Tagged / Health

New CMMPH international midwifery publication

international, Publishing, writing

Congratulations to Professor Vanora Hundley in the Centre for Midwifery, Maternal & Perinatal Health (CMMPH) on the publication of her latest international paper ‘How do midwives in Slovenia view their professional status?’ [1]. slovenia midwifery 2015

The paper explores Slovenian midwives’ views of their professional status, linkng this to the participants’ educational background. Most participants did not consider midwifery to be a profession in its ow right. Midwives with secondary education were more likely to consider practical skills to be important than theoretical midwifery knowledge. In general Slovenian midwives did not feel enabled to practise autonomously causing them several ethical dilemmas. All participants with midwifery secondary school education thought that obstetrics jeopardises midwifery scope of practice, but only half of the B.Sc. participants thought this. One-fifth of all participants estimated that midwifery is also threatened by nursing. The respondents reported feeling a lack of control over their professional activity and policy making; however the majority of midwives claimed that they were willing to take on more responsibility for independent practice. The authors conclude that Slovenian midwifery cannot be considered to be a profession yet. It faces several hindrances, due to its historical development.

 

Prof. Edwin van Teijlingen

CMMPH

 

Reference:

Mivšek, P., Pahor, M., Hlebec, V., Hundley, V. (2015) How do midwives in Slovenia view their professional status? Midwifery 31(12):1193-201

Latest BU Nursing publication

Centre for Excellence in Learning, writing

Scammel J Clin Nurse 2016Congratulations to Janet Scammell, Vanessa Heaslip and Emma Crowley in FHSS on their new publication which appeared at the very end of 2015.  Their most recent paper is the first systematic review of service user involvement in non-mental health specific preregistration  nurse education.  The paper ‘Service user involvement in preregistration general nurse education: a systematic review’ is published in the current issue of the Journal of Clinical Nursing. [1]

Well done!

Prof. Edwin van Teijlingen

CMMPH

Reference:

  1. Scammell, J., Heaslip, V., Crowley, E. (2015) ‘Service user involvement in preregistration general nurse education: a systematic review’ Journal of Clinical Nursing 25:53-69.

Mental health & maternity care in Nepal: THET-funded training

international, open access

group work NawalparasiIMG_6649

A few days I posted a short report of our first session as part of the THET-funded project ‘Mental Health Training for Community-based Maternity Providers in Nepal’, see this previous post here.  Yesterday we completed the final third day training of the first session of this BU-led project.  Over three days we had 70 ANMs (Auxiliary Nurse Midwives) in attendance, which we think is (nearly) all such staff based in all birthing centres in the district (=province).  The three days were the same, i.e. each session was repeated twice so each day one third of the ANMs could attend, and two-third could be at work in the birthing centre ensuring women could deliver safely.

logo THETAs part of this project we send UK volunteers (health and/or education) experts to Nepal to offer high quality training in areas where it is most needed.  Further detail on this BU-led THET project can be found in our scientific paper Mental health issues in pregnant women in Nepal  published in the Nepal Journal of Epidemiology available through Open Access.  Mental illness is still very much a taboo topic in Nepal as it has often a serious stigma attached to it.  Moreover, the relatively short training of ANMs is often fairly basic and the national curriculum does not cover mental health issues in any detail.  This joint project between Bournemouth University, Liverpool John Mooores University, Tribhuvan University and the local charity Green Tata Nepal addresses issues about mental health in general and in pregnant women and new mothers in particular.  Tribhuvan University is the oldest university in Nepal and one of the ten largest universities in the world (based on student numbers).  The project is multi-disciplinary involving midwives, (mental health) nurses, and doctors as well as global health researchers, educationalists and sociologists.

 

Prof. Edwin van Teijlingen

CMMPH

 

 

New Public Health paper on Christmas Eve

Publishing, writing

Douglas 2015 Men healthOur latest paper and the last one for 2015, published the day before Christmas.  The paper ‘Implementing Health Policy: Lessons from the Scottish Well Men’s Policy Initiative’ appeared in AIMS Public Health [1].  The paper draws on evaluation research led by Dr. Flora Douglas (University of Aberdeen).  This was a set of evaluations of the Well Men’s Health projects which were part of an initiative running in many health regions (or health boards as they are called in Scotland).

