Implementing the Single Assessment Process: Opportunities and challenges

Peer reviewe

What is being conveyed to health professionals and consumers through web and print sources of nutrition information?

Nutrition misinformation can be harmful. Within dietetics there is an acknowledgement that nutrition information should be consistent, science-based and made relevant to different segments of the population. This paper reports on a study, conducted in Scotland, which involved focus groups and interviews with consumers and health professionals to explore messages relating to a healthy diet and to starchy foods and foods high in fat or sugar in particular. The research also involved a discourse analysis of articles aimed at health professionals and consumers. Evidence based, clearly written web and print articles were not the norm. Many articles contained value-laden messages and inconsistent or unclear advice. Nutrition information was rarely contextualized for consumers to help them incorporate the advice into their daily lives. Consumers and health professionals reported feeling 'bombarded' by messages about diet, which was sometimes confusing. There is considerable scope for improving nutrition messaging in Scotland.Peer reviewe

The role of culture and diversity in the prevention of falls among older Chinese people

Original article can be found at : http://journals.cambridge.org/ Copyright Canadian Association on GerontologyThis grounded-theory study explored the perceptions of Chinese older people, living in England, on falls and fear of falling, and identified facilitators and barriers to fall prevention interventions. With a sample of 30 Chinese older people, we conducted two focus groups and 10 in-depth interviews in Mandarin or Cantonese. Interview transcripts, back translated, were analyzed using N6. Constant comparative analysis highlighted a range of health-seeking behaviors after a fall: Chinese older people were reluctant to use formal health services; talking about falls was avoided; older people hid falls from their adult children to avoid worrying them; and fatalistic views about falls and poor knowledge about availability and content of interventions were prevalent. Cost of interventions was important. Chinese older adults valued their independence, and cultural intergenerational relations had an impact on taking action to prevent falls. Cultural diversity affects older adults’ acceptance of fall prevention interventions.Peer reviewe

Meals on wheels services and the food security of older people

© 2022 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License https://creativecommons.org/licenses/by/4.0/In recent years Meals on Wheels (MoW) services have been in a state of decline as austerity policies have become entrenched. However, this decline is occurring with little knowledge of the impact withdrawal of MoW services has on the health and well-being of those who use them. The pandemic has raised awareness of precarity and vulnerability in relation to food that affects many people in the UK and other Westernised countries and this provides further context for the analysis presented. This paper presents findings of a mixed methods ethnographic study drawing on qualitative interviews and visual methods underpinned by social practice theory to explore the household food practices of older people receiving MoW services. Interviews were conducted with 14 older people receiving MoW, eight MoW staff delivering MoW services in the east of England and one expert. The Covid-19 pandemic interrupted the study, and once the first lockdown began visits to the homes of older people were terminated and remaining interviews were undertaken by telephone. The study found that a number of threats accumulated to change food practices and moved people towards vulnerability to food insecurity. Threats included difficulty accessing food and cooking due to sensory and physical challenges. The MoW service increased participants’ coping capacity. As well benefiting from the food provided, the relational aspect of the service was important. Brief encounters between MoW staff built caring relationships that developed over time to ensure older people felt valued and cared for. The study demonstrates how MoW services make a positive contribution to food practices, supporting vulnerable adults to continue living well in their own homes and protecting them from food insecurity and ill-being. Local authorities looking to make cost savings through ending MoW services should consider the impact this would have on the well-being of older residents.Peer reviewe

