1
|
Goodwin L, Kirby K, McClelland G, Beach E, Bedson A, Benger JR, Deave T, Osborne R, McAdam H, McKeon-Carter R, Miller N, Taylor H, Voss S. Inequalities in birth before arrival at hospital in South West England: a multimethods study of neonatal hypothermia and emergency medical services call-handler advice. BMJ Open 2024; 14:e081106. [PMID: 38684256 PMCID: PMC11057285 DOI: 10.1136/bmjopen-2023-081106] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/18/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES To examine inequalities in birth before arrival (BBA) at hospitals in South West England, understand which groups are most likely to experience BBA and how this relates to hypothermia and outcomes (phase A). To investigate opportunities to improve temperature management advice given by emergency medical services (EMS) call-handlers during emergency calls regarding BBA in the UK (phase B). DESIGN A two-phase multimethod study. Phase A analysed anonymised data from hospital neonatal records between January 2018 and January 2021. Phase B analysed anonymised EMS call transcripts, followed by focus groups with National Health Service (NHS) staff and patients. SETTING Six Hospital Trusts in South West England and two EMS providers (ambulance services) in South West and North East England. PARTICIPANTS 18 multidisciplinary NHS staff and 22 members of the public who had experienced BBA in the UK. RESULTS 35% (64/184) of babies conveyed to hospital were hypothermic on arrival. When compared with national data on all births in the South West, we found higher percentages of women with documented safeguarding concerns at booking, previous live births and 'late bookers' (booking their pregnancy >13 weeks gestation). These women may, therefore, be more likely to experience BBA. Preterm babies, babies to first-time mothers and babies born to mothers with disability or safeguarding concerns at booking were more likely to be hypothermic following BBA. Five main themes emerged from qualitative data on call-handler advice: (1) importance placed on neonatal temperature; (2) advice on where the baby should be placed following birth; (3) advice on how to keep the baby warm; (4) timing of temperature management advice and (5) clarity and priority of instructions. CONCLUSIONS Findings identified factors associated with BBA and neonatal hypothermia following BBA. Improvements to EMS call-handler advice could reduce the number of babies arriving at hospital hypothermic.
Collapse
Affiliation(s)
- Laura Goodwin
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Kim Kirby
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
- Research, Audit and Quality Improvement Department, South Western Ambulance Service NHS Foundation Trust, Exeter, UK
| | | | - Emily Beach
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Adam Bedson
- South Western Ambulance Service NHS Foundation Trust, Exeter, UK
| | | | - Toity Deave
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Ria Osborne
- Research, Audit & Improvement, South Western Ambulance Service NHS Foundation Trust, Exeter, UK
| | - Helen McAdam
- Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | | | - Nick Miller
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Hazel Taylor
- Research Design Service, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sarah Voss
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| |
Collapse
|
2
|
Spurlock K, Deave T, Lucas PJ, Dowling S. Parental engagement with complementary feeding information in the United Kingdom: A qualitative evidence synthesis. Matern Child Nutr 2023; 19:e13553. [PMID: 37551916 PMCID: PMC10483955 DOI: 10.1111/mcn.13553] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 06/22/2023] [Accepted: 07/20/2023] [Indexed: 08/09/2023]
Abstract
Complementary feeding is the process of introducing solid foods to milk-fed infants (also known as weaning). Current UK guidance states that complementary feeding should occur around 6 months but not before 4 months. This systematic review explores how parents in the UK, with an infant under 24 months of age, engage with sources of information and advice about complementary feeding. Engaging with sources of information can influence parents' feeding choices and so a better understanding of parents' information behaviours can improve service provisions. Six databases were searched, identifying 15 relevant qualitative studies with the predefined criteria. Data from each study were coded line by line allowing for a synthesis of higher analytical themes. Using thematic synthesis, four main themes were observed: (1) trust and rapport-parents valued information from a trusted source (2), accessibility-information needs were often time sensitive, and parents showed varying levels of understanding, (3) adapting feeding plans-often influenced by practicalities (4), being a good parent-feeding plans were changed to comply with societal ideas of 'good parenting'. The review concluded that parents receive information and advice about complementary feeding from multiple sources and are highly motivated to seek further information. The scope of this novel review explored the parental experience of finding, receiving and engaging with information sources and how this may or may not have influenced their feeding behaviours. The review has provided a new perspective to add to the growing body of literature that focuses on the experience of feeding an infant.
Collapse
Affiliation(s)
- Kelly Spurlock
- School of Health and Social WellbeingUniversity of the West of EnglandBristolUK
| | - Toity Deave
- School of Health and Social WellbeingUniversity of the West of EnglandBristolUK
| | | | - Sally Dowling
- Bristol Medical SchoolUniversity of BristolBristolUK
| |
Collapse
|
3
|
Bhatta S, Mytton J, Deave T. Home environmental change for child injury prevention in Nepal: A qualitative study. J Child Health Care 2023; 27:323-335. [PMID: 34839755 PMCID: PMC10472719 DOI: 10.1177/13674935211052156] [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] [Indexed: 11/16/2022]
Abstract
In Nepal, unintentional home injury is a leading reason for death and disability among pre-school children. However, there is a lack of evidence to inform culturally appropriate interventions to reduce home injuries. This study explored the potential for home environmental change at a community level to prevent unintentional home injury in children and identified the barriers to, and facilitators of, such changes. Focus groups were conducted in the Nepali language with mothers, fathers, teachers, school students and community health volunteers in rural areas of Makwanpur district in Nepal. The discussions were audio-recorded, transcribed, translated into English and analysed thematically. NVivo software was used to support coding and identification of themes. Five focus groups, involving forty-seven participants, were completed leading to the development of four themes. Overall, the findings highlight that community people perceive injuries to be a normal part of childhood and, therefore, few prevention measures were considered. Parents were, however, able to identify ways to change their environment that made it safer. Changes included removing hazards or adding safety equipment, adapting the home or restricting access to potential hazards. Barriers to implementation included limited awareness about injury hazards and risk management, poor quality housing and financial constraint. Facilitators included raising community awareness, acquiring resources and financial support and involving the family and community. Development of interventions to prevent injuries at home in pre-school children should reflect local context and culture; this is best achieved through engagement with parents.
Collapse
Affiliation(s)
- Santosh Bhatta
- Research Associate, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Julie Mytton
- Professor of Child Health, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Toity Deave
- Associate Professor for Family & Child Health, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| |
Collapse
|
4
|
Webb CM, Collin SM, Deave T, Haig-Ferguson A, Spatz A, Crawley E. Correction: What stops children with a chronic illness accessing health care: a mixed methods study in children with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). BMC Health Serv Res 2023; 23:443. [PMID: 37147675 PMCID: PMC10163761 DOI: 10.1186/s12913-023-09485-6] [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: 05/07/2023] Open
Affiliation(s)
- Carly M Webb
- St George's University of London, Cranmer Terrace, London, UK
| | - Simon M Collin
- Centre for Child and Adolescent Health, School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Toity Deave
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Andrew Haig-Ferguson
- Centre for Child and Adolescent Health, School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Amy Spatz
- St George's University of London, Cranmer Terrace, London, UK
| | - Esther Crawley
- Centre for Child and Adolescent Health, School of Social & Community Medicine, University of Bristol, Bristol, UK.
| |
Collapse
|
5
|
Bailey E, Nightingale S, Thomas N, Coleby D, Deave T, Goodenough T, Ginja S, Lingam R, Kendall S, Day C, Coad J. First-time Mothers' Understanding and Use of a Pregnancy and Parenting Mobile App (The Baby Buddy App): Qualitative Study Using Appreciative Inquiry. JMIR Mhealth Uhealth 2022; 10:e32757. [PMID: 36409530 PMCID: PMC9723971 DOI: 10.2196/32757] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/17/2022] [Accepted: 07/26/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Internationally, there is increasing emphasis on early support for pregnant women to optimize the health and development of mothers and newborns. To increase intervention reach, digital and app-based interventions have been advocated. There are growing numbers of pregnancy health care apps with great variation in style, function, and objectives, but evidence about impact on pregnancy well-being and behavior change following app interaction is lacking. This paper reports on the qualitative arm of the independent multicomponent study exploring the use and outcomes of first-time mothers using the Baby Buddy app, a pregnancy and parenting support app, available in the National Health Service App Library and developed by a UK child health and well-being charity, Best Beginnings. OBJECTIVE This study aims to understand when, why, and how first-time mothers use the Baby Buddy app and the perceived benefits and challenges. METHODS This paper reports on the qualitative arm of an independent, longitudinal, mixed methods study. An Appreciative Inquiry qualitative approach was used with semistructured interviews (17/60, 28%) conducted with new mothers, either by telephone or in a focus group setting. First-time mothers were recruited from 3 study sites from across the United Kingdom. Consistent with the Appreciative Inquiry approach, mothers were prompted to discuss what worked well and what could have been better regarding their interactions with the app during pregnancy. Thematic analysis was used, and findings are presented as themes with perceived benefits and challenges. RESULTS The main benefit, or what worked well, for first-time mothers when using the app was being able to access new information, which they felt was reliable and easy to find. This led to a feeling of increased confidence in the information they accessed, thus supporting family and professional communication. The main challenge was the preference for face-to-face information with a health care professional, particularly around specific issues that they wished to discuss in depth. What could have been improved included that there were some topics that some mothers would have preferred in more detail, but in other areas, they felt well-informed and thus did not feel a need to seek additional information via an app. CONCLUSIONS Although this study included a small sample, it elicited rich data and insights into first-time mothers' app interactions. The findings suggest that easily accessible pregnancy information, which is perceived as reliable, can support first-time mothers in communicating with health care professionals. Face-to-face contact with professionals was preferred, particularly to discuss specific and personalized needs. Further studies on maternal and professional digital support preferences after the COVID-19 global pandemic and how they facilitate antenatal education and informed decision-making are recommended, particularly because digital solutions remain as a key element in pregnancy and early parenting care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1017/S1463423618000294.
Collapse
Affiliation(s)
- Elizabeth Bailey
- Coventry University, Coventry, United Kingdom
- Elizabeth Bryan Multiple Births Centre, Centre for Social Care, Health and Related Research, Birmingham City University, Birmingham, United Kingdom
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | | | - Nicky Thomas
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Dawn Coleby
- School of Nursing and Midwifery, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Toity Deave
- School of Health and Social Wellbeing, University of the West of England, Bristol, United Kingdom
| | - Trudy Goodenough
- School of Health and Social Wellbeing, University of the West of England, Bristol, United Kingdom
| | - Samuel Ginja
- School of Psychology, Ulster University, Ulster, United Kingdom
| | - Raghu Lingam
- University of New South Wales, Sydney, Australia
| | - Sally Kendall
- Centre for Health Services Studies, University of Kent, Canterbury, United Kingdom
| | - Crispin Day
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
| | - Jane Coad
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, United Kingdom
| |
Collapse
|
6
|
Felton N, Deave T. The Lived Experience of Healthcare Workers in Preventing Falls in Community Dwelling Individuals with Dementia. Geriatrics (Basel) 2022; 7:113. [PMID: 36286216 PMCID: PMC9601408 DOI: 10.3390/geriatrics7050113] [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: 08/29/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
Older adults living with dementia have at least twice the risk of falling compared to their peers living without cognitive impairment. There is evidence for the effectiveness of standard interventions in falls prevention in community dwellings, but they may not translate to individuals with Mild Cognitive Impairment (MCI) or dementia. A qualitative enquiry, adopting an interpretive research design underpinned by a phenomenological approach using semi-structured interviews with four healthcare workers from the field was adopted. Data were analysed using Interpretive Phenomenological Analysis to identify themes. Four major themes were developed: on-going assessment is important in guiding interventions and influencing change, knowledge and experience informs practice, individuals living with dementia have complex physical and cognitive needs, and teamwork is essential in falls prevention strategies, which highlighted falls prevention in this context being multifactorial and complex. The findings found that combining physical and cognitive strategies as part of falls prevention has potential benefits for this population, including reducing falls risks and maintaining function. Targeted training and awareness raising within a supportive multi-disciplinary team structure is required, underpinned by on-going, person-centred assessments.
