• A qualitative exploration of staff views towards the uptake of NHS Direct

      Cook, Erica Jane; Randhawa, Gurch; Large, Shirley; Guppy, Andrew; Chater, Angel M.; Ali, Nasreen (Elsevier, 2014-02-24)
      Objectives To explore the views of staff to examine the underlying factors that may contribute to the variation of uptake to NHS Direct. Methods Adopting a qualitative approach two focus groups were carried out with staff (n=13); which included registered nurse advisors and health advisors at two NHS Direct sites: Bristol and Manchester in England. Findings were analysed using framework analysis [1] . Results Staff views for explaining reasons why people do and do not engage with NHS Direct focused on themes centred on ‘knowledge of NHS Direct’, ‘attitudes towards NHS Direct’, ‘the cost of using NHS Direct’, ‘time/speed of using NHS Direct’ and finally ‘satisfaction with the service’. Conclusion This research has explored staff views of the barriers and facilitators that may impact on the uptake NHS Direct, which can help enable the development of future promotional campaigns that can target particular sections of the population to encourage use of telephone based healthcare services.
    • Qualitative investigation of the flipped classroom teaching approach as an alternative to the traditional lecture

      Abdulaziz Almanasef, M.; Chater, Angel M.; Portlock, Jane (International Pharmaceutical Federation (FIP), 2020-04-25)
    • A qualitative study exploring the experiences of bereavement after stillbirth in Pakistani, Bangladeshi and White British mothers living in Luton, UK

      Garcia, Rebecca; Ali, Nasreen; Griffiths, Malcolm; Randhawa, Gurch; Open University; University of Bedfodshire; Luton & Dunstable University Hospital NHS Foundation Trust (Elsevier, 2020-08-29)
      This study aims to explore the experiences of bereavement after stillbirth of Pakistani, Bangladeshi and White British mothers in a town with multi-ethnic populations in England. A purposive sample of Pakistani, Bangladeshi and White British mothers aged over 16 (at time of infant birth), who suffered a stillbirth in the preceding 6-24 months and residing in a specified postcode area were invited to take part in the study, by an identified gatekeeper (audit midwife) from the local National Health Service Trust, in addition to local bereavement charities. Qualitative methods using face-to-face semi-structured interviews were undertaken, recorded and transcribed verbatim. Using framework analysis, several themes were identified. There were three main themes identified from the data; 1. knowledge and information of pregnancy and perinatal mortality; 2. attitudes and perceptions to pregnancy and perinatal mortality and 3. experiences with maternity care. The findings revealed mostly similarities in the bereavement experiences of the Pakistani, Bangladeshi and White British mothers. A few cultural and religious differences were identified. This study found important similarities in bereavement experiences of Pakistani, Bangladeshi and White British mothers and highlights considerations for policy makers and maternity services in how the timing of bereavement after care is provided, including advice surrounding the infant post-mortem.
    • A qualitative study of healthcare professionals’ experiences of providing maternity services for Muslim women in the UK

