Participant views on involvement in a trial of social recovery cognitive behaviour therapy

Background The PRODIGY trial (Prevention of long term social disability amongst young people with emerging psychological difficulties, ISRCTN47998710) is a pilot trial of social recovery cognitive behaviour therapy (SRCBT). Aims The PRODIGY qualitative substudy aimed to (a) explore individual experiences of participating in the pilot randomised, controlled trial (recruitment, randomisation, assessment) andinitial views of therapy, and (b) to explore perceived benefits of taking part in research v. ethical concerns and potential risks. Method Qualitative investigation using semi-structured interviews with thematic analysis. Results Analysis revealed participant experiences around the key themes of acceptability, disclosure, practicalities, altruism and engagement. Conclusions Participants in both trial arms perceived themselves as gaining benefits from being involved in the study, above and beyond the intervention. This has implications for the design of future research and services for this client group, highlighting the importance of being flexible and an individualised approach as key engagement tools

Improving Early Detection of Refugee-Related Stress Symptoms: Evaluation of an Inter-Professional and Inter-Cultural Skills Training Course in Sweden

Twenty-three of 26 participants, mainly women from six local agencies involved in the reception of refugees, completed a university course titled “Refugee-related stress and mental health—local cooperation”, which was spread over seven days in 2011. The course was based on evidence and clinical experience and was commissioned to serve as competency training by Stockholm County Council and Södertälje Municipality. It received funding from the Swedish National Board of Health and Welfare. It was a continuation of an earlier one-week full-time university course from 2010 with the same title. As a result of a new law relating to refugee reception, which led to organizational change, the participants requested a continuation of the original course. The learning objectives were met (5.4 on a 6-point scale; 1 = strongly disagree, 6 = strongly agree). The general assessment of the course as a whole by the participants was 5.7 (on a 6-point scale, 1 = very unsatisfied, 6 = very satisfied). The participants thought that their skills had increased, and their perception was that they had significantly better control of their work situation following completion of the course. The most important findings were that participants from different agencies at the local level: (1) perceived that they had developed the sense that there was a local inter-cultural and inter-professional inter-agency collaboration in the reception of newly arrived refugees and (2) will continue efforts to stabilize and develop this together. This method of teaching, in terms of skills training, is not a “quick fix.” It is a process, and it needs support from those in power in order to continue

Identity as a causal power : contextualising entrepreneurs' concerns

We propose a critical realist-informed conception of entrepreneurial identity – the personal power to create a new venture. Although most people have the power to become an entrepreneur, not everyone can, or is motivated to, realize that potential. Other countervailing powers – personal, material and social – can constrain, or discourage, action. Utilizing a stratified, emergent ontology, we contextualize entrepreneurial identity within three analytical orders – natural, practical and social. We distinguish personal identity, the set of concerns in the three orders that motivate action, from social identity, the roles we commit to in society. While entrepreneurial identity is a type of social identity, the underlying concerns that motivate commitment to an entrepreneurial role cannot be reduced to social interaction alone. The concept of internal conversation is used to theorize the connection of entrepreneurial motivation, context and behaviour. We draw on qualitative data from three UK-based disabled entrepreneurs to demonstrate the value of our framework

“That little doorway where I could suddenly start shouting out”: barriers and enablers to the disclosure of distressing voices

Hearing distressing voices is a key feature of psychosis. The time between voice onset and disclosure may be crucial as voices can grow in complexity. This study investigated barriers and enablers to early voice disclosure. Interviews with 20 voice hearers underwent Thematic Analysis. Beliefs about the effect of disclosure on self and others acted as a barrier and enabler to voices being discussed. Voice hearing awareness should be increased amongst young people, the public and care services. To support earlier disclosure measures need to increase skill amongst those likely to be disclosed to

Current reported outcome domains in studies of adults with a focus on the treatment of tinnitus: protocol for a systematic review

Introduction: In Europe alone, over 70 million people experience tinnitus. Despite its considerable socioeconomic relevance, progress in developing successful treatments has been limited. Clinical effectiveness is judged according to change in primary outcome measures, but because tinnitus is a subjective condition, the definition of outcomes is challenging and it remains unclear which distinct aspects of tinnitus (ie, ‘domains’) are most relevant for assessment. The development of a minimum outcome reporting standard would go a long way towards addressing these problems. In 2006, a consensus meeting recommended using 1 of 4 questionnaires for tinnitus severity as an outcome in clinical trials, in part because of availability in different language translations. Our initiative takes an approach motivated by clinimetrics, first by determining what to measure before seeking to determine how to measure it. Agreeing on the domains that contribute to tinnitus severity (ie, ‘what’) is the first step towards achieving a minimum outcome reporting standard for tinnitus that has been reached via a methodologically rigorous and transparent process. Methods and analysis: Deciding what should be the core set of outcomes requires a great deal of discussion and so lends itself well to international effort. This protocol lays out the first-step methodology in defining a Core Domain Set for clinical trials of tinnitus by establishing existing knowledge and practice with respect to which outcome domains have been measured and which instruments used in recent registered and published clinical trials. Ethics and dissemination: No ethical issues are foreseen. Findings will be reported at national and international ear, nose and throat (ENT) and audiology conferences and in a peer-reviewed journal, using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analysis) guidelines

Efficacy of Telephone Information and Advice on Welfare: the Need for Realist Evaluation

In the context of increased marketisation in welfare provision, formal information and advice (I&A) is widely assumed to enable users, as consumers, to make informed choices about services, support and care. There is emerging evidence that telephone I&A services represent important ways of providing such services. This article proposes a framework that identifies key areas of focus delineating the efficacy of I&A, which is then used in a comprehensive literature review to critique existing research on outcomes and/or impact of telephone I&A. Existing, predominately quantitative, research has critical weaknesses. There is a lack of adequate contextual focus, understanding agency, and how I&A is used in different contexts to influence causal processes. The article contends that the efficacy of I&A is not adequately reported and provides much needed theoretical clarity in key areas, including the desirability of further realist evaluation approaches

Improving the Nutritional Quality of Charitable Meals for Homeless and Vulnerable Adults: A Mixed Method Study of Two Meals Services in a Large English City

Inadequate nutrition may contribute to poor health in homeless and vulnerable adults. Charitable meals are critical to this group’s nutrition. The nutrient content of charitable meals at 2 organizations was assessed. Ethnography investigated organizational practice; semistructured interviews explored influences on meal provision. Meals were adequate for energy and the majority of nutrients but exceeded thresholds of saturated fat, salt, and sugars and lacked vitamin D and selenium in both organizations. Organizations were constrained by budget, equipment, food donations, volunteer capabilities, and time. Organizational values influenced meal provision; strategies to reduce fat, salt, and sugar content may be resisted because of an ethos of hospitality and overprovision

Relocation and Health Effects on the Elderly A Commented Research Review

This paper summarizes and comments on the research on the relationship between relocation and morbidity/mortality among the elderly. In the present state of research there are not sufficient grounds for the drawing of general conclusions. On the other hand there is good reason for assuming that relocation under certain circumstances and for certain groups does lead to ill-health and to an increase in mortality. There is a lack of studies devoted to systematic investigation of the influence of such conditions. Various designs and methods have been used, and this reduces comparability. There is also a lack of theoretically guided empirical investigations. Research on relocation among the elderly needs to include recognition of the importance of the meaning of home for the elderly, and of the concept of control