Qualitative Study In England Research Articles

Factors affecting implementation of interventions for oral health, substance use, smoking and diet for people with severe and multiple disadvantage: a community-based qualitative study in England

BackgroundPopulations facing severe and multiple disadvantage (SMD), co-occurring homelessness, substance use and repeat offending have high levels of physical and mental ill-health. Poor oral health is one of the most...

Hospital-based caregiver intervention for people following hip fracture surgery (HIP HELPER): multicentre randomised controlled feasibility trial with embedded qualitative study in England

ObjectivesTo assess the feasibility of conducting a pragmatic, multicentre randomised controlled trial (RCT) to test the clinical and cost-effectiveness of an informal caregiver training programme to support the recovery of...

Physiotherapists' perspectives of barriers and facilitators to effective community provision after hip fracture: a qualitative study in England.

to investigate physiotherapists' perspectives of effective community provision following hip fracture. qualitative semi-structured interviews were conducted with 17 community physiotherapists across England. Thematic analysis drawing on the Theoretical Domains Framework identified barriers and facilitators to implementation of effective provision. Interviews were complemented by process mapping community provision in one London borough, to identify points of care where suggested interventions are in place and/or could be implemented. four themes were identified: ineffective coordination of care systems, ineffective patient stratification, insufficient staff recruitment and retention approaches and inhibitory fear avoidance behaviours. To enhance care coordination, participants suggested improving access to social services and occupational therapists, maximising multidisciplinary communication through online notation, extended physiotherapy roles, orthopaedic-specific roles and seven-day working. Participants advised the importance of stratifying patients on receipt of referrals, at assessment and into appropriately matched interventions. To mitigate insufficient staff recruitment and retention, participants proposed return-to-practice streams, apprenticeship schemes, university engagement, combined acute-community rotations and improving job description advertisements. To reduce effects of fear avoidance behaviour on rehabilitation, participants proposed the use of patient-specific goals, patient and carer education, staff education in psychological strategies or community psychologist access. Process mapping of one London borough identified points of care where suggested interventions to overcome barriers were in place and/or could be implemented. physiotherapists propose that effective provision of community physiotherapy following hip fracture could be improved by refining care coordination, utilising stratification techniques, employing enhanced recruitment and retainment strategies and addressing fear avoidance behaviours.

Invisibility and diagnosis stigma: disabling factors for female adults with myalgia encephalomyelitis (ME)/chronic fatigue syndrome (CFS) in a small-scale qualitative study in England

Purpose Female adults diagnosed with myalgia encephalomyelitis (ME) and chronic fatigue syndrome (CFS) often are marginalised because their condition is not fully recognised by medical and health-care systems. The purpose of this small-scale study was to explore the lived experiences of adult females with ME/CFS in England in relation to contributing factors that impact their occupational participation. Design/methodology/approach A qualitative study design using semi-structured interviews was used with nine female adult participants who were selected using a purposive sampling method. A Thematic Networks tool was used to analyse data. Findings Four organising themes were identified: impairment-, person-, environment- and society-related factors. Two global themes, invisibility and diagnosis stigma, were identified as the overarching issues that female adults with ME/CFS face in occupational participation. Originality/value Many of the issues that contribute to lack of participation by this population are associated with environmental factors which are secondary to their illness.

‘I don't really associate climate change with actual people's health’: a qualitative study in England of perceptions of climate change and its impacts on health

ObjectivesThe health impacts of climate change are increasing, but qualitative evidence on people's perceptions is limited. This qualitative study investigated people's perceptions of climate change and its impacts on health. Study designThis was an online study using semistructured interviews. MethodsA total of 41 semistructured interviews were conducted in 2021 with members of the public aged ≥15 years living in England, recruited via community-based groups. Data were analysed using reflexive thematic analysis. ResultsParticipants were concerned about climate change, which was often perceived as extreme weather events happening elsewhere. Changes in the UK's seasons and weather patterns were noted, but participants were uncertain whether these changes resulted from climate change. Participants often struggled to identify health impacts of climate change; where health impacts were described, they tended to be linked to extreme weather events outside the United Kingdom and their associated threats to life. The mental health impacts of such events were also noted. ConclusionsThe study found that most participants did not perceive climate change to be affecting people's health in England. This raises questions about whether framing climate change as a health issue, an approach advocated for countries less exposed to the direct effects of climate change, will increase its salience for the British public.

Young Adult Carers Services in England: Facilitating Choice over Future Caring?