 

The focus of this particular paper centres around the fact that little is known about how health professionals translate government health policy into action [2]. Our paper examines that process using the  Scottish Well Men’s Services policy initiative as a ‘real world’ case study [1]. These Well Men’s Services were launched by the Scottish Government to address men’s health inequalities. Our analysis aimed to develop a deeper understanding of policy implementation as it naturally occurred.  We used an analytical framework that was developed to reflect the ‘rational planning’ principles health professionals are commonly encouraged to use for implementation purposes.

Our analysis revealed four key themes: (1) ambiguity regarding the policy problem and means of intervention; (2) behavioral framing of the policy problem and intervention; (3) uncertainty about the policy evidence base and outcomes, and; (4) a focus on intervention as outcome. This study found that mechanistic planning heuristics (as a means of supporting implementation) fails to grapple with the indeterminate nature of population health problems. A new approach to planning and implementing public health interventions is required that recognises the complex and political nature of health problems; the inevitability of imperfect and contested evidence regarding intervention, and, future associated uncertainties.

 

The paper is published in an Open Access journal, so it is easily and freely available to public health professionals, policy-makers and health workers across the globe.

Prof. Edwin van Teijlingen 

CMMPH

 

Reference:

  1. Douglas, F., van Teijlingen, E., Smith, W.C.S., Moffat, M. (2015) Implementing Health Policy: Lessons from the Scottish Well Men’s Policy Initiative, AIMS Public Health 2 (4): 887-905. http://www.aimspress.com/article/10.3934/publichealth.2015.4.887/fulltext.html
  2. Killoran, A., Kelly, M. (2004) Towards an evidence-based approach to tackling health inequalities: The English experience. Health Education Journal;63: 7-14.

Mixed methods: not without its downside?

REF Subjects

Prof Edwin van Teijlingen

Conducting mixed-methods research has become very popular over the past decade especially in the health research field.1-4 This development ties in with the growth in inter-disciplinary and multi-disciplinary research. Many grant applications, PhD project and the resulting papers especially in the health field apply a mixed-methods approach, where in the past a single approach would have dominated.   This interest in combining methods seems to be the case even in the more traditional quantitative field of clinical effectiveness and randomised controlled trials. Whilst I find this development encouraging as a mixed-methods social scientist, it also makes me wonder whether the applicants putting forward a mixed-methods project have thought about the disadvantages or at least the opportunity costs of using such approach.

A mixed-methods approach is ‘simply’ combining two or more research methods to address a research question, i.e. what the label suggests. It is often perceived as the combining of qualitative with quantitative methods, but it can technically also be a mix of quantitative methods or a combination of qualitative methods. The advantage of a mixed-methods approach is that the different methods in the mix address different aspects of the research question and that combining these methods offers a synergetic effect. So what are the possible limitations of or barriers to mixed-methods research?

First, using a mixed-methods approach means you need an understanding of two different philosophies and how to bring the findings of these two different methods together.4-6   One requires expertise in two different research approaches, either as individual or in the team as well as someone who can do the combining of the findings. For the latter you really need someone in the team who understand the pragmatic approach commonly used in mixed-methods approaches. Otherwise there is a great risk that the original mixed-methods study will be analysed and reported as two or more separate papers each based on data from one of the methods applied in the mixed-methods study.

Secondly, you can spend your money only once, hence there are opportunity costs. Thus if the maximum grant is £200,000 or £300,000 you can’t spend the full amount on the designing a large-scale quantitative study/survey, as you need to spend a proportion of your money and your attention and time on your qualitative study.

Thirdly, and related the above, both quantitative and qualitative methods have ‘rules’ about sampling and sample-size.5 Just because you have two methods this does not mean you can necessarily do a study with a smaller sample. The sample size calculations will still say you need at least xxx participants. Similarly, although perhaps not so rigidly you need a certain number of interviews or focus groups to do you qualitative study appropriately.

Fourthly, a common mistake seems to be to add a bit of qualitative research to a larger quantitative study, perhaps a bit tokenistic.7 Often it is so obvious in a grant application that the qualitative research is an add-on, an afterthought perhaps from a reviewer in the previous failed grant application.

