scholarly journals How, why, for whom and in what context, do sexual health clinics provide an environment for safe and supported disclosure of sexual violence: protocol for a realist review

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e037599
Author(s):  
Rachel J Caswell ◽  
Ian Maidment ◽  
Jonathan D C Ross ◽  
C Bradbury-Jones
Keyword(s):  
Data Analysis ◽  
Health Services ◽  
Sexual Health ◽  
Sexual Violence ◽  
Data Extraction ◽  
Knowledge Exchange ◽  
Realist Review ◽  
Advisory Group ◽  
Programme Theory ◽  
Sexual Health Clinics

IntroductionSupporting people subjected to sexual violence includes provision of sexual and reproductive healthcare. There is a need to ensure an environment for safe and supported disclosure of sexual violence in these clinical settings. The purpose of this research is to gain a deeper understanding of how, why, for whom and in what circumstances safe and supported disclosure occurs in sexual health services.Methods and analysisTo understand how safe and supported disclosure of sexual violence works within sexual health services a realist review will be undertaken with the following steps: (1) Focussing of the review including a scoping literature search and guidance from an advisory group. (2) Developing the initial programme theories and a search strategy using context-mechanism-outcome (CMO) configurations. (3) Selection, data extraction and appraisal based on relevance and rigour. (4) Data analysis and synthesis to further develop and refine programme theory, CMO configurations with consideration of middle-range and substantive theories.Data analysisA realist logic of analysis will be used to align data from each phase of the review, with CMO configurations being developed. Programme theories will be sought from the review that can be further tested in the field.Ethics and disseminationThis study has been approved by the ethics committee at University of Birmingham, and has Health Research Authority approval. Findings will be disseminated through knowledge exchange with stakeholders, publications in peer-reviewed journals, conference presentations and formal and informal reports. In addition, as part of a doctoral study, the findings will be tested in multisite case studies.PROSPERO registration detailsCRD4201912998. Dates of the planned realist review, from protocol design to completion, January 2019 to July 2020.

scholarly journals Motivation as a mechanism underpinning exercise-based falls prevention programmes for older adults with cognitive impairment: a realist review

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e024982 ◽  
Author(s):  
Vicky Booth ◽  
Rowan Harwood ◽  
Jennie E Hancox ◽  
Victoria Hood-Moore ◽  
Tahir Masud ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Exercise Intervention ◽  
Data Extraction ◽  
Realist Review ◽  
Falls Prevention ◽  
Cochrane Library ◽  
Programme Theory ◽  
Eligibility Criteria ◽  
Prevention Programmes

ObjectivesThis review aimed to identify mechanisms underlying participation in falls prevention interventions, in older adults with cognitive impairment. In particular we studied the role of motivation.DesignA realist review of the literature.Data sourcesEMBASE, MEDLINE, CINAHL, the Cochrane Library, PsycINFO and PEDRO.Eligibility criteriaPublications reporting exercise-based interventions for people with cognitive impairment, including dementia, living in the community.Data extraction and synthesisA ‘rough programme theory’ (a preliminary model of how an intervention works) was developed, tested against findings from the published literature and refined. Data were collected according to elements of the programme theory and not isolated to outcomes. Motivation emerged as a key element, and was prioritised for further study.ResultsAn individual will access mechanisms to support participation when they think that exercise will be beneficial to them. Supportive mechanisms include having a ‘gate-keeper’, such as a carer or therapist, who shares responsibility for the perception of exercise as beneficial. Lack of access to support decreases adherence and participation in exercise. Motivational mechanisms were particularly relevant for older adults with mild-to-moderate dementia, where the exercise intervention was multicomponent, in a preferred setting, at the correct intensity and level of progression, correctly supported and considered, and flexibly delivered.ConclusionMotivation is a key element enabling participation in exercise-based interventions for people with cognitive impairment. Many of the mechanisms identified in this review have parallels in motivational theory. Clinically relevant recommendations were derived and will be used to further develop and test a motivationally considered exercise-based falls intervention for people with mild dementia.PROSPERO registration numberCRD42015030169.

scholarly journals Improving best practice for patients receiving hospital discharge letters: a realist review

