What makes a successful volunteer Expert Patients Programme tutor? Factors predicting satisfaction, productivity and intention to continue tutoring of a new public health workforce in the United Kingdom

Exploring the barriers and facilitators to volunteering as an intervention for those with long-term neurological conditions: How make therapeutic volunteering possible?

BACKGROUND

Volunteering may have therapeutic benefits, but little is known about its requirements and potential for people with neurological conditions (pwNC).

DESIGN

Two separate focus groups were conducted in Darmstadt, Germany: one group consisting of six pwNC and another group consisting of four health care professionals and three volunteering service providers. The focus groups were audio-recorded, transcribed and data were managed using NVivo12. The thematic analysis was applied.

RESULTS

Four main themes were identified: (1) Impact of volunteering, (2) Individualisation, (3) Developmental space and (4) Funded supported volunteering.

CONCLUSION

According to the findings, volunteering can be used as a strategy to enhance physical, mental and social well-being in disease management for people with long-term neurological conditions.

PATIENTS OR PUBLIC CONTRIBUTION

Facilitators for accessibility of therapeutic volunteering; involvement of pwNC.

Examining the Volunteer Satisfaction Index - Chinese (VSI-C) among Chinese Adolescents in Hong Kong

Purpose: The purpose of this study was to validate an existing measure of The Volunteer Satisfaction Index - Chinese (VSI-C) using the sample of 1,046 secondary school students. Method: In this study, the factor structure of VSI-C was explored and reexamined with a sample of secondary school students in Hong Kong in order to ensure the scale to be psychometrically sound and applicable to diversified student populations. Results: The exploratory factor analysis revealed in this examination that a three-factor structure that differs from the model proposed by the scale developers and the version used in a number of previous studies. A revised 19-item scale was introduced after the confirmatory factor analysis was conducted. VSI-C would be a psychometrically sound measure in measuring volunteer satisfaction across different student populations. Discussion: Implications are discussed for assessing volunteer satisfaction, offering volunteer training and conducting future research on related topics.

General practitioners who never perform Pap smear: the medical offer and the socio-economic context around their office could limit their involvement in cervical cancer screening

BACKGROUND

In France, with the growing scarcity of gynecologists and a globally low and socially differentiated coverage of cervical cancer screening (CCS), general practitioners (GPs) are valuable resources to improve screening services for women. Still all GPs do not perform Pap smears. In order to promote this screening among GPs, the characteristics of physicians who never perform CCS should be more precisely specified. Besides already-known individual characteristics, the contextual aspects of the physicians' office, such as gynecologist density in the area, could shape GPs gynecological activities.

METHODS

To analyze county (département) characteristics of GPs' office associated with no performance of CCS, we used a representative sample of 1063 French GPs conducted in 2009 and we constructed mixed models with two levels, GP and county.

RESULTS

Almost 35% (n = 369) of the GPs declared never performing CCS. GPs working in counties with a poor GP-density per inhabitants were more likely to perform CCS (odds ratio (OR) = 0.52 for each increase of density by 1 GP per 10,000 inhabitants, 95% confidence interval (CI) = 0.37-0.74). On the contrary, GPs working in counties with an easier access to a gynecologist were more likely not to perform CCS (OR = 1.06 for each increase of density by 1 gynecologist per 100,000 women, 95%CI = 1.03-1.10 and OR = 2.02 if the first gynecologist is reachable in less than 15 min, 95%CI = 1.20-3.41) as well as GPs working in areas with a poverty rate above the national average (OR = 1.66, 95%CI = 1.09-2.54). These contextual characteristics explain most of the differences between counties concerning rates of not performing CCS.

CONCLUSIONS

Specific programs should be developed for GPs working in contexts unfavorable to their involvement in CCS.

Factors associated with the implementation of community-based peer-led health promotion programs: A scoping review

Peer education is growing in popularity as a useful health promotion strategy. However, optimal conditions for implementing peer-led health promotion programs (HPPs) remain unclear. This scoping review aimed to describe factors that can influence implementation of peer-led HPPs targeting adult populations. Five databases were searched using the keywords "health promotion/prevention", "implementation", "peers", and related terms. Studies were included if they reported at least one factor associated with the implementation of community-based peer-led HPPs. Fifty-five studies were selected for the analysis. The method known as "best fit framework synthesis" was used to analyze the factors identified in the selected papers. Many factors included in existing implementation conceptual frameworks were deemed applicable to peer-led HPPs. However, other factors related to individuals, programs, and implementation context also emerged from the analysis. Based on this synthesis, an adapted theoretical framework was elaborated, grounded in a complex adaptive system perspective and specifying potential mechanisms through which factors may influence implementation of community-based peer-led HPPs. Further research is needed to test the theoretical framework against empirical data. Findings from this scoping review increase our knowledge of the optimal conditions for implementing peer-led HPPs and thereby maximizing the benefits of such programs.

