Now showing items 21-40 of 538

    • Midwifery and psychological care

      Jones, Alun Charles (Mark Allen Group, 2018-12-02)
    • Sugar sweetened beverage consumption in the early years and implications for type 2 diabetes: A sub-Saharan Africa context

      Audain, Keiron; Levy, Louis; Ellahi, Basma; University of Zambia; Public Health England; University of Chester (Cambridge University Press, 2018)
      This review aims to explore trends of early consumption of sugar-sweetened beverages (SSBs) in Sub-Saharan Africa (SSA), within the context of growing child and adolescent obesity and escalating type-2 diabetes prevalence. We explore efforts to mitigate these, drawing on examples from Africa and elsewhere. SSBs including carbonated drinks and fruit juices, play a contributory role in the development of obesity and associated non-communicable diseases. SSA is an attractive market for beverage companies owing to its rapid economic growth, growing middle class and youthful populations. SSBs already contribute significantly to total sugar and energy consumption in SSA where a plethora of marketing techniques targeted at younger people are utilised to ensure brand recognition and influence purchasing and brand loyalty. Coupled with a general lack of nutrition knowledge or engagement with preventative health, this can lead to frequent consumption of sugary drinks at a young age. Many high and some middle income countries public health efforts address increasing prevalence of obesity and type-2 diabetes by focussing on strategies to encourage reduction in sugar consumption via health policy and public education campaigns. However, similar efforts are not as developed or forthcoming in low-income countries. Health care systems across SSA are ill-prepared to cope with epidemic proportions of non-communicable diseases, particularly when contextualized with the ongoing battle with infectious diseases. We conclude that greater efforts by governments and the nutrition community to educate the public on the health effects of increased and excessive consumption of SSBs are necessary to help address this issue.
    • Older adults and violence: An analysis of domestic homicide reviews in England involving adults over 60 years of age

      Benbow, Susan Mary; Bhattacharyya, Sarmishtha; Kingston, Paul; University of Chester; Older Mind Matters; Betsi Cadwaladr University Health Board (Cambridge University Press, 2018-01-11)
      Domestic Homicide Reviews (DHRs) are conducted when an individual aged 16 or over appears to have died from violence, abuse or neglect by a person to whom they are related or with whom they are in an intimate relationship or who is a member of the same household. DHRs aim to identify lessons to be learned, to improve service responses to domestic abuse, and to contribute to prevention of domestic abuse/ homicide. We submitted freedom of information requests to English Local Authorities to identify DHRs where victim, perpetrator, or both were aged over 60. Collected Reports and/ or Executive Summaries were thematically analysed. Analysis identified four key themes in the context of the key relationship and caring: major mental illness of the perpetrator; drug and/or alcohol abuse; financial issues; and a history of domestic abuse in key or family relationships. We analysed 14 adult family homicides, 16 intimate partner homicides, and five homicide-suicides. Age per se did not emerge as a significant factor in our analysis. Terminology needs to be standardised, and training/ education regarding risk assessment improved in relation to age, myths around ageing/ dementia, and stresses of caring. Management of mental illness is a key factor. A central repository of DHR Reports accessible for research and subject to regular review would contribute to maximising learning and improving practice.
    • Inhibitor clinical burden of disease: a comparative analysis of the CHESS data.

