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  1. Article ; Online: Approaches and challenges to assessing risk of violence in first episode psychosis: A qualitative interview study of clinicians, patients and carers.

    Whiting, Daniel / Glogowska, Margaret / Fazel, Seena / Lennox, Belinda

    Early intervention in psychiatry

    2024  

    Abstract: Aim: Clinical services for early psychosis seek to improve prognosis for a range of adverse outcomes. For some individuals, perpetration of violence is an important potential outcome to reduce. How these clinical services currently assess this risk ... ...

    Abstract Aim: Clinical services for early psychosis seek to improve prognosis for a range of adverse outcomes. For some individuals, perpetration of violence is an important potential outcome to reduce. How these clinical services currently assess this risk however is uncertain. This study aimed to address this gap by using qualitative methods to examine in depth current approaches, attitudes and challenges to assessing violence risk in this clinical setting, from the perspectives of multidisciplinary clinicians, patients and carers.
    Methods: Participants were recruited from two UK Early Intervention in Psychosis services. Semi-structured individual interviews were undertaken using a topic guide. In addition, clinical vignettes were presented to clinician participants as a probe to prompt discussion. Data were analysed using thematic analysis, informed by the constant comparative method.
    Results: We conducted 30 qualitative interviews, of 18 clinicians and 12 patients and carers. Themes developed from clinician interviews included key difficulties of low confidence, limited training, accessing collateral information and variation in how risk is appraised and communicated. Potential stigma and sensitivity of the topic of violence were perceived as barriers to its discussion. Patient and carer perspectives provided insight into how to address barriers, and highlighted the importance of an open approach, including with families.
    Conclusions: We recommend developing contextually appropriate pathways to collaboratively assess violence risk and identify modifiable needs to reduce this risk, and for practical improvements in training and information-sharing.
    Language English
    Publishing date 2024-02-15
    Publishing country Australia
    Document type Journal Article
    ZDB-ID 2272425-4
    ISSN 1751-7893 ; 1751-7885
    ISSN (online) 1751-7893
    ISSN 1751-7885
    DOI 10.1111/eip.13502
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  2. Article ; Online: How do primary care clinicians approach the management of frailty? A qualitative interview study.

    Seeley, Anna / Glogowska, Margaret / Hayward, Gail

    Age and ageing

    2024  Volume 53, Issue 5

    Abstract: Background: Around 15% of adults aged over 65 live with moderate or severe frailty. Contractual requirements for management of frailty are minimal and neither incentivised nor reinforced. Previous research has shown frailty identification in primary ... ...

    Abstract Background: Around 15% of adults aged over 65 live with moderate or severe frailty. Contractual requirements for management of frailty are minimal and neither incentivised nor reinforced. Previous research has shown frailty identification in primary care is ad hoc and opportunistic, but there has been little focus on the challenges of frailty management, particularly within the context of recent introduction of primary care networks and an expanding allied health professional workforce.
    Aim: Explore the views of primary care clinicians in England on the management of frailty.
    Design and setting: Semi-structured interviews were conducted with clinicians across England, including general practitioners (GPs), physician associates, nurse practitioners, paramedics and clinical pharmacists. Thematic analysis was facilitated through NVivo (Version 12).
    Results: A total of 31 clinicians participated. Frailty management was viewed as complex and outside of clinical guidelines with medication optimisation highlighted as a key example. Senior clinicians, particularly experienced GPs, were more comfortable with managing risk. Relational care was important in prioritising patient wishes and autonomy, for instance to remain at home despite deteriorations in health. In settings where more formalised multidisciplinary frailty services had been established this was viewed as successful by clinicians involved.
    Conclusion: Primary care clinicians perceive frailty as best managed through trusted relationships with patients, and with support from experienced clinicians. New multidisciplinary working in primary care could enhance frailty services, but must keep continuity in mind. There is a lack of evidence or guidance for specific interventions or management approaches.
    MeSH term(s) Humans ; Qualitative Research ; Primary Health Care ; Frailty/diagnosis ; Frailty/therapy ; Frailty/psychology ; Attitude of Health Personnel ; England ; Interviews as Topic ; Frail Elderly ; Aged ; Male ; Female ; Geriatric Assessment/methods ; Health Knowledge, Attitudes, Practice
    Language English
    Publishing date 2024-05-05
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 186788-x
    ISSN 1468-2834 ; 0002-0729
    ISSN (online) 1468-2834
    ISSN 0002-0729
    DOI 10.1093/ageing/afae093
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  3. Article ; Online: Experiences of urine collection devices during suspected urinary tract infections: a qualitative study in primary care.

