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Introduction: In England, primary care networks (PCNs) offer opportunities to improve access to and sustainability of general practice through collaboration between groups of practices to provide care with a broader range of practitioner roles. However, there are concerns that these changes may undermine continuity of care. Our study investigates what the organisational shift to PCNs means for continuity of care. Methods: The paper uses thematic analysis of qualitative data from interviews with general practitioners and other healthcare professionals (HCPs, n = 33) in 19 practices in five PCNs, and their patients (n = 35). Three patient cohorts within each participating practice were recruited, based on anticipated higher or lower needs for continuity of care: patients over 65 years with polypharmacy, patients with anxiety or depression and 'working age' adults aged between 18 and 45 years. Findings: Patients and clinicians perceived changes to continuity in PCNs in our study. Larger‐scale care provision in PCNs required better care coordination and information‐sharing processes, aimed at improving care for 'vulnerable' patients in target groups. However, new working arrangements and ways of delivering care in PCNs undermine HCPs' ability to maintain continuity through ongoing relationships with patients. Patients experience this in terms of reduced availability of their preferred clinician, inefficiencies in care and unfamiliarity of new staff, roles and processes. Conclusions: New practitioners need to be effectively integrated to support effective team‐based care. However, for patients, especially those not deemed 'vulnerable', this may not be sufficient to counter the loss of relationship with their practice. Therefore, caution is required in relation to designating patients as in need of, or not in need of continuity. Rather, continuity for all patients could be maintained through a dynamic understanding of the need for it as fluctuating and situational and by supporting clinicians to provide follow‐up care. Patient and Public Involvement (PPI): A PPI group was recruited and consulted during the study for feedback on the study design, recruitment materials and interpretation of findings. [ABSTRACT FROM AUTHOR]

Aim: To develop and explore the validity of a Patient Reported Experience Measure (PREM) for adult inpatient diabetes care. Method: 27 in‐depth interviews were conducted to inform the development of the 42‐item PREM which was cognitively tested with 10 people. A refined 38‐item PREM was piloted with 228 respondents completing a paper (n = 198) or online (n = 30) version. The performance of the PREM was evaluated by exploring (i) uptake/number of responses and (ii) survey validity by investigating whether the PREM data were of adequate quality and delivered useful information. Results: The PREM had low drop‐out or missing data rates suggesting it was appropriately constructed. Analysis of item frequencies and variances, and problem score calculations concluded that questions provided sufficient score differentiation. Conclusions: This new PREM allows for experiences of inpatient diabetes care to be measured, understood and reported on to help identify priority areas for improving care quality. [ABSTRACT FROM AUTHOR]

Background and context: Breastfeeding peer support is valued by women, but UK trials have not demonstrated efficacy. The ABA feasibility trial offered proactive peer support underpinned by behaviour change theory and an assets‐based approach to women having their first baby, regardless of feeding intention. This paper explores women's and infant feeding helpers' (IFHs) views of the different components of the ABA intervention. Setting and participants: Trained IFHs offered 50 women an antenatal meeting to discuss infant feeding and identify community assets in two English sites—one with a paid peer support service and the other volunteer‐led. Postnatally, daily contact was offered for the first 2 weeks, followed by less frequent contact until 5 months. Methods: Interviews with 21 women and focus groups/interviews with 13 IFHs were analysed using thematic and framework methods. Results: Five themes are reported highlighting that women talked positively about the antenatal meeting, mapping their network of support, receiving proactive contact from their IFH, keeping in touch using text messaging and access to local groups. The face‐to‐face antenatal visit facilitated regular text‐based communication both in pregnancy and in the early weeks after birth. Volunteer IFHs were supportive of and enthusiastic about the intervention, whereas some of the paid IFHs disliked some intervention components and struggled with the distances to travel to participants. Conclusions: This proactive community assets‐based approach with a woman‐centred focus was acceptable to women and IFHs and is a promising intervention warranting further research as to its effect on infant feeding outcomes. [ABSTRACT FROM AUTHOR]

Value sets for the EQ-5D-5L are required to facilitate its use in estimating quality-adjusted life years. An international protocol has been developed to guide the collection of stated preference data for this purpose and has been used to generate EQ-5D-5L valuation data for England. The aim of this paper is report the innovative methods used for modelling those data to obtain a value set. Nine hundred and ninety-six members of the English general public completed time trade-off (TTO) and discrete choice experiment (DCE) tasks. We estimate models, with and without interactions, using DCE data only, TTO data only, and TTO/DCE data combined. TTO data are interpreted as both left and right censored. Heteroskedasticity and preference heterogeneity between individuals are accounted for. We use Bayesian methods in the econometric analysis. The final model is chosen based on the deviance information criterion (DIC). Censoring and taking account of heteroskedasticity have important effects on parameter estimation. For DCE data only, TTO data only, and DCE/TTO data combined, models with parameters for all dimensions and levels perform best, as judged by the DIC. Taking account of heterogeneity improves fit, and the multinomial model reports the lowest DIC. This paper presents approaches that suit observed characteristics of EQ-5D-5L valuation data and recognise respondents' preference heterogeneity. The methods described are potentially relevant to other value set studies. [ABSTRACT FROM AUTHOR]

Background: Geographical and cultural differences have been shown to affect public attitudes towards stuttering. However, increasingly for many individuals in the world one's birthplace culture (or home culture) and culture in their local geographical environment (or host culture) are not the same. Aims: The effects of home culture and host culture in shaping the attitudes towards stuttering among students with British, Arab and Chinese home cultures attending one British university were explored. The effects of host culture were investigated by considering the time lived in the UK for Arab and Chinese students. Methods & Procedures: The study used a descriptive survey design that included a standardized self‐delivered questionnaire: the Public Opinion Survey of Human Attributes—Stuttering (POSHA‐S). Purposive sampling was carried out thorough volunteer mailing lists, student societies and personal contact. The final sample of 156 university students included 51 British, 52 Arab and 53 Chinese students. Outcomes & Results: Overall stuttering score (OSS), which is indicative of attitudes towards stuttering, was highest for British participants (mean = 30) and lowest for Chinese participants (mean = 13), with Arab participants falling in the middle (mean = 21). The differences in attitudes between the three groups were statistically significant, suggesting that home culture is a contributor to attitudes towards stuttering. A post‐hoc item analysis of the POSHA‐S revealed numerous specific differences in attitudes towards stuttering between the three groups, including differences in the attribution of the aetiology of stuttering, their role in helping people who stutter (PWS) and sympathy toward PWS. Time lived in the UK—a proxy measure for the role of host culture—did not significantly influence the attitudes of Arab and Chinese respondents. Conclusions & Implications: To varying degrees, all three groups had evidence of stereotypical stuttering attitudes. Nevertheless, given similar ages and student status in the same university, observed respondent differences confirm previous research documenting geographical influences on stuttering attitudes in Western versus East Asian and Middle Eastern samples. The study also provides evidence that home culture was influential in shaping attitudes towards stuttering, but host culture was not a significant contributor. What this paper addsWhat is already known on the subjectPublic stereotypical beliefs towards stuttering are found across the world and hinder the quality of life among PWS. Different cultures have unique stereotypical beliefs towards PWS.What this study adds to existing knowledgeTo the best of our knowledge, no other study has investigated specifically if individuals who live in the same geographical location but have different home cultures, have similar or differing attitudes towards PWS. Results provide preliminary evidence that the home culture of an individual was influential in shaping attitudes towards PWS, but host culture, measured as the length of time living in the current geographical location, did not have a significant relationship with attitudes towards stuttering.What are the potential or actual clinical implications of this workThis study highlights that culturally sensitive clinical practice should not be based on just the culture of the region but should take home culture into consideration as well, and clinicians should discuss cultural perceptions of stuttering with clients in clinical practice. [ABSTRACT FROM AUTHOR]

