• Identification of complex health interventions suitable for evaluation: development and validation of the 8-step scoping framework

      Davidson, Rosemary; Randhawa, Gurch; Cash, Stephanie; University of Bedfordshire; Flying Start (JMIR Publications, 2019-03-05)
      Background: There is extensive literature on the methodology of evaluation research and the development and evaluation of complex interventions but little guidance on the formative stages before evaluation and how to work with partner organizations that wish to have their provision evaluated. It is important to be able to identify suitable projects for evaluation from a range of provision and describe the steps required, often with academic institutions working in partnership with external organizations, in order to set up an evaluation. However, research evaluating programs or interventions rarely discusses these stages. Objective: This study aimed to extend work on evaluability assessment and pre-evaluation planning by proposing an 8-Step Scoping Framework to enable the appraisal of multiple programs in order to identify interventions suitable for evaluation. We aimed to add to the literature on evaluability assessment and more recent evaluation guidance by describing the processes involved in working with partner organizations. Methods: This paper documents the steps required to identify multiple complex interventions suitable for process and outcome evaluation. The steps were developed using an iterative approach by working alongside staff in a local government organization, to build an evidence base to demonstrate which interventions improve children’s outcomes. The process of identifying suitable programs for evaluation, thereby establishing the pre-evaluation steps, was tested using all Flying Start provision. Results: The 8-Step Scoping Framework was described using the example of the local government organization Flying Start to illustrate how each step contributes to finding projects suitable for process and outcome evaluation: (1) formulating overarching key questions that encompass all programs offered by an organization, (2) gaining an in-depth understanding of the work and provision of an organization and engaging staff, (3) completing a data template per project/program offered, (4) assessing the robustness/validity of data across all programs, (5) deciding on projects suitable for evaluation and those requiring additional data, (6) negotiating with chosen project leads, both within and outside the organization, (7) developing individual project evaluation protocols, and (8) applying for ethical approval from the university and partner organization. Conclusions: This paper describes the processes involved in identifying suitable projects for evaluation. It adds to the existing literature on the assessment of specific programs suitable for evaluation and guidance for conducting evaluations by establishing the formative steps required to identify suitable programs from a range of provision. This scoping framework particularly relates to academic partners and organizations tasked with delivering evidence-based services designed to meet local needs. The steps identified have been described in the context of early years provision but can be applied to a range of community-based evaluations, or more generally, to cases where an academic partner is working with external stakeholders to identify projects suitable for academic evaluation.
    • Identification of the period of stability in a balance test after stepping up using a simplified cumulative sum

      Safieddine, Doha; Chkeir, Aly; Herlem, Cyrille; Bera, Delphine; Collart, Michèle; Novella, Jean-Luc; Dramé, Moustapha; Hewson, David; Duchêne, Jacques; University of Technology of Troyes; et al. (Elsevier, 2017-09-19)
      Falls are a major cause of death in older people. One method used to predict falls is analysis of Centre of Pressure (CoP) displacement, which provides a measure of balance quality. The Balance Quality Tester (BQT) is a device based on a commercial bathroom scale that calculates instantaneous values of vertical ground reaction force (Fz) as well as the CoP in both anteroposterior (AP) and mediolateral (ML) directions. The entire testing process needs to take no longer than 12 s to ensure subject compliance, making it vital that calculations related to balance are only calculated for the period when the subject is static. In the present study, a method is presented to detect the stabilization period after a subject has stepped onto the BQT. Four different phases of the test are identified (stepping-on, stabilization, balancing, stepping-off), ensuring that subjects are static when parameters from the balancing phase are calculated. The method, based on a simplified cumulative sum (CUSUM) algorithm, could detect the change between unstable and stable stance. The time taken to stabilize significantly affected the static balance variables of surface area and trajectory velocity, and was also related to Timed-up-and-Go performance. Such a finding suggests that the time to stabilize could be a worthwhile parameter to explore as a potential indicator of balance problems and fall risk in older people.
    • Identifying patterns in signs and symptoms preceding the clinical diagnosis of Alzheimer's disease : retrospective medical record review study and a nested case -control design

