Project description:IntroductionPeople who call emergency ambulances frequently are often vulnerable because of health and social circumstances, have unresolved problems or cannot access appropriate care. They have higher mortality rates. Case management by interdisciplinary teams can help reduce demand for emergency services and is available in some UK regions. We report results of interviews with people who use emergency ambulance services frequently to understand their experiences of calling and receiving treatment.MethodsWe used a two-stage recruitment process. A UK ambulance service identified six people who were known to them as frequently calling emergency services. Through third-sector organisations, we also recruited nine individuals with healthcare experiences reflecting the characteristics of people who call frequently. We gained informed consent to record and transcribe all telephone interviews. We used thematic analysis to explore the results.ResultsPeople said they make frequent calls to emergency ambulance services as a last resort when they perceive their care needs are urgent and other routes to help have failed. Those with the most complex health needs generally felt their immediate requirements were not resolved and underlying mental and physical problems led them to call again. A third of respondents were also attended to by police and were arrested for behaviour associated with their health needs. Those callers receiving case management did not know they were selected for this. Some respondents were concerned that case management could label frequent callers as troublemakers.ConclusionPeople who make frequent calls to emergency ambulance services feel their health and care needs are urgent and ongoing. They cannot see alternative ways to receive help and resolve problems. Communication between health professionals and service users appears inadequate. More research is needed to understand service users' motivations and requirements to inform design and delivery of accessible and effective services.Patient or public contributionPeople with relevant experience were involved in developing, undertaking and disseminating this research. Two public contributors helped design and deliver the study, including developing and analysing service user interviews and drafting this paper. Eight public members of a Lived Experience Advisory Panel contributed at key stages of study design, interpretation and dissemination. Two more public contributors were members of an independent Study Steering Committee.

Project description:BackgroundAlthough human immunodeficiency virus (HIV) has become a manageable condition with increasing life expectancy, people living with HIV (PLHIV) are still often isolated from society due to stigma and discrimination. Peer support provides one avenue for increased social support. Given the limited research on peer support from the perspective of PLHIV, this study explored their experiences of peer support organised by healthcare professionals in an outpatient clinical setting.MethodsThe study used a qualitative, descriptive research design for an in-depth understanding of peer support provided to PLHIV in the context of outpatient clinics. Healthcare professionals contributed to the recruitment of 16 participants. We conducted in-depth interviews about participants' experiences of peer support, and performed a directed content analysis of the data. Further, we sorted the data into pre-determined categories.ResultsThe pre-determined categories constituted attachment, social integration, an opportunity for nurturance, reassurance of worth, reliable alliance, and guidance. The identified themes were: gained emotional support, disclosure behaviour allowed garnering of emotional support, non-disclosure promoted the need to meet a peer, experienced a sense of belonging, activated an opportunity for mutual support, means to re-establish belief in one's own worth, perceived a positive affirmation of disease management, facilitated dialogue about disease management, the outpatient clinic as a safe place, and a setting for flexible, individualised support.ConclusionsThis study highlights the peer support experiences of PLHIV in the context of outpatient clinics. The participants' experiences align with previous findings, showing that peer support contributes to mutual emotional support between peers. This is particularly important in cultures of non-disclosure where PLHIV experience intersectional stigma. Additionally, our results show outpatient clinics to be supportive surroundings for facilitating peer support, ensuring confidentiality in peer support outreach. Therefore, peer support contributes positively to individualising outpatient clinic services to meet the changing needs of PLHIV.

Project description:ObjectivesPatient medicines helpline services (PMHS) are available from some National Health Service (NHS) Trusts in the UK to provide medicines information to hospital patients and carers. To date, studies of PMHS have examined the views of service users via satisfaction surveys. This study used qualitative methods to explore service users' experiences of using a PMHS, including perceived benefits and areas for improvement.DesignQualitative, using semi-structured interviews.SettingThis study was conducted across seven NHS Trusts in England.ParticipantsForty users of PMHS were individually interviewed over the telephone. Interviews were audio-recorded, transcribed verbatim and analysed using Braun and Clarke's inductive reflexive thematic analysis. Ethical approval was obtained before study commencement.ResultsParticipants predominantly called a PMHS for themselves (82%; carers: 18%). Two main themes were generated. Theme 1: timeliness-PMHS provide support during the uncertain transition of care period from hospital to home, when patients and carers often feel vulnerable because support is less available. PMHS met service users' needs for timely and easily accessible support, and quick resolution of their issues. PMHS could be improved with staffing beyond typical work week hours, and by having staff available to answer calls instead of using an answerphone. Theme 2: PMHS are best-placed to help-PMHS were perceived as best-placed to answer enquiries that arose from hospital care. Service users felt reassured from speaking to pharmacy professionals, and PMHS were perceived as the optimal service in terms of knowledge and expertise regarding medicines-related questions. However, several participants were initially unaware that their PMHS existed.ConclusionsPMHS are perceived to be a valuable means of accessing timely medicines-related support when patients and carers may be feeling particularly vulnerable. However, their availability and promotion could be improved. We recommend that providers of PMHS consider whether this is achievable, in order to better meet the needs of service users.