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e027588 ◽  
Author(s):  
Katharine Weetman ◽  
Geoff Wong ◽  
Emma Scott ◽  
Eilidh MacKenzie ◽  
Stephanie Schnurr ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Best Practice ◽  
Data Extraction ◽  
Realist Review ◽  
Patient Choice ◽  
Programme Theory ◽  
Eligibility Criteria ◽  
New Information ◽  
Starting Point ◽  
Outpatient Settings

ObjectiveTo understand how different outcomes are achieved from adult patients receiving hospital discharge letters from inpatient and outpatient settings.DesignRealist review conducted in six main steps: (1) development of initial theory, (2) searching, (3) screening and selection, (4) data extraction and analysis, (5) data synthesis and (6) programme theory (PT) refinement.Eligibility criteriaDocuments reporting evidence that met criteria for relevance to the PT. Documents relating solely to mental health or children aged <18 years were excluded.AnalysisData were extracted and analysed using a realist logic of analysis. Texts were coded for concepts relating to context, mechanism, outcome configurations (CMOCs) for the intervention of patients receiving discharge letters. All outcomes were considered. Based on evidence and our judgement, CMOCs were labelled ‘positive’ or ‘negative’ in order to clearly distinguish between contexts where the intervention does and does not work.Results3113 documents were screened and 103 were included. Stakeholders contributed to refining the PT in step 6. The final PT included 48 CMOCs for how outcomes are affected by patients receiving discharge letters. ‘Patient choice’ emerged as a key influencer to the success (or not) of the intervention. Important contexts were identified for both ‘positive’ CMOCs (eg, no new information in letter) and ‘negative’ CMOCs (eg, letter sent without verifying patient contact details). Two key findings were that patient understanding is possibly greater than clinicians perceive, and that patients tend to express strong preference for receiving letters. Clinician concerns emerged as a barrier to wider sharing of discharge letters with patients, which may need to be addressed through organisational policies and direction.ConclusionsThis review forms a starting point for explaining outcomes associated with whether or not patients receive discharge letters. It suggests several ways in which current processes might be modified to support improved practice and patient experience.

Confidentiality and access to sexual health services

Sexual Health ◽  
2009 ◽  
Vol 6 (2) ◽  
pp. 153 ◽  
Author(s):  
Nathan Ryder ◽  
Anna M. McNulty
Keyword(s):  
Health Care ◽  
Health Services ◽  
Sexual Health ◽  
Risk Groups ◽  
Health Clinic ◽  
Sexual Health Care ◽  
Health Clinics ◽  
Care Workers ◽  
English Speaking ◽  
Sexual Health Clinics

Background: Confidentiality concerns are often described as barriers to seeking sexual health care. There has been little research describing the relative importance of confidentiality to clients of sexual health clinics, and whether members of high-risk groups have greater concerns. This study aimed to determine the importance of confidentiality and anonymity to clients of a public sexual health clinic, and determine associations with gender and sexuality. Methods: A self-administered questionnaire was offered to consecutive new English-speaking clients in October and November 2007. Participants were asked to describe the reasons for presenting, likelihood of disclosing identifying information, and concern should specific people and agencies become aware of their attendance. Results: Of 350 eligible clients, 270 (77%) participated in the survey. Expert care was included in the top three reasons for choosing a sexual health clinic rather than a general practitioner by over half of participants, while confidentiality and cost were each included in the top three reasons by one-third of respondents respectively. Over 90% of clients reported they were likely to give accurate identifying information to the clinic. Participants were comfortable with disclosure of information to other health-care workers but became increasingly unwilling for information to be shared with services not directly involved in their care. Overall there were few associations with gender or sexuality. Conclusion: Clients choose to attend our clinic for a variety of reasons, with confidentiality and anonymity being of lesser importance than competence and cost. Confidentiality is important to the majority of clients, whereas few desire anonymity. Most clients would accept information being shared with other health services, suggesting that confidentiality may not be a barrier to the use of electronic health records in sexual health clinics.