This is the first of two papers reporting community forensic mental health nurses' experiences of restriction orders and supervised discharge mechanisms. Service user/nurse relationships and risk are addressed in this initial paper. A mixed method/approach was used. A piloted 15-item questionnaire sought quantitative and qualitative data from 122 nurses throughout England and Wales; 57 questionnaires were returned. Limitations applying to gaining qualitative data via written questionnaire are overtly acknowledged. Quantitative data were analysed using the SPSS program. Content analysis and reflexive appraisal of qualitative data led to production of critically appraised conclusions. Findings are illustrative of complexity. Increased understanding of relevant issues, rather than definitive conclusions, is claimed as an outcome. Reductionist approaches are insufficient in illustrating relevant complexities; nurses offer considered, contextualized responses; diametrically opposed opinions exist about the value of interpersonal relationships and balances between care, control and risk assessment. [ABSTRACT FROM AUTHOR]

This is the second of two papers reporting on a descriptive mixed methods study of community forensic mental health nurses' experiences of restriction orders and supervised discharge mechanisms. Forensic community mental health nurses (FCMHNs) have a body of experience of working with mentally disordered offenders in the community. A number of these patients will be subject to conditions on discharge. This in effect acts as compulsory community treatment with the sanction of recall to hospital. This paper examines nurses' perceptions of team-working, legal powers and their effects upon compliance. Findings include that FCMHNs express general satisfaction with their input to decision-making but some concerns were raised that challenge the ethic of team-working. Respondents were broadly in favour of increased professional responsibility, although this may be related to a quest for status. A pragmatic if equivocal support for the use of compulsion in community mental healthcare was also expressed. [ABSTRACT FROM AUTHOR]

There are continuing concerns about the quality of social workers' communication and engagement with children. This has led to a focus in England on whether qualifying courses prepare students sufficiently for practice. Although research has uncovered the capabilities social workers need to engage and communicate effectively with children, there has continued to be limited evidence in relation to which pedagogical approaches might best enable students to develop capability. This paper attempts to address some of this deficit by reporting in‐depth case study findings from a larger longitudinal study into the factors that supported a cohort of students in England in learning to communicate with children. Case analyses are presented in respect of two participants whose learning journeys were emblematic of many in the cohort. Their trajectories draw attention to the significant role that pre‐course experience with children can play in the development of students' self‐efficacy and in providing a rich source of experiential learning that can be built upon. Suggestions are made for how qualifying courses might provide alternative experiential learning opportunities, including role play, child observation and opportunities for reflection on pre‐course experience with adults to help students establish the transferability of their learning. [ABSTRACT FROM AUTHOR]

Introduction: Problem‐solving skills (PSS) help to provide a systematic approach to dealing with and managing complex problems. The overall aim of this study was to assess the acceptability and feasibility of developing and adapting a prison‐based PSS workbook for adults within a medium‐ and low‐secure hospital. Method: We used the Medical Research Council framework in our participatory mixed methods study incorporating an adapted survey (to identify what types of problems people experience in secure hospitals), a series of three interactive workshops (to co‐produce two case study examples for a workbook) and we gathered feedback from patients and hospital staff on the acceptability and feasibility of the workbook. Data from the survey were used to inform the case study examples, and the feedback from patients and hospital staff was descriptively summarised and the results consolidated. Results: In total, 82 (51%) patients took part in the survey; 22 patients and 49 hospital staff provided feedback on the workbook. The survey results indicated that patients regularly experience problems while in the hospital. Patients reported problems relating to restrictions of freedom and boredom. The workshops produced two case studies for the workbooks, with mainly positive patient and staff feedback. More work is required to improve the visual representation of the characters in the case studies, the amount and content of the language and the mechanism of the intervention delivery. Conclusion: The adaptation process proved acceptable and feasible to both patients and staff. The co‐production methodology for the workbook and feedback from patients and staff was an effective way of iteratively refining the materials to ensure that they were both meaningful and acceptable to staff and patients. Subsequent work is required to develop the workbook and evaluate the feasibility of the intervention delivery, recruitment rates, uptake and adherence to the PSS using a randomised controlled trial. Patient or Public Contribution: At each stage of the project consultation with patients and/or hospital staff was involved. [ABSTRACT FROM AUTHOR]

This paper reports findings about parents' experiences of caring for young people with Autistic Spectrum Conditions (ASCs) moving into adulthood. In‐depth interviews were conducted with 38 parents of young people (15–21 years) with ASCs. Data were analysed thematically. In the perceived absence of service support, parents' acted as ‘care‐coordinators’ and ‘life‐supporters’ for their child as they moved into adulthood. These roles came with little choice, emotional demands and personal restrictions. Being supported was important for parents, but preferences differed regarding what this should look like. Implications for policy are discussed. [ABSTRACT FROM AUTHOR]

Background Although most people are aware of government guidelines for alcohol consumption, few have accurate knowledge of these and fewer still use these guidelines to monitor their drinking. Most people also lack accurate knowledge of the alcohol content of the drinks they consume. The aim of the study reported here was to examine whether or not personalized feedback on alcohol consumption based on performance in a drink-pouring task and self-reported alcohol intake would improve university students' knowledge of alcohol consumption guidelines and reduce their alcohol intake. Methods A quasi-randomized control trial with a 2-month follow-up was conducted with 200 students aged 18 to 37 in the south of England. Participants were allocated to a 'pour + feedback' group that completed a drink-pouring task and received personalized feedback, a 'pour only' group that completed the drink-pouring task but did not receive feedback, and a control group. Results At follow-up, participants in the 'pour + feedback' group had significantly better knowledge of government guidelines, and significantly lower weekly alcohol intake when compared to the 'control' and 'pour only' groups. Conclusions Further refinement of the drink-pouring intervention and feedback is reported in this paper, and assessment of their impact in various populations may lead to better understanding of which elements of personalized feedback have the greatest influence on young people's alcohol use. [ABSTRACT FROM AUTHOR]

ABSTRACT Parental mental illness, substance misuse and domestic violence are common risk factors for the maltreatment and neglect of children. Safeguarding children is everyone's responsibility, including professionals working primarily with adults. In the UK, Local Safeguarding Children Boards (LSCBs) were established to ensure that all agencies work together to safeguard children. Many LSCBs developed multi-agency joint protocols to enhance collaboration, but there is limited evidence of their effectiveness. This paper reports findings from a cross-sectional survey of practitioner self-reported experiences of joint protocols, which was conducted in one inner London borough, to evaluate their impact on professional practice. A self-complete questionnaire administered to all professionals in adult mental-health and children's social care services in the borough yielded a response from 119 practitioners. The survey found that the protocols had been widely disseminated and provided clear guidance to practitioners. Practitioners perceived that they had increased awareness of the risk factors for safeguarding children and some had used the protocols to help them gain access to services for their clients. Practitioners also perceived that they had improved inter-agency working between children's social care and adult mental-health services. However, respondents indicated that positive interpersonal contact with practitioners from other agencies was equally important in promoting joint working and inter-agency collaboration. [ABSTRACT FROM AUTHOR]

