Health literacy profiles of final year pre-service teachers in two initial education programs compared with the general population: A cross-sectional study using the Health Literacy Questionnaire

ISSUE ADDRESSED

Health literacy (HL) can be developed throughout the lifespan starting from the early years highlighting that educational institutions, curriculum and teachers are powerful settings, places and people that can foster HL in youth. Current research shows that Australian teachers need more support to teach health education that promotes students' HL, with limited research focusing on pre-service teachers (PST). This study aims to identify the HL strengths and challenges of PST at one Australian university across two initial teacher education programs (HPE and primary) and compare their health literacy profiles with that of the Australian general population.

METHODS

The Health Literacy Questionnaire (HLQ) was administered in March and April, 2022 to measure HL in Australian PST. The research setting was a university in Sydney, Australia, with two of the University's undergraduate initial teacher education (ITE) programs (Health and Physical Education [HPE] and Primary). Of the 24 PST in the HPE cohort, 23 consented. Of the 70 PST in the Primary cohort, 34 consented. The results were compared with Australian Bureau of Statistics data.

RESULTS

The participants' median age was 22.3(4.3) years (SD), age ranged from 20 to 54 years, with 36% of participants under the age of 22 years. When comparing the PST data with the general population there were two significant differences: (1) PST scored significantly higher than the general population for Domain 4 (Social support for health, 3.41 vs. 3.19; p < 0.001; d = 0.57); and (2) the PST scored significantly lower for Domain 9 (Understand health information enough to know what to do, 4.02 vs. 4.27; p < 0.01; d = -0.43). In addition, we found that primary PST had significantly lower scores for domains 5-9 (demonstrative of interactive and critical HL), compared with the general Australian population.

CONCLUSIONS

Findings show that PST strengths are that they perceive that there they are able to access social support for health, however the PST find it more difficult to analyse and apply health information, compared with the general Australian population. SO WHAT?: Further understanding of health literacy profiles of Australian PST should influence the design of ITE programs and its health education curricular to ensure that PST are able to further develop their HL understandings and capabilities.

Medical student experiences of equality, diversity, and inclusion: content analysis of student feedback using Bronfenbrenner's ecological systems theory

BACKGROUND

Issues relating to equality, diversity, and inclusion (EDI) significantly impact on medical student achievement and wellbeing. Interventions have been introduced at curricular and organisational levels, yet progress in addressing these issues remains limited. Timely evaluation is needed to assess effectiveness of interventions, and to explore issues and interactions in learning environments impacting on student experience. We introduced an anonymous question concerning students' experiences of EDI into routine online student feedback questionnaires, to scope the nature of ongoing issues and develop greater understanding of students' experiences in our programme environment. Ecological systems theory, which conceptualizes learning as a function of complex social interactions, determined by characteristics of individual learners and their environment, provides a framework for understanding.

METHODS

Free-text responses regarding experiences of EDI gathered over 20 months from all programme years (n = 760) were pooled for analysis, providing a holistic overview of experiences in the learning environment. A counting exercise identified broad categories reported by students. Content analysis of the qualitative dataset was undertaken. Bronfenbrenner's ecological systems theory was applied as a framework to demonstrate interdependencies between respondents' experiences and environments, and associated impacts.

RESULTS

Three hundred and seventy-six responses were received relating to wide-ranging EDI issues, most frequently gender or ethnicity. Responses mapped onto all areas of the ecological systems model, with frequent links between subsystems, indicating considerable complexity and interdependencies. Interpersonal interactions and associated impacts like exclusion were frequently discussed. Differential experiences of EDI-related issues in medical school compared to clinical settings were reported. Impacts of institutional leadership and wider societal norms were considered by respondents. Respondents discussed their need for awareness of EDI with reference to future professional practice.

