To describe experiences with and knowledge of minor illness, self-care interventions used in minor illness and channels of information used when providing self-care for minor illness.

Although minor illness is self-limiting, symptoms can be substantial and have a great impact on the affected person’s wellbeing. Possibilities to seek and find information about health and self-care have significantly increased through internet-based communities, forums, and websites. Still, a considerable number of consultations with general practitioners are for conditions that are potentially self-treatable. Seeking advanced care for minor illnesses is costly for society and can create discomfort for patients as they are down-prioritized at emergency departments.

Study participants were recruited randomly from the Swedish Adress Register. A questionnaire was sent out, and the final sample included 317 randomly selected persons aged 18–80 and living in Sweden.

Having experienced a specific illness correlated with self-reported knowledge. Preferred self-care interventions differed between different conditions, but resting and self-medicating were commonly used, along with consulting health care facilities. Compliance to advice was the highest for official information channels, and family members were a popular source of advice.

The aim of this study is to illuminate primary health care (PHC) nurses’ experiences of physical activity referrals (PARs).

Despite extensive knowledge about the substantial health effects physical activities can produce, fewer and fewer people in our modern society regularly engage in physical activity. Within health care and, particularly, within the PHC arena, nurses meet people on a daily basis who need help to engage in a healthier lifestyle. The possibility of issuing written prescriptions for physical activities, often referred to as PARs, has been introduced as a tool to support such lifestyles. However, even though PHC nurses can prescribe physical activities, studies investigating their experience in this type of nursing intervention are rare.

For this study, 12 semi-structured interviews were conducted with PHC nurses, and the transcribed texts were analysed using a qualitative content analysis.

Two categories – PARs, an important nursing intervention, and PARs, the necessity of organisational support – reflected the nurses’ experiences in using PARs.

Our findings suggest that viewing the PAR as a complex intervention, with all that this entails, might be one approach to increasing the number of PARs being issued. Simpler systems, more time and the potential for testing the effectiveness of follow-ups could be possible ways of achieving this.

We wanted to pinpoint any differences in treatment between participating nursing homes, investigate which drugs are currently prescribed most frequently for long-term patients in nursing homes, estimate prevalence of administration for the following drug groups: neuroleptics, antidepressants, antidementia agents, opioids and the neuroleptics/anti-Parkinson's drug combination, and study comorbidity correlations. We also wanted to study differences in the administration of medications to patients with reduced cognitive functions in relation to those with normal cognition.

Information about 513 patients was collected from seven nursing homes in the city of Bergen, Norway, during the period March–April 2008. This consisted of copying personal medication records, weighing, recording the previous weight from records, electrocardiography, anamnestic particulars of any stroke suffered, recording if there is cognitive impairment or not and analyzing a standardized set of blood samples.

Considerable treatment differences existed between nursing homes, both percentage patients and Defined Daily Dosages. Patients with reduced cognitive functions were prescribed less drugs in general, except neuroleptics. Of all patients, 41.5% were given antidepressants, 24.4% neuroleptics, 22.0% benzodiazepines, 8.0% anticholinesterases and 5.0% memantine. The ratio of traditional to atypical neuroleptics was 122:23. In all, 30.0% of the patients taking neuroleptics were on more than one drug and 35.0% of the patients had opioids by way of regular or as-needed drugs, ratio 14.6%:28.7%. Of 146 patients on neuroleptics, five patients had anti-Parkinson's drugs too. The average use of regular drugs for patient with intact cognition was 7.1 drugs, and for patients with reduced cognitive functions 5.7 drugs.

There are differences in treatment with psychoactive drugs between nursing homes. Patients with reduced cognitive functions receive less cardiovascular drugs than patients with normal cognition. The reason for this still remains unclear. Improvement strategies are needed. The proportion of patients per institution on selected drugs can serve as a feedback parameter in quality systems.

Subclinical hypothyroidism (SCHo) is a common biochemical diagnosis in older age. Evidence of impact is inconclusive and guidelines are inconsistent. With increasing numbers of thyroid function tests (TFTs) performed, GPs frequently have to make management decisions regarding this diagnosis. However, little is known about how SCHo is currently being managed in primary care.

To explore management of SCHo in primary care and GP reported rationale for treatment of SCHo in older individuals.

Descriptive study using retrospective case note review and GP survey.

Nineteen General Practices, Central England, UK.

Follow-up of a large cohort with subsequent detailed review of individuals for whom therapy had been initiated following diagnosis of SCHo. Data on practice policies, and rationale behind treatment were collected via GP questionnaire.

