Users Of Care Services Research Articles

Using the matrixed multiple case study methodology to understand site differences in the outcomes of a Hybrid Type 1 trial of a peer-led healthy lifestyle intervention for people with serious mental illness.

Site differences in implementation trial outcomes are common but often not examined. In a Hybrid Type 1 trial examining the effectiveness-implementation of a peer-led group life-style balance (PGLB) intervention for people with serious mental illness (SMI) in three supportive housing agencies, we found that PGLB recipients' physical health outcomes differed by study sites. The matrixed multiple case study methodology was used to explore how implementation outcomes and changes in context of usual care (UC) services contributed to these site differences. Two implementation outcomes (i.e. PGLB fidelity ratings and intervention recipients' acceptability of PGLB and UC) and changes in healthcare services integration at the study sites were examined. ANOVAs were used to examine site differences in fidelity ratings and client satisfaction. Directed content analysis was used to analyze leadership interviews to identify changes in the context of UC services. Site 3 showed a trend approaching significance (P = .05) towards higher fidelity ratings. High levels of satisfaction with PGLB were reported at all sites. Significant differences in PGLB recipients' satisfaction with UC were found, with Site 3 reporting the lowest levels of satisfaction. Agency leaders reported an increase in prioritizing client's health throughout the trial with sites differing in how these priorities were put into action. Differences in PGLB recipients' satisfaction with UC, and changes in healthcare service integration seemed to have contributed to the site differences in our trial. The matrixed multiple case study methodology is a useful approach to identify implementation outcomes contributing to the heterogeneity of multisite implementation trial results.

Understanding Gender-Based Perception During Pregnancy: A Qualitative Study.

Gender-based perceptions about maternal health care during pregnancy draw attention to the existence of gender inequity in maternal health care. This study aimed to understand the gender-based perception of gender roles and norms, gender relations, social support, and psychosocial variation in maternal health care during pregnancy. A qualitative study was conducted in three rural districts of Jimma, Ethiopia. Participants were purposefully chosen from the community groups, including male and female health development armies, religious leaders, health extension workers, midwifery nurses, and primary health care unit directors. The data was gathered through in-depth interviews and focus group discussions. The actual data was collected by men and women qualitative study experts. Atlas ti Ver 9 was used for the analysis. The data was initially coded then changed to a sub-category and at last converted to a category. Four categories emerged: Gender-based roles and norms, psychosocial variation, social support, and gender relations. The informants described men's and women's independent and shared roles improve maternal health care service usage during pregnancy. Once the women became pregnant, men undertook a variety of demanding duties to enhance maternity service consumption. Gender relations and shared decision-making were essential in facilitating maternal healthcare utilization during pregnancy and beyond. This study revealed that maternal health care should not be limited to women alone. Men's and women's prior maternal health experiences, in addition to their knowledge and beliefs, have significantly impacted the utilization of maternal healthcare services during pregnancy. Policymakers and academics should consider men's essential contribution to maternal health care during pregnancy. However, in order to increase their intention to use maternal health care services, it is necessary to clearly identify the interests of women in which men should be involved.

Associations between home death, demographic factors and health care service usage for people who died in Scotland before and during the Covid-19 pandemic in Scotland

ObjectivesTo compare pre-pandemic and pandemic associations between death at home and: 1) demographic characteristics, 2) health care usage characteristics of people who died in Scotland.
 MethodsRetrospective observational study of linked routine data: death registrations of all adults who died aged 18+ in Scotland during 12-month pandemic period (2020-03-23 to 2021-03-22) and pre-pandemic period (5 years prior), linked to inpatient acute hospital, psychiatric, and cancer registration records, and unscheduled care records (NHS24 calls, Accident & Emergency, ambulance, and Out-of-hours primary care records). Service usage will be summarised for pandemic and pre-pandemic cohorts. Separate logistic regression models for the pre-pandemic and pandemic periods will be used to test associations between demographic and service usage data, and death at home.
 ResultsDeaths at home increased by about 35% during the first year of the pandemic in Scotland. N=285,770 people died in the 5 years before the pandemic and N=65,375 people died during the pandemic, of which N=76,770 and N=21,705 died at home, respectively. The associations between health service usage, demographic characteristics, and death at home changed during the pandemic.
 ConclusionStudying the effects of the pandemic on end-of-life care has important implications for policy and future pandemic preparedness. Understanding how factors associated with home death changed during the pandemic will help inform care delivery for the increased number of deaths happening at home in Scotland.