Health Care Services for men who have sex with men in different Australian states and territories since the emergence of HIV

Sexual Health ◽  
2008 ◽  
Vol 5 (2) ◽  
pp. 161 ◽  
Author(s):  
Cathy Pell ◽  
Simon Donohoe ◽  
Damian Conway
Keyword(s):  
Health Care ◽  
Health Services ◽  
Sexual Health ◽  
Health Care Services ◽  
Post Exposure Prophylaxis ◽  
People Living With Hiv ◽  
Sex With Men ◽  
Sexual Health Clinics ◽  
Living With Hiv ◽  
Hiv Aids

The purpose of this article is to describe sexual health services available in Australia across the different states and territories for gay men and men who have sex with men (MSM) and their utilisation. An assessment of services available in different states is made, then the evidence about how MSM and people living with HIV/AIDS access health care in Australia is presented. This demonstrates that the number and location of sexual health services has changed over time. It also demonstrates that services available differ by state and territory. The availability of non-occupational post-exposure prophylaxis for HIV infection has been different in each state and territory, as has its utilisation. The majority of care for sexual health-related issues and for MSM and people living with HIV/AIDS is delivered in general practice settings in Australia, with hospital outpatient settings, including sexual health clinics, utilised commonly.

scholarly journals Places and people: the perceptions of men who have sex with men concerning STI testing: a qualitative study

2017 ◽  
Vol 94 (1) ◽  
pp. 46-50 ◽  
Author(s):  
Jessica Datta ◽  
David Reid ◽  
Gwenda Hughes ◽  
Catherine H Mercer ◽  
Sonali Wayal ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Health Services ◽  
Sexual Health ◽  
Assessment Tool ◽  
Group Discussions ◽  
Health Clinics ◽  
Sti Testing ◽  
Minority Men ◽  
Sex With Men ◽  
Sexual Health Clinics

ObjectivesTo explore the experiences and views of men who have sex with men (MSM) on attending clinical sexual health services and their preferences regarding service characteristics in the context of the disproportionate burden of STIs experienced by this group. The wider study aim was to develop a risk assessment tool for use in sexual health clinics.MethodsQualitative study comprising eight focus group discussions with 61 MSM in four English cities. Topics included: experience of attending sexual health services, perceptions of norms of attendance among MSM, knowledge of, and attitudes towards, STIs and views on ‘being researched.’ Discussions were audio-recorded and transcribed and a thematic data analysis conducted.ResultsAttending sexual health services for STI testing was described as embarrassing by some and some clinic procedures were thought to compromise confidentiality. Young men seeking STI testing were particularly sensitive to feelings of awkwardness and self-consciousness. Black and ethnic minority men were concerned about being exposed in their communities. The personal qualities of staff were seen as key features of sexual health services. Participants wanted staff to be friendly, professional, discreet, knowledgeable and non-judgemental.ConclusionsA range of opinion on the type of STI service men preferred was expressed with some favouring generic sexual and reproductive health clinics and others favouring specialist community-based services. There was consensus on the qualities they would like to see in healthcare staff. The knowledge, conduct and demeanour of staff could exacerbate or ameliorate unease associated with attending for STI testing.

Sexual assault reporting amongst users of online sexual health services

2020 ◽  
pp. 095646242096394
Author(s):  
Sara Day ◽  
Gurmit Jagjit Singh ◽  
Sophie Jones ◽  
Ryan Kinsella
Keyword(s):  
Sexual Assault ◽  
Health Services ◽  
Sexual Health ◽  
Reporting Rate ◽  
High Response Rate ◽  
Transmitted Infection ◽  
Health Clinics ◽  
Sti Testing ◽  
Sexual Health Clinics ◽  
Sexual Assault Reporting

Sexual assault (SA) survivors often attend sexual health clinics (SHC) for care relating to their assault. Reported rates of SA amongst SHC attendees can be high. Online sexual health services are becoming increasingly popular. Sexual Health London (SHL) is a large online sexual transmitted infection (STI) screening service. Between 1.1.20– 8.2.20, 0.5% (242/45841) (54% female, 45.6% male) of adults disclosed a recent SA when ordering an online STI testing kit. 79% (192/242) users engaged in a call back discussion initiated by the SHL team: 45% (87/192) users confirmed a SA had occurred and 53% (101/242) users denied an assault (particularly men) stating they had reported this in error. 18% (16/87) users had already reported their SA to the police/sexual assault centre, and one user accepted an onward referral. This study found a low reporting rate of SA amongst SHL users, but despite a high response rate to call backs, >50% cited they reported in error, 25% (22/87) didn’t want to discuss their SA and few accepted onward referrals. Using e-triage to screen for SA followed by service-initiated telephonic support to everyone who discloses, may not be acceptable or offer utility to all. Further evaluation of ways to engage these individuals is required.