Forty-two individuals were treated following identification of SCHo. Factors regarded as supporting instigation of therapy recorded by practitioners included symptoms, a positive antithyroid antibody test and history of radioiodine therapy. In all, 55% were registered at 3/19 practices suggesting significant between practice variation. Reasons for testing included chronic disease check-up (n = 14), presenting ‘thyroid symptoms’ (n = 5) and presenting other symptoms (n = 9). Reasons for therapy initiation were only recorded in 26 cases and included presence of symptoms, persistently high or increasing serum thyroid stimulating hormone concentration and patient request. Only 2/15 GPs reported having practice guidelines on management.

Results suggest that GPs are uncertain how to interpret symptoms and TFT results in older individuals. There is considerable variation in management of SCHo between GPs with some GPs treating patients outside of all guideline recommendations.

In this paper, we report on how formative research was utilised to design a social marketing campaign commissioned by a Primary Care Trust within an area of high social deprivation in the North of England.

Men represent the majority of perpetrators of domestic violence and there is increasing interest in developing services for this group with the aim of changing abusive behaviour. However, men are known to be less likely to engage in help-seeking behaviours, and this reticence has been attributed to the social construction of masculinity. A further barrier for men seeking help in relation to domestic violence is the cultural construction of domestic violence.

Formative research was undertaken to explore the perceptions and attitudes of a community population of males (n = 84). Focus groups explored barriers and drivers to help-seeking and identified effective communication messages.

These findings were translated into the ‘Strength to Change’ campaign that minimised stigmatisation and blame while emphasising help-seeking as a ‘strength’ rather than a perceived weakness. Social marketing techniques facilitated an in-depth appreciation of local barriers to help-seeking and generated context-specific messages to encourage take-up of a new service for male perpetrators.

The overall purpose was to develop, test and evaluate an educational package to help people with diabetes self-manage their risk of developing chronic kidney disease (CKD), one of the main complications of diabetes.

Management of people in primary care who have both CKD and diabetes can be controlled by strict blood pressure (BP) and blood sugar control and advice on lifestyle changes, such as smoking cessation. However, there is little evidence to support the assertion that self-management can slow the rate of kidney disease progression.

A mixed-method longitudinal study. Development of the self-management package was informed by the findings of a case study in six GP Practices and also through interviews with 15 patients.

Testing of the self-management package was undertaken in the same six Practices, with one additional control Practice. Patients with Type 1 or Type 2 diabetes at risk of kidney disease were included. Outcomes in patients in the participating surgeries who did receive a pack (n = 116) were compared with patients in the control group (n = 60) over 6 time points.

At the end of the study (time point 6), the intervention group had a mean systolic BP of 4.1 mmHg lower and mean diastolic BP of 2.7 mmHg lower than in the control group.

Self-management techniques such as understanding of, and subsequent concordance with, prescribed BP medication may contribute to a reduction in BP, which in turn will reduce cardiovascular risk.

Relevance to clinical practice: This study contributes to the evidence base for self-management of early kidney disease. Although the exact reason for reduced BP in the intervention group is unclear, the importance of practitioner understanding of kidney disease management and patient understanding of BP medication are likely to be the contributing factors.

The role of the primary care mental health worker (PCMHW) in providing self-help and signposting to people referred for mild-moderate anxiety and depression is currently being complemented by low-intensity workers training under the government’s improving access to psychological therapies (IAPT) programme.

This study aims to explore the experiences of five PCMHWs working in the context of a newly designed primary care mental health team in London.

Thematic analysis of participants’ written reflective papers provides a qualitative exploration of issues and concerns raised by PCMHWs during a fortnightly reflective practice group.

Themes emerging from participants’ written accounts highlight: difficulties in applying academic and skills training to the real-life world of clinical practice; difficulties in managing issues of risk and complexity; role confusion; and the need for a visible and coherent career structure.

The study highlights the psychological impact on PCMHWs of managing complex client referrals. This is discussed in the context of the high volume case turnover anticipated by IAPT training curricula. Implications for the training and education of IAPT low-intensity workers are briefly considered.

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 paper examined the association between wealth and health insurance status and the use of traditional medicine (TM) among older persons in Ghana.

There have been considerable efforts by sub-Saharan African countries to improve access to primary health care services, partly through the implementation of risk-pooling community or national health insurance schemes. The use of TM, which is often not covered under these insurance schemes, remains common in many countries, including Ghana. Understanding how health insurance and wealth influence the use of TM, or otherwise, is essential to the development of equitable health care policies.