CONCLUSIONS

Implementation of a regular free-text evaluation question allowed data-gathering across cohorts and throughout several stages of the curriculum, illuminating student experience. Connections established demonstrated intersectionality, and how environment and other factors interact, impacting on student experiences. Students experience EDI-related issues on multiple levels within the educational environment, with consequent impacts on learning. Any successful approach towards tackling issues and promoting equity of opportunity for all requires multi-level actions and widespread culture change. Students can offer fresh and distinct perspectives regarding change needed, to complement and diversify perspectives provided by staff and organisational leadership. Student voice should be enabled to shape change.

Effects of Resistance Training on Academic Outcomes in School-Aged Youth: A Systematic Review and Meta-Analysis

BACKGROUND

The primary aim of our systematic review and meta-analysis was to investigate the effect of resistance training on academic outcomes in school-aged youth.

METHODS

We conducted a systematic search of six electronic databases (CINAHL Complete, PsycINFO, SCOPUS, Ovid MEDLINE, SPORTDiscus and EMBASE) with no date restrictions. Studies were eligible if they: (a) included school-aged youth (5-18 years), and (b) examined the effect of resistance training on academic outcomes (i.e., cognitive function, academic achievement, and/or on-task behaviour in the classroom). Risk of bias was assessed using the appropriate Cochrane Risk of Bias Tools, funnel plots and Egger's regression asymmetry tests. A structural equation modelling approach was used to conduct the meta-analysis.

RESULTS

Fifty-three studies were included in our systematic review. Participation in resistance training (ten studies with 53 effect sizes) had a small positive effect on the overall cognitive, academic and on-task behaviours in school-aged youth (standardized mean difference (SMD) 0.19, 95% confidence interval (CI) 0.05-0.32). Resistance training was more effective (SMD 0.26, 95% CI 0.10-0.42) than concurrent training, i.e., the combination of resistance training and aerobic training (SMD 0.11, 95% CI - 0.05-0.28). An additional 43 studies (including 211 effect sizes) examined the association between muscular fitness and cognition or academic achievement, also yielding a positive relationship (SMD 0.13, 95% CI 0.10-0.16).

CONCLUSION

This review provides preliminary evidence that resistance training may improve cognitive function, academic performance, and on-task behaviours in school-aged youth.

PROSPERO REGISTRATION

CRD42020175695.

Twelve tips to foster healthcare student recognition and reporting of unprofessional behaviour or concerns

Medical trainees and students are required to report concerns where they identify concerning practice or behaviours. While leadership attributes and skills are increasingly expected curricular outcomes, students still struggle to report concerns due to a variety of factors. Changing societal awareness and expectations continue to shine light on poor professionalism and unethical behaviours whose reach extends to medical training and education and that need to be systematically reported and addressed. To prepare graduates for these challenges in professional practice and for exercising skills of reporting concerns, education and training environments must ensure that speaking up is ingrained in the organisational ethos. Supported by evidence from the literature and our experience of revising and enhancing approaches, this paper outlines tips for developing and embedding an infrastructure that facilitates robust concerns reporting and management. Further, we consider mechanisms that support students to develop tendencies and skills for reporting concerns.

E-cigarette use by people who smoke or have recently quit, New South Wales, 2016-2020

OBJECTIVE

To examine e-cigarette use by adults who smoke or have recently quit, and demographic characteristics associated with their use; to assess reasons for using e-cigarettes.

DESIGN

The Cancer Institute NSW Tobacco Tracking Survey (CITTS) is an ongoing, serial, cross-sectional telephone survey study (40 interviews each week). This report is based on interviews during 4 January 2016 - 31 December 2020.

SETTING, PARTICIPANTS

Randomly selected New South Wales adults who are current smokers (smoked cigarettes, pipes, or other tobacco products daily, weekly, or less often) or recent quitters (smoked tobacco products in the past twelve months but who no longer smoked).

MAIN OUTCOMES

E-cigarette use by age group; reasons for using e-cigarettes.

