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PubMed2005

Developing and piloting an audit tool for mental health education and training: the National Mental Health Education Continuous Quality Improvement Tool.

It is clear from the international literature that education and training can play a crucial role in improving the quality of mental health service delivery. In the UK, post-qualification mental health education and training is not generally allied to the national policy agenda and there is a lack of service user and carer involvement in the design, development and delivery of educational curricula. The Department of Health in England has funded the development of a continuous quality improvement tool to address these important concerns and help commissioners of mental health education and training evaluate key aspects of courses. The design of the tool was informed by the literature and a series of semi-structured interviews and focus groups with key stakeholders. Subsequent drafts were refined through steering group consultation and the instrument was then piloted within a selected region in England. This has resulted in a brief, user-friendly tool that takes into account the views of all stakeholders in mental health education programmes, promotes dialogue and facilitates continuous quality improvement. The tool promotes self-assessment of: partnership arrangements; the relevance of the programme to the policy context; the extent to which service users and carers are involved in the design, delivery and evaluation of programmes; and the assessment of the impact of the programme. Results from the initial implementation project (to be reported separately) suggest that the tool is welcomed and can complement existing quality mechanisms.

Health Occupations↗

PubMed2006

Improving the use of research evidence in guideline development: 10. Integrating values and consumer involvement.

BACKGROUND: The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the 10th of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this. OBJECTIVES: We reviewed the literature on integrating values and consumers in guideline development. METHODS: We searched PubMed and three databases of methodological studies for existing systematic reviews and relevant methodological research. We reviewed the titles of all citations and retrieved abstracts and full text articles if the citations appeared relevant to the topic. We checked the reference lists of articles relevant to the questions and used snowballing as a technique to obtain additional information. We did not conduct a full systematic review ourselves. Our conclusions based on the available evidence, consideration of what WHO and other organisations are doing and logical arguments. KEY QUESTIONS AND ANSWERS: We did not find a systematic review of methods for integrating values in guidelines, but we found several systematic reviews that dealt with related topics. Whose values should WHO use when making recommendations? Values, the relative importance or worth of a state or consequences of a decision (outcomes relating to benefits, harms, burden and costs), play a role in every recommendation. Ethical considerations, concepts that determine what is right, also play a role. The values used in making recommendations should reflect those of the people affected. Judgements should be explicit and should be informed by input from those affected (including citizens, patients, clinicians and policy makers). When differences in values may lead to different decisions or there is uncertainty about values, this should also be explicit. If differences in values are likely to affect a decision, such that people in different setting would likely make different choices about interventions or actions based on differences in their values, global recommendations should be explicit in terms of which values were applied and allow for adaptation after incorporating local values. How should WHO ensure that appropriate values are integrated in recommendations? All WHO guideline groups should uniformly apply explicit, transparent and clearly described methods for integrating values. WHO should consider involving relevant stakeholders if this is feasible and efficient. WHO should develop a checklist for guidelines panels to help them to ensure that ethical considerations relevant to recommendations are addressed explicitly and transparently. How should users and consumers be involved in generating recommendations? Including consumers in groups that are making global recommendations presents major challenges with respect to the impossibility of including a representative spectrum of consumers from a variety of cultures and settings. Nonetheless, consideration should be given to including consumers in groups who are able to challenge assumptions that are made about the values used for making recommendations, rather than represent the values of consumers around the world. WHO should establish a network to facilitate involvement of users. Draft recommendations should be reviewed by consumers, who should be asked explicitly to consider the values that were used. How should values be presented in recommendations? Recommendations should include a description of how decisions were made about the relative importance of the consequences (benefits, harms and costs) of a decision. Values that influence recommendations should be reported along with the research evidence underlying recommendations. When differences in values would lead to different decisions or there is important uncertainty about values that are critical to a decision, this should be flagged and reflected in the strength of the recommendation. Adaptable guideline templates that allow for integration of different values should be developed and used when differences in values are likely to be critical to a decision.

Journal Article↗

PubMed2002

Importance of public relations in recycling strategies: principles and case studies.