The study used data from the first wave of the World Health Organisation’s Study of Global Ageing and Adult Health conducted in Ghana in 2008. Descriptive statistics and negative loglog regression models were fitted to the data to examine the influence of insurance and wealth status on the use of TM, controlling for theoretically relevant factors.

Seniors who had health insurance coverage were also 17% less likely to frequently seek treatment from a TM healer relative to the uninsured. For older persons in the poorest income quintile, the odds of frequently seeking treatment from TM increased by 61% when compared to those in the richest quintile. This figure was 46%, 62% and 40% for older persons in poorer, middle and richer income quintiles, respectively, compared to their counterparts in the richest income quintile.

The findings indicate that TM was primarily used by the poor and persons who were not enrolled in the National Health Insurance Scheme. TM continues to be a vital health care resource for the poor and uninsured older adults in Ghana.

To explore whether and how health visitors experience ethical tensions between the public health agenda and the need to be responsive to individual clients.

Current health policy in England gives health visitors a key role in implementing the government's public health agenda. Health visitors are also required by their Professional Code to respond to the health-related concerns and preferences of their individual clients. This may generate tensions.

A total of 17 semi-structured individual interviews covering participants’ experiences of implementing public health interventions and perceptions of the ethical tensions involved were conducted. Interviews were audio-recorded, transcribed and analysed thematically using a Framework approach.

Health visitors raised a number of ethical concerns, which they attributed to organisational resource allocation and the introduction of protocols and targets relating to public health goals. They did not always regard it as appropriate to raise topics that employing organisations had identified as public health priorities with particular clients for whom they were not priorities, or who had other more pressing needs. They noted that resources that were allocated towards reaching public health targets were unavailable for clients who needed support in other areas. Organisational protocols designed to monitor performance put pressure on health visitors to prioritise achieving targets and undermined their ability to exercise professional judgement when supporting individual clients. This had implications for health visitors’ sense of professionalism. Health visitors saw trusting relationships as key to effective health visiting practice, but the requirement to implement public health priorities, combined with a lack of resources in health visiting, eroded their ability to form these. Policies need to be evaluated with regard to their impact upon a broader range of processes and outcomes than public health goals. The erosion of health visitors’ professional values and ability to develop relationships with clients could have numerous adverse implications.

We describe how patient and public involvement (PPI) was integrated into the design of an intervention for a randomised controlled trial (RCT) based within primary care. The RCT, known as the PLEASANT trial, aimed to reduce unscheduled medical contacts in children with asthma associated with start of the new school year in September with a simple postal intervention, highlighting the importance of maintaining asthma medication for helping to prevent increased asthma exacerbations.

PPI is a key feature of UK health research policy, and is often a requirement of funding from the National Institute for Health Research. There are few detailed accounts of PPI in the design and conduct of clinical trials in the PPI literature for researchers to learn from.

We held PPI consultation events to determine whether the proposed intervention for the trial was acceptable to children with asthma and their parents, and to ascertain whether enhancements should be made. Two PPI consultation events were held with children with asthma and their parents, prior to the research commencing. Detailed field notes were taken by the research team at each consultation event.

At the first consultation event, parents and children endorsed the trial’s rationale, made suggestions to the wording of the trial intervention letter, and made recommendations about to whom the letter should be sent out. At the second consultation event, parents discussed the timing of the intervention, commented on the lay summary of the Research Ethics Application, and were invited to join the trial’s steering committee, while the children selected a logo for the study. PPI has resulted in enhancements to the PLEASANT study’s intervention. A further PPI consultation event is scheduled for the end of the trial, in order for children with asthma and their parents to contribute to the trial’s dissemination strategy.

The aim was to identify similarities and differences between private practice and the National Health Service (NHS) in practitioners’ experiences of delivering acupuncture to treat pain. We wished to identify differences that could affect patients’ experiences and inform our understanding of how trials conducted in private clinics relate to NHS clinical practice.

Acupuncture is commonly used in primary care for lower back pain and is recommended in the National Institute for Health and Clinical Excellence's guidelines. Previous studies have identified differences in patients’ accounts of receiving acupuncture in the NHS and in the private sector. The major recent UK trial of acupuncture for back pain was conducted in the private sector.

Semi-structured qualitative interviews were conducted with 16 acupuncturists who had experience of working in the private sector (n = 7), in the NHS (n =3), and in both the sectors (n = 6). The interviews lasted between 24 and 77 min (median=49 min) and explored acupuncturists’ experiences of treating patients in pain. Inductive thematic analysis was used to identify similarities and differences across private practice and the NHS.

