• Antenatal care initiation in an ethnically dense socially disadvantaged maternal cohort

      Puthussery, Shuby; Tseng, Pei-Ching; Li, L.; Puthusserry, Thomas (Oxford University Press, 2019-11-20)
      Background: Differential utilisation of antenatal care among ethnic minority mothers is a contributor to their increased risk of poor birth outcomes in developed countries. Links between ethnicity, area deprivation and the timing of antenatal care initiation remain poorly understood. This study investigated patterns of antenatal care initiation among an ethnically dense, socially disadvantaged maternal cohort. Methods: We conducted a retrospective analysis of routinely collected anonymous data of live singleton births in a maternity unit serving an ethnically diverse population. We applied univariate regression models to examine the association between late antenatal care initiation and various predictor variables in particular ethnicity and area deprivation. Results: Gestational week at antenatal initiation was available for 46,089 births. One fifth (20.9%) of mothers initiated antenatal care after 12 weeks of gestation including 11.9% who had their first antenatal appointment at 13 -20 weeks (moderately late) and 8.9% who had it later than 20 weeks (extremely late). Among all the factors considered, late initiation was most strongly associated with non-White British ethnicity. Black African (34.2%) and Black Caribbean (29.0%) mothers were more than twice as likely to initiate antenatal care after 12 weeks of gestation compared to White British mothers [Odds ratio (OR) = 2.69 and 2.15 respectively). The odds did not increase with increasing area deprivation except for moderately late initiation in the most deprived and second most deprived areas [unadjusted OR = 1.54 and 1.24 respectively]. Conclusions: Non-White British ethnicity was the key predictor of late antenatal care initiation in our ethnically dense socially disadvantaged maternal cohort. Impact: Programs and policies should take in to account ethnic variations in antenatal careinitiation while designing programs and policies to improve birth outcomes in ethnically dense socially disadvantaged areas. Key messages: Non-White British ethnicity was the key predictor of late antenatal care initiation. Area deprivation per se appeared to have limited association with late antenatal care initiation.
    • Barriers and facilitators to genetic testing amongst Black African women in the UK

      Kabeya, Valencia; Puthussery, Shuby; Furmanski, Anna L. (Oxford University Press, 2021-10-20)
      Background Black African women have the lowest attendance of genetic testing services and the highest mortality rate of breast and ovarian cancer amongst women from ethnic minority groups in the UK. Therefore, this study aimed to identify the barriers and facilitators to genetic testing to enable these women to make informed choices if found eligible. Methods A qualitative approach was used to explore the perceptions surrounding genetic testing amongst Twenty-four women aged 23-57 Black African women in Luton. Purposive sampling combined with snowballing sampling was used as a recruitment technique. Results The findings revealed that most of the participants had no awareness or knowledge of genetic testing and limited knowledge of their family medical history for eligibility to attend genetic testing services. Facilitators including family member's health, funding by the National Health services and accessibility and awareness and education on genetic testing were identified. Conclusions This study sought to explore the perceptions of Black African women on barriers and facilitators to genetic testing to enable researchers to implement efficient intervention that would increase genetic testing attendance whilst addressing the other barriers and facilitators to alter Black African's women health seeking behaviours.
    • Consent rates for video-recording general practice consultations: effect of ethnicity and other factors

      Neal, Richard D.; Ali, Nasreen; Allgar, Victoria L.; Coleman, Tim (Oxford University Press, 2004-04-01)
      We sought consent for video-recording general practice consultations from 260 consecutive attenders in nine surgeries. Intensive fieldwork including language support, from both the researcher and professional interpreters, was undertaken. The overall consent rate was 77.3%. No significant differences in consent rates were found between white and south Asian patients, even after controlling for age, gender and self-reported understanding of English. No differences in consent rates were found with respect to age, gender and self-reported understanding of English.
    • Ethnic minority women’s interactions with antenatal care providers in Europe

      Sharma, Esther; Puthussery, Shuby; Tseng, Pei-Ching; Li, Leah; Harden, Angela; Griffiths, Malcolm; Bamfo, Jacqueline (Oxford University Press, 2021-10-20)
    • “Health Party” intervention on genetic testing for ethnic minority women: study protocol

