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2. In-person and remote recruitment of people with dementia into a primary care-based cluster randomised controlled trial: lessons from the Dementia PersonAlised Care Team (D-PACT) feasibility study

Author

Oh, Tomasina M., primary, Batool, Saqba, additional, Musicha, Crispin, additional, Greene, Leanne, additional, Wheat, Hannah, additional, Smith, Lorna, additional, Griffiths, Sarah, additional, Gude, Alex, additional, Weston, Lauren, additional, Shafi, Hannah, additional, Stevens, Kara, additional, Sutcliffe, Caroline, additional, Taylor, Wendy, additional, Ingram, Wendy, additional, Hussain, Basharat, additional, Clarkson, Paul, additional, Sherriff, Ian, additional, Ukoumunne, Obioha, additional, Creanor, Siobhan, additional, and Byng, Richard, additional

Published
2024
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4. Exploring the factors which underpin young drivers' over-representation in road traffic collisions

Author

Weston, Lauren

Subjects
363.12, young drivers, reward sensitivity, message framing, road safety intervention, risky driving
Abstract

Worldwide, young drivers are involved in more road traffic collisions than any other age group (Taubman & Katz, 2012). Comprehensive driver training and various forms of pre- and- post-test road safety interventions (RSIs) are in place, but young drivers continue to be involved in more at-fault, fatal collisions than older, newly qualified drivers (e.g. Emmerson, 2008; Braitman et al, 2008; Clarke et al, 2010). The evidence base to date is mixed regarding why young drivers are at a heightened risk of collision and so this thesis aims to provide further understanding about the factors underpinning young drivers’ engagement in risky driving. An evaluation of a young driver RSI, found that young males were less likely than young females to report safer attitudes and intentions after attending the RSI. We considered that this may be due to young males’ behaviour being motivated by a desire to seek rewards (e.g. the thrill of risky driving) rather than a fear of punishment which forms the basis of traditional RSIs. Two subsequent studies were conducted to ascertain whether a heightened sensitivity to reward might underpin the risk-taking behaviour of those most at risk. We found that young males and females scoring high on reward sensitivity reported engaging in more road traffic violations and displayed slower reaction times on a driving game; suggesting that young people may have a heightened sensitivity to reward, in general, and concurrently tend to accept a higher degree of risk than other drivers. We also found that reward sensitive young drivers rated road safety messages framed in terms of financial gains as most effective, suggesting that financial incentives may be a potential route to engage young drivers in the future. The findings from another study provided insight into the precise mechanisms at play in the relationship between young drivers and their peer passengers, and the evaluation of the pilot peer-to-peer RSI showed how it might be possible to improve young drivers’ intentions to drive safely by modifying the norm that risky driving is an appropriate way to attain social prestige within a peer group. The thesis offers a significant contribution to the literature by establishing empirically the effect of reward sensitivity on young drivers’ engagement in risky driving and suggesting multiple ways to better improve young drivers’ safety in the future.

Published
2016

8. Practitioners’ ability to remotely develop understanding for personalised care and support planning: a thematic analysis of multiple data sources from the feasibility phase of the Dementia Personalised Care Team (D-PACT) intervention

Author

Wheat, Hannah, primary, Griffiths, Sarah, additional, Gude, Alex, additional, Weston, Lauren, additional, Quinn, Cath, additional, Morgan-Trimmer, Sarah, additional, Oh, Tomasina M, additional, Musicha, Crispin, additional, Greene, Leanne, additional, Clark, Mike, additional, Rybczynska-Bunt, Sarah, additional, and Byng, Richard, additional

Published
2023
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9. Longitudinal realist evaluation of the Dementia PersonAlised Care Team (D-PACT) intervention: protocol

Author

Wheat, Hannah, primary, Weston, Lauren, additional, Oh, Tomasina M, additional, Morgan-Trimmer, Sarah, additional, Ingram, Wendy, additional, Griffiths, Sarah, additional, Sheaff, Rod, additional, Clarkson, Paul, additional, Medina-Lara, Antonieta, additional, Musicha, Crispin, additional, Spicer, Stuart, additional, Ukoumunne, Obioha, additional, Allgar, Victoria, additional, Creanor, Siobhan, additional, Clark, Michael, additional, Quinn, Cath, additional, Gude, Alex, additional, McCabe, Rose, additional, Batool, Saqba, additional, Smith, Lorna, additional, Richards, Debra, additional, Shafi, Hannah, additional, Warwick, Bethany, additional, Lasrado, Reena, additional, Hussain, Basharat, additional, Jones, Hannah, additional, Dalkin, Sonia, additional, Bate, Angela, additional, Sherriff, Ian, additional, Robinson, Louise, additional, and Byng, Richard, additional

