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Health literacy: setting an international collaborative research agenda
Joanne Protheroe, Lorraine S Wallace, Gillian Rowlands, Jennifer E DeVoe
BMC Family Practice , 2009, DOI: 10.1186/1471-2296-10-51
Abstract: The debate centred around three distinct themes, including: (1) refining HL definitions and conceptual models, (2) HL measurement and assessment tools, and (3) developing a collaborative international research agenda. The attendees agreed that future research should be theoretically grounded and conceptual models employed in studies should be explicit to allow for international comparisons to be drawn.The importance of HL research and its possible contribution to health disparities is becoming increasingly recognised internationally. International collaborations and comparative studies could illuminate some of the possible determinants of disparities, and also possibly provide a vehicle to examine other research questions of interest.Health literacy is a topic that has been gaining momentum over the past few years, both in the policy and research agendas of many countries. During the 36th Annual Meeting of the North American Primary Care Research Group, the authors led a 3-hour forum, "Studying Health Literacy: Developing an International Collaboration," where the current state of health literacy (HL) in the United States (US) and United Kingdom (UK) was presented. Interested participants at the conference were invited to attend, no preparation was required. Following a brief presentation 10 forum attendees, from the US, UK, and Canada, were encouraged to share their ideas–blue-sky thinking–about proposed research collaborations and the direction of future international research agendas. The discussion was facilitated by three of the authors (JP, LW and JD), but the direction of the discussion was led by the attendees. The attendees represented a range of academic and clinical disciplines, including health service research, nursing, medical and psychology and all had an expressed research interest in Health Literacy, individuals' extent of research experience was not known. Following approval from both the Institutional Review Board of the University of Tennessee Gr
An intervention to promote patient participation and self-management in long term conditions: development and feasibility testing
Joanne Protheroe, Tom Blakeman, Peter Bower, Carolyn Chew-Graham, Anne Kennedy
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-206
Abstract: We based the intervention on published evidence on effective ways of improving participation. The intervention was developed, piloted and evaluated using a range of qualitative methods. Firstly, focus groups with stakeholders (5 patients and 3 clinicians) were held to introduce the prototype and elucidate how it could be improved. Then individual 'think aloud' and qualitative interviews (n = 10) were used to explore how patients responded to and understood the form and provide further refinement.The literature highlighted that effective methods of increasing participation include the use of patient reported outcome measures and values clarification exercises. The intervention (called PRISMS) integrated these processes, using a structured form which required patients to identify problems, rate their magnitude and identify their priority. PRISMS was well received by patients and professionals. In the individual qualitative interviews the main themes that emerged from the data related to (a) the content of the PRISMS (b) the process of completing PRISMS and how it could be operationalised in practice and (c) the outcomes of completing PRISMS for the patient. A number of different functions of PRISMS were identified by patients including its use as an aide-memoire, to provide a focus to consultations, to give permission to discuss certain issues, and to provide greater tailoring for the patient.There was evidence that patients found the PRISMS form acceptable and potentially useful. The challenge encountered by patients in completing PRISMS may encourage exploration of these issues within the consultation, complementing the more 'task focussed' aspects of consultations resulting from introduction of clinical guidelines and financial incentives. Further research is required to provide a rigorous assessment of the ability of tools like PRISMS to achieve genuine change in the process and outcome of consultations.The global burden of disease is shifting to long-term conditi
Digging deeper: quality of patient-provider communication across Hispanic subgroups
Lorraine S Wallace, Jennifer E DeVoe, Edwin S Rogers, Joanne Protheroe, Gillian Rowlands, George E Fryer
BMC Health Services Research , 2009, DOI: 10.1186/1472-6963-9-240
Abstract: Cross-sectional analysis of the 2005 Medical Expenditure Panel Survey (MEPS). Participants included non-institutionalized Hispanics (n = 5197; US population estimate = 27,070,906), aged ≥18 years, reporting visiting a health care provider within the past 12 months. Six (n = 6) items were used to capture respondents' perceptions of their health care providers' communication behaviors.After controlling for socio-demographic covariates, compared to Other Hispanics (reference group), very few differences in perceptions of health care providers communication emerged across ethnic subgroups. Puerto Ricans were more likely to report that their health care provider "always" showed respect for what they had to say (OR = 2.16, 95% CI 1.16-4.03). Both Puerto Ricans (OR = 2.28, 95% CI 1.06-4.92) and Mexicans (OR = 1.88, 95% CI 1.02-3.46) were more likely to indicate that their health care provider "always" spent enough time with them as compared to Other Hispanics.We observed very few differences among Hispanics respondents in their perceived quality of interactions with health care providers as a function of their ethnic subgroup designation. While our findings somewhat contradict previous research, they do suggest that other underlying factors may influence the quality of perceived interactions with health care providers.Hispanic Americans now represent 15% of the total US population [1]. Over the past decade, studies have consistently documented a wide array of health-related disparities between Hispanics and non-Hispanic whites [2]. For instance, using data from the 2001 National Health Interview Survey, McGruder and colleagues [3] found that Hispanics were less aware of heart attack symptoms and the need to call for emergency help if someone near them had symptoms than were whites. In a population-based study of respondents residing in ten different states, Hispanics reported receipt of fewer routine preventive services (e.g., colorectal cancer screening and cholesterol te