디지털 격차와 사회적 약자

This study analyzes public service advertisements, public campaign videos, and digital care industry advertisement videos to identify the dominant perspective on the digital divide problem of the elderly and to explore the position and meaning of the elderly in digital technology discourse. According to the analysis, public advertisements/campaign texts for bridging the digital divide assume the elderly as the digital weak and the young as the digital strong, and there is a tendency to solve the problem of the digital weak through the practice of the digital strong. This aspect of representation requires reconsideration because it can lead to reinforcing and reproducing negative stereotypes such as dependence and passivity of the elderly. On the other hand, the elderly in advertisements for the digital care industry appear as images of digital users rather than digital weaklings, as users of AI care services. As a result of reproducing the daily life of the elderly with an artificial intelligence care robot, a difference was revealed in the use of digital technology by female seniors and male seniors. It was understood that the dual inequality factors of gender and age were reflected. In the advertisements analyzed, the elderly actively interacting with AI caring robots tended to highlight the digital inclusion of ICT companies that are considerate of the minority and the vulnerable, and digital technology appeared as a friend of the elderly in all texts.

성인 공적 돌봄 서비스 이용량 영향요인: 중장년과 노인 비교를 중심으로

This study explored factors of formal care service usage, dividing service users between middle-aged (50-64) and older adults
 (65+). Despite of upsurging care needs of middle-aged adults, previous studies have not studied on their care needs. Therefore, we focused
 on examining the factors of service uses for understanding their needs for public care services. We used the second data from Care SOS
 Center in Seoul, South Korea and selected 31,265 people who used the services in 2021. Independent variables were organized into four
 categories - predisposing, enabling, need, and health care system factors - based on Andersen's theory of service uses, for which many
 previous studies have adopted. After conducting multiple regression analysis using SPSS 25.0, the results were as follows: First, regarding
 the predisposing factors, middle-aged adults who have many family members were more likely to use care services, while older adults’
 family members were not statistically significant. Second, need factors such as the discharged patients were pivotal in care service uses
 of both middle-aged and older adults. Third, older adults who had used other social care services before were less likely to use this short-term
 care SOS services, but the result was not statistically significant for middle-aged adults. Based on the results, we suggested social welfare
 interventions such as developing intensive care services for the discharged based on community care, interlocking and connecting social
 care services, making interventions for the excluded who needs imminent services as well as pointed out the importance of universal care services for both older and middle-aged adults.

Key Considerations When Developing and Implementing Digital Technology for Early Detection of Dementia-Causing Diseases Among Health Care Professionals: Qualitative Study.

The World Health Organization (WHO) promotes using digital technologies to accelerate global attainment of health and well-being. This has led to a growth in research exploring the use of digital technology to aid early detection and preventative interventions for dementia-causing diseases such as Alzheimer disease. The opinions and perspectives of health care professionals must be incorporated into the development and implementation of technology to promote its successful adoption in clinical practice. This study aimed to explore health care professionals' perspectives on the key considerations of developing and implementing digital technologies for the early detection of dementia-causing diseases in the National Health Service (NHS). Health care professionals with patient-facing roles in primary or secondary care settings in the NHS were recruited through various web-based NHS clinical networks. Participants were interviewed to explore their experiences of the current dementia diagnostic practices, views on early detection and use of digital technology to aid these practices, and the challenges of implementing such interventions in health care. An inductive thematic analysis approach was applied to identify central concepts and themes in the interviews, allowing the data to determine our themes. A list of central concepts and themes was applied systematically to the whole data set using NVivo (version 1.6.1; QSR International). Using the constant comparison technique, the researchers moved backward and forward between these data and evolving explanations until a fit was made. Eighteen semistructured interviews were conducted, with 11 primary and 7 secondary care health care professionals. We identified 3 main categories of considerations relevant to health care service users, health care professionals, and the digital health technology itself. Health care professionals recognized the potential of using digital technology to collect real-time data and the possible benefits of detecting dementia-causing diseases earlier if an effective intervention were available. However, some were concerned about postdetection management, questioning the point of an early detection of dementia-causing diseases if an effective intervention cannot be provided and feared this would only lead to increased anxiety in patients. Health care professionals also expressed mixed opinions on who should be screened for early detection. Some suggested it should be available to everyone to mitigate the chance of excluding those who are not in touch with their health care or are digitally excluded. Others were concerned about the resources that would be required to make the technology available to everyone. This study highlights the need to design digital health technology in a way that is accessible to all and does not add burden to health care professionals. Further work is needed to ensure inclusive strategies are used in digital research to promote health equity.

