Women’s intentions to Human Papillomavirus self-sample: development of an intervention to increase self-sampling intentions

Testing for Human Papillomavirus (HPV) is being incorporated into the cervical screening programme, with the probable future introduction of HPV as a primary test and a possibility of HPV self-sampling. In anticipation of this development, it is imperative to identify potential barriers to HPV self-sampling. The work presented in this thesis identified women’s attitudes and intentions regarding the possible introduction of primary HPV self-sampling, and developed a preliminary intervention designed to address barriers and increase intentions to HPV self-sample. A mixed-methods approach was used to explore women’s attitudes and intentions regarding HPV self-sampling through a cross-sectional questionnaire survey, in-depth qualitative interviews and intervention user testing. A questionnaire based on the extended Health Belief Model was developed and validated using content validity assessment and cognitive interviews. A survey of 194 women recruited through Cervical Screening Wales and in community settings identified that perceiving more barriers than benefits to HPV self-sampling, reporting lower self-efficacy in relation to self-sampling, and lower HPV knowledge were associated with lower hypothetical intention to HPV self-sample. Qualitative interviews with a sub-sample of 19 survey participants revealed further barriers including lack of confidence in ability to self-sample correctly, lack of confidence in self-sampling results, concerns about sample contamination and identity theft, and low confidence in the rationale for the introduction of a new screening programme. Content designed to address these barriers was incorporated into a leaflet designed to increase intentions to HPV self-sample. The leaflet was well received in user testing. Overall, findings suggest that if HPV self-sampling is incorporated into the cervical screening programme, personal and system barriers as well as concerns about operational factors will need to be addressed. The pilot HPV self-sampling intervention may be a mechanism for increasing intention to HPV self-sample by improving women’s HPV knowledge, confidence in their ability to self-sample properly, and confidence in operational factors. It is anticipated that this may alleviate women’s concerns about a new method of cervical screening, ultimately leading to increased uptake

Interventions to mitigate the risks of COVID-19 for people experiencing homelessness, and their effectiveness: systematic review

ObjectivesPeople experiencing homelessness also experience poorer clinical outcomes of COVID-19. Various interventions were implemented for people experiencing homelessness in 2020-22 in different countries in response to varied national guidance to limit this impact of COVID-19. It is important to understand what was done and the effectiveness of such interventions. This systematic review aims to describe interventions to mitigate the risks of COVID-19 in people experiencing homelessness and their effectiveness.MethodsA protocol was developed and registered in PROSPERO. Nine databases were searched for studies on interventions to mitigate the impact of COVID-19 in people experiencing homelessness. Included studies were summarised with narrative synthesis.ResultsFrom 8233 references retrieved from the database searches and handsearching, 15 were included. There was a variety of interventions, including early identification of potential COVID-19 infections, provision of isolation space, healthcare support, and urgent provision of housing regardless of COVID-19 infection. ConclusionThe strategies identified were generally found to be effective, feasible and transferable. This review must be interpreted with caution due to the low volume of eligible studies, and low quality of the evidence available. <br/

Women’s perspectives on Human Papillomavirus self-sampling in the context of the UK cervical screening programme

Background: Testing for human papillomavirus (HPV) is being incorporated into the cervical screening programme, with the probable future introduction of HPV as a primary test and a possibility of HPV self-sampling. In anticipation of this development, we sought to inform future policy and practice by identifying potential barriers to HPV self-sampling. Methods: A cross-sectional survey of 194 women aged 20-64 years was conducted. Logistic regression analysis was used to identify determinants of self-sampling intentions. A purposive subsample of 19 women who reported low self-sampling intentions were interviewed. Interviews were framework-analysed. Results: Most survey participants (N=133, 69.3%) intended to HPV self-sample. Lower intention was associated with lower self-efficacy (OR=24.96, P≤.001), lower education (OR=6.06, P≤.05) and lower perceived importance of HPV as a cause of cervical cancer (OR=2.33, P≤.05). Interviews revealed personal and system-related barriers. Personal barriers included a lack of knowledge about HPV self-sampling, women’s low confidence in their ability to self-sample correctly and low confidence in the subsequent results. System-related factors included a lack of confidence in the rationale for modifying the current cervical screening programme, and concerns about sample contamination and identity theft. Conclusions: Insights gained from this research can be used to guide further enquiry into the possibility of HPV self-sampling and to help inform future policy and practice. Personal and system-related barriers including low confidence in the reasons for changing current cervical screening provision need to be addressed, should HPV self-sampling be incorporated into the cervical screening programme

