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}
Susan Ayers, Rose Meades, Andrea Sinesi, Helen Cheyne, Margaret Maxwell, Catherine Best, Julie Jomeen, James Walker, Judy Shakespeare, Fiona Alderdice
<p><strong>Background: </strong>Anxiety is a common mental illness that can occur during and after pregnancy, which is associated with an increased risk of adverse outcomes for women and their infants. Despite this, there is no consensus on the best method of assessing anxiety.</p><p><strong>Objectives: </strong>The methods of assessing perinatal anxiety (MAP) study aimed to identify the most acceptable, effective and feasible method for assessing anxiety in pregnancy and after birth.</p><p><strong>Design and methods: </strong>The MAP study had four work packages: a qualitative and cognitive interview study (work package 1); a prospective longitudinal cohort study of women during pregnancy (early, mid- and late pregnancy) and post partum, with nested diagnostic interviews (work package 2) and implementation case studies (work package 3). Secondary analysis of cohort data was commissioned as an add-on project to examine the impact of socioeconomic deprivation on perinatal anxiety (work package 4). The MAP study evaluated four assessment measures based on clinical criteria and research evidence: the General Anxiety Disorder Questionnaire, 2-item, or 7-item version scale, Whooley questions, Stirling Antenatal Anxiety Scale and Clinical Outcomes in Routine Evaluation - 10 item version scale.</p><p><strong>Setting and participants: </strong>Qualitative and cognitive interviews (work package 1) were conducted with 41 pregnant and postpartum women, recruited through patient and public involvement representative organisations and social media. The MAP cohort (work package 2) included 2243 women recruited through 12 National Health Service Trusts in England and 5 National Health Service Boards in Scotland. Diagnostic interviews were conducted with a consecutive subsample of 403 participants. Implementation case studies (work package 3) were conducted with two National Health Service sites in England and one in Scotland.</p><p><strong>Results: </strong>Routine assessment of perinatal anxiety was acceptable to women and was viewed positively, although this was qualified by the extent to which the process was informed and personalised. Results from cognitive interviews found that all measures were acceptable and easy to use. Diagnostic accuracy was greatest for the Stirling Antenatal Anxiety Scale and Clinical Outcomes in Routine Evaluation - 10 item version. Increased anxiety on all measures was associated with greater difficulties with daily living, poorer quality of life and participants wanting treatment. Early pregnancy (i.e. the first trimester) was the optimal time for identifying participants with anxiety disorders who wanted treatment. Two measures met criteria for implementation: the Stirling Antenatal Anxiety Scale and the Clinical Outcomes in Routine Evaluation - 10 item version. The Stirling Antenatal Anxiety Scale was preferred by stakeholders (41 women and 55 health professionals), so it was implemented. Acceptability to health professionals (
{"title":"Identifying acceptable and effective methods of assessing perinatal anxiety: the MAP study.","authors":"Susan Ayers, Rose Meades, Andrea Sinesi, Helen Cheyne, Margaret Maxwell, Catherine Best, Julie Jomeen, James Walker, Judy Shakespeare, Fiona Alderdice","doi":"10.3310/RRHD1124","DOIUrl":"https://doi.org/10.3310/RRHD1124","url":null,"abstract":"<p><strong>Background: </strong>Anxiety is a common mental illness that can occur during and after pregnancy, which is associated with an increased risk of adverse outcomes for women and their infants. Despite this, there is no consensus on the best method of assessing anxiety.</p><p><strong>Objectives: </strong>The methods of assessing perinatal anxiety (MAP) study aimed to identify the most acceptable, effective and feasible method for assessing anxiety in pregnancy and after birth.</p><p><strong>Design and methods: </strong>The MAP study had four work packages: a qualitative and cognitive interview study (work package 1); a prospective longitudinal cohort study of women during pregnancy (early, mid- and late pregnancy) and post partum, with nested diagnostic interviews (work package 2) and implementation case studies (work package 3). Secondary analysis of cohort data was commissioned as an add-on project to examine the impact of socioeconomic deprivation on perinatal anxiety (work package 4). The MAP study evaluated four assessment measures based on clinical criteria and research evidence: the General Anxiety Disorder Questionnaire, 2-item, or 7-item version scale, Whooley questions, Stirling Antenatal Anxiety Scale and Clinical Outcomes in Routine Evaluation - 10 item version scale.