Community Health Workers (CHWs) play a key role in the functioning of Primary Health Care. However, little research on the performance of CHWs has been conducted in Kenya. This study aims to describe their performance and to determine which factors most impacted the performance of CHWs in Kenya.

A total of 750 CHWs were identified as potential subjects. However, appropriate data were submitted by 172 CHWs because of rejection and loss of their reporting status. Data on CHWs were collected through questionnaires, and information about their performance was gathered from their supervisors.

Approximately 60% of the CHWs were active. CHWs over 40 years of age were likely to display good performance in their job (P < 0.001). In addition, the performance of CHWs was influenced by training partners (P < 0.03).

Older CHWs were likely to perform well. Furthermore, their performance was influenced by their training partners.

The natural disaster in South-East Asia had a great impact in Sweden affecting many individuals and families. In this paper, a series of strategies from Ersta Association for Diaconal Work (Ersta) are described to reach survivors by the tsunami of 26 December 2004, from January 2005 to August 2007.

To find out what needs the survivors had and how professionals may work and take care of their needs during similar events in the future.

An immediate empathic effort took place at Ersta; thanks to good funding and many qualified professionals. This is a retrospective, mainly descriptive study of those strategies.

The work included training of group leaders, support groups, memorials and rituals, weekly Open House meetings, individual contacts, weekend gatherings, day seminars most marketed through Erstas’ website, advertisements and word of mouth. A total of 180 trainers/group leaders countrywide were trained and 25 became engaged at Ersta. Through the website and an unknown number of phone calls, an estimated 1362 adults, teenagers and children, grieving, injured and traumatised were reached.

The Ersta project was in many ways successful, but could not be sustained, due to lack of enough collaboration with other voluntary organisations and change of leadership. Meeting other survivors and the structure of the activities were appreciated. There was much benefit from support groups. Questions arose about how to act efficiently and when to intervene, early or/and later. Particularly to consider, early signs of resilience among survivors, their own initiatives and networks such as ‘naturally emerging groups’.

Extended collaboration between the authorities is necessary as well as continuous evaluation. A new law aimed at a more divided individual and societal responsibility. A new body (2009) under the Ministry of Defense will coordinate future resources, starting at the parish.

Australia and England show high rates of psychological distress and mental health problems in young people. Both are high-income countries and have stated their intention to improve the delivery of health care to young people in primary care settings. Australia has an international reputation for improving care through innovative services and educational initiatives. England has taken a different direction and has concentrated more on developing policy and making recommendations to improve access for young people.

To describe a Churchill Fellowship visit to Australia to observe initiatives in primary care based youth-friendly mental health care and to reflect upon the observations, comparing and contrasting with the English model.

The observations and reflections presented draw on field notes from site visits and meeting with key players, accessing web resources and referring to the literature, both grey and published.

Australia offers plurality in health care delivery and innovative responses to addressing youth mental health. There are two key approaches. The first is the development of services specializing in youth mental health. The second approach is to build capacity of existing primary care services to recognize the particular bio-psychosocial needs of adolescents (and their families). In contrast, England has tended to focus primarily on policy development and improving youth access.

The paper draws attention to a number of political, clinical and educational developments in both Australia and England. Both countries demonstrate different strategies in response to the high levels of psychological distress in young people. Learning from colleagues in other settings can inform our own practice. Ultimately responding to young people's mental health needs is best served by youth-friendly policy which prepares clinicians for effective practice, informed by applied research and supported by adequate resources. Investment in young people's health must be a priority for us all.

The purpose of this scoping literature review was to determine what is known about: 1) structures and processes required to build successful collaborations between primary care (PC) and public health (PH); 2) outcomes of such collaborations; and 3) markers of their success.

Collaboration between PC and PH is believed to enable more effective individual and population services than what might be achieved by either alone.

The study followed established methods for a scoping literature review and was guided by a framework that identifies systemic, organizational and interactional determinants for collaboration. The review was restricted to articles published between 1988 and 2008. Published quantitative and qualitative primary studies, evaluation research, systematic and other types of reviews, as well as descriptive accounts without an explicit research design, were included if they addressed either the structures or processes to build collaboration or the outcomes or markers of such collaboration, and were published in English.

