Why carers use adult day respite: a mixed method case study

BACKGROUND: We need to improve our understanding of the complex interactions between family carers’ emotional relationships with care-recipients and carers use of support services. This study assessed carer’s expectations and perceptions of adult day respite services and their commitment to using services. METHODS: A mixed-method case study approach was used with psychological contract providing a conceptual framework. Data collection was situated within an organisational case study, and the total population of carers from the organisation’s day respite service were approached. Fifty respondents provided quantitative and qualitative data through an interview survey. The conceptual framework was expanded to include Maslow’s hierarchy of needs during analysis. RESULTS: Carers prioritised benefits for and experiences of care-recipients when making day respite decisions. Respondents had high levels of trust in the service and perceived that the major benefits for care-recipients were around social interaction and meaningful activity with resultant improved well-being. Carers wanted day respite experiences to include all levels of Maslow’s hierarchy of needs from the provision of physiological care and safety through to the higher levels of belongingness, love and esteem. CONCLUSION: The study suggests carers need to trust that care-recipients will have quality experiences at day respite. This study was intended as a preliminary stage for further research and while not generalizable it does highlight key considerations in carers’ use of day respite services

A tool to support meaningful person-centred activity for clients with dementia – a Delphi study

BACKGROUND: This paper reports on a study to validate the concept of the ‘Activity Support Tool’ that aimed to assist dementia service workers to identify and act upon the support needs of people with dementia living alone, in line with the person-centred ideal. METHODS: The tool was part of a two-stage exploratory qualitative study, which used interview and observational data from seven people with dementia living alone. Findings highlighted that people with dementia use objects and spaces within their homes to maintain or re-enact identities from the past. Thematic results from interviews were translated into a tool, with construct validation using the Delphi technique. Eighteen expert health professionals received round one of the questionnaire and six participants completed round three. The first round directed our focus towards operationalizing the person-centred ideal of dementia care. RESULTS: The tool was considered by almost all advisory panel members to be a potentially valuable resource for helping to address impediments to integrated, effective and person-centred dementia care. Specific strengths identified were simplicity, person-centeredness and applicability across service settings. Issues of concern included practicability, risk management, gender stereotyping and terminology. The results support the findings of previous research into the intuitive and ethical appeal, but problematic applicability, of person-centred dementia services. CONCLUSION: Health professionals with a range of service-related expertise found the concept of person-centred care compelling, but required tangible, enduring structures to translate the ideal into practical action. The tool now requires further research to test its usefulness in practice. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12912-015-0060-3) contains supplementary material, which is available to authorized users

Improving response rates using a monetary incentive for patient completion of questionnaires: an observational study

Background: Poor response rates to postal questionnaires can introduce bias and reduce the statistical power of a study. To improve response rates in our trial in primary care we tested the effect of introducing an unconditional direct payment of 5 pound for the completion of postal questionnaires. Methods: We recruited patients in general practice with knee problems from sites across the United Kingdom. An evidence-based strategy was used to follow-up patients at twelve months with postal questionnaires. This included an unconditional direct payment of 5 pound to patients for the completion and return of questionnaires. The first 105 patients did not receive the 5 pound incentive, but the subsequent 442 patients did. We used logistic regression to analyse the effect of introducing a monetary incentive to increase the response to postal questionnaires. Results: The response rate following reminders for the historical controls was 78.1% ( 82 of 105) compared with 88.0% ( 389 of 442) for those patients who received the 5 pound payment (diff = 9.9%, 95% CI 2.3% to 19.1%). Direct payments significantly increased the odds of response ( adjusted odds ratio = 2.2, 95% CI 1.2 to 4.0, P = 0.009) with only 12 of 442 patients declining the payment. The incentive did not save costs to the trial - the extra cost per additional respondent was almost 50 pound. Conclusion: The direct payment of 5 pound significantly increased the completion of postal questionnaires at negligible increase in cost for an adequately powered study

The utilisation of a standardised educational framework to develop and deliver impactful programmes of simulation-based learning

Simulation has become a well-integrated modality of learning in pre- and postgraduate healthcare education programmes. The use of advanced technologies and the delivery of complex simulation-based learning opportunities require adequate preparation of healthcare educators. This paper details a European collaborative development and utilisation of an educational framework designed to prepare educators for the delivery of simulation-based learning strategies. The framework was subsequently adapted by a commercial partner and an evaluative study identified the impact of this programme of education on United Kingdom Faculty and within the National Health Service utilising qualitative methods of enquiry.The evaluation study demonstrated that the use of the educational framework effectively educates faculty to construct and deliver simulation-based learning. Furthermore, the valuation demonstrated positive impacts on patient safety by increasing the confidence and skills of frontline staff and by improving the ‘preparedness’ of systems. It has also contributed to significant economic benefits within healthcare organisations

The utilisation of a standardised educational framework to develop and deliver impactful programmes of simulation-based learning

