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Background: Person-centred care is a growing imperative in healthcare, but the documentation of person-centred care is challenging. According to the Gothenburg Framework of Person-centred Care, care should be documented in continuously revised care plans and based on patients’ personally formulated goals and resources to secure a continuous partnership. Objectives: This study aimed to examine care plans produced within a randomised controlled trial that tested a person-centred care intervention in older people with acute coronary syndrome. Nurses with training in the theory and practice of person-centred care had written the care plans. Methods: We conducted a secondary analysis of care plans developed in a randomised controlled trial for assessing person-centred care in patients with acute coronary syndrome (Myocardial Infarct [MI] or unstable angina pectoris). The study sample included 84 patients, with three care plans for each patient from inpatient (T1), outpatient (T2) and primary care (T3), that is, a total of 252 care plans. We conducted a descriptive quantitative content analysis of the care plans to examine the reported patients' life-world and medical/health resources and goals. Results: The analysis illustrates the differences and overlaps between life-world and medical/health goals and resources. The documented goals and resources change over time: life-world goals and resources decreased with time as medical/health goals and resources documentation increased. Conclusions: This paper illustrates that in the setting of a randomised controlled trial, nurses with training in person-centred care recorded fewer life-world and more medical/health goals over time. Placing life-world goals at the top of the goal hierarchy enables alignment with medical/health goals. Further research should explore whether the goals and resources documented in care plans accurately reflect patients' wishes as they transition along the care chain. Trial registration: Swedish regi

Background Countries are adapting their health and social care systems to better meet the needs of growing populations with (multiple) chronic conditions. To guide this process, assessment of the ‘patient experience’ is becoming increasingly important. For this purpose, the Person-Centred Coordinated Care Experience Questionnaire (P3CEQ) was developed in the United Kingdom, and translated into several languages. Aim This study aimed to assess the internal and construct validity of the Dutch P3CEQ to capture the experience of person-centred coordinated care of people with chronic conditions in the Netherlands. Participants and Methods Adults with chronic conditions (N = 1098) completed the Dutch P3CEQ, measures of health literacy and patient activation, and reported the use and perceived quality of care services. Data analysis included Principal Component and reliability analysis (internal validity), analysis of variance and Student's T-tests (construct validity). Results The two-component structure found was pretty much the same as in the UK validation study. Sociodemographic correlates also resembled those found in the United Kingdom. Women, persons who were less educated, less health-literate or less activated experienced less person-centred coordinated care. P3CEQ scores correlated positively with general practitioner performance scores and quality ratings of the total care received. Conclusion The Dutch P3CEQ is a valid instrument to assess the experience of person-centred coordinated care among people with chronic conditions in the Netherlands. Awareness of inequity and more attention to communication skills in professional training are needed to ensure that care professionals better recognize the needs of women, lower educated or less health-literate persons, and improve their experiences of care. Patient Contribution The P3CEQ has been developed in collaboration with a range of stakeholders.

The increasing popularity of the term ‘person‐centred’ in the healthcare literature and a wide range of ideals and practices it implies point to the need for a more inclusive and holistic healthcare provision. A framework developed in a Swedish context suggested narrative elicitation as a key practice in transition to person‐centred care. Initiating clinical communication by inviting people to tell their stories makes persistent yet often subtle problems in clinical communication visible. By drawing upon an observational study on narrative elicitation and vignette‐based focus group interviews with nurses, our aim is to trace ‘credibility deficits’ (Fricker 2007. Epistemic Injustice. Power and the Ethics of Knowing. Oxford: Oxford University Press) and ‘credibility excesses’ (Medina 2011, Social Epistemology, 25, 1, 15–35, 2013, The Epistemology of Resistance: Gender and Racial Oppression, Epistemic Injustice, and the Social Imagination. Oxford: Oxford University Press) in narrative elicitation. We argue that narrative elicitation may be one way to tackle epistemic injustices by giving voice to previously silenced groups, yet it is not enough to erase the effects of ‘credibility deficits’ in clinical communication. Rather than judging individual professionals’ success or failure in eliciting narratives, we underline some extrinsic problems of narrative elicitation, namely structural and positional inequalities reflecting on narrative elicitation and the credibility of patients. ‘Credibility excesses’ can be useful and indicative to better understand where they are missing.

