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Abbott-Smith S, Dougall N, Ring N. Suicide prevention: Introducing the Lothian Safekeeping Plan © for parents as a clinical innovation for use alongside safety plans for children and young people. J Child Adolesc Psychiatr Nurs 2024; 37:e12455. [PMID: 38368534 DOI: 10.1111/jcap.12455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/19/2024]
Abstract
TOPIC Internationally, preventing suicide in children and young people is a priority and there are a range of preventative approaches available for health professionals to use, including brief interventions. Safety planning is one such brief intervention. Safety plans have long been recommended for use with young people who are suicidal but, these were initially developed for adults. A recent scoping review revealed safety plans need to be tailored to children and young people. This review also identified an important practice gap, that parents also require plans supporting them to keep their child safe. PURPOSE This paper highlights how a Scottish clinical child and adolescent mental health setting in the UK's National Health Service developed and implemented evidence-based safety plans for suicidality-the Lothian Safety Plan for young people and the Lothian Safekeeping Plan for parents. This paper outlines both plans and gives recommendations for their use by healthcare professionals. The parental Lothian Safekeeping Plan is discussed in more depth as this is a novel intervention. CONCLUSION The Lothian Safekeeping Plan is a clinically led evidence-based practice innovation. It is a specific suicide prevention plan for use by parents as an additional, complementary, and enhanced resource to the Lothian Safety Plan for young people. It is recommended that healthcare professionals also use a parental safety plan when supporting young people presenting with suicidal crisis. Further research is needed to evaluate the impact of these plans.
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Affiliation(s)
- Susan Abbott-Smith
- Child and Adolescent Mental Health Services, NHS Lothian Royal Hospital for Children and Young People, Edinburgh, UK
| | - Nadine Dougall
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Nicola Ring
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
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Abbott-Smith S, Ring N, Dougall N, Davey J. Suicide prevention: What does the evidence show for the effectiveness of safety planning for children and young people? - A systematic scoping review. J Psychiatr Ment Health Nurs 2023; 30:899-910. [PMID: 37052321 DOI: 10.1111/jpm.12928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 04/14/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Suicide prevention is an international healthcare priority. There is an urgent need to use approaches that are helpful and follow research evidence. Safety planning is now widely used in suicide prevention; however, it was developed for use with adults, and little is known about its effectiveness for children/young people. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This systematic scoping review brings together all research evidence since 2008 that reported how effective safety planning is for children/young people. Findings highlight that when healthcare professionals help children/young people who are suicidal, they need to ensure that the safety plan is completed collaboratively with healthcare professionals and children/young people and that it is appropriate for their age and development. There is also need for healthcare professionals to better recognize and respond to the needs of parents/carers who are caring for a child/young person with suicidal ideations/behaviours. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is some research indicating that safety planning is effective for use with children/young people, but such evidence has primarily been obtained from females and there is need for more evidence from male study populations. Further research on its use is needed for certain groups of children/young people including those who are care experienced, or identify as lesbian, gay, bisexual and transgender. This review highlighted that healthcare professionals need specific training before they deliver safety planning for children/young people. It was identified that parents/carers have additional needs and should be involved in safety planning. An additional resource specifically for parents/carers should be developed. ABSTRACT INTRODUCTION: Suicide is a leading cause of death for children and young people and its prevention is a global priority. Many Mental Health Services employ safety planning as a brief intervention. There is some evidence of safety planning effectiveness for adults, but little is known about its effectiveness with young people. AIM To synthesize research reporting safety planning effectiveness for children/young people with suicidal ideation and identify good practice recommendations. INCLUSION CRITERIA The review relates to safety planning around suicide prevention for children/young people aged less than 18 years, even if it was within a wider intervention. The review was inclusive of all clinical areas (including mental health, primary care, etc), any geographical location or social economic status and inclusivity around the method of delivery. METHODS A systematic scoping review of literature reporting effectiveness data for the use of safety planning with children/young people with suicidal ideation. The systematic scoping review protocol (pre-registered with Open Science Framework) followed Joanna Briggs Institute conduct guidance and PRISMA-ScR checklist. DATA ANALYSIS AND PRESENTATION Fifteen studies were reported during 2008-2021. Overall, there is promising, but limited, evidence of effectiveness for safety planning for children/young people but with complete evidence gaps for some demographic sub-groups. Evidence determined that healthcare professionals should deliver a safety planning intervention that is completed collaboratively, developmentally appropriate, and recognizes parental/carer involvement. DISCUSSION AND IMPLICATIONS FOR PRACTICE Further research is needed but current evidence suggests safety planning should be a routine part of care packages for children/young people with suicidal ideation proportionate to their needs. Developing/implementing these plans needs bespoke health professional training and additional support and resources for parents/carers should be developed.
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Affiliation(s)
- Susan Abbott-Smith
- NHS Lothian-CAMHS, Royal Hospital Children and Young People 50 Little France, Edinburgh, UK
- Edinburgh Napier University-Health and Social Care, Edinburgh, UK
| | - Nicola Ring
- Edinburgh Napier University-Health and Social Care, Edinburgh, UK
| | - Nadine Dougall
- Edinburgh Napier University-Health and Social Care, Edinburgh, UK
| | - Jill Davey
- Edinburgh Napier University-Health and Social Care, Edinburgh, UK
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Hutton P, Kelly J, Taylor CDJ, Williams B, Emsley R, Alexander CH, Vikram A, Saddington D, McCann A, Burke J, Eliasson E, Harper S, Karatzias T, Taylor PJ, Watson A, Dougall N, Stavert J, O'Rourke S, Glasgow A, Murphy R, Palmer K, Zaidi N, Bidwell P, Pritchard J, Carr L, Woodrow A. Correction: Accelerating the development of a psychological intervention to restore treatment decision‑making capacity in patients with schizophrenia‑spectrum disorder: a study protocol for a multi‑site, assessor‑blinded, pilot Umbrella trial (the DEC:IDES trial). Pilot Feasibility Stud 2023; 9:142. [PMID: 37580805 PMCID: PMC10424412 DOI: 10.1186/s40814-023-01376-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Affiliation(s)
- Paul Hutton
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK.
- Edinburgh Research & Innovation Centre for Complex and Acute Mental Health Problems, Edinburgh, UK.
| | - James Kelly
- Faculty of Health & Medicine, Lancaster University, Lancaster, UK
- Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | - Christopher D J Taylor
- Pennine Care NHS Foundation Trust, Ashton‑Under‑Lyne, UK
- Division of Psychology & Mental Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Brian Williams
- School of Health, Social Care & Life Sciences, University of the Highlands and Islands, Inverness, UK
| | - Richard Emsley
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | | | - Anvita Vikram
- Pennine Care NHS Foundation Trust, Ashton‑Under‑Lyne, UK
| | | | - Andrea McCann
- Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | - Joseph Burke
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Emma Eliasson
- NHS Lothian, Edinburgh, UK
- NHS Research Scotland Mental Health Network, Edinburgh, UK
- National Centre for Suicide Research and Prevention, Karolinska Institutet, Stockholm, Sweden
| | - Sean Harper
- Edinburgh Research & Innovation Centre for Complex and Acute Mental Health Problems, Edinburgh, UK
- NHS Lothian, Edinburgh, UK
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
- Edinburgh Research & Innovation Centre for Complex and Acute Mental Health Problems, Edinburgh, UK
| | - Peter J Taylor
- Division of Psychology & Mental Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | | | - Nadine Dougall
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Jill Stavert
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Suzanne O'Rourke
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | | | | | - Karen Palmer
- Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | - Nosheen Zaidi
- Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | - Polly Bidwell
- Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | | | - Lucy Carr
- Pennine Care NHS Foundation Trust, Ashton‑Under‑Lyne, UK
| | - Amanda Woodrow
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
- Edinburgh Research & Innovation Centre for Complex and Acute Mental Health Problems, Edinburgh, UK
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Hutton P, Kelly J, Taylor CDJ, Williams B, Emsley R, Alexander CH, Vikram A, Saddington D, McCann A, Burke J, Eliasson E, Harper S, Karatzias T, Taylor PJ, Watson A, Dougall N, Stavert J, O'Rourke S, Glasgow A, Murphy R, Palmer K, Zaidi N, Bidwell P, Pritchard J, Carr L, Woodrow A. Accelerating the development of a psychological intervention to restore treatment decision-making capacity in patients with schizophrenia-spectrum disorder: a study protocol for a multi-site, assessor-blinded, pilot Umbrella trial (the DEC:IDES trial). Pilot Feasibility Stud 2023; 9:117. [PMID: 37422659 PMCID: PMC10329297 DOI: 10.1186/s40814-023-01323-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/26/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND A high proportion of patients diagnosed with schizophrenia-spectrum disorders will at some point in their lives be assessed as not having the capacity to make their own decisions about pharmacological treatment or inpatient care ('capacity'). Few will be helped to regain it before these interventions proceed. This is partly because effective and safe methods to do so are lacking. Our aim is to accelerate their development by testing, for the first time in mental healthcare, the feasibility, acceptability and safety of running an 'Umbrella' trial. This involves running, concurrently and under one multi-site infrastructure, multiple assessor-blind randomised controlled trials, each of which is designed to examine the effect on capacity of improving a single psychological mechanism ('mechanism'). Our primary objectives are to demonstrate feasibility of (i) recruitment and (ii) data retention on the MacArthur Competence Assessment Tool-Treatment (MacCAT-T; planned primary outcome for a future trial) at end-of-treatment. We selected three mechanisms to test: 'self-stigma', low self-esteem and the 'jumping to conclusions' bias. Each is highly prevalent in psychosis, responsive to psychological intervention, and hypothesised to contribute to impaired capacity. METHODS Sixty participants with schizophrenia-spectrum diagnoses, impaired capacity and one or more mechanism(s) will be recruited from outpatient and inpatient mental health services in three UK sites (Lothian, Scotland; Lancashire and Pennine; North West England). Those lacking capacity to consent to research could take part if the key criteria were met, including either proxy consent (Scotland) or favourable Consultee advice (England). They will be allocated to one of three randomised controlled trials, depending on which mechanism(s) they have. They will then be randomised to receive, over an 8-week period and in addition to treatment as usual (TAU), 6 sessions of either a psychological intervention which targets the mechanism, or 6 sessions of assessment of the causes of their incapacity (control condition). Participants are assessed at 0 (baseline), 8 (end-of-treatment) and 24 (follow-up) weeks post-randomisation using measures of capacity (MacCAT-T), mechanism, adverse events, psychotic symptoms, subjective recovery, quality of life, service use, anxiety, core schemata and depression. Two nested qualitative studies will be conducted; one to understand participant and clinician experiences and one to investigate the validity of MacCAT-T appreciation ratings. DISCUSSION This will be the first Umbrella trial in mental healthcare. It will produce the first 3 single-blind randomised controlled trials of psychological interventions to support treatment decision-making in schizophrenia-spectrum disorder. Demonstrating feasibility will have significant implications not only for those seeking to support capacity in psychosis, but also for those who wish to accelerate the development of psychological interventions for other conditions. TRIAL REGISTRATION ClinicalTrials.gov NCT04309435 . Pre-registered on 16 March 2020.
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Affiliation(s)
- Paul Hutton
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK.
- Edinburgh Research & Innovation Centre for Complex and Acute Mental Health Problems, Edinburgh, UK.
| | - James Kelly
- Faculty of Health & Medicine, Lancaster University, Lancaster, UK
- Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | - Christopher D J Taylor
- Pennine Care NHS Foundation Trust, Ashton-Under-Lyne, UK
- Division of Psychology & Mental Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Brian Williams
- School of Health, Social Care & Life Sciences, University of the Highlands and Islands, Inverness, UK
| | - Richard Emsley
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | | | - Anvita Vikram
- Pennine Care NHS Foundation Trust, Ashton-Under-Lyne, UK
| | | | - Andrea McCann
- Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | - Joseph Burke
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Emma Eliasson
- NHS Lothian, Edinburgh, UK
- NHS Research Scotland Mental Health Network, Edinburgh, UK
- National Centre for Suicide Research and Prevention, Karolinska Institutet, Stockholm, Sweden
| | - Sean Harper
- Edinburgh Research & Innovation Centre for Complex and Acute Mental Health Problems, Edinburgh, UK
- NHS Lothian, Edinburgh, UK
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
- Edinburgh Research & Innovation Centre for Complex and Acute Mental Health Problems, Edinburgh, UK
| | - Peter J Taylor
- Division of Psychology & Mental Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | | | - Nadine Dougall
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Jill Stavert
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Suzanne O'Rourke
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | | | | | - Karen Palmer
- Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | - Nosheen Zaidi
- Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | - Polly Bidwell
- Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | | | - Lucy Carr
- Pennine Care NHS Foundation Trust, Ashton-Under-Lyne, UK
| | - Amanda Woodrow
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
- Edinburgh Research & Innovation Centre for Complex and Acute Mental Health Problems, Edinburgh, UK
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Speakman EM, Hillen P, Heyman I, Murray J, Dougall N, Aston EV, McAuley A. 'I'm not going to leave someone to die': carriage of naloxone by police in Scotland within a public health framework: a qualitative study of acceptability and experiences. Harm Reduct J 2023; 20:20. [PMID: 36805681 PMCID: PMC9938955 DOI: 10.1186/s12954-023-00750-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 02/03/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Scotland has one of the highest rates of drug-related deaths (DRDs) per capita in Europe, the majority of which involve opioids. Naloxone is a medication used to reverse opioid-related overdoses. In efforts to tackle escalating DRDs in many countries, naloxone is increasingly being provided to people who are likely first responders in overdose situations. This includes non-healthcare professionals, such as police officers. A pilot exercise to test the carriage and administration of naloxone by police officers was conducted in selected areas of Scotland between March and October 2021. The aim of the study was to explore the acceptability and experiences of naloxone carriage and administration by police in Scotland. METHODS The study comprised of two stages. Stage 1 involved in-depth one-to-one qualitative interviews with 19 community stakeholders (people with lived experience, family members, support workers). Stage 2 involved a mixture of in-depth one-to-one interviews and focus groups with 41 police officers. Data were analysed thematically, and the findings from the two stages were triangulated to develop overarching themes and subthemes. RESULTS By the end of the pilot, 808 police officers had been trained in the use of intranasal naloxone. Voluntary uptake of naloxone kits among police officers who completed training was 81%. There were 51 naloxone administration incidents recorded by police officers at suspected opioid-related overdose incidents during the pilot. Most officers shared positive experiences of naloxone administration. Naloxone as a first aid tool suited their role as first responders and their duty and desire to preserve life. Perceived barriers included concerns about police undertaking health-related work, potential legal liabilities and stigmatising attitudes. The majority of participants (and all community stakeholders) were supportive of the pilot and for it to be expanded across Scotland. CONCLUSIONS Police carriage of naloxone is an acceptable and potentially valuable harm reduction tool to help tackle the DRDs crisis in Scotland. However, it requires appropriate integration with existing health and social care systems. The intervention lies at the intersection between public health and policing and implies a more explicit public health approach to policing.
