'Think differently and be prepared to demonstrate trust': findings from public hearings, England, on supporting lay people in public health roles

Mesothelioma patient and carer experience research: A research prioritisation exercise

OBJECTIVES

Incidence of mesothelioma worldwide is growing and the UK reports the highest global incidence. Mesothelioma is an incurable cancer with a high symptom burden. However, it is under researched when compared to other cancers. The aim of this exercise was to identify unanswered questions about the mesothelioma patient and carer experience in the UK and to prioritise research areas of most importance through consultation with patients, carers and professionals.

MATERIALS AND METHODS

A virtual Research Prioritisation Exercise was conducted. This involved a review of mesothelioma patient and carer experience literature to identify research gaps and a national online survey to identify and rank research gaps. Following this, a modified consensus method with mesothelioma experts (patients, carers and professionals from healthcare, legal, academic and volunteer organisations) was undertaken to reach a consensus regarding mesothelioma patient and carer experience research priorities.

RESULTS

Survey responses were received from 150 patients, carers and professionals and 29 research priorities were identified. During consensus meetings, 16 experts refined these into a list of 11 key priorities. The five most urgent priorities were symptom management, receiving a mesothelioma diagnosis, palliative and end of life care, treatment experiences, barriers and facilitators to joined up service provision.

CONCLUSION

This novel priority setting exercise will shape the national research agenda, contribute knowledge to inform nursing and wider clinical practice and ultimately improve the experiences of mesothelioma patients and carers.

A mixed methods analysis evaluating an alcohol health champion community intervention: How do newly trained champions perceive and understand their training and role?

Globally, alcohol harm is recognised as one of the greatest population risks and reducing alcohol harm is a key priority for the UK Government. The Communities in Charge of Alcohol (CICA) programme took an asset-based approach in training community members across nine areas to become alcohol health champions (AHCs); trained in how to have informal conversations about alcohol and get involved with alcohol licensing. This paper reports on the experiences of AHCs taking part in the training through the analysis of: questionnaires completed pre- and post-training (n = 93) and semi-structured interviews with a purposive sample of five AHCs who had started their role. Questionnaires explored: characteristics of AHCs, perceived importance of community action around alcohol and health, and confidence in undertaking their role. Following training AHCs felt more confident to talk about alcohol harms, give brief advice and get involved in licensing decisions. Interviews explored: AHCs' experiences of the training, barriers and facilitators to the adoption of their role, and how they made sense of their role. Four overarching themes were identified through thematic analysis taking a framework approach: (a) perceptions of AHC training; (b) applying knowledge and skills in the AHC role; (c) barriers and facilitators to undertaking the AHC role; and (d) sustaining the AHC role. Findings highlight the challenges in establishing AHC roles can be overcome by combining the motivation of volunteers with environmental assets in a community setting: the most important personal asset being the confidence to have conversations with people about a sensitive topic, such as alcohol.

Barriers to health promotion strategy work in Finnish municipalities

This study's aim is to increase insights into the characteristics and conditions of municipal health promotion strategy work. Specifically, we aim to find barriers connected to strategy work, that is, creating and formulating municipal health promotion strategy documents, with the following empirical research question: What perceptions do municipal health promotion strategy actors have on barriers connected to low citizen participation, narrow cross-departmental collaboration and weak goal orientation in health promotion strategy work? Empirical data comprised 22 thematics, individual interviews collected from municipal managers, sector managers and municipal health coordinators. Analysis was conducted using content analysis. This study's findings showed that the main barriers impeding optimal strategy work conditions were administrators' sceptical views of participation and undeveloped administrative practices in inclusive citizen participation, inadequate leadership to unite actors and facilitate collaborative strategy work practices, and challenges in integrating various views into coherent strategic goals. Also, a need for boundary-spanning leadership that strengthens mutual interaction and creates a shared understanding of health promotion to build strategic collaboration and goal-oriented strategy work was revealed. Finally, to strengthen this leadership, influencing administrators' mindsets, behaviour and administrative culture is imperative.