Published
2023
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12. Supplemental Material - Practitioners’ ability to remotely develop understanding for personalised care and support planning: a thematic analysis of multiple data sources from the feasibility phase of the Dementia Personalised Care Team (D-PACT) intervention

Author

Wheat, Hannah, Griffiths, Sarah, Gude, Alex, Weston, Lauren, Quinn, Cath, Morgan-Trimmer, Sarah, Oh, Tomasina M, Musicha, Crispin, Greene, Leanne, Clark, Mike, Rybczynska-Bunt, Sarah, and Byng, Richard

Subjects
111099 Nursing not elsewhere classified, 111708 Health and Community Services, FOS: Clinical medicine, FOS: Political science, FOS: Health sciences, 160512 Social Policy, 110308 Geriatrics and Gerontology
Abstract

Supplemental Material for Practitioners’ ability to remotely develop understanding for personalised care and support planning: a thematic analysis of multiple data sources from the feasibility phase of the Dementia Personalised Care Team (D-PACT) intervention by Hannah Wheat, Sarah Griffiths, Alex Gude, Lauren Weston, Cath Quinn, Sarah Morgan-Trimmer, Tomasina M Oh, Crispin Musicha, Leanne Greene, Mike Clark, Sarah Rybczynska-Bunt and Richard Byng in Dementia

Published
2023
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15. Skin fragility disorder misdiagnosed as child abuse: a cautionary tale.

Author

Willems, Anneliese, Weston, Lauren, and Robertson, Susan

Abstract

A two-year-old girl was initially suspected of being a victim of child abuse due to the presence of large erosions and scars on her buttocks and other areas of her body. However, further examination and history-taking revealed that she had a rare skin fragility disorder called epidermolysis bullosa. The disorder causes blistering and fragility of the skin and mucous membranes. The girl was enrolled in a specialized care program and responded well to preventive treatment. This case highlights the importance of considering alternative diagnoses and obtaining a thorough history when evaluating unusual skin presentations in children. [Extracted from the article]

Published
2024
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16. Implementing diagnostic stewardship to improve diagnosis of urinary tract infections across three medical centers: A qualitative assessment

Author

Claeys, Kimberly C., Weston, Lauren E., Pineles, Lisa, Morgan, Daniel J., and Krein, Sarah L.

Abstract

AbstractBackground:Urine-culture diagnostic stewardship aims to decrease misdiagnosis of urinary tract infections (UTIs); however, these interventions are not widely adopted. We examined UTI diagnosis and management practices to identify barriers to and facilitators of diagnostic stewardship implementation.Methods:Using a qualitative descriptive design, we conducted semistructured interviews at 3 Veterans’ Affairs medical centers. Interviews were conducted between November 2021 and May 2022 via Zoom videoconferencing using an interview guide and visual prototypes of proposed interventions. Interviewees were asked about current practices and thoughts on proposed interventions for urine-culture ordering, processing, and reporting. We used a rapid analysis matrix approach to summarize key interview findings and compare practices and perceptions across sites.Results:We interviewed 31 stakeholders and end users. All sites had an antimicrobial stewardship program but limited initiatives targeting appropriate diagnosis and management of UTIs. The majority of those interviewed identified the importance of diagnostic stewardship. Perceptions of specific interventions ranged widely by site. For urine-culture ordering, all 3 sites agreed that documentation of symptomology would improve culturing practices but did not want it to interrupt workflow. Representatives at 2 sites expressed interest in conditional urine-culture processing and 1 was opposed. All sites had similar mechanisms to report culture results but varied in perceptions of the proposed interventions. Feedback from end users was used to develop a general diagnostic stewardship implementation checklist.Conclusion:Interviewees thought diagnostic stewardship was important. Qualitative assessment involving key stakeholders in the UTI diagnostic process improved understanding of site-specific beliefs and practices to better implement interventions for urine-culture ordering, processing, and reporting.

Published
2023
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17. Development and evaluation of a collaborative care intervention for male prison leavers with mental health problems: the Engager research programme

Author

Byng, Richard, primary, Lennox, Charlotte, additional, Kirkpatrick, Tim, additional, Quinn, Cath, additional, Anderson, Rob, additional, Brand, Sarah Louise, additional, Callaghan, Lynne, additional, Carroll, Lauren, additional, Durcan, Graham, additional, Gill, Laura, additional, Goodier, Sara, additional, Graham, Jonathan, additional, Greer, Rebecca, additional, Haddad, Mark, additional, Harris, Tirril, additional, Henley, William, additional, Hunter, Rachael, additional, Maguire, Mike, additional, Leonard, Sarah, additional, Michie, Susan, additional, Owens, Christabel, additional, Pearson, Mark, additional, Rybczynska-Bunt, Sarah, additional, Stevenson, Caroline, additional, Stewart, Amy, additional, Stirzaker, Alex, additional, Taylor, Rod, additional, Todd, Roxanne, additional, Walter, Florian, additional, Warren, Fiona C, additional, Weston, Lauren, additional, Wright, Nat, additional, and Shaw, Jenny, additional