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Affiliation(s)
| | - Peter Hillen
- grid.20409.3f000000012348339XSchool of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Inga Heyman
- grid.20409.3f000000012348339XSchool of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Jennifer Murray
- grid.20409.3f000000012348339XSchool of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Nadine Dougall
- grid.20409.3f000000012348339XSchool of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Elizabeth V. Aston
- grid.20409.3f000000012348339XSchool of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Andrew McAuley
- grid.5214.20000 0001 0669 8188School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Farquharson B, Johnston M, Williams B, Smith K, Dombrowski S, Jones C, Treweek S, Dougall N, Grindle M, Savinc J, Abyhankar P. Reducing patient delay in acute coronary syndrome: Randomized controlled trial testing effect of behaviour change intervention on intentions to seek help. Br J Health Psychol 2023; 28:188-207. [PMID: 35942523 PMCID: PMC10086951 DOI: 10.1111/bjhp.12619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the efficacy of a behaviour change intervention to reduce patient delay with symptoms of acute coronary syndrome. DESIGN A 3-arm web-based, parallel randomized controlled trial. METHODS The intervention comprised 12 behaviour change techniques (BCTs) embedded in a text-only or text+visual narrative (the techniques were systematically identified through systematic review and a consensus exercise). Between February and November 2017, n = 145 people who had recently experienced acute coronary syndrome were randomly allocated to intervention ('text+visual' or 'text-only') or control. Intentions to phone an ambulance immediately for acute coronary syndrome symptoms were assessed before and after the intervention using symptom scenarios, and the change in intention was compared across the three groups. RESULTS Significant increases in intention to phone an ambulance immediately for ACS symptoms were seen following the 'text+visual' intervention but not following 'text-only' or control. However, the study was underpowered to detect any significant changes in intention between the 3 groups. There were no unintended effects on intentions for non-urgent symptoms. CONCLUSIONS A 'text+visual' BCT-based intervention may significantly increase intention to phone an ambulance with symptoms of ACS. Further testing of the effect of the intervention on actual behaviour is required.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Mark Grindle
- University of Highlands and Islands, Inverness, UK
| | - Jan Savinc
- Edinburgh Napier University, Edinburgh, UK
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Lawrence M, Davis B, De Amicis L, Booth J, Dickson S, Dougall N, Grealy M, Jani B, Maxwell M, Parkinson B, Pieri M, Mercer S. The HEADS: UP Development Study: Working with Key Stakeholders to Adapt a Mindfulness-Based Stress Reduction Course for People with Anxiety and Depression after Stroke. Healthcare (Basel) 2023; 11:healthcare11030355. [PMID: 36766930 PMCID: PMC9914141 DOI: 10.3390/healthcare11030355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/17/2023] [Accepted: 01/22/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Following stroke, rates of mood disorder are and remain high at five years (anxiety 34.4%; depression 23%). Structured mindfulness-based stress reduction (MBSR) courses are effective in a range of health conditions, but stroke survivors find adherence challenging. We aimed to adapt a standard MBSR course specifically for people affected by stroke. METHODS We recruited stroke survivors and family members with symptoms of anxiety and/or depression to take part in a co-development study comprising two rounds of MBSR 'taster' sessions, followed by focus groups in which views were sought on the practices sampled. Data were collected in October 2017 and May 2018 and were analysed using framework analysis, informed adaptations to mindfulness materials and delivery. RESULTS Twenty-eight stroke survivors and seven family members participated. Nineteen (76%) stroke survivors had anxiety; 15 (60%) had depression. Five (71.4%) family members reported anxiety; n = 4 (57.1%) depression. Thirty participants attended the first round of taster sessions and focus groups; twenty (66%) the second and three (10%) were unable to attend either round. Framework analysis informed adaptations to course delivery, practices, and materials, ultimately resulting in a stroke-specific MBSR course, HEADS: UP (Helping Ease Anxiety and Depression after Stroke). CONCLUSIONS HEADS: UP may provide a feasible, appropriate, and meaningful self-management intervention to help alleviate symptoms of mood disorder.
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Affiliation(s)
- Maggie Lawrence
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow G4 0BA, UK
- Correspondence: ; Tel.: +44-(0)141-331-8863
| | - Bridget Davis
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow G4 0BA, UK
| | - Leyla De Amicis
- School of Education, University of Glasgow, Glasgow G3 6NH, UK
| | - Jo Booth
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow G4 0BA, UK
| | - Sylvia Dickson
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow G4 0BA, UK
| | - Nadine Dougall
- Health and Social Care Sciences, Edinburgh Napier University, Edinburgh EH11 4BN, UK
| | - Madeleine Grealy
- Psychological Services and Health, University of Strathclyde, Glasgow G1 1XQ, UK
| | - Bhautesh Jani
- General Practice and Primary Care, School of Health and Wellbeing, MVLS, University of Glasgow, Glasgow G12 9LJ, UK
| | - Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP-RU), Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK
| | - Ben Parkinson
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow G4 0BA, UK
| | - Matilde Pieri
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow G4 0BA, UK
| | - Stewart Mercer
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
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Hayes CB, Patterson J, Castello S, Burke E, O'Connell N, Darker C, Vance J, Bauld L, Dobbie F, Loudon K, Devane D, Dougall N. A pilot cluster randomised controlled trial of a peer-delivered outreach community-based smoking cessation intervention for women living in disadvantaged communities in Ireland. Rural Remote Health 2023; 23:8163. [PMID: 36802719 DOI: 10.22605/rrh8163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION The health of women in rural communities is adversely impacted by increased rates of tobacco use linked to socio-economic disadvantage (SED) and by limited access to services. We Can Quit (WCQ) is a smoking cessation programme delivered by trained lay women (community facilitators) in local communities, which was developed using a Community-based Participatory Research (CBPR) approach and tailored to women living in SED areas of Ireland. METHODS The We Can Quit2 (WCQ2) pilot cluster randomised controlled trial with an inbuilt process evaluation was conducted in four matched pairs of urban and semi-rural SED districts (8-10,000 women per district) to assess feasibility. Districts were independently randomised to WCQ (group support +/- nicotine replacement therapy), or to individual support delivered by health professionals. RESULTS Findings showed that that the WCQ outreach programme is acceptable and feasible to implement for smoking women living in disadvantaged neighbourhoods. A secondary outcome of smoking abstinence (self-report + biochemical validation) demonstrated 27% abstinence in the intervention group versus 17% in usual care at end of programme. Low literacy was highlighted as a major barrier to participants' acceptability. DISCUSSION The design of our project provides an affordable solution for governments in prioritising outreach smoking cessation in vulnerable populations in countries with rising rates of female lung cancer. Our community-based model using a CBPR approach empowers local women to become trained to deliver smoking cessation programmes within their own local communities. This provides a foundation to create a sustainable and equitable way to address tobacco use in rural communities.
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Affiliation(s)
- Catherine B Hayes
- Public Health and Primary Care, School of Medicine, Trinity College Dublin, Tallaght, Dublin, Ireland
| | - Jenny Patterson
- School of Health and Social Care, Edinburgh Napier University , Edinburgh, Scotland
| | - Stefania Castello
- Public Health and Primary Care, School of Medicine, Trinity College Dublin, Tallaght, Dublin, Ireland
| | - Emma Burke
- Public Health and Primary Care, School of Medicine, Trinity College Dublin, Tallaght, Dublin, Ireland
| | - Nicola O'Connell
- Public Health and Primary Care, School of Medicine, Trinity College Dublin, Tallaght, Dublin, Ireland
| | - Catherine Darker
- Public Health and Primary Care, School of Medicine, Trinity College Dublin, Tallaght, Dublin, Ireland
| | | | - Linda Bauld
- Usher Institute, College of Medicine and Veterinary Sciences, Edinburgh, Scotland
| | - Fiona Dobbie
- Usher Institute, College of Medicine and Veterinary Sciences, Edinburgh, Scotland
| | | | - Declan Devane
- HRB Trials Methodology Research Network & School of Nursing & Midwifery, The University of Galway, Galway, Ireland
| | - Nadine Dougall
- School of Health and Social Care, Edinburgh Napier University , Edinburgh, Scotland
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Savinc J, Dougall N, Maxwell M, Karatzias T, O'Connor R, Williams B, John A, Cheyne H, Fyvie C, Bisson J, Hibberd C, Abbott-Smith S, Nolan L. Childhood adversity, mental health and suicide (CHASE): a longitudinal case-control linked data study of lifetime inpatient records associated with suicide. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.1878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
ObjectivesChildhood adversity (CA) carries an increased risk of developing later mental health (MH) problems and suicidal behaviour. This study aimed to summarise lifetime hospital attendances for CA and MH in young people who later died by suicide.
ApproachThis study is a retrospective longitudinal case control study. Lifetime Scottish inpatient acute and psychiatric records were linked to death records and summarised for individuals born since 1981 who died by suicide in the period 1991-2017 (cases), and controls (1:10) matched on sex, age, and postcode. Relevant records were coded MH (including self-harm) and/or CA. Descriptive statistics and odds ratios (OR) were computed.
ResultsData for 2,477 and 24,777 ‘cases’ and ‘controls’ were extracted, of whom 2,106 cases (85%) and 13,589 controls (55%) had lifespan hospital records. Mean age at death for cases was 23.7 (SD=4.9) and 75.9% were male. Psychiatric records represented 11.6% and 1.4% of records for cases and controls, respectively.
For the age range 10-18, Maltreatment & violence-related codes were recorded for 160 (7.6%) cases and 371 (2.7%) controls, corresponding to OR=2.9 (95%CI: 2.4-3.6). This was compared with MH at 458 (21.7%) cases and 560 (4.1%) controls and OR=6.5 (95%CI: 5.7-7.4). The highest adjusted ORs were for self-harm episodes recorded in general hospital with aORmale=6.56 (95%CI: 4.96-8.68) and aORfemale=6.87 (95%CI: 4.99-9.48).
ConclusionAll CA and MH presentations in inpatient hospital records were associated with greater risk of subsequent suicide, with the strongest association for self-harm.
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Darker CD, Burke E, Castello S, O'Sullivan K, O'Connell N, Vance J, Reynolds C, Buggy A, Dougall N, Loudon K, Williams P, Dobbie F, Bauld L, Hayes CB. A process evaluation of 'We Can Quit': a community-based smoking cessation intervention targeting women from areas of socio-disadvantage in Ireland. BMC Public Health 2022; 22:1528. [PMID: 35948970 PMCID: PMC9367164 DOI: 10.1186/s12889-022-13957-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 07/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Smoking poses a serious risk of early preventable death and disease especially for women living with socio-economic disadvantage (SED). A smoking cessation programme, ‘We Can Quit’, was developed in Ireland tailored to SED women. This includes group-based support delivered by trained lay local community facilitators (CFs) and free nicotine replacement therapy (NRT). The intervention was pilot tested in a cluster randomised controlled trial, ‘We Can Quit 2’. This paper reports on the WCQ2 process evaluation which assessed feasibility and acceptability of the programme and trial processes. Methods Embedded qualitative design using the UK Medical Research Council’s process evaluation framework. Semi-structured interviews with trial participants (N = 21) and CFs (N = 8). Thematic analysis was utilised. Results Peer-modelling, a non-judgemental environment, CFs facilitation of group support were viewed as acceptable programme related factors. Some participants expressed concerns about NRT side effects. Provision of free NRT was welcomed and accepted by participants, although structural barriers made access challenging. Pharmacists took on a role that became larger than originally envisaged – and the majority provided additional support to women in their quit attempts between group meetings which augmented and supplemented the intervention sessions provided by the CFs. Participants reported good acceptance of repeated measures for data collection, but mixed acceptability of provision of saliva samples. Low literacy affected the feasibility of some women to fully engage with programme and trial-related materials. This was despite efforts made by intervention developers and the trial team to make materials (e.g., participant intervention booklet; consent forms and participant information leaflets) accessible while also meeting requirements under 2018 European General Data Protection Regulation legislation. Hypothetical scenarios of direct (e.g., researcher present during programme delivery) and indirect (e.g., audio recordings of programme sessions) observational fidelity assessments for a future definitive trial (DT) were acceptable. Conclusions Intervention and trial-related processes were generally feasible and acceptable to participants and CFs. Any future DT will need to take further steps to mitigate structural barriers to accessing free NRT; and the established problem of low literacy and low educational attainment in SED areas, while continuing to comply within the contemporary legislative research environment. Trial registration WCQ2 pilot trial (ISRCTN74721694). Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13957-5.
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Affiliation(s)
- Catherine D Darker
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Emma Burke
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Stefania Castello
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Karin O'Sullivan
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Nicola O'Connell
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | | | - Aine Buggy
- Health Promotion and Improvement, Health Service Executive, Dublin, Ireland
| | - Nadine Dougall
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, Scotland
| | | | | | - Fiona Dobbie
- College of Medicine, Usher Institute and SPECTRUM Consortium, University of Edinburgh, Edinburgh, Scotland
| | - Linda Bauld
- College of Medicine, Usher Institute and SPECTRUM Consortium, University of Edinburgh, Edinburgh, Scotland
| | - Catherine B Hayes
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
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11
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O’Connell N, Burke E, Dobbie F, Dougall N, Mockler D, Darker C, Vance J, Bernstein S, Gilbert H, Bauld L, Hayes CB. The effectiveness of smoking cessation interventions for socio-economically disadvantaged women: a systematic review and meta-analysis. Syst Rev 2022; 11:111. [PMID: 35655281 PMCID: PMC9164420 DOI: 10.1186/s13643-022-01922-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/16/2020] [Accepted: 03/06/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION This systematic review and meta-analysis assessed the effectiveness of smoking cessation interventions among women smokers in low socio-economic status (SES) groups or women living in disadvantaged areas who are historically underserved by smoking cessation services. METHODS A systematic literature search was conducted using MEDLINE (OVID), EMBASE, Cochrane, CINAHL, PsychINFO and Web of Science databases. Eligibility criteria included randomised controlled trials of any smoking cessation intervention among women in low SES groups or living in socio-economically disadvantaged areas. A random effects meta-analysis assessed effectiveness of interventions on smoking cessation. Risk of bias was assessed with the Cochrane Risk of Bias tool. The GRADE approach established certainty of evidence. RESULTS A total of 396 studies were screened for eligibility and 11 (6153 female participants) were included. Seven studies targeted women-only. 5/11 tested a form of face-to-face support. A pooled effect size was estimated in 10/11 studies. At end of treatment, two-thirds more low SES women who received a smoking cessation intervention were more likely to stop smoking than women in control groups (risk ratio (RR) 1.68, 95% CI 1.36-2.08, I2= 34%). The effect was reduced but remained significant when longest available follow-up periods were pooled (RR 1.23, 95% CI 1.04-1.48, I2 = 0%). There was moderate-to-high risk of bias in most studies. Certainty of evidence was low. CONCLUSIONS Behavioural and behavioural + pharmacotherapy interventions for smoking cessation targeting women in low SES groups or women living in areas of disadvantage were effective in the short term. However, longer follow-up periods indicated reduced effectiveness. Future studies to explore ways to prevent smoking relapse in this population are needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42019130160.
