"Even the dog has Attention Deficit Hyperactivity Disorder" (ADHD) A cross-cultural comparative study of parents’ and teachers’ knowledge and attitudes towards ADHD in Scotland and Romania

The aim of this research was to investigate the way in which ADHD is understood and constructed within Romania and Scotland, comparing and contrasting the discourses that constitute ADHD within different cultural contexts.Overall, this study employed a mixed method design based on a concurrent nested approach which was undertaken in 2 phases. In phase 1, 50 parents, 72 primary school teachers and 48 support staff from Scotland, and 50 parents, 86 primary school teachers and 57 support staff from Romania, completed a self-report questionnaire that measured their knowledge and attitudes towards ADHD. The statistical results showed that, for the knowledge of ADHD test, both sample of parents, teachers and support staff scored the highest at symptoms/diagnosis subscale. Parents,teachers and support staff from the Romanian sample scored the lowest at the treatment subscale whereas the Scottish respondents had difficulties in answering questions about the nature, causes and prognosis of ADHD. In terms of their self-reported attitudes, both samples of Scottish and Romanian parents, teachers and support staff scored the highest on the affective attitude subscale. Scottish teachers and support staff scored the lowest on the behavioural attitude subscale whereas Romanian teachers and support staff scored the lowest on the cognitive attitude subscale. On the other hand, both samples of Scottish and Romanian parents scored the lowest on the behavioural attitude subscale. These patterns were further explored in phase 2 of the study, where 5 Scottish and Romanian mothers, 3 Scottish and Romanian primary-school teachers and 3 Scottish and Romanian support staff were selected to take part in a semi-structured interview. Parents, teachers and support staff from both countries responded within a medical model of disability employing themes such as ADHD as a medical condition, the medicalisation of behaviour, behaviour as out of control or the specialness of ADHD. However, participants also adopted a social conceptualisation of ADHD, referring to ADHD as a social phenomenon, resisting medicalisation and describing the educational and medical "wrongs". Reflecting the uncertainty in the field, participants’ conceptualisation of ADHD expanded, modified or even shifted from one perspective to another. The cross-cultural comparisons used the Appadurai's theoretical framework of "scapes" to explain the global nature of ADHD as well as the differences between Scottish and Romanian parents, teachers and support staff in relation to the three most important results of this study: treatment of ADHD, inclusion of children diagnosed with ADHD in mainstream education and parents’ and teachers’ willingness to get involved. The findings have been used to develop a multidisciplinary framework for support, empowering teachers and parents with knowledge of ADHD and improving cross-professional relationships. The fundamental idea of this framework is that it moves beyond the deficit paradigm, helping teachers, parents and stakeholders to be alert and responsive to the various conceptualisations of ADHD and to understand how these schemata have come into existence in specific periods of time and in different cultural contexts

Balancing measures or a balanced accounting of improvement impact:a qualitative analysis of individual and focus group interviews with improvement experts in Scotland

Background As quality improvement (QI) programmes have become progressively larger scale, the risks of implementation having unintended consequences are increasingly recognised. More routine use of balancing measures to monitor unintended consequences has been proposed to evaluate overall effectiveness, but in practice published improvement interventions hardly ever report identification or measurement of consequences other than intended goals of improvement. Methods We conducted 15 semistructured interviews and two focus groups with 24 improvement experts to explore the current understanding of balancing measures in QI and inform a more balanced accounting of the overall impact of improvement interventions. Data were analysed iteratively using the framework approach. Results Participants described the consequences of improvement in terms of desirability/undesirability and the extent to which they were expected/unexpected when planning improvement. Four types of consequences were defined: expected desirable consequences (goals); expected undesirable consequences (trade-offs); unexpected undesirable consequences (unpleasant surprises); and unexpected desirable consequences (pleasant surprises). Unexpected consequences were considered important but rarely measured in existing programmes, and an improvement pause to take stock after implementation would allow these to be more actively identified and managed. A balanced accounting of all consequences of improvement interventions can facilitate staff engagement and reduce resistance to change, but has to be offset against the cost of additional data collection. Conclusion Improvement measurement is usually focused on measuring intended goals, with minimal use of balancing measures which when used, typically monitor trade-offs expected before implementation. This paper proposes that improvers and leaders should seek a balanced accounting of all consequences of improvement across the life of an improvement programme, including deliberately pausing after implementation to identify and quantitatively or qualitatively evaluate any pleasant or unpleasant surprises

