Patrick Stark

Background: Medication adherence in Parkinson's is complex, time‐sensitive, and influenced by clinical, behavioural, and contextual factors. Educational interventions have attempted to support medication adherence; however, the scope, focus, and effectiveness of such interventions remain unclear. Methods: This scoping review aimed to identify and map educational interventions for people with Parkinson's that included medication‐related education. Seven databases were searched with no date restrictions. Quantitative, qualitative, and mixed‐methods studies were eligible. Data were charted and synthesised using descriptive mapping and reflexive thematic analysis to explore intervention characteristics, reported evidence relating to medication adherence, intervention outcomes, and reported barriers and facilitators. Results: Eight papers reporting seven educational interventions were included. Interventions varied widely in content, delivery mode, and intensity, with medication education often embedded within broader programmes rather than delivered as a standalone intervention. Evidence regarding the potential of educational interventions to support medication adherence was reported, although this was based on a limited number of studies using direct adherence measures and more commonly on proxy indicators such as changes in knowledge, beliefs, and self‐management behaviours. Outcome measures were heterogeneous, limiting comparability. Improvements were more commonly observed in understanding, confidence, and communication than in sustained symptom outcomes. No study reported explicit use of behaviour change theory or co‐design approaches involving people with Parkinson's or their informal carers. Conclusions: Educational interventions show potential to support Parkinson's medication adherence, particularly through mechanisms conceptually aligned with self‐efficacy. Future interventions may be strengthened by explicit use of behaviour change theory and/or meaningful co‐design with people with lived experience. Lived Experience or Public Contribution: A Research Involvement Manager from Parkinson's UK is a co‐author and contributed to the design, conduct, and interpretation of this review, representing the perspectives of people living with Parkinson's. An advisory group comprising people with Parkinson's, carers, and healthcare professionals informed the wider research programme and reviewed the findings of this study. While no substantive changes were requested, this process supported interpretation and relevance to lived experience. Consistent with these perspectives, the review highlights a lack of co‐design in existing interventions and advocates for greater involvement of people with Parkinson's in future intervention development.

Introduction: Dementia-friendly communities (DFCs) have been developed internationally to support the participation and inclusion of people living with dementia (PLWD) in everyday community life and civic society, yet there is limited empirical evidence explaining how these communities operate in practice. This study aimed to explore how DFCs function within geographical communities in Northern Ireland (NI) and identify the contextual conditions that enable participation and inclusion for PLWD. Methods: A realist evaluation was conducted to test and refine a candidate programme theory derived from a prior realist review. Data were collected between September 2022 and March 2024 across several DFC locations using three sequential phases: non-participant observations with PLWD in community settings ( n = 10), semi-structured interviews with the same participants ( n = 10), and four online focus groups with carers and individuals working or volunteering in DFCs ( n = 21). Data were analysed using theory-driven reflexive thematic analysis informed by context–mechanism–outcome configurations (CMOCs). Results: Findings show that environmental design, interpersonal interactions, organisational commitment, and community resources shape how PLWD experience and engage with geographical DFCs. Supportive features such as accessible environments, familiar staff interactions, and community activities fostered mechanisms including reassurance, confidence, and belonging, while complex environments, sensory overload, and limited public awareness reduced ease of participation. Conclusion: Dementia friendliness therefore emerges through the interaction of organisational, social, and environmental contexts that enable participation and inclusion for PLWD in everyday community settings. These findings highlight the potential of dementia-friendly communities as a public health approach to promoting participation, inclusion, and social connectedness for people living with dementia.

Background: Diabetes is highly prevalent among care home residents and is associated with increased clinical complexity due to multimorbidity, frailty, and cognitive impairment. Care home staff play a central role in diabetes management; however, there is limited theoretical understanding of how diabetes care is organised and delivered in long-term care settings. This study aimed to explore care home staff experiences of supporting residents living with diabetes and to develop an empirically grounded explanation of the processes shaping diabetes care in care homes. Methods: A qualitative study informed by Glaserian grounded theory was conducted. Semi-structured interviews were undertaken with 20 care home staff across 17 care homes in Northern Ireland, including registered nurses, care assistants, home managers, and catering staff. Data collection and analysis proceeded concurrently using constant comparative methods and theoretical sampling. Analysis focused on identifying key processes influencing how diabetes care was prioritised, enacted, and sustained in everyday practice. Results: Three interrelated categories were identified: Prioritisation, Risk, and Labour. Diabetes education was inconsistently prioritised relative to mandatory training and was unevenly distributed across staff roles. Diabetes-related risk was primarily conceptualised in terms of avoiding acute events, particularly hypoglycaemia, with less attention to longer-term complications or interactions with multimorbidity. Substantial informal and relational labour was undertaken by staff to support residents’ quality of life, negotiate dietary practices, and coordinate care. These categories were integrated through a core category of Misalignment, describing the disconnect between the complexity of diabetes care needs and the organisation of education, roles, and support within care home systems. Conclusions: Diabetes care in care homes is sustained through adaptation, informal labour, and pragmatic risk management within systems that are not fully aligned to the demands of long-term diabetes care. Addressing this misalignment is essential to strengthening staff capability and informing the development of contextually appropriate educational and service-level interventions for care home settings. Clinical trial number: Not applicable.

