Ruth Riley, Johanna Spiers, Hilary Causer, Jill Maben, Carolyn Chew-Graham, Nikolaos Efstathiou, Anya Gopfert, Kathryn Grayling, Maria van Hove
<p><strong>Background: </strong>Healthcare professionals are 24% more likely to die by suicide than the general population. The impact of such deaths on National Health Service colleagues is unclear. Early post-suicide support (postvention) is beneficial for those affected, yet little is known about how to offer this support within the National Health Service.</p><p><strong>Objectives: </strong>We set out to: (1) review existing research on suicide impact and postvention interventions in workplace settings; (2) explore the impact of colleague suicide on staff well-being; (3) examine staff perceptions of contributing factors to their colleague's suicide; (4) identify what supports or hinders bereaved colleagues in seeking help, and gather staff preferences for future support; (5) explore how managers currently support workers following a death by suicide; and (6) use the findings to develop evidence-based postvention guidance for National Health Service organisations.</p><p><strong>Methods: </strong>This study had four work packages: (1) an integrative review of primary research to review the impact of suicide in the workplace; (2) a qualitative interview study with National Health Service staff affected by a colleague's suicide or involved in supporting others (<i>n</i> = 29 affected staff, <i>n</i> = 22 supporters). Data were analysed using grounded theory and thematic analysis; (3) a co-production workshop with key stakeholders to review research findings and generate recommendations; and (4) a synthesis of all findings and recommendations to develop evidence-based postvention guidance.</p><p><strong>Results: </strong>The integrative review revealed that existing postvention guidance often lacks empirical support and does not address how workplace culture affects staff after a suicide. Those tasked with delivering postvention face stigma and complex challenges, and current support does not fully meet the needs of affected staff. In the interview study, two theories were developed. First, staff affected by a colleague's suicide faced cultural and behavioural barriers to accessing support. Some devised strategies to overcome these barriers, while others fell through the gaps. Second, those providing postvention support also encountered barriers and required emotional and practical backing to effectively support others. Thematic analysis generated key recommendations for National Health Service trusts: (1) promote staff mental health and encourage open discussions about suicide; (2) establish trained teams to deliver timely support; (3) share information swiftly and compassionately, giving staff space to reflect together; (4) offer ongoing emotional support and staff-led activities like memorials and (5) ensure support teams also receive emotional and practical assistance. All findings and recommendations were discussed during our co-design workshop. Stakeholder attendees supported the recommendations. Findings informed our guidance, which emphasi
{"title":"Evidence of the impact on and views of NHS staff following a colleague's suicide to inform postvention guidance: a multi-methods study.","authors":"Ruth Riley, Johanna Spiers, Hilary Causer, Jill Maben, Carolyn Chew-Graham, Nikolaos Efstathiou, Anya Gopfert, Kathryn Grayling, Maria van Hove","doi":"10.3310/GFTA1212","DOIUrl":"10.3310/GFTA1212","url":null,"abstract":"<p><strong>Background: </strong>Healthcare professionals are 24% more likely to die by suicide than the general population. The impact of such deaths on National Health Service colleagues is unclear. Early post-suicide support (postvention) is beneficial for those affected, yet little is known about how to offer this support within the National Health Service.</p><p><strong>Objectives: </strong>We set out to: (1) review existing research on suicide impact and postvention interventions in workplace settings; (2) explore the impact of colleague suicide on staff well-being; (3) examine staff perceptions of contributing factors to their colleague's suicide; (4) identify what supports or hinders bereaved colleagues in seeking help, and gather staff preferences for future support; (5) explore how managers currently support workers following a death by suicide; and (6) use the findings to develop evidence-based postvention guidance for National Health Service organisations.</p><p><strong>Methods: </strong>This study had four work packages: (1) an integrative review of primary research to review the impact of suicide in the workplace; (2) a qualitative interview study with National Health Service staff affected by a colleague's suicide or involved in supporting others (<i>n</i> = 29 affected staff, <i>n</i> = 22 supporters). Data were analysed using grounded theory and thematic analysis; (3) a co-production workshop with key stakeholders to review research findings and generate recommendations; and (4) a synthesis of all findings and recommendations to develop evidence-based postvention guidance.</p><p><strong>Results: </strong>The integrative review revealed that existing postvention guidance often lacks empirical support and does not address how workplace culture affects staff after a suicide. Those tasked with delivering postvention face stigma and complex challenges, and current support does not fully meet the needs of affected staff. In the interview study, two theories were developed. First, staff affected by a colleague's suicide faced cultural and behavioural barriers to accessing support. Some devised strategies to overcome these barriers, while others fell through the gaps. Second, those providing postvention support also encountered barriers and required emotional and practical backing to effectively support others. Thematic analysis generated key recommendations for National Health Service trusts: (1) promote staff mental health and encourage open discussions about suicide; (2) establish trained teams to deliver timely support; (3) share information swiftly and compassionately, giving staff space to reflect together; (4) offer ongoing emotional support and staff-led activities like memorials and (5) ensure support teams also receive emotional and practical assistance. All findings and recommendations were discussed during our co-design workshop. Stakeholder attendees supported the recommendations. Findings informed our guidance, which emphasi","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 40","pages":"1-87"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Henry Goodfellow, Ann Blandford, Katherine Bradbury, Manuel Gomes, Fiona Hamilton, William Henley, Fiona Stevenson, Delmiro Fernandez-Reyes, John Hurst, Melissa Heightman, Paul Pfeffer, William Ricketts, Richa Singh, Hannah Hylton, Stuart Linke, Julia Bindman, Chris Robson, Sarah Walker, Hadiza Ismaila
<p><strong>Background: </strong>By July 2020, large numbers of post-COVID patients were experiencing symptoms for weeks or months, but traditional National Health Service models of rehabilitation service delivery could not meet demand.</p><p><strong>Objectives: </strong>Design and deploy a digital health intervention to provide digitally delivered, remotely supported rehabilitation to long COVID patients on complicated and evolving pathways.</p><p><strong>Methods: </strong>The multidisciplinary team combined established research methods based on engineering and computer science (considering safety, stability and user requirements) with those based on biomedical and health service research (considering effectiveness and population impact). Qualitative data comprised recordings of meetings between study team members and clinicians and semistructured interviews with clinician and patient users. Quantitative data comprised referral, registration and usage rates; demographic and clinical characteristics of patients; and patient-reported outcome measures.</p><p><strong>Results: </strong>We created a modifiable digital health intervention, 'Living With COVID Recovery<sup>TM</sup> developed by Living With Ltd', London, UK, that continues to be used by National Health Service trusts. The digital health intervention included integration into a clinical pathway, a clinician-facing dashboard, two-way messaging and a patient-facing app with information and evidence-based treatments. We aimed to register 1000 users. By study completion on 20 December 2022, there were 9781 patients invited, of whom 7679 (78.5%) had registered, at 33 National Health Service clinics.</p><p><strong>Limitations: </strong>Data came from patients at long COVID clinics, however data were unlikely to be representative of people with long COVID. We could not observe clinics under lockdown and had limited access to patient digital health intervention users or to people not engaging with the digital health intervention. Patient user data were incomplete, with inconsistent patient-reported outcome measure and other questionnaire data completion and no data on initial severity of disease, vaccination status, comorbidities or other individual circumstances.</p><p><strong>Conclusions: </strong>Long COVID can be extremely debilitating, comparable to stage IV lung cancer in relation to fatigue and health-related quality of life. Care and rehabilitation should address the management of fatigue and reflect the impact of social disadvantage on symptom severity. With sufficient resources, a digital health intervention can be developed quickly and effectively using agile methodology and bringing together a genuinely multidisciplinary team, including, importantly, an industry partner. Digital health intervention product design and deployment are both important in getting National Health Service trusts, healthcare professionals and patients to engage with a digital health intervention. Projects should
