Christine Milligan

Emergency Hormonal Contraception (EHC) has been underused in Britain and internationally since its introduction. ‘Stigmatisation’ has been identified as one of the barriers to EHC. However, few, if...

The drive towards living well with dementia has resulted in a growing recognition of the value of community-based participatory arts activities. This review aimed to explore their overall impact an...

Background and Objectives: Although telehealth research among the general population is voluminous, the quality of studies is low and results are mixed. Little is known specifically concerning older people and their self-efficacy to engage with and benefit from such technologies. This article reviews the evidence for which self-care telehealth technology supports the self-efficacy of older people with long-term conditions (LTCs) living at home. Research Design and Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA) guidelines, this overview of systematic reviews focused on four LTCs and the concept of “self-efficacy.” Quality was appraised using R-AMSTAR and study evaluation was guided by the PRISMS taxonomy for reporting of self-management support. Heterogeneous data evidencing technology-enhanced self-efficacy were narratively synthesized. Results: Five included articles contained 74 primary studies involving 9,004 participants with chronic obstructive pulmonary disease, hypertension, heart failure, or dementia. Evidence for self-care telehealth technology supporting the self-efficacy of older people with LTCs living at home was limited. Self-efficacy was rarely an outcome, also attrition and dropout rates and mediators of support or education. The pathway from telehealth to self-efficacy depended on telehealth modes and techniques promoting healthy lifestyles. Increased self-care and self-monitoring empowered self-efficacy, patient activation, or mastery. Discussion and Implications: Future research needs to focus on the process by which the intervention works and the effects of mediating variables and mechanisms through which self-management is achieved. Self-efficacy, patient activation, and motivation are critical components to telehealth’s adoption by the patient and hence to the success of self-care in self-management of LTCs. Their invisibility as outcomes is a limitation.

The urgent need for innovative approaches to dementia treatment that are acceptable, effective and affordable underlies this research. Growing evidence supports ‘integrative medicine’ as a potential treatment approach aligned with and including conventional medicine. However, success will depend on addressing barriers, recognising needs of diverse communities and involving people in co-creating desired interventions. The three aims of this study were to, 1) describe conventional allopathic medicine and integrative or functional medicine (I/FM) approaches for dementia treatment in NW England; 2) to explore the views of informal dementia caregivers and service users, compared to healthcare professionals on the benefits and barriers to providing and receiving these two approaches. Thirdly, we engaged caregivers and service users in co-creating a vision for dementia treatment based on their needs and expectations. We conducted semi-structured interviews, focus groups and a deliberative workshop. Data were analysed using framework analysis. A total of 49 participants reported benefits and barriers to providing and receiving treatments. Themes related to inequalities of socioeconomics and access, cultural influences, disempowerment, demotivation and physician pressures. For instance, the NHS conventional medicine approach provided free nearby access, highly rated post-diagnostic support and good quality web-based information. Barriers included limited discussion of non-pharmaceutical treatment options, low-morale and high rates of stress and burnout among GPs who felt de-motivated as they could not slow or stop the progression. I/FM benefits included time for in-depth investigations to determine the underlying causes of a patient’s dementia, and practitioners trained in addressing them. Barriers included limited access to I/FM practitioners, need to pay for services, difficulties of making lifestyle changes such as diet, need for strong support from caregivers (or payment for a health coach) and poor compliance. Participants co-created a vision for dementia treatment including the wider environmental, social and cultural context. Neither conventional NHS medicine nor I/FM provided consistently beneficial treatment outcomes for dementia. Findings support the development of a model of dementia treatment that includes the benefits provided by both existing approaches, but further informed by patient, caregiver and practitioner experience and co-design. Such an approach must consider a complexity of cultural and generational needs, ensuring empowerment, making available current evidence, resources and support.

Cancer-related fatigue and loss of physical functioning are distressing symptoms which negatively impact the quality of life of people with advanced cancer. Physical activity has been shown to have positive effects on these symptoms in early-stage cancer, but previous research demonstrated an incongruence between people with advanced cancer’s expressed interest and actual participation in a physical activity intervention. To gain an in-depth understanding of the experience of activity and quality of life in people with advanced cancer, using a classic grounded theory approach. Through the post-positivist lens of subtle realism, and informed by classic grounded theory methods, a two-phase, cross-sectional, qualitative study was conducted. For 7 days duration, participants wore an activPAL™ activity monitor and completed a daily record sheet, which were then used as qualitative probes for face-to-face, semi-structured interviews. A total of 15 people with advanced cancer, aged 18 years or older, and with a median survival of 100 days from time of study consent, were recruited from an outpatient department of a tertiary cancer centre in Alberta, Canada. Maintaining their responsibilities, no matter how small, was the prime motive for participants’ behaviour. For people with advanced cancer, the minimum level of responsibility was dynamic and unique. It was achieved through a multifaceted interaction between the perceived benefits, prevailing conditions and mechanisms. This grounded theory enables understanding of activity as a mechanism through which responsibility is managed and may inform future behavioural interventions in people with advanced cancer.