scholarly journals Telephone outreach by community workers to improve uptake of NHS Health Checks in more deprived localities and minority ethnic groups: a qualitative investigation of implementation

2019 ◽  
Vol 42 (2) ◽  
pp. e198-e206
Author(s):  
T J Stone ◽  
E Brangan ◽  
A Chappell ◽  
V Harrison ◽  
J Horwood
Keyword(s):  
Care Practice ◽  
Successful Implementation ◽  
Structured Interviews ◽  
Health Checks ◽  
Minority Ethnic Groups ◽  
Outreach Workers ◽  
Risk Assessment And Management ◽  
Minority Ethnic ◽  
Nhs Health Checks ◽  
Outreach Intervention

Abstract Background NHS Health Checks is a national cardiovascular risk assessment and management programme in England. To improve equity of uptake in more deprived, and Black, Asian and minority ethnic (BAME) communities, a novel telephone outreach intervention was developed. The outreach call included an invitation to an NHS Health Check appointment, lifestyle questions, and signposting to lifestyle services. We examined the experiences of staff delivering the intervention. Methods Thematic analysis of semi-structured interviews with 10 community Telephone Outreach Workers (TOWs) making outreach calls, and 5 Primary Care Practice (PCP) staff they liaised with. Normalization Process Theory was used to examine intervention implementation. Results Telephone outreach was perceived as effective in engaging patients in NHS Health Checks and could reduce related administration burdens on PCPs. Successful implementation was dependent on support from participating PCPs, and tensions between the intervention and other PCP priorities were identified. Some PCP staff lacked clarity regarding the intervention aim and this could reduce the potential to capitalize on TOWs’ specialist skills. Conclusions To maximize the potential of telephone outreach to impact equity, purposeful recruitment and training of TOWs is vital, along with support and integration of TOWs, and the telephone outreach intervention, in participating PCPs.

Users’ experiences of interpreters

Interpreting ◽  
2005 ◽  
Vol 7 (1) ◽  
pp. 77-95 ◽  
Author(s):  
Rosalind Edwards ◽  
Bogusia Temple ◽  
Claire Alexander
Keyword(s):  
Research Methodology ◽  
Community Context ◽  
Informal Networks ◽  
Structured Interviews ◽  
Policy And Practice ◽  
Personal Character ◽  
The People ◽  
Minority Ethnic Groups ◽  
Minority Ethnic ◽  
Gain Access

This article explores the experiences of people who need interpreters to gain access to and use of a range of services, drawing on semi-structured interviews with people from Chinese, Kurdish, Bangladeshi, Indian and Polish minority ethnic groups living in Manchester and London, UK. We describe our research methodology, and place the study in its political and community context. We look at the qualities the people we interviewed considered made for a good interpreter, and their experiences using both professional interpreters, and family and friends as interpreters. We show how personal character and trust are important in people’s understandings of good interpreting, leading them to prefer interpreters drawn from their own informal networks. We consider the implications of this for policy and practice.

scholarly journals Views of practice managers and general practitioners on implementing NHS Health Checks

2015 ◽  
Vol 17 (02) ◽  
pp. 198-205 ◽  
Author(s):  
Janet Krska ◽  
Ruth du Plessis ◽  
Hannah Chellaswamy
Keyword(s):  
General Practitioners ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Successful Implementation ◽  
North West ◽  
Health Checks ◽  
Nurse Workload ◽  
It Support ◽  
Barriers To Implementation ◽  
Nhs Health Checks

As part of an evaluation of a contract with general practices to deliver the national NHS Health Checks programme in Sefton, North West England, we surveyed general practitioners (GPs) and practice managers (PMs) in all 55 practices.The contract required practices to identify individuals from their practice registers with potentially high cardiovascular disease risk, and provide annual reviews. Responses were obtained from 43/178 GPs and 40/55 PMs representing 56 and 73% of practices, respectively. There was variation in many aspects of implementation. Time and software were viewed as barriers to implementation, the increased nurse workload impacted on other services and payments were insufficient to cover costs. The main enabler for successful implementation was IT support. Fewer than half the respondents viewed the programme as beneficial to their practice.Findings have been used to address many issues raised. Practices need more support from commissioners to help implement NHS Health Checks.

scholarly journals Implementation of a standard outcome set in perinatal care: a qualitative analysis of barriers and facilitators from all stakeholder perspectives