      Hassan, Shaima Mohamed; Leavey, Conan; Rooney, Jane S.; Puthussery, Shuby (Biomed Central, 2020-07-10)
      Background: A growing Muslim population in the UK suggests the need for healthcare professionals (HCPs) to gain a better understanding of how the Islamic faith influences health related perceptions and healthcare seeking behaviour. Although some researchers have explored the experiences of Muslim women as recipients of healthcare, little attention has been paid to the challenges HCPs face as service providers on a day-to-day basis whilst caring for Muslim women. The aim of this study was to investigate HPCs lived experiences of providing maternity care for Muslim women. Method: Data was collected through twelve semi-structured one-to-one qualitative interviews with HCPs in a large National Health Service (NHS) maternity unit located in the North West of England. Interview participants included Community and specialist clinic (e.g. clinic for non-English speakers), Midwives in a variety of specialist roles (7), Gynaecology Nurses (2), Breastfeeding Support Workers (2) and a Sonographer (1). The audio-recorded interviews were transcribed and analysed thematically. Results: The majority of participants expressed an understanding of some religious values and practices related to Muslim women, such as fasting the month of Ramadhan and that pregnant and breastfeeding women are exempt from this. However, HCPs articulated the challenges they faced when dealing with certain religious values and practices, and how they tried to respond to Muslim women’s specific needs. Emerging themes included: 1) HCPs perceptions about Muslim women; 2) HCPs understanding and awareness of religious practices; 3) HCPs approaches in addressing and supporting Muslim women’s religious needs; 4) Importance of training in providing culturally and religiously appropriate woman-centred care. Conclusion: Through this study we gained insight into the day-to-day experiences of HCPs providing care provision for Muslim women. HCPs showed an understanding of the importance of religious and cultural practices in addressing the needs of Muslim women as part of their role as maternity care providers. However, they also identified a need to develop training programmes that focus on cultural and religious practices and their impact on women’s health care needs. This will help support HCPs in overcoming the challenges faced when dealing with needs of women from different backgrounds.
    • Quality improvements in diabetes care, how holistic have they been? a case-study from the United Kingdom

      Wilkinson, Emma; Randhawa, Gurch; Singh, Maninder; University of Bedfordshire (BioMed Central Ltd., 2014-04-01)
      Aims: As quality in diabetes care includes patient centred support for self-management, investigating patients’ experiences upon diagnosis can help improve access to this element of care among diverse populations. This research explored this care in the context of recent national quality improvement initiatives which support self-management. Methods: South Asian and White European patients over 16 years with a recent (< 1 year) diagnosis of diabetes were recruited from 18 General Practitioner (GP) practices in three UK locations - Luton, West London and Leicester. A semi-structured qualitative interview was conducted with 47 patients. Results: Twenty one out of 47 (45%) reported unmet support and information needs at diagnosis. Although there was a small proportion of participants (8 out of 47, 17% of all respondents) who felt they did not require any help or support with managing their diabetes because their GP had provided comprehensive and efficient care, there was an equal number who voiced a negative view of the care they had received to date. This concerned information giving, support and communication, suggesting that recently implemented national quality improvement interventions may not have been successful in improving all aspects of diabetes care, particularly those encouraging self-management. The emerging analysis led to consideration of concordance as an important concept through which to understand inequalities and improve access to quality diabetes care. In order to encourage self-management from the start, care providers need to be cognisant that patients are not homogeneous and be responsive to their different information needs and emotional responses to diagnosis. Conclusions: In order to support self-management and deliver patient centred care in diverse populations, care providers will need to be adaptable to individual needs around diagnosis.
    • Racial and ethnic differences in falls among older adults: a systematic review and meta‑analysis

      Wehner‑Hewson, Natasha; Watts, Paul; Buscombe, Richard; Bourne, Nicholas; Hewson, David; (Springer Nature, 2021-11-16)
      The aim of this systematic review and meta-analysis was to determine whether differences in reported fall rates exist between different ethnic groups. Searches were carried out on four databases: Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Web of Science. Only English language studies with community-dwelling participants aged 60 + years were included. Studies also needed to compare fall prevalence for at least two or more ethnic groups. Two reviewers independently screened all articles and evaluated study quality. Twenty-three articles were included for systematic review, and meta-analyses were carried out on the 16 retrospective studies that reported falls in the previous 12 months. The Asian group demonstrated significantly lower fall prevalence than all other ethnic groups at 13.89% (10.87, 16.91). The Hispanic group had a fall prevalence of 18.54% (12.95, 24.13), closely followed by the Black group at 18.60% (13.27, 23.93). The White group had the highest prevalence at 23.77% (18.66, 28.88). Some studies provided adjusted estimates of effect statistics for the odds/risk of falls, which showed that differences still existed between some ethnic groups even after adjusting for other risk factors. Overall, differences in fall prevalence do appear to exist between different ethnic groups, although the reasons for these differences currently remain undetermined and require further investigation. These findings highlight the need to provide more ethnically tailored responses to public health challenges, which could potentially increase the adherence to prevention interventions, and allow for a more targeted use of resources.
    • A randomised controlled trial of a computerised intervention for children with social communication difficulties to support peer collaboration

