• Perinatal outcomes among migrant mothers in the United Kingdom: is it a matter of biology, behaviour, policy, social determinants or access to health care?

      Puthussery, Shuby; University of Bedfordshire (Elsevier, 2016-04)
      This paper examines trends in perinatal outcomes among migrant mothers in the UK, and it explores potential contributors to disparities focusing on pregnancy, birth and the first year of life. Trends in perinatal outcomes indicate that ethnic minority grouping, regardless of migrant status, is a significant risk factor for unfavourable outcomes. It is unclear whether migrant status per se adds to this risk as within-group comparisons between UK-born and foreign-born women show variable findings. The role of biological and behavioural factors in producing excess unfavourable outcomes among ethnic minority mothers, although indicated, is yet to be fully understood. UK policies have salient aspects that address ethnic inequalities, but their wide focus obscures provisions for migrant mothers. Direct associations between socio-economic factors, ethnicity and adverse infant outcomes are evident. Evidence is consistent about differential access to and utilisation of health services among ethnic minority mothers, in particular recently arrived migrants, refugees and asylum seekers.
    • Parental factors and the risk of childhood overweight and obesity in low- and middle-income countries: a systematic review

      Puthussery, Shuby; Libonda, Liyali; Mistry, Sabuj Kanti; Norgate, Christine (Prospero, 2016-01)
      The aim of this systematic review is to identify and describe parental factors associated with the risk of childhood overweight and obesity in low- and middle-income countries.
    • Crisis intervention for people with severe mental illnesses

      Murphy, Suzanne; Irving, Claire B.; Adams, Clive E.; Waqar, Muhammad (Cochrane Library, 2015-12-03)
      Background A particularly difficult challenge for community treatment of people with serious mental illnesses is the delivery of an acceptable level of care during the acute phases of severe mental illness. Crisis-intervention models of care were developed as a possible solution. Objectives To review the effects of crisis-intervention models for anyone with serious mental illness experiencing an acute episode compared to the standard care they would normally receive. If possible, to compare the effects of mobile crisis teams visiting patients' homes with crisis units based in home-like residential houses. Search methods We searched the Cochrane Schizophrenia Group’s Study-Based Register of Trials. There is no language, time, document type, or publication status limitations for inclusion of records in the register. This search was undertaken in 1998 and then updated 2003, 2006, 2010 and September 29, 2014. Selection criteria We included all randomised controlled trials of crisis-intervention models versus standard care for people with severe mental illnesses that met our inclusion criteria. Data collection and analysis We independently extracted data from these trials and we estimated risk ratios (RR) or mean differences (MD), with 95% confidence intervals (CI). We assessed risk of bias for included studies and used GRADE to create a 'Summary of findings' table. Main results The update search September 2014 found no further new studies for inclusion, the number of studies included in this review remains eight with a total of 1144 participants. Our main outcomes of interest are hospital use, global state, mental state, quality of life, participant satisfaction and family burden. With the exception of mental state, it was not possible to pool data for these outcomes. Crisis intervention may reduce repeat admissions to hospital (excluding index admissions) at six months (1 RCT, n = 369, RR 0.75 CI 0.50 to 1.13, high quality evidence), but does appear to reduce family burden (at six months: 1 RCT, n = 120, RR 0.34 CI 0.20 to 0.59, low quality evidence), improve mental state (Brief Psychiatric Rating Scale (BPRS) three months: 2 RCTs, n = 248, MD -4.03 CI -8.18 to 0.12, low quality evidence), and improve global state (Global Assessment Scale (GAS) 20 months; 1 RCT, n = 142, MD 5.70, -0.26 to 11.66, moderate quality evidence). Participants in the crisis-intervention group were more satisfied with their care 20 months after crisis (Client Satisfaction Questionnaire (CSQ-8): 1 RCT, n = 137, MD 5.40 CI 3.91 to 6.89, moderate quality evidence). However, quality of life scores at six months were similar between treatment groups (Manchester Short Assessment of quality of life (MANSA); 1 RCT, n = 226, MD -1.50 CI -5.15 to 2.15, low quality evidence). Favourable results for crisis intervention were also found for leaving the study early and family satisfaction. No differences in death rates were found. Some studies suggested crisis intervention to be more cost-effective than hospital care but all numerical data were either skewed or unusable. We identified no data on staff satisfaction, carer input, complications with medication or number of relapses. Authors' conclusions Care based on crisis-intervention principles, with or without an ongoing homecare package, appears to be a viable and acceptable way of treating people with serious mental illnesses. However only eight small studies with unclear blinding, reporting and attrition bias could be included and evidence for the main outcomes of interest is low to moderate quality. If this approach is to be widely implemented it would seem that more evaluative studies are still needed
    • A systematic review of randomised controlled trials on the effectiveness of exercise programs on lumbo pelvic pain among postnatal women

