Sahdia Parveen

Developing a reliable and valid patient measure of safety in hospitals (PMOS): a validation study

Introduction Patients represent an important and as yet untapped source of information about the factors that contribute to the safety of their care. The aim of the current study is to test the reliability and validity of the Patient Measure of Safety (PMOS), a brief patient-completed questionnaire that allows hospitals to proactively identify areas of safety concern and vulnerability, and to intervene before incidents occur. Methods 297 patients from 11 hospital wards completed the PMOS questionnaire during their stay; 25 completed a second 1 week later. The Agency for Healthcare Research and Quality (AHRQ) safety culture survey was completed by 190 staff on 10 of these wards. Factor structure, internal reliability, test-retest reliability, discriminant validity and convergent validity were assessed. Results Factor analyses revealed 8 key domains of safety (eg, communication and team work, access to resources, staff roles and responsibilities) explaining 58% variance of the original questionnaire. Cronbachs α (range 0.66–0.89) and test-retest reliability (r=0.75) were good. The PMOS positive index significantly correlated with staff reported ‘perceptions of patient safety’ (r=0.79) and ‘patient safety grade’ (r=−0.81) outcomes from the AHRQ (demonstrating convergent validity). A multivariate analysis of variance (MAMOVA) revealed that three PMOS factors and one retained single item discriminated significantly across the 11 wards. Discussion The PMOS is the first patient questionnaire used to assess factors contributing to safety in hospital settings from a patient perspective. It has demonstrated acceptable reliability and validity. Such information is useful to help hospitals/units proactively improve the safety of their care.

Ethnic variations in the caregiver role: A qualitative study

The present study aimed to establish an in-depth qualitative analysis of the convergence and divergence of the experiences of caregivers from four ethnic groups. Eight Bangladeshi, nine Indian, four Pakistani and nine White-British caregivers participated in five focus groups. Differences and similarities between motivations for role adoption, willingness to care, experience of role, adaptation to role, coping, use of and satisfaction with support were discussed. Key differences were found in adaptation to care role and use of social support. The article highlights the need for further study of the ethnic minority caregiver experience and has implications for service development.

Predicting caregiver gains: A longitudinal study

OBJECTIVES The aim of this study was to examine if changes in motivations to care, familism, illness perceptions, caregiver tasks, coping, and social support were related to caregiver reported gains (subjective feelings of satisfaction and rewards as a result of the care role). DESIGN A longitudinal design was employed whereby 123 caregivers completed a questionnaire at three time points: baseline, 3 months, and 9 months from baseline. METHOD Independent variables were converted into residual change scores (between time 1 and time 2) and their influence on caregiver gains at time 2 and time 3 was examined. RESULTS Caregiver reported gains remained stable over time. Hierarchical regression analysis found that an increase in illness coherence was a strong predictor of caregiver gains at time 2, whereas predictors of time 3 gains included ethnicity, number of hours caregiving, and an increase in self-distraction and denial as coping methods. CONCLUSION The study has implications for the development of time-specific interventions to increase caregiver gains and also for service development.

Psychosocial interventions for people with dementia: An overview and commentary on recent developments

An influential review in 2010 concluded that non-pharmacological multi-component interventions have positive effects on cognitive functioning, activities of daily living, behaviour and mood of people with dementia. Our aim here is to provide an up-to-date overview of research into psychosocial interventions and their impact on psychosocial outcomes. We focused on randomised controlled trials, controlled studies and reviews published between October 2008 and August 2015, since the earlier review. The search of PsychInfo, Medline and the Cochrane database of systematic reviews yielded 61 relevant articles, organised into four themes echoing key phases of the care pathway: Living at home with dementia (five reviews, eight studies), carer interventions (three reviews, four studies), interventions in residential care (16 reviews, 12 studies) and end-of-life care (three reviews, two studies), along with an additional group spanning community and institutional settings (six reviews, two studies). Community findings suggested that appointment of dementia specialists and attention to case management can produce positive outcomes; physical therapies, cognitive training and modified cognitive behaviour therapy also had a range of benefits. There was more limited evidence of positive benefits for people with dementia through interventions with family carers. Thirty-two articles focused on the management of ‘behavioural symptoms’ through a range of interventions all of which had some evidence of benefit. Also a range of multi-component and specific interventions had benefits for cognitive, emotional and behavioural well-being of people with dementia in residential settings, as well as for quality of life. Overall, interventions tended to be short term with impact only measured in the short term. We recommend further research on interventions to promote living well in the community post-diagnosis and to address end-of-life care. Development of psychosocial interventions would benefit from moving beyond the focus on control of behaviours to focus on wider aspects of life for people with dementia.

Predictors of familism in the caregiver role: a pilot study.

This study aimed to investigate whether age, gender and ethnicity were predictive of familism in caregivers; and whether familism was associated with coping. Forty-five British South-Asian and 43 British Caucasian caregivers completed a cross-sectional questionnaire of demographics, the brief Cope and the Heller Familism scale. Asian and younger caregivers endorsed higher levels of familsim than Caucasian and older caregivers. In the final model, demographic variables, humour, religious, active and instrumental coping explained 41 per cent of the variance in caregiver familism. The findings suggest the need to consider familism values when providing caregiver services to minimize the potential negative impact of caregiving.

Ethnicity, familism and willingness to care: important influences on caregiver mood?

