Shaun Speed

What do community-dwelling Caucasian and South Asian 60–70 year olds think about exercise for fall prevention?

Background: strategies to prevent falls often recommend regular exercise. However, 40% of over 50s in the UK report less physical activity than is recommended. Even higher rates of sedentary behaviour have been reported among South Asian older adults. Objective: to identify salient beliefs that influence uptake and adherence to exercise for fall prevention among community-dwelling Caucasian and South Asian 60–70 year olds in the UK. Methods: we undertook an ethnographic study using participant observation, 15 focus groups (n = 87; mean age = 65.7 years) and 40 individual semi-structured interviews (mean age = 64.8 years). Data analysis used framework analysis. Results: young older adults do not acknowledge their fall risk and are generally not motivated to exercise to prevent falls. Those who had fallen are more likely to acknowledge risk of future falls. Whilst many of the beliefs about falls and exercise expressed were very similar between Caucasians and South Asians, there was a tendency for South Asians to express fatalistic beliefs more often. Conclusion: fall prevention should not be the focus of strategies to increase uptake and adherence to exercise. The wider benefits of exercise, leading to an active healthy lifestyle should be encouraged.

Attitudes and beliefs to the uptake and maintenance of physical activity among community-dwelling South Asians aged 60-70 years: A qualitative study

OBJECTIVES To identify the attitudes and beliefs associated with the uptake and adherence of physical activity among community-dwelling South Asians aged 60-70 years. STUDY DESIGN A qualitative research study using an ethnographic approach. METHODS Focus groups and in-depth interviews were conducted to explore motivational factors associated with initiating and maintaining physical activity. Data analysis followed the framework approach. RESULTS Health, maintaining independence and social support were important in terms of initiating physical activity. Social support, psychosocial elements of activity, health and integrating physical activity within everyday activities were important for adherence to physical activity. The need for gendered physical activity sessions was important to initiating exercise among Muslim South Asians aged 60-70 years. CONCLUSION Promoting active lifestyles and building physical activity in and around day-to-day activities are important strategies in increasing activity levels. However, the needs for culturally appropriate facilities, peer mentors who could assist those with language barriers, specific tailored advice, advice on integrating physical activity in everyday life and general social support could promote uptake and subsequent adherence among this population group.

Pitfalls, perils and payments: Service user, carers and teaching staff perceptions of the barriers to involvement in nursing education

BACKGROUND There is an impetus to involve service users and carers in the education of nurses and a general consensus in the literature about the benefits that this brings to all involved. Whilst these benefits are well rehearsed in the literature there is little written about the potential barriers to service user and carer involvement in nurse education. OBJECTIVE The objective of this study was to investigate service users, carers and staff views on the potential barriers to becoming engaged in nurse education. DESIGN A qualitative study using focus group discussions (FGD) was used to canvas the views of service users, carers and teaching staff. SETTING A large school of nursing in the North West of England. PARTICIPANTS 38 service users and carers recruited from the North West of England and 23 nursing and midwifery teachers and lecturers. METHODS Focus group discussions were employed as the main data collection method. The data were analysed using thematic analysis. RESULTS Six themes occurred in the data as being negatively associated with potential and actual involvement: not knowing the context of the group, lack of preparation of the group, not being supported, not being allowed to be real, not receiving feedback, not being paid appropriately. CONCLUSIONS The process of involvement is not without difficulties. These data show that some consideration needs to be given to the potential barriers to involvement if the engagement of service users and carers is to be effective.

A scoping review on the experiences and preferences in accessing diabetes-related healthcare information and services by British Bangladeshis

Diabetes is a chronic condition requiring lifelong self-management. Patients are encouraged to access appropriate services to facilitate optimum management of diabetes. Although equitable access to healthcare in the United Kingdom is a legal right, not all groups and individuals in the community experience equity. Despite various equality laws and numerous efforts to minimise health inequalities related to access, particular community groups are more likely to experience inequitable access than others. The Bangladeshi community are one such community who experience some of the worst diabetes-related health outcomes in the United Kingdom. Little is known about their experiences and preferences in accessing diabetes healthcare information and services. Consequently, we undertook a scoping review of the literature by following the York Scoping Reviews Framework to identify the experiences and preferences of Bangladeshi patients and carers when gaining access to diabetes-related healthcare information and services. We identified eight articles and reported our results in relation to four domains of access: health service availability, health service utilisation, health service outcomes and the notion of equity. The review identified that language and literacy issues were the most common barriers hindering access to information and services. Patient knowledge regarding diabetes and its management was generally low, and friends and family were frequently being used as information sources and as informal interpreters. Additionally, there were feelings of isolation from mainstream information and services possibly resulting in the high prevalence of depression in the Bangladeshi community with women more affected than men. Social networks combined with religious and cultural beliefs as well as wider societal duties played a crucial role in accessing information and services for this population, and the identification of these issues merit further research and are possible avenues towards improved access to healthcare information and services for the Bangladeshi population.

Falls prevention and the value of exercise: salient beliefs among South asian and white british older adults.