Postacute Care Services Use and Outcomes Among Traditional Medicare and Medicare Advantage Beneficiaries

Better evidence is needed on whether Medicare Advantage (MA) plans can control the use of postacute care services while achieving excellent outcomes. To compare self-reported use of postacute care services and outcomes among traditional Medicare (TM) beneficiaries and MA enrollees. This cohort study used data from the National Health and Aging Trends Study (NHATS) with linked Medicare enrollment data from 2015 to 2017. Participants were community-dwelling MA or TM beneficiaries 70 years and older; those with dual Medicare and Medicaid eligibility were also identified. Analyses were conducted from May 2022 to February 2023 and were weighted to account for the complex survey design. Enrollment in MA and dual eligibility for Medicare and Medicaid. Postacute care service use including site of use, duration, primary indication, and whether participants met their goals or experienced improved functional status during or after services. Included in the analysis were 2357 Medicare beneficiaries who used postacute care. Of these beneficiaries, 815 (32.6%; 62.0% were females [weighted percentages]) had MA and 1542 (67.4%; 59.5% were females [weighted percentages]) had TM. Enrollees in MA reported using postacute care services across all NHATS survey rounds: between 16.2% (95% CI, 14.3%-18.4%) and 17.7% (95% CI, 15.4%-20.4%) of MA enrollees reported using postacute care services each round, vs 22.4% (95% CI, 20.9%-24.1%) to 24.1% (95% CI, 21.8%-26.6%) of TM beneficiaries (P for all rounds <.002). Enrollees in MA reported less functional improvement during postacute care use (63.1% [95% CI, 59.2%-66.8%] vs 71.7% [95% CI, 68.9%-74.3%], P < .001). Among beneficiaries who ended postacute service use, fewer MA enrollees than TM enrollees reported that they met their goals (70.5% [95% CI, 65.1%-75.3%] vs 76.2% [95% CI, 73.1%-79.1%]; P = .053) or had improved functional status (43.9% [95% CI, 38.9%-49.1%] vs 46.0% [95% CI, 42.5%-49.5%]; P = .42), but differences were not statistically significant. Differences in postacute care use and functional improvement were not statistically significant between MA and TM enrollees with dual eligibility. In this cohort study of Medicare beneficiaries, we found that MA enrollees overall used less postacute care services than their TM counterparts. Among users of postacute care services, MA enrollees reported less favorable outcomes compared with TM enrollees. These findings highlight the importance of assessing patient-reported outcomes, especially as MA and other payment models seek to reduce inefficient use of postacute care services.

Liquidity and uncertainty: digital adaptation of a complex intervention for people with severe mental illness during the COVID-19 lockdown

BackgroundThis paper explores the extent to which the implementation and evaluation of a collaborative care model of face-to-face service delivery for people with severe mental illness was viable during the first UK lockdown associated with COVID-19. The PARTNERS2 cluster randomised controlled trial and process evaluation were co-designed with service users and carers. The aim of this paper is to explore whether digital adaptation of the PARTNERS model for people with severe mental illness during the COVID-19 lockdown was equitable, in terms of fostering collaboration and trust in a vulnerable population.ResultsWe collected qualitative data from multiple sources during lockdown and subsequently constructed case-studies of participating secondary care workers. We adopted Bauman’s notions of liquid modernity to inform our analysis, and identified that digital adaptation during lockdown was only successful where organisational policies, care partner skills and service users’ existing resources were optimal.ConclusionPARTNERS2 can be delivered digitally by a care partner to support people with severe mental illness to identify and work towards their goals when existing resources are optimal. However, at a time of increased need, we identified that people who are very unwell and living with limited access to resources and opportunities, remained disenfranchised at great cost.Trial registrationISRCTN 95702682, registered 26.10.2017

