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Background: There have been recent important advances in conceptualizing and operationalizing involvement in health research and health ‐ care service development. However, problems persist in the field that impact on the scope for meaningful involvement to become a routine – normalized – way of working in primary care. In this review, we focus on current practice to critically interrogate factors known to be relevant for normalization – definition, enrolment, enactment and appraisal. Method: Ours was a multidisciplinary, interagency team, with community representation. We searched EBSCO host for papers from 2007 to 2011 and engaged in an iterative, reflexive approach to sampling, appraising and analysing the literature following the principles of a critical interpretive synthesis approach and using Normalization Process Theory. Findings: Twenty ‐ six papers were chosen from 289 papers, as a purposeful sample of work that is reported as service user involvement in the field. Few papers provided a clear working definition of service user involvement. The dominant identified rationale for enrolling service users in primary care projects was linked with policy imperatives for co ‐ governance and emancipatory ideals. The majority of methodologies employed were standard health services research methods that do not qualify as research with service users. This indicates a lack of congruence between the stated aims and methods. Most studies only reported positive outcomes, raising questions about the balance or completeness of the published appraisals. Conclusion: To improve normalization of meaningful involvement in primary care, it is necessary to encourage explicit reporting of definitions, methodological innovation to enhance co ‐ governance and dissemination of research processes and findings. [ABSTRACT FROM AUTHOR]

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This paper examines the potential for, and the contradictions inherent in, voluntary sector health service providers acting as consumer representatives. The paper examines a U.K. gay men's HIV prevention organization to consider whether members are united by their experiences of using services, whether their work involves consumerist strategies, if so whether these are influential, and what tensions emerge from the dual provider/consumer role. Fieldwork was carried out in 1997–98, examining, via documents and interviews, activity between 1992 and 1997. Qualitative analysis was performed. Consumer action is shown to emerge not so much from abstract constructions of consumer interest, but more from the particularities of consumption, which become politicized more powerfully through their attachment to other interests and ideologies. [ABSTRACT FROM AUTHOR]

The aim of this paper is to identify the factors that determine the prevalence of private medical insurance (PMI) in England.Secondary data sources are the British Household Panel Survey (BHPS) 1997–2000, Laing's Healthcare Market Review 1999–2000, the United Kingdom (U.K.) Department of Health's National Health Service Waiting Times Team, and the Work Force Statistics Branch of the Department of Health.Logistic regression models for panel data were used to compare non-PMI subscribers with individual subscribers and those with employer-provided PMI.The BHPS data are collected by the Institute for Social and Economic Research at the University of Essex. Other data used were collected by Laing and Buisson and the U.K. Department of Health.Individual PMI is more prevalent among the well-educated and healthy. Income, age, sex, and political preference are key determinants of PMI prevalence for both individual and employer paid PMI. Individuals are also likely to reflect on information with regard to waiting times in deciding whether or not to purchase PMI cover. The withdrawal of the tax subsidy in 1997 to PMI subscribers over 60 years of age did not impact on their rate of withdrawal from PMI coverage relative to the rate among all PMI subscribers, but may have discouraged potential new subscribers.Current trends in the PMI market suggest that, over time, individually purchased PMI is likely to be partially displaced by PMI purchased as part of a company-based plan. However, having PMI is linked to economic factors in both groups, suggesting a similar segment of the population valuing the responsiveness that PMI provides. Geographic factors relating to waiting times and supply-side factors are associated with both individual and company-based PMI. The withdrawal of the tax subsidy to individual subscribers older than age of 60 resulted in a significant decline in the demand for PMI. In particular, the number of new subscribers in this group declined substantially. [ABSTRACT FROM AUTHOR]

