North East England Research Articles

Building Connections and Striving to Build Better Futures: A Qualitative Interview Study of Alcohol Recovery Navigators’ Practice in the North East of England, UK

To address the holistic and continuity of care needs of people who attend North East hospitals frequently for alcohol-related reasons, Recovery Navigator (Navigator) roles were introduced into Alcohol Care Teams in six hospitals in the North East of England, UK, in 2022. The Navigators aimed to provide dedicated holistic support to patients experiencing alcohol harms, starting whilst in the hospital with the potential to continue this beyond discharge. This qualitative study explores the contributions that the Navigators make towards integrated alcohol care. Twenty-five semi-structured interviews were undertaken with 7 patients, 1 carer, and 17 staff. We used reflexive thematic analysis and applied the concept of continuity of care and Self-Determination Theory. The findings suggest that all of the participants value Navigators having dedicated time to work with patients to address their social needs, that patients benefit from having someone who provides relational support and is ‘gently persistent’, and that most of the Navigators have good relationships with community providers and have supported the transition of patients to these services. Staff recognise the challenges of holistic alcohol care in hospitals, and the support of the Alcohol Care Teams and Navigators is seen as invaluable. Navigators help to address gaps in the provision of holistic support for patients who experience significant health inequalities.

EP46 Developing the rib fracture management pathway: a quality improvement project in a large district general hospital in the North East of England

eP46 Developing the rib fracture management pathway: a quality improvement project in a large district general hospital in the North East of England

Antibiotic prophylaxis for patients undergoing dental care: a multi-centre evaluation in community and hospital dental services.

Background Infective endocarditis (IE) is a life-threatening condition known to be associated with transient bacteraemia, the source of which can be the oral cavity. Scottish Dental Clinical Effectiveness Programme (SDCEP) 2018 implementation advice was introduced to provide practical guidance on National Institute for Health and Care Excellence Clinical Guideline 64 (2016) for management of patients at risk of IE undergoing dental treatment.Aims To assess current compliance with SDCEP's Antibiotic prophylaxis against infective endocarditis in six UK special care dentistry services.Method Four specific standards were set based on current guidance. Retrospective data were collected (from 01/01/2019 to 01/04/23) across six special care dentistry services in the UK, with an aim of 50 episodes of antibiotic prophylaxis (AP) in each service.Results In total, 248 episodes of care were included from dental services in London, East Surrey, Birmingham, Newcastle and North East England, Greater Glasgow and Clyde, and Newport (Wales). In 78% of episodes of care (n = 193), AP was administered to patients within SDCEP's special consideration sub-group. Additionally, 91% of patients outside the SDCEP sub-group had a justified reason recorded for AP. In all but three cases (99%), patients had an invasive dental procedure following AP. In 92% of cases, antibiotics were administered as per SDCEP 2018 advice.Conclusion Even with national implementation advice, this evaluation demonstrates inconsistencies in provision of AP throughout the UK. Practitioners prescribing and administering AP should remain aware of the changing aetiology of IE, as well as the reasons for and against prophylaxis, so that patients can make an informed decision.

Social entrepreneurship and the social economy of Victorian and Edwardian Britain

Taking Northeast England as our proving ground, we argue that social entrepreneurship played a highly productive role in deepening the social economy of Victorian and Edwardian Britain. Social enterprises flourished in the fields of community welfare, education, healthcare, recreation, and religion, enriching innumerable lives, and creating value at scale for both economy and society. Analysis of data relating to 3,919 Northeast social enterprises active between 1835 and 1914 reveals that social innovations spread rapidly from one locality to another in waves, as activists emulated developments elsewhere, within the region and beyond. We identify the factors that made this possible and reconceptualise social entrepreneurship as a collective endeavour led by social activists with support from the wider community and members of the business, professional, and ecclesiastical elites. In demonstrating how resources were once routinely mobilised by social enterprises, we provide a standard against which to evaluate social entrepreneurship in the present.

