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This research examined the social drivers of entrepreneurship among business owners in Aboabo market in Tamale. A quantitative research approach was adopted and the target population was business owners in Aboabo market in Tamale. It was found that not all social drivers that influence decision to become entrepreneurs motivate entrepreneurs to remain in business. Also, family or close relation, belonging to a social club (social capital), previous work experience and social status positively affect business performance while being a married woman and being a woman does not affect entrepreneurial performance. Access to finance, family and friends involvement are major challenges of entrepreneurship whereas lack of social support, low educational background and gender discrimination are not major challenges of entrepreneurship. Based on these findings, the study recommended entrepreneur education, community support and easy access to finance through government intervention to help entrepreneurs relish their full potential to support economic growth and development significantly.

This research examined the application of mobile phone in business practice among small scale businesses in Tamale metropolis. A quantitative research approach was adopted and the target population was users of mobile money application among Small Scale Businesses in Tamale Metropolis. The general objective of the study is to examining the application of mobile phones in business practice among Small Scale Businesses in Tamale metropolis. It is found out by the researcher that usually people use it to transact business that is making and receiving money as payment. Hence, it is established that mobile phone gives them opportunity to keep records as evidence. The research revealed that, mobile money is noted to facilitate and speed up transaction of businesses. Also, it is found out that, it enhances convenience of handling resources effectively. It is established that, monies in the mobile phone are safer and remain safe even if the mobile device is lost. It is clearly indicated that many people lose their monies every now and then from fraudsters through the introduction of mobile money. The study shows that technological changes are some of the factors Small Scale Businesses faced. To optimize the benefits to be realized from mobile money application in businesses, there is the need to overcome the challenges of the application among small scale businesses.

Aims and objectives To update and re-validate the Valuing Patients as Individuals Scale for use as a patient appraisal of received healthcare. Background Healthcare in the United Kingdom and beyond is required to deliver high quality, person-centred care that is clinically effective and safe. However, patient experience is not uniform, and complaints often focus on the way patients have been treated. Legislation in United Kingdom requires health services to gather and use patients' evaluations of care to improve services. Design This study uses scoping literature reviews, cognitive testing of questionnaire items with patient and healthcare staff focus groups, and exploratory factor analysis. Methods/Setting/Participants Data were collected from 790 participants across 34 wards in two acute hospitals in one National Health Service Health Board in Scotland from September 2011–February 2012. Ethics and Research and Development approval were obtained. Results Fifty six unique items identified through literature review were added to 72 original Valuing Patients as Individuals Scale items. Face validity interviews removed ambiguous or low relevance items leaving 88 items for administration to patients. Two hundred and ninety questionnaires were returned, representing 37% response rate, 71 were incomplete. Thus 219 complete data were used for Exploratory Factor Analysis with varimax orthogonal rotation. This revealed a 31 item, three factor solution, Care and Respect; Understanding and Engagement; Patient Concerns, with good reliability, concurrent and discriminant validity in terms of gender. A shortened 10 item measure based on the top 3 or 4 loading items on each scale was comparable. Relevance to clinical practice The short scale version is now being routinized in real-time evaluation of patient experience contributing to this United Kingdom, National Health Service setting meeting its policy and legislative requirements. What does this paper contribute to the wider global clinical community? •The updated Valuing Patients as Individuals Scale; •Is a reliable and valid measure specifically designed to capture the issues that matter most to people receiving secondary care. •Has been developed based upon current conceptualisations of person-centred care and the clinical practices required to deliver this. •May be used within service improvement work as a trigger to ensure person-centred care delivery.

