This paper describes an initiative in North East London that aimed to facilitate access to training for care-home staff by using a mobile skills-centre in the form of an adapted bus.

It has proved difficult to take a strategic approach to quality assurance in care homes and the first comprehensive national training strategy for the sector was not published until 2000. Staff value and benefit from training, but organizing the provision of education and training may be problematic, given resource constraints and staffing levels that make it difficult to release staff to go off-site.

Collaboration between the School of Community and Health Sciences, City University London; My Home Life, an initiative led by Help the Aged in collaboration with the National Care Forum and City University London; local care homes; local primary care trusts (PCTs); and the Centre for Excellence in Teaching and Learning at City University London and Queen Mary University of London. The project involved facilitation, training in the mobile skills-centre and evaluation through questionnaires.

The project was successful at a number of different levels: providing training to care-home staff; fostering collaborative relationships between care homes and PCTs; providing a forum to enable a wider educational discussion of care-home needs; and stimulating the planning of future education programmes for care-home staff and of the provision in care homes of student nurse placements.

Although there is existing activity within the NHS and local communities to support self-care there has been no previous attempt at integration across a Primary Care Trust (PCT). The Joining Up Self-Care (JUSC) study aimed to implement and evaluate such a programme.

Three self-care support modules for members of the public, together with a training course for primary care teams, were developed with, and implemented in, one PCT. The modules related to disease prevention (community-based coronary heart disease (CHD) prevention), care of people with long-term conditions (a disease-specific self-care skills training course for asthma) and the management of minor ailments aimed at mothers of children aged 3 months to 12 years (the ‘Pharmacy First’ service plus information booklets and campaigns). Postal questionnaires were completed by participants in CHD prevention (178), management of asthma (76) and minor ailments management (92), and by controls. A general population survey (n = 540) provided a comparison group for the CHD module and assessed general awareness of local self-care support. Four focus groups were held with mothers of young children. An audit of general practitioner (GP) records was conducted for consultations for minor ailments. Structured telephone interviews were conducted with 51 local health professionals and nine members of staff from the PCT.

Participants in the CHD module reported significantly more risk-reducing behaviours. Participants in a disease-specific Expert Patient Programme (EPP) for people with asthma rated the course positively, were subsequently more confident about discussing asthma with their doctor and had fewer concerns about their asthma medicines. Most users of the ‘Pharmacy First’ minor ailments scheme reported positive feedback and an intent to use the service again in the future. There were no significant differences in numbers of GP consultations for minor ailments between intervention and control groups. Health professionals were generally positive about encouraging self-care. Many felt they were already doing this but had insufficient time to implement it. A Local Enhanced Service (LES) was successful in engaging local general practices with self-care. Some organizational development relating to self-care occurred within the PCT but integration across different directorates was not achieved.

The JUSC programme was associated with changes in self-reported CHD risk reduction behaviours, in confidence to manage asthma and fewer concerns about medication, and with more positive attitudes towards consulting a pharmacist for minor ailments. Key principles for future PCT self-care strategies were identified. Further work is needed to embed support for self-care across the PCT as an organization.

To map the results of four empirical quantitative and qualitative studies to the Normalization Process Model (NPM) to explain why open access hysterosalpingography (HSG) for the initial management of infertile couples has or has not normalized in primary care.

The NPM is an applied theoretical model to help understand the factors that lead to the routine embedding of a complex intervention in everyday practice. Open access HSG has recently become available for the initial assessment of infertility in primary care.

The results of two qualitative studies (a focus group study and an in-depth interview study with patients and professionals) and two quantitative studies (a pilot survey and a pragmatic cluster-randomized controlled trial) evaluating open access HSG are interpreted by mapping the results to the NPM.

Application of the model shows that open access HSG would confer an advantage to all agencies if they could be sure that the expertise was present and supported within primary care.

Open access HSG was adopted but not normalized into everyday practice. Despite demonstration of modest workability, it has been counteracted by limited integration. Further evaluation of integration within contexts is required.

The study sought to explore parents’ views of the injury risks to young children at home and their perceptions of supervision, targeting families living in economically deprived areas, including those living in black and minority ethnic communities.