Perceived impact of formulating, implementing and enacting national mental health policies recommendations in practice:An exploratory qualitative study within child and adolescent mental health services in Scotland

OBJECTIVE: To understand the process of formulating, implementing and enacting national recommendations into practice, by exploring the interactions between government policymakers and national and local organisations supporting and delivering policy implementation within a Child and Adolescent Mental Health Service (CAMHS) context in Scotland. METHODS: Data collection involved 16 semi-structured individual and four focus group interviews with a purposeful sample of policymakers, national health and social care stakeholders and local outpatient and inpatient CAMHS teams representing three NHS health boards in Scotland. RESULTS: Study participants highlighted the challenges of navigating through evolving and often conflicting policy agendas, seen to not acknowledging the current evidence base or experiential learning from services and prior evaluations. Accounts of transformation fatigue often emerged from increased expectations for staff to adopt new approaches to accommodate constantly changing recommendations. Participants also reported a lack of integration and implementation support from national health and social care organisations, leading to duplication of effort and gaps in provision or waste. Policy recommendations were perceived as sometimes vague, lacking clarity about how to deliver service transformation using a whole-system approach. The collective narratives reflected increased tension between the need for local autonomy to innovate and the limitations created vertically by the relative inflexibility of policy recommendations, and horizontally by the proliferation of national organisations delivering the same transformation aims using different approaches in a resource-constrained environment. CONCLUSION: The findings contribute to the wider literature by offering an exploration of importance of evaluation and evidence uptake in policy formulation; the roles and remits in supporting the implementation of policy recommendations; and how the dynamics of central control and local autonomy might impact on the local enactment of policy recommendations

Pharmacist and Data-driven Quality Improvement in Primary Care (P-DQIP):A qualitative study of anticipated implementation factors informed by the Theoretical Domains Framework

Objectives: The quality and safety of drug therapy in primary care are global concerns. The Pharmacist and Data driven Quality Improvement in Primary care (P-DQIP) intervention aims to improve prescribing safety via an informatics tool which facilitates proactive management of drug therapy risks (DTRs) by health-board employed pharmacists with established roles in general practices. Study objectives were (1) to identify and prioritise factors that could influence P-DQIP implementation from the perspective of practice pharmacists, and (2) to identify potentially effective, acceptable and feasible strategies to support P-DQIP implementation. Design: Semi-structured face-to-face interviews using a Theoretical Domains Framework (TDF) informed topic guide. The framework method was used for data analysis. Identified implementation factors were prioritised for intervention based on research team consensus. Candidate intervention functions, behaviour change techniques (BCTs) and policies targeting these were identified from the Behaviour Change Wheel. The final intervention content and modes of delivery were agreed with local senior pharmacists. Setting: General practices from three Health and Social Care Partnerships (HSCPs) in NHS Tayside. Participants: 14 NHS employed practice pharmacists. Results: Identified implementation factors were linked to thirteen theoretical domains (all except intentions) and six (skill, memory/attention/decision-making, behavioural regulation, reinforcement, environmental context/resources, social influences) were prioritised. Three intervention functions (training, enablement, and environmental restructuring) were relevant and were served by two policy categories (guidelines, communication/marketing) and eight BCTs (Instructions on how to perform a behaviour, problem solving, action planning, prompt/cues, goal setting, self-monitoring, feedback, restructuring the social environment). Intervention components encompass an informatics tool, written educational material, a workshop for pharmacists, promotional activities, and small financial incentives. Conclusions: This study explored pharmacists’ perceptions of implementation factors which could influence management of DTRs in general practices to inform implementation of P-DQIP, which will initially be implemented in one Scottish health board with parallel evaluation of effectiveness and implementation

