A qualitative exploration of barriers and facilitatorsto adherence to an online self-help intervention for cancer-related distress

This author accepted manuscript is made available following 12 month embargo from date of publication (March 2017) in accordance with the publisher’s copyright policyObjective This study qualitatively explored barriers and facilitators of adherence to an online psychological intervention for cancer-related distress. Methods Semi-structured interviews were conducted with 13 adults with cancer, randomised to receive either a 6-week intervention (n = 8) or attention control (n = 5) as part of a larger RCT. Transcripts were coded for themes and subthemes, and recruitment ceased when saturation of themes occurred. Results Adherence overall was high: six participants completed all six modules, three completed five modules, two completed four modules, one completed one module, and one did not access the program. The total numbers of barriers (n = 19) and facilitators (n = 17) identified were equivalent and were categorised into five overarching themes: illness factors, psychological factors, personal factors, intervention factors and computer factors. However, the prevalence with which themes were discussed differed: illness factors (specifically cancer treatment side effects) were the main reported barrier to adherence; intervention factors (email reminders, program satisfaction, ease of use, program content) were the most common facilitators. Conclusion While some factors were cited as both facilitating and barring adherence, and therefore reflective of personal preferences and circumstances, a number of recommendations were derived regarding (i) the best timing for online interventions and (ii) the need for multi-platform programs

Understanding the information needs of perinatal women: the role of technology support tools for new mothers

Information seeking during the perinatal period (the period spanning pregnancy to twelve months post giving birth) comprises of several methods women use to meet information needs and gain support through pregnancy and early motherhood. Perinatal women have been shown to rely on healthcare professionals such as midwives and technology-based platforms to provide information relating to maternal and infant health. However, women have described ‘gaps in care’ which occur during early pregnancy (first trimester), prior to labour and the postnatal period. Postnatal mothers have a need for additional support and information after giving birth as new mothers experience less contact with healthcare professionals and access to referral services is limited in the UK. Less is known about the postnatal ‘gap in care’, how digital information sources tailor towards this period and how maternity services are providing postnatal care to new mothers. This thesis set out to examine further i) the changing information needs of perinatal women, ii) the role of healthcare professionals in providing information and support to new mothers, and iii) how technology sources are utilised during the perinatal period. Three research questions were investigated through a mixed-methods approach across five studies. Qualitative findings identified a ‘timeline of information needs’ during pregnancy and motherhood, particularly focusing on the gaps in care experienced and the need for information often acquired through technology-based platforms. Mobile health apps for pregnancy have been shown to be beneficial for perinatal women seeking information and they increase wellbeing and encouraging self-reflection. Mobile apps specific to motherhood are seldom seen, however. A final quantitative study examined predictors of a journal-based concept app tailored towards new mothers based on an extended Technology Acceptance Model and found ‘perceived usefulness’ to be the most important predictor of intention to use. Findings from this thesis have provided a deeper understanding of the information work of new mothers and shown how the implementation of technology-based support tools to maternity services for new mothers has the potential to encourage self-reflection increase communication with healthcare professionals and improve the mental health and wellbeing of new mothers

Influence of agents and mechanisms of injury on anatomical burn locations in children <5 years old with a scald

Objective To demonstrate how the mechanism and agent of injury can influence the anatomical location of a scald. Design Prospective multicentre cross-sectional study. Setting 20 hospital sites across England and Wales including emergency departments, minor injury units and regional burns units. Patients Children aged 5 years and younger who attended hospital with a scald. Main outcome measures Primary outcome: a descriptive analysis of the mechanism, agent and anatomical location of accidental scalds. Secondary outcome: a comparison of these factors between children with and without child protection (CP) referral. Results Of 1041 cases of accidental scalds, the most common narrative leading to this injury was a cup or mug of hot beverage being pulled down and scalding the head or trunk (132/1041; 32.9% of cases). Accidental scalds in baths/showers were rare (1.4% of cases). Accidental immersion injuries were mainly distributed on hands and feet (76.7%). There were differences in the presentation between children with accidental scalds and the 103 who were referred for CP assessment; children with scalds caused by hot water in baths/showers were more likely to get referred for CP assessment (p<0.0001), as were those with symmetrically distributed (p<0.0001) and unwitnessed (p=0.007) scalds. Conclusions An understanding of the distributions of scalds and its relationship to different mechanisms of injury and causative agents will help clinicians assess scalds in young children, particularly those new to the emergency department who may be unfamiliar with expected scald patterns or with the importance of using appropriate terminology when describing scalds

