Areas Of Socioeconomic Deprivation Research Articles

Attention deficit-hyperactivity symptoms among Palestinian children

We aimed to establish the prevalence and distribution of attention deficit-hyperactivity disorder (ADHD) symptoms and other associated comorbid mental health problems in Palestinian schoolchildren. Thus 349 children aged 6-15 years were randomly selected from 23 schools in Gaza and the West Bank and were rated by their parents and teachers using both the ADHD DSM-IV Checklist and the Strengths and the Difficulties Questionnaire, which also measures conduct and emotional problems. There was a significant agreement between parents and teachers, with 4.3% of the children rated above the established cut-off scores on both the parent and teacher DSM-IV Checklist. Male gender, family size and living in an area of socioeconomic deprivation were independently associated with ADHD symptoms.

Home blood pressure monitoring

Shah and colleagues found patients with heart failure who lived in areas of socioeconomic deprivation were less likely than those in more affluent areas to be treated with recommended beta blockers.1 We recently investigated use of home blood pressure (BP) monitoring in stroke patients registered at a deprived inner city general practice in Lambeth. In March 2008 we sent confidential postal questionnaires, backed up by a telephone call if required, to 74 patients listed on the stroke register at an inner London general practice. We excluded 57 patients in nursing homes and four patients with severe illness because of the difficulty of completing and posting questionnaires. The questions included asking patients whether they measured their BP at home and whether they were aware of their target BP. The protocol, patient information leaflet, and questionnaire were reviewed by Wandsworth Research Ethics Committee. Data were entered and analysed using SPSS (version 13).

Language abilities of secondary age pupils at risk of school exclusion: A preliminary report

In the UK, exclusions from school because of behaviour problems usually occur when other alternatives have proved unsuccessful. There is some evidence to suggest that behaviour problems and resulting school exclusions are associated with language impairment. In older children who are permanently excluded, expressive rather than receptive language impairment is more common and this is associated with increased rates of emotional problems (Ripley and Yuill, 2005). The language abilities of secondary age pupils at risk of permanent school exclusion who are still in mainstream educational provision have not yet been a focus of study. Fifteen pupils attending a mainstream secondary school located in an area of socio-economic deprivation were studied. All the pupils were at risk of permanent exclusion owing to significant behaviour problems. Measures of language and behaviour identified language difficulties in 10 of the 15 pupils, where five of these pupils had significant and severe language difficulties. In contrast, the remaining five pupils showed age-appropriate or typical language abilities. Although differences were identified in language abilities, severe behaviour problems were found in both the pupils with language difficulties and those with age-appropriate language. Mixed receptive-expressive language difficulties were more common than expressive only difficulties but these were not associated with a particular type of behaviour problem. For a high proportion of secondary age pupils at risk of permanent school exclusion, language difficulties are a factor in their behaviour problems and school exclusion. The preliminary findings are discussed with reference to the relationship between language impairment and behaviour problems, the criteria for defining language impairment in this population, the need for further research and potential implications for education and speech and language therapy.

Trends and inequities in beta-blocker prescribing for heart failure

Treatment with specific beta-blockers reduces mortality and hospitalisation in heart failure. To describe trends and inequities in beta-blocker prescribing for heart failure. Repeated cross-sectional analysis of a nationally representative primary care database (DIN-LINK). A total of 152 UK general practices. Prescribing of beta-blockers between 2000 and 2005 was examined among a yearly average of 7294 patients aged>or=50 years who had actively managed heart failure - defined as a recorded diagnosis of heart failure and two prescriptions of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker during the calendar year. The main outcome was the prescription of a guideline-recommended beta-blocker (bisoprolol, carvedilol, metoprolol, or nebivolol) in the year. Determinants of beta-blocker prescribing were analysed using logistic regression. Between 2000 and 2005, age-adjusted use of recommended beta-blockers rose from 6.1% to 27.0% in men, and from 4.2% to 21.5% in women. In 2005, younger patients were more likely to be treated; the fully adjusted odds ratio was 4.83 (95% confidence interval=3.78 to 6.17) for patients aged 60-64 years compared with those aged 85 years. Women and patients living in areas of socioeconomic deprivation were less likely to be treated. In 2005, in addition to treatment with guideline-recommended beta-blockers, a further 11.7% of men and 12.5% of women were prescribed other beta-blockers. Recommended beta-blocker use has risen in the UK but remains low and inequitable, with many patients still treated with beta-blockers that are not recommended in guidelines. This suggests further improvements in prescribing are still possible.