Addressing current challenges in adult nursing: Describing a virtual consensus development project methodology

Aim

This article describes the development and implementation of a virtual Consensus development project to address current challenges in adult nursing care in the UK.

Design

This is a Consensus Development Project (CDP).

Methods

The five stages of this CDP were: develop questions (informed by PPI representatives and a documentary review), generate evidence reviews, recruit and orient the lay panel, host Consensus seminars, and consult with panel members and stakeholders.

Results

To the best of our knowledge, a CDP has not previously been conducted in a UK nursing context, and this is the first of its kind to be hosted virtually. This article contributes a detailed outline of the Consensus development methodology and constructive commentary to support future Consensus development projects. Learning points include reflections on the impact of hosting this event virtually, the relationship between the project coordinator and chair, and the composition of the lay panel.

Personal development, wellbeing and empowerment gains for nutrition peer educators: a South Australian perspective

This study aimed to explore the experience of being a Community Foodies (CF) peer educator with respect to personal benefits, specifically, personal development, wellbeing and empowerment. Qualitative semi-structured telephone interviews conducted with metropolitan and country peer educators of the CF programme. The CF programme in South Australia (SA) delivers nutrition education to disadvantaged communities. Ten adult peer educators from the CF programme: seven from country SA and three from Adelaide. Phenomenon of interest is that peer educators' perceptions of personal growth and development from involvement in the CF programme. The interviews were audiotaped and analysed thematically. The experience of being a nutrition peer educator improved personal skills and knowledge, dietary habits, self-esteem, confidence, sense of belonging and civic engagement. Peer educators felt that the CF programme was run in a straightforward, easy to understand way, with a welcoming environment and abundant support from the coordinators. Apart from benefits to themselves, peer educators appeared to be most proud of their capacity to contribute to the nutritional health of the broader community. Peer education programmes in disadvantaged communities provide policy makers with valuable and cost-effective approaches to improve health, build self-efficacy, strengthen community engagement, and, foster active participation and trust.

Volunteers' Experiences Delivering a Community-University Chronic Disease Health Awareness Program for South Asian Older Adults

Volunteers and voluntary organizations can connect preventative health care programs to communities and may play an important role in addressing the health needs of older adults. Despite this, tensions may exist in the structures that drive volunteers and voluntary organizations representing immigrant communities to provide unpaid labour to augment and supplement health care services. Furthermore, organizational challenges may exist for community agencies relying on volunteers to sustain a health screening and education program. The intervention program was led by one voluntary agency specifically for South Asian communities in partnership with the university and five local organizations. This paper draws on volunteer surveys (n = 22) and key informant interviews (n = 12) to detail volunteer experiences providing this intervention. Volunteers were university students and other community volunteers. A total of 810 adults participated in the intervention within the Greater Toronto Area, Ontario, Canada between October 2014 and June 2016. We found that volunteers often used their experience as a 'stepping stone' position to other education or work. They also gained from the knowledge and used it to educate themselves and their family members and friends. This paper provides a critical reflection on the role of volunteers in a preventative and educational healthcare intervention program for older adults from the South Asian community. Tensions exist when relying on volunteer labour for the implementation of preventative community health care programming and must be explored to ensure program sustainability as well as equity within the health care system.

Getting past the dual logic: findings from a pilot asset mapping exercise in Sheffield, UK

