Participatory asset mapping and photovoice interviews to scope cultural and community resources to reduce alcohol harm in Chitwan, Nepal

AIMS

To scope the breadth of existing cultural and community assets and how alcohol drinkers and community health workers perceived them in relation to reducing alcohol-related harm.

METHODS

The study was conducted in Chitwan, south-central Nepal, which has considerable alcohol problems. Participatory asset mapping was conducted using field notes, photography, and through engaging with communities to explore how community assets affect alcohol consumption. Semi-structured photovoice interviews were conducted with harmful/hazardous drinkers (AUDIT score 8 to 19) and community health workers. Purposive and snowball sampling were used to recruit participants. During interviews, participants used their photographs to reflect on how community assets influenced alcohol use. Thematic framework analysis was used to analyse the data.

RESULTS

We recruited 12 harmful/hazardous drinkers (3 females) and 6 health workers (2 females). The mean AUDIT score of the former was 12.17 (SD ±2.86). Thematic analysis of the photovoice interviews produced three themes: 'influences and impact of families and communities'; 'culture and spirituality'; and 'nature and the environment'. The community mapping produced five assets that promoted alcohol consumption: (1) availability; (2) advertising; (3) negative attitudes towards users; (4) festivals/gatherings; and (5) illiteracy/poverty. Six assets that discouraged consumption were: (1) legislation restricting use; (2) community organisations; (3) cultural/spiritual sites; (4) healthcare facilities; (5) family and communities; and (6) women's community groups. Those from certain ethnic groups consumed more alcohol, experienced more family discord, or felt stigmatised due to their drinking. Assets 'festivals/gatherings' and 'negative attitudes toward users' and the theme 'family and communities' concerned with relationships and community activities were perceived to both promote and reduce alcohol use.

CONCLUSIONS

This study provides new insight into a variety of cultural and community assets that promote and reduce alcohol use. The study identifies new possibilities to build on visual participatory and arts-based methods that have potential to be effectively implemented at scale.

Systematic review on the effects of the physical and social aspects of community pharmacy spaces on service users and staff

Aim:

This systematic review aimed to provide new insights into how pharmacy spaces, or the architecture of pharmacies, are experienced by pharmacy service users and staff. The review sought to identify environmental factors which may influence service users’ and staff participation in community-based pharmacy health services.

Method:

Ten databases were searched for English language publications, using a combination of search terms relating to pharmacy service users and staff; pharmacy spaces; and health and social care outcomes. Data from the final selected studies were extracted, thematically analysed using a narrative approach and the quality of each study assessed using the Integrated quality Criteria for the Review of Multiple Study designs (ICROMS).

Results:

80 articles reporting 80 studies published between 1994 and 2020 were identified; they were from 28 countries, involving around 3234 community pharmacies, 13,615 pharmacy service users, 5056 pharmacists and 78 pharmacy health staff. Most studies (94%) met the ICROMS minimum score, and half did not meet the mandatory quality criteria. Four themes likely to influence service users’ and staff experiences of pharmacy health services were identified: (1) privacy; (2) experience of the physical environment; (3) professional image; and (4) risk of error.

Conclusion:

To optimise the delivery and experience of pharmacy health services, these spaces should be made more engaging. Future applied research could focus on optimising inclusive pharmacy design features.

The development of a family intervention competency assessment and reflection scale (FICARS) for psychosis

Family intervention (FI) for psychosis has a robust evidence base. In recommending its use the revised NICE schizophrenia guideline states 'Healthcare professionals providing psychological interventions should have an appropriate level of competence'. Yet, no definitive instrument exists to outline what competences are required during and post FI training or help recruit staff with the appropriate knowledge and skill. This paper reports on the development of a Family Intervention competency assessment and reflection scale (FICARS). Using a systematic three-staged approach commonly used in health outcomes measurement development, a comprehensive literature review on UK-based FI training and commonly used assessment tools was undertaken. A FICARS draft was then constructed and revised in consultation with expert FI clinicians. Finally, a content validity study with FI trainers and students across three FI training programmes was undertaken to optimize FICARS aim to promote reflective assessment and professional development in FI skills and practice.

Implementing a structured psychosocial interventions group programme for people with bipolar disorder

It has been reported that, at any time, over half of the people with bipolar disorder are receiving no active treatment. Despite the availability of effective medications and psychotherapies, research concludes that the care of bipolar disorder in everyday practice is often deficient. Evidence base reports the effectiveness of psychosocial interventions using many of the same ideas as the recovery approach; both attempt to place clients at the heart of service delivery. This paper reports on the development and implementation of three pilot group programmes for service users with bipolar disorder, in a community clinical setting in South East England. The group programme design and development was based upon the evidence-based psychosocial interventions advocated in national clinical guidelines and research literature. The programme incorporated the key effective psychosocial interventions and self-management mechanisms within its 12 sessions spanning over 3 months, followed by three booster sessions in 6 months' time. Twenty-three service users have to date completed the programme. Participant feedback will be discussed and reported to inform further development and research implications of such innovative evidence-based interventions for service users with bipolar disorder.

