Lorna Porcellato

Giving older workers a voice: constraints on the employment of older people in the North West of England

This article contributes to the literature on older workers and employment, providing a regional perspective on the relationship between age and work. The study is based on interviews in conjunction with occupational-event calendars with 56 individuals in North West England. The primary aim was to gain in-depth understanding of perceived constraints that older people feel hinder their employment prospects within the context of their daily lives. Significant constraints on employment and re-employment were identified and attributed to health, negative perceptions of self, lack of formal human capital and undervaluation of experience, financial disincentives for employers to employ older workers and prevailing ageist attitudes.

Using focus groups to explore children's perceptions of smoking: reflections on practice

This paper reflects on the appropriateness of using focus groups with young children, based on a real life study carried out in Liverpool, UK which used 12, single‐sex focus groups (n=50, mean age=7) to explore children’s perceptions of smoking. The technique proved both useful and appropriate for young children, although in practice the groups needed more direction by the moderator than is thought to be ideal with adults. The findings produced by the study were comparable to those attained by other research methods. There was no evidence of over conformity as a range of responses were given, and the children appeared to enjoy the exercise, which encouraged spontaneity. We conclude, with certain preconditions, that focus groups with young children are a viable method for exploring young children’s perspectives but need to be small in number, homogenous and interactive, to maintain a high level of interest.

Views and experiences of hepatitis C testing and diagnosis among people who inject drugs: Systematic review of qualitative research

BACKGROUND Many developed countries are facing a major challenge to improve identification of individuals acutely and chronically infected with hepatitis C virus (HCV) infection. We explored the views and experiences of people who inject drugs (PWID) in relation to HCV testing, and diagnosis through a review and synthesis of qualitative research. METHODS Based on the thematic synthesis of qualitative research. Searches were conducted in 14 databases and supplemented by reference checking, hand searching of selected journals, and searches of relevant websites. Studies of any qualitative design that examined the views and experiences of, and attitudes towards, HCV testing and diagnosis among PWID or practitioners involved in their care were included. Key themes and sub-themes were systematically coded according to the meaning and content of the findings of each study which proceeded to the preparation of a narrative account of the synthesis. RESULTS 28 qualitative studies were identified. We identified a number of overarching descriptive themes in the literature, finding overall that PWID hold complex and differing views and experiences of testing and diagnosis. Three major themes emerged: missed opportunities for the provision of information and knowledge; shifting priorities between HCV testing and other needs; and testing as unexpected and routine. Evidence of missed opportunities for the provision of knowledge and information about HCV were clear, contributing to delays in seeking testing and providing a context to poor experiences of diagnosis. Influenced by the nature of their personal circumstances, perceptions of the risk associated with HCV and the prioritisation of other needs acted both to encourage and discourage the uptake of HCV testing. Undergoing HCV testing as part of routine health assessment, and an unawareness of being testing was common. An unexpected positive diagnosis exacerbated anxiety and confusion. CONCLUSION This review has identified that there are modifiable factors that affect the uptake of HCV testing and experiences of HCV diagnosis among PWID. Intervention development should focus on addressing these factors. There is a need for further research that engages PWID from a diverse range of populations to identify interventions, strategies and approaches that they consider valuable.

Developing new community health roles: can reflective learning drive professional practice?

A variety of new non‐professional roles, such as health trainers and community food workers, have evolved from recent UK public health policy developments. These roles predominantly operate in communities characterised by extreme social deprivation. Their remit is to offer local people support to help change lifestyle ‘choices’, for example, healthy eating or drinking responsibly. However, encouraging people to change health‐related behaviour often ignores the underlying social determinants of health related behaviour. Health trainers and community food workers have been identified as being able to bridge the gap between the health professional and lay person, because of their ability to identify with local people. The challenges faced by these non‐professionals, working at the coal‐face of communities, and in a new and evolving role, are as yet poorly understood and this paper details the mechanism of reflective learning adopted by these practitioners in order to explore the professional practices involved. Emergent issues faced by these new practitioners include: understanding the boundaries between the trainer role and other health services; and the issues raised by the community, for example, presenting with non‐health reasons such as financial crisis, which the trainers were often unprepared to deal with, rather than ‘lack of health skills’ (e.g. cooking skills). This paper explores how reflective learning processes can deconstruct the experiences of this ‘new level of the health workforce’ who have on the one hand the sensibility and sensitivity to develop relationships with individuals and households in poorer communities, yet are ill equipped to deal with the wider structural factors often determining behaviour.