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Affiliation(s)
- Nicola O’Connell
- grid.8217.c0000 0004 1936 9705The Discipline of Public Health and Primary Care, The Institute of Population Health, Trinity College Dublin, Russell Centre, Tallaght Cross, Dublin, D24 DH74 Ireland
| | - Emma Burke
- grid.8217.c0000 0004 1936 9705The Discipline of Public Health and Primary Care, The Institute of Population Health, Trinity College Dublin, Russell Centre, Tallaght Cross, Dublin, D24 DH74 Ireland
| | - Fiona Dobbie
- grid.4305.20000 0004 1936 7988Usher Institute and SPECTRUM Consortium, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Nadine Dougall
- grid.20409.3f000000012348339XSchool of Health and Social Care, Edinburgh Napier University, Sighthill Court, Edinburgh, EH11 4BN UK
| | - David Mockler
- grid.8217.c0000 0004 1936 9705Trinity College Library, Trinity College Dublin, Dublin 2, Ireland
| | - Catherine Darker
- grid.8217.c0000 0004 1936 9705The Discipline of Public Health and Primary Care, The Institute of Population Health, Trinity College Dublin, Russell Centre, Tallaght Cross, Dublin, D24 DH74 Ireland
| | - Joanne Vance
- grid.453311.10000 0001 1014 9181Irish Cancer Society, 43/45 Northumberland Road, Dublin 4, Ireland
| | - Steven Bernstein
- grid.47100.320000000419368710Emergency Medicine, Yale University School of Medicine, 464 Congress Avenue, Suite 260, New Haven, CT 06519-1315 USA
| | - Hazel Gilbert
- grid.83440.3b0000000121901201Department of Primary Care and Population Health, University College London Medical School, Royal Free Campus, Rowland Hill Street, London, NW3 2PF UK
| | - Linda Bauld
- grid.4305.20000 0004 1936 7988Usher Institute and SPECTRUM Consortium, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Catherine B. Hayes
- grid.8217.c0000 0004 1936 9705The Discipline of Public Health and Primary Care, The Institute of Population Health, Trinity College Dublin, Russell Centre, Tallaght Cross, Dublin, D24 DH74 Ireland
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12
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Castello S, Darker C, Vance J, Dougall N, Bauld L, Hayes CB. The We Can Quit2 Smoking Cessation Trial: Knowledge Exchange and Dissemination Following a Community-Based Participatory Research Approach. Int J Environ Res Public Health 2022; 19:ijerph19042333. [PMID: 35206521 PMCID: PMC8872427 DOI: 10.3390/ijerph19042333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/28/2022] [Accepted: 02/11/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND 'We Can Quit2' pilot randomised controlled trial determined the feasibility [of conducting a community-based trial of We Can Quit, a peer-delivered stop-smoking programme (group support, combination nicotine replacement therapy (NRT), and tailored individual support) for women living in socioeconomically disadvantaged areas in Ireland. Lessons from a knowledge exchange (KE) workshop that reengaged trial stakeholders are presented. METHODS The trial dissemination plan included invitation of community, regional and national stakeholders (n = 176) to a KE interactive workshop, who received an accessible brief beforehand. Trial findings were presented. Enhancements to community engagement, participants' recruitment and retention, and policy priorities arising from the research were discussed. Field notes and responses to a post-event anonymous questionnaire were analysed using thematic content analysis. RESULTS Workshop attendees (41/176, 23%) recommended: dedicated additional time to engage community stakeholders; social prescribing pathways to enhance recruitment; more adaptation of trial-related information and assistance in completion of data forms for low literacy individuals; encouraging women to join healthy community programmes to facilitate retention and sustainability; removal of barriers to access NRT; and ongoing provision of cessation services tailored to disadvantaged groups. CONCLUSIONS The findings are relevant to the implementation of other community-based health interventions for disadvantaged groups, to policy makers and to service providers.
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Affiliation(s)
- Stefania Castello
- Public Health & Primary Care, Institute of Population Health, Trinity College Dublin, D24DH74 Dublin, Ireland; (S.C.); (C.D.)
| | - Catherine Darker
- Public Health & Primary Care, Institute of Population Health, Trinity College Dublin, D24DH74 Dublin, Ireland; (S.C.); (C.D.)
| | - Joanne Vance
- Community Programmes, Irish Cancer Society, D04VX65 Dublin, Ireland;
| | - Nadine Dougall
- School of Health and Social Care, Edinburgh Napier University, Edinburgh EH11 4BN, UK;
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, College of Medicine and Veterinary Science, University of Edinburgh, Edinburgh EH16 4TJ, UK;
| | - Catherine B. Hayes
- Public Health & Primary Care, Institute of Population Health, Trinity College Dublin, D24DH74 Dublin, Ireland; (S.C.); (C.D.)
- Correspondence:
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13
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Darker C, Loudon K, O'Connell N, Castello S, Burke E, Vance J, Reynolds C, Buggy A, Dougall N, Williams P, Dobbie F, Bauld L, Hayes CB. An application of PRECIS-2 to evaluate trial design in a pilot cluster randomised controlled trial of a community-based smoking cessation intervention for women living in disadvantaged areas of Ireland. Pilot Feasibility Stud 2022; 8:19. [PMID: 35078530 PMCID: PMC8787878 DOI: 10.1186/s40814-022-00969-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND "We Can Quit2" (WCQ2) was a pilot cluster randomised controlled trial with an embedded process evaluation assessing the feasibility and acceptability of 'We Can Quit' (WCQ, a peer-delivered community-based stop-smoking programme for women in disadvantaged communities. The control group comprised 'enhanced usual care' offered by the Irish Health Service Executive (HSE). The PRagmatic Explanatory Continuum Indicator Summary (PRECIS-2) is a tool to assess whether a trial design is more explanatory (working under ideal conditions) or pragmatic (working under 'real-world' conditions). The aim of this paper was to retrospectively evaluate the WCQ2 pilot trial using PRECIS-2 to inform the decision-making process on progression to a future definitive trial (DT). METHODS The WCQ2 trial protocol and HSE standard stop-smoking service were described across the nine PRECIS-2 domains: eligibility, recruitment, setting, organisation, flexibility-delivery, flexibility-adherence, follow-up and primary outcome. Team members scored the domains as pragmatic or explanatory for each arm in a half-day workshop. RESULTS Seven team members (practitioners and researchers) assessed the overall trial design as more explanatory than pragmatic. Important differences emerged between the two arms. WCQ targeted adult women from disadvantaged communities whereas HSE run a limited enhanced service for all quitters. Trial recruitment was challenging, intense efforts were needed as the trial proceeded. WCQ was delivered in a non-clinical community setting, HSE services in a clinical setting. WCQ organisation was co-designed with community partners and comprises peer-to-peer group support delivered by trained lay community facilitators, whereas HSE one-to-one support is delivered by Smoking Cessation Officers with a clinical background. Only WCQ allowed flexibility in delivery and adherence. Follow-up was more intensive in WCQ. Greater efforts to improve participant retention will be required in a future DT. CONCLUSIONS PRECIS-2 allowed the reflection of practitioners and researchers on similarities and differences between intervention and control arms. Results will inform the decision on progression to an effectiveness DT, which will require more a pragmatic and less explanatory design. This novel use of PRECIS-2 to retrospectively evaluate a complex community-based pilot trial in advance of a full DT will also support learning for those undertaking hybrid trials of implementation and effectiveness. TRIAL REGISTRATION This trial is registered with the ISRCTN registry ( No. 74721694 ).
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Affiliation(s)
- Catherine Darker
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Nicola O'Connell
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Stefania Castello
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Emma Burke
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | | | - Aine Buggy
- Health Promotion and Improvement, Health Service Executive, Dublin, Ireland
| | - Nadine Dougall
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, Scotland
| | - Pauline Williams
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Public and Patient Representative, Dublin, Ireland
| | - Fiona Dobbie
- Usher Institute and SPECTRUM Consortium, College of Medicine, University of Edinburgh, Edinburgh, Scotland
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, College of Medicine, University of Edinburgh, Edinburgh, Scotland
| | - Catherine B Hayes
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland.
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14
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Johnson CF, Maxwell M, Williams B, Dougall N, MacGillivray S. Dose-response effects of selective serotonin reuptake inhibitor monotherapy for the treatment of depression: systematic review of reviews and meta-narrative synthesis. BMJ Med 2022; 1:e000017. [PMID: 36936596 PMCID: PMC9978765 DOI: 10.1136/bmjmed-2021-000017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/05/2022] [Indexed: 12/04/2022]
Abstract
Objective To assess and clarify the relations between selective serotonin reuptake inhibitor (SSRI) dose efficacy, acceptability (early treatment discontinuation (dropouts)), and tolerability (reported adverse drug effects), and critically evaluate methods previously used to examine SSRI dose-response effects for the treatment of depression in adults. Design Systematic review of reviews and meta-narrative synthesis. Data sources Embase, Medline, PsycINFO, Scopus, and the Cochrane Collaboration library, from 1975 to December 2021. Reference lists of national depression treatment guidelines were systemically searched by hand. Eligibility criteria for selecting studies Reviews assessing SSRI monotherapy dose-response effects for the treatment of depression in adults (age ≥18 years) reporting efficacy, acceptability, or tolerability. Reviews meeting inclusion criteria had a high degree of heterogeneity, due to methodological diversity; therefore, a meta-narrative synthesis approach was applied. Standard daily doses were defined as 20 mg citalopram, fluoxetine, paroxetine; 50 mg sertraline; and 10 mg escitalopram. Risk of bias was assessed using the Risk of Bias in Systematic Reviews tool, in line with Cochrane recommendations. Results The search identified 9138 records; 387 full text reports were assessed for eligibility, 42 of which matched the inclusion criteria. The majority, 83% (n=35), of reviews included data for studies with a duration of ≤12 weeks (ie, the acute phase of depression treatment). Of 39 reviews assessing efficacy, the majority (n=26) indicated that individual SSRIs and SSRI class demonstrated flat dose-response effects; standard doses were optimal for efficacy. Acceptability or tolerability were assessed in 28 reviews. Higher than standard daily doses were associated with higher dropout rates and a greater incidence of adverse drug effects (eg, nausea, sexual dysfunction, fatigue, anxiety). Despite a range of methods being reported, there was an overall consensus regarding SSRI dose related efficacy, dropouts, and adverse drug effects. Conclusion Standard daily doses of SSRIs for the treatment of depression in adults provide a favourable balance between efficacy, acceptability, and tolerability. Patients are encouraged to talk to their prescriber or community pharmacist if they experience adverse effects or have any concerns about their drug treatments.
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Affiliation(s)
- Chris F Johnson
- Pharmacy Services, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Margaret Maxwell
- Midwifery and AHP Research Unit, University of Stirling, Stirling, UK
| | - Brian Williams
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Nadine Dougall
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
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15
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Hayes C, Castello S, Darker C, Vance J, Buckley E, Reynolds C, Buggy A, O'Hagan K, Cronin N, Dougall N, Devane D, Bauld L. The We Can Quit2 trial knowledge exchange and dissemination plan: Future research and policy priorities from a community perspective. Tob Prev Cessat 2021. [DOI: 10.18332/tpc/143624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Hayes C, Darker C, Burke E, Castello S, O'Sullivan K, O'Connell N, Vance J, Reynolds C, Buggy A, Dougall N, Loudon K, Williams P, Dobbie F, Bauld L. A process evaluation of We Can Quit: A stop-smoking programme for women living in socio-disadvantaged areas in Ireland. Tob Prev Cessat 2021. [DOI: 10.18332/tpc/143623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Hayes C, Castello S, Patterson J, O'Connell N, Burke E, Dobbie F, Vance J, Devane D, Bauld L, Darker C, Dougall N. Results of We Can Quit2: A pilot cluster randomised controlled trial of a community-based stop-smoking intervention for women living in disadvantaged areas of Ireland. Tob Prev Cessat 2021. [DOI: 10.18332/tpc/143622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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Hayes CB, Patterson J, Castello S, Burke E, O'Connell N, Darker CD, Bauld L, Vance J, Ciblis A, Dobbie F, Loudon K, Devane D, Dougall N. Peer-Delivery of a Gender-Specific Smoking Cessation Intervention for Women Living in Disadvantaged Communities in Ireland We Can Quit2 (WCQ2)-A Pilot Cluster Randomized Controlled Trial. Nicotine Tob Res 2021; 24:564-573. [PMID: 34939119 PMCID: PMC8887585 DOI: 10.1093/ntr/ntab242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 10/22/2021] [Accepted: 11/17/2021] [Indexed: 01/19/2023]
Abstract
Introduction We Can Quit” (WCQ) is community-based stop-smoking program delivered by trained community facilitators, based on the socio-ecological framework and developed using a Community-based Participatory Research approach, targeting women living in socioeconomically disadvantaged (SED) areas of Ireland. Aims and Methods The We Can Quit2 (WCQ2) pilot trial assessed the feasibility of WCQ. A pragmatic cluster randomized controlled trial with a process evaluation WCQ2, was conducted in four matched pairs of SED districts (8–10 000 women per district). Districts were independently randomized to WCQ (group support + nicotine replacement therapy), or to individual support delivered by health professionals. Participants were adult women smokers interested in quitting, who were living or working in trial districts. Recruitment of districts and 194 women in four waves (49 women per wave); retention at 12 weeks and 6 months; fidelity to intervention delivery and acceptability of trial-related processes were assessed. Validated smoking abstinence at 12-week and 6-month post-intervention was recorded, missing data assumed as continued smoking. Results Eight districts were recruited. 125/188 (66.5%) eligible women consented. The 49 women target was reached in wave4. Retention at 12 weeks was (Intervention [I]: 55.4%; Control [C]: 51.7%), at 6 months (I: 47.7%; C: 46.7%). Smoking abstinence at 12 weeks was (I: 23.1%, [95% CI: 14.5 to 34.7]; C: 13%, [95% CI: 6.9 to 24.1]). 83.8% of session activities were delivered. Trial-related processes were acceptable to facilitators. Low literacy was highlighted as a barrier for participants’ acceptability. Conclusions WCQ was feasible to deliver by trained facilitators and indicated a positive direction in abstinence rates. Low literacy will need to be addressed in a future trial design. Implications This pilot trial showed that a stop-smoking intervention tailored to a group of women smokers living in SED areas which was delivered by trained local women within their local communities was feasible. Furthermore, although not formally compared, more WCQ women were abstinent from smoking at the end of treatment. The results are relevant to enhance the design of a fully powered effectiveness trial, and provide important evidence on the barriers to deliver a tailored smoking cessation service to SED women smokers in Ireland.
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Affiliation(s)
- Catherine B Hayes
- Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Jenny Patterson
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland
| | - Stefania Castello
- Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Emma Burke
- Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Nicola O'Connell
- Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Catherine D Darker
- Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, College of Medicine and Veterinary Science, University of Edinburgh, Edinburgh, Scotland
| | | | | | - Fiona Dobbie
- Usher Institute, College of Medicine and Veterinary Science, University of Edinburgh, Edinburgh, Scotland
| | | | - Declan Devane
- HRB Trials Methodology Research Network, School of Nursing & Midwifery, NUI Galway, Galway, Ireland
| | - Nadine Dougall
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland
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Castello S, Darker C, Vance J, Buckley E, Reynolds C, Cronin N, Dougall N, Devane D, Bauld L, Hayes CB. The knowledge exchange and dissemination plan of the We Can Quit2 community-based stop-smoking trial. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
Abstract
Background
We Can Quit2 was a community-based randomised controlled trial which determined the feasibility and acceptability of We Can Quit (WCQ), a peer delivered stop-smoking programme comprising group support and free Nicotine Replacement Therapy (NRT) tailored to women living in socioeconomically disadvantaged areas in Ireland. Reengagement with key stakeholders took place as part of the trial Knowledge Exchange and Dissemination plan, to discuss strategies to optimise community engagement, recruitment and retention in a future definitive trial (DT), and the policy priorities arising from the trial.
Methods
Community stakeholders involved in trial recruitment and planning, Irish Cancer Society and Health Service Executive representatives were invited to an online interactive workshop in November 2020. Key trial findings were presented. Workshop discussion (field notes) and responses to a post-event anonymous questionnaire informed a list of challenges and suggestions for a future DT and policy development from a community perspective.
Results
Forty-one stakeholders attended the workshop, six completed the questionnaire. Dedicated additional time for community engagement and use of social prescribing as a recruitment tool were recommended. Greater adaptation of trial data and assistance to complete forms were suggested to address low literacy, which was a barrier to recruitment and retention. An intervention boost after WCQ delivery and encouragement of women to join other healthy community programmes to maintain their group, were recommended to facilitate retention and enhance sustainability. Policy priorities were to remove cost and administrative barriers to access NRT and ongoing provision of cessation services tailored to disadvantaged groups.
Conclusions
Important strategies to optimise design of a DT of WCQ effectiveness were recommended. Lessons learned may be relevant to other community-based health interventions in socioeconomically disadvantaged areas.
Key messages
The workshop provided a suitable forum for engagement of community and statutory stakeholders. Knowledge exchange activities facilitated an enhanced research design from a community perspective.
