Maternal critical care: what can we learn from patient experience? A qualitative study.

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Partner Experiences of “Near-Miss” Events in Pregnancy and Childbirth in the UK : A Qualitative Study

Funding: This article presents independent research funded by the National Institute for Health Research (NIHR) under the “Beyond maternal death: Improving the quality of maternity care through national studies of ‘near-miss’ maternal morbidity” programme (Programme Grant RP-PG-0608-10038). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Acknowledgments The authors are grateful to all the women and men who contributed to the study, and the reviewers’ comments on the previous version of this article.Peer reviewedPublisher PD

Mapping men's anticipations and experiences in the reproductive realm: (in)fertility journeys.

This paper examines men's experiences of fertility/infertility against a backdrop of changing understandings of men's role in society and medical possibilities. It presents findings from two qualitative research projects on men's experiences of engagement with reproductive health services as they sought to become fathers and anticipate impending fatherhood. The findings from both projects provide insights into men's experiences of (in)fertility and their engagement with services set against cultural ideals of masculinity. Discussions of reproduction have historically focused most centrally upon women's bodies and maternal processes, leaving little space for consideration of men's experiences and perspectives. While women's experiences of infertility/fertility have been characterized in relation to productive or faulty biological processes, male infertility has been largely invisible and male fertility typically assumed. This context provides a difficult terrain for men in which to contemplate the potential of not being able to father a child. The findings discussed in this paper illuminate the ways in which men talk about and make sense of their reproductive journeys. In doing so, it challenges current understandings of masculinity and reproductive bodies and highlights the need to rethink how men are treated in reproductive spheres and how services to men are delivered

What can make things better for parents when babies need abdominal surgery in their first year of life? : A qualitative interview study in the UK

This study was funded through a National Institute for Health Research (NIHR) Professorship award to Marian Knight (NIHR-RP-011-032). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and by the National Institute for Health Research Biomedical Research Centre, Oxford, grant BRC-1215-20008 to the Oxford University Hospitals NHS Foundation Trust and the University of Oxford.Peer reviewedPublisher PD

Clinical encounters about obesity: Systematic review of patients' perspectives.

Guidelines recommend clinicians intervene on obesity but it is unclear how people with overweight react. In this systematic review, we searched 20 online databases for qualitative studies interviewing people with overweight or obesity who had consulted a primary care clinician. Framework synthesis was used to analyse 21 studies to produce a new theoretical understanding. Consultations in which patients discussed their weight were more infrequent than patients would have liked, which some perceived was because they were unworthy of medical time; others that it indicated doctors feel being overweight is not a serious risk. Patients reported that doctors offered banal advice assuming that the patient ate unhealthily or was not trying to address their weight. Patients reported doctors assumed that their symptoms were due to overweight without a proper history or examination, creating concern that serious illness may be missed. Patients responded positively to offers of support for weight loss and active monitoring of weight. Patients with overweight internalize weight stigma sensitizing them to clues that clinicians are judging them negatively, even if weight is not discussed. Patients' negative experiences in consultations relate to perceived snap judgements and flippant advice and negative experiences appear more salient than positive ones

Patient preferences for management of high blood pressure in the UK:A discrete choice experiment

Background: With a variety of potentially effective hypertension management options, it is important to determine how patients value different models of care, and the relative importance of factors in their decision-making process. Aim: To explore patient preferences for the management of hypertension in the UK. Design and setting: Online survey of patients who have hypertension in the UK including an unlabelled discrete choice experiment (DCE). Method: A DCE was developed to assess patient preferences for the management of hypertension based on four attributes: model of care, frequency of blood pressure (BP) measurement, reduction in 5-year cardiovascular risk, and costs to the NHS. A mixed logit model was used to estimate preferences, willingness-to-pay was modelled, and a scenario analysis was conducted to evaluate the impact of changes in attribute levels on the uptake of different models of care. Results: One hundred and sixty-seven participants completed the DCE (aged 61.4 years, 45.0% female, 82.0% >5 years since diagnosis). All four attributes were significant in choice (P<0.05). Reduction in 5-year cardiovascular risk was the main driver of patient preference as evidenced in the scenario and willingness-to-pay analyses. GP management was significantly preferred over self-management. Patients preferred scenarios with more frequent BP measurement, and lower costs to the NHS. Conclusion: Participants had similar preferences for GP management, pharmacist management, and telehealth, but a negative preference for self-management. When introducing new models of care for hypertension to patients, discussion of the potential benefits in terms of risk reduction should be prioritised to maximise uptake

Monitoring sound levels in the intensive care unit: A mixed-methods system development project to optimize design features for a new electronic interface in the healthcare environment.

BACKGROUND: Intensive care units (ICU) are busy round the clock and it is difficult to maintain low sound levels that support patient rest. To help ICU staff manage activities we developed a visual display that monitors and reports sound levels in real-time. This facilitates immediate feedback, encouraging proactive behavior change to limit disturbances. METHODS: Following the principles of user-centered design practices we created our 'user persona' to understand the needs and goals of potential users of the system. We then conducted iterative user testing with current members of the ICU team, primarily using the 'think aloud' method to refine the design and functionality of our novel system. Ethnography evaluated team use of the display. RESULTS: The final design was simple, clear, and efficient, and both functional and aesthetically pleasing for the key user demographic. We identified challenges in the implementation and adoption process that were separate from the 'usability' of the system itself. CONCLUSIONS: Embedding the design process within the core user demographic ensured the final product delivered relevant information for key users, and that this information was intuitive to interpret. Initiating sustainable change is not straightforward. It requires recognition of cultural practices within teams, departments, professions, organizations, and strategies to maximize engagement

Using patient narratives to design an intervention to reduce noise in the Intensive Care Unit

Patient narratives can be used to guide improvements in health care. The authors found that including patients and staff on the design team keeps the focus meaningful and ensures that interventions are acceptable and deliverable