Assessment of cardiovascular risks among users of primary health care services

Objective: The aim of the study was to investigate Cardiovascular Risk (CVR) among users of Primary Health Care (PHC) services in a municipality in the state of Minas Gerais/Brazil. Materials and Methods: The study was carried out from January to April 2023, with an assessment of CVR through the application of the Franmgham Global Risk Score (GRS) among PHC users. Results: Eighty PHC users were evaluated, 31 males (39%) and 49 females (61%), mean age between 55 and 59 years. Among those evaluated, 57 (71%) do not smoke and 23 (29%) smoke, 54 (68%) are not diabetic and 26 (32%) are diabetic, 62 (78%) have a history of arterial disease in the family and 18 (22%) do not have it, the mean total cholesterol assessed ranged between 178.5 and 217.5 mg/dl and the mean untreated systolic blood pressure ranged between 134 and 143 mmHg, and treated between 125 and 134 mmHg. Data on the GRS showed an overall mean score of 15.75 (18.83%). The analysis of the Franmgham GRS average among women identified a value of 14.92 (15.98%) and among men, 17.1 (23.34). Most men and women had high CVR. Conclusion: It is concluded that most patients had a high cardiovascular risk and that prevention strategies and urgent treatments are needed among those evaluated.

Improving Care for Service Users With Learning Disability by Increasing Early MDT Coordination for Those Referred With Behaviours That Challenge

AimsOur aim was for 80% of new referrals for behaviours that challenge within Tower Hamlets Community Learning Disability service to have an MDT coordinated approach by July 2022. This followed concerns about disjointed care and long waits for therapeutic support when being referred between different MDT branches within the service having a negative impact on patient care.MethodsAn MDT project team was formed and weekly meetings were arranged. A driver diagram was created. Our primary outcome measure was determined: percentage of referred patients per week that had MDT coordinated assessments, with data being collected manually from electronic progress notes and MDT meeting minutes. Number of referrals per week was recorded as a process measure. Baseline data were added to the Life QI web platform upon collection, allowing generation of run charts for outcome and process measures. The time-frame over which referrals were recorded was changed from weekly to fortnightly, to help differentiate graphically between zero values resulting from the absence of MDT coordination and those resulting from no referrals being received on a given week. Attempts were made to obtain service user input via easy-read questionnaires and subsequent discussion in a service user participation group. A weekly Positive Behavioural Support meeting was set up and a Positive Behavioural Support database was established, and the combination of these changes simplified data collection and gave a focus to MDT working and collaboration for these service users. Data were recorded from 28/06/2021 to 03/07/2022 initially and subsequently extended to 06/11/2022 as part of a further PDSA cycle.ResultsA shift in proportion of service users referred with behaviour that challenges who had MDT involvement at the point of allocation was observed, to above the mean value of 0.5, commencing 07/02/2022, this shift was sustained until the project's endpoint. In terms of our process measure, the median number of new behaviour that challenges referrals per fortnightly period to psychiatry and psychology was one. This ranged from 0-4 referrals per fortnightly period, but no sustained change in this value was observed over the course of the project.ConclusionImplementing a new behaviour that challenges database and weekly meeting to focus on MDT coordinated working in those newly referred with behaviour that challenges has been successful in leading to a measurable and sustained improvement in the proportion of those service users receiving timely MDT coordinated care.

Service contents and recovery orientation of psychiatric home-visit nursing evaluated by users in Japan.