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Affiliation(s)
- S Castello
- Public Health & Primary Care, Institute of Population Health, Trinity College Dublin, Dublin, Ireland
| | - C Darker
- Public Health & Primary Care, Institute of Population Health, Trinity College Dublin, Dublin, Ireland
| | - J Vance
- Community Programmes, Irish Cancer Society, Dublin, Ireland
| | - E Buckley
- Tobacco Free Ireland Programme, Health Service Executive, Dublin, Ireland
| | - C Reynolds
- Community Programmes, Irish Cancer Society, Dublin, Ireland
| | - N Cronin
- Action on Smoking and Health, ASH Ireland, Dublin, Ireland
| | - N Dougall
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - D Devane
- HRB TMRN and School of Nursing & Midwifery, NUI Galway, Galway, Ireland
| | - L Bauld
- Usher Institute, SPECTRUM Consortium, College of Medicine, University of Edinburgh, Edinburgh, UK
| | - CB Hayes
- Public Health & Primary Care, Institute of Population Health, Trinity College Dublin, Dublin, Ireland
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Mc Glanaghy E, Jackson JL, Morris P, Prentice W, Dougall N, Hutton P. Discerning the adverse effects of psychological therapy: Consensus between experts by experience and therapists. Clin Psychol Psychother 2021; 29:579-589. [PMID: 34260130 DOI: 10.1002/cpp.2648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 07/08/2021] [Indexed: 11/12/2022]
Abstract
Measurement of adverse effects of psychological therapy is inconsistent due to ambiguity about the concept. The perspective of people undertaking psychological therapy (that is, experts by experience) has largely been overlooked. This study will investigate whether there is consensus between the opinions of professionals and experts by experience. The Delphi method was used. In Round 1 thematic analysis was used to analyse qualitative responses. Wilcoxon rank-sum tests were used to examine group differences in Rounds 2 and 3. The study protocol was prospectively registered, reference osf.io/f9wp7. Fifty-one professionals and 51 experts by experience generated 147 potential adverse effects in Round 1, across 9 themes; including 'therapy amplifies problem', 'emotional lability' and 'sense of self'. Each item was rated for overall consensus in Rounds 2 (n = 62) and 3 (n = 63). Thirty-eight items were rated as essential, very important or important to include on a list of potential adverse effects. A further 12 items were rated as important by the expert by experience group only. Professionals were more conservative in their ratings. There appeared to be consensus between professionals and experts by experience on what to include in a list of adverse effects of psychological therapy (the EDAPT), including novel adverse effects which have not been previously considered. Further research is required to understand which adverse effects are necessary, unnecessary, or indeed harmful to psychotherapy outcomes.
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Affiliation(s)
- Edel Mc Glanaghy
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK.,School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK.,Adult Psychological Therapies, NHS Forth Valley, Stirling, UK
| | | | - Paul Morris
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Wendy Prentice
- Adult Psychological Therapies, NHS Forth Valley, Stirling, UK
| | - Nadine Dougall
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Paul Hutton
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
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Martin CJH, Patterson J, Paterson C, Welsh N, Dougall N, Karatzias T, Williams B. ICD-11 complex Post Traumatic Stress Disorder (CPTSD) in parents with perinatal bereavement: Implications for treatment and care. Midwifery 2021; 96:102947. [PMID: 33610906 DOI: 10.1016/j.midw.2021.102947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 12/21/2020] [Accepted: 02/09/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The 11th revision of the WHO International Classification of Diseases (ICD-11) has identified Complex PTSD (CPTSD) as a new condition. AIM To explore whether the new diagnosis of CPTSD (ICD11) is relevant to women who have experienced perinatal bereavement and to advance knowledge about the acceptability, feasibility and perceived impact of delivering an innovative flexible Compassionate Focused Therapy (CFT) informed treatment package to alleviate symptoms of this condition. METHODS A mixed methods study using survey and interviews was conducted. Participants first completed the International Trauma Questionnaire (ITQ) to assess if they met the criteria for PTSD or CPTSD (n=72), and subsequent semi-structured interviews (n=12) identified participants' views about different treatment approaches. PARTICIPANTS A convenience sample of women who had experienced perinatal bereavement were recruited from one geographical region in Scotland. DATA COLLECTION Information was gathered about trauma experiences related to perinatal bereavement; participants' levels of PTSD or CPTSD using the ITQ; and views regarding the features of treatment options. In-depth interviews with women (n=12) and a focus group with staff (n=5) were also conducted. FINDINGS Of 74 participants (n=74) who fully completed the ITQ, 10.8% (n=8) met the criteria for PTSD and 29.7% (n=22) for CPTSD, equating to a total of 40.5% of participants experiencing traumatic stress. Results suggest that CPTSD is a more common condition than PTSD in people with perinatal bereavement, with qualitative data suggesting that CFT and EMDR can be useful and acceptable interventions for this population group. CONCLUSION A feasibility study is recommended next to evaluate acceptability of trial processes in preparation for a definitive randomised controlled trial of a new flexible CFT informed treatment package to address PTSD and CPTSD in people with perinatal bereavement. RECOMMENDATIONS FOR PRACTICE Routine assessment of ICD-11 CPTSD is recommended in this population group.
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Affiliation(s)
- Caroline J Hollins Martin
- Maternal Health, School of Health and Social Care, Edinburgh Napier University (ENU), Sighthill Campus, Edinburgh, Scotland, UK, EH11 4BN.
| | - Jenny Patterson
- School of Health and Social Care, Sighthill Campus, Edinburgh Napier University, 9 Sighthill Court, UK, EH11 4BN.
| | | | - Nicola Welsh
- 'Held in Our Hearts', 177, Colinton Road, Edinburgh, EH14 1BZ, UK.
| | - Nadine Dougall
- School of Health and Social Care, Sighthill Campus, Edinburgh Napier University, 9 Sighthill Court, UK, EH11 4BN, UK.
| | - Thanos Karatzias
- School of Health and Social Care, Sighthill Campus, Edinburgh Napier University, 9 Sighthill Court, UK, EH11 4BN.
| | - Brian Williams
- School of Health and Social Care, 4B06, Sighthill Campus, Edinburgh Napier University, 9 Sighthill Court, UK, EH11 4BN.
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Mc Glanaghy E, Turner D, Davis GA, Sharpe H, Dougall N, Morris P, Prentice W, Hutton P. A network meta-analysis of psychological interventions for schizophrenia and psychosis: Impact on symptoms. Schizophr Res 2021; 228:447-459. [PMID: 33578368 DOI: 10.1016/j.schres.2020.12.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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] [Received: 06/24/2020] [Revised: 11/30/2020] [Accepted: 12/30/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Evidence for the effectiveness of psychological interventions for schizophrenia/psychosis is growing, however there is no consensus on the psychological intervention most likely to reduce symptoms. METHODS A network meta-analysis was conducted to identify all randomised controlled trials (RCTs) of psychological interventions for adults with schizophrenia/psychosis. A systematic review of the literature using MEDLINE, PsycINFO, EMBASE and CENTRAL led to an analysis of 90 RCTs with 8440 randomised participants across 24 psychological intervention, and control groups. Psychological interventions were categorised and rated for treatment fidelity and risk of bias. Data for total symptoms were extracted and network meta-analysis, using a frequentist approach, was undertaken using Stata SE v15 to compare the direct and indirect evidence for the effectiveness of each psychological intervention. FINDINGS Psychological interventions were more likely to reduce symptoms than control groups, and one intervention, mindfulness-based psychoeducation, was consistently ranked as most likely to reduce total symptoms. Subgroup analyses identified differential effectiveness in different settings and for different subgroups. INTERPRETATION Mindfulness-based psychoeducation was consistently ranked as most likely to reduce symptoms; however all studies were based in China. More RCTs in a variety of cultural contexts would help to elucidate whether these findings generalise internationally. A number of psychological interventions could potentially be more effective than interventions recommended by NICE guidelines, such as CBT and family therapy, and additional RCTs and meta-analyses are needed to generate more conclusive evidence in this regard.
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Affiliation(s)
- Edel Mc Glanaghy
- School of Health in Social Science, University of Edinburgh, UK; School of Health and Social Care, Edinburgh Napier University, UK; NHS Forth Valley, UK.
| | | | - Georgina A Davis
- School of Health and Social Care, Edinburgh Napier University, UK
| | - Helen Sharpe
- School of Health in Social Science, University of Edinburgh, UK
| | - Nadine Dougall
- School of Health and Social Care, Edinburgh Napier University, UK
| | - Paul Morris
- School of Health in Social Science, University of Edinburgh, UK
| | | | - Paul Hutton
- School of Health and Social Care, Edinburgh Napier University, UK
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Murray J, Heyman I, Dougall N, Wooff A, Aston E, Enang I. Co-creation of five key research priorities across law enforcement and public health: A methodological example and outcomes. J Psychiatr Ment Health Nurs 2021; 28:3-15. [PMID: 32516840 DOI: 10.1111/jpm.12664] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/12/2020] [Accepted: 05/29/2020] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Between policing and health, there are many shared issues. Mental health distress and crises and caring for people who may be vulnerable are priority areas. Working together in partnership is challenging, and fragmented systems and processes are the result. This leads to poor experiences for the police, health professions and the public. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper describes an event that brought together 26 stakeholders involved in law enforcement and public health. The aim of this work was to identify the biggest shared challenges that they experience in their day to day jobs. The five key priorities were as follows: vulnerability; mental health crisis; decision-making around assessment and triage across professional groups and professional roles; peer support and organizational well-being; and information and data sharing. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This paper demonstrates the strength of bringing partners together throughout law enforcement and public health, making proper time to actually discuss the "big issues" which affect them, how they each experience these issues, and how they might have overcome these within their own professions. Only through working together as partners and having everyone on the same page with the shared priorities can we really start to make a difference in the areas and with the people who matter. The focus on "vulnerability" and "mental health crisis" demonstrates the complexity of the issues between the professions, and that they need to find effective ways to work together to support people. No one professional group can solve inter-professional challenges alone. ABSTRACT: Introduction Law enforcement professions now assume more responsibility for tackling mental health issues alongside public health colleagues than ever before. The term "vulnerability" is frequently used within Law Enforcement and Public Health (LEPH) to identify those requiring emergency mental health care. However, there are ongoing challenges within LEPH to determine whose responsibility this is. Aim To co-create the most important priorities for LEPH research in Scotland. Method The paper describes a collaborative workshop which brought together an Expert Advisory Group (EAG) of 26 senior stakeholders, from academia, policing, mental health nursing, psychiatry, paramedics, emergency medicine, people with lived experience, policy makers and third sector. Results The five key priorities included: vulnerability; mental health crisis; decision-making around assessment and triage across professional groups and professional roles; peer support and organizational well-being; and information and data sharing. Discussion The paper discusses the EAG group event as a co-production process, focusing on how key LEPH research priorities were derived. Implications for practice This paper demonstrates the inextricable link between co-production and co-creation of value via EAG group consensus on LEPH research priorities. Shared vision and professional will are not enough to ensure progress: there must also be shared policy, knowledge and access.
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Affiliation(s)
- Jennifer Murray
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Inga Heyman
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Nadine Dougall
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Andrew Wooff
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Elizabeth Aston
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Iniobong Enang
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
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Burke E, Dobbie F, Dougall N, Adebolu Oluwaseun M, Mockler D, Vance J, O'Connell N, Darker CD, Bauld L, Hayes C. Smoking cessation programmes for women living in disadvantaged communities, “We Can Quit 2”: A systematic review protocol. HRB Open Res 2019. [DOI: 10.12688/hrbopenres.12901.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Tobacco use is the leading cause of preventable death in Ireland with almost 6,000 smokers dying each year from smoking-related diseases. Amongst younger Irish women, smoking rates are considerably higher in those from socially disadvantaged areas compared to women from affluent areas. Women from poorer areas also experience higher rates of lung cancer. To our knowledge, there are no peer reviewed published systematic reviews on the effectiveness of interventions tailored to reduce smoking rates in women from disadvantaged areas. This systematic review protocol will aim to examine the effectiveness of such interventions and to describe trial processes such as recruitment, follow-up and dropout prevention strategies, as well as barriers and enablers of successful implementation. A systematic review will be conducted of peer-reviewed randomised controlled trials and associated process evaluations of smoking cessation interventions designed for women living in socially disadvantaged areas. If the search returns, less than five studies are review criteria will expand to include quasi-experimental studies. A number of databases of scholarly literature will be searched from inception using a detailed search strategy. Two independent reviewers will screen titles, abstracts and full-text articles to identify relevant studies using a pre-defined checklist based on PICOS. In the case of disagreement, a third reviewer will be consulted. The quality of included studies will be assessed using the ‘Grading of Recommendations Assessment, Development and Evaluation’ (GRADE) criteria. Quantitative data will be extracted and, if comparable, will be assessed using meta-analysis. A narrative meta-synthesis of qualitative data will be conducted. This review aims to synthesise information from relevant studies on smoking cessation interventions tailored for women from socially disadvantaged areas. The evidence obtained from studies and presented in this review will help guide future research in this area. Registration: This review will be registered with International Prospective Register of Systematic Reviews (PROSPERO).
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Hayes C, Ciblis A, Darker C, Dougall N, Vance J, O’Connell N, Dobbie F, Loudon K, Burke E, Devane D, Bauld L. We Can Quit2 (WCQ2): a community-based intervention on smoking cessation for women living in disadvantaged areas of Ireland-study protocol for a pilot cluster randomised controlled trial. Pilot Feasibility Stud 2019; 5:138. [PMID: 31788324 PMCID: PMC6875165 DOI: 10.1186/s40814-019-0511-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 10/01/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Tobacco use is the leading cause of preventable death in Ireland with almost 6000 smokers dying each year from smoking-related diseases. The 'We Can Quit2' (WCQ2) study is a pilot pragmatic two-arm, parallel-group, cluster randomised trial that aims to explore the feasibility and acceptability of trial processes including recruitment and to estimate parameters to inform sample size estimates needed for an effectiveness trial. This future trial will assess the effectiveness of a community-based smoking cessation intervention for women living in disadvantaged areas on short- and medium-term cessation rates. METHODS/DESIGN Four matched pairs of districts (eight clusters) selected by area level of deprivation, geographical proximity, and eligibility for free medical services will be randomised to receive either WCQ (behavioural support + access to Nicotine Replacement Therapy (NRT)) delivered over 12 weeks by trained Community Facilitators (CFs) or to a form of usual care, a one-to-one smoking cessation service delivered by Smoking Cessation Officers from Ireland's national health service, the Health Service Executive (HSE). Within each cluster, 24-25 women will be recruited (97 per arm; 194 in total) in 4 phases with consent obtained prior to cluster randomisation. The outcome measures will assess feasibility and acceptability of trial processes, including randomisation. Outcome data for a future definitive intervention (biochemically validated smoking abstinence) will be collected at end of programme (12 weeks) and at 6 months. WCQ2 has an embedded process evaluation using both qualitative and quantitative methods. This will be conducted (semi-structured client and CF interviews, intervention delivery checklist, and diary) to explore acceptability of trial processes, intervention fidelity, trial context, and implementation. Trial processes will be assessed against domains of the PRECIS-2 wheel to inform a future definitive trial design. DISCUSSION Data from this pilot trial will inform the design and sample size for a full cluster randomised trial to determine the effectiveness of an intervention tailored to disadvantaged women in improving smoking cessation rates. It will provide transferable learning on the systems and implementation strategies needed to support effective design of future pragmatic community-based trials which address health promotion interventions for women in disadvantaged communities. TRIAL REGISTRATION Concurrent to publication. Controlled trials ISRCTN74721694.
