• Gaining employment: The experience of students at a further education college for individuals with learning disabilities

      Skellern, Joanne; Astbury, Geoff; University of Chester (Wiley, 2012-01-02)
      Employment is widely acknowledged as a key factor to social inclusion, but it is estimated that <7% of people with learning disabilities are in paid employment. It was the aim of the research study to critically examine the experience of gaining employment from the perspectives of students with learning disabilities, parents, education staff and employers. All participants were recruited from one collaborating UK organisation, a college offering further education for young people with learning disabilities. Twenty-three interviews were conducted. Analysis of the data identified three themes surrounding the perceived roles of: Protector, Rescuer and Worker. Recommendations are discussed to improve collaborative working between student, parent, education staff and employer to overcome some of the difficulties influencing employment rates and contribute to the empowerment and inclusion of people with learning disabilities in society.
    • A genetic approach to examine the relationship between vitamin B12 status and metabolic traits in a South Asian population

      Surendran, S; Alsulami, S; Lankeshwara, R; Jayawardena, R; Wetthasinghe, K; Sarkar, S; Ellahi, B; Lovegrove, JA; Anthony, D; Vimaleswaran, KS; et al.
      Background: Observational studies in South Asian populations have suggested an association between vitamin B12 status and metabolic traits; however, the findings have been inconclusive. Hence, the aim of the present study was to use a genetic approach to explore the relationship between metabolic traits and vitamin B12 status in a Sri Lankan population and to investigate whether these relationships were modified by dietary intake. Methods: A total of 109 Sinhalese adults (61 men and 48 women aged 25-50 years), from Colombo city underwent anthropometric, biochemical, dietary intake analysis and genetic tests. Genetic risk scores (GRS) based on 10 metabolic single nucleotide polymorphisms (SNPs) (metabolic-GRS) and 10 vitamin B12 SNPs (B12-GRS) were constructed. Results: The B12-GRS was significantly associated with serum vitamin B12 (P=0.008), but not with metabolic traits (P>0.05); whereas, the metabolic-GRS had no effect on metabolic traits (P>0.05) and vitamin B12 concentrations (P>0.05). An interaction was observed between B12-GRS and protein energy intake (%) on waist circumference (P=0.002). Interactions were also seen between the metabolic-GRS and carbohydrate energy intake (%) on waist to hip ratio (P=0.015). Conclusion: Our findings suggest that a genetically lowered vitamin B12 concentration may have an impact on central obesity in the presence of a dietary influence; however, our study failed to provide evidence for an impact of metabolic-GRS on lowering B12 concentrations. Given that our study has a small sample size, further large studies are required to confirm our findings.
    • The Global Mental Health Assessment Tool Primary Care and General Health Setting Version (GMHAT/PC) – Spanish version: A validity and feasibility study

      Tejada, Paola A.; Jaramillo, Luís Eduardo; Marulanda, Jefferson; Sharma, Vimal; University of Chester; National University of Colombia; Cheshire and Wirral NHS Foundation Trust (University of Zaragoza, 2016-08-31)
      The study aims to assess the feasibility of using a computer assisted diagnostic interview by GPs and to examine the level of agreement between the Spanish version GMHAT/PC diagnosis and psychiatrists' ICD-10 based clinical diagnosis. Participants in the study ranged from those who were in remission to others who had different mental illnesses. They were recruited from inpatient and outpatient mental health settings. All consecutive patients were interviewed using Spanish version of GMHAT/PC and they were assessed independently by psychiatrists to in order to get their ICD-10 based diagnosis. Two hundred ninety-nine patients participated in the study. The mean duration of interview was 12.5 minutes. There is an acceptable to good level of agreement between the GP’s (GMHAT/PC) diagnoses and the psychiatrists’ (clinical) diagnoses of any mental illness, Kappa 0.58 95% C.I (0.46, 0.72). There is good level of sensitivity (81%) and specificity (92%), with GPs correctly identifying 242 out of the 250 participants diagnosed with mental illness and 27 out of 35 of those without. The finding of the study suggest that GMHAT/PC Spanish version used by GPs detected mental disorders accurately and it was feasible to use GMHAT/PC (Spanish version) in Latin America settings.
    • The Global Mental Health Assessment Tool Primary Care and General Health Setting Version (GMHAT/PC): A validity and feasibility study – Spanish version