</p><p><strong>Setting and participants: </strong>Qualitative and cognitive interviews (work package 1) were conducted with 41 pregnant and postpartum women, recruited through patient and public involvement representative organisations and social media. The MAP cohort (work package 2) included 2243 women recruited through 12 National Health Service Trusts in England and 5 National Health Service Boards in Scotland. Diagnostic interviews were conducted with a consecutive subsample of 403 participants. Implementation case studies (work package 3) were conducted with two National Health Service sites in England and one in Scotland.</p><p><strong>Results: </strong>Routine assessment of perinatal anxiety was acceptable to women and was viewed positively, although this was qualified by the extent to which the process was informed and personalised. Results from cognitive interviews found that all measures were acceptable and easy to use. Diagnostic accuracy was greatest for the Stirling Antenatal Anxiety Scale and Clinical Outcomes in Routine Evaluation - 10 item version. Increased anxiety on all measures was associated with greater difficulties with daily living, poorer quality of life and participants wanting treatment. Early pregnancy (i.e. the first trimester) was the optimal time for identifying participants with anxiety disorders who wanted treatment. Two measures met criteria for implementation: the Stirling Antenatal Anxiety Scale and the Clinical Outcomes in Routine Evaluation - 10 item version. The Stirling Antenatal Anxiety Scale was preferred by stakeholders (41 women and 55 health professionals), so it was implemented. Acceptability to health professionals (","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 32","pages":"1-44"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071328","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}
Daniele Carrieri, Alison Pearson, Anna Melvin, Charlotte Bramwell, Jason Hancock, Chrysanthi Papoutsi, Mark Pearson, Geoff Wong, Karen Mattick
<p><strong>Background: </strong>The key role of medical workforce well-being in the delivery of excellent and equitable care is recognised internationally. However, doctors are known to experience significant mental ill health and erosion of their well-being due to challenging demands and pressurised work environments. Existing workplace support strategies often have limited effect and do not consider the multiple factors contributing to poor well-being in doctors (e.g. individual, organisational and social), nor whether interventions have been implemented effectively.</p><p><strong>Aim: </strong>To work with, and learn from, diverse hospital settings to understand how to optimise strategies to improve doctors' workplace well-being and reduce negative impacts on the workforce and patient care.</p><p><strong>Design and method: </strong>Three inter-related sequential phases of research activity: Phase 1: a typology of interventions and mapping tool to improve hospital doctors' workplace well-being based on iterative cycles of analysis of published and in-practice interventions and informed by relevant theories and frameworks and engagement with stakeholders. Phase 2: realist evaluation consistent with Realist And MEta-narrative Evidence Syntheses: Evolving Standards quality standards of existing strategies to improve hospital doctors' workplace well-being in eight purposively selected acute National Health Service trusts in England based on 124 interviews with doctors, well-being intervention implementers/practitioners and leaders. Phase 3: codeveloped implementation guidance for all National Health Service trusts to optimise their strategies to improve hospital doctors' workplace well-being - drawing on phases 1 and 2, and engagement with stakeholders in three online national workshops.</p><p><strong>Results: </strong>Phase 1: although many sources did not clarify their underlying assumptions about causal pathways or the theoretical basis of interventions, we were able to develop a typology and mapping tool which can be used to conceptualise interventions by type (e.g. whether they are designed to be largely preventative or 'curative'). Phase 2: key findings from our realist interviews were that: (1) solutions needed to align with problems to support doctor's well-being and avoid harm to doctors; (2) involving doctors in creating solutions was important to address their well-being problems; (3) doctors often do not know what well-being support is available and (4) there were physical and psychological barriers to accessing well-being support. Phase 3: our 'Workplace well-being MythBuster's guide' provides constructive evidence-based implementation guidance, while authentically representing the predominantly negative experiences reported in phase 2.</p><p><strong>Limitations: </strong>Although we sampled for diversity, the eight trusts we worked with may not be representative of all trusts in England.</p><p><strong>Conclusions: </strong>Misaligned
