Now showing 1 - 10 of 19
  • Publication
    Factors that influence family and parental preferences and decision making for unscheduled paediatric healthcare: a systematic review protocol
    There is a plethora of factors that dictate where parents and families choose to seek unscheduled healthcare for their child; and the complexity of these decisions can present a challenge for policy makers and healthcare planners as these behaviours can have a significant impact on resources in the health system. The systematic review will seek to identify the factors that influence parents' and families' preferences and decision making when seeking unscheduled paediatric healthcare.  Five databases will be searched for published studies (CINAHL, PubMed, SCOPUS, PsycInfo, EconLit) and grey literature will also be searched. Inclusion and exclusion criteria will be applied and articles assessed for quality. A narrative approach will be used to synthesise the evidence that emerges from the review. By collating the factors that influence decision-making and attendance at these services, the review can inform future health policies and strategies seeking to expand primary care to support the provision of accessible and responsive care. The systematic review will also inform the design of a discrete choice experiment (DCE) which will seek to determine parental and family preferences for unscheduled paediatric healthcare. Policies such as Sláintecare that seek to expand primary care and reduce hospital admissions from emergency departments need to be cognisant of the nuanced and complex factors that govern patients' behaviour.
  • Publication
    Contact tracing during the COVID-19 outbreak: a protocol for enabling rapid learning from experiences and exploring the psychological impact on contact tracers
    Background: Given the unprecedented nature of the COVID-19 pandemic, the Irish health system required the redeployment of public sector staff and the recruitment of dedicated contact tracing staff in the effort to contain the spread of the virus. Contact tracing is crucial for effective disease control and is normally a role carried out by public health teams. Contact tracing staff are provided with rapid intensive training but are operating in a dynamic environment where processes and advice are adapting continuously. Real-time data is essential to inform strategy, coordinate interconnected processes, and respond to needs. Given that many contact tracers have been newly recruited or redeployed, they may not have significant experience in healthcare and may experience difficulties in managing the anxieties and emotional distress of members of the public. Aim: This research aims to: (i) identify emerging needs and issues and feed this information back to the Health Service Executive for updates to the COVID-19 Contact Management Programme (CMP); (ii) understand the psychological impact on contact tracers and inform the development of appropriate supports. Methods: We will use a mixed-methods approach. A brief online survey will be administered at up to three time points during 2021 to measure emotional exhaustion, anxiety, general health, and stress of contact tracing staff, identify tracing systems or processes issues, as well as issues of concern and confusion among the public. Interviews will also be conducted with a subset of participants to achieve a more in-depth understanding of these experiences. Observations may be conducted in contact tracing centres to document processes, practices, and explore any local contextual issues. Impact: Regular briefs arising from this research with data, analysis, and recommendations will aim to support the work of the CMP to identify problems and implement solutions. We will deliver regular feedback on systems issues; challenges; and the psychological well-being of contact tracing staff.
  • Publication
    A Rapid Realist Review of Group Psychological First Aid for Humanitarian Workers and Volunteers
    Humanitarian workers are at an elevated risk of occupational trauma exposure and its associated psychological consequences, and experience increased levels of anxiety, depression, and post-traumatic stress disorder (PTSD) compared to the general population. Psychological first aid (PFA) aims to prevent acute distress reactions from developing into long-term distress by instilling feelings of safety, calmness, self- and community efficacy, connectedness and hope. Group PFA (GPFA) delivers PFA in a group or team setting. This research sought to understand ‘What works, for whom, in what context, and why for group psychological first aid for humanitarian workers, including volunteers?’ A rapid realist review (RRR) was conducted. Initial theories were generated to answer the question and were subsequently refined based on 15 documents identified through a systematic search of databases and grey literature, in addition to the inputs from a core reference panel and two external experts in GPFA. The findings generated seven programme theories that addressed the research question and offered consideration for the implementation of GPFA for the humanitarian workforce across contexts and age groups. GPFA enables individuals to understand their natural reactions, develop adaptive coping strategies, and build social connections that promote a sense of belonging and security. The integrated design of GPFA ensures that individuals are linked to additional supports and have their basic needs addressed. While the evidence is sparce on GPFA, its ability to provide support to humanitarian workers is promising.