背景：截至2020年7月，大量新冠肺炎后患者出现数周或数月的症状，但传统的国家卫生服务体系（nhs）康复服务模式无法满足需求。目标：设计和部署数字健康干预措施，为长期感染COVID的患者提供数字交付、远程支持的康复，途径复杂且不断发展。方法：多学科团队将基于工程和计算机科学（考虑安全性、稳定性和用户需求）的既定研究方法与基于生物医学和卫生服务研究（考虑有效性和人群影响）的研究方法相结合。定性数据包括研究小组成员和临床医生之间的会议记录，以及与临床医生和患者用户的半结构化访谈。定量数据包括转诊率、注册率和使用率；患者的人口学和临床特征；以及患者报告的结果测量。结果：我们创建了一个可修改的数字健康干预措施，由英国伦敦Living With Ltd开发的“Living With COVID RecoveryTM”，继续被国家卫生服务信托机构使用。数字健康干预包括整合到临床途径、面向临床医生的仪表板、双向信息和面向患者的应用程序中，其中包含信息和循证治疗。我们的目标是注册1000名用户。到2022年12月20日研究结束时，共邀请了9781名患者，其中7679名（78.5%）已在33个国家卫生服务诊所登记。局限性：数据来自长COVID诊所的患者，但数据不太可能代表长COVID患者。我们无法观察到被封锁的诊所，接触数字健康干预患者或不参与数字健康干预的人的机会有限。患者用户数据不完整，患者报告的结果测量和其他问卷数据不一致，没有关于疾病初始严重程度、疫苗接种状况、合并症或其他个人情况的数据。结论：长COVID可能非常虚弱，在疲劳和健康相关生活质量方面与IV期肺癌相当。护理和康复应解决疲劳的管理问题，并反映社会不利条件对症状严重程度的影响。有了足够的资源，就可以使用敏捷方法，并将真正的多学科团队（重要的是，包括行业合作伙伴）聚集在一起，快速有效地制定数字卫生干预措施。数字健康干预产品的设计和部署对于让国民健康服务信托机构、医疗保健专业人员和患者参与数字健康干预都很重要。项目应与所有用户组密切合作。封锁和新患者群体的需求未得到满足，鼓励了那些本来可能不愿尝试数字健康干预的人。许多患者和诊所接受了这种数字远程支持，这有助于患者感到受到照顾，同时减少了卫生服务的压力。这可能会鼓励人们接受其他数字医疗干预措施，尽管医疗记录整合仍然是诊所的一个障碍。未来工作：本研究的重点是长期COVID数字化康复计划的开发、部署和评估。临床有效性将在“症状、轨迹、不平等和管理：了解长期covid以解决和改变现有综合护理途径”（伦敦大学学院，英国伦敦）研究中进行评估。资助：本摘要介绍了由国家卫生和保健研究所（NIHR）卫生和社会保健提供研究计划资助的独立研究，奖励号为NIHR132243。
{"title":"Development and implementation of a digital health intervention in routine care for long COVID patients: a comprehensive synopsis.","authors":"Henry Goodfellow, Ann Blandford, Katherine Bradbury, Manuel Gomes, Fiona Hamilton, William Henley, Fiona Stevenson, Delmiro Fernandez-Reyes, John Hurst, Melissa Heightman, Paul Pfeffer, William Ricketts, Richa Singh, Hannah Hylton, Stuart Linke, Julia Bindman, Chris Robson, Sarah Walker, Hadiza Ismaila","doi":"10.3310/GJHG0331","DOIUrl":"10.3310/GJHG0331","url":null,"abstract":"<p><strong>Background: </strong>By July 2020, large numbers of post-COVID patients were experiencing symptoms for weeks or months, but traditional National Health Service models of rehabilitation service delivery could not meet demand.</p><p><strong>Objectives: </strong>Design and deploy a digital health intervention to provide digitally delivered, remotely supported rehabilitation to long COVID patients on complicated and evolving pathways.</p><p><strong>Methods: </strong>The multidisciplinary team combined established research methods based on engineering and computer science (considering safety, stability and user requirements) with those based on biomedical and health service research (considering effectiveness and population impact). Qualitative data comprised recordings of meetings between study team members and clinicians and semistructured interviews with clinician and patient users. Quantitative data comprised referral, registration and usage rates; demographic and clinical characteristics of patients; and patient-reported outcome measures.</p><p><strong>Results: </strong>We created a modifiable digital health intervention, 'Living With COVID Recovery<sup>TM</sup> developed by Living With Ltd', London, UK, that continues to be used by National Health Service trusts. The digital health intervention included integration into a clinical pathway, a clinician-facing dashboard, two-way messaging and a patient-facing app with information and evidence-based treatments. We aimed to register 1000 users. By study completion on 20 December 2022, there were 9781 patients invited, of whom 7679 (78.5%) had registered, at 33 National Health Service clinics.</p><p><strong>Limitations: </strong>Data came from patients at long COVID clinics, however data were unlikely to be representative of people with long COVID. We could not observe clinics under lockdown and had limited access to patient digital health intervention users or to people not engaging with the digital health intervention. Patient user data were incomplete, with inconsistent patient-reported outcome measure and other questionnaire data completion and no data on initial severity of disease, vaccination status, comorbidities or other individual circumstances.</p><p><strong>Conclusions: </strong>Long COVID can be extremely debilitating, comparable to stage IV lung cancer in relation to fatigue and health-related quality of life. Care and rehabilitation should address the management of fatigue and reflect the impact of social disadvantage on symptom severity. With sufficient resources, a digital health intervention can be developed quickly and effectively using agile methodology and bringing together a genuinely multidisciplinary team, including, importantly, an industry partner. Digital health intervention product design and deployment are both important in getting National Health Service trusts, healthcare professionals and patients to engage with a digital health intervention. Projects should","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 39","pages":"1-27"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145491401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nikolina Jovanović, Maev Conneely, Sarah Bicknell, Jelena Janković
<p><strong>Background: </strong>Ethnic minority women face worse maternity outcomes and increased risk of perinatal mental health issues, yet research on the accessibility and acceptability of perinatal mental health services for these groups is limited.</p><p><strong>Objectives: </strong>(1) To explore access to and utilisation of mental health services during the perinatal period among ethnic minority women; (2) to explore care pathways to community and inpatient perinatal mental health services; (3) to explore the attitudes, experiences and service improvement suggestions of ethnic minority women with perinatal mental health problems, as well as those of their partners, family members and healthcare professionals and (4) to produce recommendations for improving clinical practice.</p><p><strong>Methods: </strong>Mixed-methods study was conducted during 2018-23, encompassing four studies aligned with specific aims: (1) a population-based study of 615,092 women who gave birth in National Health Services hospitals in England, using data from the National Commissioning Data Repository; (2) a retrospective evaluation of patients accessing community perinatal mental health services in Birmingham and London (<i>n</i> = 228) and inpatient services in Birmingham, London and Nottingham (<i>n</i> = 198) using an adapted World Health Organization care pathways questionnaire; (3) a qualitative study with four cohorts across England: service users (<i>n</i> = 37), non-users or those who disengaged (<i>n</i> = 23), partners/family (<i>n</i> = 15) and healthcare professionals (<i>n</i> = 24); (4) findings informed recommendations for practice improvements, coproduced with individuals with lived experience of perinatal mental illness and of being in a minoritised ethnic group. Data were analysed using quantitative and qualitative approaches.</p><p><strong>Results: </strong>Access issues to mental health services were evident for Black African, Asian and White other women compared to White British women. Variability in patient journeys to community perinatal mental health services seem to stem from service-level factors rather than patient needs. Asian patients had more emergency admissions to Mother and Baby Units, while Black patients were less likely to experience multiple services before Mother and Baby Unit admission. Barriers to access included limited service awareness, fear of child removal, stigma, remote clinical appointments and unresponsive services. Despite these challenges, many women found services helpful. Family members noted gaps in family-focused care. Recommendations for improvement include raising awareness, monitoring access for different ethnic groups and addressing concerns about child removal, with a focus on consistent care, family involvement and cultural sensitivity.</p><p><strong>Conclusion: </strong>These findings shed light on health inequalities in perinatal mental health care for ethnic minority women. The results can be utilised
