Biomedical subjects

Louise M Wallace

Publications and source records attributed to Louise M Wallace.

11 recordsLinked to original sources

PubMed2007

Informing school sex education using the stages of change construct: sexual behaviour and attitudes towards sexual activity and condom use of children aged 13-16 in England.

A survey of 3820 school children in England aged 13-16 years examined sexual activity using the Transtheoretical Model (TTM) Stages of Change. A quarter (26%) of teens were sexually experienced, 44.8 per cent did not use contraception and 48.9 per cent did not use condoms, every time. Past history of condom and contraceptive use, and partner willingness to use condoms were the best predictors of being in Action or Maintenance stage for condom use. Of virgins, 19.82 per cent were in Contemplation or Preparation stages for intercourse, and 85.4 per cent would use condoms every time. Sex education should be tailored to Stage, and signposting to sexual health and contraception services.

Adolescent↗

PubMed2006

A home-based, transtheoretical change model designed strength training intervention to increase exercise to prevent osteoporosis in Iranian women aged 40-65 years: a randomized controlled trial.

Physical activity (PA) helps to prevent osteoporosis, but older women are often sedentary. This study used a pre-post randomized controlled design to evaluate a 12-week exercise education intervention program based on the stages of change (SoC) and processes of change from the transtheoretical change model (TTM) to improve adherence with strength and balance training recommendations at levels sufficient to prevent osteoporosis in Iranian women aged 40-65 years. The home-based exercise prescription consisted of strength and balance training that was progressive, individually tailored and included a walking program. Individuals in the training group (n=61) had a positive, significant progression in psychological SoC (P<0.001), whereas no progression in stages occurred in the control group (n=55). After the intervention, the training group demonstrated significant improvements in PA, lower body muscle strength, static and dynamic balance, with no significant changes in the control group. These results support the applicability of the TTM for a PA intervention and indicate that this training program is very effective in improving balance and lower body strength in older women.

Aged↗

PubMed2006

Breastfeeding works: the role of employers in supporting women who wish to breastfeed and work in four organizations in England.

An important factor influencing duration of breastfeeding is mother's employment status. The main aim of this study was to determine the experience and views of employees (n = 46) in four large public sector organizations concerning breastfeeding support at work. Participants were recruited if they were employed by one of four public service employers and if they were planning to go on maternity leave in the next 6 months, on maternity leave or within 6 months of return from maternity leave. They completed a questionnaire anonymously. Almost 80% of women wanted to continue breastfeeding after returning to work. However, 90% of all respondents were not aware of any employer policy nor offered any information concerning support to enable breastfeeding after returning to work, despite two organizations having a range of maternity- and breastfeeding-related policies in development and some facilities in place. Almost 90% of respondents stated the employers should do more to support breastfeeding. This should include providing pregnant staff with information about breastfeeding support that they should expect and could therefore plan to use, including access to facilities to express and to store breast milk, to enable them to work flexible hours and to take rest breaks during working hours. Recommendations are made for employers.

Adult↗

PubMed2006

Developing practice in breastfeeding.

This paper reports on an approach to practice development in breastfeeding as part of a national programme of work to address inequalities in maternal and child nutrition. The production and dissemination of evidence and guidelines is necessary but not sufficient on its own to effect change in practice, particularly when dealing with complex public health issues. In the case of breastfeeding, review evidence and national guidance have shown that multifaceted changes are essential if policy aspirations are to be realized. The objectives of the programme described here were to (1) inform and enable practice development in breastfeeding in low-income areas; (2) evaluate the impact of approaches used; and (3) develop robust approaches and appropriate material for use nationally. A conceptual framework was established, and a six-stage process is outlined. The recruitment of four sentinel sites across whole health economies, involving professionals and the voluntary sector, was an essential component of the programme. The strength of the model is that it provides a structured, cross-sectoral approach to practice development in public health. A key challenge is to identify whose responsibility it is to resource practice development when a number of disciplines and sectors are involved. This question needs to be addressed if public health guidance is to be of sustained benefit.

Breast Feeding↗

PubMed2006

Addressing the learning deficit in breastfeeding: strategies for change.

