Catherine Homer

Understanding factors influencing vulnerable older people keeping warm and well in winter: a qualitative study using social marketing techniques

Objectives To understand the influences and decisions of vulnerable older people in relation to keeping warm in winter. Design A qualitative study incorporating in-depth, semi-structured individual and group interviews, framework analysis and social marketing segmentation techniques. Setting Rotherham, South Yorkshire, UK. Participants 50 older people (>55) and 25 health and social care staff underwent individual interview. The older people also had household temperature measurements. 24 older people and 19 health and social care staff participated in one of the six group interviews. Results Multiple complex factors emerged to explain whether vulnerable older people were able to keep warm. These influences combined in various ways that meant older people were not able to or preferred not to access help or change home heating behaviour. Factors influencing behaviours and decisions relating to use of heating, spending money, accessing cheaper tariffs, accessing benefits or asking for help fell into three main categories. These were situational and contextual factors, attitudes and values, and barriers. Barriers included poor knowledge and awareness, technology, disjointed systems and the invisibility of fuel and fuel payment. Findings formed the basis of a social marketing segmentation model used to develop six pen portraits that illustrated how factors that conspire against older people being able to keep warm. Conclusions The findings illustrate how and why vulnerable older people may be at risk of a cold home. The pen portraits provide an accessible vehicle and reflective tool to raise the capacity of the NHS in responding to their needs in line with the Cold Weather Plan.

Expectations and patients’ experiences of obesity prior to bariatric surgery: a qualitative study

Objectives This study aimed to understand the experiences and expectations of people seeking bariatric surgery in England and identify implications for behavioural and self-management interventions. Design A qualitative study using modified photovoice methods, triangulating photography with semistructured indepth interviews analysed using framework techniques. Setting Areas served by two bariatric surgery multidisciplinary teams in the north of England. Participants 18 adults (14 women and 4 men) who accepted for bariatric surgery, and were aged between 30 and 61 years. Participants were recruited through hospital-based tier 4 bariatric surgery multidisciplinary teams. Results The experiences of participants indicates the nature and extent of the burden of obesity. Problems included stigmatisation, shame, poor health, physical function and reliance on medications. Participants expected surgery to result in major physical and psychological improvement. They described how this expectation was rooted in their experiences of stigma and shame. These feelings were reinforced by previous unsuccessful weight loss attempts. Participants expected extreme and sometimes unrealistic levels of sustained weight loss, as well as improvements to physical and mental health. The overall desire and expectation of bariatric surgery was of ‘normality’. Participants had received previous support from clinicians and in weight management services. However, they reported that their expectations of surgery had not been reviewed by services, and expectations appeared to be unrealistic. Likewise, their experience of stigmatisation had not been addressed. Conclusions The unrealistic expectations identified here may negatively affect postoperative outcomes. The findings indicate the importance of services addressing feelings of shame and stigmatisation, and modifying patients expectations and goals for the postoperative period.

Understanding influences and decisions of households with children with asthma regarding temperature and humidity in the home in winter: a qualitative study.

Objectives This study aimed to understand the influences and decisions of households with children with asthma regarding keeping warm and well at home in winter. Setting Community settings in Rotherham and Doncaster, South Yorkshire, UK. Participants Individuals from 35 families and 25 health, education and social care staff underwent interview. 5 group interviews were held, 1 with parents (n=20) and 4 with staff (n=25). Outcome measures This qualitative study incorporated in-depth, semistructured individual and group interviews, framework analysis and social marketing segmentation techniques. Results The research identifies a range of psychological and contextual influences on parents that may inadvertently place a child with asthma at risk of cold, damp and worsening health in a home. Parents have to balance a range of factors to manage fluctuating temperatures, damp conditions and mould. Participants were constantly assessing their familys needs against the resources available to them. Influences, barriers and needs interacted in ways that meant they made ‘trade-offs’ that drove their behaviour regarding the temperature and humidity of the home, including partial self-disconnection from their energy supply. Evidence was also seen of parents lacking knowledge and understanding while working their way through conflicting and confusing information or advice from a range of professionals including health, social care and housing. Pressure on parents was increased when they had to provide help and support for extended family and friends. Conclusions The findings illustrate how and why a child with asthma may be at risk of a cold home. A ‘trade-off model’ has been developed as an output of the research to explain the competing demands on families. Messages emerge about the importance of tailored advice and information to families vulnerable to cold-related harm.