Finally, not all mixed-methods studies are the same, in fact each mixed-methods study is more or less unique in the way in the way it mixes and matched individual research methods.3 So although mixed-methods may be the best way to address a particular research question, your particular proposed mixed of quantitative and qualitative research might not be the most appropriate to answer the overall research question.8

As with all research methods and research proposals my recommendation is if in doubt go and find an expert for advice.6 If necessary get an expert on your team of researchers to strengthen your application.

 

Professor Edwin van Teijlingen

CMMPH

 

References:

  1.  Barbour, R.S. (1999) The case of combining qualitative and quantitative approaches in health services research. Journal of Health Services Research Policy, 4(1): 39-43.
  2. Simkhada, P., van Teijlingen, E., Wasti, S.P., Sathian, B. (2014) Mixed-methods approaches in health research in Nepal, Nepal Journal of Epidemiology 4(5): 415-416.
  3. Plano Clark, V.L., Anderson, N., Wertz, J.A., Zhou, Y., Schumacher, K., Miaskowski, C. (2015) Conceptualizing Longitudinal Mixed Methods Designs: A Methodological Review of Health Sciences Research, Journal of Mixed Methods Research, 9: 297-319.
  4. MacKenzie Bryers, H., van Teijlingen, E. Pitchforth, E. (2014) Advocating mixed-methods approaches in health research, Nepal Journal of Epidemiology 4(5): 417-422. http://www.nepjol.info/index.php/NJE/article/view/12018/9768
  5. Bryman, A. (1988) Quality and Quantity in Social Research, London: Routledge
  6. Bazeley, P. (2003) Teaching mixed methods. Qualitative Research Journal, 4: 117-126.
  7. Maxwell, J.A. (2016) Expanding the History and Range of Mixed Methods Research, Journal of Mixed Methods Research, 10: 12-27.
  8. Brannen, J. (2005) Mixing methods: The entry of qualitative & quantitative approaches into the research process. International Journal of Social Research Methodology 8(3): 173-85.

 

Congratulations to FHSS staff on latest KPI publication

Knowledge Exchange, Knowledge Transfer, Publishing

Five RiversCongratulations to FHSS Celia Beckett and Jaqui Hewitt-Taylor and colleagues Richard Cross and Pam McConnell based at Five Rivers Child Care, Salisbury. Their first paper describes the exciting process of a Knowledge Transfer Partnership (KTP) project between BU and Five Rivers Child Care which started in 2012 and finished recently in 2015.[1]    The project was established to develop a stepped assessment package that would help to identify the emotional and behavioural needs of children who are looked after to ensure the right services are accessed and to monitor their progress.

 

Congratulations,

Professor Edwin van Teijlingen

CMMPH

 

Reference:

  1. Celia Beckett , Richard Cross , Jaqui Hewitt-Taylor , Pam McConnell (2015) Developing a process for assessment of the emotional and behavioural needs of “looked after” children: the Five Rivers model Journal of Children’s Services, 10(4):  324-38.

New joint AECC and FHSS publication

PG research, Publishing

journal 2015

Congratulations to Joyce Miller, Monica Beharie and Elisabeth Simmenes based at the Anglo-European College of Chiropractic (AECC) and FHSS’s Alison Taylor and Sue Way who just had their paper ‘Parent reports of exclusive breastfeeding after attending a combined midwifery and chiropractic feeding clinic in the UK: A cross sectional service evaluation’ accepted in the journal Journal of Evidence-Based Complementary & Alternative Medicine.

Congratulations!

