Patricia Anne Lyne

Childhood diabetes: parents’ experience of home management and the first year following diagnosis

Aims  To explore parents’ experience of having a child diagnosed with Type 1 diabetes, managed at home, and their first year following diagnosis.

Understanding Why People with Type 1 Diabetes Do Not Attend for Specialist Advice: A Qualitative Analysis of the Views of People with Insulin-dependent Diabetes Who Do Not Attend Diabetes Clinic:

Attendance at diabetes clinic is associated with improved medical outcome, however, significant numbers of people with type 1 diabetes choose not to attend. In order to understand the reasons underlying this decision, qualitative interviews were carried out with 12 long-term non-attenders. Three distinct groups emerged differing in terms of their cognitive and emotional responses to diabetes and their coping strategies: (1) the ‘High fear’ group; (2) the ‘Patient as expert’ group; and (3) the ‘Low motivation’ group. These differences should be recognized and suitable approaches developed to ensure that all people with diabetes are able to accept appropriate specialist support.

Using the IPQ and PMDI to predict regular diabetes care-seeking among patients with Type 1 diabetes

OBJECTIVES The objectives were, first, to identify factors associated with regular diabetes care-seeking and, second, to compare the performance of the Illness Perception Questionnaire (IPQ) and a modified version of the Personal Models of Diabetes Interview (PMDI) in predicting care-seeking. METHOD This was a cross-sectional study involving 42 patients who had not attended hospital diabetes clinic for a period of 18 months or more and 42 matched controls receiving specialist care. Differences in illness representations between clinic attenders and non-attenders were examined. Due to the variability in care-seeking between non-attenders (ranging from no contact with health professionals to regular general practitioners care), participants were then reclassified for further analyses into those receiving regular care from either hospital diabetes clinic or general practice (n = 52) and those receiving no regular care (n = 32). RESULTS Patients not seeking regular care held more negative views of the control, course and consequences of diabetes than those who received regular care. Regression analyses showed that the most important construct was treatment effectiveness. Treatment effectiveness (PMDI) and control (IPQ) dimensions were associated with clinic attendance. PMDI constructs of treatment effectiveness, threat and worries were associated with regular care-seeking. CONCLUSIONS IPQ and PMDI results were generally consistent. In order to understand diabetes care-seeking behaviour it is important to measure beliefs about the benefits of treatment recommendations in addition to those of the disease itself. Emotional and cognitive responses to diabetes should be assessed.

Improving the accuracy of pressure ulcer risk calculators: some preliminary evidence

This study presents data from a prospective cohort study of 213 in-patient admissions of people over 65. Logit analysis was used to investigate the relative contribution of a range of risk factors to the risk of pressure ulcer occurrence, as a basis for development of improved risk assessment tools. It was found that for this population, a model containing the Waterlow risk factors appetite, continence, skin condition and age, plus diagnosis, performed better than one based on the complete set of Waterlow factors. Gender was not significant. A diagnosis of cancer was positively associated with pressure ulcer occurrence but presence of Parkinsons disease had the opposite effect.

Using the discrete choice experimental design to investigate decision-making about pressure ulcer prevention by community nurses

This study investigates the preferences of senior community nurses who work as district nurse team leaders in selecting preventive care plans for elderly people at high risk of pressure ulcer formation. The discrete choice experiment (DCE) technique was used. Focus group work produced the following five attributes of nurse decision-making: ‘ease of care plan management’, ‘impact of care plan on patients lifestyle’, ‘speed of obtaining the equipment’, ‘affordability’, ‘evidence-based practice’. These were incorporated into a self-administered questionnaire, posted to 102 nurses from two integrated acute/community NHS Trusts in Wales. A response rate of 55% was achieved. Respondents were asked to rate the importance of the selected attributes on a 5-point scale. They rated ‘evidence-based practice’, ‘impact of care plan on patients lifestyle’, ‘ease of care plan management’ and ‘speed of obtaining the equipment’ highly, whereas ‘affordability’ was of less importance. However, regression analysis, which is part of the DCE technique, produced a somewhat different picture, with ‘impact’ being least and ‘affordability’ most statistically significant. The reasons for this apparent anomaly are discussed and the paper concludes that the DCE approach is capable of yielding important information, which is not produced by simple rating exercises. Such information is potentially of value in the context of modernisation and service configuration.