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Affiliation(s)
- Catherine Hayes
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Russell Centre, Tallaght Cross, Dublin, D24 DH 74 Ireland
| | - Aurelia Ciblis
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Russell Centre, Tallaght Cross, Dublin, D24 DH 74 Ireland
| | - Catherine Darker
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Russell Centre, Tallaght Cross, Dublin, D24 DH 74 Ireland
| | - Nadine Dougall
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Edinburgh, EH11 4BN UK
| | - Joanne Vance
- Irish Cancer Society, 43/45 Northumberland Road, Ballsbridge, Dublin 4, Ireland
| | - Nicola O’Connell
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Russell Centre, Tallaght Cross, Dublin, D24 DH 74 Ireland
| | - Fiona Dobbie
- Usher Institute, College of Medicine and Veterinary Science, University of Edinburgh, Edinburgh, EH8 9AG UK
| | | | - Emma Burke
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Russell Centre, Tallaght Cross, Dublin, D24 DH 74 Ireland
| | - Declan Devane
- HRB Trials Methodology Research Network & School of Nursing & Midwifery, NUI Galway, Galway, Ireland
| | - Linda Bauld
- Usher Institute, College of Medicine and Veterinary Science, University of Edinburgh, Edinburgh, EH8 9AG UK
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Burke E, Dobbie F, Dougall N, Adebolu Oluwaseun M, Mockler D, Vance J, O'Connell N, Darker CD, Bauld L, Hayes C. Smoking cessation programmes for women living in disadvantaged communities, “We Can Quit 2”: A systematic review protocol. HRB Open Res 2019. [DOI: 10.12688/hrbopenres.12901.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Tobacco use is the leading cause of preventable death in Ireland with almost 6,000 smokers dying each year from smoking-related diseases. Amongst younger Irish women, smoking rates are considerably higher in those from socially disadvantaged areas compared to women from affluent areas. Women from poorer areas also experience higher rates of lung cancer. To our knowledge, there are no peer reviewed published systematic reviews on the effectiveness of interventions tailored to reduce smoking rates in women from disadvantaged areas. This systematic review protocol will aim to examine the effectiveness of such interventions and to describe trial processes such as recruitment, follow-up and dropout prevention strategies, as well as barriers and enablers of successful implementation. A systematic review will be conducted of peer-reviewed randomised controlled trials and associated process evaluations of smoking cessation interventions designed for women living in socially disadvantaged areas. If the search returns, less than five studies are review criteria will expand to include quasi-experimental studies. A number of databases of scholarly literature will be searched from inception using a detailed search strategy. Two independent reviewers will screen titles, abstracts and full-text articles to identify relevant studies using a pre-defined checklist based on PICOS. In the case of disagreement, a third reviewer will be consulted. The quality of included studies will be assessed using the ‘Grading of Recommendations Assessment, Development and Evaluation’ (GRADE) criteria. Quantitative data will be extracted and, if comparable, will be assessed using meta-analysis. A narrative meta-synthesis of qualitative data will be conducted. This review aims to synthesise information from relevant studies on smoking cessation interventions tailored for women from socially disadvantaged areas. The evidence obtained from studies and presented in this review will help guide future research in this area. Registration: This review will be registered with International Prospective Register of Systematic Reviews (PROSPERO).
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Dobbie F, Purves R, McKell J, Dougall N, Campbell R, White J, Amos A, Moore L, Bauld L. Implementation of a peer-led school based smoking prevention programme: a mixed methods process evaluation. BMC Public Health 2019; 19:742. [PMID: 31196124 PMCID: PMC6567418 DOI: 10.1186/s12889-019-7112-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 01/22/2019] [Accepted: 06/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking prevention programmes that reach adolescents before they experiment with tobacco may reduce the prevalence of tobacco use. ASSIST is a school-based, peer-led smoking prevention programme that encourages the diffusion of non-smoking norms among secondary school students (aged 12-13), and was shown in a randomised control trial (conducted 2001-2004) to reduce the prevalence of weekly smoking. This paper presents findings from a process evaluation of the implementation of ASSIST in Scotland in 2014-2017. It examines acceptability and fidelity of implementation and explores the context of message diffusion between peers. METHODS Mixed method implementation study with students (n = 61), school staff (n = 41), trainers (n = 31) and policy and commissioning leads (n = 17), structured observations (n = 42) and student surveys (n = 2130). RESULTS ASSIST was delivered with a high degree of fidelity to the licensed manual with all elements of the programme implemented. Student survey findings indicated that the frequency of conversations about smoking increased over the ASSIST delivery period (18% at baseline, 26% at follow-up), but student recollection of conversations about smoking with peer supporters was low (9%). The delivery context of ASSIST was important when considering perceptions of message diffusion. In the study schools, survey findings showed that 0.9% (n = 19) of participants were regular smokers (at least once a week), with nine out of ten (89.9%, n = 1880) saying they had never smoked. This very low prevalence may have affected when and with whom conversations took place. Study participants indicated that there were wider benefits of taking part in ASSIST for: peer supporters (i.e. personal and communication skills); schools (an externally delivered health promotion programme that required minimal resource from schools); and communities (via communication about the risks of smoking to wider social networks). CONCLUSIONS ASSIST in Scotland was delivered with a high degree of fidelity to the licensed programme and was acceptable from the perspective of schools, students and trainers. Targeting ASSIST in deprived areas with higher youth smoking prevalence or in other countries where youth smoking rates are rising or higher than in Scotland may be particularly relevant for the future delivery.
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Affiliation(s)
- Fiona Dobbie
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
- UK Centre for Tobacco and Alcohol Studies, Nottingham, UK.
| | - Richard Purves
- UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Jennifer McKell
- UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Nadine Dougall
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Rona Campbell
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - James White
- DECIPHer, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Amanda Amos
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
| | - Laurence Moore
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Linda Bauld
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
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Burke E, Dobbie F, Dougall N, Adebolu Oluwaseun M, Mockler D, Vance J, O'Connell N, Darker C, Bauld L, Hayes C. Smoking cessation programmes for women living in disadvantaged communities, "We Can Quit 2": A systematic review protocol. HRB Open Res 2019; 2:10. [PMID: 32104776 PMCID: PMC7017191 DOI: 10.12688/hrbopenres.12901.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 05/23/2019] [Indexed: 11/29/2022] Open
Abstract
Tobacco use is the leading cause of preventable death in Ireland with almost 6,000 smokers dying each year from smoking-related diseases. Amongst younger Irish women, smoking rates are considerably higher in those from socially disadvantaged areas compared to women from affluent areas. Women from poorer areas also experience higher rates of lung cancer. To our knowledge, there are no peer reviewed published systematic reviews on the effectiveness of interventions tailored to reduce smoking rates in women from disadvantaged areas. This systematic review protocol will aim to examine the effectiveness of such interventions and to describe trial processes such as recruitment, follow-up and dropout prevention strategies, as well as barriers and enablers of successful implementation. A systematic review will be conducted of peer-reviewed randomised controlled trials and associated process evaluations of smoking cessation interventions designed for women living in socially disadvantaged areas. If the search returns, less than five studies are review criteria will expand to include quasi-experimental studies. A number of databases of scholarly literature will be searched from inception using a detailed search strategy. Two independent reviewers will screen titles, abstracts and full-text articles to identify relevant studies using a pre-defined checklist based on PICOS. In the case of disagreement, a third reviewer will be consulted. The quality of included studies will be assessed using the 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE) criteria. Quantitative data will be extracted and, if comparable, will be assessed using meta-analysis. A narrative meta-synthesis of qualitative data will be conducted. This review aims to synthesise information from relevant studies on smoking cessation interventions tailored for women from socially disadvantaged areas. The evidence obtained from studies and presented in this review will help guide future research in this area. Registration: This review will be registered with International Prospective Register of Systematic Reviews (PROSPERO).
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Affiliation(s)
- Emma Burke
- School of Medicine, Trinity College Dublin, Dublin, Ireland, D24 DH74, Ireland
| | - Fiona Dobbie
- Usher Institute, College of Population Health Sciences Medicine and Informatics Veterinary Medicine, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Nadine Dougall
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Edinburgh, EH11 4BN, UK
| | | | - David Mockler
- School of Medicine, Trinity College Dublin, Dublin, Ireland, D24 DH74, Ireland
| | | | - Nicola O'Connell
- School of Medicine, Trinity College Dublin, Dublin, Ireland, D24 DH74, Ireland
| | - Catherine Darker
- School of Medicine, Trinity College Dublin, Dublin, Ireland, D24 DH74, Ireland
| | - Linda Bauld
- Usher Institute, College of Population Health Sciences Medicine and Informatics Veterinary Medicine, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Catherine Hayes
- School of Medicine, Trinity College Dublin, Dublin, Ireland, D24 DH74, Ireland
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Dougall N, Savinc J, Maxwell M, Karatzias T, O'Connor RC, Williams B, Grandison G, John A, Cheyne H, Fyvie C, Bisson JI, Hibberd C, Abbott-Smith S, Nolan L. Childhood adversity, mental health and suicide (CHASE): a methods protocol for a longitudinal case-control linked data study. Int J Popul Data Sci 2019; 5:1338. [PMID: 34232970 PMCID: PMC7473285 DOI: 10.23889/ijpds.v5i1.1338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction Suicide is a tragic outcome with devastating consequences. In 2018, Scotland experienced a 15% increase in suicide from 680 to 784 deaths. This was marked among young people, with an increase of 53% in those aged 15-24, the highest since 2007. Early intervention in those most at risk is key, but identification of individuals at risk is complex, and efforts remain largely targeted towards universal suicide prevention strategies with little evidence of effectiveness. Recent evidence suggests childhood adversity is a predictor of subsequent poor social and health outcomes, including suicide. This protocol reports on methodology for harmonising lifespan hospital contacts for childhood adversity, mental health, and suicidal behaviour. This will inform where to 1) focus interventions, 2) prioritise trauma-informed approaches, and 3) adapt support avenues earlier in life for those most at risk. Methods This study will follow a case-control design. Scottish hospital data (physical health SMR01; mental health SMR04; maternity/birth record SMR02; mother’s linked data SMR01, SMR04, death records) from 1981 to as recent as available will be extracted for people who died by suicide aged 10-34, and linked on Community Health Index unique identifier. A randomly selected control population matched on age and geography at death will be extracted in a 1:10 ratio. International Classification of Disease (ICD) codes will be harmonised between ICD9-CM, ICD9, ICD10-CM and ICD10 for childhood adversity, mental health, and suicidal behaviour. Results ICD codes for childhood adversity from four key studies are reported in two categories, 1) Maltreatment or violence-related codes, and 2) Codes suggestive of maltreatment. ‘Clinical Classifications Software’ ICD codes to operationalise mental health codes are also reported. Harmonised lifespan ICD categories were achieved semi-automatically, but required labour-intensive supplementary manual coding. Cross-mapped codes are reported. Conclusion There is a dearth of evidence about touchpoints prior to suicide. This study reports methods and harmonised ICD codes along the lifespan to understand hospital contact patterns for childhood adversity, which come to the attention of hospital practitioners. Key words Childhood Adversity, Adverse Childhood Experiences, Mental Health, Self-harm, Suicide, Suicidality, Violence, Hospital episodes, Routine Data, Data Linkage, Study Protocol
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Affiliation(s)
- N Dougall
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, UK
| | - J Savinc
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, UK
| | - M Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit, Scion House, University of Stirling, Stirling, FK9 4LA, UK
| | - T Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, UK
| | - R C O'Connor
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
| | - B Williams
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, UK
| | - G Grandison
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, UK
| | - A John
- Swansea University Medical School, Swansea University, Swansea, SA2 8PP, UK
| | - H Cheyne
- Nursing, Midwifery and Allied Health Professions Research Unit, Scion House, University of Stirling, Stirling, FK9 4LA, UK
| | - C Fyvie
- The Rivers Centre, NHS Lothian, Edinburgh, EH11 1BG, UK
| | - J I Bisson
- Cardiff University School of Medicine, Cardiff University, Cardiff, CF24 4HQ, UK
| | - C Hibberd
- Faculty of Health Sciences & Sport, University of Stirling, Stirling, FK9 4LA, UK
| | - S Abbott-Smith
- Child and Adolescent Mental Health Service (CAMHS), NHS Lothian, Edinburgh, EH10 5HF, UK
| | - L Nolan
- Aberlour, Scotland's children's charity (SC007991), Stirling, FK8 2JR, UK
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Hayes C, Darker C, Dougall N, Vance J, Dobbie F, O'Connell N, Loudon K, Burke E, Devane D, Bauld L. We Can Quit2 (WCQ2): A community-based intervention on smoking cessation for women living in disadvantaged areas of Ireland: study protocol for a pilot cluster randomised controlled trial. Tob Prev Cessat 2019. [DOI: 10.18332/tpc/105271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Duncan EAS, Best C, Dougall N, Skar S, Evans J, Corfield AR, Fitzpatrick D, Goldie I, Maxwell M, Snooks H, Stark C, White C, Wojcik W. Epidemiology of emergency ambulance service calls related to mental health problems and self harm: a national record linkage study. Scand J Trauma Resusc Emerg Med 2019; 27:34. [PMID: 30894214 PMCID: PMC6425659 DOI: 10.1186/s13049-019-0611-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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] [Received: 08/10/2018] [Accepted: 03/11/2019] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND People experiencing a mental health crisis receive variable and poorer quality care than those experiencing a physical health crisis. Little is known about the epidemiology, subsequent care pathways of mental health and self-harm emergencies attended by ambulance services, and subsequent all-cause mortality, including deaths by suicide. This is the first national epidemiological analysis of the processes and outcomes of people attended by an ambulance due to a mental health or self-harm emergency. The study aimed to describe patient characteristics, volume, case-mix, outcomes and care pathways following ambulance attendance in this patient population. METHODS A linked data study of Scottish ambulance service, emergency department, acute inpatient and death records for adults aged ≥16 for one full year following index ambulance attendance in 2011. RESULTS The ambulance service attended 6802 mental health or self harm coded patients on 9014 occasions. This represents 11% of all calls attended that year. Various pathways resulted from these attendances. Most frequent were those that resulted in transportation to and discharge from the emergency department (n = 4566/9014; 51%). Some patients were left at home (n = 1003/9014 attendances, 11%). Others were admitted to hospital (n = 2043/9014, 23%). Within 12 months of initial attendance, 279 (4%) patients had died, 97 of these were recorded as suicide. CONCLUSIONS This unique study finds that ambulance service and emergency departments are missing opportunities to provide better care to this population and in potentially avoidable mortality, morbidity and service burden. Developing and testing interventions for this patient group in pre-hospital and emergency department settings could lead to reductions in suicide, patient distress, and service usage.
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Affiliation(s)
- Edward A S Duncan
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK.
| | - Catherine Best
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Nadine Dougall
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Silje Skar
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Josie Evans
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Alasdair R Corfield
- Department of Emergency Medicine, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - David Fitzpatrick
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | | | - Margaret Maxwell
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | | | - Cameron Stark
- Department of Public Health, NHS Highlands, Inverness, UK
| | - Chris White
- Mental Health Foundation Scotland, Glasgow, UK
| | - Wojtek Wojcik
- Department of Liaison Psychiatry, NHS Lothian, Edinburgh, UK
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Enang I, Murray J, Dougall N, Wooff A, Heyman I, Aston E. Defining and assessing vulnerability within law enforcement and public health organisations: a scoping review. Health Justice 2019; 7:2. [PMID: 30825016 PMCID: PMC6717956 DOI: 10.1186/s40352-019-0083-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 02/12/2019] [Indexed: 05/31/2023]
Abstract
BACKGROUND Historically, police departments focused solely on criminal justice issues. Recently, there has been a dynamic shift in focus, with Law Enforcement professional groups assuming more responsibility for tackling mental health and distress-related issues (that may arise because of mental health related problems and learning disabilities) alongside Public Health departments. While Law Enforcement has become a 'last line of support' and an increasing partner in mental health support, there is partnership working between law enforcement, psychology, and health professions in training and mental health service delivery. The term vulnerability is frequently used across Law Enforcement and Public Health (LEPH) to identify those in need of these services. Effective vulnerability assessment is therefore expected to prevent unintentional harmful health and criminal justice consequences and manage the negative impact of such in cases where prevention is not possible. This scoping review aimed to identify how vulnerability is defined and assessed across LEPH organisations. RESULTS Vulnerability is context-specific from a Law Enforcement perspective, and person-specific from a Public Health perspective. Definitions of vulnerability are at best fragmented, while models for assessing vulnerability lack uniformity across LEPH. The implications are two-fold. For "vulnerable groups", the lack of an evidence-based definition and assessment model could prevent access to relevant LEPH services, exacerbating issues of multiple vulnerabilities, co-morbidity, and/or dual diagnosis. All could inadvertently enable social exclusion of vulnerable groups from political discourse and policy interventions. The lack of consistency regarding vulnerability may result in reactive crisis responses as opposed to proactive preventative measures. CONCLUSIONS This scoping review exposes the complexities associated with defining and assessing vulnerability from a LEPH perspective, which are perceived and prioritised differently across the organizations. Future research must bridge this gap. Building on the establishment of a definition of vulnerability within the empirical literature, researchers ought to engage with service users, LEPH staff, and those engaged in policy making to craft effective vulnerability definitions and assessment models. Only through evidence based, co-produced definitions and assessment models for vulnerability can we ensure that best-practice, but also meaningful and feasible practice, in vulnerability assessment can be achieved.