General practitioner empathy, patient enablement, and patient-reported outcomes in primary care in an area of high socio-economic deprivation in Scotland—A pilot prospective study using structural equation modeling

The aim of this pilot prospective study was to investigate the relationships between general practitioners (GPs) empathy, patient enablement, and patient-assessed outcomes in primary care consultations in an area of high socio-economic deprivation in Scotland. This prospective study was carried out in a five-doctor practice in an area of high socioeconomic deprivation in Scotland. Patients' views on the consultation were gathered using the Consultation and Relational Empathy (CARE) Measure and the Patient Enablement Instrument (PEI). Changes in main complaint and well-being 1 month after the contact consultation were gathered from patients by postal questionnaire. The effect of GP empathy on patient enablement and prospective change in outcome was investigated using structural equation modelling. 323 patients completed the initial questionnaire at the contact consultation and of these 136 (42%) completed and returned the follow-up questionnaire at 1 month. Confirmatory factor analysis confirmed the construct validity ofthe CARE Measure, though omission of two ofthe six PEI items was required in order to reach an acceptable global data fit. The structural equation model revealed a direct positive relationship between GP empathy and patient enablement at contact consultation and a prospective relationship between patient enablement and changes in main complaint and well-being at 1 month. In a high deprivation setting, GP empathy is associated with patient enablement at consultation, and enablement predicts patient-rated changes 1 month later. Further larger studies are desirable to confirm or refute these findings. Ways of increasing GP empathy and patient enablement need to be established in order to maximise patient outcomes. Consultation length and relational continuity of care are known factors: the benefit of training and support for GPs needs to be further investigated.

Provision of Domiciliary Dental Care in North and West Belfast

To determine the level of domiciliary care currently provided for patients by general dental practitioners (GDPs) and to investigate factors that influence the provision of domiciliary dental care in an area of high socioeconomic deprivation in North and West Belfast. A descriptive study, involving a self-administered postal questionnaire sent to GDPs (n=89) in North and West Belfast. A valid response rate of 67% was achieved. Almost 20% of responding GDPs reported that they did not routinely offer domiciliary dental care. Of those who did, prosthetic treatment was undertaken most commonly, and other more time-consuming treatments such as fillings were referred to the Community Dental Services (CDS). Many GDPs reported not having a full range of domiciliary equipment, with only half of the GDPs surveyed carrying emergency drugs. Reasons cited for not providing the service were lack of time, the perception that patients would be too difficult to manage, and not having the appropriate equipment. The majority of responding dentists (85%) felt that domiciliary care should be referred to the community service. The rate of domiciliary care provision in North and West Belfast appears to be falling, despite it being an area of high socioeconomic deprivation where the demand for the service is growing. The general perception was that domiciliary care is too time-consuming, that the patients are too difficult to manage, and that there was a lack of appropriate equipment. As a result, the majority of GDPs in North and West Belfast felt that the CDS should care for all domiciliary patients.

Working with schools in deprived areas to raise aspirations for medicine and other healthcare science careers

Educational attainment is inversely related to socio-economic status. The achievement gap widens as children progress through the system. Take up of science options is particularly poor and difficulties are compounded by lack of relevant science-based work experience in deprived areas. The interaction of these factors is examined in some detail in an area of socio-economic deprivation. High attainment in sciences is usually considered a core requirement for acceptance into medicine and widening access to medicine for school leavers is therefore very difficult in these circumstances. A partnership between hospitals and local schools, including science-based work placements, is described. Cooperation between the NHS and schools by provision of work experience and teaching materials could help to address these issues as well as potential staffing difficulties in other healthcare science careers in the future. Expenditure can be justified on the grounds of known links between health, education and employment.