      Bature, Fidelia; Pang, Dong; Robinson, Anthea; Polson, Norma; Pappas, Yannis; Guinn, Barbara-Ann (Bentham, 2018-04-04)
      OBJECTIVE: Evidence suggests that individuals with Alzheimer's disease (AD) are often diagnosed in the later stages of their disease with a poor prognosis. This study aimed to identify patterns in signs and symptoms preceding the clinical diagnosis of AD to suggest a predictive model for earlier diagnosis of the disease in the primary care. DESIGN: A retrospective medical record review; nested case control design. PARTICIPANTS: Participants included one hundred and nine patients from three general practice (GP) surgeries in Milton Keynes and Luton Clinical Commissioning groups (CCG) (37 cases with AD and 72 controls without AD). MAIN OUTCOME MEASURE: A retrospective analysis using the logistic regression of the presence of signs and symptoms before the diagnosis of AD was attained. Identification of the timing and sequence of appearance of these presentations as first reported before the clinical diagnosis was measured. RESULT: Episodic memory with an odds ratio of 1.85 was the most frequent presentation, documented in 1.38% of the controls and 75.6% in cases. Auditory disturbance with an odds ratio of 3.03, which has not previously been noted except in the form of auditory hallucination, could have a diagnostic value. CONCLUSION: Auditory disturbance, which occurred mostly in the Caucasian females, could discriminate individuals with AD from those without. The symptom, which presented up to 14.5 (mean time) years prior to clinical diagnosis, was identified in Caucasians and mixed race individuals only.
    • IFITM proteins drive type 2 T helper cell differentiation and exacerbate allergic airway inflammation

      Yánez, Diana C.; Sahni, Hemant; Ross, Susan; Solanki, Anisha; Lau, Ching-In; Papaioannou, Eleftheria; Barbarulo, Alessandro; Powell, Rebecca; Lange, Ulrike C.; Adams, David J.; et al. (Wiley, 2018-10-26)
      T cells differentiated more efficiently to Th1, whereas Th2 differentiation was inhibited. Ifitm-family-deficient mice, but not Ifitm3-deficient mice, were less susceptible than WT to induction of allergic airways disease, with a weaker Th2 response and less severe disease and lower Il4 but higher Ifng expression and IL-27 secretion. Thus, the Ifitm family is important in adaptive immunity, influencing Th1/Th2 polarization, and Th2 immunopathology.
    • Impact of clinical placements on graduates' choice of first staff-nurse post

      Wareing, Mark; Taylor, Renate; Wilson, Aileen; Sharples, Adrienne; University of Bedfordshire (Mark Allen, 2018-09-01)
      The demand for quality clinical placements for pre-registration healthcare students is set to rise as student numbers within medical and non-medical education are to increase at a time when there is a recruitment crisis within nursing. A study was conducted to identify what impact clinical placements have on pre-registration adult nursing students’ choice of clinical speciality as a newly qualified nurse (NQN). Data was collected from students on their final day of a BSc (Hons) programme at two campus sites at an east of England University. Participants regard the desirability of a clinical placement on the basis of the quality of the learning, working and clinical environment and nature of the speciality. The influence of clinical placements on the choice of first destination of NQNs more than doubles within the final year of study. Clinical placements generate vivid experiences which exert a strong influence on the first employment destination decisions of NQNs.
    • The impact of COVID-19 on health behaviour, well-being, and long-term physical health.

      McBride, Emily; Arden, Madelynne A.; Chater, Angel M.; Chilcot, Joseph; ; University College London; Sheffield Hallam University; University of Bedfordshire; King's College London (Wiley, 2021-03-31)
      Editorial
    • Impact of Covid-19 on the experiences of parents and family carers of autistic children and young people in the UK

      Pavlopoulou, Georgia; Wood, Rebecca; Papadopoulos, Chris; UCL Institute of Education; University of East London; University of Bedfordshire (UCL Institute of Education, 2020-07-01)
      A new study led by the Institute of Education at University College London, in collaboration with the University of East London and the University of Bedfordshire, has shed light on the experiences of the parents and carers of autistic children and young people during lockdown in the UK. The findings reveal that many families feel let down by the government and that they have had to face the lockdown tackling new struggles, often with significantly reduced support. However, parents and carers also experienced a number of positives, providing important lessons for support and health services and education providers in the future.
    • The impact of location of the uptake of telephone based healthcare