Background: Income levels and Socio-economic status at the individual level are known to be associated with adverse health outcomes including risk of diabetes and its complications. However it is unclear how neighbourhood deprivation levels influence perceived quality of life among people with diabetes. This study investigated the relationship between neighbourhood deprivation and quality of life among people with diabetes attending two hospital trusts in Liverpool, England. Methods: eligible participants completed a set of study questionnaires including demographic characteristics and the Audit of Diabetes Dependent Quality of Life questionnaire. Postcode based neighbourhood deprivation data were obtained from the UK’s Department for Communities and Local Government website. Relevant statistical analyses were undertaken using SPSS version 22. Results: a total of 123 people with type 1 and type 2 diabetes participated in the study. Majority of participants were type 2 diabetes patients (53%) and about half were men (51%). Overall 20% of participants reported poor quality of life. Compared to those with type 2 diabetes, a higher proportion of people with type 1 diabetes reported good quality of life (58% vs. 61%; p0.05). Conclusion: Neighbourhood deprivation levels are significantly associated with quality of life among people with diabetes and could potentially be used to guide interventions aimed at promoting their health and well-being. Disclosure A. Abubakari: None.

Table S1. Study characteristics and outcomes by year of publication. (DOCX 32 kb)

Abdul-Razak Abubakari,1 Martyn C Jones,2 William Lauder,3 Alison Kirk,4 John Anderson,5 Devasenan Devendra,6 Ebrahim K Naderali11School of Health Sciences, Liverpool Hope University, Hope Park, Liverpool, 2School of Nursing and Midwifery, University of Dundee, Dundee, 3School of Nursing and Midwifery and Health, University of Stirling, Stirling, 4Department of Sport, Culture and the Arts, University of Strathclyde, Glasgow, 5Homerton University Hospital NHS Trust, Homerton Row, London, 6West Hertfordshire Hosptials NHS Trust, Watford, UKObjectives: This study investigated ethnic differences in diabetes-specific knowledge, illness perceptions, self-management, and metabolic control among black-African, black-Caribbean,and white-British populations with type 2 diabetes. The study also examined associations between demographic/disease characteristics and diabetes-specific knowledge, illness perceptions, self-management, and metabolic control in each of the three ethnic groups.Design: Cross-sectionalSetting: Diabetes/retinal screening clinics in Hackney and Brent, London.Methods: Black-African, black-Caribbean and white-British populations with type 2 diabetes were asked to participate. Questionnaires measuring demographic/disease characteristics, diabetes-specific knowledge, self-management, and illness perceptions were used for data collection. Data for glycated hemoglobin (HbA1c) and microvascular complications were obtained from medical records. Ethnic differences in diabetes-related measures were estimated using analysis of variance/covariance. Multiple regression techniques were used to determine relationships between demographic/disease characteristics and measured diabetes-related outcomes.Results: Three hundred and fifty-nine patients participated in the study. White-British participants had high diabetes-specific knowledge compared to their black-African and black-Caribbean counterparts. Black-Africans reported better adherence to self-management recommendations than the other ethnic groups. Compared to the white-British patients, black-African and black-Caribbean participants perceived diabetes as a benign condition that could be cured. Educational status and treatment category were determinants of diabetes-specific knowledge in all three ethnic groups. However, different demographic/disease characteristics predicted adherence to self-management recommendations in each ethnic group.Conclusion: Clearly, there is disease (diabetes) knowledge-perception variation between different ethnic groups in the UK which may partly influence overall disease outcome. It is plausible to recommend screening, identifying, and dispelling misconceptions about diabetes among ethnic minority patients by health care professionals as well as emphasizing the importance of self-management in managing chronic diseases such as diabetes.Keywords: black-African, black-Caribbean, white-British, diabetes, illness perceptions, self-management