      Murphy, Suzanne; Faulkner, Dorothy; Reynolds, Laura; University of Bedfordshire; Open University; Child and Adolescent Mental Health Services, Bedfordshire (Elsevier, 2014-08-05)
      An intervention aiming to support children with social communication difficulties was tested using a randomised controlled design.Children aged 5–6 years old (n = 32) were tested and selected for participation on the basis of their scores on the Test of Pragmatic Skills (TPS) and were then randomly assigned to the intervention arm or to the delayed intervention control group. Following previous research which suggested that computer technology may be particularly useful for this group of children, the intervention included a collaborative computer game which the children played with an adult.Subsequently, children’s performance as they played the game with a classmate was observed. Micro-analytic observational methods were used to analyse the audio-recorded interaction of the children as they played. Pre- and post intervention measures comprised the Test of Pragmatic Skills, children’s performance on the computer game and verbal communication measures that the children used during the game. This evaluation of the intervention shows promise. At post-test,the children who had received the intervention, by comparison to the control group who had not,showed significant gains in their scores on the Test of Pragmatic Skills (p = .009,effect size r = .42), a significant improvement in their performance on the computer game (p = .03, r = .32) and significantly greater use of high-quality questioning during collaboration (p < .001, r = .60).Furthermore,the children who received the intervention made significantly more positive statements about the game and about their partners (p = .02, r = .34) suggesting that the intervention increased their confidence and enjoyment.
    • A randomised controlled trial of energetic activity for depression in young people (READY): a multi-site feasibility trial protocol

      Howlett, Neil; Bottoms, Lindsay; Chater, Angel M.; Clark, A.B.; Clarke, T.; David, L.; Irvine, K.; Jones, A.; Jones, J.; Mengoni, S.E.; et al. (BioMed Central Ltd, 2021-01-04)
      Background: Prevalence of depression is increasing in young people, and there is a need to develop and evaluate behavioural interventions which may provide benefits equal to or greater than talking therapies or pharmacological alternatives. Exercise could be beneficial for young people living with depression, but robust, large-scale trials of effectiveness and the impact of exercise intensity are lacking. This study aims to test whether a randomised controlled trial (RCT) of an intervention targeting young people living with depression is feasible by determining whether it is possible to recruit and retain young people, develop and deliver the intervention as planned, and evaluate training and delivery. Methods: The design is a three-arm cluster randomised controlled feasibility trial with embedded process evaluation. Participants will be help-seeking young people, aged 13–17 years experiencing mild to moderate low mood or depression, referred from three counties in England. The intervention will be delivered by registered exercise professionals, supported by mental health support workers, twice a week for 12 weeks. The three arms will be high-intensity exercise, low-intensity exercise, and a social activity control. All arms will receive a ‘healthy living’ behaviour change session prior to each exercise session and the two exercise groups are energy matched. The outcomes are referral, recruitment, and retention rates; attendance at exercise sessions; adherence to and ability to reach intensity during exercise sessions; proportions of missing data; adverse events, all measured at baseline, 3, and 6 months; resource use; and reach and representativeness. Discussion: UK National Health Service (NHS) policy is to provide young people with advice about using exercise to help depression but there is no evidence-based exercise intervention to either complement or as an alternative to medication or talking therapies. UK National Institute for Health and Care Excellence (NICE) guidelines suggest that exercise can be an effective treatment, but the evidence base is relatively weak. This feasibility trial will provide evidence about whether it is feasible to recruit and retain young people to a full RCT to assess the effectiveness and cost-effectiveness of an exercise intervention for depression. Trial registration: ISRCTN, ISRCTN66452702. Registered 9 April 2020.
    • A randomised-controlled feasibility study of the REgulate your SItting Time (RESIT) intervention for reducing sitting time in individuals with type 2 diabetes: study protocol