{"title":"Accessibility and acceptability of perinatal mental health services for women from ethnic minority groups: a synopsis of the PAAM study.","authors":"Nikolina Jovanović, Maev Conneely, Sarah Bicknell, Jelena Janković","doi":"10.3310/TDAS1298","DOIUrl":"10.3310/TDAS1298","url":null,"abstract":"<p><strong>Background: </strong>Ethnic minority women face worse maternity outcomes and increased risk of perinatal mental health issues, yet research on the accessibility and acceptability of perinatal mental health services for these groups is limited.</p><p><strong>Objectives: </strong>(1) To explore access to and utilisation of mental health services during the perinatal period among ethnic minority women; (2) to explore care pathways to community and inpatient perinatal mental health services; (3) to explore the attitudes, experiences and service improvement suggestions of ethnic minority women with perinatal mental health problems, as well as those of their partners, family members and healthcare professionals and (4) to produce recommendations for improving clinical practice.</p><p><strong>Methods: </strong>Mixed-methods study was conducted during 2018-23, encompassing four studies aligned with specific aims: (1) a population-based study of 615,092 women who gave birth in National Health Services hospitals in England, using data from the National Commissioning Data Repository; (2) a retrospective evaluation of patients accessing community perinatal mental health services in Birmingham and London (<i>n</i> = 228) and inpatient services in Birmingham, London and Nottingham (<i>n</i> = 198) using an adapted World Health Organization care pathways questionnaire; (3) a qualitative study with four cohorts across England: service users (<i>n</i> = 37), non-users or those who disengaged (<i>n</i> = 23), partners/family (<i>n</i> = 15) and healthcare professionals (<i>n</i> = 24); (4) findings informed recommendations for practice improvements, coproduced with individuals with lived experience of perinatal mental illness and of being in a minoritised ethnic group. Data were analysed using quantitative and qualitative approaches.</p><p><strong>Results: </strong>Access issues to mental health services were evident for Black African, Asian and White other women compared to White British women. Variability in patient journeys to community perinatal mental health services seem to stem from service-level factors rather than patient needs. Asian patients had more emergency admissions to Mother and Baby Units, while Black patients were less likely to experience multiple services before Mother and Baby Unit admission. Barriers to access included limited service awareness, fear of child removal, stigma, remote clinical appointments and unresponsive services. Despite these challenges, many women found services helpful. Family members noted gaps in family-focused care. Recommendations for improvement include raising awareness, monitoring access for different ethnic groups and addressing concerns about child removal, with a focus on consistent care, family involvement and cultural sensitivity.</p><p><strong>Conclusion: </strong>These findings shed light on health inequalities in perinatal mental health care for ethnic minority women. The results can be utilised","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 36","pages":"1-22"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fiona L Hamilton, Sumayyah Imran, Aamina Mahmood, Joanna Dobbin, Katherine Bradbury, Shoba Poduval, Jamie Scuffell, Fred Thomas, Fiona Stevenson
<p><strong>Background: </strong>Digital health interventions can support health-related knowledge transfer, for example through websites or mobile applications, and may reduce health inequalities by making health care available, where access is difficult, and by translating content to overcome language barriers. However, digital health intervention can also increase health inequalities due to the digital divide. To reach digitally excluded populations, design and delivery mechanisms need to specifically address this issue. This review was conducted during the evolving COVID-19 pandemic and informed the rapid design, deployment and evaluation of a post-COVID-19 rehabilitation digital health intervention: 'Living with COVID Recovery' (LWCR). LWCR needed to be engaging and usable for patients and to avoid exacerbating health inequalities. LWCR was introduced as a service into 33 NHS clinics, was used by 7679 patients, and evaluation ran from August 2020 to December 2022.</p><p><strong>Objective: </strong>To identify evidence-based digital health intervention design and deployment features conducive to mitigating the digital divide.</p><p><strong>Methods: </strong>Cochrane Library, Epistemonikos, National Institute for Health and Care Excellence Evidence, PROSPERO, PubMed (with MEDLINE and Europe PMC) and Turning Research into Practice; OpenGrey and Google Scholar were searched for primary research studies published in English from 1 October 2011 to 1 October 2021. Adults who were likely to be affected by the digital divide, including older age, minority ethnic groups, lower income/education level and in any healthcare setting.</p><p><strong>Interventions: </strong>Any digital health intervention with features of design and/or deployment intended to enable access and engagement by the population of focus.</p><p><strong>Comparators: </strong>Any or none.</p><p><strong>Outcome measures: </strong>Any related to participants' access and/or use of digital health intervention and/or change in digital skills and confidence.</p><p><strong>Analysis: </strong>Data from studies that met the inclusion criteria were extracted, narratively synthesised and thematically analysed.</p><p><strong>Results: </strong>Twenty-two papers met the inclusion criteria. Digital health interventions evaluated included telehealth, text message interventions, virtual assistants, self-management programmes and decision aids. Co-development with end-users, user testing through iterative design cycles, digital health interventions that also helped improve digital skills and digital health literacy, tailoring for low literacy through animations, pictures, videos and writing for low reading ages; virtual assistants to collect information from patients and guide the use of a digital health intervention.</p><p><strong>Deployment themes included: </strong>Free devices and data, or signposting to sources of cheap/free devices and Wi-Fi, text message interventions, providing 'human support',
背景：数字卫生干预措施可以支持与卫生有关的知识转移，例如通过网站或移动应用程序，并且可以通过向难以获得的地方提供卫生保健以及通过翻译内容克服语言障碍来减少卫生不平等现象。然而，数字卫生干预也可能因数字鸿沟而加剧卫生不平等。为了接触到被数字排斥的人群，设计和实施机制需要专门解决这一问题。本综述是在不断演变的COVID-19大流行期间进行的，为COVID-19后康复数字健康干预措施的快速设计、部署和评估提供了信息：“与COVID-19一起康复”（LWCR）。LWCR需要对患者具有吸引力和可用性，并避免加剧卫生不平等。LWCR作为一项服务被引入33家NHS诊所，有7679名患者使用，评估从2020年8月持续到2022年12月。目的：确定有助于缓解数字鸿沟的循证数字卫生干预设计和部署特征。方法：Cochrane Library、Epistemonikos、National Institute for Health and Care Excellence Evidence、PROSPERO、PubMed （with MEDLINE和Europe PMC）和Turning Research into Practice；OpenGrey和谷歌Scholar检索了2011年10月1日至2021年10月1日发表的英文初级研究。环境和人口：可能受到数字鸿沟影响的成年人，包括年龄较大、少数民族群体、收入/教育水平较低以及在任何医疗保健环境中。干预措施：任何数字卫生干预措施，其设计和/或部署特点旨在使重点人群能够获得和参与。比较对象：有或没有。结果衡量指标：任何与参与者获取和/或使用数字健康干预措施和/或数字技能和信心变化有关的指标。分析：从符合纳入标准的研究中提取数据，进行叙事综合和主题分析。结果：22篇论文符合纳入标准。评估的数字卫生干预措施包括远程保健、短信干预、虚拟助理、自我管理方案和决策辅助。设计主题包括：与最终用户共同开发、通过迭代设计周期进行用户测试、也有助于提高数字技能和数字卫生素养的数字卫生干预措施、通过针对低阅读年龄的动画、图片、视频和写作为低识字率量身定制；虚拟助理从患者那里收集信息并指导数字健康干预的使用。部署主题包括：免费设备和数据，或标明廉价/免费设备和Wi-Fi的来源，短信干预，提供“人力支持”，提供量身定制的数字技能教育作为干预的一部分，并提供同伴/家庭支持。局限性：我们的研究延伸到2021年底，在大流行之后，文献数量大幅增加。然而，由于我们的审查是为了为LWCR数字健康干预措施的设计和部署提供信息而进行的，因此我们报告了为这项工作提供信息的结果。纳入本综述的研究是异质性的，因此通用性可能有限。很少有随机对照试验通过使用有效的措施来评估数字卫生干预对数字卫生技能的影响。结论：在制定数字卫生干预措施时使用上述设计和部署结果可能有助于克服数字鸿沟。除了为LWCR数字卫生干预措施的发展提供信息外，审查结果对数字卫生干预措施的公平设计、提供和评估具有更广泛的影响。资助：本文介绍了由国家卫生和保健研究所（NIHR）卫生和社会保健提供研究项目资助的独立研究，奖励号为NIHR132243。
{"title":"Design and deployment of digital health interventions to reduce the risk of the digital divide and to inform development of the living with COVID recovery: a systematic scoping review.","authors":"Fiona L Hamilton, Sumayyah Imran, Aamina Mahmood, Joanna Dobbin, Katherine Bradbury, Shoba Poduval, Jamie Scuffell, Fred Thomas, Fiona Stevenson","doi":"10.3310/GJHG1331","DOIUrl":"10.3310/GJHG1331","url":null,"abstract":"<p><strong>Background: </strong>Digital health interventions can support health-related knowledge transfer, for example through websites or mobile applications, and may reduce health inequalities by making health care available, where access is difficult, and by translating content to overcome language barriers. However, digital health intervention can also increase health inequalities due to the digital divide. To reach digitally excluded populations, design and delivery mechanisms need to specifically address this issue. This review was conducted during the evolving COVID-19 pandemic and informed the rapid design, deployment and evaluation of a post-COVID-19 rehabilitation digital health intervention: 'Living with COVID Recovery' (LWCR). LWCR needed to be engaging and usable for patients and to avoid exacerbating health inequalities. LWCR was introduced as a service into 33 NHS clinics, was used by 7679 patients, and evaluation ran from August 2020 to December 2022.</p><p><strong>Objective: </strong>To identify evidence-based digital health intervention design and deployment features conducive to mitigating the digital divide.</p><p><strong>Methods: </strong>Cochrane Library, Epistemonikos, National Institute for Health and Care Excellence Evidence, PROSPERO, PubMed (with MEDLINE and Europe PMC) and Turning Research into Practice; OpenGrey and Google Scholar were searched for primary research studies published in English from 1 October 2011 to 1 October 2021. Adults who were likely to be affected by the digital divide, including older age, minority ethnic groups, lower income/education level and in any healthcare setting.</p><p><strong>Interventions: </strong>Any digital health intervention with features of design and/or deployment intended to enable access and engagement by the population of focus.</p><p><strong>Comparators: </strong>Any or none.</p><p><strong>Outcome measures: </strong>Any related to participants' access and/or use of digital health intervention and/or change in digital skills and confidence.</p><p><strong>Analysis: </strong>Data from studies that met the inclusion criteria were extracted, narratively synthesised and thematically analysed.</p><p><strong>Results: </strong>Twenty-two papers met the inclusion criteria. Digital health interventions evaluated included telehealth, text message interventions, virtual assistants, self-management programmes and decision aids. Co-development with end-users, user testing through iterative design cycles, digital health interventions that also helped improve digital skills and digital health literacy, tailoring for low literacy through animations, pictures, videos and writing for low reading ages; virtual assistants to collect information from patients and guide the use of a digital health intervention.</p><p><strong>Deployment themes included: </strong>Free devices and data, or signposting to sources of cheap/free devices and Wi-Fi, text message interventions, providing 'human support', ","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-18"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145369284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alan Watkins, Rabeea'h Aslam, Alex Dearden, Timothy Driscoll, Adrian Edwards, Bethan Edwards, Bridie Angela Evans, Angela Farr, Theresa Foster, Rachael Fothergill, Penny Gripper, Imogen M Gunson, Ann John, Ashrafunnesa Khanom, Tessa Noakes, Robin Petterson, Alison Porter, Nigel Rees, Andy Rosser, Jason Scott, Bernadette Sewell, Anna Tee, Helen Snooks