Published
2022
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18. Evaluation of a complex intervention for prisoners with common mental health problems, near to and after release: the Engager randomised controlled trial

Author

Byng, Richard, primary, Kirkpatrick, Tim, additional, Lennox, Charlotte, additional, Warren, Fiona C., additional, Anderson, Rob, additional, Brand, Sarah Louise, additional, Callaghan, Lynne, additional, Carroll, Lauren, additional, Durcan, Graham, additional, Gill, Laura, additional, Goodier, Sara, additional, Graham, Jonathan, additional, Greer, Rebecca, additional, Haddad, Mark, additional, Harris, Tirril, additional, Henley, William, additional, Hunter, Rachael, additional, Leonard, Sarah, additional, Maguire, Mike, additional, Michie, Susan, additional, Owens, Christabel, additional, Pearson, Mark, additional, Quinn, Cath, additional, Rybczynska-Bunt, Sarah, additional, Stevenson, Caroline, additional, Stewart, Amy, additional, Stirzaker, Alex, additional, Todd, Roxanne, additional, Walter, Florian, additional, Weston, Lauren, additional, Wright, Nat, additional, Taylor, Rod S., additional, and Shaw, Jenny, additional

Published
2022
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20. Interrogating intervention delivery and participants’ emotional states to improve engagement and implementation: A realist informed multiple case study evaluation of Engager

Author

Weston, Lauren, primary, Rybczynska-Bunt, Sarah, additional, Quinn, Cath, additional, Lennox, Charlotte, additional, Maguire, Mike, additional, Pearson, Mark, additional, Stirzaker, Alex, additional, Durcan, Graham, additional, Stevenson, Caroline, additional, Graham, Jonathan, additional, Carroll, Lauren, additional, Greer, Rebecca, additional, Haddad, Mark, additional, Hunter, Rachael, additional, Anderson, Rob, additional, Todd, Roxanne, additional, Goodier, Sara, additional, Brand, Sarah, additional, Michie, Susan, additional, Kirkpatrick, Tim, additional, Leonard, Sarah, additional, Harris, Tirril, additional, Henley, William, additional, Shaw, Jenny, additional, Owens, Christabel, additional, and Byng, Richard, additional

Published
2022
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22. sj-pdf-1-dem-10.1177_14713012211067320 ��� Supplemental Material for ���Do I have the capacity to make capacity judgements?��� Researcher reflections from a person-centred dementia support study

Author

Griffiths, Sarah, Gude, Alex, Greene, Leanne, Weston, Lauren, Sutcliffe, Caroline L, Wheat, Hannah, Oh, Tomasina M, and Byng, Richard

Subjects
111099 Nursing not elsewhere classified, 111708 Health and Community Services, FOS: Clinical medicine, FOS: Political science, FOS: Health sciences, 160512 Social Policy, 110308 Geriatrics and Gerontology
Abstract

Supplemental Material, sj-pdf-1-dem-10.1177_14713012211067320 for ���Do I have the capacity to make capacity judgements?��� Researcher reflections from a person-centred dementia support study by Sarah Griffiths, Alex Gude, Leanne Greene, Lauren Weston, Caroline L Sutcliffe, Hannah Wheat, Tomasina M Oh and Richard Byng in Dementia

Published
2022
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24. Engaging Stakeholders in Realist Programme Theory Building: Insights from the Prospective Phase of a Primary Care Dementia Support Study

Author

Griffiths, Sarah, primary, Weston, Lauren, additional, Morgan-Trimmer, Sarah, additional, Wheat, Hannah, additional, Gude, Alex, additional, Manger, Lorna, additional, Oh, Tomasina M., additional, Clarkson, Paul, additional, Quinn, Cath, additional, Sheaff, Rod, additional, Clark, Mike, additional, Sherriff, Ian, additional, and Byng, Richard, additional

Published
2022
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25. Evaluation of a Complex Intervention for Prisoners with Common Mental Health Problems, Near To and After Release:The Engager Randomised Controlled Trial

Author

Byng, Richard, Kirkpatrick, Tim, Lennox, Charlotte, Walter, Florian, Anderson, Robert, Brand, Sarah Louise, Callaghan, Lynne, Carroll, Lauren, Durcan, Graham, Gill, Laura, Goodier, Sara, Green, Jonathan, Greer, Rebecca, Haddad, Mark, Harris, Tirril, Henley, William, Hunter, Rachael M, Leonard, Sarah, Maguire, Mike, Michie, Susan, Owens, Christabel, Pearson, Mark, Quinn, Cath, Rybczynska-Bunt, Sarah, Stevenson, Caroline, Stewart, Amy, Stirzaker, Alex, Todd, Roxanne, Weston, Lauren, Wright, Nat, and Taylor, Rod

