Health and social care delivery research最新文献

{"title":"Extra care housing in the UK: a scoping review.","authors":"Sian de Bell, Zhivko Zhelev, Alison Bethel, Jo Thompson Coon, Rob Anderson","doi":"10.3310/GJRA2822","DOIUrl":"10.3310/GJRA2822","url":null,"abstract":"<p><strong>Background: </strong>Extra care housing is a model of housing for older people where residents live in self-contained accommodation with flexible care and support available at all times. Ageing populations, seen globally and in the United Kingdom, mean increasing demand for this type of housing. While extra care housing may help people live longer independently, its provision poses challenges (e.g. resourcing flexible care). By identifying existing evidence, this scoping review will inform future research into extra care housing, to support the development of schemes that meet the needs of older people.</p><p><strong>Objectives: </strong>To identify the volume, focus/questions, study design, quality and main findings of empirical research and evaluations relating to extra care housing in the United Kingdom.</p><p><strong>Methods: </strong>We conducted a scoping review of evidence syntheses and primary research. Applied Social Sciences Index and Abstracts, Cumulated Index in Nursing and Allied Health Literature, MEDLINE, Health Management Information Consortium, ProQuest Dissertations and Theses Global, Social Policy and Practice (SPP) and Web of Science, along with relevant websites, were searched for studies (June 2024). We also completed citation-chasing on included studies. We included systematic reviews and empirical evaluations published since 2010, conducted in the United Kingdom, focused on extra care housing for older people, and investigating any outcome. Data were tabulated and summarised narratively. Critical appraisal was conducted using the Mixed Methods Appraisal Tool checklist (primary studies) or A MeaSurement Tool to Assess systematic Reviews 2 (systematic reviews). Consultation with stakeholders and extra care housing residents informed the review.</p><p><strong>Results: </strong>Ninety-eight publications were included. Thirty-seven were qualitative, 28 were quantitative, 19 took a mixed-method approach and 2 were modelling studies using secondary data. Older people were participants in 57 studies. Many studies provided limited information on the characteristics of participants and the included extra care housing schemes. Included studies had three overlapping areas of focus: (1) the supply of extra care housing and older people's decision-making regarding relocation; (2) living in extra care housing (e.g. impact on quality of life, residents' experiences of community, physical infrastructure); and (3) leaving extra care housing (there was little research in this area). While much of the available research supports the provision of extra care housing as a model of housing with care for older people, studies were variable in their methodological quality and reporting. Consultation with extra care housing residents raised topics that corresponded with the findings of included studies (e.g. the importance of care provision in supporting independence).</p><p><strong>Limitations: </strong>Extra care housing is known by dif","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 26","pages":"1-117"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148715205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asymptomatic testing compared with standard care of the care home staff in shaping care home COVID-19 testing policy: the VIVALDI-CT pragmatic cluster RCT (VIVALDI-CT).","authors":"Natalie Adams, Oliver Stirrup, James Blackstone, Maria Krutikov, Jackie Cassell, Dorina Cadar, Catherine Henderson, Martin Knapp, Lara Goscé, Lily O'Brien, Ruth Leiser, Martyn Regan, Iona Cullen-Stephenson, Robert Fenner, Arpana Verma, Adam L Gordon, Susan Hopkins, Andrew Copas, Nick Freemantle, Paul Flowers, Laura Shallcross","doi":"10.3310/GJLS1610","DOIUrl":"10.3310/GJLS1610","url":null,"abstract":"<p><strong>Background: </strong>Regular severe acute respiratory syndrome coronavirus 2 testing of care home staff was introduced to reduce transmission following significant morbidity, mortality and disruption for residents early in the pandemic. However, evidence was lacking on benefits relative to disadvantages.</p><p><strong>Objectives: </strong>The VIVALDI-Clinical Trial aimed to investigate whether regular asymptomatic staff testing for severe acute respiratory syndrome coronavirus 2, alongside funding for sick pay and agency backfill, was feasible and effective in reducing severe coronavirus disease discovered in 2019-related outcomes in residents.</p><p><strong>Design and methods: </strong>VIVALDI-Clinical Trial comprised five interlinking work packages. A cluster randomised controlled trial was conducted from January to August 2023. The 'Test to Care' intervention was coproduced with the care sector.</p><p><strong>Settings and participants: </strong>Eighty-one residential/nursing homes in England providing care to adults aged ≥ 65 years. Forty-one homes were randomised to intervention and 40 to control.