{"title":"Optimising the delivery and impacts of interventions to improve hospital doctors' workplace wellbeing in the NHS: The Care Under Pressure 3 realist evaluation study.","authors":"Daniele Carrieri, Alison Pearson, Anna Melvin, Charlotte Bramwell, Jason Hancock, Chrysanthi Papoutsi, Mark Pearson, Geoff Wong, Karen Mattick","doi":"10.3310/PASQ1155","DOIUrl":"https://doi.org/10.3310/PASQ1155","url":null,"abstract":"<p><strong>Background: </strong>The key role of medical workforce well-being in the delivery of excellent and equitable care is recognised internationally. However, doctors are known to experience significant mental ill health and erosion of their well-being due to challenging demands and pressurised work environments. Existing workplace support strategies often have limited effect and do not consider the multiple factors contributing to poor well-being in doctors (e.g. individual, organisational and social), nor whether interventions have been implemented effectively.</p><p><strong>Aim: </strong>To work with, and learn from, diverse hospital settings to understand how to optimise strategies to improve doctors' workplace well-being and reduce negative impacts on the workforce and patient care.</p><p><strong>Design and method: </strong>Three inter-related sequential phases of research activity: Phase 1: a typology of interventions and mapping tool to improve hospital doctors' workplace well-being based on iterative cycles of analysis of published and in-practice interventions and informed by relevant theories and frameworks and engagement with stakeholders. Phase 2: realist evaluation consistent with Realist And MEta-narrative Evidence Syntheses: Evolving Standards quality standards of existing strategies to improve hospital doctors' workplace well-being in eight purposively selected acute National Health Service trusts in England based on 124 interviews with doctors, well-being intervention implementers/practitioners and leaders. Phase 3: codeveloped implementation guidance for all National Health Service trusts to optimise their strategies to improve hospital doctors' workplace well-being - drawing on phases 1 and 2, and engagement with stakeholders in three online national workshops.</p><p><strong>Results: </strong>Phase 1: although many sources did not clarify their underlying assumptions about causal pathways or the theoretical basis of interventions, we were able to develop a typology and mapping tool which can be used to conceptualise interventions by type (e.g. whether they are designed to be largely preventative or 'curative'). Phase 2: key findings from our realist interviews were that: (1) solutions needed to align with problems to support doctor's well-being and avoid harm to doctors; (2) involving doctors in creating solutions was important to address their well-being problems; (3) doctors often do not know what well-being support is available and (4) there were physical and psychological barriers to accessing well-being support. Phase 3: our 'Workplace well-being MythBuster's guide' provides constructive evidence-based implementation guidance, while authentically representing the predominantly negative experiences reported in phase 2.</p><p><strong>Limitations: </strong>Although we sampled for diversity, the eight trusts we worked with may not be representative of all trusts in England.</p><p><strong>Conclusions: </strong>Misaligned ","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 30","pages":"1-35"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985381","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}
Emma Smith, Shirley Lewis, Lynne Gilmour, Louise Honeybul, Helen Cheyne, Narendra Aladangady, Brigid Featherstone, Margaret Maxwell, Joanne Neale, Mariana Gonzalez Utrilla, Polly Radcliffe
<p><strong>Background: </strong>Women who use and/or are in treatment for using drugs during the perinatal period have complex health and social care needs. Substance use in the perinatal period is multifaceted, with many confounding factors that may impact the long-term health and well-being of both mothers and children. Evidence is needed to identify which psychosocial interventions are effective for women who use and/or are in treatment for drug use during the perinatal period.</p><p><strong>Objective(s): </strong>(1) Describe the range of psychosocial interventions available for women who use and/or are in treatment for drugs in the perinatal period; (2) to document evidence on the effectiveness of interventions and (3) identify interventions that women feel most meet their needs.</p><p><strong>Design: </strong>A mixed-methods systematic review was conducted following a predetermined protocol and the Joanna Briggs Institute guidance for mixed-methods systematic reviews, adopting a segregated approach.