Asset-based approaches seek to identify and mobilise the personal, social and organisational resources available to communities. Asset mapping is a recognised method of gathering an inventory of neighbourhood assets and is underpinned by a fundamentally different logic to traditional needs assessments. The aim of this paper is to explore how asset mapping might be used as a tool for health improvement. It reports on a qualitative evaluation of a pilot asset mapping project carried out in two economically disadvantaged neighbourhoods in Sheffield, UK. The project involved community health champions working with two community organisations to identify assets linked to the health and wellbeing of their neighbourhoods. The evaluation was undertaken in 2012 after mapping activities had been completed. A qualitative design, using theory of change methodology, was used to explore assumptions between activities, mechanisms and outcomes. Semi structured interviews were undertaken with a purposive sample of 11 stakeholders including champions, community staff and strategic partners. Thematic analysis was used and themes were identified on the process of asset mapping, the role of champions and the early outcomes for neighbourhoods and services. Findings showed that asset mapping was developmental and understandings grew as participatory activities were planned and implemented. The role of the champions was limited by numbers involved, nonetheless meaningful engagement occurred with residents which led to personal and social resources being identified. Most early outcomes were focused on the lead community organisations. There was less evidence of results feeding into wider planning processes because of the requirements for more quantifiable information. The paper discusses the importance of relational aspects of asset mapping both within communities and between communities and services. The conclusions are that it is insufficient to switch from the logic of needs to assets without building asset mapping as part of a broader planning process.

A systematic-qualitative research for diffusion of innovation in the primary healthcare centers

Purpose

– This paper aims to discuss a model for diffusion of innovation among the professionals of primary health-care centers in Finland. The authors answer partially to one of the important questions of the policymakers titled “How primary health-care centers can move toward systems that continuously improve their innovation?”.

Design/methodology/approach

– A systematic-qualitative framework based on an action research is presented to assess dynamics of diffusion of innovation in the primary health-care centers in Finland.

Findings

– The authors conceptualize the innovation systems of primary health-care systems by three different diagrams: subsystem diagram, policy structure diagram and causal loop diagram. The investigation reviews innovation process of Finnish professionals (staffs, nurses and doctors) in the frame of a systematic-qualitative analysis. The relationships and consequences of decisions and policies are discussed with a new way of thinking in the health-care sector studies.

Originality/value

– The implemented systematic-qualitative research in this article is an innovative approach in the innovation studies of the health-care systems.

Health promotion by communities and in communities: current issues for research and practice

BACKGROUND AND AIMS

This paper explores contemporary issues around community-based health promotion in the light of international health policies reaffirming the central role of community action within broader efforts to achieve health equity. Adopting a system-level approach poses challenges for current health promotion practice and evaluation, particularly where there is a shift in emphasis from small-scale community health projects towards mainstream community programmes, capable of engaging widely across diverse populations.

METHODS

Drawing on research with community members carried out by the Centre for Health Promotion Research, Leeds Metropolitan University, UK, the paper re-examines assumptions about the nature of interventions within community settings, and what participation means from a lay perspective. Key research issues for community-based health promotion are highlighted.

CONCLUSIONS

The paper concludes by proposing that community-based interventions need to be reframed, if the dual challenges of citizen involvement and evidence based practice are to be met.

A systematic review of the effectiveness and cost-effectiveness of peer-based interventions to maintain and improve offender health in prison settings

Background

Offender health is deemed a priority issue by the Department of Health. Peer support is an established feature of prison life in England and Wales; however, more needs to be known about the effectiveness of peer-based interventions to maintain and improve health in prison settings.

Objectives

The study aimed to synthesise the evidence on peer-based interventions in prison settings by carrying out a systematic review and holding an expert symposium. Review questions were (1) what are the effects of peer-based interventions on prisoner health and the determinants of prisoner health?, (2) what are the positive and negative impacts on health services within prison settings of delivering peer-based interventions?, (3) how do the effects of peer-based approaches compare with those of professionally led approaches? and (4) what are the costs and cost-effectiveness of peer-based interventions in prison settings?

Data sources

For the systematic review, 20 electronic databases including MEDLINE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature and EMBASE were searched from 1985. Grey literature and relevant websites were also searched. To supplement the review findings 58 delegates, representing a variety of organisations, attended an expert symposium, which provided contextual information.

Review methods

Two reviewers independently selected studies using the following inclusion criteria: population – prisoners resident in prisons and young offender institutions; intervention – peer-based interventions; comparators: review questions 3 and 4 compared peer-led and professionally led approaches; outcomes – prisoner health or determinants of health, organisational/process outcomes or views of prison populations; study design: quantitative, qualitative and mixed-methods evaluations. Two reviewers extracted data and assessed validity using piloted electronic forms and validity assessment criteria based on published checklists. Results from quantitative studies were combined using narrative summary and meta-analysis when appropriate; results from qualitative studies were combined using thematic synthesis.