Street-level diplomacy? Communicative and adaptive work at the front line of implementing public health policies in primary care

Public services are increasingly operating through network governance, requiring those at all levels of the system to build collaborations and adapt their practice. Agent-focused implementation theories, such as 'street-level bureaucracy', tend to focus on decision-making and the potential of actors to subvert national policy at a local level. While it is acknowledged that network leaders need to be adaptable and to build trust, much less consideration has been given to the requirement for skills of 'diplomacy' needed by those at the front line of delivering public services. In this article, drawing on theoretical insights from international relations about the principles of 'multi-track diplomacy', we propose the concept of street level diplomacy, offer illustrative empirical evidence to support it in the context of the implementation of public health (preventative) policies within primary care (a traditionally responsive and curative service) in the English NHS and discuss the contribution and potential limitations of the new concept. The article draws on qualitative data from interviews conducted with those implementing case finding programmes for cardiovascular disease in the West Midlands. The importance of communication and adaptation in the everyday work of professionals, health workers and service managers emerged from the data. Using abductive reasoning, the theory of multi-track diplomacy was used to aid interpretation of the 'street-level' work that was being accomplished.

Participation in voluntary and community organisations in the United Kingdom and the influences on the self-management of long-term conditions

Voluntary and community organisations (VCOs) have health benefits for those who attend and are viewed as having the potential to support long-term condition management. However, existing community-level understandings of participation do not explain the involvement with VCOs at an individual level, or the nature of support, which may elicit health benefits. Framing active participation as 'doing and experiencing', the aim of this qualitative study was to explore why people with long-term vascular conditions join VCOs, maintain their membership and what prevents participation. Twenty participants, self-diagnosed as having diabetes, chronic heart disease or chronic kidney disease, were purposefully sampled and recruited from a range of VCOs in the North West of England identified from a mapping of local organisations. In semi-structured interviews, we explored the nature of their participation. Analysis was thematic and iterative involving a continual reflection on the data. People gave various reasons for joining groups. These included health and well-being, the need for social contact and pursuing a particular hobby. Barriers to participation included temporal and spatial barriers and those associated with group dynamics. Members maintained their membership on the basis of an identity and sense of belonging to the group, developing close relationships within it and the availability of support and trust. Participants joined community groups often in response to a health-related event. Our findings demonstrate the ways in which the social contact associated with continued participation in VCOs is seen as helping with long-term condition management. Interventions designed at improving chronic illness management might usefully consider the role of VCOs.

The experiences of peer leaders in a driving cessation programme

Introduction

Peer leaders are increasingly involved in health-related programmes due to the perceived benefits that they bring to the group process. This exploratory study examined the experiences of peer leaders in the University of Queensland Driver Retirement Initiative, an educational support group for older people undergoing driving cessation.

Method

Semi-structured interviews were conducted with five peer leaders (two men, three women, age range: 67–81 years) regarding their role and involvement as a peer leader in the University of Queensland Driver Retirement Initiative programme as well as their positive and negative experiences.

Results

Inductive thematic analysis revealed three themes: diversity of peer leaders, drawing on personal strengths and experiences, and taking the middle ground.

Conclusion

This study revealed that peer leaders drew from their diverse range of personal resources and experiences to perform the role of peer leader, using varying approaches to perform the role successfully. The provision of broad guidelines in training allowed individual approaches to be developed and this contributed to a positive experience for peer leaders in the University of Queensland Driver Retirement Initiative. These findings have implications for the development of future peer-led driving cessation programmes and the selection of their peer leaders.

Rewarding altruism: addressing the issue of payments for volunteers in public health initiatives