</p><p><strong>Interventions: </strong>Care homes were randomised 1 : 1 to intervention (twice weekly staff testing, staff sick pay and agency backfill) or control arm (national testing guidance at time of trial).</p><p><strong>Main outcome measure: </strong>Primary outcome was incidence of coronavirus disease discovered in 2019-related hospital admissions in residents.</p><p><strong>Data sources: </strong>Health data from routine national data sets were used alongside aggregate data from participating homes. Health economic and modelling analyses evaluated costs and cost-effectiveness of staff testing. Interviews with care home managers explored post-pandemic policies on staff testing, sickness pay and absence. A process evaluation was conducted to understand intervention roll-out. A mixed-study design investigated the impact of coronavirus disease discovered in 2019 outbreaks on care home residents' quality of life. Stakeholder engagement was undertaken to enable the sector to coproduce recommendations for policy-makers.</p><p><strong>Results: </strong>The trial stopped early for futility due to site recruitment and primary outcome incidence being lower than expected. There was no significant difference in resident coronavirus disease discovered in 2019-linked hospital admission incidence between intervention and control arms (incidence rate ratio 1.19, 95% confidence interval 0.55 to 2.58; <i>p</i> = 0.66). The process evaluation found that changing epidemiology, policy and social norms around coronavirus disease discovered in 2019 shaped the uptake and maintenance of testing. Interviews with care home managers suggested most homes no longer test staff, even when symptomatic, and do not pay for sickness absence outside of statutory sick pay. Modelling concluded that regular staff testing, when combined with non-pharmaceutical interventi","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"195-232"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146204405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethnic differences in injury mortality rates among adult emergency healthcare service users in high-income countries: a scoping review.","authors":"Gargi Naha, Fadi Baghdadi, Alan Watkins, Alison Porter, Ann John, Bridie Angela Evans, Jenna Jones, Julia Williams, Niroshan Siriwardena, Ronan A Lyons, Sophie Harwood, Steve Goodacre, Helen Snooks, Ashrafunnesa Khanom","doi":"10.3310/GJAK4819","DOIUrl":"10.3310/GJAK4819","url":null,"abstract":"<p><strong>Background: </strong>Ethnic disparities in healthcare access and outcomes have been widely reported across different settings. In this scoping review, we aimed to explore whether adults from minority racial and ethnic backgrounds face higher risks of death after presenting with injuries to emergency healthcare services in high-income countries.</p><p><strong>Methods: </strong>We searched five electronic databases [Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Cochrane, Scopus and PsycInfo<sup>®</sup> (American Psychological Association, Washington, DC, USA)] for peer-reviewed studies published between January 2010 and March 2024. We included studies that compared mortality outcomes by race or ethnicity in emergency healthcare settings such as ambulance services, trauma centres and hospital emergency departments in high-income countries.</p><p><strong>Results: </strong>Out of the 1873 articles identified, 32 met the inclusion criteria. Of these, 20 reported higher risk of mortality for ethnic minority patients compared to White patients following injury. Most studies were conducted in the USA with limited representation from other high-income countries such as Canada and Israel. This strong emphasis on USA-based research limits how well the findings apply to other countries with different healthcare systems. A major issue identified across the studies was the inconsistency in how race and ethnicity were recorded and reported. This lack of standardisation makes it difficult to compare results across studies and may hide the true extent of disparities.</p><p><strong>Future work: </strong>To better understand and address ethnic disparities in trauma care, future research should adopt consistent and inclusive ethnicity coding to improve data quality and comparability across studies. Studies should be conducted in a wider range of high-income countries and include pre-hospital settings, where disparities may first appear. This will help build a more globally relevant evidence base. Researchers should also take an intersectional approach, examining how ethnicity combines with other social determinants to influence outcomes. In addition to mortality, future studies using longitudinal and mixed-methods designs should explore long-term recovery and access to rehabilitation to gauge the full impact of these health disparities.</p><p><strong>Limitations: </strong>The review focused solely on mortality outcomes, limiting insight into broader health outcomes such as long-term recovery, quality of life or patient experiences. It also did not explore how ethnicity interacts with other social factors such as gender, income, disability or immigration status. These gaps obscure the full extent of inequalities in emergency care.