Introduction: While several evaluation studies on (cost-)effectiveness of integrated care have been conducted in recent years, more insight is deemed necessary into integrated care from the perspective of service users. In the context of a European project on integrated care for older people living at home (SUSTAIN), this paper shares the experience and methodological reflections from applying a Patient Reported Experience Measure (PREM) on person-centred coordinated care -the P3CEQ- among this population. Methods: A combination of quantitative and qualitative data and analysis methods was used to assess the usability and the quality of applying a PREM among older people presenting complex care needs, using the P3CEQ delivery in SUSTAIN as a case study. 228 service users completed the P3CEQ and nine SUSTAIN researchers participated in a consultation about their experience administering the questionnaire. P3CEQ scores were analysed quantitatively using principal component analysis and multilevel linear regression. P3CEQ open responses and researcher notes collected when administering the questionnaire were thematically analysed. Results: Service user inclusion was high and most P3CEQ items had low non-response rates. Quantitative analysis and researcher experience indicate the relevance of face-to-face administration for obtaining such an amount of data in this population group. The presence of a carer increased inclusion of more vulnerable respondents, such as the cognitively impaired, but posed a challenge in data interpretation. Although several P3CEQ items were generally understood as intended by questionnaire developers, the analysis of open responses highlights how questions can lead to diverging and sometimes narrow interpretations by respondents. Cognitive impairment and a higher educational attainment were associated with lower levels of perceived person-centredness of care. Conclusion: his study shows essential pr

Background: Revitalized interest in narrative has informed some recent models of patient and person‐centred care. Yet, scarce attention has been paid to how narrative elicitation is actually used in person‐centred care practice and in which ways it is incorporated into clinical routine. Aim: We aimed to identify facilitators and barriers for narrative elicitation and setting goals in a particular example of person‐centred care practice (University of Gothenburg Centre for Person‐centred Care, GPCC) where narrative elicitation is considered as a method of setting goals for the patient. Methods: Observation of 14 admission interviews including narrative elicitation on an internal medicine ward in Sweden where person‐centred care was implemented. Five focus group vignette‐based interviews with nurses (n = 53) were conducted to assess confirmation of the emerging themes. Results: The inductive analysis resulted in three themes about the strategies to elicit patients' narratives: (a) Preparing for narrative elicitation, (b) Lingering in the patient's narrative, and (c) Co‐creating, that is, the practitioner's and third parties' engagement in the patient's narration. Even though there were obstacles to eliciting narratives and setting lifeworld goals in a medical setting, narrative elicitation was often useful to turn general and medical goals into more specific and personal goals. Conclusions: Narrative elicitation is neither a simple transition from traditional medical history taking nor a type of structured interview. It entails skills and strategies to be practiced. On the one hand, it revitalizes ethical considerations about clinical relationship building. On the other hand, it can help patients articulate lifeworld goals that are meaningful and important for themselves.

Art interpretation can make or break an individual’s experience in an art gallery. At its best, it can inspire a sense of connection, expanded understanding and excitement but, at its worst, it can leave visitors feeling baffled, frustrated or out of their depth. International literature indicates public responsibility, engagement and accessibility are essential to the new museology and new museum ethics, with audience-focused interpretation practices being led by heritage and museum professionals. Public art galleries also have a responsibility to create inclusive interpretation, yet, especially in New Zealand, the way they go about this is largely ungoverned, under-theorised and lacking systematic evaluation. Interpretation is one of the primary functions of public art galleries, therefore understanding how and why interpretation is currently done is essential in developing a critically reflective practice. Inspired by models overseas and addressing this lack of research about the topic, especially in the New Zealand context, this dissertation explores how galleries might enhance meaning, diversity and accessibility through audience-centric art interpretation. Taking three small-medium public art galleries in the Wellington region – the Dowse Art Museum, Pātaka Art + Museum and the Adam Art Gallery – as case studies, this dissertation investigates current practices, philosophies and training available to and demonstrated by gallery staff. Employing qualitative data collection methods, semi-structured interviews with the director and senior curator of each gallery were conducted using iterative, grounded theory approaches. As well as examining a wide range of international theoretical and professional literature, the research explores understandings of interpretation, audience needs and motivations, and strategies for interpretive planning and policy. This dissertation addresses a gap in the local literature by providing original research on interpretive practice.