Unintentional injury is a leading cause of death and disability in young children; most injury occurs in and around the home, and children from more deprived families are more vulnerable. Inadequate supervision is often cited as an important risk factor in childhood injury.

Qualitative semi-structured interviews were carried out with 34 families (23 white, 6 black, 5 South Asian) in economically deprived communities in Bristol, UK from September 2005 to July 2006.

The four main interview themes were perceptions of risk, coping with kitchen hazards, attitudes to supervision, and learning strategies. No major differences were seen between different ethnic groups in perceptions expressed or methods used by parents to keep children safe. The common practice of barring children from entering the kitchen when cooking by using stair gates is discussed. Reduced use of safety equipment and a perceived risk of burns from irons in the South Asian communities are highlighted. Constant supervision and learning by experience are common strategies employed by these parents to keep their children safe in often adverse living conditions. Parents need to be aware of the link between child development and injury risk, and also of differences in injury rate as a function of the child’s individual temperament and ability.

UK health policy identifies partnership working as fundamental to tackling health inequalities. Related to this is the development of a multi-disciplinary public health workforce, including an increase in the public health role of primary care nurses. Within this policy context, a primary care trust in the north of England established a community health team (CHT) in September 2005 to improve intra- and inter-agency working for public health. The Clinical Microsystems (CMS) framework informed the process of development, an approach not previously applied to public health.

This paper describes an evaluation of the CHT and presents the key lessons learnt in terms of what worked and did not work in the context of the CMS framework.

Participants were members and wider stakeholders of the CHT from three professional groups: individuals holding relevant strategic posts in the Public Health and Nursing Directorates within the Primary Care Trust, health visitors and school nurses, and voluntary sector staff. Focus group (n = 9 focus groups) and postal questionnaire (n = 21) data were collected at baseline, 6 and 12 months post-implementation. Participants’ views on the implementation of the CHT were explored within the ‘five Ps’ (purpose, population, people, processes and patterns) of the CMS framework.

Six themes emerged from the focus group data that illustrated key issues for the implementation of the CHT: ‘agreeing the focus,’ ‘strong leadership,’ ‘the challenge of communication,’ ‘managing workloads and new ways of working,’ ‘success of the CHT’ and ‘outside influences.’ Communication and heavy workloads were identified as key barriers to the success of the CHT in the questionnaire data. These data highlight the complex and evolving nature of public health partnership working and identify important issues that might usefully be considered in future initiatives of this kind.

To describe the context, mechanisms and outputs of a regional primary care partnership for research facilitation over a three-year period, and evaluate factors which were likely to be worth replicating in the new UK Clinical Research Network (UKCRN) structures.

The revision of NHS research and development structures into the UKCRN has presented organizational challenges to pre-existing partnerships. This raises questions of whether pre-existing arrangements had already delivered effective research facilitation in NHS settings, and makes evaluation of successful practice a crucial part of organizational learning for the current management of research delivery in the UK.

A mixed methods case study in one R&D consortium (Norfolk and Waveney, England). Using a model of realistic evaluation, we analysed context, mechanisms, working practices, and outcomes for research delivery in the primary care context – covering key priorities of research governance and ethics, hosting and recruiting to studies, and training and support approaches.

From January 2005 to December 2007, 35 general practices opted into a host practice research network, each hosting an average of 10 studies over that period, with 278 projects being active overall. By the last year, an extension of network activity to all practices in Norfolk, Great Yarmouth and Waveney had led to 96% of all practices delivering at least one study, and a turnaround, from application to commencement of approved studies, of 28 days for 74% of studies. This level of activity can act as a baseline for future UKPCRN activities, and the factors associated with it may be helpful for others seeking to provide an effective networking structure. The larger structures of the new UKCRN regional networks will be able to draw on extensive good practice in some areas, and should be sure to preserve these, as they may already be fulfilling the important goals for which UKCRN was created.

To establish the acceptability of telemetric monitoring of blood pressure to patients and clinicians.

Telemetric monitoring of blood pressure (BP) may allow clinicians and patients, in partnership, to more quickly control high BP through medication and lifestyle alterations. However, it is not clear if patients and clinicians would find such a system acceptable.

Questionnaire study followed by focus groups of patients with high BP, and clinicians involved in managing BP.

