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Weich S, Fenton SJ, Staniszewska S, Canaway A, Crepaz-Keay D, Larkin M, Madan J, Mockford C, Bhui K, Newton E, Croft C, Foye U, Cairns A, Ormerod E, Jeffreys S, Griffiths F. Using patient experience data to support improvements in inpatient mental health care: the EURIPIDES multimethod study. Health Serv Deliv Res 2020. [DOI: 10.3310/hsdr08210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
All NHS providers collect data on patient experience, although there is limited evidence about what to measure or how to collect and use data to improve services. We studied inpatient mental health services, as these are important, costly and often unpopular services within which serious incidents occur.
Aims
To identify which approaches to collecting and using patient experience data are most useful for supporting improvements in inpatient mental health care.
Design
The study comprised five work packages: a systematic review to identify evidence-based patient experience themes relevant to inpatient mental health care (work package 1); a survey of patient experience leads in NHS mental health trusts in England to describe current approaches to collecting and using patient experience data in inpatient mental health services, and to populate the sampling frame for work package 3 (work package 2); in-depth case studies at sites selected using the work package 2 findings, analysed using a realist approach (work package 3); a consensus conference to agree on recommendations about best practice (work package 4); and health economic modelling to estimate resource requirements and potential benefits arising from the adoption of best practice (work package 5). Using a realist methodology, we analysed and presented our findings using a framework based on four stages of the patient experience data pathway, for which we coined the term CRAICh (collecting and giving, receiving and listening, analysing, and quality improvement and change). The project was supported by a patient and public involvement team that contributed to work package 1 and the development of programme theories (work package 3). Two employed survivor researchers worked on work packages 2, 3 and 4.
Setting
The study was conducted in 57 NHS providers of inpatient mental health care in England.
Participants
In work package 2, 47 NHS patient experience leads took part and, in work package 3, 62 service users, 19 carers and 101 NHS staff participated, across six trusts. Forty-four individuals attended the work package 4 consensus conference.
Results
The patient experience feedback cycle was rarely completed and, even when improvements were implemented, these tended to be environmental rather than cultural. There were few examples of triangulation with patient safety or outcomes data. We identified 18 rules for best practice in collecting and using inpatient mental health experience data, and 154 realist context–mechanism–outcome configurations that underpin and explain these.
Limitations
The study was cross-sectional in design and we relied on examples of historical service improvement. Our health economic models (in work package 5) were therefore limited in the estimation and modelling of prospective benefits associated with the collection and use of patient experience data.
Conclusions
Patient experience work is insufficiently embedded in most mental health trusts. More attention to analysis and interpretation of patient experience data is needed, particularly to ways of triangulating these with outcomes and safety data.
Future work
Further evaluative research is needed to develop and evaluate a locally adapted intervention based on the 18 rules for best practice.
Study registration
The systematic review (work package 1) is registered as PROSPERO CRD42016033556.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 21. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Scott Weich
- Warwick Medical School, University of Warwick, Coventry, UK
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Sarah-Jane Fenton
- Warwick Medical School, University of Warwick, Coventry, UK
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Sophie Staniszewska
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Michael Larkin
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Jason Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Kamaldeep Bhui
- Centre for Psychiatry, Wolfson Institute of Preventative Medicine – Barts and The London, Queen Mary University of London, London, UK
| | | | - Charlotte Croft
- Warwick Business School, University of Warwick, Coventry, UK
| | - Una Foye
- Centre for Psychiatry, Wolfson Institute of Preventative Medicine – Barts and The London, Queen Mary University of London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Aimee Cairns
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Stephen Jeffreys
- Mental Health Foundation, London, UK
- National Survivor User Network, London, UK
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Staniszewska S, Mockford C, Chadburn G, Fenton SJ, Bhui K, Larkin M, Newton E, Crepaz-Keay D, Griffiths F, Weich S. Experiences of in-patient mental health services: systematic review. Br J Psychiatry 2019; 214:329-338. [PMID: 30894243 DOI: 10.1192/bjp.2019.22] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In-patients in crisis report poor experiences of mental healthcare not conducive to recovery. Concerns include coercion by staff, fear of assault from other patients, lack of therapeutic opportunities and limited support. There is little high-quality evidence on what is important to patients to inform recovery-focused care.AimsTo conduct a systematic review of published literature, identifying key themes for improving experiences of in-patient mental healthcare. METHOD A systematic search of online databases (MEDLINE, PsycINFO and CINAHL) for primary research published between January 2000 and January 2016. All study designs from all countries were eligible. A qualitative analysis was undertaken and study quality was appraised. A patient and public reference group contributed to the review. RESULTS Studies (72) from 16 countries found four dimensions were consistently related to significantly influencing in-patients' experiences of crisis and recovery-focused care: the importance of high-quality relationships; averting negative experiences of coercion; a healthy, safe and enabling physical and social environment; and authentic experiences of patient-centred care. Critical elements for patients were trust, respect, safe wards, information and explanation about clinical decisions, therapeutic activities, and family inclusion in care. CONCLUSIONS A number of experiences hinder recovery-focused care and must be addressed with the involvement of staff to provide high-quality in-patient services. Future evaluations of service quality and development of practice guidance should embed these four dimensions.Declaration of interestK.B. is editor of British Journal of Psychiatry and leads a national programme (Synergi Collaborative Centre) on patient experiences driving change in services and inequalities.