Collapse
Affiliation(s)
- Nansi Felton
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bath NHS House, Newbridge Hill, Bath BA1 3QE, UK
- School for Health and Social Well-Being, University of the West of England, Bristol BS16 1DD, UK
| | - Toity Deave
- School for Health and Social Well-Being, University of the West of England, Bristol BS16 1DD, UK
| |
Collapse
|
7
|
Goodwin L, Voss S, McClelland G, Beach E, Bedson A, Black S, Deave T, Miller N, Taylor H, Benger J. Temperature measurement of babies born in the pre-hospital setting: analysis of ambulance service data and qualitative interviews with paramedics. J Accid Emerg Med 2022; 39:826-832. [PMID: 35914922 DOI: 10.1136/emermed-2021-211970] [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: 08/25/2021] [Accepted: 07/19/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Birth before arrival at hospital (BBA) is associated with unfavourable perinatal outcomes and increased mortality. An important risk factor for mortality following BBA is hypothermia, and emergency medical services (EMS) providers are well placed to provide warming strategies. However, research from the UK suggests that EMS providers (paramedics) do not routinely record neonatal temperature following BBA. This study aimed to determine the proportion of cases in which neonatal temperature is documented by paramedics attending BBAs in the South West of England and to explore the barriers to temperature measurement by paramedics. METHODS A two-phase multi-method study. Phase I involved an analysis of anonymised data from electronic patient care records between 1 February 2017 and 31 January 2020 in a single UK ambulance service, to determine 1) the frequency of BBAs attended and 2) the percentage of these births where a neonatal temperature was recorded, and what proportion of these were hypothermic. Phase II involved interviews with 20 operational paramedics from the same ambulance service, to explore their experiences of, and barriers and facilitators to, neonatal temperature measurement and management following BBA. RESULTS There were 1582 'normal deliveries' attended by paramedics within the date range. Neonatal temperatures were recorded in 43/1582 (2.7%) instances, of which 72% were below 36.5°C. Data from interviews suggested several barriers and potential facilitators to paramedic measurement of neonatal temperature. Barriers included unavailable or unsuitable equipment, prioritisation of other care activities, lack of exposure to births, and uncertainty regarding responsibilities and roles. Possible facilitators included better equipment, physical prompts, and training and awareness-raising around the importance of temperature measurement. CONCLUSIONS This study demonstrates a lack of neonatal temperature measurement by paramedics in the South West following BBA, and highlights barriers and facilitators that could serve as a basis for developing an intervention to improve neonatal temperature measurement.
Collapse
Affiliation(s)
- Laura Goodwin
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Sarah Voss
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Graham McClelland
- Research and Development, North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK.,Stroke Research Group, Newcastle University School of Population and Health Sciences, Newcastle upon Tyne, UK
| | - Emily Beach
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Adam Bedson
- EPRR/Specialist Practice, South Western Ambulance Service NHS Foundation Trust, Taunton, Somerset, UK
| | - Sarah Black
- Research and Audit, South Western Ambulance Service NHS Foundation Trust, Exeter, Devon, UK
| | - Toity Deave
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Nick Miller
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Hazel Taylor
- Research Design Service, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jonathan Benger
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| |
Collapse
|
8
|
Lezard R, Deave T. The factors influencing community nurses' usage of electronic health records: findings from focus groups. Br J Community Nurs 2021; 26:604-610. [PMID: 34878908 DOI: 10.12968/bjcn.2021.26.12.604] [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] [Indexed: 11/11/2022]
Abstract
Electronic health records (EHRs) are integral to community nursing, and mobile access aids seamless, responsive care, prevents repetition and reduces hospital admissions. This saves time and money, enabling smoother workflows and increased productivity. Common practice among community nurses is to return to workbases to access EHRs. This research was conducted to explore what leads to inconsistency in EHR use. Focus groups were held with community nurses, and reflexive thematic analysis of the data was undertaken. Nurses who used EHRs during consultations described the practice as integrative and informed, promoting collaborative care. Those who did not described EHRs as time-consuming, template-laden and a barrier to nurse-patient communication. One barrier to mobile working is the threat to collegiate teamworking and the social and clinical supports it provides. This study suggests specific strategies could increase mobile EHR engagement: role-specific training for effective EHR use; clear organisational directives; innovative team communication; and peer-to-peer coaching.
Collapse
Affiliation(s)
- Ruth Lezard
- Registered General Nurse, Sirona Care and Health, Bristol, UK
| | - Toity Deave
- Centre for Academic Child Health, School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| |
Collapse
|
9
|
Pant PR, Deave T, Banstola A, Bhatta S, Joshi E, Adhikari D, Manandhar SR, Joshi SK, Mytton JA. Home-related and work-related injuries in Makwanpur district, Nepal: a household survey. Inj Prev 2021; 27:450-455. [PMID: 33148799 PMCID: PMC8461414 DOI: 10.1136/injuryprev-2020-043986] [Citation(s) in RCA: 4] [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: 09/02/2020] [Accepted: 10/01/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To describe the epidemiology of home-related and work-related injuries, their mechanisms, inequalities and costs associated with these injuries. METHODS A household survey was undertaken in three palikas of Makwanpur district between April and June 2019. Data were collected electronically on non-fatal injuries that occurred in the previous 3 months and fatal injuries that occurred in the previous 5 years. FINDINGS 17 593 individuals were surveyed from 3327 households. Injury rates were 8.0 per 1000 population for home injuries and 6.4 per 1000 for work-related injuries; 61.0% of home injuries were among women and 69.9% of work-related injuries among men. Falls were the cause of 48% home injuries, affecting 50.9% of men and 46.5% of women. Burns/scalds were higher in women than men, affecting 17.4% of women reporting home injuries. Cuts and piercings accounted for 39.8% of all work-related injuries and 36.3% were falls. Injury incidence varied by ethnic group: home injuries were highest in Brahmin (12.0 per 1000) and work-related injuries highest in Rai groups (21.0 per 1000). The total mean costs (transport and treatment) of work-related injury was US$143.3 (SD 276.7), higher than for home injuries (US$130.4, SD 347.6). The number of home (n=74, 64.9%) and work-related (n=67, 77.9%) injuries were higher in families below the poverty line than families in the next income bracket (home: n=22, 19.3%; work: n=11, 12.8%). CONCLUSIONS Home-related and work-related fall injuries are common. The inequalities in injury identified in our study by rurality, age, sex, income level and ethnic group can help target injury prevention interventions for vulnerable groups.
Collapse
Affiliation(s)
- Puspa Raj Pant
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Toity Deave
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Amrit Banstola
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Sumiksha Bhatta
- Kathmandu Medical College Public Limited, Nepal Injury Research Centre, Kathmandu, Nepal
| | - Elisha Joshi
- Kathmandu Medical College Public Limited, Nepal Injury Research Centre, Kathmandu, Nepal
| | - Dhruba Adhikari
- Mother and Infant Research Activities (MIRA), Kathmandu, Nepal
| | - Sunil Raja Manandhar
- Mother and Infant Research Activities (MIRA), Kathmandu, Nepal
- Department of Paediatrics, Kathmandu Medical College Public Limited, Kathmandu, Nepal
| | - Sunil Kumar Joshi
- Department of Community Medicine, Kathmandu Medical College Public Limited, Kathmandu, Nepal
| | - Julie A Mytton
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| |
Collapse
|
10
|
Thornton M, Harcourt D, Deave T, Kiff J, Williamson H. "Have We Done Enough?" A Cross-condition Exploration of the Experiences of Parents Caring for A Child with an Appearance-affecting Condition or Injury. Dev Neurorehabil 2021; 24:418-428. [PMID: 33852812 DOI: 10.1080/17518423.2021.1901150] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Children and young people (CYP) with appearance-affecting conditions/injuries report common pervasive psychosocial difficulties, regardless of cause, nature or extent of their visible differences. Parents or carers can also experience psychosocial difficulties and challenges specific to having CYP with a visible difference. Current literature is confined to exploring condition-specific concerns of parents, typically in more prevalent appearance-affecting conditions/injuries, whilst the experiences of parents of CYP with other visible differences are unknown. Thirty-one interviews (parents n = 20, health and support professionals n = 11) and 4 parent focus groups (n = 25) were conducted. Three overarching themes were constructed: "Appearance does(n't) matter" describes the impact of having a child with a socially undesirable appearance; "Being 'battle' ready" reflects parents' desire to arm their child with resources to manage challenges, whilst "Walking the tightrope" reflects parents' lack of clarity about how best to approach this. Findings highlight shared and common cross-condition psychosocial difficulties among parents and carers.
Collapse
Affiliation(s)
- Maia Thornton
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Diana Harcourt
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Toity Deave
- Nursing and Midwifery, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - James Kiff
- Outlook Service, Southmead Hospital, Bristol, UK
| | - Heidi Williamson
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| |
Collapse
|
11
|
Caputo M, Scott LJ, Deave T, Dabner L, Parry A, Angelini GD, Sheehan K, Stoica S, Ellis L, Harris R, Rogers CA. A randomized controlled trial comparing controlled reoxygenation and standard cardiopulmonary bypass in paediatric cardiac surgery. Eur J Cardiothorac Surg 2021; 59:349-358. [PMID: 33123718 PMCID: PMC7850030 DOI: 10.1093/ejcts/ezaa318] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/22/2020] [Accepted: 07/28/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Controlled reoxygenation on starting cardiopulmonary bypass (CPB) rather than hyperoxic CPB may confer clinical advantages during surgery for congenital cyanotic heart disease. METHODS A single-centre, randomized controlled trial was carried out to compare the effectiveness of controlled reoxygenation (normoxia) versus hyperoxic CPB in children with congenital cyanotic heart disease undergoing open-heart surgery (Oxic-2). The co-primary clinical outcomes were duration of inotropic support, intubation time and postoperative intensive care unit (ICU) and hospital stay. Analysis of the primary outcomes included data from a previous trial (Oxic-1) conducted to the same protocol. RESULTS Ninety participants were recruited to Oxic-2 and 79 were recruited to the previous Oxic-1 trial. There were no significant differences between the groups for any of the co-primary outcomes: inotrope duration geometric mean ratio (normoxia/hyperoxic) 0.97, 95% confidence interval (CI) (0.69-1.37), P-value = 0.87; intubation time hazard ratio (HR) 1.03, 95% CI (0.74-1.42), P-value = 0.87; postoperative ICU stay HR 1.14 95% CI (0.77-1.67), P-value = 0.52, hospital stay HR 0.90, 95% CI (0.65-1.25), P-value = 0.53. Lower oxygen levels were successfully achieved during the operative period in the normoxic group. Serum creatinine levels were lower in the normoxic group at day 2, but not on days 1, 3-5. Childhood developmental outcomes were similar. In the year following surgery, 85 serious adverse events were reported (51 normoxic group and 34 hyperoxic group). CONCLUSIONS Controlled reoxygenation (normoxic) CPB is safe but with no evidence of a clinical advantage over hyperoxic CPB. CLINICAL TRIAL REGISTRATION NUMBER Current Controlled Trials-ISRCTN81773762.
Collapse
Affiliation(s)
- Massimo Caputo
- Department of Cardiac Surgery, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Lauren J Scott
- Department of Cardiac Surgery, Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Toity Deave
- Department of Cardiac Surgery, Centre for Health and Clinical Research, University of the West of England, Bristol, UK
| | - Lucy Dabner
- Department of Cardiac Surgery, Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Andrew Parry
- Department of Cardiac Surgery, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Gianni D Angelini
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Karen Sheehan
- Department of Cardiac Surgery, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Serban Stoica
- Department of Cardiac Surgery, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Lucy Ellis
- Department of Cardiac Surgery, Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Rosie Harris
- Department of Cardiac Surgery, Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Chris A Rogers
- Department of Cardiac Surgery, Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
| |
Collapse
|
12
|
Joshi E, Bhatta S, Deave T, Mytton J, Adhikari D, Manandhar SR, Joshi SK. Perceptions of injury risk in the home and workplace in Nepal: a qualitative study. BMJ Open 2021; 11:e044273. [PMID: 33766843 PMCID: PMC7996655 DOI: 10.1136/bmjopen-2020-044273] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 02/24/2021] [Accepted: 03/05/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Injuries are a global health problem. To develop context-specific injury prevention interventions, one needs to understand population perceptions of home and workplace injuries. This study explored a range of views and perceptions about injuries in a variety of settings and identified barriers and facilitators to injury prevention. DESIGN Qualitative study: interviews and focus groups. SETTING Three administrative areas: Hetauda submetropolitan city, Thaha municipality and Bakaiya rural municipality in Makwanpur, Nepal. PARTICIPANTS Nine focus groups (74 participants) and nine one-to-one interviews were completed; workers from diverse occupations, residents (slum, traditional or modern homes) and local government decision-makers participated in the study between May and August 2019. The interviews and discussions were audio-recorded, transcribed verbatim, translated to English and analysed thematically. RESULTS Six themes were developed: unsafe home and workplace environment; inadequate supervision and monitoring; perceptions that injuries are inevitable; safety takes low priority: financial and behavioural considerations; safety education and training; and government-led safety programmes and enforcement. Key barriers to injury prevention were perceived to be lack of knowledge about injury risk and preventive measures both at the community level and at the workplace. Facilitators were community-level educational programmes and health and safety training to employees and employers. Participants stressed the importance of the role of the government in planning future injury prevention programmes in different environments. CONCLUSIONS This study highlighted that both home and workplace injuries are complex and multifactorial. Lack of knowledge about injury risks and preventive measures, both at the community level and at the workplace, was found to be a common barrier to injury prevention, perceived to be mitigated by educational programmes. Together with previously published epidemiological evidence, the barriers and facilitators identified in this study offer useful basis to inform policy and practice.