Promoting patient engagement with self-management support information: a qualitative meta-synthesis of processes influencing uptake
Joanne Protheroe, Anne Rogers, Anne P Kennedy, Wendy Macdonald, Victoria Lee
Implementation Science , 2008, DOI: 10.1186/1748-5908-3-44
Abstract: Four published qualitative studies from a programme of research about self-management were analysed as a group; these included studies of the management of inflammatory bowel disease (IBD); self-help in anxiety and depression (SHADE); menorrhagia, treatment, information, and preference (MENTIP) study; and self-help for irritable bowel syndrome (IBS). For the analysis, we used an adapted meta-ethnographic approach to the synthesis of qualitative data in order to develop an evidence base.The ontological status and experience of the condition in everyday life was the most dominant theme to emerge from this synthesis. This, coupled with access to and experience of traditional health services responses, shaped the engagement with and use of information to support self-management. Five key elements were found which were likely to influence this: the perception and awareness of alternative self-management possibilities; the prior extent and nature of engagement with information; the extent of and ability to self-manage; opportunities for use of the information and the stage of the illness career; and congruence and synergy with the professional role.People with chronic conditions need support from providers in both supply and engagement with information, in a way which gives legitimacy to the person's own self-management strategies and possible alternatives. Thus, a link could usefully be made between information offered, as well as patients' past experiences of self-management and engagement with services for their condition. The timeliness of the information should be considered, both in terms of the illness career and the type of condition (i.e., before depression gets too bad or time to reflect on existing knowledge about a condition and how it is to be managed) and in terms of the pre-existing relationship with services (i.e., options explored and tried).More considered use of information (how it is provided, by whom, and at what point it should be introduced) is key
Delivering the WISE (Whole Systems Informing Self-Management Engagement) training package in primary care: learning from formative evaluation
Anne Kennedy, Carolyn Chew-Graham, Thomas Blakeman, Andrew Bowen, Caroline Gardner, Joanne Protheroe, Anne Rogers, Linda Gask
Implementation Science , 2010, DOI: 10.1186/1748-5908-5-7
Abstract: Normalisation Process Theory provided a framework for development of the intervention. Practices were recruited from an inner city Primary Care Trust in NW England. All practice staff were expected to attend two afternoon training sessions. The training sessions were observed by members of the training team. Post-training audio recordings of consultations from each general practitioner and nurse in the practices were transcribed and read to provide a narrative overview of the incorporation of WISE skills and tools into consultations. Face-to-face semi-structured interviews were conducted with staff post-training.Two practices out of 14 deemed eligible agreed to take part. Each practice attended two sessions, although a third session on consultation skills training was needed for one practice. Fifty-four post-training consultations were recorded from 15 clinicians. Two members of staff were interviewed at each practice. Significant elements of the training form and methods of delivery fitted contemporary practice. There were logistical problems in getting a whole practice to attend both sessions, and administrative staff founds some sections irrelevant. Clinicians reported problems incorporating some of the tools developed for WISE, and this was confirmed in the overview of consultations, with limited overt use of WISE tools and missed opportunities to address patients' self-management needs.The formative evaluation approach and attention to normalisation process theory allowed the training team to make adjustments to content and delivery and ensure appropriate staff attended each session. The content of the course was simplified and focussed more clearly on operationalising the WISE approach. The patient arm of the approach was strengthened by raising expectations of a change in approach to self-care support by their practice.The effective management of long-term conditions is a key focus of health for which policy and support for self-management has been a core com
Female Headship and Life History Research: Using Emotional Turning Points  [PDF]
Joanne Cliffe
Creative Education (CE) , 2016, DOI: 10.4236/ce.2016.718258
Abstract: A natural line of enquiry for women studying women’s lives is to use life history. Life history helps us to know and understand a subject’s identity. It distinguishes what people are “trying to do” and provides a framework to comprehend a person’s actions so an individual is a dynamic, rather than reflexive participant in her own life. Life history reflects the lived experience of those being researched as they construct their identity through recounting their stories and gaining a deeper understanding of themselves. This paper draws on stories recounted by female headteachers with an emphasis on the rich tapestry of their life experiences and their associated learning through positive and/or negative events. It is the outcomes of these events where the focus lies; particularly how the headteachers made effective use of emotional “turning points” in their lives. Their subsequent actions provide insight and possible contributions to future headship preparation programmes. Findings from two studies provide the data from which the paper is based. The first explored the career paths of seven female secondary school headteachers making sole use of life history interviews; the second was a through five-year longitudinal investigation of another seven secondary school female headteachers with a focus on emotional intelligence which used a range of methods, including life history interviews and psychometric tests (including emotional intelligence tests).