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Affiliation(s)
- Sophie Staniszewska
- Professor of Patient and Public Involvement and Experiences of Care,Division of Health Sciences, Warwick Medical School,University of Warwick,UK
| | - Carole Mockford
- Senior Research Fellow,Division of Health Sciences,Warwick Medical School,University of Warwick,UK
| | - Greg Chadburn
- Researcher,Surrey and Sussex Healthcare National Health Service Trust,UK
| | - Sarah-Jane Fenton
- Comparative Social Policy,PGCert Advanced Research Methods and Skills,PhD Social Policy,Research Fellow,Division of Health Sciences,Warwick Medical School,University of Warwick,UK
| | - Kamaldeep Bhui
- Professor of Psychiatry,Centre for Psychiatry,Wolfson Institute of Preventive Medicine,Barts and The London School of Medicine and Dentistry,Queen Mary University of London,East London National Health Service Foundation Trust,UK
| | - Michael Larkin
- Reader in Psychology,School of Life and Health Sciences,Aston University,UK
| | - Elizabeth Newton
- Consultant Clinical Psychologist,Research Fellow, School of Psychology,University of Birmingham,UK
| | - David Crepaz-Keay
- Head of Empowerment and Social Inclusion,Mental Health Foundation,UK
| | - Frances Griffiths
- Professor of Medicine in Society,Division of Health Sciences,Warwick Medical School,University of Warwick,UK
| | - Scott Weich
- Professor of Mental Health,Division of Health Sciences,Warwick Medical School,University of Warwick;and School of Health and Related Research (ScHARR),University of Sheffield,UK
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Seers K, Rycroft-Malone J, Cox K, Crichton N, Edwards RT, Eldh AC, Estabrooks CA, Harvey G, Hawkes C, Jones C, Kitson A, McCormack B, McMullan C, Mockford C, Niessen T, Slater P, Titchen A, van der Zijpp T, Wallin L. Facilitating Implementation of Research Evidence (FIRE): an international cluster randomised controlled trial to evaluate two models of facilitation informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework. Implement Sci 2018; 13:137. [PMID: 30442174 PMCID: PMC6238407 DOI: 10.1186/s13012-018-0831-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 10/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health care practice needs to be underpinned by high quality research evidence, so that the best possible care can be delivered. However, evidence from research is not always utilised in practice. This study used the Promoting Action on Research Implementation in Health Services (PARIHS) framework as its theoretical underpinning to test whether two different approaches to facilitating implementation could affect the use of research evidence in practice. METHODS A pragmatic clustered randomised controlled trial with embedded process and economic evaluation was used. The study took place in four European countries across 24 long-term nursing care sites, for people aged 60 years or more with documented urinary incontinence. In each country, sites were randomly allocated to standard dissemination, or one of two different types of facilitation. The primary outcome was the documented percentage compliance with the continence recommendations, assessed at baseline, then at 6, 12, 18, and 24 months after the intervention. Data were analysed using STATA15, multi-level mixed-effects linear regression models were fitted to scores for compliance with the continence recommendations, adjusting for clustering. RESULTS Quantitative data were obtained from reviews of 2313 records. There were no significant differences in the primary outcome (documented compliance with continence recommendations) between study arms and all study arms improved over time. CONCLUSIONS This was the first cross European randomised controlled trial with embedded process evaluation that sought to test different methods of facilitation. There were no statistically significant differences in compliance with continence recommendations between the groups. It was not possible to identify whether different types and "doses" of facilitation were influential within very diverse contextual conditions. The process evaluation (Rycroft-Malone et al., Implementation Science. doi: 10.1186/s13012-018-0811-0) revealed the models of facilitation used were limited in their ability to overcome the influence of contextual factors. TRIAL REGISTRATION Current Controlled Trials ISRCTN11598502 . Date 4/2/10. The research leading to these results has received funding from the European Union's Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 223646.
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Affiliation(s)
- Kate Seers
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Karen Cox
- Fontys School of People and Health Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Nicola Crichton
- School of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 0AA UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
| | - Ann Catrine Eldh
- Faculty of Medicine and Health Science, Department of Nursing, Linkoping University, Linkoping, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | | | - Gill Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Claire Hawkes
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Carys Jones
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia Australia
| | | | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Theo Niessen
- Fontys School of People and Health Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Paul Slater
- Institute of Nursing and Health Research, Ulster University, Shore Rd, Belfast, Northern Ireland
| | - Angie Titchen
- Institute of Nursing and Health Research, Ulster University, Shore Rd, Belfast, Northern Ireland
| | - Teatske van der Zijpp
- Fontys School of People and Health Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Lars Wallin
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Rycroft-Malone J, Seers K, Eldh AC, Cox K, Crichton N, Harvey G, Hawkes C, Kitson A, McCormack B, McMullan C, Mockford C, Niessen T, Slater P, Titchen A, van der Zijpp T, Wallin L. A realist process evaluation within the Facilitating Implementation of Research Evidence (FIRE) cluster randomised controlled international trial: an exemplar. Implement Sci 2018; 13:138. [PMID: 30442165 PMCID: PMC6238283 DOI: 10.1186/s13012-018-0811-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/27/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Facilitation is a promising implementation intervention, which requires theory-informed evaluation. This paper presents an exemplar of a multi-country realist process evaluation that was embedded in the first international randomised controlled trial evaluating two types of facilitation for implementing urinary continence care recommendations. We aimed to uncover what worked (and did not work), for whom, how, why and in what circumstances during the process of implementing the facilitation interventions in practice. METHODS This realist process evaluation included theory formulation, theory testing and refining. Data were collected in 24 care home sites across four European countries. Data were collected over four time points using multiple qualitative methods: observation (372 h), interviews with staff (n = 357), residents (n = 152), next of kin (n = 109) and other stakeholders (n = 128), supplemented by facilitator activity logs. A combined inductive and deductive data analysis process focused on realist theory refinement and testing. RESULTS The content and approach of the two facilitation programmes prompted variable opportunities to align and realign support with the needs and expectations of facilitators and homes. This influenced their level of confidence in fulfilling the facilitator role and ability to deliver the intervention as planned. The success of intervention implementation was largely dependent on whether sites prioritised their involvement in both the study and the facilitation programme. In contexts where the study was prioritised (including release of resources) and where managers and staff support was sustained, this prompted collective engagement (as an attitude and action). Internal facilitators' (IF) personal characteristics and abilities, including personal and formal authority, in combination with a supportive environment prompted by managers triggered the potential for learning over time. Learning over time resulted in a sense of confidence and personal growth, and enactment of the facilitation role, which resulted in practice changes. CONCLUSION The scale and multi-country nature of this study provided a novel context to conduct one of the few trial embedded realist-informed process evaluations. In addition to providing an explanatory account of implementation processes, a conceptual platform for future facilitation research is presented. Finally, a realist-informed process evaluation framework is outlined, which could inform future research of this nature. TRIAL REGISTRATION Current controlled trials ISRCTN11598502 .