    Glogowska, Margaret / Croxson, Caroline / Butler, Christopher / Hayward, Gail

    The British journal of general practice : the journal of the Royal College of General Practitioners

    2023  Volume 73, Issue 732, Page(s) e537–e544

    Abstract: Background: Up to 30% of urine samples from women with suspected urinary tract infection (UTI) are contaminated and need to be repeated, burdening health services and delaying antibiotic prescription. To prevent contamination, midstream urine (MSU) ... ...

    Abstract Background: Up to 30% of urine samples from women with suspected urinary tract infection (UTI) are contaminated and need to be repeated, burdening health services and delaying antibiotic prescription. To prevent contamination, midstream urine (MSU) sampling, which can be difficult to achieve, is recommended. Urine collection devices (UCDs) that automatically capture MSU have been proposed as a solution. There are few studies exploring women's experiences of using such devices.
    Aim: To explore women's experiences of urine collection and the use of UCDs during a suspected UTI.
    Design and setting: An embedded qualitative study in a UK randomised controlled trial (RCT) of UCDs among women attending primary care for UTI symptoms.
    Method: Semi-structured telephone interviews with 29 women who had participated in the RCT were conducted. The transcribed interviews were then thematically analysed.
    Results: Most of the women were dissatisfied with how they normally produced urine samples. Many were able to use the devices, found them hygienic, and would use them again, even if they had initially experienced problems. Women who had not used the devices expressed interest in trying them. Potential barriers to UCD use included positioning for the sample, UTI symptoms making urine collection difficult, and waste disposal because of the single-use plastic in the UCDs.
    Conclusion: Most women agreed there was a need for a user- and environmentally-friendly device to improve urine collection. Although using UCDs can be difficult for women experiencing UTI symptoms, they may be appropriate for asymptomatic sampling in other clinical populations.
    MeSH term(s) Female ; Humans ; Urinary Tract Infections/diagnosis ; Urinary Tract Infections/drug therapy ; Urine Specimen Collection ; Anti-Bacterial Agents/therapeutic use ; Specimen Handling ; Primary Health Care
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2023-06-29
    Publishing country England
    Document type Randomized Controlled Trial ; Journal Article
    ZDB-ID 1043148-2
    ISSN 1478-5242 ; 0035-8797 ; 0960-1643
    ISSN (online) 1478-5242
    ISSN 0035-8797 ; 0960-1643
    DOI 10.3399/BJGP.2022.0491
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  4. Article ; Online: 'Frailty as an adjective rather than a diagnosis'-identification of frailty in primary care: a qualitative interview study.

    Seeley, Anna / Glogowska, Margaret / Hayward, Gail

    Age and ageing

    2023  Volume 52, Issue 6

    Abstract: Introduction: In 2017, NHS England introduced proactive identification of frailty into the General Practitioners (GP) contract. There is currently little information as to how this policy has been operationalised by front-line clinicians, their working ... ...

