"It's a question of priorities, and smoking is not one of my priorities." Staff and patients' views of factors which affect the introduction of a smoking cessation service in a hospital

Aims and Introduction: This thesis aimed to investigate individual and structural factors affecting the introduction of a new smoking cessation service into an acute hospital in the West of Scotland. The research was carried out within the context of the growth of health promotion in hospitals and the increase in the provision of smoking cessation services in the UK and elsewhere. Smoking cessation services have been shown to be effective, however there has been little discussion of whether these are appropriate in acute hospitals. Furthermore there has been little research which has attempted to identify the factors which affect the implementation of these services or examined the attitudes of patients and staff towards them. Such research would help to assess whether these services were appropriate, and if so help to introduce them more effectively. Any findings would also have lessons for the introduction of other preventive health services. Methods: Quantitative and qualitative methods were used. Patients took part in a survey which was carried out before the service was set up and staff were interviewed in depth as the service was being set up. Inpatients and outpatients attending the hospital for treatment in the medical department were surveyed either immediately after their outpatient appointment or during their inpatient stay. The survey aimed to determine what smoking advice was given before the service was introduced and whether patients felt such advice and the provision of a dedicated service were appropriate in this context. The patient survey was originally intended to be repeated after the smoking cessation service had been in place for twelve months in order to estimate the effect of the service on the smoking cessation advice which patients were offered. However due to an eleven- month delay in the employment of the smoking coordinator this was not possible and the aims of the thesis were changed. In addition twenty key people, including both clinical and management staff, were interviewed in depth. Interviewees were chosen because of their role in the hospital or because they had some impact on the development of the smoking cessation service. These interviews aimed to identify their perceptions of individual and structural barriers which would affect the implementation of the smoking cessation service in the hospital. Interviews were analysed thematically. Results: The survey results showed that a third of the patients were current smokers. Sixty-six percent of inpatients and 40% of outpatients reported that they were asked if they smoked during their visit to the hospital, and smokers were significantly more likely to report this than non-smokers. Of those who smoked, 44% reported that they had been advised to stop smoking. However few had been offered any help to do so. The majority were unaware of any services to help smokers to stop smoking though they believed that such a service would be appropriate. Half of the smokers wanted help to stop smoking. The findings from the in depth interviews showed that most interviewees with a clinical role believed that they routinely asked patients if they smoked and advised them to stop but only if they felt that this advice was appropriate. This depended largely on their perception of patients' motivation and whether smoking was related to their presenting illness. Clinicians who smoked were more reluctant to routinely ask patients about smoking than non-smokers. Interviewees did not accept without question that all patients should be advised to stop smoking and felt that this should be targeted at the appropriate groups. Interviewees discussed their health-promoting role and, while they believed that they were responsible for health promotion, largely preferred to give advice which was related to the work which they did and the patients presenting illness. Interviewees were concerned that the patients should be given advice at an appropriate time when they were able to listen to this and were willing to change, and concern was expressed that patients would not sustain any health change once they returned to their home environment. One of the main themes to emerge from these interviews was that staff felt under enormous time pressures. Clinical staff, in particular', felt under pressure because of their knowledge of waiting lists and the number of patients whom they had to see. This made it difficult to engage with patients and thus give them advice. Management staff too were concerned with waiting lists and discussed at length strategies to decrease them. The smoking cessation coordinator often found it difficult to arrange to see staff because they did not have enough time to see her. A change in government policy at the time the study was being earned out resulted in an increase in the number of smoking cessation services in general practice and decreased the need for such services in hospital. Conclusion: In conclusion it was clear that patients felt that smoking advice was appropriate and acceptable in the hospital. Many patients wanted to stop smoking and most of these wanted help to do so. Staff were generally positive towards the provision of the smoking service and accepted that they had a health promoting role. However barriers, in particular at a structural level, were likely to prevent the service from meeting its objectives. Specifically, it is unlikely that the culture of this hospital will be changed so that smoking cessation services are routinely offered

Improving public health evaluation: a qualitative investigation of practitioners' needs.