Objective: Few studies have to date examined the effects of ethnicity on caregiver motivations, coping responses and mood. This theoretically informed study uses the socio-cultural model of stress and coping to explore these relationships amongst a White-British and British South-Asian caregiver sample. Method: A total of 235 primary family caregivers were recruited for a cross-sectional questionnaire survey; of which 162 were White-British and 73 were British South-Asian. Results : British South-Asian caregivers differed from White-British caregivers on several variables within the stress-coping framework. British South-Asian caregivers were younger, had significantly higher levels of familism, used significantly more behavioural disengagement and religious coping and reported having significantly less support than White-British caregivers. White-British caregivers were more likely to make use of substances and humour as coping methods, and also in these caregivers, familism was significantly related to caregiver depression. Whilst levels of willingness to care did not differ between the two caregiver groups, opposing relationships were seen in the association between willingness to care and caregiver anxiety. Regression analyses found that self-blame explained a significant proportion of variance in South-Asian anxiety and depression, whereas depression amongst White-British caregivers was associated with high use of substances, low use of humour and low mean satisfaction with support. Conclusion: These findings offer support to the socio-cultural model of stress and coping in that coping is associated with two outcomes (anxiety and depression), but motivational factors are also highlighted which have additional implications for the development of culturally specific interventions aimed at reducing caregiver distress.

Effective Dementia Education and Training for the Health and Social Care Workforce: A Systematic Review of the Literature:

Ensuring an informed and effective dementia workforce is of international concern; however, there remains limited understanding of how this can be achieved. This review aimed to identify features of effective dementia educational programs. Critical interpretive synthesis underpinned by Kirkpatrick’s return on investment model was applied. One hundred and fifty-two papers of variable quality were included. Common features of more efficacious educational programs included the need for educational programs to be relevant to participants’ role and experience, involve active face-to-face participation, underpin practice-based learning with theory, be delivered by an experienced facilitator, have a total duration of at least 8 hours with individual sessions of 90 minutes or more, support application of learning in practice, and provide a structured tool or guideline to guide care practice. Further robust research is required to develop the evidence base; however, the findings of this review have relevance for all working in workforce education.

Perceptions of dementia and use of services in minority ethnic communities: a scoping exercise.

Despite the rapidly ageing population and a predicted sevenfold increase in the prevalence of dementia in minority ethnic communities, people from these communities remain under-represented in specialist dementia services. Leventhals Model of Self-Regulation suggests perceptions of illness facilitate help-seeking behaviours such as the use of services. This scoping exercise makes use of the model to explore perceptions of dementia in British Indian, African and Caribbean, and East and Central European communities in the United Kingdom. Between August 2013 and April 2014, culturally specific dementia awareness roadshows were attended by people living with dementia, carers and members of the public. During the roadshows, 62 British Indian, 50 African and Caribbean, and 63 East and Central European attenders participated in discussion groups and a dementia knowledge quiz. Thematic and framework analysis were conducted on the discussion group data. Three main themes are presented: Perceptions of dementia, awareness of dementia in the wider family and community, and awareness and use of services. The findings suggest that although groups attributed a biological basis for memory loss, a number of misconceptions prevailed regarding the cause of dementia. Groups also made use of religion, as opposed to medical healthcare services, as a form of personal and treatment control. Seeking help from healthcare services was hindered by lack of awareness of services, and culturally specific barriers such as language. The findings have a number of implications for policy and practice including the development of public health interventions and the need to focus further on reducing barriers to accessing services.

Does coping mediate the relationship between familism and caregiver outcomes

Objectives: The sociocultural model of stress and coping, which despite receiving support from several studies conducted with diverse ethnic groups, has yet to be tested longitudinally or used within the context of positive caregiver outcomes. The aim of the current study was to test a specific component of the model, which posits that caregiver coping will be influenced by the cultural value of familism (feelings of solidarity and loyalty among family members), which will in turn affect caregiver outcomes. Method: A questionnaire was completed by 123 family caregivers in the UK assessing familism, use of coping strategies, caregiver gains, anxiety and depression at three time points over nine months. Results: Mediation analysis followed guidelines proposed by Baron and Kenny. Religious coping and positive reframing at time 2 (T2) were found to significantly mediate between familism values at time 1 (T1) and caregiver gains at time 3 (T3). Behavioural disengagement at T2 was found to mediate between familism at T1 and caregiver depression atT3. Additionally familism was found to be positively associated with both negative and positive aspects of caregiving. Conclusion: Our longitudinal findings suggest that interventions and services acknowledging caregiver values and the associated coping responses may prove beneficial.

Adherence of patients to long-term medication: a cross-sectional study of antihypertensive regimens in Austria.

SummaryObjectiveThe objective of this study was to evaluate adherence and causes for non-adherence to antihypertensive therapy in Austrian patients. A special focus was placed on social parameters and behavioural theories.MethodsPatients were invited via advertisements in community pharmacies in Austria to complete an online survey. Inclusion criteria were an age of 18 years or older, a diagnosis of arterial hypertension and a current prescription of antihypertensive medication. Adherence was measured by the four-item Morisky scale. Non-adherence was defined by at least one point in the Morisky scale. Several demographic, social and behavioural parameters were analysed as potential co-variables associated with adherence.ResultsA total of 323 patients completed the online survey, of which 109 (33.7 %) met the criteria for non-adherence. In a multivariable model, self-efficacy and age were associated with adherence, whereas intention and barriers were linked to non-adherence; 56 patients (17.3 %) were classified as intentionally non-adherent.ConclusionThis study demonstrates that non-adherence affects an important proportion of patients in the treatment of arterial hypertension. Young age was a particularly important risk factor for non-adherence, and this patient population is, therefore, in need of special attention. Modifiable risk factors were identified that could help improving the treatment of arterial hypertension and potentially other chronic conditions.