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The article presents the study on the interaction of family-clinicians on the outcome of children's health services through the analysis of occupational therapists' practice. Qualitative analysis was designed and categorized the practice action into ranges of participatory and relational family-centered interactions through modified framework analysis. Results were outlined and conclude the frequency between participatory and relational interactions among therapists and family-clinicians.

Background Inappropriate maternal and infant-feeding practices are known to have a major impact on morbidity in infancy, childhood and later life. Ring-fenced funding over 3 years from the Scottish Government to the National Health Service ( NHS) in Scotland has allowed the development of a range of nutrition interventions for women of childbearing age and infants living in areas of deprivation to help address these issues. The present study aimed to determine mothers' knowledge of appropriate infant-feeding practices, opinions about feeding advice and any changes in practice following attendance at workshops. Methods Fifteen semi-structured interviews with women who participated in NHS infant-feeding workshops. Verbatim transcripts were analysed using framework analysis. Results Participants appreciated the opportunity to enhance their knowledge and there was evidence of a reasonable understanding and awareness of appropriate infant-feeding behaviours following workshop attendance. However, the findings highlight the challenge of multiple sources of advice and identify persistent uncertainties about feeding practice. Reported feeding behaviour following workshops was encouraging (e.g. delayed weaning, increased use of -prepared fruits and vegetables), although there was also evidence of resistance to change. The legacy of the workshop in terms of reported confidence in infant feeding was also apparent. Conclusions The workshops appears to aid current knowledge and practice about infant feeding but further work is needed to examine the long term impact of these interventions on maternal and infant dietary behaviours. [ABSTRACT FROM AUTHOR]

Background: Personal asthma action plans (PAAPs) have been guideline recommended for years, but consistently under-issued by health professionals and under-utilised by patients. Previous studies have investigated sub-optimal PAAP implementation but more insight is needed into barriers to their use from the perspective of professionals, patients and primary care teams. Methods: A maximum variation sample of professional and patient participants were recruited from five demographically diverse general practices and another group of primary care professionals in one Scottish region. Interviews were digitally recorded and data thematically analysed using NVivo. Results: Twenty-nine semi-structured interviews were conducted (11 adults with asthma, seven general practitioners, ten practice nurses, one hospital respiratory nurse). Three over-arching themes emerged: 1) patients generally do not value PAAPs, 2) professionals do not fully value PAAPs and, 3) multiple barriers reduce the value of PAAPs in primary care. Six patients had a PAAP but these were outdated, not reflecting their needs and not used. Patients reported not wanting or needing PAAPs, yet identified circumstances when these could be useful. Fifteen professionals had selectively issued PAAPs with eight having reviewed one. Many professionals did not value PAAPs as they did not see patients using these and lacked awareness of times when patients could have benefited from one. Multi-level compounding barriers emerged. Individual barriers included poor patient awareness and professionals not reinforcing PAAP use. Organisational barriers included professionals having difficulty accessing PAAP templates and fragmented processes including patients not being asked to bring PAAPs to their asthma appointments. Conclusions: Primary care PAAP implementation is in a vicious cycle. Professionals infrequently review/update PAAPs with patients; patients with out-dated PAAPs do not value or use these; professionals observing patients' lack of interest in PAAPs do not discuss these. Patients observing this do not refer to their plans and perceive them to be of little value in asthma self-management. Twenty-five years after PAAPs were first recommended, primary care practices are still not ready to support their implementation. Breaking this vicious cycle to create a healthcare context more conducive to PAAP implementation requires a whole systems approach with multi-faceted interventions addressing patient, professional and organisational barriers. [ABSTRACT FROM AUTHOR]

Background Many theories have been proposed to explain the high levels of ‘excess' mortality (i.e. higher mortality over and above that explained by differences in socio-economic circumstances) shown in Scotland—and, especially, in its largest city, Glasgow—compared with elsewhere in the UK. One such proposal relates to differences in optimism, given previously reported evidence of the health benefits of an optimistic outlook. Methods A representative survey of Glasgow, Liverpool and Manchester was undertaken in 2011. Optimism was measured by the Life Orientation Test (Revised) (LOT-R), and compared between the cities by means of multiple linear regression models, adjusting for any differences in sample characteristics. Results Unadjusted analyses showed LOT-R scores to be similar in Glasgow and Liverpool (mean score (SD): 14.7 (4.0) for both), but lower in Manchester (13.9 (3.8)). This was consistent in analyses by age, gender and social class. Multiple regression confirmed the city results: compared with Glasgow, optimism was either similar (Liverpool: adjusted difference in mean score: 20.16 (95% CI 20.45 to 0.13)) or lower (Manchester: 20.85 (21.14 to 20.56)). Conclusions The reasons for high levels of Scottish ‘excess' mortality remain unclear. However, differences in psychological outlook such as optimism appear to be an unlikely explanation. [ABSTRACT FROM AUTHOR]

Purpose: Group identification has been shown to be associated with reduced risk of depression, but this research has important limitations. Our aim was to establish a robust link between group identification and depression whilst overcoming previous studies' shortcomings.Methods: 1824 participants, recruited from General Practice throughout Scotland, completed a questionnaire measuring their identification with three groups (family, community, and a group of their choice), as well as their intensity of contact with each group. They also completed a self-rated depression measure and provided demographic information. Their medical records were also accessed to determine if they had been prescribed antidepressants in the previous 6 months.Results: The number of group identifications was associated with both lower self-rated depression and lower odds of having received a prescription for antidepressants, even after controlling for the number of contact-intensive groups, level of education, gender, age, and relationship status.Conclusions: Identifying with multiple groups may help to protect individuals against depression. This highlights the potential importance of social prescriptions, where health professionals encourage a depressed patient to become a member of one or more groups with which the patient believes he/she would be likely to identify. [ABSTRACT FROM AUTHOR]