Abstract

Background: Many male prisoners have significant mental health problems, including anxiety and depression. High proportions struggle with with homelessness and substance misuse. Only a minority receive specialist mental health care, including on release from prison. Few theoretically informed interventions have been developed to address these complex needs, and none formally evaluated. This study tests the hypothesis that the Engager intervention improves mental health outcomes following release. Methods: Two group parallel randomised superiority trial conducted in the North West and South West of England between in 2016-19. Men serving a prison sentence of two years or less were individually allocated 1:1 to either intervention (Engager plus usual care) or the control (usual care alone) group. Engager included psychological and practical support in prison, on release, and for three to five months in the community. Primary outcome: Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), six months after release. Primary analysis compared groups based on intention to treat (ITT). Outcomes: A total of 280 men were randomised out of the 396 who were potentially eligible and agreed to participate; 105 did not meet the mental health inclusion criteria. There was no mean difference in either the ITT complete case analysis between groups (92 in each arm) for change in the CORE-OM score (1·1, 95% confidence interval -1·1 to 3·2, p= 0·325) or secondary analyses. There were no consistent clinically significant between group differences for secondary outcomes. Full implementation and delivery were not achieved with 18% receiving no post release intervention. Interpretation: Engager is the first trial of a collaborative care intervention adapted for prison leavers. The intervention was not effective using standard outcome measures. Future research may benefit from improved delivery and more sensitive outcomes measures. Trial Registration: Engager was a two group parallel randomised superiority trial (ISRCTN11707331)Funding: Funding for the study was provided by the NIHR Programme Grants for Applied Research (grant number: RP-PG-1210-12011)Declaration of Interest: None to declare.Ethical Approval: The study was approved by the UK National Health Service, Wales ResearchEthics Committee 3 (ref: 15/WA/0314), and the National Research Committee of Her Majesty’s Prison and Probation Service.

Published
2021
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26. Clarifying realist analytic processes and interdisciplinary consensus processes in complex health intervention [Engager] research: A detailed worked example of Judgemental Rationality in action:A worked example of Judgemental Rationality in action

Author

Rybczynska-Bunt, Sarah, Weston, Lauren, Byng, Richard, Stirzaker, Alex, Lennox, Charlotte, Pearson, Mark, Brand, Sarah, Maguire, Mike, Durcan, Graham, Graham, Jonathan P., Leonard, Sarah, Shaw, Jennifer, Kirkpatrick, Tim, Owens, Christabel, and Quinn, Cath

Subjects
interdisciplinarity, realist evaluation, transfactual theorising, Judgemental rationality, process evaluation
Abstract

Judgemental rationality is infrequently referenced within discussions of Realist Evaluations. Judgemental rationality refers to researchers’ capacity to assess which, potential, meanings provide the most credible explanations. In evaluation work, rationale’s for analysis are provided though rarely do we see how an evaluator made judgements between competing theories, and which theories were discarded and why. We provide a worked example of the application of judgemental rationality. The Engager intervention offered support to prison leavers with common mental health problems. The data for 24, purposively sampled, participants from the intervention arm of the trial, were integrated. Bhaskar’s (2016) DREIC, a 5-step analytical procedure, was used to transfactually theorise and interrogate the inferences made within, and across, cases. The findings demonstrated that the intervention was more effective when practitioners developed an in-depth understanding of the participant. We recommend that intervention developers look for ways to enhance therapeutic competencies and judgemental rationality in practitioner teams.

Published
2021
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27. Clarifying realist analytic and interdisciplinary consensus processes in a complex health intervention: A worked example of Judgemental Rationality in action

Author

Rybczynska-Bunt, Sarah, primary, Weston, Lauren, additional, Byng, Richard, additional, Stirzaker, Alex, additional, Lennox, Charlotte, additional, Pearson, Mark, additional, Brand, Sarah, additional, Maguire, Mike, additional, Durcan, Graham, additional, Graham, Jonathan, additional, Leonard, Sarah, additional, Shaw, Jenny, additional, Kirkpatrick, Tim, additional, Owens, Christabel, additional, and Quinn, Cath, additional

Published
2021
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29. sj-docx-1-evi-10.1177_13563890211037699 – Supplemental material for Clarifying realist analytic and interdisciplinary consensus processes in a complex health intervention: A worked example of Judgemental Rationality in action

Author

Rybczynska-Bunt, Sarah, Weston, Lauren, Byng, Richard, Stirzaker, Alex, Lennox, Charlotte, Pearson, Mark, Brand, Sarah, Maguire, Mike, Durcan, Graham, Graham, Jonathan, Leonard, Sarah, Shaw, Jenny, Kirkpatrick, Tim, Owens, Christabel, and Quinn, Cath