Influence of family and friend smoking on intentions to smoke and smoking-related attitudes and refusal self-efficacy among 9–10 year old children from deprived neighbourhoods: a cross-sectional study

BackgroundSmoking often starts in early adolescence and addiction can occur rapidly. For effective smoking prevention there is a need to identify at risk groups of preadolescent children and whether gender-specific intervention components are necessary. This study aimed to examine associations between mother, father, sibling and friend smoking and cognitive vulnerability to smoking among preadolescent children living in deprived neighbourhoods.MethodsCross-sectional data was collected from 9–10 year old children (n =1143; 50.7% girls; 85.6% White British) from 43 primary schools in Merseyside, England. Children completed a questionnaire that assessed their smoking-related behaviour, intentions, attitudes, and refusal self-efficacy, as well as parent, sibling and friend smoking. Data for boys and girls were analysed separately using multilevel linear and logistic regression models, adjusting for individual cognitions and school and deprivation level.ResultsCompared to girls, boys had lower non-smoking intentions (P = 0.02), refusal self-efficacy (P = 0.04) and were less likely to agree that smoking is ‘definitely’ bad for health (P < 0.01). Friend smoking was negatively associated with non-smoking intentions in girls (P < 0.01) and boys (P < 0.01), and with refusal self-efficacy in girls (P < 0.01). Sibling smoking was negatively associated with non-smoking intentions in girls (P < 0.01) but a positive association was found in boys (P = 0.02). Boys who had a smoking friend were less likely to ‘definitely’ believe that the smoke from other people’s cigarettes is harmful (OR 0.57, 95% CI: 0.35 to 0.91, P = 0.02). Further, boys with a smoking friend (OR 0.38, 95% CI: 0.21 to 0.69, P < 0.01) or a smoking sibling (OR 0.45, 95% CI: 0.21 to 0.98) were less likely to ‘definitely’ believe that smoking is bad for health.ConclusionThis study indicates that sibling and friend smoking may represent important influences on 9–10 year old children’s cognitive vulnerability toward smoking. Whilst some differential findings by gender were observed, these may not be sufficient to warrant separate prevention interventions. However, further research is needed.

Older age and ill‐health: links to work and worklessness

Purpose: To provide insights on the relationship between health and employment in older age. Design/methodology: Qualitative methods are used with some additional quantitative analysis to explore generalisations. The qualitative analysis is based on interviews with 56 men and women between the ages of 50 and 68. This part of the study uses the respondents’ own words to explain how physical and mental ill-health has impacted on labour market participation and vice versa. The quantitative analysis uses data from the British Household Panel Study and multivariate techniques. Findings: The research highlights the complexity, individuality and two-way causality underlying the relationships between health, work and worklessness in older age. The analysis also suggests that type of job and workplace conditions matter. The negative impact of the onset of ill-health on employment participation only appears to be accentuated by age for women. Research limitations: The two data sets are not directly comparable. Social implications: Planned rises in the age at which state pensions are payable need to be accompanied by policies that improve the health of older people and changes in workplace practices that facilitate longer working lives. Originality: A specific focus on the relationship between ill-health and employment in older age. The use of qualitative methods to draw out the main issues and the use of quantitative analysis to draw additional insights and make some comparisons with younger cohorts.

Using occupational history calendars to capture lengthy and complex working lives: a mixed method approach with older people

Accurately documenting the occupational biographies of older people can be challenging given their lengthy duration and the complexity of contemporary employment. This paper shows how a traditionally quantitative occupational history calendar (OHC) instrument can be adapted for use in a mixed methods research design, to gather in-depth information about long working lives. The OHCs were embedded within semi-structured interviews and recorded lifetime work histories of between 33 and 53 years for 56 participants. Sequence analysis of the calendar data was undertaken in parallel to thematic analysis of interview transcripts. This included in-depth exploration of the factors motivating occupational changes and transitions and their impact in older age. Mixing methods allowed us to collate data over relatively long periods of time and enabled an examination of the complex interplay between work, family and personal circumstances that shapes employment histories. Selected research findings are used to demonstrate how this tool can effectively facilitate the exploration of long working lives.

Out-of-school lives of physically disabled children and young people in the United Kingdom A qualitative literature review

Currently there appears to be few opportunities and little evidence of physically disabled children and young people (C&YP) participating in mainstream social activities. A qualitative review was undertaken to examine the factors affecting physically disabled C&YP (8–15 years) in the United Kingdom participating in out-of-school activities. Views and experiences were explored from the perspective of the service users and providers to assess current provision and to determine the need for future research into factors that may affect participation. Searches were conducted across eight databases, the references of the included studies were checked and the websites were searched. Studies that used a qualitative design that examined the views relating to out-of-school activities were included. Nine papers were identified, which included three peer-reviewed papers and six pieces of grey literature and pertinent government documents to include views and experiences of out-of-school activity provision. The main themes emerging from the review were the need for social inclusion, out-of-school activities run by volunteers and accessibility, with threads throughout, which require further research including parental influence, provision, training and attitudes. This review highlights the absence of the service user’s voice and sheds light on the limited provision and barriers affecting participation in out-of-school activities.

Ageism and Age Discrimination: The Experiences and Perceptions of Older Employees

This chapter explores reasons for the lower employment participation rates of older people by considering the views and perspectives of older people themselves. The chapter begins by setting out some contextual issues. In section 8.2 some recent qualitative research that provides an ‘insider perspective’ on the views of older men and women is reviewed. Within this body of work, a range of factors that constrain the employment of older people has been identified. Among these factors, ageist attitudes are found to be of particular importance since these are manifested in discriminatory practices. In section 8.3 new research by the authors is presented which explores in detail how ageism can restrict the opportunities of older people in employment. Section 8.4 concludes.

‘It's something you have to put up with’—service users’ experiences of in utero transfer: a qualitative study

The purpose of this study was to gain in‐depth insight and enhance understanding of service users’ experiences of the in utero transfer (IUT) process, in order to inform policy and improve the current service provision of maternal care.