      Kabeya, Valencia; Puthussery, Shuby; Furmanski, Anna L. (Oxford University Press, 2019-11-20)
      Background Culturally appropriate interventions are needed to improve the uptake of genetic counselling and testing among ethnically diverse communities. This study aims to assess the feasibility and preliminary effectiveness of a “Health Party” intervention to increase awareness, knowledge and uptake of genetic testing for breast and ovarian cancer among ethnic minority women in the UK. Methods The “Health Party” intervention will include an educational session in a party setting. Participants will be taught by professionals about genetic testing and how to access genetic testing services in the UK National Health Service. We will recruit a sample of 60 women aged 18 years and over from key ethnic minority groups in the UK (Black African, Black Caribbean, Indian, Pakistani, Bangladeshi) and will conduct four community based sessions, each with about 15 participants. The outcomes will primarily relate to recruitment and attrition rates, data collection, study resources and intervention delivery. A quantitative pre-post evaluation with measurements before, shortly after, and at 6 months following the intervention will be conducted to assess the preliminary effectiveness on awareness, knowledge and uptake of genetic testing. We will use three way mixed analysis of variance (MANOVA) to analyse changes pre- and post- intervention. The fidelity of the intervention including facilitation strategies, quality of delivery and participant response will be assessed. Conclusions Findings will establish the feasibility of the intervention and will provide insights into its effectiveness to increase the awareness, knowledge and uptake of genetic testing for breast and ovarian cancer among women from ethnic minority groups in the UK. Impact: Depending on its feasibility and effectiveness, the intervention can be used to help women from ethnic minority groups to make informed choices about genetic testing and improve early diagnosis and treatment of breast and ovarian cancer. Key messages “Health Party” may be a feasible intervention for ethnic minority women in the UK. “Health Party” intervention may increase awareness, knowledge and uptake of services.
    • The impact of social prescribing services on service users: a systematic review of the evidence

      Pescheny, Julia Vera; Randhawa, Gurch; Pappas, Yannis; University of Bedfordshire (Oxford University Press, 2019-06-14)
      Social prescribing initiatives are widely implemented in the UK National Health Service to integrate health and social care. Social prescribing is a service in primary care that links patients with non-medical needs to sources of support provided by the community and voluntary sector to help improve their health and wellbeing. Such programmes usually include navigators, who work with referred patients and issue onward referrals to sources of non-medical support. This systematic review aimed to assess the evidence of service user outcomes of social prescribing programmes based on primary care and involving navigators. We searched 11 databases, the grey literature, and the reference lists of relevant studies to identify the available evidence on the impact of social prescribing on service users. Searches were limited to literature written in English. No date restrictions were applied, and searches were conducted to June 2018. Findings were synthesized narratively, employing thematic analysis. The Mixed Methods Appraisal Tool Version 2011 was used to evaluate the methodological quality of included studies. Sixteen studies met the inclusion criteria. The evidence base is mixed, some studies found improvements in health and wellbeing, health-related behaviours, self-concepts, feelings, social contacts and day-to-day functioning post-social prescribing, whereas others have not. The review also shows that the evaluation methodologies utilized were variable in quality. In order to assess the success of social prescribing services, more high quality and comparable evaluations need to be conducted in the future.International Prospective Register of Systematic Reviews number: CRD42017079664.
    • The impact of the Luton social prescribing programme on mental well-being: a quantitative before-and-after study

      Pescheny, Julia Vera; Gunn, Laura H.; Pappas, Yannis; Randhawa, Gurch; (Oxford University Press, 2019-12-27)
      Background Social prescribing programmes expand the range of options available to primary care health professionals to address patients’ psychosocial needs, impacting on their health and well-being. The objective of this study was to assess the change in the mental well-being of service users after participation in the Luton social prescribing programme. Methods Skew-normal (SN) regression was applied to analyse the change in mental well-being post-intervention (N = 63). The short Warwick–Edinburgh mental well-being scale was used as the outcome measure. Results The SN regression found a statistically significant change (P < 0.0001) in the average difference score between baseline and post-intervention measures. However, the observed change does not appear to be of clinical relevance. No significant associations in mental well-being scores by gender, age or working status were found. Conclusion Findings of this study indicate that social prescribing may have the potential to improve the mental well-being of service users. The study findings contribute to the sparse evidence base on social prescribing outcomes by socio-demographic characteristics of participants and highlight the importance of considering subgroup analysis in future research.
    • Influences on antibiotic prescribing by non-medical prescribers for respiratory tract infections: a systematic review using the theoretical domains framework