      Oladapo, Abiola O; email:; Lu, Mei; Walsh, Shaun; O'Hara, Jamie; Kauf, Teresa L (2018-11-09)
      BACKGROUND:Patients with hemophilia and inhibitors generally face greater disease burden compared to patients without inhibitors. While raising awareness of relative burden may improve the standard of care for patients with inhibitors, comparative data are sparse. Analyzing data drawn from the Cost of Haemophilia across Europe - a Socioeconomic Survey (CHESS) study, the aim of this study was to compare the clinical burden of disease in patients with severe hemophilia with and without inhibitors. Hemophilia specialists (N = 139) across five European countries completed an online survey between January-April 2015, providing demographic, clinical and 12-month ambulatory/secondary care activity data for 1285 patients. Patients with hemophilia who currently presented with inhibitors and those who never had inhibitors were matched on baseline characteristics via propensity score matching. Outcomes were compared between the two cohorts using a paired t-test or Wilcoxon signed-rank or McNemar's test. RESULTS:The proportion of patients who currently presented with inhibitors was 4.5% (58/1285). Compared to PS-matched patients without inhibitors, patients with inhibitors experienced more than twice the mean annual number of bleeds (mean ± standard deviation, 8.29 ± 9.18 vs 3.72 ± 3.95; p < .0001) and joint bleeds (2.17 ± 1.90 vs 0.98 ± 1.15; p < .0001), and required more hemophilia-related (mean ± standard deviation, 1.79 ± 1.83 vs 0.64 ± 1.13) and bleed-related hospitalizations (1.86 ± 1.88 vs 0.81 ± 1.26), hemophilia-related consultations (9.30 ± 4.99 vs 6.77 ± 4.47), and outpatient visits (22.09 ± 17.77 vs 11.48 ± 16.00) (all, p < .001). More than one-half (53.5%) experienced moderate/severe pain necessitating medication compared to one-third (32.8%) of patients without inhibitors (p = .01). CONCLUSIONS:Patients with hemophilia and inhibitors exhibited greater clinical burden and higher resource utilization compared to their peers without inhibitors. Strategies for improving the standard of care may alleviate burden in this population.
    • Being homeless in an unequal society: A qualitative analysis of stories of homeless people

      Mabhala, Mzwandile A. (Oxford University Press (OUP), 2018-11-21)
    • A Retrospective Cross Sectional Study of the Effectiveness of a Project in Improving Infant Health in Bwindi, South Western Uganda.

      Kamugisha, S Robert; Dobson, Andrew E; Stewart, Alex G; Haven, Nahabwe; Mutahunga, Birungi; Wilkinson, Ewan (2018-10-12)
      Introduction: Low-cost community-based interventions to improve infant health potentially offer an exciting means of progressing toward the Sustainable Development Goals (SDGs). However, the feasibility of such interventions in low-income settings remains unclear. Bwindi Community Hospital (BCH), Uganda implemented a 3-year nurse-led community project to address child-health issues. Nurses supported Community Health Volunteers (CHVs) and visited mothers pre- and/or postnatally to assess and educate mothers and infants. CHVs gathered data and gave basic advice on health and hygiene to mothers. We hypothesized that increased interventions by nurses and CHVs and increased contact with households, would improve health and reduce infant mortality. Methods: This was a retrospective cohort study analyzing routine data of all children born between January 2015 and December 2016. There were three interventions: antenatal nurse visit, postnatal nurse visit and CHV participation. Children received different numbers of interventions. We defined four diverse outcomes: facility-based delivery, immunization completeness, nutritional status, and infant mortality. Odds ratios, adjusted odds ratios, and multivariate logistic regression were used to assess associations between interventions and outcomes. Results: Of the 4,442 children born in 2015 and 2016, 91% were visited by a nurse (81% antenatally and 10% postnatally); 7% lived in villages with a high participating CHV. Households receiving a postnatal visit were more likely to complete immunization (aOR: 1.55, p = 0.016) and have the infant survive (aOR: 1.90, p = 0.05). Children from a hard-to-reach village (no road access) were less likely to be delivered in a health facility (aOR: 0.55, p < 0.001) and less likely to survive in their first year (aOR: 0.69, p = 0.03). Having two or more interventions was associated with a child having all four positive outcomes (aOR 0.78, p = 0.03). Lack of baseline data, a control area, or integrated assessment data limited more detailed evaluation. Conclusion: Visits to mothers after birth, by a nurse to educate and identify child illness, were associated with lower infant mortality and improved infant health as measured by completion of immunizations. Community health interventions could potentially have a greater impact if focused on hard-to-reach areas. Building evaluation into all project designs, whether local or internationally funded, would enable greater learning, and hence better use of resources.
    • Community-Based Health Insurance Increased Health Care Utilization and Reduced Mortality in Children Under-5, Around Bwindi Community Hospital, Uganda Between 2015 and 2017.