The importance of increasing exercise to prevent falls among older adults remains a key worldwide public health priority. However, older adults do not necessarily take up exercise as a preventative measure for falls. This qualitative study aimed to explore the beliefs of community-dwelling South Asian and White British older adults aged 60 to 70 about falls and exercise for fall prevention through 15 focus groups (n = 87) and 40 in-depth interviews. Data were transcribed verbatim and analyzed using a framework approach. Data analysis identified six salient beliefs that influenced older adults’ intention to exercise for fall prevention. In general, older adults aged 60 to 70 did not acknowledge their risk of falling and were not motivated to exercise simply to help prevent falls. Positive beliefs were found to be an unlikely barrier to taking up exercise for fall prevention for those who had experienced a fall. The implications for health promotion and health professionals with this group of older adults are discussed.

Perceptions and attitudes towards exercise among Chinese elders – the implications of culturally based self-management strategies for effective health-related help seeking and person-centred care

Encouraging the uptake of physical activity among a culturally diverse elderly population presents a challenge for health‐care providers across the world. Little is known about the health‐care needs of these populations, for example the increasingly ageing group of Chinese elders in many parts of the world who are now facing later life and increasing challenges to their health.

Being healthy: A Grounded Theory study of help seeking behaviour among Chinese elders living in the UK

The health of older people is a priority in many countries as the worlds population ages. Attitudes towards help seeking behaviours in older people remain a largely unexplored field of research. This is particularly true for older minority groups where the place that they have migrated to presents both cultural and structural challenges. The UK, like other countries, has an increasingly aging Chinese population about who relatively little is known. This study used a qualitative grounded theory design following the approach of Glaser (1978). Qualitative data were collected using semi-structured interviews with 33 Chinese elders who were aged between 60 and 84, using purposive and theoretical sampling approaches. Data were analysed using the constant comparative method until data saturation occurred and a substantive theory was generated. “Being healthy” (the core category) with four interrelated categories: self-management, normalizing/minimizing, access to health services, and being cured form the theory. The theory was generated around the core explanations provided by participants and Chinese elders’ concerns about health issues they face in their daily life. We also present data about how they direct their health-related activities towards meeting their physical and psychological goals of being healthy. Their differential understanding of diseases and a lack of information about health services were potent predictors of non–help seeking and “self” rather than medical management of their illnesses. This study highlights the need for intervention and health support for Chinese elders.

Recruitment to the "Breast-Activity and Healthy Eating After Diagnosis" (B-AHEAD) Randomized Controlled Trial.

Excess weight at breast cancer diagnosis and weight gain during treatment are linked to increased breast cancer specific and all-cause mortality. The Breast—Activity and Healthy Eating After Diagnosis (B-AHEAD) trial tested 2 weight loss diet and exercise programmes versus a control receiving standard written advice during adjuvant treatment. This article identifies differences in characteristics between patients recruited from the main trial site to those of the whole population from that site during the recruitment period and identifies barriers to recruitment. A total of 409 patients with operable breast cancer were recruited within 12 weeks of surgery. We compared demographic and treatment factors between women recruited from the main trial coordinating site (n = 300) to the whole breast cancer population in the center (n = 532). Uptake at the coordinating site was 42%, comparable to treatment trials in the unit (47%). Women recruited were younger (55.9 vs 61.2 years, P < .001), more likely to live in least deprived postcode areas (41.7% vs 31.6%, P = .004), and more likely to have screen-detected cancers (55.3% vs 48.7%, P = .026) than the whole breast cancer population. The good uptake highlights the interest in lifestyle change around the time of diagnosis, a challenging time in the patient pathway, and shows that recruitment at this time is feasible. Barriers to uptake among older women and women with a lower socioeconomic status should be understood and overcome in order to improve recruitment to future lifestyle intervention programs.

Providing Care to Drug Users on Wirral: a case study analysis of a Primary Health Care / General Practice-led drug service

This paper represents a case study analysis of a Primary Health Care / GP-led Community Drug and Health Care Service based on Wirral, Merseyside. A chronological description of the service is presented followed by a description of the major components of the case. Semi-structured interviews were undertaken with 11 staff members and were recorded and transcribed. Salient descriptive elements of the services they provide were extracted and descriptions of the treatment approaches have been included in the text of this analysis. Vignettes of real cases are also included to highlight the criteria used to measure effectiveness. This case study details biographical and service-specific data from a major provider of services to illicit drug users in the North-West of England. The study systematically examines five main areas of work: making contact, assessing and treating health care problems, maintaining contact and promoting change, caring for vulnerable groups of users and reintegrating users into primary car...This paper represents a case study analysis of a Primary Health Care / GP-led Community Drug and Health Care Service based on Wirral, Merseyside. A chronological description of the service is presented followed by a description of the major components of the case. Semi-structured interviews were undertaken with 11 staff members and were recorded and transcribed. Salient descriptive elements of the services they provide were extracted and descriptions of the treatment approaches have been included in the text of this analysis. Vignettes of real cases are also included to highlight the criteria used to measure effectiveness. This case study details biographical and service-specific data from a major provider of services to illicit drug users in the North-West of England. The study systematically examines five main areas of work: making contact, assessing and treating health care problems, maintaining contact and promoting change, caring for vulnerable groups of users and reintegrating users into primary care. The findings of this case study describe how a GP (Primary Care) led unit, working in conjunction with other specialized services, provides effective care to a group of heterogeneous illicit drug users.