This study aimed to identify and describe the motivators for underage, curbside drinking leading to antisocial behavior and to use these insights to develop a suitable intervention to tackle this. A cross-sectional study was conducted with youths and key stakeholders. “Street drinking” was identified as the most common recreational activity for youths and was motivated by a lack of appropriate leisure services, peer pressure and behavior, and the local accessibility of alcohol. Antisocial behavior was a major theme associated with street drinking. Few studies have examined the root causes of youth drinking and antisocial behavior. Our findings show that deprivation, social bonds, and the symbolic capital attached to alcohol along with its relative cost and availability enhance its appeal to the young, and provide some illumination to the relationship between these related problems.

OBJECTIVE: The correlates of parental burden in schizophrenia may differ between ethnic groups, but few studies have examined this in a UK setting. Our aim was to identify the correlates of burden in a UK sample of first-generation North Indian Punjabi Sikh parents and their white British counterparts. METHOD: Test the association of burden with a series of clinical, social and service use variables and control for potential confounding factors in a model predicting drivers of burden in a combined sample of the above. RESULTS: The strongest correlates of burden were patient symptoms and parental distress. Differences in correlates of burden between the groups emerged when individual components of service use and parental social network were tested. The group comparisons also revealed differences in expressed emotion (EE) and social networks. CONCLUSION: The similarities in sources of burden between the groups could be explained by a commonality of sociocultural and economic experience, resulting from the successful acculturation and affluence of this British Sikh group. The differences between the groups may be related to enduring cultural factors such as kin support, since larger family groups were associated with low burden in the British Sikh group. The nature of EE in this British Sikh group may explain why it was not associated with burden in this sample.

In this article, we present an exemplar of the initial theory-building phase of theory-driven evaluation for the PARTNERS2 project, a collaborative care intervention for people with experience of psychosis in England. Initial theory-building involved analysis of the literature, interviews with key leaders and focus groups with service users. The initial programme theory was developed from these sources in an iterative process between researchers and stakeholders (service users, practitioners, commissioners) involving four activities: articulation of 442 explanatory statements systematically developed using realist methods; debate and consensus; communication; and interrogation. We refute two criticisms of theory-driven evaluation of complex interventions. We demonstrate how the process of initial theory-building made a meaningful contribution to our complex intervention in five ways. Although time-consuming, it allowed us to develop an internally coherent and well-documented intervention. This study and the lessons learnt provide a detailed resource for other researchers wishing to build theory for theory-driven evaluation.

This thesis is a study of the autobiographical writings of Naomi Mitchison, a prolific writer of exceptional versatility who was born in the last years of the Victorian period and is now best known as a writer of fiction, and as part of the 'Scottish literary Renaissance' of the first half of the twentieth century. In her late seventies, towards the end of a highly productive literary career, Mitchison published three volumes of autobiography, Small Talk: Memoirs of an Edwardian Childhood (1973), All Change Here: Girlhood and Marriage (1975) and You May Well Ask: A Memoir 1920-1940 (1979). Unusually for retrospective memoir, however, these texts cover less than half of her hundred and one years, leading the reader to question the location and mode of her complete autobiographical writings. Working extensively with archival material, much of which has been previously unavailable, this thesis sets out to demonstrate that Mitchison's personal writings are far more extensive than have been previously acknowledged, and are to be found through a wide range of out-of-print and unpublished material which include diaries, travel writing, personal correspondence, and, in few instances, poetry and prose fiction. In the course of this research I have compiled two substantial volumes of source materials which have been lodged in the Department of Scottish Literature Library. A contribution to Mitchison studies in themselves, I here draw attention to their existence and availability. While at first sight many of the texts on which this study focuses are minor writings in relation to the major achievements of Mitchison's literary career, this thesis argues that as a collected body of work, they form an autobiographical corpus which documents and bears witness to an extraordinary twentieth-century life, and constitutes a substantial literary achievement. Autobiographical- and life-writings often escape strict generic boundaries, and this study employs genre theory to interrogate th