</p><p><strong>Conclusion: </strong>This review adds to the growing evidence that ethnic minority patients in high-income countries could be at a higher risk of injury-related deaths. However, inconsistent ethn","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"263-284"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Linkage of routinely collected NHS data to evaluate liaison mental health services: challenges and lessons learned.","authors":"Elspeth Guthrie, Allan House, Chris Smith, Sam Relton, Daniel Romeu, Sonia Saraiva, Peter Trigwell, Robert West, Farag Shuweihdi, Mike Crawford, Matt Fossey, Jenny Hewison, Claire Hulme, Sandy Tubeuf","doi":"10.3310/WCPA5283","DOIUrl":"10.3310/WCPA5283","url":null,"abstract":"<p><strong>Background: </strong>Liaison mental health services provide mental health care to patients in acute hospital settings. Evaluation of liaison services is challenging due to their heterogeneous organisation and delivery, high case throughput and varied patient case mix. We aimed to link routinely collected National Health Service data from secondary care settings, chosen for their service characteristics, to data from primary care to evaluate hospital-based liaison mental health services in England.</p><p><strong>Methods: </strong>We planned to compare patients referred to hospital-based liaison services with comparable patients in the same hospital not referred to liaison services and comparable patients in hospitals without any liaison services. We designed and enacted a methodology to link data from: (1) Hospital Episode Statistics, a database controlled by the National Health Service Digital and (2) ResearchOne, a primary care database controlled by The Phoenix Partnership.</p><p><strong>Results: </strong>Obtaining approvals for the steps prespecified in the methodological protocol took 907 days. Enactment following approvals took 385 days. Data supplied from Hospital Episode Statistics contained 181,063 patients from 6 hospitals (mean = 30,177, standard deviation = 28,875.86) who matched the inclusion and exclusion criteria. Data supplied from ResearchOne contained 33,666 (18.6%) of these patients from the 6 hospitals (mean = 5611, standard deviation = 5206.59).</p><p><strong>Discussion: </strong>Time required for approvals and enactment was attributable to slowness of data handling processes within each data holder and to resolution of technical and organisational queries between them. Variation in number of patients for which data was supplied between databases and between hospitals was attributable to coding inconsistencies and to the limited intersection of patient populations between databases and variation in recording practices between hospitals.</p><p><strong>Conclusion: </strong>Although it is technically feasible to link primary and secondary care data, the current system is challenging, complicated, unnecessarily bureaucratic, time consuming and costly. This limits the number of studies that could be conducted with these rich data sources.</p><p><strong>Funding: </strong>This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number 13/58/08.</p>","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-16"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving medicines use in people with polypharmacy in primary care: a synopsis from the IMPPP cluster-RCT with pilot-feasibility study.","authors":"Rupert A Payne, Ammar Annaw, Peter S Blair, Barbara Caddick, Carolyn A Chew-Graham, Tobias Dreischulte, Lorna J Duncan, Bruce Guthrie, Nouf Jeynes, Cindy Mann, RoxanneM Parslow, Jeff Round, Christopher Salisbury, Katrina M Turner, Nicholas L Turner, Deborah McCahon","doi":"10.3310/GJRP0919","DOIUrl":"10.3310/GJRP0919","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Polypharmacy is a major challenge for patient safety and effective resource use. High-quality evidence supporting polypharmacy management is lacking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To develop, optimise and evaluate a primary care complex intervention for reducing medically defined potentially inappropriate prescribing among patients experiencing polypharmacy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Phase 1: Qualitative interviews and focus groups with patients and professionals explored views/experiences of existing National Health Service Scotland interventions, informing development of core intervention components. Phase 2: An external pilot-feasibility study was conducted in five general practitioner practices to optimise the Improving Medicines use in People with Polypharmacy in Primary care intervention. A formative mixed-methods process evaluation examined intervention implementation, alongside evaluating trial processes and collecting data to inform phase 3. Phase 3: A pragmatic, open-label two-arm parallel cluster-randomised trial was conducted in English general practice. The intervention (19 practices) comprised a structured, collaborative and patient-centred approach to medication review, supported by informatics, clinician training, performance feedback and financial incentivisation. The comparator was usual care (18 practices). Up to 50 adults receiving ≥ 5 regular medications, with ≥ 1 indicator of potentially inappropriate prescribing, were reviewed per practice over 6 months. Primary outcome was number of potentially inappropriate prescribing indicators at 26-week follow-up. Secondary outcomes included patient-reported measures and service use. Cost-effectiveness and cost-utility analyses were conducted (primary economic outcome quality-adjusted life-years). A mixed-methods process evaluation (patient surveys, patient/clinician interviews, audio-recorded observations) explored implementation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Phase 1: Intervention component design was informed by findings related to elements of the medication review, informatics and clinician training. Phase 2: Core intervention elements were successfully implemented in the pilot, although clinical delivery was hampered by disruptions due to the coronavirus disease pandemic. Phase 3: Participants were recruited between January and June 2022 (intervention &lt;i&gt;N&lt;/i&gt; = 891, usual care &lt;i&gt;N&lt;/i&gt; = 836), median age 73 years, 49% female, with median four long-term conditions and eight medications. No improvement in the primary outcome was observed (mean difference potentially inappropriate prescribing count - 0.007; 95% confidence interval -0.21 to 0.199). Treatment burden was slightly improved, and subgroup analysis suggested potential improvements in less complex patients. The process evaluation found general practitioners and pharmacists valued and benefitted from the model of interprofessional collaboration, which strengthened working relationships ","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 25","pages":"1-33"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the implementation of Electronic Palliative Care Co-ordination Systems (EPaCCS) and optimising future service provision for palliative and end-of-life care: a synopsis of the Optimal Care mixed-method study.","authors":"Matthew J Allsop, Jacqueline Birtwistle, Andy Bradshaw, Paul Carder, Catherine J Evans, Robbie Foy, Barbara Hibbert, Pablo Millares Martin, Sam Relton, Suzanne Richards, Katherine E Sleeman, Maureen Twiddy, Michael I Bennett","doi":"10.3310/HSDA7175","DOIUrl":"10.3310/HSDA7175","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Electronic Palliative Care Co-ordination Systems are central to end-of-life care policy despite critical gaps in the evidence base underpinning their use. It is unclear how Electronic Palliative Care Co-ordination Systems are being implemented across England and there is a lack of research to understand their use in routine care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To understand how Electronic Palliative Care Co-ordination Systems are currently being used in routine care and to guide the development of interventions to support their optimal implementation and maximise patient benefit.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;A mixed-method approach was adopted across the five-stage programme of research. Packages of work included: (1) a national online survey of end-of-life care leads at clinical commissioning groups in England; (2) an online survey of community and hospital-based health and care professionals in West Yorkshire and London; (3) semistructured interviews with a sample of survey respondents; (4) focus groups and interviews with patients with progressive chronic illnesses and carers and (5) regional and national Theory of Change workshops.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Two-thirds of surveyed regions have Electronic Palliative Care Co-ordination Systems in place. Where present, there is limited use of Electronic Palliative Care Co-ordination Systems to document patients' wishes and preferences. Low uptake may be explained by challenges experienced by health professionals. This includes limited interoperability across electronic health record systems in which Electronic Palliative Care Co-ordination Systems are typically nested, affecting information sharing across settings. Uncertainty was common across health and care professionals relating to what Electronic Palliative Care Co-ordination Systems are, who they are for and how organisations should monitor them. Mid-range programme theory was generated to guide the development and evaluation of Electronic Palliative Care Co-ordination Systems alongside recommendations for decision-makers and commissioners for palliative and end-of-life care in England.