Barriers to keeping warm in later life

AIM To identify factors influencing older peoples ability to keep warm and well in winter. METHOD This qualitative study used in-depth individual interviews with older people (n=50) and health and social care staff,(n=25), alongside six focus groups with 43 participants and a consultation event. Temperatures were measured in the homes of the older people interviewed. Framework analysis techniques were used. FINDINGS The data indicated a lack of awareness among participants of the importance to a persons health of keeping warm. A summary of findings related to the themes of awareness, money, mindset and machinery is presented here, with reflections on their relevance to nursing in terms of identifying older people at risk of the negative health effects of cold, their assessment and support. CONCLUSION The study revealed a number of ways older people are vulnerable to cold at home. Timely interventions from nurses in various sectors could help avoid cold-related harm.

A qualitative study to explore the attitude of clinical staff to the challenges of caring for obese patients

AIMS AND OBJECTIVES To examine, from the perspective of staff, if obese patients have any additional care needs, and what the impact of these care requirements are on care provision. We have selected obese patients with venous leg ulceration as an example patient population to explore these questions. BACKGROUND Anecdotal evidence indicates obesity can increase care requirements and have implications for obesity for care provision. However, little research exists nationally or internationally that provides evidence from a health care perspective. Obesity is a contributory causative factor of lower limb ulceration. In addition to affecting the development of venous leg ulceration, obesity may also impact on the care an obese patient may require and receive. DESIGN Qualitative study using semi-structured in interviews and framework analysis. METHODS Interviews were conducted with 18 health care professionals and one focus group with 12 health care professionals who cared for patients with venous ulceration. Data were analysed to identify recurring themes relating to the impact of obesity on care provision. RESULTS This study found that the increasing numbers of obese patients with leg ulcers are currently presenting challenges to care delivery in many different ways. There was an impact of obesity on patient experience in terms of dignity, safety and quality. Data indicated that neither hospital nor community care services were adequately set up to meet the needs of obese patients in general. CONCLUSION Health care providers need to recognise that increasing numbers of overweight and obese patients are presenting challenges to care delivery. The study also indicated the need for senior strategic leadership in planning for meeting the needs of obese patients. RELEVANCE TO CLINICAL PRACTICE Nursing is well placed to provide specialist support to co-ordinate services for obese/oversize patients if a suitable strategic and leadership role is developed. Nurses are used to offering patients help in areas of health promotion such as smoking cessation. Lessons learnt from this area could be applied to help and encourage staff to support patients with weight management.

Using environmental monitoring to complement in-depth qualitative interviews in cold homes research

Cold homes contribute to 20,000 to 40,000 excess winter deaths each year in the UK and approximately 300,000 hospital admissions. Using fuel poverty as an identifier for those at risk does not always capture everyday exposure to cold homes due to variations in financial trade-offs and behavioural factors. Few fuel poverty studies have combined environmental measurements with qualitative data on lived experiences of fuel poverty and cold homes. This paper looks at strengths and limitations of using a mixed method, environmental and qualitative interviewing approach. A series of six discreet studies were conducted between 2001 and 2015 using a similar methodology with a mixed methods design, where in-depth interviews were conducted alongside temperature and humidity measurements. The research studies found that combining environmental monitoring with qualitative research methods allows both cross-validation and triangulation of data in order to provide a richer and more insightful examination into the lives of people living in cold homes. The studies demonstrate how a combined methodological approach can help explain the choices, decisions and behaviour of households experiencing cold homes and fuel poverty. The paper concludes with recommendations for future development and implementation of the research method.

Healthy eating in the early years : a qualitative exploration of food provision in the childminder setting

Purpose – A nutritious diet is critical to the health and development of pre-school children. Children in the UK consume much food outside the home yet day-care food provision is unregulated, and informed by disparate and conflicting dietary guidelines. Factors affecting nursery food provision have been much studied, but less is known about food provision in the child-minder setting. The purpose of this paper is to examine factors influencing child-minders’ food provision. Design/methodology/approach – Qualitative methods were employed, combining participant observation with semi-structured interviews. Participants were selected via purposive and convenience sampling. Eight child-minders from an English borough were interviewed. Findings – The food provided by child-minders was not consistent with dietary guidelines for young children, following menu plans was reported to be difficult, and knowledge about healthy eating guidelines for young children was various. Child-minders reported limited time for foo...