This paper presents a critical exploration of the relationship between masculinity, sport and health by reporting findings from a wider qualitative study on lay men's and health professionals' beliefs about masculinity and preventative health care. Recent years have seen a surge of interest in relation to ‘men's health’. In particular, the Department of Health has highlighted how men's connection to sport, fitness and competitiveness can be used in health promotion initiatives to introduce facets of health. In contrast, work in the sociological and feminist literature has raised issues of concern about the relationship between men, masculinity and sport, particularly the links to aggression, misogyny and homophobia. It would appear then that a straightforward ‘men + sport = health’ relationship cannot be assumed. Focus groups and interviews with health professionals and men, including gay and disabled men, were undertaken to facilitate examination of the socially integrative meanings of sport and masculinity, and their relationship to health. Socializing, ‘macho’ culture and the body emerged as three main themes, and the implications of these empirical findings for health promotion are discussed. [ABSTRACT FROM AUTHOR]

Introduction: This literature review was conducted to provide a background understanding of the literature around integrated health and social care prior to a research project evaluating two integrated health and social care teams in England, UK. Methods: A systematic literature search of relevant databases was employed to identify all articles relating to integrated health and social care teams produced in the last 10 years in the UK. Results: Sixteen articles were found and reviewed; all were reviewed by the first reviewer and half by the second reviewer. Discussion: Key themes identified were: drivers, barriers and benefits of integrated working; staff development; and meeting the needs of service users. Conclusion: Recommendations for integrated working include; a focus on the management of integrated teams; a need to invest in resources for the successful integration of teams; a need for the development of clear standards for monitoring the success and failure of integrated teams; and the need for further empirical evidence of the processes used by integrated teams. These findings will be valuable for practitioners who are establishing services or want to improve integrated care in their own practice. [ABSTRACT FROM AUTHOR]

This paper describes a simulation-based project to help North Mersey Community National Health Service Trust to design and plan the operation of a NHS Walk-in Centre. The simulation model developed of this multi-service facility was used to facilitate managers and health professionals to recognize existing problems and potential future problems, and to investigate ideas for their `solution'. In the fast-moving NHS where initiatives to improve access, such as walk-in centres, are a recent development and where no two centres are the same, ideas for best practice borrowed from elsewhere can be quickly tested for suitability in the local situation. [ABSTRACT FROM AUTHOR]

The article focuses on the White Paper "Healthy Lives, Healthy People," which was produced as a response to the work of M. Marmot and to address wider social determinants of health. Several factors contributing to the challenges facing the public health system of Great Britain include policy failures, concerns over communicable disease control, the imminent reorganization of the National Health Service (NHS) and demoralized public health workforce. An extended public health role for general practitioners (GPs) is being offered by the White Paper.

The article discusses papers published within the issue, including one a model for the stages of patients and service user involvement and engagement, another on service user involvement in research and service development, and lastly on the involvement of patients in a feasibility study using a patient panel approach.

This article examines the development and impact of a national knowledge translation project aimed at improving access to evidence and learning on community-centred approaches for health and wellbeing. Structural changes in the English health system meant that knowledge on community engagement was becoming lost and a fragmented evidence base was seen to impact negatively on policy and practice. A partnership started between Public Health England, NHS England and Leeds Beckett University in 2014 to address these issues. Following a literature review and stakeholder consultation, evidence was published in a national guide to community-centred approaches. This was followed by a programme of work to translate the evidence into national strategy and local practice. The article outlines the key features of the knowledge translation framework developed. Results include positive impacts on local practice and national policy, for example adoption within National Institute for Health and Care Evidence (NICE) guidance and Local Authority public health plans and utilization as a tool for local audit of practice and commissioning. The framework was successful in its non-linear approach to knowledge translation across a range of inter-connected activity, built on national leadership, knowledge brokerage, coalition building and a strong collaboration between research institute and government agency. [ABSTRACT FROM AUTHOR]

