2.30pm, 21 October
Facilitator: Hazel Everitt
Between 2009 and 2013, the number of antidepressant prescriptions rose by 36%, while the prevalence of depression rose by only 3.9%, due to the rise in long-term use. Some patients have no evidence-based indications to continue long-term antidepressants, and could stop treatment. However, many are prepared to continue indefinitely. Patient beliefs and attitudes towards antidepressant treatment may be important in determining their use and subsequent depression management. The PhD aims to investigate constructs of the Theory of Planned Behaviour and other psychological models of health behaviour, to see whether beliefs and attitudes predict the intentions of patients to stop or continue long-term antidepressant use, and if these intentions are translated into actual behaviour. An embedded-mixed methods study was conducted. Three hundred and forty-four patients from primary care practices receiving antidepressant treatment for two years or more completed postal and online questionnaires concerning their beliefs about long-term antidepressant use, and their intentions to stop or continue treatment. Notes reviews were conducted for these patients to determine whether patients continued or started to discontinue antidepressant use six months after completing the questionnaire. Qualitative interviews with a purposive sample of 18 participants who completed the questionnaires were conducted to further explain the quantitative findings. The findings will illustrate patients’ attitudes and behaviours towards long-term antidepressant use and whether these beliefs influence intentions to stop or continue treatment. Findings may identify psychosocial factors that help or hinder the discontinuation of antidepressants and give suggestions around how to encourage greater self-management of the illness.
Keywords: Antidepressants, Primary Care, Mixed-methods, Behaviour
Paul Pascall Jones
The Covid-19 pandemic has highlighted longstanding complexities in preventing and controlling carriage of infection between care home residents and staff. Increased susceptibility to infection of residents makes infection prevention and control a key issue in reducing mortality and complication rates from infectious disease in the older population. The care home is a specific environment separate from hospital and private accommodation. As such it requires evidence-based infection policy derived from trustworthy research specific to it. To date the experiences of key stakeholders in relation to infection control practices and behaviours in care homes have not been understood in depth. A qualitative meta-synthesis using Noblit’s Meta-Ethography methodology was conducted. Multiple databases were searched from inception to June 2020 including CINAHL, Medline, Embase, PsychINFO and ASSIA. Fifteen eligible studies were identified from 28 which reached inclusion criteria from 652 screened abstracts, on the basis of relevance and trustworthiness. We synthesised these findings of these 15 studies into key concepts, assessed where the literature is alike or diverges, and look to move beyond single studies conceptually. Findings are emergent but early analysis identified a range of factors influencing infection prevention and control including resident and staff behaviour and knowledge, health system design and culture, and interaction between care home and other healthcare settings. The findings suggest that organisational and systemic change, rather than an individualistic blame culture focused on those who receive inadequate training, will do better to increase infection prevention and control. There is a absence in the literature of residents voices.
Keywords: ID, transmission, care homes, Qualitative synthesis
Background There has been an increase in the use of online forums for health-related purposes, although few studies have explored parents’ use of online forums for childhood eczema. Method Parents’ discussions about children’s eczema and treatments were collected from three popular online forums posted February 2016-2019. Discussions were included where 1) at least one eczema treatment or management method was mentioned; 2) the parent was clearly discussing their child with eczema; 3) there was at least one reply to the original post. Discussions were analysed inductively with thematic analysis. Results A total of 213 discussions were analysed across the three online forums (Forum 1: 68; Forum 2: 76; Forum 3: 69). 2508 individual posts and 429 pages of text were included. Parents discussed a diverse range of treatments, with some providing emphatic advice that the same treatment that worked for them must work for others, whereas others expressed more awareness that different treatments work for different people. Many parents were desperate to help their children’s eczema, which was often replied to with expert-like statements, cautions and encouragements to ‘fight’ for allergy testing and referral to a dermatologist. Parents also appraised each other’s advice, and made assumptions about the nature of others’ eczema. Parents often praised their children’s coping, and expressed gratitude for each other’s advice and support. Conclusion Findings could be used to help health professionals treating families with eczema understand their support and information needs, and researchers designing online or offline interventions for managing children’s eczema.
Keywords: Online forums, Parents/carers, Atopic eczema/dermatitis, Qualitative
Carpal tunnel syndrome (CTS) is a common and bothersome condition causing discomfort and dysfunction of the hand and wrist. In more severe cases, CTS can impact on a patient’s ability to work and perform their usual activities of daily living. The onset of CTS is known to be associated with certain occupations but less is known about outcome. A systematic search and rapid review of the literature was performed, which identified a gap in the evidence addressing the outcome of conservatively managed CTS, as determined by occupation. Our secondary analysis compared the effectiveness of corticosteroid injection with night splinting. In participants who were employed at baseline, we used linear regression modelling to identify if job category predicted (along with other variables) patient reported outcome at 6-months, as measured by the Boston Carpal Tunnel Questionnaire (BCTQ). Patients that worked in the sales and customer service industry experienced a more favourable outcome. Sex, symptom duration, high risk employment category, treatment type and age were adjusted for in the model. • Carpal tunnel syndrome is the most common peripheral entrapment neuropathy and is known to be a leading cause of long-term work-related disability claims (Wellman et al., 2004). • Incidence of CTS will continue to increase under current trends. • It is important that patients receive reliable prognostic information that is applicable to them as an individual. This allows patients to make informed choices with regard to future treatment. • There is a need for further research into occupation as a predictor of outcome in CTS.
Keywords: Carpal tunnel syndrome
Development of a brief mindfulness-based intervention to improve wellbeing.
Background: Wellbeing is a priority for the UK and protects people from mental health problems. Brief mindfulness-based interventions (MBIs) that are shorter and less intensive than the standard 8-week courses could provide health and wellbeing benefits to patients while requiring fewer resources to implement at scale. However, brief MBIs are typically developed ad hoc and lack a clear rationale for the components they include. The aim was to develop a brief person-centred mindfulness-based intervention using a theory-, evidence- and person-based approach (Yardley et al. 2015).
Methods: Attitudes to brief MBIs, MBI components, and the minimum size and shape of an effective brief MBI were collected from mindfulness teachers and mindfulness course attendees using an online survey (N=42) and “INDIGO” (N=21) (INtervention DesIGn with stakehOlders). INDIGO is a novel visual mixed-methods approach that combines storyboarding and timelining. Data were analysed using mixed methods and combined with the Mindfulness-to-Meaning Theory, to create a prototype intervention plan. The prototype plan was presented to focus group participants (N=12) for discussion and suggestions for changes.
Results: The resulting brief MBI comprises five 90-minute sessions and includes focused attention practice, informal mindfulness, the three-step breathing space, group discussion and psychoeducation. The intervention is person-centred as it promotes flexibility and participant choice, for example by providing options for mindfulness practice.
Discussion: This new MBI will be of benefit to multiple settings including primary care, public health, and higher education. The person-centred orientation should enable a wider group of individuals to participate, including those with acute symptoms.
Keywords: Mindfulness, intervention development, mixed methods, wellbeing