Children from low‐income families have less access to sports facilities, but are no less physically active: cross‐sectional study (EarlyBird 35)

Rising levels of childhood obesity have led to an increasing number of Government sponsored initiatives attempting to stem the problem. Much of the focus to date has been on physical activity and out-of-school activity in particular. There is an assumption that children from low-income families suffer most where there is a lack of structured physical education in school. Accordingly, provision of additional facilities for sport and other forms of active recreation tend to target areas of socio-economic deprivation. We have assessed the relationship between parental income, the use of out-of-school sports facilities and the overall physical activity of young children across a wide socio-economic range. Total weekly physical activity was measured, objectively, over 7 days both at 7 years and 8 years in a healthy cohort of 121 boys and 93 girls using actigraph accelerometers. Questionnaires were used to establish parental income and parents reported the child's weekly use of out-of-school facilities for structured physical activity. Children from low-income families attended significantly fewer sessions of structured out-of-school activities than those from wealthier families (r = 0.39), with a clear dose-response relationship across income groups. Nevertheless, total physical activity, measured objectively over seven continuous days, showed no relationship between parental income and the mean activity level of the children (r = -0.08). Nor did we find a relationship between parental income and time spent in higher intensity activity (r = -0.04). Social inequality appears to have little impact on physical activity in young children. Those from poorer families make less use of facilities for structured activity out-of-school but they nevertheless record the same overall level of activity as others. What they lack in opportunity they appear to make up in the form of unstructured exercise. Improving provision for sport may not lead to the expected rise in activity levels in young children.

The impact of a community food initiative in changing the ‘food culture’ of a community: a focus on mothers with young children in Skelmersdale, West Lancashire

The link between a nutritionally-poor diet and the development of chronic disease is well established (1) . The incidence of such disease is of particular concern amongst population groups in areas of high socio-economic deprivation (2) . Community-based initiatives (CBI) have been gaining in popularity as a method to direct health promotion efforts at low-income populations (3) . Evaluation of food and health CBI has focused in the main on intended outcomes. The opportunity to examine unintended outcomes and the mechanisms and triggers that make an intervention successful could be increasingly valued as part of the evaluation design. The present research aims to examine the role and outcomes of a community-based food and health intervention in relation to processes of behavioural change and to broader socio-economic influences. This objective is examined from both client- and non-client-based perspectives using mothers with young children as the focus. The methodology is informed by social research and takes a phenomenological approach using ethnographic data-recording techniques (4) . This combined stance is taken in order to reflect both nutritional and social (community development) outcomes of the intervention. Incorporating non-clients allows the evaluation to account for the key influences, enablers and barriers for participants and, importantly for public health research, to determine how much of any change is socially driven, i.e. any ‘background noise’. Early analysis of findings relating to clients indicates the importance of individual capacity (self-efficacy) and problem-solving capabilities for engaging in healthy eating patterns, resulting from addressing a number of common barriers in this population. The comparison with non-clients has brought to light the complex and contending influences involved in food choice, and thus far has enabled an understanding of a ‘hierarchy of influences’ for mothers of young children (Figure).

Socioeconomic Deprivation and Extended Hospitalization in Severe Mental Disorder: A Two-Year Follow-Up Study

Socioeconomic Deprivation and Extended Hospitalization in Severe Mental Disorder: A Two-Year Follow-Up Study

Peer-mentoring for first-time mothers from areas of socio-economic disadvantage: A qualitative study within a randomised controlled trial

BackgroundNon-professional involvement in delivering health and social care support in areas of socio-economic deprivation is considered important in attempting to reduce health inequalities. However, trials of peer mentoring programmes have yielded inconsistent evidence of benefit: difficulties in implementation have contributed to uncertainty regarding their efficacy. We aimed to explore difficulties encountered in conducting a randomised controlled trial of a peer-mentoring programme for first-time mothers in socially disadvantaged areas, in order to provide information relevant to future research and practice. This paper describes the experiences of lay-workers, women and health professionals involved in the trial.MethodsThematic analysis of semi-structured interviews with women (n = 11) who were offered peer mentor support, lay-workers (n = 11) who provided mentoring and midwives (n = 2) who supervised the programme, which provided support, from first hospital antenatal visit to one year postnatal. Planned frequency of contact was two-weekly (telephone or home visit) but was tailored to individuals' needs.ResultsDespite lay-workers living in the same locality, they experienced difficulty initiating contact with women and this affected their morale adversely. Despite researchers' attempts to ensure that the role of the mentor was understood clearly it appeared that this was not achieved for all participants. Mentors attempted to develop peer-mentor relationships by offering friendship and sharing personal experiences, which was appreciated by women. Mentors reported difficulties developing relationships with those who lacked interest in the programme. External influences, including family and friends, could prevent or facilitate mentoring. Time constraints in reconciling flexible mentoring arrangements with demands of other commitments posed major personal difficulties for lay-workers.ConclusionDifficulties in initiating contact, developing peer-mentor relationships and time constraints pose challenges to delivering lay-worker peer support. In developing such programmes, awareness of potential difficulties and of how professional support may help resolve these should improve uptake and optimise evaluation of their effectiveness.Trial Registration Number: ISRCTN55055030