Subjects
160807 Sociological Methodology and Research Methods, FOS: Sociology
Abstract

Supplemental material, sj-docx-1-evi-10.1177_13563890211037699 for Clarifying realist analytic and interdisciplinary consensus processes in a complex health intervention: A worked example of Judgemental Rationality in action by Sarah Rybczynska-Bunt, Lauren Weston, Richard Byng, Alex Stirzaker, Charlotte Lennox, Mark Pearson, Sarah Brand, Mike Maguire, Graham Durcan, Jonathan Graham, Sarah Leonard, Jenny Shaw, Tim Kirkpatrick, Christabel Owens and Cath Quinn in Evaluation

Published
2021
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30. Evaluation of a Complex Intervention for Prisoners with Common Mental Health Problems, Near To and After Release: The Engager Randomised Controlled Trial

Author

Byng, Richard, primary, Kirkpatrick, Tim, additional, Lennox, Charlotte, additional, Warren, Fiona C., additional, Anderson, Robert, additional, Brand, Sarah Louise, additional, Callaghan, Lynne, additional, Carroll, Lauren, additional, Durcan, Graham, additional, Gill, Laura, additional, Goodier, Sara, additional, Graham, Jonathan, additional, Greer, Rebecca, additional, Haddad, Mark, additional, Harris, Tirril, additional, Henley, William, additional, Hunter, Rachael M., additional, Leonard, Sarah, additional, Maguire, Mike, additional, Michie, Susan, additional, Owens, Christabel, additional, Pearson, Mark, additional, Quinn, Cath, additional, Rybczynska-Bunt, Sarah, additional, Stevenson, Caroline, additional, Stewart, Amy, additional, Stirzaker, Alex, additional, Todd, Roxanne, additional, Walter, Florian, additional, Weston, Lauren, additional, Wright, Nat, additional, and taylor, rod, additional

Published
2021
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32. Comparing peripherally inserted central catheter-related practices across hospitals with different insertion models: a multisite qualitative study.

Author

Krein, Sarah L., Harrod, Molly, Weston, Lauren E., Garlick, Brittani R., Quinn, Martha, Fletcher, Kathlyn E., and Chopra, Vineet

Subjects
HOSPITALS, RESEARCH, PATIENT aftercare, PERIPHERAL central venous catheterization, MEDICAL device removal, PERIPHERALLY inserted central catheters, RESEARCH methodology, ATTITUDE (Psychology), MEDICAL cooperation, INTERVIEWING, MEDICAL personnel, QUALITATIVE research, COMPARATIVE studies, RESEARCH funding, MEDICAL instrument maintenance, MEDICAL practice, PHILOSOPHY, DECISION making in clinical medicine, JUDGMENT sampling, CATHETERIZATION, PATIENT discharge instructions
Abstract

Background Peripherally inserted central catheters (PICCs) provide reliable intravenous access for delivery of parenteral therapy. Yet, little is known about PICC care practices or how they vary across hospitals. We compared PICC-related processes across hospitals with different insertion delivery models. Methods We used a descriptive qualitative methodology and a naturalist philosophy, with site visits to conduct semistructured interviews completed between August 2018 and January 2019. Study sites included five Veterans Affairs Medical Centres, two with vascular access teams (VATs), two with PICC insertion primarily by interventional radiology (IR) and one without on-site PICC insertion capability. Interview participants were healthcare personnel (n=56), including physicians, bedside and vascular access nurses, and IR clinicians. Data collection focused on four PICC domains: use and decision-making process, insertion, in-hospital management and patient discharge education. We used rapid analysis and a summary matrix to compare practices across sites within each domain. Results Our findings highlight the benefits of dedicated VATs across all PICC-related process domains, including implementation of criteria to guide PICC placement decisions, timely PICC insertion, more robust management practices and well-defined patient discharge education. We also found areas with potential for improvement, such as clinician awareness of PICC appropriateness criteria and alternative devices, deployment of VATs and patient discharge education. Conclusion Vascular access nurses play critical roles in all aspects of PICC-related care. There is variation in PICC decision-making, care and maintenance, and patient education across hospitals. Quality and safety improvement opportunities to reduce this variation are highlighted. [ABSTRACT FROM AUTHOR]

Published
2021
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37. Definitive radiotherapy for Merkel cell carcinoma in the setting of epidermolysis bullosa simplex.

Author

Ong, Wee Loon, Bailey, Eliza, McCormack, Christopher, Weston, Lauren, Morgan, Vanessa, and McDowell, Lachlan

Subjects
EPIDERMOLYSIS bullosa, MERKEL cell carcinoma, RADIOTHERAPY
Abstract

The article presents a case study of a 66-year-old man presented with a 6-week history of progressively enlarging right parotid lump. It discusses the Fine needle aspiration confirmed a poorly differentiated neuroendocrine tumour, positive for synaptophysin and chromogranin. It notes the definitive radiotherapy using intensity-modulated radiotherapy for surgical management and subsequent treatment provided to the patient.