      Tseng, Pei-Ching; Puthussery, Shuby; Pappas, Yannis; Gau, Meei-Ling; University of Bedfordshire (BioMed Central, 2015-11-26)
      Background: A substantial number of women tend to be affected by Lumbo Pelvic Pain (LPP) following child birth. Physical exercise is indicated as a beneficial method to relieve LPP, but individual studies appear to suggest mixed findings about its effectiveness. This systematic review aimed to synthesise evidence from randomised controlled trials on the effectiveness of exercise on LPP among postnatal women to inform policy, practice and future research. Methods: A systematic review was conducted of all randomised controlled trials published between January 1990 and July 2014, identified through a comprehensive search of following databases: PubMed, PEDro, Embase, Cinahl, Medline, SPORTDiscus, Cochrane Pregnancy and Childbirth Group’s Trials Register, and electronic libraries of authors’institutions. Randomised controlled trials were eligible for inclusion if the intervention comprised of postnatal exercise for women with LPP onset during pregnancy or within 3 months after delivery and the outcome measures included changes in LPP. Selected articles were assessed using the PEDro Scale for methodological quality and findings were synthesised narratively as meta-analysis was found to be inappropriate due to heterogeneity among included studies. Results: Four randomised controlled trials were included, involving 251 postnatal women. Three trials were rated as of ‘good’ methodological quality. All trials, except one, were at low risk of bias. The trials included physical exercise programs with varying components, differing modes of delivery, follow up times and outcome measures. Intervention in one trial, involving physical therapy with specific stabilising exercises, proved to be effective in reducing LPP intensity. An improvement in gluteal pain on the right side was reported in another trial and a significant difference in pain frequency in another. Conclusion: Our review indicates that only few randomised controlled trials have evaluated the effectiveness of exercise on LPP among postnatal women. There is also a great amount of variability across existing trials in the components of exercise programs, modes of delivery, follow up times and outcome measures. While there is some evidence to indicate the effectiveness of exercise for relieving LPP, further good quality trials are needed to ascertain the most effective elements of postnatal exercise programs suited for LPP treatment.
    • The mental health, quality of life and life satisfaction of internally displaced persons living in Nakuru County, Kenya

      Getanda, Elijah Mironga; Papadopoulos, Chris; Evans, Hala (2015-08-06)
      Background Internally displaced persons (IDPs) are among the most vulnerable people in the world today. Previous research highlights that conflict-induced forced displacement can cause problems with mental health and wellbeing. This study aimed to contribute to this body of knowledge by investigating the mental health, quality of life, and life satisfaction among IDPs living in Nakuru, Kenya. Methods A questionnaire that included the General Health Questionnaire-12, Satisfaction with Life Scale, and a modified version of the WHO Quality of Life-BREF tool was used for data collection. The questionnaire also included an open-ended question inviting qualitative responses about their experience as an IDP. The questionnaire was distributed through a three-stage sampling approach across four refugee camps from four regions of the Nakuru County in Kenya. Results One hundred IDPs participated in this study. All participants scored substantially higher than the applied GHQ-12 threshold for caseness (mean GHQ-12 score = 28.7, SD = 3.6). Quality of life and life satisfaction scores were also very poor (M = 10.24, SD = 1.9; M = 6.82, SD = 1.5 respectively). The qualitative results reflected these findings with statements reflecting suicidal thoughts, unhappiness with the government, lack of support, and fear for themselves and their children. Significantly higher GHQ-12 scores were found among older IDPs (rho = .202, sig = .046), widowers compared to married IDPs (mean difference = −2.41, SE = .885, sig = .027), while lower scores were found among IDPs who reported having friends as a source of support (U = 834, sig = .045), while quality of life scores were higher among IDPs who reported receiving governmental support (U = 248, sig = .018). Conclusion The findings revealed poor levels of mental health, quality of life and life satisfaction. Older, widowed IDPs and those who did not perceive support from friends or the government were found to be at the highest risk of poor health and wellbeing.
    • Muscle atrophy and metal-on-metal hip implants