‘You can see when your parents are struggling’: a qualitative study of children and young people’s views of Universal Credit

Abstract By 2025, over eight million UK households will be receiving Universal Credit (UC). Introduced in 2013 to simplify the benefit system and improve work incentives for working age adults, UC has been criticised for causing hardship and exacerbating inequalities. There is limited research on children and young people’s (CYP) views of UC, as well as its health and social impacts. In this pilot qualitative study, creative methods were used to understand the views of UC among CYP (n = 40) aged 12–16 years in North East England. Findings showed diverse and nuanced understanding of UC as well as contested views about conditionality, sanctions, lower UC rates for under-25s and the two-child limit alongside recognition of the stigma and shame associated with benefits. While CYP value paid employment, they stressed the importance of minimum income standards and tailored employment support for UC claimants, taking account of their personal, health and family circumstances. Findings suggest CYP are aware when parents and carers are struggling financially and may try to ease pressures on parents. Debates about principles of equality, fairness, social justice and deservingness were present in young people’s accounts. We conclude by exploring future directions for a CYP-centred approach to social policy.

Barriers to using yoga and mindfulness in the Key Stage 1 classroom: perspectives of educators working in faith and non-faith state schools across North East England

Barriers to using yoga and mindfulness in the Key Stage 1 classroom: perspectives of educators working in faith and non-faith state schools across North East England

‘They have no right to safety and protection’: Brexit, Eastern European women in the UK and domestic abuse

Domestic abuse is a prevalent form of violence against women in the UK. Migrant women living in the UK often face an increased risk of domestic abuse, as well as barriers to accessing support to end this abuse, due to multiple intersecting disadvantages. These disadvantages can include lack of social support, precarious immigration and under-employment. In the wake of Brexit, the immigration status of migrants from EU countries has become precarious, and evidence of the consequences of this change in status are now emerging. This study forms part of a larger research project examining the lived experiences of Eastern European migrant women living in North East England, and the agencies that support them. Data were gathered during small group interviews with Eastern European migrant women from EU countries (n=6) and interviews with staff from local voluntary agencies (n=3). Data were analysed using a thematic analysis framework. Findings highlight how barriers to accessing domestic abuse support services have increased in the wake of Brexit, yet these women are often invisible to services. Our research offers empirical evidence about ‘intersectional invisibility’ through a narrative exploring the recent history of changing immigration status for a group of EU citizens living in the UK.

Austerity's implications: Parasitism and charity in an English village

AbstractEnglish political discourse has long featured accusations of parasitical behavior. In this article, I provide insight into how discussions of parasitism feature in English people's daily lives. Specifically, I discuss how more than a decade of austerity has informed perceptions of parasitical behavior. In exploring this, I make use of more than a dozen months of fieldwork conducted with residents of Lyon, a rural, postindustrial village in North East England. My specific focus is discussions of parasitism occurring in two fixtures of austerity‐era England: the food bank and the charity shop. After more than a decade of austerity, even those villagers volunteering at charity shops and food banks frequently engaged in conversations about parasitism. I draw on Michel Serres's scholarship on the parasite and place it in conversation with George Foster's various writings on the image of the limited good and the static economy to explain why this occurred. I suggest that the development of a worldview informed by a sense of limited good has encouraged beliefs about parasitism's contemporary prevalence.

Palliative and end-of-life care for patients with pleural mesothelioma: A cohort study.

Pleural mesothelioma is a rare and incurable cancer, with complex physical and psychological symptoms. Despite recent advances in treatment, prognosis remains poor (average 8-15 months) with a lack of research on palliative and end-of-life care. To examine markers suggestive of quality palliative and end-of-life care, including receipt of specialist palliative care, advance care planning, fewer unplanned hospital admissions at end-of-life. To compare variables with socio-economic position to identify if inequalities exist. A cohort study, retrospectively reviewing the medical notes from diagnosis to death for all patients diagnosed with pleural mesothelioma between 01/01/2016 and 31/12/2021. Over 5 years, n = 181 patients were diagnosed with pleural mesothelioma across Teesside (north-east England), n = 30 were alive at study commencement and excluded. For the 151-patient cohort, demographics were as follows: 92% male, 79% aged 70-89 years and 26% in the lowest socio-economic quintile (based on area-level deprivation). Median survival was 246 days. Within the final 90 days of life, 69% of patients had at least 1 unplanned hospital admission, with 20% having 3+ (range 0-7). Those with the highest socio-economic position had less admissions on average. Specialist palliative care was received by patients, at home 34%, in hospital 26%, in hospice 11%. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions, were in the final 24 h of life for 18% of patients (median 7 days). Disease specific findings included police attendance for expected deaths and lack of signposting. Patients with pleural mesothelioma have unplanned admissions to hospital towards the end of life, with possible inequalities; they receive late advance care planning and face challenges unique to their disease. It is important that patients receive high quality palliative end-of-life care through accessing specialist palliative care or have guidance/signposting to other potential sources of support.