Published
2019
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38. Longitudinal realist evaluation of the Dementia PersonAlised Care Team (D-PACT) intervention: protocol

Author

Wheat, Hannah, Weston, Lauren, Oh, Tomasina M., Morgan-Trimmer, Sarah, Ingram, Wendy, Griffiths, Sarah, Sheaff, Rod, Clarkson, Paul, Medina-Lara, Antonieta, Musicha, Crispin, Spicer, Stuart, Ukoumunne, Obioha, Allgar, Victoria, Creanor, Siobhan, Clark, Michael, Quinn, Cath, Gude, Alex, McCabe, Rose, Batool, Saqba, Smith, Lorna, Richards, Debra, Shafi, Hannah, Warwick, Bethany, Lasrado, Reena, Hussain, Basharat, Jones, Hannah, Dalkin, Sonia, Bate, Angela, Sherriff, Ian, Robinson, Louise, Byng, Richard, Wheat, Hannah, Weston, Lauren, Oh, Tomasina M., Morgan-Trimmer, Sarah, Ingram, Wendy, Griffiths, Sarah, Sheaff, Rod, Clarkson, Paul, Medina-Lara, Antonieta, Musicha, Crispin, Spicer, Stuart, Ukoumunne, Obioha, Allgar, Victoria, Creanor, Siobhan, Clark, Michael, Quinn, Cath, Gude, Alex, McCabe, Rose, Batool, Saqba, Smith, Lorna, Richards, Debra, Shafi, Hannah, Warwick, Bethany, Lasrado, Reena, Hussain, Basharat, Jones, Hannah, Dalkin, Sonia, Bate, Angela, Sherriff, Ian, Robinson, Louise, and Byng, Richard

Abstract

Background: Different dementia support roles exist but evidence is lacking on which aspects are best, for whom, and in what circumstances, and on their associated costs and benefits. Phase 1 of the Dementia PersonAlised Care Team programme (D-PACT) developed a post-diagnostic primary care-based intervention for people with dementia and their carers and assessed the feasibility of a trial. Aim: Phase 2 of the programme aims to 1) refine the programme theory on how, when, and for whom the intervention works; and 2) evaluate its value and impact. Design & setting: A realist longitudinal mixed-methods evaluation will be conducted in urban, rural, and coastal areas across South West and North West England where low-income or ethnic minority populations (for example, South Asian) are represented. Design was informed by patient, public, and professional stakeholder input and phase 1 findings. Method: High-volume qualitative and quantitative data will be collected longitudinally from people with dementia, carers, and practitioners. Analyses will comprise the following: 1) realist longitudinal case studies; 2) conversation analysis of recorded interactions; 3) statistical analyses of outcome and experience questionnaires; 4a) health economic analysis examining costs of delivery; and 4b) realist economic analysis of high-cost events and ‘near misses’. All findings will be synthesised using a joint display table, evidence appraisal tool, triangulation, and stakeholder co-analysis. Conclusion: The realist evaluation will describe how, why, and for whom the intervention does or does not lead to change over time. It will also demonstrate how a non-randomised design can be more appropriate for complex interventions with similar questions or populations.

39. Practitioners’ ability to remotely develop understanding for personalised care and support planning: a thematic analysis of multiple data sources from the feasibility phase of the Dementia Personalised Care Team (D-PACT) intervention

Author

Wheat, Hannah, Griffiths, Sarah, Gude, Alex, Weston, Lauren, Quinn, Cath, Morgan-Trimmer, Sarah, Oh, Tomasina M., Musicha, Crispin, Greene, Leanne, Clark, Mike, Rybczynska-Bunt, Sarah, Byng, Richard, Wheat, Hannah, Griffiths, Sarah, Gude, Alex, Weston, Lauren, Quinn, Cath, Morgan-Trimmer, Sarah, Oh, Tomasina M., Musicha, Crispin, Greene, Leanne, Clark, Mike, Rybczynska-Bunt, Sarah, and Byng, Richard

Abstract

Practitioner understanding of patients’ preferences, wishes and needs is essential for personalised health care i.e., focusing on ‘what matters’ to people based on their individual life situation. To develop such an understanding, dementia practitioners need to use communication practices that help people share their experiences, preferences, and priorities. Following the COVID-19 pandemic, dementia support is likely to continue to be delivered both remotely and in-person. This study analysed multiple sources of qualitative data to examine the views of practitioners, people living with dementia and carers, and researchers on how an understanding of what matters to people living with dementia can be developed remotely via telephone and video call. Access to environmental stimuli, the remote use of visual tools, peoples’ tendency to downplay or omit details about their troubles and carers’ ability to disclose privately were interpreted, through thematic analysis, to be factors affecting how practitioners sought to develop understanding remotely. Cumulatively, findings show that while remote support created unique challenges to practitioners’ ability to develop understanding for personalised care, practitioners developed adaptive strategies to overcome some of these challenges. Further research should examine how, when and for whom these adapted practices for remote personalised care work, informing the development of evidence-based guidance and training on how practitioners can remotely develop the understanding required for personalised care.