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Affiliation(s)
- Jo Rycroft-Malone
- Bangor Institute for Health and Medical Research, School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Kate Seers
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Ann Catrine Eldh
- Faculty of Medicine and Health Science, Department of Nursing, Linkoping, and Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Linkopings University, Stockholm, Sweden
| | - Karen Cox
- Fontys School of People and Health Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Nicola Crichton
- School of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 0AA UK
| | - Gill Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Claire Hawkes
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia Australia
| | - Brendan McCormack
- Division of Nursing, Queen Margaret University Edinburgh, Edinburgh, UK
| | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Theo Niessen
- Fontys School of People and Health Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Paul Slater
- Institute of Nursing and Health Research, Ulster University, Shore Rd Belfast, Ulster, Northern Ireland
| | - Angie Titchen
- Institute of Nursing and Health Research, Ulster University, Jordanstown, UK
| | - Teatske van der Zijpp
- Fontys School of People and Health Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Lars Wallin
- Faculty of Medicine and Health Science, Department of Nursing, Linkoping, and Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Linkopings University, Stockholm, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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5
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Brett J, Staniszewska S, Simera I, Seers K, Mockford C, Goodlad S, Altman D, Moher D, Barber R, Denegri S, Entwistle AR, Littlejohns P, Morris C, Suleman R, Thomas V, Tysall C. Reaching consensus on reporting patient and public involvement (PPI) in research: methods and lessons learned from the development of reporting guidelines. BMJ Open 2017; 7:e016948. [PMID: 29061613 PMCID: PMC5665282 DOI: 10.1136/bmjopen-2017-016948] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/18/2017] [Accepted: 08/09/2017] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Patient and public involvement (PPI) is inconsistently reported in health and social care research. Improving the quality of how PPI is reported is critical in developing a higher quality evidence base to gain a better insight into the methods and impact of PPI. This paper describes the methods used to develop and gain consensus on guidelines for reporting PPI in research studies (updated version of the Guidance for Reporting Patient and Public Involvement (GRIPP2)). METHODS There were three key stages in the development of GRIPP2: identification of key items for the guideline from systematic review evidence of the impact of PPI on health research and health services, a three-phase online Delphi survey with a diverse sample of experts in PPI to gain consensus on included items and a face-to-face consensus meeting to finalise and reach definitive agreement on GRIPP2. Challenges and lessons learnt during the development of the reporting guidelines are reported. DISCUSSION The process of reaching consensus is vital within the development of guidelines and policy directions, although debate around how best to reach consensus is still needed. This paper discusses the critical stages of consensus development as applied to the development of consensus for GRIPP2 and discusses the benefits and challenges of consensus development.
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Affiliation(s)
- Jo Brett
- Department of Midwifery, Community and Public Health, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, Oxfordshire, UK
| | - Sophie Staniszewska
- Division of Health Sciences, RCN Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - Iveta Simera
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, EQUATOR Network, Centre for Statistics in Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Kate Seers
- Division of Health and Social Care Research, RCN Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - Carole Mockford
- Division of Health Sciences, RCN Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - Susan Goodlad
- Centre for Research in Psychology, Behaviour and Acheivement, University of Coventry, Coventry, UK
| | - Doug Altman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, EQUATOR Network, Centre for Statistics in Medicine, University of Oxford, Oxford, Oxfordshire, UK
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Centre for Statistics in Medicine, Oxford, UK
| | - David Moher
- Ottawa Hospital Research Institute, School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Rosemary Barber
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Simon Denegri
- INVOLVE, National Institute of Health Research (NIHR), University of Southampton, Southampton, UK
| | | | | | - Christopher Morris
- Peninsula Cerebra Childhood Disability Research Unit (PenCRU), University of Exeter Medical School, Exeter, UK
| | | | - Victoria Thomas
- Patient and Public Involvement Unit, Public Involvement Programme, National Institute for Health and Clinical Excellence, London, UK
| | - Colin Tysall
- UNTRAP, University of Warwick, Coventry, Warwicks, UK
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Staniszewska S, Brett J, Simera I, Seers K, Mockford C, Goodlad S, Altman DG, Moher D, Barber R, Denegri S, Entwistle A, Littlejohns P, Morris C, Suleman R, Thomas V, Tysall C. GRIPP2 reporting checklists: tools to improve reporting of patient and public involvement in research. Res Involv Engagem 2017; 3:13. [PMID: 29062538 PMCID: PMC5611595 DOI: 10.1186/s40900-017-0062-2] [Citation(s) in RCA: 290] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 07/19/2017] [Indexed: 05/06/2023]
Abstract
BACKGROUND While the patient and public involvement (PPI) evidence base has expanded over the past decade, the quality of reporting within papers is often inconsistent, limiting our understanding of how it works, in what context, for whom, and why. OBJECTIVE To develop international consensus on the key items to report to enhance the quality, transparency, and consistency of the PPI evidence base. To collaboratively involve patients as research partners at all stages in the development of GRIPP2. METHODS The EQUATOR method for developing reporting guidelines was used. The original GRIPP (Guidance for Reporting Involvement of Patients and the Public) checklist was revised, based on updated systematic review evidence. A three round Delphi survey was used to develop consensus on items to be included in the guideline. A subsequent face-to-face meeting produced agreement on items not reaching consensus during the Delphi process. RESULTS One hundred forty-three participants agreed to participate in round one, with an 86% (123/143) response for round two and a 78% (112/143) response for round three. The Delphi survey identified the need for long form (LF) and short form (SF) versions. GRIPP2-LF includes 34 items on aims, definitions, concepts and theory, methods, stages and nature of involvement, context, capture or measurement of impact, outcomes, economic assessment, and reflections and is suitable for studies where the main focus is PPI. GRIPP2-SF includes five items on aims, methods, results, outcomes, and critical perspective and is suitable for studies where PPI is a secondary focus. CONCLUSIONS GRIPP2-LF and GRIPP2-SF represent the first international evidence based, consensus informed guidance for reporting patient and public involvement in research. Both versions of GRIPP2 aim to improve the quality, transparency, and consistency of the international PPI evidence base, to ensure PPI practice is based on the best evidence. In order to encourage its wide dissemination this article is freely accessible on The BMJ and Research Involvement and Engagement journal websites.
