Making Every Contact Count: Evaluation of the use of MECC within the outpatient MSK Physiotherapy service and Bury Integrated MSK Service at Fairfield General Hospital, part of the Bury and Rochdale Care Organisation which is part of the Northern Care Alliance Group

This report presents the findings of a commissioned study to evaluate the use of Making Every Contact Count (MECC) within the outpatient MSK Physiotherapy service and Bury Integrated MSK Service at Fairfield General Hospital, part of the Bury and Rochdale Care Organisation which is part of the Northern Care Alliance Group (hereafter referred to as Fairfield MSK Physiotherapy Services). The study was a three–stage evaluation to include: an initial service description analysis for musculoskeletal (MSK) treatment a secondary data analysis of data related to MECC referrals made by Fairfield MSK Physiotherapy Services and a patient questionnaire relating to experiences of MECC within Fairfield MSK Physiotherapy Services</ol

Living with and beyond breast cancer : exploring women’s use of social media to support psychosocial health

Background: Despite the extensive use of social media, its role in supporting women living with and beyond breast cancer (LwBBC), across the survivorship trajectory, remains underexplored. Existing research has tended to focus on single or dual platform use and utilised secondary data, principally from Facebook and Twitter. In contrast, this study sought to ensure women’s experiences of use took centre stage by adopting a qualitative approach to explore social media use across the survivorship trajectory. Aims: The aims of this thesis were to: a) explore how women LwBBC use social media; b) examine how women use social media as communicative resources in relation to LwBBC; and c) make sense of how women use social media to support their psychosocial health. Methods: Twenty-one women (age range 27-64) participated in semi-structured interviews. Twelve participated in a photo-elicitation study using pre-existing photographs to explore social support. Nine participated in a photo-production study in which they took photographs (n=157) to represent how they communicate their experiences of LwBBC to others. A bricolaged approach to data analysis using thematic, polytextual and voice centred methodological approaches ensured women’s voices were brought to the fore within the analysis process. Findings: Social media use is integral to many, but not all, women’s daily lives and considered by women an appropriate space to explore their own experiences. Women describe using multiple social media platforms, such as Facebook, YouTube, Wikipedia and WhatsApp concurrently. The use of multiple platforms simultaneously to satisfy psychosocial needs demonstrates use to be more fluid and dynamic than the current literature suggests. Through listening to women’s voices, and using photographs to visualise voices, three key themes came to the fore: (i) finding relevant, timely and appropriate support; (ii) navigating disrupted identities; and (iii) (re)gaining a sense of control. Analysis shows these themes to be entangled, interconnected, and dynamic with women’s use shifting across time. Women describe social media use as both empowering but also as dislocating. Conclusions: This is the first in depth qualitative study that takes an overview of women’s engagement across social media platforms to support their experiences of LwBBC. It demonstrates significant digital labour by women through use of social media to support their physical, emotional, and (anti) social experiences of LwBBC. It indicates naturally occurring networked communities as important contributors to the ongoing psychosocial support women need at different stages of LwBBC. Social media enables women to (re) gain a sense of control and can reduce need to draw on health service provision. Knowledge of women’s use can provide insight and guidance for healthcare professionals (HCPs), producers of online content, moderators of social media communities and other women LwBBC

“Thanks for letting us all share your mammogram experience virtually” : developing an online hub for cancer screening

Background: The decision around whether to attend breast screening can often involve making sense of confusing and contradictory information on risks and benefits. The Word of Mouth Mammogram e-Network (WoMMeN) project was established to create an online resource to support decision making around breast screening. This paper presents data from our user-centred approach to engaging stakeholders (both health professionals and service-users) in the design of this online resource. Our novel approach involved creating a user-design group within Facebook to allow access to ongoing discussion between researchers, radiographers and existing and potential service-users. Objective: The current study had two objectives. The first was to examine the utility of an online user-design group for generating insight for the creation of online health resources. We sought to explore the advantages and limitations of this approach. The second objective was to analyse what women want from an online resource for breast screening information. Methods: We recruited a user-design group in Facebook, and also posted a survey within the group asking questions around design considerations for an online breast screening hub. Although the membership of the Facebook group varied over time, there were 71 members in the Facebook group at the end point of analysis. We next conducted framework analysis on 70 threads from Facebook and thematic analysis on the 23 survey responses. We focused additional analysis on how the themes were discussed by the different stakeholders within the context of the design group. Results: Two major themes were found across both the Facebook discussion and the survey data: ‘The power of information’, and ‘The hub as a place for communication and support’. Information was discussed as empowering, but also recognised as threatening. Communication and the sharing of experiences were deemed important but there was also recognition of potential miscommunication within online discussion. Health professionals and service-users expressed the same broad concerns, but also showed subtle differences. Importantly, the themes were triangulated between the Facebook discussions and the survey data, supporting the validity of an online user-design group. Conclusions: Online user-design groups afford a useful method for understanding stakeholder needs. In contrast to focus groups, they afford access to users from diverse geographical locations, and traverse time constraints allowing more considered follow-ups to responses. The use of Facebook provides a familiar and naturalistic setting for discussion. Whilst also acknowledging limitations in the sample, this approach has allowed us to understand the views of stakeholders in the user-centred design of the WoMMeN hub for breast screening

Mobilising communities to address alcohol harm : an Alcohol Health Champion approach

In this article, Cathy Ure et al. look at engaging communities in order to reduce alcohol harms. By training Alcohol Health Champions, individuals can support vulnerable friends and family, and work within their communities to influence policy and promote change

Charities’ use of Twitter : exploring social support for women living with and beyond breast cancer

