"I'm Managing My Diabetes between Two Worlds": Beliefs and Experiences of Diabetes Management in British South Asians on Holiday in the East-A Qualitative Study.

Background. Diabetes is disproportionately high among British South Asians compared to the general UK population. Whilst the migrant British South Asians group has received most attention on research related to diabetes management, little consideration has been given to impact of travel back to the East. This study aimed to explore the role of social networks and beliefs about diabetes in British South Asians, to better understand their management behaviours whilst holidaying in the East. Methods. Semistructured interviews were conducted in Greater Manchester. Forty-four participants were recruited using random and purposive sampling techniques. Interviews were analysed thematically using a constant comparison approach. Results. Migrant British South Asians expressed a strong preference to be in a hot climate; they felt they had a healthier lifestyle in the East and often altered or abandoned their diabetes medication. Information acquisition on diabetes and availability of social networks in the East was valued. Conclusion. Social networks in the East are a valued source of information and support for diabetes. The lack of adherence to medication whilst abroad suggests that some migrant British South Asians have a poor understanding of diabetes. Future research needs to explore whether patients are seeking professional advice on diabetes management prior to their extended holiday

"Always paracetamol, they give them paracetamol for everything": a qualitative study examining Eastern European migrants' experiences of the UK health service.

BACKGROUND: The enlargement of the European Union since 2004 has led to an increase in the number of Eastern European migrants living in the UK. The health of this group is under-researched though some mixed evidence shows they are at higher risk of certain physical health conditions such as heart attacks, strokes, HIV and alcohol use and have poorer mental health. This is compounded by poor or insecure housing, low pay, isolation and prejudice. We aimed to understand the health needs and health service experiences of the Eastern European population in a town in Northern England. METHODS: Five semi structured one-to-one and small group interviews and five focus groups were conducted with 42 Eastern European participants between June and September 2014. The majority of participants were Polish and other participants were from Belarus, Hungary, Latvia, Russia, Slovakia and Ukraine. The data were analysed using thematic framework analysis. RESULTS: Key findings included a good understanding the UK health service structure and high registration and use of general practice/primary care services. However, overall, there were high levels of dissatisfaction, frustration and distrust in General Practitioners (GP). The majority of participants viewed the GP as unhelpful and dismissive; a barrier to secondary/acute care; reluctant to prescribe antibiotics; and that GPs too often advised them to take paracetamol (acetaminophen) and rest. CONCLUSIONS: Overwhelmingly participants had strong opinions about access to primary care and the role of the general practitioners. Although the design of the UK health service was well understood, participants were unhappy with the system of GP as gatekeeper and felt it inferior to the consumer-focused health systems in their country of origin. More work is needed to promote the importance of self-care, reduce antibiotic and medication use, and to increase trust in the GP

Exploring Charity Worker Perceptions of the Social Value and Sustainability of Solar Lighting in Malawi, Kenya and Zambia: A Scoping Study

Approximately 600 million people in sub-Saharan Africa have no access to electricity and use kerosene as a source of light. Solar lighting is a safer and cost effective alternative allowing families to study, work and live without the harmful effects of kerosene. Qualitative, semi-structured interviews were undertaken with staff from a United Kingdom (UK) based charity to explore the social value of solar lighting (n=7). These staff were based in the UK, Malawi, Kenya and Zambia. Two overarching themes: ‘The Social Value of Solar Lighting’ and ’Improving the Sustainability and Economic Viability of Solar Lighting’ illustrated perceived multi-faceted and wide reaching benefits on the micro-level creating positive social, economic and environmental outcomes. Future studies may look to identify the impact that solar lights may have upon the macro-level, and medium to long-term outcomes; and estimated social return on investment in different developing countries

A Constellation of Misfortune. Narrative Accounts of Adverse Life Events, Chronic Illness, and Subjective Social Status

Quantitative studies have drawn attention to the patterning of health inequalities in relation to subjective social status (SSS). There is currently little insight into the complexities of the social and biographical aspects that lie behind these findings. Narrative accounts were gathered in a mixed-methods study involving a population of people with coronary heart disease (CHD) and/or diabetes in a region of the United Kingdom with above average levels of socio-economic deprivation. The aim of this secondary qualitative analysis was to examine the accounts of interviewees with low socio-economic status (SES) who ranked themselves either low or high in terms of SSS. The results highlight the multiplicity of adverse circumstances leading to subjective assessments of low SSS. Loss of employment status contributed more to a feeling of being “at the bottom of the ladder” than the symptoms of chronic illness did, perhaps because having somewhere to go is central to the accrual of social, economic, and cultural capital. The narratives of those who ranked themselves highly (in spite of low SES) appeared to have more family and community connections. The findings contribute to theories of socio-economic biographies or trajectories, subjective social status, and engagement with the self-management aspects of chronic illness