      112Scopus© Citations 4
  • Publication
    The co-design, implementation and evaluation of a serious board game ‘PlayDecide patient safety’ to educate junior doctors about patient safety and the importance of reporting safety concerns
    Background: We believe junior doctors are in a unique position in relation to reporting of incidents and safety culture. They are still in training and are also ‘fresh eyes’ on the system providing valuable insights into what they perceive as safe and unsafe behaviour. The aim of this study was to co-design and implement an embedded learning intervention – a serious board game – to educate junior doctors about patient safety and the importance of reporting safety concerns, while at the same time shaping a culture of responsiveness from senior medical staff. Methods: A serious game based on the PlayDecide framework was co-designed and implemented in two large urban acute teaching hospitals. To evaluate the educational value of the game voting on the position statements was recorded at the end of each game by a facilitator who also took notes after the game of key themes that emerged from the discussion. A sample of players were invited on a voluntary basis to take part in semi-structured interviews after playing the game using Flanagan’s Critical Incident Technique. A paper-based questionnaire on ‘Safety Concerns’ was developed and administered to assess pre-and post-playing the game reporting behaviour. Dissemination workshops were held with senior clinicians to promote more inclusive leadership behaviours and responsiveness to junior doctors raising of safety concerns from senior clinicians. Results: The game proved to be a valuable patient safety educational tool and proved effective in encouraging deep discussion on patient safety. There was a significant change in the reporting behaviour of junior doctors in one of the hospitals following the intervention. Conclusion: In healthcare, limited exposure to patient safety training and narrow understanding of safety compromise patients lives. The existing healthcare system needs to value the role that junior doctors and others could play in shaping a positive safety culture where reporting of all safety concerns is encouraged. Greater efforts need to be made at hospital level to develop a more pro-active safe and just culture that supports and encourages junior doctors and ultimately all doctors to understand and speak up about safety concerns.
      284Scopus© Citations 11
  • Publication
    Factors that influence clinicians' decisions to offer intravenous alteplase in acute ischaemic stroke patients with uncertain treatment indication: results of a discrete choice experiment
    Background: Treatment with intravenous (IV) alteplase for eligible patients with acute ischemic stroke is underused and treatment rates vary across the UK. This study sought to elucidate factors influencing variation in clinicians' decision-making about this thrombolytic treatment. Methods: A discrete choice experiment (DCE) using hypothetical patient vignettes framed around areas of clinical uncertainty was conducted with UK-based clinicians. Mixed logit regression analyses were conducted on the data. Results: 138 clinicians completed the DCE. Seven patient factors were individually predictive of increased likelihood of immediately offering IV alteplase (compared to reference levels in brackets): stroke onset time 2 hours 30 minutes [50 minutes]; pre-stroke dependency mRS 3 [mRS 4]; systolic blood pressure 185mm/Hg [140mm/Hg]; stroke severity scores of NIHSS 5 without aphasia, NIHSS 14 and NIHSS 23 [NIHSS 2 without aphasia]; age 85 [68]; Afro-Caribbean [white]. Factors predictive of withholding treatment with IV alteplase were: age 95 [68]; stroke onset time of 4 hours 15 minutes [50 minutes]; severe dementia [no memory problems]; SBP 200mm/Hg [140 mm/Hg]. Three clinician-related factors were predictive of an increased likelihood of offering IV alteplase (perceived robustness of the evidence for IV alteplase; thrombolysing more patients in the past 12 months; and high discomfort with uncertainty) and one with a decreased likelihood (high clinician comfort with treating patients outside the licencing criteria). Conclusions: Both patient and clinician-related factors have a major influence on the use of alteplase to treat patients with acute ischaemic stroke. Clinicians' views of the evidence, comfort with uncertainty and treating patients outside the licence criteria are important factors to address in programmes that seek to reduce variation in care quality about treatment with IV alteplase. Further research is needed to further understand differences in clinical decision-making about treating patients with acute ischaemic stroke with IV alteplase.
      183Scopus© Citations 9
  • Publication
    Factors that predict consumer acceptance of enriched processed meats
    The study aimed to understand predictors of consumers' purchase intention towards processed meat based functional foods (i.e. enriched processed meat). A cross-sectional survey was conducted with 486 processed meat consumers in spring 2016. Results showed that processed meats were perceived differently in healthiness, with sausage-type products perceived less healthy than cured meat products. Consumers were in general more uncertain than positive about enriched processed meat but differences existed in terms of the attitudes and purchase intention. Following regression analysis, consumers' purchase intention towards enriched processed meat was primarily driven by their attitudes towards the product concept. Perceived healthiness of existing products and eating frequency of processed meat were also positively associated with the purchase intention. Other factors such as general food choice motives, socio-demographic characteristics, consumer health and the consumption of functional foods and dietary supplements in general, were not significant predictors of the purchase intention for enriched processed meat.
  • Publication
    A systematic review and narrative synthesis of the experiences of caring for older people living with dementia in sub-Saharan Africa
    (University of York, 2019-06-24) ; ;
    The broad review question will be: What are the experiences of caring for older people with dementia in sub-Saharan Africa (SSA)?