Collapse
Affiliation(s)
- Elisha Joshi
- Nepal Injury Research Centre, Kathmandu Medical College Public Limited, Kathmandu, Nepal
| | - Santosh Bhatta
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Toity Deave
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Julie Mytton
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Dhruba Adhikari
- Mother and Infant Research Activities, Makwanpur, Bagmati, Nepal
| | | | - Sunil Kumar Joshi
- Nepal Injury Research Centre, Kathmandu Medical College Public Limited, Kathmandu, Nepal
| |
Collapse
|
13
|
Bhatta S, Mytton J, Deave T. Environmental change interventions to prevent unintentional home injuries among children in low- and middle-income countries: A systematic review and meta-analysis. Child Care Health Dev 2020; 46:537-551. [PMID: 32410304 DOI: 10.1111/cch.12772] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 08/06/2019] [Revised: 04/16/2020] [Accepted: 05/02/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Unintentional home injury is an important cause of death and disability among children, especially those living in low- and middle-income countries (LMICs). This systematic review aimed to synthesize evidence about the effectiveness of environmental interventions to prevent unintentional child injury and/or reduce injury hazards in the home in LMICs. METHODS Seven electronic databases were searched for randomized controlled trials (RCTs) and controlled before and after (CBA) studies published up to 1 April 2018. Potentially eligible citations were screened by title and abstract and full texts of studies obtained. Synthesis was reported narratively, and where possible, meta-analysis was conducted. RESULTS Four studies met the inclusion criteria: One CBA study reported changes in injury incidence, and three RCTs reported changes in frequency of home hazards. In one study, child resistant containers were found effective in reducing the incidence of paraffin ingestion by 47% during and by 50% postintervention. A meta-analysis of two trials found that home inspection, safety education and safety devices reduced postintervention mean scores for poisoning hazards [mean difference (MD) -0.77; 95% CI [-1.36, -0.19]] and burn-related unsafe practices (MD -0.37; 95% CI [-0.66, -0.09]) but not for falls or electrical and paraffin burn hazards. A single trial found that home inspection and safety education reduced the postintervention mean scores for fall hazards (MD -0.5; 95% CI [-0.66, -0.33]) but not for ingestion hazards. CONCLUSION There is limited evidence that environmental change interventions reduce child injuries but evidence that they reduce some home hazards. More evidence is needed to determine if altering the physical home environment by removing potential hazards reduces injuries in LMICs.
Collapse
Affiliation(s)
- Santosh Bhatta
- Centre for Academic Child Health, University of the West of England, Bristol, UK
| | - Julie Mytton
- Centre for Academic Child Health, University of the West of England, Bristol, UK
| | - Toity Deave
- Centre for Academic Child Health, University of the West of England, Bristol, UK
| |
Collapse
|
14
|
Bhatta S, Mytton JA, Deave T. Assessment of home hazards for non-fatal childhood injuries in rural Nepal: a community survey. Inj Prev 2020; 27:104-110. [PMID: 32060131 DOI: 10.1136/injuryprev-2019-043482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Unintentional injuries in and around the home are important causes of preventable death and disability among young children globally. In Nepal, there is a lack of data regarding home injuries and home hazards to guide the development of effective interventions for preventing childhood home injuries. This study aimed to determine the burden of unintentional home injuries in children <5 years in rural Nepal and quantify the injury hazards in their homes. METHODS A survey was conducted in 740 households in rural areas of the Makwanpur district during February and March 2015. The primary carer reported home injuries which occurred in the previous 3 months and data collector observation identified the injury hazards. Injury incidence, mechanism and the proportion of households with different hazards were described. Multivariable logistic regression explored associations between the number and type of home hazards and injuries. RESULTS Injuries severe enough to need treatment, or resulting in non-participation in usual activities for at least a day, were reported in 242/1042 (23.2%) children <5 years. The mean number of injury hazards per household was 14.98 (SD=4.48), range of 3-31. Regression analysis found an estimated increase of 31% in the odds of injury occurrence associated with each additional injury hazard found in the home (adjusted OR 1.31; 95% CI 1.20 to 1.42). CONCLUSIONS A high proportion of young children in rural Nepal sustained injuries severe enough to miss a day of usual activities. Increased frequency of hazards was associated with an increased injury risk.
Collapse
Affiliation(s)
- Santosh Bhatta
- Centre for Academic Child Health, University of the West of England, Bristol, UK
| | - Julie A Mytton
- Centre for Academic Child Health, University of the West of England, Bristol, UK
| | - Toity Deave
- Centre for Academic Child Health, University of the West of England, Bristol, UK
| |
Collapse
|
15
|
Burr S, Harding S, Wren Y, Deave T. The Relationship between Feeding and Non-Nutritive Sucking Behaviours and Speech Sound Development: A Systematic Review. Folia Phoniatr Logop 2020; 73:75-88. [DOI: 10.1159/000505266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/05/2019] [Indexed: 11/19/2022] Open
|
16
|
Deave T, Ginja S, Goodenough T, Bailey E, Piwek L, Coad J, Day C, Nightingale S, Kendall S, Lingam R. The Bumps and BaBies Longitudinal Study (BaBBLeS): a multi-site cohort study of first-time mothers to evaluate the effectiveness of the Baby Buddy app. Mhealth 2019; 5:42. [PMID: 31620469 PMCID: PMC6789295 DOI: 10.21037/mhealth.2019.08.05] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/08/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Health mobile applications (apps) have become very popular, including apps specifically designed to support women during the ante- and post-natal periods. However, there is currently limited evidence for the effectiveness of such apps at improving pregnancy and parenting outcomes. This study aims to assess the effectiveness of a pregnancy and parenting app, Baby Buddy, in improving maternal self-efficacy at 3 months post-birth. METHODS Participants were 16 years old or over, first-time mothers, 12-16 weeks gestation, recruited by midwives from five English study sites. The Tool to Measure Parenting Self-Efficacy (TOPSE) (primary outcome) was used to compare mothers at 3 months post-birth who had downloaded the Baby Buddy app with those who had not downloaded the app, controlling for confounding factors. RESULTS Four hundred and eighty-eight participants provided valid data at baseline (12-16 weeks gestation), 296 participants provided valid data at 3 months post-birth, 114 (38.5%) of whom reported that they had used the Baby Buddy app. Baby Buddy app users were more likely to use pregnancy or parenting apps (80.7% vs. 69.6%, P=0.035), more likely to have been introduced to the app by a healthcare professional (P=0.005) and have a lower median score for perceived social support (81 vs. 83, P=0.034) than non-app users. The Baby Buddy app did not elicit a statistically significant change in TOPSE scores from baseline to 3 months post-birth [adjusted odds ratio (OR) 1.12, 95% confidence interval (CI): 0.59 to 2.13, P=0.730]. Finding out about the Baby Buddy app from a healthcare professional appeared to grant no additional benefit to app users compared to all other participants in terms of self-efficacy at 3 months post-birth (adjusted OR 1.16, 95% CI: 0.60 to 2.23, P=0.666). There were no statistically significant differences in the TOPSE scores for the in-app data, in terms of passive use of the app between high and low app users (adjusted OR 0.82, 95% CI: 0.21 to 3.12, P=0.766), nor in terms of active use (adjusted OR 0.47, 95% CI: 0.12 to 1.86, P=0.283). CONCLUSIONS This study is one of few, to date, that has investigated the effectiveness of a pregnancy and early parenthood app. No evidence for the effectiveness of the Baby Buddy app was found. New technologies can enhance traditional healthcare services and empower users to take more control over their healthcare but app effectiveness needs to be assessed. Further work is needed to consider: (I) how we can best use this new technology to deliver better health outcomes for health service users and, (II) methodological issues of evaluating digital health interventions.
Collapse
Affiliation(s)
- Toity Deave
- Centre for Academic Child Health, Faculty of Health & Applied Sciences, University of the West of England Bristol, Bristol, UK
| | - Samuel Ginja
- School of Psychology, Faculty of Life & Health Sciences, Ulster University, Coleraine, Northern Ireland
| | - Trudy Goodenough
- Centre for Academic Child Health, Faculty of Health & Applied Sciences, University of the West of England Bristol, Bristol, UK
| | - Elizabeth Bailey
- Centre for Innovative Research Across the Life-Course (CIRAL), Coventry University, Coventry, UK
| | - Lukasz Piwek
- Division of Information, Decisions and Operations, School of Management, University of Bath, Bath, UK
| | - Jane Coad
- Centre for Innovative Research Across the Life-Course (CIRAL), Coventry University, Coventry, UK
| | - Crispin Day
- King’s Health Partners, Child & Adolescent Mental Health Service Research Unit, Guy’s Munro Centre, London, UK
| | - Samantha Nightingale
- Centre for Innovative Research Across the Life-Course (CIRAL), Coventry University, Coventry, UK
| | - Sally Kendall
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Raghu Lingam
- School of Women’s & Children’s Health, University of New South Wales, Randwick, New South Wales, Australia
| |
Collapse
|
17
|
Deave T, Kendal S, Lingam R, Day C, Goodenough T, Bailey E, Ginja S, Nightingale S, Coad J. A study to evaluate the effectiveness of Best Beginnings' Baby Buddy phone app in England: a protocol paper. Prim Health Care Res Dev 2019; 20:e19. [PMID: 30032734 PMCID: PMC6476387 DOI: 10.1017/s1463423618000294] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 03/28/2018] [Accepted: 04/02/2018] [Indexed: 11/08/2022] Open
Abstract
IntroductionDevelopments in information and communication technologies have enabled electronic health and seen a huge expansion over the last decade. This has increased the possibility of self-management of health issues.PurposeTo assess the effectiveness of the Baby Buddy app on maternal self-efficacy and mental well-being three months post-birth in a sample of mothers recruited antenatally. In addition, to explore when, why and how mothers use the app and consider any benefits the app may offer them in relation to their parenting, health, relationships or communication with their child, friends, family members or health professionals. METHODS: We will use a mixed-methods approach, a cohort study, a qualitative element and analysis of in-app data. Participants will be first-time pregnant women, aged 16 years and over, between 12 and 16 weeks of gestation and recruited from five English study sites.Evaluation planWe will compare maternal self-efficacy and mental health at three months post-delivery in mothers who have downloaded the Baby Buddy app compared with those that have not downloaded the app, controlling for confounding factors. Women will be recruited antenatally between 12 and 16 weeks of gestation. Further follow-ups will take place at 35 weeks of gestation and three months post-birth. Data from the cohort study will be supplemented by in-app data that will include, for example, patterns of usage. Qualitative data will assess the impact of the app on the lives of pregnant women and health professionals using both focus groups and interviews.EthicsApproval from the West Midlands-South Birmingham Research Ethics Committee (NRES) (16/WM/0029) and the University of the West of England, Bristol, Research Ethics Committee (HAS.16.08.001).DisseminationFindings of the study will be published in peer reviewed and professional journals, presented locally, nationally and at international conferences. Participants will receive a summary of the findings and the results will be published on Best Beginnings' website.