    Abstract Introduction: In 2017, NHS England introduced proactive identification of frailty into the General Practitioners (GP) contract. There is currently little information as to how this policy has been operationalised by front-line clinicians, their working understanding of frailty and impact of recognition on patient care. We aimed to explore the conceptualisation and identification of frailty by multidisciplinary primary care clinicians in England.
    Methods: Qualitative semi-structured interviews were conducted with primary care staff across England including GPs, physician associates, nurse practitioners, paramedics and pharmacists. Thematic analysis was facilitated through NVivo (Version 12).
    Results: Totally, 31 clinicians participated. Frailty was seen as difficult to define, with uncertainty about its value as a medical diagnosis. Clinicians conceptualised frailty differently, dependant on job-role, experience and training. Identification of frailty was most commonly informal and opportunistic, through pattern recognition of a frailty phenotype. Some practices had embedded population screening and structured reviews. Visual assessment and continuity of care were important factors in recognition. Most clinicians were familiar with the electronic frailty index, but described poor accuracy and uncertainty as to how to interpret and use this tool. There were different perspectives amongst professional groups as to whether frailty should be more routinely identified, with concerns of capacity and feasibility in the current climate of primary care workload.
    Conclusions: Concepts of frailty in primary care differ. Identification is predominantly ad hoc and opportunistic. A more cohesive approach to frailty, relevant to primary care, together with better diagnostic tools and resource allocation, may encourage wider recognition.
    MeSH term(s) Humans ; Frailty/diagnosis ; Qualitative Research ; General Practitioners ; England ; Primary Health Care ; Attitude of Health Personnel
    Language English
    Publishing date 2023-06-26
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 186788-x
    ISSN 1468-2834 ; 0002-0729
    ISSN (online) 1468-2834
    ISSN 0002-0729
    DOI 10.1093/ageing/afad095
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  5. Article ; Online: Clinician and parent views on urine collection in precontinent children in the UK: a qualitative interview study.

    Armengol, Monica / Hayward, Gail / Abbott, Molly Grace / Bird, Chris / Bergmann, Jeroen H M / Glogowska, Margaret

    BMJ open

    2024  Volume 14, Issue 4, Page(s) e081306

    Abstract: Objective: To explore the experiences of healthcare professionals (HCPs) and parents of urine collection methods, to identify barriers to successful sampling and what could improve the process.: Design: Qualitative research, using individual ... ...

    Abstract Objective: To explore the experiences of healthcare professionals (HCPs) and parents of urine collection methods, to identify barriers to successful sampling and what could improve the process.
    Design: Qualitative research, using individual semistructured interviews with HCPs and parents. The interviews were audiorecorded, transcribed and thematically analysed.
    Setting: UK-based HCPs from primary and secondary care settings and parents with experience with urine collection in primary and/or secondary care settings.
    Participants: HCPs who were involved in aiding, supervising or ordering urine samples. Parents who had experience with urine collection in at least one precontinent child.
    Results: 13 HCPs and 16 parents were interviewed. 2 participating HCPs were general practitioners (GPs), 11 worked in paediatric secondary care settings (8 were nurses and 3 were doctors). Two parents had children with underlying conditions where frequent urine collection was required to rule out infections.HCPs and parents reported that there were no straightforward methods of urine collection for precontinent children. Each method-'clean catch', urine bag and urine pad-had limitations and problems with usage. 'Clean catch', regarded as the gold standard by HCPs with a lower risk of contamination, often proved difficult for parents to achieve. Other methods had elevated risk of contamination but were more acceptable to parents because they were less challenging. Many of the parents expressed the need for more information about urine collection.
    Conclusions: Current methods of urine collection are challenging to use and may be prone to contamination. A new device is required to assist with urine collection in precontinent children, to simplify and reduce the stress of the situation for those involved. Parents are key partners in the process of urine collection with young children. Meeting their expressed need for more information could be an important way to achieve better-quality samples while awaiting a new device.
    MeSH term(s) Humans ; Parents/psychology ; Qualitative Research ; United Kingdom ; Male ; Female ; Urine Specimen Collection/methods ; Interviews as Topic ; Attitude of Health Personnel ; Child, Preschool ; Infant ; Adult ; Child
    Language English
    Publishing date 2024-04-29
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2023-081306
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  6. Article ; Online: GPs' perspectives on diagnostic tests for children: a qualitative interview study.