The aim of this study was to clarify the differences perceived by users of home-visit nursing care between providers from medical institutions and services from independent home-visit nursing stations, as well as to examine the recovery orientation from the perspectives of the users. We conducted a questionnaire survey of 32 home-visit nursing stations and 18 medical institutions. From these facilities, 10 users of psychiatric home-visit nursing services who were being treated for schizophrenia and bipolar disorder were selected. With regard to the care that they thought was good, the home-visit nursing station users responded more often than users of home-visit nursing care provided by medical institutions regarding "help with hobbies and fun" and "support to empower you". Regarding what users wanted from home-visit nursing care, a statistically significant difference was found between users of home nursing stations who answered, "I want the same person to come", and users of home-visit nursing services provided by medical institutions, who answered, "I want various people to come". Brief INSPIRE-J score for study participants was 81.9 (standard deviation; SD 18.1) for users of home-visit nursing care services from medical institutions and 83.7 (SD 15.5) for home-visit nursing station users. It is conceivable that the care provided by psychiatric home-visit nursing services may have a greater potential for promoting recovery. However, since the characteristics of users and facilities may differ, future research is needed to clarify which recovery factors are effectively promoted by each service.

Evaluating the Discriminatory Ability of the Sickle Cell Data Collection Program's Administrative Claims Case Definition in Identifying Adults With Sickle Cell Disease: Validation Study.

Sickle cell disease (SCD) was first recognized in 1910 and identified as a genetic condition in 1949. However, there is not a universal clinical registry that can be used currently to estimate its prevalence. The Sickle Cell Data Collection (SCDC) program, funded by the Centers for Disease Control and Prevention, funds state-level grantees to compile data within their states from various sources including administrative claims to identify individuals with SCD. The performance of the SCDC administrative claims case definition has been validated in a pediatric population with SCD, but it has not been tested in adults. The objective of our study is to evaluate the discriminatory ability of the SCDC administrative claims case definition to accurately identify adults with SCD using Medicaid insurance claims data. Our study used Medicaid claims data in combination with hospital-based medical record data from the Alabama, Georgia, and Wisconsin SCDC programs to identify individuals aged 18 years or older meeting the SCDC administrative claims case definition. In order to validate this definition, our study included only those individuals who were identified in both Medicaid's and the partnering clinical institution's records. We used clinical laboratory tests and diagnostic algorithms to determine the true SCD status of this subset of patients. Positive predictive values (PPV) are reported overall and by state under several scenarios. There were 1219 individuals (354 from Alabama and 865 from Georgia) who were identified through a 5-year time period. The 5-year time period yielded a PPV of 88.4% (91% for data from Alabama and 87% for data from Georgia), when only using data with laboratory-confirmed (gold standard) cases as true positives. With a narrower time period (3-year period) and data from 3 states (Alabama, Georgia, and Wisconsin), a total of 1432 individuals from these states were included in our study. The overall 3-year PPV was 89.4% (92%, 93%, and 81% for data from Alabama, Georgia, and Wisconsin, respectively) when only considering laboratory-confirmed cases as true cases. Adults identified as having SCD from administrative claims data based on the SCDC case definition have a high probability of truly having the disease, especially if those hospitals have active SCD programs. Administrative claims are thus a valuable data source to identify adults with SCD in a state and understand their epidemiology and health care service usage.

EXPERTS II - How are patient and caregiver participation in health and social care shaped by experienced burden of treatment and social inequalities? Protocol for a qualitative synthesis.

The workload health and social care service users and caregivers take on, and their capacity to do this work is important. It may play a key part in shaping the implementation of innovations in health service delivery and organisation; the utilisation and satisfaction with services; and the outcomes of care. Previous research has often focused on experiences of a narrow range of long-term conditions, and on factors that shape adherence to self-care regimes. With the aim of deriving policy and practice implications for service redesign, this evidence synthesis will extend our understanding of service user and caregiver workload and capacity by comparing how they are revealed in qualitative studies of lived experience of three kinds of illness trajectories: long-term conditions associated with significant disability (Parkinson's disease, schizophrenia); serious relapsing remitting disease (Inflammatory Bowel Disease, bipolar disorder); and rapidly progressing acute disease (brain cancer, early onset dementia). We will review and synthesise qualitative studies of lived experience of participation in health and social care that are shaped by interactions between experienced treatment burdens, social inequalities and illness trajectories. The review will involve:1.Construction of a theory-informed coding manual; systematic search of bibliographic databases to identify, screen and quality assess full-text papers.2.Analysis of papers using manual coding techniques, and text mining software; construction of taxonomies of service user and caregiver work and capacity.3.Designing a model of core components and identifying common factors across conditions, trajectories, and contexts.4.Work with practitioners, and a Patient and Public Involvement (PPI) group, to explore the validity of the models produced; to develop workload reduction strategies; and to consider person-centred service design. We will promote workload reduction models to support service users and caregivers and produce policy briefs and peer-reviewed publications for practitioners, policy-makers, and researchers.