This paper summarizes the findings of the learning needs assessment described in this issue. Limitations and strengths are discussed. The paper describes a national, multi-sectoral, multidisciplinary picture. Our respondents may over-represent those with an interest in breastfeeding; if so, the true picture may be even more problematic than described here. Major deficits were identified in the knowledge and skills of practitioners from all backgrounds and all sectors. Many professionals report poor knowledge about breastfeeding and have low levels of confidence and clinical competence. Organizational constraints and barriers to effective education and practice include fragmentation of care and education, lack of facilities, and a low priority being given to breastfeeding. There is a range of current educational provision, although not all is fit for purpose. Voluntary organizations seem to have higher standards than do some current professional learning opportunities. Preferred methods of training include practical observation and mentorship, volunteer counsellor involvement in training programmes, as well as self-study and online opportunities. Recommendations include: a funded, mandatory, interagency and multidisciplinary approach; appropriate content; support at local and national levels; breastfeeding education to be included in clinical governance and audit mechanisms; and further research and evaluation to examine optimum ways of providing education and training. Organizational barriers could be addressed through a public health policy and evidence-based approach.

Breast Feeding↗

PubMed2006

A training needs survey of doctors' breastfeeding support skills in England.

The study examined the training needs of paediatricians and general practitioners (GPs). Respondents rated their competence on 23 breastfeeding support skills, importance of update in the next 2 years, actual and potential helpfulness of different forms of professional updates, and accessibility in the next 2 years. The perception of organizational barriers to breastfeeding support and practitioners' knowledge of policies and guidance on breastfeeding were also examined. The sample comprised 120 paediatricians and 57 GPs. Response rates were estimated as between 4% and 29%, depending upon the method of recruitment. Although both groups rated themselves as fairly competent in most of the skill areas, they welcomed training in key areas of practice. Paediatricians identified more areas for update than GPs (t = 3.44; d.f. = 178; P < 0.00001). Those who believed that they were less competent in clinical skills were least likely to seek update (r = 0.35; P < 0.00001). Practical forms of training were most often welcomed. Only 47% of GPs and 62.5% of paediatricians had access to a local breastfeeding policy. There were evident gaps in knowledge on key aspects of public health policy, which could influence local practice; for example, 50.8% of GPs and 47.5% of paediatricians identified a younger age for introducing solids than the minimum according to current government guidance. Organizational barriers to breastfeeding support were experienced by all respondents. Recommendations include purposively targeting training to those least likely to seek training, and developing effective self-study and observational methods of learning. All training should be evaluated and implemented alongside breastfeeding policies and clinical leadership to improve the practice of all healthcare practitioners.

Breast Feeding↗

PubMed2006

Barriers to breastfeeding: a qualitative study of the views of health professionals and lay counsellors.

Increasing breastfeeding initiation rates is now a target for the NHS. The attitudes and beliefs of health professionals are known to influence mothers' decisions to breastfeed. This paper describes a small qualitative study of health visitors' (n = 7), midwives' (n = 3) and lay breastfeeding counsellors' (n = 2) views of obstacles to breastfeeding. Interviews showed that day-to-day practice is informed by training and personal experience with research evidence having a more limited influence. Health professionals may experience tensions between these influences on their practice. Practical problems in accessing training make it difficult for health professionals to stay up-to-date with new evidence. Information from the study was used to develop a self-study training workbook for local health professionals.

Attitude of Health Personnel↗

PubMed2005

A randomised-controlled trial in England of a postnatal midwifery intervention on breast-feeding duration.

OBJECTIVE: To determine whether postnatal 'hands off' care by midwives on positioning and attachment of the newborn baby improves breast-feeding duration. DESIGN: Mothers were randomised at the first postnatal feed to receive either care by a midwife trained in the experimental protocol or by a control midwife undertaking routine care. SETTING: Eight wards in four English Midlands hospitals. PARTICIPANTS: 370 primiparous mothers with term babies who intended to breast feed, and could sit out of bed to do so. INTERVENTIONS: Experimental protocol of verbal-only advice on positioning and attachment, delivered at the first postnatal ward feed compared with routine care by a qualified midwife. MAIN OUTCOME MEASURES: Duration of breast feeding up to 17 weeks as assessed by diaries and interviews with mothers and protocol adherence from self-completed checklist by the midwife. The mothers' self-reported experience of care and support before, during and after delivery were assessed at 6 weeks, and feeding outcomes and employment status at 17 weeks. FINDINGS: Experimental group mothers more often held the baby across their lap and received 'hands off advice', but fewer babies in the experimental than control groups attached and fed: 59% (106/180) vs. 67% (118/175), p=0.1. No significant differences were found in the numbers of mothers breast feeding at 6 or 17 weeks in the experimental and control groups (stopped exclusive breast feeding: 76% (130/172) vs. 77% (126/163) at 6 weeks; 96% (167/174) vs. 96% (161/168) at 17 weeks; odds ratio 1.02, 95% CI 0.77 to 1.22; p=0.8; stopped any breast feeding: 35% (61/172) vs. 32% (53/167) at 6 weeks; 63% (109/173) vs. 60% (101/167) at 17 weeks; odds ratio 1.10, 0.84 to 1.45; p=0.5). There were no significant differences in the incidence of problems with breast feeding and care experienced by mothers before or during hospitalisation (other than at the first postnatal ward feed), nor after discharge home. CONCLUSIONS: No significant beneficial effect was found on breast-feeding duration of the verbal- only advice on positioning and attachment, perhaps because aspects of the intervention are already within routine UK practice. Other care practices at subsequent feeds may negate benefits of care at earlier feeds. 'Hands off' care at the first feed may be less important to subsequent feeding than achieving a first feed under supervision in the postnatal ward. IMPLICATIONS FOR PRACTICE: Midwives can be trained in a 4-hr workshop to achieve improved knowledge of 'hands off' positioning and attachment care, and these can be translated into clinical practice. Future studies should differentiate the elements of the care that are effective in achieving postnatal feeds, and apply this advice consistently at successive feeds.