      Sharma, V. K.; Tejada, Paola A. (University of Chester, 2017)
      BACKGROUND: There is an urgent need to provide training and tools to frontline health workers in order for them to properly diagnose and treat mental illnesses in Latin-American communities, since the vast majority of people with a mental illness suffer in silence. A computer-assisted interview, the Global Mental Health Assessment Tool (GMHAT/PC) has been developed to assist general practitioners and other health professionals to make a quick, convenient, yet reasonably comprehensive and standardised mental health assessment. GMHAT/PC has been translated into various languages including German, Dutch, Chinese, Hindi and Arabic. This is the first study, of a GMHAT/PC Spanish version carried out in Latin America, to establish its validity in that culture and feasibility to be used in the health care setting. If proven a valid tool through this study, the GMHAT/PC Spanish version will be an important aid towards improving the mental health of Spanish-speaking communities within the Latin-American region. AIM: The study aims at assessing both the validity of a GMHAT/PC Spanish version, and the feasibility of utilising a computer assisted diagnostic interview by GPs. DESIGN: 1) Validation study was planned to establish whether the GMHAT/PC based diagnosis compares well with the consultants ICD-10 based diagnosis (Gold Standard) 2) Feasibility study was carried out to examine whether GMHAT/PC can be used in routine clinical care in a general health setting. MATERIALS AND METHODS: In the first study (validation), participants varied from those who were in remission i.e. without much psychopathology to those had symptoms of a severe mental illness. They were recruited from in-patient (82%) and out-patient (18%) mental health settings in Colombia. The participants were expected to have a wide range of psychiatric diagnoses (anxiety disorders, depression, psychosis, bipolar affective disorder, organic mental disorders, and other diagnoses). All consecutive patients were interviewed by GPs using GMHAT/PC and psychiatrists made an independent diagnosis applying ICD-10 criteria. The second study (feasibility) was carried out on patients hospitalised at medical, surgical and women’s wards during a period of one month in each service. The diagnosis of a medical illness was made by specialists in each service. A trained GP carried out psychiatric assessment of all participants using GMHAT/PC. RESULTS: First study (validity): two hundred ninety-nine patients (n=299) participated, 54.18% males and 45.81% females in the age range of 14-78. All patients were interviewed independently by seven psychiatrists with over five years of clinical experience. The mean duration of GMHAT/PC interview was 12.5 minutes. Most patients were pleased that they were asked about every aspect of their mental health. Psychiatrists made a single diagnosis in 183 (61%) cases, multiple (two) diagnosis in 112 (37%) cases and multiple (three) diagnosis in another four cases. GMHAT/PC in almost all cases gave additional multiple diagnoses.The results show an acceptable-to-good level of agreement between the GPs’ (GMHAT/PC) diagnoses and the psychiatrists’ (clinical) diagnoses of any mental illness, Kappa 0.58- 95% C.I (0.46, 0.72). There is a good level of sensitivity (81%) and specificity (92%), with GPs correctly identifying 242 out of the 250 participants diagnosed with a mental illness, and 27 out of 35 of those who do not present any whatsoever. The agreement (kappa value) between GMHAT/PC diagnosis and psychiatrists ICD-10 based diagnosis of specific disorders were as follows: Organic disorders-0.87; Psychosis- 0.56; Depression-0.53; Mania-0.6, Alcohol and drug misuse- 0.62, Learning disorder- 0.4; Personality Disorder- 0.39 and Anxiety disorders- 0.14. The sensitivity of different disorders ranged from 63% (Mania) to 100% (Anxiety) and specificity from 71% (Anxiety) to 100% (organic). The second study (feasibility): out of 455 medically-ill patients, 4.8% had a mental illness identified by GMHAT/PC interview. Anxiety, depression and organic disorders were the most frequently identified mental disorders in internal medicine and surgery. Cancer had a significantly higher prevalence of comorbid mental illness. CONCLUSION: GMHAT/PC -Spanish version used by GPs in this study detected mental disorders accurately and it was feasible to use GMHAT/PC in Colombia and Latin-American health settings. The findings of this study will have a big impact upon mental health service provision in Spanish-speaking nations within the Latin-American region as the Spanish version for GMHAT/PC will assist primary care physicians and other health workers in detecting and managing mental health disorders in the communities. There is no other comparable easy-to-use comprehensive mental health diagnostic tool available in Spanish.
    • Good death

