• A collaborative brief engagement with medically unexplained sexual and other persistent physical symptoms: a realist service evaluation

      Penman, Jean; Cook, Erica Jane; Randhawa, Gurch; University of Bedfordshire (Taylor & Francis, 2019-12-10)
      Attempts to secure improved outcomes with persistent medically unexplained physical symptoms (MUS/PPS) are in their early stages of development and effective implementation in the United Kingdom remains inconsistent. There are scant systematically examined process and outcome studies in this field published in peer reviewed journals. Moreover, persistent sexual symptoms no longer appear in listed examples of MUS/PPS in the professional literature and consequently few studies can be found on 'what works' for improved outcomes with this group of sufferers. A systematic evaluation of an NHS Community Psychosexual Counselling Service delivered within an Integrated Contraception and Sexual Health Service for adults with persistent sexual dysfunction is summarised. The findings from the synthesis of evaluated research, professional guidance and a particular practice, at clinic cohort and embedded case levels, revealed common themes of engagement across the therapy divides when addressing “medically unexplained” physical symptoms. This supports future research in this area and calls for the inclusion of persistent sexual symptoms. The extracted themes from the therapy process may be used as tools to enhance skills of engagement with unresolved PPS in similar settings in which the individual seeks help to achieve improved outcomes.
    • How can health systems be strengthened to control and prevent an Ebola outbreak? a narrative review

      Regmi, Krishna; Gilbert, Ruth; Thunhurst, Colin (Taylor & Francis, 2015-11-24)
      The emergence and re-emergence of infectious diseases are now more than ever considered threats to public health systems. There have been over 20 outbreaks of Ebola in the past 40 years. Only recently, the World Health Organization has declared a public health emergency of international concern (PHEIC) in West Africa, with a projected estimate of 1.2 million deaths expected in the next 6 months. Ebola virus is a highly virulent pathogen, often fatal in humans and non-human primates. Ebola is now a great priority for global health security and often becomes fatal if left untreated. This study employed a narrative review. Three major databases MEDLINE, EMBASE, and Global Health were searched using both ‘text-words’ and ‘thesaurus terms’. Evidence shows that low- and middle-income countries (LMICs) are not coping well with the current challenges of Ebola, not only because they have poor and fragile systems but also because there are poor infectious disease surveillance and response systems in place. The identification of potential cases is problematic, particularly in the aspects of contact tracing, infection control, and prevention, prior to the diagnosis of the case. This review therefore aims to examine whether LMICs’ health systems would be able to control and manage Ebola in future and identifies two key elements of health systems strengthening that are needed to ensure the robustness of the health system to respond effectively.
    • Inter-rater reliability of treatment fidelity and therapeutic alliance measures for psychological therapies for anxiety in young people with autism spectrum disorders

      Brown, Rachel; Iqbal, Zeinab; Reynolds, Laura; Press, Dee A.; Shaker-Naeeni, Hadi; Scrivener, Louise; Chowdhury, Uttom; Murphy, Suzanne (Taylor & Francis, 2014-08-07)
      Objectives: This article presents work undertaken to establish inter-rater reliability for a measure of treatment fidelity and a measure of therapeutic alliance for therapies for anxiety for young people with autism spectrum disorders. The discussion and decision-making processes behind achieving consensus of raters are rarely published. Margolin et al. (1998) have highlighted this issue and called for researchers to communicate the details of their observational and rating procedures. This article is a response to their call for greater transparency so that these methods are readily accessible for comparison with other studies. Methods: Participants were young people with autism spectrum disorders receiving treatment for anxiety, clinical staff treating these young people and the independent raters assessing the treatment sessions. We report: (i) the processes involved in establishing inter-rater reliability for two instruments, (ii) the results obtained with a sample of young people with autism spectrum disorders using these instruments. Results and conclusions: Results demonstrate that it was possible to attain satisfactory inter-rater reliability with each of these two instruments with a client group with autism spectrum disorders, even though the instruments were originally designed for typically-developing populations.
    • Pakistani young people’s views on barriers to accessing mental health services

      Ali, Nasreen; Mclachlan, Niel; Kanwar, Shama; Randhawa, Gurch (Taylor & Francis, 2016-11-08)
      There is extensive literature acknowledging inequalities in health, particularly mental health services for adults, children and young people from Black and minority ethnic communities in the UK. However, there is little existing evidence on UK Pakistani young people’s views of mental health and mental health services. Four focus-group discussions were carried out (n = 33 participants) at local schools, madrasas and a youth group; and data analysed using a framework approach. The findings from this study highlighted a number of barriers to accessing mental health services. Participants had a poor awareness of mental health services and treatment options. Most respondents referred to GPs as their first point of contact for mental health concerns. Knowledge of treatment options for mental illness focused mainly on counselling. There was little awareness of cognitive behavioural therapy (CBT) or family-based CBT as a therapeutic regime. Based on the findings of this study it is clear that young people have a poor awareness of mental health services, specifically child and adolescent mental health services services and treatment options for mental illness. Participants suggested a culturally appropriate mental health awareness intervention for young people. It was proposed that this took the form of community-based ambassadors facilitating knowledge exchange and discussion at community level
    • The role of culture in the general practice consultation process