Impacto del confinamiento domiciliario por COVID 19 en población con diabetes tipo 2 de una zona rural

Objective: to determine the impact of home confinement due to the COVID-19 pandemic on the control of glycosylated hemoglobin (Hb1Ac) and cardiovascular risk in diabetic persons living in a rural area of Catalonia, as well as their self-perception of disease control Method: a descriptive longitudinal retrospective study with persons diagnosed with T2D and users of the Primary Care services of the Institut Català de la Salut, in the rural area of Ripollés (Catalonia, Spain). Data were collected from clinical records about: Hb1Ac, cardiovascular risk (according to the Framingham-REGICOR equation), age, gender, smoking, blood pressure, weight, body mass index and biochemical variables, both before and after lockdown; and they were compared. Besides, an ad hoc questionnaire on self-perceived health was administered. Results: the study included N= 233 persons with a mean age of 69.8 (SD: 10) years, mostly male (56.2%) and non-smoking (90.3%). Of these, 46.3% had good control of their Hb1Ac before the confinement, which increased to 48.1% (p= 0.555). No significant differences were detected between the average HbA1c before (7.26; SD: 1.17) and after the confinement (7.28; SD:1.23). The majority of participants had medium (51.4%) or high cardiovascular risk (25.7%), and this increased by 0.11 points post-confinement (p= 0.307). There was a perception of worsening in their T2D after the confinement by 18% of participants (N= 42), mainly due to sedentarism (42.8%) and changes in their diet (21.4%).Conclusions: lockdown did not generate any impact on Hb1Ac levels in cardiovascular risk, or in the self-perception of T2D management of patients with diabetes in a rural area.

Embracing Challenges for Population Aging in China: Building Scientific Evidence to Inform Long-Term Care Policymaking and Practice

ABSTRACT In China, rapid aging of the population is driving up demand for healthcare and long-term care services for older adults. This special issue of the Journal of Aging & Social Policy features a collection of studies that provided timely analyses and fresh insights into a wide range of policy relevant topics concerning long-term care for older adults in China. In this introductory article, we orient readers to these studies organized under four themes: migration, caregiving, and elder care challenges; long-term care service users, frontline workers, and workforce challenges; unmet needs across the care span in healthcare, long-term care, and end of life care; and long-term care financing. We highlight major findings and contributions of each study and provide perspectives on key issues within China’s evolving healthcare and social policy contexts. Collectively, these studies contribute to building scientific evidence where it is lacking and supporting evidence-based long-term care policymaking and practice to meet the mounting challenges of population aging in China.

To queue or not to queue: Facility managers and mental health care users' experiences of integrated health care in a rural South African district.

A key feature of South Africa's state health care strategy since 1994 has been the development and expansion of services towards integrated health care at primary health care level. Within the new system, emphasis has been on the integration of patients with mental health care needs with other patients where multiple health conditions and needs would be addressed simultaneously. As part of a larger study into mental health care in a predominantly rural district, we investigated the experiences of facility managers and mental health service users in rural clinics within the system of care. We were interested both in their views as to the advisability of the integrated model and the ways in which they managed any challenges they may have experienced within the system at local level. Data were collected through once-off semi-structured interviews with facility managers and mental health care service users to gather qualitative information. Narratives were transcribed and translated into English. Transcriptions were imported to Atlas.ti 22 and analysed through Thematic Analysis. The integration of mental health care into routine primary health services poses challenges to treatment delivery and to patients who come for treatment. Our study also suggests resegregating mental health care as a possible solution to facilitate service delivery and treatment to service users. This research provided first insights into facility managers' and service users' views of integrated mental health care at primary health care level in this district. While mental health care services have been expanded and integrated into primary health care over recent years, the system may not have been as streamlined as in other parts of the country. The integration of mental health into primary health care can pose various challenges to facilities, health care providers, and mental health service users. Managers in these constrained circumstances have observed that resegregating mental health care from physical treatment, as in the past, may be deemed more effective for health care provision and reception. Generalised integration of mental health treatment with physical care should be approached with caution unless there is wider scale provisioning and greater organisational change.