This paper reports findings from a national, qualitative study in England that investigated if young adult carers services are facilitating young people’s transitions to adulthood, including considering a future beyond caring. Semi-structured, online interviews were conducted in 2022 with a purposive sample of managers or lead workers of eleven young adult carers services in England. We discuss the consideration given in assessments to young people’s caring preferences and the availability of support to facilitate them to relinquish their role, if they so wished. The majority of young adult carers services gave young people the opportunity to express their views on this issue. Although the Care Act 2014 aimed to provide choice over caring in adulthood to young adult carers, this was not matched by the necessary service provision to facilitate their preferences. A new national carers strategy is urgently required to ensure that young people, particularly women, have a credible choice over their future lives.

Exploring LGBT resilience and moving beyond a deficit-model: findings from a qualitative study in England

ABSTRACT The aim of this study is to critique and extend psychological approaches to resilience by examining retrospective accounts of LGBT people in England who had directly experienced or witnessed events that were salient as significantly negative or traumatic. Pre-screening telephone interviews identified ten individuals who matched inclusion criteria (mean age: 39 years; range 26–62 years) as part of a larger study. Interviews were semi-structured and informed by a literature review undertaken at the start of the study. We identified three themes of that extend the resilience literature for LGBTQ+ people: (1) identifying and foregrounding inherent personal traits – how non-contextual inborn qualities or attributes needed external effort to be recognised and operationalised; (2) describing asymmetric sources of social support and acceptance – the importance of positive environment is unequally available to LGBT people compared to heterosexuals, and uneven within the LGBT group; and (3) blurring distinctions between resilience and coping – experiential approaches to moving beyond distress. We suggest that narratives of resilience in the accounts of LGBT people can inform the development of resilience promotion models for minoritized individuals and support movement away from deficit-focused approaches to health policy.

When is Subnational, Supralocal Tobacco Control "just right"? A Qualitative Study in England.

Subnational, supralocal (or "regional") approaches to tobacco control are often central federal nation tobacco control and can be superfluous for very small nations. However, their relevance to countries with weak intermediate tiers of governance are less clear. This study explores expert and policymaker perceptions on the function, form, footprint, and funding of regional tobacco control (RTC) in England. One-to-one semistructured interviews (n = 16) and four focus groups (n = 26) exploring knowledge and perceptions of the past, present, and future of RTC in England were conducted with public health leaders, clinicians, tobacco control practitioners, civil servants, and politicians. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Participants reported several key functions for RTC, including illicit tobacco control, media campaigns, advocacy, policy development, and network facilitation for local actors. A small minority of participants reported little role for RTC. Broader perceived features of effective RTC included subject expertise, strong regional ties, systems leadership, and a distinctive program of work. Views varied on whether regional programs should be developed nationally or locally, and their optimal footprint. Participants generally agreed stable funding was a prerequisite for success, although there was lesser agreement on funding sources. Pooling resources at the regional level in countries with weak intermediate tiers of governance may increase reach, cost-effectiveness and impact of campaigns, policy interventions, and advocacy, whilst retaining the ability to tailor approaches to regional populations. There are likely to be greater funding and governance challenges associated with introducing or strengthening RTC in countries with weak intermediate tiers of governance. Despite this, evidence from England shows it is possible to develop RTC approaches reported as effective by key stakeholders. Possible benefits of regional approaches in this context include cost-effective delivery of illicit tobacco control, media campaigns, advocacy, research, policy development, and coordinated support for local action on tobacco.

Understanding economic inactivity and NEET status among young women in the UK and France

ABSTRACT This article examines the position of young women in the UK and France who are defined as not in education, employment or training (NEET) and economically inactive (EI). While the challenges facing the young unemployed are well documented, far less is known about economic inactivity and its propensity to impact to a much greater extent on the lives of young women. The UK and France share some similarities with regard to their NEET EI female populations, in terms of the relative size of the group and the barriers young women face, despite being exposed to very different types of policy intervention and welfare support. Drawing on quantitative evidence (via the Céreq) from France and a recent qualitative study in England, the paper provides a deeper understanding of the characteristics and trajectories of young women who are NEET and EI. It highlights a need for policy interventions beyond employability initiatives: policies which tackle the barriers that young women, especially young mothers, face in accessing employment, as well as their difficulties in securing good quality and sustainable employment.

