Francine M Cheater

Communicating with parents about vaccination: a framework for health professionals

BackgroundA critical factor shaping parental attitudes to vaccination is the parent’s interactions with health professionals. An effective interaction can address the concerns of vaccine supportive parents and motivate a hesitant parent towards vaccine acceptance. Poor communication can contribute to rejection of vaccinations or dissatisfaction with care. We sought to provide a framework for health professionals when communicating with parents about vaccination.MethodsLiterature review to identify a spectrum of parent attitudes or ‘positions’ on childhood vaccination with estimates of the proportion of each group based on population studies. Development of a framework related to each parental position with determination of key indicators, goals and strategies based on communication science, motivational interviewing and valid consent principles.ResultsFive distinct parental groups were identified: the ‘unquestioning acceptor’ (30–40%), the ‘cautious acceptor’ (25–35%); the ‘hesitant’ (20–30%); the ‘late or selective vaccinator’ (2–27%); and the ‘refuser’ of all vaccines (<2%). The goals of the encounter with each group will vary, depending on the parents’ readiness to vaccinate. In all encounters, health professionals should build rapport, accept questions and concerns, and facilitate valid consent. For the hesitant, late or selective vaccinators, or refusers, strategies should include use of a guiding style and eliciting the parent’s own motivations to vaccinate while, avoiding excessive persuasion and adversarial debates. It may be necessary to book another appointment or offer attendance at a specialised adverse events clinic. Good information resources should also be used.ConclusionsHealth professionals have a central role in maintaining public trust in vaccination, including addressing parents’ concerns. These recommendations are tailored to specific parental positions on vaccination and provide a structured approach to assist professionals. They advocate respectful interactions that aim to guide parents towards quality decisions.

A systematic review of decision support needs of parents making child health decisions

Objective  To identify the decision support needs of parents attempting to make an informed health decision on behalf of a child.

Expert consensus on the desirable characteristics of review criteria for improvement of health care quality

OBJECTIVES To identify the desirable characteristics of review criteria for quality improvement and to determine how they should be selected. BACKGROUND Review criteria are the elements against which quality of care is assessed in quality improvement. Use of inappropriate criteria may impair the effectiveness of quality improvement activities and resources may be wasted in activities that fail to facilitate improved care. METHODS A two round modified Delphi process was used to generate consensus amongst an international panel of 38 experts. A list of 40 characteristics of review criteria, identified from literature searches, was distributed to the experts who were asked to rate the importance and feasibility of each characteristic. Comments and suggestions for characteristics not included in the list were also invited. RESULTS The Delphi process refined a comprehensive literature based list of 40 desirable characteristics of review criteria into a more precise list of 26 items. The expert consensus view is that review criteria should be developed through a well documented process involving consideration of valid research evidence, possibly combined with expert opinion, prioritisation according to health outcomes and strength of evidence, and pilot testing. Review criteria should also be accompanied by full clear information on how they might be used and how data might be collected and interpreted. CONCLUSION The desirable characteristics for review criteria have been identified and will be of use in the development, evaluation, and selection of review criteria, thus improving the cost effectiveness of quality improvement activities in healthcare settings.

A model for clinical governance in primary care groups

Clinical governance is the core component of the new quality programme for the NHS (see box on next page) announced in the consultation document A First Class Service .1 It is described as “a framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.” It will be the central focus for assuring the quality of care and addressing the issue of providing accountability through the Commission for Health Improvement.2 The activities of the commission will reflect national and local priorities as identified by the National Institute of Clinical Excellence and health improvement programmes respectively. Although A First Class Service included details about the structure and functioning of clinical governance in health service trusts, arrangements for primary care groups were not specified. In this paper, we suggest a possible model for clinical governance in primary care groups. Clinical governance is central to the NHS quality programme, but how it will operate in primary care groups remains unclear Although many activities included in the new concept of clinical governance are already being undertaken, these need to be coordinated A model of governance that addresses the core tasks of defining, accounting for, and improving quality and incorporates evidence on effective methods of changing performance is suggested This model can improve professional, practice, and primary care group performance It shows how groups can introduce and develop clinical governance and how health authorities and the Commission for Health Improvement can monitor progress The model is based on three underlying precepts:

Does the use of a theoretical approach tell us more about hand hygiene behaviour? The barriers and levers to hand hygiene

Background: Despite many strategies employed to improve hand hygiene, compliance remains low at around 50%. Two reasons have been identified for this. First, implementation strategies are rarely tailored according to assessed barriers and levers to best practice. Secondly there is a lack of explicit theoretical basis for the assessment of these barriers and levers to practice. Aim: This paper reports barriers and levers to hand hygiene and an evaluation of the use of theory in assessing barriers and levers to hand hygiene. Methods: Identification of barriers and levers occurred through interviews, questionnaires and focus groups. In each case two different question schedules were used, one based on psychological theory and the other with no explicit theoretical underpinning. Results: Although there was considerable overlap in the barriers and levers identified using the two schedules there were also marked differences. Conclusions: Identification of further barriers and levers may help us address lack of compliance with hand hygiene. Using a theoretical framework may prompt the identification of barriers that people may not ordinarily report but which have an important impact on behaviour, particularly emotion.

Cluster randomized controlled trial of the effectiveness of audit and feedback and educational outreach on improving nursing practice and patient outcomes.