Background The speech and language therapy/pathology (SLT/SLP) profession is characterized by extreme 'occupational sex segregation', a term used to refer to persistently male- or female-dominated professions. Men make up only 2.5% of all SLTs in the UK, and a similar imbalance is found in other countries. Despite calls to increase diversity in the allied health professions more generally, research into the reasons for occupational sex segregation and gender as a potential key factor remains scarce. Aims This study aims to explore the potential role of gender/gendered discourses in people's decision to pursue a career in SLT/SLP. It seeks to illustrate how gendered assumptions/expectations/discourses continue to construct SLT as a 'gendered' profession, and to make some recommendations in this area for SLT recruitment and practice. Methods & Procedures The study adopted a qualitative design which elicited research participants' views, knowledge and experiences (in their own words) in relation to the research questions. Data collection involved two iterative phases: a preliminary data phase-which involved semi-structured interviews with newly qualified SLT graduates and practising SLTs, and the completion of questionnaires by undergraduate SLTs-and a main/focus group phase. In the focus group phase reported in this paper, six focus groups in total were held with SLTs, teachers of SLT, and careers advisors in London, UK. The data were analysed qualitatively using grounded theory principles, thematic analysis and discourse analysis. Outcomes & Results The findings extend our knowledge and understanding of gender as a parameter of people's motivations and perceptions, which can influence their choice of career (e.g. as regards pay and flexibility). The findings also show that discourses around women as carers, nurturers and communicators constitute key ways through which the SLT profession continues to be constructed as 'women's work'. The topic of structural gender inequalities in the profession was also discussed in the data. Some recommendations for change, with implications for SLT recruitment and practice, were made by the participants themselves. Conclusions & Implications Gender imbalance in SLT needs to be researched further in order to help address inequalities, re-evaluate professional practices and develop service delivery in the profession. This area also needs to be researched via analysis that goes beyond gender distribution in numerical terms to consider the complex perceptions or discourses around gender and work. Cross-disciplinary and comparative perspectives in future research would also be fruitful. [ABSTRACT FROM AUTHOR]

Objectives. Dissatisfaction with services has been associated with poorer child mental health outcomes, early treatment termination as well as disagreements over the nature of mental health difficulties, reasons for referral and therapy goals. The development of straightforward, reliable, and accurate methods of eliciting service users' views is essential within child and adolescent mental health care. This paper describes the development of the child and adolescent service experience (ChASE), a tool to measure children and young people's service experience Design. The study comprises a non-experimental, cross-sectional design. Methods. Participants were 132 mental health service users aged 8-18 years. Participants and their main carer completed the ChASE, Parent Satisfaction Questionnaire (PSQ) () and Strengths and Difficulties (SDQ) Impact Supplement. Clinicians completed the SDQ Impact Supplement and provided clinical activity data. A sub-sample of participants completed the ChASE on a second occasion, 6 weeks after the completion of the first questionnaire. Results. Scrutiny of ChASE data indicated high levels of completion. Principal axis factoring identified three factors within the ChASE: Relationship, Privacy, and Session Activity. The ChASE has good internal consistency and test-retest reliability. Significant correlations were found between the ChASE and carer satisfaction, service use, and youth clinical outcomes. Conclusions. The ChASE is a short, psychometrically robust tool for routine measurement of children, and young people's experience of mental health services, which users can complete easily. The results underline the importance of alliance factors to children and young people and their association with clinical improvement as well as the potential for the ChASE to be used a measure of children's therapeutic progress and alliance. [ABSTRACT FROM AUTHOR]

Introduction: Remote home monitoring models were implemented during the COVID‐19 pandemic to shorten hospital length of stay, reduce unnecessary hospital admission, readmission and infection and appropriately escalate care. Within these models, patients are asked to take and record readings and escalate care if advised. There is limited evidence on how patients and carers experience these services. This study aimed to evaluate patient experiences of, and engagement with, remote home monitoring models for COVID‐19. Methods: A rapid mixed‐methods study was carried out in England (conducted from March to June 2021). We remotely conducted a cross‐sectional survey and semi‐structured interviews with patients and carers. Interview findings were summarized using rapid assessment procedures sheets and data were grouped into themes (using thematic analysis). Survey data were analysed using descriptive statistics. Results: We received 1069 surveys (18% response rate) and conducted interviews with patients (n = 59) or their carers (n = 3). 'Care' relied on support from staff members and family/friends. Patients and carers reported positive experiences and felt that the service and human contact reassured them and was easy to engage with. Yet, some patients and carers identified problems with engagement (e.g., hesitancy to self‐escalate care). Engagement was influenced by patient factors such as health and knowledge, support from family/friends and staff, availability and ease of use of informational and material resources (e.g., equipment) and service factors. Conclusion: Remote home monitoring models place responsibility on patients to self‐manage symptoms in partnership with staff; yet, many patients required support and preferred human contact (especially for identifying problems). Caring burden and experiences of those living alone and barriers to engagement should be considered when designing and implementing remote home monitoring services. Patient or Public Contribution: The study team met with service users and public members of the evaluation teams throughout the project in a series of workshops. Workshops informed study design, data collection tools and data interpretation and were conducted to also discuss study dissemination. Public patient involvement (PPI) members helped to pilot patient surveys and interview guides with the research team. Some members of the public also piloted the patient survey. Members of the PPI group were given the opportunity to comment on the manuscript, and the manuscript was amended accordingly. [ABSTRACT FROM AUTHOR]

Aims: To develop a questionnaire to identify Intensive Care survivor needs at key transitions during the recovery process, and assess its validity and reliability in a group of ICU survivors. Methods: Development of the Support Needs After ICU (SNAC) questionnaire was based on a systematic scoping review, and analysis of patient interviews (n = 22). Face and content validity were assessed by service users (n = 12) and an expert panel of healthcare professionals (n = 6). A pilot survey among 200 ICU survivors assessed recruitment at one of five different stages after ICU discharge [(1) in hospital, (2) < 6 weeks, (3) 7 weeks to 6 months, (4) 7 to 12 months, or (5) 12 to 24 months post‐hospital discharge]; to assess reliability of the SNAC questionnaire; and to conduct exploratory data analysis. Reliability was determined using Cronbach's alpha for internal consistency; intraclass correlation coefficients for test–retest reliability. We explored correlations with sociodemographic variables using Pearson's correlation coefficient; differences between questionnaire scores and patient demographics using one‐way ANOVA. Results: The SNAC questionnaire consisted of 32 items that assessed five categories of support needs (informational, emotional, instrumental [e.g. practical physical help, provision of equipment or training], appraisal [e.g. clinician feedback on recovery] and spiritual needs). ICU survivors were recruited from Northern Ireland, England and Scotland. From a total of 375 questionnaires distributed, 202 (54%) were returned. The questionnaire had high internal consistency (0.97) and high test–retest reliability (r = 0.8) with subcategories ranging from 0.3 to 0.9. Conclusions: The SNAC questionnaire appears to be a comprehensive, valid, and reliable questionnaire. Further research will enable more robust examination of its properties e.g. factor analysis, and establish its utility in identifying whether patients' support needs evolve over time. Relevance to clinical practice: The SNAC questionnaire has the potential to be used to identify ICU survivors' needs and inform post‐hospital support services. [ABSTRACT FROM AUTHOR]