      Cook, Erica Jane; Randhawa, Gurch; Guppy, Andrew; Chater, Angel M.; Pang, Dong; Large, Shirley; University of Bedfordshire; Public Health England (2016-06-01)
      Telephone healthcare systems have been put forward as a key strategy to overcome geographical disadvantage, however, evidence has suggested that usage decreases with increasing rurality. This research aimed to identify geographical high and low areas of usage of NHS Direct, a leading telephone healthcare provider worldwide to determine if usage is influenced by rurality. National call data was collected (January, 2011) from the NHS Direct Clinical Assessment System for all 0845 4647 calls in England, UK (N=360,137). Data extracted for analysis included; unit postcode of patient, type of call, date of call, time of call and final disposition. Calls were mapped using GIS mapping software using full postcode, aggregated by population estimate by local authority to determine confidence intervals across two thresholds by call rate. Uptake rate Output Area Classification (OAC) group profiles was performed using the chi-square goodness of fit. The majority of calls were ‘symptomatic’ (N=280,055; 74.8%) i.e. calls that were triaged by an expert nurse, with the remaining 25.2% of calls health/ medicine information only (N=94,430). NHS Direct were able to manage through self-care advice and health information 43.5 of all calls made (N=99,367) with no onward referral needed. Geographical pattern of calls were highest for more urbanised areas with significant higher call usage found in larger cities. Lower observed usage was found in areas that are more rural of which were characterised by above average older populations. This was supported by geo-segmentation, which highlighted that rural and older communities had the lowest expected uptake rate. There is a variation of usage of NHS Direct relating to rurality, which suggests that this type of service has not been successful in reducing accessible barriers. However, geographical variations are likely to be influenced by age. There is a need for exploratory to determine the underlying factors that contribute to variation in uptake of these services particularly older people who reside in rural communities. This will have worldwide implications as to how telephone based healthcare is introduced.
    • Impact of non-pharmaceutical interventions for reducing transmission of COVID-19: a systematic review and meta-analysis protocol

      Regmi, Krishna; Lwin, Cho Mar; ; University of Bedfordshire; University of Medicine Mandalay (BMJ Open, 2020-10-22)
      Introduction Implementing non-pharmaceutical interventions (NPIs) protect the public from COVID-19. However, the impact of NPIs has been inconsistent and remains unclear. This study, therefore, aims to measure the impact of major NPIs (social distancing, social isolation and quarantine) on reducing COVID-19 transmission. Methods and analysis We will conduct a systematic review and meta-analysis research of both randomised and non-randomised controlled trials. We will undertake a systematic search of: MEDLINE, Embase, Allied & Complementary Medicine, COVID-19 Research, WHO database on COVID-19, ClinicalTrails.Gov for clinical trials on COVID-19, Cochrane Resources on Coronavirus (COVID-19), Oxford COVID-19 Evidence Service and Google Scholar for published and unpublished literatures on COVID-19 including preprint engines such as medRxiv, bioRxiv, Litcovid and SSRN for unpublished studies on COVID-19 and will be reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Outcomes of interest for impact analysis will include the reduction of COVID-19 transmission, avoiding crowds and restricting movement, isolating ill and psychological impacts. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist has been used for this protocol. For quality of included studies, we will use the Cochrane Collaboration’s tool for assessing risk of bias for randomised controlled trials and the Newcastle-Ottawa Scale for observational studies. The Grading of Recommendations Assessment, Development and Evaluation approach will grade the certainty of the evidence for all outcome measures across studies. Random-effects model for meta-analysis will measure the effect size of NPIs or the strengths of relationships. For quantitative data, risk ratio or OR, absolute risk difference (for dichotomous outcome data), or mean difference or standardised mean difference (for continuous data) and their 95% CIs will be calculated. Where statistical pooling is not possible, a narrative synthesis will be conducted for the included studies. To assess the heterogeneity of effects, I2 together with the observed effects will be evaluated to provide the true effects in the analysis. Ethics and dissemination Formal ethical approval from an institutional review board or research ethics committee is not required as primary data will not be collected. The final results of this study will be published in an open-access peer-reviewed journal, and abstract will be presented at suitable national/international conferences or workshops. We will also share important information with public health authorities as well as with the WHO. In addition, we may post the submitted manuscript under review to medRxiv, or other relevant preprint servers.
    • Impact of nutrition interventions for reduction of maternal anemia in low and middle income countries - an evidence summary

