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Background Despite the availability of effective evidence-based treatments for depression and anxiety, many ‘harder-to-reach’ social and patient groups experience difficulties accessing treatment. We developed a complex intervention, the AMP (Improving Access to Mental Health in Primary Care) programme, which combined community engagement (CE), tailored (individual and group) psychosocial interventions and primary care involvement. Objectives To develop and evaluate a model for community engagement component of the complex intervention. This paper focuses on the development of relationships between stakeholders, their engagement with the issue of access to mental health and with the programme through the CE model. Design Our evaluation draws on process data, qualitative interviews and focus groups, brought together through framework analysis to evaluate the issues and challenges encountered. Setting & participants A case study of the South Asian community project carried out in Longsight in Greater Manchester, United Kingdom. Key findings Complex problems require multiple local stakeholders to work in concert. Assets based approaches implicitly make demands on scarce time and resources. Community development approaches have many benefits, but perceptions of open-ended investment are a barrier. The time-limited nature of a CE intervention provides an impetus to ‘do it now’, allowing stakeholders to negotiate their investment over time and accommodating their wider commitments. Both tangible outcomes and recognition of process benefits were vital in maintaining involvement. Conclusions CE interventions can play a key role in improving accessibility and acceptability by engaging patients, the public and practitioners in research and in the local service ecology.

Children's health policy has highlighted the need to develop self-care programmes. However, there is a lack of evidence on which to base the development of such programmes. This paper reviews the published research on the effectiveness of self-care support interventions for children and young people with asthma, cystic fibrosis and diabetes. A systematic search was conducted of a range of electronic databases, supplemented by searching the reference lists of retrieved papers and published reviews. Retrieved studies were assessed against quality and eligibility criteria by two independent reviewers. The results were narratively synthesized to examine the effectiveness of self-care support interventions on health status, psycho-social well-being, condition-related knowledge, health service use and participant satisfaction. The search strategy identified 4261 papers which were screened against the review inclusion criteria. A total of 194 papers were assessed as being potentially eligible for inclusion with 15 papers being judged as adequate to include in the review. There is strong evidence of the effectiveness of interventions that target children/young people; use e-health or group-based methods; that are delivered in community settings. There is no evidence that interventions that focus on parents alone or are delivered only in hospital settings are effective. While there is some evidence to inform the development of self-care support programmes, there is a need for well-designed trials of interventions that are feasible to transfer into real-life settings and which involve parents and children in their development.

Aims and objectives. To: (1) Examine children’s/young people’s, parents’ and professionals’/workers’ perceptions of the effectiveness of different models of self-care support, (2) identify factors that support and inhibit self-care and (3) explore how different models integrate with self-care support provided by other organisations. Background. Childhood long-term illness has been largely overlooked in government policy and self-care support under-researched when compared with adults. There is a lack of evidence on which are the most appropriate models and methods to engage young people and their parents in self-care. Design. Case study. Methods. Case studies of six different models of self-care support were conducted using multiple methods of data collection in 2009. Semi-structured interviews were conducted with 26 young people, 31 parents and 36 self-care support providers. A sample of self-care support activities was observed and relevant documents reviewed. Data were analysed using the Framework approach. Results. The effectiveness of self-care support projects was defined in relation to four dimensions – providing a sense of community, promoting independence and confidence, developing knowledge and skills and engaging children/young people. Self-care support provided by schools appeared to be variable with some participants experiencing barriers to self-management and inclusion. Participants self-referred themselves to self-care support projects, and there was a lack of integration between some projects and other forms self-care support. Conclusion. This study adds to knowledge by identifying four dimensions that are perceived to be central to effective self-care support and the contextual factors that appear to influence access and experiences of self-care support. Relevance to clinical practice. Study findings can inform the development of self-care support programmes to meet the needs of individuals, families and communities. In addition, the findings suggest that healthcare professionals need to support schools if young people with long-term conditions are to have the same educational and social opportunities as their peers.