      Haven, Nahabwe; Dobson, Andrew E; Yusuf, Kuule; Kellermann, Scott; Mutahunga, Birungi; Stewart, Alex G; Wilkinson, Ewan (2018-10-09)
      Introduction: Out-of-pocket fees to pay for health care prevent poor people from accessing health care and drives millions into poverty every year. This obstructs progress toward the World Health Organization goal of universal health care. Community-based health insurance (CBHI) improves access to health care primarily by reducing the financial risk. The association of CBHI with reduced under-5 mortality was apparent in some voluntary schemes. This study evaluated the impact of eQuality Health Bwindi CBHI scheme on health care utilization and under-5 mortality in rural south-western Uganda. Methods: This was a retrospective cross-sectional study using routine electronic data on health insurance status, health care utilization, place of birth, and deaths for children aged under-5 in the catchment area of Bwindi Community Hospital, Uganda between January 2015 and June 2017. Data was extracted from four electronic databases and cross matched. To assess the association with health insurance, we measured the difference between those with and without insurance; in terms of being born in a health facility, outpatient attendance, inpatient admissions, length of stay and mortality. Associations were assessed by Chi-Square tests with p-values < 0.05 and 95% confidence intervals. For variables found to be significant at this level, multivariable logistic regression was done to control for possible confounders. Results: Of the 16,464 children aged under-5 evaluated between January 2015 and June 2017, 10% were insured all of the time 19% were insured for part of the period, and 71% were never insured. Ever having had health insurance reduced the risk of death by 36% [aOR; 0.64, p = 0.009]. While children were insured, they visited outpatients ten times more, and were four times more likely to be admitted. If admitted, they had a significantly shorter length of stay. If mother was uninsured, children were less likely to be born in a health facility [adjusted odds ratio (aOR) 2.82, p < 0.001]. Conclusion: This study demonstrated that voluntary CBHI increased health care utilization and reduced mortality for children under-5. But the scheme required appreciable outside subsidy, which limits its wider application and replicability. While CBHIs can contribute to progress toward Universal Health Care they cannot always be afforded.
    • Knowledge translation and the power of the nursing academic conference

      Finnegan, Alan; McGhee, Stephen; Roxburgh, Michelle; Kent, Bridie; University of Chester; University of South Florida; University of Highlands and Islands; University of Plymouth (Elsevier, 2018-11-08)
      The national and international conference experiences present a unique learning opportunity. There are differing events that reflect the full nursing employment spectrum from clinical delivery, organizational and policy development and academia in education and research. Many conferences provide a platform for academics with differing levels of experience to come together and welcome contributions from students and all grades of post-registration nurses, educationalists, administrators, and researchers. In selecting the programme, the conference organisers will often circulate a calling notice and potential presenters will submit their abstracts to be blind peer reviewed. Therefore, conferences showcase the best of the best and provide the current perspective of areas of growth within the nursing sector. Conferences have a plethora of delivery routes ranging from posters, oral presentations (both short and long), panel discussions, key notes, seminars, exhibitions and workshops. These present an exceptional chance to listen, present, network and discuss nursing innovation and academic research.
    • Why we must say goodbye to 'clinical' pharmacists

      Khan, Nahim; University of Chester (Royal Pharmaceutical Society of Great Britain, 2017-07-11)
      A response to a writing competition on the subject of 'the future pharmacist'.
    • Exploring Preceptorship Programmes: Implications for Future Design