Background: A third of children admitted to paediatric intensive care units (PICUs) in the United Kingdom (UK) are transported by paediatric critical care transport services (PCCTs). Parents have described the transfer journey as particularly stressful. Critical care nurses have a key role in mitigating the impact of the journey on parents. Evaluating parents' experiences is important to inform service improvements. Aim and objectives: Our aim was to describe the development of a new measure of parents' experiences of PCCTs, derived from data collected in the Differences in access to Emergency Paediatric Intensive Care and care during Transport (DEPICT) study. Design: A descriptive cross‐sectional survey was used. Methods: As part of the DEPICT study, a 17‐item transport experience questionnaire was developed and given to parents of children transported by PCCTs to 24 UK PICUs during a 12‐month period. Analyses included exploratory factor analysis and a validation review by a PCCT stakeholder group. Results: Families of 1722 children (1798 journeys) completed questionnaires. Five items were excluded from further analysis as correlation coefficients were <0.3. Two factors explained 53% of the variance and all 12 items loaded on one of these factors. Factor 1 (8 items) explained 47% of the variance, had excellent internal reliability and the clustered items were conceptually coherent with a specific relevance to PCCTs; these were offered for consideration, with other items possibly discarded. Twenty‐eight PCCT clinicians reviewed the questions. Using a 70% agreement threshold, one additional, previously discarded, item was identified for inclusion, resulting in a nine‐item experience measure. Conclusion: Our brief measure of parents' experience of critical care transport provides a standardized measure that can be used across all PCCTs, enabling national benchmarking of services and potentially increasing the collection and use of parent experience data to improve services. Relevance to clinical practice: Being able to measure experience provides an opportunity to understand how to make services better to improve experience. [ABSTRACT FROM AUTHOR]

Background and Aims: The three-question Alcohol Use Disorders Identification Test (AUDIT-C) is frequently used in healthcare for screening and brief advice about levels of alcohol consumption. AUDIT-C scores (0-12) provide feedback as categories of risk rather than estimates of actual alcohol intake, an important metric for behaviour change. The study aimed to (i) develop a continuous metric from the Extended AUDIT-C expressed in United Kingdom (UK) units (8 g pure ethanol), offering equivalent accuracy, and providing a direct estimator of weekly alcohol consumption (EWAC) and (ii) evaluate the EWAC's bias and error using the graduated-frequency (GF) questionnaire as a reference standard of alcohol consumption. Design: Cross-sectional diagnostic study based on a nationally-representative survey. Settings: Community dwelling households in England. Participants: A total of 22 404 household residents aged =16 years reporting drinking alcohol at least occasionally. Measurements: Computer-assisted personal interviews consisting of (i) AUDIT questionnaire with extended response items (the 'Extended AUDIT') and (ii) GF. Primary outcomes were: mean deviation <1 UK unit (metric of bias); root-mean-square deviation <2 UK units (metric of total error) between EWAC and GF. The secondary outcome was the receiver operating characteristic area under the curve for predicting alcohol consumption in excess of 14 and 35 UK units. Findings: EWAC had a positive bias of 0.2 UK units (95% CI = 0.08, 0.4) compared with GF. Deviations were skewed: whereas the mean error was 11 UK units/week [9.5, 11.9], in half of participants the deviation between EWAC and GF was between 0 and 2.1 UK units/week. EWAC predicted consumption in excess of 14 UK units/week with a significantly greater area under the curve (0.918 [0.914, 0.923]) than AUDIT-C (0.870 [0.864, 0.876]) or the full AUDIT (0.854 [0.847, 0.860]). Conclusions: A new estimator of weekly alcohol consumption, which uses answers to the Extended AUDIT-C, meets the targeted bias tolerance. It is superior in accuracy to AUDIT-C and the full 10-item AUDIT when predicting consumption thresholds, making it a reliable complement to the Extended AUDIT-C for health promotion interventions. [ABSTRACT FROM AUTHOR]

Aims and objectives: The cumulative time that critical care nurses spend implementing a tight glycaemic control (TGC) protocol was estimated in a time-in-motion (TiM) study conducted in a hospital in the UK. Background: TGC protocols were introduced to the critical care setting to reduce hyperglycaemic events in high-risk patients. The time burden to critical care nurses of implementing such protocols has not yet been studied in the UK. Design: A prospective TiM pilot study was conducted in an eligible UK intensive care unit by four protocol-trained observers over five consecutive weekdays from 3 to 7 November 2008. Three nurses were also interviewed on site to gather their attitudes and perceptions about the benefits of and time associated with administering a TGC protocol. Methods: Independent observers shadowed nurses, observing when a blood glucose measurement was taken, when each predefined subtask was completed and the duration of each task. Semistructured interviews with nurses were conducted in-person and one-on-one by a trained study member. Results: Considered together, the episodic median duration of all TGC activities was 6·65 min. Across a total shift, nurses devoted approximately 7% of their time to administering a TGC protocol. Nurses perceived that a TGC protocol is beneficial to patient safety and outcomes in a critical care setting but acknowledged that the tasks can be mildly to moderately tedious. Conclusions: This TiM analysis indicated that the additional responsibility of implementing a TGC protocol represents a substantive commitment of nursing time in a critical care setting. Relevance to clinical practice: The episodic data of our pilot study in the UK contributes further evidence that TGC protocols may be arduous to maintain and constitute a substantial investment of nursing time. [ABSTRACT FROM AUTHOR]

Background: Our study aimed to evaluate to what extent Zero2 Expo's 'Birthing a Better Future', a co‐created multimedia exhibition, was effective in raising awareness on the importance of the first 1001 days of life and explore what refinements would help to optimize the impact of future exhibitions. Methods: We conducted a mixed‐methods evaluation of the exhibition delivered in the John Radcliffe Hospital, Oxford. Through convenience sampling, 14 participants were selected to participate in 12 structured interviews and 19 participants completed a questionnaire. Interviews were thematically analysed alongside quantitative analysis of questionnaire responses through Likert scales. Results: The majority (78.6%, n = 11/14) of participants who completed the questionnaire either agreed or strongly agreed that the exhibition raised their awareness about the first 1001 days of life. This was supported by the analysis of interviews. The use of art was found to provoke an emotional engagement from participants. Participants felt that the length of the written pieces and location of the exhibition were important factors for designers to consider in future exhibitions. Conclusion: This study demonstrated that multimedia exhibitions, combining science with art, may be an effective way to raise awareness of public health messages. Engaging with key stakeholders will be an essential step in order to improve future public health exhibitions. Public Contribution: When designing the study, the public reviewed the study tools, which were refined based on their feedback. At every phase of the study, members of the public who are artists co‐created the exhibition content. [ABSTRACT FROM AUTHOR]

There has been little previous research regarding the effectiveness of ethics education interventions for residential care‐givers. The Researching Interventions to Promote Ethics in social care project responded to the question: Which is the most effective ethics education intervention for care‐givers in residential social care? A pragmatic cluster trial explored the impact of three ethics education interventions for: (a) interactive face‐to‐face ethics teaching; (b) reflective ethics discussion groups; and (c) an immersive simulation experience. There was also a control arm (d). 144 trial participants were recruited from 39 residential care homes for older people in southern England. Change scores compared across intervention arms showed a significant reduction in work‐related moral stress in the teaching arm compared with control group (p =.03); there were no significant differences between control and intervention arms in change scores for moral sensitivity, interpersonal reactivity (empathy) or ethical leadership. Qualitative data themes were as follows: ethical care; care challenges; and ethical care inhibitors. Overall findings stimulate reflection on the value of three different ethics education interventions and the most appropriate means to evaluate their impact. Findings suggest the complexity and diverse nature of ethical competence in care. We suggest a way forward for research evaluating ethics education. [ABSTRACT FROM AUTHOR]

