Louise Laverty

Integrating mobile-phone based assessment for psychosis into people’s everyday lives and clinical care: a qualitative study

BackgroundOver the past decade policy makers have emphasised the importance of healthcare technology in the management of long-term conditions. Mobile-phone based assessment may be one method of facilitating clinically- and cost-effective intervention, and increasing the autonomy and independence of service users. Recently, text-message and smartphone interfaces have been developed for the real-time assessment of symptoms in individuals with schizophrenia. Little is currently understood about patients’ perceptions of these systems, and how they might be implemented into their everyday routine and clinical care.Method24 community based individuals with non-affective psychosis completed a randomised repeated-measure cross-over design study, where they filled in self-report questions about their symptoms via text-messages on their own phone, or via a purpose designed software application for Android smartphones, for six days. Qualitative interviews were conducted in order to explore participants’ perceptions and experiences of the devices, and thematic analysis was used to analyse the data.ResultsThree themes emerged from the data: i) the appeal of usability and familiarity, ii) acceptability, validity and integration into domestic routines, and iii) perceived impact on clinical care. Although participants generally found the technology non-stigmatising and well integrated into their everyday activities, the repetitiveness of the questions was identified as a likely barrier to long-term adoption. Potential benefits to the quality of care received were seen in terms of assisting clinicians, faster and more efficient data exchange, and aiding patient-clinician communication. However, patients often failed to see the relevance of the systems to their personal situations, and emphasised the threat to the person centred element of their care.ConclusionsThe feedback presented in this paper suggests that patients are conscious of the benefits that mobile-phone based assessment could bring to clinical care, and that the technology can be successfully integrated into everyday routine. However, it also suggests that it is important to demonstrate to patients the personal, as well as theoretical, benefits of the technology. In the future it will be important to establish whether clinical practitioners are able to use this technology as part of a personalised mental health regime.

Evaluation of a programme to increase referrals to stop-smoking services using Children's Centres and smoke-free families schemes.

AIMS To assess the feasibility and effectiveness of a new service using referral liaison advisers to increase the number of referrals of parents/carers at selected Childrens Centres to National Health Service (NHS) Stop Smoking Services (SSS) and/or smoke-free families schemes (SFS). DESIGN This mixed-methods pilot study collected numerical data on indicators of smoking behaviours and carried out face-to-face and telephone interviews. SETTINGS Thirteen Childrens Centres in Liverpool and Nottingham using local providers of smoking cessation services, from September 2010 to April 2011. PARTICIPANTS Parents and carers registered with, and staff working for, Childrens Centres. MEASURES Number of smokers referred to smoking cessation services and/or smoke-free family schemes and the views of service providers and users on the new service. FINDINGS In Liverpool, 181 referrals to NHS SSS were made from 331 identified smokers (54.7%); extrapolated to 12 months, this represents a 182% increase in referrals from baseline and a similar extrapolation indicates a 643% increase from baseline of referrals to smoke-free families schemes. There were no reliable baseline data for Nottingham; 31 referrals were made (30.7% of smokers) to SSS and 44 referrals to SFS from 52 contacts (84.6%). The interviews highlighted the need for sustained personal contact with parents/carers to discuss smoking behaviours and concerns and their willingness to be referred to SFS as part of caring for their child. CONCLUSIONS Routine recording of smoking status and appropriate follow-up by trained staff in Childrens Centres can lead to significant numbers of clients attending stop-smoking services, although relatively few stop smoking.

Gendered forms of responsibility and control in teenagers' views of alcohol

There has been a shift in the most recent UK Governments Alcohol Strategy (2012) from personal responsibility towards a model of shared responsibility for young peoples drinking. On closer examination of the strategy, however, it appears that rather than exonerating young people from blame, governance is merely extended to include wider partners. Using findings from nine focus groups with young people in Liverpool, UK, we explore who they believe are responsible for their drinking behaviours and how they learn to become ‘good drinkers’. Our findings show that while teenagers were aware of dominant alcohol-related messages and maintained a moral position as responsible citizens; they also negotiated and resisted norms about teenage drinking. Although both boys and girls agreed that parents were the primary responsible authority for regulating their drinking, there was gendered disagreement about personal responsibility. The girls described how they were ultimately responsible for any adverse consequences if they drank too much whilst the boys considered a wide range of partners who would be implicated. However, unlike the girls, the boys described a willingness to either abstain or moderate their alcohol intake in order to remain in control and avoid any alcohol-related trouble or harm.