      Baldwin, Moyra A.; Woodhouse, Jan; University of Chester (2010-10-15)
      This book chapter discusses the concept of a good death.
    • GP practice pharmacist collaboration

      Khan, Nahim; University of Chester (Chemist and Druggist, 2016-06-11)
      This is a short case study how community pharmacy and pharmacists part of the NHS England GP Practice Pharmacy Pilot can work together to each others' benefit.
    • A grounded theory study to explore how clinical nurses undertaking research as master's students accommodate and adjust to the experience

      Thomas, Mike; Keen, Adam (University of Chester, 2016-02)
      Taught master's degree programmes represent a popular mechanism for part-time students to access postgraduate level education. A common feature of such programmes is the inclusion of some form of independent research project. Whilst such projects are recognised as being demanding for the students involved, there is a scarcity of research literature that explores their experiences. In this study I have now explored how clinical nurses, as an example of a particular professional group, accommodated and adjusted to the experience of undertaking part-time master's research. My intent was to contribute to the body of knowledge relating to the support of part-time students undertaking master's research.
    • Guest editorial

      Skellern, Joanne; University of Chester (Emerald, 2016-06-13)
      This is the editorial for a special edition entitled 'Intellectual Disabilities: Nursing' of the Journal of Intellectual Disabilities and Offending Behaviour.
    • Guest Editorial

      Harlow, Elizabeth; Izod, Karen; University of Chester; University of the West of England (Taylor and Francis, 2015-06-01)
      This guest editorial introduces the special edition on the supervision of social work practice
    • The handbook of midwifery research

      Steen, Mary; Roberts, Taniya; University of Chester (Wiley-Blackwell, 2011-03-04)
      Part 1 - starts with a chapter on Introduction to Midwifery Research which sets the scene and covers an understanding of the general principles of research, the importance of the research question, the approaches that can be undertaken, the differences between these and the importance of applying evidence to midwifery practice. Chapter 2 - Finding the Evidence, explains in detail how to undertake a literature review, the sources of evidence available, how to use a search strategy and gives useful examples. In addition, midwifery related structured and systematic reviews are described and discussed in an attempt to promote a better understanding of how to undertake these aspects of research. Chapter 3 — Making Sense of the Evidence, covers the critiquing aspects of research evidence, gives an insight into how evidence is graded and clearly differentiates the differences between qualitative and quantitative approaches. Part 2 —focuses on how to undertake research and includes four chapters. Data collection techniques cover both qualitative and quantitative methods and are the focus of chapter 4. This chapter gives specific details on how to undertake a research interview and how to design a questionnaire as these will be the most likely data collection tools a midwife or student will make use of. Chapter 5 - ethics and research governance introduces the role of ethics when undertaking research and discusses the importance of research governance. Ethical issues relating to midwifery research are considered and specific details on how to obtain ethical approval is addressed to help midwives and students achieve this successfully. Data analysis is the focus of chapter 6. An introduction to data analysis which is followed by specific sections of both qualitative and quantitative analysis methods is covered and a basic understanding of statistics is also included to help midwives and students link the type of data collected with the appropriate statistical test required to analyse a specific type of data (fit for purpose). Finally, dissemination and the research dissertation/thesis are the focus of chapter 7. Writing skills and how to structure your dissertation/thesis is described and discussed. Guidelines and advice on how to get your work published and presenting a conference paper are given. A specific section on useful resources and becoming a researcher brings the book to a close.
    • The health consultation experience for people with learning disabilities: A constructivist grounded theory study based on symbolic interactionism

