scholarly journals Factors influencing the utilisation of free-standing and alongside midwifery units in England: a qualitative research study

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e033895 ◽  
Author(s):  
Denis Walsh ◽  
Helen Spiby ◽  
Christine McCourt ◽  
Celia Grigg ◽  
Dawn Coleby ◽  
...  
Keyword(s):  
Focus Groups ◽  
Information Needs ◽  
Complex Interventions ◽  
Care Staff ◽  
Full Potential ◽  
Service Users ◽  
Free Standing ◽  
Maternity Services ◽  
Factors Influencing ◽  
Lack Of Commitment

ObjectiveTo identify factors influencing the provision, utilisation and sustainability of midwifery units (MUs) in England.DesignCase studies, using individual interviews and focus groups, in six National Health Service (NHS) Trust maternity services in England.Setting and participantsNHS maternity services in different geographical areas of England Maternity care staff and service users from six NHS Trusts: two Trusts where more than 20% of all women gave birth in MUs, two Trusts where less than 10% of all women gave birth in MUs and two Trusts without MUs. Obstetric, midwifery and neonatal clinical leaders, managers, service user representatives and commissioners were individually interviewed (n=57). Twenty-six focus groups were undertaken with midwives (n=60) and service users (n=52).Main outcome measuresFactors influencing MU use.FindingsThe study findings identify several barriers to the uptake of MUs. Within a context of a history of obstetric-led provision and lack of decision-maker awareness of the clinical and economic evidence, most Trust managers and clinicians do not regard their MU provision as being as important as their obstetric unit (OU) provision. Therefore, it does not get embedded as an equal and parallel component in the Trust’s overall maternity package of care. The analysis illuminates how implementation of complex interventions in health services is influenced by a range of factors including the medicalisation of childbirth, perceived financial constraints, adequate leadership and institutional norms protecting the status quo.ConclusionsThere are significant obstacles to MUs reaching their full potential, especially free-standing midwifery units. These include the lack of commitment by providers to embed MUs as an essential service provision alongside their OUs, an absence of leadership to drive through these changes and the capacity and willingness of providers to address women’s information needs. If these remain unaddressed, childbearing women’s access to MUs will continue to be restricted.

scholarly journals Factors influencing utilisation of ‘free-standing’ and ‘alongside’ midwifery units for low-risk births in England: a mixed-methods study

2020 ◽  
Vol 8 (12) ◽  
pp. 1-106 ◽  
Author(s):  
Denis Walsh ◽  
Helen Spiby ◽  
Christine McCourt ◽  
Dawn Coleby ◽  
Celia Grigg ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Health Services ◽  
Case Studies ◽  
Media Coverage ◽  
Information Needs ◽  
Low Risk ◽  
Barriers And Facilitators ◽  
Full Potential ◽  
Free Standing ◽  
Maternity Services

Background Midwifery-led units (MUs) are recommended for ‘low-risk’ births by the National Institute for Health and Care Excellence but according to the National Audit Office were not available in one-quarter of trusts in England in 2013 and, when available, were used by only a minority of the low-risk women for whom they should be suitable. This study explores why. Objectives To map the provision of MUs in England and explore barriers to and facilitators of their development and use; and to ascertain stakeholder views of interventions to address these barriers and facilitators. Design Mixed methods – first, MU access and utilisation across England was mapped; second, local media coverage of the closure of free-standing midwifery units (FMUs) were analysed; third, case studies were undertaken in six sites to explore the barriers and facilitators that have an impact on the development of MUs; and, fourth, by convening a stakeholder workshop, interventions to address the barriers and facilitators were discussed. Setting English NHS maternity services. Participants All trusts with maternity services. Interventions Establishing MUs. Main outcome measures Numbers and types of MUs and utilisation of MUs. Results Births in MUs across England have nearly tripled since 2011, to 15% of all births. However, this increase has occurred almost exclusively in alongside units, numbers of which have doubled. Births in FMUs have stayed the same and these units are more susceptible to closure. One-quarter of trusts in England have no MUs; in those that do, nearly all MUs are underutilised. The study findings indicate that most trust managers, senior midwifery managers and obstetricians do not regard their MU provision as being as important as their obstetric-led unit provision and therefore it does not get embedded as an equal and parallel component in the trust’s overall maternity package of care. The analysis illuminates how provision and utilisation are influenced by a complex range of factors, including the medicalisation of childbirth, financial constraints and institutional norms protecting the status quo. Limitations When undertaking the case studies, we were unable to achieve representativeness across social class in the women’s focus groups and struggled to recruit finance directors for individual interviews. This may affect the transferability of our findings. Conclusions Although there has been an increase in the numbers and utilisation of MUs since 2011, significant obstacles remain to MUs reaching their full potential, especially FMUs. This includes the capacity and willingness of providers to address women’s information needs. If these remain unaddressed at commissioner and provider level, childbearing women’s access to MUs will continue to be restricted. Future work Work is needed on optimum approaches to improve decision-makers’ understanding and use of clinical and economic evidence in service design. Increasing women’s access to information about MUs requires further studies of professionals’ understanding and communication of evidence. The role of FMUs in the context of rural populations needs further evaluation to take into account user and community impact. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 12. See the NIHR Journals Library website for further project information.