      Panchal, Pooja; Menon, Kavitha; Ravalia, Anal; Rana, Ritu; Puthussery, Shuby; Gauri, Vaze (Karger, 2019-12-31)
    • Impact of social distancing measures for preventing coronavirus disease 2019 [COVID-19]: a systematic review and meta-analysis protocol

      Regmi, Krishna; Lwin, Cho Mar (medRxiv, 2020-06-16)
      This article is a preprint and has not been peer-reviewed. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice. Introduction: Social distancing measures (SDMs) protect public health from the outbreak of coronavirus disease 2019 (COVID-19). However, the impact of SDMs has been inconsistent and unclear. This study aims to assess the effects of SDMs (e.g. isolation, quarantine) for reducing the transmission of COVID-19. Methods and analysis: We will conduct a systematic review meta-analysis research of both randomised controlled trials and non-randomised controlled trials. We will search MEDLINE, EMBASE, Allied & Complementary Medicine, COVID-19 Research and WHO database on COVID-19 for primary studies assessing the enablers and barriers associated with SDMs, and will be reported in accordance with PRISMA statement. The PRISMA-P checklist will be used while preparing this protocol. We will use Joanna Briggs Institute guidelines (JBI Critical Appraisal Checklists) to assess the methodological qualities and synthesised performing thematic analysis. Two reviewers will independently screen the papers and extracted data. If sufficient data are available, the random-effects model for meta-analysis will be performed to measure the effect size of SDMs or the strengths of relationships. To assess the heterogeneity of effects, I2 together with the observed effects (Q-value, with degrees of freedom) will be used to provide the true effects in the analysis. Ethics and dissemination: Ethics approval and consent will not be required for this systematic review of the literature as it does not involve human participation. We will be able to disseminate the study findings using the following strategies: we will be publishing at least one paper in peer-reviewed journals, and an abstract will be presented at suitable national/international conferences or workshops. We will also share important information with public health authorities as well as with the World Health Organization.
    • 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 telehealth remote patient monitoring on glycemic control in type 2 diabetes: a systematic review and meta-analysis of systematic reviews of randomised controlled trials

      Lee, Puikwan; Greenfield, Geva; Pappas, Yannis; Imperial College London; University of Bedfordshire (BioMed Central Ltd., 2018-06-26)
      Background There is a growing body of evidence to support the use of telehealth in monitoring HbA1c levels in people living with type 2 diabetes. However, the overall magnitude of effect is yet unclear due to variable results reported in existing systematic reviews. The objective of this study is to conduct a systematic review and meta-analysis of systematic reviews of randomised controlled trials to create an evidence-base for the effectiveness of telehealth interventions on glycemic control in adults with type 2 diabetes. Methods Electronic databases including The Cochrane Library, MEDLINE, EMBASE, HMIC, and PsychINFO were searched to identify relevant systematic reviews published between 1990 and April 2016, supplemented by references search from the relevant reviews. Two independent reviewers selected and reviewed the eligible studies. Of the 3279 references retrieved, 4 systematic reviews reporting in total 29 unique studies relevant to our review were included. Both conventional pairwise meta-analyses and network meta-analyses were performed. Results Evidence from pooling four systematic reviews found that telehealth interventions produced a small but significant improvement in HbA1c levels compared with usual care (MD: -0.55, 95% CI: -0.73 to − 0.36). The greatest effect was seen in telephone-delivered interventions, followed by Internet blood glucose monitoring system interventions and lastly interventions involving automatic transmission of SMBG using a mobile phone or a telehealth unit. Conclusion Current evidence suggests that telehealth is effective in controlling HbA1c levels in people living with type 2 diabetes. However there is need for better quality primary studies as well as systematic reviews of RCTs in order to confidently conclude on the impact of telehealth on glycemic control in type 2 diabetes.
    • The impact of the Luton social prescribing programme on energy expenditure: a quantitative before-and-after study