This study aimed to implement and evaluate a work‐based personal resilience enhancement intervention for forensic nurses. A mixed methods design consisting of surveys, interviews, and a case study approach, whereby the experiences of a group of nurses were studied in relation to their experiences of an intervention programme to enhance personal resilience, was utilized. Nurses working on forensic inpatient wards were invited to participate. Senior nurses were recruited as mentors. Data were collected via pre‐ and post‐programme surveys to evaluate nurses' levels of resilience. Post‐programme interviews were undertaken with nurses and mentors to explore their experiences of the programme. Descriptive statistics of survey data examined changes in nurses' resilience levels pre‐ and post‐intervention. Free‐text survey data and interview data were analysed thematically. The SQUIRE 2.0 checklist was adhered to. Twenty‐nine nurses participated. Levels of personal resilience (M = 4.12, SD = 0.60) were significantly higher post‐programme than pre‐programme (M = 3.42, SD = 0.70), (t49 = 3.80, P = 0.000, 95% CI = 0.32, 1.07). Nurses felt the programme had a marked impact on their personal resilience, self‐awareness, confidence, and professional relationships. The benefits of the programme demonstrate the advantages of providing a nurturing environment for nurses to consolidate their resilience levels. Findings demonstrated that resilience enhancement programmes can increase nurses' levels of resilience and confidence and improve inter‐professional relationships. Our findings are important for clinicians, nurse managers, and policymakers considering strategies for improving the workplace environment for nurses. The long‐term impact of resilience programmes may improve nurse retention and recruitment. [ABSTRACT FROM AUTHOR]

Objective: To evaluate factors affecting unselected population-based BRCA testing in Ashkenazi Jews (AJ).Design: Cohort-study set within recruitment to the GCaPPS trial (ISRCTN73338115).Setting: North London AJ population.Population or Sample: Ashkenazi Jews women/men >18 years, recruited through self-referral.Methods: Ashkenazi Jews women/men underwent pre-test counselling for BRCA testing through recruitment clinics (clusters). Consenting individuals provided blood samples for BRCA testing. Data were collected on socio-demographic/family history/knowledge/psychological well-being along with benefits/risks/cultural influences (18-item questionnaire measuring 'attitude'). Four-item Likert-scales analysed initial 'interest' and 'intention-to-test' pre-counselling. Uni- and multivariable logistic regression models evaluated factors affecting uptake/interest/intention to undergo BRCA testing. Statistical inference was based on cluster robust standard errors and joint Wald tests for significance. Item-Response Theory and graded-response models modelled responses to 18-item questionnaire.Main Outcome Measures: Interest, intention, uptake, attitude towards BRCA testing.Results: A total of 935 individuals (women = 67%/men = 33%; mean age = 53.8 (SD = 15.02) years) underwent pre-test genetic-counselling. During the pre-counselling, 96% expressed interest in and 60% indicated a clear intention to undergo BRCA testing. Subsequently, 88% opted for BRCA testing. BRCA-related knowledge (P = 0.013) and degree-level education (P = 0.01) were positively and negatively (respectively) associated with intention-to-test. Being married/cohabiting had four-fold higher odds for BRCA testing uptake (P = 0.009). Perceived benefits were associated with higher pre-counselling odds for interest in and intention to undergo BRCA testing. Reduced uncertainty/reassurance were the most important factors contributing to decision-making. Increased importance/concern towards risks/limitations (confidentiality/insurance/emotional impact/inability to prevent cancer/marriage ability/ethnic focus/stigmatisation) were significantly associated with lower odds of uptake of BRCA testing, and discriminated between acceptors and decliners. Male gender/degree-level education (P = 0.001) had weaker correlations, whereas having children showed stronger (P = 0.005) associations with attitudes towards BRCA testing.Conclusions: BRCA testing in the AJ population has high acceptability. Pre-test counselling increases awareness of disadvantages/limitations of BRCA testing, influencing final cost-benefit perception and decision-making on undergoing testing.Tweetable Abstract: BRCA testing in Ashkenazi Jews has high acceptability and uptake. Pre-test counselling facilitates informed decision-making. [ABSTRACT FROM AUTHOR]

Background: Reciprocal relationships between researchers and patient and public involvement (PPI) contributors can enable successful PPI in research. However, research and anecdotal evidence suggest that researchers do not commonly provide feedback to PPI contributors thus preventing them from knowing whether, how or where their contributions were useful to researchers and research overall. Aims: The aim of this study was to explore the variation, types, importance of, and satisfaction with feedback given by researchers to PPI contributors in six PPI groups in England, and identify the barriers to the process of feedback. Methods: An explanatory mixed methods sequential study design with a questionnaire survey followed by semi‐structured interviews with researchers and PPI contributors in six PPI groups. PPI contributors were involved in all stages of the research process. Results: Researchers do not routinely give feedback to PPI contributors. Feedback was found to have different meanings: an acknowledgement, impact and study success and progress. PPI contributors who receive feedback are motivated for further involvement; it supports their learning and development and prompts researchers to reflect on PPI impact. The importance of the role of a PPI lead or coordinator to facilitate the process of providing feedback was also highlighted. Conclusion: This study found no generic way to give feedback indicating that mutual feedback expectations should be discussed at the outset. PPI feedback needs to become integral to the research process with appropriate time and resources allocated. PPI feedback can be seen as a key indicator of mature, embedded PPI in research. [ABSTRACT FROM AUTHOR]

Abstract: Background: In response for the need of a freely available, stand‐alone, validated outcome measure for use within musculoskeletal (MSK) physiotherapy practice, sensitive enough to measure clinical effectiveness, we developed an MSK patient reported outcome measure. Objectives: This study examined the validity and reliability of the newly developed Brighton musculoskeletal Patient‐Reported Outcome Measure (BmPROM) within physiotherapy outpatient settings. Methods: Two hundred twenty‐four patients attending physiotherapy outpatient departments in South East England with an MSK condition participated in this study. The BmPROM was assessed for user friendliness (rated feedback, N = 224), reliability (internal consistency and test–retest reliability, n = 42), validity (internal and external construct validity, N = 224), and responsiveness (internal, n = 25). Results: Exploratory factor analysis indicated that a two‐factor model provides a good fit to the data. Factors were representative of “Functionality” and “Wellbeing”. Correlations observed between the BmPROM and SF‐36 domains provided evidence of convergent validity. Reliability results indicated that both subscales were internally consistent with alphas above the acceptable limits for both “Functionality” (α = .85, 95% CI [.81, .88]) and ‘Wellbeing’ (α = .80, 95% CI [.75, .84]). Test–retest analyses (n = 42) demonstrated a high degree of reliability between “Functionality” (ICC = .84; 95% CI [.72, .91]) and “Wellbeing” scores (ICC = .84; 95% CI [.72, .91]). Further examination of test–retest reliability through the Bland–Altman analysis demonstrated that the difference between “Functionality” and “Wellbeing” test scores did not vary as a function of absolute test score. Large treatment effect sizes were found for both subscales (Functionality d = 1.10; Wellbeing 1.03). Conclusion: The BmPROM is a reliable and valid outcome measure for use in evaluating physiotherapy treatment of MSK conditions. [ABSTRACT FROM AUTHOR]