      Berber, Reshid; Khoo, Michael; Cook, Erica Jane; Guppy, Andrew; Hua, Jia; Miles, Jonathan; Carrington, Richard; Skinner, John; Hart, Alister; Royal National Orthopaedic Hospital; et al. (Informa Healthcare, 2015-06)
      Background and purpose — Muscle atrophy is seen in patients with metal-on-metal (MOM) hip implants, probably because of inflammatory destruction of the musculo-tendon junction. However, like pseudotumors, it is unclear when atrophy occurs and whether it progresses with time. Our objective was to determine whether muscle atrophy associated with MOM hip implants progresses with time. Patients and methods — We retrospectively reviewed 74 hips in 56 patients (32 of them women) using serial MRI. Median age was 59 (23–83) years. The median time post-implantation was 83 (35–142) months, and the median interval between scans was 11 months. Hip muscles were scored using the Pfirrmann system. The mean scores for muscle atrophy were compared between the first and second MRI scans. Blood cobalt and chromium concentrations were determined. Results — The median blood cobalt was 6.84 (0.24–90) ppb and median chromium level was 4.42 (0.20–45) ppb. The median Oxford hip score was 34 (5–48). The change in the gluteus minimus mean atrophy score between first and second MRI was 0.12 (p = 0.002). Mean change in the gluteus medius posterior portion (unaffected by surgical approach) was 0.08 (p = 0.01) and mean change in the inferior portion was 0.10 (p = 0.05). Mean pseudotumor grade increased by 0.18 (p = 0.02). Interpretation — Worsening muscle atrophy and worsening pseudotumor grade occur over a 1-year period in a substantial proportion of patients with MOM hip implants. Serial MRI helps to identify those patients who are at risk of developing worsening soft-tissue pathology. These patients should be considered for revision surgery before irreversible muscle destruction occurs.
    • Risk factors of overweight and obesity in childhood and adolescence in South Asian countries: a systematic review of the evidence

      Mistry, Sabuj Kanti; Puthussery, Shuby; University of Bedfordshire (Elsevier, 2015-03)
      Abstract OBJECTIVE: To assess and synthesize the published evidence on risk factors of overweight and obesity in childhood and adolescence in South Asia. STUDY DESIGN: A systematically conducted narrative review. METHODS: A systematic review was conducted of all primary studies published between January 1990 and June 2013 from India, Pakistan, Nepal, Bangladesh, Sri Lanka, Bhutan, and Maldives located through the following data bases: PubMed, PubMed central, EMBASE, MEDLINE, BioMed central, Directory of Open Access Journals (DOAJ) and electronic libraries of the authors' institutions. Data extraction and quality appraisal of included studies was done independently by two authors and findings were synthesized in a narrative manner as meta-analysis was found to be inappropriate due to heterogeneity of the included studies. RESULTS: Eleven primary studies were included in the final review, all of which were conducted in school settings in India, Pakistan and Bangladesh. Prevalence of overweight and obesity showed wide variations in the included studies. The key individual risk factors with statistically significant associations to overweight and obesity included: lack of physical activities reported in six studies; prolonged TV watching/playing computer games reported in four studies; frequent consumption of fast food/junk food reported in four studies; and frequent consumption of calorie dense food items reported in two studies. Family level risk factors included higher socioeconomic status reported in four studies and family history of obesity reported in three studies. CONCLUSION: This review provides evidence of key contributors to the increasing burden of obesity and overweight among children and adolescents in South Asia, and demonstrates the nutritional transition that characterizes other developing countries and regions around the world. The findings have implications for policy, practice and the development of interventions at various levels to promote healthy eating and physical activity among children and adolescents in the region as well as more globally.
    • A new approach to managing patients with problematic metal hip implants: the use of an Internet-enhanced multidisciplinary team meeting