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Affiliation(s)
- S. Staniszewska
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - J. Brett
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - I. Simera
- Centre for Tropical Medicine and Global Health and UK EQUATOR Centre, University of Oxford, Oxford, UK
| | - K. Seers
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | | | | | - D. G. Altman
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - D. Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - R. Barber
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - S. Denegri
- National Institute for Health Research, UCL School of Life and Medical Sciences, London, UK
| | | | | | - C. Morris
- University of Exeter Medical School, Exeter, UK
| | | | - V. Thomas
- Public Involvement Programme, National Institute for Health and Care Excellence, London, UK
| | - C. Tysall
- Warwick Medical School, Coventry, UK
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7
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Staniszewska S, Brett J, Simera I, Seers K, Mockford C, Goodlad S, Altman DG, Moher D, Barber R, Denegri S, Entwistle A, Littlejohns P, Morris C, Suleman R, Thomas V, Tysall C. GRIPP2 reporting checklists: tools to improve reporting of patient and public involvement in research. BMJ 2017; 358:j3453. [PMID: 28768629 PMCID: PMC5539518 DOI: 10.1136/bmj.j3453] [Citation(s) in RCA: 686] [Impact Index Per Article: 98.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background While the patient and public involvement (PPI) evidence base has expanded over the past decade, the quality of reporting within papers is often inconsistent, limiting our understanding of how it works, in what context, for whom, and why.Objective To develop international consensus on the key items to report to enhance the quality, transparency, and consistency of the PPI evidence base. To collaboratively involve patients as research partners at all stages in the development of GRIPP2.Methods The EQUATOR method for developing reporting guidelines was used. The original GRIPP (Guidance for Reporting Involvement of Patients and the Public) checklist was revised, based on updated systematic review evidence. A three round Delphi survey was used to develop consensus on items to be included in the guideline. A subsequent face-to-face meeting produced agreement on items not reaching consensus during the Delphi process.Results 143 participants agreed to participate in round one, with an 86% (123/143) response for round two and a 78% (112/143) response for round three. The Delphi survey identified the need for long form (LF) and short form (SF) versions. GRIPP2-LF includes 34 items on aims, definitions, concepts and theory, methods, stages and nature of involvement, context, capture or measurement of impact, outcomes, economic assessment, and reflections and is suitable for studies where the main focus is PPI. GRIPP2-SF includes five items on aims, methods, results, outcomes, and critical perspective and is suitable for studies where PPI is a secondary focus.Conclusions GRIPP2-LF and GRIPP2-SF represent the first international evidence based, consensus informed guidance for reporting patient and public involvement in research. Both versions of GRIPP2 aim to improve the quality, transparency, and consistency of the international PPI evidence base, to ensure PPI practice is based on the best evidence. In order to encourage its wide dissemination this article is freely accessible on The BMJ and Research Involvement and Engagement journal websites.
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Affiliation(s)
- S Staniszewska
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - J Brett
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - I Simera
- Centre for Tropical Medicine and Global Health and UK EQUATOR Centre, University of Oxford, UK
| | - K Seers
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | | | | | - D G Altman
- Centre for Statistics in Medicine, University of Oxford, UK
| | - D Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - R Barber
- School of Health and Related Research, Section of Public Health, University of Sheffield, Sheffield, UK
| | - S Denegri
- National Institute for Health Research, UCL School of Life and Medical Sciences, London, UK
| | | | | | - C Morris
- University of Exeter Medical School, Exeter, UK
| | - R Suleman
- Warwick Medical School, Coventry, UK
| | - V Thomas
- Public Involvement Programme, National Institute for Health and Care Excellence, London, UK
| | - C Tysall
- Warwick Medical School, Coventry, UK
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Abstract
Informal carers are increasingly providing specialist care at home for people living with motor neurone disease. The carers may experience significant deterioration in their quality of life as a result of the physical and psychological burden they undertake. This systematic review seeks to provide evidence-based recommendations to enable healthcare professionals to support carers appropriately to maintain their wellbeing and to continue providing care at home. Inclusion criteria included articles focusing on the experience of informal carers of people with motor neurone disease, particularly when reporting on their perspective of professional services. Twenty-three studies were included and a thematic analysis was undertaken. Four key recommendations were identified: providing support, early access to palliative care, information regarding availability of services, and offering carers training for using specialist equipment. These recommendations offer healthcare professionals practical, cost-effective suggestions to improve existing services.
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Affiliation(s)
- Susan Bergin
- Specialist Palliative Care Team, Coventry and Warwickshire Partnership NHS Trust
| | - Carole Mockford
- Senior Research Fellow, Warwick Medical School, University of Warwick
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Mockford C, Seers K, Murray M, Oyebode J, Clarke R, Staniszewska S, Suleman R, Boex S, Diment Y, Grant R, Leach J, Sharma U. The development of service user-led recommendations for health and social care services on leaving hospital with memory loss or dementia - the SHARED study. Health Expect 2016; 20:495-507. [PMID: 27389613 PMCID: PMC5433530 DOI: 10.1111/hex.12477] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2016] [Indexed: 11/27/2022] Open
Abstract
Background Health and social care services are under strain providing care in the community particularly at hospital discharge. Patient and carer experiences can inform and shape services. Objective To develop service user‐led recommendations enabling smooth transition for people living with memory loss from acute hospital to community. Design Lead and co‐researchers conducted semi‐structured interviews with 15 pairs of carers and patients with memory loss at discharge, 6 and 12 weeks post‐discharge and one semi‐structured interview with health and social care professionals and Admiral Nurses. Framework analysis was guided by co‐researchers. Two focus groups of study participants, facilitated by co‐researchers, met to shape and finalize recommendations. Setting and participants Recruitment took place in acute hospitals in two National Health Service (NHS) Trusts in England. Patients were aged 65 and over, with memory loss, an in‐patient for at least 1 week returning to the community, who had a carer consenting to be in the study. Results Poor delivery of services caused considerable stress to some study families living with memory loss. Three key recommendations included a need for a written, mutually agreed discharge plan, a named coordinator of services, and improved domiciliary care services. Discussion and conclusions Vulnerable patients with memory loss find coming out of hospital after an extended period a stressful experience. The SHARED study contributes to understanding the hospital discharge process through the eyes of the patient and carer living with memory loss and has the potential to contribute to more efficient use of resources and to improving health outcomes in communities.