Adult↗

PubMed2004

Empowerment and advocacy: reflections on action research with Bangladeshi and Pakistani families who have children with severe disabilities.

The concepts of empowerment and advocacy, and how they impinge on power relationships for service providers working with black and Asian communities, are explored through the findings of a 20-month project carried out between 2000 and 2001 with 19 Pakistani and Bangladeshi families who have children with severe disabilities in Birmingham. This action research project evaluated an advocacy project designed to improve the quality of life for Pakistani and Bangladeshi families with at least one child with severe disabilities. The objectives included improving access to resources, services, information and support in ways which were non-stigmatising, and which were sensitive to the particular needs of the children and their carers. The present paper discusses four main themes: (1) advocacy and empowerment in practice; (2) issues of the efficacy of advocacy and of consultation within advocacy; (3) individual empowerment versus the families' needs; and (4) cultural and gender issues which emerged from the analysis of the study. The authors identify features of empowerment which must be addressed in advocacy services which are sensitive to ethnic differences. These issues must be addressed if services are to reap their potential to make a positive impact on the lives of the most vulnerable and powerless members of the community.

Adult↗

PubMed2003

Attitudes towards disability amongst Pakistani and Bangladeshi parents of disabled children in the UK: considerations for service providers and the disability movement.

It has sometimes been assumed that religiously based explanations for and attitudes to having a disabled child have led to the low uptake of health and social services by ethnic minority families in the UK. A series of semi-structured interviews were held between 1999 and 2001 with 19 Pakistani and Bangladeshi families with a disabled child as part of an evaluation of an advocacy service. The families' understandings of the causes of their child's impairment, whether they felt shame and experienced stigma, and whether these factors influenced service uptake and their expectations of their child's future are reported. While religious beliefs did inform the ways in which some families conceptualised their experience, the families' attitudes were complex and varied. There was little evidence that religious beliefs and associated attitudes rather than institutional racism had resulted in the low levels of service provision which the families experienced prior to the advocacy service. There was also no evidence that the families' attitudes had been informed by the disability movement. The implications for service providers and the movement are considered.

Adolescent↗

PubMed1985

Surgical patients' expectations of pain and discomfort: does accuracy of expectations minimise post-surgical pain and distress?

The predictive relationship of expectancies of pain and symptoms to the experience of postoperative pain, symptoms and distress are examined in two studies of adult patients undergoing minor gynaecological surgery. The first hypothesis is based on the clinical wisdom that patients who expect pain to occur will report greater pain intensity than patients who do not hold these expectancies. That is, pain and symptom expectation and experience are positively associated. A second hypothesis based on a cognitive information processing model suggests that the greater the discrepancy between expected and actual pain the greater the experience of postoperative distress. A third hypothesis suggests that the direction of the discrepancy is important such that those patients who expect pain to be more intense than it is in actuality will report being least distressed. Data are presented which partially support all 3 hypotheses. A critical test between the second and third hypotheses did not provide support for either hypothesis. The positive correlations between expected and reported pain and emotional variables suggest that the manipulation of patients' emotional responses may be as effective as manipulating pain expectancies in controlling the pain and distress of surgery. This is supported by the finding that patients who receive accurate preparatory information about their surgery, in comparison to those who had no additional information, reported lower pain intensity but did not differ on expected pain intensity before the operation. However, the experimental manipulation was associated with reduced pain and emotional responses after surgery. The implications for the design of preparatory psychological interventions to reduce the pain and distress of surgery are discussed.

Adult↗