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Affiliation(s)
- Iniobong Enang
- School of Health & Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh, EH11 4BN Scotland, UK
| | - Jennifer Murray
- School of Health & Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh, EH11 4BN Scotland, UK
| | - Nadine Dougall
- School of Health & Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh, EH11 4BN Scotland, UK
| | - Andrew Wooff
- School of Applied Sciences, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh, EH11 4BN Scotland, UK
| | - Inga Heyman
- School of Health & Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh, EH11 4BN Scotland, UK
| | - Elizabeth Aston
- School of Applied Sciences, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh, EH11 4BN Scotland, UK
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Denham SH, Humphrey T, deLabrusse C, Dougall N. Mode of birth after caesarean section: individual prediction scores using Scottish population data. BMC Pregnancy Childbirth 2019; 19:84. [PMID: 30819140 PMCID: PMC6396527 DOI: 10.1186/s12884-019-2226-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/19/2019] [Indexed: 11/30/2022] Open
Abstract
Background Rising caesarean section (CS) rates are a global health concern. Contemporary data indicates that almost 50% of CS are electively performed, with a high proportion of these being a repeat procedure. Vaginal birth after caesarean (VBAC) is recognised as a safe way to give birth in developed countries. UK national maternity policy and worldwide professional guidance supports shared decision-making about mode of birth with women following CS. Evidence suggests that women want individualised information, particularly about their likeilihood of successful VBAC, to enable them to participate in the decision making process. This study aimed to identify characteristics that could inform a predictive model which would allow women to receive personalised and clinically specific information about their likelihood of achieving a successful VBAC in subsequent pregnancies. Methods An observational study using anonymised clinical data extracted from a detailed, comprehensive socio-demographic and clinical dataset. All women who attempted a singleton term VBAC between 2000 and 2012 were included. Data were analysed using both logistic regression and Bayesian statistical techniques to identify clinical and demographic variables predictive of successful VBAC. Results Variables significantly associated with VBAC were: ethnicity (p = 0.011), maternal obstetric complications (p < 0.001), previous vaginal birth (p = < 0.001), antepartum haemorrhage (p = 0.005), pre-pregnancy BMI (p < 0.001) and a previous second stage CS (p < 0.001). Conclusions By using current literature, expert clinical opinion and having access to clinically detailed variables, this study has identified a new significant characteristic. Women who had a previous CS in the second stage of labour are more likely to have a successful VBAC. This predictor may have international significance for women and clinicians in shared VBAC decision-making. Further research is planned to validate this model on a larger national sample leading to further development of the nomogram tool developed in this study for use in clinical practice to assist women and clinicians in the decision-making process about mode of birth after CS.
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Affiliation(s)
- Sara Helen Denham
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4BN, UK.
| | - Tracy Humphrey
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4BN, UK
| | - Claire deLabrusse
- School of Health Sciences (HESAV) Midwifery Department, University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Nadine Dougall
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4BN, UK
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Farquharson B, Abhyankar P, Smith K, Dombrowski SU, Treweek S, Dougall N, Williams B, Johnston M. Reducing delay in patients with acute coronary syndrome and other time-critical conditions: a systematic review to identify the behaviour change techniques associated with effective interventions. Open Heart 2019; 6:e000975. [PMID: 30997136 PMCID: PMC6443141 DOI: 10.1136/openhrt-2018-000975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 11/21/2018] [Indexed: 12/29/2022] Open
Abstract
Background Time to treatment in many conditions, particularly acute coronary syndrome, is critical to reducing mortality. Delay between onset of symptoms and treatment remains a worldwide problem. Reducing patient delay has been particularly challenging. Embedding behaviour change techniques (BCTs) within interventions might lead to shorter delay. Objective To identify which BCTs are associated with reductions in patient delay among people with symptoms or conditions where time to treatment is critical. Methods The data sources were Cochrane Library, MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO. Study eligibility criteria include intervention evaluations (randomised controlled trials, controlled clinical trials and cohort studies) involving adults (aged >18 years) and including an outcome measure of patient delay up to August 2016. Study appraisal and synthesis methods include screening potential studies using a transparent, replicable process. Study characteristics, outcomes and BCTs were extracted from eligible studies. Results From 39 studies (200 538 participants), just over half (n=20) reported a significant reduction in delay. 19 BCTs were identified, plus 5 additional techniques, with a mean of 2 (SD=2.3) BCTs and 2 (SD=0.7) per intervention. No clear pattern between BCTs and effectiveness was found. In studies examining patient delay specifically, three of four studies that included two or more BCTs, in addition to the two most commonly used additional techniques, reported a significant reduction in delay. Conclusions Around half of the interventions to reduce prehospital delay with time-critical symptoms report a significant reduction in delay time. It is not clear what differentiates effective from non-effective interventions, although in relation to patient delay particularly additional use of BCTs might be helpful. Trial registration number CRD42014013106.
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Affiliation(s)
| | - Purva Abhyankar
- School of Health Sciences, University of Stirling, Stirling, UK
| | - Karen Smith
- NHS Tayside School of Nursing & Midwifery, University of Dundee, Dundee, UK
| | | | - Shaun Treweek
- Health Sciences Research Unit, University of Aberdeen, Aberdeen, UK
| | - Nadine Dougall
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Brian Williams
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Marie Johnston
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Paterson C, Karatzias T, Harper S, Dougall N, Dickson A, Hutton P. A feasibility study of a cross‐diagnostic, CBT‐based psychological intervention for acute mental health inpatients: Results, challenges, and methodological implications. Br J Clin Psychol 2018; 58:211-230. [DOI: 10.1111/bjc.12209] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/01/2018] [Indexed: 01/13/2023]
Affiliation(s)
| | | | - Sean Harper
- Psychology Department Royal Edinburgh Hospital, NHS Lothian UK
| | - Nadine Dougall
- School of Health and Social Care Edinburgh Napier University UK
| | - Adele Dickson
- Department of Psychology and Allied Health Sciences Glasgow Caledonian University UK
| | - Paul Hutton
- School of Health and Social Care Edinburgh Napier University UK
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Ball W, Kyle R, Atherton I, Dougall N. Health Inequalities in British Nurses using Census derived databases linked to an adjusted UK Index of Multiple Deprivation. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i4.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
IntroductionScottish health outcomes are worse than in England and Wales. This variation remains after controlling for deprivation, which explains less excess mortality now than previously. Alternative cross-national deprivation measures have limitations which may explain some of this trend. Recent policy interventions to reduce inequalities have not been effective.
Objectives and ApproachThis study aims to test a recently developed measure of area deprivation, the UK adjusted Index of Multiple Deprivation which has been linked to National Census derived Longitudinal Studies in England, Wales and Scotland. This adjusted measure is consistent across UK countries and addresses some limitations of previously utilised area measures of deprivation.
This study also aims to test whether characteristics of Nurses are protective against inequalities in health. This study will test whether Nurses are more socio-economically homogenous and whether higher health literacy is protective against the social gradient in health outcomes.
Results(1) Comparing Nurses to Non-Nurses in Scotland we found that they have systematically different demographic characteristics. Nurses are; older on average, more likely to be female, more likely to own their home, more likely to live in less deprived areas and they report better self-rated health. (1a) Correlation tests will examine the strength of relationship between health and Deprivation quintile for these groups.
(2) Comparing Self-Rated Health of Scottish Nurses with English and Welsh Nurses will determine whether any ‘excess’ in worse health outcomes exists and (2a) if an excess does exist, whether the UK consistent deprivation measure can account for this.
Analysis is currently ongoing and will be completed, with full results cleared for dissemination through disclosure control, prior to conference.
Conclusion/ImplicationsThis study implements methods which provide a basis for cross-national comparison of inequalities using individual-level data and a consistent measure of area deprivation.
Results from this study may also permit recommendations to improve the effectiveness of policy aimed at improving population health and reducing socio-economic inequalities in health.
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Ball W, Kyle R, Atherton I, Dougall N. Health Inequalities in the British Nursing Workforce. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i2.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BackgroundAverage health in the UK is improving, yet geographical inequalities in health persist. The relative difference between the least and most deprived is also growing. Recent policy interventions to reduce these inequalities have not been effective.
MethodsThis work compares Self-Rated Health using the ONS LS and SLS linked to an adjusted UK-consistent small-area Deprivation measure.
This study aims to compare Nurses to the general population to assess whether they also exhibit a social gradient in health. Using a single occupational group adjusts for potential confounders and tests whether characteristics of Nurses, such a good health literacy, degree education and above average income, are protective against inequalities.
ResultsIn Scotland, Nurses are more likely to be older, female, homeowners who live in less deprived areas with better Self-Rated Health than Non-Nurses. We will test whether the social gradient in health is observed for this occupational group.Forthcoming results from cross-national analysis will be presented at conference following disclosure checks.
ConclusionThe relationship between area deprivation and health may remain even in relatively privileged groups.
Results from this study may inform recommendations to improve the effectiveness of policy aimed at improving population health and reducing socio-economic inequalities in health
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Paterson C, Karatzias T, Dickson A, Harper S, Dougall N, Hutton P. Psychological therapy for inpatients receiving acute mental health care: A systematic review and meta-analysis of controlled trials. Br J Clin Psychol 2018; 57:453-472. [PMID: 29660770 DOI: 10.1111/bjc.12182] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/28/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The effectiveness of psychological therapies for those receiving acute adult mental health inpatient care remains unclear, partly because of the difficulty in conducting randomized controlled trials (RCTs) in this setting. The aim of this meta-analysis was to synthesize evidence from all controlled trials of psychological therapy carried out with this group, to estimate its effects on a number of important outcomes and examine whether the presence of randomization and rater blinding moderated these estimates. METHOD A systematic review and meta-analysis of all controlled trials of psychological therapy delivered in acute inpatient settings was conducted, with a focus on psychotic symptoms, readmissions or emotional distress (anxiety and depression). Studies were identified through ASSIA, EMBASE, CINAHL, Cochrane, MEDLINE, and PsycINFO using a combination of the key terms 'inpatient', 'psychological therapy', and 'acute'. No restriction was placed on diagnosis. The moderating effect of the use of assessor-blind RCT methodology was examined via subgroup and sensitivity analyses. RESULTS Overall, psychological therapy was associated with small-to-moderate improvements in psychotic symptoms at end of therapy but the effect was smaller and not significant at follow-up. Psychological therapy was also associated with reduced readmissions, depression, and anxiety. The use of single-blind randomized controlled trial methodology was associated with significantly reduced benefits on psychotic symptoms and was also associated with reduced benefits on readmission and depression; however, these reductions were not statistically significant. CONCLUSIONS The provision of psychological therapy to acute psychiatric inpatients is associated with improvements; however, the use of single-blind RCT methodology was associated with reduced therapy-attributable improvements. Whether this is a consequence of increased internal validity or reduced external validity is unclear. Trials with both high internal and external validity are now required to establish what type, format, and intensity of brief psychological therapy is required to achieve sustained benefits. PRACTITIONER POINTS Clinical implications: This review provides the first meta-analytical synthesis of brief psychological therapy delivered in acute psychiatric inpatient settings. This review suggests that brief psychological therapy may be associated with reduced emotional distress and readmissions. LIMITATIONS The evidence in this review is of limited quality. The type, format, and intensity of brief psychological therapy required to achieve sustained benefits are yet to be established.
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Affiliation(s)
| | - Thanos Karatzias
- School of Health and Social Care, Edinburgh Napier University, UK.,Rivers Centre for Traumatic Stress, Fountainbridge Library, NHS Lothian, Edinburgh, UK
| | - Adele Dickson
- Department of Psychology and Allied Health Sciences, Glasgow Caledonian University, UK
| | - Sean Harper
- Rivers Centre for Traumatic Stress, Fountainbridge Library, NHS Lothian, Edinburgh, UK
| | - Nadine Dougall
- School of Health and Social Care, Edinburgh Napier University, UK
| | - Paul Hutton
- School of Health and Social Care, Edinburgh Napier University, UK
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McGrail KM, Jones K, Akbari A, Bennett TD, Boyd A, Carinci F, Cui X, Denaxas S, Dougall N, Ford D, Kirby R, Kum HC, Moorin R, Moran R, O’Keefe CM, Preen D, Quan H, Sanmartin C, Schull M, Smith M, Williams C, Williamson T, Wyper GMA, Kotelchuck M. A Position Statement on Population Data Science: The Science of Data about People. Int J Popul Data Sci 2018; 3:415. [PMID: 34095517 PMCID: PMC8142960 DOI: 10.23889/ijpds.v3i1.415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Information is increasingly digital, creating opportunities to respond to pressing issues about human populations using linked datasets that are large, complex, and diverse. The potential social and individual benefits that can come from data-intensive science are large, but raise challenges of balancing individual privacy and the public good, building appropriate socio-technical systems to support data-intensive science, and determining whether defining a new field of inquiry might help move those collective interests and activities forward. A combination of expert engagement, literature review, and iterative conversations led to our conclusion that defining the field of Population Data Science (challenge 3) will help address the other two challenges as well. We define Population Data Science succinctly as the science of data about people and note that it is related to but distinct from the fields of data science and informatics. A broader definition names four characteristics of: data use for positive impact on citizens and society; bringing together and analyzing data from multiple sources; finding population-level insights; and developing safe, privacy-sensitive and ethical infrastructure to support research. One implication of these characteristics is that few people possess all of the requisite knowledge and skills of Population Data Science, so this is by nature a multi-disciplinary field. Other implications include the need to advance various aspects of science, such as data linkage technology, various forms of analytics, and methods of public engagement. These implications are the beginnings of a research agenda for Population Data Science, which if approached as a collective field, can catalyze significant advances in our understanding of trends in society, health, and human behavior.