Interactions with retail salespersons in stores contribute to building trust and profits. Within the largely impersonal Internet, an interactive animated character or avatar, playing the social role of an online sales assistant, should provide a potent source of social presence and so have the potential to replace some of these interactions. This investigation tests whether avatars with social- or task-oriented communication styles contribute to user trust and patronage intentions. Further tests explore the moderating effects of product/service type. The study includes an online experiment and survey, involving 636 participants, mainly from North America, Oceania and Europe, allocated randomly to different treatments. Task-oriented communications contribute to trust, which in turn contributes to patronage intentions, especially for search goods/services. Social-oriented communications also contribute directly to trust and to patronage intentions, most strongly for credence goods/services. The authors recommend a three-fold approach to avatar implementation, involving requirements captured to define appropriate appearance, role, interaction style and content for the task. Conclusions include further suggestions for development and research.

The Information Commons at the University of Calgary (http://library.ucalgary.ca/infocommons) is a 42,000 ft2 facility on the 2nd floor of the main library building. It is an integrated service facility that provides both technical and library assistance. In this article, the author describes the main features of the planning process, the services and staffing, and highlights the collaborative partnerships which have developed over time. The next steps for the commons will be towards establishing new services, programs and partnerships in the Learning Commons in the new Taylor Family Digital Library, set to open in 2010.

Avatars are now appearing as online assistants on transactional websites, yet their scope is still limited. This paper explores their potential roles in providing assistance, a friendlier interface and purchase recommendations. As avatars are at early stages of implementation, the conceptual framework draws upon human-computer interaction research, plus cognate literature on salesperson roles and the use of synthetic characters in other contexts. The empirical study involved two longitudinal panels of online buyers and an international, online survey of 2114 internet users. Following split-sample principal components analysis and k-means clustering, four categories of role preference are identified. The results inform decisions on the appropriateness of avatars, their adaptation to customer needs and buying contexts, and their possible roles. Hypothesised relationships with age, gender and online buying experience are tested, suggesting scope for avatar role segmentation. Suggestions are offered for marke...

BACKGROUND: Many people with mental distress are disadvantaged because care is not available or does not address their needs. In order to increase access to high quality primary mental health care for under-served groups, we created a model of care with three discrete elements: community engagement, primary care training and tailored wellbeing interventions. We have previously demonstrated the individual impact of each element of the model. Here we assess the effectiveness of the combined model in increasing access to and improving the quality of primary mental health care. We test the assumptions that access to the wellbeing interventions is increased by the presence of community engagement and primary care training; and that quality of primary mental health care is increased by the presence of community engagement and the wellbeing interventions. METHODS: We implemented the model in four under-served localities in North-West England, focusing on older people and minority ethnic populations. Using a quasi-experimental design with no-intervention comparators, we gathered a combination of quantitative and qualitative information. Quantitative information, including referral and recruitment rates for the wellbeing interventions, and practice referrals to mental health services, was analysed descriptively. Qualitative information derived from interview and focus group responses to topic guides from more than 110 participants. Framework analysis was used to generate findings from the qualitative data. RESULTS: Access to the wellbeing interventions was associated with the presence of the community engagement and the primary care training elements. Referrals to the wellbeing interventions were associated with community engagement, while recruitment was associated with primary care training. Qualitative data suggested that the mechanisms underlying these associations were increased awareness and sense of agency. The quality of primary mental health care was enhanced by information gained from our community mapping activities, and by the offer of access to the wellbeing interventions. There were variable benefits from health practitioner participation in community consultative groups. We also found that participation in the wellbeing interventions led to increased community engagement. CONCLUSIONS: We explored the interactions between elements of a multilevel intervention and identified important associations and underlying mechanisms. Further research is needed to test the generalisability of the model. TRIAL REGISTRATION: Current Controlled Trials, reference ISRCTN68572159 . Registered 25 February 2013.

