Margaret Coffey

Working in the public sector: a case study of social services

• Summary: This article explores working conditions and quality of life in social services. The article focuses on the qualitative findings generated throughout a phased study comprising: in-depth interviews (n = 8) used to develop an original questionnaire; a large survey (n = 1237) of staff in two social service departments in the UK; and focus groups (n = 4) used in Children and Families Division to develop a better understanding of the difficulties experienced and develop context-specific interventions aimed at reducing or eliminating these stressors. It also reports quantitative findings in respect stress (measured using the General Health Questionnaire — GHQ-12). • Findings: The survey findings indicated that 36 percent (n = 392) of the respondents were considered to be suffering from mental distress. Children and Families Division was worst affected, reporting the highest levels of absenteeism and poorest well-being. The qualitative findings were summarized into five broad themes: organizational culture and function; control; lack of resources; responsibility for people; and the rate and pace of change, which were incorporated into a model. • Application: The article suggests that during times of change a thorough understanding of working conditions in the public sector are a fundamental prerequisite to developing interventions aimed at improving them. Additionally, the model clearly identifies a number of factors that are ‘organizational’, rather than being intrinsic to working in social services.

Designing a stress management intervention in social services

Purpose – The purpose of this paper is to present an evaluation of the design of a stress management intervention (rather than an evaluation of the implementation and outcomes of the programme).Design/methodology/approach – This paper uses data generated from a large study carried out in two social service departments in the UK. The study is carried out in three phases: first, a problem diagnosis phase, comprising the development of a questionnaire and survey (n=1,234); second, focus groups (n=16) to develop interventions in a participatory way from the baseline established; and finally, an evaluation of the processes involved in phases one and two.Findings – Key barriers include: major changes are currently taking place within the organisations; staff are distrustful of management and sceptical of the value of the research; lack of resources; and difficulties translating the findings into actions. Key factors necessary for success include: strong commitment from senior management; willingness by staff to...

Exploring barriers and solutions to academic writing: Perspectives from students, higher education and further education tutors

Staff and student perceptions of what constitutes good academic writing in both further and higher education often differ. This is reflected in written assignments which frequently fall below the expected standard. In seeking to develop the writing skills of students and propose potential solutions to writing difficulties, a study was conducted in a university and a nearby further education college in the north west of England to explore barriers and solutions to AW difficulties. This paper reports the findings generated using unmoderated focus groups with second-year university health studies students (n=70) and moderated focus groups with further education college teachers (n=3) and health studies lecturers in a university (n=6). Findings indicated that staff and students’ perceptions of what constitutes AW differed. The barriers to academic writing that were identified included lack of time and confidence; lack of extended writing at FE level; lack of reading and understanding of academic texts or journals; referencing; and academic jargon.

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.

Barriers to employment for visually impaired women

Purpose – The purpose of this paper is to explore barriers to employment for visually impaired (VI) women and potential solutions to those barriers. Design/methodology/approach – Mixed methods, comprising three phases; first, exploratory interviews with VI women (n=6) and employers (n=3); second, a survey to assess the barriers to employment experienced by this group (n=96); and third, in-depth interviews with VI women (n=15). This paper reports phases 2 and 3. Findings – The most commonly reported barriers to work were: negative employer attitudes; the provision of adjustments in the workplace; restricted mobility; and having an additional disability/health condition. Significantly more barriers were reported by women: who reported that their confidence had been affected by the barriers they had experienced; with dependents under 16; and women who wanted to work. Research limitations/implications – Key solutions to these barriers included: training for employers; adaptive equipment; flexibility; better s...

Stress, support and well-being as perceived by probation trainees:

A study on stress, support and well-being was carried out with probation trainees (n = 110). The study indicated that working as a probation trainee entailed high demands. Greater levels of demands were experienced by trainees with children and those undertaking part-time work. A large majority of trainees reported a high sense of personal accomplishment, had good self esteem, held positive attitudes towards themselves and enjoyed their work with offenders. Female trainees had significantly less positive attitudes towards themselves than males. Small, but significant numbers of trainees experienced problems with stress, well-being, low self-esteem, tiredness and emotional exhaustion. They might benefit from receiving more individual support, mutual group support and stress management courses. ‘Professional’ support opportunities from fellow students and practice development assessors were perceived as more important than from family or friends. There were some significant differences between trainees in their perceptions of support offered by Consortia and their tutors. Overall, there were no significant differences in relation to age or ethnicity.

Working as a community food worker: Voices from the inside:

Aims: Community food worker (CFW) is one of the new roles that were proposed in the 2004 White Paper Choosing Health: Making Healthier Choices Easier. CFWs are recruited from local communities and generally operate in areas characterized by extreme social deprivation. The aim of this paper is to illuminate the experience of being a CFW in the context of working in a relatively new non-professional role. Methods: As part of an ongoing evaluation of a CFW scheme in the north west of England, a qualitative interview and two focus groups were conducted with CFWs. Thematic analysis of the data was undertaken. Results: Emergent issues faced by these new practitioners include: the nature of their role; quantifying success; working with other health professionals; skills and knowledge; and strategies used to work with communities. Conclusion: This study has highlighted some pertinent and previously unreported issues related to the experience of being a CFW, raising questions about their assimilation into the public health workforce and their use in delivering effective public health interventions without further integration.