  • Publication
    “To stop #FGM it is important to involve the owners of the tradition aka men”: An Exploratory Analysis of Social Media Discussions on Female Genital Mutilation
    (Centre for Democracy, Research and Development, 2020-02-06) ; ;
    Female genital mutilation (FGM) remains a significant public health challenge and affects the lives of a million girls and women. Advocacy by men and their involvement in fighting the practice may influence the intention to have it performed; however, men often lack the opportunities and support to voice their stand. Increasingly, social media platforms are becoming effective and culturally relevant communication channels to engage ‘hard-to-reach’ populations on sensitive topics. This study explored the views on the involvement of men in discussions about FGM on Twitter. Data were obtained from Twitter-based activity for February 5th and 6th 2017 to coincide with the International Day of Zero Tolerance for FGM using the search terms ‘FGM and Men’. Thematic data analysis was conducted using a data- driven inductive approach and resulted in four main themes a) Prevailing attitudes of FGM b) Support for FGM c) FGM is an issue for men and d) Strategies to effect change. Our study suggests that men can play a role in the continuation of FGM but can also rally the abandonment of the practice. However, men were considered disengaged from the issue as most consider FGM a woman’s issue. The need to empower men through health literacy was deemed particularly influential in creating awareness and ultimately change. Young men may, in certain contexts, be important agents of change and male musicians or sportsmen may particularly be influential in effecting change. Our findings demonstrate that increased use and involvement of ‘hard to reach’ populations with social media can offer a window into real-time ongoing discussions of sensitive topics like FGM. Exploring the use of social media platforms and the content of the discussions among these populations can offer valuable insights of their perspectives on where change is needed in terms of designing effective interventions.
  • Publication
    Impact of organisational change for leaders in mental health
    (Emerald Publishing, 2018-10-31) ; ;
    Purpose – The purpose of this paper is to examine the impact of organisational and structural change on the evolution of quality and safety in health organisations, specifically in mental health services. Design/methodology/approach – Data were gathered through semi-structured interviews. In total, 25 executive management team members in both public and private mental health services were interviewed and data were analysed using Burnard’s framework. Findings – Three overarching themes emerged: organisational characteristics, leadership and accountability; sustaining collaboration and engagement with stakeholders; and challenges to and facilitators of quality and safety. Taken together, the findings speak to the disruptive and disorienting impact of on-going organisational change and restructuring on leaders’ ability to focus on, and advance, the quality and safety agenda. Research limitations/implications – Typical with qualitative research of this nature, the potentially limited generalisability of the findings must be acknowledged. Practical implications – There is a need for strategies to implement change that are informed by evidence and theory and informed by decades of research on this topic, rather than introduced ad hoc. Change agents must pair effective change management and implementation science strategies to specific contexts, depending on what is being implemented and ensure appropriate evaluation of organisational change to bolster the evidence base around quality and safety and inform future decision-making. Originality/value – The study explores an identified gap in the literature on the impact of on-going organisational re-structuring and transformation on the evolution of quality and safety in mental health services.
      849Scopus© Citations 5
  • Publication
    PReSaFe: a model of barriers and facilitators to patients providing feedback on experiences of safety
    Objective: The importance of involving patients in reporting on safety is increasingly recognised. Whilst studies have identified barriers to clinician incident reporting, few have explored barriers and facilitators to patient reporting of safety experiences. This paper explores patient perspectives on providing feedback on safety experiences. Design/Participants: Patients (n=28) were invited to take part in semi-structured interviews when given a survey about their experiences of safety following hospital discharge. Transcripts were thematically analysed using NVivo10. Setting: Patients were recruited from four hospitals in the UK. Results: Three themes were identified as barriers and facilitators to patient involvement in providing feedback on their safety experiences. The first, cognitive-cultural, found that whilst safety was a priority for most, some felt the term was not relevant to them because safety was the ‘default’ position, and/or because safety could not be disentangled from the overall experience of care. The structural-procedural theme indicated that reporting was facilitated when patients saw the process as straightforward, but that disinclination or perceived inability to provide feedback was a barrier. Finally, learning and change illustrated that perception of the impact of feedback could facilitate or inhibit reporting. Conclusions: When collecting patient feedback on experiences of safety, it is important to consider what may help or hinder this process, beyond the process alone. We present a staged model of prerequisite barriers and facilitators, and hypothesise that each stage needs to be achieved for patients to provide feedback on safety experiences. Implications for collecting meaningful data on patients' safety experiences are considered.                  
      231Scopus© Citations 18