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The project was conducted across England with in-depth health and care professional engagement in two regions of England. This may limit the applicability of findings across England, although the project included large regions with multiple Electronic Palliative Care Coordination Systems operating at different levels of maturity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Electronic Palliative Care Co-ordination Systems are not working as intended for palliative and end-of-life care delivery in England. The application of the recommendations generated through this project can ensure consideration of the wider ecosystem in which Electronic Palliative Care Co-ordination Systems are being implemented, guiding system development that promotes health and care professional engagement and facilitates","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 24","pages":"1-32"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recovery Colleges for post-diagnostic dementia support: The DiSCOVERY realist evaluation synopsis.","authors":"George Christopher Fox, Juniper West, Thomas Rhodes, Fiona Poland, Linda Birt, Melanie Handley, Geoff Wong, Esme Moniz-Cook, Emma Wolverson, Bonnie Teague, Corinna Hackmann, Rachael Litherland, Leanne Hague, Jarin Alam, Kathryn Sams, Ruth Mills","doi":"10.3310/GJCF2730","DOIUrl":"10.3310/GJCF2730","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Recovery Colleges offer peer-led, coproduced psychoeducational courses to support people to have meaningful lives. There is limited knowledge of their use in the context of dementia. This study used a realist programme theory approach to develop an in-depth understanding of how United Kingdom Recovery College dementia courses lead to outcomes for people with dementia, families and staff.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To build knowledge through mapping Recovery College dementia courses across the United Kingdom; conduct a realist review of evidence; identify key components of effective Recovery College dementia courses within a realist programme theory; identify outcome measures for evaluating Recovery College dementia courses; understand diverse ethnic and cultural needs of people with dementia in accessing Recovery College dementia courses; and coproduce resources for implementing Recovery College dementia courses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design and methods: &lt;/strong&gt;A mixed-methods design to examine what works for who and in what circumstances, coproduced with people with lived experience of dementia and staff from National Health Service Recovery Colleges and memory services. This involved: a United Kingdom-based staff survey of memory services and Recovery College dementia course provision, delivery and attendance; a realist review combining literature and stakeholder knowledge to build an initial programme theory; a realist evaluation using ethnographic observation within five case studies, realist interviews and documentary evidence, with analysis involving stakeholders using realist logic to explore causal processes operating in different contexts and intended and unintended outcomes (i.e. Contexts, Mechanisms and Outcomes); a scoping review of potential outcome measures for evaluation; and coproduced resources using three rounds of stakeholder workshops.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting and participants: &lt;/strong&gt;Set in United Kingdom National Health Service mental health organisations, staff recruitment from Recovery Colleges and memory services and people with dementia/families from Recovery Colleges.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Twelve (from 51) Recovery Colleges offered dementia-specific courses, and 210 memory service staff completed the survey. Thirty-five documents and discussions with 19 stakeholders (7 people with dementia, 2 family carers, 10 staff) informed the initial programme theory. A trusted person endorsing a course encouraged attendance. Shared coproduction values underpinned the success of setting up and running courses. Through co-facilitation of recovery-focused content by peer-tutors with well-developed facilitation skills, attendees appeared to mediate self-stigma, manage emotional uncertainty and make meaningful social connections in ways which engendered hope for the future. Course evaluation was challenging as people often left without completing a written survey. One attempt at pre and post co","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 19","pages":"1-36"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attracting, recruiting, and retaining registered nurses and care workers in care homes: the REACH realist review.","authors":"Reena Devi, Kirsty Haunch, Sonia Dalkin, Angela Bate, Natalie King, Judy Wright, Liz Jones, Claire Goodman, Karen Winterburn, Edna Feenan, Vinny Kennedy, Karen Spilsbury","doi":"10.3310/GJRD0408","DOIUrl":"10.3310/GJRD0408","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Social care staff shortages are having a detrimental impact across the health and care system. There are reports of care homes closing, stopping nursing services and not admitting new residents because of challenges with staff shortages.