      Taylor, Louise M; Eost-Telling, Charlotte L; Ellerton, Annie; University of Chester (John Wiley & Sons Ltd, 2018-11-15)
      • Aims and objectives: To review and analyse current preceptorship programmes within NHS trusts in the North West of England. To evaluate the pedagogic rigour of the programme and suggest recommendations to inform the future design of preceptorship programmes. • Background: Enhancing the retention of newly qualified staff is of particular importance given that the journey from a new registrant to a competent healthcare professional poses a number of challenges, for both the individual staff member and organisations. • Design: A mixed methods evaluative approach was employed, using online questionnaires and content analysis of preceptorship documentation. • Methods: Forty-one NHS trusts across the North West region employing newly qualified nurses were invited to participate in the completion of an online questionnaire. In addition, preceptorship programme documentation was requested for inclusion in the content analysis. This study utilised the SQUIRE (Standards for Quality Improvement Reporting Excellence) guidelines. • Results: The response rate for the questionnaire was 56.1% (n=23). Eighteen trusts (43.9%) forwarded their programme documentation. Findings highlighted the wide variation in preceptorship programmes across the geographical footprint. • Conclusions: There were instances of outstanding preceptorship and preceptorship programmes where there was a clear link between the strategic vision, i.e., trust policy, and its delivery, i.e. preceptorship offering. There was no one framework that would universally meet the needs of all trusts, yet there are key components which should be included in all preceptorship programmes. Therefore, we would encourage innovation and creativity in preceptorship programmes, cognisant of local context. Relevance to clinical practice: The significant shortage of nursing staff in England is an ongoing issue. Recruitment and retention are key to ameliorating the shortfall, and formal support mechanisms like preceptorship, can improve the retention of newly qualified staff. Understanding current preceptorship programmes is an important first step in establishing the fundamental building blocks of successful preceptorship programmes and enabling the sharing of exemplary good practice across organisations.
    • Views of old age psychiatrists on use of community treatment orders in ageing population in England and Wales - a pilot study

      Bhattacharyya, Sarmishtha; Bailey, Jan; Khan, Farooq; Kingston, Paul; Tadros, George; University of Chester (2017-05)
      Background Community Treatment orders (CTO) were introduced in England and Wales during the 2008 reformation of mental health legislation. There is scant research evidence regarding the use of CTOs with older adults (people aged 65 and over). Aims The aims were to explore old age psychiatrists’ rationale for using CTOs with older adults and its efficacy. Method A mixed-method approach with a quantitative questionnaire followed by a series of one-to-one semi-structured interviews was utilised. Results About half of respondents had used a CTO with an older adult and more than half reported they would be comfortable using CTOs with older adults. Data showed that CTOs were predominantly used with patients diagnosed with relapsing mental illnesses with few respondents considering its use in people with dementia. There was also evidence that older people were viewed as being compliant with treatment, which may reflect reality or a stereotype of older people. Conclusions Evidence suggested that old age psychiatrists perceived CTOs to have limited efficacy with older people, considering other legislation more appropriate to their care. Further research is recommended to explore whether CTOs are appropriate for older adults and whether respondents’ perception of treatment compliance is accurate.
    • The Global Mental Health Assessment Tool Primary Care and General Health Setting Version (GMHAT/PC) – Spanish version: A validity and feasibility study

      Tejada, Paola; 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)
      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.
    • Promoting a healthy diet in young adults: The role of nutrition labelling