      Chapman, Hazel M. (University of Chester, 2014-06-09)
      Aims. The aim of this study was to explore the effects of the health consultation experience for people with learning disabilities, particularly in terms of their self-concept Background. Annual health checks have been introduced as a reasonable adjustment for health providers to make in meeting the needs of people with learning disabilities, who experience significantly poorer health outcomes than the general population. Evaluation of the health consultation from the service user perspective can inform this service provision. Design. A constructivist grounded theory approach, based on symbolic interactionism, was used to explore the meaning of the health consultation experience for the person with learning disabilities, and its effects on their sense of self. Methods. Purposive and snowballing sampling was used to recruit 25 participants with learning disabilities through a GP practice, self-advocacy groups and a health facilitator. Nine individual interviews, three interviews with two participants, three focus groups (n=7, n=5 and n=3), and an audio-recorded health check consultation were carried out (with two participants interviewed twice and four attending two focus groups), as well as a member check used to assess the resonance of the findings. Data collection was undertaken in different primary care trusts across the north west of England. Data were subjected to constant comparative analysis, using a symbolic interactionist approach, to explore all aspects of the health consultation experience and its effects on the self. Findings. Current expectations, attitudes and feelings about health consultations were strongly influenced by previous experience. Participants negotiated their own reality within the consultation, which affected their self-concept and engagement with their health care. Respectful and secure health professional – service user relationships, developed over time, were central to an effective consultation. Perspectives on the consultation, and engagement within it, were co-constructed with a companion, who could help to promote the personhood of the service user with support from the health professional. Anxiety, embarrassment and felt stigma were identified as significant barriers to communication and engagement within the consultation. Conclusions. People with learning disabilities have similar health consultation needs and expectations to other people, but may have more difficulties in engaging with the process and building trusting relationships with the health professional, due to previous negative experiences, anticipated stigma and loss of self within health settings leading to a fear of disclosure. This, combined with difficulties in communication and cognitive processing, results in less satisfactory outcomes persisting over time. The effects of triadic consultations are generally positive, particularly where relatives or health facilitators are involved. However, continuity of companion as well as health professional is needed, and more service user engagement should be supported. Fundamental attitude change by health professionals, supported by specific educational initiatives to enhance their understanding of the service user perspective, is needed to reduce health inequalities. Participatory research by people with learning disabilities should inform future health care practice.
    • Health inequalities as a foundation for embodying knowledge within public health teaching: a qualitative study

      Mabhala, Mzwandile A.; University of Chester (BioMed Central, 2013-06-28)
      Introduction: Recent UK health policies identified nurses as key contributors to the social justice agenda of reducing health inequalities, on the assumption that all nurses understand and wish to contribute to public health. Following this policy shift, public health content within pre-registration nursing curricula increased. However, public health nurse educators (PHNEs) had various backgrounds, and some had limited formal public health training, or involvement in or understanding of policy required to contribute effectively to it. Their knowledge of this subject, their understanding and interpretation of how it could be taught, was not fully understood. Methodology This research aimed to understand how public health nurse educators’ professional knowledge could be conceptualised and to develop a substantive theory of their knowledge of teaching public health, using a qualitative data analysis approach. Qualitative in-depth semi-structured interviews (n=26) were conducted with eleven university-based PHNEs. Results Integrating public health into all aspects of life was seen as central to the knowing and teaching of public health; this was conceptualised as ‘embodying knowledge’. Participants identified the meaning of embodying knowledge for teaching public health as: (a) possessing a wider vision of health; (b) reflecting and learning from experience; and (c) engaging in appropriate pedagogical practices. Conclusion The concept of public health can mean different things to different people. The variations of meaning ascribed to public health reflect the various backgrounds from which the public health workforce is drawn. The analysis indicates that PHNEs are embodying knowledge for teaching through critical pedagogy, which involves them engaging in transformative, interpretive and integrative processes to refashion public health concepts; this requires PHNEs who possess a vision of what to teach, know how to teach, and are able to learn from experience. Their vision of public health is influenced by social justice principles in that health inequalities, socioeconomic determinants of health, epidemiology, and policy and politics are seen as essential areas of the public health curriculum. They believe in forms of teaching that achieve social transformation at individual, behavioural and societal levels, while also enabling learners to recognise their capacity to effect change.
    • Health literacy: The public health perspective