Introduction: There is little discussion in the United Kingdom occupational therapy literature surrounding the topic of older people and alcohol, despite the growing prevalence of alcohol-related health problems in older adults resulting from an ageing population and changing patterns of consumption. Occupational therapists in physical health care settings are likely to work with older people whose drinking pattern may not be alcohol dependent, but may put their physical or psychological health at risk. Method: A survey methodology was employed using open and closed questions, recruiting occupational therapists (band 5 to 9) (n=122) working with older people (65þ years) in physical health care settings across all, except one, National Health Service Regional Health Boards in Scotland. Results: Responses highlight gaps in occupational therapists' knowledge around alternative 'safe limits' of alcohol intake for older people. Belief in professional role was evident, but the perception was that this was not supported by undergraduate education. Occupation focused theory and assessment were not prioritized when considering alcohol in the older adult. Conclusion: This study has highlighted a need to develop pre- and post-qualification education for occupational therapists, to enhance understanding of theory, assessment and knowledge of alcohol with older adults in physical health care settings. [ABSTRACT FROM AUTHOR]

Learning to live with a diagnosis of dementia is a complex process. Being able to talk about the diagnosis to others represents a major challenge for some people with dementia. This study explores the experiences of people with dementia, and members of their families, around the task of informing others during the six months immediately following their diagnosis of dementia. Five people with dementia living in the community, and their immediate family members, were recruited into an ethnographic study. Data were collected through recorded interviews and participant observation, and were analysed through a grounded theory method within a continuing iterative process. Findings suggest that participants recognised the need to tell others about their diagnosis but these conversations were difficult to initiate and manage, and hindered the processing of emotions. Findings are discussed in relation to implications for practice. [ABSTRACT FROM AUTHOR]

Aims and objectives. To investigate the dynamics of domestic abuse awareness and recognition among primary healthcare professionals and abused women. Background. Domestic abuse is a serious, public health issue that crosses geographical and demographic boundaries. Health professionals are well placed to recognise and respond to domestic abuse, but empirical evidence suggests that they are reluctant to broach the issue. Moreover, research has shown that women are reluctant to disclose abuse. Design. A two-phase, qualitative study was conducted in Scotland. Methods. Twenty-nine primary health professionals (midwives, health visitors and general practitioners) participated in the first phase of the study, and 14 abused women took part in phase two. Data were collected in 2011. Semi-structured, individual interviews were conducted with the health professionals, and three focus groups were facilitated with the abused women. Data were analysed using a framework analysis approach. Findings. Differing levels of awareness of the nature and existence of abuse are held by abused women and primary healthcare professionals. Specifically, many women do not identify their experiences as abusive. A conceptual representation of domestic abuse - the "abused women, awareness, recognition and empowerment' framework - arising from the study - presents a new way of capturing the complexity of the disclosure process. Conclusion. Further research is necessary to test and empirically validate the framework, but it has potential pedagogical use for the training and education of health professionals and clinical use with abused women. Relevance to clinical practice. The framework may be used in clinical practice by nurses and other health professionals to facilitate open discussion between professionals and women. In turn, this may empower women to make choices regarding disclosure and safety planning. [ABSTRACT FROM AUTHOR]

Background Little is known about peoples' self-management experiences and their desires or expectations to engage in self-management. As such, there is little understanding about individuals' perceived cues and barriers to engagement in self-management, particularly in people affected by cancer. Objective To understand cues and barriers to people's engagement in self-management during chemotherapy treatment for colorectal cancer. Design Secondary analysis of qualitative data from mixed methods, longitudinal study. Setting and participants Eleven participants undergoing treatment for colorectal cancer. Semi-structured interviews were conducted twice with each participant, at the start and end of a 6-month course of chemotherapy treatment in a Scottish cancer centre. Results Cues and barriers to engagement in self-management appeared to stem from perceptions of the impact and associated severity of side effects experiences as well as the perceptions about the efficacy of chosen self-management activities and perceptions of control in minimizing the consequences of cancer treatment. Severe, episodic or unexpected side effects coupled with perceptions of uncertainty, lack of control and lack of adequate preparation to engage in self-management were identified as key barriers to engagement. Discussion and conclusion Participants' reflection on, or appraisal of, their treatment-related experiences and personal abilities, confidence and preferences to manage the impact of these shaped their subsequent engagement in self-management. The findings highlight the importance of understanding individual's self-management experiences, perceptions, preferences, priorities and needs to help support, prepare and enable them to feel capable and confident to engage actively and effectively in self-management. [ABSTRACT FROM AUTHOR]

Background The sexual health needs of younger adults with intellectual disability (ID) are not currently being met by mainstream sexual health services. Little research has been conducted into improving these services' accessibility. Method Thirty-four people with ID aged 16-35, who attended ID services in Lothian, Scotland, completed a questionnaire at a face-to-face interview about whom they could go to for advice and information about sex and relationships, which information sources they used, their experiences of sexual health services, and their preferences regarding these services. Results Most participants wanted to attend mainstream services and felt staff from these services should be able to meet their special needs. Preferences on services varied between individuals. Conclusions It is important that there continues to be a variety of sexual health services available and that staff are appropriately trained in working with people with ID. Further research is needed to identify and resolve unmet needs in this area. [ABSTRACT FROM AUTHOR]

Introduction CPD is an important feature of healthcare professions and regulatory bodies consider it mandatory. Studies of CPD activity of pharmacists showed that 10% were undertaking no CPD. Practice-based small group learning (PBSGL) is a well-received and popular learning resource for GPs in Scotland. From 2011, a pharmacy pilot was undertaken: pharmacists were trained as peer-facilitators and existing PBSGL modules were adapted. Four NHS boards took part and this study aimed to explore the perceptions and experiences of pharmacists. Methods A qualitative research approach was adopted using focus groups and in-depth interviews. Interviews were audio-recorded and transcriptions made. Transcripts were coded and themes developed using grounded theory methods. Results Participants welcomed PBSGL: it was a feasible learning method, acceptable and had educational impact. They appreciated its interactive nature and discussions founded on their experiences in practice. Participants liked the self-reliance of PBSGL in that they were not dependent on specialist practitioners. There were logistical challenges that impacted on the success of group discussion; some pharmacists were less familiar with small group work. Pharmacists felt isolated during work and appreciated peer discussion. There was a tentative welcome to inter-professional learning but group composition and module topics might impact on the success of this. Conclusion Pharmacists were able to change their learning practice in uni-professional PBSGL groups and were able to learn from each other. There may be further learning opportunities if pharmacists participate in inter-professional groups. [ABSTRACT FROM AUTHOR]

