old to 8-year-old children. Design: Cross-sectional survey. Setting: Online survey. Main outcome: Parental report of the number of hours per weekday that they and, separately, their 6- year-old to 8-year-old child spent watching TV, using a games console, a smart-phone and multiscreen viewing. Parental screen-viewing, parental attitudes and pieces of media equipment were exposures. Results: Over 75% of the parents and 62% of the children spent more than 2 h/weekday watching TV. Over two-thirds of the parents and almost 40% of the children spent more than an hour per day multiscreen viewing. The mean number of pieces of media equipment in the home was 5.9 items, with 1.3 items in the child’s bedroom. Children who had parents who spent more than 2 h/day watching TV were over 7.8 times more likely to exceed the 2 h threshold. Girls and boys who had a parent who spent an hour or more multiscreen viewing were 34 times more likely to also spend more than an hour per day multiscreen viewing. Media equipment in the child’s bedroom was associated with higher TV viewing, computer time and multiscreen viewing. Each increment in the parental agreement that watching TV was relaxing for their child was associated with a 49% increase in the likelihood that the child spent more than 2 h/day watching TV. Conclusions: Children who have parents who engage in high levels of screen-viewing are more likely to engage in high levels of screen-viewing. Access to media equipment, particularly in the child’s bedroom, was associated with higher levels of screen-viewing. Family-based strategies to reduce screen-viewing and limit media equipment access may be important ways to reduce child screen-viewing

Process evaluation of the Teamplay parenting intervention pilot : implications for recruitment, retention and course refinement

Background Parenting programs could provide effective routes to increasing children’s physical activity and reducing screen-viewing. Many studies have reported difficulties in recruiting and retaining families in group parenting interventions. This paper uses qualitative data from the Teamplay feasibility trial to examine parents’ views on recruitment, attendance and course refinement. Methods Semi-structured interviews were conducted with 16 intervention and 10 control group parents of 6–8 year old children. Topics discussed with the intervention group included parents’ views on the recruitment, structure, content and delivery of the course. Topics discussed with the control group included recruitment and randomization. Interviews were digitally recorded, transcribed and thematically analyzed. Results Many parents in both the intervention and control group reported that they joined the study because they had been thinking about ways to improve their parenting skills, getting ideas on how to change behavior, or had been actively looking for a parenting course but with little success in enrolling on one. Both intervention and control group parents reported that the initial promotional materials and indicative course topics resonated with their experiences and represented a possible solution to parenting challenges. Participants reported that the course leaders played an important role in helping them to feel comfortable during the first session, engaging anxious parents and putting parents at ease. The most commonly reported reason for parents returning to the course after an absence was because they wanted to learn new information. The majority of parents reported that they formed good relationships with the other parents in the group. An empathetic interaction style in which leaders accommodated parent’s busy lives appeared to impact positively on course attendance. Conclusions The data presented indicate that a face-to-face recruitment campaign which built trust and emphasized how the program was relevant to families positively affected recruitment in Teamplay. Parents found the parenting component of the intervention attractive and, once recruited, attendance was facilitated by enjoyable sessions, empathetic leaders and support from fellow participants. Overall, data suggest that the Teamplay recruitment and retention approaches were successful and with small refinements could be effectively used in a larger trial

Design Considerations for the Integrated Delivery of Cognitive Behavioral Therapy for Depression:A User-Centered Design Study

Background: Adherence to computerized Cognitive Behavioral Therapy (cCBT) programs in real world settings can be poor and, in the absence of therapist support, effects are modest and short-term. Moreover, because cCBT systems tend towards limited support and thus low-intensity treatment, they are typically most appropriate for people with mild to moderate difficulties. Blended therapy, i.e. combining direct contact with a therapist with cCBT or psychoeducational materials, has been identified as one possible approach to addressing these limitations and widening access to individual CBT for depression. To date research on blended therapy systems is quite limited, particularly in comparison to more widely explored cCBT systems. While the design space and range of potential configurations for blended systems is large, only a small portion of this design space has been investigated to date. Objective: First, to explore patients’ and therapists’ views on using a system for the delivery of individual treatment for depression that integrates face-to-face contact with a therapist with access to online resources and with synchronous online therapy sessions that allow collaborative worksheet editing. Second, to establish design requirements and thus key design considerations for blended systems that further integrate different modes of communication. In particular, we were interested in exploring barriers relating to remote therapy and engagement with this type of treatment, understanding patients’ expectations of technology, and understanding therapists’ experiences of and attitudes towards the use of technology to support their work. Methods: We conducted design workshops and prototype testing sessions with 18 people who had received CBT for depression in the past, and qualitative interviews and role-play sessions with 12 CBT therapists experienced in the treatment of depression. Results: Workshops and prototyping sessions with people who had received CBT identified three important requirements for an integrated platform delivering CBT therapy for depression: 1) features that help to overcome depression-related barriers, 2) features that support engagement, and 3) features that reinforce learning and support the development of new skills. Research with therapists highlighted the importance of the therapist and client working together, the impact of technology on therapists’ workflow and workload, challenges and opportunities related to the use of online resources, and the potential of technology to support patient engagement. We use these findings to inform 12 design considerations for developing integrated therapy systems. Conclusions: To meet clients’ and therapists’ needs, integrated systems need to help retain the personal connection, support both therapist- and patient-led activities, provide access to materials and the ability to monitor progress. However, developers of such systems should be mindful of their capacity to disrupt current work practices and increase therapists’ workload. Future work should evaluate the impact of integrated systems on delivering and receiving therapy in a real-world context