      Chater, Angel M.; Family, Hannah; Lim, Rosemary; Courtenay, Molly; University of Bedfordshire; University of Bristol; University of Reading; Cardiff University (Oxford University Press, 2020-08-07)
      Background The need to conserve antibiotic efficacy, through the management of respiratory tract infections (RTIs) without recourse to antibiotics, is a global priority. A key target for interventions is the antibiotic prescribing behaviour of healthcare professionals including non-medical prescribers (NMPs: nurses, pharmacists, paramedics, physiotherapists) who manage these infections. Objectives To identify what evidence exists regarding the influences on NMPs’ antimicrobial prescribing behaviour and analyse the operationalization of the identified drivers of behaviour using the Theoretical Domains Framework (TDF). Methods The search strategy was applied across six electronic bibliographic databases (eligibility criteria included: original studies; written in English and published before July 2019; non-medical prescribers as participants; and looked at influences on prescribing patterns of antibiotics for RTIs). Study characteristics, influences on appropriate antibiotic prescribing and intervention content to enhance appropriate antibiotic prescribing were independently extracted and mapped to the TDF. Results The search retrieved 490 original articles. Eight papers met the review criteria. Key issues centred around strategies for managing challenges experienced during consultations, managing patient concerns, peer support and wider public awareness of antimicrobial resistance. The two most common TDF domains highlighted as influences on prescribing behaviour, represented in all studies, were social influences and beliefs about consequences. Conclusions The core domains highlighted as influential to appropriate antibiotic prescribing should be considered when developing future interventions. Focus should be given to overcoming social influences (patients, other clinicians) and reassurance in relation to beliefs about negative consequences (missing something that could lead to a negative outcome).
    • Negotiating difference and belonging in families from mixed racial, ethnic and faith backgrounds in Britain: Implications for mental health

      Puthussery, Shuby; Caballero, Chamion; Edwards, Rosalind (Oxford University Press, 2008-09-30)
      Poster presentations: abstracts Key points * Mixed-parent couples in Britain were often in sustained relationships, and a high proportion were middle class. * The couples interviewed used three typical approaches to instil a sense of belonging in their children; particular approaches were not associated with particular racial or faith combinations: o Individual: children's sense of belonging was not seen as rooted in their mixed background. o Mix: children's mixed background was understood as a factual part of their identity; all aspects were emphasised. o Single: one aspect of children's mixed background was stressed. * Couples whose approach differed in giving their children a sense of belonging were not necessarily in conflict. For some, divergent approaches were complementary. Others saw difficulties between them as humanistic, political or personality choices. * Parents identified supportive or constraining resources and relationships in creating a sense of belonging, including neighbourhoods, schools, travel, languages, grandparents and children themselves. What some regarded as supportive, others saw as drawbacks. * Mixed-parent couples can be more concerned with other issues, such as children's safety and health, unity over discipline and financial security. * The researchers conclude that it is important that family support, health, education and social services do not make assumptions about mixed families. Families who seem to share a form of mixing can differ from each other. 'Mixedness' may be insignificant for some, compared to other issues. Mixed families would benefit from policies and practice that further tackle prejudice based on race and faith.
    • Personalised adherence support for maintenance treatment of inflammatory bowel disease: a tailored digital intervention to change adherence-related beliefs and barriers

      Chapman, Sarah; Sibelli, Alice; St-Clair Jones, Anja; Forbes, Alastair; Chater, Angel M.; Horne, Robert; UCL School of Pharmacy; University of Bath; King’s College London; Brighton and Sussex University Hospitals NHS Trust; et al. (Oxford University Press, 2020-05-07)
      Background and aims: Interventions to improve adherence to medication may be more effective if tailored to the individual, addressing adherence-related beliefs about treatment and overcoming practical barriers to daily use. We evaluated whether an algorithm tailoring support to address perceptual and practical barriers to adherence reduced barriers and was acceptable to patients with IBD. Methods: Participants with IBD, prescribed azathioprine and/or mesalazine were recruited via patient groups, social media and hospital clinics and allocated to Intervention or Control Groups. The online intervention comprised messages tailored to address beliefs about IBD and maintenance treatment and provide advice on overcoming practical difficulties with taking regular medication. The content was personalised to address specific perceptual and practical barriers identified by a pre-screening tool. Validated questionnaires assessed barriers to adherence and related secondary outcomes at baseline, one and three months of follow-up. Results: 329 participants were allocated to the Intervention (n=153) and Control (n=176) Groups; just under half (46.2%) completed follow-up. At one and three months the Intervention Group had significantly fewer concerns about IBD medication (p≤.01); and, at three months only, fewer doubts about treatment need, fewer reported practical barriers and lower nonadherence (p<.05). Relative to controls at follow-up, the Intervention Group were more satisfied with information about IBD medicines, and viewed pharmaceuticals in general more positively. Questionnaires, interviews and intervention usage indicated the intervention was acceptable. Conclusions: Personalised adherence support using a digital algorithm can help patients overcome perceptual (doubts about treatment necessity and medication concerns) and practical barriers to adherence.
    • Policy perspectives: International survey of nephrologists' perceptions of and attitudes towards rewards and compensation for kidney donation