      Buyuktuncer, Zehra; Ayaz, Aylin; Dedebayrakta, Damla; Inan-Eroglu, Elif; Ellahi, Basma; Besler, Halit Tanju; Hacettepe University; University of Chester; Eastern Mediterranean University (MDPI, 2018-09-20)
      The use of the nutrition facts label has been associated with healthy eating behaviours for adults. However, the relationship between nutrition facts label use and overall diet quality is not well known in young adults, a vulnerable group that acquire lifelong eating behaviours during this period of life. This study aimed to assess if the use of information on the nutrition facts label is associated with a higher diet quality in young adults. In this cross-sectional study, 958 university students, aged 18-34 years were recruited. Nutrition facts label use was recorded. Dietary intake was assessed using 24-hour dietary recall. Healthy Eating Index-2005 (HEI-2005) scores were calculated. HEI-2005 score was significantly associated with using nutrition facts label (P < 0.001). The mean total HEI-2005 score was 60.7±10.11, 62.4±11.43 and 67.1±12.23 respectively for Never, Sometimes and Every time users of nutrition facts label (P < 0.001). Subgroup scores of HEI-2005 for total fruits, whole fruits, total vegetables, whole grains, milk, oils, saturated fat, and calories from solid fat, alcohol and added sugar (SoFAAS) were significantly higher in regular nutrition facts label users (P < 0.05, for each). This study showed that young adults who regularly use nutrition facts label have a higher diet quality.
    • Visual Perceptions of Ageing; A Longitudinal Mixed Methods Study of UK Undergraduate Student Nurses’ Attitudes and Perceptions Towards Older People.

      Ridgway, Victoria; Mason-whitehead, Elizabeth; Mcintosh-Scott, Annette; University of Chester (Elsevier, 2018)
      Ageism and negative attitudes are said to be institutionally embedded in healthcare during a time when there are unprecedented increases in older population numbers. As nurses’ care for older people in a range of environments it was timely to examine attitudes and perceptions of undergraduate nurses towards older people. A longitudinal mixed methods study in conjunction with a three-year undergraduate UK nursing programme 2009-2012 was conducted with 310 undergraduate nurses. A questionnaire incorporating Kogan’s attitude towards older people scale and a drawing of a person aged 75 years was completed three times, once each year. Thurstone scale and photo elicitation were also employed. Comparisons were made between individual participant’s attitude score and drawing. The study established 75% of participants had moderately positive attitudes towards older people when the programme began, at the programme end this had increased to 98%. Age, gender, educational qualifications, practice learning, nursing field and contact with older people influenced participants’ overall attitude score. Drawings provided a visual narrative of participants’ perceptions of older people, appearance was a dominant discourse and the images were socially constructed. The study established the undergraduate nursing programme influenced attitudes and perceptions towards older people and suggests nurse education can influence changing attitudes. To date there is no known study that has advanced this understanding.
    • Elderly Persons Health and Wellbeing

      Ridgway, Victoria; University of Chester (2018)
      This chapter considers older persons’ health and wellbeing. As the world population changes there are global challenges to ensure that health and social care systems, individuals, communities and countries meet the needs of older people so that they are empowered to lead active and connected later lives. However, these opportunities are heavily dependent on two fundamental characteristics that of good health and wellbeing and healthy ageing. The conceptualisation of ‘being old or older’ first needs to be considered. The use of 65 as a parameter to measure old age is a political and social construct. Baar et al. (2014) for example noted the tendency to use 60 to 65 as the entrance point to old age and although useful to establish understanding writers in the field of gerontology have argued against such use. Culturally older age can occur from 50 upwards (Baar et al. 2014) as consequence of poor health, education, financial situation and environment and there is no typical older person (World Health Organisation (WHO) 2018a). Other authors have defined no age categorisation boundaries but have referred to a third and fourth age. The third age being conceptualised as a life period full of opportunity and good health and wellbeing, whilst the fourth age is perceived as a period of decline, increasing dependency and ultimately death (Higgs and Gilleard 2015). Therefore, being older is difficult to define and for this chapter 60 will be used as a ‘marker of old age’. There are two lenses from which society view and perceive older people, first by some they are considered a burden, a drain on resources and are less valued. Alternatively, older people are considered wise, dependable individuals who contribute to society, local communities and family life. The increasing older demographic has both immense potential for society but also comes with challenges. This chapter will explore population growth, perceptions of ageing, health and wellbeing in later life, factors that negate against healthy ageing and will end with preventive strategies
    • Stigma: Personality disorder and homicide in the U.K. red-top tabloid press, 2001-2012