<p><strong>Background: </strong>Emergency ambulance services aim to respond to patients calling with urgent healthcare needs, prioritising the sickest. A small minority make high use of the service, which raises clinical and operational concerns. Multidisciplinary 'case management' approaches combining emergency, primary and social care have been introduced in some areas but evidence about effectiveness is lacking.</p><p><strong>Aim: </strong>To evaluate effectiveness, safety and costs of case management for people frequently calling emergency ambulance services.</p><p><strong>Design: </strong>A mixed-methods 'natural experiment', evaluating anonymised linked routine outcomes for intervention ('case management') and control ('usual care') patient cohorts within participating ambulance services, and qualitative data. Cohorts met criteria for 'Frequent Callers' designation; we assessed effects of case management within 6 months on processes, outcomes, safety and costs. The primary outcome combined indicators on mortality, emergency hospital admission, emergency department attendance and emergency ambulance call. Focus groups and interviews elicited views of service providers on acceptability, successes and challenges of case management; interviews with service users examined their experiences.</p><p><strong>Setting: </strong>Four United Kingdom ambulance services each with one intervention and one control area.</p><p><strong>Participants: </strong>Natural experiment: adults meeting criteria for 'frequent caller' classification by ambulance services during 2018. Service providers: service commissioners; emergency and non-acute health and social care providers. Service users: adults with experience of calling emergency ambulance services frequently.</p><p><strong>Interventions: </strong>Usual care comprised within-service management, typically involving: patient and general practitioner letters; call centre flags invoking care plans; escalation to other services, including police. Intervention care comprised usual care with optional 'case management' referral to cross-service multidisciplinary team to review and plan care for selected patients.</p><p><strong>Results: </strong>We found no differences in intervention (<i>n</i> = 550) and control (<i>n</i> = 633) patients in the primary outcome (adjusted odds ratio: 1.159; 95% confidence interval: 0.595 to 2.255) or its components. Nearly all patients recorded at least one outcome (95.6% intervention; 94.9% control). Mortality was high (10.5% intervention; 14.1% control). Less than 25% of calls resulted in conveyance (24.3% intervention; 22.3% control). The most common reasons for calling were 'fall' (6.5%), 'sick person' (5.2%) and acute coronary syndrome (4.7%). Case management models varied highly in provision, resourcing, leadership and implementation costs. We found no differences in costs per patient of healthcare resource utilisation (adjusted difference: £243.57; 95% confidence interval: -£1972.
{"title":"Strategies to manage emergency ambulance telephone callers with sustained high needs: the STRETCHED mixed-methods evaluation with linked data.","authors":"Alan Watkins, Rabeea'h Aslam, Alex Dearden, Timothy Driscoll, Adrian Edwards, Bethan Edwards, Bridie Angela Evans, Angela Farr, Theresa Foster, Rachael Fothergill, Penny Gripper, Imogen M Gunson, Ann John, Ashrafunnesa Khanom, Tessa Noakes, Robin Petterson, Alison Porter, Nigel Rees, Andy Rosser, Jason Scott, Bernadette Sewell, Anna Tee, Helen Snooks","doi":"10.3310/PWGF6008","DOIUrl":"https://doi.org/10.3310/PWGF6008","url":null,"abstract":"<p><strong>Background: </strong>Emergency ambulance services aim to respond to patients calling with urgent healthcare needs, prioritising the sickest. A small minority make high use of the service, which raises clinical and operational concerns. Multidisciplinary 'case management' approaches combining emergency, primary and social care have been introduced in some areas but evidence about effectiveness is lacking.</p><p><strong>Aim: </strong>To evaluate effectiveness, safety and costs of case management for people frequently calling emergency ambulance services.</p><p><strong>Design: </strong>A mixed-methods 'natural experiment', evaluating anonymised linked routine outcomes for intervention ('case management') and control ('usual care') patient cohorts within participating ambulance services, and qualitative data. Cohorts met criteria for 'Frequent Callers' designation; we assessed effects of case management within 6 months on processes, outcomes, safety and costs. The primary outcome combined indicators on mortality, emergency hospital admission, emergency department attendance and emergency ambulance call. Focus groups and interviews elicited views of service providers on acceptability, successes and challenges of case management; interviews with service users examined their experiences.</p><p><strong>Setting: </strong>Four United Kingdom ambulance services each with one intervention and one control area.</p><p><strong>Participants: </strong>Natural experiment: adults meeting criteria for 'frequent caller' classification by ambulance services during 2018. Service providers: service commissioners; emergency and non-acute health and social care providers. Service users: adults with experience of calling emergency ambulance services frequently.</p><p><strong>Interventions: </strong>Usual care comprised within-service management, typically involving: patient and general practitioner letters; call centre flags invoking care plans; escalation to other services, including police. Intervention care comprised usual care with optional 'case management' referral to cross-service multidisciplinary team to review and plan care for selected patients.</p><p><strong>Results: </strong>We found no differences in intervention (<i>n</i> = 550) and control (<i>n</i> = 633) patients in the primary outcome (adjusted odds ratio: 1.159; 95% confidence interval: 0.595 to 2.255) or its components. Nearly all patients recorded at least one outcome (95.6% intervention; 94.9% control). Mortality was high (10.5% intervention; 14.1% control). Less than 25% of calls resulted in conveyance (24.3% intervention; 22.3% control). The most common reasons for calling were 'fall' (6.5%), 'sick person' (5.2%) and acute coronary syndrome (4.7%). Case management models varied highly in provision, resourcing, leadership and implementation costs. We found no differences in costs per patient of healthcare resource utilisation (adjusted difference: £243.57; 95% confidence interval: -£1972.","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 37","pages":"1-76"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heather O'Mahen, Louise Howard, Helen Sharp, Antoinette Davey, Louise Fisher, Ipek Gurol-Urganci, Margaret Heslin, Julia Langham, Ebun Makinde, Emma Tassie, Silia Vitoratou, Jo Brook, Gina Collins, Chris McCree, Dharmintra Pasupathy, Andrew Pickles, Sarah Morgan-Trimmer, Geoffrey Wong, Katie Atmore, Debra Bick, Laura Bozicevic, Clare Dolman, Jill Domoney, Jessica Gay, Chloe Hayes, Jennifer Holly, Miriam Refberg, Sarah Byford, Jan van der Meulen
Background: Perinatal mental health disorders affect one in five mothers during pregnancy or within 2 years post childbirth. These disorders can lead to poor pregnancy and childbirth outcomes and maternal deaths. Additionally, they negatively affect a child's cognitive, social and emotional development. Stigma and a lack of specialised services have limited access to mental health care. National Health Service England invested £365M in community perinatal mental health teams, but their impact on women and infants' outcomes are not known. Develop a taxonomy of community perinatal mental health teams (work package 1). Compare and validate two assessments of quality of mother-infant interaction for use by community perinatal mental health teams (work package 2). Evaluate the effectiveness and cost-effectiveness of community perinatal mental health teams (work packages 3 and 4).