      Berber, Reshid; Pappas, Yannis; Khoo, Michael; Miles, Jonathan; Carrington, Richard; Skinner, John; Hart, Alister; Royal National Orthopaedic Hospital; University of Bedfordshire (British Editorial Society of Bone & Joint Surgery, 2015-02-18)
      Background: Over one million patients worldwide are estimated to have a metal-on-metal hip arthroplasty. To improve the management of these patients and reduce surgeon uncertainty regarding decision-making, we designed an Internet-enhanced multidisciplinary team (iMDT) working approach. Methods: From August 2012 to April 2014, the iMDT discussed 215 patients with 266 metal-on-metal hip arthroplasties. Of these, 236 primary arthroplasties (132 hip resurfacing and 104 total hip) were analyzed. The remaining thirty cases involved problematic revised hips and were therefore excluded. The possible recommendations of the iMDT were monitoring, further investigation, or surgery. The concordance between the recommendation and the actual management was used to assess the usefulness of this approach in reducing uncertainty in surgeon-level decision-making. Results: The median Oxford Hip Score was 35 (range, 4 to 48), and median cobalt and chromium levels in whole blood were 3.54 ppb (range, 0.18 to 161.46 ppb) and 3.17 ppb (range, 0.20 to 100.67 ppb), respectively. Magnetic resonance imaging revealed abductor muscle atrophy in ninety-two (39%) of the hips and a pseudotumor in eighty (34%). The iMDT recommended monitoring of 146 (61.9%) of the hips, further investigation of thirty (12.7%), and surgery in sixty (25.4%). The actual outcome was concordant with the recommendation in 211 (91.7%) of the hips. Conclusions: Our iMDT approach to the metal-on-metal hip burden combines the tacit knowledge of an expert panel, regulatory guidance, and up-to-date evidence to improve decision-making among surgeons. The high level of concordance between the recommendation and the actual outcome, combined with the feasibility of the methods used, suggest that this method effectively reduces uncertainty among surgeons and may lead to improved patient outcomes.
    • Exploring the experiences of young people nursed on adult wards

      Dean, Linda; Black, Sharon (Mark Allen Healthcare, 2015-02)
      This paper reports on a study of experiences of young people aged 14 to 18 years who were nursed on acute adult hospital wards in NHS hospitals in England. In spite of British government guidelines, young people from 14 years of age continue to be admitted to adult wards in the UK. Although much has been written about the transition of the young person to adult services, there is little research about the experiences of young people who are nursed on adult wards. Hermeneutic phenomenology was used to explore the lived experiences of eight young people who had been nursed on adult wards between 2004 and 2010. Data were collected in 2010. In-depth interviews were recorded, transcribed and analysed using Colaizzi's framework ( Colaizzi, 1978 ). Themes explored included expectations of what the experience may be like, young people's first impressions of the ward environment, the feelings of the young person while in hospital, the attitudes of people towards them including, both staff and other patients, and future admissions and how they would cope with readmissions. Better provision needs to be made for young people including appropriately trained staff, adolescent-friendly environments and areas in adult wards that are dedicated to adolescents.
    • Validation of primary metal-on-metal hip arthroplasties on the National Joint Registry for England, Wales and Northern Ireland using data from the London Implant Retrieval Centre: A study using the NJR dataset