Abstract: In response to pressures on mental health inpatient beds and a perceived ‘crisis in acute care’, Crisis Resolution Teams (CRTs), acute home treatment services, were implemented nationally in England following the NHS Plan in the year 2000: an unprecedentedly prescriptive policy mandate for three new types of functional community mental health team. We examined the effects of this mandate on implementation of the CRT service model. Two hundred and eighteen CRTs were mapped in England, including services in all 65 mental health administrative regions. Eighty‐eight percent (n = 192) of CRT managers in England participated in an online survey. CRT service organization and delivery was highly variable. Nurses were the only professional group employed in all CRT staff teams. Almost no teams adhered fully to government implementation guidance. CRT managers identified several aspects of CRT service delivery as desirable but not routinely provided. A national policy mandate and government guidance and standards have proved insufficient to ensure CRT implementation as planned. Development and testing of resources to support implementation and monitoring of a complex mental health intervention is required. [ABSTRACT FROM AUTHOR]

A new version of the EQ-5D, the EQ-5D-5L, is available. The aim of this study is to produce a value set to support use of EQ-5D-5L data in decision-making. The study design followed an international research protocol. Randomly selected members of the English general public completed 10 time trade-off and 7 discrete choice experiment tasks in face-to-face interviews. A 20-parameter hybrid model was used to combine time trade-off and discrete choice experiment data to generate values for the 3,125 EQ-5D-5L health states. Valuation data are available for 996 respondents. Face validity of the data has been demonstrated, with more severe health states generally given lower values. Problems with pain/discomfort and anxiety/depression received the greatest weight. Compared to the existing EQ-5D-3L value set, there are considerably fewer "worse than dead" states (5.1%, compared with over one third), and the minimum value is higher. Values range from -0.285 (extreme problems on all dimensions) to 0.950 (for health states 11211 and 21111). Results have important implications for users of the EQ-5D-5L both in England and internationally. Quality-adjusted life year gains from interventions seeking to improve very poor health may be smaller using this value set and may previously have been overestimated. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of nurse-led telephone follow-up (TFU) for patients with stage-I endometrial cancer.Design: Multicentre, randomised, non-inferiority trial.Setting: Five centres in the North West of England.Sample: A cohort of 259 women treated for stage-I endometrial cancer attending hospital outpatient clinics for routine follow-up.Methods: Participants were randomly allocated to receive traditional hospital based follow-up (HFU) or nurse-led TFU.Main Outcome Measures: Primary outcomes were psychological morbidity (State Trait Anxiety Inventory, STAI-S) and patient satisfaction with the information provided. Secondary outcomes included patient satisfaction with service, quality of life, and time to detection of recurrence.Results: The STAI-S scores post-randomisation were similar between groups [mean (SD): TFU 33.0 (11.0); HFU 35.5 (13.0)]. The estimated between-group difference in STAI-S was 0.7 (95% confidence interval, 95% CI -1.9 to 3.3); the confidence interval lies above the non-inferiority limit (-3.5), indicating the non-inferiority of TFU. There was no significant difference between groups in reported satisfaction with information (odds ratio, OR 0.9; 95% CI 0.4-2.1; P = 0.83). Women in the HFU group were more likely to report being kept waiting for their appointment (P = 0.001), that they did not need any information (P = 0.003), and were less likely to report that the nurse knew about their particular case and situation (P = 0.005).Conclusions: The TFU provides an effective alternative to HFU for patients with stage-I endometrial cancer, with no reported physical or psychological detriment. Patient satisfaction with information was high, with similar levels between groups.Tweetable Abstract: ENDCAT trial shows effectiveness of nurse-led telephone follow-up for patients with stage-I endometrial cancer. [ABSTRACT FROM AUTHOR]

There are an increasing, but limited, number of studies investigating the benefits of mindfulness interventions for people experiencing psychosis. To our knowledge, changes following mindfulness for psychosis have not yet been explored from a personal construct perspective. This study had two main aims: (i) to explore changes in the way a person construes their self, others and their experience of psychosis following a Mindfulness-Based Cognitive Therapy (MBCT) group; and (ii) to replicate the findings of other studies exploring the feasibility and potential benefits of MBCT for psychosis. Sixteen participants, with experience of psychosis, completed an 8-week MBCT group. Participants completed pre-group and post-group assessments including a repertory grid, in addition to a range of outcome measures. There was some evidence of changes in construing following MBCT, with changes in the way participants viewed their ideal self and recovered self, and an indication of increased self-understanding. Improvements were found in participants' self-reported ability to act with awareness and in recovery. This study demonstrates the feasibility and potential benefits of MBCT groups for people experiencing psychosis. Furthermore, it provides some evidence of changes in construal following MBCT that warrant further exploration. Large-scale controlled trials of MBCT for psychosis are needed, as well as studies investigating the mechanisms of change. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message MBCT may contribute to change in individuals' perceptions and increase self-understanding., The study highlights the importance of measuring change in recovery following MBCT., Findings support the need for person-centred approaches to assessment and monitoring of personal change following therapy., Similar studies using a control group are needed in order to identify whether the changes found are attributable to participation in an MBCT group., Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives Research has suggested that the extent to which voices (i.e., auditory verbal hallucinations) are experienced as distressing might be influenced by negative beliefs about voices as well as maladaptive metacognitive styles involving the negative appraisal and maladaptive control of mental experiences. This cross-sectional study examined the contribution of both specific appraisals of voices and a metacognitive factor (i.e., experiential avoidance) to voice-related distress. Methods Self-report measurers of voice characteristics (voice frequency, duration as well as amount and intensity of voice-related distress), experiential avoidance, and appraisals of voices were collected in a sample of 101 voice-hearers. Results Experiential avoidance and negative beliefs about voices were associated with higher levels of voice-related distress, but not to measures of voice frequency and duration. Experiential avoidance and negative 'metaphysical' beliefs about voices were significant predictors of voice-related distress even after accounting for the effect of frequency and duration of voices, and explained similar proportions of unique variance in distress. Conclusions These findings suggest that the appraisals of voices and experiential avoidance are predictive of voice-related distress and that cognitive-behavioural interventions targeting both voice-specific appraisals and general maladaptive metacognitive processes could prove useful treatment approaches for clients with distressing voices. Practitioner points Experiential avoidance ( EA) and negative appraisals predict voice-related distress caused by voices, but not their frequency and duration., Interventions for voices should consider targeting EA and negative appraisals (e.g., cognitive-behavioural therapy, Acceptance and Commitment Therapy) to ameliorate distress. [ABSTRACT FROM AUTHOR]

About 15–20% of hospital inpatients are catheterized, and it has been estimated that in an average sized hospital 10–15 patients will die each year from catheter‐related sepsis. Reducing catheterization rates or indwell times has been shown to reduce associated sepsis. This study examined patient experience of catheterization; the rationale for the study was to broaden understanding of catheter impact as part of a wider quality improvement agenda. Fifty patients completed a detailed catheter‐experience patient questionnaire. The patients were all inpatients from 17 wards across a range of specialties. Data were sought on demographics, catheter status, experience and their knowledge of and involvement in the catheter care. Fifty percent gender split. Median catheter time was 5 d (range 2 h to long term). Median age 72 years (range 22–92). Thirty‐four percent (n = 17) of patients did not have the process and options discussed before catheterization. Eighteen percent did not know why they were catheterized. Patients experienced leaking (32%), ‘pain’ (26%), inconvenience (26%), embarrassment (24%), blocking (24%) with 8% finding their catheters ‘restrictive’. Fourteen percent felt they could have coped without the catheter. Urinary catheters have a profound and often negative effect on the inpatient experience. This information can help support and empower colleagues to push for less urinary catheter use in the non‐urological inpatient population and start to better understand the patient experience. [ABSTRACT FROM AUTHOR]

