"Talk" about male suicide? Learning from community programmes

Purpose – The purpose of this paper is to examine the contribution of public awareness campaigning in developing community capacity toward preventing male suicide and explores emerging considerations for suicide prevention programme development. Design/methodology/approach – The paper draws on campaign evaluation data, specifically qualitative discussion groups with the general public, to report results concerning campaign processes, and “interim” effectiveness in changing public awareness and attitudes, and then discusses how progress is to be lasting and transformational. Findings – The campaign raised the awareness of a substantial proportion of those targeted, and affected attitudes and behaviour of those who were highly aware. The community settings approach was effective in reaching younger men, but there were challenges targeting the public more selectively, and engaging communities in a sustained way. Practical implications – The paper discusses emerging considerations for suicide prevention, focusing on gender and approaches and materials for engaging with the public as “influencers”. There are challenges to target audiences more specifically, provide a clear call to action, and engage the public in a sustained way. Social implications – The paper discusses emerging considerations for suicide prevention, focusing on gender and approaches and materials for engaging with the public as “influencers”. There are challenges to target audiences more specifically, provide a clear call to action, and engage the public in a sustained way. Originality/value – The paper adds fresh evidence of gendered communication processes, including their effects on public awareness, attitudes and engagement. Application of a theory of change model leads to systems level findings for sustaining programme gains

Evaluation of the Choose Life North Lanarkshire Awareness Programme: Final Report

The Centre for Men’s Health at Leeds Metropolitan University, with consultants from MRC Social and Public Health Sciences Unit, Glasgow, and Men’s Health Forum, Scotland (MHFS), were appointed to conduct the Choose Life (North Lanarkshire) evaluation, beginning in March 2011. The key evaluation questions are: 1. How has the social marketing approach to increase awareness of crisis service numbers and de-stigmatise understandings and attitudes about suicide worked? 2. Has the programme as implemented been effective? Which aspects of the programme have been particularly effective? 3. Has this programme been of benefit to the community, in particular young men aged 16-35? 4. What contribution has the community made to the effectiveness of the programme

Influencing public awareness to prevent male suicide

Purpose – The purpose of this paper is to report findings from a formative evaluation of a suicide prevention public awareness campaign – Choose Life, North Lanarkshire. The focus is on preventing male suicide. The paper explores how the public campaign supports a co-ordinated and community-based direction for suicide prevention work, and examines how good practice can be identified, spread, and sustained. Design/methodology/approach – The paper draws on data collected from March to November 2011, using mixed primary research methods, including a quota survey, discussion groups with the general public, and stakeholder interviews. Findings – The campaign effectively raised the suicide awareness of a substantial proportion of those targeted, but with regional variations. It also affected the attitudes and behaviour of those who were highly aware. However, men and women engaged somewhat differently with the campaign. The sports and leisure settings approach was effective in reaching younger men. Practical implications – The paper discusses emerging considerations for suicide prevention, focusing on gender and approaches and materials for engaging with the public as “influencers”. There are challenges to target audiences more specifically, provide a clear call to action, and engage the public in a sustained way. Originality/value – This paper reflects on insights from a complex programme, exceptional in its focus on targeted sections of the public, especially young males. The paper indicates the importance for research and practice of intersecting dimensions of male identity, stigma and mental health, and other risk and protective factors which can inform campaigns highlighting talk about suicide among men

Holistic Experiences and Strategies for Conducting Research With Couples.

In this article we outline methodological considerations for conducting research interviews with couples. We draw from two qualitative men’s health studies, both developed to explore social interactions between men and their partners of either sex in relation to their health practices. We utilized a combination of separate interviews and joint couple interviews. From these studies we offer insight into our experiences of using both types of interview styles, addressing four key areas which span elements across the research project journey: (a) choosing a mode of interview; (b) ethical concerns in couple research; (c) the interview as a platform for disclosure; and (d) analyzing data from couple research