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To develop an explanatory framework of strategies used to attract, recruit, and retain registered nurses and care workers working in care homes. Explain how and why strategies work, for whom, the conditions needed and the costs involved.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design and methods: &lt;/strong&gt;A realist synthesis approach was used. In step 1, strategies were identified and initial programme theories developed using data from stakeholder consultations (&lt;i&gt;n&lt;/i&gt; = 10), theory gleaning interviews with registered nurses and care workers (&lt;i&gt;n&lt;/i&gt; = 13), and evidence retrieved from scoping literature searches (&lt;i&gt;n&lt;/i&gt; = 50). Strategies (and initial programme theories) prioritised by sector stakeholders focused on staff recruitment and retention, and were taken forward for testing/refinement. Step 2 involved searching academic databases and social care websites for evidence. Step 3 involved screening and selecting records relevant to the prioritised initial programme theories. Relevant data were extracted and analysed to identify context-mechanism-outcome configurations. To assess rigour, the appropriateness of research methods, and the plausibility/transparency of grey literature were assessed. Step 4 involved testing and refining the programme theories, with programme theories sense checked/refined by sector stakeholders. Existing and established theories were used to help further explain the programme theories and develop an overarching explanatory framework.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;During step 1, strategies used to attract, recruit, and retain registered nurses and care workers were identified and initial programme theories developed (&lt;i&gt;n&lt;/i&gt; = 22). Ten strategies and initial programme theories were prioritised for testing/refining and were focused on recruitment and retention: staff recognition, flexible working, career development, salary package, early investment, induction, continuous feedback, caring community, effective interviewing and listening to all staff. From the focused literature searches, 153 papers were included and data from these were used to test and refine the prioritised strategies and initial programme theories, and throughout the process collated into five final theories: effective interviewing, career development, reward and recognition, promoting work-life balance and caring conversations. These strategies do not operate independently; they interact and work together. Effective interviewing sets accurate expectations, and loyalty starts to develop through setting an accurate 'psychological contract' which is fulfilled over time. Opportunities for career development, rewarding and recognising staff, providing flexible working options an","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 21","pages":"1-142"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A realist synthesis of integrated palliative care and oncology: Synopsis.","authors":"Carolyn Blair, Natasha Bradley, Peter O'Halloran, Gillian Prue, Fiona Lynn, Nia Roberts, Geoff Wong, Elspeth Banks, Tracey McConnell, Joanne Reid","doi":"10.3310/GJJR3630","DOIUrl":"10.3310/GJJR3630","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Existing evidence demonstrates the benefits of integrated palliative care for people with cancer and their carers, for improved symptom burden, quality of life and appropriate healthcare resource use. The integration of palliative care and oncology has the potential to improve the quality of life and is recommended by international guidelines. However, it is not yet consistent practice. There are many approaches to integration, but it is unclear what works, for whom and in what contexts to achieve the best possible outcomes for people with cancer, carers and healthcare systems.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To conduct a realist synthesis to develop a programme theory of how integrated palliative care in cancer works, for whom and in what contexts to achieve improved symptom management and increased quality of life for people with cancer and their carers. To use the programme theory to coproduce, with stakeholders (e.g. patient and public involvement representatives, local, national, international content experts and multidisciplinary practitioners), guidance to inform delivery of best practice and guide future research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design and methods: &lt;/strong&gt;Realist review, conducted in accordance with Realist and Meta-narrative Evidence Synthesis: Evolving Standards. Evidence was identified through systematically searching academic databases and through stakeholder engagement. Data were extracted from included articles and were synthesised using a realist logic of analysis to develop explanations of how and why integrated palliative care in oncology works, for whom and in what contexts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;One hundred and sixty-four papers from 33 countries were included in the review. Integrated palliative care and oncology could improve people with cancer's outcomes, increase the goal-concordance