Health and social care delivery research最新文献

{"title":"Models of perinatal care for women using drugs and their infants: synopsis of The Stepping Stones Study.","authors":"Polly Radcliffe, Brid Featherstone, Narendra Aladangady, Margaret Maxwell, Joanne Neale, Lynne Gilmour, Louise Honeybul, Shirley Lewis, Emma Smith, Mariana Gonzalez Utrilla, Helen Cheyne","doi":"10.3310/GJPR0411","DOIUrl":"10.3310/GJPR0411","url":null,"abstract":"<p><strong>Background: </strong>Women who use drugs during the perinatal period often have complex health and social care needs. Their infants can experience developmental and health problems. Despite United Kingdom's guidelines and policies on the care of pregnant women and mothers who use drugs, there is little evidence of the services that are available in the United Kingdom and whether they meet the needs of women and their infants. This study sought evidence of (1) best practice models for care that have the potential to interrupt the transmission of adversity across generations and (2) the views and experiences of women and staff on different models of care and how services could be improved. The study involved systematic reviews, longitudinal qualitative research and coproduction. There were three phases. In phase 1, an Expert Advisory and CoProduction Group was established to guide the research and to develop a theory of change for improved service models. The group comprised multidisciplinary stakeholders from health and social care and peer advisers. Two reviews were undertaken: A scoping review of UK guidance for perinatal care for women who use drugs included 111 documents, recommending integrated multidisciplinary working. A mixed-methods systematic review of evidence of integrated models of perinatal care for women who use drugs and their babies reviewed 197 studies. Qualitative findings suggest that women appreciate collocated services that are easy to access. Quantitative findings found evidence that integrated programmes at the point of delivery decrease substance use during the perinatal period. Phase 2 involved a qualitative longitudinal study in four sites, two in England and two in Scotland, that aimed to explore perinatal care pathways. Up to five interviews were conducted with 36 women, from early pregnancy up to 18 months post natal (131 interviews). Many women experienced stigma and were anxious about social services' involvement. Access to residential treatment and mental health support was uneven. Support for women who had lost care of their babies was poor. Focus group interviews (79 staff) and individual interviews (21 staff) were conducted with health and social care practitioners. Staff reported that high caseloads, staff turnover and training gaps contributed to difficulties in providing care to this challenging group. In phase 3, the Expert Advisory and CoProduction Group worked with the research team to develop a theory of change for recommendations for an optimised service model. The theory of change identified eight key recommendations and emphasised that a whole-system approach is required to meet the complex needs of this population.</p><p><strong>Limitations: </strong>For the quantitative findings of the mixed-methods systematic review, the diversity of study types made it difficult to draw firm conclusions on the effectiveness of different approaches. Not all women recruited to the qualitative longitudinal ","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 2","pages":"1-36"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146014021","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 randomised feasibility trial of an intervention involving mental health support workers as link workers to improve dental visiting in people with severe mental illness: The Mouth Matters in Mental Health Study.","authors":"Jasper Palmier-Claus, Abigail Morris, Paul French, Robert Griffiths, Vishal Aggarwal, Katherine Berry, Efstathia Gkioni, Rebecca Harris, Louise Laverty, Fiona Lobban, Sarah Procter, David Shiers, Chris Lodge, Girvan Burnside","doi":"10.3310/GJJP0425","DOIUrl":"https://doi.org/10.3310/GJJP0425","url":null,"abstract":"<p><strong>Background: </strong>People with severe mental illness (e.g. bipolar disorder, psychosis) experience poor oral health compared to the general population. They are more likely to have decayed, missing or filled teeth, and periodontal disease, which can affect quality of life and functioning. It can add to the burden of living with severe mental illness. Dentists can prevent and treat oral health problems. However, people with severe mental illness experience profound and multifaceted barriers to attendance, including practical issues, financial difficulties and dental anxiety. Unfortunately, existing dental interventions have not addressed these issues. They have not helped people with severe mental illness to attend the dentist. This project aimed to develop and evaluate a link work intervention, delivered by mental health support workers, to enable dental access in people with severe mental illness. The intervention attempted to help people to navigate dental systems and bridge the gap between services. There were four work packages: Work package 1 involved 4 co-production workshops with patients, staff, and carers (7, 6, 8 and 12 attendees, respectively). We used this information to co-develop and refine the link work intervention and associated training materials. This step ensured that the intervention was relevant and helpful to people with mental health difficulties. Work package 2 was a realist review to understand the contexts and resultant