BACKGROUND: In 2011, the House of Lords published a report on Behaviour Change, in which they report that "a lot more could, and should, be done to improve the evaluation of interventions." This study aimed to undertake a needs assessment of what kind of evaluation training and materials would be of most use to UK public health practitioners by conducting interviews with practitioners about everyday evaluation practice and needed guidance and materials. METHODS: Semi-structured interviews were conducted with 32 public health practitioners in two UK regions, Cambridgeshire and the South West. Participants included directors of public health, consultants in public health, health improvement advisors, public health intelligence, and public health research officers. A topic guide included questions designed to explore participants existing evaluation practice and their needs for further training and guidance. Data were analysed using thematic analyses. RESULTS: Practitioners highlighted the need for evaluation to defend the effectiveness of existing programs and protect funding provisions. However, practitioners often lacked training in evaluation, and felt unqualified to perform such a task. The majority of practitioners did not use, or were not aware of many existing evaluation guidance documents. They wanted quality-assured, practical guidance that relate to the real world settings in which they operate. Practitioners also mentioned the need for better links and support from academics in public health. CONCLUSION: Whilst numerous guidance documents supporting public health evaluation exist, these documents are currently underused by practitioners - either because they are not considered useful, or because practitioners are not aware of them. Integrating existing guides into a catalogue of guidance documents, and developing a new-quality assured, practical and useful document may support the evaluation of public health programs. This in turn has the potential to identify those programs that are effective; thus improving public health and reducing financial waste

Child trafficking in Scotland

First paragraph: The Scottish Government Trafficking and Exploitation Strategy (2017) identified the need for Scotland-wide research to explore experiences of child trafficking in Scotland. This study, commissioned by the Scottish Government, aimed to provide an overview of how many children and young people had been identified as victims of human trafficking, to establish their geographic and demographic routes into Scotland and their experiences of professional responses. The research employed case file analysis and interviews with young people and professionals to illuminate these issues. For the index time-period for the research, no UK nationals were identified for the case file analysis. Consequently, the focus of the research was on children and young people who came to the UK across international borders

Development of a Karplus-Type Relationship for Solid State Deuterium Nuclear Magnetic Resonance Spectroscopy.

This dissertation is the first application of a Karplus-type relationship to solid-state deuterium NMR spectroscopy. In particular zero-field high-resolution deuterium adiabatic demagnetization in the laboratory frame (ADLF) spectroscopy has been used to distinguish between two inequivalent deuterium positions in alpha substituted arylacetic acids. High resolution spectra with linewidths of 1-2 kHz were observed and have been used successfully to document the inequivalent positions both by single and double transition spectra. Further, small applied fields, inducing Zeeman splitting, have proven the deuterons observed to be from the transition frequencies of two different deuterons. Individual spectra are shown for all compounds included in this study. The quadrupole coupling constants, e\sp2q\sb{\rm zz}Q/h, were calculated from spectral data. Torsion angle data were calculated from single crystal X-ray analysis. The Karplus equation, a method of examining three bond J coupling in solution NMR spectroscopy has been adapted for use in solid-state zero-field deuterium NMR spectroscopy for the H-C-C-X torsion angle where X is an heavy atom: e\sp2q\sb{\rm zz}Q/h = A $-$ B cos($\theta$) $-$ C cos(2$\theta$) $-$ D sin(2$\phi$). The parameters, A, C, and D are derived from experimental data; B was obtained from molecular orbital calculations. The quadrupole coupling constants and torsion angles, \sp2H-C\sb{\rm alpha}-C\sb{\rm acid}-OH($\theta$) and C\sb{\rm ortho}-C\sb{\rm ring}-C\sb{\rm alpha}-C\sb{\rm acid}($\phi$), were calculated from experimental data. Two and three dimensional graphs have been generated. From the three dimensional graphs, the torsion angles for an arylacetic acid without a crystal structure have been predicted based upon the results of ADLF spectroscopy and the Karplus-type relationship

Patient and public attitudes to and awareness of clinical practice guidelines : a systematic review with thematic and narrative syntheses

Article Accepted Date: 15 July 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Acknowledgements The research leading to these results has received funding from the European Community’s Seventh Framework Programme (FP7/2007-2013) under grant agreement n° 258583 (DECIDE project). The Health Services Research Unit, Aberdeen University, is funded by the Chief Scientist Office of the Scottish Government Health Directorates. The authors accept full responsibility for this paper and the views expressed in it are those of the authors and do not necessarily reflect those of the Chief Scientist Office. NS receives funding through a Knowledge Translation Fellowship from the Canadian Institutes of Health Research. No funding bodies had a role in the manuscript. We would like to thank Healthcare Improvement Scotland and the University of Dundee for support, including access to literature. We would also like to thank Lorna Thompson (Healthcare Improvement Scotland), for her help with the protocol for this review.Peer reviewedPublisher PD

Child Trafficking in Scotland

First paragraph: The Scottish Government Trafficking and Exploitation Strategy (2017) identified the need for Scotland-wide research to explore experiences of child trafficking in Scotland. This study, commissioned by the Scottish Government, aimed to provide an overview of how many children and young people had been identified as victims of human trafficking, to establish their geographic and demographic routes into Scotland and their experiences of professional responses. The research employed case file analysis and interviews with young people and professionals to illuminate these issues. For the index time-period for the research, no UK nationals were identified for the case file analysis. Consequently, the focus of the research was on children and young people who came to the UK across international borders