RESULTS

CITTS callers rang 1 494 233 randomly selected numbers; in 203 203 answered calls (13.6%), 11 125 people were eligible for the survey (5.5% of answered calls), of whom 10 004 completed the survey interview, including the question about whether they used e-cigarettes (89.9%). Overall e-cigarette use increased from 6.6% of respondents in 2016 to 13.0% in 2020 (adjusted odds ratio, 1.86; 95% confidence interval [CI], 1.47-2.36). The proportion of respondents aged 18-24 years who reported e-cigarette use increased from 18.4% (95% CI, 12.9-23.9%) in 2018 to 27.2% (95% CI, 20.5-33.9%) in 2020, a larger proportion than for any other age group. The leading reasons offered for e-cigarette use were "to help me quit smoking" (33%; 95% CI, 30-37%) and "to cut down on the number of cigarettes I smoke" (25%; 95% CI, 22-28%).

CONCLUSION

The increase between 2016 and 2020 in the proportions of young adults who smoke or have recently quit who use e-cigarettes undermines claims that these products are designed for older smokers who have struggled to quit using other methods.

Impact of Increased Patient-Clinician Virtual Visits During the COVID-19 Pandemic on Medical Student Enthusiasm for Future General Practice Careers

BACKGROUND

The COVID-19 pandemic restricted the availability of face-to-face primary care visits. This rapidly increased the proportion of primary care patient-clinician visits conducted virtually and asynchronously (remote consultations via video, telephone, and web-based text/email), altering the educational environment for medical students. Our study explored the impact of the increased proportion of primary care visits conducted virtually and asynchronously, on medical students' self-reported interest in pursuing a career in general (family) practice.

METHODS

We conducted a cross-sectional survey study of medical students at six universities within England and Wales to explore the impact of the increased proportion of primary care visits conducted virtually and asynchronously on medical students' interest in pursuing a career in general practice.

RESULTS

One hundred fifty-four medical students were recruited between December 2020 and May 2021; 79 (51%) of the participants reported being less interested in pursuing a career in general practice as a result of the increased proportion of virtual and asynchronous primary care visits during the COVID-19 pandemic. This increased to 104 (68%) of the participants reporting being less interested should primary care visits continue to be delivered virtually or asynchronously by default. Analysis of open-ended survey questions identified a poorer educational experience, concerns regarding the impact on patient care, an isolated working environment and technological challenges as key negative themes.

CONCLUSIONS

Sociable, supportive working and learning environments and offering equitable care are important motivators for the future workforce. There is a need to develop robust training and assessment in patient-clinician virtual visits and asynchronous communication and to integrate this into curricula.

Physical activity, burnout and quality of life in medical students: A systematic review

BACKGROUND

Medical students are at risk of burnout and reduced quality of life (QoL). The risk of burnout doubles from third to sixth year of medical school, and medical students have an 8%-11% lower QoL than nonmedical students. It is imperative to prevent this, as burnout and reduced QoL is independently associated with errors in practice. This systematic review aims to examine whether physical activity/exercise is associated with burnout and/or QoL in medical students.

METHODS

Articles were identified through database searches of Embase, Medline, PsycINFO, Scopus and Web of Science. Studies were included if both physical activity/exercise and burnout or QoL were measured and limited to those focussing on medical students. Risk of bias was assessed using accredited cohort and cross-sectional checklists. A narrative synthesis was conducted due to heterogeneity in the dataset.

FINDINGS

Eighteen studies were included, comprising 11,500 medical students across 13 countries. Physical activity was negatively associated with burnout and positively associated with QoL. Furthermore, the findings were suggestive of a dose-response effect of physical activity on both burnout and QoL; higher intensities and frequencies precipitated greater improvements in outcomes.

CONCLUSIONS

This multinational review demonstrates that physical activity is associated with reduced burnout and improved QoL in medical students. It also identifies a paucity of research into the optimal intensity, frequency, volume and mode of physical activity. Further research, building on this review, is likely to inform the long overdue development of evidence-based, well-being curricula. This could involve incorporating physical activity into medical education which may improve well-being and better prepare students for the demands of medical practice.