Gender differences in teenage alcohol consumption and spatial practices

ABSTRACT In recent years teenagers have reported a decline in under-age drinking at the same time as their access to public space has been increasingly curtailed. In this paper we explore the spatial practices and drinking behaviours of a group of teenage girls and boys aged 13–14 years in Liverpool, UK. Our analysis considers how their use of space was bound up with experimentation with alcohol and how this varied by gender. We find in support of previous research that both boys and girls report nuanced experiences of public space, with some enjoying greater freedom while others have moved into more domestic and supervised leisure spaces in response to fears about their safety in public spaces. The boys also reported less alcohol consumption than the girls. These gendered experiences were mediated by social relationships and encounters with other young people, their parents and carers and also other adults in positions of authority.

Can conditional health policies be justified? A policy analysis of the new NHS dental contract reforms

Conditional policies, which emphasise personal responsibility, are becoming increasingly common in healthcare. Although used widely internationally, they are relatively new within the UK health system where there have been concerns about whether they can be justified. New NHS dental contracts include the introduction of a conditional component that restricts certain patients from accessing a full range of treatment until they have complied with preventative action. A policy analysis of published documents on the NHS dental contract reforms from 2009 to 2016 was conducted to consider how conditionality is justified and whether its execution is likely to cause distributional effects. Contractualist, paternalistic and mutualist arguments that reflect notions of responsibility and obligation are used as justification within policy. Underlying these arguments is an emphasis on preserving the finite resources of a strained NHS. We argue that the proposed conditional component may differentially affect disadvantaged patients, who do not necessarily have access to the resources needed to meet the behavioural requirements. As such, the conditional component of the NHS dental contract reform has the potential to exacerbate oral health inequalities. Conditional health policies may challenge core NHS principles and, as is the case with any conditional policy, should be carefully considered to ensure they do not exacerbate health inequities.

Reasons for low adherence to diet-diaries issued to pediatric dental patients: a collective case study

Objective Dietary habits are an important etiological factor in the development of dental caries. Several tools, such as 24-h dietary recall (retrospective) and diet-diaries (prospective), have been recommended for dietary assessment in dental practice. Diet-diaries are commonly advocated as a tool for oral health education; however, low adherence is found to be a recognized downside of their use in dental settings, as well as nutritional research more widely. However, the reasons for poor adherence to diet-diaries remain unclear. This study aimed to explore the reasons for poor adherence to diet-diaries issued to children in a dental hospital setting. Methods A qualitative collective case study design was employed to explore the use of diet-diaries as a health education tool. Twenty-eight data sources across 11 appointments included: observation of dentist–patient interactions, semi-structured interviews with child–parent dyads and dentists, in addition to documentary analysis of returned diet-diaries (this included 11 observations of dentist–patient interactions, 14 interviews with the child/parent dyads and dentists, and documentary analysis of three completed diet-diaries). Data from these multiple sources were integrated in a thematic analysis to identify themes and sub-themes. Results Two overarching themes were identified: 1) the diet-diary is perceived as a test which carries a potential for embarrassment and blame, which in turn generates defensive behavior from parents; and 2) parents’ values, priorities, and circumstances affect the level of commitment to completing a diet-diary. Conclusion Low adherence to diet-diary completion in clinical dentistry results from interacting factors related to the diet-diary itself, the patient, and the clinician. This study identifies a need for a more appropriate tool for dietary assessment that is patient-centered and compatible with modern lifestyles.

9 Shame, Disgust and the Moral Economies of Young Women’s Sexual Health in the North of England

The range of austerity measures implemented in the UK following the Global Financial Crisis of 2008 has been accompanied by, and justified through, emotive and stigmatising discourses that recast blame on those suffering the greatest inequalities (Clayton et al. 2015; Tyler 2013). As a number of authors have noted, heightened stigmatisation in recent UK public and political discourse has created a division between the ‘deserving’ and ‘undeserving’ poor in society (Hancock and Mooney 2012; Tyler 2013; Wacquant 2009; Wacquant 2008). Most notably, as part of this shift in attitudes, poverty has been recast as the moral failure of the individual rather than the result of structural inequalities (Slater 2014; Valentine and Harris 2014; Wacquant 2008). This discourse is particularly evident in the UK’s Child Poverty Strategy (2011, p.4) where behavioural rather than structural causes are outlined. The cause of child poverty, according to this strategy, is ‘a lack of opportunity, aspiration and stability’ among children and their families, a lack that can be tackled by reducing criminality, teenage pregnancies and risky behaviour. To experience poverty, therefore, is to occupy a stigmatised social position (Ridge 2011; Ridge 2009; Sutton 2009) that people seek to distance and differentiate themselves from (Shildrick and MacDonald 2013).