scholarly journals What are the opportunities for cancer care and related research in primary care? A qualitative study of the views of patients, carers, and practice staff

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703505
Author(s):  
Joseph Clark ◽  
Elvis Amoakwa ◽  
John Blenkinsopp ◽  
Florence Reedy ◽  
Miriam Johnson
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Qualitative Study ◽  
Focus Groups ◽  
Cancer Care ◽  
Information Needs ◽  
Controlled Trial ◽  
Unmet Need ◽  
Care Staff ◽  
Trial Participation

BackgroundResearch to identify the role of primary care in cancer care is important. However, trials in primary care are difficult.AimTo understand how patients, families, and primary care clinicians view their role in cancer care and identify opportunities for cancer primary care research.MethodQualitative study embedded within a feasibility cluster randomised controlled trial of a primary care based needs assessment intervention. The Supportive Cancer Needs Survey (SCNS) was the main outcome. In-depth interviews with patients/carers and focus groups with primary care staff explored views on cancer care and trial participation. Data were recorded, transcribed verbatim, and analysed thematically by three independent researchers.ResultsFifteen cancer patients and three carers were interviewed and four focus groups (n = 11) were conducted. Three themes were generated satisfaction with current care; key time-points for improved cancer care; and information and research. Satisfaction with current care among patients was high in spite of 72% reporting at least one moderate-high unmet need at baseline. Most patients undergoing cancer treatment were unsure when to access primary care. Patients and carers highly valued proactive contact from their practice following diagnosis though this was uncommon. Post-oncology discharge was a key time-point for information needs and support for patients. Patients were reluctant to consider palliative care in spite of palliative care needs. Some felt therapeutic benefit from completing study measures.ConclusionPatients are satisfied with cancer primary care despite unmet needs. Palliative care is poorly understood by many who may benefit. Research participation may benefit some patients.

scholarly journals A worked example of initial theory-building: PARTNERS2 collaborative care for people who have experienced psychosis in England

Evaluation ◽  
2019 ◽  
Vol 26 (1) ◽  
pp. 6-26
Author(s):  
Ruth Gwernan-Jones ◽  
Nicky Britten ◽  
Jon Allard ◽  
Elina Baker ◽  
Laura Gill ◽  
...  
Keyword(s):  
Focus Groups ◽  
Complex Intervention ◽  
Collaborative Care ◽  
Iterative Process ◽  
Complex Interventions ◽  
Theory Building ◽  
Service Users ◽  
Programme Theory ◽  
Worked Example ◽  
Care Intervention

In this article, we present an exemplar of the initial theory-building phase of theory-driven evaluation for the PARTNERS2 project, a collaborative care intervention for people with experience of psychosis in England. Initial theory-building involved analysis of the literature, interviews with key leaders and focus groups with service users. The initial programme theory was developed from these sources in an iterative process between researchers and stakeholders (service users, practitioners, commissioners) involving four activities: articulation of 442 explanatory statements systematically developed using realist methods; debate and consensus; communication; and interrogation. We refute two criticisms of theory-driven evaluation of complex interventions. We demonstrate how the process of initial theory-building made a meaningful contribution to our complex intervention in five ways. Although time-consuming, it allowed us to develop an internally coherent and well-documented intervention. This study and the lessons learnt provide a detailed resource for other researchers wishing to build theory for theory-driven evaluation.

scholarly journals Producing a new website for a paediatric liaison mental health team with our service users