Agents, mechanisms and clinical features of non-scald burns in children: a prospective UK study

ABSTRACT Aims: To inform childhood burn prevention by identifying demographics, clinical features and circumstances of unintentional non-scald burns. Methods: A prospective cross-sectional study was conducted across Cardiff, Bristol and Manchester, including six emergency departments, three minor injury units and one burns unit between 13/01/2013-01/10/2015. Data collected for children aged <16 years with any burn (scald, contact, flame, radiation, chemical, electrical, friction) included: demographics, circumstances of injury and clinical features. Scalds and burns due to maltreatment were excluded from current analysis. Results: Of 564 non-scald cases, 60.8% were male, 51.1% were 0.6meters and 76.5% affected the hands. Hairstyling devices were the most common agent of contact burns (20.5%), 34.1% of hairstyling devices were on the floor. 63.7% of children aged 10-15 years sustained contact burns of which 23.2% were preparing food, and in burns from hairstyling devices, 73.3% were using them at the time of injury. Conclusions: Parents of toddlers must learn safe storage of hazardous items. Older children should be taught skills in safe cooking and hairstyling device use

Exploring the acceptability of a clinical decision rule to identify paediatric burns due to child abuse or neglect

Objective An evidence based clinical decision rule (CDR) was developed from a systematic review and epidemiological study to identify burns due to child maltreatment (abuse or neglect). Prior to an implementation evaluation, we aim to explore clinicians' views of the CDR, the likelihood that it would influence their management and factors regarding its acceptability. Methods A semistructured questionnaire exploring demographics, views of the CDR and data collection pro forma, ability to recognise maltreatment and likelihood of following CDR recommended child protection (CP) action, was administered to 55 doctors and nurses in eight emergency departments and two burns units. Recognition of maltreatment was assessed via four fictitious case vignettes. Analysis Fisher's exact test and variability measured by coefficient of unalikeability. Results The majority of participants found the CDR and data collection pro forma useful (45/55, 81.8%). Only five clinicians said that they would not take the action recommended by the CDR (5/54, 9.3%). Lower grade doctors were more likely to follow the CDR recommendations (p=0.04) than any other grade, while senior doctors would consider it within their decision making. Factors influencing uptake include: brief training, background to CDR development and details of appropriate actions. Conclusions It is apparent that clinicians are willing to use a CDR to assist in identifying burns due to child maltreatment. However, it is clear that an implementation evaluation must encompass the influential variables identified to maximise uptake

Growth and soil carbon dynamics of short rotation coppice species (Willow and Poplar) under variable nutrient and water availability

Short rotation coppice (SRC) bioenergy crops are an attractive option to reduce anthropogenic greenhouse gas (GHG) emissions from primary energy production and agriculture. Fast-growing, high-yield SRC crops sequester large amounts of carbon in biomass, require minimum input, and can be grown on marginal land. However, we do not know how the carbon dynamics of SRC crops will be affected by future climate changes. Given that crops grown on marginal land often require nutrient additions and are subject to large fluctuations in soil moisture, I assessed the potential for inoculation with arbuscular mycorrhizal fungi (AMF) and fertilization to mitigate or exacerbate the effects of extreme weather events (drought and flood) on the growth, biomass, and soil GHG emissions of two SRC crop species (willow and poplar). I hypothesised that fertilization and AMF inoculation would mitigate the effects of extreme weather events on crop growth and biomass, but that nutrient addition would increase soil GHG emissions after drought and during flooding. My mesocosm experiments demonstrated that biomass increased by 26% with AMF inoculation and by 56% with nitrogen (N) addition. However, AMF inoculation stabilised soil CO2 emissions during a drought-rewetting event, whereas N-addition resulted in higher soil CO2 emissions during rewetting and after the drought. Furthermore, N-addition boosted soil CO2 and methane (CH4) emissions during flooding. Importantly, soil CO2 or CH4 emissions during flooding were higher in N-fertilized trees with a history of drought, and drought resulted in lower leaf biomass at the start of the subsequent growing season. The body of work presented in this thesis provides strong evidence that fertilization of SRC crops could increase soil GHG emissions during extreme weather events, and highlights promising new avenues for investigation into AMF inoculation as a potential alternative to boost SRC crop yield and resilience to drought