Background Service users wish to be involved in care planning but typically feel marginalized in this process. Qualitative explorations of the barriers and enablers of user involvement in mental health care planning are limited. Question How is user involvement in care planning conceptualized by service users and how can meaningful involvement be instilled in the care planning process? Methods In 2013, we conducted five focus groups (n = 27) and 23 individual interviews with current or recent adult users of secondary care mental health services (n = 27) in England. Eight users participated in both. Data were analysed using Framework Analysis. Results Ten themes emerged from the data: these themes encompassed procedural elements (connection; contribution; currency; care consolidation; and consequence), service user characteristics (capacity and confidence) and professional enablers (consultation; choice; and clarity of expression). Procedural elements were discussed most frequently in service user discourse. Discussion The process of care planning, centred on the user-clinician relationship, is key to user involvement. Implications for Practice Users describe a common model of meaningful involvement in care planning. Their requests, summarized through a 10C framework of care planning involvement, provide clear direction for improving service users satisfaction with care planning and enhancing the culture of services.

BackgroundInvolving service users in planning their care is at the centre of policy initiatives to improve mental health care quality in England. Whilst users value care planning and want to be more involved in their own care, there is substantial empirical evidence that the majority of users are not fully involved in the care planning process. Our aim is to evaluate the effectiveness and cost-effectiveness of training for mental health professionals in improving user involvement with the care planning processes. Methods/DesignThis is a cluster randomised controlled trial of community mental health teams in NHS Trusts in England allocated either to a training intervention to improve user and carer involvement in care planning or control (no training and care planning as usual). We will evaluate the effectiveness of the training intervention using a mixed design, including a ‘cluster cohort’ sample, a ‘cluster cross-sectional’ sample and process evaluation. Service users will be recruited from the caseloads of care co-ordinators. The primary outcome will be change in self-reported involvement in care planning as measured by the validated Health Care Climate Questionnaire. Secondary outcomes include involvement in care planning, satisfaction with services, medication side-effects, recovery and hope, mental health symptoms, alliance/engagement, well-being and quality of life. Cost- effectiveness will also be measured. A process evaluation informed by implementation theory will be undertaken to assess the extent to which the training was implemented and to gauge sustainability beyond the time-frame of the trial. DiscussionIt is hoped that the trial will generate data to inform mental health care policy and practice on care planning. Trial Registration NumberISRCTN16488358 (14 May 2014)

Information Commons service models generally include some element(s) of collaboration, whether it is for the delivery of technical support, e-literacy instruction, face to face and virtual ...

PurposePrevious research has focused on how trustworthiness can be evoked by the physical design of on‐screen characters (OSCs) within the e‐commerce interface. The purpose of this study is to investigate whether or not the OSCs representation, along with user differences, influence, how likeable, appropriate and trustworthy they are.Design/methodology/approachA web site was created for a simulated online bookseller and 183 people from various countries participated in the experiments. OSC representations were tested under four conditions in the main experiment: facial appearance (human‐like vs cartoon‐like) and gender (male vs female).FindingsThe results suggest that the human‐like characters are more likeable, appropriate and trustworthy in general terms. However, when perceived capabilities of OSCs are measured, a mismatch can occur between expectations and capabilities of the human‐like OSCs. In fact, cartoon‐like OSCs, especially female, had more positive effects on the web site interface.Research limitations/implicationsThis study was limited to simulations of on‐screen scenarios. Future work, with access to the huge database required, could investigate the effects of truly interactive OSCs. Larger national sub‐samples would permit generalisations about cross‐cultural differences.Practical implicationsFor e‐tailers and web designers, this study suggests critical design variables and response‐moderating variables that mediate the effects of OSCs in e‐retailing. It helps to understand customers' interaction needs in establishing and maintaining para‐social relationships, potentially increasing purchase intentions and persuasion.Originality/valueThe efficacy of different representations of OSCs to retail situations has been little investigated previously; this study measured how likeable, appropriate and trustworthy different OSC design formats are to different customer types.