Collapse
Affiliation(s)
- Toity Deave
- Centre for Child & Adolescent Health, University of the West of England, Faculty of Health & Applied Sciences, Oakfield House, Oakfield Grove, Bristol, UK
| | - Sally Kendal
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Raghu Lingam
- School of Women’s & Children’s Health, University of New South Wales, Australia
| | - Crispin Day
- Child & Adolescent Mental Health Service Research Unit, Guy’s Munro Centre, London, UK
| | - Trudy Goodenough
- Centre for Child & Adolescent Health, University of the West of England, Faculty of Health & Applied Sciences, Oakfield House, Oakfield Grove, Bristol, UK
| | - Elizabeth Bailey
- Centre for Technology Enabled Health Research, Coventry University, Coventry, UK
| | - Sam Ginja
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Sam Nightingale
- Centre for Technology Enabled Health Research, Coventry University, Coventry, UK
| | - Jane Coad
- Centre for Technology Enabled Health Research, Coventry University, Coventry, UK
| |
Collapse
|
18
|
Ginja S, Coad J, Bailey E, Kendall S, Goodenough T, Nightingale S, Smiddy J, Day C, Deave T, Lingam R. Associations between social support, mental wellbeing, self-efficacy and technology use in first-time antenatal women: data from the BaBBLeS cohort study. BMC Pregnancy Childbirth 2018; 18:441. [PMID: 30419842 PMCID: PMC6233574 DOI: 10.1186/s12884-018-2049-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 11/29/2017] [Accepted: 10/09/2018] [Indexed: 01/13/2023] Open
Abstract
Background Information and communication technologies are used increasingly to facilitate social networks and support women during the perinatal period. This paper presents data on how technology use affects the association between women’s social support and, (i) mental wellbeing and, (ii) self-efficacy in the antenatal period. Methods Data were collected as part of an ongoing study - the BaBBLeS study - exploring the effect of a pregnancy and maternity software application (app) on maternal wellbeing and self-efficacy. Between September 2016 and February 2017, we aimed to recruit first-time pregnant women at 12–16 gestation weeks in five maternity sites across England and asked them to complete questionnaires. Outcomes included maternal mental wellbeing (Warwick-Edinburgh Mental Wellbeing Scale), and antenatal self-efficacy (antenatal version of the Tool to Measure Parenting Self-Efficacy). Other variables assessed were perceived social support (Multidimensional Scale of Perceived Social Support), general technology use (adapted from Media and Technology Usage and Attitudes Scale). Potential confounders were age, ethnicity, education, socioeconomic deprivation, employment, relationship status and recruitment site. Linear regression models were developed to analyse the relationship between social support and the outcomes. Results Participants (n = 492, median age = 28 years) were predominantly white British (64.6%). Half of them had a degree or higher degree (49.3%), most were married/living with a partner (83.6%) and employed (86.2%). Median (LQ-UQ) overall scores were 81.0 (74.0–84.0) for social support (range 12–84), 5.1 (4.7–5.4) for technology use (range 1–6), 54.0 (48.0–60.0) for mental well-being (range 14–70), and 319.0 (295.5–340) for self-efficacy (range 0–360). Social support was significantly associated with antenatal mental well-being adjusting for confounders [adj R2 = 0.13, p < .001]. The addition of technology use did not alter this model [adj R2 = 0.13, p < .001]. Social support was also significantly associated with self-efficacy after adjustment [adj R2 = 0.14, p < .001]; technology had limited impact on this association [adj R2 = 0.13, p < .001]. Conclusions Social support is associated with mental well-being and self-efficacy in antenatal first-time mothers. This association was not significantly affected by general technology use as measured in our survey. Future work should investigate whether pregnancy-specific technologies yield greater potential to enhance the perceived social support, wellbeing and self-efficacy of antenatal women. Electronic supplementary material The online version of this article (10.1186/s12884-018-2049-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Samuel Ginja
- School of Psychology, Ulster University, Cromore Road, Coleraine, Co., Londonderry, BT52 1SA, UK
| | - Jane Coad
- Centre for Innovative Research Across the Life Course (CIRAL), Faculty of Health & Life Sciences, Coventry University, Priory Street, Coventry, CV1 5FB, UK
| | - Elizabeth Bailey
- Centre for Innovative Research Across the Life Course (CIRAL), Faculty of Health & Life Sciences, Coventry University, Priory Street, Coventry, CV1 5FB, UK
| | - Sally Kendall
- Centre for Health Services Studies, University of Kent, Canterbury, Kent, CT2 7NF, UK
| | - Trudy Goodenough
- Centre for Child & Adolescent Health, University of the West of England Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol, BS8 2BN, UK
| | - Samantha Nightingale
- Centre for Innovative Research Across the Life Course (CIRAL), Faculty of Health & Life Sciences, Coventry University, Priory Street, Coventry, CV1 5FB, UK
| | - Jane Smiddy
- Nursing, Midwifery and Health, Health and Life Sciences, Northumbria University, Coach Lane Campus, Benton, Newcastle upon Tyne, NE7 7XA, UK
| | - Crispin Day
- Department of Psychology, Child & Adolescent Mental Health Service Research Unit, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AB, UK
| | - Toity Deave
- Centre for Child & Adolescent Health, University of the West of England Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol, BS8 2BN, UK
| | - Raghu Lingam
- Population Child Health Research Group, Women's and Children's Health, University of New South Wales, Sydney, Australia.
| |
Collapse
|
19
|
Biswas A, Abdullah ASM, Dalal K, Deave T, Rahman F, Mashreky SR. Exploring perceptions of common practices immediately following burn injuries in rural communities of Bangladesh. BMC Health Serv Res 2018; 18:467. [PMID: 29914495 PMCID: PMC6006944 DOI: 10.1186/s12913-018-3287-3] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 06/11/2018] [Indexed: 11/16/2022] Open
Abstract
Background Burns can be the most devastating injuries in the world, they constitute a global public health problem and cause widespread public health concern. Every year in Bangladesh more than 365,000 people are injured by electrical, thermal and other causes of burn injuries. Among them 27,000 need hospital admission and over 5600 people die. Immediate treatment and medication has been found to be significant in the success of recovering from a burn. However, common practices used in the treatment of burn injuries in the community is not well documented in Bangladesh. This study was designed to explore the perception of local communities in Bangladesh the common practices used and health-seeking behaviors sought immediately after a burn injury has occurred. Methods A qualitative study was conducted using Focus Group Discussions (FGD) as the data collection method. Six unions of three districts in rural Bangladesh were randomly selected and FGDs were conducted in these districts with six burn survivors and their relatives and neighbours. Data were analyzed manually, codes were identified and the grouped into themes. Results The participants stated that burn injuries are common during the winter in Bangladesh. Inhabitants in the rural areas said that it was common practice, and correct, to apply the following to the injured area immediately after a burn: egg albumin, salty water, toothpaste, kerosene, coconut oil, cow dung or soil. Some also believed that applying water is harmful to a burn injury. Most participants did not know about any referral system for burn patients. They expressed their dissatisfaction about the lack of available health service facilities at the recommended health care centers at both the district level and above. Conclusions In rural Bangladesh, the current first-aid practices for burn injuries are incorrect; there is a widely held belief that using water on burns is harmful.
Collapse
Affiliation(s)
- Animesh Biswas
- Reproductive and Child Health Department, Centre for Injury Prevention and Research, Bangladesh (CIPRB), House B 162, Road 23, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh.
| | - Abu Sayeed Md Abdullah
- Reproductive and Child Health Department, Centre for Injury Prevention and Research, Bangladesh (CIPRB), House B 162, Road 23, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
| | - Koustuv Dalal
- Department of Public Health Science, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Toity Deave
- Centre for Child & Adolescent Health, Faculty of Health & Applied Sciences, University of the West of England, Bristol, UK
| | - Fazlur Rahman
- Reproductive and Child Health Department, Centre for Injury Prevention and Research, Bangladesh (CIPRB), House B 162, Road 23, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh.,Bangladesh University of Health sciences (BUHS), Dhaka, Bangladesh
| | - Saidur Rahman Mashreky
- Reproductive and Child Health Department, Centre for Injury Prevention and Research, Bangladesh (CIPRB), House B 162, Road 23, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh.,Bangladesh University of Health sciences (BUHS), Dhaka, Bangladesh
| |
Collapse
|
20
|
Kendrick D, Ablewhite J, Achana F, Benford P, Clacy R, Coffey F, Cooper N, Coupland C, Deave T, Goodenough T, Hawkins A, Hayes M, Hindmarch P, Hubbard S, Kay B, Kumar A, Majsak-Newman G, McColl E, McDaid L, Miller P, Mulvaney C, Peel I, Pitchforth E, Reading R, Saramago P, Stewart J, Sutton A, Timblin C, Towner E, Watson MC, Wynn P, Young B, Zou K. Keeping Children Safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives. Programme Grants Appl Res 2017. [DOI: 10.3310/pgfar05140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundUnintentional injuries among 0- to 4-year-olds are a major public health problem incurring substantial NHS, individual and societal costs. However, evidence on the effectiveness and cost-effectiveness of preventative interventions is lacking.AimTo increase the evidence base for thermal injury, falls and poisoning prevention for the under-fives.MethodsSix work streams comprising five multicentre case–control studies assessing risk and protective factors, a study measuring quality of life and injury costs, national surveys of children’s centres, interviews with children’s centre staff and parents, a systematic review of barriers to, and facilitators of, prevention and systematic overviews, meta-analyses and decision analyses of home safety interventions. Evidence from these studies informed the design of an injury prevention briefing (IPB) for children’s centres for preventing fire-related injuries and implementation support (training and facilitation). This was evaluated by a three-arm cluster randomised controlled trial comparing IPB and support (IPB+), IPB only (no support) and usual care. The primary outcome was parent-reported possession of a fire escape plan. Evidence from all work streams subsequently informed the design of an IPB for preventing thermal injuries, falls and poisoning.ResultsModifiable risk factors for falls, poisoning and scalds were found. Most injured children and their families incurred small to moderate health-care and non-health-care costs, with a few incurring more substantial costs. Meta-analyses and decision analyses found that home safety interventions increased the use of smoke alarms and stair gates, promoted safe hot tap water temperatures, fire escape planning and storage of medicines and household products, and reduced baby walker use. Generally, more intensive interventions were the most effective, but these were not always the most cost-effective interventions. Children’s centre and parental barriers to, and facilitators of, injury prevention were identified. Children’s centres were interested in preventing injuries, and believed that they could prevent them, but few had an evidence-based strategic approach and they needed support to develop this. The IPB was implemented by children’s centres in both intervention arms, with greater implementation in the IPB+ arm. Compared with usual care, more IPB+ arm families received advice on key safety messages, and more families in each intervention arm attended fire safety sessions. The intervention did not increase the prevalence of fire escape plans [adjusted odds ratio (AOR) IPB only vs. usual care 0.93, 95% confidence interval (CI) 0.58 to 1.49; AOR IPB+ vs. usual care 1.41, 95% CI 0.91 to 2.20] but did increase the proportion of families reporting more fire escape behaviours (AOR IPB only vs. usual care 2.56, 95% CI 1.38 to 4.76; AOR IPB+ vs. usual care 1.78, 95% CI 1.01 to 3.15). IPB-only families were less likely to report match play by children (AOR 0.27, 95% CI 0.08 to 0.94) and reported more bedtime fire safety routines (AOR for a 1-unit increase in the number of routines 1.59, 95% CI 1.09 to 2.31) than usual-care families. The IPB-only intervention was less costly and marginally more effective than usual care. The IPB+ intervention was more costly and marginally more effective than usual care.LimitationsOur case–control studies demonstrate associations between modifiable risk factors and injuries but not causality. Some injury cost estimates are imprecise because of small numbers. Systematic reviews and meta-analyses were limited by the quality of the included studies, the small numbers of studies reporting outcomes and significant heterogeneity, partly explained by differences in interventions. Network meta-analysis (NMA) categorised interventions more finely, but some variation remained. Decision analyses are likely to underestimate cost-effectiveness for a number of reasons. IPB implementation varied between children’s centres. Greater implementation may have resulted in changes in more fire safety behaviours.ConclusionsOur studies provide new evidence about the effectiveness of, as well as economic evaluation of, home safety interventions. Evidence-based resources for preventing thermal injuries, falls and scalds were developed. Providing such resources to children’s centres increases their injury prevention activity and some parental safety behaviours.Future workFurther randomised controlled trials, meta-analyses and NMAs are needed to evaluate the effectiveness and cost-effectiveness of home safety interventions. Further work is required to measure NHS, family and societal costs and utility decrements for childhood home injuries and to evaluate complex multicomponent interventions such as home safety schemes using a single analytical model.Trial registrationCurrent Controlled Trials ISRCTN65067450 and ClinicalTrials.gov NCT01452191.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 14. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Joanne Ablewhite
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Felix Achana
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Penny Benford
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Rose Clacy
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Frank Coffey
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nicola Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Carol Coupland
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Toity Deave
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Trudy Goodenough
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Adrian Hawkins
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mike Hayes
- Child Accident Prevention Trust, London, UK
| | - Paul Hindmarch
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephanie Hubbard
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Bryony Kay
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Arun Kumar
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | | | - Elaine McColl
- Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Lisa McDaid
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Phil Miller
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Isabel Peel
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Richard Reading
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norfolk Community Health and Care NHS Trust, Norwich, UK
| | - Pedro Saramago
- Centre for Health Economics, University of York, York, UK
| | - Jane Stewart
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Alex Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Clare Timblin
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Elizabeth Towner
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Michael C Watson
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Persephone Wynn
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Ben Young
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Kun Zou
- Division of Primary Care, University of Nottingham, Nottingham, UK
| |
Collapse
|
21
|
Deave T, Hawkins A, Kumar A, Hayes M, Cooper N, Watson M, Ablewhite J, Coupland C, Sutton A, Majsak-Newman G, McDaid L, Goodenough T, Beckett K, McColl E, Reading R, Kendrick D. Evaluating implementation of a fire-prevention injury prevention briefing in children's centres: Cluster randomised controlled trial. PLoS One 2017; 12:e0172584. [PMID: 28339460 PMCID: PMC5365108 DOI: 10.1371/journal.pone.0172584] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 02/05/2017] [Indexed: 11/22/2022] Open
Abstract
Background Many developed countries have high mortality rates for fire-related deaths in children aged 0–14 years with steep social gradients. Evidence-based interventions to promote fire safety practices exist, but the impact of implementing a range of these interventions in children’s services has not been assessed. We developed an Injury Prevention Briefing (IPB), which brought together evidence about effective fire safety interventions and good practice in delivering interventions; plus training and facilitation to support its use and evaluated its implementation. Methods We conducted a cluster randomised controlled trial, with integrated qualitative and cost-effectiveness nested studies, across four study sites in England involving children’s centres in disadvantaged areas; participants were staff and families attending those centres. Centres were stratified by study site and randomised within strata to one of three arms: IPB plus facilitation (IPB+), IPB only, usual care. IPB+ centres received initial training and facilitation at months 1, 3, and 8. Baseline data from children’s centres were collected between August 2011 and January 2012 and follow-up data were collected between June 2012 and June 2013. Parent baseline data were collected between January 2012 and May 2012 and follow-up data between May 2013 and September 2013. Data comprised baseline and 12 month parent- and staff-completed questionnaires, facilitation contact data, activity logs and staff interviews. The primary outcome was whether families had a plan for escaping from a house fire. Treatment arms were compared using multilevel models to account for clustering by children’s centre. Results 1112 parents at 36 children’s centres participated. There was no significant effect of the intervention on families’ possession of plans for escaping from a house fire (adjusted odds ratio (AOR) IPB only vs. usual care: 0.93, 95%CI 0.58, 1.49; AOR IPB+ vs. usual care 1.41, 95%CI 0.91, 2.20). However, significantly more families in the intervention arms reported more behaviours for escaping from house fires (AOR IPB only vs. usual care: 2.56, 95%CI 01.38, 4.76; AOR IPB+ vs. usual care 1.78, 95%CI 1.01, 3.15). Conclusion Our study demonstrated that children’s centres can deliver an injury prevention intervention to families in disadvantaged communities and achieve changes in home safety behaviours.