A cluster randomised controlled trial of the clinical and cost-effectiveness of a 'whole systems' model of self-management support for the management of long- term conditions in primary care: trial protocol
Peter Bower, Anne Kennedy, David Reeves, Anne Rogers, Tom Blakeman, Carolyn Chew-Graham, Robert Bowen, Martin Eden, Caroline Gardner, Mark Hann, Victoria Lee, Rebecca Morris, Joanne Protheroe, Gerry Richardson, Caroline Sanders, Angela Swallow, David Thompson
Implementation Science , 2012, DOI: 10.1186/1748-5908-7-7
Abstract: The evaluation involves a large-scale, multi-site study of the implementation, effectiveness, and cost-effectiveness of this model of self-management support using a cluster randomised controlled trial in patients with three long-term conditions of diabetes, chronic obstructive pulmonary disease (COPD), and irritable bowel syndrome (IBS). The outcome measures include healthcare utilisation and quality of life. We describe the methods of the cluster randomised trial.If the 'whole systems' model proves effective and cost-effective, it will provide decision-makers with a model for the delivery of self-management support for populations with long-term conditions that can be implemented widely to maximise 'reach' across the wider patient population.ISRCTN: ISRCTN90940049Long-term conditions are increasingly important determinants of quality of life and healthcare costs in populations worldwide [1]. There are major initiatives ongoing to improve quality of care and achieve better health in these populations [2]. Increasing healthcare costs associated with an ageing population and growing awareness of the links between behaviour and health has meant that even greater focus has been placed on self-management, defined as 'the care taken by individuals towards their own health and well being: it comprises the actions they take to lead a healthy lifestyle; to meet their social, emotional and psychological needs; to care for their long-term condition; and to prevent further illness or accidents' [3]. Self-management has the potential to improve population health without incurring major cost increases. In the UK, the influential Wanless report suggested that the future costs of healthcare were very much dependent on 'how well people become fully engaged with their own health' [4], although others have suggested self-management policies are part of an ideological shift from patient rights to individual responsibilities [5].However, realising the potential of self-management requi
Social networks, work and network-based resources for the management of long-term conditions: a framework and study protocol for developing self-care support
Anne Rogers, Ivaylo Vassilev, Caroline Sanders, Susan Kirk, Carolyn Chew-Graham, Anne Kennedy, Joanne Protheroe, Peter Bower, Christian Blickem, David Reeves, Dharmi Kapadia, Helen Brooks, Catherine Fullwood, Gerry Richardson
Implementation Science , 2011, DOI: 10.1186/1748-5908-6-56
Abstract: Drawing on evidence syntheses about social networks and capital and the role of information in self-management, we build on four conceptual approaches to inform the design of our research on the implementation of self-care support for people with long-term conditions. Our approach takes into consideration the form and content of social networks, notions of chronic illness work, normalisation process theory (NPT), and the whole systems informing self-management engagement (WISE) approach to self-care support.The translation and implementation of a self-care agenda in contemporary health and social context needs to acknowledge and incorporate the resources and networks operating in patients' domestic and social environments and everyday lives. The latter compliments the focus on healthcare settings for developing and delivering self-care support by viewing communities and networks, as well as people suffering from long-term conditions, as a key means of support for managing long-term conditions. By focusing on patient work and social-network provision, our aim is to open up a second frontier in implementation research, to translate knowledge into better chronic illness management, and to shift the emphasis towards support that takes place outside formal health services.The increase in the number of people living with long-term conditions (LTCs) and the high cost of providing services and support for long-term-condition management (LTCM) has highlighted the need for a greater focus on developing a variety of means of self-care support and behaviour change. As part of a wider agenda about public health and patient involvement [1], self-care support strategies have been identified as potentially benefiting 70% to 80% of people with LTCs.At the level of policy, the benefits associated with self-management support include patient empowerment, increased self-efficacy, changes in behaviour, and a reduction in utilisation of healthcare resources. However, self-care strategies
Origin and propagation of the highest energy cosmic rays
R. J. Protheroe
Physics , 1996,
Abstract: In this lecture I give an overview of shock acceleration, interactions of high energy cosmic rays with, and propagation through, the background radiation, and the resulting electron-photon cascade. I argue that while the origin of the highest energy cosmic rays is still uncertain, it is not necessary to invoke exotic models such as emission by topological defects to explain the existing data. It seems likely that shock acceleration at Fanaroff-Riley Class II radio galaxies can account for the existing data. However, new cosmic ray data, as well as better estimates of the extragalactic radiation fields and magnetic fields will be necessary before we will be certain of the origin of the highest energy particles occurring in nature.
Astrophysical sources of high energy neutrinos
R. J. Protheroe
Physics , 1996,
Abstract: I give a brief critical review of the predicted intensity of diffuse high energy neutrinos of astrophysical origin over the energy range from 10^12 eV to 10^24 eV. Neutrinos from interactions of galactic cosmic rays with interstellar matter are guaranteed, and the intensity can be reliably predicted to within a factor of about 2 up to 10^17 eV. Somewhat less certain are intensities in the same energy range from cosmic rays escaping from normal galaxies or active galactic nuclei (AGN) and interacting with intracluster gas. At higher energies, neutrinos will be produced by interactions of extragalactic cosmic rays with the microwave background. Other sources, such as AGN, in particular blazars, and topological defects, are more speculative. However, searches for neutrinos from all of these potential sources should be made because their observation would have important implications for high energy astrophysics and cosmology.
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