Cancer diagnosis, treatment and care: A qualitative study of the experiences and health service use of Roma, Gypsies and Travellers

BackgroundEarly diagnosis and treatment are key to reducing deaths from cancer, but people from Black and Minority Ethnic (BME) groups are more likely to encounter delays in entering the cancer care system. Roma, Gypsies and Travellers are ethnic minorities who experience extreme health inequalities.ObjectiveTo explore the experiences of cancer diagnosis, treatment and care among people who self-identify as Roma or Gypsies and Travellers.MethodsA participatory qualitative approach was taken. Peer researchers conducted semi-structured interviews (n = 37) and one focus group (n = 4) with community members in Wales and England, UK.ResultsCancer fatalism is declining, but Roma, Gypsies and Travellers experience barriers to cancer healthcare at service user, service provider and organisational levels. Communication was problematic for all groups, and Roma participants reported lack of access to interpreters within primary care. Clear communication and trusting relationships with health professionals are highly valued and most frequently found in tertiary care.ConclusionThis study suggests that Roma, Gypsies and Travellers are motivated to access health care for cancer diagnosis and treatment, but barriers experienced in primary care can prevent or delay access to diagnostic and treatment services. Organisational changes, plus increased cultural competence among health professionals, have the potential to reduce inequalities in early detection of cancer

Teaching with Quantitative Data in the Social Sciences at the University of New Hampshire: An Ithaka S+R Local Report

This exploratory study investigated the teaching practices of social science instructors at the University of New Hampshire who engage with undergraduate students using quantitative data in the classroom. The participants interviewed teach both general and discipline-specific data concepts as academic, work, and life skills. Primary challenges discussed by the participants that students face in engaging with these topics are understanding math and statistical concepts, learning new software and computing skills, limited prior exposure to data, and lack of retention of content from earlier courses. Participants addressed challenges in several ways in order to lower barriers to learning, including finding, vetting, and cleaning data for their students to use. Participants could use additional support and new strategies to alleviate student challenges; specific recommendations are discussed in the report. This study is connected to a suite of parallel studies being developed locally at other higher education institutions and coordinated by Ithaka S+R

Teaching Quantitative Data in the Social Sciences at the University of New Hampshire: Data Management Plan

This data management plan describes data management for the study Teaching quantitative data in the social sciences at the University of New Hampshire. This research study examines social science instructors’ practices in teaching undergraduate students to work with quantitative data. The goal of the study is to understand approaches and challenges associated with teaching data and delineate resources and services needed to support this work. The study at the University of New Hampshire (UNH) is connected to a suite of parallel studies being developed locally at twenty-three other higher education institutions. Ithaka S+R has been hired to coordinate this parallel effort and will compile the findings from the research at UNH with findings from the other institutions to produce an aggregated report

Prudent healthcare in emergency departments: a case study in Wales

AbstractTo deliver a patient-centred service Emergency Departments must be efficient, effective and meet the needs of the local population. Following the principles of prudent healthcare, a service redesign of unscheduled care was carried out at Prince Phillip Hospital, Llanelli to improve the patient experience. Extending the roles of specialist nurse practitioners was a major component of this redesign. Six working groups were established to guide the process, including one group with a responsibility for working cooperatively with the local community, who had concerns about perceived ‘downgrading’ of the Emergency Department. The service redesign was completed in 2016 and evaluation has shown that the target for patients being seen within four hours improved from 88% to 96%, significantly more acute medical admission patients were discharged in less than 24 hours and patient satisfaction increased overall

Understanding preventive community health services for pre-school children : origins, policy and current practice

Community health services for pre-school children have been the major universal health provision for well-children for over a hundred years. Traditionally these services have been largely delivered by health visitors, who are now community nurses with a specialist post-graduate qualification. Preventive health services for children in the UK have been increasingly criticised as insufficiently evidence-based. Criticism has led to reform of national policy and subsequent major changes to existing services, particularly in targeting services to those with the highest health and social needs. The effect of these policy changes upon the service provided for pre-school children by health visitors is not known. This thesis explores the origins and development of children’s preventive health services and examines the effect of post-1989 policy changes in practice, in particular the move to a predominately targeted child health promotion programme. The empirical study used a mixed methods approach to investigate changes to local policy and practice. A national survey was made of health visitors’ child health promotion practice (n=1043) which was followed by an in-depth interview study (n=25) of health visitors’ views on service changes. Study findings illuminate the effect of post-1989 reforms on child health services, showing a diversity of practice across the country, and resistance to key aspects of policy and practice among health visitors. Despite a revised national child health promotion programme being published in April 2008, which addresses some of the areas of concern highlighted by this study, flaws remain which have implications for the successful implementation of this programme. These flaws reflect wider contentious issues in NHS policy-making, related to the distribution of power and resources between different professional groups within the NHS and service users. Failing to explore these issues in policy and practice reduces the ability of preventive health services to maintain and improve pre-school children’s health.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

‘Differences between the earth and the sky’: Migrant parents’ experiences of child health services for pre-school children in the UK

AIM: To explore parents' experiences of using child health services for their pre-school children post-migration. BACKGROUND: Migrating between countries necessitates movement and adjustment between systems of healthcare. Children of migrants are known to have poorer health than local children on some measures and are less likely to access primary care. In the United Kingdom (UK), children are offered a preventive Healthy Child programme in addition to reactive services; this programme consists of health reviews and immunisations with some contacts delivered in the home by public health nurses. METHODS: Five focus groups were held in a city in South West England. Participants were parents of pre-school children (n = 28) who had migrated to the UK from Romania, Poland, Pakistan or Somalia within the last 10 years. Groups selected included both 'new migrants' (from countries which acceded to the European Union in the 2000s) and those from communities long-established in the UK (Somali and Pakistani). One focus group consisted of parents of Roma ethnicity. Interpreters co-facilitated focus groups. FINDINGS: Participants described profound differences between child health services in the UK and in their country of origin, with the extent of difference varying according to nationality and ethnic group. All appreciated services free at the point of delivery and an equitable service offered to all children. Primary care services such as treatment of minor illness and immunisation were familiar, but most parents expected doctors rather than nurses to deliver these. Proactive child health promotion was unfamiliar, and some perceived this service as intruding on parental autonomy. Migrants are not a homogenous group, but there are commonalities in migrant parents' experiences of UK child health services. When adjusting to a new healthcare system, migrants negotiate differences in service provision and also a changing relationship between family and state