Joint associations of social health and movement behaviours with mortality and cardiovascular disease: an analysis of 497,544 UK biobank participants

Background

Poor physical activity and excessive sedentary behaviour are well-established risk factors for morbidity and mortality. In the presence of emerging social problems, including loneliness and social isolation, these risks may be even greater. We aimed to investigate the joint effects of social health and movement behaviours on mortality and cardiovascular disease (CVD).

Methods

497,544 UK Biobank participants were followed for an average of 11 years. Loneliness and social isolation were measured via self-report. Physical activity was categorised around current World Health Organisation (WHO) guidelines as low (< 600 metabolic equivalent of task [MET]-mins/week), moderate (600 < 1200) and high (≥ 1200). Sedentary behaviour was classified as low (≤ 3.5 h/day), moderate (3.5 ≤ 5) and high (> 5.5). We derived 24 social health–movement behaviour combinations, accordingly. Mortality and hospitalisations were ascertained to May 2020 for all-cause and CVD mortality, and non-fatal cardiovascular events.

Results

Social isolation amplified the risk of both all-cause and CVD death across all physical activity and sedentary levels (hazard ratio, 95% confidence interval [HR, 95% CIs] for all-cause mortality; 1.58 [1.49 to 1.68] for low active-isolated vs. 1.26 [1.22 to 1.30] for low active-not isolated). Loneliness was only found to amplify the risk of death from cardiovascular disease among the high active and low sedentary participants. Loneliness and social isolation did not add to the risk of non-fatal cardiovascular events across most activity levels.

Conclusion

The detrimental associations of poor physical activity and sedentary behaviour with mortality were consistently amplified by social isolation. Our study supports the need to target the socially isolated as a priority group in preventive public health strategies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01372-3.

O3-2 Evaluation of implementation and impact of a national mass media campaign to promote active lifestyles in Portugal: ‘Follow the Whistle: Physical Activity is Calling You'

Background

Portugal has one of the highest rates of physical inactivity in Europe. To raise the profile of physical activity (PA) among adults, the Portuguese National Physical Activity Promotion Program of the Directorate-General of Health developed and implemented a national mass media campaign in 2019 named ?Follow the Whistle?. The campaign was based on social marketing principles and behavior change theory, namely the COM-B model, and was developed through formative research. We aim to describe the implementation process and short-term impact evaluation data.

Methods

‘Follow the Whistle' was launched in June 2019 and continued for 4 weeks (TV, Radio, Online and Cinema, newspapers, outdoors). Pre (n = 878, 57%women) and post (n = 1319, 58%women) independent adult population samples were used to assess campaign impact. Participants were recruited through the mailing list of a Portuguese mutual insurance company, a network from across Portugal. The online questionnaire comprised socio-demographic factors, campaign awareness and recall, and psychosocial and behavioral measures linked to the four targets of the COM-B model, including items to assess perceived capability for physical activity(C), perceived opportunity for practice/ ease of integration of PA in daily living(O), motivation for PA practice(M) and behavior(B) assessed with IPAQ and the Activity Choice Index.

Results

Pre-and post-campaign samples were broadly demographically similar. Campaign recall increased significantly from 1% to 24% in prompted tagline recall (1/3 at post-campaign correctly recalled specific campaign images). All the targeted COM-B indicators changed in the expected direction, suggesting increases in perceived capability to engage in PA, perceived daily opportunities for being physically active, and in motivation (considering PA as fun, important, and compatible with other important things in life) (all p > 0.05). Results from PA behavior measures revealed increases only for vigorous activities (p > 0.001).

Conclusions

The GAPPA recommends the creation of active societies starting with best-practice community-wide communications campaigns. Although one focus of the ?Follow-the whistle? (i.e. promotion of active transport and incidental everyday forms of physical activity) was not entirely achieved (i.e. changes only in vigorous activities), the initial campaign objectives of increases in awareness, and influencing intermediate outcomes were achieved. Further campaign waves are planned for future years.