Design: Mixed-methods study.
Setting: Community perinatal mental health teams in England.
Participants: Women who were pregnant or within 2 years postnatal.
Methods and outcome measures: Work package 1: Typology of community perinatal mental health teams in England. Work package 2: Reliability and validity of two observational assessments of parent-infant interaction. Work package 3: Realist evaluation interviews with women, partners/close others, and staff to determine effective community perinatal mental health team components. Work package 4: Analysis of linked data: Association of community perinatal mental health teams with access to secondary care mental health services. Risk of acute relapse and improved obstetric and neonate outcomes for women with pre-existing severe disorders in areas with community perinatal mental health teams compared to generic services. Economic analysis of cost of community perinatal mental health teams.
Results: Objective 1: Community perinatal mental health team typologies revealed in 2020, 84% had basic staffing levels and 63% had more multi-professionals. Objective 2: The 'Parent Infant Interaction Observation Scale' and 'National Institute of Child Health and Human Development' assessments of mother-infant interaction were reliable and valid; the National Institute of Child Health and Human Development is more suitable for community perinatal mental health teams. Objective 3: Work package 3: Interviews with 139 women, 55 partners/close others and 80 health workers highlighted the importance of specialist perinatal knowledge, responding in a warm and non-judgemental way, working closely with other healthcare providers, optimising medication, supporting mothers to reduce conflict and improve social support, helping mother-infant bonding, and teaching emotional management. Work package 4: Analysis of linked health data revealed higher risks for obstetric and neonate problems in women with severe mental health
{"title":"Effectiveness and cost-effectiveness of community perinatal mental health services on access, experience, recovery/relapse and obstetric and neonate outcomes: the ESMI-II mixed-methods study.","authors":"Heather O'Mahen, Louise Howard, Helen Sharp, Antoinette Davey, Louise Fisher, Ipek Gurol-Urganci, Margaret Heslin, Julia Langham, Ebun Makinde, Emma Tassie, Silia Vitoratou, Jo Brook, Gina Collins, Chris McCree, Dharmintra Pasupathy, Andrew Pickles, Sarah Morgan-Trimmer, Geoffrey Wong, Katie Atmore, Debra Bick, Laura Bozicevic, Clare Dolman, Jill Domoney, Jessica Gay, Chloe Hayes, Jennifer Holly, Miriam Refberg, Sarah Byford, Jan van der Meulen","doi":"10.3310/RRAP0011","DOIUrl":"https://doi.org/10.3310/RRAP0011","url":null,"abstract":"<p><strong>Background: </strong>Perinatal mental health disorders affect one in five mothers during pregnancy or within 2 years post childbirth. These disorders can lead to poor pregnancy and childbirth outcomes and maternal deaths. Additionally, they negatively affect a child's cognitive, social and emotional development. Stigma and a lack of specialised services have limited access to mental health care. National Health Service England invested £365M in community perinatal mental health teams, but their impact on women and infants' outcomes are not known. Develop a taxonomy of community perinatal mental health teams (work package 1). Compare and validate two assessments of quality of mother-infant interaction for use by community perinatal mental health teams (work package 2). Evaluate the effectiveness and cost-effectiveness of community perinatal mental health teams (work packages 3 and 4).</p><p><strong>Design: </strong>Mixed-methods study.</p><p><strong>Setting: </strong>Community perinatal mental health teams in England.</p><p><strong>Participants: </strong>Women who were pregnant or within 2 years postnatal.</p><p><strong>Methods and outcome measures: </strong>Work package 1: Typology of community perinatal mental health teams in England. Work package 2: Reliability and validity of two observational assessments of parent-infant interaction. Work package 3: Realist evaluation interviews with women, partners/close others, and staff to determine effective community perinatal mental health team components. Work package 4: Analysis of linked data: Association of community perinatal mental health teams with access to secondary care mental health services. Risk of acute relapse and improved obstetric and neonate outcomes for women with pre-existing severe disorders in areas with community perinatal mental health teams compared to generic services. Economic analysis of cost of community perinatal mental health teams.</p><p><strong>Results: </strong>Objective 1: Community perinatal mental health team typologies revealed in 2020, 84% had basic staffing levels and 63% had more multi-professionals. Objective 2: The 'Parent Infant Interaction Observation Scale' and 'National Institute of Child Health and Human Development' assessments of mother-infant interaction were reliable and valid; the National Institute of Child Health and Human Development is more suitable for community perinatal mental health teams. Objective 3: Work package 3: Interviews with 139 women, 55 partners/close others and 80 health workers highlighted the importance of specialist perinatal knowledge, responding in a warm and non-judgemental way, working closely with other healthcare providers, optimising medication, supporting mothers to reduce conflict and improve social support, helping mother-infant bonding, and teaching emotional management. Work package 4: Analysis of linked health data revealed higher risks for obstetric and neonate problems in women with severe mental health","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 38","pages":"1-92"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Louise Locock, Andrew S Maclaren, Zoë Skea, Lorraine Angell, Jennifer Cleland, Topher Dawson, Alan Denison, Christina Dobson, Rosemary Hollick, Peter Murchie, Diane Skåtun, Verity Watson
<p><strong>Background: </strong>Recruitment and retention of healthcare staff in rural and remote areas is a significant problem for the National Health Service. Some communities have experimented with initiatives to support recruitment and retention, but these actions are often ad hoc and undocumented.</p><p><strong>Objectives: </strong>To explore the experiences of remote and rural community members and organisations of trying to attract healthcare staff and their families. To map local context and describe initiatives they have undertaken to improve recruitment. To understand how community initiatives have been received by those staff and families who have been attracted to work and live in a rural area as a result. To assess which initiatives seem to have been more or less successful and why. To provide resources for other communities and the National Health Service based on this learning.</p><p><strong>Design and setting: </strong>Qualitative case studies, three in Scotland and two in England. A case description of each site was developed, and interviews were analysed thematically. Documentary framework analysis of published job adverts for remote and rural healthcare posts.</p><p><strong>Participants: </strong>Case studies: 22 individuals, including community members, healthcare practitioners and family members, took part in interviews and focus groups. Job adverts: 270 from <i>British Medical Journal</i>, and National Health Service Scotland websites for general practitioner and general National Health Service vacancies.</p><p><strong>Results: </strong>Case studies: communities engaged in a range of activities, such as making promotional videos, social media campaigns, help finding accommodation and informal social integration efforts. They drew on multiple local 'assets' to encourage healthcare staff to move to the area, including showcasing beautiful local landscapes; outdoor activities; a safe, cohesive community for children; and high quality of life. Often a small number of people drove these efforts. While this worked well in some communities, the burden of responsibility could be unsustainable, and not all communities have people with the necessary skills and time. There was less focus on retention than recruitment. Where this worked well, it relied on informal networks of key individuals who created social links for incoming families. Communities struggle with the absence of some key assets, including housing; schools; employment opportunities for family members; cultural activities. Job adverts: different emphases on job details, place and wider area. Only 18/49 advertisers (of 189 approached) reported positive outcome in terms of appointments. We suggest greater use of photographs and place descriptions in future advertisements.</p><p><strong>Limitations: </strong>This is a small exploratory study. Sampling was constrained by the small number of eligible communities and people involved. Planned ethnographic fieldwork was impacted