Introduction of shared electronic records: multi-site case study using diffusion of innovation theory

Objective To explore the introduction of a centrally stored, shared electronic patient record (the summary care record (SCR)) in England and draw wider lessons about the implementation of large scale...

Designing school programmes to be effective vehicles for changing oral hygiene behaviour

Schools are a commonly used setting for dental health education, health promotion and interventions with preventive agents. However, traditional dental health education programmes are rarely designed to be effective change agents. Twice daily tooth brushing with fluoride toothpaste has consistently been shown to be an important behaviour for controlling dental caries in children. Ideally, parents incorporate twice daily brushing into their child’s hygiene routine. Families where brushing is irregular are over-represented in areas of socio-economic deprivation and the effects of irregular oral hygiene are often compounded by cariogenic diets. Therefore, in communities with high caries levels, a targeted community approach to prevention can provide additional benefit, through fluoride programmes delivered in school. It is essential that dental health education programmes are designed to recognise the social, cultural and environmental context in which the behaviours occur. This paper provides a new framework to classify school programmes. In addition, evidence-based guidance is developed of the necessary components for programmes to enhance effectiveness in establishing the key behaviour of twice-daily tooth brushing with fluoridated toothpaste.

Involving deprived communities in improving the quality of primary care services: does participatory action research work?

BackgroundParticipation by communities in improving the quality of health services has become a feature of government policy in the United Kingdom. The aim of the study was to involve a deprived community in the UK in shaping quality improvements of local primary care services. The specific objectives were firstly to create participation by local people in evaluating the primary care services available in the area and secondly to bring about change as a result of this process.MethodsThe methods of participatory action research was used. The study was set in an area of high socio-economic deprivation served by a 'Local Health Care Co-operative' in a peripheral housing estate in Glasgow, Scotland. 72 local residents took part in 11 focus groups: eight of these were with community groups and three with other residents. 372 local residents completed questionnaires either by brief face-to-face interviews (114) or by self or carer completion (258).ResultsThe study group produced recommendations on physical access to the health centre, time constraints in accessing services and problems encountered in individual relationships with health staff. They also highlighted the social gap between health service providers and the daily life of community residents. Action was taken to bring these recommendations to the attention of the Primary Care Organisation.ConclusionParticipatory action research was used to involve a deprived community in the UK in a 'bottom-up' approach aimed at improving quality of local primary care services. Although successful in creating a partnership between academic researchers and lay researchers and participation by local people in evaluating the primary care services available in the area, the impact of the study in terms of immediate action taken over specific issues has been modest. The possible reasons for this are discussed.

Social deprivation and hand injury

This study investigated the relationship between socioeconomic deprivation and the incidence, patterns of injury, process of care and outcome of hand trauma using data collected prospectively on 1234 injuries presented during six months. The Index of Multiple Deprivation 2004 was derived from census data and postcodes. Socioeconomic deprivation is significantly associated with hand trauma. The odds ratio for suffering hand injuries in the most deprived quintile is 1.6 (SE 0.09 95% CI 1.45, 1.83) compared to the least deprived quintile. This is most marked among older children and adults. Fractures, sprains and ligament injuries showed the strongest association with the degree of deprivation. Injuries related to sport were not associated with deprivation. Surgical time utilised is greater in more deprived patients and their self reported physical outcome is worse. Hand surgery units working in areas of high socioeconomic deprivation will have higher trauma workloads and unit costs. Social deprivation may also influence physical outcomes.

Quality in general practice consultations; a qualitative study of the views of patients living in an area of high socio-economic deprivation in Scotland.