Collapse
Affiliation(s)
- Toity Deave
- Centre for Child & Adolescent Health, Health & Applied Sciences, University of the West of England Bristol, Bristol, United Kingdom
| | - Adrian Hawkins
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Arun Kumar
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Mike Hayes
- Child Accident Prevention Trust, Barnet, London, United Kingdom
| | - Nicola Cooper
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Michael Watson
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Joanne Ablewhite
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Carol Coupland
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Alex Sutton
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Gosia Majsak-Newman
- Norfolk and Suffolk Primary and Community Care Research Office, Hosted by South Norfolk CCG, Norwich, United Kingdom
| | - Lisa McDaid
- Norfolk and Norwich University Hospital, NHS Clinical Research and Trials Unit, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Trudy Goodenough
- Centre for Child & Adolescent Health, Health & Applied Sciences, University of the West of England Bristol, Bristol, United Kingdom
| | - Kate Beckett
- University of the West of England, Research and Innovation, University Hospitals Bristol NHS Foundation Trust, Education Centre, Bristol, United Kingdom
| | - Elaine McColl
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Richard Reading
- Jenny Lind Paediatric Department, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Denise Kendrick
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- * E-mail:
| |
Collapse
|
22
|
Pant PR, Ellis M, Deave T, Mytton J. 181 Developing educational package on child injury prevention mobilising womens’ groups in rural nepal. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.181] [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: 11/04/2022]
|
23
|
Watson MC, Mulvaney C, Timblin C, Stewart J, Coupland C, Deave T, Hayes M, Kendrick D. 690 National survey of injury prevention activities of children’s centres. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.690] [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]
|
24
|
Deave T, Hawkins A, Hayes M, Cooper N, Coupland C, Majsak-Newman G, Goodenough T, McColl E, Reading R, Kendrick D. 119 Cluster-randomised controlled trial of a fire safety injury prevention briefing in children’s centres. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.119] [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: 11/04/2022]
|
25
|
Pant PR, Ellis M, Deave T, Mytton J. 699 Community mobilisation to establish a community creche to increase child supervision in rural nepal. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.699] [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: 11/04/2022]
|
26
|
Bhatta S, Deave T, Mytton J. 608 Environmental change to reduce child injury in low and middle income countries: a systematic review. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.608] [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]
|
27
|
Stewart J, Benford P, Wynn P, Watson MC, Coupland C, Deave T, Hindmarch P, Majsak-Newman G, Kendrick D. Modifiable risk factors for scald injury in children under 5 years of age: A Multi-centre Case-Control Study. Burns 2016; 42:1831-1843. [PMID: 27576925 DOI: 10.1016/j.burns.2016.06.027] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/18/2016] [Accepted: 06/24/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the relationship between a range of modifiable risk factors and medically attended scalds in children under the age of 5 years. METHODS Multicentre matched case-control study in acute hospitals, minor injury units and GP practices in four study centres in England. Cases comprised 338 children under 5 presenting with a scald, and 1438 control participants matched on age, gender, date of event and study centre. Parents/caregivers completed questionnaires on safety practices, safety equipment use, home hazards and potential confounders. Odds ratios were estimated using conditional logistic regression. RESULTS Parents of cases were significantly more likely than parents of controls to have left hot drinks within reach of their child (adjusted odds ratio (AOR) 2.33, 95%CI 1.63 to 3.31; population attributable fraction (PAF) 31%). They were more likely not to have taught children rules about climbing on kitchen objects (AOR 1.66, 95%CI 1.12 to 2.47; PAF 20%); what to do or not do when parents are cooking (AOR 1.95, 95%CI 1.33 to 2.85; PAF 26%); and about hot things in the kitchen (AOR 1.89, 95%CI 1.30 to 2.75; PAF 26%). CONCLUSIONS Some scald injuries may be prevented by parents keeping hot drinks out of reach of children and by teaching children rules about not climbing on objects in the kitchen, what to do or not do whilst parents are cooking using the top of the cooker and about hot objects in the kitchen. Further studies, providing a more sophisticated exploration of the immediate antecedents of scalds are required to quantify associations between other hazards and behaviours and scalds in young children.
Collapse
Affiliation(s)
- Jane Stewart
- Nottinghamshire Healthcare NHS Foundation Trust, Institute of Mental Health, University of Nottingham Innovation Park, Jubilee Campus, Triumph Road, Nottingham NG7 2TU, United Kingdom.
| | - Penny Benford
- Faculty of Medicine and Health Sciences, University of Nottingham, Division of Primary Care, 13(th) Floor, Tower Building, University Park, Nottingham NG72RD, United Kingdom
| | - Persephone Wynn
- Faculty of Medicine and Health Sciences, University of Nottingham, Division of Primary Care, 13(th) Floor, Tower Building, University Park, Nottingham NG72RD, United Kingdom
| | - Michael Craig Watson
- Faculty of Medicine and Health Sciences, University of Nottingham, School of Health Sciences, D1019, Queen's Medical Centre, Nottingham NG7 2HA, United Kingdom
| | - Carol Coupland
- Faculty of Medicine and Health Sciences, University of Nottingham, 13(th) Floor, Tower Building, University of Nottingham NG72RD, United Kingdom
| | - Toity Deave
- Centre for Child & Adolescent Health, Faculty of Health & Life Sciences, University of the West of England Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, United Kingdom
| | - Paul Hindmarch
- Institute of Health & Society, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, United Kingdom
| | - Gosia Majsak-Newman
- Norfolk and Norwich University Hospitals NHS Foundation Trust, NHS Clinical Research & Trials Unit, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, United Kingdom
| | - Denise Kendrick
- Faculty of Medicine and Health Sciences, University of Nottingham, 13(th) Floor, Tower Building, University of Nottingham NG72RD, United Kingdom
| |
Collapse
|
28
|
Abstract
The argument for evidence-based nursing practice informed by research has placed nursing research capacity-building firmly on the agenda. Despite the recognition of the need for sustainable sources of funding, the emphasis has remained on NHS R&D undertaken by doctor, supported by other professions such as nurses. Indeed, it is common for nurses to be employed in the role of research assistant or data collector, under the supervision of a doctor. The titles ‘Research Nurse’ and ‘Nurse Researcher’ are used interchangeably and this paper highlights the distinction between the two, the requirements of their posts, reasons why nurses may become involved in research and the difficulties that this may entail. We draw attention to the expectations of the research training that first-level nurses receive, the assumption that it results in them being research competent, and the implications for the status of nursing research. Investment in research capacity-building needs to be reflected in the organisation and infrastructure of academic departments and NHS trusts. Joint, long-term educator/practitioner/researcher appointees are required to facilitate the nurseorientated research necessary to inform the increasing demands on practice. If the practice of nursing, midwifery and health visiting is to be underpinned by a scientific evidence-base specific to its own needs, it is necessary to foster an environment conducive to reflection on practice and cultivation of ideas.
Collapse
|
29
|
Ablewhite J, McDaid L, Hawkins A, Peel I, Goodenough T, Deave T, Stewart J, Watson M, Kendrick D. Approaches used by parents to keep their children safe at home: a qualitative study to explore the perspectives of parents with children aged under five years. BMC Public Health 2015; 15:983. [PMID: 26419449 PMCID: PMC4588674 DOI: 10.1186/s12889-015-2252-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 09/08/2015] [Indexed: 12/03/2022] Open
Abstract
Background Childhood unintentional injury represents an important global health problem. Many unintentional injuries experienced by children aged under 5 years occur within the home and are preventable. The aim of this study was to explore the approaches used by parents of children under five in order to help prevent unintentional injuries in the home and the factors which influence their use. Understanding how parents approach risk-management in the home has important implications for injury practitioners. Methods A multi-centre qualitative study using semi-structured interviews. A thematic approach was used to analyse the data. Sixty five parents of children aged under 5 years, from four study areas were interviewed: Bristol, Newcastle, Norwich and Nottingham. Results Three main injury prevention strategies used by parents were: a) Environmental such as removal of hazards, and use of safety equipment; b) parental supervision; and c) teaching, for example, teaching children about safety and use of rules and routine. Strategies were often used in combination due to their individual limitations. Parental assessment of injury risk, use of strategy and perceived effectiveness were fluid processes dependent on a child’s character, developmental age and the prior experiences of both parent and child. Some parents were more proactive in their approach to home safety while others only reacted if their child demonstrated an interest in a particular object or activity perceived as being an injury risk. Conclusion Parents’ injury prevention practices encompass a range of strategies that are fluid in line with the child’s age and stage of development; however, parents report that they still find it challenging to decide which strategy to use and when.
Collapse
Affiliation(s)
- Joanne Ablewhite
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK.
| | - Lisa McDaid
- Clinical Research & Trials Unit, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, NR4 7UY, UK.
| | - Adrian Hawkins
- Emergency Department, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
| | - Isabel Peel
- Clinical Research & Trials Unit, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, NR4 7UY, UK.
| | - Trudy Goodenough
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, BS16 1QY, UK.
| | - Toity Deave
- School of Health Sciences, University of Nottingham, Nottingham, NG7 2HA, UK.
| | - Jane Stewart
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK.
| | - Michael Watson
- School of Health Sciences, University of Nottingham, Nottingham, NG7 2HA, UK.