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Affiliation(s)
- Kimberlyn M McGrail
- The University of British Columbia, School of Population and Public Health, 2206 East Mall, Vancouver, BC Canada V6T 1Z3
| | - Kerina Jones
- Population Data Science, Swansea University Medical School, Singleton Park, Swansea SA2 8PP
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Singleton Park, Swansea SA2 8PP
| | - Tellen D Bennett
- University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Andy Boyd
- Bristol Medical School: Population Health Sciences, Office OF3 Oakfield House, Oakfield Grove, Clifton BS8 2BN
| | - Fabrizio Carinci
- Department of Statistical Sciences "Paolo Fortunati", University of Bologna, Via Belle Arti 41, Bologna, Italy
| | - Xinjie Cui
- PolicyWise for Children & Families, 9925 109 St NW, Edmonton, AB T5K 2J8, Canada
| | | | - Nadine Dougall
- School of Health & Social Care, Edinburgh Napier University, Sighthill Campus Sighthill Court Edinburgh EH11 4BN
| | - David Ford
- Population Data Science, Swansea University Medical School, Singleton Park, Swansea SA2 8PP
| | - Russell Kirby
- Dept of Pediatrics, College of Medicine Obstetrics & Gynecology, University of South Florida,, 13201 Bruce B Downs Blvd, MDC56 Tampa FL 33612
| | - Hye-Chung Kum
- Texas A&M School of Public Health 212 Adriance Lab Road College Station, TX
| | | | | | - Christine M O’Keefe
- Commonwealth Scientific and Industrial Research Organisation (CSIRO), GPO Box 1700 Canberra ACT 2601 Australia
| | - David Preen
- University of Western Australia, School of Population and Global Health, 35 Stirling Highway, Perth WA 6009 Australia
| | - Hude Quan
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, TRW Building, 3rd Floor, 3280 Hospital Drive NW, Calgary, Alberta CANADA T2N 4Z6
| | - Claudia Sanmartin
- Statistics Canada 150 Tunney's Pasture Driveway Ottawa, Ontario K1A 0T6
| | - Michael Schull
- ICES Central, G1 06, 2075 Bayview Avenue Toronto, ON M4N 3M5 Canada
| | - Mark Smith
- University of Manitoba, Manitoba Centre for Health Policy
| | - Christine Williams
- Australian Bureau of Statistics, ABS House 45 Benjamin Way, Belconnen ACT 2617. Australia
| | - Tyler Williamson
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, TRW Building, 3rd Floor, 3280 Hospital Drive NW, Calgary, Alberta CANADA T2N 4Z6
| | - Grant MA Wyper
- Public Health and Intelligence, NHS National Services Scotland
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Maxwell M, Hibberd C, Aitchison P, Calveley E, Pratt R, Dougall N, Hoy C, Mercer S, Cameron I. The Patient Centred Assessment Method for improving nurse-led biopsychosocial assessment of patients with long-term conditions: a feasibility RCT. Health Serv Deliv Res 2018. [DOI: 10.3310/hsdr06040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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
Annual reviews of people living with long-term conditions (LTCs) are mostly conducted by practice nurses (PNs), who focus on the physical needs of patients. The broader mental well-being and social needs of patients are also important if they are to live well. The Patient Centred Assessment Method (PCAM) is a new tool to help PNs conduct biopsychosocial assessments of patients’ needs.
Research questions
Is it feasible and acceptable to use the PCAM in primary care nurse-led reviews for those with LTCs? Is it feasible and acceptable to run a cluster randomised trial of the PCAM in primary care?
Methods
Four practitioner and two patient focus groups explored the acceptability and implementation requirements of the PCAM, which was then tested in a feasibility cluster randomised controlled trial aiming to recruit eight general practitioner (GP) practices and 16 nurses. Baseline data collection was conducted with nurses prior to randomisation, with a cohort of 10 patients per nurse, including patient demographics, patient evaluation of consultation, patient-completed outcomes (measured via the Consultation and Relational Empathy, Patient Enablement Instrument, Warwick–Edinburgh Mental Well-Being Scale, General Health Questionnaire and the Short Form questionnaire-12 items) and nurse referrals/signposting to services. Patient follow-up questionnaires were completed at 8 weeks. Practices were then randomised to the PCAM intervention or care as usual (CAU). Data collection was repeated for a second cohort of patients. Fidelity was tested by comparing a sample of recorded consultations before and after PCAM training. Qualitative interviews were conducted with PCAM nurses and a sample of patients.
Results
Approaches to 159 eligible practices resulted in the recruitment of six practices (10 nurses), with five practices (seven nurses) completing both data collection phases. Nurses collected baseline data on 113 patients, 71 of whom (62.8%) completed follow-up questionnaires. Five practices were randomised: three practices (six nurses) to the PCAM arm and two practices (four nurses) to the CAU arm. In phase 2, seven nurses collected data on 77 patients, of whom 40 (52%) completed follow-up. Only four PCAM nurses agreed to recording consultations, with five pre- and four post-PCAM recordings obtained. Post PCAM training, there was evidence of more attention being given to patients’ mental well-being and social issues. The PCAM was fairly easily integrated into consultation, although some nurses reflected that this benefited from early support. Patients were not always aware of its use, but most were happy to have their needs assessed.
Limitations
Recruitment of GP practices, and nurse recruitment and retention.
Conclusions
The PCAM is feasible and acceptable for use by primary care nurses and may have potential for encouraging biopsychosocial assessment of patients. Efforts required to recruit and retain staff indicate that a full trial is not feasible or cost-effective at this time.
Future work
The PCAM intervention warrants further exploration as an effective mechanism for improving care for people with LTCs; this could be conducted within an implementation study.
Trial registration
Current Controlled Trials ISRCTN98973169.
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. 6, No. 4. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit, School of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Carina Hibberd
- Nursing, Midwifery and Allied Health Professions Research Unit, School of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Patricia Aitchison
- Nursing, Midwifery and Allied Health Professions Research Unit, School of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Eileen Calveley
- Nursing, Midwifery and Allied Health Professions Research Unit, School of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Rebekah Pratt
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Nadine Dougall
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Christine Hoy
- Health and Social Care Alliance Scotland (the ALLIANCE), Glasgow, UK
| | - Stewart Mercer
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Isobel Cameron
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
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Dougall N, Stark C, Agnew T, Henderson R, Maxwell M, Lambert P. An analysis of suicide trends in Scotland 1950-2014: comparison with England & Wales. BMC Public Health 2017; 17:970. [PMID: 29262828 PMCID: PMC5738808 DOI: 10.1186/s12889-017-4956-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/28/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Scotland has disproportionately high rates of suicide compared with England. An analysis of trends may help reveal whether rates appear driven more by birth cohort, period or age. A 'birth cohort effect' for England & Wales has been previously reported by Gunnell et al. (B J Psych 182:164-70, 2003). This study replicates this analysis for Scotland, makes comparisons between the countries, and provides information on 'vulnerable' cohorts. METHODS Suicide and corresponding general population data were obtained from the National Records of Scotland, 1950 to 2014. Age and gender specific mortality rates were estimated. Age, period and cohort patterns were explored graphically by trend analysis. RESULTS A pattern was found whereby successive male birth cohorts born after 1940 experienced higher suicide rates, in increasingly younger age groups, echoing findings reported for England & Wales. Young men (aged 20-39) were found to have a marked and statistically significant increase in suicide between those in the 1960 and 1965 birth cohorts. The 1965 cohort peaked in suicide rate aged 35-39, and the subsequent 1970 cohort peaked even younger, aged 25-29; it is possible that these 1965 and 1970 cohorts are at greater mass vulnerability to suicide than earlier cohorts. This was reflected in data for England & Wales, but to a lesser extent. Suicide rates associated with male birth cohorts subsequent to 1975 were less severe, and not statistically significantly different from earlier cohorts, suggestive of an amelioration of any possible influential 'cohort' effect. Scottish female suicide rates for all age groups converged and stabilised over time. Women have not been as affected as men, with less variation in patterns by different birth cohorts and with a much less convincing corresponding pattern suggestive of a 'cohort' effect. CONCLUSIONS Trend analysis is useful in identifying 'vulnerable' cohorts, providing opportunities to develop suicide prevention strategies addressing these cohorts as they age.
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Affiliation(s)
- Nadine Dougall
- School of Health & Social Care, Sighthill Campus, Edinburgh Napier University, Edinburgh, EH11 4BN UK
| | - Cameron Stark
- Department of Public Health, NHS Highland, Assynt House, Beechwood Park, Inverness, IV2 3BW UK
| | - Tim Agnew
- Department of Public Health, NHS Highland, Assynt House, Beechwood Park, Inverness, IV2 3BW UK
| | - Rob Henderson
- Department of Public Health, NHS Highland, Assynt House, Beechwood Park, Inverness, IV2 3BW UK
| | - Margaret Maxwell
- NMAHP Research Unit, Faculty of Health Sciences & Sport, University of Stirling, Stirling, FK9 4NF UK
| | - Paul Lambert
- School of Applied Social Science, Colin Bell Building, University of Stirling, Stirling, FK9 4LA UK
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Best C, Dougall N, Skar S, Fitzpatrick D, Evans J, Corfield A, Goldie I, Maxwell M, Snooks H, Stark C, White C, Wojcik W. 01 Investigating the population characteristics, processes and outcomes of pre-hospital psychiatric and self-harm emergencies in scotland: a national record linkage study. Arch Emerg Med 2017. [DOI: 10.1136/emermed-2017-207114.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Farquharson B, Johnston M, Smith K, Williams B, Treweek S, Dombrowski SU, Dougall N, Abhyankar P, Grindle M. Reducing patient delay in Acute Coronary Syndrome (RAPiD): research protocol for a web-based randomized controlled trial examining the effect of a behaviour change intervention. J Adv Nurs 2016; 73:1220-1234. [PMID: 27779777 DOI: 10.1111/jan.13191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 10/04/2016] [Indexed: 11/27/2022]
Abstract
AIMS To evaluate the efficacy of a behaviour change technique-based intervention and compare two possible modes of delivery (text + visual and text-only) with usual care. BACKGROUND Patient delay prevents many people from achieving optimal benefit of time-dependent treatments for acute coronary syndrome. Reducing delay would reduce mortality and morbidity, but interventions to change behaviour have had mixed results. Systematic inclusion of behaviour change techniques or a visual mode of delivery might improve the efficacy of interventions. DESIGN A three-arm web-based, parallel randomized controlled trial of a theory-based intervention. METHODS The intervention comprises 12 behaviour change techniques systematically identified following systematic review and a consensus exercise undertaken with behaviour change experts. We aim to recruit n = 177 participants who have experienced acute coronary syndrome in the previous 6 months from a National Health Service Hospital. Consenting participants will be randomly allocated in equal numbers to one of three study groups: i) usual care, ii) usual care plus text-only behaviour change technique-based intervention or iii) usual care plus text + visual behaviour change technique-based intervention. The primary outcome will be the change in intention to phone an ambulance immediately with symptoms of acute coronary syndrome ≥15-minute duration, assessed using two randomized series of eight scenarios representing varied symptoms before and after delivery of the interventions or control condition (usual care). Funding granted January 2014. DISCUSSION Positive results changing intentions would lead to a randomized controlled trial of the behaviour change intervention in clinical practice, assessing patient delay in the event of actual symptoms. TRIAL REGISTRATION Registered at ClinicalTrials.gov: NCT02820103.
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Affiliation(s)
| | - Marie Johnston
- Institute of Applied Health Sciences, University of Aberdeen, UK
| | | | - Brian Williams
- School of Health and Social Care, Edinburgh Napier University, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, UK
| | | | - Nadine Dougall
- School of Health & Social Care, Edinburgh Napier University, UK
| | | | - Mark Grindle
- Nursing, Midwifery and Allied Health Professionals Research Unit (NMAHP-RU), Faculty of Health and Sports Sciences, University of Stirling, UK
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Roberts NJ, Kidd L, Dougall N, Patel IS, McNarry S, Nixon C. Measuring patient activation: The utility of the Patient Activation Measure within a UK context-Results from four exemplar studies and potential future applications. Patient Educ Couns 2016; 99:1739-1746. [PMID: 27217050 DOI: 10.1016/j.pec.2016.05.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 05/05/2016] [Accepted: 05/08/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Patient activation can be measured using the Patient Activation Measure (PAM) developed by Hibbard et al., however, little is known about the uses of the PAM in research and in practice. This study aims to explore its differing utility in four UK exemplar sites. METHODS Data from four exemplars in a range of health settings with people living with long-term conditions (i.e. stroke or COPD) were evaluated. PAM scores were described and explored in relation to clinical and sociodemographic variables and outcome measures. RESULTS PAM scores illustrated that most with COPD or stroke reported PAM levels of 3 or 4, indicating that they are engaging, but may need help to sustain their scores. The exemplars illustrate the utility of, and potential issues involved in, using PAM as a process/outcome measure to predict activation and the effectiveness of interventions, and as a tool to inform tailoring of targeted interventions. CONCLUSIONS The PAM tool has been shown to be useful as an outcome measure, a screening tool to tailor education, or a quality indicator for delivery of care. PRACTICE IMPLICATIONS However good demographic and patient history are needed to substantiate PAM scores. Further work is needed to monitor PAM prospectively.
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Affiliation(s)
- N J Roberts
- Institute for Applied Health Research, School of Health and Life Sciences Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK.
| | - L Kidd
- School of Nursing & Midwifery, Robert Gordon University, Garthdee Road, Aberdeen AB10 7QG, UK
| | - N Dougall
- Nursing Midwifery and Allied Health Professions Research Unit School of Health Sciences, University of Stirling, Unit 13 Scion House, Stirling FK9 4NF, UK
| | - I S Patel
- King's Health Partners Academic Health Sciences Centre, London, UK
| | - S McNarry
- Pulmonary Rehabilitation, Edinburgh Community Health Partnership, NHS Lothian, UK
| | - C Nixon
- Co-creating Health Project Team, Ayrshire Central General Hospital, Irvine KA12 8SS, UK
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Wells M, King E, Toft K, MacAulay F, Patterson J, Dougall N, Hulbert-Williams N, Boa S, Slaven E, Cowie J, McGarva J, Niblock PG, Philp J, Roe J. Development and feasibility of a Swallowing intervention Package (SiP) for patients receiving radiotherapy treatment for head and neck cancer-the SiP study protocol. Pilot Feasibility Stud 2016; 2:40. [PMID: 27965858 PMCID: PMC5153906 DOI: 10.1186/s40814-016-0079-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/07/2016] [Indexed: 01/27/2023] Open
Abstract
Background Head and neck cancer (HNC) is the sixth most common cancer worldwide, and the functional, psychological and social consequences of HNC cancer and its treatment can be severe and chronic. Dysphagia (swallowing problems) affects up to two thirds of patients undergoing combined chemoradiotherapy. Recent reviews suggest that prophylactic swallowing exercises may improve a range of short- and long-term outcomes; however, the importance of psychological and behavioural factors on adherence to swallowing exercises has not been adequately studied. This study aims to develop and test the feasibility of a Swallowing intervention Package (SiP) designed in partnership with patients, speech and language therapists (SLTs) and other members of the head and neck multi-disciplinary team (MDT), for patients undergoing chemoradiotherapy (CRT) or radiotherapy (RT) for head and neck cancer. Methods/design This feasibility study uses quantitative and qualitative research methods, within a quasi-experimental design, to assess whether patients will tolerate and adhere to the SiP intervention, which aspects of the intervention can be implemented and which cannot, whether treatment fidelity can be achieved across different contexts, whether study processes and outcome measures will be feasible and acceptable and to what extent the intervention is likely to have an impact on swallowing dysfunction and quality of life. Patients are being recruited from five sites in Scotland and England (three interventions and two usual care). The SLT based in the relevant intervention centre teaches the exercise programme and provides supporting materials. A combination of patient-reported outcome measures (PROMs), adherence measures and clinical swallowing assessments are used prior to intervention (baseline), at the end of treatment, 3 and 6 months post-treatment. Discussion This collaborative study has taken a unique approach to the development of a patient-centred and evidence-based swallowing intervention. The introduction of an e-SiP app provides an exploration of the use of technology in delivering this intervention. The study provides an opportunity to examine the feasibility of delivering and participating in a supported swallowing intervention across several different NHS sites and will provide the evidence needed to refine intervention and study processes for a future trial. Trial registration NCRI portfolio, 18192 & 20259
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Affiliation(s)
- Mary Wells
- NMAHP Research Unit, University of Stirling, Stirling, UK
| | - Emma King
- NMAHP Research Unit, University of Stirling, Stirling, UK
| | | | | | | | - Nadine Dougall
- NMAHP Research Unit, University of Stirling, Stirling, UK
| | | | | | | | - Julie Cowie
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | | | | | | | - Justin Roe
- The Royal Marsden NHS Foundation Trust, London, UK
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Levati S, Campbell P, Frost R, Dougall N, Wells M, Donaldson C, Hagen S. Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used. Pilot Feasibility Stud 2016; 2:17. [PMID: 27965837 PMCID: PMC5153688 DOI: 10.1186/s40814-016-0058-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 03/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many complex intervention trials fail to show an intervention effect. Although this may be due to genuine ineffectiveness, it may also be the result of sub-optimal intervention design, implementation failure or a combination of these. Given current financial constraints and the pressure to reduce waste and increase value in health services research, pre-trial strategies are needed to reduce the likelihood of design or implementation failure and to maximise the intervention's potential for effectiveness. In this scoping review, we aimed to identify and synthesise the available evidence relating to the strategies and methods used to 'optimise' complex interventions at the pre-trial stage. METHODS We searched MEDLINE, CINAHL, AMED, PsycINFO and ProQuest Nursing & Allied Health Source for papers published between January 2000 and March 2015. We included intervention development and optimisation studies that explored potential intervention weaknesses and limitations before moving to a definitive randomised controlled trial (RCT). Two reviewers independently applied selection criteria and systematically extracted information relating to the following: study characteristics; intervention under development; framework used to guide the development process; areas of focus of the optimisation process, methods used and outcomes of the optimisation process. Data were tabulated and summarised in a narrative format. RESULTS We screened 3968 titles and 231 abstracts for eligibility. Eighty-nine full-text papers were retrieved; 27 studies met our selection criteria. Optimisation strategies were used for a range of reasons: to explore the feasibility and acceptability of the intervention to patients and healthcare professionals; to estimate the effectiveness and cost-effectiveness of different combinations of intervention components; and to identify potential barriers to implementation. Methods varied widely across studies, from interviews and focus groups to economic modelling and probability analysis. CONCLUSIONS The review identifies a range of optimisation strategies currently used. Although a preliminary classification of these strategies can be proposed, a series of questions remain as to which methods to use for different interventions and how to determine when the intervention is ready or 'optimised enough' to be tested in a RCT. Future research should explore potential answers to the questions raised, to guide researchers in the development and evaluation of more effective interventions.