The combined search strategy yielded 6125 articles of which 114 were included. Systemic-level factors influencing collaboration included: government involvement, policy and fit with local needs; funding and resource factors, power and control issues; and education and training. Lack of a common agenda; knowledge and resource limitations; leadership, management and accountability issues; geographic proximity of partners; and shared protocols, tools and information sharing were influential at the organizational level. Interpersonal factors included having a shared purpose; philosophy and beliefs; clear roles and positive relationships; and effective communication and decision-making strategies. Reported benefits of collaboration included: improved chronic disease management; communicable disease control; and maternal child health. More research is needed to explore the conditions and contexts in which collaboration between PC and PH makes most sense and potential gains outweigh the associated risks and costs.

Annual physical health checks are recommended for patients with severe mental illness (SMI) as this group has a higher risk of developing cardiovascular disease than the rest of the general population. There is little guidance for healthcare professionals to assist them in encouraging patients to attend a health check.

To explore whether an invitation appointment letter is effective in prompting patients with SMI to attend a physical health check in primary care compared with those with diabetes.

A retrospective audit comparing the response rate of patients with SMI and diabetes to an appointment letter inviting them to attend a primary care health check.

Two-thirds (n = 61, 66%) of the patients with SMI (n = 92) and three-quarters (n = 338, 81%) of those with diabetes (n = 416) attended the practice on the date and time stipulated in the letter. Patients with diabetes were 2.2 times more likely to attend a health check compared with those with SMI (OR = 2.20, 95% CI = 1.13–3.62).

Although attendance rates were lower than in patients with diabetes, they were higher than expected from the SMI group. An invitation appointment letter is an effective way of ensuring that patients with SMI have a physical health check.

This qualitative study explored the professional and practice-based factors affecting the role legitimacy and adequacy of practice nurses in managing obese patients.

There are strong clinical, financial and practical reasons for tackling obesity in UK general practice. Although practice nurses may seem to be in an ideal position to manage obesity, there remain questions about their role adequacy (sense of self-efficacy in responding to patients’ problems) and role legitimacy (their perceived boundaries of professional responsibility and right to intervene).

Semi-structured face-to-face interviews were conducted with 22 practice nurses in Lambeth, Southwark and Lewisham in South London. Interviews were digitally recorded and transcribed. Key themes were identified following coding of the data.

Factors that positively affected nurses’ role adequacy and legitimacy were: their belief that obesity management was part of their chronic disease management and health promotion remit; their confidence in their own communication skills and ability to build rapport with patients; having attended training and being supported to take extra time for obesity management. Factors negatively affecting their role legitimacy and adequacy were: their low awareness and use of guidance; lack of knowledge of referral options; limited knowledge and use of non-medical and non-persuasive approaches; perceived lack of expertise in motivating patients, as well as in nutrition, child obesity and assessment; belief that there were some contexts in which it was more appropriate to raise the issue than others; lack of culturally appropriate materials and language barriers; belief that they had limited impact on outcome and that the patient is responsible for lack of success. Other factors negatively affecting their role adequacy and legitimacy included their ambivalence about the effectiveness of the interventions offered; perceived lack of priority for obesity management within practices; lack of time; workload and lack of clarity on protocols and roles within the practice.

To explore whether changes in parenting self-efficacy after attending a parenting programme are related to changes in parenting stress and child behaviour.

Adverse parenting is a risk factor in the development of a range of health and behavioural problems in childhood and is predictive of poor adult outcomes. Strategies for supporting parents are recognised as an effective way to improve the health, well-being and development of children. Parenting is influenced by many factors including the behaviour and characteristics of the child, the health and psychological well-being of the parent and the contextual influences of stress and support. Parenting difficulties are a major source of stress for parents, and parenting self-efficacy has been shown to be an important buffer against parenting stress.

In all, 63 parents who had a child under the age of 10 years took part in the research. Of those, 58 returned completed measures of parenting self-efficacy, parenting stress and child behaviour at the start of a parenting programme and 37 at three-month follow-up.