Barriers to initiating and maintaining participation in parkrun

Interventions that increase population physical activity are required to promote health and wellbeing. parkrun delivers community-based, 5 km events worldwide yet 43% who register never participate in a parkrun event. This research had two objectives; i) explore the demographics of people who register for parkrun in United Kingdom, Australia, Ireland, and don’t initiate or maintain participation ii) understand the barriers to participating in parkrun amongst these people. Mandatory data at parkrun registration provided demographic characteristics of parkrun registrants. A bespoke online survey distributed across the three countries captured the reasons for not participating or only participating once. Of 680,255 parkrun registrants between 2017 and 19, 293,542 (43%) did not participate in any parkrun events and 147,148 (22%) only participated in one parkrun event. Females, 16–34 years and physically inactive were more likely to not participate or not return to parkrun. Inconvenient start time was the most frequently reported barrier to participating, with females more likely than males to report the psychological barrier of feeling too unfit to participate. Co-creating strategies with and for people living with a chronic disease, women, young adults, and physically inactive people, could increase physical activity participation within parkrun.

Effectiveness and acceptability of a text message intervention (DTEXT) on HbA1c and self-management for people with type 2 diabetes. A randomized controlled trial

OBJECTIVE

Determine the effectiveness and acceptability of a text message intervention (DTEXT) on HbA1c and self-management behaviors for Australian adults with type 2 diabetes.

METHODS

Using intention to treat analysis and generalized estimating equations, this randomized controlled trial of 395 adults determined change in HbA1c at 3 and 6 months between the intervention and control group. Secondary outcomes included change in nutrition, physical activity, blood lipid profile, body mass index, quality of life, self-efficacy, medication taking and program acceptability.

RESULTS

No significant difference was observed between the intervention or control group for HbA1c at 3 months (P = 0.23) or 6 months (P = 0.22). Significant improvements were seen in consumption of vegetables at 3 months (P < 0.001) and 6 months (P = 0.04); fruit at 3 months (P = 0.046) and discretionary sweet foods at 3 months (P = 0.02). No other significant effects seen. The intervention demonstrated high rates of acceptability (94.0%) and minimal withdrawal (1.5%).

CONCLUSIONS

DTEXT was an acceptable text message intervention that improved some nutritional behaviors in people with type 2 diabetes, but did not significantly improve HbA1c or other outcomes. Further research is required to optimize DTEXT.

PRACTICE IMPLICATIONS

DTEXT provides an acceptable, feasible form of self-management support that may complement existing diabetes care.

Active Kids: evaluation protocol for a universal voucher program to increase children's participation in organised physical activity and sport

OBJECTIVE

Background: Regular participation in physical activity during childhood and adolescence is important for good health. There is strong evidence of the physical and psychosocial benefits associated with recreational physical activity in these age groups, specifically in the context of organised sport. Most children in New South Wales (NSW), Australia, do not meet the recommended guidelines for physical activity, with financial cost commonly cited as a barrier to the initiation and maintenance of sport. The Active Kids program is a major policy initiative introduced in 2018 that aimed to overcome this barrier by implementing a statewide sport voucher scheme, allowing all NSW school-enrolled children (1.2 million) initial access to a $100 annual contribution towards organised sport and physical activity, with concurrent evaluation over the initial 4-year phase of the program.

STUDY TYPE

This paper presents the protocol for evaluation of the Active Kids program, including an assessment of program impact on children's organised sport participation and recreational physical activity level, and analysis of the correlates of participation at individual, state and national levels.