      Bailey, Daniel Paul; Edwardson, Charlotte L.; Pappas, Yannis; Dong, Feng; Hewson, David; Biddle, Stuart J. H.; Brierley, Marsha L.; Chater, Angel M. (BMC, 2021-03-19)
      People with type 2 diabetes mellitus (T2DM) generally spend a large amount of time sitting. This increases their risk of cardiovascular disease, premature mortality, diabetes-related complications and mental health problems. There is a paucity of research that has evaluated interventions aimed at reducing and breaking up sitting in people with T2DM. The primary aim of this study is to assess the feasibility of delivering and evaluating a tailored intervention to reduce and break up sitting in ambulatory adults with T2DM.
    • Reaching out – a consultant palliative medicine clinic within a Luton mosque

      Herodotu, Nicholas; Ali, Nasreen (Hayward, 2012-05-01)
      The provision of cancer and palliative care services is an increasingly important part of delivering services to ethnic minority groups, as rates of cancer morbidity and mortality begin to parallel those of the majority population.
    • Reconstructed phase spaces of intrinsic mode functions : application to postural stability analysis

      Snoussi, Hichem; Amoud, Hassan; Doussot, Michel; Hewson, David; Duchêne, Jacques (IEEE, 2006-12-31)
      In this contribution, we propose an efficient nonlinear analysis method characterizing postural steadiness. The analyzed signal is the displacement of the centre of pressure (COP) collected from a force plate used for measuring postural sway. The proposed method consists of analyzing the nonlinear dynamics of the intrinsic mode functions (IMF) of the COP signal. The nonlinear properties are assessed through the reconstructed phase spaces of the different IMFs. This study shows some specific geometries of the attractors of some intrinsic modes. Moreover, the volume spanned by the geometric attractors in the reconstructed phase space represents an efficient indicator of the postural stability of the subject. Experiments results corroborate the effectiveness of the method to blindly discriminate young subjects, elderly subjects and subjects presenting a risk of falling.
    • Recurrence quantification analysis of sustained sub-maximal grip contractions in patients with various metabolic muscle disorders

      Li, Ke; Hewson, David; Snoussi, Hichem; Duchêne, Jacques; Hogrel, Jean-Yves; Université de Technologie de Troyes; Shandong University; Université Paris (Elsevier, 2010-11-01)
      Recurrence quantification analysis (RQA) was used to analyse force signals during sustained sub-maximal grip contraction (SSGC) of three types of patients suffering from a metabolic muscle disorder (glycogen storage disease type III (GSD III), glycogen storage disease type V (GSD V) and mitochondrial myopathies (MITO)) compared to control subjects. Recurrence plots (RP) of patients showed clear non-uniformity, in comparison to control subjects who displayed quasi-periodic patterns. Quantitative analysis of the RP showed significant differences between patients with metabolic disorders and the control group for four RQA parameters. The results showed that the SSGC signals of patients had decreased Lmax, which indicated more chaotic patterns. In addition the deterministic component of the signals was less complex for patients than for controls. The differences of SSGC signal observed using RP and RQA were possibly related to the underlying changes in metabolism of muscle fibres due to the disease. Results of this study illustrate that the RQA technique is well suited to analyse sustained grip-force signals.
    • Reducing obesity in pre-school children: Implementation and Effectiveness of the HENRY Programme, Luton, UK

