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Article ; Online: An Exploratory Qualitative Study of Computer Screening to Support Decision-Making about Use of Palliative Care Registers in Primary Care

Gill Hubbard / Kirsten Broadfoot / Clare Carolan / Hugo C. van Woerden

Journal of Primary Care & Community Health, Vol

GP Think Aloud and Patient and Carer Interviews

2021 Volume 12

Abstract: Objectives: This study aimed to understand factors that influence general practitioner (GP) use of automated computer screening to identify patients for the palliative care register (PCR) and the experiences of palliative care and this emerging ... ...

Abstract	Objectives: This study aimed to understand factors that influence general practitioner (GP) use of automated computer screening to identify patients for the palliative care register (PCR) and the experiences of palliative care and this emerging technology from patients’ and carers’ perspectives. Methods: A computer screening program electronically searches primary care records in routine clinical practice to identify patients with advanced illness who are not already on a PCR. Five GPs were asked to “think aloud” about adding patients identified by computer screening to the PCR. Key informant interviews with 6 patients on the PCR and 4 carers about their experiences of palliative care while on the PCR and their views of this technology. Data were analyzed thematically. Results and Conclusions: Using computer screening, 29% additional patients were added by GPs to the PCR. GP decision-making for the PCR was informed by clinical factors such as: if being treated with curative intent; having stable or unstable disease; end-stage disease, frailty; the likelihood of dying within the next 12 months; and psychosocial factors such as, age, personality, patient preference and social support. Six (60%) patients/carers did not know that they/their relative was on the PCR. From a patient/carer perspective, having a non-curative illness was not in and of itself sufficient reason for being on the PCR; other factors such as, unstable disease and avoiding pain and suffering were equally if not more, important. Patients and carers considered that computer screening should support but not replace, GP decision-making about the PCR. Computer screening merits ongoing development as a tool to aid clinical decision-making around entry to a PCR, but should not be used as a sole criterion. Care need, irrespective of diagnosis, disease trajectory or prognosis, should determine care.
Keywords	Computer applications to medicine. Medical informatics ; R858-859.7 ; Public aspects of medicine ; RA1-1270
Subject code	610
Language	English
Publishing date	2021-06-01T00:00:00Z
Publisher	SAGE Publishing
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Exercise Referral Instructors’ Perspectives on Supporting and Motivating Participants to Uptake, Attend and Adhere to Exercise Prescription

Colin B. Shore / Stuart D. R. Galloway / Trish Gorely / Angus M. Hunter / Gill Hubbard

International Journal of Environmental Research and Public Health, Vol 19, Iss 203, p

A Qualitative Study

2022 Volume 203

Abstract: Exercise referral schemes are designed to support people with non-communicable diseases to increase their levels of exercise to improve health. However, uptake and attendance are low. This exploratory qualitative study aims to understand uptake and ... ...

Abstract	Exercise referral schemes are designed to support people with non-communicable diseases to increase their levels of exercise to improve health. However, uptake and attendance are low. This exploratory qualitative study aims to understand uptake and attendance from the perspectives of exercise referral instructors using semi-structured interviews. Six exercise referral instructors from one exercise referral scheme across four exercise referral sites were interviewed. Four themes emerged: (i) the role that instructors perceive they have and approaches instructors take to motivate participants to take-up, attend exercise referral and adhere to their exercise prescription; (ii) instructors’ use of different techniques, which could help elicit behaviour change; (iii) instructors’ perceptions of participants’ views of exercise referral schemes; and (iv) barriers towards providing an exercise referral scheme. Exercise referral instructors play an important, multifaceted role in the uptake, attendance and adherence to exercise referral. On-going education and peer support for instructors may be useful. Instructors’ perspectives help us to further understand how health and leisure services can design successful exercise referral schemes.
Keywords	community-based research ; exercise prescription ; physical activity ; motivation ; public health practice ; behaviour change ; Medicine ; R
Subject code	796
Language	English
Publishing date	2022-12-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Hernia Active Living Trial (HALT)

Julie Munro / William Goodman / Raymond Oliphant / Sarah Russell / Claire Taylor / Rebecca J. Beeken / Gill Hubbard

Pilot and Feasibility Studies, Vol 9, Iss 1, Pp 1-

a feasibility study of a physical activity intervention for people with a bowel stoma who have a parastomal hernia/bulge

2023 Volume 21

Abstract: Abstract Background Parastomal bulging/hernia is a common complication associated with a stoma. Strengthening of the abdominal muscles via exercise may be a useful self-management strategy. The aim of this feasibility work was to address uncertainties ... ...