Vulnerability to food insecurity among older people: the role of social capital

© The Author(s) 2023. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (CC BY). https://creativecommons.org/licenses/by/4.0/Food insecurity is a public health issue in Western countries, including the UK. Being food insecure means older adults may not access sufficient nutritious, safe and socially acceptable food, leading to a higher risk of malnutrition. We conducted a qualitative study of 25 households with men and women aged 60-95 years to investigate how older adults access food and to explore social capital, which might contribute to food security or prevent malnutrition. We conducted participant-led kitchen tours, interviews, photo and video elicitation across multiple household visits. In addition, we brought stakeholders together from a range of sectors in a workshop to explore how they might respond to our empirical findings, through playing a serious game based on scenarios drawn from our data. This was a successful way to engage a diverse audience to identify possible solutions to threats to food security in later life. Analysis of the data showed that older people’s physical and mental health status and the local food environment often had a negative impact on food security. Older people leveraged social capital through reciprocal bonding and bridging social networks which supported the maintenance of food security. Data were collected before COVID-19 but the pandemic amplifies the utility of our study findings. Many social elements associated with food practices as well as how people shop have changed because of COVID-19 and other global and national events, including a cost-of-living crisis. To prevent ongoing adverse impacts on food security, focus and funding should be directed to re-establishment of social opportunities and rebuilding bridging social capital.Peer reviewe

Translators as Networkers: The Role of Virtual Communities

Recent years have seen a rise in the importance of virtual and real-life knowledge sharing communities and communities of practice across many fi elds of private and commercial interest, including professional translation. This article examines the characteristics of knowledge sharing communities in general, identifies their key elements, looks at the motivation for membership and presents an empirical study of life in a thriving virtual translation community. In doing so, it draws on the results of a literature review combined with a participant observation based study and member survey of a major virtual translation community. The results indicate that virtual translation communities can be lively platforms and offer translators a forum not only for sharing expert knowledge and collaborating, but also for keeping in touch with like-minded individuals

Fall prevention in the community: what older people say they need

Original article can be found at: http://www.bjcn.co.uk/ Copyright MA HealthcareUptake of and adherence to fall prevention interventions is often poor and we know little about how older people’s perceptions of and beliefs about fall prevention interventions affect uptake. This study aimed to explore older people’s perceptions of the facilitators and barriers to participation in fall prevention interventions. We undertook a qualitative study with older people who had taken part in, declined to participate or adhere to fall prevention interventions using semi-structured interviews (n=65), and 17 focus groups (n=122) with older people (including 32 South Asian and 30 Chinese older people) in primary and community care settings in the South of England. A number of factors acted as either barriers or facilitators to uptake of interventions. Older people also made recommendations for improving access to interventions. Community nurses are ideally placed to screen older people, identify those at risk of falling and refer them to appropriate interventions as well as providing health promotion and education.Peer reviewe

Informing the Hertfordshire Food Poverty Needs Assessment: Household Experiences of Food Poverty and Support Service Provision in Hertfordshire

Although the proportion of residents at a higher risk of experiencing food poverty in Hertfordshire is below the national average (15.8%), 10.3 per cent of residents are still at a high risk. ‘Food poverty’ is a visible symptom and consequence of poverty. The aim of this research is to contribute an understanding of residents’ experiences of food poverty, their experiences of accessing support services and to determine what gaps there are in service provision in Hertfordshire. This research was undertaken to inform the Hertfordshire County Council (HCC) ‘Food Poverty Needs Assessment’ being undertaken to inform policy and practice across Hertfordshire (HCC, 2021). Although this work is not directly exploring the COVID-19 pandemic, the proportion of people experiencing food poverty in the UK has increased since its onset, so this work is timely. Twenty-three Hertfordshire residents completed a survey and five residents took part in an in-depth semi-structured interview. Three focus groups were undertaken with 15 service providers from organisations providing support for those experiencing food poverty across Hertfordshire. Residents identified multiple factors that contributed to their experience of food poverty, including physical and/or mental health issues, the high cost of housing, unemployment or furlough during the pandemic, low pay and/or insecure work, debt and Universal Credit. These factors were often cumulative. Households described how they used numerous strategies in response and often prioritised paying housing costs and household utilities. Food budgets were then determined by the little money left over. Other strategies included exhaustive budgeting, pre-planning purchases and meals, shopping in multiple outlets and using cheaper ‘budget’ supermarkets. For households with children, parents sometimes skipped meals and/or bought cheaper poorer quality food (or ‘junk food’) to ensure that their children were not hungry. Informal social networks (such as family and friends) provided financial and practical support including childcare. Formal support included food aid from food banks as well as guidance and advice from services such as Herts Help, Citizens Advice and the Money Advice Unit. Free school meals were also seen as vital to families with children. Residents were largely positive about their experiences of accessing support services. However, they often struggled to know what support was available to them or how to access support in the first instance. They recommended better availability of information about what support is available and that this information should not just be accessible via the internet. Focus groups suggested that the root cause of food poverty was poverty itself, caused by insufficient income. They stated that local responses to the complexities of food poverty should be multiagency and there were good examples of existing partnership working between organisations. Service providers explained how the demand for services had increased during the COVID-19 pandemic with food banks noting changes in the demographic profile of service users. There was consensus that a countywide response to food poverty in Hertfordshire should be informed by public health approaches that prioritise prevention. There was widespread agreement for the need to map the existing services operating across Hertfordshire to identify gaps in provision and ensure residents are able to access the most appropriate support available to them and that organisations can work collaboratively as efficiently as possible. Service providers also recommended a need for strategic leadership, establishment of outcomes and priority setting for food poverty work across Hertfordshire