BackgroundInequality in health and health care services is an important policy issue internationally as well as in the UK, and is closely linked to socio-economic deprivation, which in Scotland is concentrated in and around Glasgow. Patients views on primary care in deprived areas are not well documented. In the present study we explore the views of patients living in a high deprivation area on the quality of consultations in general practice.MethodsQualitative focus group study set in an area of high socio-economic deprivation in a large peripheral housing estate in Glasgow, Scotland. 11 focus groups were conducted; 8 with local community groups and 3 with other local residents. In total 72 patients took part. Grounded theory was used to analyse the data.ResultsPatients' perceptions of the quality of the consultation with GPs consisted of two broad, inter-relating themes; (1) the GPs' competence, and (2) the GPs empathy or ' caring'. Competence was often assumed but many factors coloured this assumption, in particular whether patients had experienced (directly or indirectly with a close family member) 'successful' outcomes with that doctor previously or not. 'Caring' related to patients feeling (a) listened to by the doctor and being able to talk; (b) valued as an individual by the doctor (c) that the doctor understood 'the bigger picture', and (d) the doctors' explanations were clear and understandable.Relational continuity of care (being able to see the same GP and having a good relationship), and having sufficient time in the consultation were closely linked with perceptions of consultation quality.ConclusionPatients from deprived areas want holistic GPs who understand the realities of life in such areas and whom they can trust as both competent and genuinely caring. Without this, they may judge doctors as socially distant and emotionally detached. Relational continuity, empathy and sufficient time in consultations are key factors in achieving this.

‘Creating a safety net’: Women's experiences of antenatal depression and their identification of helpful community support and services during pregnancy

Objective to explore the feelings of depression during pregnancy of a local sample of women living in an area of socio-economic deprivation, and to identify the support mechanisms that they report as personally or potentially helpful for antenatal depression. Design a retrospective study using a qualitative approach, informed by constructivism, to explore the participants’ individual experiences of depression during pregnancy. Data were collected via tape-recorded semi-structured interviews. Setting a socio-economically deprived area in North London, UK, identified as a Sure Start Local Programme providing local services specifically designed for socially disadvantaged families with children aged 0–4 years. Participants a self-selected sample of nine women aged 23–40 years, from a variety of ethnic backgrounds, who retrospectively admitted to feeling low or depressed during pregnancy. All the participants had had a baby more than 6 weeks previously and less than 1 year before the start of the study. Findings despite different cultural and ethnic backgrounds, the participants shared similar feelings of emotional isolation that seemed to contribute largely to their experience of antenatal depression. Partner support (or lack of it) seemed to be crucial to the women's psychological well-being during pregnancy. For some of these women, the research interview was the first opportunity to talk about their needs and feelings during pregnancy. Potentially helpful mechanisms for support were identified by the participants and were judged to be relatively simple to introduce, involving connecting with other women via peer support and having ‘somewhere to go’ to meet others during pregnancy. Implications for practice some women do not disclose their feelings of depression during pregnancy, with potentially damaging effects on both the family and the baby. Feelings of loss and emotional isolation may occur, which could be partly alleviated by providing models of midwifery care that offer continuity of carer. Isolated and vulnerable women require increased midwifery resources, and partners may also have particular needs for support and adjustment, which currently remain unmet and need further research. Many ‘low tech’ interventions aimed at supporting women with antenatal depression could be developed, including peer support, which may offer realistic models of social capital and community empowerment in the new Children's Centres in England and Wales.

A pilot Internet "Value of Health" Panel: recruitment, participation and compliance

ObjectivesTo pilot using a panel of members of the public to provide preference data via the InternetMethodsA stratified random sample of members of the general public was recruited and familiarised with the standard gamble procedure using an Internet based tool. Health states were perdiodically presented in "sets" corresponding to different conditions, during the study. The following were described: Recruitment (proportion of people approached who were trained); Participation (a) the proportion of people trained who provided any preferences and (b) the proportion of panel members who contributed to each "set" of values; and Compliance (the proportion, per participant, of preference tasks which were completed). The influence of covariates on these outcomes was investigated using univariate and multivariate analyses.ResultsA panel of 112 people was recruited. 23% of those approached (n = 5,320) responded to the invitation, and 24% of respondents (n = 1,215) were willing to participate (net = 5.5%). However, eventual recruitment rates, following training, were low (2.1% of those approached). Recruitment from areas of high socioeconomic deprivation and among ethnic minority communities was low. Eighteen sets of health state descriptions were considered over 14 months. 74% of panel members carried out at least one valuation task. People from areas of higher socioeconomic deprivation and unmarried people were less likely to participate. An average of 41% of panel members expressed preferences on each set of descriptions. Compliance ranged from 3% to 100%.ConclusionIt is feasible to establish a panel of members of the general public to express preferences on a wide range of health state descriptions using the Internet, although differential recruitment and attrition are important challenges. Particular attention to recruitment and retention in areas of high socioeconomic deprivation and among ethnic minority communities is necessary. Nevertheless, the panel approach to preference measurement using the Internet offers the potential to provide specific utility data in a responsive manner for use in economic evaluations and to address some of the outstanding methodological uncertainties in this field.