Prostate cancer is the most common cancer in men in the UK accounting for 25% of all new cases of cancer. It is predicted to become the most common cancer overall by 2030. A national survey of the specialist nursing workforce caring for men with prostate cancer was completed across the four countries of the UK during June and July 2014. In total 302 specialist nurses completed the survey and data from 285 was used in the analysis. This is the biggest whole population survey of this workforce in recent years. The most common job title was clinical nurse specialist (185) and the most common band was agenda for change band 7 (174). However in Scotland 50% of the respondents stated that they were paid on band 6. Over half the group (158) had worked in prostate cancer care for more than 10 years. Few (48) had come into specialist posts from a specific specialist nurse development role. There is wide geographic variation in the provision of specialist nursing for men with prostate cancer. This is reflected in available hours and caseload sizes. The respondents reported frozen and vacant posts across the UK. This equated to 58·3 full time equivalents. The work of specialist nurses caring for men with prostate cancer is clinically complex and appears to cover most key times in the cancer journey. However workload appears to be limiting the care that the nurses are able to provide with over half the respondents (163) saying that they left work undone for patients. [ABSTRACT FROM AUTHOR]

The article presents a study which aims to gather feedback from primary care patients on their experiences and perceptions of the care provided by nurse independent prescribers (NIPs) and pharmacist independent prescribers (PIPs). The researchers detail the study design using cross-sectional postal surveys on patients by NIPs or PIPs in England. It reveals that patients do not experience any difference in the quality and safety of care provided.

The article presents a study which aims to explore the acceptability of antenatal enquiry for domestic abuse from the perspective of women using maternity services. The researchers detail the multimethod approach in data collection procedure and outcomes. It implies that women patients support and have positive views of antenatal enquiry for domestic abuse in healthcare settings.

The article presents the research that investigates the implications of patients' varied information requirements and socio-demographic attributes on their choice of healthcare institutions in Great Britain. The topics discussed include the factors that influence patients' choice of hospitals and the reasons why some patients decided to switch hospitals and healthcare providers.

The views of children diagnosed with ADHD have, until recently, largely been neglected in research, policy and practice. This article focuses on qualitative research which explored children's lived experience, drawing attention to the ways that they actively 'take' responsibility for managing their physical, psychological and emotional well-being within the constraints of a medical diagnosis. The neglect of a tradition which asks children about their own experiences of ADHD is crucially bound up with children's low social and political status in UK society and notions of competency and responsibility in relation to ADHD. [ABSTRACT FROM AUTHOR]

Background In recent years, patient-focused interventions have been introduced aimed at increasing patient involvement in safety-related behaviours. However, patients' attitudes towards these interventions and comfort in participating in the recommended behaviours remain largely unexplored. Objective To evaluate patients' attitudes towards a video and leaflet aimed at encouraging patient involvement in safety-related behaviours. Design Two exploratory studies employing a within-subjects mixed-methods design. Setting Six hospital wards on an inner-city London teaching hospital. Participants Medical and surgical inpatients: 80 patients in study 1 (mean age 55; 69% men) and 80 patients in study 2 (mean age 52; 60% men). Intervention Patients watched the PINK patient safety video (study 1) or read the National Patient Safety Agency's 'Please Ask' about staying in hospital leaflet (study 2). Main outcome measures Perceived comfort in participating in safety-related behaviours; attitudes towards the video or leaflet. Results Both video and leaflet increased patients' perceived comfort in engaging in some (but not all) safety-related behaviours ( P < 0.05). In both studies, the majority of patients questioned whether the intervention could help to reduce medical errors in health care. Suggestions on how the video/leaflet could be improved mainly related to content and layout. Conclusion Video and leaflet could be effective at encouraging patient involvement in some safety-related behaviours. Further in-depth research on patients' attitudes towards different educational materials is required to help inform future policies and interventions in this very important but under-researched area. [ABSTRACT FROM AUTHOR]

Objective To investigate hospital patients' reports of undesirable events in their health care. Design Cross-sectional mixed methods design. Participants A total of 80 medical and surgical patients (mean age 58, 56 male). Intervention Patients were interviewed post-discharge using a survey to assess patient reports of errors or problems in their care. Patients' medical records and notes were also reviewed. Main outcome measures Frequency of health care process problems, medical complications and interpersonal problems, and patient willingness to report an undesirable event in their care. Results In total, 258 undesirable events were reported (rate of 3.2 per person), including 136 interpersonal problems, 90 medical complications and 32 health care process problems. Patients identified a number of events that were reported in the medical records (30 out of 36). In addition, patients reported events that were not recorded in the medical records. Patients were more willing ( P < 0.05) to report undesirable events to a researcher (as in the present case) than to a local or national reporting system. Conclusion Patients appear able to report undesirable events that occur in their health care management over and above those that are recorded in their medical records. However, patients appear more willing to report these incidents for the purpose of a study rather than to an established incident reporting system. Interventions aimed at educating and encouraging patients about incident reporting systems need to be developed in order to enhance this important contribution patients could make to improving patient safety. [ABSTRACT FROM AUTHOR]

Introduction The concept of participation was introduced by the World Health Organisation in the International Classification of Functioning, Disability and Health, 2001. Instruments to measure participation have been developed for children and adults, but none specifically for adolescents. Adolescence is a life stage with distinct patterns of participation, and previous research has shown that young people with disabilities have poorer participation than the general population. The aim of this study was to develop a measure of participation frequency, covering all major domains, for young people with cerebral palsy ( CP). CP was chosen as an exemplar because it is a significant cause of disability in young people, with affected individuals experiencing a range of different impairments of varying severity. Methods A pool of 88 items was developed using the published literature, existing measures and qualitative data from young people. The item pool was revised following expert review by 17 experts. Cognitive interviews on the items were carried out with 12 young people and 12 carers; field-testing was then undertaken with 107 young people with CP aged 13-21 years, and 540 young people from the general population to enable item reduction and to examine reliability and construct validity. Results The content review resulted in a 92-item draft questionnaire, content validity index of 93%. Cognitive interviews led to further wording changes. Following field-testing, the questionnaire was shortened to 45 items. Known-groups validity was demonstrated by correlation with impairment severity. Test-retest reliability was satisfactory for all domains. Internal consistency varied between domains. Conclusion This is the first instrument developed specifically to measure frequency of participation across multiple domains for young people with disability. Use of the questionnaire in research and clinical work will enable its properties to be better understood and its generalizability to wider groups to be clearer. [ABSTRACT FROM AUTHOR]

Our re-analysis of census data shows that 95% of kinship arrangements are 'informal', i.e. made outside the formal child welfare system. Interviews with 80 children aged 8-18 years in informal kinship care and their carers showed that most children were well attached to their kin carers, but one-third had been taunted or bullied because they did not live with their parents. Many children tightly controlled who knew about this potentially stigmatizing information. Most children had good numbers of adults and children in their social networks, and for three-fifths, their parents were still key figures in their lives. The children who regarded few people as very important to them significantly more often lived with older kin carers (many of whom were in poor health), were more often anxious and depressed, and did not talk about their living situation to others. A considerable number of children worried about their carers' poor health and about their own future if they died. The significance of these findings for statutory and voluntary services is discussed. [ABSTRACT FROM AUTHOR]