Background: The NHS policy of constructing multispecialty community providers (MCPs) rests on a complex set of assumptions about how health systems can replace hospital use with enhanced primary care for people with complex, chronic or multiple health problems, while contributing savings to health-care budgets. Objectives: To use policy-makers’ assumptions to elicit an initial programme theory (IPT) of how MCPs can achieve their outcomes and to compare this with published secondary evidence and revise the programme theory accordingly. Design: Realist synthesis with a three-stage method: (1) for policy documents, elicit the IPT underlying the MCP policy, (2) review and synthesise secondary evidence relevant to those assumptions and (3) compare the programme theory with the secondary evidence and, when necessary, reformulate the programme theory in a more evidence-based way. Data sources: Systematic searches and data extraction using (1) the Health Management Information Consortium (HMIC) database for policy statements and (2) topically appropriate databases, including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Applied Social Sciences Index and Abstracts (ASSIA). A total of 1319 titles and abstracts were reviewed in two rounds and 116 were selected for full-text data extraction. We extracted data using a formal data extraction tool and synthesised them using a framework reflecting the main policy assumptions. Results: The IPT of MCPs contained 28 interconnected context–mechanism–outcome relationships. Few policy statements specified what contexts the policy mechanisms required. We found strong evidence supporting the IPT assumptions concerning organisational culture, interorganisational network management, multidisciplinary teams (MDTs), the uses and effects of health information technology (HIT) in MCP-like settings, planned referral networks, care planning for individ

This thesis is a study of the autobiographical writings of Naomi Mitchison, a prolific writer of exceptional versatility who was born in the last years of the Victorian period and is now best known as a writer of fiction, and as part of the 'Scottish literary Renaissance' of the first half of the twentieth century. In her late seventies, towards the end of a highly productive literary career, Mitchison published three volumes of autobiography, Small Talk: Memoirs of an Edwardian Childhood (1973), All Change Here: Girlhood and Marriage (1975) and You May Well Ask: A Memoir 1920-1940 (1979). Unusually for retrospective memoir, however, these texts cover less than half of her hundred and one years, leading the reader to question the location and mode of her complete autobiographical writings. Working extensively with archival material, much of which has been previously unavailable, this thesis sets out to demonstrate that Mitchison's personal writings are far more extensive than have been previously acknowledged, and are to be found through a wide range of out-of-print and unpublished material which include diaries, travel writing, personal correspondence, and, in few instances, poetry and prose fiction. In the course of this research I have compiled two substantial volumes of source materials which have been lodged in the Department of Scottish Literature Library. A contribution to Mitchison studies in themselves, I here draw attention to their existence and availability. While at first sight many of the texts on which this study focuses are minor writings in relation to the major achievements of Mitchison's literary career, this thesis argues that as a collected body of work, they form an autobiographical corpus which documents and bears witness to an extraordinary twentieth-century life, and constitutes a substantial literary achievement. Autobiographical- and life-writings often escape strict generic boundaries, and this study employs genre theory to interrogate th

This thesis is a study of the autobiographical writings of Naomi Mitchison, a prolific writer of exceptional versatility who was born in the last years of the Victorian period and is now best known as a writer of fiction, and as part of the 'Scottish literary Renaissance' of the first half of the twentieth century. In her late seventies, towards the end of a highly productive literary career, Mitchison published three volumes of autobiography, Small Talk: Memoirs of an Edwardian Childhood (1973), All Change Here: Girlhood and Marriage (1975) and You May Well Ask: A Memoir 1920-1940 (1979). Unusually for retrospective memoir, however, these texts cover less than half of her hundred and one years, leading the reader to question the location and mode of her complete autobiographical writings. Working extensively with archival material, much of which has been previously unavailable, this thesis sets out to demonstrate that Mitchison's personal writings are far more extensive than have been previously acknowledged, and are to be found through a wide range of out-of-print and unpublished material which include diaries, travel writing, personal correspondence, and, in few instances, poetry and prose fiction. In the course of this research I have compiled two substantial volumes of source materials which have been lodged in the Department of Scottish Literature Library. A contribution to Mitchison studies in themselves, I here draw attention to their existence and availability. While at first sight many of the texts on which this study focuses are minor writings in relation to the major achievements of Mitchison's literary career, this thesis argues that as a collected body of work, they form an autobiographical corpus which documents and bears witness to an extraordinary twentieth-century life, and constitutes a substantial literary achievement. Autobiographical- and life-writings often escape strict generic boundaries, and this study employs genre theory to interrogate th