Exploring the Impact of the First Wave of COVID-19 on Social Work Practice: A Qualitative Study in England, UK

SummaryThe COVID-19 pandemic signalled a radical shift in health and social care services globally. In UK, many of the people with existing social care needs were identified as ‘clinically vulnerable’ to COVID-19. Those at greatest risk were encouraged to adhere to additional public health measures that inadvertently exacerbated social disadvantages. Social workers were challenged to ‘dig deep’ to continue to provide services as usual. However, problems implementing new ways of working were reported but not examined in-depth through research. Our study explored experiences and perceptions of social workers responding to the first wave (April–July 2020) of COVID-19, in England, UK. Interviews with thirteen social workers, all working in the West Midlands region, were conducted via telephone or online video. Transcripts were analysed using reflexive thematic analysis. We use ‘managing uncertainty’ as a central concept underpinning the four themes identified after analysis: (1) providing social care at a physical distance, (2) negotiating home/work boundaries, (3) managing emerging risks and (4) long-term implications for social work. We discuss our findings in the context of resilience and organisational adaptation. Social workers in our study demonstrated resilience in action and rapid adaptation to new practices, but equally expressed concern about short-term efficiencies being prioritised over individual service user needs.

Supporting dentists' health and wellbeing - workforce assets under stress: a qualitative study in England.

Background Multiple determinants influence dentists' health and wellbeing. In light of recent concerns, the aim of this research was to explore contemporary influences on dentists' health and wellbeing in England, drawing on their lived experience.Methods Semi-structured interviews were conducted with a purposive sample of dentists working in England, taking into account age, gender, career stage, work sector, geographical area, position and route of entry to registration. A topic guide, informed by the literature, was used to guide the discourse. Dentists were approached via gatekeepers, supported by snowball sampling. Interviews were recorded and transcribed for analysis. Framework analysis was used, taking an interpretative phenomenological approach to develop theory.Results Twenty dentists, from a range of backgrounds, participated in this research. While health and wellbeing was reported to be more positive among dentists in their later career, those in their early career and/or with high NHS work commitments shared concerns about their physical, psychological and emotional health. Influences ranged from macro-level issues relating to professional regulation and health systems, through meso-level, notably their workplace and job specification, to micro-level issues relating to their professional careers, relationships and personal life. Dentists highlighted ethical concerns and feeling driven to deliver, together with being demoralised by a survival culture, all leading to perceived lack of control and reduced professional fulfilment. In contrast, being able to deliver quality care, innovate and effect change, as well as being valued for their delivery, were perceived to positively contribute to general health and wellbeing.Conclusion Dentists have a vital role in providing care for patients, so there are serious public health implications if urgent action is not taken to improve and sustain their health and wellbeing. This study confirms that dentists are affected by multiple contemporary influences, and although greater support is needed for individuals, organisational, system and policy changes may be required to fully address the challenges they face.Supplementary InformationZusatzmaterial online: Zu diesem Beitrag sind unter 10.1038/s41415-021-3130-9 für autorisierte Leser zusätzliche Dateien abrufbar.

Renal staffs' understanding of patients' experiences of transition from peritoneal dialysis to in-centre haemodialysis and their views on service improvement: A multi-site qualitative study in England and Australia.

Many studies have explored patients' experiences of dialysis and other treatments for kidney failure. This is the first qualitative multi-site international study of how staff perceive the process of a patient's transition from peritoneal dialysis to in-centre haemodialysis. Current literature suggests that transitions are poorly coordinated and may result in increased patient morbidity and mortality. This study aimed to understand staff perspectives of transition and to identify areas where clinical practice could be improved. Sixty-one participants (24 UK and 37 Australia), representing a cross-section of kidney care staff, took part in seven focus groups and sixteen interviews. Data were analysed inductively and findings were synthesised across the two countries. For staff, good clinical practice included: effective communication with patients, well planned care pathways and continuity of care. However, staff felt that how they communicated with patients about the treatment journey could be improved. Staff worried they inadvertently made patients fear haemodialysis when trying to explain to them why going onto peritoneal dialysis first is a good option. Despite staff efforts to make transitions smooth, good continuity of care between modalities was only reported in some of the Australian hospitals where, unlike the UK, patients kept the same consultant. Timely access to an appropriate service, such as a psychologist or social worker, was not always available when staff felt it would be beneficial for the patient. Staff were aware of a disparity in access to kidney care and other healthcare professional services between some patient groups, especially those living in remote areas. This was often put down to the lack of funding and capacity within each hospital. This research found that continuity of care between modalities was valued by staff but did not always happen. It also highlighted a number of areas for consideration when developing ways to improve care and provide appropriate support to patients as they transition from peritoneal dialysis to in-centre haemodialysis.