    Thomas, Elizabeth T / Glogowska, Margaret / Hayward, Gail / Gill, Peter J / Perera, Rafael / Heneghan, Carl J

    The British journal of general practice : the journal of the Royal College of General Practitioners

    2024  

    Abstract: Background: Most healthcare contacts for children in the UK occur in general practice. Diagnostic tests can be beneficial in narrowing differential diagnoses; however, there is substantial variation in the use of tests for children in general practice. ... ...

    Abstract Background: Most healthcare contacts for children in the UK occur in general practice. Diagnostic tests can be beneficial in narrowing differential diagnoses; however, there is substantial variation in the use of tests for children in general practice. Unwarranted variation in testing can lead to variation in quality of care and may exacerbate health inequities. To our knowledge, no previous study has tried to understand why variation in testing exists for children in general practice.
    Aim: To explore GPs' perspectives on using diagnostic tests for children in primary care and the underlying drivers of variation.
    Design and setting: Qualitative study in which semi-structured interviews were conducted with GPs and trainee GPs in England.
    Method: Interviews were conducted with 18 GPs and two trainee GPs between April and June 2023. The interviews were transcribed and analysed using reflexive thematic analysis.
    Results: GPs reflected that their approach to testing in children differed from their approach to testing in adults: their threshold to test was higher, and their threshold to refer to specialists was lower. GPs' perceptions of test utility varied, including objective testing for asthma. Perceived drivers of variation in testing were intrinsic (clinician-specific) factors relating to their risk tolerance and experience; and extrinsic factors, including disease prevalence, parental concern and expectations of health care, workforce changes leading to fragmentation in care, time constraints, and differences in guidelines.
    Conclusion: The findings of this study identify actionable issues for clinicians, researchers, and policymakers to address gaps in education, evidence, and guidance, reduce unwarranted differences in test use, and improve the quality of health care delivered to children in general practice.
    Language English
    Publishing date 2024-05-13
    Publishing country England
    Document type Journal Article
    ZDB-ID 1043148-2
    ISSN 1478-5242 ; 0035-8797 ; 0960-1643
    ISSN (online) 1478-5242
    ISSN 0035-8797 ; 0960-1643
    DOI 10.3399/BJGP.2023.0469
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  7. Article ; Online: Implementation of significant mental health service change: perceptions and concerns of a mental health workforce in the context of transformation.

    Glogowska, Margaret / Stepney, Melissa / Rocks, Stephen / Fazel, Mina

    Journal of health organization and management

    2022  Volume 36, Issue 9, Page(s) 66–78

    Abstract: Purpose: As part of an evaluation of the nationally mandated Child and Adolescent Mental Health Services (CAMHS) "transformation" in one foundation NHS trust, the authors explored the experiences of mental health staff involved in the transformation.: ...

    Abstract Purpose: As part of an evaluation of the nationally mandated Child and Adolescent Mental Health Services (CAMHS) "transformation" in one foundation NHS trust, the authors explored the experiences of mental health staff involved in the transformation.
    Design/methodology/approach: The authors employed a qualitative methodology and followed an ethnographic approach. This included observation of mental health staff involved in the transformation and informal interviews (80 h). The authors also undertook semi-structured interviews with key staff members (
    Findings: The findings fall into three thematic areas around the transformation, namely (1) rationale; (2) implementation; and (3) maintenance. Staff members were supportive of the rationale for the changes, but implementation was affected by perceived poor communication, resulting in experiences of unpreparedness and de-stabilisation. Staff members lacked time to set up the necessary processes, meaning that changes were not always implemented smoothly. Recruiting and retaining the right staff, a consistent challenge throughout the transformation, was crucial for maintaining the service changes.
    Originality/value: There is little published on the perceptions and experiences of mental health workforces around the CAMHS transformations across the UK. This paper presents the perceptions of mental health staff, whose organisation underwent significant "transformational" change. Staff demonstrated considerable resilience in the change process, but better recognition of their needs might have improved retention and satisfaction. Time for planning and training would enable staff members to better develop the processes and resources necessary in the context of significant service change. Developing ways for services to compare changes they are implementing and sharing good practice around implementation with each other are also vital.
    MeSH term(s) Adolescent ; Attitude of Health Personnel ; Child ; Health Personnel ; Health Workforce ; Humans ; Mental Health Services ; Qualitative Research
    Language English
    Publishing date 2022-02-10
    Publishing country England
    Document type Journal Article
    ZDB-ID 2109532-2
    ISSN 1758-7247 ; 1477-7266
    ISSN (online) 1758-7247
    ISSN 1477-7266
    DOI 10.1108/JHOM-06-2021-0205
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  8. Article ; Online: Women's information needs around urine testing for urinary tract infections: a qualitative study.

