Rhona Hogg

Patterns of primary care service use by families with young children

BACKGROUND In the UK, early years policy emphasizes that all families should have access to support tailored to their individual needs. Knowledge of the determinants of health service use should help to inform rational and equitable planning and delivery of services to parents. OBJECTIVES We seek to investigate the determinants of primary care service use in families with preschool children. METHODS Determinants of service use in two population cohorts (families with children aged 0-1 and 2-3 years) from the Growing Up in Scotland study are presented. Services related to use of the family doctor or health visitor for information on the childs health or behaviour in the last year. RESULTS A range of socio-demographic determinants were significant predictors of service use on multivariate analysis. Determinants of service use differed between the health visitor and family doctor. CONCLUSIONS The analysis provides an insight into the determinants and patterns of health service use by families with young children at two stages of development. While some of our findings are expected or supported by previous research, others highlight areas that require further investigation.

Development of a cross-cultural HPV community engagement model within Scotland.

Objective: To examine cultural barriers and participant solutions regarding acceptance and uptake of the human papillomavirus (HPV) vaccine from the perspective of Black African, White-Caribbean, Arab, Indian, Bangladeshi and Pakistani young people. Methods: In total, 40 young people from minority ethnic communities in Scotland took part in a qualitative study, involving seven focus groups and four paired interviews, to explore their views and experiences of the HPV vaccine. Using critical discursive psychology, the analysis focused on young people’s accounts of barriers and enablers to information, access and uptake of the HPV vaccination programme. Results: Participants suggested innovative strategies to tackle intergenerational concerns, information design and accessibility, and public health communications across diverse contexts. A cross-cultural community engagement model was developed, embracing diversity and contradiction across different ethnic groups. This included four inter-related strategies: providing targeted and flexible information for young people, vaccine provision across the life-course, intergenerational information and specific cross-cultural communications. Conclusion: This is the first HPV cross-cultural model inductively derived from accounts of young people from different ethnic communities. We recommend public health practitioners and policymakers consider using the processes and strategies within this model to increase dialogue around public engagement, awareness and receptivity towards HPV vaccination.

Transition to parenthood in the neonatal care unit: a qualitative study and conceptual model designed to illuminate parent and professional views of the impact of webcam technology

BackgroundComplications during pregnancy, childbirth and/or the postnatal period may result in the admission of a baby to a neonatal unit (NNU). While the survival and long-term prospects of high-risk infants are enhanced by admission, the enforced separation of the parent and child may have psychological consequences for both. There is a need to develop and evaluate interventions to help parents ‘feel closer’ to their infants in circumstances where they are physically separated from them. In this paper we present findings from an in-depth, theoretically-driven, evaluation of a technological innovation designed to address this need. The study sought to explore parent and professional views of the impact of the technology, which transmits real-time images of the baby via a webcam from the NNU to the mother’s bedside in the post-natal care environment.MethodsA qualitative approach was adopted, guided by a critical realist perspective. Participants were recruited purposively from a NNU located in East-central Scotland. Thirty-three parents and 18 professionals were recruited. Data were collected during individual, paired and small group interviews and were analysed thematically. Following the initial analysis process, abductive inference was used to consider contextual factors and mechanisms of action appearing to account for reported outcomes.ResultsViews on the technology were overwhelmingly positive. It was perceived as a much needed and important advancement in care delivery. Benefits centred on: enhanced feelings of closeness and responsiveness; emotional wellbeing; physical recovery; and the involvement of family/friends. These benefits appeared to function as important mechanisms in supporting the early bonding process and wider transition to parenthood. However, for a small number of the parents, use of the technology had not enhanced their experience and it is important, as with any intervention, that professionals monitor the parents’ response and act accordingly.ConclusionsWith a current global increase in premature births, the technology appears to offer an important solution to periods of enforced parent-infant separation in the early post-natal period. The current study is one of a few world-wide to have sought to evaluate this form of technology in the neonatal care environment.

Learning lessons from the analysis of patient complaints relating to staff attitudes, behaviour and communication, using the concept of emotional labour

AIMS AND OBJECTIVES This article explores the content of letters of complaint by patients and carers about the behaviour, attitudes and communication of healthcare staff. BACKGROUND The most common focus of patient complaints in the UK and other high-income countries is staff attitudes, behaviour and communication. There is a move to learn lessons from patient complaints, which can be used to improve patient care and experience. METHODS Fifty letters of complaint made by patients and carers relating to the behaviour, attitudes and communication of healthcare staff were analysed. RESULTS Poor attitudes, behaviours and communication have significant negative impact on the emotional well-being of patients and carers. Many patients and carers have heightened sensitivities due to both health-related stresses and also other factors. The healthcare role is expected to include compassion and kindness. The concept of emotional labour is useful in explaining the skills and effort required of staff in this often invisible and undervalued aspect of health care. CONCLUSIONS Given the increasing focus on patient experience, it is important that the importance of good staff attitudes, behaviours and communication is understood and that the emotional labour associated with this is recognised. RELEVANCE TO CLINICAL PRACTICE An understanding of emotional intelligence can protect staff from burnout and other negative outcomes which those in a caring role can experience.