PhD trials and parenthood tribulations: adopting a person-centred approach to support the ticking of two clocks

Women who are trying to carry out doctoral studies and build a career may find this time overlaps with their biologically optimal reproductive years. The assumption that this should oblige women to prioritise one or the other needs to be challenged and a person-centred approach adopted for students wishing to start a family during their PhD studies. Challenging this binaristic premise and taking person-centred approaches to support doctoral student mothers can help to encourage further women of childbearing age to undertake doctoral research training. Person-centredness is defined by McCormack and McCance (2017, p 3) as: ‘…an approach to practice established through the formation and fostering of healthful relationships between all care providers, service users and others significant to them in their lives. It is underpinned by values of respect for persons, individual right to self-determination, mutual respect and understanding. It is enabled by practice development.’ Research has shown that the ability of women to balance work and family responsibilities is a significant determinant of their ability to advance academically (Thanacoody et al., 2009). Studies have also demonstrated that women take longer than men to complete doctoral programmes and experience a lower publication rate compared with men as a result of family obligations (Velander et al., 2021). Equally, it has been shown that starting a family during academic studies can negatively affect women’s careers but not men’s (Acker and Webber, 2017). Combining motherhood and academic work within higher education has long been discussed and these discrepancies are significant when it comes to women developing research careers. So we need to ask, how can we adopt person-centred approaches to support doctoral student mothers in completing their PhD research and its associated publications as well as successfully navigating motherhood?

Fidelity to the ACT SMART Toolkit: an instrumental case study of implementation strategy fidelity

BackgroundEvidence-based practices (EBPs) are shown to improve a variety of outcomes for autistic children. However, EBPs often are mis-implemented or not implemented in community-based settings where many autistic children receive usual care services. A blended implementation process and capacity-building implementation strategy, developed to facilitate the adoption and implementation of EBPs for autism spectrum disorder (ASD) in community-based settings, is the Autism Community Toolkit: Systems to Measure and Adopt Research-based Treatments (ACT SMART Toolkit). Based on an adapted Exploration, Adoption decision, Preparation, Implementation, Sustainment (EPIS) Framework, the multi-phased ACT SMART Toolkit is comprised of (a) implementation facilitation, (b) agency-based implementation teams, and (c) a web-based interface. In this instrumental case study, we developed and utilized a method to evaluate fidelity to the ACT SMART Toolkit. This study responds to the need for implementation strategy fidelity evaluation methods and may provide evidence supporting the use of the ACT SMART Toolkit.MethodsWe used an instrumental case study approach to assess fidelity to the ACT SMART Toolkit during its pilot study with six ASD community agencies located in southern California. We assessed adherence, dose, and implementation team responsiveness for each phase and activity of the toolkit at both an aggregate and individual agency level.ResultsOverall, we found that adherence, dose, and implementation team responsiveness to the ACT SMART Toolkit were high, with some variability by EPIS phase and specific activity as well as by ASD community agency. At the aggregate level, adherence and dose were rated notably lowest during the preparation phase of the toolkit, which is a more activity-intensive phase of the toolkit.ConclusionsThis evaluation of fidelity to the ACT SMART Toolkit, utilizing an instrumental case study design, demonstrated the potential for the strategy to be used with fidelity in ASD community-based agencies. Findings related to the variability of implementation strategy fidelity in the present study may also inform future adaptations to the toolkit and point to broader trends of how implementation strategy fidelity may vary by content and context.