Results

A total of 15,320 potentially relevant papers were identified of which 57 studies were included in the effectiveness review and one study was included in the cost-effectiveness review; most were of poor methodological quality. A typology of peer-based interventions was developed. Evidence suggested that peer education interventions are effective at reducing risky behaviours and that peer support services provide an acceptable source of help within the prison environment and have a positive effect on recipients; the strongest evidence came from the Listener scheme. Consistent evidence from many predominantly qualitative studies suggested that being a peer deliverer was associated with positive effects across all intervention types. There was limited evidence about recruitment of peer deliverers. Recurring themes were the importance of prison managerial and staff support for schemes to operate successfully, and risk management. There was little evidence on the cost-effectiveness of peer-based interventions. An economic model, developed from the results of the effectiveness review, although based on data of variable quality and a number of assumptions, showed the cost-effectiveness of peer-led over professionally led education in prison for the prevention of human immunodeficiency virus (HIV) infection.

Limitations

The 58 included studies were, on the whole, of poor methodological quality.

Conclusions

There is consistent evidence from a large number of studies that being a peer worker is associated with positive health. Peer support services can also provide an acceptable source of help within the prison environment and can have a positive effect on recipients. This was confirmed by expert evidence. Research into cost-effectiveness is sparse but a limited HIV-specific economic model, although based on a number of assumptions and evidence of variable quality, showed that peer interventions were cost-effective compared with professionally led interventions. Well-designed intervention studies are needed to provide robust evidence including assessing outcomes for the target population, economic analysis of cost-effectiveness and impacts on prison health services. More research is needed to examine issues of reach, utilisation and acceptability from the perspective of recipients and those who choose not to receive peer support.

Study registration

This study was registered as PROSPERO CRD42012002349.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

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.

Towards a methodology for cluster searching to provide conceptual and contextual "richness" for systematic reviews of complex interventions: case study (CLUSTER)

Background

Systematic review methodologies can be harnessed to help researchers to understand and explain how complex interventions may work. Typically, when reviewing complex interventions, a review team will seek to understand the theories that underpin an intervention and the specific context for that intervention. A single published report from a research project does not typically contain this required level of detail. A review team may find it more useful to examine a “study cluster”; a group of related papers that explore and explain various features of a single project and thus supply necessary detail relating to theory and/or context.

We sought to conduct a preliminary investigation, from a single case study review, of techniques required to identify a cluster of related research reports, to document the yield from such methods, and to outline a systematic methodology for cluster searching.

Methods

In a systematic review of community engagement we identified a relevant project – the Gay Men’s Task Force. From a single “key pearl citation” we conducted a series of related searches to find contextually or theoretically proximate documents. We followed up Citations, traced Lead authors, identified Unpublished materials, searched Google Scholar, tracked Theories, undertook ancestry searching for Early examples and followed up Related projects (embodied in the CLUSTER mnemonic).

Results

Our structured, formalised procedure for cluster searching identified useful reports that are not typically identified from topic-based searches on bibliographic databases. Items previously rejected by an initial sift were subsequently found to inform our understanding of underpinning theory (for example Diffusion of Innovations Theory), context or both. Relevant material included book chapters, a Web-based process evaluation, and peer reviewed reports of projects sharing a common ancestry. We used these reports to understand the context for the intervention and to explore explanations for its relative lack of success. Additional data helped us to challenge simplistic assumptions on the homogeneity of the target population.

Conclusions

A single case study suggests the potential utility of cluster searching, particularly for reviews that depend on an understanding of context, e.g. realist synthesis. The methodology is transparent, explicit and reproducible. There is no reason to believe that cluster searching is not generalizable to other review topics. Further research should examine the contribution of the methodology beyond improved yield, to the final synthesis and interpretation, possibly by utilizing qualitative sensitivity analysis.