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Affiliation(s)
- Carole Mockford
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Kate Seers
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Jan Oyebode
- School of Dementia Studies, University of Bradford, Bradford, UK
| | - Rosemary Clarke
- University/Users Teaching and Research Action Partnership (UNTRAP), University of Warwick, Coventry, UK
| | - Sophie Staniszewska
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Rashida Suleman
- University/Users Teaching and Research Action Partnership (UNTRAP), University of Warwick, Coventry, UK
| | - Sue Boex
- Alzheimer's Society Research Network, London, UK
| | | | - Richard Grant
- University/Users Teaching and Research Action Partnership (UNTRAP), University of Warwick, Coventry, UK.,National Institute for Health Research, Collaboration for Leadership in Applied Heath Research and Care, West Midlands (NIHR CLAHRC WM), Coventry, UK
| | - Jim Leach
- Patient and Public Action Group, Clinical Research Network, Coventry, UK
| | - Uma Sharma
- University/Users Teaching and Research Action Partnership (UNTRAP), University of Warwick, Coventry, UK
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Perkins GD, Griffiths F, Slowther AM, George R, Fritz Z, Satherley P, Williams B, Waugh N, Cooke MW, Chambers S, Mockford C, Freeman K, Grove A, Field R, Owen S, Clarke B, Court R, Hawkes C. Do-not-attempt-cardiopulmonary-resuscitation decisions: an evidence synthesis. Health Serv Deliv Res 2016. [DOI: 10.3310/hsdr04110] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundCardiac arrest is the final common step in the dying process. In the right context, resuscitation can reverse the dying process, yet success rates are low. However, cardiopulmonary resuscitation (CPR) is a highly invasive medical treatment, which, if applied in the wrong setting, can deprive the patient of dignified death. Do-not-attempt-cardiopulmonary-resuscitation (DNACPR) decisions provide a mechanism to withhold CPR. Recent scientific and lay press reports suggest that the implementation of DNACPR decisions in NHS practice is problematic.Aims and objectivesThis project sought to identify reasons why conflict and complaints arise, identify inconsistencies in NHS trusts’ implementation of national guidelines, understand health professionals’ experience in relation to DNACPR, its process and ethical challenges, and explore the literature for evidence to improve DNACPR policy and practice.MethodsA systematic review synthesised evidence of processes, barriers and facilitators related to DNACPR decision-making and implementation. Reports from NHS trusts, the National Reporting and Learning System, the Parliamentary and Health Service Ombudsman, the Office of the Chief Coroner, trust resuscitation policies and telephone calls to a patient information line were reviewed. Multiple focus groups explored service-provider perspectives on DNACPR decisions. A stakeholder group discussed the research findings and identified priorities for future research.ResultsThe literature review found evidence that structured discussions at admission to hospital or following deterioration improved patient involvement and decision-making. Linking DNACPR to overall treatment plans improved clarity about goals of care, aided communication and reduced harms. Standardised documentation improved the frequency and quality of recording decisions. Approximately 1500 DNACPR incidents are reported annually. One-third of these report harms, including some instances of death. Problems with communication and variation in trusts’ implementation of national guidelines were common. Members of the public were concerned that their wishes with regard to resuscitation would not be respected. Clinicians felt that DNACPR decisions should be considered within the overall care of individual patients. Some clinicians avoid raising discussions about CPR for fear of conflict or complaint. A key theme across all focus groups, and reinforced by the literature review, was the negative impact on overall patient care of having a DNACPR decision and the conflation of ‘do not resuscitate’ with ‘do not provide active treatment’.LimitationsThe variable quality of some data sources allows potential overstatement or understatement of findings. However, data source triangulation identified common issues.ConclusionThere is evidence of variation and suboptimal practice in relation to DNACPR decisions across health-care settings. There were deficiencies in considering, discussing and implementing the decision, as well as unintended consequences of DNACPR decisions being made on other aspects of patient care.Future workRecommendations supported by the stakeholder group are standardising NHS policies and forms, ensuring cross-boundary recognition of DNACPR decisions, integrating decisions with overall treatment plans and developing tools and training strategies to support clinician and patient decision-making, including improving communication.Study registrationThis study is registered as PROSPERO CRD42012002669.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Gavin D Perkins
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Anne-Marie Slowther
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Robert George
- Cicely Saunders Institute, King’s College London, London, UK
- Palliative Care, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - Zoe Fritz
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Barry Williams
- Patient and Relative Committee, The Intensive Care Foundation, London, UK
| | - Norman Waugh
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Matthew W Cooke
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Sue Chambers
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Carole Mockford
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Karoline Freeman
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Amy Grove
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Richard Field
- Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Sarah Owen
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Ben Clarke
- Medical School, University of Glasgow, Glasgow, UK
| | - Rachel Court
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Claire Hawkes
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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van der Zijpp TJ, Niessen T, Eldh AC, Hawkes C, McMullan C, Mockford C, Wallin L, McCormack B, Rycroft-Malone J, Seers K. A Bridge Over Turbulent Waters: Illustrating the Interaction Between Managerial Leaders and Facilitators When Implementing Research Evidence. Worldviews Evid Based Nurs 2016; 13:25-31. [PMID: 26788694 DOI: 10.1111/wvn.12138] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Emerging evidence focuses on the importance of the role of leadership in successfully transferring research evidence into practice. However, little is known about the interaction between managerial leaders and clinical leaders acting as facilitators (internal facilitators [IFs]) in this implementation process. AIMS To describe the interaction between managerial leaders and IFs and how this enabled or hindered the facilitation process of implementing urinary incontinence guideline recommendations in a local context in settings that provide long-term care to older people. METHODS Semistructured interviews with 105 managers and 22 IFs, collected for a realist process evaluation across four European countries informed this study. An interpretive data analysis unpacks interactions between managerial leaders and IFs. RESULTS This study identified three themes that were important in the interactions between managerial leaders and IFs that could hinder or support the implementation process: "realising commitment"; "negotiating conditions"; and "encouragement to keep momentum going." The findings revealed that the continuous reciprocal relationships between IFs and managerial leaders influenced the progress of implementation, and could slow the process down or disrupt it. A metaphor of crossing a turbulent river by the "building of a bridge" emerged as one way of understanding the findings. LINKING EVIDENCE TO ACTION Our findings illuminate a neglected area, the effects of relationships between key staff on implementing evidence into practice. Relational aspects of managerial and clinical leadership roles need greater consideration when planning guideline implementation and practice change. In order to support implementation, staff assigned as IFs as well as stakeholders like managers at all levels of an organisation should be engaged in realising commitment, negotiating conditions, and keeping momentum going. Thus, communication is crucial between all involved.