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK.
| |
Collapse
|
30
|
Pant PR, Budhathoki B, Ellis M, Manandhar D, Deave T, Mytton J. The feasibility of community mobilisation for child injury prevention in rural Nepal: a programme for female community health volunteers. BMC Public Health 2015; 15:430. [PMID: 25928451 PMCID: PMC4418066 DOI: 10.1186/s12889-015-1783-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 02/24/2015] [Accepted: 04/22/2015] [Indexed: 11/10/2022] Open
Abstract
Background Injuries accounted for 23% of all deaths in children and adolescents in Nepal during 2010 (n = 3,700). Despite this, there is no national death registration or injury surveillance system. Non-fatal injuries are many times more common than fatal injuries and may leave the injured person with lifelong consequences. Children in low-income settings are exposed to widespread risks of injuries but there is little awareness of how they can be prevented. Community mobilisation has been shown to be effective to reduce maternal and neonatal morbidity. This study aimed to develop a child safety programme and assess the feasibility of delivering the programme through a community mobilisation approach. Methods We developed a culturally appropriate, educational programme for Female Community Health Volunteers that included both primary and secondary prevention materials for unintentional child injuries. We determined the feasibility of evaluating its effectiveness through the mobilisation of women’s groups in rural Nepal. Ten women’s groups across 9 wards in one village development committee area completed the programme during 6 monthly meetings. Parent-reported injuries were collected through a notification system established for this study. Experience of the programme by women’s group participants and leaders was assessed through a structured questionnaire and process measures assessed the delivery and reach of the programme. Results Programme resources were developed for this setting and adapted following feedback from users. Nine FCHVs received first-aid training and shown how to use the facilitation manual and injury prevention resources. The FCHVs convened 10 women’s groups to run over 6 months with 24–29 mothers attending each meeting (290 mothers participated in total). Each group presented their views on child injury risks and proposed prevention activities at local public meetings. Women reported 155 injuries to children under 18 years during 7 months of follow up using the notification system. Conclusions It is feasible to develop and implement a community mobilisation intervention where women’s groups work together with local FCHVs to prevent injuries in children. The intervention was well received by the women’s groups and by community members. The effectiveness and cost effectiveness of the intervention should now be evaluated through an experimental study. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1783-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Puspa Raj Pant
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK.
| | | | - Matthew Ellis
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
| | | | - Toity Deave
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK.
| | - Julie Mytton
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK.
| |
Collapse
|
31
|
Ablewhite J, Peel I, McDaid L, Hawkins A, Goodenough T, Deave T, Stewart J, Kendrick D. Parental perceptions of barriers and facilitators to preventing child unintentional injuries within the home: a qualitative study. BMC Public Health 2015; 15:280. [PMID: 25885179 PMCID: PMC4392794 DOI: 10.1186/s12889-015-1547-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 02/16/2015] [Indexed: 11/25/2022] Open
Abstract
Background Childhood unintentional injury represents an important global health problem. Most of these injuries occur at home, and many are preventable. The main aim of this study was to identify key facilitators and barriers for parents in keeping their children safe from unintentional injury within their homes. A further aim was to develop an understanding of parents’ perceptions of what might help them to implement injury prevention activities. Methods Semi-structured interviews were conducted with sixty-four parents with a child aged less than five years at parent’s homes. Interview data was transcribed verbatim, and thematic analysis was undertaken. This was a Multi-centre qualitative study conducted in four study centres in England (Nottingham, Bristol, Norwich and Newcastle). Results Barriers to injury prevention included parents’ not anticipating injury risks nor the consequences of some risk-taking behaviours, a perception that some injuries were an inevitable part of child development, interrupted supervision due to distractions, maternal fatigue and the presence of older siblings, difficulties in adapting homes, unreliability and cost of safety equipment and provision of safety information later than needed in relation to child age and development. Facilitators for injury prevention included parental supervision and teaching children about injury risks. This included parents’ allowing children to learn about injury risks through controlled risk taking, using “safety rules” and supervising children to ensure that safety rules were adhered to. Adapting the home by installing safety equipment or removing hazards were also key facilitators. Some parents felt that learning about injury events through other parents’ experiences may help parents anticipate injury risks. Conclusions There are a range of barriers to, and facilitators for parents undertaking injury prevention that would be addressable during the design of home safety interventions. Addressing these in future studies may increase the effectiveness of interventions.
Collapse
Affiliation(s)
- Joanne Ablewhite
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK.
| | - Isabel Peel
- Emergency Department, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
| | - Lisa McDaid
- Clinical Research & Trials Unit, Norfolk and Norwich University Hospital NHS, Foundation Trust, Norwich, NR4 7UY, UK.
| | - Adrian Hawkins
- The Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, UK.
| | - Trudy Goodenough
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, BS16 1QY, UK.
| | - Toity Deave
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, BS16 1QY, UK.
| | - Jane Stewart
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK.
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK.
| |
Collapse
|
32
|
Hindmarch P, Hawkins A, McColl E, Hayes M, Majsak-Newman G, Ablewhite J, Deave T, Kendrick D. Recruitment and retention strategies and the examination of attrition bias in a randomised controlled trial in children's centres serving families in disadvantaged areas of England. Trials 2015; 16:79. [PMID: 25886131 PMCID: PMC4359386 DOI: 10.1186/s13063-015-0578-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 08/11/2014] [Accepted: 01/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Failure to retain participants in randomised controlled trials and longitudinal studies can cause significant methodological problems. We report the recruitment and retention strategies of a randomised controlled trial to promote fire-related injury prevention in families with pre-school children attending children's centres in disadvantaged areas in England. METHODS Thirty-six children's centres were cluster randomised into one of three arms of a 12-month fire-related injury prevention trial. Two arms delivered safety interventions and there was one control arm. Retention rates compared the numbers of participants responding to the 12-month questionnaire to the number recruited to the trial. Multivariable random effects logistic regression was used to explore factors independently associated with participant retention. RESULTS The trial exceeded its required sample size through the use of multiple recruitment strategies. All children's centres remained in the study, despite increased reorganisation. Parent retention was 68% at 12 months, ranging from 65% to 70% across trial arms and from 62% to 74% across trial sites. There was no significant difference in the rates of retention between trial arms (p = 0.58) or between trial sites (p = 0.16). Retention was significantly lower amongst mothers aged 16-25 years than older mothers [adjusted odds ratio (AOR) 0.57, 95% CI 0.41, 0.78], those living in non-owner occupied accommodation than in owner occupied accommodation (AOR 0.53, 95% CI 0.38, 0.73) and those living in more disadvantaged areas (most versus least disadvantaged quintiles AOR 0.50, 95% CI 0.30, 0.82). CONCLUSIONS Studies recruiting disadvantaged populations should measure and report attrition by socioeconomic factors to enable determination of the extent of attrition bias and estimation of its potential impact on findings. Where differential attrition is anticipated, consideration should be given to over-sampling during recruitment and targeted and more intensive strategies of participant retention in these sub-groups. In transient populations collection of multiple sources of contact information at recruitment and throughout the study may aid retention. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT01452191 ; Date of registration: 10 October 2011, ISRCTN65067450.
Collapse
Affiliation(s)
- Paul Hindmarch
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
| | - Adrian Hawkins
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
| | - Elaine McColl
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
| | - Mike Hayes
- Child Accident Prevention Trust, Canterbury Court (1.09), 1-3 Brixton Road, London, SW9 6DE, UK.
| | - Gosia Majsak-Newman
- Clinical Research & Trials Unit, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, NR4 7UY, UK.
| | - Joanne Ablewhite
- Division of Primary Care, School of Medicine, Floor 13, Tower Building, University Park, Nottingham, NG7 2RD, UK.
| | - Toity Deave
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, BS16 1QY, UK.
| | - Denise Kendrick
- Division of Primary Care, School of Medicine, Floor 13, Tower Building, University Park, Nottingham, NG7 2RD, UK.
| | | |
Collapse
|
33
|
Kendrick D, Maula A, Reading R, Hindmarch P, Coupland C, Watson M, Hayes M, Deave T. Risk and protective factors for falls from furniture in young children: multicenter case-control study. JAMA Pediatr 2015; 169:145-53. [PMID: 25436605 DOI: 10.1001/jamapediatrics.2014.2374] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Falls from furniture are common in young children but there is little evidence on protective factors for these falls. OBJECTIVE To estimate associations for risk and protective factors for falls from furniture in children aged 0 to 4 years. DESIGN, SETTING, AND PARTICIPANTS Multicenter case-control study at hospitals, minor injury units, and general practices in and around 4 UK study centers. Recruitment commenced June 14, 2010, and ended April 27, 2012. Participants included 672 children with falls from furniture and 2648 control participants matched on age, sex, calendar time, and study center. Thirty-five percent of cases and 33% of control individuals agreed to participate. The mean age was 1.74 years for cases and 1.91 years for control participants. Fifty-four percent of cases and 56% of control participants were male. Exposures included safety practices, safety equipment use, and home hazards. MAIN OUTCOMES AND MEASURES Falls from furniture occurring at the child's home resulting in attendance at an emergency department, minor injury unit, or hospital admission. RESULTS Compared with parents of control participants, parents of cases were significantly more likely not to use safety gates in the home (adjusted odds ratio [AOR], 1.65; 95% CI, 1.29-2.12) and not to have taught their children rules about climbing on kitchen objects (AOR, 1.58; 95% CI, 1.16-2.15). Cases aged 0 to 12 months were significantly more likely to have been left on raised surfaces (AOR, 5.62; 95% CI, 3.62-8.72), had their diapers changed on raised surfaces (AOR, 1.89; 95% CI, 1.24-2.88), and been put in car/bouncing seats on raised surfaces (AOR, 2.05; 95% CI, 1.29-3.27). Cases 3 years and older were significantly more likely to have played or climbed on furniture (AOR, 9.25; 95% CI, 1.22-70.07). Cases were significantly less likely to have played or climbed on garden furniture (AOR, 0.74; 95% CI, 0.56-0.97). CONCLUSIONS AND RELEVANCE If estimated associations are causal, some falls from furniture may be prevented by incorporating advice into child health contacts, personal child health records, and home safety assessments about use of safety gates; not leaving children, changing diapers, or putting children in car/bouncing seats on raised surfaces; allowing children to play or climb on furniture; and teaching children safety rules about climbing on objects.
Collapse
Affiliation(s)
- Denise Kendrick
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, England
| | - Asiya Maula
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, England
| | - Richard Reading
- Norfolk and Norwich University Hospitals, National Health Service Foundation Trust, Norwich, England
| | - Paul Hindmarch
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, England
| | - Carol Coupland
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, England
| | - Michael Watson
- School of Health Sciences, University of Nottingham, Nottingham, England
| | - Mike Hayes
- Child Accident Prevention Trust, London, England
| | - Toity Deave
- Centre for Child and Adolescent Health, Health, and Life Sciences, Department of Family and Child Health, University of the West of England, Bristol, England
| |
Collapse
|
34
|
Beckett K, Goodenough T, Deave T, Jaeckle S, McDaid L, Benford P, Hayes M, Towner E, Kendrick D. Implementing an Injury Prevention Briefing to aid delivery of key fire safety messages in UK children's centres: qualitative study nested within a multi-centre randomised controlled trial. BMC Public Health 2014; 14:1256. [PMID: 25492496 PMCID: PMC4295482 DOI: 10.1186/1471-2458-14-1256] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 07/17/2014] [Accepted: 11/19/2014] [Indexed: 11/24/2022] Open
Abstract
Background To improve the translation of public health evidence into practice, there is a need to increase practitioner involvement in initiative development, to place greater emphasis on contextual knowledge, and to address intervention processes and outcomes. Evidence that demonstrates the need to reduce childhood fire-related injuries is compelling but its translation into practice is inconsistent and limited. With this knowledge the Keeping Children Safe programme developed an "Injury Prevention Briefing (IPB)" using a 7 step process to combine scientific evidence with practitioner contextual knowledge. The IPB was designed specifically for children’s centres (CCs) to support delivery of key fire safety messages to parents. This paper reports the findings of a nested qualitative study within a clustered randomised controlled trial of the IPB, in which staff described their experiences of IPB implementation to aid understanding of why or how the intervention worked. Methods Interviews were conducted with key staff at 24 CCs participating in the two intervention arms: 1) IPB supplemented by initial training and regular facilitation; 2) IPB sent by post with no facilitation. Framework Analysis was applied to these interview data to explore intervention adherence including; exposure or dose; quality of delivery; participant responsiveness; programme differentiation; and staff experience of IPB implementation. This included barriers, facilitators and suggested improvements. Results 83% of CCs regarded the IPB as a simple, accessible tool which raised awareness, and stimulated discussion and behaviour change. 15 CCs suggested minor modifications to format and content. Four levels of implementation were identified according to content, frequency, duration and coverage. Most CCs (75%) achieved ‘extended’ or ‘essential’ IPB implementation. Three universal factors affected all CCs: organisational change and resourcing; working with hard to engage groups; additional demands of participating in a research study. Six specific factors were associated with the implementation level achieved: staff engagement and training; staff continuity; adaptability and flexibility; other agency support; conflicting priorities; facilitation. CCs achieving high implementation levels increased from 58% (no facilitation) to 92% with facilitation. Conclusion Incorporating service provider perspectives and scientific evidence into health education initiatives enhances potential for successful implementation, particularly when supplemented by ongoing training and facilitation. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-1256) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Denise Kendrick
- School of Medicine, Division of Primary Care, University of Nottingham, University Park, Nottingham, UK.
| | | |
Collapse
|
35
|
Boosey R, Prestwich G, Deave T. Menstrual hygiene management amongst schoolgirls in the Rukungiri district of Uganda and the impact on their education: a cross-sectional study. Pan Afr Med J 2014; 19:253. [PMID: 25852796 PMCID: PMC4382073 DOI: 10.11604/pamj.2014.19.253.5313] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [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: 09/05/2014] [Accepted: 10/27/2014] [Indexed: 12/03/2022] Open
Abstract
Introduction An increasing number of studies have found that girls in low-income settings miss or struggle at school during menstruation if they are unable to manage their menstrual hygiene effectively. This study explores the menstrual hygiene practices and knowledge of girls at rural government primary schools in the Rukungiri district in Uganda and assesses the extent to which poor menstrual hygiene management (MHM) affects their education. Methods A self-administered questionnaire was completed by schoolgirls in six government-run primary schools in the Rukungiri district. Focus groups were held with girls from each school and semi-structured interviews were conducted with headteachers and female teachers from the participating schools. A toilet assessment was also conducted in each school. Results One hundred and forty schoolgirls completed the questionnaire. The girls reported a lack of access to adequate resources, facilities and accurate information to manage their menstrual hygiene effectively at school. They reported that, as a result, during menstruation they often struggle at school or miss school. Eighty-six girls (61.7%) reported missing school each month for menstrual-related reasons (mean 1.64, range 0-10, SD. 1.84). Conclusion It is common for girls who attend government-run primary schools in the Rukungiri district to miss school or struggle in lessons during menstruation because they do not have access to the resources, facilities, or information they need to manage for effective MHM. This is likely to have detrimental effects on their education and future prospects. A large-scale study is needed to explore the extent of this issue.