The Risk for Sexual Violence Protocol is a structured professional judgement (SPJ) tool that aids risk assessment of sexual violence. It is widely used internationally. The aim of this study was to explore the clinical practice of SPJ risk assessment and risk management through qualitative analysis of the accounts of users of these assessments. Questionnaires and semi-structured interviews were conducted with a sample of 31 criminal justice professionals in southeast Scotland. The participants' accounts were explored using the framework method. Five themes emerged from this analysis: informing risk management; confirming what was known and giving weight; understanding personality; treatment; and the usefulness and limitations of risk assessment. The participants reported that the assessments were influential with respect to risk management. The study revealed some important implications for service development. The authors suggest possible future use of the framework method in research investigating the risk assessment of sexual violence. [ABSTRACT FROM PUBLISHER]

The article presents a research article that reviews the planning process of a Scottish sitting prison and the sighting communities for which the objections are raised by local residents. The topics discussed include significance of emotional aspects of objection for understanding historical background of areas of dispute, concerns raised by locals that include fear of strangers, fragility of a local orchid, and pollution from mining, and regulations governing Great Britain's planning system.

Objectives. We explored the role of faith and religious identities in shaping end of life experiences in South Asian Muslims and Sikhs with life-limiting illnesses. Design. Secondary analysis of data from a longitudinal, multi-perspective qualitative study of the experience of life-limiting illness and access to palliative care services among South Asian Sikhs and Muslims in Scotland. Up to three semi-structured interviews were conducted with 25 participants, 15 family members and 20 health care professionals over a period of 18 months. Analysis was informed by Mattingly's theory on hope. Results. Hope emerged as a central construct in the accounts of illness constructed by the participants as they struggled to make sense of and uphold a meaningful life. Clinical encounters and, for some, religious beliefs served as sources of hope for participants. Hope unfolded as an active process that enabled them to live with the personal and in particular the social ramifications of their illness. Changing images of hope were formulated and reflected as illness progressed or treatments failed. These ranged from hoping for cure, prolonged life, the regaining of lost capabilities needed to fulfil social roles, or at times death when suffering and the consequences for the family became too hard to bear. Conclusions. For those suffering from a life-limiting illness, sustaining hope is a complex challenge. The social character of hope is evident as it focuses on envisioning a life that is worth living, not only for oneself, but most importantly for social relations. Continuity in care at the end of life and a holistic approach is important in order to enable patients to articulate complex and changing notions of hope that at times are silenced within families, and for patients to feel confident in discussing the possible role of religious beliefs in shaping personal notions of hope. [ABSTRACT FROM AUTHOR]

Aims and objectives To understand the views of patients and professionals on the acceptability and perceived usefulness of telemonitoring in the management of chronic heart failure in the context of day-to-day care provision. Background There is an increasing interest in the potential for telemonitoring to support the home-based management of patients with chronic heart failure. However, little is known about the views of patients and professionals on the use of telemonitoring in this context. A chronic heart failure telemonitoring service was set-up by NHS Lothian, Scotland, to evaluate the intervention. Design A qualitative design was adopted to explore the views of patients and professionals participating in the service. Methods Semi-structured interviews were undertaken with 18 patients (61% male, mean age 75 years) and five professionals participating at different time points in this new service. Interviews were audio recorded, coded and thematically analysed using the Framework approach. Results Five main themes were identified: 'information, support and reassurance'; 'compliance and dependence'; 'changes and challenges'; 'determining the criteria for patient applicability to telemonitoring'; and 'continuity of care'. Conclusion Patients and professionals considered telemonitoring useful in the management of chronic heart failure, although with some caveats. Telemonitoring was popular with patients because they felt reassurance arising from what was perceived as continuous practitioner surveillance. Professionals expressed concern regarding perceived patient dependence on practitioner support. Increased workload was also a concern. Both groups acknowledged the need for improved technology and changes to service provision in order to better meet the intended objectives of the service. Relevance to clinical practice Although popular with patients, professionals emphasised the importance of case selection and adequate training and support, both for patients and themselves, in order to maximise the expected benefits of the service, particularly with regard to enabling self-management. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the use on the Facilitating Representative and EquitablE involvement through Targeted Engagement and Assisted involvement (FREE TEA) model in maximizing the participation of patients and clinicians in research-priority setting. The researchers applied FREE TEA to support the standard James Lind Alliance (JLA) research priority setting process for stroke survivors, care givers and health professionals in Scotland.

Aims and objectives To explore the experiences and perceptions of close and sexual relationships of people with an intellectual disability. Background Positive interpersonal relationships are beneficial for people with an intellectual disability, acting as a protective barrier against, social stigma and negative outcomes such as physical and mental health problems. The social networks of people with an intellectual disability are, however, often more restricted than those of the general population. There has been very little research exploring the views and experiences of people with an intellectual disability about social and sexual relationships. Design Exploratory study using a qualitative research design. Methods Semi-structured interviews were conducted with 10 (6 male, 4 female) participants. Data were analysed using interpretive phenomenological analysis. Results 'Touching other people in relationships' was identified as a superordinate theme. The theme was represented by five subthemes: 'Is wrong'; 'Unsafe to talk about'; 'Suggesting is safe'; 'No freedom or fun'; and 'Being touched'. The findings presented are drawn from a larger qualitative study. Conclusions The findings highlight the importance of touch and sexual behaviours in the close relationships of participants. Negative perceptions were observed to surround sexual behaviours. Rules and restrictions regarding physical contact were also described. Relevance to clinical practice Disseminating these findings may increase awareness of the importance of physical contact in the close relationships of people with an intellectual disability and promote positive support arrangements. [ABSTRACT FROM AUTHOR]

