Beth Milton

Qualitative studies of type 1 diabetes in adolescence: a systematic literature review

Spencer J, Cooper H, Milton B. Qualitative studies of type 1 diabetes in adolescence: a systematic literature review.

The social and economic consequences of childhood-onset Type 1 diabetes mellitus across the lifecourse: a systematic review

Background  The incidence of childhood‐onset (Type 1) diabetes is high, and increasing, particularly among the very young. The aim of this review was to determine the longer‐term social consequences of having diabetes as a child and to determine whether adverse consequences are more severe for disadvantaged children.

Critically appraising qualitative research for systematic reviews: defusing the methodological cluster bombs.

This article examines the place of qualitative research within systematic reviews as evidence for policy, discusses the critical appraisal process as applied to qualitative research, and gives illustrative examples of sound qualitative studies from the health policy field. A checklist is a useful tool for the quality evaluation of qualitative research, facilitating comparison of the strengths and weaknesses of different studies, and should stimulate debate between reviewers as part of the broader critical appraisal process. Critical appraisal must be central to research syntheses, thus enabling reviewers to make only good-quality qualitative evidence accessible for policy makers and practitioners.

The lived experiences of young people (13–16 years) with Type 1 diabetes mellitus and their parents – a qualitative phenomenological study

Within a programme of research aiming to develop a technology‐based educational intervention for young people with Type 1 diabetes, this study aimed to explore adolescents’ and parents’ experiences of living with Type 1 diabetes from an interpretive phenomenological perspective.

Technology‐based approaches to patient education for young people living with diabetes: a systematic literature review

Cooper H, Cooper J, Milton B. Technology‐based approaches to patient education for young people living with diabetes: a systematic literature review.

Policy-makers' attitudes to decision support models for coronary heart disease: a qualitative study.

Objectives: To explore attitudes to the use of models for coronary heart disease to support decision-making for policy and service planning. Methods: Qualitative study using semi-structured interviews with 33 policy- and decision-makers purposively sampled from the UK National Health Service (NHS) (national, regional and local levels), academia and voluntary organizations. Interviews were transcribed, coded and emergent themes identified using framework analysis aided by NVivo software. Results: Policy-makers and planners were generally enthusiastic about models to assist in decision-making through: predicting trends; assessing the effect of interventions on health inequalities; quantifying the impact of population level and targeted interventions, and facilitating economic evaluation. The perceived advantages of using models included: more rational commissioning; the facility for scenario testing; advocacy for population level interventions and off-the-shelf synthesis to aid real time decision-making. However, although participants were aware of models to support decision-making, these were not being used routinely. Some participants felt that models oversimplify complex situations and that there is a lack of shared understanding as to how models work. Factors that increase confidence in decision support models included: rigorous validation and peer review, the availability of user-support and increased transparency. Conclusion: Policy-makers and planners were generally enthusiastic about the use of models to support decision-making, illustrating the potential uses for models and the factors that improve confidence in them. However, existing models are often not being used in practice. So new models that are fit for practice need to be developed.

Students' attitudes to the communications employed during an outbreak of meningococcal disease in a UK school: a qualitative study.

BACKGROUND Following an outbreak of meningococcal disease in a school in the North West of England, the communication methods employed by the Health Protection Agency (HPA) were evaluated in order to explore ways of improving communication with the public. METHODS Qualitative questionnaires were distributed to Year 12 (sixth form) students. The Framework approach was used to analyse the data, which were coded, and emergent themes identified. RESULTS In the absence of clear communication from official sources, many participants suggested that circulating rumours caused confusion and anxiety in the student population. Rumours were spread through informal networks in person or through text and MSN messaging. It was generally perceived that accurate information in this period would have been useful to allay potentially unfounded anxiety. Most students surveyed reported that they were sufficiently aware of the situation prior to receiving official announcements. The information provided by the HPA through the school was generally perceived as being useful, but it came too late. CONCLUSION In outbreak situations, rumours will spread rapidly in the absence of early communication, and this can be a significant cause of anxiety. The use of digital communication strategies should be considered, since they can seed dependable information that will disseminate rapidly through peer groups.

‘McDonalds and KFC, it's never going to happen’: the challenges of working with food outlets to tackle the obesogenic environment

BACKGROUND Food outlets may make an important contribution to an obesogenic environment. This study investigated barriers and facilitators to public health work with food outlets in disadvantaged areas. METHODS In-depth qualitative interviews with 36 directors, managers and public health service delivery staff in a coterminous primary care trust and local authority in northwest England. Data were analysed using the constant comparative method. RESULTS Three interventions were available to engage with businesses; awards for premises that welcomed breastfeeding mothers or offered healthy menu options and local authority planning powers. Sensitivity to the potential conflict between activities that generate profit and those that promote health, led to compromises, such as awards for cafés that offer only one healthy option on an otherwise unhealthy menu. An absence of existing relationships with businesses and limited time were powerful disincentives to action, leading to greater engagement with public rather than private sector organizations. Hiring staff with commercial experience and incentives for businesses were identified as useful strategies, but seldom used. CONCLUSIONS Encouraging food outlets to contribute to tackling the obesogenic environment is a major challenge for local public health teams that requires supportive national policies. Commitment to engage with the local public health service should be part of any national voluntary agreements with industry.

Devolution and the regional health divide: a longitudinal ecological study of 14 countries in Europe.

BACKGROUND Greater regional devolution can reduce economic inequalities between regions; however, the impact on health inequalities is not clear. We investigated the association between changes over time in the level of devolution in European countries and regional economic and health inequalities. METHODS We used the proportion of government expenditure controlled by subnational levels of government as our measure of devolution in 14 European countries between 1995 and 2011. Fixed effects linear regression models were used to analyse trends in the level of devolution, trends in regional economic inequalities (Gini-coefficient) and trends in regional health inequalities (slope index) in life expectancy. RESULTS Each additional percentage of government expenditure managed at subnational level reduced the Gini-coefficient of regional GDP by -0.17 points (95% CI: -0.33 to -0.01; P = 0.04). However, it increased the slope index of regional life expectancy by 23 days (95% CI: -2 to 48; P = 0.07). When trends in regional economic inequalities were controlled for, as a potential mediator-increased devolution-was significantly associated with an increase in health inequalities between regions (P = 0.01). CONCLUSIONS Increased devolution does not appear to reduce regional health inequalities-even when it reduces regional economic inequalities-and it could be associated with increased health inequalities.