The Presentation of the Anti-Vaccination Movement in Social Networking Sites

Introduction: The anti-vaccination movement has started to develop into a major public health problem. After 1998, measles re-emerged in the UK and subsequently caused further outbreaks in Europe. Methods: MEDLINE, EMBASE and CINAHL databases were searched with keywords antivaccine, media, internet, social media. The results were ranked according to their content. The anti-vaccination movement's online media presence was reviewedon websites and search engines and social media such as facebook, twitter, instagram, pinterest and the older chatrooms and myspace. Results: While Web 1 was static, Web 2 and its future evolution, the Semantic Web is mutable and interactive. Social media offers the possibility to publish not only text but also image and video increasing the power and immediacy of communication. Users can upload content such as videos, pages and interact with each other. Thus, the roles of producers and consumers of news alternate, without the need for an intermediary. Thus, anyone is at the same time a channel owner, a broadcast producer without being subject to ethical rules. Conclusions: The anti-vaccination movement is not new. But has evolved with the advancement of technology and managed to follow the trends of the time by exploiting the nature of interactive media. The rhetoric of the anti-vaccination movement uses the power of image and video, the emotional charge of the personal stories they invoke. His argument is rooted in safeguarding personal liberty, conspiracy theories, and concern about adverse reactions are the main arguments used by vaccine hesitancy groups and should be addressed in communication with the health care service users.

Nutritional risk, nutrition plan and risk of death in older health care service users with chronic diseases: A register-based cohort study

Nutritional risk in older health care service users is a well-known challenge. Nutritional risk screening and individualised nutrition plans are common strategies for preventing and treating malnutrition. The aim of the current study was to investigate whether nutritional risk is associated with an increased risk of death and whether a nutrition plan to those at nutritional risk could reduce this potential risk of death in community health care service users over 65 years of age. We conducted a register-based, prospective cohort study on older health care service users with chronic diseases. The study included persons ≥65 years of age receiving health care services from all municipalities in Norway from 2017 to 2018 (n=45,656). Data on diagnoses, nutritional risk, nutrition plan and death were obtained from the Norwegian Registry for Primary Health Care (NRPHC) and the Norwegian Patient Registry (NPR). We used Cox regression models to estimate the associations of nutritional risk and use of a nutrition plan with the risk of death within three and six months. Analyses were performed within the following diagnostic strata: chronic obstructive pulmonary disease (COPD), dementia, type 2 diabetes, stroke, osteoporosis and heart failure. The analyses were adjusted for age, gender, living situation and comorbidity. Of the 45,656 health care service users, 27,160 (60%) were at nutritional risk, and 4437 (10%) and 7262 (16%) died within three and six months, respectively. Among those at nutritional risk, 82% received a nutrition plan. Health care service users at nutritional risk had an increased risk of death compared to health care service users not at nutritional risk (13% vs 5% and 20% vs 10% at three and six months). Adjusted hazard ratios (HRs) for death within six months were 2.26 (95% confidence interval (CI): 1.95, 2.61) for health care service users with COPD, 2.15 (1.93, 2.41) for those with heart failure, 2.37 (1.99, 2.84) for those with osteoporosis, 2.07 (1.80, 2.38) for those with stroke, 2.65 (2.30, 3.06) for those with type 2 diabetes and 1.94 (1.74, 2.16) for those with dementia. The adjusted HRs were larger for death within three months than death within six months for all diagnoses. Nutrition plans were not associated with the risk of death for health care service users at nutritional risk with COPD, dementia or stroke. For health care service users at nutritional risk with type 2 diabetes, osteoporosis or heart failure, nutrition plans were associated with an increased risk of death within both three and six months (adjusted HR 1.56 (95% CI: 1.10, 2.21) and 1.45 (1.11, 1.88) for type 2 diabetes; 2.20 (1.38, 3.51) and 1.71 (1.25, 2.36) for osteoporosis and 1.37 (1.05, 1.78) and 1.39 (1.13, 1.72) for heart failure). Nutritional risk was associated with the risk of earlier death in older health care service users with common chronic diseases in the community. Nutrition plans were associated with a higher risk of death in some groups in our study. This may be because we could not control sufficiently for disease severity, the indication for providing a nutrition plan or the degree of implementation of nutrition plans in community health care.