Through ‘thick and thin’ as long as it is healthy: shared meanings of commitment in long-term couple relationships, whether married or not

ABSTRACT Social theorists have suggested relationship practice changes such as rising rates of nonmarital cohabitation imply external anchors are lifting with relations become increasingly individualized and fragile. These suppositions are in part based on theories of commitment which have taken conventional characteristics of marriage as a blueprint from which to compare. Reporting findings from an in-depth qualitative study in England, in this paper, what it means to be committed and how commitment is displayed within 10 long-term (15 plus years) couple relationships across forms (same-sex, opposite-sex, married, civil partnership, cohabitant) is explored. The findings challenge conventional signifiers by which cohabitants are deemed less committed than married couples. In line with the individualization thesis, couples described an importance attached to autonomy and equality. Instead of public promises for a lifetime together, sexual intimacy and financial interdependence, couples displayed commitment through mutual reciprocity. However, these' individualized' relationships were not sustained only to the extent of personal satisfaction. Moral consistency values to stick together through adversity, unless the relationship became unhealthy, signified what it meant to be committed; whether the relationship was formalized or not. Further research is needed to develop theories of commitment which better reflect the diversity of contemporary relationship practices.

‘Do the resilient things.’ Residents' perspectives on responsibilities for flood risk adaptation in England

AbstractResidents should take adaptive action to reduce flood risk—this claim increasingly resonates in the academic debate on flood risk management (FRM). Hence, it must be assumed that a change in the division of responsibilities between actors involved is an imperative, that is, beyond the public authorities, residents should become more responsible for their own flood resilience. However, residents' perspectives on their own and other's responsibility for adaptive action has not yet been explored extensively. In this contribution, we distinguish between four notions of responsibility in analysing the perspectives of residents regarding flood risk adaptation measures undertaken by public authorities, insurance companies and residents themselves. A qualitative study in England shows how residents perceive responsibilities for flood risk adaptation across the various notions and actors, including themselves. We found that residents have clear expectations and perceptions on how they think responsibility is divided among stakeholders and how they would like it to be. Additionally, the discourse on responsibility division in FRM raises questions and causes mismatches between the formal legal parameters and residents' perceptions. With the insights into residents' perceptions, opportunities arise to better inform and encourage them to take flood risk adaptation measures and thereby improve flood resilience.

How do patients and their family members experience the transition from peritoneal dialysis to incentre haemodialysis? A multisite qualitative study in England and Australia.

While numerous studies have explored the patient experience of dialysis or other end-stage kidney disease (ESKD) treatments, few have explored the process of transitioning between dialysis modalities. This study aimed to develop an in-depth understanding of patient and caregiver perceptions and experiences of the transition from peritoneal to haemodialysis (HD) and to identify ways in which transitions can be optimised. Fifty-four in-depth, semi-structured interviews were undertaken at six study sites across the West Midlands, UK (n = 23), and Queensland, Australia (n = 31). Thirty-nine participants were patients with ESKD; the remainder were family members. An inductive analytical approach was employed, with findings synthesised across sites to identify themes that transcended country differences. Of the 39 patient transitions, only 4 patients reported a wholly negative transition experience. Three cross-cutting themes identified common transition experiences and areas perceived to make a difference to the treatment transition: resistance to change and fear of HD; transition experience shared with family; and bodily adjustment and sense of self. Although each transition is unique to the individual and their circumstances, kidney care services could optimise the process by recognising these patient-led themes and developing strategies that engage with them. Kidney care services should consider ways to keep patients aware of potential future treatment options and present them objectively. There is potential value in integrating expert support before and during treatment transitions to identify and address patient and family concerns.

Perceptions of healthcare professionals and people with type 2 diabetes on emotional support: a qualitative study.

BackgroundType 2 diabetes mellitus (T2DM) is a demanding condition that impacts the person living with the condition physically and psychologically. Promoting emotional support is a key strategy to improve diabetes care.AimTo explore the views and experiences of people with T2DM and healthcare professionals (HCPs) on emotional support in diabetes care, and identify barriers and facilitators to the provision of emotional support in clinical practice.Design & settingA qualitative study in England with data collected from four focus groups.MethodFocus group discussions were conducted with people with T2DM (n = 10) and HCPs (n = 10). The analysis was informed by the framework method and principles of the constant comparative approach.ResultsEmotional support was lacking in diabetes primary care, and there was a need to normalise the emotional impact of T2DM. Barriers to emotional support included: lack of HCP confidence to discuss emotional issues; lack of counselling training; and time constraints in consultations. Inappropriate use of the word ‘depression’ creates a sense of taboo for those experiencing emotions other than depression.ConclusionConsensus between the two target groups indicated a strong need to integrate emotional support in diabetes care, and the need to support and train HCPs in addressing psychosocial aspects of T2DM. Shared language is recommended across diabetes services to appropriately refer to wellbeing. Addressing barriers and considering ways to incorporate emotional management in diabetes consultations is recommended, includings introducing HCP training to increase confidence and enhance counselling skills.