HEART--the Hounslow Early Active Recovery Team: implementing an inclusive strength-based model of care for people with early psychosis

In recent years in the UK, the National Health Service has made policy commitments to delivering mental health services based on recovery principles. In general though, the UK mental health service providers are in the early stages of implementing recovery principles and approaches in front-line services. This paper describes the work of the Hounslow Early Active Recovery Team (HEART), which has made substantial progress in placing recovery principles and approaches at the heart of the work of an early intervention for psychosis team working in an ethnically diverse area of West London. As evidence of the success of the HEART, in its first year and half, the team has achieved high levels of customer satisfaction with its work and a recent audit has revealed that 57% of respondents were in employment or education contrasting with the extremely high unemployment rates reported in several UK studies of people with serious mental health problems.

An evaluation of education and implementation of psychosocial interventions within one UK mental healthcare trust

Psychosocial interventions (PSI), though recommended in the NICE guidelines for schizophrenia and bipolar affective disorder, are not routinely available to people with a serious mental illness in the UK. Education and training initiatives to equip mental health professionals with skills in PSI have grown over the last decade; yet the literature indicates serious problems in implementation of PSI in routine service provision. This paper examines on a local level the factors which support and limit the education and practice of PSI in one UK mental healthcare trust. It reports on a survey of trainees and their managers which aims to evaluate the impact of a PSI training programme and practice development strategy on staff, managers and service provision. The key findings are: a high rate of implementation of PSI by PSI-trained staff in the Trust; a strong association between PSI training and career progression for staff; and the support mechanisms which are most effective in the education and implementation of PSI. The paper concludes that certain measures and support mechanisms have facilitated the successful implementation of PSI with positive outcomes for staff and service provision. Further recommendations are made identifying measures which facilitate the implementation of PSI through an integrated education and practice development strategy owned by all stakeholders.

Developing services for the carers of young adults with early-onset psychosis - implementing evidence-based practice on psycho-educational family intervention

This paper describes a series of practice and service development initiatives to incorporate the family-inclusive approach into the newly established Early Intervention in Psychosis Service in Berkshire, England. Following a local study on carers' experiences and needs from those who cared for a young adult with a first-episode psychosis (FEP), a series of flexible services for this group of carers has been developed incorporating the much-researched psycho-educational family interventions. The findings of our local phenomenological study on the carers for young adults with FEP clearly specified the unique needs of this group of carers and that well-established approaches in family work and carers support facilities may have to be adapted to meet such needs. This paper reports the service development process through which a series of specially designed carers' services were set up for carers caring for a young adult with FEP. These services were developed to address carers' needs for knowledge, skills and support to cope with their caring roles and situation, from the stressful beginning of a potentially long caring journey.

Developing services for the carers of young adults with early-onset psychosis--listening to their experiences and needs

The care-giving experience of carers of young adults with early onset psychosis is relatively unexplored. New carers are less likely to be engaged with local services for carers and families, than those more established in their caring role. Understanding the experience of these carers provides some valuable insight into the value of caring and in guiding service development. This paper reports on a study designed to explore carers' experiences of caring for a young adult diagnosed with a first psychotic episode and their needs in relation to the development of an early intervention for psychosis service. A phenomenological approach was used. Eleven carers were given a semi-structured interview in their own homes. All of the carers in the study had a son with early onset psychosis. The outcome revealed that all carers were providing a comprehensive range of practical, emotional and financial support for their son including initiating and sustaining engagement between them and local mental health services. Many carers were felt to be invisible and silent partners in care and felt under-valued by mental health services.

Implementing a self-management model of relapse prevention for psychosis into routine clinical practice

This paper describes an implementation project to incorporate an evidence-based, structured model of relapse prevention into routine clinical practice at the Community Mental Health Team in Reading, Berkshire. This project has currently reached the end of the pilot stage, which this paper reports in details. It is proposed that clinicians will adopt Smith's Self-Management Training Manual for individuals with psychosis as a clinical tool for working with patients who have schizophrenic-form disorders or bipolar affective disorders with psychosis. Effects of the proposed change are considered from the viewpoint of the clients and families/carers, the clinicians and the service. The process of transition and its impact on members of the multidisciplinary team is examined. It includes an audit of Care Programme Approach (CPA) forms and a staff survey, which give background information on the needs for improvement and staff development initiatives. A pilot study incorporating the structured relapse prevention work into the local community mental health team is also underway. The method of evaluation and dissemination to the wider team and service settings across the organizational boundaries is reviewed with implications for practice drawn. This paper aims to describe the background and development of this ongoing development project whilst focusing on the current pilot stage. Ongoing work will be carried out in addressing and reporting the outcomes of the full project in future papers.