We received responses from 25 (50%) practice nurses, 76 (50%) general practitioners and 126 (62%) patients. We ran three focus groups of patients and clinicians. Participants were supportive of the technology, willing to try it, thought it would encourage adherence to medication and lifestyle and felt it would diagnose problems sooner than current methods. However, both groups thought the technology would be more useful for new patients or those whose BP was uncontrolled. They were concerned that individual high readings might provoke anxiety and thought patients would need reassurances about this. Clinicians were concerned about workload and the responsibility to act immediately when faced with a continuous stream of readings, regardless of how inconvenient this may be.

Participants, in general, welcomed this technology and thought it would aid adherence to medication and lifestyle advice, but felt it was most suitable to those with newly diagnosed or uncontrolled hypertension. Patients will need to be educated and reassured about the nature of occasional high readings and the need to consider average BP.

This longitudinal study was designed to address four research questions and the hypothesis; that adults living in a rural community receiving primary health care and emergency services from a team that included an on-site nurse practitioner (NP) and paramedics and an off-site family physician would, over time, demonstrate evidence of improved psychosocial adjustment and less expenditure of health care resources.

In Canada, there is a growing awareness and commitment to addressing the challenges of providing primary health care services in rural areas. A literature review supported the role of NPs in primary health care and a potential role for paramedics. No studies were found that evaluated the combination of NPs, paramedics and physicians as providers of primary health care.

Structured questionnaires, individual and group interviews with patients, health and social service care providers and administrators and community members were used to describe and evaluate the impact of the model of care over the three years of the study.

The innovative model of care resulted in decreased cost, increased access, a high level of acceptance and satisfaction and effective collaboration among care providers. Organizational structures to support the innovative model of primary health care were identified.

To explore parents’ perceptions of environmental household risks to their child’s asthma and to identify the strategies they adopt in relation to these perceived risks.

The prevalence of childhood asthma is increasing worldwide and especially in the UK. Asthma is more common in areas of socio-economic disadvantage. Household environmental factors have been implicated in some of this increase. A number of factors in the home environment have been found to act as triggers to asthma symptoms, including high humidity levels, poor ventilation, mould, second-hand tobacco smoke and pet allergens. Little is known about how parents, as the main care-givers and decision makers in the home, perceive and cope with the risks posed by these triggers.

Semi-structured interviews were conducted with a purposive sample of parents of 32 children with asthma aged 4 to 16 years and living in a socio-economically disadvantaged urban community in the North East of England. Interviews were audiotaped, transcribed verbatim and analysed using constant comparison techniques.

All parents were aware of some of the risks their children faced at home. Some appeared to know more than others and coping styles varied. A typology of three groups of parents was identified: those who actively seek advice and adopt clear preventative strategies (preventers); those who minimize the risks and only react when things go wrong (reactors); and those who engage in compensatory activities in an attempt to trade-off between harms and benefits (compensators). The unifying themes underpinning these different styles are that all parents are motivated to maintain normal family life but that they adopt different strategies to achieve this.

This study aimed to explore how the views of patients with coronary heart disease (CHD) could inform the design of an information booklet aimed at providing patients and practitioners with a resource to help influence positive health behavioural outcomes.

Coronary heart disease has major consequences in terms of patient suffering and economic costs, with morbidity and mortality figures in the United Kingdom and the Republic of Ireland among the highest in Europe. Lifestyle behaviours such as smoking, eating an unhealthy diet and a lack of exercise are strongly associated with an increased CHD risk, and practitioners report that health education materials are used in practice to help advise and educate patients about the consequences of their lifestyle.

Opinions of patients with CHD were explored concerning their information needs, particularly lifestyle advice, using a qualitative approach in four general practices. This information was used to design a booklet for a pilot study aimed at promoting healthy lifestyle behaviours and medication adherence among people with CHD. Focus group discussions explored patients’ opinions about the booklet’s ‘fitness for purpose’; semi-structured interviews with practitioners examined their views on the booklet’s usefulness.

In initial focus groups, patients identified gaps in their information provision regarding coping with stress, available local community support and medication purpose. Previously published literature was modified to address these gaps. Patients in the pilot study were satisfied with the re-designed booklet. Practitioners reported that its use in consultations enabled change implementation and facilitated patients’ understanding of connections between lifestyle and health outcomes.