      Davidson, Rosemary (BMC, 2018-03-05)
      The HENRY Programme trains Early Years Practitioners (suitable for Health Visitors, Midwives, Children’s Centre workers, Nutritionists, Dieticians and Childminders) usually based in Children’s Centres to facilitate groups with families and carers of 0 to 5 year olds. The eight week programme (2.5 hours per week) builds upon mutual support and praise, with families and facilitators working together to focus on factors known to be associated with later obesity. The approach is based on behaviour change and self management techniques. The study design is a process and outcome evaluation using a mixed method approach. The process evaluation aims to understand how and why the intervention was adopted, drivers and barriers to implementation and the role of context. With respect to HENRY this will involve semi-structured interviews with families, staff and stakeholders at agreed time points throughout the delivery of the HENRY Programme, and observations of staff training and HENRY sessions and settings. ISRCTN62454430
    • Reduction and prevention of aggression and behavioural problems in disadvantaged pre-school children: implementation and effectiveness of the Incredible Years Programme, Luton, UK

      Davidson, Rosemary; University of Bedfordshire (BMC, 2018-03-05)
      The Incredible Years pre-school course is designed for families living in disadvantaged areas with children aged 3-5 years who are showing early onset behaviour problems. The programme consists of 14 weekly sessions of 2.5 hours duration with childcare provided. Incredible Years facilitators work with parents to improve emotional and social functioning and address, reduce and prevent aggression and behavioural problems. The course uses video clips depicting everyday scenarios to encourage group discussion, problem solving and sharing of ideas and experiences. Parents receive manuals and group materials throughout the course in addition to home assignments. Programme fidelity is maintained with a standardized training process involving peer review, videotape feedback and consultation. The study design is a process and outcome evaluation using a mixed method approach. The process evaluation aims to understand how and why the intervention was adopted, drivers and barriers to implementation and the role of context. With respect to Incredible Years, this will involve semi-structured interviews with families, staff and stakeholders throughout the delivery of Incredible Years. ISRCTN14311503
    • Reflection or critical thinking? : a pedagogical revolution in North American health care education

      Beckwith, Mary A.R.; Beckwith, Philip; University of Bedfordshire (Chinese American Scholars Association, 2008-01-01)
      George Bernard Shaw's observation that the United States of America and Great Britain are "two nations divided by a common language" is as pertinent today as when it was made in1887. This juxtaposition has many other manifestations one of which is the delivery of health care education. It has been established in the United States of America that the preferred pedagogy is critical thinking, exponents of this educational module include Dr. Martin Luther King who suggested that, the function of education, therefore, is to teach one to think intensively and to think critically . . . The complete education gives one not only power of concentration but worthy objectives upon which to concentrate (King,1948). This is further supported by the Yale professor, William Sumner, who enthuses that education in the critical faculty is the only education of which it can be truly said that it makes good citizens (Sumner, 1943).
    • Reflections on personal psychological resilience arising from the Shoreham air crash in 2015

      Kemp, Anthony (RCN Publishing (RCNi), 2019-03-26)
      Following critical events many people experience a period of emotional and cognitive disturbance before re-establishing well-being without the need for formal psychological support. Those working in emergency care have frequent and repeated exposure to such incidents and are therefore at increased risk of psychological distress. This article discusses the psychological sequalae of the author’s witnessing and involvement in the immediate on-scene care of those injured in the Shoreham, England air show crash in August 2015. Using narrative reflection, the author describes, with reference to the literature, his psychological journey drawing particularly on the conservation of resources theory. Within this is the recognition that unduly early and misinformed emphasis on psychological disorder and post-traumatic stress disorder are not only unhelpful but may deliver the person into greater distress and long-term mental health problems.
    • Refugee and immigrant community health champions: a qualitative study of perceived barriers to service access and utilisation of the National Health Service (NHS) in the West Midlands, UK