A Qualitative Study of Barriers and Facilitators to the Uptake of Cardiac Rehabilitation in Octogenarians.

Introduction: Despite an established evidence-base for cardiac rehabilitation (CR) improving functional outcomes and quality of life and reducing re-hospitalisation, there is limited research on CR for older cardiac patients, who require rehabilitation the most, as they are often very deconditioned due to aortic stenosis (AS). CR uptake in the UK is limited to 52% with national variability of provision and accessibility, and it is a national priority to increase uptake to 85%. Frequently, research has excluded older populations as they are deemed to be too frail or generally not suitable for inclusion. This study aimed to explore factors that can impact the uptake of CR in octogenarians. Methods: Qualitative interviews were carried out with 20 AS patients (12 female, 8 male), from a large NHS Trust in the North East of England. Results: Four main themes were identified in the data: Perceptions and Understanding, Delivery and Accessibility, Perceived Impact of Exercise and Health and Life Changes, and Transportation. Discussion: The findings suggested that the major factors were the understanding of the nature, purpose and relevance of CR to older patients, whether CR was offered, and the role of social support. Barriers and facilitators can impact uptake based on the mode of delivery and the individual circumstances identified. Future research could explore how to develop CR programmes that overcome the barriers identified in the research, such as education, monitoring strategies, use of telehealth, and home-based elements to create an acceptable and accessible programme for octogenarians.

Genetically identified Salmonella typhimurium outbreak linked to a rural Butcher's Shop, February-March 2018, North East England.

Between February and April 2018, Salmonella typhimurium within a unique 5-single nucleotide polymorphism (SNP) address was isolated from 28 cases with links to a small rural area of Northeast England, with five cases prospectively identified by whole genome sequencing (WGS). Infections had a severe clinical picture with ten cases hospitalized (36%), two cases with invasive disease, and two deaths reported. Interviews determined that 24 cases (86%) had been exposed to a local independent butcher's shop (Butcher A).A case-control study using controls recruited by systematic digit dialling established that cases were 68 times more likely to have consumed cooked meat from Butcher A (Adjusted OR 68.1; 95% CI: 1.9-2387.6; P=0.02). Salmonella typhimurium genetically highly related to 28 of the outbreak cases was also isolated from a sample of cooked meat on sale in the premises.Epidemiological and microbiological investigations suggest this outbreak was likely associated with the consumption of ready-to-eat foods supplied by the implicated butcher. A relatively large number of cases were involved despite the rurality of the food business, with cases resident across the Northeast and Yorkshire identified using WGS, demonstrating the benefit of timely sequencing information to community outbreak investigations.

Patient-level analysis of the cost and variation in melatonin prescribing patterns in those under 18 in the North East of England

BackgroundMelatonin is widely used to promote sleep in both normally developing children and adolescents and those with neurodevelopmental disorders. It has an evidence base as both hypnotic and chronobiotic although...

Are exercise classes for older people, including those with dementia, located in areas with the greatest need in the North East of England?

Are exercise classes for older people, including those with dementia, located in areas with the greatest need in the North East of England?

The Potential Association between Asthenopia and its Risk Factors amongst Student at the University of Sunderland

Background Asthenopia contributes to visual tiredness, and lack of sleep leading to low mental state, thus students put off completing their coursework, which negatively affects their academic performance. With limited information on the risk factors associated with asthenopia at the University of Sunderland. This study aimed to assess the potential risk factors associated with asthenopia among students at the University of Sunderland, North-East England. Method This cross-sectional research was conducted between May and August 2023 with 400 participants. A validated questionnaire was used to obtain responses. Descriptive and correlational statistics (bivariate analysis) were conducted to establish associations between asthenopia and potential risk variables, binary logistic regression was utilised to calculate the odds ratio. Results Females were more dominant (53.4) compared to males (46.6%), the prevalence of asthenopia was 69.9%, and headache 53.7% was the most prevalent symptom. Participants within age 43 and above were negatively associated with the development of asthenopia (r=-0.115, p<0.028, 95% Cl-0.215/-0.012). Asian Ethnic group had an odds ratio of 0.660 times (95% Cl=0.742-1.208, P<0.001). Astigmatism was significantly associated with asthenopia (r=0.107, p=<0.041, 95%Cl 0.04/0.207) and the odds ratio (OR) was 1.499 times (95% Cl, 0.99/2.257). Participants who studied (>6 hours) were 2.889 times more prone to developing asthenopia. Conclusion Refractive error (astigmatism), time spent of digital device (>6hours) and age (43years above) were associated with asthenopia. Asian ethnic group was shown to have lesser likelihood of experiencing asthenopia. Anti-reflective glasses and eye drop were good protective measures for reducing asthenopia.