Background: Measuring patients’ experiences to determine health ‐ care performance and quality of care from their perspective can provide valuable evidence for international improvements in the quality of care. We compare patients’ experiences in Accident & Emergency departments (A&E) in England and the Netherlands and discuss the usefulness of this comparison. Methods: A cross ‐ sectional survey was conducted among patients attending A&Es aged 18 years and older. In England, 134 A&Es were surveyed. In the Netherlands, nine hospitals participated in the study. Main outcome measures were patients’ experiences represented by six domain scores aggregated on the country level or on the A&E level. Results: In England, 43 892 completed questionnaires were received (40%). In the Netherlands, 1865 completed questionnaires were received (42%). Three of six domain scores were significantly higher for patients in the Netherlands: ‘waiting time’ [mean scores of 73.8 (NL) versus 67.2 (ENG)], ‘doctors and nurses’ [mean scores of 85.7 (NL) versus 80.6 (ENG)] and ‘your care and treatment’ [mean scores of 82.6 (NL) and 80.2 (ENG)]. The variance among the English A&Es was large. The best and worst practices on five domains were English. Conclusions: The mean quality of care in the A&E appeared to be better in the Netherlands on three domains, but the best practices were English A&Es. The within ‐ country differences between A&Es were much larger than differences between countries. Healthcare performance in the A&E can be compared between countries by surveying patients’ experiences, and there seems much to learn across A&Es both within and among countries. [ABSTRACT FROM AUTHOR]

Background: A study of involvement initiatives within secure mental health services across one UK region, where these have been organized to reflect alliances between staff and service users. There is little previous relevant international research, but constraints upon effective involvement have been noted. Objective: To explore and evaluate involvement initiatives in secure mental health settings. Design: A case study design with thematic analysis of qualitative interviews and focus groups. Setting and participants: Data collection was carried out between October 2011 and February 2012 with 139 staff and service users drawn from a variety of secure mental health settings. Findings: Our analysis offers four broad themes, titled: safety and security first?; bringing it all back home; it picks you up; it's the talk. The quality of dialogue between staff and services users was deemed of prime importance. Features of secure environments could constrain communication, and the best examples of empowerment took place in non ‐ secure settings. Discussion: Key aspects of communication and setting sustain involvement. These features are discussed with reference to Jurgen Habermas's work on communicative action and deliberative democracy. Conclusions: Involvement initiatives with service users resident in secure hospitals can be organized to good effect and the active role of commissioners is crucial. Positive outcomes are optimized when care is taken over the social space where involvement takes place and the process of involvement is appreciated by participants. Concerns over risk management are influential in staff support. This is germane to innovative thinking about practice and policy in this field. [ABSTRACT FROM AUTHOR]

Background: The policy imperative to engage the public and patients in research can be seen as part of a wider shift in the research environment. This study addresses the question: Has there been a shift in attitudes to Patient and Public Involvement (PPI) and Public Engagement in Science (PES) amongst researchers? Methods: Attitudes to PPI and PES within a cluster of three NIHR supported Biomedical Research Centres were explored through in ‐ depth interviews with 19 researchers. Results: Participants distinguished PPI (as an activity involving patients and carers in research projects and programmes) from PES (as an activity that aims to communicate research findings to the public, engage the public with broader issues of science policy or promote a greater understanding of the role of science in society). While participants demonstrated a range of attitudes to these practices, they shared a resistance to sharing power and control of the research process with the public and patients. Conclusion: While researchers were prepared to engage with the public and patients and listed the advantages of engagement, the study revealed few differences in their underlying attitudes towards the role of society in science (and science in society) to those reported in previous studies. To the participants science remains the preserve of scientists, with patients and the public invited to ‘tinker at the edges’. [ABSTRACT FROM AUTHOR]

