Facilitating family engagement in older people's home-based reablement: A realist inquiry

An ageing population brings pressures and opportunities. Since 2010, the UK Government has invested substantially in reablement, to release pressure in health and social care services and to promote wellbeing. When a deterioration in an individual’s health results in increased difficulty with everyday activities, reablement offers them short-term help to start doing things for themselves again. Current policy and guidelines for reablement emphasise a person-centred approach to delivery, making no differentiation between a service user with family and one with none. This exposes gaps in knowledge about family engagement in reablement.AimThe aim of this thesis is to build theory-led explanations about what works and does not, when engaging families in their relative’s home-based reablement.MethodsRealist methods were used to develop and refine theories. Preliminary consultation with stakeholders led into a review and synthesis of existing literature. This resulted in initial theories that were then refined through fieldwork (within a Local Authority reablement service in England). Data were collected through interviews and a focus group with study participants. A group of members of the public contributed their expertise as family carers. Data were analysed using a realist approach to identify what contexts are relevant to engaging families in reablement, how different people might respond to resources aimed at engaging them, and how, as a result, outcomes might be affected.FindingsThe findings explore four areas: instilling an understanding of reablement, the additional skills and support required by the workforce to engage families, customising service delivery to family circumstances, and empowering families to use a reabling approach themselves. They identify and link mechanisms associated with applying a reabling approach to different family contexts. They show how, for example, families can be encouraged to adopt the core mechanism of standing back with empathy in different circumstances. Considering reablement as a mindset that needs to be instilled actively in service users and their families during service delivery, the findings show that if this mindset is only introduced in a superficial way, there is a risk that families will revert to doing things for their relative, rather than helping them to maximise their capabilities in the longer term.ImplicationsThis research provides new insights into how reablement can either be enhanced or threatened by family members. It identifies considerations to take into account in future development of guidelines, policy and practice to optimise and sustain the benefits of reablement beyond its immediate delivery. It contributes to the field by reframing reablement as a relationship-centred service and mindset so as to empower families to enhance its success

Empowering future care workforces: Scoping Capabilities to Leverage Assistive Robotics through Co-Design

Project aims: Understand how health and social care professionals can benefit from using assistive robotics on their own terms. Specify capabilities that matter to professionals, service users /carers. Scope a framework for co-designing assistive robotics that forefronts health and social care professionals and service users

'Shooting in the dark': implications of the research-practice gap for enhancing research use in adult social care

Background: Despite calls for greater use of research and an appetite to do so within adult social care, a gap persists between research and practice. Aims and objectives: To explore views of adult social care staff about research and its application to everyday practice. To understand how these might impact upon research use capacity-building initiatives within adult social care organisations. Methods: Thematic analysis of semi-structured qualitative interviews with 25 staff members working within the adult social care departments of three English local authorities. Findings: Participants characterised research as feeling separate from practice. They reflected on their use of it in relation to pressures affecting adult social care and identified a lack of relevant research. Research benefiting service users, supporting individual practice or informing organisational decision-making was considered useful. However, research could also be viewed as a luxury where its findings were felt to represent an ‘ideal’ rather than real world of practice or did not accord with practice knowledge or local experience. Discussion and conclusions: While participants feel positively towards research, there remains a gap between these perceptions and its use in practice. There remains a need to improve research relevance and accessibility and to clarify its role in decision-making in social care, including where there is no evidence, where evidence challenges existing practice, or where the evidence base is growing. Collaborative partnerships between adult social care organisations, researchers and service users could help to narrow the research–practice gap and support the routine translation of research to practice

Schoolgirls’ experience and appraisal of menstrual absorbents in rural Uganda: a cross-sectional evaluation of reusable sanitary pads

BACKGROUND: Governments, multinational organisations, and charities have commenced the distribution of sanitary products to address current deficits in girls’ menstrual management. The few effectiveness studies conducted have focused on health and education outcomes but have failed to provide quantitative assessment of girls’ preferences, experiences of absorbents, and comfort. Objectives of the study were, first, to quantitatively describe girls’ experiences with, and ratings of reliability and acceptability of different menstrual absorbents. Second, to compare ratings of freely-provided reusable pads (AFRIpads) to other existing methods of menstrual management. Finally, to assess differences in self-reported freedom of activity during menses according to menstrual absorbent. // METHODS: Cross-sectional, secondary analysis of data from the final survey of a controlled trial of reusable sanitary padand puberty education provision was undertaken. Participants were 205 menstruating schoolgirls from eight schools in rural Uganda. 72 girls who reported using the intervention-provided reusable pads were compared to those using existing improvised methods (predominately new or old cloth). // RESULTS: Schoolgirls using reusable pads provided significantly higher ratings of perceived absorbent reliability across activities, less difficulties changing absorbents, and less disgust with cleaning absorbents. There were no significant differences in reports of outside garment soiling (OR 1.00 95%CI 0.51–1.99), or odour (0.84 95%CI 0.40–1.74) during the last menstrual period. When girls were asked if menstruation caused them to miss daily activities there were no differences between those using reusable pads and those using other existing methods. However, when asked about activities avoided during menstruation, those using reusable pads participated less in physical sports, working in the field, fetching water, and cooking. // CONCLUSIONS: Reusable pads were rated favourably. This translated into some benefits for self-reported involvement in daily activities, although reports of actual soiling and missing activities due to menstruation did not differ. More research is needed comparing the impact of menstrual absorbents on girls’ daily activities, and validating outcome measures for menstrual management research