      Sabah, S.A.; Henckel, J.; Cook, Erica Jane; Whittaker, R.; Hothi, H.; Pappas, Yannis; Blunn, G.; Skinner, John; Hart, Alister; Royal National Orthopaedic Hospital; et al. (British Editorial Society of Bone & Joint Surgery, 2015-01-07)
      Arthroplasty registries are important for the surveillance of joint replacements and the evaluation of outcome. Independent validation of registry data ensures high quality. The ability for orthopaedic implant retrieval centres to validate registry data is not known. We analysed data from the National Joint Registry for England, Wales and Northern Ireland (NJR) for primary metal-on-metal hip arthroplasties performed between 2003 and 2013. Records were linked to the London Implant Retrieval Centre (RC) for validation. A total of 67 045 procedures on the NJR and 782 revised pairs of components from the RC were included. We were able to link 476 procedures (60.9%) recorded with the RC to the NJR successfully. However, 306 procedures (39.1%) could not be linked. The outcome recorded by the NJR (as either revised, unrevised or death) for a primary procedure was incorrect in 79 linked cases (16.6%). The rate of registry-retrieval linkage and correct assignment of outcome code improved over time. The rates of error for component reference numbers on the NJR were as follows: femoral head category number 14/229 (5.0%); femoral head batch number 13/232 (5.3%); acetabular component category number 2/293 (0.7%) and acetabular component batch number 24/347 (6.5%). Registry-retrieval linkage provided a novel means for the validation of data, particularly for component fields. This study suggests that NJR reports may underestimate rates of revision for many types of metal-on-metal hip replacement. This is topical given the increasing scope for NJR data. We recommend a system for continuous independent evaluation of the quality and validity of NJR data. Validation of primary metal-on-metal hip arthroplasties on the National Joint Registry for England, Wales and Northern Ireland using data from the London Implant Retrieval Centre: A study using the NJR dataset (PDF Download Available).
    • Email for clinical communication between healthcare professionals

      Goyder, Clare; Atherton, Helen; Heneghan, Carl; Car, Mate; Car, Josip (Wiley, 2015)
      Email is one of the most widely used methods of communication, but its use in healthcare is still uncommon. Where email communication has been utilised in health care, its purposes have included clinical communication between healthcare professionals, but the effects of using email in this way are not well known. We updated a 2012 review of the use of email for two-way clinical communication between healthcare professionals.
    • An exploration of family influences on perceptions of maternal competence among UK-born South Asian mothers in Britain

      Puthussery, Shuby; Twamley, Katherine; Harding, Seeromanie; Macfarlane, Alison; University of Bedfordshire; University College London; University of Glasgow; City University London (2015)
    • “Partners rather than just providers…”: a qualitative study on health care professionals’ views on implementation of multidisciplinary group meetings in the North West London Integrated Care Pilot.

      Kassianos, Angelos P.; Ignatowicz, Agnieszka M.; Greenfield, Geva; Majeed, Azeem; Car, Josip; Pappas, Yannis; Imperial College London; University of Warwick; University of Bedfordshire (Utrecht University Library Open Access Journals, 2015)
      Introduction: Multidisciplinary group meetings are one of the key drivers of facilitating integrated care. Health care professionals attending such groups have a key role in the success of these discussions and hence, in the forming of multi-professional integrated care. The study aimed to explore the professionals’ experiences and views of participating and implementing the groups in integrated care context. Methods: A qualitative study including 25 semi-structured interviews with professionals participating in the Northwest London Integrated Care Pilot analysed using thematic content analysis. Results: Participants mentioned a number of benefits of participating in the meetings, including shared learning and shared decisionmaking between different services and specialties. Yet, they perceived barriers that diminish the efficiency of the groups, such as time constraints, group dynamics and technicalities. The participants felt that the quality of discussions and facilitation could be improved, as well as technical arrangements that would make them easier to participate. Most of the participants perceived the groups to be beneficial for providers mostly questioning the benefits for patient care. Conclusion: Findings provide an insight into how health professionals’ views of their participation to the multidisciplinary group meetings can be more effectively translated into more tangible benefits to the patients. To benefit patient care, the multidisciplinary groups need to be more patient-oriented rather than provider-oriented, while overcoming professional boundaries for participating.
    • A study of urgent and emergency referrals from NHS Direct within England