Background Empirical research suggests that involving carers brings benefits to families and services. Consequently, drug-related policy and guidance has increasingly encouraged drug services to involve carers at all levels of service provision. Objective To explore the purpose and scope of carer involvement with adult drug services in North-east Scotland. Design, Setting and Participants A total of 82 participants (20 informal carers, 43 service providers and 19 policy makers) were purposively selected to take part in a qualitative study. Eight focus groups and 32 interviews were conducted between 2007 and 2008. Findings Three themes were identified through thematic coding: 'Current levels of involvement', 'Use of the term carer' and 'Opportunities for change?' Carer involvement was described as limited, unplanned and unstructured, and consisted largely of information and advice, practical and emotional support, and signposting of services. Although use of the term 'carer' was contested within and across the groups, caring in a drug context was considered the 'same but different' from caring in other contexts. Carers remained sceptical that services actually wanted to involve them in supporting their relative or to offer carers support in their own right. Many service providers and policy makers regarded carer involvement as an aspiration. Conclusion Encouraging carers, service providers and policy makers to reach a shared understanding of caring in a drug context may help translation of policy into practice. However, there is also a fundamental need for drug services to widen the level and type of involvement activities on offer to carers. [ABSTRACT FROM AUTHOR]

There is growing evidence to suggest that, for child and adolescent mental health services, telehealth might be better than some aspects of traditional face-to-face service provision. Staff willingness to embrace new ways of working is critical to adopting technological innovation into practice. This article describes efforts to articulate telehealth 'readiness' among staff in the north of Scotland. Findings suggest that many participants are comfortable with introducing telehealth in their clinical areas, although less than half of the target population responded to the survey. The authors believe that positive attitudes should lead practitioners to engage in a structured programme that addresses gaps in knowledge and skills about telehealth. [ABSTRACT FROM AUTHOR]

Domestic abuse is increasingly recognised as a serious, worldwide public health concern. There is a significant body of literature regarding domestic abuse, but little is known about health professionals' beliefs about domestic abuse disclosure. In addition, the intersection between health professionals' beliefs and abused women's views remains uninvestigated. We report on a two-phase, qualitative study using Critical Incident Technique ( CIT) that aimed to explore community health professionals' beliefs about domestic abuse and the issue of disclosure. We investigated this from the perspectives of both health professionals and abused women. The study took place in Scotland during 2011. The study was informed theoretically by the Common Sense Model of Self-Regulation of Health and Illness ( CSM). This model is typically used in disease-orientated research. In our innovative use, however, CSM was used to study the social phenomenon, domestic abuse. The study involved semi-structured, individual CIT interviews with health professionals and focus groups with women who had experienced domestic abuse. Twenty-nine health professionals ( Midwives, Health Visitors and General Practitioners) participated in the first phase of the study. In the second phase, three focus groups were conducted with a total of 14 women. Data were analysed using a combination of an inductive classification and framework analysis. Findings highlight the points of convergence and divergence between abused women's and health professionals' beliefs about abuse. Although there was some agreement, they do not always share the same views. For example, women want to be asked about abuse, but many health professionals do not feel confident or comfortable discussing the issue. Overall, the study shows the dynamic interaction between women's and health professionals' beliefs about domestic abuse and readiness to discuss and respond to it. Understanding these complex dynamics assists in the employment of appropriate strategies to support women post-disclosure. [ABSTRACT FROM AUTHOR]

The incidence of prostate cancer in Scotland continues to grow; men are now living with their disease which can be seen as an increased burden for the health service and in particular the Uro-Oncology team which delivers its treatment and manage its follow up. A new model of follow up was established for men who have received treatment for prostate cancer, replacing conventional outpatient clinic. The virtual prostate cancer follow-up clinic was set up for men who are 2 years post radiotherapy with stable prostate-specific antigen. The aim of this follow up was to improve the patient experience of living with prostate cancer and reduce the high demand to the service. A successful bid to Macmillan allowed a nurse to be employed by the department for a 3-year project post. The aim of this role was to develop the prostate cancer follow-up clinic and evaluate this new way of working. Method A questionnaire was designed to obtain the views of the patients who were recipients of care and treatment from the clinical nurse specialist rather than the oncologist. The questionnaire was sent to all 302 men recruited to this new clinic. The patients were asked six questions which focused on support/communication, problems experienced and improvement. Results for 191 questionnaires were returned out of the 302 questionnaires sent, giving a 63·2% response rate. About 98% was very happy with the new service, 98·8% of patients reported being well supported by this new service. The success of this new follow-up system will allow us to use this model for men post prostatectomy and receiving hormone suppression treatment. The role of the uro-oncology nurse is vital to ensure that this clinic continues to be effective and give positive outcomes for patients with prostate cancer and the team involved in their journey. [ABSTRACT FROM AUTHOR]

While the benefits of breastfeeding are well established, few Scottish women exclusively breastfeed, as recommended nationally and internationally. Breastfeeding peer support can help mothers to breastfeed for longer, but the training peer supporters receive is variable and few studies have measured the effectiveness of peer supporter training. This study aimed to compare mothers' attitudes towards and knowledge of breastfeeding before and after undertaking Breastfeeding Network (BfN) peer supporter training. This study used a quasi-experimental design to investigate levels of breastfeeding knowledge and attitudes in 28 women, immediately before and after the BfN peer supporter (Helper) training programme. Data were collected using the Infant Feeding Questionnaire. Mothers had high baseline scores for attitude (88.8%) and knowledge (76.4%). After training 78% of mothers improved their attitude scores. The mean difference in attitude scores was 4.9%, which was statistically significant ( t = 4.44, P < 0.001). Ninety-six per cent of mothers had increased their knowledge scores. The mean difference in knowledge scores was 10.4%, which was statistically significant ( t = 6.25, P < 0.001). This study provides evidence that the BfN's accredited peer support training can improve both breastfeeding knowledge and attitudes of breastfeeding mothers. Peer supporters who have undertaken this training are therefore suitably qualified to provide mothers with the support and information required to make informed choices in breastfeeding and to contribute to effective support and promotion of breastfeeding as suggested in the National Institute for Health and Clinical Excellence guideline on maternal and infant nutrition (PH11) and Scottish Government's Maternal and Infant Nutrition: A Framework for Action (2011). [ABSTRACT FROM AUTHOR]