Participation in voluntary and community organisations in the United Kingdom and the influences on the self-management of long-term conditions

Voluntary and community organisations (VCOs) have health benefits for those who attend and are viewed as having the potential to support long-term condition management. However, existing community-level understandings of participation do not explain the involvement with VCOs at an individual level, or the nature of support, which may elicit health benefits. Framing active participation as ‘doing and experiencing’, the aim of this qualitative study was to explore why people with long-term vascular conditions join VCOs, maintain their membership and what prevents participation. Twenty participants, self-diagnosed as having diabetes, chronic heart disease or chronic kidney disease, were purposefully sampled and recruited from a range of VCOs in the North West of England identified from a mapping of local organisations. In semi-structured interviews, we explored the nature of their participation. Analysis was thematic and iterative involving a continual reflection on the data. People gave various reasons for joining groups. These included health and well-being, the need for social contact and pursuing a particular hobby. Barriers to participation included temporal and spatial barriers and those associated with group dynamics. Members maintained their membership on the basis of an identity and sense of belonging to the group, developing close relationships within it and the availability of support and trust. Participants joined community groups often in response to a health-related event. Our findings demonstrate the ways in which the social contact associated with continued participation in VCOs is seen as helping with long-term condition management. Interventions designed at improving chronic illness management might usefully consider the role of VCOs

Asset-Based Community Development: Narratives, Practice, and Conditions of Possibility-A Qualitative Study With Community Practitioners

Asset-Based Community Development (ABCD) is seen as a way of tackling the social determinants of health and reducing health inequalities. However, a better understanding of the mechanisms through which ABCD operates, and the environmental and relational conditions within which it is likely to be most effective, could increase its effectiveness at improving health and well-being and reducing inequalities. Interviews and focus groups were conducted with 25 people working in third sector and voluntary organizations to begin to improve understanding about ABCD approaches, how they are implemented, and how they are meeting the needs of disadvantaged populations. These individuals had local area knowledge of programs that follow an ABCD approach and which are currently running in the North West of England. The interviews were transcribed and thematically analyzed. Four overarching themes gave insight into the principles and practices of ABCD: Relationships and trust as mechanisms for change, Reciprocity and connectivity: “people not services,” Accountability and reducing dependency, and A socially sustainable model. ABCD focuses on identifying and developing individual capabilities, relationships, engagement within communities, and outcomes that are meaningful to people and consistent with relationships and support that are reciprocal and acceptable. ABCD is likely to be most effective in supporting vulnerable people where building trust is mirrored by an institutional and relational environment that is trustworthy and facilitative of developing people’s capabilities

Aligning everyday life priorities with people's self-management support networks: an exploration of the work and implementation of a needs-led telephone support system

Background: Recent initiatives to target the personal, social and clinical needs of people with long-term health conditions have had limited impact within primary care. Evidence of the importance of social networks to support people with long-term conditions points to the need for self-management approaches which align personal circumstances with valued activities. The Patient-Led Assessment for Network Support (PLANS) intervention is a needs-led assessment for patients to prioritise their health and social needs and provide access to local community services and activities. Exploring the work and practices of patients and telephone workers are important for understanding and evaluating the workability and implementation of new interventions. Methods: Qualitative methods (interviews, focus group, observations) were used to explore the experience of PLANS from the perspectives of participants and the telephone support workers who delivered it (as part of an RCT) and the reasons why the intervention worked or not. Normalisation Process Theory (NPT) was used as a sensitising tool to evaluate: the relevance of PLANS to patients (coherence); the processes of engagement (cognitive participation); the work done for PLANS to happen (collective action); the perceived benefits and costs of PLANS (reflexive monitoring). 20 patients in the intervention arm of a clinical trial were interviewed and their telephone support calls were recorded and a focus group with 3 telephone support workers was conducted. Results: Analysis of the interviews, support calls and focus group identified three themes in relation to the delivery and experience of PLANS. These are: formulation of ‘health’ in the context of everyday life; trajectories and tipping points: disrupting everyday routines; precarious trust in networks. The relevance of these themes are considered using NPT constructs in terms of the work that is entailed in engaging with PLANS, taking action, and who is implicated this process. Conclusions: PLANS gives scope to align long-term condition management to everyday life priorities and valued aspects of life. This approach can improve engagement with health-relevant practices by situating them within everyday contexts. This has potential to increase utilisation of local resources with potential cost-saving benefits for the NH