2020 ◽  
Vol 9 (4) ◽  
pp. e001128
Author(s):  
Alexander Adams ◽  
Virginia Davies ◽  
Bethany Stubbs
Keyword(s):  
Mental Health ◽  
Focus Groups ◽  
Patient Experience ◽  
Service Users ◽  
Health Issues ◽  
Web Page ◽  
Mental Health Team ◽  
Children And Young People ◽  
Specific Feedback ◽  
Source Of Information

IntroductionOnline resources are an important source of information about mental health issues and services for children and young people. Our service’s website had an out-of-date appearance and was aimed at professionals. More importantly, comments in our routinely collected patient experience data indicated that service users did not know what to expect when coming to our service.MethodsWe followed the model for improvement by testing out changes in plan, do, study and act cycles that included a review of recently updated child and adolescent mental health services’ and youth charities’ websites, designing a new web page for our service and then testing out the website in focus groups. We used routinely collected patient experience data to assess impact on wider patient satisfaction.ResultsFocus groups involving patients, parents and professionals judged the new website to be clearer, more attractive and easier to understand. Routine patient experience data did not reveal any website-specific feedback.ConclusionThis study demonstrates that it is easy and possible to create an attractive and accessible website for a mental health service using quality improvement methodology. In order to capture and integrate ongoing feedback about a service’s website from service users, routinely collected patient experience measures would need to ask specific questions related to this area. In this study, preproject and postproject patient experience data did not generate any specific comments.

User-centered Requirements for Patient Fluid Intake Monitoring Support

2020 ◽  
Vol 64 (1) ◽  
pp. 736-740
Author(s):  
Ellen J. Bass ◽  
Andrew J. Abbate ◽  
Yaman Noaiseh ◽  
Rose Ann DiMaria-Ghalili
Keyword(s):  
Data Analysis ◽  
Focus Group ◽  
Focus Groups ◽  
Real Time ◽  
Information Needs ◽  
Fluid Intake ◽  
Fluid Consumption ◽  
Registered Dietitians ◽  
Group Data ◽  
Focus Group Data

There is a need to support patients with monitoring liquid intake. This work addresses development of requirements for real-time and historical displays and reports with respect to fluid consumption as well as alerts based on critical clinical thresholds. We conducted focus groups with registered nurses and registered dietitians in order to identify the information needs and alerting criteria to support fluid consumption measurement. This paper presents results of the focus group data analysis and the related requirements resulting from the analysis.

scholarly journals Group-based cognitive–behavioural anger management for people with mild to moderate intellectual disabilities: cluster randomised controlled trial

2013 ◽  
Vol 203 (4) ◽  
pp. 288-296 ◽  
Author(s):  
Paul Willner ◽  
John Rose ◽  
Andrew Jahoda ◽  
Biza Stenfert Kroese ◽  
David Felce ◽  
...  
Keyword(s):  
Intellectual Disabilities ◽  
Anger Management ◽  
Care Staff ◽  
Treatment Manual ◽  
Service Users ◽  
Anger Control ◽  
Cluster Randomised ◽  
Cognitive Behavioural ◽  
People With Intellectual Disabilities

BackgroundMany people with intellectual disabilities find it hard to control their anger and this often leads to aggression which can have serious consequences, such as exclusion from mainstream services and the need for potentially more expensive emergency placements.AimsTo evaluate the effectiveness of a cognitive–behavioural therapy (CBT) intervention for anger management in people with intellectual disabilities.MethodA cluster-randomised trial of group-based 12-week CBT, which took place in day services for people with intellectual disabilities and was delivered by care staff using a treatment manual. Participants were 179 service users identified as having problems with anger control randomly assigned to either anger management or treatment as usual. Assessments were conducted before the intervention, and at 16 weeks and 10 months after randomisation (trial registration: ISRCTN37509773).ResultsThe intervention had only a small, and non-significant, effect on participants' reports of anger on the Provocation Index, the primary outcome measure (mean difference 2.8, 95% Cl −1.7 to 7.4 at 10 months). However, keyworker Provocation Index ratings were significantly lower in both follow-up assessments, as were service-user ratings on another self-report anger measure based on personally salient triggers. Both service users and their keyworkers reported greater usage of anger coping skills at both follow-up assessments and keyworkers and home carers reported lower levels of challenging behaviour.ConclusionsThe intervention was effective in improving anger control by people with intellectual disabilities. It provides evidence of the effectiveness of a CBT intervention for this client group and demonstrates that the staff who work with them can be trained and supervised to deliver such an intervention with reasonable fidelity.