METHODS

A quasi-experimental and mixed-method evaluation will be used to examine the patterns of organised sport and recreational physical activity behaviour and the correlates associated with sports participation, voucher uptake and program reach. Sociodemographic information will be collected for each child who registers for a voucher. The effects of this program on children's health-enhancing physical activity, engagement with the sport sector, self-efficacy and social influences on participation will be monitored through a cohort study. Acceptability, engagement and experience of the voucher program will be assessed from both user and provider perspectives. Additionally, effects of the program on families' annual sport-related expenditure will be assessed.

RESULTS AND CONCLUSION

It is anticipated that the implementation of the NSW Government's Active Kids program will increase participation in recreational physical activity among NSW children. The results of this evaluation will contribute to the evidence base and policy directions for sport voucher programs in Australia and internationally.

Qualitative exploration of medical student experiences during the Covid-19 pandemic: implications for medical education

BACKGROUND

During the Covid-19 pandemic medical students were offered paid roles as medical student healthcare assistants. Anecdotal reports suggested that students found this experience rich for learning. Previous studies have explored alternative models of student service, however this defined medical student support role is novel.

METHODS

Individual semi-structured interviews were recorded with 20 medical students at a UK medical school exploring their experiences of placement learning and experiences of working as healthcare assistants. Responses were analysed qualitatively using a framework approach. The framework was developed into a model describing key findings and their relationships.

RESULTS

Interviews yielded data that broadly covered aspects of (1) Medical students' experiences of clinical placement learning (2) Medical students' experiences of working as medical student healthcare assistants (3) Learning resulting from working as a healthcare assistant (4) Hierarchies and professional barriers in the clinical environment (5) Influences on professional identity. Participants described barriers and facilitators of clinical learning and how assuming a healthcare assistant role impacted on learning and socialisation within the multidisciplinary team. Students became increasingly socialised within the healthcare team, contributing directly to patient care; the resulting social capital opened new opportunities for learning, team working and enhanced students' interprofessional identity. Students described the impact of these experiences on their aspirations for their future practice.

CONCLUSIONS

Changes to work patterns in healthcare and delivery models of medical education have eroded opportunities for students to contribute to healthcare delivery and be embedded within a team. This is impacting negatively on student learning and socialisation and we suggest that medical curricula have much to learn from nursing and allied health professional training. Longitudinal embedment with a multidisciplinary team, where students have a defined role and work directly with patients may not only add value to clinical service, but also overcome current barriers to effective placement learning and interprofessional identity formation for medical students.

Comparisons of leisure-time physical activity participation by adults with and without a disability: results of an Australian cross-sectional national survey

Objectives

The objective of this study was to describe and compare the amount and type of leisure-time physical activity, and motivations and barriers to participation among adults with and without a disability.

Methods

Analysis of deidentified data from an Australian cross-sectional national telephone-based survey (October 2015 to June 2018) of sport and physical recreation participation over the previous 12 months, and barriers and motivations to participation. Descriptive statistics (incorporating weighted proportions), χ² tests and regression analyses were conducted to describe aspects of participation and compare those with and without self-reported disability.

Results

Of the 54 343 adults surveyed, 15% reported a disability. Adults with a disability were half as likely to meet physical activity guidelines through sport and/or physical recreation than adults without a disability (OR 0.53, 95% CI 0.51 to 0.57). A greater proportion of adults with a disability participated in physical recreation only (40% vs 31%; χ²=187; p<0.001), whereas a greater proportion of adults without a disability participated in sport only (20% vs 12%; χ²=188; p<0.001). Adults with a disability were more motivated than adults without a disability to try a new activity for physical health or fitness benefits (55% vs 46%; χ²=36; p<0.001). The most reported barrier to participation for adults with a disability not currently participating in sport and/or physical recreation was poor health or injury (62%), whereas for adults without a disability it was lack of time/too many other commitments (43%).

Conclusion

Adults with a disability are less physically active and report different physical activity profiles and barriers to being active than adults without a disability. Urgent action is required to address this discrepancy.