‘Shooting in the dark’: Implications of the research–practice gap for enhancing research use in adult social care

Background: Despite calls for greater use of research and an appetite to do so within adult social care, a gap persists between research and practice. Aims and objectives: To explore views of adult social care staff about research and its application to everyday practice. To understand how these might impact upon research use capacity-building initiatives within adult social care organisations. Methods: Thematic analysis of semi-structured qualitative interviews with 25 staff members working within the adult social care departments of three English local authorities. Findings: Participants characterised research as feeling separate from practice. They reflected on their use of it in relation to pressures affecting adult social care and identified a lack of relevant research. Research benefiting service users, supporting individual practice or informing organisational decision-making was considered useful. However, research could also be viewed as a luxury where its findings were felt to represent an ‘ideal’ rather than real world of practice or did not accord with practice knowledge or local experience. Discussion and conclusions: While participants feel positively towards research, there remains a gap between these perceptions and its use in practice. There remains a need to improve research relevance and accessibility and to clarify its role in decision-making in social care, including where there is no evidence, where evidence challenges existing practice, or where the evidence base is growing. Collaborative partnerships between adult social care organisations, researchers and service users could help to narrow the research–practice gap and support the routine translation of research to practice

Menstruation and the cycle of poverty: a cluster quasi-randomised control trial of sanitary pad and puberty education provision in Uganda

BACKGROUND: Poor menstrual knowledge and access to sanitary products have been proposed as barriers to menstrual health and school attendance. In response, interventions targeting these needs have seen increasing implementation in public and private sectors. However, there has been limited assessment of their effectiveness. // OBJECTIVES: Assess the impact of providing reusable sanitary pads and puberty education on girls’ school attendance and psychosocial wellbeing outcomes. // METHODS: A cluster quasi-randomised controlled trial was conducted across 8 schools, including 1124 girls, in rural Uganda. Schools were allocated to one of four conditions: the provision of puberty education alone; reusable sanitary pads alone; puberty education and reusable sanitary pads; and a control (no intervention). The primary outcome was school attendance. Secondary outcomes reflected psychosocial wellbeing. // RESULTS: At follow-up, school attendance had worsened for girls across all conditions. Per-protocol analysis revealed that this decline was significantly greater for those in the control condition d = 0.52 (95%CI 0.26–0.77), with those in control schools having a 17.1% (95%CI: 8.7–25.5) greater drop in attendance than those in any intervention school. There were no differences between the intervention conditions. High rates of school drop-out and transfer meant the trial suffered from substantial participant drop-out. Intention-to-treat analyses using two different imputation strategies were consistent with the main results, with mean differences of 5.2% attendance in best-case and 24.5% in worst-case imputations. Results were robust to adjustments for clustering. There was no impact of the interventions on girls’ self-reported shame or insecurity during menstruation. // CONCLUSION: Results of the trial support the hypothesised positive impact of providing sanitary pads or puberty education for girls’ school attendance in a developing country context. Findings must be interpreted with caution in light of poor participant retention, intervention fidelity, and the attendance measures used

Exploring the impact of public health teams on alcohol premises licensing in England and Scotland (ExILEnS): procotol for a mixed methods natural experiment evaluation.

Background: Recent regulatory changes in the system by which premises are licensed to sell alcohol, have given health representatives a formal role in the process in England and Scotland. The degree to which local public health teams engage with this process varies by locality in both nations, which have different licensing regimes. This study aims to critically assess the impact on alcohol-related harms - and mechanisms - of public health stakeholders’ engagement in alcohol premises licensing from 2012 to 2018, comparing local areas with differing types and intensities of engagement, and examining practice in Scotland and England. Methods: The study will recruit 20 local authority areas where public health stakeholders have actively engaged with the alcohol premises licensing system (the 'intervention’) and match them to a group of 20 lower activity areas using genetic matching. Four work packages are included: (1) Structured interviews and documentary analysis will examine the type and level of intervention activity from 2012 to 2018, creating a novel composite measure of the intensity of such activity and will assess the local licensing system and potential confounding activities over the same period. In-depth interviews with public health, licensing, police and others will explore perceived mechanisms of change, acceptability, and impact. (2) Using longitudinal growth models and time series analyses, the study will evaluate the impact of high and low levels of activity on alcohol-related harms using routine data from baseline 2009 to 2018. (3) Intervention costs, estimated National Health Service cost savings and health gains will be evaluated using the Sheffield Alcohol Policy Model to estimate impact on alcohol consumption and health inequalities. (4) The study will engage public health teams to create a new theory of change for public health involvement in the licensing process using our data. We will share findings with local, national and international stakeholders. Discussion: This interdisciplinary study examines, for the first time, whether and how public health stakeholders involvement in alcohol licensing impacts on alcohol harms. Using mixed methods and drawing on complex systems thinking, it will make an important contribution to an expanding literature evaluating interventions not suited to traditional epidemiological research