Collapse
Affiliation(s)
- Robyn Boosey
- Department of Sociology, Politics, and International Studies, University of Bristol, Bristol, UK
| | | | - Toity Deave
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| |
Collapse
|
36
|
Mytton J, Ingram J, Manns S, Stevens T, Mulvaney C, Blair P, Powell J, Potter B, Towner E, Emond A, Deave T, Thomas J, Kendrick D, Stewart-Brown S. The feasibility of using a parenting programme for the prevention of unintentional home injuries in the under-fives: a cluster randomised controlled trial. Health Technol Assess 2014; 18:1-184. [PMID: 24433822 DOI: 10.3310/hta18030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Unintentional injury is the leading cause of preventable death of children over the age of 1 year in the UK and a major cause of attendance at emergency departments. Children having one injury are at increased risk of further injuries. Parenting programmes can reduce injuries in preschool children if delivered in the home and on a one-to-one basis. It is not known if group-based programmes delivered outside the home are effective. OBJECTIVES To develop (1) a parenting programme to prevent recurrent unintentional home injuries in preschool children and (2) a tool for parents to report unintentional home injuries occurring to their preschool children. To assess the feasibility of delivering and evaluating the parenting programme through a cluster randomised controlled trial, specifically to (1) assess methods for the recruitment and retention of parents; (2) determine the training, equipment and facilities needed for the delivery of the programme; (3) establish appropriate primary and secondary outcome measures and methods for their collection; (4) determine how 'normal care' in a comparison arm should be defined; and (5) determine the resource utilisation and costing data that would need to be collected for the cost-effectiveness component of a future trial; and (6) produce estimates of effect sizes to inform sample size estimation for a main trial. DESIGN Feasibility multicentre, cluster, randomised, unblinded trial. SETTING Eight children's centres in Bristol and Nottingham, UK. PARTICIPANTS Ninety-six parents of preschool children who had sustained an unintentional injury requiring medical attention in the previous 12 months. INTERVENTIONS The First-aid Advice and Safety Training (FAST) parent programme, comprising parenting support and skills combined with first aid and home safety advice. MAIN OUTCOME MEASURES Parent-reported medically attended injuries in the index child and any preschool siblings sustained during a 6-month period of observation. RESULTS An 8-week parenting programme was produced, designed with participant-friendly, incrementally progressive content. A slimline, month-to-a-view injury calendar, spiral bound and suitable for hanging on a wall, was designed for parents to record injuries occurring to their preschool children during the 6-month period of observed time. Fifty-one parents were recruited (40 meeting eligibility criteria plus 11 following 'open invite' to participate); 15 parents completed the FAST parent programme and 49 provided data at baseline and during follow-up. Completion of the programme was significantly greater for participants using the 'open invite' approach (85%) than for those recruited using the original eligibility criteria (31%). Prototype resource use checklists, unit costs and total costs were developed for phases 0, 1 and 2 of the study for use in a future trial. CONCLUSIONS This feasibility study has developed an innovative injury prevention intervention and a tool to record parent-reported injuries in preschool children. It was not feasible to recruit parents of children who had sustained a recent injury, or to ask health visitor teams to identify potential participants and to deliver the programme. A trial should target all families attending children's centres in disadvantaged areas. The intervention could be delivered by a health professional supported by a member of the children's centre team in a community setting. TRIAL REGISTRATION Current Controlled Trials ISRCTN03605270. SOURCE OF FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 3. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Julie Mytton
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Jenny Ingram
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sarah Manns
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Tony Stevens
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | | | - Peter Blair
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jane Powell
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | | | - Elizabeth Towner
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Alan Emond
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Toity Deave
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - James Thomas
- Institute of Education, University of London, London, UK
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | | |
Collapse
|
37
|
Wynn P, Stewart J, Kumar A, Clacy R, Coffey F, Cooper N, Coupland C, Deave T, Hayes M, McColl E, Reading R, Sutton A, Watson M, Kendrick D. Keeping children safe at home: protocol for a case-control study of modifiable risk factors for scalds. Inj Prev 2014; 20:e11. [PMID: 24842981 PMCID: PMC4174015 DOI: 10.1136/injuryprev-2014-041255] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Scalds are one of the most common forms of thermal injury in young children worldwide. Childhood scald injuries, which mostly occur in the home, result in substantial health service use and considerable morbidity and mortality. There is little research on effective interventions to prevent scald injuries in young children. Objectives To determine the relationship between a range of modifiable risk factors for medically attended scalds in children under the age of 5 years. Design A multicentre case-control study in UK hospitals and minor injury units with parallel home observation to validate parental reported exposures. Cases will be 0–4 years old with a medically attended scald injury which occurred in their home or garden, matched on gender and age with community controls. An additional control group will comprise unmatched hospital controls drawn from children aged 0–4 years attending the same hospitals and minor injury units for other types of injury. Conditional logistic regression will be used for the analysis of cases and matched controls, and unconditional logistic regression for the analysis of cases and unmatched controls to estimate ORs and 95% CI, adjusted and unadjusted for confounding variables. Main exposure measures Use of safety equipment and safety practices for scald prevention and scald hazards. Discussion This large case-control study will investigate modifiable risk factors for scalds injuries, adjust for potential confounders and validate measures of exposure. Its findings will enhance the evidence base for prevention of scalds injuries in young children.
Collapse
Affiliation(s)
- P Wynn
- Division of Primary Care, School of Medicine, Nottingham, UK
| | - J Stewart
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - A Kumar
- Division of Primary Care, School of Medicine, Nottingham, UK
| | - R Clacy
- Division of Primary Care, School of Medicine, Nottingham, UK
| | - F Coffey
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Nottingham, UK
| | - N Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - C Coupland
- Division of Primary Care, School of Medicine, Nottingham, UK
| | - T Deave
- Centre for Child & Adolescent Health, Health and Life Sciences, University of the West of England, Bristol, UK
| | - M Hayes
- Child Accident Prevention Trust, Canterbury Court (1.09), 1 - 3 Brixton Road, London, UK
| | - E McColl
- Great North Children's Hospital, Research Unit Level 2, New Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - R Reading
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - A Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - M Watson
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - D Kendrick
- Division of Primary Care, School of Medicine, Nottingham, UK
| |
Collapse
|
38
|
Watson M, Benford P, Coupland C, Clacy R, Hindmarch P, Majsak-Newman G, Deave T, Kendrick D. Validation of a home safety questionnaire used in a series of case-control studies. Inj Prev 2014; 20:336-42. [PMID: 24591447 PMCID: PMC4174113 DOI: 10.1136/injuryprev-2013-041006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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] [Indexed: 11/07/2022]
Abstract
Objective To measure the validity of safety behaviours, safety equipment use and hazards reported on a questionnaire by parents/carers with children aged under 5 years participating in a series of home safety case-control studies. Methods The questionnaire measured safety behaviours, safety equipment use and hazards being used as exposures in five case-control studies. Responses to questions were compared with observations made during a home visit. The researchers making observations were blind to questionnaire responses. Results In total, 162 families participated in the study. Overall agreement between reported and observed values of the safety practices ranged from 48.5% to 97.3%. Only 3 safety practices (stair gate at the top of stairs, stair gate at the bottom of stairs, stairs are carpeted) had substantial agreement based on the κ statistic (k=0.65, 0.72, 0.74, respectively). Sensitivity was high (≥70%) for 19 of the 30 safety practices, and specificity was high (≥70%) for 20 of the 30 practices. Overall for 24 safety practices, a higher proportion of respondents over-reported than under-reported safe practice (negative predictive value>positive predictive value). For six safety practices, a higher proportion of respondents under-reported than over-reported safe practice (negative predictive value<positive predictive value). Conclusions This study found that the validity of self-reports varied with safety practice. Questions with a high specificity will be useful for practitioners for identifying households who may benefit from home safety interventions and will be useful for researchers as measures of exposures or outcomes.
Collapse
Affiliation(s)
- Michael Watson
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Penny Benford
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Carol Coupland
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Rose Clacy
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Paul Hindmarch
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Toity Deave
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Denise Kendrick
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | | |
Collapse
|
39
|
Deave T, Towner E, McColl E, Reading R, Sutton A, Coupland C, Cooper N, Stewart J, Hayes M, Pitchforth E, Watson M, Kendrick D. Multicentre cluster randomised controlled trial evaluating implementation of a fire prevention Injury Prevention Briefing in children's centres: study protocol. BMC Public Health 2014; 14:69. [PMID: 24450931 PMCID: PMC3913957 DOI: 10.1186/1471-2458-14-69] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 01/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The UK has one of the highest fatality rates for deaths from fire-related injuries in children aged 0-14 years; these injuries have the steepest social gradient of all injuries in the UK. Children's centres provide children under five years old and their families with a range of services and information, including home safety, but their effectiveness in promoting injury prevention has yet to be evaluated. We developed a fire prevention intervention for use in children's centres comprising an Injury Prevention Briefing (IPB) which provides evidence on what works and best practice from those running injury prevention programmes, and a facilitation package to support implementation of the IPB. This protocol describes the design and methods of a trial evaluating the effectiveness and cost-effectiveness of the IPB and facilitation package in promoting fire prevention. METHODS/DESIGN Pragmatic, multicentre cluster randomised controlled trial, with a nested qualitative study, in four study centres in England. Children's centres in the most disadvantaged areas will be eligible to participate and will be randomised to one of three treatment arms comprising: IPB with facilitation package; IPB with no facilitation package; usual care (control). The primary outcome measure will be the proportion of families who have a fire escape plan at follow-up. Eleven children's centres per arm are required to detect an absolute difference in the percentage of families with a fire escape plan of 20% in either of the two intervention arms compared with the control arm, with 80% power and a 5% significance level (2-sided), an intraclass correlation coefficient of 0.05 and assuming outcomes are assessed on 20 families per children's centre. Secondary outcomes include the assessment of the cost-effectiveness of the intervention, other fire safety behaviours and factors associated with degree of implementation of the IPB. DISCUSSION This will be the first trial to develop and evaluate a fire prevention intervention for use in children's centres in the UK. Its findings will be generalisable to children's centres in the most disadvantaged areas of the UK and may also be generalisable to similar interventions to prevent other types of injury. TRIAL REGISTRATION http://NCT01452191 (date of registration: 13/10/2011).