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Affiliation(s)
| | - Theo Niessen
- Associate Professor, Fontys University of Applied Sciences, Faculty of Nursing, Eindhoven, The Netherlands
| | - Ann Catrine Eldh
- Senior lecturer, School of Education, Health and Social Studies, Dalarna University, Falun, Sweden, and Researcher, Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Claire Hawkes
- Senior Research Fellow-Emergency Care, Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK
| | - Christel McMullan
- Research Fellow, Public Health, Institute of Applied Health Research, Murray Learning Centre, University of Birmingham, Birmingham, UK
| | - Carole Mockford
- Senior Research Fellow, Royal College of Nursing Research Institute, Department of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Lars Wallin
- Professor, School of Education, Health and Social Studies, Dalarna University, Falun, Sweden, and Associate Professor, Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Brendan McCormack
- Head of the Division of Nursing, School of Health Sciences, Queen Margaret University, East Lothian, UK
| | - Jo Rycroft-Malone
- Professor and Head of School, Bangor University, UK, and School of Healthcare Sciences, Bangor, UK
| | - Kate Seers
- Director, RCN Research Institute and Professor of Health Research, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Mockford C, Murray M, Seers K, Oyebode J, Grant R, Boex S, Staniszewska S, Diment Y, Leach J, Sharma U, Clarke R, Suleman R. A SHARED study-the benefits and costs of setting up a health research study involving lay co-researchers and how we overcame the challenges. Res Involv Engagem 2016; 2:8. [PMID: 29062509 PMCID: PMC5611649 DOI: 10.1186/s40900-016-0021-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/10/2016] [Indexed: 05/16/2023]
Abstract
PLAIN ENGLISH SUMMARY In the United Kingdom (UK), official bodies such as the Department of Health and research funders such as the National Institute for Health Research support and encourage lay involvement in all stages of research studies. The SHARED study has had substantial patient and public involvement (PPI) from developing the idea to dissemination. The aim of the study has been to develop recommendations led by service users for health and social care professionals to use at hospital discharge and in care planning for people living with memory loss and their carers. This article is about how the study started and the benefits, costs and challenges we encountered as the lead and lay co-researchers. Once we were successful with the grant application, we had to recruit and train the lay co-researchers and obtain various approvals before we could start the project. We had various support from funders, the Research Ethics Committee, lay members of Alzheimer's Society and from the lay co-researchers. However, we encountered some challenges with paying the lay co-researchers and with getting the approval for the co-researchers to interview staff on NHS premises. The challenges were overcome eventually but some aspects of the study changed because of this. We suggest that some changes could be made to the research system which would lead to greater inclusion of the lay co-researchers in research studies and would make the process more straightforward for the research team. ABSTRACT Background Involving patients and the public in all stages of research has been the focus of the SHARED study. Patient and public involvement (PPI) is an important strategic priority for the Department of Health and funders such as the National Institute for Health Research. The aim of this paper is to describe the benefits, challenges and costs involved in setting up the research study with lay members as part of the research team. The study focused on developing service user-led recommendations for people with memory loss and their carers, on discharge from acute hospital to the community. Methods This began with a discussion of an initial research idea with a lay group of carers and people living with dementia. Once funded, approval was sought from the Research Ethics Committee and NHS Trusts to conduct the research including the active involvement of lay co-researchers. Finally, to recruit, train and pay lay co-researchers in their role. Results The benefits of PPI have included developing ideas which are important to people living with memory loss; support for PPI received from the funders and research ethics committee, high levels of interest from volunteer groups, and lasting enthusiasm from many of the co-researchers. Organisational challenges were met in the requirement for research passports and with payment methods for the co-researchers. Training was beneficial but incurred extra costs for repeated training days. Discussion Overall the benefits outweighed the challenges which were overcome to varying degrees. The lay co-researchers gained membership of a study group and a beneficial partnership developed with the third sector. The biggest challenge was in overcoming the differences in approach to lay co-researchers between NHS Trusts. Organisational culture has been slow to incorporate PPI and this has not yet been fully addressed. It has the potential to delay the start of projects, affect recruitment time, incur extra research costs and disadvantage PPI. Conclusion Buy-in to service user involvement in research studies could be improved by clarifying the requirements for NHS Trust approval and by simplifying the system for financial reimbursement to lay co-researchers. This would improve inclusivity and provide a smoother process for the research team and the co-researchers.
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Affiliation(s)
- Carole Mockford
- Royal College of Nursing Research Institute, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | | | - Kate Seers
- Royal College of Nursing Research Institute, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Jan Oyebode
- School of Dementia Studies, University of Bradford, Bradford, UK
| | - Richard Grant
- University/Users Teaching and Research Action Partnership (UNTRAP), University of Warwick, Coventry, UK
| | - Sue Boex
- Alzheimer’s Society Research Network, London, UK
| | - Sophie Staniszewska
- Royal College of Nursing Research Institute, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | | | - Jim Leach
- Patient and Public Action Group, Comprehensive Local Research Network, Coventry, UK
| | - Uma Sharma
- University/Users Teaching and Research Action Partnership (UNTRAP), University of Warwick, Coventry, UK
| | - Rosemary Clarke
- University/Users Teaching and Research Action Partnership (UNTRAP), University of Warwick, Coventry, UK
| | - Rashida Suleman
- University/Users Teaching and Research Action Partnership (UNTRAP), University of Warwick, Coventry, UK
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Mockford C. A review of family carers' experiences of hospital discharge for people with dementia, and the rationale for involving service users in health research. J Healthc Leadersh 2015; 7:21-28. [PMID: 29355178 PMCID: PMC5740992 DOI: 10.2147/jhl.s70020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In the UK, service user involvement is an important factor in health policy, and obtaining research funding. It may be helpful in expanding our knowledge in areas where research evidence is poor such as experiences of hospital discharge planning for the family carers of people with dementia.
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Affiliation(s)
- Carole Mockford
- Division of Health Sciences, Royal College of Nursing Research Institute, University of Warwick, Coventry, UK
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Mockford C, Fritz Z, George R, Court R, Grove A, Clarke B, Field R, Perkins GD. Do not attempt cardiopulmonary resuscitation (DNACPR) orders: A systematic review of the barriers and facilitators of decision-making and implementation. Resuscitation 2015; 88:99-113. [DOI: 10.1016/j.resuscitation.2014.11.016] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/14/2014] [Accepted: 11/18/2014] [Indexed: 12/21/2022]
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Mockford C, Clarke B, Court R, Field R, Fritz Z, Grove A, Waugh N, Perkins G. A systematic review of do-not-attempt-cardiopulmonary-resuscitation (DNACPR) orders: Summarising the evidence around decision making and implementation. Resuscitation 2014. [DOI: 10.1016/j.resuscitation.2014.03.212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Brett J, Staniszewska S, Mockford C, Herron-Marx S, Hughes J, Tysall C, Suleman R. Mapping the impact of patient and public involvement on health and social care research: a systematic review. Health Expect 2012; 17:637-50. [PMID: 22809132 DOI: 10.1111/j.1369-7625.2012.00795.x] [Citation(s) in RCA: 790] [Impact Index Per Article: 65.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2012] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There is an increasing international interest in patient and public involvement (PPI) in research, yet relatively little robust evidence exists about its impact on health and social care research. OBJECTIVE To identify the impact of patient and public involvement on health and social care research. DESIGN A systematic search of electronic databases and health libraries was undertaken from 1995 to 2009. Data were extracted and quality assessed utilizing the guidelines of the NHS Centre for Reviews and Dissemination 2009 and the Critical Appraisal Skills Programme (CASP). Grey literature was assessed using the Dixon-Woods et al. (2005) checklist. INCLUSION CRITERIA All study types that reported the impact PPI had on the health and/or social care research study. MAIN RESULTS A total of 66 studies reporting the impact of PPI on health and social care research were included. The positive impacts identified enhanced the quality and appropriateness of research. Impacts were reported for all stages of research, including the development of user-focused research objectives, development of user-relevant research questions, development of user-friendly information, questionnaires and interview schedules, more appropriate recruitment strategies for studies, consumer-focused interpretation of data and enhanced implementation and dissemination of study results. Some challenging impacts were also identified. CONCLUSION This study provides the first international evidence of PPI impact that has emerged at all key stages of the research process. However, much of the evidence base concerning impact remains weak and needs significant enhancement in the next decade.