The separate collection of waste, and especially of recyclables with specific collection systems, would not be possible without the involvement of the users. Apart from the physical installations such as collection containers, collection points, etc., the motivation of the users is an essential component. Motivation can be reinforced through public relations work. In addition to the underlying technical considerations, this paper describes the difference between communication in general and public relations and specifically examines public involvement in recycling. Through the use of examples, we look at the targeted users and typical media employed. Furthermore, we analyzes the development of public involvement. The examples show that public relations for recycling strategies relies to a great extent on attitudes, habits, and access to the target group. Thus, standardized procedures cannot be developed. For these reasons, public relation activities must be planned carefully and professionally and include an analysis of the target group, choice of media, and verification of success.

Communication↗

PubMed2006

Service users and other stakeholders' evaluation of a liaison mental health service in an accident and emergency department and a general hospital setting.

Liaison mental health care has been an emerging specialism of mental health nursing in the UK since the early 1990s. Studies have so far looked only briefly at service user evaluation. A qualitative study involving 47 interviews with service user and professional stakeholders was undertaken to determine what is important to stakeholders in a liaison mental health-care service. The largest group of stakeholders interviewed were service users. Analysis of the data was undertaken using the service user interviews to guide the development of themes. The majority of the issues identified were raised by both service users and professionals. The three key themes were, the practicalities of the service including waiting time, the staffing profile and receiving the service, which included issues such as the opportunity to talk and outcomes. The findings provide new information regarding what service users and other stakeholders expect from a liaison mental health service and important areas to consider when offering a satisfactory service.

Attitude of Health Personnel↗

PubMedDate not supplied

[The experimental drug prescription program in Andalusia [PEPSA]: procedure for recruiting participants].

In this field note we describe the steps followed in the process of recruiting participants for the experimental drug prescription program in Andalusia (PEPSA). This trial is a comparative, randomized, open study of the difference between intravenous heroin treatment and oral methadone for socially excluded, opiate-dependent patients, in whom other available treatments have been unsuccessful. Because this is a hidden and hard-to-reach population, a specific approach was planned to put as many patients as possible in touch with the program. A previous study of the target population's distribution in the City of Granada was performed and the city was divided into three areas. Potential participants were interviewed in squares, soup kitchens and methadone dispensaries by outreach workers and peers, who suggested they make an appointment with a PEPSA physician. Peer-driven intervention was a crucial instrument in this recruitment procedure, allowing greater access to the target population. Furthermore, this approach allowed contact with drug users who do not attend health and social services. The work of the outreach team involved educating these users in harm reduction and offering them health and social alternatives beyond the clinical trial.

Administration, Oral↗

PubMed2001

Absent voices compromise the effectiveness of nursing home regulation: a critique of regulatory reform in the UK nursing home industry.

Over the last decade there has been consistent pressure for the healthcare services in the UK to become more accountable to users. Now over half the healthcare beds in England are in the privatised nursing home sector, and regulation of the sector is under reform. Yet requirements for user accountability have not been reflected in these reforms. In other sectors, consumer involvement in regulatory agencies and processes is seen as important to the success of the regulatory enterprise. But in the care sector neither users nor their representatives have been given legal rights of involvement in the National Care Standards Commission or in regulatory processes. This paper argues that failure to involve users not only places the regulation enterprise at risk of capture by the industry, but will also weaken the legitimacy of the new Commission.

Community Participation↗

PubMed1997

Evaluation of the HIV risk reduction intervention for women entering inpatient substance abuse treatment.