A model for widening access into medicine and dentistry: the SAMDA-BL project

To assess whether assistance with and/or advice on the UK Universities & Colleges Admissions Service (UCAS) application process by undergraduate medical and dental students increases the offer rate to applicants from educational institutions situated in areas of socio-economic deprivation for medical and dental courses. A sample of 42 students making 172 applications in 2001 and another sample of 40 students making 158 applications in 2002 from 4 further education and sixth form colleges across East London were entered into the study. Applicants were either offered advice and assistance with writing their personal statement and extra curricular activities, such as work experience (group A) or advice only on the importance of the personal statement and extra curricular activities (group B). Applicants were also assisted with or advised to submit their applications early. All applicants were offered mock interviews. Main outcome measures The number of offers made to applicants by medical and dental schools and the dates of offered interviews. The total offer rate rose from 9% (preceding 4 years) to 38% (CI 25-51%, P < 0.05) in 2001 and 44% (CI 27-61%, P < 0.05) in 2002, confirming a rising trend in offers to applicants in group A. Applicants who were only advised on the importance of the personal statement and extra curricular activities (group B) showed smaller increases, ranging from 10% to 29% for 2001 and from 28% to 37% for 2002. The dates for the offered interviews were earlier in group A than group B. Undergraduate students can help applicants to medical and dental schools from socio-economically deprived areas submit earlier, improved UCAS applications and provide interview practice, all of which are associated with a higher offer rate. Applicants benefit from advice on activities such as work experience, community work and personal interests, but assistance in organising such activities increases the offer rate more. The study was conducted during a period of time when there was an increase in the number of medical school places available. Therefore, more research is needed to confirm that such assistance can increase applicants' offer rates elsewhere, particularly applications from students who traditionally would not apply for medicine or dentistry.

What Happens When GPs Proactively Prescribe NRT Patches in a Disadvantaged Community

The high prevalence of smoking in disadvantaged communities gives serious cause for concern in terms of adverse effects on health and social outcomes. In Scotland, smoking -related lung cancer rates are particularly high and compare less favourably with the rest of the U.K. and Europe. GPs are increasingly being recognised as having an important role in smoking cessation and are allowed to prescribe NRT to those on a low income. This study aimed to follow up a group patientsfrom a disadvantaged area who had been prescribed nicotine patches by their GP. An initial self-complete questionnaire gathered details on age, sex, motivation, marital status, employment history, contact with other smokers, concern about weight gain, and nicotine dependence. (Nicotine dependence was assessed by using the Fagerstrom Test). Follow up was carried out at three months after commencing NRT prescription. Data was also gathered from patient case notes as to whether the participant had a smoking-related diagnosis, periods of depression, drug and/or alcohol problems. Outcome was measured in terms of "smoke the same", "smoke less" and "stopped". The statistical methods used for testing each factor against smoking were Spearman rank correlation, chi-squared test for trend and Kruskal-Wallis test. Basic descriptive statistics were used to report general outcomes of the study. The study enrolled 120 patients but 19 were lost to follow up. Out of 101 who used their prescription, 35 were smoking the same, 46 were smoking less and 20 had stopped. The variables most strongly affecting outcome were age, with older smokers having more success (p < 0.001), and those who had a diagnosis of depression having a worse outcome in terms of smoking cessation (p < 0.05). This study's findings indicate that encouraging GPs to take a proactive approach in prescribing NRT is effective, even in an area of socio-economic deprivation, and particularly with older smokers.