      Randhawa, Gurch; University of Bedfordshire (Oxford University Press, 2013-06-01)
      The challenge to resolve the gap between supply and demand for organs is a global phenomenon. The possible solutions can invariably involve a range of ethical and moral dilemmas. This is certainly the case when considering rewards and compensation for kidney donation. In their thought provoking study, Ghahramami et al. provide the perspectives of medical professionals on these issues. The views of nephrologists concerning rewards and compensation chime with views of the public, which have been highlighted in many previous studies. Rewards and compensation for organ donation are perceived, by some, as barriers to successful organ donation transplant programmes; whereas others view them as potential facilitators to increasing organ donation rates. It is interesting to note that two-thirds of survey respondents believe that introducing some kind of reward or offering compensation would lead to an increase in organ donation. This finding is not unique to this study and is evident in many public surveys where respondents have expressed a belief that offering some form of incentive would have a positive impact on organ donation rates. Disappointingly, the debates concerning the type of reward or compensation and its potential impact on donation rates continue to take place in a relatively 'evidence base-free' vacuum. What is abundantly clear is that many lives continue to be lost in many countries due to a lack of suitable organs for transplant. What is less clear is which forms of reward and compensation actually have an impact on donation rates and whether they positively impact the life experiences of donors, recipients and their families. This level of evidence- base is urgently required.
    • Prevalence of Human Immunodeficiency Virus among pregnant women in Nigeria

      Ozim, C.; Mahendran, Rahini; Amalan, Mahendran; Puthussery, Shuby (Oxford University Press, 2020-09-30)
      Background Human Immunodeficiency Virus (HIV) infection among pregnant women has been associated with a number of adverse maternal and infant outcomes. Nigeria accounts for about 10% of the HIV/AIDS burden worldwide and has the second highest incidence of new HIV infections among women globally. This study estimated the overall prevalence of HIV among pregnant women in Nigeria and examined variations across the geo-political zones of the country. Methods We conducted a systematic review and meta-analysis. A comprehensive search was conducted using eight electronic databases and grey sources for studies published from 1·1·2008 to 31·8·2019. Primary studies reporting prevalence estimates of HIV among pregnant women diagnosed using a diagnostic/ screening test were identified, screened and appraised using a two-stage process. A meta-analysis was conducted with the primary outcome measure as proportion (%) of pregnant women identified as having HIV infection. Results Twenty three eligible studies involving 72,728 pregnant women were included in the meta-analysis. The overall pooled prevalence of HIV among pregnant women was 7·22% (95% CI: 5·64, 9·21). A high degree of heterogeneity (I2=97·2%) and publication bias (p = 0.728) was reported. Prevalence rate for South-East geo-political zone (17·04%, 95% CI: 9·01, 29·86) was higher compared to the overall prevalence. Conclusions Findings imply that 7 out of every 100 pregnant women in Nigeria are likely to have HIV infection. The magnitude of the issue highlight the need for targeted efforts at local, national and international levels towards prevention, diagnosis and treatment.
    • A retrospective analysis of variations in antenatal care initiation in an ethnically diverse maternal population in the UK with high levels of area deprivation

      Puthussery, Shuby; Tseng, Pei-Ching; Li, Leah; Puthusserry, Thomas; University of Bedfordshire; University College London (Oxford University Press, 2018-04-17)
      Background: Research has indicated differential utilisation of antenatal care among ethnic minority mothers in the UK.  However, links between ethnicity, area deprivation and the timing of antenatal care initiation remain poorly understood.   This study investigates variations in antenatal care initiation among mothers residing in an ethnically diverse area in the UK with high levels of area deprivation.  Methods:  Data were derived from an on-going  retrospective cohort study using routinely collected anonymous data of live singleton  births over a 9 year period from 2007-2016 in a maternity unit catering to an ethnically diverse population. Logistic regression and Geographical Information Systems (GIS) were used to examine the associations between antenatal care initiation and ethnicity with and without adjustment for area deprivation. Preliminary results:  Among 45695 births recorded on the Ciconia Maternity information System, great  majority (80%) of mothers lived in neighbourhoods that are in the three most deprived area quintiles and 34.4% belonged to one of the ethnic minority groups. One fifth (20.8%)  of mothers initiated antenatal care late after 12 weeks of gestation. Late initiation was the highest among Black African (34.2%) and Black Caribbean (29.0%) groups who were more than twice as likely than the White British group to initiate antenatal care late (Odds ratio [OR]= 2.65 and 2.08 respectively). The risk appeared to remain after adjustment for area deprivation. Conclusions:  Ethnic minority mothers from some groups are at substantially higher risk of initiating antenatal care late compared to White British mothers regardless of the level of area deprivation. Main messages: Mothers from some ethnic minority groups are at  substantially higher risk of initiating antenatal care after 12 weeks of gestation compared to White British mothers.  Area level deprivation has very little effect on ethnic variations in antenatal care initiation.