Purpose -- This study aimed to evaluate the "Out of the Box" initiative, by investigating any impacts on participants' wellbeing. Aimed at general population adults, Out of the Box comprised two art-oriented groups and one social group, led by a community art worker. Design/methodology/approach -- Individual semi-structured interviews were undertaken with 14 group members (six men, eight women; age range 36-71 years) from a potential pool of around 30. Data were analysed thematically. Findings -- Dramatic benefits in confidence, outlook and happiness were reported by people who had experienced poor mental or physical health, or adverse life events. Participants believed Out of the Box to have facilitated social contact and friendships. They appreciated the opportunity to get out of the house and take part in activity. They described feeling accepted and encouraged. Artistic skills were developed to the extent that work was exhibited and sold. Research limitations/implications -- The focus on contemporaneous Out of the Box participants, and a level of awareness of funding uncertainty, could have biased findings towards beneficial outcomes. The relative importance of the group leader and other contextual features was unclear. Community-based art may offer opportunities for effective cheap public mental health interventions. Originality/value -- As well as providing evidence of benefits to wellbeing from Out of the Box, new knowledge was generated on mental health benefits of community-based art including becoming more outgoing, improved self-efficacy, worrying less and not panicking. [ABSTRACT FROM AUTHOR]

This article reports a study exploring what older people believe would enable them to adjust to and gain maximum benefit from wearing a hearing aid. A mixed methods approach was employed during 2006 involving interviews with key stakeholders, a survey across three Scottish health board areas and focus groups. Nine key stakeholders from six national and local organisations were interviewed about the needs of older people being fitted with hearing aids. In total, 240 older people belonging to three different types of hearing impaired older people were surveyed: long-term users of hearing aids, new hearing aid users, and those on a waiting list from urban and rural areas (response rate = 24%). A series of eight follow-up focus groups with 31 audiology patients was held. Health professionals appeared to neglect appropriate provision of information and overly rely on technological interventions. Of 154 older people already fitted with hearing aids, only 52% of hearing aid users reported receiving enough practical help post fitting and only 41% reported receiving enough support. Approximately 40% reported not feeling confident in the use of their aids or their controls. Older people wanted more information than they received both before and after hearing aid fitting. Information provision and attention to the psychosocial aspects of care are key to enabling older people to adjust and optimise hearing aid benefit. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Medication-related safety incidents are a source of concern to patients, policy makers and clinicians. The role of education in improving safety-critical practices in health care is poorly appreciated. This pilot study aimed to initiate collective discussion among professional groups of clinical staff about a range of medicine-related patient safety issues which were identified from a local incident reporting system. In engaging staff to collectively reflect on reported medication incidents we attempted to uncover a deeper understanding of local contextual issues and potential educational needs. Methods A mixed method study was conducted involving categorical analysis of 1058 medication incident reports (Phase 1) and the use of three mixed focus groups of clinical staff (Phase 2) in three acute hospitals in one locality in NHS Scotland. Results Focus group transcript analysis produced four main themes (e.g. the medical role) and 12 related sub-themes (e.g. pharmacological education and skill mix for administration of medicines) concerning medication-related practices and possible educational interventions. Conclusions While it is necessary to review reported incident data and disseminate the educational messages for the improvement of quality, this traditional risk management process is inadequate on its own. Reporting systems can be enhanced by collective examination of reported information about medicines by local clinical teams. We identified a strong message from the focus groups for learning about each other and from each other, and that the method piloted may be an important inter-professional mechanism for improvement. [ABSTRACT FROM AUTHOR]

This article explores the ways that individuals experience recovery from gambling problems. Arguing against reductive, bio-medical models of addiction, we adopt a broadly interpretive epistemology to analyse gamblers' narratives of recovery. Using data from a longitudinal qualitative study of 'gambling careers' we suggest that processes of behaviour change are embedded in wider social relations and revolve around shifting concepts of self-identity. This involves processes of biographical and temporal reconstruction which are grounded in material circumstances, particularly those relating to money and social relationships. Various configurations of recovery exist, but common to all is a dynamic temporal reorientation and an increased sense of agency and authenticity as individuals move into a future that they feel they have some control over. These narratives suggest that experiences of gambling addiction and recovery, and the self-concepts that accompany them, are fluid and contextual and that 'managing' gambling is about re-shaping the self in culturally appropriate ways. It is hoped that aspects of this analysis may be of relevance for understanding the narrative dimensions of addiction and recovery more generally. [ABSTRACT FROM AUTHOR]

Two studies are reported in which ethnic majority children's reactions to media representations of ethnic minorities are examined. In Study 1, 20 white Scottish 6-year-olds viewed short television stories in which white or ethnic minority children were depicted as hostile to the participants' in-group (threat present) or not (threat absent). A strong effect of threat on liking was obtained but no effect of ethnicity of target and no interaction. In Study 2, 4- and 6-year-old white Scottish children viewed PowerPoint displays in which Scottish people were shown only as white (traditional version) or as ethnically diverse (multicultural version). Intergroup threat was manipulated. Again, a strong effect of threat was obtained. However, when threat was absent, participants exposed to the traditional condition liked the white out-group more than the multi-ethnic out-group, while participants exposed to the multicultural condition liked the multi-ethnic out-group more than the white out-group. The results are interpreted as consistent with the predictions of Social Identity Development Theory. [ABSTRACT FROM AUTHOR]

The present article reports a longitudinal study of the psychological antecedents for, and outcomes of, collective action for a community sample of activists. At Time 1, activist identification influenced intentions to engage in collective action behaviours protesting the Iraq war, both directly and indirectly via perceptions of the efficacy of these behaviours for achieving group goals, as well as perceptions of individual-level benefits. At Time 2, identification was associated with differences in the dimensions on which the movement's success was evaluated. In the context of the movement's failure to achieve its stated objectives of troop withdrawal, those with strong activist identity placed less importance on influencing government decision making. The implications are discussed in terms of models of collective action and social identity, focusing on a dynamic model that relates identification with a group to evaluations of instrumentality at a group and individual level; and to beliefs about strategic responses to achieve group goals. [ABSTRACT FROM AUTHOR]