Incorporating psycho-educational family and carers work into routine clinical practice

There is growing evidence of the benefits of family and carers interventions using a psycho-educational model for carers of people with psychosis. In order to get this work into clinical practice, a network of interrelated services for carers and families of people with psychoses has been established in Reading, Berkshire. This paper reports the experience of the authors in establishing these services using a series of practice development initiatives including training for staff, education programmes, integration projects and collaboration across organizations. This work illustrates change processes through which evidence-based practice has been incorporated into routine clinical care and in which research-based assessment and evaluation tools have being used in routine clinical practice to measure outcomes.

Managing side-effects to the optimum: valuing a client's experience

Despite the recent emergence of psychosocial interventions and other forms of practical treatments, antipsychotic medication remains the cornerstone of treatment for schizophrenia, as it is recognized to be effective in reducing relapse rates. Nevertheless, the side-effects of psychotropic medication make adherence to treatment regimens difficult for many clients and, until recently, little has been done by mental health nurses to consistently monitor or manage these symptoms. This report describes how the integration of knowledge and clinical skills in psychopharmacology optimized one client's concordance with medication. It reports on 'John's' treatment experience with medication and addresses the role that mental health nurses can play in appraising pharmaceutical effects, and assessing and working with side-effects, using a medication-management multidisciplinary team approach.

DNA vaccines encoding interleukin-8 and RANTES enhance antigen-specific Th1-type CD4(+) T-cell-mediated protective immunity against herpes simplex virus type 2 in vivo

Chemokines are inflammatory molecules that act primarily as chemoattractants and as activators of leukocytes. Their role in antigen-specific immune responses is of importance, but their role in disease protection is unknown. Recently it has been suggested that chemokines modulate immunity along more classical Th1 and Th2 phenotypes. However, no data currently exist in an infectious challenge model system. We analyzed the modulatory effects of selected chemokines (interleukin-8 [IL-8], gamma interferon-inducible protein 10 [IP-10], RANTES, monocyte chemotactic protein 1 [MCP-1], and macrophage inflammatory protein 1 alpha [MIP-1 alpha]) on immune phenotype and protection against lethal challenge with herpes simplex virus type 2 (HSV-2). We observed that coinjection with IL-8 and RANTES plasmid DNAs dramatically enhanced antigen-specific Th1 type cellular immune responses and protection from lethal HSV-2 challenge. This enhanced protection appears to be mediated by CD4(+) T cells, as determined by in vitro and in vivo T-cell subset deletion. Thus, IL-8 and RANTES cDNAs used as DNA vaccine adjuvants drive antigen-specific Th1 type CD4(+) T-cell responses, which result in reduced HSV-2-derived morbidity, as well as reduced mortality. However, coinjection with DNAs expressing MCP-1, IP-10, and MIP-1 alpha increased mortality in the challenged mice. Chemokine DNA coinjection also modulated its own production as well as the production of cytokines. These studies demonstrate that chemokines can dominate and drive immune responses with defined phenotypes, playing an important role in the generation of protective antigen-specific immunity.

Survey of raw egg use by home caterers

Outbreaks of egg related salmonella infection continue to occur despite over ten years of national guidance on this subject. Fifty-four out of 70 registered home caterers in Cheshire responded to a telephone questionnaire, which revealed that a sixth prepared raw egg dishes containing shell eggs, none used pasteurised egg, and advice about storage of eggs and handwashing was not always followed. A postal questionnaire sent to 13 wholesalers and major supermarket chains showed that pasteurised egg was available in large packs from wholesalers but not from supermarkets. It is time to consider new approaches to reinforce advice about pasteurised egg use for raw egg dishes, storage, and measures to prevent cross contamination. These findings have implications for the training of home caterers and the general public.

A simple clinical method for the preparation of improved cervical smears-approximating to monolayers

Conventionally prepared cervical smears contain multilayers of cells deposited within strands of mucin. The present study is concerned with chemical reduction of disulphide bonds in the mucin leading to depolymerisation prior to forming a smear in the conventional manner. The resultant distribution of cells on the slide is similar to that obtained by machines designed to produce monolayers of cells. These monolayers have been developed for use in automated analysis of cervical smears and sputum samples. This new technique does not interfere with conventional PAP analysis of dyskaryotic cells nor does it interfere with the fluorescent location of such cells of cytological interest.

Fluorescent location of cells of cytological interest in cervical smears prestained with thionin

Cervical cells of cytological interest were located in conventional smears, treated with thionin for quantitative DNA staining by subsequent treatment with fluorescent probes for a cell surface protease. Normal mature cervical epithelial cells failed to bind these fluorescent probes whilst metaplastic cells, glandular cells, and dyskaryotic cells were readily located. By this means, the nuclear staining of these fluorescent cells of cyotological interest enabled them to be classified by a cytologist.