The aim of this study was to obtain qualitative data to understand how type 2 diabetic patients with unregulated blood glucose levels (HbA1c >140 mg/dL) seek and use information sources for their diet.

A descriptive, explorative study design was used with focus group interviews in the Brussels-Capital Region. Each interview was recorded, transcribed literally, and analysed thematically using a grounded theory approach.

GPs were the most important information source in this study. GPs and other professionals were considered to be reliable sources of information by the patients. All patients received information passively at diagnosis. Patients that actively sought information differed in their search behaviour and reported they were not sufficiently informed. Some information sources remained unknown to the diabetic patients in this study.

Diabetic patients of the Brussels-Capital Region are not well informed about their diet. The main problem is how patients perceived the accessibility of information.

Public health strategies are required to promote well-informed, proactive patients supported by healthcare teams.

To explore the beliefs, attitudes, and behaviours of fathers towards breastfeeding and how they impact either positively or negatively on their partners’ decisions to initiate or continue breastfeeding.

Despite policy initiatives at a national and international level and the increased number of baby-friendly hospitals within the UK, breastfeeding rates are slow to rise. Support from both parents has been proven to increase uptake and continuation rates, but there is little research into the emotional experience of fathers when it comes to breastfeeding.

We conducted qualitative interviews with 18 fathers in Wiltshire, England. Principles of grounded theory were used throughout this study to guide the sampling, data collection, and data analysis.

Fathers knew the health benefits of breastfeeding and wanted their child to breastfeed but were unsure of their place in the feeding process because they felt it was not their body. While they were aware of the benefits of breast milk for infants, fathers felt less informed of the practicalities of breastfeeding and the potential challenges they and their partner might have to overcome to breastfeed successfully for the recommended six-month period. Based on these findings, three segments were identified: the problem bonders, the dual bonders, and the pragmatists. All segments were concerned with the well-being of their partner and child and wanted their child to be breastfed. Health professionals can use the results of this study to create prenatal educational resources that take more of a preventive and problem-solving approach as opposed to promoting breastfeeding in efforts to comply with National Health Service guidelines, without offering solutions to common breastfeeding problems.

Overweight and obesity are growing problems for primary care. Although effective weight management programs exist, these programs experience significant attrition, which limits effectiveness.

This study examined provider and staff perceptions of attrition from the Veterans Health Administration MOVE!® Weight Management Program as an initial step toward understanding attrition from primary care-based programs.

MOVE!® clinicians, primary care providers, and other staff members who interacted with patients about participating in MOVE!® (n=754) from Department of Veterans Affairs medical centers throughout the United States. Respondents were predominantly female (80.8%), Caucasian (79.2%), and trained as nurses (L.P.N., R.N., or N.P.; 50%).

Participants completed a web-mediated survey; items assessed agreement with personal and programmatic reasons for dropout, and allowed respondents to indicate the number one reason for dropout in an open-ended format. This survey was adapted from an existing tool designed to capture patient perceptions.

Respondents indicated that veterans experienced practical barriers to attendance (eg, transportation and scheduling difficulties) and desire for additions to the program (eg, a live exercise component). Low motivation was the primary factor identified by respondents as associated with dropout, particularly as noted by MOVE!® clinicians (versus other providers/staff; P<0.01).

These findings suggest that programmatic changes, such as adding additional meeting times or in-session exercise time, may be of benefit to MOVE!®. In addition, increasing the use of techniques such as Motivational Interviewing among providers who refer patients to MOVE!® may improve participant engagement in MOVE!® and other primary care-based weight management programs. Further research is needed to effectively identify those likely to withdraw from weight management programs before achieving their goals, and the reasons for withdrawal.

To study (a) the covariation between patient reported experience measures (PREMs) and registered process measures of access and continuity when ranking providers in a primary care setting, and (b) whether registered process measures or PREMs provided more or less information about potential linkages between levels of access and continuity and explaining variables.