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Affiliation(s)
- Sara Levati
- NMAHP Research Unit, Glasgow Caledonian University, Level 6, Govan Mbeki Building 70 Cowcaddens Road, Glasgow, G4 0BA Scotland
| | - Pauline Campbell
- NMAHP Research Unit, Glasgow Caledonian University, Level 6, Govan Mbeki Building 70 Cowcaddens Road, Glasgow, G4 0BA Scotland
| | - Rachael Frost
- NMAHP Research Unit, Glasgow Caledonian University, Level 6, Govan Mbeki Building 70 Cowcaddens Road, Glasgow, G4 0BA Scotland
| | - Nadine Dougall
- NMAHP Research Unit, University of Stirling, Unit 13 Scion House, Innovation Park, Stirling, FK9 4NF UK
| | - Mary Wells
- NMAHP Research Unit, University of Stirling, Unit 13 Scion House, Innovation Park, Stirling, FK9 4NF UK
| | - Cam Donaldson
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, M201, George Moore Building 70 Cowcaddens Road, Glasgow, G4 0BA Scotland
| | - Suzanne Hagen
- NMAHP Research Unit, Glasgow Caledonian University, Level 6, Govan Mbeki Building 70 Cowcaddens Road, Glasgow, G4 0BA Scotland
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Booth J, Connelly L, Lawrence M, Chalmers C, Joice S, Becker C, Dougall N. Evidence of perceived psychosocial stress as a risk factor for stroke in adults: a meta-analysis. BMC Neurol 2015; 15:233. [PMID: 26563170 PMCID: PMC4643520 DOI: 10.1186/s12883-015-0456-4] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [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: 05/12/2015] [Accepted: 10/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several studies suggest that perceived psychosocial stress is associated with increased risk of stroke; however results are inconsistent with regard to definitions and measurement of perceived stress, features of individual study design, study conduct and conclusions drawn and no meta-analysis has yet been published. We performed a systematic review and meta-analysis of studies assessing association between perceived psychosocial stress and risk of stroke in adults.The results of the meta-analysis are presented. METHODS Systematic searches of MEDLINE, EMBASE, CINAHL, PsycInfo, and Cochrane Database of Systematic Reviews were undertaken between 1980 and June 2014. Data extraction and quality appraisal was performed by two independent reviewers. Hazard ratios (HR) and odds ratios (OR) were pooled where appropriate. RESULTS 14 studies were included in the meta-analysis, 10 prospective cohort, 4 case-control design. Overall pooled adjusted effect estimate for risk of total stroke in subjects exposed to general or work stress or to stressful life events was 1.33 (95 % confidence interval [CI], 1.17, 1.50; P < 0.00001). Sub-group analyses showed perceived psychosocial stress to be associated with increased risk of fatal stroke (HR 1.45 95 % CI, 1.19,1.78; P = 0.0002), total ischaemic stroke (HR 1.40 95 % CI, 1.00,1.97; P = 0.05) and total haemorrhagic stroke (HR 1.73 95 % CI, 1.33,2.25; P > 0.0001).A sex difference was noted with higher stroke risk identified for women (HR 1.90 95 % CI, 1.4, 2.56: P < 0.0001) compared to men (HR 1.24 95 % CI, 1.12, 1.36; P < 0.0001). CONCLUSIONS Current evidence indicates that perceived psychosocial stress is independently associated with increased risk of stroke.
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Affiliation(s)
- Joanne Booth
- Institute for Applied Health Research, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.
| | - Lesley Connelly
- Institute for Applied Health Research, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.
| | - Maggie Lawrence
- Institute for Applied Health Research, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.
| | - Campbell Chalmers
- NHS Lanarkshire, Coathill Hospital, Hospital Street, Coatbridge, ML5 4DN, UK.
| | - Sara Joice
- School of Psychology, Massey University, Private Bag 11 222, Palmerston North, New Zealand.
| | - Clarissa Becker
- Institute for Applied Health Research, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.
| | - Nadine Dougall
- Nursing, Midwifery & Allied Health Professions Research Unit, University of Stirling Unit 13 Scion House, Stirling University Innovation Park, Stirling, FK9 4NF, UK.
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Abstract
People with schizophrenia typically experience auditory hallucinations or delusions during acute episodes. Although effective drug treatments are available, many have intractable symptoms that do not recover between acute episodes. One proposed alternative to drug treatments is transcranial magnetic stimulation (TMS). To date, many research trials to assess effectiveness of TMS for people with symptoms of schizophrenia have been conducted worldwide. However, there is a lack of consensus on whether TMS should be recommended to be adopted in routine clinical practice. We conducted a systematic review of the literature for all relevant randomized controlled trials (RCTs) comparing TMS with sham or standard treatment. Forty-one trials (1473 participants) survived eligibility criteria and had extractable data. We found significant differences in favor of temporoparietal TMS compared with sham TMS for global state (7 RCTs, n = 224, MD: -0.5, 95% CI: -0.76 to -0.23) and for positive symptoms measured on the Positive and Negative Syndrome Scale (5 RCTs, n = 127, MD: -6.09, 95% CI: -10.95 to -1.22). However, we also found that the quality of trial reporting was frequently suboptimal and the risks of bias were strong or unascertainable for many trial aspects; this led to many results being graded as very low-quality evidence. On that basis, we were unable to definitively support or refute the routine use of TMS in clinical practice. Future definitive trials of TMS with rigorous processes and high-quality reporting are needed.
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Affiliation(s)
- Nadine Dougall
- NMAHP Research Unit, School of Health Sciences, University of Stirling, Stirling, UK;
| | | | | | - Lisa M McDermott
- Primary Care and Public Health Sciences, King's College London, London, UK
| | - Andrew McIntosh
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
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Abstract
BACKGROUND People with schizophrenia often experience symptoms which fail to fully respond to antipsychotic medication. Transcranial magnetic stimulation (TMS) has been proposed as a new treatment for people with schizophrenia, especially those who experience persistent auditory hallucinations. OBJECTIVES To estimate the effects of TMS alone, compared with sham TMS or with 'standard management' and any other comparison interventions in reducing psychotic symptoms associated with schizophrenia. SEARCH METHODS We searched the Cochrane Schizophrenia Group Trials Register (June 2006, June 2008, April 2013). This register is compiled by methodical searches of MEDLINE, EMBASE, BIOSIS, CINAHL, Dissertation abstracts, LILACS, PSYNDEX, PsycINFO, RUSSMED, and Sociofile, and is supplemented with handsearching of relevant journals and numerous conference proceedings. SELECTION CRITERIA We included all randomised controlled trials recruiting at least five participants and comparing TMS with sham TMS or any other treatment for people with schizophrenia. DATA COLLECTION AND ANALYSIS We extracted data independently. For dichotomous data we calculated relative risks (RRs) and their 95% confidence intervals (CIs). For continuous data, we calculated mean differences (MD) and 95% CI. We used a fixed-effect model. We assessed overall quality of the evidence using the GRADE approach. MAIN RESULTS We included 41 studies with 1473 participants in the review. We found significant differences in favour of temporoparietal TMS compared to sham TMS for global state measured on the CGI scale (7 RCTs, n = 224, MD -0.5, 95% CI -0.76 to -0.23, very low-quality evidence) and positive symptoms measured on the PANSS scale (5 RCTs, n = 127, MD -6.09, 95% CI -10.95 to -1.22, very low-quality evidence). Participants experienced significantly more headaches in the temporoparietal TMS group (10 RCTs, n = 392, RR 2.65, 95% CI 1.56 to 4.50, very low-quality evidence). However, no more participants left the study early from the TMS group than from the sham group (very low-quality evidence). Cognitive state was assessed using 39 different measures, and all were equivocal (very low-quality evidence).We included only two trials which compared temporoparietal TMS with standard treatment. In both trials the participants received first- and second-generation antipsychotic medication in both treatment groups, therefore TMS was used an adjunctive therapy to medication. We found no significant differences in the number of participants that showed clinical improvement in global state (1 RCT, n = 100, RR 1.19, 95% CI 0.91 to 1.57) or left the study early (2 RCTs, n = 140, RR 0.33, 95% CI 0.08 to 1.46) (both very low-quality evidence). No studies reported on global state score, mental state, cognitive state and adverse effects.For prefrontal TMS compared to sham TMS, global state was measured on three different scales, all of which presented equivocal results (very low quality evidence). We could not pool data for mental state on the PANSS scale due to high heterogeneity. Cognitive state was assessed using 19 different measures, with 15/19 being equivocal (very low-quality evidence). Prefrontal TMS caused more headaches (6 RCTs, n = 164, RR 2.77, 95% CI 1.22 to 6.26, very low-quality evidence) but there was no difference in the number of participants leaving the study early (very low-quality evidence). No studies reported data for clinical improvement.We found a significant difference in favour of prefrontal theta burst stimulation TMS compared to sham TMS for mental state on the PANNS scale (3 RCTs, n = 108, MD -5.71, 95% CI -9.32 to -2.10, very low evidence). We found no difference for clinical improvement, cognitive state, number of headaches, and leaving the study early (very low-quality evidence).None of the included studies reported satisfaction with care. AUTHORS' CONCLUSIONS Based on this review, there is insufficient evidence to support or refute the use of TMS to treat symptoms of schizophrenia. Although some evidence suggests that TMS, and in particular temporoparietal TMS, may improve certain symptoms (such as auditory hallucinations and positive symptoms of schizophrenia) compared to sham TMS, the results were not robust enough to be unequivocal across the assessment measures used. There was insufficient evidence to suggest any added benefit with TMS used as an adjunctive therapy to antipsychotic medication.The overall quality of evidence was graded as very low due to risk of bias, and this was accompanied by an imprecision in estimates due to the relatively small number of participants in the studies. Thus, consideration is required in improving the quality of trial processes, as well as the quality of reporting of ongoing and future TMS trials, so as to facilitate accurate future judgements in assessing risk of bias. Differences in TMS techniques in relation to stimulation intensity, stimulation length, brain areas stimulated and variations in the design of sham TMS all contributed to the heterogeneity of study findings and limited the interpretation and applicability of the results. In addition, the trials assessed their outcomes with a variety of scales, and usable data were limited. Therefore, to better evaluate the treatment effects of TMS in people with schizophrenia, we favour the use of standardised treatment protocols and outcome measures.
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Affiliation(s)
- Nadine Dougall
- University of StirlingNMAHP Research UnitUnit 13 Scion HouseStirling University Innovation ParkStirlingUKFK9 4NF
| | - Nicola Maayan
- Enhance Reviews LtdCentral Office, Cobweb BuildingsThe Lane, LyfordWantageUKOX12 0EE
| | - Karla Soares‐Weiser
- Enhance Reviews LtdCentral Office, Cobweb BuildingsThe Lane, LyfordWantageUKOX12 0EE
| | - Lisa M McDermott
- King's College LondonPrimary Care and Public Health Sciences42 Weston StreetLondonUKSE1 3QD
| | - Andrew McIntosh
- University of Edinburgh, Royal Edinburgh HospitalEdinburghUKEH10 5HF
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Farquharson B, Dombrowski S, Pollock A, Johnston M, Treweek S, Williams B, Smith K, Dougall N, Jones C, Pringle S. Reducing patient delay with symptoms of acute coronary syndrome: a research protocol for a systematic review of previous interventions to investigate which behaviour change techniques are associated with effective interventions. Open Heart 2014; 1:e000079. [PMID: 25332805 PMCID: PMC4189291 DOI: 10.1136/openhrt-2014-000079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 06/13/2014] [Accepted: 07/15/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction Delay to presentation with symptoms of acute coronary syndrome (ACS) is common meaning many fail to achieve optimal benefit from treatments. Interventions have had variable success in reducing delay. Evidence suggests inclusion of behaviour change techniques (BCTs) may improve effectiveness of interventions but this has not yet been systematically evaluated. Data from other time-critical conditions may be relevant. Methods and analysis A systematic review will be undertaken to identify which BCTs are associated with effective interventions to reduce patient delay (or prompt rapid help-seeking) among people with time-critical conditions (eg, chest pain, ACS, lumps, stroke, cancer and meningitis). A systematic search of a wide range of databases (including Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycInfo) and grey literature will be undertaken to identify all relevant intervention studies (randomised controlled trials, controlled clinical trials and cohort studies). Two independent reviewers will screen abstracts to identify relevant studies, apply inclusion criteria to full papers, assess methodological quality and extract data. Primary outcome measure Change in patient decision time BCTs reported in each of the included studies will be categorised and presented according to the latest reliable taxonomy. Results of included studies will be synthesised, exploring relationships between inclusion of each BCT and effectiveness of the overall intervention. Where possible, means and SDs for differences in delay time will be calculated and combined within meta-analyses to derive a standardised mean difference and 95% CI. Analysis of (1) all time-critical and (2) ACS-only interventions will be undertaken. Ethics and dissemination No ethical issues are anticipated. Results will be submitted for publication in a relevant peer-reviewed journal.
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Affiliation(s)
- Barbara Farquharson
- Nursing, Midwifery and Allied Health Professionals Research Unit , University of Stirling , Stirling , UK
| | | | - Alex Pollock
- Nursing, Midwifery and Allied Health Professionals Research Unit , Glasgow Caledonian University , Glasgow , UK
| | - Marie Johnston
- Institute of Applied Health Sciences, University of Aberdeen , Aberdeen , UK
| | - Shaun Treweek
- Health Services Research Unit , University of Aberdeen , Aberdeen , UK
| | - Brian Williams
- Nursing, Midwifery and Allied Health Professionals Research Unit , University of Stirling , Stirling , UK
| | - Karen Smith
- School of Nursing and Midwifery, University of Dundee , Dundee , UK
| | - Nadine Dougall
- Nursing, Midwifery and Allied Health Professionals Research Unit , University of Stirling , Stirling , UK
| | - Claire Jones
- Health Informatics Centre, University of Dundee , Dundee , UK
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