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Affiliation(s)
- Jo Brett
- Royal College of Nursing Research Institute, School of Health and Social Studies, University of Warwick, Coventry, UK
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Seers K, Cox K, Crichton NJ, Edwards RT, Eldh AC, Estabrooks CA, Harvey G, Hawkes C, Kitson A, Linck P, McCarthy G, McCormack B, Mockford C, Rycroft-Malone J, Titchen A, Wallin L. FIRE (Facilitating Implementation of Research Evidence): a study protocol. Implement Sci 2012; 7:25. [PMID: 22453077 PMCID: PMC3356232 DOI: 10.1186/1748-5908-7-25] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 03/27/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research evidence underpins best practice, but is not always used in healthcare. The Promoting Action on Research Implementation in Health Services (PARIHS) framework suggests that the nature of evidence, the context in which it is used, and whether those trying to use evidence are helped (or facilitated) affect the use of evidence. Urinary incontinence has a major effect on quality of life of older people, has a high prevalence, and is a key priority within European health and social care policy. Improving continence care has the potential to improve the quality of life for older people and reduce the costs associated with providing incontinence aids. OBJECTIVES This study aims to advance understanding about the contribution facilitation can make to implementing research findings into practice via: extending current knowledge of facilitation as a process for translating research evidence into practice; evaluating the feasibility, effectiveness, and cost-effectiveness of two different models of facilitation in promoting the uptake of research evidence on continence management; assessing the impact of contextual factors on the processes and outcomes of implementation; and implementing a pro-active knowledge transfer and dissemination strategy to diffuse study findings to a wide policy and practice community. SETTING AND SAMPLE Four European countries, each with six long-term nursing care sites (total 24 sites) for people aged 60 years and over with documented urinary incontinence METHODS AND DESIGN Pragmatic randomised controlled trial with three arms (standard dissemination and two different programmes of facilitation), with embedded process and economic evaluation. The primary outcome is compliance with the continence recommendations. Secondary outcomes include proportion of residents with incontinence, incidence of incontinence-related dermatitis, urinary tract infections, and quality of life. Outcomes are assessed at baseline, then at 6, 12, 18, and 24 months after the start of the facilitation interventions. Detailed contextual and process data are collected throughout, using interviews with staff, residents and next of kin, observations, assessment of context using the Alberta Context Tool, and documentary evidence. A realistic evaluation framework is used to develop explanatory theory about what works for whom in what circumstances. TRIAL REGISTRATION Current Controlled Trials ISRCTN11598502.
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Affiliation(s)
- Kate Seers
- Royal College of Nursing Research Institute, School of Health and Social Studies, University of Warwick, Coventry, UK.
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Mockford C, Staniszewska S, Griffiths F, Herron-Marx S. The impact of patient and public involvement on UK NHS health care: a systematic review. Int J Qual Health Care 2011; 24:28-38. [PMID: 22109631 DOI: 10.1093/intqhc/mzr066] [Citation(s) in RCA: 327] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Patient and public involvement (PPI) has become an integral part of health care with its emphasis on including and empowering individuals and communities in the shaping of health and social care services. The aims of this study were to identify the impact of PPI on UK National Health Service (NHS) healthcare services and to identify the economic cost. It also examined how PPI is being defined, theorized and conceptualized, and how the impact of PPI is captured or measured. DATA SOURCES Seventeen key online databases and websites were searched, e.g. Medline and the King's Fund. STUDY SELECTION UK studies from 1997 to 2009 which included service user involvement in NHS healthcare services. Date extraction Key themes were identified and a narrative analysis was undertaken. RESULTS OF DATA SYNTHESIS The review indicates that PPI has a range of impacts on healthcare services. There is little evidence of any economic analysis of the costs involved. A key limitation of the PPI evidence base is the poor quality of reporting impact. Few studies define PPI, there is little theoretical underpinning or conceptualization reported, there is an absence of robust measurement of impact and descriptive evidence lacked detail. CONCLUSION There is a need for significant development of the PPI evidence base particularly around guidance for the reporting of user activity and impact. The evidence base needs to be significantly strengthened to ensure the full impact of involving service users in NHS healthcare services is fully understood.
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Affiliation(s)
- Carole Mockford
- Royal College of Nursing Research Institute, School of Health and Social Studies, University of Warwick, Coventry CV4 7AL, UK.
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Staniszewska S, Herron-Marx S, Mockford C. Measuring the impact of patient and public involvement: the need for an evidence base. Int J Qual Health Care 2008; 20:373-4. [DOI: 10.1093/intqhc/mzn044] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Barlow J, Davis H, McIntosh E, Jarrett P, Mockford C, Stewart-Brown S. Role of home visiting in improving parenting and health in families at risk of abuse and neglect: results of a multicentre randomised controlled trial and economic evaluation. Arch Dis Child 2007; 92:229-33. [PMID: 17068074 PMCID: PMC2083433 DOI: 10.1136/adc.2006.095117] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2006] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate the effectiveness and cost effectiveness of an intensive home visiting programme in improving outcomes for vulnerable families. DESIGN Multicentre randomised controlled trial in which eligible women were allocated to receive home visiting (n = 67) or standard services (n = 64). Incremental cost analysis. SETTING 40 general practitioner practices across 2 counties in the UK. PARTICIPANTS 131 vulnerable pregnant women. INTERVENTION Selected health visitors were trained in the Family Partnership Model to provide a weekly home visiting service from 6 months antenatally to 12 months postnatally. MAIN OUTCOME MEASURES Mother-child interaction, maternal psychological health attitudes and behaviour, infant functioning and development, and risk of neglect or abuse. RESULTS At 12 months, differences favouring the home-visited group were observed on an independent assessment of maternal sensitivity (p<0.04) and infant cooperativeness (p<0.02). No differences were identified on any other measures. A non-significant increase in the likelihood of intervention group infants being the subject of child protection proceedings, or being removed from the home, and one death in the control group were found. The mean incremental cost per infant of the home visiting intervention was 3246 pounds sterling (bootstrapped 95% CI for the difference 1645-4803 pounds sterling). CONCLUSION This intervention may have the potential to improve parenting and increase the identification of infants at risk of abuse and neglect in vulnerable families. Further investigation is needed, along with long-term follow-up to assess possible sleeper effects.
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Affiliation(s)
- Jane Barlow
- Warwick Medical School, University of Warwick, Coventry, UK.