    Glogowska, Margaret / Croxson, Caroline / Hayward, Gail

    The British journal of general practice : the journal of the Royal College of General Practitioners

    2022  Volume 72, Issue 717, Page(s) e244–e251

    Abstract: Background: Urinary tract infection (UTI) is one of the commonest bacterial infections in general practice, with urine testing a frequent feature of its management. Urinary dipsticks are widely used, with urine culture the reference standard test. To ... ...

    Abstract Background: Urinary tract infection (UTI) is one of the commonest bacterial infections in general practice, with urine testing a frequent feature of its management. Urinary dipsticks are widely used, with urine culture the reference standard test. To avoid contamination, patients are advised to discard the first part of the urine stream, retaining the midstream part for the sample. This process, however, can be challenging both to explain and to perform. There is a lack of literature investigating women's perceptions and understanding of urine sampling.
    Aim: To explore women's understanding of urine collection, sample contamination, and how information from samples informed UTI management.
    Design and setting: Qualitative study embedded in a UK randomised controlled trial (RCT) of urinary collection devices (UCDs) among women attending primary care with a suspected UTI.
    Method: Semi-structured telephone interviews were conducted with 29 women participating in the RCT. Interviews were transcribed and thematically analysed.
    Results: Participants were not always aware about what midstream samples were and why they were preferable. They also lacked understanding about how urine samples may be contaminated, and sources of contamination. Participants experienced variability in the information received following analysis of their sample.
    Conclusion: Provision of clear information could help provide better urine samples, aiding the diagnosis of UTIs, presenting results with greater clarity, and creating less need for repeat samples. Sharing of information derived from uncontaminated samples may also support better UTI management, helping to reduce unnecessary prescribing and antibiotic resistance.
    MeSH term(s) Anti-Bacterial Agents/therapeutic use ; Family Practice ; Female ; Humans ; Qualitative Research ; Urinalysis/methods ; Urinary Tract Infections/diagnosis ; Urinary Tract Infections/urine ; Urine Specimen Collection/methods
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2022-03-31
    Publishing country England
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 1043148-2
    ISSN 1478-5242 ; 0035-8797 ; 0960-1643
    ISSN (online) 1478-5242
    ISSN 0035-8797 ; 0960-1643
    DOI 10.3399/BJGP.2021.0564
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  9. Article ; Online: Paradigms, pragmatism and possibilities: mixed-methods research in speech and language therapy.

    Glogowska, Margaret

    International journal of language & communication disorders

    2011  Volume 46, Issue 3, Page(s) 251–260

    Abstract: Background: After the decades of the so-called 'paradigm wars' in social science research methodology and the controversy about the relative place and value of quantitative and qualitative research methodologies, 'paradigm peace' appears to have now ... ...