Identifying the participant characteristics that predict recruitment and retention of participants to randomised controlled trials involving children : a systematic review

BackgroundRandomised controlled trials (RCTs) are recommended as the ‘gold standard’ in evaluating health care interventions. The conduct of RCTs is often impacted by difficulties surrounding recruitment and retention of participants in both adult and child populations. Factors influencing recruitment and retention of children to RCTs can be more complex than in adults. There is little synthesised evidence of what influences participation in research involving parents and children.AimTo identify predictors of recruitment and retention in RCTs involving children.MethodsA systematic review of RCTs was conducted to synthesise the available evidence. An electronic search strategy was applied to four databases and restricted to English language publications. Quantitative studies reporting participant predictors of recruitment and retention in RCTs involving children aged 0–12 were identified. Data was extracted and synthesised narratively. Quality assessment of articles was conducted using a structured tool developed from two existing quality evaluation checklists.ResultsTwenty-eight studies were included in the review. Of the 154 participant factors reported, 66 were found to be significant predictors of recruitment and retention in at least one study. These were classified as parent, child, family and neighbourhood characteristics. Parent characteristics (e.g. ethnicity, age, education, socioeconomic status (SES)) were the most commonly reported predictors of participation for both recruitment and retention. Being young, less educated, of an ethnic minority and having low SES appear to be barriers to participation in RCTs although there was little agreement between studies. When analysed according to setting and severity of the child’s illness there appeared to be little variation between groups. The quality of the studies varied. Articles adhered well to reporting guidelines around provision of a scientific rationale for the study and background information as well as displaying good internal consistency of results. However, few studies discussed the external validity of the results or provided recommendations for future research.ConclusionParent characteristics may predict participation of children and their families to RCTs; however, there was a lack of consensus. Whilst sociodemographic variables may be useful in identifying which groups are least likely to participate they do not provide insight into the processes and barriers to participation for children and families. Further studies that explore variables that can be influenced are warranted. Reporting of studies in this field need greater clarity as well as agreed definitions of what is meant by retention.

Policies alone are not enough: Workplace health development in the public, private and voluntary sectors

A 2001 survey of public (n = 28), private (n = 113) and voluntary sector (n = 64) workplaces in Sefton, Merseyside indicated that there were significantly different levels of health-related policy provision across the three sectors, with the public sector having the highest level of provision (7.18 policies on average), followed by the voluntary (5.09 policies on average) and the private sector (3.94 policies on average). Policies already in place were mostly based around health and safety (89%), smoking (80%), sickness absenteeism (68%) and manual handling (49%). Workplaces reported that in order to benefit their employees’ health they wanted to improve: the physical work environment (38%); communications (31%); job content/organization (30%) and wage levels (29%). In addition, they wanted to develop stress management (51%) and family-friendly (25%) policies. The major perceived barriers to implementing these policies were: lack of time/monetary resources (70%); not having the skills/expertise (37%); knowing which issues are priorities (25%); and knowing where to go to for help (17%). In order to achieve this, workplaces would like support in the form of: advice/information (63%); free health and safety checks (52%); training courses (49%) and monetary subsidies (49%). This study uniquely compares the public, private and voluntary sectors, highlighting that the sectors with the most health policies in place (public and voluntary) are also the sectors with the greatest number of reported difficulties, e.g. absenteeism, recruitment and retention. Recommendations from this study are that a ‘one-size-fits-all’ approach to health promotion would be inadequate to bring about changes in practice; that health promotion campaigns should focus on addressing the contextual difficulties, e.g. lack of resources, facing the voluntary and public sector, rather than on solely developing policy provision; and that information and advice for workplaces should be tailored to this end.

An evaluation of a storybook targeting parental attitudes, intention and self-efficacy to change their child’s oral health behaviour

Objective: Methods for reducing dental disease have traditionally focused on health education rather than targeting psychosocial determinants of the core behaviors through behavior change strategies. This study tested a novel intervention in the form of a children’s story (Kitten’s First Tooth) embedded with behavior change techniques (Abraham & Michie, 2008) with the aim of investigating how effective the intervention was at improving parents’ efficacy and intention to enact oral health behaviors for their child. Method: A controlled before and after study conducted in a deprived area of England (n = 149; child mean age 4 years) with an intervention and control group. Changes in task specific parental self-efficacy (PSE) and intention were measured using the Oral Health Behaviors Questionnaire (OHBQ; Adair et al., 2004) at baseline and 3 months following intervention. Results: Of the 149 participants, 129 returned both baseline and evaluation questionnaires (retention 86.6%), 125 of these pairs of questionnaires were used in the analysis (83.4%). The OHBQ was analyzed using a general linear model (ANCOVA). A significant difference was found in favor of the intervention group for PSE related to child tooth brushing behaviors, F(1,1) = 12.04, p = .001, however no change was observed for PSE related to control of dietary sugars. Conclusions: A theorized children’s story can be effective as an oral health promotion intervention by supporting parents to improve their child’s oral health-related behavior. Change was observed for child tooth brushing but not sugar control. This may reflect story contents or may be indicative of difficulties of changing dietary behavior.