Barriers and facilitators to shared decision-making in neonatal medicine: A systematic review and thematic synthesis of parental perceptions

Objectives Systematically review parental perceptions of shared decision-making (SDM) in neonatology, identifying barriers and facilitators to implementation. Methods Electronic database (Medline, PsycINFO, CINAHL and Scopus) and follow-up searches were conducted to identify qualitative studies. Data were extracted, thematically analysed and synthesised. Results Searches yielded 2445 papers, of which 25 were included. Thematic analysis identified six key themes. Key barriers included emotional crises experienced in the NICU setting, lack of medical information provided to parents to inform decision-making, inadequate communication of information, poor relationships with caregivers, lack of continuity in care, and perceived power imbalances between HCPs and parents. Key facilitators included clear, honest and compassionate communication of medical information, caring and empathetic caregivers, continuity in care, and tailored approaches that reflected parent’s desired level of involvement. Conclusion The highly specialised environment, and the emotional crises experienced by parents impact significantly on their perceived capacity to engage in surrogate decision-making. Practice Implications Complex and multi-factorial interventions that address the training needs of HCPs, and the emotional, informational and decision support needs of parents are needed. SDM skills training, improved information delivery, and integrated emotional and decisional support could help parents to become more involved in SDM for their infant

The role of perceived public and private green space in subjective health and wellbeing during and after the first peak of the COVID-19 outbreak

Research has consistently shown that access to parks and gardens is beneficial to people’s health and wellbeing. In this paper, we explore the role of both public and private green space in subjective health and wellbeing during and after the first peak of the COVID-19 outbreak that took place in the UK in the first half of 2020. It makes use of the longitudinal COVID-19 Public Experiences (COPE) study, with baseline data collected in March/April 2020 (during the first peak) and follow-up data collected in June/July 2020 (after the first peak) which included an optional module that asked respondents about their home and neighbourhood (n = 5,566). Regression analyses revealed that both perceived access to public green space (e.g. a park or woodland) and reported access to a private green space (a private garden) were associated with better subjective wellbeing and self-rated health. In line with the health compensation hypothesis for green space, private gardens had a greater protective effect where the nearest green space was perceived to be more than a 10-minute walk away. This interaction was however only present during the first COVID-19 peak when severe lockdown restrictions came into place, but not in the post-peak period when restrictions were being eased. The study found few differences across demographic groups. A private garden was relatively more beneficial for men than for women during but not after the first peak. The results suggest that both public and private green space are an important resource for health and wellbeing in times of crisis

Effects of the COVID-19 pandemic on people experiencing incarceration: a systematic review

Objective: To assess the effect of the COVID-19 pandemic on people experiencing incarceration (PEI), focusing particularly on clinical outcomes compared with the general population. Design: Systematic review with narrative synthesis in accordance with the Centre for Reviews and Dissemination’s good practice guidelines. Data sources: Medline, Social Policy and Practice, Criminology Connection, ASSIA, EMBASE, SCOPUS, Web Of Science, CINAHL, Cochrane Library, Cochrane COVID-19 reviews, COVID-19 Evidence Reviews and L*OVE COVID-19 Evidence databases were searched up to 21 October 2022. Eligibility criteria for selecting studies: We included studies presenting data specific to adults ≥18 years experiencing incarceration, with exposure to SARS-CoV-2 infection. All studies with a comparison group, regardless of study design and country were included. Studies with no comparison group data or not measuring clinical outcomes/health inequalities were excluded. Studies focussing on detained migrants, forensic hospitals, prison staff and those not in English were also excluded. Data extraction and synthesis: Two reviewers extracted data and assessed risk of bias. Data underwent narrative synthesis using a framework analysis based on the objectives, for infection rates, testing, hospitalisation, mortality, vaccine uptake rates and mental health outcomes. There was no scope for meta-analysis, due to the heterogeneity of evidence available. Results: 4516 references were exported from the databases and grey literature searched, of which 55 met the inclusion criteria. Most were from the USA and were retrospective analyses. Compared with the general population, PEI were usually found to have higher rates of SARS-CoV-2 infection and poorer clinical outcomes. Conflicting data were found regarding vaccine uptake and testing rates compared with the general population. The mental health of PEI declined during the pandemic. Certain subgroups were more adversely affected by the COVID-19 pandemic, such as ethnic minorities and older PEI. Conclusion: PEI have poorer COVID-19 clinical outcomes than the general public, as shown by largely low-quality heterogenous evidence. Further high-quality research of continuing clinical outcomes and appropriate mitigating interventions is required to assess downstream effects of the pandemic on PEI. However, performing such research in the context of incarceration facilities is highly complex and potentially challenging. Prioritisation of resources for this vulnerable group should be a focus of national policy in the event of future pandemics. PROSPERO registration number: CRD42022296968