Background: Diabetes affects approximately 10.5% of the global adult population and is more prevalent in care homes due to residents’ advanced age and multimorbidity. Effective diabetes management in these settings is essential to prevent complications and maintain quality of life, yet evidence addressing the specific needs of this population remains limited. High-quality care relies on access to appropriate clinical education. This scoping review will synthesise evidence on educational interventions to support diabetes care provision in care home settings. Methods: This scoping review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A comprehensive literature search was conducted across three electronic databases: CINAHL Plus, Medline, and PsycINFO. Methodological quality of the included primary studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Results: In total, 10 studies were included in the review, encompassing evidence from a range of international contexts. Analysis revealed three prominent themes; Firstly, educating nurses about diabetes can improve practice and behaviour. Secondly, educational interventions can increase staff knowledge and confidence, which is linked to enhancing the quality of care. Finally, a range of facilitators and barriers influencing the delivery of diabetes training in care homes were identified. Discussion: The review suggests that educational interventions in care homes can enhance diabetes care. However, while the current evidence is encouraging, there are a lack of empirically tested educational interventions for diabetes education in this setting. Further, current educational programmes appear to lack key detail including footcare, eye care and COVID-19. To ensure the provision of high-quality diabetic care, it is therefore important to enhance the training and education of staff members.

Background: Delirium is frequently unrecognised, and healthcare professionals lack knowledge and confidence in recognition and management of the condition. Increased delirium education within pre-registration healthcare profession curricula may help to address this. A modified Delphi approach was utilised to develop a set of education priorities associated with delirium education for healthcare profession students. Methods: An initial list of 72 education priorities were identified from a literature review, stakeholder focus groups, and a review of available clinical guidelines. Priorities were grouped into eight domains ‘assessment and diagnosis’, ‘aetiology and risk factors’, ‘pathophysiology’, ‘treatment of delirium’, ‘prevention’, ‘delirium and dementia’, ‘impact on people with delirium, informal caregivers and family’ and ‘health promotion and public education’. Academic experts and healthcare professionals were invited to rank each priority and each domain across two rounds. Round one consisted of a survey including the list of 72 potential education priorities which participants were asked to rank from one (not a priority) to five (essential priority). Items which did not reach consensus criteria following round one were re-distributed as round two of the survey and participants were asked to repeat this exercise for the shorter list of items. Additionally, in round two, participants were asked to rank the eight domains from most important to least important. Results: Eighty participants completed round one of the Delphi survey and 55 (68.75%) also completed round two. Following round one, 41 priorities were considered highly relevant and therefore met the criteria to be included in the final set of education priorities. An additional four items reached these criteria following round two and so the final set consists of 45 items. Priorities related to prevention, diagnosis, and treatment were consistently ranked highly whereas priorities related to pathophysiology and health promotion were consistently ranked lowest. Discussion: This Delphi study identified areas of education viewed as the highest priorities for healthcare profession students’ delirium education, drawn from a range of academics and healthcare professionals. The final set may help to inform the development of delirium education reflecting these priorities.