What Motivates the Decision to Enrol, Engage In, and Complete the Inner Strength Program for Partner-Abusive Men and Women: A Synthesis of Qualitative Findings

The Inner Strength (IS) program (Graham-Kevan & Wilks-Riley, 2011) is a group-based, 26-session trauma-based therapeutic intervention, delivered in community settings or in prison, for people who have perpetrated partner abuse and often other forms of general violence. The intervention combines elements of dialectical behavioural therapy and mentalisation-based therapy with practical support and advocacy. This article synthesizes qualitative findings from the evaluation of the pilot version of IS in a highly deprived area of North East England. The intervention was delivered by a small team of social workers and police trained and supervised by an external clinician and coauthor of the intervention. As of June 2019, 34 individuals (31 men and 3 women) had completed the program in seven cohorts before the evaluation. Quantitative trends are reported in a separate article (redacted, forthcoming). The 34 names were randomized, and participants were contacted in order of randomization. Of the first 12 to be contacted, 10 agreed to take part in a face-to-face, semistructured interview. Next, participants’ motivation to enroll, engage in, and complete the intervention were explored. Eight of 10 interviewees were men whose primary motivation was their role as fathers and recognition of the need to change if they were to have access to and a relationship with their children. The primary motivation to engage in the intervention was a sense of trust in the practitioner developed in one-to-one sessions before the group intervention started, feeling accepted and safe within the group, acquiring skills in emotional regulation and mentalization, and the availability of practitioners after and between sessions. Participants who often felt shame in other settings experienced IS as a place of respite and valued a range of experiential learning techniques and the bonds formed with the group. Practitioners were available out of hours and postintervention to help participants apply new skills at times of crisis until the skills became habitual. These findings are congruent with two common factors across successful psychological treatment identified by Laska et al. (2014): the centrality of the therapeutic relationship and an intervention that matches the client’s needs.

Volunteer Voices: building volunteer agency in the field of contemporary art in heritage

ABSTRACT Volunteers are a key but underexploited resource in advocating for and interpreting the contemporary artworks that are increasingly being commissioned for heritage places. Volunteers are not typically offered any training to help them talk about contemporary artworks with visitors or provided with much background information about the art or artists concerned. Nor is the organisation’s rationale for engaging with contemporary art well-understood by volunteers. While heritage organisations rely heavily on volunteers to provide high quality experiences for their visitors, in failing to adequately prepare volunteers, the full value of investment in a contemporary art project – time, money, organisational input, the creative energy of the artist – might not be properly realised. In this article, which draws on findings from a pilot volunteer training programme conducted in North East England in 2021–2022, we develop existing research into ‘serious leisure’ to suggest the value of building a community of practice through peer-learning that can offer a distinctive experience for volunteers, enhancing both their ownership and agency. We argue for the benefits of knowledge exchange across heritage sites and suggest that volunteers could be at the forefront in improving commissioning and exhibiting practices and visitor appreciation of contemporary art in heritage places.

“They pulled that funding away and we’re not recovering. it’s getting worse”: deaths of despair in post-austerity north east England

BackgroundDeaths related to suicide, drug misuse, and alcohol-specific causes, known collectively as “deaths of despair” are of growing interest to researchers in England. Rates of death from these causes are highest in deprived northern communities and are closely tied to the social determinants of health and the policy decisions that have shaped them. The aim of this paper is to explore how stakeholders and community members living in Middlesbrough and South Tyneside, two Northern towns with above average rates of deaths of despair, understood the relationship between austerity policies and rates of deaths from these causes in their areas.MethodsI conducted interviews and one focus group with a total of 54 stakeholders and community members in Middlesbrough and South Tyneside. Data were analysed using the iterative categorisation technique and the findings were interpreted through thematic analysis.ResultsThe findings highlight four primary ways through which austerity exacerbated rates of deaths of despair in Middlesbrough and South Tyneside: reduced access to mental health services, diminished substance abuse treatment capacity, loss of youth services, and the closure of community institutions. Participants linked these cuts to rising social isolation, declining mental health, and increased substance misuse, which collectively deepened geographic inequalities in deaths of despair.ConclusionsThis study underscores the urgent need for reinvestment in local services to reduce inequalities and prevent further unnecessary deaths due to drug, suicide, and alcohol-specific causes. Prioritising the restoration and enhancement of services lost to austerity is critical. Such reinvestment will not only help to alleviate some of the most immediate need but also form a foundation for addressing the wider structural inequalities that perpetuate deaths of despair.

