Markus Themessl-Huber

What do we know about who does and does not attend general health checks? Findings from a narrative scoping review

BackgroundGeneral and preventive health checks are a key feature of contemporary policies of anticipatory care. Ensuring high and equitable uptake of such general health checks is essential to ensuring health gain and preventing health inequalities. This literature review explores the socio-demographic, clinical and social cognitive characteristics of those who do and do not engage with general health checks or preventive health checks for cardiovascular disease.MethodsAn exploratory scoping study approach was employed. Databases searched included the British Nursing Index and Archive, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews (CDSR) and Database of Abstracts of Reviews of Effects (DARE), EMBASE, MEDLINE, PsycINFO and the Social Sciences Citation Index (SSCI). Titles and abstracts of 17463 papers were screened; 1171 papers were then independently assessed by two researchers. A review of full text was carried out by two of the authors resulting in 39 being included in the final review.ResultsThose least likely to attend health checks were men on low incomes, low socio-economic status, unemployed or less well educated. In general, attenders were older than non-attenders. An individual’s marital status was found to affect attendance rates with non-attenders more likely to be single. In general, white individuals were more likely to engage with services than individuals from other ethnic backgrounds. Non-attenders had a greater proportion of cardiovascular risk factors than attenders, and smokers were less likely to attend than non-smokers. The relationship between health beliefs and health behaviours appeared complex. Non-attenders were shown to value health less strongly, have low self-efficacy, feel less in control of their health and be less likely to believe in the efficacy of health checks.ConclusionRoutine health check-ups appear to be taken up inequitably, with gender, age, socio-demographic status and ethnicity all associated with differential service use. Furthermore, non-attenders appeared to have greater clinical need or risk factors suggesting that differential uptake may lead to sub-optimal health gain and contribute to inequalities via the inverse care law. Appropriate service redesign and interventions to encourage increased uptake among these groups is required.

Empirical evidence of the relationship between parental and child dental fear: a structured review and meta-analysis.

BACKGROUND The relationship between parental and child dental fear has been studied for over a century. During this time, the concept of dental fear as well as methodological approaches to studying dental fear in children have evolved considerably. AIM To provide an overview of the published empirical evidence on the link between parental and child dental fear. DESIGN A structured literature review and meta-analysis. RESULTS Forty-three experimental studies from across the six continents were included in the review. The studies ranged widely with respect to research design, methods used, age of children included, and the reported link between parental and child dental fear. The majority of studies confirmed a relationship between parental and child dental fear. This relationship is most evident in children aged 8 and under. A meta-analysis of the available data also confirmed an association between parental and child dental fear. CONCLUSION The narrative synthesis as well as the meta-analysis demonstrate a significant relationship between parental and child dental fear, particularly in children 8 years and younger.

Audio-visual recording of patient–GP consultations for research purposes: A literature review on recruiting rates and strategies

OBJECTIVE To identify ethical processes and recruitment strategies, participation rates of studies using audio or video recording of primary health care consultations for research purposes, and the effect of recording on the behaviour, attitudes and feelings of participants. METHODS A structured literature review using Medline, Embase, Cochrane Library, and Psychinfo. This was followed by extensive hand search. RESULTS Recording consultations were regarded as ethically acceptable with some additional safeguards recommended. A range of sampling and recruitment strategies were identified although specific detail was often lacking. Non-participation rates in audio-recording studies ranged from 3 to 83% for patients and 7 to 84% for GPs; in video-recording studies they ranged from 0 to 83% for patients and 0 to 93% for GPs. There was little evidence to suggest that recording significantly affects patient or practitioner behaviour. CONCLUSIONS Research involving audio or video recording of consultations is both feasible and acceptable. More detailed reporting of the methodical characteristics of recruitment in the published literature is needed. PRACTICE IMPLICATIONS Researchers should consider the impact of diverse sampling and recruitment strategies on participation levels. Participants should be informed that there is little evidence that recording consultations negatively affects their content or the decisions made. Researchers should increase reporting of ethical and recruitment processes in order to facilitate future reviews and meta-analyses.

The cyclical process of action research The contribution of Gilles Deleuze

Action Research is normally described as both a cyclical process and a participatory (democratic/egalitarian) undertaking. This article does not seek to contest the idiosyncrasies and pragmatics of the cyclical process involved in action research. Rather, it seeks to enrich it by developing further the idea of action research as a process that engages with problems and learning in the act of creating change. To do this we draw primarily on aspects of the work of the French philosopher, Gilles Deleuze. Deleuze has argued that all learning is essentially a direct apprentice-type engagement with the problematic nature of the material or project under consideration. We argue that an explication of what Deleuze means by this can augment our understanding of the contingencies involved in both the participatory and cyclical dimensions of action research. To give explanatory substance to Deleuzes potential contribution to action research, we use illustrative moments based on a hypothetical scenario of the development of a large piece of waste-ground into a community gardening project. We seek to connect aspects of Deleuzian philosophy to the cyclical process of action research to show the dynamic relationship between action researchers and an action research project. Our argument is that in doing this, an understanding of the variables involved in the cyclical process of action research may be enhanced.