      Lovell, Andy; McIntosh-Scott, Annette; Bowen, Matt (University of Chester, 2018-08-28)
      There is evidence of stigma towards people with personality disorder from within healthcare systems, but relatively little known about other aspects of stigmatisation. This study explored the image within the red-top tabloids of people with personality disorder who have committed homicide and how this may have contributed to the processes of stigmatisation. The analysis was underpinned by a symbolic interactionist perspective on individuals and society and was informed by the modified labelling model. The role the press plays in the processes of stigmatisation is elaborated through exploration of the theoretical models and empirical evidence. The data set for the thesis was articles published by the red-top tabloids between the years 2001 and 2012 (inclusively) that made reference to personality disorder. The data set was analysed using three methods: content analysis, corpus linguistics and frame analysis. The three methods were used in a mixed methods approach with a sequential design so that the results from one stage of the analysis fed into the next stage. The content analysis of the data set identified that of the 552 articles published about people with personality disorder, 42% met the criteria for being homicide themed. Analysis identified that there was a significant reduction in the proportion of homicide themed newspaper articles in the period 2007-2012 compared to 2001-2006 ((1, n=552) = 7.38, p < .05), however, the effect size was small (φ = .12). Corpus linguistics analysis was used on articles that were homicide themed and identified 22 words that were stigmatising in their use, and were used proportionally more frequently than a comparator data set. These words were categorised as either epithets (e.g. psycho, monster), qualities (e.g. evil) or contributing to the process of labelling (e.g. branded). Comparison between 2001-2006 and 2007-2012 identified a proportional increase in the use of stigmatising descriptors, but to a level that was not considered to be significant ((1, n=114110) = 1.53, p > .05). Frame analysis of the homicide data set identified a dominant news frame in the articles, referred to as lock them up and throw away the key. This news frame was structured on a model that the problem was a failure to protect us, the public, from the risk presented by them, dangerous people with personality disorder who commit homicide. The results of the study are discussed in relation to the model elaborated in the study of the role the red-top tabloids may play in the processes of stigmatisation. Implications for practice include using personality disorder in press guidance, and training for clinicians about attitudes towards people with personality disorder to include reviewing the impact of the press.
    • Real-world comparative analysis of bleeding complications and health-related quality of life in patients with haemophilia A and haemophilia B.

      Booth, Jason; Oladapo, Abiola; Walsh, Shaun; orcid: 0000-0002-3610-2602; O'Hara, Jamie; orcid: 0000-0001-8262-034X; Carroll, Liz; Garcia Diego, Daniel-Anibal; orcid: 0000-0001-9410-3825; O'Mahony, Brian; orcid: 0000-0001-9780-6972 (2018-08-09)
      Clinical severity and impact of haemophilia on quality of life have been generally considered to be lower for haemophilia B (HB) compared with haemophilia A (HA) patients. To compare annual bleeding rate (ABR), target joint development and health-related quality of life (HRQoL) between adult (≥18 years) severe HA and HB patients using recent data from the Cost of Haemophilia in Europe: a Socioeconomic Survey (CHESS) study. Multivariate generalized linear models (GLM) were constructed to assess the relationship between haemophilia type, ABR, HRQoL (derived from EQ-5D index scores) and the presence of target joints while controlling for covariates. Of the 1225 patients included, 77% (n = 949) had HA and 23% (n = 278) had HB. Of the 514 patients who completed the EQ-5D, 78% (n = 405) had HA, and 22% (n = 110) had HB. Unadjusted mean ABR was 3.79 in HA and 4.60 in HB. The presence of ≥1 target joint was reported in 59% and 54% of patients with HA and HB, respectively. Unadjusted mean EQ-5D index score was 0.78 in HA and 0.76 in HB. Haemophilia type was not a significant predictor of ABR, target joints or HRQoL when adjusted for confounding factors such as BMI, age and replacement therapy regimen. Data suggest comparable ABR, incidence of target joints and HRQoL between patients with HB and HA indicating comparable clinical severity and disease impact on patient quality of life. [Abstract copyright: © 2018 John Wiley & Sons Ltd.]
    • An evaluation of cognitive stimulation therapy sessions for people with dementia and a concomitant support group for their carers.