Care planning interventions for care home residents: a scoping review

Context: Previous reviews of care planning (CP) interventions in care homes focus on higher quality research methodologies and exclusively consider advanced care planning (ACP), thereby excluding many intervention-based studies that could inform current practice. CP is concerned with residents’ current circumstances while ACP focuses on expressing preferences which relate to future care decisions. Objectives: To identify, map and summarise studies reporting CP interventions for older people in care homes. Methods: Seven electronic databases were searched from 1 January 2012 until 1 January 2022. Studies of CP interventions, targeted at older people (>60 years), whose primary place of residence was a care home, were eligible for inclusion. Two reviewers independently screened the titles and abstracts of 3778 articles. Following a full-text review of 404 articles, data from 112 eligible articles were extracted using a predefined data extraction form. Findings: Studies were conducted in 25 countries and the majority of studies took place in the United States, Australia and the UK. Most interventions occurred within nursing homes (61%, 68/112). More than 90% of interventions (93%, 104/112) targeted staff, and training was the most common focus (80%, 83/104), although only one included training for ancillary staff (such as cleaners and caterers). Only a third of the studies (35%, 39/112) involved family and friends, and 62% (69/112) described interventions to improve CP practices through multiple means. Limitations: Only papers written in English were included, so potentially relevant studies may have been omitted. Implications: Two groups of people – ancillary workers and family and friends – who could play a valuable role in CP were often not included in CP interventions. These oversights should be addressed in future research

Feasibility study of the effects of art as a creative engagement intervention during stroke rehabilitation on improvement of psychosocial outcomes: Study protocol for a single blind randomized controlled trial: The ACES study

BackgroundBenefits of art participation after stroke are becoming increasingly recognized. Qualitative studies suggest that participation in visual arts creative engagement interventions (CEIs) during rehabilitation after stroke may improve mood, self-esteem, hope and some aspects of physical recovery. This study examines the feasibility of undertaking a randomized controlled trial of a CEI delivered by artists within in-patient stroke rehabilitation to test effectiveness.Methods/DesignThis trial is a two arm, single-blind, randomized controlled feasibility trial within in-patient stroke rehabilitation. We will recruit 80 patients receiving stroke rehabilitation in two stroke units in a health board area of Scotland (40 patients in each arm). Intervention arm participants will receive a visual-arts based CEI facilitated by experienced artists. Artists will follow an intervention protocol with specific components that enable participants to set, achieve and review artistic goals. Participants will receive up to eight intervention sessions, four within a group and four one-to-one with the artist. Control group participants will receive usual care only.Data collection will occur at baseline, post-intervention and three-month follow-up. Stroke-related health status is the primary outcome; mood, self-esteem, self-efficacy, perceived recovery control and hope are secondary outcomes. Semi-structured interviews will be conducted with purposively selected patients, artists and healthcare staff to elicit views and experiences of the intervention and feasibility and acceptability of trial processes. Recruitment rates, retention rates and patient preference for art participation will also be collected. Data will indicate, with confidence intervals, the proportion of patients choosing or refusing participation in the CEI and will allow calculation of recruitment rates for a future definitive trial. Summary data will indicate potential variability, magnitude and direction of difference between groups. Findings will inform sample size calculations for a definitive trial. Thematic analysis of qualitative data will be managed using the Framework Approach. Framework is an analytical approach for qualitative data, commonly used in policy and medical research.DiscussionIf shown to demonstrate effects, this intervention has the potential to address aspects of stroke recovery previously. Not routinely addressed in rehabilitation.Trial registrationRegistered with Clinical Trials.Gov: NCT02085226 on 6th March 2014