Background:Current understanding of implementation methods is limited, and research has focused on changing doctors’ behaviors. Aim:Our aim was to evaluate the impact of audit and feedback and educational outreach in improving nursing practice and patient outcomes. Methods:Using a factorial design, cluster randomized controlled trial, we evaluated 194 community nurses in 157 family practices and 1078 patients with diagnosis of urinary incontinence (UI) for nurses compliance with evidence-linked review criteria for the assessment and management of UI and impact on psychologic and social well-being and symptoms. In the outreach arms, nurses’ self-reported barriers informed development of tailored strategies. Results:In comparison with educational materials alone, the implementation methods tested did not improve care at 6 months follow-up. Moderate rates of improvement (10–17% of patients) in performance for the assessment of UI and greater rates of improvement (20–30% of patients) for the management of care were found but effects were similar across arms. Improvement in patient outcomes was more consistently positive for educational outreach than for audit and feedback but differences were not significant. Adjustment for caseload size, severity or duration of UI and patients’ age did not alter results. Conclusions:Printed educational materials alone may be as effective as audit and feedback and educational outreach in improving nurses’ performance and outcomes of care for people with UI. Greater understanding of the underlying processes in improving performance within multidisciplinary teams through further, theory-driven studies with “no intervention” control groups and longer follow-up are needed.

What is the role of masculinity in white and South Asian men's decisions to seek medical help for cardiac chest pain?

Objectives: To explore how masculinity influences white, Indian and Pakistani mens interpretation of cardiac chest pain and the decision to seek or delay seeking medical help. Method: Semi-structured interviews were conducted with 36 men of white ethnicity (UK ancestry) and 20 men of South Asian ethnicity (Indian or Pakistani ancestry) who had a confirmed diagnosis of acute myocardial infarction or angina pectoris. The study setting was two coronary care units and eight cardiology wards situated in two teaching hospitals in the North of England. All interviews were tape-recorded, transcribed verbatim and analysed using a constant comparative method. Results: Displaying a high threshold for pain and discomfort was a masculine attribute valued by white men in the study but not by the Indian and Pakistani men. White mens fears of being seen to be weak contributed to delays in seeking medical treatment and led to reluctance to disclose symptoms to others. Indian and Pakistani men emphasized wisdom, education and responsibility for the family and their own health as more valued masculine attributes, and this contributed to a greater willingness to seek medical help. Conclusion: Masculinity had a differing role in white and South Asian mens decisions to seek or delay seeking medical help for chest pain. The study supports the development of coronary heart disease policy and practice that acknowledges mens gender as an important determinant of their health behaviour, but illustrates that there is no probable single appropriate approach to tackling the delay in how men seek treatment for chest pain.

A cluster randomised controlled trial of a web based decision aid to support parents' decisions about their child's Measles Mumps and Rubella (MMR) vaccination

Highlights • The use of decision aids for immunisation decisions is under researched and controversial.• Parents receiving a decision aid or a leaflet had reduced decisional conflict for the MMR decision.• MMR uptake in the decision aid and control arms achieved levels required for population immunity.• Leaflet arm parents were less likely to vaccinate their child.• Childhood immunisation decision aids can achieve both informed decision-making and uptake.

The association between social capital and mental health and behavioural problems in children and adolescents: an integrative systematic review

BackgroundMental health is an important component of overall health and wellbeing and crucial for a happy and meaningful life. The prevalence of mental health problems amongst children and adolescent is high; with estimates suggesting 10-20% suffer from mental health problems at any given time. These mental health problems include internalising (e.g. depression and social anxiety) and externalising behavioural problems (e.g. aggression and anti-social behaviour). Although social capital has been shown to be associated with mental health/behavioural problems in young people, attempts to consolidate the evidence in the form of a review have been limited. This integrative systematic review identified and synthesised international research findings on the role and impact of family and community social capital on mental health/behavioural problems in children and adolescents to provide a consolidated evidence base to inform future research and policy development.MethodsNine electronic databases were searched for relevant studies and this was followed by hand searching. Identified literature was screened using review-specific inclusion/exclusion criteria, the data were extracted from the included studies and study quality was assessed. Heterogeneity in study design and outcomes precluded meta-analysis/meta-synthesis, the results are therefore presented in narrative form.ResultsAfter screening, 55 studies were retained. The majority were cross-sectional surveys and were conducted in North America (n = 33); seven were conducted in the UK. Samples ranged in size from 29 to 98,340. The synthesised results demonstrate that family and community social capital are associated with mental health/behavioural problems in children and adolescents. Positive parent–child relations, extended family support, social support networks, religiosity, neighbourhood and school quality appear to be particularly important.ConclusionsTo date, this is the most comprehensive review of the evidence on the relationships that exist between social capital and mental health/behavioural problems in children and adolescents. It suggests that social capital generated and mobilised at the family and community level can influence mental health/problem behaviour outcomes in young people. In addition, it highlights key gaps in knowledge where future research could further illuminate the mechanisms through which social capital works to influence health and wellbeing and thus inform policy development.

Retention of nurses in the primary and community care workforce after the age of 50 years:database analysis and literature review

AIM This paper is a report of a study conducted to explore strategies for retaining nurses and their implications for the primary and community care nursing workforce. BACKGROUND An ageing nursing workforce has forced the need for recruitment and retention of nurses to be an important feature of workforce planning in many countries. However, whilst there is a growing awareness of the factors that influence the retention of nurses within secondary care services, little is known about those that influence retention of nurses in primary and community care. Little is known about the age profile of such nurses or the impact of the ageing nursing workforce on individual nursing specialities in the England. METHODS Nursing databases were analysed to explore the impact of age on nursing specialities in primary and community care. The nurse retention literature was reviewed from 1995 to 2006. FINDINGS Workforce statistics reveal that primary and community care nurses have a higher age profile than the National Health Service nursing workforce as a whole. However, there are important gaps in the literature in relation to the factors influencing retention of older primary and community care nurses. Specific factors exist for older nurses within primary care that are unique. Implications for their retention are suggested. CONCLUSION Particular attention needs to be paid to factors influencing retention of older nurses in primary and community care. These factors need to be incorporated into local and national policy planning and development.