      Horah, Mike; Mabhala, Mzwandile A.; Department of Health ; University of Chester (SAGE, 2008-11-20)
      This book chapter discusses health literary and how general literacy as a key determinant of health.
    • Health professionals’ responses to women’s disclosure of domestic violence

      Keeling, June J.; Fisher, Colleen; University of Chester ; University of Western Australia (SAGE, 2014-10-20)
      This study explored women’s experiences of their responses from health professionals following disclosure of domestic violence within a health setting. The existence of health based policies guiding professionals in the provision of appropriate support following disclosure of domestic violence is only effective if health professionals understand the dynamics of violent relationships. This paper focuses on the findings from the interviews conducted with fifteen women living in the UK who disclosed their experiences of domestic violence when accessing healthcare. Following thematic analysis, themes emerged that rotated around their disclosure and the responses they received from health professionals. The first two themes revealed the repudiation of, or recognition of and failure to act upon, domestic violence. A description of how the health professional’s behaviour became analogous with that of the perpetrator is discussed. The final theme illuminated women’s’ receipt of appropriate and sensitive support, leading to a positive trajectory away from a violent relationship. The findings suggest that the implicit understanding of the dynamics of violent relationships and the behaviours of the perpetrator of domestic violence are essential components of health care provision to avoid inadvertent inappropriate interactions with women.
    • Health Promoting Behaviours and Lifestyle Characteristics of Students at Seven Universities in the UK

      El Ansari, Walid; Stock, Christiane; John, Jill; Deeny, Pat; Phillips, Ceri; Snelgrove, Sherrill; Adetunji, Hamed; Hu, Xiaoling; Parke, Sian; Stoate, Mary; et al. (PMID, 2011-12-01)
      AIMS: University students' wellbeing and health promoting and damaging behaviours are important and comprise many parameters. The purpose of this study was to assess a range of health behaviours and lifestyle characteristics of 3,706 undergraduate students from seven universities in England, Wales and Northern Ireland. We compared differences in these parameters between males and females, and across the participating universities. METHODS: A self-administered questionnaire assessed socio-demographic information (e.g., gender, age), nutrition, dietary intake and food consumption patterns, as well as the importance of healthy eating, three levels of physical activity, restful sleep, tobacco smoking, use of illicit substance (recreational drugs), frequency of binge drinking and problem drinking. The data was collected in 2007-2008. RESULTS: While females generally reported lower use of tobacco, illicit substances and alcohol (binge drinking/problem drinking) and consumed more fruits and vegetables, male students had a higher level of physical activity, consumed less sweets and had more restful sleep. When lifestyle characteristics of students were compared between the different universities we observed some 'clustering' of the parameters under study, whereby favourable health practices would be exhibited at some universities; and conversely, the clustering of less favourable practices exhibited at other participating sites. CONCLUSIONS: We conclude that only a minority of students exhibited positive health practices above recommended levels and the level of binge drinking and problem drinking was high. This calls for increased awareness of university administrators, leaders and policy makers to the risky health habits of their students. The observed clustering effects also indicate the need for local (university-specific) health profiles as basis and guidance for relevant health promotion programmes at universities
    • The Healthy Futures Project