Project description:BackgroundThe quality of working relationships between service users and health providers is fundamental in the processes of recovery in mental health. How Internet-based interventions will influence these relationships for persons with long-term care needs, and the measures that can be taken to maintain and enhance working relationships through Internet, is still not well understood.ObjectiveThe aim of this study was to gain insights into how service users and health providers experience their working relationships when they are offered the option of supplementing ongoing collaboration with an e-recovery portal.MethodsIn this exploratory and descriptive study, an e-recovery portal was used by service users and their health providers in 2 mental health communities in Norway for at least 6 months and at most 12 months (2015-2016). The portal consists of secure messaging, a peer support forum, and a toolbox of resources for working with life domains including status, goals and activities, network map, crisis plan, and exercises. The portal was owned and managed by the service user while health providers could remotely access parts of the service user-generated content. The participants could use the portal in whatever way they wished, to suit their collaboration. Data from 6 focus groups, 17 individual interviews, and an interview with 1 dyad about their experiences of use of the portal over the study period were inductively coded and thematically analyzed.ResultsThe thematic analysis resulted in 2 main themes: (1) new relational avenues and (2) out of alignment, illustrated by 8 subthemes. The first main theme is about dyads who reported new and enriching ways of working together through the portal, particularly related to written communication and use of the goal module. Illustrative subthemes are ownership, common ground, goals and direction, and sense of presence and availability. The second main theme illuminates the difficulties that arose when service users' and health providers' expectations for portal use were not aligned, and the consequences of not addressing these difficulties. Illustrative subthemes are initiative and responsibility, waiting for the other, feeling overwhelmed, and clarifications and agreements.ConclusionsThe degree to which dyads benefited from using the e-recovery portal appeared to be mainly associated with the degree to which the dyads' relations were open and flexible before the portal was introduced. For those who experienced frustrations, the portal may have both exposed and added to suboptimal working relationships. Use of the goal module appeared to strengthen the person-centered nature of collaboration. A key question is how health providers balance between enabling service users' greater control over their care, without relinquishing responsibility for the quality of the working relationship, also when using an e-recovery portal. Implications for implementation are discussed.

Project description:BackgroundUnderstanding what adolescents want and how preferences are likely to vary among different groups is important to make the healthcare system responsive to the needs of adolescents and to maximize service utilization. Despite this, evidence is scarce in this aspect. Therefore, this study aimed to explore preferences for accessing Sexual and Reproductive Health (SRH) services from the perspective of adolescents and health care providers in the South Ethiopia Regional State.MethodsA phenomenological qualitative study was conducted from September 04 to October 15, 2023. Seven Focus Group Discussions (FGDs) and ten Key Informant Interviews (KIIs) were conducted with purposively selected seventy-five adolescents and ten healthcare providers respectively. A semi-structured interview guide was used to explore their lived experiences. All interviews and discussions were audio-recorded. The research team transcribed the collected data verbatim and translated it into English. The data was analyzed using a thematic analysis approach.ResultsIn this study, five main themes were identified. The identified main themes were preferred SRH services provider, preferred SRH services venue, preferred SRH services provision time, preferred SRH services information sources, and preferred strategies to improve access to SRH services. Regarding preferred SRH service providers, adolescents prefer males by sex, younger health care providers by age, and not neighborhood health providers by residence. Concerning preferred SRH services venue, adolescents prefer pharmacies as a venue to access condoms and emergency pills, while they prefer traditional medical centers as a source of abortion services. Besides this, schools are a preferred venue for adolescents to access SRH information. Moreover, sexual partners, close friends, and peers who experienced similar problems are the preferred sources of SRH information for adolescents. Furthermore, engagement of private health facilities, strengthening engagement of faith-based organization, and strengthening community-based SRH services provision were identified as preferred strategies to improve access to SRH services.ConclusionImproving access to sexual and reproductive health services necessitates the implementation of innovative and responsive strategies that address the diverse preferences and needs of adolescents. Prioritizing adolescent engagement in healthcare is vital, as it fosters a better understanding of their unique perspectives and ultimately enhances the accessibility and utilization of these essential services.

Project description:BackgroundYoga is becoming an increasingly popular holistic approach in the West to manage long-term health conditions. This study presents the evaluation of a pilot yoga intervention, Yoga4Health, that was developed for the NHS to be socially prescribed to patients at risk of developing specific health conditions (risk factors for cardiovascular disease, pre-diabetes, anxiety/depression or experiencing social isolation). The aim of this qualitative study was to explore service users' experiences of Yoga4Health and the acceptability of the programme.MethodsQualitative data were collected from three sources: 1. Open-ended questions on questionnaires completed by services users at three different time-points (baseline, post intervention and 3 months); 2. Interviews and focus groups with a subset of participants (n = 22); 3. interviews with yoga teachers delivering Yoga4Health (n = 7). Each data source was analysed thematically, then findings were combined.ResultsOf participants completing baseline questionnaires (n = 240), 82.5% were female, 50% White, with a mean age of 53 (range 23-82) years. Baseline questionnaires revealed key motivations to attend Yoga4Health were to improve psychological and physical health, and believing Yoga4Health would be accessible for people with their health condition. Post-intervention, participants reported a range of benefits across psychological, physical and social domains from Yoga4Health. Increased confidence in self-management of health was also reported, and a number of participants described making positive lifestyle changes after attending the programme. Unanticipated benefits of yoga emerged for participants, such as enjoyment and social connectedness, which facilitated ongoing attendance and practice. Also key to facilitating practice (during and after the intervention) were suitability of the classes for those with health conditions, practising with a group and qualities of the yoga teacher. Home practice was supported by course materials (manual, videos), as well as the teaching of techniques for everyday application that offered immediate benefits, such as breathing practices. Follow-up questionnaires revealed a key challenge was continuation of practice once the intervention had finished, with the structure of a class important in supporting practice.ConclusionsYoga4Health was a highly acceptable intervention to services users, which brought a range of biopsychosocial improvements, suggesting yoga is an appropriate intervention to offer on social prescription.

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Accessing Meals on Wheels: A qualitative study exploring the experiences of service users and people who refer them to the service

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