Simulation has become a well-integrated modality of learning in pre- and postgraduate healthcare education programmes. The use of advanced technologies and the delivery of complex simulation-based learning opportunities require adequate preparation of healthcare educators. This paper details a European collaborative development and utilisation of an educational framework designed to prepare educators for the delivery of simulation-based learning strategies. The framework was subsequently adapted by a commercial partner and an evaluative study identified the impact of this programme of education on United Kingdom Faculty and within the National Health Service utilising qualitative methods of enquiry.The evaluation study demonstrated that the use of the educational framework effectively educates faculty to construct and deliver simulation-based learning. Furthermore, the valuation demonstrated positive impacts on patient safety by increasing the confidence and skills of frontline staff and by improving the ‘preparedness’ of systems. It has also contributed to significant economic benefits within healthcare organisations

The governance of sociotechnical transformations to sustainability

The contribution makes use of a sociotechnical imaginaries (STI) framework to expose crucial but neglected governance issues in sociotechnical areas of key relevance to sustainability transformations such as energy systems. It explores how the STI concept can contribute to understanding transformations to sustainability (T2S) by illustrating their multidimensionality and temporality. It takes as its starting point a ‘co-productionist’ view illuminating how collective visions of desirable (or resisted) environmental futures limit or enable political imagination and the search for alternative transformative practices. It demonstrates how a focus on imaginaries can help reveal the complex multidimensionality of human needs, expectations, and uses of natural resources — and associated societal phenomena to enable T2S. By more explicitly addressing the technical as well as political and normative dimensions of T2S, this approach helps uncover the taken-for-granted assumptions that often shut down potentially promising imaginations, as well as makes visible alternate pathways and possible constitutional relationships in the triad of state and society

Climate risk management and rural poverty reduction

Climate variability is a major source of risk to smallholder farmers and pastoralists, particularly in dryland regions. A growing body of evidence links climate-related risk to the extent and the persistence of rural poverty in these environments. Stochastic shocks erode smallholder farmers’ long-term livelihood potential through loss of productive assets. The resulting uncertainty impedes progress out of poverty by acting as a disincentive to investment in agriculture – by farmers, rural financial services, value chain institutions and governments. We assess evidence published in the last ten years that a set of production technologies and institutional options for managing risk can stabilize production and incomes, protect assets in the face of shocks, enhance uptake of improved technologies and practices, improve farmer welfare, and contribute to poverty reduction in risk-prone smallholder agricultural systems. Production technologies and practices such as stress-adapted crop germplasm, conservation agriculture, and diversified production systems stabilize agricultural production and incomes and, hence, reduce the adverse impacts of climate-related risk under some circumstances. Institutional interventions such as index-based insurance, adaptive safety nets and climate services play a complementary role in enabling farmers to manage risk, overcome risk-related barriers to adoption of improved technologies and practices, and protect their assets against the impacts of extreme climatic events. While some research documents improvements in household welfare indicators, there is limited evidence that the risk-reduction benefits of the interventions reviewed have benefited significant numbers of chronically poor farmers. We discuss the roles that climate-risk management interventions can play in efforts to reduce rural poverty, and the need for further research on identifying and targeting environments and farming populations where improved climate risk management could accelerate efforts to reduce rural poverty

Delivering Patient Decision Aids on the Internet: Definitions, Theories, Current Evidence, and Emerging Research Areas

Background: In 2005, the International Patient Decision Aids Standards Collaboration identified twelve quality dimensions to guide assessment of patient decision aids. One dimension — the delivery of patient decision aids on the Internet — is relevant when the Internet is used to provide some or all components of a patient decision aid. Building on the original background chapter, this paper provides an updated definition for this dimension, outlines a theoretical rationale, describes current evidence, and discusses emerging research areas. Methods: An international, multidisciplinary panel of authors examined the relevant theoretical literature and empirical evidence through 2012. Results: The updated definition distinguishes Internet-delivery of patient decision aids from online health information and clinical practice guidelines. Theories in cognitive psychology, decision psychology, communication, and education support the value of Internet features for providing interactive information and deliberative support. Dissemination and implementation theories support Internet-delivery for providing the right information (rapidly updated), to the right person (tailored), at the right time (the appropriate point in the decision making process). Additional efforts are needed to integrate the theoretical rationale and empirical evidence from health technology perspectives, such as consumer health informatics, user experience design, and human-computer interaction. Despite Internet usage ranging from 74% to 85% in developed countries and 80% of users searching for health information, it is unknown how many individuals specifically seek patient decision aids on the Internet. Among the 86 randomized controlled trials in the 2011 Cochrane Collaboration ’ s review of patient decision aids, only four studies focused on Internet-delivery. Given the limited number of published studies, this paper particularly focused on identifying gaps in the empirical evidence base and identifying emerging areas of research. Conclusions: As of 2012, the updated theoretical rationale and emerging evidence suggest potential benefits to delivering patient decision aids on the Internet. However, additional research is needed to identify best practices and quality metrics for Internet-based development, evaluation, and dissemination, particularly in the areas of interactivity, multimedia components, socially-generated information, and implementation strategies