      Rabie, Gabrielle; Evers, Jean; Olsen, Veronica; Byrne, Kevin; University of Chester (Gay Rabie, Jean Evers, Veronica Olsen, K.Byrne, 2017)
      This article discusses the formation of the Healthy Futures Network which is an informal network of schools in the North West who began meeting over a period of several months seeking to address issues relating to the Health and Wellbeing of young people. The health focus was mainly on Obesity and Physical activity. There was however a recognition of the need to address underlying contribution factors relating to health and wellbeing. In 2014, this informal “Network” became the ‘Healthy Futures Network’, a cross-sector partnership between the University of Chester and 8 schools from the North West of England funded by Health Education England (North). The Project was designed to assess how a collaborative network of schools at a regional/sub-regional level could work together to promote health and wellbeing, and to improve emotional health and wellbeing of their pupils. This project was also part of an engagement strategy for raising aspiration and awareness of potential career education opportunities within the NHS.
    • Historical developments

      Whitehead, Elizabeth; Carlisle, Caroline; Watkins, Caroline; Mason, Tom; Chester College of Higher Education ; University of Liverpool ; Manchester University ; Caswell Clinic/University of Glamorgan (Routledge, 2001-07-12)
      This book chapter discusses stigma and social exclusion within a historical context, focusing on the work of Durkheim, Goffman, Edward Jones, & Scambler.
    • Holism

      Baldwin, Moyra A.; Greenwood, Joanne M.; University of Chester (SAGE, 2010-10-15)
      This book chapter discusses how holism relates to the whole person.
    • Homelessness Is Socially Created: Cluster Analysis of Social Determinants of Homelessness (SODH) in North West England in 2020

      Mabhala, Mzwandile; Esealuka, Winifred Adaobi; Nwufo, Amanda Nkolika; Enyinna, Chinwe; Mabhala, Chelsea Nonkosi; Udechukwu, Treasure; Reid, John; Yohannes, Asmait; University of Chester; University of East Anglia; École des Hautes Études en Santé Publique; Asmait Skincare and Design
      Abstract: Poverty creates social conditions that increase the likelihood of homelessness. These include exposure to traumatic life experiences; social disadvantages such as poor educational experiences; being raised in a broken family, care homes or foster care; physical, emotional, and sexual abuse; and neglect at an early age. These conditions reduce people’s ability to negotiate through life challenges. This cross-sectional study documents the clustering and frequency of adverse social conditions among 152 homeless people from four cities in North West England between January and August 2020. Two-step cluster analysis showed that having parents with a criminal record, care history, and child neglect/abuse history was predictive of homelessness. The cluster of indicator variables among homeless people included sexual abuse (χ2 (N = 152) = 220.684, p < 0.001, Cramer’s V = 0.7), inappropriate sexual behaviour (χ2 (N = 152) = 207.737, p < 0.001, Cramer’s V = 0.7), emotional neglect (χ2 (N = 152) = 181.671, p < 0.001, Cramer’s V = 0.7), physical abuse by step-parent (χ2 (N = 152) = 195.882, p < 0.001, Cramer’s V = 0.8), and physical neglect (χ2 (N = 152) = 205.632, p < 0.001, Cramer’s V = 0.8). Poverty and homelessness are intertwined because of the high prevalence of poverty among the homeless. Poverty sets up a chain of interactions between social conditions that increase the likelihood of unfavourable outcomes: homelessness is at the end of the interaction chain. Interventions supporting families to rise out of poverty may also reduce entry into homelessness.
    • Homeopathic remedies for self-adminstration during childbirth

      Calvert, Jan; Steen, Mary; Leeds Complementary Therapy Centre; Royal College of Midwives/University of Central Lancashire (Mark Allen Publishing, 2007-03)
      The first of two articles. This article discusses a study that assessed the usage and impact of providing a self-administered kit of homeopathic remedies at the end of pregnancy, childbirth, and post-childbirth. The study was undertaken at the hospital and at home. Nineteen women in south Leeds participated in this study between September 2005 and February 2006.