Abstract	Abstract Background Parastomal bulging/hernia is a common complication associated with a stoma. Strengthening of the abdominal muscles via exercise may be a useful self-management strategy. The aim of this feasibility work was to address uncertainties around testing a Pilates-based exercise intervention for people with parastomal bulging. Methods An exercise intervention was developed and tested in a single-arm trial (n = 17 recruited via social media) followed by a feasibility randomised controlled trial RCT (n = 19 recruited from hospitals). Adults with an ileostomy or colostomy with a bulge or diagnosed hernia around their stoma were eligible. The intervention involved a booklet, videos, and up to 12 online sessions with an exercise specialist. Feasibility outcomes included intervention acceptability, fidelity, adherence, and retention. Acceptability of self-report measures for quality of life, self-efficacy, and physical activity were assessed based on missing data within surveys pre- and post-intervention. Interviews (n = 12) explored participants’ qualitative experiences of the intervention. Results Nineteen of 28 participants referred to the intervention completed the programme (67%) and received an average of 8 sessions, lasting a mean of 48 min. Sixteen participants completed follow-up measures (44% retention), with low levels of missing data across the different measures, apart from body image and work/social function quality of life subscales (50% and 56% missing, respectively). Themes from qualitative interviews related to the benefits of being involved, including behavioural and physical changes in addition to improved mental health. Identified barriers included time constraints and health issues. Conclusions The exercise intervention was feasible to deliver, acceptable to participants, and potentially helpful. Qualitative data suggests physical and psycholosical benefits. Strategies to improve retention need to be included in a future study. Trial registration ISRCTN, ISRCTN15207595 . Registered on ...
Keywords	Physical activity ; Exercise ; Stoma ; Parastomal hernia ; Feasibility ; Medicine (General) ; R5-920
Subject code	796
Language	English
Publishing date	2023-07-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Predicting reattendance to the second round of the Maltese national breast screening programme

Danika Marmarà / Vincent Marmarà / Gill Hubbard

BMC Public Health, Vol 19, Iss 1, Pp 1-

an analytical descriptive study

2019 Volume 14

Abstract: Abstract Background A range of barriers influence women’s uptake to a first breast screening invitation. Few studies however, have examined factors associated with second screening uptake. This study follows Maltese women to explore predictors and ... ...

Abstract	Abstract Background A range of barriers influence women’s uptake to a first breast screening invitation. Few studies however, have examined factors associated with second screening uptake. This study follows Maltese women to explore predictors and behaviours to re-attendance, and to determine if uptake of first invitation to the Maltese Breast Screening Programme (MBSP) is a significant predictor of second screening uptake. Methods A prospective study was conducted to determine factors associated with re-attendance for 100 women invited to the second MBSP round. Records of women’s second attendance to the MBSP were extracted in January 2016 from the MBSP database. Data were analyzed using chi-square tests, Independent Samples t-test, Mann Whitney test, Shapiro Wilk test and logistic regression. Results There were no significant associations for sociodemographic or health status variables with second screening uptake (p > 0.05), except breast condition (Fisher’s exact test, p = 0.046). Non-attendees at second screening were most unsure of screening frequency recommendations (χ2 = 9.580, p = 0.048). Attendees were more likely to perceive their susceptibility to breast cancer (p = 0.041), believed breast cancer to be life changing (p = 0.011) and considered cues to action to aid attendance (p = 0.028). Non-attendees were in stronger agreement on mammography pain (p = 0.008) and were less likely to consider cues to action (15.4% non-attendees vs 1.4% attendees) (p = 0.017 respectively). ‘Perceived barriers’, ‘breast cancer identity’, ‘causes’ and ‘consequences’ were found to be significant predictors of second screening uptake, with ‘perceived barriers’ being the strongest. The inclusion of illness perception items improved the regression model’s accuracy in predicting non-attendance to the second screening round (84.6% vs 30.8%). First screening uptake was found to be a significant predictor of subsequent uptake (OR = 0.102; 95% CI = 0.037, 0.283; p = 0.000). Conclusions Interventions to increase uptake should ...
Keywords	Breast cancer ; Screening ; Mammography ; Attendance ; Reattendance ; Second invitation ; Public aspects of medicine ; RA1-1270
Subject code	150
Language	English
Publishing date	2019-02-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The match between what is prescribed and reasons for prescribing in exercise referral schemes