Twitter is one social media platform that enables those experiencing breast cancer to access support from others. This study explores how cancer charities provide support to women living with and beyond breast cancer (LWBBC) through their Twitter feeds. Seven hundred and seventy-two tweets from seven purposively sampled cancer charities were used to explore Twitter posts made relating to social support. Two questions were posed: (1) what type of support is positioned by cancer charities on Twitter for women LWBBC and (2) what themes emerge from tweet content pertaining to support for women LWBBC? Using a peer-reviewed typology of ‘social support’ [Rui, J., Chen, Y., & Damiano, A. (2013). Health organizations providing and seeking social support: A twitter-based content analysis. Cyberpsychology, Behavior, And Social Networking, 16(9), 669–673. doi:10.1089/cyber.2012.0350], a deductive content analysis was utilised to identify informational, instrumental or emotional social support tweets (n = 199). Over half (56%) of tweets offered informational support; 27% provided or sought instrumental support and 18% related to emotional support. Interestingly, 74.3% (n = 573) of tweets were not related to providing or seeking social support. An inductive qualitative thematic analysis of the 199 tweets identified the focus (i.e., themes) of support. Three themes were identified: (1) raising awareness, (2) focusing on the future and (3) sharing stories. Cancer charities predominantly use Twitter to signpost women to informational resources and to seek instrumental support to meet charitable objectives. As the number of women LWBBC continues to increase, this study provides valuable insight into how charities represent themselves on Twitter in relation to the social support needs of women LWBBC

A mixed methods analysis evaluating an alcohol health champion community intervention : how do newly trained champions perceive and understand their training and role?

Globally, alcohol harm is recognised as one of the greatest population risks and reducing alcohol harm is a key priority for the UK Government. The Communities in Charge of Alcohol (CICA) programme took an asset-based approach in training community members across nine areas to become alcohol health champions (AHCs); trained in how to have informal conversations about alcohol and get involved with alcohol licensing. This paper reports on the experiences of AHCs taking part in the training through the analysis of: questionnaires completed pre- and post-training (n=93) and semi-structured interviews with a purposive sample of five AHCs who had started their role. Questionnaires explored: characteristics of AHCs, perceived importance of community action around alcohol and health, and confidence in undertaking their role. Following training AHCs felt more confident to talk about alcohol harms, give brief advice and get involved in licensing decisions. Interviews explored: AHCs’ experiences of the training, barriers, and facilitators to the adoption of their role, and how they made sense of their role. Four overarching themes were identified through thematic analysis taking a framework approach: 1) perceptions of AHC training; 2) applying knowledge and skills in the AHC role; 3) barriers and facilitators to undertaking the AHC role; and 4) sustaining the AHC role. Findings highlight the challenges in establishing AHC roles can be overcome by combining the motivation of volunteers with environmental assets in a community setting: the most important personal asset being the confidence to have conversations with people about a sensitive topic, such as alcohol

An asset-based community development approach to reducing alcohol harm : exploring barriers and facilitators to community mobilisation at initial implementation stage

Globally there is a need to engage communities in actions to reduce alcohol harm. This paper reports on the initial implementation phase of an asset-based community development (ABCD) approach to reducing alcohol harm in ten pre-identified areas across Greater Manchester (UK). This qualitative study highlights the experiences of stakeholders responsible for, or engaged in, implementation. Findings show that it is challenging to recruit sufficient volunteers in a specific, small area/community, which may limit the ability to build health assets. Wider policy and organisational factors, which should be understood prior to implementing a place-based volunteer18 led health promotion programme, are also identified

‘A priori’ external contextual factors and relationships with process indicators: a mixed methods study of the pre-implementation phase of ‘Communities in Charge of Alcohol’

Background It is widely recognised that complex public health interventions roll out in distinct phases, within which external contextual factors influence implementation. Less is known about relationships with external contextual factors identified a priori in the pre-implementation phase. We investigated which external contextual factors, prior to the implementation of a community-centred approach to reducing alcohol harm called ‘Communities in Charge of Alcohol’ (CICA), were related to one of the process indicators: numbers of Alcohol Health Champions (AHCs) trained. Methods A mixed methods design was used in the pre-implementation phase of CICA. We studied ten geographic communities experiencing both high levels of deprivation and alcohol-related harm in the North West of England. Qualitative secondary data were extracted from pre-implementation meeting notes, recorded two to three months before roll-out. Items were coded into 12 content categories using content analysis. To create a baseline ‘infrastructure score’, the number of external contextual factors documented was counted per area to a maximum score of 12. Descriptive data were collected from training registers detailing training numbers in the first 12 months. The relationship between the baseline infrastructure score, external contextual factors, and the number of AHCs trained was assessed using non-parametric univariable statistics. Results There was a positive correlation between baseline infrastructure score and total numbers of AHCs trained (Rs = 0.77, p = 0.01). Four external contextual factors were associated with significantly higher numbers of lay people recruited and trained: having a health care provider to coordinate the intervention (p = 0.02); a pool of other volunteers to recruit from (p = 0.02); a contract in place with a commissioned service (p = 0.02), and; formal volunteer arrangements (p = 0.03). Conclusions Data suggest that there were four key components that significantly influenced establishing an Alcohol Health Champion programme in areas experiencing both high levels of deprivation and alcohol-related harm. There is added value of capturing external contextual factors a priori and then testing relationships with process indicators to inform the effective roll-out of complex interventions. Future research could explore a wider range of process indicators and outcomes, incorporating methods to rate individual factors to derive a mean score. Trial registration ISRCTN81942890, date of registration 12/09/2017