      Ali, Nasreen; Atkin, Karl; Neal, Richard D. (Taylor & Francis, 2006-11-01)
      In this paper, we will examine the importance of culture and ethnicity in the general practice consultation process. Good communication is associated with positive health outcomes. We will, by presenting qualitative material from an empirical study, examine the way in which communication within the context of a general practitioner (GP) consultation may be affected by ethnicity and cultural factors. The aim of the study was to provide a detailed understanding of the ways in which white and South Asian patients communicate with white GPs and to explore any similarities and differences in communication. This paper reports on South Asian and white patients' explanations of recent videotaped consultations with their GP. We specifically focus on the ways in which issues of ethnic identity impacted upon the GP consultation process, by exploring how our sample of predominantly white GPs interacted with their South Asian patients and the extent to which the GP listened to the patients' needs, gave patients information, engaged in social conversation and showed friendliness. We then go on to examine patients' suggestions on improvements (if any) to the consultation. We conclude, by showing how a non-essentialist understanding of culture helps to comprehend the consultation process when the patients are from Great Britain's ethnicised communities. Our findings, however, raise generic issues of relevance to all multi-racial and multi-ethnic societies.
    • Self-stigma experiences among older adults with mental health problems residing in long term care facilities: a qualitative study

      Tzouvara, Vasiliki; Papadopoulos, Chris; Randhawa, Gurch; King's College London; University of Bedfordshire (Taylor & Francis, 2017-12-29)
      Self-stigma is linked with a variety of deleterious consequences for the stigmatised individual. Much of the past research on self-stigma focuses on younger adults; however, little is known about the self-stigma experience among institutionalised older adults with mental health problems. This study aims to explore experiences of self-stigma among older adults with mental health problems in long-term care facilities. Ten semi-structured interviews were conducted. Insight into mental illness was identified as having a key influence upon the self-stigma experiences among this group. Participants shared common understandings, views, and behavioural reactions towards mental health problems. Lacking control, public stigma, sympathy, disinterest, avoidance, and fear were key themes among them. Re-conceptualising self-stigma theories and implementing interventions that aim at reducing stigmatising attitudes among this group are essential.
    • A systematic review of knowledge, attitudes and beliefs about malaria among the South Asian population

      Regmi, Krishna; Kunwar, Anju; Ortega, Leonard; University of Bedfordshire; World Health Organization (Taylor & Francis, 2016-05-02)
      Background Malaria is one of the deadliest mosquito-borne diseases in the world. More than 80% of the total populations are at risk of malaria in the 22 countries in Asia and the Pacific. South Asia alone is home to an estimated 1.4 billion people at risk of contracting malaria. Despite the remarkable progress in reducing the burden of malaria, evidence of the disease based on knowledge of the social and cultural contexts from a South Asian perspective is limited. Our objective was to understand the knowledge, attitudes and beliefs about malaria in South Asian communities. Methodology We conducted a systematic literature review, searching six databases, between 1990 and 2015, focusing on knowledge, attitudes and beliefs about malaria in South Asia. Databases were searched using both ‘free terms’ and ‘index terms’ funnelled using Boolean operators and truncations. Inclusion and exclusion criteria were set, and included papers were scrutinised, employing a critical appraisal tool to find the best available evidences to support the study purpose. Results and discussion Evidence from 32 articles (26 quantitative, four qualitative and two mixed methods). General knowledge and awareness of the disease, its transmission, and control and preventative measures were generally found to be lacking amongst both the general public and healthcare professionals. In addition, the study shows that poor socio-economic factors – including limited access to services due to poor/limited availability – and issues of affordability are considered as major risk factors. Conclusion This review suggests the importance of increasing health awareness, mobilising the local or community healthcare professionals, for prevention as well as early detection and effective treatment of malaria among people who are at risk. Malaria is also a disease associated with poverty and socio-cultural factors; therefore, strong political will, wider partnerships between health and non-health sectors, and strengthening health systems’ technical and managerial capabilities at all level of primary healthcare systems, is inevitable.
    • What are the biomechanical modifications created by sensorial degradations when stepping up?

      Michel-Pellegrino, Valerie; Hewson, David; Duchêne, Jacques (Taylor & Francis, 2008-07-29)