OBJECTIVES: Interventions to lower HIV risk behavior among drug users have concentrated on reduction of high risk injection practices. Less attention has been directed to non-injecting drug users and drug-involved women. Female non-injecting drug users (e.g., women who abuse alcohol or crack cocaine) are also at substantial risk for sexual transmission of HIV due to multiple partners, partners who self-inject and share needles, exchange of sex for drugs, coerced sex, high rates of sexually transmitted diseases, and low rates of condom use. This study compared the effectiveness of an educational intervention (EC) against the behavior skills training intervention (BST) in reducing sexual risk behavior among women (N = 117) court-ordered into inpatient drug treatment. METHODS: Participants were assessed at baseline, post intervention, and 2 months after discharge from the drug treatment facility. RESULTS: Women in both conditions reported high rates of sexual risk behavior prior to the intervention. Women in both conditions had more positive attitudes toward HIV prevention and reported greater partner agreement with condom use at the post intervention assessment. However, these changes were not maintained at follow-up for women in the EC condition, whereas women in BST continued to show improvement post discharge. Women in the BST condition showed marked, while women in EC showed little improvement in communication skills and no improvement in condom application skill. At follow-up, women in both conditions had reduced drug use and drug-related high risk sex activities. BST women had increased their condom use while women in EC evidenced a decrease. Condom use increased from 35.7% to 49.5% of vaginal intercourse occasions for BST women and decreased from 28.8% to 15.8% for women in EC. CONCLUSIONS: Results suggest a brief skills training intervention embedded in drug treatment programs can reduce sexual risk for HIV-infection after discharge.

Adult↗

PubMed1985

Cocaine use among American adolescents and young adults.

In this chapter, we have tried to provide some objective information about the levels of and recent trends in cocaine use among America's adolescents and young adults, as well as some of their attitudes and beliefs about the drug and their reasons for using it. We have also examined cross-time patterns of use, certain predictors of use, and some of the conditions of the social and physical environments which are associated with use. Overall, we have found levels of use to be relatively stable for the past several years after a period of rapid increase between 1976 and 1979. We also found a strong age effect, with cocaine use increasing in the first few years after high school. The levels of use, though stable recently, are disturbingly high, particularly among young adults in their early to mid twenties. Self reported use has followed patterns that parallel exposure to use and use by friend, as would be expected, assuming valid measures. Perceived availability also has moved in tandem with these other measures. The great majority of today's seniors believe regular use to be dangerous, and 77% disapprove of even experimenting with cocaine. Use is found most frequently in the western and northeastern regions of the country, in more urban areas, among males, and among those who are not college-bound. Neither socioeconomic status nor personal income are very strongly associated with use; but a history of truancy, going out frequently in the evenings, and having relatively low religious involvement are. Cocaine users tend to use other illicit drugs (particularly marijuana) and to be cigarette smokers and heavy drinkers much more frequently than nonusers. Thus, there is little evidence that cocaine involves a separate drug-using syndrome. In fact, it is not uncommon for cocaine users to use marijuana or alcohol concurrently. When taking cocaine, high school students most often snort it, though some (24% of recent users) smoke it while only 4% of the users inject it. It is almost always used with other people present, often at a party but more often with just one or two people present. Most use occurs in the evening, with very few young people using at school and a minority ever using at home or in a car. Among the reasons most often cited for using cocaine use are: "to see what it's like," "to get high," and "to have a good time with my friends."(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMed1992

Effects of speech output type, message length, and reauditorization on perceptions of the communicative competence of an adult AAC user.

The effects of speech output type, aided message length, and partner reauditorization on naive observers' perceptions of the communicative competence of an adult augmentative and alternative communication (AAC) system user were examined. Subjects consisted of 48 naive adults with minimal exposure to nonspeaking persons. Eight scripted videotaped conversational conditions involving an AAC user and a normal-speaking partner were employed in the manipulation of the three independent variables. A balanced incomplete block design was used. Following each viewing, subjects completed a questionnaire designed to assess the communicative competence of the AAC user. Results indicated a significant main effect for aided message length only. Ratings of the AAC user were higher in conditions with phrases than in conditions with single-word messages. Of interest was the finding that the use of digitized versus synthesized speech output had no effect on observer ratings. Clinical implications are discussed.

Adult↗

PubMedDate not supplied

["User embracement" and the working process in health: Betim's case, Minas Gerais, Brazil].

The subject of this paper is changes in health care when "user embracement" is used as a strategic aim. According to the "user embracement" concept, health care clients are the center of the health services' organization, including the following: 1) care for everyone seeking it, thus guaranteeing universal accessibility; 2) reorganization of the work process, such that its central thrust is shifted from the physician to the multiprofessional staff, or "user embracement team", in charge of "hearing" users and becoming involved in solving their health problems; and 3) solidarity, humanity, and citizenship as parameters for the relationship between health care users and providers. The research showed improvement of non-medical health care productivity and greater accessibility by users. After nine months, the "user embracement team" solved 50% of the health problems themselves. The above-mentioned effects were also linked to workers' motivation, leading to greater creativity in the work process.