Finding Fault? Divorce Law and Practice in England and Wales

This is the final version of the report. Available from Nuffield Foundation via the link in this record.1. Key messages The law of divorce in England and Wales has been subject to criticism for decades, most recently following the rare defended case of Owens v Owens. This major research study aimed to explore how the law is working in practice. The current law and use of fault The sole ground for divorce in England and Wales is the irretrievable breakdown of the marriage. But a divorce may be granted only if one of five ‘Facts’ is proved. Whilst many people might assume this is required, it is not necessary to prove that that ‘Fact’ was a cause of the breakdown. Three Facts are fault-based: adultery, behaviour, and desertion. Two Facts are based on separation: two years if the other spouse consents to divorce, five years if they do not. In 2015, 60% of English and Welsh divorces were granted on adultery or behaviour. In Scotland, where different procedural and related legal rules create different incentive structures, it was just 6%. Elsewhere, fault has been abolished or is just one option, and often a practically insignificant one, among several divorce grounds. The continuing problems of fault Academic research and Law Commission reviews from the 1970s onwards reported serious problems with the divorce law, including the lack of honesty of the system with the parties exaggerating behaviour allegations to get a quick divorce, while the court could do little more than ‘pretend’ to inquire into allegations. This study found that those problems continue and have worsened in some respects. Fault, especially behaviour, continues to be relied on to secure a faster divorce. The consequence is that parties often feel under pressure to exaggerate allegations or retro-fit the reasons for their separation into one of the legal Facts, even though the court’s expectations of what is required to make out each Fact is now actually very low, particularly for behaviour. The court has a duty to inquire into allegations but in practice in undefended cases only has the capacity to take the petitioner’s allegations at face value. That is procedurally unfair for the great majority of respondents who cannot defend themselves against the allegations. Parties embarking on the process might reasonably assume that the law is underpinned by a fault-based logic: that petitions should reflect who and what was to blame for the relationship breakdown. Yet whilst the law invites parties to rely on fault-based Facts, it does not require the court to adjudicate on responsibility in that way – not least because it will very often be impossible to allocate blame accurately in this context. Yet respondents on the receiving end of fault-based petitions inevitably feel cast as the ‘guilty’ party. The study found no evidence that fault prevents or slows down the decision to divorce and some evidence that it may shorten the time from break up to filing. We also found, as previously, that producing evidence of fault can create or exacerbate unnecessary conflict with damaging consequences for children and contrary to the thrust of family law policy. 10 The current divorce law is now nearly 50 years old. Its apparent rationale and operation are at odds with a modern, transparent, problem-solving family justice system that seeks to minimise the consequences of relationship breakdown for both adults and children. The need for law reform to finally remove fault The study shows that we already have something tantamount to immediate unilateral divorce ‘on demand’, but masked by an often painful, and sometimes destructive, legal ritual with no obvious benefits for the parties or the state. A clearer and more honest approach, that would also be fairer, more child-centred and cost-effective, would be to reform the law to remove fault entirely. We propose a notification system where divorce would be available if one or both parties register that the marriage has broken down irretrievably and that intention is confirmed by one or both parties after a minimum period of six months.Nuffield Foundatio

'It's coming at things from a very different standpoint': evaluating the 'Supporting Self-Care in General Practice Programme' in NHS East of England

Aim: To undertake a service evaluation of the NHS East of England Supporting Self-Care in General Practice programme. Background: The number of people purported to live with long-term conditions continues to rise generating increasing policy emphasis on the importance of self-care. Previous work has highlighted barriers to implementing self-care interventions in general practice, including a lack of organisational approaches to providing self-care and limited engagement and training of healthcare professionals. In response to these barriers and policy drivers, NHS East of England Strategic Health Authority developed and commenced the Supporting Self-care in General Practice (SSCiGP) programme, which seeks to transform the relationships between people with long-term conditions and primary care practitioners. Methods: This was a mixed methods study, carried out over two phases, which included interviews, survey work and practice-based case studies. Results: This paper focuses on findings related to clinician and practice level change. Clinicians reported changes in their perceptions and in consultation practices following attendance on the SSCiGP programme. These changes were linked to empathy and patient-centredness that mirrored what patients valued in interactions with clinicians. There were qualitative and descriptive differences, but no statistically significant differences between clinicians who had and had not attended the SSCiGP programme. Time was recognised as a significant barrier to implementing, and sustaining skills learnt from the SSCiGP programme. Greater impact at practice level could be achieved when there was whole practice commitment to values that underpinned the SSCiGP programme. There was evidence that such approaches are being incorporated to change practice systems and structures to better facilitate self-care, particularly in practices who were early programme adopters. Conclusion: This evaluation demonstrates that training around clinician change can be effective in shifting service delivery when sat within a cultural framework that genuinely situates patients at the centre of consultations and practice activity