of care and support workforce well-being. Interventions to support integration should be tailored to the context in which they are delivered. Ensuring the timely delivery of palliative care for people with cancer requires integration that overcomes siloes between oncology, specialist palliative care and primary and community care. The motivation to prioritise the integration of palliative care relies upon all stakeholders first understanding its value. Enriched interdisciplinary collaboration involves developing confidence in their own and their colleagues' skillsets, facilitating co-ordination between care settings and supporting communication within and between teams. Supportive leadership could promote an institutional culture of acceptance of the value of integrating palliative care into oncology management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The realist approach to analysis means that findings are based on our interpretation of the data. To manage the high volume of studies, we limited inclusion to documents published since 2010, using qualitative, mixed or economic methods; therefore, we may ","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 23","pages":"1-100"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148348350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pressure Ulcer Prevention at Home for People with Long-term Neurological Conditions, Carers and Personal Assistants: Synopsis - a Participatory, Qualitative study (PUP@Home1).","authors":"Delia Muir, Laura McLarty, Jessica Drinkwater, Carole Bennett, Yvonne Birks, Andrea Broadway-Parkinson, Vanessa Cooksey, Phil Gleeson, Christy Holland, Lisa Ledger, Daniella-Jade Lowe, Andrea McGoverin, Jane Nixon, Tanya Perry, Brian Rawson, Yvonne Rawson, Heidi Sandoz, Nikki Stubbs, Kay Walker, Helen Whitaker, Susanne Coleman","doi":"10.3310/GJSC0721","DOIUrl":"10.3310/GJSC0721","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Many people with long-term neurological conditions (e.g. multiple sclerosis, spina bifida) live independently and manage complex health needs, including mobility and sensory limitations which mean they have a high risk of pressure ulcer development. Despite their high risk, appropriate pressure ulcer prevention support and resources are often lacking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;To develop a Theory of Change pathway, which will underpin future development of a multicomponent intervention package supporting pressure ulcer risk identification and management, in partnership with people with long-term neurological conditions who self-manage care and live at home, their informal carers and personal assistants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used a partnership approach based in the participatory research paradigm, with extensive input from those whose lives are the focus of the research. The study comprised four interlinked work packages: Work package 1 - Development of two co-operative inquiry groups Work package 2 - Semistructured interviews and/or participation via a smartphone app Work package 3 - Professional and strategic stakeholder engagement Work package 4 - Systems mapping and Theory of Change pathway development Iterative, qualitative data analysis was undertaken with emerging findings from each work package informing subsequent elements of the study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Overall, 74 participants contributed across the 4 work packages. This incorporated 31 service users, 8 carers, 9 personal assistants and 26 professional stakeholders. The findings indicate the complexities of pressure ulcer prevention for this population, who are often fulfilling multiple roles in society (i.e. in their families, communities, work) alongside onerous self-care routines. Systemic and professional barriers were found to hamper people's ability to self-care, support others and seek help. Areas of learning were highlighted around developing safe routines, third sector and peer support, learning about pressure ulcer prevention, navigating complex systems, adapting and reacting to change, perceptions of risk, risk negotiation and the role of non-clinical carers. By collaboratively reflecting on these findings with key stakeholders (service users, carers, personal assistants, professional/strategic partners), we were able to identify points in the system amenable to change. This underpinned the development of a Theory of Change for a multicomponent intervention incorporating awareness raising, routine guidance, escalation guidance and communication components (supported by preconditions, contextual requirements, long-term outcomes, impacts and explanatory rationale).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;We acknowledge that despite our best efforts (incorporating targeted National Health Service and third-sector recruitment), the ethnic diversity of our research was not as representative as we had intended. We have inc","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 20","pages":"1-46"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}