Access and continuity are important objectives in primary care. They can be measured through registered process measures or PREMs. These measures do not necessarily converge in terms of outcomes. Patient views are affected by factors not necessarily reflecting quality of services. Results from surveys are often uncertain due to low response rates, particularly in vulnerable groups. The quality of process measures, on the other hand, may be influenced by registration practices and are often more easy to manipulate. With increased transparency and use of quality measures for management and governance purposes, knowledge about the pros and cons of using different measures to assess the performance across providers are important.

Four regression models were developed with registered process measures and PREMs of access and continuity as dependent variables. Independent variables were characteristics of providers as well as geographical location and degree of competition facing providers. Data were taken from two large Swedish county councils.

Although ranking of providers is sensitive to the measure used, the results suggest that providers performing well with respect to one measure also tended to perform well with respect to the other. As process measures are easier and quicker to collect they may be looked upon as the preferred option. PREMs were better than process measures when exploring factors that contributed to variation in performance across providers in our study; however, if the purpose of comparison is continuous learning and development of services, a combination of PREMs and registered measures may be the preferred option. Above all, our findings points towards the importance of a pre-analysis of the measures in use; to explore the pros and cons if measures are used for different purposes before they are put into practice.

Historically, epilepsy care has been documented as poor. The New Contract introduced epilepsy as a quality indicator from April 2004.

To measure the unmet clinical needs in patients with epilepsy, following an audit, with educational intervention and the introduction of the New Contract.

Prospective audit.

Thirteen general practices (population 68 240).

The case notes of 388 patients receiving treatment for epilepsy were reviewed in the two years before, and four years after, the introduction of the New Contract in April 2004. An intervention took place, which consisted of (a) a letter to each practice summarising the main findings; (b) the provision of a comprehensive template; (c) an individualised categorisation for each patient; (d) a single educational session led by a Neurologist with an interest in epilepsy in March 2004; and (e) the introduction of the New Contract in April 2004.

The audit was completed in 267 cases. There was a significant increase in the annual review rate and documentation of seizure frequency. This happened after the New Contract was introduced, and has been sustained. The number of patients under shared care fell significantly from 22% to 16%. Thirty of the 62 (48%) patients with poor control were not receiving shared care. There were 13 referrals and 32 practice interventions related to the audit, with 39 positive outcomes. There was one death in a poorly controlled patient who was not under shared care, nor had been seen regularly by their general practitioner.

The unmet needs of some patients were highlighted by the audit resulting in appropriate management of these patients. However, despite the significantly improved review rates in primary care, and the availability of specialist services locally, we remain concerned about the proportion of patients with refractory epilepsy who do not seem to be receiving coordinated shared care.

This paper describes the study protocol, which aims to evaluate the effectiveness of a multifaceted intervention package called ‘Enhanced Primary Healthcare’ (EnPHC) on the process of care and intermediate clinical outcomes among patients with Type 2 diabetes mellitus (T2DM) and hypertension. Other outcome measures include patients’ experience and healthcare providers’ job satisfaction.

In 2014, almost two-thirds of Malaysia’s adult population aged 18 years or older had T2DM, hypertension or hypercholesterolaemia. An analysis of health system performance from 2016 to 2018 revealed that the control and management of diabetes and hypertension in Malaysia was suboptimal with almost half of the patients not diagnosed and just one-quarter of patients with diabetes appropriately treated. EnPHC framework aims to improve diagnosis and effective management of T2DM, hypertension or hypercholesterolaemia and their risk factors by increasing prevention, optimising management and improving surveillance of diagnosed patients.

This is a quasi-experimental controlled study which involves 20 intervention and 20 control clinics in two different states in Malaysia, namely Johor and Selangor. The clinics in the two states were matched and randomly allocated to ‘intervention’ and ‘control’ arms. The EnPHC framework targets different levels from community to primary healthcare clinics and integrated referral networks.

Data are collected via a retrospective chart review (RCR), patient exit survey, healthcare provider survey and an intervention checklist. The data collected are entered into tablet computers which have installed in them an offline survey application. Interrupted time series and difference-in-differences (DiD) analyses will be conducted to report outcomes.

We explored the ‘coping reflections’ of elderly couples living alone (without any other family members) during the COVID-19 pandemic in urban Odisha, India.