The perceived effectiveness of acupuncture was described consistently and participants felt they did (or would) deliver acupuncture similarly in NHS and in private practice. In both the sectors, patients sought acupuncture as a last resort and acupuncturist–patient relationships were deemed important. Acupuncture availability differed across sectors: in the NHS it was constrained by Trust policies and in the private sector by patients’ financial resources. There were greater opportunities for autonomous practice in the private sector and regulation was important for different reasons in each sector. In general, NHS practitioners had Western-focussed training and also used conventional medical techniques, whereas private practitioners were more likely to have Traditional Chinese training and to practise other complementary therapies in addition to acupuncture. Future studies should examine the impact of these differences on patients' clinical outcomes.

To test the feasibility of written emotional disclosure (WED) for UK primary care patients with Type 2 diabetes.

WED holds potential to address depressive symptoms in diabetes, yet its feasibility, and potential benefit, for primary care patients has not been established.

Forty-one adults with Type 2 diabetes were randomised to WED (n=23) or neutral writing (n=18). Principal outcomes were feasibility of recruitment, compliance, acceptability and intervention fidelity. Potential benefit was assessed on between-group differences in depressive symptoms (Centre for Epidemiological Studies Depression scale), diabetes distress (Problem Areas in Diabetes scale), diabetes self-management behaviours (Summary of Diabetes Self-care Activities questionnaire) and perceived health status (EQ-5D) at three-month follow-up.

Recruitment was modest (6%), yet an unmet treatment need was identified. Fourteen intervention (61%) and 13(72%) control participants returned their writing, while 12 in each group (89%) then completed all sessions. Intervention fidelity was confirmed. Acceptability to patients was mixed. Exploratory effectiveness analyses suggested that relative to improvement in controls, WED is associated with a potentially clinically important worsening in depressive symptoms (P=0.006) and a non-significant trend for a reduction in healthy dietary behaviour (P=0.057). There was no significant effect on other outcomes. The exploratory nature of the study, however, necessitates that the observed effects are interpreted with caution, and both the feasibility and effectiveness findings may be an artefact of the sample obtained. The evidence for the feasibility of WED in primary care diabetes was hence mixed, and in an unevaluated environment it may cause iatrogenic harm. On balance, WED is apparently not appropriate for use in this context in its current format. At most, further research with a more appropriate sample is required. The feasibility that was demonstrated and the unmet need identified suggest that this may be a worthy endeavour.

To explore how e-cigarettes are perceived by a group of e-cigarette users and a group of Stop Smoking Advisors (SSAs), what are the risks and benefits they associate with e-cigarettes and how do these understandings shape participants’ attitude towards e-cigarettes?

Face-to-face and phone interviews were conducted with 15 e-cigarette users and 13 SSAs in South East England between 2014 and 2015. Transcribed data were analysed inductively through thematic analysis.

E-cigarettes were used as a therapeutic aid to stop or cut down smoking and as a smoking substitute. A prominent theme is the uncertainty e-cigarettes have generated. This included ambiguity of e-cigarettes’ status and efficacy, and ambiguity of e-cigarettes’ physical and social risks. Different attitudes towards e-cigarettes were identified.

E-cigarettes’ benefits and risks should be continuously evaluated, put into perspective and circulated to avoid ambiguity. Stop smoking services need to recognise the benefits that can be gained by using e-cigarettes as a harm reduction tool.

To investigate cases of suicide in which there was no healthcare contact, by looking at history of help-seeking and evidence of previous mental health vulnerability. To identify any life events associated with suicide for which individuals did not seek help.

Previous research has suggested that non-consultation is the main barrier to suicide prevention among men. Estimates suggest approximately 22% of men who die by suicide have not consulted their GP in the year before their death. Little is known about the lifetime pattern of engagement with services among these individuals and whether or not this may influence their help-seeking behaviour before death.

Coroner records of suicide deaths in Northern Ireland over 2 years were linked to general practice (GP) records. This identified 63 individuals who had not attended health services in the 12 months before death. Coroner’s data were used to categorise life events associated with the male deaths. Lifetime mental health help-seeking at the GP was assessed.

The vast majority of individuals who did not seek help were males (n=60, 15% of all suicide deaths). Lack of consultation in the year before suicide was consistent with behaviour over the lifespan; over two-thirds had no previous consultations for mental health. In Coroner’s records, suicides with no prior consultation were primarily linked to relationship breakdown and job loss. These findings highlight the limitations of primary care in suicide prevention as most had never attended GP for mental health issues and there was a high rate of supported consultation among those who had previously sought help. Public health campaigns that promote service use among vulnerable groups at times of crisis might usefully be targeted at those likely to be experiencing financial and relationship issues.