Sexually transmitted infections (STIs) disproportionately affect men who have sex with men, with marked increases in most STIs in recent years. These are likely underpinned by coterminous increases in behavioural risks which have coincided with the development of Internet and geospatial sociosexual networking. Current guidelines advocate regular, annual sexually transmitted infection testing amongst sexually active men who have sex with men (MSM), as opposed to symptom-driven testing. This paper explores sexually transmitted infection testing regularity amongst MSM who use social and sociosexual media. Data were collected from 2668 men in Scotland, Wales, Northern Ireland and the Republic of Ireland, recruited via social and gay sociosexual media. Only one-third of participants report regular (yearly or more frequent) STI testing, despite relatively high levels of male sex partners, condomless anal intercourse and high-risk unprotected anal intercourse. The following variables were associated with regular STI testing; being more ‘out’ (adjusted odds ratio = 1.79; confidence interval = 1.20–2.68), HIV-positive (adjusted odds ratio = 14.11; confidence interval = 7.03–28.32); reporting ≥10 male sex partners (adjusted odds ratio = 2.15; confidence interval = 1.47–3.14) or regular HIV testing (adjusted odds ratio = 48.44; confidence interval = 28.27–83.01). Men reporting long-term sickness absence from work/carers (adjusted odds ratio = 0.03; confidence interval = 0.00–0.48) and men aged ≤25 years (adjusted odds ratio = 0.36; 95% confidence interval = 0.19–0.69) were less likely to test regularly for STIs. As such, we identify a complex interplay of social, health and behavioural factors that each contribute to men’s STI testing behaviours. In concert, these data suggest that the syndemics placing men at elevated risk may also mitigate against access to testing and prevention services. Moreover, successful reduction of STI transmission amongst MSM will necessitate a comprehensive range of approaches which address these multiple interrelated factors that underpin MSM's STI testing.

Using Leventhal’s Common-sense self-regulation model, this study investigated associations between illness perceptions, self-management and metabolic-control outcomes for diabetes among European and African-origin patients with type 2 diabetes. Background. Compared to the general populations of their host countries, African-origin populations in the diaspora are disproportionately affected by diabetes and its microvascular complications. However, comparatively little is known about how African-origin patients with type 2 diabetes perceive about their condition and whether such perceptions influence their self-management behaviours. Design. Cross-sectional design. Methods. Participants were recruited from diabetes clinics in London. Illness perceptions and adherence to self-management recommendations were assessed using questionnaires and data for metabolic-control outcomes were obtained from patient records. Associations between variables were investigated using correlations and multiple-regression techniques. Data collection for the study was conducted between February and June 2008. Results. In all, 359 patients participated in the study. The results indicated that perceiving diabetes with severe consequences was associated with poor self-management in both African-origin (black-African and black-Caribbean) and European-origin (white-British) patients with type 2 diabetes. However, personal control perceptions were associated with better self-management in African-origin patients. In multivariate analysis, illness perceptions explained significant proportions of the variations in self-management behaviours in both European-origin and African-origin patients. Perceived personal control over diabetes was a main determinant of the variations in self-management among European and African-origin patients. Other dimensions of illness perceptions, including consequences and emotional representations contributed to variations in self-management among African-origin patients. After controlling for demographic/disease characteristics, self-management of diabetes did not predict any metabolic-control outcome for diabetes in any ethnic group. Conclusion. Illness perceptions are important determinants of self-management among African-origin patients.

Summary Objective To determine the prevalence and distribution of, and trends in, physical inactivity and diabetes in adult West African populations. Design Systematic review and meta-analysis. Methods Literature searches were conducted using four electronic databases. Journal hand searches and examination of citations of relevant articles were also undertaken. To be included, studies had to be population based, use clearly defined criteria for measuring diabetes and physical inactivity, present data that allowed calculation of the prevalence of diabetes or physical inactivity, and sample adult participants. Studies retrieved were appraised critically. Meta-analysis was performed using the DerSimonian-Laird random effect model. Results Twenty-one reports were retrieved for diabetes and 15 reports were retrieved for physical in/activity. Most studies (10 for diabetes and six for physical activity) were conducted solely among urban populations. The prevalence of diabetes in West Africa was approximately 4.0% [95% confidence interval (CI) 2.0–9.0] in urban adults and 2.6% (95%CI 1.5–4.4) in rural adults, and was similar in men and women [prevalence ratio (PR) 1.36, 95%CI 0.96–1.92]. Cumulative time trend analyses suggested an increase in the prevalence of diabetes among adults in urban West Africa, from approximately 3.0% (95%CI 1.0–7.0) to 4.0% (95%CI 2.0–9.0) in the past 10 years. The prevalence of inactivity in West Africa was 13% (95%CI 9.0–18.0). An association was found between physical inactivity and being older (≥50 years) (PR 1.82, 95%CI 1.36–2.44), female gender (PR 1.62, 95%CI 1.41–1.87) and urban residence (PR 2.04, 95%CI 1.58–2.63). Conclusions Diabetes and physical inactivity are important public health issues in urban West Africa, with similar prevalences to wealthy industrialized countries. There is an urgent need for policy makers, politicians and health promotion experts to put measures in place to encourage active lifestyles and control diabetes in urban West Africa.