Colin B. Shore / Gill Hubbard / Trish Gorely / Angus M. Hunter / Stuart D. Galloway

BMC Public Health, Vol 21, Iss 1, Pp 1-

a mixed method study

2021 Volume 12

Abstract: Abstract Background Exercise referral schemes (ERS) aim to tackle non-communicable disease (NCD) by increasing physical activity levels through prescribed exercise. However, there is a sparsity of knowledge upon what exercises are prescribed and if they ... ...

Abstract	Abstract Background Exercise referral schemes (ERS) aim to tackle non-communicable disease (NCD) by increasing physical activity levels through prescribed exercise. However, there is a sparsity of knowledge upon what exercises are prescribed and if they are targeted towards tackling NCD. Method Mixed methods were employed. Quantitative data was extracted from exercise prescription cards of 50 participants and were assessed for frequency, intensity, type and time of prescribed exercise. Descriptive measures of aggregate data are expressed as median (range: minimum-maximum). Thematic analysis of semi-structured interviews generated qualitative data on exercise referral instructors’ experiences of prescribing exercise. Results Thirty-eight different types of exercise were prescribed. Median prescription was 4 (1–11) exercises per session, at a moderate intensity. Participants were prescribed a median of 35 (5–70) minutes of aerobic exercise per referral session. Exercise referral instructors prescribed exercise to improve activities of daily living, promote independence and autonomy of participants, rather than explicitly targeting the referral condition. Conclusions Knowledge that prescribed exercises are not explicitly targeted to the referral condition provides critical information in understanding the purpose of exercise prescription. Future evaluations of ERS should be mindful of this, that is, perceived outcomes might not match up to what is being prescribed within ERS.
Keywords	Prescription ; Community-based research ; Exercise prescription ; Measurement ; Physical activity ; Public health practice ; Public aspects of medicine ; RA1-1270
Subject code	796
Language	English
Publishing date	2021-05-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Are Rurality, Area Deprivation, Access to Outside Space, and Green Space Associated with Mental Health during the COVID-19 Pandemic? A Cross Sectional Study (CHARIS-E)

Gill Hubbard / Chantal den Daas / Marie Johnston / Peter Murchie / Catharine Ward Thompson / Diane Dixon

International Journal of Environmental Research and Public Health, Vol 18, Iss 3869, p

2021 Volume 3869

Abstract: The study investigated if rurality, area deprivation, access to outside space (Study 1), and frequency of visiting and duration in green space (Study 2) are associated with mental health during the COVID-19 pandemic and examined if individual ... ...

Abstract	The study investigated if rurality, area deprivation, access to outside space (Study 1), and frequency of visiting and duration in green space (Study 2) are associated with mental health during the COVID-19 pandemic and examined if individual demographics (age, gender, COVID-19 shielding status) and illness beliefs have a direct association with mental health during the COVID-19 pandemic. A serial, weekly, nationally representative, cross-sectional, observational study of randomly selected adults was conducted in Scotland during June and July 2020. If available, validated instruments were used to measure psychological distress, individual demographics, illness beliefs, and the following characteristics: Rurality, area deprivation, access to residential outside space, frequency of visiting, and duration in green space. Simple linear regressions followed by examination of moderation effect were conducted. There were 2969 participants in Study 1, of which 1765 (59.6%) were female, 349 (11.9%) were in the shielding category, and the median age was 54 years. There were 502 participants in Study 2, of which 295 (58.60%) were female, 58 (11.6%) were in shielding category, and the median age was 53 years. Direct effects showed that psychological distress was worse if participants reported the following: Urban, in a deprived area, no access to or sharing residential outside space, fewer visits to green space (environment), younger, female, in the shielding category (demographics), worse illness (COVID-19) representations, and greater threat perception (illness beliefs). Moderation analyses showed that environmental factors amplified the direct effects of the individual factors on psychological distress. This study offers pointers for public health and for environmental planning, design, and management, including housing design and public open space provision and regulation.
Keywords	COVID-19 ; environment ; place ; rural ; urban ; area deprivation ; Medicine ; R
Subject code	150
Language	English
Publishing date	2021-04-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Lifetime utilization of mammography among Maltese women