Lay involvement in public health programmes occurs through formalised lay health worker (LHW) and other volunteer roles. Whether such participation should be supported, or indeed rewarded, by payment is a critical question. With reference to policy in England, UK, this paper argues how framing citizen involvement in health only as time freely given does not account for the complexities of practice, nor intrinsic motivations. The paper reports results on payment drawn from a study of approaches to support lay people in public health roles, conducted in England, 2007-9. The first phase of the study comprised a scoping review of 224 publications, three public hearings and a register of projects. Findings revealed the diversity of approaches to payment, but also the contested nature of the topic. The second phase investigated programme support matters in five case studies of public health projects, which were selected primarily to reflect role types. All five projects involved volunteers, with two utilising forms of payment to support engagement. Interviews were conducted with a sample of project staff, LHWs (paid and unpaid), external partners and service users. Drawing on both lay and professional perspectives, the paper explores how payment relates to social context as well as various motivations for giving, receiving or declining financial support. The findings show that personal costs are not always absorbed, and that there is a potential conflict between financial support, whether sessional payment or expenses, and welfare benefits. In identifying some of the advantages and disadvantages of payment, the paper highlights the complexity of an issue often addressed only superficially. It concludes that, in order to support citizen involvement, fairness and value should be considered alongside pragmatic matters of programme management; however policy conflicts need to be resolved to ensure that employment and welfare rights are maintained.

Exploring the mechanisms of change in the chronic disease self-management programme: secondary analysis of data from a randomised controlled trial

OBJECTIVE

The Chronic Disease Self-Management Programme (CDSMP) has been shown to be clinically and cost effective; however the specific mechanisms by which benefits are achieved are not well understood. We investigate what aspects of the course are associated with different outcomes.

METHODS

Post-hoc analysis of data from participants in a randomised controlled trial of the CDSMP using evaluations after 6 months for all patients and longer term outcomes at 12 months for a sub-set of patients. Data were analysed using univariate and multivariate regressions.

RESULTS

All course quality variables apart from the venue predicted satisfaction with CDSMP. The best predictors were ratings of the group process and course content. Group process was also significantly associated with self-care behaviour and long-term group outcomes (such as maintaining contact). Few associations between course ratings and patient health outcomes were found.

CONCLUSION

The most consistent predictor of CDSMP outcomes was the rating of the group process, highlighting the importance of group dynamics, however the complexity of mechanisms by which the CDSMP works cautions against giving primacy to any single factor.

PRACTICE IMPLICATIONS

Taking measures to ensure group processes are of high quality and effective within CDSMP are important in maximising patient satisfaction and self-care behaviour change.

'It's not my job. I'm the patient not the doctor': patient perspectives on medicines management in the treatment of schizophrenia

OBJECTIVES

Medicines management plays a key role in schizophrenia treatment. Objectives were to investigate the feasibility of undertaking in-depth research involving in-patients with a diagnosis of schizophrenia and to determine patients' views and experiences of medicines management.

METHODS

Research was carried out in the forensic ward of a psychiatric hospital and two rehabilitation settings in north-east Scotland. A qualitative methodology was adopted incorporating semi-structured interviews. Full text transcripts were produced and analysed.

RESULTS

Fifteen of 16 patients approached were willing to participate. Ages ranged from 27 to 70 years and they had been prescribed antipsychotics from six months to 27 years. Nearly everyone was aware of their medication regimen. Most relied on staff for information, but this was supplemented by learning from other patients' experiences. Most were happy to leave decisions to staff and few sought any role in shared decision making.

CONCLUSION

The research demonstrated the feasibility of undertaking qualitative work with patients with schizophrenia. Findings indicated that it should not be assumed that all patients want to take responsibility for their medications.

PRACTICE IMPLICATIONS

Patients' reluctance to assume responsibility needs to be explored and patients' wishes taken into account when planning future medicine related education.

Creating 'good' self-managers?: facilitating and governing an online self care skills training course

Background

In chronic disease management, patients are increasingly called upon to undertake a new role as lay tutors within self-management training programmes. The internet constitutes an increasingly significant healthcare setting and a key arena for self-management support and communication. This study evaluates how a new quasi-professional health workforce – volunteer tutors – engage, guide and attempt to manage people with long-term conditions in the ways of 'good' self-management within the context of an online self-management course.

Methods

A qualitative analysis of postings to the discussion centre of 11 online classes (purposively selected from 27) run as part of the Expert Patients Programme. Facilitators (term for tutors online) and participants posted questions, comments and solutions related to self-management of long-term conditions; these were subjected to a textual and discursive analysis to explore:

a) how facilitators, through the internet, engaged participants in issues related to self-management;

b) how participants responded to and interacted with facilitators.

Results

Emergent themes included: techniques and mechanisms used to engage people with self-management; the process facilitators followed – 'sharing', 'modelling' and 'confirming'; and the emergence of a policing role regarding online disclosure. Whilst exchanging medical advice was discouraged, facilitators often professed to understand and give advice on psychological aspects of behaviour.

Conclusion

The study gave an insight into the roles tutors adopt – one being their ability to 'police' subjective management of long-term conditions and another being to attempt to enhance the psychological capabilities of participants.