Aim. To establish levels of mental health at a community level and to model the relationship between mental health difficulty, health-related impact and health related quality of life in school pupils aged 11–18 years old. Background. The issue of psychosocial and mental health in school pupils is a topic of considerable academic and public interest. The incidence of mental health problems in children 11–18 years shows marked differences between countries and within countries. Much of the epidemiological literature has focused on diagnostic categories rather than population health. Design. The study employed a cross-sectional survey. Methods. A cross-sectional survey of 1786 school children aged 11–18 years was conducted in Scotland. Participants completed the strengths and difficulties questionnaire and the SF-10 for Children. Results. This group of school pupils had similar levels of mental health needs and psychosocial health status as UK and age-related US norms. They had poorer levels of physical health status. The most important predictors of psychosocial health status were difficulty category, impact, physical health status and chronicity. The most important predictors of impact were difficulty category, chronicity and psychosocial health status. Conclusion. There is a need to tackle psychosocial health problems in schools. Problems are often chronic in nature and whilst still having an impact on the life of pupils may not be severe enough for a diagnosis which would trigger treatment in the conventional sense. Psychosocial health is predicted by physical health therefore nursing interventions which are focussed on both physical and psychosocial health may be needed. Relevance to clinical practice. This study suggests that in some geographical areas in UK targeting of services to ‘high-need’ schools is not necessary and universal services are required. Problems need to be detected before they reach current treatment thresholds. Interventions should be school-based with a focus on impact on classroom learning and family difficulties.

This poster session discusses the prevalence and distribution of physical inactivity among adult West African populations.

Self-management is critical if people with diabetes are to minimise their risk of macrovascular and microvascular complications, yet adherence to self-management recommendations is suboptimal. Understanding the predictors of optimal diabetes self-management in specific populations is needed to inform effective interventions. This study investigated the role of demographic and clinical characteristics, illness perceptions, and self-efficacy in explaining adherence to self-management recommendations among people with poorly controlled diabetes in North West of England. Illness perceptions and self-efficacy data were collected using validated questionnaires and clinical data were obtained from hospital records. Correlations were used to investigate bivariate relationships between independent variables and self-management, and multiple regression techniques were used to determine demographic and psychosocial predictors of self-management. Various demographic and clinical characteristics were associated with adherence to self-management recommendations. In particular, employment status explained 11% of the variation in adherence to foot care whilst diabetes treatment category explained 9% of exercise and 21% of the variations in SMBG recommendations. Also, 22% and 8% of the variations in overall self-management were explained by illness perceptions and self-efficacy beliefs, respectively. Illness perceptions and self-efficacy beliefs of people with poorly controlled diabetes are important predictors of their self-management behaviours and could potentially guide effective interventions.