Background Treatment trials that enquire into parents' and teachers' views on speech-language interventions and outcomes for primary school-age children are relatively rare. The current study sought perceptions of the process of intervention and value placed on outcomes resulting from a trial of intervention, the Social Communication Intervention Project (SCIP), for children with communication disorders characterized by persistent needs in pragmatics and social use of language. Aims Aims: To describe parent and teacher views around the process and experience of participating in SCIP intervention, including aspects of collaborative practice; and to gain understanding of parents' and teachers' perceptions of communication outcomes for children who had received intervention. Methods & Procedures Parents and teachers of eight children in the intervention arm of the SCIP study participated in semi-structured interviews with a researcher within 2 months of completion of SCIP intervention. The framework method of analysis was used to explore predetermined themes based around a list of topics informed by previous thinking and experience of the research. Outcomes & Results Parents and teachers perceived liaison with the SCIP speech and language therapist as being an important element of the intervention. Indirect approaches to liaison with parents were perceived as effective in transferring information as were brief meetings with teachers. Teachers and parents were able to make explicit links between therapy actions and perceived changes in the child. Work on comprehension monitoring and emotional vocabulary was perceived to be particularly effective with respect to communication outcomes. Parents also reflected that they had adopted different strategies towards communication and behaviour in the home as a result of intervention. The limits of potential change in terms of child communication in areas such as non-verbal communication and pragmatic skills were discussed by parents. Conclusions & Implications This analysis has contributed essential information to the evaluation of SCIP by describing the experience of the intervention as delivered, exploring processes of effective implementation and change in the school setting and by describing the value placed on different outcomes by parents and teachers. These findings can inform planning for collaborations between speech and language therapists and teachers and provide useful information about mechanisms of change in different components of the SCIP intervention which have not been individually evaluated before. Information on changes in children's communication skills which were perceived as meaningful to those living and working with the children daily is crucial to the acceptance and translation of the SCIP intervention into practice. [ABSTRACT FROM AUTHOR]

Based on 65 interviews with professionals and parents conducted during 2007-2008, this 16-month, mainly qualitative evaluation of Parentline Plus' Time to Talk Community Programme (a preventative initiative within England's teenage pregnancy strategy) found that a community development approach and an ethos of partnership with parents and professionals facilitated engagement. Respectful and realistic implementation involved skilled workers building relationships of trust. By consulting with other professionals and parents it was possible to establish local need and to build on existing provision. Initially, insufficient prior local consultation and negotiation created perceptions of an imposed initiative, led by outsiders, resulting in wary local parents and professionals. The engagement and evaluation processes are considered in relation to the short-term nature of the initiative and potential conflicts between responding flexibly to the needs of parents and delivering targeted programmes. [ABSTRACT FROM AUTHOR]

Context: The long-term sustainability of whole-system change programs is rarely studied, and when it is, it is inevitably undertaken in a shifting context, thereby raising epistemological and methodological questions. This article describes a transferable methodology that was developed to guide the evaluation of a three-year follow-up of a large health care change program in London, which took place during a period of economic turbulence and rapid policy change. Method: Using a mixed-method organizational case study design, we studied three services (stroke, kidney, and sexual health) across primary and secondary care. Each had received £5 million (US$7.8 million) in modernization funding in 2004. In 2010/2011, we gathered data on the services and compared them with data from 2004 to 2008. The new data set contained quantitative statistics (access, process, and outcome metrics), qualitative interviews with staff and patients, documents, and field notes. Our data analysis was informed by two complementary models of sustainability: intervention-focused (guided by the question, What, if anything, of the original program has been sustained?) and system-dynamic (guided by the question, How and why did change unfold as it did in this complex system?). Findings: Some but not all services introduced in the original transformation effort of 2004-2008 were still running; others had ceased or been altered substantially to accommodate contextual changes (e.g., in case mix, commissioning priorities, or national policies). Key cultural changes (e.g., quality improvement, patient centeredness) largely persisted, and innovative ideas and practices had spread elsewhere. To draw causal links between the original program and current activities and outcomes, it was necessary to weave a narrative thread with multiple intervening influences. In particular, against a background of continuous change in the local health system, the sustainability of the original vision and capacity for quality improvement was strongly influenced by (1) stakeholders' conflicting and changing interpretations of the targeted health need; (2) changes in how the quality cycle was implemented and monitored; and (3) conflicts in stakeholders' values and what each stood to gain or lose. Conclusions: The sustainability of whole-system change embodies a tension between the persistence of past practice and the adaptation to a changing context. Although the intervention-focused question, What has persisted from the original program? (addressed via a conventional logic model), may be appropriate, evaluators should qualify their findings by also considering the system-dynamic question, What has changed, and why? (addressed by producing a meaningful narrative). [ABSTRACT FROM AUTHOR]

ABSTRACT Background A model of psychologically informed offender management for high risk of harm offenders with personality disorder (PD) was piloted, in which NHS psychologists worked alongside London probation staff. Aim The aim of the study was to evaluate the initiatives taken to develop probation staff's capability to work effectively with the group of offenders. Method Self-report measures assessing competency for working with PD and team climate were administered to the probation staff ( N = 150) at baseline and at 1 year follow-up. At follow-up, qualitative data was also collected from a subset of Public Protection Unit staff ( N = 17), evaluating their experience of the project. Results The probation staff significantly improved across a range of generic and forensic PD-related competencies. The largest improvements were found in the Public Protection Unit, which received the highest level of support. There was also a significant improvement in one facet of team climate (team vision). The qualitative findings suggested that the primary areas of skills development were in the participants' understanding of PD and their capacity to identify PD and to develop treatment and management pathways. Conclusions The results provide evidence for the effectiveness of the project model that supports its implementation on a broader scale. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Current guidelines recommend that infants are exclusively breast fed for the first 6 months of life, with particular solid foods being gradually introduced from 6 months. Our objective was to compare the growth of infants whose feeding most closely followed current guidelines with the growth of infants with other feeding practices. Participants were 1740 infants in a prospective cohort study in Southampton, UK. At 6 and 12 months, infants’ milk feeding was recorded, diets assessed using food frequency questionnaires (FFQ), and anthropometry performed. Principal components analysis was used to identify patterns of foods in the diet using the food intakes assessed by the FFQs. Two patterns (‘infant guidelines’ and ‘adult foods’) explained most variance in infant diet at 6 and 12 months of age. The main outcomes were conditional growth in weight, length and skinfold thickness from 0–6 and 6–12 months. Infants who were breast fed from 0–6 months gained weight, length and adiposity more slowly than formula-fed infants, independent of age at introduction of solids and maternal factors: compared with infants who were breast fed from 0–6 months, formula-fed infants gained 0.21 standard deviation scores (SDS) in weight [95% confidence interval (CI) 0.00, 0.42]. Infants whose dietary pattern was most similar to current feeding guidelines, with high frequencies of fresh fruit and vegetables, home-prepared foods and breast milk, gained weight and skinfold thickness more rapidly from 6 to 12 months than other infants, independent of milk feeding, age at introduction of solids and maternal factors. Compared with infants in the lowest quarter, infants in the highest ‘infant guidelines’ score quarter gained 0.24 SDS [95% CI 0.06, 0.43] in weight and 0.26 SDS [95% CI 0.07, 0.45] in skinfold thickness. Conversely, infants whose diets had the highest frequencies of breads and processed foods gained weight less rapidly from 6 to 12 months than other infants. The extent to which the patterns of diet and growth we have described will influence the current or later health of infants is unknown. We are following up the infants in this study to assess the impact of these patterns beyond the first year of life. These associations should also be examined in other settings and populations. [ABSTRACT FROM AUTHOR]