Fiona Fylan

Improving response rates using a monetary incentive for patient completion of questionnaires: an observational study

BackgroundPoor response rates to postal questionnaires can introduce bias and reduce the statistical power of a study. To improve response rates in our trial in primary care we tested the effect of introducing an unconditional direct payment of £5 for the completion of postal questionnaires.MethodsWe recruited patients in general practice with knee problems from sites across the United Kingdom. An evidence-based strategy was used to follow-up patients at twelve months with postal questionnaires. This included an unconditional direct payment of £5 to patients for the completion and return of questionnaires. The first 105 patients did not receive the £5 incentive, but the subsequent 442 patients did. We used logistic regression to analyse the effect of introducing a monetary incentive to increase the response to postal questionnaires.ResultsThe response rate following reminders for the historical controls was 78.1% (82 of 105) compared with 88.0% (389 of 442) for those patients who received the £5 payment (diff = 9.9%, 95% CI 2.3% to 19.1%). Direct payments significantly increased the odds of response (adjusted odds ratio = 2.2, 95% CI 1.2 to 4.0, P = 0.009) with only 12 of 442 patients declining the payment. The incentive did not save costs to the trial – the extra cost per additional respondent was almost £50.ConclusionThe direct payment of £5 significantly increased the completion of postal questionnaires at negligible increase in cost for an adequately powered study.

The DAMASK trial protocol: a pragmatic randomised trial to evaluate whether GPs should have direct access to MRI for patients with suspected internal derangement of the knee

BackgroundThough new technologies like Magnetic Resonance Imaging (MRI) may be accurate, they often diffuse into practice before thorough assessment of their value in diagnosis and management, and of their effects on patient outcome and costs. MRI of the knee is a common investigation despite concern that it is not always appropriate. There is wide variation in general practitioners (GPs) access to, and use of MRI, and in the associated costs. The objective of this study was to resolve uncertainty whether GPs should refer patients with suspected internal derangement of the knee for MRI or to an orthopaedic specialist in secondary care.Methods/DesignThe design consisted of a pragmatic multi-centre randomised trial with two parallel groups and concomitant economic evaluation. Patients presenting in general practice with suspected internal derangement of the knee and for whom their GP was considering referral to an orthopaedic specialist in secondary care were eligible for inclusion. Within practices, GPs or practice nurses randomised eligible and consenting participants to the local radiology department for an MRI examination, or for consultation with an orthopaedic specialist. To ensure that the waiting time from GP consultation to orthopaedic appointment was similar for both trial arms, GPs made a provisional referral to orthopaedics when requesting the MRI examination. Thus we evaluated the more appropriate sequence of events independent of variations in waiting times. Follow up of participants was by postal questionnaires at six, twelve and 24 months after randomisation. This was to ensure that the evaluation covered all events up to and including arthroscopy.DiscussionThe DAMASK trial should make a major contribution to the development of evidence-based partnerships between primary and secondary care professionals and inform the debate when MRI should enter the diagnostic pathway.

Marginalisation of men in family planning texts: An analysis of training manuals

Objective: Men’s engagement in family planning has become part of the global health agenda; however, little is known about the training manuals health practitioners’ use and how these manuals describe and explain men’s roles within a family planning context. Design: To further understand engagement, this paper examines how training manuals written for health practitioners describe and define men’s participation within family planning. Setting: The training manuals were written for UK health practitioners and covered men’s contributions to family planning. Method: Discourse analysis was used to examine the three training manuals focused upon. Results: Three main discourses were identified: ‘contraception is a woman’s responsibility’, ‘men disengage with health practitioners’ and ‘men are biologically predisposed to avoid sexual responsibility’. Conclusion: Together, these three discourses function to marginalise men in family planning, constructing them as detached accessories that lack the ability to engage.

Monitoring and Measuring Building Performance

The whole-life sustainability of a building should be underpinned with a demonstration of functional value and an awareness of the direct environmental impact. While a great deal of energy and resources are consumed in the construction of buildings, this is marginal when compared to the operation costs and associated energy used during a building’s life cycle. Many reports identify the build costs and associated resources to be less than 1 % of the whole-life operation costs. The exact energy use of a building can vary widely, depending on the use, energy efficiency of the building and occupant behaviour; thus, a greater deal of attention should be given to understanding the energy used in buildings and how energy efficient operation is achieved.

Buildings that Perform: Thermal Performance and Comfort

Building performance evaluation considers the whole building system from a fabric, service and occupant perspective, as well as its response to the environment and potential integration into smart cities. There are many BPE methods used to collect building data and inform designs. Energy and environment monitoring, simulation, building surveys, post occupancy evaluation, element and whole building testing and their link to future development are discussed.

Switch, Don’t Save

Efforts to meet targets on carbon emission and to reduce the number of people in fuel poverty often focus on building new highly energy-efficient homes and retrofitting existing ones. However, as occupant behaviour is a major predictor of energy use, it is also valuable to provide interventions that help occupants to use less energy. Here, we report qualitative research with 26 occupants in homes retrofitted with external wall insulation and ask what influences the actions they take to reduce the energy they use. Semi-structured interviews, lasting up to one hour, were audio recorded and transcribed verbatim. Taking a social constructionist paradigm, we used a discursive approach to analyse the ways in which people construct and represent their energy consumption and the discursive practices they employ to legitimise their actions or inactions. We identified two main discourses. The dominant discourse positions savvy and responsible consumers as those who switch suppliers to obtain the best energy deals, thereby saving money and enabling them to enjoy a warm and comfortable home. Making efforts to use less energy did not feature in this discourse. Participants’ talk was of disappointment and betrayal when the anticipated savings did not materialise. They blamed suppliers and usually switched again. An alternative discourse of changing behaviour to reduce energy use was drawn upon less often, when present it accompanied other life events, such as moving home, a change in work status or a period of illness. Talk centred on trying to offset the increasing cost of energy, with the purpose of reducing energy bills rather than using less energy. Protecting the environment was not a feature of this discourse. We conclude that campaigns that encourage consumers to switch energy providers have the potential to adversely affect interventions to help them reduce the energy they use.