{"title":"'Come and work here!' Qualitative research exploring community-led initiatives to improve healthcare recruitment and retention in remote and rural areas.","authors":"Louise Locock, Andrew S Maclaren, Zoë Skea, Lorraine Angell, Jennifer Cleland, Topher Dawson, Alan Denison, Christina Dobson, Rosemary Hollick, Peter Murchie, Diane Skåtun, Verity Watson","doi":"10.3310/DJGR6622","DOIUrl":"10.3310/DJGR6622","url":null,"abstract":"<p><strong>Background: </strong>Recruitment and retention of healthcare staff in rural and remote areas is a significant problem for the National Health Service. Some communities have experimented with initiatives to support recruitment and retention, but these actions are often ad hoc and undocumented.</p><p><strong>Objectives: </strong>To explore the experiences of remote and rural community members and organisations of trying to attract healthcare staff and their families. To map local context and describe initiatives they have undertaken to improve recruitment. To understand how community initiatives have been received by those staff and families who have been attracted to work and live in a rural area as a result. To assess which initiatives seem to have been more or less successful and why. To provide resources for other communities and the National Health Service based on this learning.</p><p><strong>Design and setting: </strong>Qualitative case studies, three in Scotland and two in England. A case description of each site was developed, and interviews were analysed thematically. Documentary framework analysis of published job adverts for remote and rural healthcare posts.</p><p><strong>Participants: </strong>Case studies: 22 individuals, including community members, healthcare practitioners and family members, took part in interviews and focus groups. Job adverts: 270 from <i>British Medical Journal</i>, and National Health Service Scotland websites for general practitioner and general National Health Service vacancies.</p><p><strong>Results: </strong>Case studies: communities engaged in a range of activities, such as making promotional videos, social media campaigns, help finding accommodation and informal social integration efforts. They drew on multiple local 'assets' to encourage healthcare staff to move to the area, including showcasing beautiful local landscapes; outdoor activities; a safe, cohesive community for children; and high quality of life. Often a small number of people drove these efforts. While this worked well in some communities, the burden of responsibility could be unsustainable, and not all communities have people with the necessary skills and time. There was less focus on retention than recruitment. Where this worked well, it relied on informal networks of key individuals who created social links for incoming families. Communities struggle with the absence of some key assets, including housing; schools; employment opportunities for family members; cultural activities. Job adverts: different emphases on job details, place and wider area. Only 18/49 advertisers (of 189 approached) reported positive outcome in terms of appointments. We suggest greater use of photographs and place descriptions in future advertisements.</p><p><strong>Limitations: </strong>This is a small exploratory study. Sampling was constrained by the small number of eligible communities and people involved. Planned ethnographic fieldwork was impacted","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 34","pages":"1-70"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145067236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hiten D Mistry, Sergio A Silverio, Emma Duncan, Abigail Easter, Peter von Dadelszen, Laura A Magee
<p><strong>Background: </strong>During the COVID-19 pandemic, significant reconfigurations were made to maternity care, to deliver this essential service while minimising the risk of infection for pregnant/post partum women and their infants, initially considered to be more vulnerable.</p><p><strong>Design: </strong>This mixed-methods study had three work packages. Work package 1 used quantitative methods to analyse pregnancy outcomes over time, considering service reconfiguration and inequalities, using routinely collected maternity and offspring data from three diverse South London trusts. Work package 2 involved in-depth interviews with a diverse sample of pregnant/post partum women, partners, healthcare professionals and policy-makers, and used thematic framework analysis. Systematic reviews were undertaken of women's experiences of receiving maternity care during the pandemic, and healthcare professionals' experiences of providing that care. Questionnaires (October-December 2021 and August-September 2022) were administered nationally via the King's College London COVID Symptom Study Biobank, to evaluate vaccine uptake among women who were planning pregnancy, pregnant or post partum. Work package 3 engaged stakeholders within maternity systems through regional Listening Events and a national Policy Lab.</p><p><strong>Results: </strong>Among women of reproductive age (8 December 2020-15 February 2021), older age, white ethnicity and a lack of social deprivation were associated with higher vaccine uptake, although ethnicity exerted the strongest effect (Office for National Statistics data). Across pre-pandemic, pandemic with and pandemic without lockdowns, pregnancy outcomes, over time, largely followed pre-pandemic trends (record linkage, South London). However, virtual antenatal care in the second and third trimesters was associated with an excess of adverse pregnancy outcomes (and increased costs).</p><p><strong>Work package 2: </strong>Our systematic reviews of experiences of receiving (by women) or delivering (by healthcare professionals) maternity care during the pandemic identified the need for personalised care adapted to service users and communities, including those who are marginalised, and including provision of information; and co-design and coproduction of services with service users and staff, to reflect their collective lived experiences. This has the potential to improve workplace well-being for maternity care staff and facilitate inclusive and equitable care for service users. Interviews about COVID-19 vaccination in pregnancy identified a legacy of mistrust, lack of information, and confusing guidance that contributed to vaccine hesitancy for pregnant women during the pandemic. In our national survey, women of reproductive age (including pregnant/post partum women) reported being promptly vaccinated, but with angst and despite having received misinformation and discouragement from some healthcare professionals.</p><p><strong>
{"title":"Post-pandemic planning for maternity care for local, regional, and national maternity systems across the four nations: a mixed-methods study.","authors":"Hiten D Mistry, Sergio A Silverio, Emma Duncan, Abigail Easter, Peter von Dadelszen, Laura A Magee","doi":"10.3310/HHTE6611","DOIUrl":"10.3310/HHTE6611","url":null,"abstract":"<p><strong>Background: </strong>During the COVID-19 pandemic, significant reconfigurations were made to maternity care, to deliver this essential service while minimising the risk of infection for pregnant/post partum women and their infants, initially considered to be more vulnerable.</p><p><strong>Design: </strong>This mixed-methods study had three work packages. Work package 1 used quantitative methods to analyse pregnancy outcomes over time, considering service reconfiguration and inequalities, using routinely collected maternity and offspring data from three diverse South London trusts. Work package 2 involved in-depth interviews with a diverse sample of pregnant/post partum women, partners, healthcare professionals and policy-makers, and used thematic framework analysis. Systematic reviews were undertaken of women's experiences of receiving maternity care during the pandemic, and healthcare professionals' experiences of providing that care. Questionnaires (October-December 2021 and August-September 2022) were administered nationally via the King's College London COVID Symptom Study Biobank, to evaluate vaccine uptake among women who were planning pregnancy, pregnant or post partum. Work package 3 engaged stakeholders within maternity systems through regional Listening Events and a national Policy Lab.</p><p><strong>Results: </strong>Among women of reproductive age (8 December 2020-15 February 2021), older age, white ethnicity and a lack of social deprivation were associated with higher vaccine uptake, although ethnicity exerted the strongest effect (Office for National Statistics data). Across pre-pandemic, pandemic with and pandemic without lockdowns, pregnancy outcomes, over time, largely followed pre-pandemic trends (record linkage, South London). However, virtual antenatal care in the second and third trimesters was associated with an excess of adverse pregnancy outcomes (and increased costs).</p><p><strong>Work package 2: </strong>Our systematic reviews of experiences of receiving (by women) or delivering (by healthcare professionals) maternity care during the pandemic identified the need for personalised care adapted to service users and communities, including those who are marginalised, and including provision of information; and co-design and coproduction of services with service users and staff, to reflect their collective lived experiences. This has the potential to improve workplace well-being for maternity care staff and facilitate inclusive and equitable care for service users. Interviews about COVID-19 vaccination in pregnancy identified a legacy of mistrust, lack of information, and confusing guidance that contributed to vaccine hesitancy for pregnant women during the pandemic. In our national survey, women of reproductive age (including pregnant/post partum women) reported being promptly vaccinated, but with angst and despite having received misinformation and discouragement from some healthcare professionals.</p><p><strong>","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 35","pages":"1-25"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Trisha Greenhalgh, Anica Alvarez Nishio, Aileen Clarke, Richard Byng, Francesca Dakin, Stuart Faulkner, Isabel Hanson, Nina Hemmings, Gemma Hughes, Laiba Husain, Asli Kalin, Emma Ladds, Ellen MacIver, Lucy Moore, Sarah O'Rourke, Rebecca Payne, Tabitha Pring, Rebecca Rosen, Sarah Rybczynska-Bunt, Sara E Shaw, Nadia Swann, Sietse Wieringa, Joseph Wherton