Although elite commentators have regularly predicted an English backlash to the asymmetric devolution settlement, public opinion surveys generally reveal widespread acceptance of the principle of Scottish self-governance. In this article, I explore some of the reasoning behind English responses to UK constitutional change, drawing on a comprehensive programme of conversational interview research initiated in 2000. Analysis suggests that although people in England often endorse sincere and consistent views on various aspects of the devolution process, currently these are not typically salient, central or strongly held, and are rarely rooted in detailed domain-specific information. In the first decade following the devolution settlement, English responses to UK constitutional reform have tended to be based on abstract values of national rights and procedural justice rather than on calculations of comparative national self-interest. However, popular acceptance of the new constitutional arrangements may be contingent upon a particular set of ideological circumstances, and it would be premature to assume that asymmetric devolution necessarily reflects the settled will of the English people. [ABSTRACT FROM AUTHOR]

The purpose of this study was to survey primary health care professionals' perceptions of type 2 diabetes, an evaluation during a service redesign. Management of people with type 2 diabetes has been led by hospital based secondary care. The objective of the service redesign was to transfer the management of the majority of people with type 2 diabetes from secondary care to general practitioner (GP) led, multidisciplinary primary care (comprising the GP, practice nurses, dietitians and podiatrists) delivered closer to the patients. Prior to implementation, all primary health care professionals undertook accredited educational preparation and there was infrastructure development by the creation of new posts and streamlining of IT systems to support the planned change. The study aim was to examine health care professionals' perspectives of diabetes, its management, the value of clinical guidelines and the impact of practice organisation. A cross-sectional survey design was used. Primary health care professionals in one geographical area were sent the validated Perceptions of Diabetes Questionnaire (n=112). The response rate was 34% (n=38). Professionals attached great importance to ongoing education of people with type 2 diabetes in essential areas of care. Type 2 diabetes was perceived as more difficult to treat than other chronic conditions. There was a high level of satisfaction with the workload associated with the service redesign and a team approach is valued. There is an association between diabetes-specific education and confidence in diabetes management. Professionals identified some barriers to using clinical guidelines. Overall, professionals were satisfied with the new model of multidisciplinary, GP led care management and their workload with the support of additional education in diabetes. Copyright © 2012 FEND. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Building a strong and positive safety culture in health care teams and organizations is essential for patient safety. Measuring individual perceptions of safety climate is an integral part of this process. Evidence of the successful application and potential usefulness of this approach is increasingly available for secondary care settings but little is known about the safety climate in UK primary care. We therefore aimed to measure perceptions of safety climate in primary care. Further aims were to determine whether perceptions varied significantly between practice teams and according to specific participant and practice characteristics. Method We undertook a cross-sectional, anonymous postal questionnaire survey of randomly selected west of Scotland primary care teams. Safety climate mean scores with standard deviations were calculated for respondents, practice teams and the region. Results A total of 563 (84%) team members from 49 practices (24.5%) returned questionnaires. The overall safety climate mean score was 5.48 (0.78). Significant differences in safety climate perceptions were found at the practice team level ( P < 0.001) and for specific characteristics: respondents' years of experience, whether they were community or practice based, their professional roles and practices' training status. Practice managers and general practitioners perceived the safety climate more positive than other respondents ( P < 0.001). Conclusion This was the first known attempt to measure perceptions of safety climate in UK primary care with a validated instrument specifically developed for that purpose. Reported perceptions of the prevailing safety climate were generally positive. This may reflect ongoing efforts to build a strong safety culture in primary care or alternatively point to an overestimation of the effectiveness of local safety systems. The significant variation in perception between certain staff groups has potential safety implications and may have to be aligned for a positive and strong safety culture to be built. While safety climate measurement has various benefits at the individual, practice team and regional level, further research of its association with specific safety outcomes is required. [ABSTRACT FROM AUTHOR]

Background: Some people with psychological distress do not seek professional help but opt instead for self‐help strategies to reduce their symptoms. Little is known about these strategies. Aim: To investigate which self‐help approaches might be employed to reduce the effects of emotional distress, and the reasons for these choices. Method: Semi‐structured interviews with 11 clerical employees generated data analysed using grounded theory. Findings: Managing distress is a complex and multi‐dimensional process unique to each individual. The use of self‐help options is determined by the interconnection between the person's core beliefs, their social networks, and ideas about coping. Such beliefs may hinder help‐seeking. People tend to engage in activities that are familiar to them already, rather than attempt new ones. The purpose of self‐help strategies is to distract the person from their problems and to contribute to physical and mental well‐being. Implications for practice are discussed. [ABSTRACT FROM AUTHOR]

Background Women with one previous caesarean section must decide which mode of delivery they would prefer in their next pregnancy. This involves a choice between attempted vaginal birth and elective caesarean section. Objective To explore women's mode of delivery preferences and the values placed on the outcomes of decision making. Greater insight into these issues could benefit both clinical care and future research. Design Observational study using longitudinal data collected within a randomized controlled trial. Setting and Participants Seven hundred and forty-two women with one previous caesarean section recruited at four antenatal clinics in South West England and Scotland. Main outcome measures Mode of delivery preference recorded at 19 and 37 weeks' gestation and visual analogue scale ratings of health and delivery outcomes. Results Comparison of mid and late pregnancy preferences and actual mode of delivery shows that 57% of women hold the same mode of delivery preferences at both times and 65% of women actually have the birth they prefer. The visual analogue scale ratings show variation in the way women value the outcomes of the decision. Discussion and Conclusions Understanding the way women's mode of delivery preferences change, how these relate to actual mode of delivery and how women value the outcomes of their decision will be beneficial to health professionals who wish to support women both during pregnancy and after birth. In addition, the visual analogue scale ratings provide evidence that may improve the development of population-level and economic models of decision making. [ABSTRACT FROM AUTHOR]