The role of illness perceptions, coping and evaluation in care-seeking among people with type 1 diabetes

Attendance at diabetes clinic is associated with improved medical outcome. In the present study, we used self-regulatory theory to identify factors associated with diabetes care-seeking. This article examines (i) differences in coping strategies and evaluation of coping success (general health, impact of diabetes on life and clinic satisfaction) between attenders and non-attenders, (ii) the relationships between personal models and coping strategies and (iii) the role of personal models and coping strategies in predicting diabetes care-seeking. The sample comprised of 42 non-attenders and 42 matched controls receiving specialist care. Attenders employed more effective coping strategies than non-attenders and reported higher levels of clinic satisfaction. Groups expressed similar views regarding health status and impact of diabetes. Participants were reclassified into ‘regular care’ (hospital or general practice) (n = 52) and ‘no regular care’ (n = 32) for further analysis. The results support the utility of self-regulatory theory. More positive personal models were associated with more effective coping strategies, which were in turn associated with regular care-seeking.

Improving the evidence base for practice: a realistic method for appraising evaluations

Introduction: To present and discuss a method for the appraisal of evaluations which can be used by the informed practitioner and will facilitate the incorporation of research evidence into every day nursing, midwifery, and health visiting practice. Background: The development of current systems for the appraisal of published studies is described, showing that they still reflect their origin in experimental methodology, despite increasing awareness of the potential contribution of non-experimental work to the evidence base for healthcare practice. The difficulties that this creates for practitioners are then explored. Appraising evaluations: The unique character of evaluation studies is emphasised. We contend that the underlying unity of purpose is more important than methodological distinctions. Four key questions to shape the appraisal of such studies are presented. Drawing on the methodological work of Campbell and Stanley (1966) we propose a method for answering these questions which focuses on the assessment of threats to internal validity. The system in use: Finally, a worked example of the system in operation is provided. We discuss the issues which this raises, and conclude that the system permits a more practical and accessible method for appraising the evidence produced by evaluation studies.

Supporting evidence-based service delivery and organisation: a comparison of an emergent realistic appraisal technique with a standard qualitative critical appraisal tool

A major component of current policies aimed at promoting the delivery of an effective health service is to ensure that practitioners base their practice on research findings. Considerable attention has been focussed on the research community and developing appropriate methods and tools to support these objectives at the national and international level. The appraisal needs of individual practitioners, who might wish to inform local service delivery and organisation and who are often not methodological experts, has been hitherto ignored. This paper reports on the application and testing of a technique for the appraisal of evaluation studies, which is being developed for use by practitioners to inform local service delivery. This technique has previously been applied to a quantitative evaluation. In this paper we report on its application to the appraisal of a qualitative paper. Our aim is to compare it with a standard tool to establish which generates more meaningful information for use by practitioners for the purposes of informing service delivery and organisation. The emergent technique successfully extracted relevant methodological and contextual information, with developmental issues being identified.

Construct validity and sensitivity of an instrument commonly used to assess the clinical effectiveness of rehabilitative care

Objectives to examine the construct validity and sensitivity of the Barthel Index (BI) and, thus, to assess its utility as an outcome measure in stroke rehabilitation. Design comparison of BI scores with qualitative assessment of functional status for a cohort of patients recovering from a first stroke. Setting re-analysis of data arising in an acute hospital setting (care of the elderly and medical units) as a result of a nursing and midwifery audit initiative, funded by the Welsh Office. Participants 23 patients with discharge BI scores greater than or equal to 16/20. (12 men, 11 women. Age range 55–89.) Main outcome measure within subject comparison of BI scores, with numbers and types of impairment and/or disability as defined by the International Classification of Impairment, Disability and Handicap. Results for this cohort of patients there was no direct relationship between BI score and numbers of identified impairments and disabilities. Patients with similar BI scores had different patterns of impairment. Patients with similar change scores had different patterns of improvement. Patients with maximum BI scores on discharge had residual impairments and disabilities. Conclusions the construct that BI measures is not clearly defined. Therefore, the meaning of BI scores, in terms of patient functional ability, is unclear, and its construct validity is questionable. Its sensitivity is not demonstrated as it has a definite ceiling effect. There is a need to approach outcome measurement for complex areas, such as stroke rehabilitation, in a way that clearly specifies the construct being studied and allows individual progress and support needs to be assessed.