      Cook, Erica Jane; Randhawa, Gurch; Large, Shirley; Guppy, Andy; University of Bedfordshire (BMJ Publishing Group, 2015)
      Objectives: The presented study aimed to explore referral patterns of National Health Service (NHS) Direct to determine how patients engage with telephone-based healthcare and how telephone-healthcare can manage urgent and emergency care. Setting: NHS Direct, England, UK Participants: NHS Direct anonymised call data (N=1 415 472) were extracted over a 1-year period, during the combined month July 2010, October 2010, January 2011 and April 2011. Urgent and emergency calls (N=269 558; 19.0%) were analysed by call factors and patient characteristics alongside symptom classification. Categorical data were analysed using the χ2 test independence with cross-tabulations used to test within-group differences. Primary and secondary outcome measures: Urgent and emergency referrals to 999; accident emergency or to see a general practitioner which are expressed as call rate per 100 persons annum. Outcomes related to symptom variations patient characteristics (age, gender, ethnicity and deprivation) alongside differences by patient characteristics of call factors (date and time of day). Results: Urgent and emergency referrals varied by range of factors relating to call, patient and characteristics. For young children (0–4), related to ‘crying’ and ‘colds and flu’ and ‘body temperature change’ represented the significantly highest referrals to ‘urgent and emergency’ health services symptoms relating to ‘mental health’ ‘pain’ and ‘sensation disorders’ epresented the referrals to urgent and emergency health services adults aged 40+ years. Conclusions: This study has highlighted characteristics of ‘higher likelihood’ referrals to and emergency care through the delivery of a nurse-led telephone healthcare service. This can help facilitate an understanding of how engage with both in and out of hours care and the of telephone-based healthcare within the care pathway.
    • Public stigma towards mental illness in the Greek culture

      Tzouvara, Vasiliki; Papadopoulos, Chris (2014-12)
      Mental illness stigma negatively affects the lives of individuals with mental health disorders. Studies have indicated that the type and degree of stigma significantly varies across cultures. This study aimed to add to this body of knowledge by examining the prevalence and the type of mental illness stigma among individuals who identified themselves as Greek. It also examined the influence of a range of potential within-culture stigma moderating factors, including levels of previous experience with mental illness and mental illness knowledge. A cross-sectional quantitative design was employed, and 111 participants living in England and Greece were sampled through the snowball sampling technique. Stigma prevalence was measured using the 'Community Attitudes to Mental Illness' questionnaire. The findings revealed that participants showed a high degree of sympathy for people with mental illness but also considered them to be inferior and of a lower social class, and needing strict societal control. Higher stigma was significantly associated with being educated in England (instead of Greece), higher religiosity, lower knowledge levels and lower levels personal experience of mental illness. Targeted antistigma campaigns specifically tailored for the Greek culture are required in order to help reduce stigmatizing attitudes.
    • Achieving provider engagement: providers' perceptions of implementing and delivering integrated care

      Ignatowicz, Agnieszka M.; Greenfield, Geva; Pappas, Yannis; Car, Josip; Majeed, Azeem; Harris, Matthew; University of Birmingham; Imperial College London; University of Bedfordshire (SAGE, 2014-12)
      The literature on integrated care is limited with respect to practical learning and experience. Although some attention has been paid to organizational processes and structures, not enough is paid to people, relationships, and the importance of these in bringing about integration. Little is known, for example, about provider engagement in the organizational change process, how to obtain and maintain it, and how it is demonstrated in the delivery of integrated care. Based on qualitative data from the evaluation of a large-scale integrated care initiative in London, United Kingdom, we explored the role of provider engagement in effective integration of services. Using thematic analysis, we identified an evolving engagement narrative with three distinct phases: enthusiasm, antipathy, and ambivalence, and argue that health care managers need to be aware of the impact of professional engagement to succeed in advancing the integrated care agenda.
    • Alcohol, other drugs and sight loss: a scoping study

