Assessing partnership working: Evidence from the National Sexual Health Demonstration Project

Partnership working has become something of a government imperative for tackling complex public health issues and is now more often the norm than the exception in health education and disease prevention work. The literature however, highlights that partnership working may be explained more by rhetorical appeal rather than any concrete evidence of effectiveness. There is little evidence from the literature examining the functioning, effectiveness or outcomes of partnership for health improvement. Partnership working was used within one such public health initiative (Healthy Respect) as a means of implementing and delivering a complex sexual health intervention programme to young people aged 10-18 years in Lothian. The main aim of Healthy Respect was to create an environment that would lead to long term improvements in the sexual health and wellbeing of young people through a multi-faceted approach which linked to education, information and services. This PhD study aimed to assess the extent and impact of partnership working in the Healthy Respect project; it aimed to examine the process and outcomes of partnership working for the organisations involved in the programme and to theoretically assess how this may impact on improving young people’s sexual health and wellbeing. The study used Healthy Respect’s logic model as a framework to examine the theory of how change occurred through partnership working in the project. A mixed method research design was used consisting of two postal surveys and in depth interviews with a sample of providers delivering sexual health education, information and services to young people in Lothian.Results suggest that Healthy Respect was only partially successful in working in partnership with some of the organisations involved in delivering sexual health education, information and services to young people. Partnerships were formed with approximately half of the providers. Those most engaged and working in partnership with Healthy Respect were from the NHS (including school nurses) and voluntary organisations which offered sexual health services to young people. Sexual health services also occupied a dominant position in the local networks of providers. Many providers linked with these services including secondary schools which offered Sexual Health and Relationship Education (SHARE). Other organisations most notably those from the Local Authority organisations were less willing to work in partnership with Healthy Respect. Many of the barriers (identified through the qualitative interviews with providers) to working in partnership with Healthy Respect came mostly from the Local Authority organisations and offered an explanation as to why partnerships with these organisations didn’t develop as planned. Results did suggest that where partnership work was taking place, this impacted on an organisations ability to deliver sexual health information, education and services to young people. However, partnerships with Healthy Respect were only formed with approximately 46% of the providers targeted, therefore not all organisations and subsequently young people would have benefitted from the Healthy Respect programme. The Healthy Respect programme was heavily reliant on partnership working to deliver the complex intervention. Yet results suggest that they were only partially effective in working in partnership with the organisations involved which may have led to them having little impact on the sexual health and wellbeing of young people (especially the most vulnerable). Partnerships take a long time to build and require a great deal of time and resources to be invested in them to work. However, the results of the study leave us with the fundamental question of whether all this time and effort should be applied to partnership working and interventions of this type for what could be very little impact on young people’s sexual health? This study has contributed to knowledge in the area of partnership working for health improvement. It defined what partnership was using a range of methods which moved beyond supportive attitudes and was able to examine and measure both the process and outcomes of partnership work in this project, something which few studies have been able to achieve

Adolescents in Scotland: Challenges and Opportunities for Sexual Risk Reduction

Sexually transmitted infections, HIV, and unplanned pregnancy challenge the health of Scottish teens. We conducted focus groups with teens (ages 16-19 years) recruited from an urban youth cafe in Edinburgh and assessed sexual risk-taking and protective behaviors. A trained facilitator, using a semi-structured interview guide, led the groups. We taped and transcribed data verbatim for coding and theming. The teens revealed similar concerns despite differences in gender and/or sexual histories. Despite school-based sex education, sex was rarely discussed with peers or adults outside classrooms; the ability to practice communication and negotiation skills was minimal. Much risky behavior occurred in public spaces and was often linked to drug or alcohol intake. There was a glaring lack of teen planning for, or contemplating, future adult lives. Findings highlight the challenges these teens faced in practicing safer sex and limited opportunities to tailor intervention strategies to address the cultural realities of their lives

Development of a cross-cultural HPV community engagement model within Scotland

Objective To examine cultural barriers and participant solutions regarding acceptance and uptake of the Human Papillomavirus (HPV) vaccine from the perspective of Black African, White-Caribbean, Arab, Indian, Bangladeshi and Pakistani young people.Methods Forty young people from minority ethnic communities in Scotland took part in a qualitative study, involving seven focus groups and four paired interviews, to explore their views and experiences of the HPV vaccine. Using critical discursive psychology, the analysis focussed on young people’s accounts of the barriers and enablers to information, access and uptake of the HPV vaccination programme.Results Participants suggested innovative strategies to tackle intergenerational concerns, information design and accessibility, and public health communications across diverse contexts. A cross-cultural community engagement model was developed, embracing diversity and contradiction across different ethnic groups. This included four inter-related strategies: providing targeted and flexible information for young people; vaccine provision across the life-course; intergenerational information and; specific cross-cultural communications.Conclusion This is the first HPV cross-cultural model inductively derived from accounts of young people from different ethnic communities. We recommend public health practitioners and policymakers consider utilising the processes and strategies illustrated within this model in order to increase dialogue around public engagement, awareness and receptivity towards the HPV vaccination