Danika Marmarà / Vincent Marmarà / Gill Hubbard

BMC Public Health, Vol 18, Iss 1, Pp 1-

a cross-sectional survey

2018 Volume 14

Abstract: Abstract Background The knowledge of Maltese women not attending the Maltese Breast Screening Programme (MBSP) for mammography screening is scarce. Previous research has identified two distinct groups of non-attendees: those who do not attend because a ... ...

Abstract	Abstract Background The knowledge of Maltese women not attending the Maltese Breast Screening Programme (MBSP) for mammography screening is scarce. Previous research has identified two distinct groups of non-attendees: those who do not attend because a mammogram was taken elsewhere and those who never attended for mammography anywhere. It is however unknown which determinants are predictive of lifetime attendance ‘anywhere’ and ‘real’ non-attendance. The present study examines the relationship between ever-using (Lifetime attendees) or never using mammography (Lifetime non-attendees) and psychosocial - as well as sociodemographic factors, with the aim to identify predictors that can inform practice. Methods Women’s characteristics, knowledge, health beliefs and illness perceptions were compared, based on prior data of 404 women, aged 50–60 years at the time of their first MBSP invitation. The main variable of interest described women’s attendance to mammography (LIFETIME ATTENDEES) and no mammography (LIFETIME NON-ATTENDEES). Data were analyzed using descriptive statistics, chi-square tests, Mann Whitney test, Independent Samples t-test, Shapiro Wilk test and logistic regression. Results During their lifetime, 86.1% of Maltese women (n = 348) were attendees, while 13.9% (n = 56) were non-attendees. Non-attendees were more likely to be women with a lower family income (χ2 = 13.1, p = 0.011), widowers (χ2 = 9.0, p = 0.030), non-drivers (χ2 = 7.7, p = 0.006), without a breast condition (χ2 = 14.2, p < 0.001), who had no relatives or close friends with cancer (χ2 = 8.3, p = 0.016), and who were less encouraged by a physician (χ2 = 4.9, p = 0.027), unsure of the screening frequency (χ2 = 28.5, p < 0.001), more anxious (p = 0.040) and fearful (p = 0.039). Perceived benefits, barriers, cues to action, self-efficacy and emotional representations were the most significant variables to describe the differences between lifetime attendees and non-attendees. Perceived barriers and cues to action were the strongest ...
Keywords	Breast cancer ; Mammography ; Attendance ; Non-attendance ; Health beliefs ; Illness perceptions ; Public aspects of medicine ; RA1-1270
Subject code	150
Language	English
Publishing date	2018-01-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Survey to identify research priorities for primary care in Scotland during and following the COVID-19 pandemic

Bruce Guthrie / Stewart W Mercer / Gill Hubbard / Marion Bennie / Margaret Maxwell / Scott Cunningham / Lindsey Margaret Pope / Fiona Grist

BMJ Open, Vol 12, Iss

2022 Volume 5

Keywords	Medicine ; R
Language	English
Publishing date	2022-05-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Health beliefs, illness perceptions and determinants of breast screening uptake in Malta

Danika Marmarà / Vincent Marmarà / Gill Hubbard

BMC Public Health, Vol 17, Iss 1, Pp 1-

a cross-sectional survey

2017 Volume 19

Abstract: Abstract Background Women’s beliefs and representations of breast cancer (BC) and breast screening (BS) are salient predictors for BS practices. This study utilized the health belief model (HBM) and common-sense model (CSM) of illness self-regulation to ... ...