scholarly journals A realist review protocol of the role and contribution of the advanced nurse practitioner (ANP) in gastroenterology nursing

2021 ◽  
Vol 4 ◽  
pp. 126
Author(s):  
Marlize Barnard ◽  
Mary Casey ◽  
Laserina O'Connor
Keyword(s):  
Patient Care ◽  
Patient Outcomes ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Data Extraction ◽  
Realist Review ◽  
Programme Theory ◽  
Quality Patient Care ◽  
Education And Health ◽  
Review Protocol

Background: The role and contribution of advanced nurse practitioners (ANP) has been well researched and found to be of great value for improving quality patient care and enhancing patient outcomes through education and health promotion. However, the role and the contribution of the ANP to gastroenterology nursing have not been evaluated either nationally or internationally. A review to determine the role and contribution of the ANP in gastroenterology nursing will inform on the contribution of the role and whether the role makes a difference to patient outcomes and cost effectiveness of patient care. Objective: This review aims to investigate the nursing role and contribution of the advanced nurse practitioner in gastroenterology. Furthermore, improved understanding of the underlying causal mechanisms explaining how the ANP role in gastroenterology nursing works, will provide a deeper understanding of how, why, for whom and in what contexts the role and contribution of the ANP to gastroenterology nursing are most successful. Methods: A realist review will consolidate evidence on how, when why and where the ANP role in gastroenterology works or fails through identifying programme theories underlying to the role’s introduction. The following steps will be operationalised; locating existing theories, searching the literature, documenting literature selection, engaging in data extraction and synthesis and refining programme theory. As an iterative approach, review cycles will uncover explanatory and contingent theories through context-mechanism-outcome configurations (CMOCc). Due to the variation in context and mechanisms, different outcomes will be likely across different clinical settings although similar patterns may be identified. Conclusions: Due to the theory-oriented approach of realist reviews, the pragmatic consequences of the review, will lend itself to deeper understanding of how the role and contribution of the ANP in gastroenterology nursing works in practice.

scholarly journals Quality care metrics (QC-M) in nursing and midwifery care processes: a rapid realist review (RRR) protocol

2020 ◽  
Vol 3 ◽  
pp. 85
Author(s):  
Laserina O'Connor ◽  
Alice Coffey ◽  
Veronica Lambert ◽  
Mary Casey ◽  
Martin McNamara ◽  
...  
Keyword(s):  
Data Extraction ◽  
Quality Care ◽  
Realist Review ◽  
Care Process ◽  
Programme Theory ◽  
Ethical Approval ◽  
Local Reference ◽  
Review Protocol ◽  
Health Nursing ◽  
Rapid Realist Review

Background: In 2018, the Office of the Nursing and Midwifery Services Director (ONMSD) completed phase one of work which culminated in the development and launch of seven research reports with defined suites of quality care process metrics (QC-Ms) and respective indicators for the practice areas – acute care, midwifery, children’s, public health nursing, older persons, mental health and intellectual disability nursing in Ireland. This paper presents a rapid realist review protocol that will systematically review the literature that examines QC-M in practice; what worked, or did not work for whom, in what contexts, to what extent, how and why? Methods: The review will explore if there are benefits of using the QC-Ms and what are the contexts in which these mechanisms are triggered. The essence of this rapid realist review is to ascertain how a change in context generates a particular mechanism that produces specific outcomes. A number of steps will occur including locating existing theories on implementation of quality care metrics, searching the evidence, selecting relevant documents, data extraction, validation of findings, synthesising and refining programme theory. This strategy may help to describe potential consequences resulting from changes in context and their interactions with mechanisms. Initial theories will be refined throughout the process by the local reference panel, comprised of eight key intervention stakeholders, knowledge users such as healthcare professionals and an expert panel. Ethical approval is not required for this rapid realist review. Conclusion: It is anticipated that the final programme theory will help to explain how QC-Ms work in practice; for whom, why and in what circumstances. Findings of this review could help to give insights into realism as a framework and how nursing and midwifery QC-Ms have been implemented previously.