Collapse
Affiliation(s)
- Toity Deave
- Centre for Child & Adolescent Health, Health & Life Sciences, University of the West of England Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - Elizabeth Towner
- Centre for Child & Adolescent Health, Health & Life Sciences, University of the West of England Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - Elaine McColl
- Newcastle Clinical Trials Unit, 4th Floor, William Leech Building, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK
| | - Richard Reading
- Jenny Lind Paediatric Department, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK
| | - Alex Sutton
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Carol Coupland
- Division of Primary Care, School of Medicine, Tower Building, University Park, Nottingham NG7 2RD, UK
| | - Nicola Cooper
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Jane Stewart
- Division of Primary Care, School of Medicine, Tower Building, University Park, Nottingham NG7 2RD, UK
| | - Mike Hayes
- Child Accident Prevention Trust, Canterbury Court (1.09), 1 - 3 Brixton Road, London SW9 6DE, UK
| | - Emma Pitchforth
- London School of Economics Health, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
| | - Michael Watson
- School of Health Sciences, D86, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2HA, UK
| | - Denise Kendrick
- Division of Primary Care, School of Medicine, Tower Building, University Park, Nottingham NG7 2RD, UK
| |
Collapse
|
40
|
Deave T, Goodenough T, Stewart J, Towner E, Majsak-Newman G, Hawkins A, Coupland C, Kendrick D. Contemporary hazards in the home: keeping children safe from thermal injuries. Arch Dis Child 2013; 98:485-9. [PMID: 23592729 DOI: 10.1136/archdischild-2012-302901] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the knowledge and reported thermal injury prevention practices among parents of children aged 0-4 years in disadvantaged areas. METHODS Parents of pre-school children in Children's Centres in four study areas in England (Nottingham, Newcastle, Norwich and Bristol) were interviewed using a structured schedule. Interviews covered smoke alarms, bedtime routines, fire escape plans, other thermal prevention practices and parental knowledge of first aid. RESULTS Of the 200 respondents, most reported ownership of at least one smoke alarm (n=191, 96%), of which 95% were working. Half reported a fire prevention bedtime routine (n=105, 53%) or fire escape plan (n=81, 42%). Most parents had matches or lighters in the home (n=159, 80%), some stored where children under 5 years of age could reach them (n=30, 19%). There was a high prevalence of irons (n=188, 94%) and hair straighteners (n=140, 70%). A third of both devices were used daily. Just 17 (12%) parents reported leaving hair straighteners, when hot but not in use, in a heatproof bag. Knowledge of correct initial first aid for a small burn was good (n=165, 83%), but parents reported other potentially harmful actions, for example, applying ointment (n=44, 22%). CONCLUSIONS Most families report at least one working smoke alarm, but many do not have fire escape plans or fire prevention bedtime routines. A number of reported practices could compromise child safety, such as storage of matches or lighters and leaving hair straighteners to cool unprotected. Reappraisal of health promotion messages, in light of new household consumables, is necessary.
Collapse
Affiliation(s)
- Toity Deave
- Centre for Child & Adolescent Health, Health and Life Sciences, University of the West of England, Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK.
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Jones M, Kimberlee R, Deave T, Evans S. The role of community centre-based arts, leisure and social activities in promoting adult well-being and healthy lifestyles. Int J Environ Res Public Health 2013; 10:1948-62. [PMID: 23665850 PMCID: PMC3709358 DOI: 10.3390/ijerph10051948] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 05/02/2013] [Accepted: 05/08/2013] [Indexed: 11/17/2022]
Abstract
Developed countries are experiencing high levels of mental and physical illness associated with long term health conditions, unhealthy lifestyles and an ageing population. Given the limited capacity of the formal health care sector to address these public health issues, attention is turning to the role of agencies active in civil society. This paper sought to evaluate the associations between participation in community centre activities, the psycho-social wellbeing and health related behaviours. This was based on an evaluation of the South West Well-being programme involving ten organisations delivering leisure, exercise, cooking, befriending, arts and crafts activities. The evaluation consisted of a before-and-after study with 687 adults. The results showed positive changes in self-reported general health, mental health, personal and social well-being. Positive changes were associated with diet and physical activity. Some activities were different in their outcomes-especially in cases where group activities were combined with one-to-one support. The results suggest that community centre activities of this nature offer benefits that are generically supportive of health behaviour changes. Such initiatives can perform an important role in supporting the health improvement objectives of formal health care services. For commissioners and partner agencies, accessibility and participation are attractive features that are particularly pertinent to the current public health context.
Collapse
Affiliation(s)
- Mat Jones
- Department of Health and Applied Social Studies, University of the West of England, Bristol, BS16 1DD, UK; E-Mail:
| | - Richard Kimberlee
- Department of Health and Applied Social Studies, University of the West of England, Bristol, BS16 1DD, UK; E-Mail:
| | - Toity Deave
- Centre for Child & Adolescent Health, University of the West of England, Bristol, BS8 2BN, UK; E-Mail:
| | - Simon Evans
- Institute of Health & Society, University of Worcester, Worcester, WR2 6AJ, UK; E-Mail:
| |
Collapse
|
42
|
Mytton JA, Towner EM, Kendrick D, Stewart-Brown S, Emond A, Ingram J, Blair PS, Powell J, Mulvaney C, Thomas J, Deave T, Potter B. The First-aid Advice and Safety Training (FAST) parents programme for the prevention of unintentional injuries in preschool children: a protocol. Inj Prev 2013; 20:e2. [PMID: 23302145 DOI: 10.1136/injuryprev-2012-040689] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Unintentional injury is the leading cause of preventable death in children in the UK, and 0-4-year-olds frequently attend emergency departments following injuries in the home. Parenting programmes designed to support parents, promote behaviour change and enhance parent-child relationships have been shown to improve health outcomes in children. It is not known whether group-based parenting programmes have the potential to prevent unintentional injuries in preschool children. METHODS A study to develop a group-based parenting programme to prevent unintentional home injuries in preschool children, and assess the feasibility of evaluation through a cluster-randomised controlled trial. The intervention, designed for parents of children who have sustained a medically attended injury, will be developed with two voluntary sector organisations. The feasibility study will assess ability to recruit parents, deliver the programme and follow-up participants. Participants will complete questionnaires at baseline, 3 months and 6 months, and report injuries in their preschool children using a tool designed and validated for this study. Qualitative methods will assess user and deliverer perceptions of the programme. DISCUSSION This study will develop the first group-based parenting programme to prevent injuries in preschool children, and design tools for parent-reported injury outcomes. A key challenge will be to recruit parents to participate in a manner that is non-stigmatising, and does not result in feelings of guilt or belief that they are perceived to be a bad parent. The findings will be used to prepare a trial to assess the effectiveness and cost-effectiveness of the intervention.
Collapse
Affiliation(s)
- Julie A Mytton
- University of the West of England, Bristol, Centre for Child and Adolescent Health, , University of the West of England, Bristol, UK
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Deave T, Towner E, Baset MK, Brussoni M, Pant P. CHILD INJURY PREVENTION AND THE UN CONVENTION ON THE RIGHTS OF THE CHILD. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040580b.8] [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]
|
44
|
Hayes M, Towner E, Kendrick D, Deave T, Stewart J. Implementation matters: developing an injury prevention briefing. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590d.68] [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: 11/04/2022]
|
45
|
Ingram JC, Deave T, Towner E, Errington G, Kay B, Kendrick D. Identifying facilitators and barriers for home injury prevention interventions for pre-school children: a systematic review of the quantitative literature. Health Educ Res 2012; 27:258-68. [PMID: 21873613 PMCID: PMC3529629 DOI: 10.1093/her/cyr066] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 07/06/2011] [Indexed: 05/21/2023]
Abstract
Injuries are the leading cause of childhood death internationally; steep social gradients exist in mortality and morbidity. The majority of pre-school injuries occur in the home, but implementing research into practice for injury prevention has received little attention. This systematic review describes key facilitators and barriers when implementing injury prevention interventions. The review used articles included in a Cochrane systematic review of the effectiveness of home safety education, with or without the provision of safety equipment. Each paper was screened to ensure that children under 5 years, intervention details and process measures and/or barriers and facilitators were included. Two authors independently reviewed each paper and extracted data. Themes were identified and framework analysis used in an iterative process. Ninety-nine papers were identified, 42 excluded and 57 included in the analysis. Seven facilitators and six barriers were identified. Facilitators related to the approach used, focused messages, minimal changes, deliverer characteristics, equipment accessibility, behaviour change and including incentives. The barriers included complex interventions, cultural, socio-economic, physical and behavioural barriers and deliverer constraints. Barriers and facilitators should be addressed when implementing injury prevention interventions and studies should explicitly explore factors that help or hinder the process.
Collapse
Affiliation(s)
- Jenny C. Ingram
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK
- Correspondence to: Jenny C. Ingram. E-mail:
| | - Toity Deave
- Centre for Child and Adolescent Health, Faculty of Health and Applied Social Sciences, University of the West of England, Bristol BS8 2BN, UK
| | - Elizabeth Towner
- Centre for Child and Adolescent Health, Faculty of Health and Applied Social Sciences, University of the West of England, Bristol BS8 2BN, UK
| | - Gail Errington
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, NG7 2HA, UK
| | - Bryony Kay
- Bristol Royal Hospital for Children, University Hospitals Bristol NHSFT, Bristol BS2 8BJ, UK
| | - Denise Kendrick
- Division of Primary Care Research, University of Nottingham, Nottingham, NG7 2RD, UK
| |
Collapse
|
46
|
Webb CM, Collin SM, Deave T, Haig-Ferguson A, Spatz A, Crawley E. What stops children with a chronic illness accessing health care: a mixed methods study in children with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). BMC Health Serv Res 2011; 11:308. [PMID: 22078101 PMCID: PMC3228771 DOI: 10.1186/1472-6963-11-308] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 11/11/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Paediatric Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is relatively common and disabling with a mean time out of school of more than one academic year. NICE guidelines recommend referral to specialist services immediately if severely affected, within 3 months if moderately affected and within 6 months if mildly affected. However, the median time-to-assessment by a specialist service in the UK is 18 months. This study used a mixed-methods approach to examine factors associated with time taken to access specialist services. METHODS Time-to-assessment was analysed as a continuous "survival-time" variable in Cox regression models using data from self-completed assessment forms for children attending a regional specialist CFS/ME service between January 2006 and December 2009. Semi-structured interviews about barriers experienced in accessing healthcare for their child were conducted with nine parents of children aged < 17 years (8 individual and one parent couple). Interviews were digitally recorded and analysed using "thematic analysis". RESULTS 405 children were assessed between 2006 and 2009 and information on school attendance was available on 388. Only 1/125 with severe CFS/ME and 49/263 (19%) with mild to moderate CFS/ME were seen within NICE recommended timeframe. Increased fatigue was associated with shorter time to assessment (HR = 1.15; 95% CI 1.03, 1.29 per unit increase in Chalder fatigue score; P = 0.01). Time-to-assessment was not associated with disability, mood, age or gender. Parents described difficulties accessing specialist services because of their own as well as their GP's and Paediatrician's lack of knowledge. They experienced negative attitudes and beliefs towards the child's condition when they consulted GPs, Paediatricians and Child Psychiatrists. Parents struggled to communicate an invisible illness that their child and not themselves were experiencing. CONCLUSIONS GPs, Child Psychiatrists and Paediatricians need more knowledge about CFS/ME and the appropriate referral pathways to ensure timeliness in referral to specialist services.
Collapse
Affiliation(s)
- Carly M Webb
- St George's University of London, Cranmer Terrace, London, UK
| | - Simon M Collin
- Centre for Child and Adolescent Health, School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Toity Deave
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Andrew Haig-Ferguson
- Centre for Child and Adolescent Health, School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Amy Spatz
- St George's University of London, Cranmer Terrace, London, UK
| | - Esther Crawley
- Centre for Child and Adolescent Health, School of Social & Community Medicine, University of Bristol, Bristol, UK
| |
Collapse
|
47
|
Goodenough T, Towner E, Kendrick D, Deave T, Stewart J. Keeping children safe at home: interview study of fire safety practices of parents of preschool children. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
48
|
Stewart J, Deave T, Goodenough T, Towner E, Kendrick D, Pitchforth E, Sealey P. Keeping children safe at home: qualitative study of children's centre managers and staff. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.874] [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]
|
49
|
Stewart J, Kendrick D, Towner E, Pitchforth E, Sealey P, Goodenough T, Deave T. Parents perceptions of barriers to and facilitators for injury prevention: a qualitative study. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.1001] [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: 11/04/2022]
|
50
|
Chan CMS, Deave T, Greenhalgh T. Obesity in Hong Kong Chinese preschool children: where are all the nurses? J Pediatr Nurs 2010; 25:264-73. [PMID: 20620807 DOI: 10.1016/j.pedn.2009.02.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 02/05/2009] [Accepted: 02/15/2009] [Indexed: 10/20/2022]
Abstract
We report an ethnographic study of 10 preschool children aged 2-6 years recruited from kindergartens in Hong Kong, 6 of whom were overweight or obese. Each was followed for 12-18 months. We confirmed previously described risk factors and showed how these interacted to produce obesity in some but not all at-risk children. Despite much rhetoric in the literature about holistic care of the preschool child, we were struck by the lack of coordinated professional input to the needs of children at risk of obesity and by the absence of nursing input in particular. We argue that a "whole-systems" nursing role, based in the community and with remit that includes clinical care, education, and policy, is urgently needed, as well as review examples of such roles from other countries.
Collapse
Affiliation(s)
- Christine M S Chan
- Department of Early Childhood Education, The Hong Kong Institute of Education, Tai Po, New Territories, Hong Kong.
| | | | | |
Collapse
|