Pups at Pride: A Reflection on Negotiating Consent, Power, and Agency with Subversive Subcultures

Gaining consent from individuals who give control over aspects of their agency, autonomy, and ability to consent to another person by subverting normative power dynamics - such as those who belonging to kink communities - has seen little ethical discussion. This reflection provides a critical commentary on a specific scenario that occurred while conducting an LGBT hate crime project at a local Pride event in the North-East of England. While conducting a survey on antiLGBT+ hate crime, a self-identified 'pup' approached the researcher to express interest in participation. The pup was unable to physically sign a consent form or fill out the survey themselves as their hands were covered and restricted by paw gloves. Further, they had indicated that they were under the control and supervision of their 'handler' who was observing the interaction from a distance. The pup was an unexpected respondent in the research as the survey was not kink-orientated. The ethical guidance underpinning the research was, therefore, not prepared for engaging with members of the kink community. Due to the subverted power dynamics over 'who' should give consent in this scenario, the author uses this as a case study to pose a series of questions on best ethical practice ‘in action’ when conducting research with individuals who challenge normative power relations.

Exploring what works well and less well in a community-based drop-in hub providing health and wellbeing services for people experiencing homelessness: a participatory action evaluation of service coordination

BackgroundPeople experiencing homelessness often face obstacles accessing health and social care support. Challenges are further exacerbated when support provision for multiple unmet needs are not integrated or coordinated. To overcome these challenges, there has been growing attention on integrating and co-locating health and wellbeing services for people experiencing homelessness. In an urban area of North East England, a long-standing Hub or ‘drop-in centre’ offers a range of health and wellbeing support by bringing together the different health and care system agencies in one space. However, little is known about the perspectives of providers on what works well and less well in how the different services are coordinated.MethodsUsing a participatory action research approach, a qualitative service evaluation was undertaken between June and September 2023. Fourteen interviews were conducted with providers who work in a paid or voluntary capacity operating some of their service offerings or support in the Hub. Interview transcripts were analysed using inductive reflexive thematic analysis.ResultsThree themes were evident from the evaluation: 1) location and space matter, 2) co-location and relationships make a difference, and 3) service consistency and flexibility are paramount.ConclusionCo-locating support to cover the breadth of health and care needs has the potential to increase engagement and access for people experiencing homelessness, and to enhance trust with service users and between agencies. This model provides a unique example of co-location and integration of support, particularly with it being operated by a community housing organisation.

Socioeconomic deprivation and perinatal anxiety: an observational cohort study

BackgroundWomen from areas of social deprivation and minority ethnic groups are more likely to experience poor physical health and have higher rates of mental health problems relative to women from less socially disadvantaged groups. However, very little research has examined this in relation to perinatal anxiety. The current study aims to determine prevalence, risk factors and desire for treatment for perinatal anxiety in three regions of the UK with diverse regional characteristics.MethodsWomen completed measures of anxiety in early, mid-, late-pregnancy and postpartum. Participants were included from three regions of the UK: Region 1 = North East England & North Cumbria n = 512; Region 2 = London North Thames n = 665; Region 3 = West Midlands n = 705.ResultsPrevalence of perinatal anxiety was lower in Region 1 (OR 0.63 95% CI 0.45 to 0.89) and Region 2 (OR 0.72 95% CI 0.52 to 0.98) relative to Region 3. Analysis showed the effect of neighbourhood socioeconomic deprivation on perinatal anxiety differed by region. In more affluent regions, living in a deprived neighbourhood had a greater impact on perinatal anxiety than living in a deprived neighbourhood in a deprived region. Other factors associated with risk of anxiety in the perinatal period included physical health problems and identifying as being from ‘mixed or multiple’ ethnic groups.ConclusionsNeighbourhood deprivation relative to regional deprivation is a better predictor of perinatal anxiety than either regional deprivation or neighbourhood deprivation alone. Women of mixed ethnic backgrounds and women with physical health problems may warrant more attention in terms of screening and support for perinatal anxiety. Self-reported desire for treatment was found to be low.