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Abstract
Carers of people with MND may experience changes to their health and lifestyle. Statutory and voluntary organizations are able to support the carer in various ways. This review investigates the personal impact on carers and their experiences of service provision. A systematic search of online and grey literature was made for the period 1994-2004. Thirty-two key texts were retrieved and a narrative synthesis conducted. The main themes were: 1) Impact on carer: general health, emotional state, life satisfaction, socio-economic concerns, relationships, and protective factors; 2) Experience of service provision: primary care, health professionals, social care, written information, and voluntary organizations. There is a paucity of written documentation on the experience of assisting someone with MND. Data collected are diverse and sometimes contradictory. Sample sizes are often small and generalization difficult. Main findings show that maintenance of social support, activities, and a positive outlook may lessen the chance of ill health arising from long hours spent caring, and having a named coordinator may assist with access to resources, and provide practical and emotional support during and after the caring role. Carers may become ill themselves unless adequate support is given to them throughout the course of the disease.
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Affiliation(s)
- Carole Mockford
- Health Services Research Unit, Department of Public Health, University of Oxford, UK
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Patterson J, Mockford C, Stewart-Brown S. Parents' perceptions of the value of the Webster-Stratton Parenting Programme: a qualitative study of a general practice based initiative. Child Care Health Dev 2005; 31:53-64. [PMID: 15658966 DOI: 10.1111/j.1365-2214.2005.00479.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Parenting styles and parent-child relationships are a determinant of emotional and behavioural problems in children. Controlled trials of parenting programmes have been shown to be effective in helping parents of children with clinical levels of behaviour problems, but there is little research on the impact of such programmes in families where children's development falls in the 'normal' range. Also, such trials do not shed light on why or how programmes do, or do not, work, or how they might be improved. METHODS A qualitative study of the impact of the Webster-Stratton 'Parents and Children Series' programme on participants in a controlled trial of this programme, whose children's behaviour was below average, but, for the majority, in the normal range. Data were gathered in interviews, open-ended questions on a questionnaire and tape recordings of group leader supervision sessions. RESULTS Parents reported increased confidence, better relationships with their children, successful use of new behaviour management techniques and improvements in their children's behaviour as a result of the programme. One parent found the programme unsuitable because she was already using the techniques that were taught, and another parent felt the programme was designed for parents of younger children. Many parents reported that additional sessions would have been useful to consolidate what they had learnt, and some parents felt the course would have been more effective if their partners had attended. CONCLUSIONS The Webster-Stratton Parenting Programme is useful for parents of 'normal' children as well as for parents of children whose behaviour is in the clinical range. Follow-up sessions and attendance by both parents might increase effectiveness. The findings of this study suggest greater benefits to parents and children than were apparent in the controlled trial.
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Affiliation(s)
- J Patterson
- Health Services Research Unit, Department of Public Health, University of Oxford, Oxford, UK
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Stewart-Brown S, Patterson J, Mockford C, Barlow J, Klimes I, Pyper C. Impact of a general practice based group parenting programme: quantitative and qualitative results from a controlled trial at 12 months. Arch Dis Child 2004; 89:519-25. [PMID: 15155394 PMCID: PMC1719934 DOI: 10.1136/adc.2003.028365] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To test the effectiveness at one year of the Webster Stratton Parents and Children Series group parenting programme in a population sample of parents. METHODS In a multicentre block randomised controlled trial, parents of children aged 2-8 years in 116 families who scored in the upper 50% on a validated behaviour inventory, took part in Webster-Stratton's 10 week parenting programme led by trained and supervised health visitors. The following outcome measures were used: Eyberg Child Behaviour Inventory, Goodman Strengths and Difficulties Questionnaire, General Health Questionnaire, Parenting Stress Index, Rosenberg Self Esteem Scale. RESULTS The intervention significantly reduced child behaviour problems and improved mental health at immediate and 6 month follow ups. One year differences between control and intervention groups were not significant. Qualitative results suggest that these findings might be attributable in part to either Hawthorne effects or contamination of control group. At interview parents described ways in which the programme had improved their mental health. They reported gains in confidence and feeling less stressed. Some also reported beneficial changes in their own and their children's behaviour and improved relationships with their children. Some spoke of a need for further sessions to support the behaviour changes they had managed to make, and some the desire for attendance by both parents. CONCLUSIONS Parenting programmes have the potential to promote mental health and reduce social inequalities, but further work is needed to improve long term effectiveness.
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Affiliation(s)
- S Stewart-Brown
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
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Abstract
AIMS To assess the effectiveness of a parenting programme, delivered by health visitors in primary care, in improving the mental health of children and their parents among a representative general practice population. METHODS Parents of children aged 2-8 years who scored in the upper 50% on a behaviour inventory were randomised to the Webster-Stratton 10 week parenting programme delivered by trained health visitors, or no intervention. Main outcome measures were the Eyberg Child Behaviour Inventory and the Goodman Strengths and Difficulties Questionnaire to measure child behaviour, and the General Health Questionnaire, Abidin's Parenting Stress Index, and Rosenberg's Self Esteem Scale to measure parents' mental health. These outcomes were measured before and immediately after the intervention, and at six months follow up. RESULTS The intervention was more effective at improving some aspects of the children's mental health, notably conduct problems, than the no intervention control condition. The Goodman conduct problem score was reduced at immediate and six month follow up, and the Eyberg Child Behaviour Inventory was reduced at six months. The intervention also had a short term impact on social dysfunction among parents. These benefits were seen among families with children scoring in the clinical range for behaviour problems and also among children scoring in the non-clinical (normal) range. CONCLUSION This intervention could make a useful contribution to the prevention of child behaviour problems and to mental health promotion in primary care.
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Affiliation(s)
- J Patterson
- Health Services Research Unit, Institute of Health Sciences, Old Road, Headington, Oxford OX3 7LF, UK John Radcliffe Hospital, Oxford, UK.
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Abstract
AIMS To establish the prevalence of behaviour problems and the level of interest in parenting programmes in a population sample of parents of children aged 2-8 years, and to assess to what extent they are associated with socioeconomic factors. METHODS Postal survey of parents of children aged 2-8 years registered with three general practitioner surgeries; 70% response rate. RESULTS One fifth of parents from this population sample were experiencing difficulties with their children's behaviour. While behaviour problems were more prevalent in the manual social classes, "need" was high across all social groups. Just under a fifth of parents reported prior attendance at a parenting programme and 58% expressed interest in attending in the future. Interest in attending a parenting programme was not class related, but was predicted by the age of the eldest child and the existence of behaviour problems. CONCLUSION Behaviour problems are an important public health issue. Findings support the use of a non-selective approach to the provision of parenting programmes in the UK.
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Affiliation(s)
- J Patterson
- Health Services Research Unit, Institute of Health Sciences, Old Road, Headington, Oxford OX3 7LF, UK.
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