Design and Administration of Patient-Centred Outcome Measures: The Perspectives of Children and Young People with Life-Limiting or Life-Threatening Conditions and Their Family Members

BACKGROUND: Self-reported health data from children with life-limiting conditions is rarely collected. To improve acceptability and feasibility of child and family-centred outcome measures for children, they need to be designed in a way that reflects preferences, priorities and abilities. OBJECTIVES: The aim was to identify preferences for patient-reported outcome measure design (recall period, response format, length, administration mode) to improve the feasibility, acceptability, comprehensibility and relevance of a child and family-centred outcome measure, among children with life-limiting conditions and their family members. METHOD: A semi-structured qualitative interview study seeking the perspectives of children with life-limiting conditions, their siblings and parents on measure design was conducted. Participants were purposively sampled and recruited from nine UK sites. Verbatim transcripts were analysed using framework analysis. RESULTS: A total of 79 participants were recruited: 39 children aged 5–17 years (26 living with a life-limiting condition; 13 healthy siblings) and 40 parents (of children aged 0–17 years). Children found a short recall period and a visually appealing measure with ten questions or fewer most acceptable. Children with life-limiting conditions were more familiar with using rating scales such as numeric and Likert than their healthy siblings. Children emphasised the importance of completing the measure alongside interactions with a healthcare professional to enable them to talk about their responses. While parents assumed that electronic completion methods would be most feasible and acceptable, a small number of children preferred paper. CONCLUSIONS: This study demonstrates that children with life-limiting conditions can engage in communicating preferences regarding the design of a patient-centred outcome measure. Where possible, children should be given the opportunity to participate in the measure development process to enhance acceptability and uptake in clinical practice. Results of this study should be considered in future research on outcome measure development in children

Investigation of bovine serum albumin denaturation using ultrasonic spectroscopy

The ability of ultrasound spectroscopy to characterise protein denaturation at relatively high concentrations and under conditions found in foods, is examined. Measurement of longitudinal sound velocity against concentration and frequency (20-160 MHz) for the bovine serum albumin monomer at pH 7.0 gave a frequency independent value for molecular compressibility of at 25 °C, corresponding to a sound velocity for the BSA molecule of 1920 ms-1. At 160 MHz, the longitudinal sound attenuation in BSA molecules is ~5200 Npm-1, a factor of 10 higher than in water. The excess attenuation of the solution over water was nearly 90 Npm-1 at the highest measured volume fraction of 0.03 (or 3% v/v). Concentration-dependent ultrasound velocity (20 - 160 MHz) and attenuation (2 - 120 MHz) spectra were obtained over time for heated bovine serum albumin (BSA) solutions up to 40 mg/mL at neutral pH and at 25 °C. An acoustic scattering model was used which considered the solute molecules as scatterers of ultrasound, to determine the molecules' sound velocity, compressibility, and attenuation properties. Mild heat treatment caused the molecule to organise into dimers and trimers, without change in sound velocity; implying that there is little or no change in secondary structure. Changes in attenuation spectra correlated with estimated molecular weight as determined through DLS and SEC measurements. During oligomerisation, the BSA molecules continue to behave acoustically as monomers. Under severe heat treatment, BSA rapidly suffered irreversible denaturation and gelation occurred which affected both ultrasound attenuation spectra and the velocity of sound, consistent with significant molecular conformation changes and/or molecule-molecule interactions