Abdul-Razak Abubakari,1 Mohammad-Mahdi Naderali,2 Ebrahim K Naderali3 1School of Health and Life Sciences, Glasgow Caledonian University, London, UK; 2Blue Coat School, Liverpool, UK; 3School of Health Sciences, Liverpool Hope University, Hope Park Campus, Liverpool, UK Abstract: As longevity increases, so does the global prevalence of cognitive dysfunction. Numerous lifestyle and/or dietary interventions such as omega-3 fatty acids have been suggested to improve memory. Therefore, this study examined the consistency and strength of the impact of supplementation of omega-3 fatty acids on overall cognitive function using systematic reviews and meta-analytic methods. Of 905 studies retrieved from all searches, 12 randomized controlled trials were included in the meta-analysis. There were differences between studies reporting outcomes for single memory function parameters. Subgroup analysis of doses used (low versus high) indicated that subjects receiving low (

The study sought to assess the link between socio-cultural factors and the causes of maternal death. In attaining the objective of the study, simple random and purposeful sampling techniques were used to sample 199 women in fertility age from the population size of 27606 from the East Gonja District of Ghana. A questionnaire with both opened-ended and closed-ended questions were used in gathering data from the respondents. The study found that socio-cultural factors may directly cause maternal death through harmful traditional practices like the administration of toxic substances to pregnant women in pregnancy and also indirectly by preventing pregnant women from accessing adequate antenatal services and skilled attendance at delivery.. It is recommended that if maternal mortality is to be reduced, harmful traditional practices and socio-cultural and other perceived barriers that prevent women from accessing antenatal and skilled delivery services need to be removed. These barriers among others include: harmful customs and traditions and believe system; financial constraints; superstition religious believes; and fear of surgery. The stakeholders of maternal health need to appreciate the essence of incorporating social cultural concerns in addressing the debilitating high maternal mortality rates in Ghana.

Background The Revised Illness Perception Questionnaire (IPQ-R) has been used extensively to measure illness perceptions of several patient populations. However, the instrument was developed using participants of mainly European-origin. The reliability and validity of the IPQ-R may therefore need to be established before use among populations of different ethnic and cultural origins. Objectives This study investigated the factor structure and internal consistency reliability of the IPQ-R in African-origin patients with type 2 diabetes. Methods In this cross-sectional study, 221 adults of African descent with type 2 diabetes completed the IPQ-R. Participants were recruited from patients attending diabetes and retinal screening clinics in the London boroughs of Brent and Hackney. Confirmatory Factor Analysis based on the covariance matrix was used to determine factorial validity for the Timeline-acute/chronic, Consequences, Personal control, Treatment control, Illness coherence, Timeline-cyclical, Emotional representation and three causal subscales of the IPQ-R. Composite internal consistency reliability for individual subscales was determined using Cronbach's alpha coefficients. Results After eliminating three items and re-specifying six error covariances associated with large standardised residuals and low factor loadings, the hypothesised model adequately explained the covariance of African and Caribbean patients' responses to items of the IPQ-R. Also, composite reliability coefficients of all measured subscales were acceptable and inter-correlations between subscales were in line with those reported from other population groups. Conclusions The findings in this study suggest that although the IPQ-R may be valid and reliable across cultures, investigators may need to modify (e.g. by rewording) some of its items taking into account any linguistic origins of their populations of study. Further evaluation of the IPQ-R (including the identity subscale) in larger samples of African-origin populations is also recommended.

The objective of this study was to determine the distribution of and trends in obesity in adult West African populations. Between February and March 2007, a comprehensive literature search was conducted using four electronic databases. Journal hand searches, citations and bibliographic snowballing of relevant articles were also undertaken. To be included, studies had to be population-based, use well-defined criteria for measuring obesity, present data that allowed calculation of the prevalence of obesity and sample adult participants. Studies retrieved were critically appraised. Meta-analysis was performed using the DerSimonian-Laird random effect model. Twenty-eight studies were included. Thirteen studies were conducted in urban settings, 13 in mixed urban/rural and one in rural setting. Mean body mass index ranged from 20.1 to 27.0 kg(2). Prevalence of obesity in West Africa was estimated at 10.0% (95% CI, 6.0-15.0). Women were more likely to be obese than men, odds ratios 3.16 (95% CI, 2.51-3.98) and 4.79 (95% CI, 3.30-6.95) in urban and rural areas respectively. Urban residents were more likely to be obese than rural residents, odds ratio 2.70 (95% CI, 1.76-4.15). Time trend analyses indicated that prevalence of obesity in urban West Africa more than doubled (114%) over 15 years, accounted for almost entirely in women. Urban residents and women have particularly high risk of overweight/obesity and obesity is rising fast in women. Policymakers, politicians and health promotion experts must urgently help communities control the spread of obesity in West Africa.