The Mediterranean diet: socio-cultural relevance for contemporary health promotion

In biomedical literature, The Mediterranean Diet describes a healthy eating model, based on epidemiological findings on the predominant eating practices in Crete and Southern Italy in the 1960s. At the time, the level of life expectancy in this region was amongst the highest worldwide and rates of cardiovascular disease were amongst the lowest. Medical research has since given increasing attention to this dietary pattern and its potential health benefits. The various components of The Mediterranean Diet are fast becoming a paradigm for healthier lifestyles as well as potential model for weight loss. In 2010 UNESCO recognised The Mediterranean Diet as an intangible cultural heritage of Italy, Spain, Greece and Morocco and the diet has moved away from a uniquely biomedical model to a cultural representation. This has led to increased recognition of the importance of social and cultural context in the dietary model, particularly the idea of conviviality, the pleasure of shared meals. It has also brought to light the debate over the cultural legitimacy of The Mediterranean Diet and its ability to represent the cultural diversity of the region. This literature review consolidates interdisciplinary perspectives on the cultural context of the Mediterranean Diet. A literature search was conducted using both biomedical and social science databases to reflect the interdisciplinary nature of the article. This review explores the relevance o

Falling in Acute Mental Health Settings for Older People : Who falls, where, when and why?

Copyright: © 2014 Dickinson A et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Falls, slips and trips are a major patient safety concern in hospital settings accounting for 26 per cent of all reported patient safety incidents in England. Mental health conditions and their treatments add further to fall risk but we have little information regarding who falls, where and when within mental health settings. Methods: This paper presents an overview of the pattern of falls by older patients within an in-patient mental health setting in the South of England using routine records completed by staff when a fall occurs. 920 fall reports over three years were analysed, and 7 focus groups were undertaken with ward staff to explore how staff understood falls and their experiences of using the falls reporting system. Results: In terms of diagnosis 40% of fallers had a primary functional diagnosis, 46% an organic mental health diagnosis (14% non-specific diagnosis), average age was 81.7 years (range 59 to 99 years; SD 8.3) and 57% were female. Approximately one quarter, 27%, of falls were observed by staff. Falls were not evenly distributed across either day of week or time of day, with peak times for falls on Tuesday and Saturday and morning (7-8 and 9-10am) and subsidiary peaks between noon and 1pm and early evening (5-6pm). Almost half of falls occurred in private spaces in the ward such as bedrooms, and 42% in public spaces such as sitting rooms. However 60% of falls in public spaces were unseen. Reporting in these settings was problematic for staff and patients were sometimes described as placing themselves on the floor as a consequence of their mental health condition. The average time to first fall was 5 weeks. Conclusions: Routine mapping of falls could be undertaken at ward and organization level and contribute to better understanding of the local factors contributing to falls. Exploring incident report data in focus groups with staff helped us and them to interpret the data and to understand some of the decision making staff engage in everyday when reporting falls.Peer reviewedFinal Published versio