<p><strong>Background: </strong>Remote services (in which the patient and staff member are not physically colocated) and digital services (in which a patient encounter is digitally mediated in some way) were introduced extensively when the COVID-19 pandemic began in 2020. We undertook a longitudinal qualitative study of the introduction, embedding, evolution and abandonment of remote and digital innovations in United Kingdom general practice. This synoptic paper summarises study design, methods, key findings, outputs and impacts to date.</p><p><strong>Overview of the study and key findings: </strong>From September 2021 to December 2023, we collected > 500 hours of ethnographic observation from a diverse sample of 12 general practices. Other data sources included over 200 interviews (with practice staff, patients and wider stakeholders), 4 multi-stakeholder workshops (184 participants), grey literature (e.g. Care Quality Commission reports) and safety incident reports. Patient involvement included digitally excluded individuals from disadvantaged backgrounds (e.g. homeless, complex needs). Data were de-identified, uploaded to NVivo (QSR International, Warrington, UK), coded thematically and analysed using various theoretical lenses. Despite an adverse context for general practice including austerity, workforce shortages, rising demand, rising workload and procurement challenges, all 12 participating practices adjusted to some extent to a 'new normal' of hybrid (combined traditional and remote/digital) provision following the external shock of the pandemic. By late 2023, practices showed wide variation in digital maturity from a 'trailblazer' practice which used digital technologies extensively and creatively to 'strategically traditional' practices offering mainly in-person services to deprived and vulnerable populations. We explained practices' varied fortunes using diffusion of innovations theory, highlighting the extensive work needed to embed and routinise technologies and processes. Digitally enabled patients often, but not always, found remote and digital services convenient and navigable, but vulnerable groups experienced exclusion. We explored these inequities through the lenses of digital candidacy, fractured reflexivity and intersectionality. For staff, remote and digital tasks and processes were often complex, labour-intensive, stressful and dependent on positive interpersonal relations - findings that resonated with theories of technostress, suffering and relational co-ordination. Our initial plan for workshop-based co-design of access pathways with patients was unsuccessful due to dynamic complexities; shifting to a more bespoke and agile design process generated helpful resources for patients and staff.</p><p><strong>Discussion: </strong>This study has confirmed previous findings from sociotechnical research showing that new technologies are never 'plug and play' and that appropriate solutions vary with context. Much variation in dig
{"title":"Remote and digital services in UK general practice 2021-2023: the Remote by Default 2 longitudinal qualitative study synopsis.","authors":"Trisha Greenhalgh, Anica Alvarez Nishio, Aileen Clarke, Richard Byng, Francesca Dakin, Stuart Faulkner, Isabel Hanson, Nina Hemmings, Gemma Hughes, Laiba Husain, Asli Kalin, Emma Ladds, Ellen MacIver, Lucy Moore, Sarah O'Rourke, Rebecca Payne, Tabitha Pring, Rebecca Rosen, Sarah Rybczynska-Bunt, Sara E Shaw, Nadia Swann, Sietse Wieringa, Joseph Wherton","doi":"10.3310/QQTT4411","DOIUrl":"https://doi.org/10.3310/QQTT4411","url":null,"abstract":"<p><strong>Background: </strong>Remote services (in which the patient and staff member are not physically colocated) and digital services (in which a patient encounter is digitally mediated in some way) were introduced extensively when the COVID-19 pandemic began in 2020. We undertook a longitudinal qualitative study of the introduction, embedding, evolution and abandonment of remote and digital innovations in United Kingdom general practice. This synoptic paper summarises study design, methods, key findings, outputs and impacts to date.</p><p><strong>Overview of the study and key findings: </strong>From September 2021 to December 2023, we collected > 500 hours of ethnographic observation from a diverse sample of 12 general practices. Other data sources included over 200 interviews (with practice staff, patients and wider stakeholders), 4 multi-stakeholder workshops (184 participants), grey literature (e.g. Care Quality Commission reports) and safety incident reports. Patient involvement included digitally excluded individuals from disadvantaged backgrounds (e.g. homeless, complex needs). Data were de-identified, uploaded to NVivo (QSR International, Warrington, UK), coded thematically and analysed using various theoretical lenses. Despite an adverse context for general practice including austerity, workforce shortages, rising demand, rising workload and procurement challenges, all 12 participating practices adjusted to some extent to a 'new normal' of hybrid (combined traditional and remote/digital) provision following the external shock of the pandemic. By late 2023, practices showed wide variation in digital maturity from a 'trailblazer' practice which used digital technologies extensively and creatively to 'strategically traditional' practices offering mainly in-person services to deprived and vulnerable populations. We explained practices' varied fortunes using diffusion of innovations theory, highlighting the extensive work needed to embed and routinise technologies and processes. Digitally enabled patients often, but not always, found remote and digital services convenient and navigable, but vulnerable groups experienced exclusion. We explored these inequities through the lenses of digital candidacy, fractured reflexivity and intersectionality. For staff, remote and digital tasks and processes were often complex, labour-intensive, stressful and dependent on positive interpersonal relations - findings that resonated with theories of technostress, suffering and relational co-ordination. Our initial plan for workshop-based co-design of access pathways with patients was unsuccessful due to dynamic complexities; shifting to a more bespoke and agile design process generated helpful resources for patients and staff.</p><p><strong>Discussion: </strong>This study has confirmed previous findings from sociotechnical research showing that new technologies are never 'plug and play' and that appropriate solutions vary with context. Much variation in dig","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 31","pages":"1-49"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kathryn Greenwood, Christopher Iain Jones, Nahel Yaziji, Andy Healey, Carl May, Stephen Bremner, Richard Hooper, Shanaya Rathod, Peter Phiri, Richard de Visser, Tanya Mackay, Gergely Bartl, Iga Abramowicz, Jenny Gu, Rebecca Webb, Sunil Nandha, Belinda Lennox, Louise Johns, Paul French, Jo Hodgekins, Heather Law, James Plaistow, Rose Thompson, David Fowler, Philippa Garety, Anastacia O'Donnell, Michelle Painter, Rebecca Jarvis, Stuart Clark, Emmanuelle Peters
Background: Early Intervention in Psychosis services improves outcomes for young people with psychosis, but 25% disengage in the first 12 months with costs to their mental health.
Objectives: To refine a toolkit and training and evaluate effectiveness, implementation, and cost-effectiveness of the Early Youth Engagement-2 intervention to reduce disengagement.
Design: Cluster randomised controlled trial with economic and process evaluation.
Randomisation: Randomisation at team level stratified by site.
Masking: Research assistants, outcome assessors and statisticians were masked to treatment allocation for the primary disengagement and cost-effectiveness outcomes. Participants and teams administering the interventions were unmasked.
Setting: Twenty Early Intervention in Psychosis teams in five sites across England.
Participants: A total of 1027 young people (14-35 years) with first-episode psychosis (F20-29, 31; ICD-10); 20-282 Early Intervention in Psychosis staff.
Intervention: Team-based motivational engagement (Early Youth Engagement-2) intervention, delivered by Early Intervention in Psychosis clinicians alongside standardised Early Intervention in Psychosis, supported by the implementation toolkit (training, website and booklet series).