Background: The involvement of patient representatives in health technology assessment is increasingly seen by policy makers and researchers as key for the deployment of patient‐centred health care, but there is uncertainty and a lack of theoretical understanding regarding the knowledge and expertise brought by patient representatives and organisations to HTA processes. Objective: To propose a conceptually‐robust typological model of the knowledge and expertise held by patient organisations. Design, data collection and analysis: The study followed a case‐study design. Data were collected within an international research project on patient organisations' engagement with knowledge, and included archival and documentary data, in‐depth interviews with key members of the organisation and participant observation. Data analysis followed standard procedure of qualitative analysis anchored in an analytic induction approach. Results: Analysis identified three stages in the history of the patient organisation under analysis – Alzheimer's Society. In a first period, the focus is on ‘caring knowledge’ and an emphasis on its volunteer membership. In a transition stage, a combination of experiential, clinical and scientific knowledge is proposed in an attempt to expand its field of activism into HTA. In the most recent phase, there is a deepening of its network of associations to secure its role in the production of evidence. Conclusions: Analysis identified an important relationship between the forms of knowledge deployed by patient organisations and the networks of expertise and policy they mobilise to pursue their activities. A model of this relationship is outlined, for the use of further research and practice on patient involvement. [ABSTRACT FROM AUTHOR]

Background: Health outcomes for long‐term conditions (LTCs) can be improved by lifestyle, dietary and condition management‐related behaviour change. Primary care is an important setting for behaviour change work. Practitioners have identified barriers to this work, but there is little evidence examining practices of behaviour change in primary care consultations and how patients and practitioners perceive these practices. Objective: To examine how behaviour change is engaged with in primary care consultations for LTCs and investigate how behaviour change is perceived by patients and practitioners. Design: Multiperspective, longitudinal qualitative research involving six primary health‐care practices in England. Consultations between patients with LTCs and health‐care practitioners were audio‐recorded. Semi‐structured interviews were completed with patients and practitioners, using stimulated recall. Patients were re‐interviewed 3 months later. Framework analysis was applied to all data. Participants: Thirty‐two people with at least one LTC (chronic obstructive pulmonary disease, diabetes, asthma and coronary heart disease) and 10 practitioners. Results: Behaviour change talk in consultations was rare and, when it occurred, was characterized by deflection and diffidence on the part of practitioners. Patient motivation tended to be unaddressed. While practitioners positioned behaviour change work as outside their remit, patients felt uncertain about, yet responsible for, this work. Practitioners raised concerns that this work could damage other aspects of care, particularly the patient–practitioner relationship. Conclusion: Behaviour change work is often deflected or deferred by practitioners in consultations, who nevertheless vocalize support for its importance in interviews. This discrepancy between practitioners’ accounts and behaviours needs to be addressed within primary health‐care organizations. [ABSTRACT FROM AUTHOR]

This article discusses the medicinal remedies consumed at the court of the Yorkist kings of England in the light of a lawsuit in the court of common pleas (edited in an appendix) between John Clerk, king’s apothecary to Edward IV, and Katherine Neville, Duchess of Norfolk, over the partial non-payment of the apothecary’s bills. It argues that the consumption of apothecaries’ wares in large quantities was not merely a direct result of the excessive diet of the late medieval aristocracy, but in itself represented a facet of the conspicuous consumption inherent in the lifestyle of this particular social class. The remedies supplied by Clerk over a period of several years and listed in the legal record are set in the context of contemporary collections of medical recipes, particularly a ‘dispensary’ in the British Library’s Harleian collection generally attributed to the king’s apothecary. [ABSTRACT FROM PUBLISHER]

Despite a varied historical literature on the nineteenth- century royal dockyards, very little has been written about the health issues associated with naval shipbuilding or the healthcare facilities that were provided for dockworkers in the period. This article focuses mainly on the latter. Drawing on archival sources from the home dockyards, an examination is made of the duties and responsibilities of dockyard surgeons. These are found to have expanded considerably as healthcare provision became steadily more comprehensive. It is argued that as providers to a civilian workforce, the naval authorities were in the vanguard when it came to implementing perceived advances in medical practice. It is also contended, however, that while many dockworkers benefited as a result, this positive appraisal needs to be set against the more ambiguous aspects of the surgeon's role. Although surgeons treated the sick and injured, their growing prominence in other dockyard matters, such as retirement and the policing of sickness, is shown to have created tension in their relationship with the workforce. [ABSTRACT FROM AUTHOR]