Evidence worldwide suggests that older people are at increased risk from COVID-19 adverse outcomes and experience greater stress. In our previous community-based study urban dwelling, particularly elderly participants, and living alone reported higher pandemic-associated health care challenges than their rural and residing-with-family counterparts. We intended to explore how the elderly couples living alone coped through this challenging yet stressful situation during the COVID-19 pandemic and what were their key strategies adopted toward this.

We conducted telephonic in-depth interviews (IDIs) with 11 urban elderly couples living alone in Bhubaneswar city of Odisha, India using a semi-structured interview guide. All IDIs were digitally recorded, transcribed into the original language, and translated to English. We used a thematic approach for analysis.

Four themes emerged: (1) Risk appraisal and feeling vulnerable; (2) Safeguarding against COVID-19; (3) Managing routine health care and emergency; and (4) Pursuing mental and psychological well-being. Although fear, anxiety, and loneliness were continuing stressors, many of them learnt to adapt and emerge resilient with the evolving situation. Various elements at the individual, family, community, and organizational levels were conducive to better coping. The companionship and complementary support of spouse, self-health literacy, and digital efficacy, virtual connectedness with family and friends, availability of community pharmacy and diagnostic services in the vicinity, support of neighbors, reengaging with creative leisure time activity, and assurance of a responsive administration at the time of emergency helped them to cruise through the pandemic. Furthermore, watching the re-telecast of prime time serials made these elderly fondly remember their own youth time memories. Self-health monitoring, indoor physical exercise, spiritual practices, continuation of previous prescription, telephonic advice of physicians were add-on strategies that facilitated their physical and psychological well-being during the pandemic.

To identify which patient-related effect modifiers influence the outcomes of integrated care programs for type 2 diabetes in primary care.

Integrated care is a widespread management strategy for the treatment of type 2 diabetes. However, most integrated care programs are not tailored to patients’ needs, preferences and abilities. There is increasing consensus that such a patient-centered approach could improve the management of type 2 diabetes. Thus far, it remains unclear which patient-related effect modifiers should guide such an approach.

PubMed, CINAHL and EMBASE were searched for empirical studies published after 1998. A systematic literature review was conducted according to the PRISMA guidelines.

In total, 23 out of 1015 studies were included. A total of 21 studies measured the effects of integrated diabetes care programs on hemoglobin A1c (HbA1c) and three on low-density lipoprotein cholesterol, systolic blood pressure and health-care utilization. In total, 49 patient characteristics were assessed as potential effect modifiers with HbA1c as an outcome, of which 46 were person or health-related and only three were context-related. Younger age, insulin therapy and longer disease duration were associated with higher HbA1c levels in cross-sectional and longitudinal studies. Higher baseline HbA1c was associated with higher HbA1c at follow-up in longitudinal studies. Information on context- and person-related characteristics was limited, but is necessary to help identify the care needs of individual patients and implement an effective integrated type 2 diabetes tailored care program.

Paediatric chronic fatigue syndrome or myalgic encephalopathy (CFS/ME) is relatively common and disabling. Current guidance recommends referral to specialist services, although some general practitioners believe the label of CFS/ME is harmful and many are not confident about diagnosing CFS/ME.

Explore whether or not adolescents and their mothers value referral to a specialist service for young people with CFS/ME.

A qualitative study nested within a feasibility study of interventions for CFS/ME [Specialist Medical Intervention and Lightning Evaluation (SMILE)]. In-depth interviews were undertaken with 13 mothers and 12 adolescents participating in the SMILE study. Transcripts were systematically assigned codes using the qualitative data organisation package NVivo and analysed thematically using techniques of constant comparison.

Gaining access to the specialist service was difficult and took a long time. Mothers felt that they needed to be proactive and persistent, partly because of a lack of knowledge in primary and secondary care. Having gained access, mothers felt the CFS/ME service was useful because it recognised and acknowledged their child's condition and opened channels of dialogue between health-care professionals and education providers. Adolescents reported that specialist medical care resulted in better symptom management, although some adolescents did not like the fact that the treatment approach limited activity.