      Pescheny, Julia Vera; Gunn, Laura H.; Randhawa, Gurch; Pappas, Yannis; University of Bedfordshire; University of North Carolina (UNC); Imperial College London (BMJ, 2019-06-16)
      The objective of this study was to assess the change in energy expenditure levels of service users after participation in the Luton social prescribing programme. Uncontrolled before-and-after study. This study was set in the East of England (Luton). Service users with complete covariate information and baseline measurements (n=146) were included in the analysis. Social prescribing, which is an initiative that aims to link patients in primary care with sources of support within the community sector to improve their health, well-being and care experience. Service users were referred to 12 sessions (free of charge), usually provided by third sector organisations. Energy expenditure measured as metabolic equivalent (MET) minutes per week. Using a Bayesian zero-inflated negative binomial model to account for a large number of observed zeros in the data, 95% posterior intervals show that energy expenditure from all levels of physical activities increased post intervention (walking 41.7% (40.31%, 43.11%); moderate 5.0% (2.94%, 7.09%); vigorous 107.3% (98.19%, 116.20%) and total 56.3% (54.77%, 57.69%)). The probability of engaging in physical activity post intervention increased, in three of four MET physical activity levels, for those individuals who were inactive at the start of the programme. Age has a negative effect on energy expenditure from any physical activity level. Similarly, working status has a negative effect on energy expenditure in all but one MET physical activity level. No consistent pattern was observed across physical activity levels in the association between gender and energy expenditure. This study shows that social prescribing may have the potential to increase the physical activity levels of service users and promote the uptake of physical activity in inactive patient groups. Results of this study can inform future research in the field, which could be of use for commissioners and policy makers.
    • 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.
    • Implementing service improvement projects within pre-registration nursing education: a multi-method case study evaluation

      Baillie, Lesley; Bromley, Barbara; Walker, Moira; Jones, Rebecca Louise; Mhlanga, Fortune; ; London South Bank University; University College London Hospitals; University of Bedfordshire; University of Surrey (Elsevier, 2013-07-15)
      Background: Preparing healthcare students for quality and service improvement is important internationally. A United Kingdom (UK) initiative aims to embed service improvement in pre-registration education. A UK university implemented service improvement teaching for all nursing students. In addition, the degree pathway students conducted service improvement projects as the basis for their dissertations. Aim: The study aimed to evaluate the implementation of service improvement projects within a pre-registration nursing curriculum. Method: A multi-method case study was conducted, using student questionnaires, focus groups with students and academic staff, and observation of action learning sets. Questionnaire data were analysed using SPSS v19. Qualitative data were analysed using Ritchie and Spencer's (1994) Framework Approach. Results: Students were very positive about service improvement. The degree students, who conducted service improvement projects in practice, felt more knowledgeable than advanced diploma students. Selecting the project focus was a key issue and students encountered some challenges in practice. Support for student service improvement projects came from action learning sets, placement staff, and academic staff. Conclusion: Service improvement projects had a positive effect on students' learning. An effective partnership between the university and partner healthcare organisations, and support for students in practice, is essential.
    • The importance of mealtime structure for reducing child food fussiness

      Powell, Faye; Farrow, Claire; Meyer, Caroline; Haycraft, Emma (Wiley, 2016-04-08)
      The aim of this study was to explore how the structure of mealtimes within the family setting is related to children's fussy eating behaviours. Seventy-five mothers of children aged between 2 and 4 years were observed during a typical mealtime at home. The mealtimes were coded to rate mealtime structure and environment as well as the child's eating behaviours (food refusal, difficulty to feed, eating speed, positive and negative vocalisations). Mealtime structure emerged as an important factor which significantly distinguished children with higher compared with lower levels of food fussiness. Children whose mothers ate with their child and ate the same food as their child were observed to refuse fewer foods and were easier to feed compared with children whose mothers did not. During mealtimes where no distractors were used (e.g. no TV, magazines or toys), or where children were allowed some input into food choice and portioning, children were also observed to demonstrate fewer fussy eating behaviours. Findings of this study suggest that it may be important for parents to strike a balance between structured mealtimes, where the family eats together and distractions are minimal, alongside allowing children some autonomy in terms of food choice and intake.
    • Improving access to organ donor registration in general practice: a feasibility study