Brazil↗

PubMed1999

Public participation in the design of educational programmes for cancer nurses: a case report.

Genuine involvement of the public in planning, monitoring and evaluation of health care is a prerequisite to a better quality of service. Similarly users of health services and their carers can contribute much to the planning and delivery of professional education, although this contribution has only recently been acknowledged in any strategic way by nursing educational and professional bodies. This paper provides one example of user and career involvement in the design of continuing education and higher education in cancer care nursing within the University of Leeds School of Healthcare Studies. The author reflects upon the positive aspects and some of the challenges presented in the achievement of public involvement in nurse education.

Consumer Behavior↗

PubMed2003

Changing epidemiology of hepatitis A: should we be doing more to vaccinate injecting drug users?

Since 2001 there have been significant outbreaks of hepatitis A virus (HAV) across South Yorkshire, largely in intravenous drug users, and HAV infection has been reported to be an increasing problem in England and Scotland during this time. This paper reports a brief investigation to clarify current HAV epidemiology in England and Wales. The epidemiology of HAV in England, but not yet Wales, has recently changed. Laboratory reports now show that most cases are occurring in young adults, mainly young men, and that the commonest reported risk group is injecting drug users. That cases may now be concentrated in injecting drug users is supported by reports from consultants in communicable disease control (CsCDC). These detail fourteen outbreaks in England in 2002 alone, all involving injecting drug users. Links to prisons and to the homeless, usually those in hostels, were also common. A combined Hepatitis A/B vaccine is readily available and we recommend that this now be used to extend the national immunisation programme against Hepatitis B in injecting drug users to include HAV.

Adolescent↗

PubMed1998

The care programme approach: the views and experiences of service users.

Service users should be involved in drawing up their care programme. In practice, however, the meetings can be intimidating, and professionals may even disregard issues which the user has specifically requested to be included in the programme. PETER PHILLIPS highlights users' concerns and criticisms of the care programme approach.

Aftercare↗

PubMed2000

Illicit drugs and driving: prevalence, beliefs and accident involvement among a cohort of current out-of-treatment drug users.

Drug-driving behaviour among out-of-treatment dependent drug users has not been investigated while a theoretical perspective on the propensity of certain drug users to drive while impaired has not been suggested. This paper examines illicit drugs and driving behaviour and accident involvement among out-of-treatment current drug users. Psychological evidence of belief-based mechanisms to account for the decision to drive while impaired by drugs are provided. A total of 210 out-of-treatment current drug users were interviewed in a non-clinical setting by privileged access interviewers. Questionnaire measures were: current illicit drug use, severity of dependence, illicit drugs and driving behaviour, impaired and unimpaired accident involvement and beliefs and perceptions about the impairing effects of a number of illicit drugs. Analyses are restricted to participants who reported driving during the previous 12 months (n = 71). Fifty-eight participants (81.7%) reported driving immediately after consuming illicit drugs, primarily heroin and cannabis. Of these 41.4% (n = 24) had at least one road accident as a driver, 15 of whom (62.4%) reported accident involvement following recent drug consumption. Belief-based results showed that participants who reported never driving after using illicit drugs perceived heroin, methadone and alcohol to be greater significance for accident risk and driving skills impairment than other drugs. Those drivers who reported drugs and driving behaviour believed only alcohol to be significantly more impairing than other drugs. Findings indicated that illicit drugs and driving behaviour is common among out-of-treatment drug users. Accident involvement among this cohort is characterised by the previous consumption of illicit substances. Differential beliefs about the effects of drugs on driving performance and accident risk were shown to be dependent upon frequency of drugs and driving behaviour. Results are discussed in terms of experiential factors and consistency theories of attitude formation and change.

Accidents, Traffic↗

PubMedDate not supplied

Ongoing consent to care for older people in care homes.