Background: The concept of evidence-based practice (EBP) is globally relevant in current healthcare climates. However, nursing students and teachers often struggle with integrating EBP effectively into a curriculum. This has implications for the way students learn to use evidence for their nursing practice. A new undergraduate EBP module was co-designed with current nursing students and university staff throughout 2023. Underpinning the module was a UDL (universal design for learning) pedagogy consisting of flexible approaches to learning for nursing students which included co-developed videos, co-developed audio podcasts, and co-developed serious games to complement traditional flipped classroom learning. The module commenced in September 2023, running in Year 1 one of a 3-year undergraduate nursing program, and was co-taught by staff and senior students. Methods: A pre/post-test design was used to collect data on student attitude, knowledge, and utilization of EBP. A total of 430 students completed two validated questionnaires, the EBP Beliefs Scale© and EBP Implementation Scale©, before and after the module. Following the post-test, six focus group interviews were also conducted with 58 students to explore how the module informed student nursing practice whilst attending clinical placement during Year 1. A convergent mixed-methods design was employed. Sample attrition occurred (~25%). Effect sizes and 95% confidence intervals were calculated for primary outcomes. Results: Quantitative data was analyzed using paired t-tests and this highlighted statistically significant improvements in attitude, knowledge and utilization of evidence-based practice after learning (p < 0.001). Qualitative data was transcribed verbatim, thematically analyzed, and highlighted three main findings; EBP is my business, EBP positively influenced the care of my patients and EBP has positively impacted my professional development. Conclusions: Partnership with current nursing students in the co-design and implementation of a module about EBP was associated with improvements in student knowledge, attitude and utilization of evidence in practice. These factors are likely to also improve professional competence and ultimately patient care.

Background: Diabetes is common among nursing home residents, with approximately one in four affected, a figure expected to rise. Despite the complexity of care required, educational support for nursing home staff remains limited. This study will aim to co-design and evaluate a digital intervention to improve staff knowledge, confidence, and practices in diabetes care. Methods: The study will follow a logic model across three workstreams. Workstream 1 (WS1) will inform the model inputs through three phases: (1) a scoping review will be conducted to summarise existing diabetes education initiatives in nursing home settings; (2) approximately 20 semi-structured interviews will be carried out with nursing home staff to explore perceived barriers and supports in delivering diabetes care; and (3) a modified Delphi process involving 50–70 diverse stakeholders will be used to establish educational priorities. Workstream 2 (WS2) will involve co-designing a digital diabetes education intervention, informed by WS1 findings. Co-design participants will include nursing home staff, diabetes professionals, and people living with diabetes or their carers. Workstream 3 (WS3) will consist of a mixed-methods evaluation of the intervention. Pre- and post-intervention questionnaires will assess staff knowledge, confidence, and attitudes. The usability of the intervention will also be measured. Following implementation, focus groups with approximately 32 staff members will be conducted to explore user experiences and perceived impact on resident care. Discussion: This study will address an important gap in staff education and support, aiming to improve diabetes care within nursing home settings through a digitally delivered, co-designed intervention.

Background: Dementia has physical, psychological, social and economic impacts, not only for people living with dementia, but also for their carers, families and wider society. Due to the growing number of people living with dementia, children are increasingly likely to encounter family members living with dementia. The aim of this project was to pilot an educational game which was co-designed with children and people living with dementia with the intention of improving children’s understanding and perception of dementia. Research design and methods: An acceptability study of the Kids Dementia Game was conducted in three classes in three schools in Northern Ireland. This study investigated acceptability of the game and the feasibility of online data collection using a pre-post test methodology to explore how best to collect evaluation data if the game was to be delivered on a larger scale. Results: Evaluation of the game with children showed a positive level of acceptability of the game. Children found the game engaging, easy to navigate and fun to play. Feasibility of the data collection method was found to be a barrier to the pre-post test evaluation of the game. Discussion and implications: These findings suggest that the game shows evidence of promise for improving public perception and understanding of dementia using an early intervention approach with children.

High blood pressure in older adults poses significant risks, including cardiovascular disease, stroke, and renal failure; yet, its management is often overlooked. Nurse-led personalised interventions provide essential guidance, helping patients adhere to treatment plans and adopt lifestyle changes, improving outcomes and quality of life. A scoping review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR). Six electronic databases were searched systematically (CINAHL, MEDLINE, PsycINFO, EMBASE, Web of Science, and Scopus). Five research studies were included in this review, from five countries (India, Korea, China, Turkey and Thailand). Primary data were synthesised using descriptive and thematic analysis methodology. The five main themes from this review relate to nurse-led empowerment strategies for hypertension management, variability in blood pressure outcomes, the importance of tailored education and counselling, the role of regular follow-ups and support, and environmental support. Overall, nurse-led personalised interventions improve blood pressure management and patient engagement in older adults, highlighting the need for research into their long-term effectiveness and broader applicability.