Adolescents and their mothers value receiving a diagnosis from a specialist service and making progress in managing CFS/ME. General practitioners should support adolescents with CFS/ME in accessing CFS/ME specialist services, consistent with current guidance.

Secondary prevention and self-management of coronary heart disease (CHD) are of major importance to people who survive myocardial infarction (MI). This can be facilitated by cardiac rehabilitation (CR; the formal health service programme) and informal CHD self-help groups. Non-participation is an important issue, yet it is poorly understood. Rehabilitation difficulties and prevention challenges have been identified among people following MI, but the particular experience and perspective of CR and CHD group non-participants are largely unknown.

The study aimed to understand non-participation in CR and CHD self-help groups from the perspectives of the non-participants and to provide insight into their experience and that of their ‘significant others’ in rehabilitating in the absence of these resources.

In-depth interviews were conducted with 27 people who had not participated in either hospital-based CR or a CHD group, 6–14 months post-MI, and 17 ‘significant others’ in Lothian, Scotland.

Factors influencing non-participation fell into three broad themes ‘No need/no point’, ‘Not worth it’, and ‘Not possible’. In the latter two categories, non-participation in these resources was often considered a ‘missed opportunity’ and needs had remained unmet. Shifts between categories could occur over time. Non-participation was linked to rehabilitation difficulties for some people and family members. Recommendations to enhance post-MI support are made.

Guidelines may improve clinical outcomes for depression, but whether they are followed in primary care is uncertain.

To assess general practioners (GPs’) adherence to the National Institute for Health and Clinical Excellence (NICE) guidelines for managing depression in adults (2004).

Anonymized Questionnaire Survey.

Thirty-eight partnerships within one primary care trust in England.

Focused questionnaire incorporating measurable criteria, posted to GPs in May 2007.

The response rate was 67% (143/215 GPs). GPs followed NICE guidelines when screening for depression in patients with physical illness, using selective serotonin reuptake inhibitor antidepressants appropriately and referring to counselling and secondary care. However, 48% GPs did not screen patients with a history of depression, 44% discontinued medication too soon and 38% avoided prescribing for ‘understandable’ moderate depression. GPs identified poor access to cognitive behaviour therapy (CBT) as the greatest barrier to implementing guidelines. Only 41% personally used CBT. Adherence to NICE guidelines was significantly higher for GPs trained in psychiatry and in younger GPs, but was not associated with gender, practice size, possessing the Membership of the Royal College of General Practitioners or reading guidelines. Less than half (38%) of the GPs rated NICE as having a moderate or substantial impact upon their clinical management. The Quality and Outcomes Framework (QOF) had more influence than NICE guidelines upon detection and recording of care, especially in larger practices.

Training more cognitive behaviour therapists, making psychiatry experience mandatory for future GPs and focusing QOF incentives upon treatment outcomes as well as screening may improve adherence to NICE depression guidelines.

To explore practice teachers understanding of the process of professional education experienced by community nursing students.

This paper analyses the concepts of situated learning and communities of practice as an underpinning theoretical framework to understand the professional education of community nurses in practice settings. The paper also highlights the strengths and limitations of the community of practice theory as applied to professional education.

A qualitative grounded theory study was undertaken involving interviews with 30 community nurse practice teachers.

Emerging from the data were the central components of Lave and Wenger's theory of communities of practice. The practice teachers appeared to use these components including legitimate peripheral participation, sponsorship and journeying to good effect in facilitating the development of community nurse students. The paper extends Lave and Wenger's community of practice phenomenon and identifies how communities are (re)produced over time. The development of professional practitioners over a lengthy period of time within supportive communities of practice where one person with expertise in professional education sponsors the student and takes responsibility for their journey was perceived by practice teachers to be an important and appropriate approach. An approach that was found by practice teachers to transform the student's professional identity, enabling them to undertake a complex multifaceted role using a holistic, problem solving and participative style with clients and communities. It is also an approach that was hypothesised to allow the profession itself to (re)produce in a way that supports continuity but also promotes changes in practice.