Comparison: Standardised Early Intervention in Psychosis, including National Institute for Health and Care Excellence guidelines approved interventions.
Main outcome measures: Primary outcome - time to disengagement over 26 months (days from date of allocation to care co-ordinator to date of last contact following refusal to engage with service, or lack of response to contact for consecutive 3-month period). Secondary outcomes - mental health, recovery, quality of life, service use, at 6 and 12 months. Economic outcomes - National Health Service mental healthcare costs, wider societal care costs, clinical and social outcomes over 12 months; cost-effectiveness. Process evaluation outcomes - fidelity to the Early Youth Engagement-2 model, implementation process scores, therapeutic alliance, qualitative outcomes.
Results: Disengagement was 16% across both arms. The multivariable Cox regression on 1005 participants estimated an adjusted hazard ratio for Early Youth Engagement-2 + standardised Early Intervention in Psychosis (n = 652) versus standardised Early Intervention in Psychosis service alone (n = 375) of 1.07 (95% confidence interval 0.76 to 1.49; p = 0.713). There were no observed differences between arms for any secondary outcomes. The health economic evaluation indicated lower mean mental healthcare costs of -£788 (95% CI -£3571 to £1994) and marginally improved mental health states for intervention participants. Early Youth Engagement-2
背景：精神病服务的早期干预改善了年轻精神病患者的预后，但25%的人在前12个月内退出治疗，这对他们的精神健康造成了损失。目标：完善工具包和培训，并评估青少年早期参与-2干预的有效性、实施和成本效益，以减少脱离参与。设计：具有经济性和工艺评价的聚类随机对照试验。随机化：按地点分层的团队水平随机化。掩蔽：研究助理、结果评估员和统计学家对主要脱离接触和成本效益结果的治疗分配进行掩蔽。参与者和管理干预的团队都被揭开了面具。背景：20个精神病早期干预小组分布在英格兰的5个地点。参与者：共有1027名首发精神病的年轻人（14-35岁）（f20 - 29,31; ICD-10）；20-282精神病早期干预工作人员。干预：以团队为基础的激励参与（早期青年参与-2）干预，由精神病早期干预临床医生提供，同时提供标准化的精神病早期干预，并得到实施工具包（培训，网站和小册子系列）的支持。比较：精神病的标准化早期干预，包括国家健康和护理卓越研究所指南批准的干预措施。主要结果指标：主要结果- 26个月内脱离接触的时间（从分配到护理协调员之日起至拒绝参与服务或连续3个月期间对联系缺乏回应后最后一次联系的天数）。次要结果——6个月和12个月时的心理健康、康复、生活质量、服务使用情况。经济成果——国民保健服务精神保健费用、更广泛的社会护理费用、12个月内的临床和社会结果；成本效益。过程评估结果-对早期青少年参与-2模型的忠实度，实施过程得分，治疗联盟，定性结果。结果：双臂的脱离率为16%。对1005名参与者的多变量Cox回归估计，早期青少年参与-2 +标准化精神病早期干预（n = 652）与单独的标准化精神病早期干预（n = 375）的调整风险比为1.07（95%置信区间0.76至1.49;p = 0.713）。没有观察到两组之间在任何次要结果上的差异。健康经济评估表明，干预参与者的平均心理保健费用降低了- 788英镑（95% CI - 3571英镑至1994英镑），心理健康状况略有改善。早期青年参与-2参与者每年在教育和培训上花费30多天（95% CI 1.52至53.68；干预的积极结果概率：99%），但这些结果必须非常谨慎地看待，因为只有22%的样本提供了数据。流程评估显示了不同的实现保真度和适应COVID-19广泛破坏的持续压力。对治疗联盟没有影响，最可能的积极改变机制是通过心理教育。局限性：脱离接触低于预期，后续工作损失大，COVID-19对保真度、实施和结果的影响。结论：在主要的临床有效性分析中，95%的置信限排除了早期青少年参与-2干预的脱离风险降低24%以上的可能性。在一项成本效益分析中，对早期青少年参与-2干预（降低成本，略微改善心理健康状况）占主导地位的估计有所下降。未来的工作：传播小册子和网站资源，并将该模型的改编版本作为独立工具，用于精神疾病护理的良好常规早期干预。研究注册：本研究注册号为ISRCTN 51629746。资助：该奖项由国家卫生和保健研究所（NIHR）卫生和社会保健提供研究项目（NIHR奖励编号：16/31/87）资助，全文发表在《卫生和社会保健提供研究》上；第13卷，第33号有关进一步的奖励信息，请参阅美国国立卫生研究院资助和奖励网站。
{"title":"Team-based motivational engagement intervention in young people with first-episode psychosis: the EYE-2 cluster RCT with economic and process evaluation.","authors":"Kathryn Greenwood, Christopher Iain Jones, Nahel Yaziji, Andy Healey, Carl May, Stephen Bremner, Richard Hooper, Shanaya Rathod, Peter Phiri, Richard de Visser, Tanya Mackay, Gergely Bartl, Iga Abramowicz, Jenny Gu, Rebecca Webb, Sunil Nandha, Belinda Lennox, Louise Johns, Paul French, Jo Hodgekins, Heather Law, James Plaistow, Rose Thompson, David Fowler, Philippa Garety, Anastacia O'Donnell, Michelle Painter, Rebecca Jarvis, Stuart Clark, Emmanuelle Peters","doi":"10.3310/WDWG4102","DOIUrl":"10.3310/WDWG4102","url":null,"abstract":"<p><strong>Background: </strong>Early Intervention in Psychosis services improves outcomes for young people with psychosis, but 25% disengage in the first 12 months with costs to their mental health.</p><p><strong>Objectives: </strong>To refine a toolkit and training and evaluate effectiveness, implementation, and cost-effectiveness of the Early Youth Engagement-2 intervention to reduce disengagement.</p><p><strong>Design: </strong>Cluster randomised controlled trial with economic and process evaluation.</p><p><strong>Randomisation: </strong>Randomisation at team level stratified by site.</p><p><strong>Masking: </strong>Research assistants, outcome assessors and statisticians were masked to treatment allocation for the primary disengagement and cost-effectiveness outcomes. Participants and teams administering the interventions were unmasked.</p><p><strong>Setting: </strong>Twenty Early Intervention in Psychosis teams in five sites across England.</p><p><strong>Participants: </strong>A total of 1027 young people (14-35 years) with first-episode psychosis (F20-29, 31; ICD-10); 20-282 Early Intervention in Psychosis staff.</p><p><strong>Intervention: </strong>Team-based motivational engagement (Early Youth Engagement-2) intervention, delivered by Early Intervention in Psychosis clinicians alongside standardised Early Intervention in Psychosis, supported by the implementation toolkit (training, website and booklet series).</p><p><strong>Comparison: </strong>Standardised Early Intervention in Psychosis, including National Institute for Health and Care Excellence guidelines approved interventions.</p><p><strong>Main outcome measures: </strong>Primary outcome - time to disengagement over 26 months (days from date of allocation to care co-ordinator to date of last contact following refusal to engage with service, or lack of response to contact for consecutive 3-month period). Secondary outcomes - mental health, recovery, quality of life, service use, at 6 and 12 months. Economic outcomes - National Health Service mental healthcare costs, wider societal care costs, clinical and social outcomes over 12 months; cost-effectiveness. Process evaluation outcomes - fidelity to the Early Youth Engagement-2 model, implementation process scores, therapeutic alliance, qualitative outcomes.</p><p><strong>Results: </strong>Disengagement was 16% across both arms. The multivariable Cox regression on 1005 participants estimated an adjusted hazard ratio for Early Youth Engagement-2 + standardised Early Intervention in Psychosis (<i>n</i> = 652) versus standardised Early Intervention in Psychosis service alone (<i>n</i> = 375) of 1.07 (95% confidence interval 0.76 to 1.49; <i>p</i> = 0.713). There were no observed differences between arms for any secondary outcomes. The health economic evaluation indicated lower mean mental healthcare costs of -£788 (95% CI -£3571 to £1994) and marginally improved mental health states for intervention participants. Early Youth Engagement-2","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 33","pages":"1-221"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145067253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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