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Biomass smoke exposure is a threat to child and maternal health in many resource-limited countries and is associated with poor pregnancy outcomes and serious lung diseases in the offspring. We aimed to assess the feasibility, acceptability and impact of a midwife-led education programme on biomass risks and prevention for women attending maternity clinics in Uganda. Education materials were co-developed through an iterative process by midwives and other stakeholders. The materials were serially tested and approved by the Ministry of Health and used by midwives and village health teams (VHTs). The district health team, 12 midwives and 40 VHTs were sensitised on biomass smoke. Two hundred and forty-four women were educated about biomass smoke by midwives; pre- and post-session questionnaires showed major improvements in knowledge of biomass smoke risks. Qualitative interviews with women three months after the sessions showed that they made behavioural changes such as avoiding smoke while cooking, using dry wood, solar power for lighting and improved ventilation. The major barrier to behavioural changes was poverty, but some improvements cost no money. The programme delivered by midwives was feasible and acceptable; implementing this programme has the potential to reduce exposure to smoke with major benefits to mother, foetus, and children throughout their lives.

Background Previous research shows that existing asthma quality of life questionnaires fail to measure the burden of oral corticosteroids that can be used to treat severe asthma, and are therefore not fit for purpose for severe asthma according to the USA’s Food and Drug Administration (FDA) criteria for content validity. Patient input and documentation of that input is key to achieving content validity according to FDA guidelines. This paper describes the process of constructing a new questionnaire to measure the burden of asthma symptoms and burden of treatment in severe asthma, using criteria specified by the FDA. Methods A draft severe asthma questionnaire (SAQ) was constructed using qualitative input from severe asthma patients who took part in an earlier study. The aim of this study was to improve that draft questionnaire using a further group of patients. In four iterative focus groups, 16 people with severe asthma completed the draft questionnaire, discussed the wording and structure and suggested changes that were incorporated into the final version. Results The original intention to ask patients to identify whether problems were caused by asthma symptoms or side effects of medication was abandoned as the attribution of cause was found to be difficult and inconsistent. The recall period of 2 weeks was acceptable but fails to reflect the patients’ desire to express the variability of severe asthma. Patients suggested improvements to the wording of the draft questionnaire, including splitting some items in two, combining two items in one, and changes to some of the words in individual items and the response scale. Conclusions The final version of the questionnaire was substantially different from one constructed using only qualitative reports from patients about the quality of life deficits of severe asthma. Patients make a valuable contribution to the questionnaire if they are asked to comment and improve an initial draft and where patients are treated as partners in the process of questionnaire construction, rather than only as a source of information to experts who construct the questionnaire.

Background: Chronic lung disease (CLD) is a growing burden in Uganda. There is no useful treatment, but sufferers have poor health status and often are stigmatised. We aimed to test feasibility of a pulmonary rehabilitation (PR) programme in Kampala, Uganda, and adapted traditional PR for patients with post-TB lung disease and COPD. Methods: In a development study, respiratory specialists, nurses and physiotherapists formed a PR team. The exercise regime was based on conventional PR; the education programme covered normal lungs, post TB damage and COPD including breathlessness, exercise, nutrition, smoking and drug treatments. Qualitative and quantitative assessment of the programme included recruitment, retention and outcome measures including exercise capacity and health status questionnaires. Results: In March 2015- December 2015, 4 groups were conducted. In total we screened 193 (Post-TB 113 and 80 COPD) patients, 72 were assessed 46 were suitable and 44 started rehab (17 male; mean age 44 years, range 17-83) with 42 (95%) completing and 39 followed 6 weeks after. Main outcomes in Table 1. Conclusion: PR is feasible and appears effective in CLD and post TB patients in Uganda, but an adequately powered controlled trial is needed to confirm this. PR offers a new and sustainable therapy for the neglected problem of chronic lung disease in low to middle income countries. This study provides patient and stakeholder feedback to inform design and implementation of a full trial planned for Zambia, Kenya and Tanzania.

Rates of non-attendance within IAPT are 45-48%. Non-attendance has negative implications for patients, staff and services.This research aimed to identify service-related factors that contribute to non-attendance.Qualitative interviews with 14 patients recruited from six IAPT services in the South West. These were individuals who, having been referred to IAPT, never attended, or only attended one treatment contact. They were interviewed face-to-face or by telephone using semi-structured interview schedules. The resulting data were analysed thematically through an iterative qualitative analysis using data mapping sheets.Five themes emerged from an analysis of the data including: the waiting process, the relationship between IAPT services and GPs, expectations of assessment and treatment, rigidity of service and practitioner contributions to the relationship.The analysis identifies ways in which IAPT services could reduce non-attendance. It also highlights areas of interest for future non-attendance in healthcare research, particularly collaborative care and protocolisation of treatment.

Purpose: This qualitative study compared communication between GP-led and nurse-led telephone triage in primary care for patients who had a requested a same-day face-to-face appointment with a GP. Theory: Understanding how clinicians interact with patients during telephone triage is central to managing the demand for primary and secondary care. We currently know very little about how telephone triage may be affecting the delivery of primary health care. Methods: We applied conversation analytic methods to systematically compare clinician and patient behaviours in 51 consented audio recordings (22 Nurse, 29 GP) of telephone triage consultations and 10 linked video-recordings of nurses’ use of computer decision support software (CDSS) used during triage. Findings: Nurses asked patients an average of 15 questions about their problem vs. 5 by GPs, yet call length was similar across both arms (04:39 Nurse; 04:37 GP). The design of clinician questions, and the range of actions implemented through them, differed markedly between the two groups. Discussion: GPs and nurses emphasised different aspects of the clinical assessment process. These different approaches to triage have potential implications for the type of information collected and recorded; patient experience of telephone triage; health outcomes; costs of care; and primary and secondary care workload.