Ethical Issues in the Feeding of Patients Suffering from Dementia: a focus group study of hospital staff responses to conflicting principles

2002 ◽  
Vol 9 (6) ◽  
pp. 599-611 ◽  
Author(s):  
Stephen Wilmot ◽  
Lesley Legg ◽  
Janice Barratt
Keyword(s):  
Focus Groups ◽  
Ethical Issues ◽  
Hospital Staff ◽  
Care Staff ◽  
Ethical Principles ◽  
Focus Group Study ◽  
Feeding Difficulties ◽  
National Health Service Trust ◽  
Feeding Methods ◽  
Personal Attitudes

Feeding difficulties in older patients who are suffering from dementia present problems with balancing conflicting ethical principles. They have been considered by several writers in recent years, and the views of nursing and care staff have been studied in different contexts. The present study used focus groups to explore the way in which nursing and care staff in a National Health Service trust deal with conflict between ethical principles in this area. Three focus groups were convened, one each from the staff of three wards caring for patients with dementia. Case histories were discussed and transcripts analysed. It emerged that staff were aware of making fine judgements of utility concerning the spectrum of feeding methods available. Informants gave some weight to the principle of autonomy, but sought to balance that against their commitment to care. In explaining their perspectives, informants gave more weight to personal attitudes and trust culture than to professional ethics

Healing touch: Using the arts to increase healthy touch between people with PMLD and their carers

2021 ◽  
Vol 12 (1) ◽  
pp. 73-85
Author(s):  
Leonie Elliott-Graves
Keyword(s):  
Learning Disabilities ◽  
Performing Arts ◽  
Well Being ◽  
Pilot Project ◽  
Care Staff ◽  
Service Users ◽  
Care Providers ◽  
Healing Touch ◽  
Adults With Learning Disabilities ◽  
Positive Touch

For adults with learning disabilities, touch is a necessary element of their everyday care. Yet touch delivered by care providers is a contentious and marginal practice, which is often avoided due to fears of abuse allegations, and the effects of touch avoidance can be significantly detrimental to the quality of care provided. The Safe Touch pilot project, developed with a London-based organization providing care to adults with learning disabilities, including those with profound and multiple learning disabilities (PMLD), used performing arts practices and massage to help the staff develop and utilize ‘positive’ touch – touch for communication, interaction and well-being – when working with service users. Fifteen service users with learning disabilities and PMLD along with the organization’s staff participated in the project. Drawing on the project’s processes and findings, some successes and limitations in employing performing arts activities with care staff to increase the use of positive touch with people with PMLD were identified.

Working towards better births for all

2021 ◽  
Vol 29 (5) ◽  
pp. 250-251
Author(s):  
Nadia Higson
Keyword(s):  
Service Users ◽  
Maternity Service ◽  
Maternity Services

The Association for Improvements in the Maternity Services supports all maternity service users to navigate the system as it exists and campaigns for a system which truly meets the needs of all

scholarly journals A qualitative study exploring therapists’ experiences of implementing a complex intervention promoting meaningful activity for residents in care homes

2018 ◽  
Vol 33 (3) ◽  
pp. 575-583 ◽  
Author(s):  
Raymond Smith ◽  
Julia Wood ◽  
Fiona Jones ◽  
Sue Turner ◽  
Michael Hurley
Keyword(s):  
Care Home ◽  
Complex Interventions ◽  
Occupational Therapists ◽  
Care Staff ◽  
Care Homes ◽  
Complex Care ◽  
Meaningful Activity ◽  
Qualitative Interview Study ◽  
Home Intervention ◽  
Trusting Relationships

Objectives: To explore the experiences of occupational therapists and physiotherapists and to reveal any factors that can facilitate delivering a complex care home intervention promoting meaningful activity. Design: Qualitative interview study using data from three focus groups conducted longitudinally post intervention implementation. Data were analysed thematically. Setting: Three residential care homes in South London, UK. Subjects: All therapists involved in the implementation of the intervention: three occupational therapists and three physiotherapists. Results: Three interconnected themes emerged from the analysis: (1) developing trusting relationships, (2) empowering staff and (3) remaining flexible. Therapists described how successfully implementing a complex care home intervention was dependant on developing trusting relationships with care staff. This enabled the therapists to empower care staff to take ownership of the intervention and help embed it in care home culture, facilitating long-term change. The therapists described how remaining flexible in their approach helped keep care staff engaged for the duration of implementation. Conclusion: This study has revealed several important factors that can help facilitate therapists delivering complex interventions in care homes.

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