'Focusing' in motivational interviewing: development of a training tool for practitioners

Rationale, aims and objectives: Motivational Interviewing (MI) is an individual-level approach to behaviour change that has been evaluated in over 600 randomised clinical trials across multiple settings. Increasingly, research efforts focus on how MI works and how it can best be integrated into public health and clinical programmes. As the application of MI expands, a key integration challenge involves specifying the focus of a conversation such that a practitioner might ignite and intensify a patient’s internal motivation for change related to that focus. At present, this challenge is poorly conceptualised. We aimed to clarify the construct of “focusing” and to develop a practical tool that can be used to develop and assess practitioner competence. Method: First we reviewed validated MI measures to elucidate current conceptualisations of focusing. Second, we identified practitioner speech acts that led to topic transitions. We then drafted the first version of MIFI. A gold standard rater, together with one expert MI and 3 non-expert MI raters, each used MIFI to coded 20 audio recordings from a feasibility study of MI and breastfeeding maintenance (n=170 observations). Internal consistency and inter-rater reliability analyses were conducted. Results: Published MI measures include ‘focusing’ as a strategy to agree a target change or to hold attention on that change target. We observed practitioners create or shift focus using 4 skills: questions, listening statements, giving information or meta-statements. Moderate to strong correlations were demonstrated between 4 of 5 global measures on the MIFI. Reliability estimates were good to excellent overall (5 coder ICCs>0.65), fair to excellent for the non-expert coding group (ICCs>0.55) and for the best coding pair (MI expert and non-expert ICCs >0.52). Conclusion: We offer conceptual clarity about focusing in MI and have developed a tool to train practitioners in “focusing” when integrating MI into healthcare and public health interventions

“It was classed as a nonemergency”: Women's experiences of kidney disease and preconception decision‐making, family planning, and parenting in the United Kingdom during COVID ‐19

Objectives: To investigate the experiences of women with kidney disease, residing in the United Kingdom (UK), living through the first 18 months of the COVID‐19 pandemic with specific focus on preconception decision‐making, family planning, and parenting. Methods: We conducted a mixed‐methods study, comprising an online survey and follow‐up interviews, with UK‐resident women aged 18–50. Results: We received 431 surveys and conducted 30 interviews. Half (n = 221, 51%) of the survey respondents considered that COVID‐19 influenced the quality of communication with healthcare professionals and 68% (n = 295) felt that the pandemic disrupted their support networks. Interview participants indicated that delayed and canceled appointments caused anxiety, grief, and loss of pregnancy options. Women's perception of themselves as (good) mothers as well as their capacity to have and raise a child, meet partners, and sustain healthy relationships was negatively affected by the “clinically extremely vulnerable” label. Women's trust in their healthcare was dismantled by miscommunication and variation in lockdown rules that caused confusion and increased worry. Women reported that COVID‐19 contributed to postnatal depression, excessive concern over infant mortality, preoccupation over others following rules, and catastrophising. Conclusion: Some women in the UK with chronic kidney disease lost or missed their opportunity to have children during the pandemic. Future pandemic planners need to look more holistically and longer term at what is and is not classed as an emergency, both in how services are reconfigured and how people with chronic conditions are identified, communicated with, and treated