Background The purpose of the study was to improve the quality of primary mental healthcare in underserved communities through involvement with the wider primary care team members and local community agencies. Methods We developed training intended for all GP practice staff which included elements of knowledge transfer, systems review and active linking. Seven GP Practices in four localities (North West England, UK) took part in the training. Qualitative evaluation was conducted using thirteen semi-structured interviews and two focus groups in six of the participating practices; analysis used principles of Framework Analysis. Results Staff who had engaged with the training programme reported increased awareness, recognition and respect for the needs of patients from under-served communities. We received reports of changes in style and content of interactions, particularly amongst receptionists, and evidence of system change. In addition, the training program increased awareness of – and encouraged signposting to - community agencies within the practice locality. Conclusions This study demonstrates how engaging with practices and delivering training in a changing health care system might best be attempted. The importance of engaging with community agencies is clear, as is the use of the AMP model as a template for further research.

Which motorists are ready to reduce their car use and how should they be helped to change? Results are reported from a postal questionnaire survey study of English car drivers (Na 791). One third (33%) of car drivers indicated they would like to reduce their car use ‘over the next 12 months’, but only 7% thought they were likely to. One third (34%) of car drivers would like to use public transport (PT) more, but only 5% thought they were likely to. While over one third anticipated changes in their transport mode usage, and 1 in 5 (19%) would like to both decrease car use and increase PT use, only 3% thought this combination likely. Effectiveness ratings of pull and push policy measures showed motorists would rather be pulled than pushed from their cars; that the old, the poor and urban dwellers would be more susceptible to push measures; and that those residing out-of-town, driving medium and large cars, driving high annual mileage and required to drive as part of their work are less likely to be persuaded to reduce their car use by either type of measure. Other social psychological research suggests that sustainable changes by individuals that can be integrated into individual patterns of life will be more readily achieved by facilitation and support than by coercion. q 2000 Elsevier Science Ltd. All rights reserved.

Background Psychological therapy is effective for symptoms of mental distress, but many groups with high levels of mental distress face significant barriers in terms of access to care, as current interventions may not be sensitive to their needs or their understanding of mental health. There is a need to develop forms of psychological therapy that are acceptable to these groups, feasible to deliver in routine settings, and clinically and cost effective. Methods We developed a culturally sensitive wellbeing intervention with individual, group and sign-posting elements, and tested its feasibility and acceptability for patients from ethnic minorities and older people in an exploratory randomised trial. Results We recruited 57 patients (57% of our target) from 4 disadvantaged localities in the NW of England. The results of the exploratory trial suggest that the group receiving the wellbeing interventions improved compared to the group receiving usual care. For elders, the largest effects were on CORE-OM and PHQ-9. For ethnic minority patients, the largest effect was on PHQ-9. Qualitative data suggested that patients found the intervention acceptable, both in terms of content and delivery. Conclusions This exploratory trial provides some evidence of the efficacy and acceptability of a wellbeing intervention for older and ethnic minority groups experiencing anxiety and depression, although challenges in recruitment and engagement remain. Evidence from our exploratory study of wellbeing interventions should inform new substantive trial designs. Trial registration Current controlled trials ISRCTN68572159

Background General practice receptionists fulfil an essential role in UK primary care, shaping patient access to health professionals. They are often portrayed as powerful ‘gatekeepers’. Existing literature and management initiatives advocate more training to improve their performance and, consequently, the patient experience. Aim To explore the complexity of the role of general practice receptionists by considering the wider practice context in which they work. Design and setting Ethnographic observation in seven urban general practices in the north-west of England. Method Seven researchers conducted 200 hours of ethnographic observation, predominantly in the reception areas of each practice. Forty-five receptionists were involved in the study and were asked about their work as they carried out their activities. Observational notes were taken. Analysis involved ascribing codes to incidents considered relevant to the role and organising these into related clusters. Results Receptionists were faced with the difficult task of prioritising patients, despite having little time, information, and training. They felt responsible for protecting those patients who were most vulnerable, however this was sometimes made difficult by protocols set by the GPs and by patients trying to ‘play’ the system. Conclusion Framing the receptionist–patient encounter as one between the ‘powerful’ and the ‘vulnerable’ gets in the way of fully understanding the complex tasks receptionists perform and the contradictions that are inherent in their role. Calls for more training, without reflective attention to practice dynamics, risk failing to address systemic problems, portraying them instead as individual failings.