Abstract	Abstract Background Women’s beliefs and representations of breast cancer (BC) and breast screening (BS) are salient predictors for BS practices. This study utilized the health belief model (HBM) and common-sense model (CSM) of illness self-regulation to explore factors associated with BS uptake in Malta and subsequently, to identify the most important predictors to first screening uptake. Methods This cross-sectional survey enrolled Maltese women (n = 404) ages 50 to 60 at the time of their first screening invitation, invited to the National Breast Screening Programme by stratified random sampling, with no personal history of BC. Participants responded to a 121-item questionnaire by telephone between June–September 2015. Data were analyzed using descriptive statistics, chi-square tests and logistic regression. Results There is high awareness of BC signs and symptoms among Maltese women (>80% agreement for 7 out of 8 signs), but wide variation about causation (e.g., germ or virus: 38.6% ‘agree’, 30.7% ‘disagree’). ‘Fear’ was the key reason for non-attendance to first invitation (41%, n = 66) and was statistically significant across all subscale items (p < 0.05). Most items within HBM constructs (perceived barriers; cues to action; self-efficacy) were significantly associated with first invitation to the National Breast Screening Programme, such as fear of result (χ2 = 12.0, p = 0.017) and life problems were considered greater than getting mammography (χ2 = 38.8, p = 0.000). Items within CSM constructs of Illness Representation (BC causes; cyclical cancer timeline; consequences) were also significantly associated, such as BC was considered to be life-changing (χ2 = 18.0, p = 0.000) with serious financial consequences (χ2 = 13.3, p = 0.004). There were no significant associations for socio-demographic or health status variables with uptake, except for family income (χ2 = 9.7, p = 0.047). Logistic regression analyses showed that HBM constructs, in particular perceived barriers, were the strongest predictors of ...
Keywords	Breast cancer screening ; Mammography ; Uptake ; Factors ; Health belief model ; Common-sense model ; Public aspects of medicine ; RA1-1270
Subject code	310
Language	English
Publishing date	2017-05-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A physical activity intervention to improve the quality of life of patients with a stoma

Gill Hubbard / Claire Taylor / Angus J. M. Watson / Julie Munro / William Goodman / Rebecca J. Beeken

Pilot and Feasibility Studies, Vol 6, Iss 1, Pp 1-

a feasibility study

2020 Volume 15

Abstract: Abstract Background We hypothesise that a physical activity (PA) intervention will improve the quality of life (QoL) of people with a stoma. A feasibility study of the intervention and trial parameters is necessary to inform a future main trial. Methods ... ...

Abstract	Abstract Background We hypothesise that a physical activity (PA) intervention will improve the quality of life (QoL) of people with a stoma. A feasibility study of the intervention and trial parameters is necessary to inform a future main trial. Methods Participants received a weekly PA consultation by telephone, video conferencing, or face-to-face for 12 weeks with a PA instructor who prescribed physical activities and supported participants by addressing stoma-related concerns and using behaviour change techniques. A feasibility study of the intervention and trial parameters was conducted in three UK sites using mixed methods. Results The number of eligible patients consenting to the study was 30 out of 174 (17%). Most participants were female (73%); 73% had an ileostomy and 27% a colostomy; mean time since diagnosis was 6 months. A total of 18 (64%) participants completed pre- (baseline) and post-intervention (follow-up) measures. Results show an improvement on all scales measuring QoL and disease-specific fatigue. The median PA consultation rate per participant was eight sessions. Participants reported completing 75% or more of the prescribed PA each week. Eight stoma-related themes were identified from qualitative interviews: fear of hernia, bending down, fatigue, pain, prolapse, surgical wounds, stoma appliance, and stigma. The intervention appeared to address these issues. Conclusion This feasibility study demonstrated that a novel manualised PA intervention for people with a stoma is safe, feasible, and acceptable, and shows promise for improving outcomes. However, difficulties with recruitment will need to be carefully considered to ensure the success of future studies in this area. Trial registration ISCTN, ISRCTN58613962 Registered 14/9/2017.
Keywords	Medicine (General) ; R5-920
Subject code	796
Language	English
Publishing date	2020-02-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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