This article considers the attitudes of pupils aged 9–11 years in Scotland towards their learning of a foreign language in primary school. It also considers their perception of difficulty, what they tell us causes them difficulty, their language preferences and the reasons for these. The article identifies any significant differences between boys and girls in these areas. [ABSTRACT FROM PUBLISHER]

The concept of social capital is very much an 'adult' concept, created by adults for adults, with children as the passive recipients of, primarily, parental social capital. The concept has been broken down into three particular subcategories - bonding (getting by), bridging (getting on) and linking (getting around). However, these subcategories equally do not relate readily to children and young people nor to different groups of young people. Young carers, for example, are a hidden population and their circumstances are relatively unknown, not least in terms of their social networks and access to social capital within the confines of their caring role. This article draws on a research study of 20 young carers in Scotland to explore the views and experiences of this particular group about their social networks and experiences of relationships with others, such as the family, friends and teachers. It concludes that young carers tend to keep their friends, family, and community networks separate from each other, and coupled with their perceived resilience and desire for self-sufficiency, this separation and protection of their individual social networks may result in reduced access to social capital in terms of getting on rather than getting by. [ABSTRACT FROM AUTHOR]

Community nurses have a central role in the provision of palliative and end-of- life care; helping people to die with dignity is an important component of this care. To conserve dignity, care should comprise a broad range of actions addressing the distress that might impact on the patient's sense of dignity. These care actions need to be defined. This study aims to suggest care actions that conserve dignity at the end of life based on evidence from local experience and community nursing practice. Data were collected by focus group interviews and analysed by framework analysis using the Chochinov model of dignity as a predefined framework. Suggestions on care actions were given in relation to all themes. As part of a multi-phase project developing and testing a dignity care pathway, this study might help community nurses to conserve dying patients' dignity. [ABSTRACT FROM AUTHOR]

Background Practice managers play an important role in the organisation and delivery of primary care, including uptake and implementation of technologies. Little is currently known about practice managers' attitudes to the use of information and communication technologies, such as email or text messaging, to communicate or consult with patients. Objectives To investigate practice managers' attitudes to non-face-to-face consultation/communication technologies in the routine delivery of primary care and their role in the introduction and normalisation of these technologies. Methods We carried out a mixed-methods study in Scotland, UK. We invited all practice managers in Scotland to take part in a postal questionnaire survey. A maximum variation sample of 20 survey respondents participated subsequently in in-depth qualitative interviews. Results Practice managers supported the use of new technologies for routine tasks to manage workload and maximise convenience for patients, but a range of contextual factors such as practice list size, practice deprivation area and geographical location affected whether managers would pursue the introduction of these technologies in the immediate future. The most common objections were medico-legal concerns and lack of perceived patient demand. Conclusion Practice managers are likely to play a central role in the introduction of new consultation/ communication technologies within general practice. They hold varying views on the appropriateness of these technologies, influenced by a complex mix of contextual characteristics.Managers from areas in which the ethos of the practice prioritises personalised care in service delivery are less enthusiastic about the adoption of remote consultation/ communication technologies. [ABSTRACT FROM AUTHOR]

Background: Previous research into drug-related death (DRD) has targeted specific groups such as the deceased themselves, witnesses, or families of victims. There has been no research on staff working in the substance misuse field and the impact that DRD has had on them. Method: A postal questionnaire survey was conducted across a Scottish health authority area and quantitatively measured the impact that this event had on the work, health, and social life. Results: Sixty-five staff persons were identified as having experiencing at least one DRD on their caseload. These 65 reported a range of grief-related reactions, with the majority (88%) identifying at least one reaction. The most common feelings identified were sadness (83%), guilt (40%), and anger (37%) about the death of their client. Female staff, those with access to more sources of support, those who had a larger caseload, those with greater career experience of DRD on their caseload, and those who felt close to their client all reported significantly greater prevalence of grief-related reactions. The length of time since the DRD had occurred was also associated. Conclusions: When a DRD occurs, staff involved in the care and treatment of the deceased need to be considered in the aftermath. [ABSTRACT FROM AUTHOR]

Background: The Mental Health (Care and Treatment) (Scotland) Act 2003 introduced the role of the Named Person, who can be nominated by service users to protect their interests if they become subject to compulsory measures and replaces the Nearest Relative. If no nomination is made, the primary carer or nearest relative is appointed the Named Person. The views of professionals involved in the development and implementation of the provisions were unknown. Aim: To describe the perceptions of mental health officers and policy makers involved in the development and implementation of the new provisions. Method: Sixteen professionals were interviewed to explore their perceptions of and experiences with the Named Person provisions. Data were analysed using Thematic Analysis. Results: Perceptions of the Named Person provisions were generally favourable but concerns were expressed over low uptake; service users' and carers' lack of understanding of the role; and potential conflict with human rights legislation over choice and information sharing. Conclusions: Legislation should be amended to allow the choice of no Named Person and the prevention of information being shared with the default appointed Named Person. Removal of the default appointment should be considered. [ABSTRACT FROM AUTHOR]

The aim of the study was to examine psychiatrists' knowledge of the child protection process and their attitudes toward child protection training. An anonymous questionnaire survey was sent out to all psychiatric staff in a large psychiatric hospital. The response rate was 72 per cent. Fifty-seven per cent of respondents had never attended child protection training and 16 per cent thought that it was of no relevance to their position. Significant differences in self-rated knowledge were identified between those who had attended training and those who had not. Variations in the availability and quality of child protection training may result in psychiatrists not attaining the core knowledge required in order to work effectively as part of the child protection process. Hospital management should work towards prioritising and disseminating local child protection policies and procedures more effectively and consider routine child protection training as part of any new staff induction. The Royal College of Psychiatrists should consider inclusion of child protection in junior staff education programmes and as part of the MRCPsych examination curriculum. Likewise, consideration should be given to enhancing the status of child protection training in continuing professional development programmes for career-grade psychiatric staff. [ABSTRACT FROM AUTHOR]