Short Description Information Commons is a collaborative service delivery model within academic libraries. The success of this model is leading others within academic institutions to collaborate to create a holistic learning environment

Although the motivational benefits of embodied conversational agents in other areas have been demonstrated their potential for relationship building within e-tailing has been little utilized. In this exploratory paper we consider customer perceptions of what types of ECA are appropriate to retailing Web sites using data from semi-structured interviews with 30 Internet shoppers. Extrapolating the findings from the advertising literature concerning match-up between endorser and brand, product or retailer we find this is an important element in the acceptability and viability of ECAs on retail Web sites. It is apparent that great care has to be taken in matching not only the physical characteristics of the ECA to perceptions of the brand, product or retailer but also to the goals and motivations of potential customers of a Web site. We also find that introducing customer interaction into the 'match-up' mix introduces a new level of complexity, that of matching customer expectations. It is this level of service that may be most difficult for technology and organizations to meet.

University students, divided on a quartile split into low ( n = 53) and high ( n = 42) depression groups (Beck scores of 0–1 or 7 and higher), were presented a series of failure situations in which failure occurred under high effort (with situational factors causing failure) or low effort. Subjects rated their affective reactions to each situation. It was hypothesized that the group low on depression would feel worse after high effort (since this would challenge their sense of self-efficacy) whereas the high depression group would feel better in this condition (since attribution of failure to situational factors would protect their sense of self-esteem). Results were consistent with expectations for the group low on depression. For the group high on depression, the means were rank-ordered as predicted but the difference was not significant.

One-electron properties calculated from SCF Xα SW/MT and near-HF functions for water are compared. A regional orbital analysis is used to assess the differences between the functions.

Vibrational predissociation of the van der Waals molecule He⋅⋅⋅I2(B 3Π) has been investigated using quasiclassical trajectories. The study was restricted to collinear motion to allow comparisons with the quantum mechanical calculations of Beswick and Jortner [J. Chem. Phys. 68, 2277 (1978); 69, 512 (1978)]. The unimolecular dissociation of He⋅⋅⋅I2(B 3Π) confined to a single adiabatic electronic potential‐energy surface was studied as a function of the initial I2 vibrational quantum state, where a zeroth‐order approximation of the separation of the I–I and He–I2 oscillators was made for the purpose of assigning initial states. The computed trajectory results show that the unimolecular decay as a function of time obeys the exponential decay law quite well. The computed decay rates are in accord with the quantum mechanical values and with experimental measurements.

One‐electron properties of LiH, including the dipole and quadrupole moments, are calculated with SCF–Xα–SW wavefunctions. The effect of the parameters of the SCF–Xα–SW method on the results has been studied. Use is made of numerical quadrature with diophantine points in the evaluation of integrals. The results are compared with those obtained with standard Hartree–Fock and configuration interaction calculations for LiH, and semiquantitative agreement is found.

We have calculated the one‐electron energy level structures of the isolated species UO2++, UO2+, and UO2 in their linear forms, using a self‐consistent relativistic multiple scattering model with Xα exchange. For UO2++, we have used the molecular orbitals of the ground state muffin‐tin potential to calculate the energies of a few of the many‐electron excited states; these afford a somewhat more fundamental basis for comparison with experiment than do the one‐electron energies, and their determination also sheds some light on the coupling scheme (ω–ω vs Λ–Σ) to be expected in these systems. These excited state energies agree well with the experimental absorption data. The calculated one‐electron excitation energies for UO2++ are in reasonable agreement with the observed onset of absorption. The behavior of the corresponding one‐electron binding energies as a function of U–O distance supports a different interpretation of the XPS than that given by Veal et al. Considering the three species at a common bond ...