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anne L. Depla ◽  
Neeltje M. Crombag ◽  
Arie Franx ◽  
Mireille N. Bekker
Keyword(s):  
Thematic Analysis ◽  
Perinatal Care ◽  
Barriers And Facilitators ◽  
Care Practice ◽  
Successful Implementation ◽  
Structured Interviews ◽  
Policy Makers ◽  
Stakeholder Perspectives ◽  
Outcome Set ◽  
Patient Reported

Abstract Background To improve their quality, healthcare systems are increasingly focused on value delivered to patients. For perinatal care, the International Consortium for Health Outcomes Measurement (ICHOM) proposed a patient-centred outcome set with both clinical and patient-reported measures for pregnancy and childbirth (PCB set). This study aimed to identify factors that affect the implementation of the PCB set at the pre-implementation stage, using the consolidated framework for implementation research (CFIR). Methods In this qualitative study, we conducted semi-structured interviews amongst a purposive sample of key stakeholders within an obstetric care network (OCN): 1) patients, 2) perinatal care professionals involved in the full cycle of perinatal care, and 3) policy makers, including hospital managers, administrative staff and health care insurers. While the CFIR guided data capture and structuring, thematic analysis revealed overarching themes that best reflected the barriers and facilitators from different stakeholder perspectives. Within these overarching themes, the CFIR constructs were maintained. Results Interviews were conducted with 6 patients, 16 professionals and 5 policy makers. Thematic analysis supported by the CFIR framework identified four main themes: the instrument and its implementation process, use in individual patient care, use in quality improvement, and the context of the OCN. Important barriers included professional workload, data reliability, and interprofessional and interorganizational collaboration. Potential facilitators were the PCB set’s direct value in individual care, interprofessional feedback and education, and aligning with existing systems. Prominent variations between stakeholder groups included the expected patient burden, the level of use, transparency of outcomes and the degree of integrated care. Conclusions This study clarified critical factors that affect successful implementation of the PCB set in perinatal care. Practice recommendations, suggested at multiple levels, can enable structural patient-centred care improvement and may unite stakeholders towards integrated birth care.

scholarly journals NHS Health Checks for people with mental ill-health 2013–2017: an observational study

2020 ◽  
Vol 29 ◽  
Author(s):  
C. Garriga ◽  
J. Robson ◽  
C. Coupland ◽  
J. Hippisley-Cox
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Events ◽  
Health Check ◽  
Health Checks ◽  
Hazard Ratios ◽  
Nationally Representative ◽  
Nhs Health Checks ◽  
Nhs Health Check

Abstract Aims People living with serious mental ill-health experience adverse cardiovascular outcomes causing some of the greatest health inequality gaps in England, UK. We describe uptake of the NHS Health Check programme in people with mental ill-health, and rates of new diagnoses and management of cardiovascular risk factors in those who attend NHS Health Checks in comparison to those people without mental ill-health. Methods We used a large nationally representative database of people registered with general practitioners in England (QResearch). Between 2013 and 2017, we analysed attendance at NHS Health Checks and outcomes in the succeeding 12 months, in people with serious mental illness (SMI) including psychoses and in people prescribed long-term antidepressant medications (LTAD), with comparison to attendees who did not have these conditions. Hazard ratios (HR) were used to describe the association between outcomes and SMI and LTAD adjusting for sociodemographic variables. Results In those eligible for the NHS Health Check programme, we found a higher percentage of people with SMI attended an NHS Health Check (65 490, 19.8%) than those without SMI (524 728, 16.6%); adjusted HR 1.05 [95% confidence interval 1.02–1.08]. We also observed a higher percentage of attendance in people on LTAD (46 437, 20.1%) compared to people who were not prescribed LTAD (543 781, 16.7%); adjusted HR 1.10 (1.08–1.13). People with SMI were more likely to be identified with chronic kidney disease (CKD, HR 1.23, 1.12–1.34) and type 2 diabetes (HR 1.14, 1.03–1.25) within the 12 months following their NHS Health Check compared with those without SMI. People on LTAD were more likely to be identified with CKD (HR 1.55, 1.42–1.70) and type 2 diabetes (HR 1.45, 1.31–1.60) and also hypertension, cardiovascular disease, non-diabetic hyperglycaemia, familial hypercholesterolemia and dementia within the 12 months following their NHS Health Check. Statins were more likely to be prescribed to NHS Health Check attendees with SMI and those on LTAD than those without these conditions; HR 1.31 (1.25–1.38) and 1.91 (1.82–2.01), respectively. Antihypertensives were more likely to be prescribed to those on LTAD; HR 1.21 (1.14–1.29). Conclusions We found evidence that people with SMI or on LTAD treatment were 5–10% more likely to access NHS Health Checks than people without these conditions. People with SMI or on LTAD treatment who attended NHS Health Checks had higher rates of diagnosis of CKD, type 2 diabetes and some other relevant co-morbidities and increased treatment with statins and also anti-hypertensive medication in people on LTAD. This is likely to contribute to equitable reduction in adverse cardiovascular events for people with mental ill-health.