In recent years, there has been continuing debate about the extent and significance of sectarianism in Scotland and the wider links with territorial gang culture. This article focuses on a small qualitative study conducted in some of the most deprived urban communities in Glasgow. Semi-structured interviews and focus group discussions were conducted with 10 youth workers and 40 young persons (aged 16--18 years), with follow-up interviews conducted with senior operational police officers. Social capital indicators generated by recent research were used as a lens through which to explore the participant responses. The findings suggest that the combined social forces associated with territoriality and intense football rivalry limit the young people's potential for maximizing social capital. However, the extent to which these issues can be fully ascribed to the continued existence of sectarianism in Scotland is less clear. The article concludes with some implications for further sociological debate around these issues. [ABSTRACT FROM AUTHOR]

The role of habit was investigated using two potential measures of habitual recycling behavior: past recycling behavior and perceived lack of habit as a reason for previous failure to recycle. Data were collected from 252 participants in Scotland, United Kingdom. Situational constraints, demographic characteristics, and variables associated with the theory of planned behavior were controlled for. Both past behavior and lack of habit made significant independent contributions to the variance of intention to recycle, suggesting that past recycling behavior was not an adequate measure of habit. Lack of habit moderated the attitude—intention relationship, such that the attitudes of those lacking a recycling habit did not predict intention to recycle. This suggests that those who had failed to recycle because of lack of habit may have had the habit of treating recyclables as garbage. Further work is required to develop a range of adequate measures of habit in the recycling domain. [ABSTRACT FROM AUTHOR]

Pupil attitude data have frequently been utilised in school effectiveness and improvement research to examine aspects of a school's educational processes, culture and ethos. However, a related approach is based on the belief that the views and attitudes of pupils are important outcomes of schooling in their own right, in addition to academic or vocational achievement. The rationale for this approach is that schools and teachers can have a positive influence on pupils' attitudes in a range of important areas that are central to the overall aims of schooling. These aims encompass enhancing pupils' capacity for lifelong and independent learning and positive attitudes to education, behaviour and self-concept as well as promoting vocational aspirations and civic values. This article addresses a sub-set of these aims, specifically in terms of pupils' attitudes to school, the learning context, self-concept and behaviour. This article also highlights the various issues and implications raised by measuring and using pupil attitudes in Scottish schools for the purpose of school self-evaluation and illustrations are drawn from the findings of the Improving School Effectiveness project funded by SOEID. Briefly, the results showed that generally both primary and secondary pupils' reported attitudes were more positive than negative. However, differences between schools in terms of the extent of positive (or negative) attitude outcomes were identified and these differences appear to be greater at the primary level than at the secondary level. The findings are discussed in relation to the development of approaches to school self-evaluation in the UK. [ABSTRACT FROM AUTHOR]

The article presents young people's reasons for leaving or remaining in a rural area in Great Britain, the Scottish Borders. Young people's views about migration and attachment demonstrate a contradictory and more complex pattern than that of detached late-modern migrants and traditional backwater stay-at-homes. These stereotypes have some resonance in local culture, for example in disdain for rootless "incomers" lacking real sympathy with the community and in the common accusation of the parochial narrow mindedness of locals who have never been elsewhere. However, such stereotypes emerge from complex social class antagonisms and cross-cutting ties to locality. Many young people's ties contradict the classifications these stereotypes imply. There are young out-migrants who are the children of rootless in-migrants, but also, nevertheless, have lasting attachments to the locality of their childhood. Then there are young "stayers" who are the children of born and bred locals but yet feel serious disaffection from their locality. These attached migrants and detached stayers may not represent settled orientations to their locality of childhood, but they, nevertheless, contradict both certain local stereotypes and Baumanesque "late modernist" sociological theorizing.

Presents an abstract of the research paper 'Does a Diagnosis of Basal Cell Carcinoma Affect Patient Attitudes to Sun Exposure and Skin Examination?,' by C.P.R. Bower, J.T. Lear, D.W. Pryce and D.A. de Berker presented during the annual meeting of the British Association of Dermatologists in Edinburgh, Scotland.

Presents an abstract of the research paper 'Basal Cell Carcinoma Follow-Up—a Survey of Patient Attitudes,' by C.P.R. Bower, J.T. Lear, D.W. Pryce and D.A. de Berker presented during the annual meeting of the British Association of Dermatologists in Edinburgh, Scotland.

Before any new antenatal screening test is introduced, the opinions of pregnant women should be considered. This is particularly relevant with HIV testing. This qualitative study reports the views of 29 women attending an antenatal clinic in a large maternity hospital in Scotland where a trial of different ways of offering HIV testing on a universal, voluntary basis occurred. Women were in favour of a test offer, although they did not necessarily wish to accept testing for themselves. Generally they were more worried about having an unhealthy baby. There was a commonly held view that routine testing would cause less anxiety because it would eliminate the stigma of saying yes to testing. A move towards the HIV test being recommended to pregnant women as opposed to merely offered is likely to be acceptable, would probably increase uptake rates and should therefore be assessed. [ABSTRACT FROM AUTHOR]

Relocation of the elderly has stimulated research into its effect on this vulnerable group. This study, by contrast, focuses attention on the staff response to relocation. Nursing staff on an Elderly and Severely Mentally Infirm Unit (ESMI) who were caring for the 50-60 inpatients completed a questionnaire, measuring job satisfaction and work-related attitudes, immediately and after the relocation to a newly refurbished unit. A follow-up was conducted 8 months after the change of environment. Only after the 8-month follow-up had overall levels of job satisfaction improved significantly. No changes over time were found in attitude to caring for ESMI patients or views about providing more facilitative activities as opposed to traditional nursing care. On all occasions there was a great sense of co-operation amongst staff, but they were unsatisfied with the pressure of work. Morale and feeling part of a team effort dropped after relocation but regained original levels on follow-up. Staff turnover was high for the duration of the study. Opinions concerning work were not associated with staff leaving immediately on relocation but low satisfaction levels did predict a future exodus of staff from the unit after the relocation. [ABSTRACT FROM AUTHOR]