40. Engaging stakeholders in realist programme theory building: insights from the prospective phase of a primary care dementia support study

Author

Griffiths, Sarah, Weston, Lauren, Morgan-Trimmer, Sarah, Wheat, Hannah, Gude, Alex, Manger, Lorna, Oh, Tomasina M., Clarkson, Paul, Quinn, Cath, Sheaff, Rod, Clark, Mike, Sherriff, Ian, Byng, Richard, Griffiths, Sarah, Weston, Lauren, Morgan-Trimmer, Sarah, Wheat, Hannah, Gude, Alex, Manger, Lorna, Oh, Tomasina M., Clarkson, Paul, Quinn, Cath, Sheaff, Rod, Clark, Mike, Sherriff, Ian, and Byng, Richard

Abstract

‘Dementia - Personalised Care Team’ (D-PACT) is a five-year NIHR funded programme, using realist methods to develop and evaluate a complex, person-centred intervention for people with dementia and their carers. During the early project stages, we engaged with multiple stakeholders, including people with dementia and their carers, to develop an initial programme theory (IPT) – into an elaborated programme theory (EPT), by helping to uncover intervention mechanisms leading to outcomes in specific contexts. Realist research methods for developing programme theories are under-reported. In addition, there is a paucity of practical guidance on how to engage underserved and vulnerable populations in complex interventions programme theory development. We attend to these gaps, providing a worked example of how we meaningfully engaged people living with dementia and carers, alongside field experts, as stakeholders in this process. Our IPT theory building included multi-stakeholder primary research exercises and meetings with PPI contributors and an Expert Reference Group. We adapted interview schedules, and used visual resources and scenario-based activities, to support stakeholders to think in a ‘realist’ way. Using realist and thematic analyses led to hypothesis-building of causal mechanisms. Sharing findings with stakeholders led to further refinement of the intervention design, ready for testing in a subsequent feasibility study. We found that, despite the cognitive challenges associated with dementia, innovative methods of engagement can enable this stakeholder group to understand the realist approach and provide a platform through which to share their experiences. Taking a highly flexible and unhurried approach, led to novel insights into the complexities of person-centred dementia support. We argue for more detailed methodological guidance, based on realist principles, on how to collaborate with underrepresented populations to rigorously gain insights as to what is lik

42. Evaluation of a complex intervention for prisoners with common mental health problems, near to and after release: the Engager randomised controlled trial.

Author

Byng R, Kirkpatrick T, Lennox C, Warren FC, Anderson R, Brand SL, Callaghan L, Carroll L, Durcan G, Gill L, Goodier S, Graham J, Greer R, Haddad M, Harris T, Henley W, Hunter R, Leonard S, Maguire M, Michie S, Owens C, Pearson M, Quinn C, Rybczynska-Bunt S, Stevenson C, Stewart A, Stirzaker A, Todd R, Walter F, Weston L, Wright N, Taylor RS, and Shaw J

Subjects
Male, Humans, Cost-Benefit Analysis, Anxiety, England, Mental Health, Prisoners
Abstract

Background: Many male prisoners have significant mental health problems, including anxiety and depression. High proportions struggle with homelessness and substance misuse., Aims: This study aims to evaluate whether the Engager intervention improves mental health outcomes following release., Method: The design is a parallel randomised superiority trial that was conducted in the North West and South West of England (ISRCTN11707331). Men serving a prison sentence of 2 years or less were individually allocated 1:1 to either the intervention (Engager plus usual care) or usual care alone. Engager included psychological and practical support in prison, on release and for 3-5 months in the community. The primary outcome was the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), 6 months after release. Primary analysis compared groups based on intention-to-treat (ITT)., Results: In total, 280 men were randomised out of the 396 who were potentially eligible and agreed to participate; 105 did not meet the mental health inclusion criteria. There was no mean difference in the ITT complete case analysis between groups (92 in each arm) for change in the CORE-OM score (1.1, 95% CI -1.1 to 3.2, P = 0.325) or secondary analyses. There were no consistent clinically significant between-group differences for secondary outcomes. Full delivery was not achieved, with 77% (108/140) receiving community-based contact., Conclusions: Engager is the first trial of a collaborative care intervention adapted for prison leavers. The intervention was not shown to be effective using standard outcome measures. Further testing of different support strategies for prison with mental health problems is needed.