scholarly journals Quality care process metrics (QCP-Ms) in nursing and midwifery care processes: a rapid realist review (RRR) protocol

2021 ◽  
Vol 3 ◽  
pp. 85
Author(s):  
Laserina O'Connor ◽  
Alice Coffey ◽  
Veronica Lambert ◽  
Mary Casey ◽  
Martin McNamara ◽  
...  
Keyword(s):  
Data Extraction ◽  
Quality Care ◽  
Realist Review ◽  
Care Process ◽  
Programme Theory ◽  
Ethical Approval ◽  
Local Reference ◽  
Process Metrics ◽  
Health Nursing ◽  
Rapid Realist Review

Background: In 2018, the Office of the Nursing and Midwifery Services Director (ONMSD) completed phase one of work which culminated in the development and launch of seven research reports with defined suites of quality care process metrics (QCP-Ms) and respective indicators for the practice areas – acute care, midwifery, children’s, public health nursing, older persons, mental health and intellectual disability nursing in Ireland. This paper presents a rapid realist review protocol that will systematically review the literature that examines QCP-Ms in practice; what worked, or did not work for whom, in what contexts, to what extent, how and why? Methods: The review will explore if there are benefits of using the QCP-Ms and what are the contexts in which these mechanisms are triggered. The essence of this rapid realist review is to ascertain how a change in context generates a particular mechanism that produces specific outcomes. A number of steps will occur including locating existing theories on implementation of quality care metrics, searching the evidence, selecting relevant documents, data extraction, validation of findings, synthesising and refining programme theory. This strategy may help to describe potential consequences resulting from changes in context and their interactions with mechanisms. Initial theories will be refined throughout the process by the local reference panel, comprised of eight key intervention stakeholders, knowledge users such as healthcare professionals and an expert panel. Ethical approval is not required for this rapid realist review. Conclusion: It is anticipated that the final programme theory will help to explain how QCP-Ms work in practice; for whom, why and in what circumstances. Findings of this review could help to give insights into the use of a rapid realist review as a framework and how nursing and midwifery QCP-Ms have been implemented previously.

Routine questioning about non-consenting sex: a survey of practice in Australasian sexual health clinics

2003 ◽  
Vol 14 (5) ◽  
pp. 329-333 ◽  
Author(s):  
Claire Hurst ◽  
Jane MacDonald ◽  
Janet Say ◽  
John Read
Keyword(s):  
New Zealand ◽  
Health Services ◽  
Sexual Health ◽  
Response Rate ◽  
Past History ◽  
Specific Training ◽  
Health History ◽  
Health Clinics ◽  
History Of ◽  
Sexual Health Clinics

The objectives of the study were, 1. To ascertain if sexual health physicians and practitioners believe a question concerning a past history of non-consensual sex should be asked routinely and are asking it. 2. To identify whether sexual health services have established protocols to integrate this question into practice. 3. To identify the barriers to this becoming part of a routine sexual health history. A questionnaire covering demographics, protocols and practice around asking the question and reasons for not asking was sent to all (20) sexual health clinics in New Zealand and 7 sexual health clinics in Australia, inviting participation from all staff who took routine sexual health histories. Twenty-seven sexual health clinics participated with a total of 122 (69% response rate) questionnaires completed and returned. One hundred and thirteen (93%) participants believed it was a relevant question to ask. Seventy-eight (63%) said asking the question was encouraged, and routinely or mostly asked the question. Only 40 (33%) identified their workplace had a written policy and 52 (43%) had not received specific training in asking the question. The majority who asked routinely said their client never or rarely objected and that it did not often add significantly to the time. The main reasons for not asking were the belief it was nothing to do with the person's presenting complaint, concern the client would find it too disturbing, inadequate training, and lack of time. Sexual health clinics should develop protocols and guidelines and provide appropriate training to ensure that routine questioning about non-consenting sex is integrated into safe practice.

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