"Follow the Whistle: Physical Activity Is Calling You": Evaluation of Implementation and Impact of a Portuguese Nationwide Mass Media Campaign to Promote Physical Activity

To raise perceived capability (C), opportunity (O) and motivation (M) for physical activity (PA) behaviour (B) among adults, the Portuguese Directorate-General of Health developed a mass media campaign named "Follow the Whistle", based on behaviour change theory and social marketing principles. Comprehensive formative and process evaluation suggests this media-led campaign used best-practice principles. The campaign adopted a population-wide approach, had clear behavioural goals, and clear multi-strategy implementation. We assessed campaign awareness and initial impact using pre (n = 878, 57% women) and post-campaign (n = 1319, 58% women) independent adult population samples via an online questionnaire, comprising socio-demographic factors, campaign awareness and recall, and psychosocial and behavioural measures linked to the COM-B model. PA was assessed with IPAQ and the Activity Choice Index. The post-campaign recall was typical of levels following national campaigns (24%). Post-campaign measures were higher for key theory-based targets (all p < 0.05), namely self-efficacy, perceived opportunities to be more active and intrinsic motivation. The impact on social norms and self-efficacy was moderated by campaign awareness. Concerning PA, effects were found for vigorous activity (p < 0.01), but not for incidental activity. Overall the campaign impacted key theory-based intermediate outcomes, but did not influence incidental activity, which highlights the need for sustained and repeated campaign efforts.

GP retention in the UK: a worsening crisis. Findings from a cross-sectional survey

OBJECTIVE

To investigate how recent national policy-led workforce interventions are affecting intentions to remain working as a general practitioner (GP).

DESIGN

Online questionnaire survey with qualitative and quantitative questions.

SETTING AND PARTICIPANTS

All GPs (1697) in Wessex region, an area in England for which previous GP career intention data from 2014 is available.

RESULTS

929 (54.7%) participated. 59.4% reported that morale had reduced over the past two years, and 48.5% said they had brought forward their plans to leave general practice. Intention to leave/retire in the next 2 years increased from 13% in the 2014 survey to 18% in October/November 2017 (p=0.02), while intention to continue working for at least the next 5 years dropped from 63.9% to 48.5% (p<0.0001). Age, length of service and lower job satisfaction were associated with intention to leave. Work intensity and amount were the most common reasons given for intention to leave sooner than previously planned; 51.0% participants reported working more hours than 2 years previously, predominantly due to increased workload.GPs suggested increased funding, more GPs, better education of the public and expanding non-clinical and support staff as interventions to improve GP retention.National initiatives that aligned with these priorities, such as funding to expand practice nursing were viewed positively, but low numbers of GPs had seen evidence of their roll-out. Conversely, national initiatives that did not align, such as video consulting, were viewed negatively.

CONCLUSION

While recent initiatives may be having an impact on targeted areas, most GPs are experiencing little effect. This may be contributing to further lowering of morale and bringing forward intentions to leave. More urgent action appears to be needed to stem the growing workforce crisis.

Language matters. Addressing the use of language in the care of people with diabetes: position statement of the English Advisory Group

The language used by healthcare professionals can have a profound impact on how people living with diabetes, and those who care for them, experience their condition and feel about living with it day-to-day. At its best, good use of language, both verbal and written, can lower anxiety, build confidence, educate and help to improve self-care. Conversely, poor communication can be stigmatizing, hurtful and undermining of self-care and can have a detrimental effect on clinical outcomes. The language used in the care of those with diabetes has the power to reinforce negative stereotypes, but it also has the power to promote positive ones. The use of language is controversial and has many perspectives. The development of this position statement aimed to take account of these as well as the current evidence base. A working group, representing people with diabetes and key organizations with an interest in the care of people with diabetes, was established to review the use of language. The work of this group has culminated in this position statement for England. It follows the contribution of Australia and the USA to this important international debate. The group has set out practical examples of language that will encourage positive interactions with those living with diabetes and subsequently promote positive outcomes. These examples are based on a review of the evidence and are supported by a simple set of principles.