      Mudyarabikwa, Oliver; Regmi, Krishna; Ouillon, Sinead; Simmonds, Raymond; Coventry University; University of Bedfordshire; MiFriendly Cities Refugee and Migrant Centre, Coventry (Springer, 2021-06-18)
      There has been much discussion recently that better healthcare systems lead to increased service access and utilisation. However, there are still concerns raised among the refugee and immigrant communities about barriers to access and utilisation of primary healthcare services in the UK. This study aimed to explore with refugee and immigrant community health champions (CHCs) their perceptions about such barriers based on feedback in their own discussions with fellow refugees, asylum-seekers and immigrants in the West Midlands, UK. A total of 42 refugees and immigrants were recruited. Qualitative design-focused group discussions were conducted among purposively selected participants. These discussions were conducted between May and September 2019, and data were analysed using thematic analysis. The barriers to service access and utilisation are categorised into four themes: (i) knowledge about health issues that most affected refugees and immigrants; (ii) community indications of factors that obstructed service access; (iii) challenges in identifying local teams involved in service provision; and (iv) accurate knowledge about the different teams and their roles in facilitating access. This study highlighted that the levels of service access and utilisation would depend on the competence and effectiveness of the health system. Urgency and seriousness of individuals’ healthcare needs were the factors that were perceived to strongly influence refugees and immigrants to seek and utilise local services. We identified a number of potential barriers and challenges to service access and utilisation that should be overcome if primary healthcare service is to be planned and delivered effectively, efficiently and equitably in the West Midlands.
    • Reliability and validity of the Grip-Ball dynamometer for grip-strength measurement

      Chkeir, Aly; Jaber, Rana; Hewson, David; Duchêne, Jacques (IEEE, 2012-12-31)
      Grip-strength measurement is a key element in the evaluation of numerous conditions including frailty. An innovative grip-strength evaluation tool, the Grip-Ball has been developed for remote assessment of grip-strength. The Grip-Ball is an airtight ball that can be inflated to different pressures, thus varying the stiffness of the ball and the grip-strength dynamics. Three different initial pressures of 100, 125, and 150 kPa were evaluated in respect to reliability and validity, when compared to the Jamar. Reliability was very high, with ICC values of 0.95, 0.98, and 0.99 for 100, 125, and 150 kPa, respectively. The new device was highly correlated with the force measured using the Jamar for all initial pressures (r= 0.88, 0.93, and 0.93 for 100, 125, and 150 kPa, respectively). The possibility of varying the initial pressure would enable the Grip-Ball to be used for standard grip-strength testing and rehabilitation, while still maintaining high reliability and validity.
    • Research combined with clinical nursing is the future

      Dove, Ian; University of Bedfordshire (2016-09-26)
      A comment on the suggestion of combining clinical nursing practice with research in practice
    • Research protocol: general practice organ donation intervention-a feasibility study (GPOD)

      Penn-Jones, Catrin Pedder; Papadopoulos, Chris; Randhawa, Gurch; Asghar, Zeeshan (BMC, 2018-11-12)
      BACKGROUND: New interventions are required to increase the number of people donating their organs after death. In the United States of America (USA), general practice has proved to be a successful location to increase organ donor registration. However, a dearth of research exists examining this in the United Kingdom (UK). due to the unique challenges presented by the National Health Service (NHS). This protocol outlines a feasibility study to assess whether UK general practice is a feasible and acceptable location for organ donation intervention targeting NHS Organ Donor Register (NHS ODR) membership. METHODS: The primary intervention element, prompted choice, requires general practice to ask patients in consultations if they wish to join the NHS ODR. Two additional intervention techniques will be used to support prompted choice: staff training and leaflets and posters. The intervention will run for 3 months (April-July 2018) followed by a period of data collection. The following methods will be used to assess feasibility, acceptability and fidelity: registration data, a training evaluation survey, focus groups with staff and online surveys for staff and patients. DISCUSSION: By examining the feasibility, acceptability and fidelity of a prompted choice intervention in UK general practice, important knowledge can be gathered on whether it is a suitable location to conduct this. Additional learning can also be gained generally for implementing interventions in general practice. This could contribute to the knowledge base concerning the feasibility of NHS general practice to host interventions.