Background: The UK has a universal health care system that is free at the point of access. Over the past decade, the UK government has implemented an ambitious agenda of quality improvement initiatives in chronic disease management.Objective: To assess the quality of diabetes care and intermediate clinical outcomes within a multiethnic population after a sustained period of investment in quality improvement.Design: Population based cross-sectional survey, using electronic general practice records, carried out between November 2005 and January 2006.Patients: Seven thousand six hundred five adults (>or=18 years) with diabetes registered with 32 primary care practices.Measurements: Percentage achievement by ethnic group (black, south Asian, or white) of the quality indicators for diabetes in a new pay-for performance contract.Results: There were only modest variations in recording of process measures of care between ethnic groups, with no significant differences in recent measurement of blood pressure, HbA1c, cholesterol, micro-albuminuria, creatinine, or retinopathy screening attendance. Blacks and south Asians were significantly less likely to meet all three national treatment targets for diabetes (HbA1c Conclusions: Our findings suggest that substantial investment in quality improvement initiatives in the UK may have led to more systematic and equitable processes of care for diabetes but have not addressed ethnic disparities in intermediate clinical outcomes. [ABSTRACT FROM AUTHOR]

Goal. Assess the progress and pitfalls of current United Kingdom (U.K.) policies to reduce health inequalities. Objectives. (1) Describe the context enabling health inequalities to get onto the policy agenda in the United Kingdom. (2) Categorize and assess selected current U.K. policies that may affect health inequalities. (3) Apply the "policy windows" model to understand the issues faced in formulating and implementing such policies. (4) Examine the emerging policy challenges in the U.K. and elsewhere. Data Sources. Official documents, secondary analyses, and interviews with policymakers. Study Design. Qualitative, policy analysis. Data Collection. 2001–2002. The methods were divided into two stages. The first identified policies which were connected with individual inquiry recommendations. The second involved case‐studies of three policies areas which were thought to be crucial in tackling health inequalities. Both stages involved interviews with policy‐makers and documentary analysis. Principal Findings. (1) The current U.K. government stated a commitment to reducing health inequalities. (2) The government has begun to implement policies that address the wider determinants. (3) Some progress is evident but many indicators remain stubborn. (4) Difficulties remain in terms of coordinating policies across government and measuring progress. (5) The "policy windows" model explains the limited extent of progress and highlights current and possible future pitfalls. (6) The U.K.'s experience has lessons for other governments involved in tackling health inequalities. Conclusions. Health inequalities are on the agenda of U.K. government policy and steps have been made to address them. There are some signs of progress but much remains to be done including overcoming some of the perverse incentives at the national level, improving joint working, ensuring appropriate measures of performance/progress, and improving monitoring arrangements. A conceptual policy model aids understanding and points to ways of sustaining and extending the recent progress and overcoming pitfalls. [ABSTRACT FROM AUTHOR]

Investigates when young people first use sexual health services in Great Britain. Methods; Reasons for the first visit.

Abstract: We report the transfer into Spanish of a multidimensional measure of perceived health originally developed in Great Britain, the Nottingham Health Profile (NHP), and an assessment of the preliminary validity of the version is presented. Translation of the questionnaire was obtained from experts and from a Spanish monolingual lay group. Construct validity of the version was assessed in two studies: testing relationship of NHP scores to other self-reported measures of health in a general population survey; and comparing NHP scores for a group of frequent users and for a group of non-users of primary health services. Mean scores of NHP dimensions were higher for people with poorer self-reported health and higher for the frequent health services users than for the non-users. Findings suggest that the Spanish version of the NHP is culturally ≡ to the original questionnaire, and has a similar level of construct validity. Nevertheless, further research on reliability and on the weighting system is required to establish the equivalence of the Spanish version definitively. (Am J Public Health 1990; 80:704-708.) [ABSTRACT FROM AUTHOR]

The article offers the author's perspectives on the widening generation gap in healthcare. The author highlights the three reasons why the gap is widening, which are the transformation of knowledge, reversal of world dominance and climate change. He stresses the importance of fostering global awareness across the generation gap, and discusses the impact of patient centredness on doctor-patient relationship.