</p><p><strong>Review methods: </strong>Eight databases were searched for articles meeting the inclusion criteria on 7 April 2022, and updated searches were run on 5 February 2024. The search was limited to include peer-reviewed articles published after 1990 and available in English. In total, 15,655 articles were identified. Following screening by four reviewers by title and abstract and then full text, 197 articles were included in the review. A data extraction template was used to extract study characteristics and results. Quality was assessed using the mixed-methods Quality Appraisal Tool. Cohen's <i>d</i> was used to measure the effect size for quantitative data to understand if an intervention had a small (> 0.2), medium (> 0.5) or large effect (> 0.8). Effectiveness was measured through three outcomes: (1) improvements and engagement with and retention in substance use treatment services for women in the prenatal and postnatal period; (2) reductions in substance use by women in the perinatal period and (3) improvements in engagement with and retention in prenatal care. For qualitative data, articles were grouped by the intervention type and the authors' analytical themes and conclusions were thematically synthesised.</p><p><strong>Results: </strong>The 197 included studies described 217 separate interventions. Most interventions (85.3%) were community-based, delivered in more than one way (49.3%), and delivered in single settings (50.6%), although some were colocated alongside other services (22.1%). No conclusive evidence for effectiveness was established for any type of intervention, although most interventions that improved retention in substance use services included practical support. The qualitative synthesis supported these findings and additionally suggested that women appreciated being able to access multiple services in one place: non-judgemental, trauma-informed services and peer-support models.</p><p><strong>Limitations: </stro
{"title":"Meeting the needs of women in the perinatal period, who use or are in treatment for using drugs: A mixed-methods systematic review.","authors":"Emma Smith, Shirley Lewis, Lynne Gilmour, Louise Honeybul, Helen Cheyne, Narendra Aladangady, Brigid Featherstone, Margaret Maxwell, Joanne Neale, Mariana Gonzalez Utrilla, Polly Radcliffe","doi":"10.3310/GJPR0321","DOIUrl":"10.3310/GJPR0321","url":null,"abstract":"<p><strong>Background: </strong>Women who use and/or are in treatment for using drugs during the perinatal period have complex health and social care needs. Substance use in the perinatal period is multifaceted, with many confounding factors that may impact the long-term health and well-being of both mothers and children. Evidence is needed to identify which psychosocial interventions are effective for women who use and/or are in treatment for drug use during the perinatal period.</p><p><strong>Objective(s): </strong>(1) Describe the range of psychosocial interventions available for women who use and/or are in treatment for drugs in the perinatal period; (2) to document evidence on the effectiveness of interventions and (3) identify interventions that women feel most meet their needs.</p><p><strong>Design: </strong>A mixed-methods systematic review was conducted following a predetermined protocol and the Joanna Briggs Institute guidance for mixed-methods systematic reviews, adopting a segregated approach.</p><p><strong>Review methods: </strong>Eight databases were searched for articles meeting the inclusion criteria on 7 April 2022, and updated searches were run on 5 February 2024. The search was limited to include peer-reviewed articles published after 1990 and available in English. In total, 15,655 articles were identified. Following screening by four reviewers by title and abstract and then full text, 197 articles were included in the review. A data extraction template was used to extract study characteristics and results. Quality was assessed using the mixed-methods Quality Appraisal Tool. Cohen's <i>d</i> was used to measure the effect size for quantitative data to understand if an intervention had a small (> 0.2), medium (> 0.5) or large effect (> 0.8). Effectiveness was measured through three outcomes: (1) improvements and engagement with and retention in substance use treatment services for women in the prenatal and postnatal period; (2) reductions in substance use by women in the perinatal period and (3) improvements in engagement with and retention in prenatal care. For qualitative data, articles were grouped by the intervention type and the authors' analytical themes and conclusions were thematically synthesised.</p><p><strong>Results: </strong>The 197 included studies described 217 separate interventions. Most interventions (85.3%) were community-based, delivered in more than one way (49.3%), and delivered in single settings (50.6%), although some were colocated alongside other services (22.1%). No conclusive evidence for effectiveness was established for any type of intervention, although most interventions that improved retention in substance use services included practical support. The qualitative synthesis supported these findings and additionally suggested that women appreciated being able to access multiple services in one place: non-judgemental, trauma-informed services and peer-support models.</p><p><strong>Limitations: </stro","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-25"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985393","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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