Assessing partnership working : evidence from the National Sexual Health Demonstration Project

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

General practice nurses' experiences of participation in an advanced nursing practice education programme

In the UK, transformation of the nursing workforce, including development of the role of the advanced nurse practitioner within general practice, is essential to meet healthcare demands. This article presents the results of a small, qualitative study conducted among students at one university in Scotland, describing their experiences of participation in advanced practice education. Data were collected through semi-structured interviews to generate in-depth descriptions and to identify the facilitators and barriers to learning. The study identified that a shared responsibility for patient care creates opportunities for learning. The facilitators to learning were identified as foundation level education in history taking and clinical examination, finance, having a supportive network and mentorship. Barriers included pressure of work and a lack of clarity about roles and training needs. Given the key role that these nurses will have in future healthcare models, there is a requirement for a national education standard. It is recommended that the Nursing and Midwifery Council leads on defining advanced nurse practitioner in general practice programme learning outcomes. The overall aim of such courses is to enhance the experience for future nurses to encourage recruitment and transform the nursing workforce

Exploring the experiences of patients attending day hospitals in the rural Scotland: capturing the patient's voice

Aims and objectivesTo understand the meaning of person-centred compassionate care for people attending day hospitals in rural Scotland.BackgroundIncreasing numbers of older people are living with chronic conditions and require support to live at home. Intermediate care services such as day hospitals can enable this. Much previous research about day hospitals focused on organisational aspects of care. This study set out to capture the voice of the patient using this service.DesignA descriptive qualitative study.MethodsIndividual interviews were undertaken in participant's homes using emotional touchpoints as prompts to help patients discuss their experience of care within a day hospital (n = 15). Data were analysed using thematic analysis.ResultsFour main themes were identified from the data: Relationships, Feeling Valued, Expectations and Perceived Benefits. The findings showed that relationships with staff and other patients were important. The patients also wanted to feel valued, and helping others was part of this. The patients had clear expectations of the service but had an acute awareness of the benefits of attending the day hospital such as coordination of their care. Overall, the patients were highly satisfied, felt that care was person-centred and recognised the advantages of remaining close to home.ConclusionsAt a time when enabling health and social care integration is a priority, this study provides insight into the patient perspective of intermediate care. The findings reveal what matters to patients cared for in the community and how this service can respond to this

Understanding complex interactions using social network analysis

Aims and objectives. The aim of this paper is to raise the awareness of social network analysis as a method to facilitate research in nursing research.Background. The application of social network analysis in assessing network properties has allowed greater insight to be gained in many areas including sociology, politics, business organisation and health care. However, the use of social networks in nursing has not received sufficient attention.Design. Review of literature and illustration of the application of the method of social network analysis using researchexamples.Methods. First, the value of social networks will be discussed. Then by using illustrative examples, the value of social network analysis to nursing will be demonstrated.Results. The method of social network analysis is found to give greater insights into social situations involving interactionsbetween individuals and has particular application to the study of interactions between nurses and between nurses and patients and other actors.Conclusion. Social networks are systems in which people interact. Two quantitative techniques help our understanding of these networks. The first is visualisation of the network. The second is centrality. Individuals with high centrality are key communicators in a network. Relevance to clinical practice. Applying social network analysis to nursing provides a simple method that helps gain an understanding of human interaction and how this might influence various health outcomes. It allows influential individuals (actors) to be identified. Their influence on the formation of social norms and communication can determine the extent to whichnew interventions or ways of thinking are accepted by a group. Thus, working with key individuals in a network could be critical to the success and sustainability of an intervention. Social network analysis can also help to assess the effectiveness of such interventions for the recipient and the service provider.

The limits, challenges and opportunities of safeguarding children in the context of primary care

The sexual health of young people is a concern for policy makers and practitioners alike in Scotland. Some young people are particularly vulnerable to the adverse consequences of early sexual behaviour and as such are widely recognized to be one of the most important groups for reproductive health interventions (Cowen 2002). In 2005, there were seven births for every 1000 women under 16 years (ISO Scotland Publications 2007) while in 2003, 25 per cent of young Scottish women aged under 20 years reported having had a pregnancy terminated (Scottish Executive 2006a). Moreover, abortion rates in all teenage age groups are rising. especially in the under 16s (ISO Scotland Publications 2007). Approximately one in seven attendances to Genito-urinary Medicine Clinics (GUM) are by young people aged under 20 years and between 2002 and 2003 there was a 40 per cent increase in Chlamydia diagnoses in females under 15 years (Scottish Executive 2006a). Over the last two decades, the sexual health ofyoung people has seen virtually no improvements (ISO Scotland Publications 2007; Viner and Barker 2005), although the availability of information, education and services is improving throughout Scotland and there is no sign of further worsening ofthe situation (Scottish Executive 2006a)