Role of primary care in supporting older adults who self-harm: a qualitative study in England.

Self-harm and suicide are major public health concerns. Self-harm is the strongest risk factor for suicide, with the highest suicide rates reported in older populations. Little is known about how older adults access care following self-harm, but they are in frequent contact with primary care. To identify and explore barriers and facilitators to accessing care within primary care for older adults who self-harm. An exploratory qualitative methods study using semi-structured interviews with older adults and third-sector workers in England. Older adults were invited to participate in one follow-up interview. Interviews occurred between September 2017 and September 2018. These were audio-recorded, transcribed verbatim, and data analysed thematically. A patient and public involvement and engagement group contributed to the study design, data analysis, and interpretation. A total of 24 interviews with nine older adults and seven support workers, including eight follow-up interviews with older adults, were conducted. Three themes emerged: help-seeking decision factors; sources of support; and barriers and facilitators to accessing primary care. Despite older adults' frequent contact with GPs, barriers to primary care existed, which included stigma, previous negative experiences, and practical barriers such as mobility restrictions. Older adults' help-seeking behaviour was facilitated by previous positive experiences. Primary care is a potential avenue for delivering effective self-harm support, management, and suicide prevention in older adults. Given the complex nature of self-harm, there is a need for primary care to work with other sectors to provide comprehensive support to older adults who self-harm.

Decision-making for active living infrastructure in new communities: a qualitative study in England.

ABSTRACTBackgroundUrban design can influence population levels of physical activity and subsequent health impacts. This qualitative study investigates local level decision-making for ‘active living’ infrastructure (ALI)—walking and cycling infrastructure and open spaces in new communities.MethodsThirty-five semi-structured interviews with stakeholders, and limited ethnographic observations, were conducted with local government and private sector stakeholders including urban and transport planners, public health practitioners, elected councillors and developers. Interview transcripts were coded and analysed thematically.ResultsPublic health practitioners in local government could act as knowledge brokers and leaders to motivate non-health stakeholders such as urban and transport planners to consider health when designing and building new communities. They needed to engage at the earliest stages and be adequately resourced to build relationships across sectors, supporting non-health outcomes such as tackling congestion, which often had greater political traction. ‘Evidence’ for decision-making identified problems (going beyond health), informed solutions, and also justified decisions post hoc, although case study examples were not always convincing if not considered contextually relevant.ConclusionWe have developed a conceptual model with three factors needed to bridge the gap between evidence and ALI being built: influential public health practitioners; supportive policies in non-health sectors; and adequate resources.

Experiences of how services supporting women with perinatal mental health difficulties work with their families: a qualitative study in England

ObjectivesPartners and wider family members play a vital role in relation to women’s perinatal mental health. Clinical guidelines in the UK and internationally recommend that services supporting women with perinatal...

Engaging \u2018hard to reach\u2019 groups in health promotion: the views of older people and professionals from a qualitative study in England

BackgroundOlder people living in deprived areas, from black and minority ethnic groups (BME) or aged over 85 years (oldest old) are recognised as ‘hard to reach’. Engaging these groups in health promotion is of particular importance when seeking to target those who may benefit the most and to reduce health inequalities. This study aimed to explore what influences them practicing health promotion and elicit the views of cross-sector professionals with experiences of working with ‘hard to reach’ older people, to help inform best practice on engagement.Methods‘Hard to reach’ older people were recruited through primary care by approaching those not attending for preventative healthcare, and via day centres. Nineteen participated in an interview (n = 15) or focus group (n = 4); including some overlaps: 17 were from a deprived area, 12 from BME groups, and five were oldest old. Cross-sector health promotion professionals across England with experience of health promotion with older people were identified through online searches and snowball sampling. A total of 31 of these 44 professionals completed an online survey including open questions on barriers and facilitators to uptake in these groups. Thematic analysis was used to develop a framework of higher and lower level themes. Interpretations were discussed and agreed within the team.ResultsOlder people’s motivation to stay healthy and independent reflected their everyday behaviour including practicing activities to feel or stay well, level of social engagement, and enthusiasm for and belief in health promotion. All of the oldest old reported trying to live healthily, often facilitated by others, yet sometimes being restricted due to poor health. Most older people from BME groups reported a strong wish to remain independent which was often positively influenced by their social network. Older people living in deprived areas reported reluctance to undertake health promotion activities, conveyed apathy and reported little social interaction. Cross-sector health professionals consistently reported similar themes as the older people, reinforcing the views of the older people through examples.ConclusionsThe study shows some shared themes across the three ‘hard-to-reach’ groups but also some distinct differences, suggesting that a carefully outlined strategy should be considered to reach successfully the group targeted.