      Bailey, Jan; Kingston, Paul; Alford, Simon; Taylor, Louise; Tolhurst, Edward; University of Chester; Staffordshire University (SAGE, 2016-01-18)
      This research aimed to ascertain the impact of a pragmatic Cognitive Stimulation Therapy course of ten sessions on the cognitive function of people living with dementia and whether attending a concomitant carers support group was beneficial to carers. A mixed method quasi-experimental approach was adopted, data was collected pre and post intervention. The quantitative arm utilised three validated questionnaires rated by the carers. Qualitative data was collected via semi-structured interviews with carers regarding their perceptions of the impact of Cognitive Stimulation Therapy and the carers support group Quantitative data analysis found no statistically significant differences within or between groups. The qualitative data demonstrated that carers perceived Cognitive Stimulation Therapy had some benefits for the people living with dementia, especially social benefits. Carers also perceived that attending the carers support group was beneficial for them in terms of gaining a better understanding of dementia, developing coping skills and having peer support. The study was limited in scale and further research with a larger sample, using direct measures of the impact of Cognitive Stimulation Therapy with people living with dementia and supplementary research exploring which characteristic of carers support groups are effective would be worthwhile
    • Digital Mental Health in the Wild: An Adapted Grounded Theory Study

      Mitchell, Andrew; Bergin, Aislinn D (University of Chester, 2017-12)
      This study explores Digital Mental Health (DMH), referring to the use of digital technologies in mental health, from the perspective of users and system builders – individuals ‘in the wild’. Using an adapted constructive Grounded Theory Methodology (Charmaz, 2014), it qualitatively explores DMH and how it is applied to everyday life. Interviews with users, developers and academics were supported by data collected from extant documents and observations. Findings addressed the complexity of development and use, where differences in priority between the technical and clinical paradigms in development challenged the usability and usefulness for consumers of DMH. Changes implemented within, and the transience of, DMH resources were constructed by users as potentially distressing and difficult for system builders to mitigate. DMH is a new and emerging way to self-manage mental health. However, whilst it provides options, it does not inform as to how to choose and, whilst it supports change, it is not in itself motivating. In understanding the role of DMH it is essential to consider it alongside existing mental health prevention and management. DMH is constructed not as use of a single resource, but rather a toolkit for self-management where resources are used in different ways and at different times. Some will be integral whilst others may be used more occasionally. Many of the participants identified the difficulties and challenges of managing their mental health with only traditional tools and interventions available, and how DMH offered additional ways of doing so. DMH offers users autonomy and a way to explore their experiences in a simulated environment, contributing to its purpose as a supplement to existing mental health provision. Understanding how DMH can supplement the existing treatment and management of mental health is essential. One key area is addressing the opportunities provided by the simulative functions of new technologies and how mobile technologies have enabled these to become part of the everyday lives of so many people. Finally, the concept of Technology-asAdvocate was constructed to identify the ways that technology can help individuals to help themselves. This study recommends that DMH stakeholders invest and conduct further research that bring together clinical, technical and user paradigms to better understand how changes to devices and resources impact users. It positions DMH within the initial stages of help-seeking and addresses its role as one of many tools in the individual’s self-care. It proposes that technology be viewed as supporting self-advocacy and theorises that future technologies, such as personal assistants, be designed to advocate rather than to dictate. It is vital that policymakers recognise the impact of changes for users who find resources that support them in their mental health and apply them within their everyday life.