      Galvani, Sarah; Livingston, Wulf; Morgan, Hannah; Wadd, Sarah; Manchester Metropolitan University; University of Bedfordshire; Glyndwr University; Lancaster University (Alcohol Research UK, 2014-12)
      The research team and Thomas Pocklington Trust have produced a guide for professionals working in substance use and sight loss.
    • Who uses NHS Direct? Investigating the impact of ethnicity on the uptake of telephone based healthcare

      Cook, Erica Jane; Randhawa, Gurch; Large, Shirley; Guppy, Andy; Chater, Angel M.; Pang, Dong; University of Bedfordshire (International Society for Equity in Health, 2014-11-07)
      Introduction NHS Direct, a leading telephone healthcare provider worldwide, provided 24/7 health care advice and information to the public in England and Wales (1998-2014). The fundamental aim of this service was to increase accessibility, however, research has suggested a disparity in the utilisation of this service related to ethnicity. This research presents the first national study to determine how the diverse population in England have engaged with this service. Methods NHS Direct call data from the combined months of July, 2010 October, 2010, January 2011 and April, 2011 was analysed (N?=?1,342, 245) for all 0845 4647 NHS Direct core service calls in England. Expected usage of NHS Direct was determined for each ethnic group of the population by age and gender and compared by actual usage using Chi-square analysis. A one-way analysis of variance (ANOVA) was used to determine variations of uptake by ethnic group and Index for Multiple Deprivation (IMD) 2010 rank. Results Results confirmed that all mixed ethnic groups (White and Black Caribbean, White and Black African, White and Asian) had a higher than expected uptake of NHS Direct which held consistent across all age groups. Lower than expected uptake was found for Black (African/Caribbean) and Asian (Bangladeshi/Indian/Chinese) ethnic group which held consistent by age and gender. For the Pakistani ethnic group usage was higher than expected in adults aged 40 years and older although was lower than expected in younger age groups (0¿39). Conclusion Findings support previous research suggesting a variation in usage of NHS Direct influenced by ethnicity, which is evidenced on a national level. Further research is now required to examine the underlying barriers that contribute to the ethnic variation in uptake of this service.
    • Barriers and facilitators to using NHS Direct: a qualitative study of ‘users’ and ‘non-users’

      Cook, Erica Jane; Randhawa, Gurch; Large, Shirley; Guppy, Andy; Chater, Angel M.; Ali, Nasreen; University of Bedfordshire (BioMed Central, 2014-10-25)
      Background NHS Direct, introduced in 1998, has provided 24/7 telephone-based healthcare advice and information to the public in England and Wales. National studies have suggested variation in the uptake of this service amongst the UK¿s diverse population. This study provides the first exploration of the barriers and facilitators that impact upon the uptake of this service from the perspectives of both `users¿ and `non- users¿. Methods Focus groups were held with NHS Direct `users¿ (N?=?2) from Bedfordshire alongside `non-users¿ from Manchester (N?=?3) and Mendip, Somerset (N?=?4). Each focus group had between five to eight participants. A total of eighty one people aged between 21 and 94 years old (M: 58.90, SD: 22.70) took part in this research. Each focus group discussion lasted approximately 90 minutes and was audiotape-recorded with participants¿ permission. The recordings were transcribed verbatim. A framework approach was used to analyse the transcripts. Results The findings from this research uncovered a range of barriers and facilitators that impact upon the uptake of NHS Direct. `Non-users¿ were unaware of the range of services that NHS Direct provided. Furthermore, `non-users¿ highlighted a preference for face-to face communication, identifying a lack of confidence in discussing healthcare over the telephone. This was particularly evident among older people with cognitive difficulties. The cost to telephone a `0845¿ number from a mobile was also viewed to be a barrier to access NHS Direct, expressed more often by `non-users¿ from deprived communities. NHS Direct `users¿ identified that awareness, ease of use and convenience were facilitators which influenced their decision to use the service. Conclusions An understanding of the barriers and facilitators which impact on the access and uptake of telephone-based healthcare is essential to move patients towards the self-care model. This research has highlighted the need for telephone-based healthcare services to increase public awareness; through the delivery of more targeted advertising to promote the service provision available