Published
2023
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43. Development and evaluation of a collaborative care intervention for male prison leavers with mental health problems: the Engager research programme

Author

Byng R, Lennox C, Kirkpatrick T, Quinn C, Anderson R, Brand SL, Callaghan L, Carroll L, Durcan G, Gill L, Goodier S, Graham J, Greer R, Haddad M, Harris T, Henley W, Hunter R, Maguire M, Leonard S, Michie S, Owens C, Pearson M, Rybczynska-Bunt S, Stevenson C, Stewart A, Stirzaker A, Taylor R, Todd R, Walter F, Warren FC, Weston L, Wright N, and Shaw J

Abstract

Background: Many male prison leavers have significant mental health problems. Prison leavers often have a history of trauma, ongoing substance misuse and housing insecurity. Only a minority of prison leavers receive mental health care on release from prison., Objectives: The aim of the Engager research programme was to develop and evaluate a theory- and evidence-informed complex intervention designed to support individuals with common mental health problems (e.g. anxiety, depression) and other complex needs, including mental health comorbidity, before and after release from prison., Methods: In phase 1, the intervention was developed through a set of realist-informed substudies, including a realist review of psychosocial care for individuals with complex needs, case studies within services demonstrating promising intervention features, focus groups with individuals from under-represented groups, a rapid realist review of the intervention implementation literature and a formative process evaluation of the prototype intervention. In a parallel randomised trial, methodological development included selecting outcome measures through reviewing literature, piloting measures and a consensus process, developing ways to quantify intervention receipt, piloting trial procedures and modelling economic outcomes. In phase 2, we conducted an individually randomised superiority trial of the Engager intervention, cost-effectiveness and cost–consequence analyses and an in-depth mixed-methods process evaluation. Patient and public involvement influenced the programme throughout, primarily through a Peer Researcher Group., Results: In phase 1, the Engager intervention included multiple components. A practitioner offered participants practical support, emotional help (including mentalisation-based approaches) and liaison with other services in prison on the day of the participant’s release and for 3–5 months post release. An intervention delivery platform (i.e. training, manual, supervision) supported implementation. Outcome measures were selected through testing and stakeholder consensus to represent a broad range of domains, with a general mental health outcome as the primary measure for the trial. Procedures for recruitment and follow-up were tested and included flexible approaches to engagement and retention. In phase 2, the trial was conducted in three prison settings, with 280 participants randomised in a 1 : 1 ratio to receive either Engager plus usual care ( n  = 140) or usual care only ( n  = 140). We achieved a follow-up rate of 65% at 6 months post release from prison. We found no difference between the two groups for the Clinical Outcomes in Routine Evaluation – Outcome Measure at 6 months. No differences in secondary measures and sensitivity analyses were found beyond those expected by chance. The cost-effectiveness analysis showed that Engager cost significantly more at £2133 (95% of iterations between £997 and £3374) with no difference in quality-adjusted life-years (–0.017, 95% of iterations between –0.042 and 0.007). The mixed-methods process evaluation demonstrated implementation barriers. These barriers included problems with retention of the intervention team, and the adverse health and criminal justice system context. Seventy-seven per cent (108/140) of individuals had at least one community contact. Significant proportions of participants engaging received day release work and practical support. In contrast, there was evidence that the psychological components, mentalisation and developing a shared understanding were used less consistently. When engagement was positive, these components were associated with positive achievement of goals for individuals. We were also able to identify how to improve the intervention programme theory, including how to support individuals who were unrealistic in their perception of their ability to cope with challenges post release., Strengths and Limitations: Our development work provides a worked example of the development of a complex intervention, particularly given little prior evidence or theory specific to male offenders to build on. Our trial methodological development enabled the completion of, to the best of our knowledge, the first fully powered trial of a mental health intervention for prison leavers with common mental health problems. There were potential weaknesses in the trial methodology in terms of follow-up rates and outcome measures, with the latter potentially being insufficiently sensitive to important but highly individual changes in participants who responded to the intervention., Conclusions: Delivering a randomised controlled trial for prison leavers with acceptable levels of follow-up is possible, despite adverse conditions. Full intervention implementation was challenging, but this is to be expected. Some individuals did respond well to the intervention when both practical and psychological support were flexibly deployed as intended, with evidence that most components were experienced as helpful for some individuals. It is recommended that several key components be developed further and tested, along with improved training and supervision, to support delivery of the Engager intervention within existing teams working with prison leavers., Trial Registration: This trial is registered as ISRCTN11707331., Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research ; Vol. 10, No. 8. See the NIHR Journals Library website for further project information., (Copyright © 2022 Byng et al. This work was produced by Byng et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaption in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/. For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited.)

Published
2022
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