Summary Objective To review the prevalence of diabetes, obesity and physical inactivity among Ghanaians and Nigerians in Africa, Europe and North America. Methods This systematic literature review used MEDLINE 1966–2005, EMBASE 1980–2005 and cited references to identify relevant studies on Ghanaians and Nigerians. Results No studies on Ghanaians or Nigerians in Europe or North America have been reported. Sixteen studies in Africa were included; 13 on Nigerians and three on Ghanaians. The data were limited, poorly reported and not easily comparable. Pooled analysis was not possible. Precise time trend analysis was not possible, but diabetes seemed rare at 0.2% in urban Ghana in 1963 and 1.65% in urban Nigeria in 1985. The prevalence of diabetes in Nigerian adults (age ⩾40 years) in 2000 was 6.8% [confidence intervals (CI) 4.6–9.0]. In Ghana, the prevalence of diabetes in adults (age ⩾25 years) was 6.3% (CI 5.6–7.0) in 1998. Obesity (body mass index ⩾30) among Nigerian adults was 8.8% (CI 7.0–10.6) in 2000, and obesity in Ghanaian adults (⩾25 years) was 14.1% (CI 13.1–15.1%) in 1998. Various studies reported that 25–57% of Nigerians were physically inactive. Conclusion Although weak, the evidence base points to a rise in diabetes prevalence in Ghana and Nigeria, with major urban–rural differences. There is an urgent need for accurate and comparable surveys on diabetes and its risk factors among Nigerians and Ghanaians. Effective public health policies are vital to control the diabetes epidemic.

Sameer Fatani,1 Abdul-Razak Abubakari,2 Imose Itua,2 Christopher Wong,3 Cecil Thomas,3 Ebrahim K Naderali21Obesity Biology Unit, School of Clinical Sciences, University of Liverpool, 2Department of Health Sciences, Liverpool Hope University, Hope Park, 3Aintree University Hospital NHS Foundation Trust, Liverpool, UKBackground: The prevalence of diet-induced obesity is increasing globally, and posing significant health problems for millions of people worldwide. Diet-induced obesity is a major contributor to the global pandemic of type 2 diabetes mellitus. The reduced ability of muscle tissue to regulate glucose homeostasis plays a major role in the development and prognosis of type 2 diabetes. In this study, an animal model of diet-induced obesity was used to elucidate changes in skeletal muscle insulin signaling in obesity-induced diabetes.Methods: Adult male Wistar rats were randomized and assigned to either a control group or to a test group. Controls were fed a standard laboratory pellet diet (chow-fed), while the test group had free access to a highly palatable diet (diet-fed). After 8 weeks, the diet-fed animals were subdivided into three subgroups and their diets were altered as follows: diet-to-chow, diet-fed with addition of fenofibrate given by oral gavage for a further 7 weeks, or diet-fed with vehicle given by oral gavage for a further 7 weeks, respectively.Results: Untreated diet-fed animals had a significantly higher body weight and metabolic profile than the control chow-fed animals. Intramuscular triacylglyceride levels in the untreated obese animals were significantly higher than those in the control chow-fed group. Expression of protein kinase C beta, phosphatidylinositol 3, Shc, insulin receptor substrate 1, ERK1/2, and endothelial nitric oxide synthase was significantly increased by dietary obesity, while that of insulin receptor beta, insulin receptor substrate 1, and protein kinase B (Akt) were not affected by obesity.Conclusion: These data suggest that diet-induced obesity affects insulin signaling mechanisms, leading to insulin resistance in muscle.Keywords: diet-induced obesity, intramuscular lipids, insulin signaling, muscle, fenofibrate