Obtaining informed consent is a fundamental part of the care-giving process. Current policy documents emphasise the importance of including patients in planning their care. This article explores the concept of consent and the challenges to this concept for older people in long-term care, where consent is not a one-off event requiring a 'consent form', but just one stage in the continuum of involvement for service users. At one end of the spectrum, service users may be unaware that they have a service user plan (care plan), while at the other end they may be enabled to complete an advance statement of their wishes, thus demonstrating significant involvement in planning their care.

Advance Directives↗

PubMedDate not supplied

Route of cocaine administration: patterns of use and problems among a Brazilian sample.

Route of administration has important implications for the understanding of drug addiction and related-problems. This cross-sectional study investigates patterns of consumption and cocaine-related problems among snorting and crack cocaine users in São Paulo and outlines changes in route of cocaine administration in Brazil between 1980-1997. Crack cocaine users had more social and health problems and higher involvement in crime than intranasal users. These problems, compounded by the larger doses being used and their greater involvement in prostitution, place crack cocaine users at higher risk from HIV infection and other sexually transmitted diseases as well as other physical risks.

Administration, Inhalation↗

PubMed2000

Longitudinal application of the medical outcomes study 36-item short-form health survey with not-in-treatment crack-cocaine users.

BACKGROUND: The Medical Outcomes Study SF-36 has been used infrequently with substance abusers. OBJECTIVES: The objectives of this study were to use the SF-36 to assess changes in the health status of crack-cocaine users over time, to determine the characteristics of users who change, to assess the influence of frequency of crack use on SF-36 health status, and to determine the utility of the SF-36 with crack users. DESIGN: A multilevel model was used to analyze data that were collected every 6 months over a 2-year period. SUBJECTS: The sample consisted of 439 not-in-treatment crack-cocaine users. MEASURES: The SF-36 was administered at baseline and follow-up interviews. Data on the frequency of crack-cocaine use were also collected. RESULTS: On average, SF-36 health status remained fairly static during the study although statistically significant increases in scores occurred on the social functioning and role-emotional subscales. Variation in subjects' health trajectories occurred but was not, for the most part, explained by individual characteristics. Frequency of crack use was negatively related to scores on the physical functioning, social functioning, and mental health subscales. Most subscales did not reflect what are commonly recognized to be the health-compromising effects of cocaine use, raising questions about the use of the SF-36 with illicit drug users. CONCLUSIONS: Changes in crack users' SF-36 health status were uncommon. Frequency of crack use was negatively associated with health status. Several SF-36 subscales may be helpful in studies involving illicit drug users in which limited assessments of health status are needed.

Activities of Daily Living↗

PubMed2006

Developing inclusive partnerships: user-defined outcomes, networking and knowledge--a case study.

Two major developments have been associated with the reorientation of United Kingdom health and social care policy and provision in recent years, placing a new emphasis on: quality and 'outcome' measures; and service user (and public and patient) involvement. These issues have become central to health and social care, representing expressions of the shift in political and ideological interest in public policy. However, these two strands of development have tended to be treated as discrete discourses and have developed separately in policy. Nevertheless, it can hardly be assumed that what policy makers, service planners, providers and purchasers would value and prioritise as good quality would necessarily coincide with what service users would want. Developing effective partnership working needs to go beyond considerations of organisations and professional groupings, and fully involve service users as one of the key stakeholders. This paper describes the findings of three projects undertaken by Shaping Our Lives. These studies confirmed that service-user concepts of outcomes and quality may differ significantly from those currently employed; moreover, service users are able to offer a complex and sophisticated model of what outcome measures might look like if they were centrally involved in their definition and application. Nevertheless, service users currently have little impact in defining and influencing quality outcomes. The projects also highlight the importance of networking and knowledge sharing for service users and user organisations in their ability to influence policy definitions of quality, and a number of the barriers and obstacles which undermine this process. The paper concludes with two proposals which, considered together, offer the basis for taking forward effective and inclusive partnerships and developing measures for quality consistent with the rights and preferences of service users themselves. They are an essential complement to broader efforts and strategies to develop effective partnerships in health and social care.

Health Services Administration↗