    Abstract Background: After the decades of the so-called 'paradigm wars' in social science research methodology and the controversy about the relative place and value of quantitative and qualitative research methodologies, 'paradigm peace' appears to have now been declared. This has come about as many researchers have begun to take a 'pragmatic' approach in the selection of research methodology, choosing the methodology best suited to answering the research question rather than conforming to a methodological orthodoxy. With the differences in the philosophical underpinnings of the two traditions set to one side, an increasing awareness, and valuing, of the 'mixed-methods' approach to research is now present in the fields of social, educational and health research.
    Aims: To explore what is meant by mixed-methods research and the ways in which quantitative and qualitative methodologies and methods can be combined and integrated, particularly in the broad field of health services research and the narrower one of speech and language therapy.
    Main contribution: The paper discusses the ways in which methodological approaches have already been combined and integrated in health services research and speech and language therapy, highlighting the suitability of mixed-methods research for answering the typically multifaceted questions arising from the provision of complex interventions. The challenges of combining and integrating quantitative and qualitative methods and the barriers to the adoption of mixed-methods approaches are also considered.
    Conclusions & implications: The questions about healthcare, as it is being provided in the 21st century, calls for a range of methodological approaches. This is particularly the case for human communication and its disorders, where mixed-methods research offers a wealth of possibilities. In turn, speech and language therapy research should be able to contribute substantively to the future development of mixed-methods research.
    MeSH term(s) Humans ; Language Disorders/therapy ; Language Therapy/methods ; Qualitative Research ; Research Design/trends ; Speech Disorders/therapy ; Speech Therapy/methods
    Language English
    Publishing date 2011-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1415919-3
    ISSN 1460-6984 ; 1368-2822
    ISSN (online) 1460-6984
    ISSN 1368-2822
    DOI 10.3109/13682822.2010.507614
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  10. Article ; Online: How does reorganisation in child and adolescent mental health services affect access to services? An observational study of two services in England.

    Fazel, Mina / Rocks, Stephen / Glogowska, Margaret / Stepney, Melissa / Tsiachristas, Apostolos

    PloS one

    2021  Volume 16, Issue 5, Page(s) e0250691

    Abstract: Background: Child and Adolescent Mental Health Services (CAMHS) in England are making significant changes to improve access and effectiveness. This 'transformation' variously involves easier access to services through a Single Point of Access (SPA), ... ...

    Abstract Background: Child and Adolescent Mental Health Services (CAMHS) in England are making significant changes to improve access and effectiveness. This 'transformation' variously involves easier access to services through a Single Point of Access (SPA), more integrated services within CAMHS and enhanced co-provision across education and third sector or non-profit organisations.
    Methods: A mixed-methods observational study was conducted to explore the process and impact of transformation over four years in two services. Ethnographic observations and in-depth interviews were conducted and Electronic Patient Records with over one million contacts analysed. Difference-in-differences analysis with propensity score matching to estimate the causal impact of the transformation on patient access was utilised.
    Outcomes: Spend and staffing increased across both CAMHS. The SPA had growing rates of self-referral and new care pathways were seeing patients according to expected degree of psychopathology. Third sector partners were providing increasing numbers of low-intensity interventions. Although the majority of staff were supportive of the changes, the process of transformation led to service tensions. In the first year after transformation there was no change in the rate of new patients accessing services or new spells (episodes of care) in the services. However, by year three, the number of new patients accessing CAMHS was 19% higher (Incidence Rate Ratio: 1·19, CI: 1·16, 1·21) and the rate of new spells was 12% higher (Incidence Rate Ratio: 1·12, CI: 1·05, 1·20).
    Interpretation: Transformation investment, both financial and intellectual, can help to increase access to CAMHS in England, but time is needed to realise the benefits of reorganisation.
    MeSH term(s) Adolescent ; Adolescent Health Services ; Child ; England ; Female ; Health Services Accessibility/statistics & numerical data ; Humans ; Male ; Mental Health Services/organization & administration ; Surveys and Questionnaires
    Language English
    Publishing date 2021-05-05
    Publishing country United States
    Document type Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
    ISSN 1932-6203
    ISSN (online) 1932-6203
    DOI 10.1371/journal.pone.0250691
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