Using action research to develop a research aware community pharmacy team

An action research approach was applied to develop a community pharmacy team into a research aware practice. A pharmacy team consisting of a pharmacist and medicine counter assistants carried out this project. They started by reflecting on their own practice and in doing so examined the reliability of the evidence base they used to give advice to customers regarding the sale of medicines. The team used this opportunity to discuss and critically analyse their core activities. This process resulted in the development of portfolios of evidence-based counter recommendations and a more knowledgeable, self-aware, confident as well as research-aware pharmacy team.

The health-promoting prison: can it improve oral health? An evaluation of an Oral Health Improvement Project for high-security prisoners

The aim of the evaluation was to examine the impact of an Oral Health Improvement Project on the oral health-related knowledge, attitudes and behaviours of prisoners in this high-security gaol. Prisoners in a high-security prison that had adopted a health-promoting prison agenda were invited to take part. Prisoners in locations where the Project had been active acted as the intervention group and those in other settings where there was no formal involvement with the Project acted as controls. All consenting prisoners were asked to complete questionnaires to assess their Project awareness, oral health-related knowledge, attitudes and behaviours. The data were subjected to Chi-squared tests, t-tests, correlation analysis and ANCOVA. Fifty-nine intervention and 48 control group prisoners completed questionnaires. Intervention group prisoners were more Project-aware (F[1,97] = 6.98, p = 0.01) and more knowledgeable about oral health (F[1,97] = 12.02, p = 0.001) when controlling for duration of current imprisonment. No significant associations between intervention group status and oral health-related attitudes or behaviours were found. Increased reported smoking and poorer dietary habits were significantly explained by duration of current imprisonment. This evaluation highlights the difficulties in changing health-related attitudes and behaviours in the prison setting. It also demonstrates the need for effective deployment of the health-promoting prison approach to improve the oral health of prisoners.

Developing a longitudinal database of routinely recorded primary care consultations linked to service use and outcome data

The primary care consultation provides access to the majority of health care services and is central to obtaining diagnoses, treatment and ongoing management of long-term conditions. This paper reports the findings of an interdisciplinary feasibility study to explore the benefits and practical, technical and ethical challenges (and solutions) of creating a longitudinal database of recorded GP consultations in Tayside, Scotland which could be linked to existing routine data on intermediate and long-term health outcomes. After consultation we attempted to recruit and audio-record the consultations of all patients attending three general practices over a two week period. Background patient data, and patient and staff experiences of participation were also collected. Eventually, two practices participated with 77% of patients approached agreeing to participate. The findings suggest that the perceived integrity of the consultation was preserved. The overwhelming majority of patients believed that recording was worthwhile and did not feel it impacted on communication or the treatment they received; 93% indicated they would be willing to have subsequent consultations recorded and 81% would recommend participation to a friend. Staff had similar beliefs but raised concerns about potential increases in workload, confidentiality issues and ease of software use. We conclude that practice participation could be increased by providing safeguards on data use, financial reward, integrated recording software, and procedures to lessen the impact on workload. The resulting Scottish Clinical Interactions Project (SCIP) would provide the largest and most detailed longitudinal insight into real world medical consultations in the world, permitting the linking of consultation events and practices to subsequent outcomes and behaviours.

Partnership working and improved service delivery: views of staff providing sexual health services.

Objectives Successful partnership working has theoretically been linked to improvements in service delivery and is dependent on the strength of the partnership, trust, communication, professional roles and resource sharing. Empirical evidence to confirm the relationships between these factors and improved service provision, however, is lacking. Our aim was to assess the views of staff as to the conditions required for partnership working. Methods This study was a cross-sectional survey of 687 staff offering sexual health education, information or support to young people in the Healthy Respect intervention area in Scotland. Views of each variable were scored and structural equation modelling was used to assess the theoretical model. Results Responses were received from 284 (41%) staff. Greater strength of partnership was directly associated with increasing the number of referrals. Establishing professional roles between organizations was also associated with increasing the number of referrals. Strength of partnership was indirectly associated with working more effectively with young people and this relationship depended on clear communication, trust, established professional roles and shared resources. Effective partnership working depends on a number of interdependent relationships between organizations, which act synergistically to improve organizational outcomes. Conclusions Effective partnership working leads to improved service delivery though there is a need for better controlled studies which demonstrate the effect on health outcomes.

The relationship between sugar-containing methadone and dental caries: A systematic review

Objectives: To review the evidence of a relationship between sugar-containing methadone and dental caries. Data sources: A systematic search of Cochrane Library, PubMed, PsychINFO, EMBASE, MEDLINE, Current Controlled Trials, WHO, OHRN, SIGLE and ERIC databases was conducted from January 1978 up to June 2010. Study selection: Articles were assessed and data abstracted independently by two reviewers. Papers that provided information about methadone and dental caries and were written in English were included, regardless of type of publication, authors, source of financial support and outcomes. Nineteen articles were identified; of these only three contained quantitative evidence, one of which was a survey. Conclusions: Many people on oral methadone maintenance programmes have been reported to have high levels of dental caries. However, there is no strong evidence to support a direct link between sugar-containing methadone and an increase in dental caries. High quality studies are required to assess the potential adverse effects of methadone on oral health.