Acknowledging the opinions of CHD patients in producing health information booklets emphasized a patient-centred approach and therefore supported practitioner–patient partnerships for choosing healthy lifestyle choices.

To gain insight into factors affecting patient and practitioner satisfaction with access to healthcare in a remote rural island community.

General practice based primary care is the focus of health service delivery in rural areas of the UK. Individuals from rural populations have reported inequalities in access to healthcare. User satisfaction with service performance is recognised as an important outcome of healthcare. Further investigation into factors underpinning patient and practitioner satisfaction with access to rural healthcare is required.

Qualitative interviews with patients and primary healthcare practitioners.

Isles of Scilly, Cornwall, UK.

A topic guide was developed following review of the literature. In-depth, semi-structured interviews with a purposive sample of 23 participants were conducted with individuals from all inhabited islands. Detailed field notes were kept, and interview content was partially transcribed and analysed thematically.

Principal themes identified were common to patient and practitioner participants. These were: concerns expressed regarding the equitable provision of services; obstacles to using health services; and the outlook of patients and professionals, including expectations, choice, patient–practitioner relationships and community cohesiveness. Emerging themes gave insight into a range of factors affecting satisfaction with access to healthcare.

Despite numerous policy initiatives aimed at reducing inequities in health service provision, problems with access and uptake of health services persist amongst individuals from remote rural populations. If implemented, recent National Health Service proposals may address some of the challenges identified by participants. Service developments need to take account of local priorities, expectations, geography and demography to achieve favourable outcomes.

To identify and describe the meaning of support and its impact on the life-situation of people diagnosed with Type 2 diabetes mellitus in relation to gender, age and duration of disease.

Social support can buffer the level and effects of stress. Diabetes requires self-care that is demanding and may cause stress. No previous investigations focusing on the perceptions of people with diabetes, concerning the content, need and desire they might have for social support, have been found.

A purposive sample of 40 Swedish adults, 24 men and 16 women, diagnosed with Type 2 diabetes was included. Mixed methods were employed and qualitative data were collected by semi-structured interviews and quantitative data collected using the Norbeck Social Support Questionnaire (NSSQ).

Participants described the meaning of support as mainly concerning informative and emotional support in managing diabetes. Women, independent of the duration of diabetes, experienced support as limited or non-existent when treated outside hospital/specialized care. Some men reported being given informative support and sufficient material support from health care professionals on diagnosis. Respondents considered the need for support individual, differing with regard to gender and age. Men were assumed to need more support and women were considered to have better networks. Younger people were perceived to need more support to learn to live with diabetes. NSSQ measurement showed people with diabetes scoring low figures on total emotional support, total aid and total function. Men scored higher on emotional support, aid and network than women.

Diabetes demands knowledge about managing the disease and self-care, which is why informative and emotional support is important to gain control over the situation. Informants had perceived lack of support, particularly during the process of diagnosis of diabetes, in their contact with physicians and with primary health care.

This study examined the factors related to whether or not school-based tobacco control efforts were associated with student smoking behaviour among two groups of students: Group 1 (15–17 years of age; grade 10 in 2000 and grade 11 in 2001) and Group 2 (16–19 years of age; grade 11 in 2000 and grade 12 in 2001).

Between 1999 and 2001, Prince Edward Island (PEI) introduced a province-wide initiative to implement both school-based policies banning smoking on school grounds and school-based smoking prevention programming, phased in over a three-year period, in all schools.

Data were collected from all 10 English-speaking secondary schools in PEI (Canada) over three years (1999–2001) using the Tobacco Module of the School Health Action, Planning and Evaluation System.

Results showed an increase in both occasional and regular smoking behaviour with Group 1 showing an 18% increase in occasional smoking compared to 3.9% for Group 2. The characteristic associated with an increased likelihood of regular and occasional smoking for 2000 and 2001 was students overestimating the percentage of youth their age who smoke. However, students’ knowledge and awareness of smoking policies and enforcement, students’ perceptions of schools having clear rules, and that students who break the rules get into trouble increased from 2000 to 2001. The findings from this study provide important information about how groups of students within schools experience tobacco control efforts differently. Addressing student misperceptions and policy implementation within schools may provide direction for tobacco control.