Prof. Edwin van Teijlingen

CMMPH

 

 

Suicide in India: Modelling data

international, Publishing

The latest BU research publication used a modelling approach to suicide in India [1].  The paper ‘Time Trend of the Suicide Incidence in India: a Statistical Modelling’ is now online and freely available as it was published in an Open Access journal.  The first author of this paper is BU Visiting Faculty Dr. Brijesh Sathian.  The modelling resulted in some useful predictions of future risk of suicide at a population level, see for example: 10.12691.ajphr-3-5A-17.fig_1

 

Prof. Edwin van Teijlingen

Reference:

Sathian, B. , De, A. , Teijlingen, E. V. , Simkhada, P. et al. (2015). Time Trend of the Suicide Incidence in India: a Statistical Modelling. American Journal of Public Health Research, 3(5A), 80-87.  Online at:  http://pubs.sciepub.com/ajphr/3/5A/17/

International Longevity Centre host blog by HSS PhD student Andy Harding

PG research, student research

The following was hosted by the International Longevity Centre:

The Future of Welfare Consumerism: Future challenges and opportunities of welfare consumerism in health and social care

Welfare rights and financial advice_mThe rationale for the creation of the welfare state in the post war period was, in large part, because a market approach to welfare had failed. So how can the market and consumerism now be the solution? Despite this philosophical question, for more than two decades welfare consumerism and markets has been and continues to be at the heart of UK health and social care policy. This presents many challenges and opportunities for practitioners, policymakers and researchers alike – particularly concerning older people. Older people are the largest ‘customer’ of welfare services, thus any welfare policy has major ramifications for us all in later life. But what are the important issues? The important issues are basic, but at the same time complex. There is not one welfare market, and with older people not a homogenous group, there are different types and cohorts of consumers.

The basic issue is simple. It is perhaps not comfortable to label welfare as a commodity. A commodity implies a good or service that we purchase to suit a desire. Yet, rarely does welfare satisfy a desire. On the other hand, we access welfare provision because we have a need. Indeed, it is a commodity and market unlike mainstream markets. Whereas mainstream consumers can use their ‘invisible hand’ to navigate markets and access the type or brand of tea, coffee, tablet or laptop that they like, the need to access welfare is characterised by significant information asymmetries, and often complex, vulnerable and emotional circumstances.

Considering these relative complexities, we know remarkably little about how older people act in welfare markets. Although the welfare consumer might have little in common with the mainstream consumer, nevertheless consumer theory provides a platform to outline the more complex challenges for future research and policy.

Implicit in using markets as a means to allocate resources is that consumers are informed and make good quality choices. This in turn requires us to focus on how older welfare consumers become informed – are they adequately informed? Do they seek impartial and independent information and advice (I&A)? How do they act on and use I&A? How can we ensure that I&A services are funded properly and have adequate coverage? These are just some of the broader future challenges and questions that must be addressed.

These are challenges for both health and social care, where the consumerist landscape created by individual budgets and direct payments, first trail blazed in social care (and mostly lobbied for by younger groups), is now being introduced for increasing numbers of older people with chronic and longer term health conditions. Choices of provider and care package/pathway are now and will increasingly be the norm in health and social care.

In addition, my own on-going doctoral study with FirstStop, a third sector provider of information and advice on housing and care issues in later life, acts to highlight another under looked area – housing. Housing may have a longer association with markets and consumerism, yet it is nevertheless a central pillar of welfare. And for good reason – the appropriateness of housing (e.g. preventing falls and fractures in the home as the stereotypical and archetypal example) in later life can be a key determinant of health and wellbeing. In other words, appropriate housing can reduce the likelihood that an older person needs to access health services and social care.

This final point should also chime with the fiscally minded – informed older welfare consumers, through accessing good quality I&A equates to older people making more informed choices about welfare and enables independence. By implication, this means less dependency on welfare – something which, as consumers who will all grow old one day, should be desirable to us all.

 

Congratulations new publication Dr. Pramod Regmi in FHSS

Publishing

Asia Pac J PH 2015Asian-Pacific Journal of Public Health published an editorial with Dr. Pramod Regmi as its first author.  The editorial ‘Importance of Health and Social Care Research into Gender and Sexual Minority Populations in Nepal.’  The authors argue that despite progressive legislative developments and increased visibility of sexual and gender minority populations in the general population, mass media often report that this population face a wide range of discrimination and inequalities. LGBT (lesbian, gay, and bisexual, and transgender) populations have not been considered as priority research populations in Nepal.

 

Prof. Edwin van Teijlingen

CMMPH

Reference:

Regmi, R.R., van Teijlingen, E.  Importance of Health and Social Care Research into Gender and Sexual Minority Populations in Nepal

Asia Pac J Public Health 2015 27: 806–808,