What is Asset-Based Community Development and how might it improve the health of people with long-term conditions? A realist synthesis

Abstract Background Asset Based Community Development (ABCD) appears to be a promising way to supporting people with long-term health problems but there is currently a lack of evidence to support this approach. Methods Taking a realist approach, a review and concept-mapping exercise of ABCD approaches to improve health were conducted with a view to providing a better understanding about these approaches, how they work, and who they work for. Results 29 papers were deemed relevant and included in the review. The realist synthesis and concept mapping helped identify concepts most commonly associated with ABCD but found no papers focussed on LTCs and thus no evidence that this approach improves health outcomes for people with LTCs. Conclusions Whilst there is a lack of clarity about how to implement ABCD or how to evaluate it, this paper offers a clearer theoretical framework about the essential ingredients needed to activate ABCD

Developing cartoons for long-term condition self-management information

Background: Advocating the need to adopt more self-management policies has brought with it an increasing demand for information about living with and making decisions about long-term conditions, with a significant potential for using cartoons. However, the purposeful use of cartoons is notably absent in many areas of health care as is evidence of their acceptability to patients and lay others. This paper outlines the process used to develop and evaluate cartoons and their acceptability for a series of self-management guidebooks for people with inflammatory bowel disease, irritable bowel syndrome, diabetes, chronic obstructive pulmonary disease and chronic kidney disease (CKD). Methods: Principles for a process to develop information and cartoons were developed. Cartoon topics were created using qualitative research methods to obtain lay views and experiences. The CKD guidebook was used to provide a detailed exemplar of the process. Focus group and trial participants were recruited from primary care CKD registers. The book was part of a trial intervention; selected participants evaluated the cartoons during in-depth interviews which incorporated think-aloud methods. Results: In general, the cartoons developed by this process depict patient experiences, common situations, daily management dilemmas, making decisions and choices and the uncertainties associated with conditions. CKD cartoons were developed following two focus groups around the themes of getting a diagnosis; understanding the problem; feeling that facts were being withheld; and setting priorities. Think-aloud interviews with 27 trial participants found the CKD cartoons invoked amusement, recognition and reflection but were sometimes difficult to interpret. Conclusion: Humour is frequently utilised by people with long-term conditions to help adjustment and coping. Cartoons can help provide clarity and understanding and could address concerns related to health literacy. Using cartoons to engage and motivate people is a consideration untapped by conventional theories with the potential to improve information to support self-management

A systematic review and metaethnography to identify how effective, cost-effective, accessible and acceptable self-management support interventions are for men with long-term conditions (SELF-MAN)

Review methods: In the quantitative review, data on relevant outcomes, patient populations, intervention type and study quality were extracted. Quality appraisal was conducted independently by two reviewers using the Cochrane risk of bias tool. Meta-analysis was conducted to compare the effects of interventions in male, female and mixed-sex groups. In the metaethnography, study details, participant quotes (first-order constructs) and study authors’ themes/concepts (second-order constructs) were extracted. Quality appraisal was conducted independently by two reviewers using the Critical Appraisal Skills Programme tool. Data were synthesised according to a metaethnography approach. Third-order interpretations/constructs were derived from the extracted data and integrated to generate a ‘line-of-argument’ synthesis. Results: Forty RCTs of self-management support interventions in male-only samples, and 20 RCTs where an analysis by gender was reported, were included in the quantitative review. Meta-analysis suggested that interventions including physical activity, education and peer support have a positive impact on quality of life in men, and that men may derive more benefit than women from them, but there is currently insufficient evidence to draw definitive conclusions. Thirty-eight qualitative studies relevant to men’s experiences of, and perceptions of, self-management support were included in the qualitative review. The metaethnography identified four concepts: (1) need for purpose; (2) trusted environments; (3) value of peers; and (4) becoming an expert. Findings indicated that men may feel less comfortable engaging in support if it is perceived to be incongruous with valued aspects of masculine identities. Men may find support interventions more attractive when they have a clear purpose, are action-oriented and offer practical strategies that can be integrated into daily life. Support delivered in an environment that offers a sense of shared understanding can be particularly appealing to some men. Conclusions: Health professionals and those involved in designing interventions may wish to consider whether or not certain components (e.g. physical activity, education, peer support) are particularly effective in men, although more research is needed to fully determine and explore this. Interventions are most likely to be accessible and acceptable to men when working with, not against, valued aspects of masculine identities