Improvements in parenting self-efficacy and parenting stress were found at follow-up, but there was less evidence for improvements in child behaviour. The findings clearly suggest a relationship between parenting self-efficacy and parenting stress; parents who are feeling less efficacious experience higher levels of stress, whereas greater parenting self-efficacy is related to less stress. This study adds to the evidence that parent outcomes may be a more reliable measure of programme effectiveness than child outcomes at least in the short term.

To explore general practitioners’ (GPs) management of osteoarthritis (OA).

OA represents a large burden on primary care. Little is known about GPs’ current management of OA, especially influences on their prescribing quality care and the barriers they face while doing so.

A total of 1006 GPs were randomly selected and invited to participate in an online survey on assessment and treatment of OA, on factors influencing their management, burden on their practice, and on the need for improving care.

There were 232 respondents (23%). National Institute for Health and Clinical Excellence (NICE) guidance (65%) and professional experience (64%) were the biggest influences on OA management. When assessing patients, pain and mobility were most frequently assessed, with quality of life, independent living, sleep and depression addressed by over half of them. In all, 52% did not use educational materials; only a third of users rated their current educational material as good or very good. Treatments employed were largely in line with NICE recommendations. Prescription review was reported by a high proportion (74%). Achieving adequate pain control and lack of time were the most frequently cited challenges, whereas more time with patients, collaboration with specialist colleagues and improved communication tools were the most common needs identified to improve OA management. In summary, national guidelines are an important influence for GP treatment of OA. This survey has highlighted issues about the adequacy of information available for OA, about GPs’ need for more time with OA patients and their interaction with specialist colleagues.

To determine the effects of a community-based training programme in self-care on the lay population.

Self Care is recognised as being a cornerstone of the populations health, but to date there have been few large-scale studies of its effectiveness on the general public. This paper reports on an evaluation of a self-care skills training course delivered in small group sessions within workplace and parent and toddler group settings to a lay population.

A quasi-experimental longitudinal study of 12-month duration was conducted in three intervention primary care trusts (PCTs) and two similar comparison PCTs in England. The sample comprised 1568 self-selecting participants: 868 received the intervention and 700 did not.

No changes were seen in usage of General Practitioner services, the primary outcome, however, statistical analysis suggested that being in the intervention group may be associated with increased use of out-of-hours and secondary care services. At six months’ follow-up small but statistically significant positive effects of being in the intervention group were seen on self-esteem, well-being and anxiety scores. At 12 months’ follow-up small but statistically significant positive effects of being in the intervention group were also seen on recovery locus of control, health literacy and self-esteem scores, and on knowledge of adult cough. The clinical significance of these very small changes is unclear.

The training programme had a small but positive effect, which was still evident at 12 months, on individuals’ knowledge and confidence levels with regard to managing their own health, but did not lead to reductions in health service use.

To obtain patient-generated data relating to the management of their chronic obstructive pulmonary disease (COPD) in Primary Care before hospitalisation with exacerbation.

Previous audits of COPD have shown high rates of hospital admission and readmission. There is significant interest in understanding the reasons so that useful preventative strategies may be developed. As part of the 2008 UK COPD audit, which comprised 9716 cases of COPD admission across 97% of acute units, we obtained a sample of patient-generated data to assess understanding of COPD, use of healthcare resources, access to care and self-management in Primary Care prior to hospitalisation with exacerbation. We anticipated the data would provide useful insight for directing improvement strategies.

A paper-based, anonymised survey was completed by patients identified as having exacerbation by participating hospital teams. Response rate was an estimated 46%.

Understanding and awareness of COPD was very variable. Patients noticed symptoms of COPD exacerbation, particularly change in sputum, for some time prior to hospitalisation but tended not to react promptly to these changes. A minority had self-care plans, many bypassed Primary Care Services and there was variable access to a named health professional or advice. Patients using home oxygen and nebulisers were at particular risk of admission.

We conclude these sick patients use a lot of resources and the data suggest a need to support and educate them in the proactive management of exacerbation. There needs to be better ‘exacerbation planning’ so patients know how to recognise and treat flare-up but also whom to contact in the event of decline. Targetted support should be considered for the most vulnerable, particularly those using home oxygen and nebulisers, who have very high rates of hospitalisation.