      Penn-Jones, Catrin Pedder; Papadopoulos, Chris; Randhawa, Gurch; Asghar, Zeeshan; (Royal College of General Practitioners, 2020-06-25)
      Background Organ donor registration helps guide decision making for families. UK general practice provides the facility to register on the NHS Organ Donor Register, but only to new patients. An intervention was developed to present a registration opportunity to existing patients in this setting. Aim To assess the feasibility and acceptability of an organ donation intervention implemented in UK general practice. Design and setting The intervention ran in a large practice in Luton in the UK, for 3 months in 2018. A single practice feasibility study was conducted using an embedded experimental mixed methods design. Method Staff were trained to ask patients in consultations if they wished to join the register, and leaflets and posters were displayed in the waiting room. Data on feasibility and acceptability were captured using SystmONE questionnaires, surveys, and focus groups. Results Over 3 months, in 12.4% of face-to-face consultations, patients were asked if they would like to join the register (812 of 6569), and 244 (30.0%) of these patients joined the register. Common reasons staff did not ask patients were due to telephone consultations, lack of time, and it not being appropriate. Nurses and healthcare assistants performed prompted choice more than doctors (23.4%, 17.1%, and 1.6% respectively). Certain clinic types, such as phlebotomy or routine clinics, facilitated asking compared to those where patients presented with unknown or more serious issues. Conclusion The intervention was found to be feasible and acceptable by some staff and patients. Feasibility criteria were met; therefore, the intervention can progress to further testing.
    • Improving speech, language and communication in pre-school children: implementation and effectiveness of the Sign 4 Programme, Luton, UK

      Davidson, Rosemary; University of Bedfordshire (BMC, 2018-02-21)
      The Sign 4 Programme uses sign language to support understanding and language development in hearing pre-school children. Nursery staff and parents read to children using Sign 4 story books and dolls to reinforce key words with sign language to facilitate story telling. Repeated use may help to improve children's comprehension, use of linking words, help with pronunciation and use of more complex words, as well as helping children to identify different emotions which allows them to 'name and tame' more challenging behaviours (such as 'frustrated' and 'angry'). The aim of this study is to find out whether the Sign 4 Programme improves language, speech and communication in pre-school children.
    • Improving support for breastfeeding mothers: a qualitative study on the experiences of breastfeeding among mothers who reside in a deprived and culturally diverse community

      Cook, Erica Jane; Powell, Faye; Ali, Nasreen; Penn-Jones, Catrin Pedder; Ochieng, Bertha; Randhawa, Gurch; ; University of Bedfordshire; De Montfort University (BMC, 2021-04-06)
      The United Kingdom has one of the lowest breastfeeding rates in Europe, with the initiation and continuation of breastfeeding shown to be closely related to the mothers' age, ethnicity and social class. Whilst the barriers that influence a woman's decision to breastfeed are well documented, less is known how these barriers vary by the UK's diverse population. As such, this study aimed to explore mothers' experiences of breastfeeding and accessing breastfeeding services offered locally amongst a deprived and culturally diverse community. A qualitative interpretive study comprising of 63 mothers (white British n = 8, Pakistani n = 13, Bangladeshi n = 10, black African n = 15 and Polish n = 17) who took part in single-sex focus groups, conducted in local community centres across the most deprived and ethnically diverse wards in Luton, UK. The focus groups were audio-recorded, transcribed and analysed thematically using Framework Analysis. The most common barriers to breastfeeding irrespective of ethnicity were perceptions surrounding pain and lack of milk. Confidence and motivation were found to be crucial facilitators of breastfeeding; whereby mothers felt that interventions should seek to reassure and support mothers not only during the early stages but throughout the breastfeeding journey. Mothers particularly valued the practical support provided by health care professions particularly surrounding positioning and attachment techniques. However, many mothers felt that the support from health care professionals was not always followed through. The findings presented inform important recommendations for the design and implementation of future programs and interventions targeted at reducing breastfeeding inequalities. Interventions should focus on providing mothers practical support and reassurance not only during the early stages but throughout their breastfeeding journey. The findings also highlight the need for tailoring services to support diverse communities which acknowledge different traditional and familial practices.