scholarly journals Unequal impact of the COVID-19 crisis on minority ethnic groups: a framework for understanding and addressing inequalities

2021 ◽  
pp. jech-2020-216061
Author(s):  
Srinivasa Vittal Katikireddi ◽  
Sham Lal ◽  
Enitan D Carrol ◽  
Claire L Niedzwiedz ◽  
Kamlesh Khunti ◽  
...  
Keyword(s):  
Ethnic Groups ◽  
Social Consequences ◽  
Control Measures ◽  
Current Evidence ◽  
Future Research ◽  
Complex Interplay ◽  
Structural Racism ◽  
Theoretical Understanding ◽  
Minority Ethnic Groups ◽  
Minority Ethnic

Minority ethnic groups have been disproportionately affected by the COVID-19 pandemic. While the exact reasons for this remain unclear, they are likely due to a complex interplay of factors rather than a single cause. Reducing these inequalities requires a greater understanding of the causes. Research to date, however, has been hampered by a lack of theoretical understanding of the meaning of ‘ethnicity’ (or race) and the potential pathways leading to inequalities. In particular, quantitative analyses have often adjusted away the pathways through which inequalities actually arise (ie, mediators for the effect of interest), leading to the effects of social processes, and particularly structural racism, becoming hidden. In this paper, we describe a framework for understanding the pathways that have generated ethnic (and racial) inequalities in COVID-19. We suggest that differences in health outcomes due to the pandemic could arise through six pathways: (1) differential exposure to the virus; (2) differential vulnerability to infection/disease; (3) differential health consequences of the disease; (4) differential social consequences of the disease; (5) differential effectiveness of pandemic control measures and (6) differential adverse consequences of control measures. Current research provides only a partial understanding of some of these pathways. Future research and action will require a clearer understanding of the multiple dimensions of ethnicity and an appreciation of the complex interplay of social and biological pathways through which ethnic inequalities arise. Our framework highlights the gaps in the current evidence and pathways that need further investigation in research that aims to address these inequalities.

scholarly journals Perceived major experiences of discrimination, ethnic group, and risk of psychosis in a six-country case−control study

2021 ◽  
pp. 1-9
Author(s):  
Supriya Misra ◽  
Bizu Gelaye ◽  
David R. Williams ◽  
Karestan C. Koenen ◽  
Christina P.C. Borba ◽  
...  
Keyword(s):  
Ethnic Groups ◽  
Psychotic Disorders ◽  
Case Control Study ◽  
Perceived Discrimination ◽  
Case Control ◽  
Excess Risk ◽  
Minority Ethnic Groups ◽  
Increased Risk ◽  
Minority Ethnic ◽  
Control Study

Abstract Background Perceived discrimination is associated with worse mental health. Few studies have assessed whether perceived discrimination (i) is associated with the risk of psychotic disorders and (ii) contributes to an increased risk among minority ethnic groups relative to the ethnic majority. Methods We used data from the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions Work Package 2, a population-based case−control study of incident psychotic disorders in 17 catchment sites across six countries. We calculated odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between perceived discrimination and psychosis using mixed-effects logistic regression models. We used stratified and mediation analyses to explore differences for minority ethnic groups. Results Reporting any perceived experience of major discrimination (e.g. unfair treatment by police, not getting hired) was higher in cases than controls (41.8% v. 34.2%). Pervasive experiences of discrimination (≥3 types) were also higher in cases than controls (11.3% v. 5.5%). In fully adjusted models, the odds of psychosis were 1.20 (95% CI 0.91–1.59) for any discrimination and 1.79 (95% CI 1.19–1.59) for pervasive discrimination compared with no discrimination. In stratified analyses, the magnitude of association for pervasive experiences of discrimination appeared stronger for minority ethnic groups (OR = 1.73, 95% CI 1.12–2.68) than the ethnic majority (OR = 1.42, 95% CI 0.65–3.10). In exploratory mediation analysis, pervasive discrimination minimally explained excess risk among minority ethnic groups (5.1%). Conclusions Pervasive experiences of discrimination are associated with slightly increased odds of psychotic disorders and may minimally help explain excess risk for minority ethnic groups.

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