mechanisms by which link work interventions affect access to community healthcare services. A search of empirical and grey literature identified 31 reports. The analysis resulted in nine context, mechanism, and outcome configurations within three theory areas, providing useful information on how and why link work interventions might be helpful. Work package 3 was a feasibility randomised controlled trial of a link work intervention to support dental access in people with severe mental illness who had not attended a routine dental appointment in the past 3 years. Seventy-nine out of the target 84 participants were randomised to receiving either treatment as usual or treatment as usual plus the link work intervention. The majority of the feasibility criteria were met and there was high engagement with the intervention. Uptake of an optional dental examination was low at follow-up (12.7%; 95% CI: 7.0% to 21.8%). There were no serious adverse events attributable to the intervention or trial procedures. Overall, the findings supported progression to a full trial. Work package 4 was an embedded qualitative evaluation of the link work intervention and trial. Narrative-informed interviews were carried out with 18 participants in the trial (13 in the intervention arm, 5 in the treatment as usual arm) and 3 link workers. The qualitative data suggested high levels of interest and engagement from stakeholders, and need for dental intervention. The link work intervention offered practical and emotional s","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 1","pages":"1-14"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146004940","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":"Meeting the needs of women in the perinatal period, who use or are in treatment for using drugs: A mixed-methods systematic review.","authors":"Emma Smith, Shirley Lewis, Lynne Gilmour, Louise Honeybul, Helen Cheyne, Narendra Aladangady, Brigid Featherstone, Margaret Maxwell, Joanne Neale, Mariana Gonzalez Utrilla, Polly Radcliffe","doi":"10.3310/GJPR0321","DOIUrl":"10.3310/GJPR0321","url":null,"abstract":"<p><strong>Background: </strong>Women who use and/or are in treatment for using drugs during the perinatal period have complex health and social care needs. Substance use in the perinatal period is multifaceted, with many confounding factors that may impact the long-term health and well-being of both mothers and children. Evidence is needed to identify which psychosocial interventions are effective for women who use and/or are in treatment for drug use during the perinatal period.</p><p><strong>Objective(s): </strong>(1) Describe the range of psychosocial interventions available for women who use and/or are in treatment for drugs in the perinatal period; (2) to document evidence on the effectiveness of interventions and (3) identify interventions that women feel most meet their needs.</p><p><strong>Design: </strong>A mixed-methods systematic review was conducted following a predetermined protocol and the Joanna Briggs Institute guidance for mixed-methods systematic reviews, adopting a segregated approach.</p><p><strong>Review methods: </strong>Eight databases were searched for articles meeting the inclusion criteria on 7 April 2022, and updated searches were run on 5 February 2024. The search was limited to include peer-reviewed articles published after 1990 and available in English. In total, 15,655 articles were identified. Following screening by four reviewers by title and abstract and then full text, 197 articles were included in the review. A data extraction template was used to extract study characteristics and results. Quality was assessed using the mixed-methods Quality Appraisal Tool. Cohen's <i>d</i> was used to measure the effect size for quantitative data to understand if an intervention had a small (> 0.2), medium (> 0.5) or large effect (> 0.8). Effectiveness was measured through three outcomes: (1) improvements and engagement with and retention in substance use treatment services for women in the prenatal and postnatal period; (2) reductions in substance use by women in the perinatal period and (3) improvements in engagement with and retention in prenatal care. For qualitative data, articles were grouped by the intervention type and the authors' analytical themes and conclusions were thematically synthesised.</p><p><strong>Results: </strong>The 197 included studies described 217 separate interventions. Most interventions (85.3%) were community-based, delivered in more than one way (49.3%), and delivered in single settings (50.6%), although some were colocated alongside other services (22.1%). No conclusive evidence for effectiveness was established for any type of intervention, although most interventions that improved retention in substance use services included practical support. The qualitative synthesis supported these findings and additionally suggested that women appreciated being able to access multiple services in one place: non-judgemental, trauma-informed services and peer-support models.</p><p><strong>Limitations: </stro","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"37-62"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985393","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":"Health visiting in the UK in light of the COVID-19 pandemic experience (RReHOPE): study synopsis.","authors":"Erica Gadsby, Emma King, Madeline Bell, Geoff Wong, Sally Kendall","doi":"10.3310/GJEG0402","DOIUrl":"10.3310/GJEG0402","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic interrupted and, in some cases, transformed the way health visiting teams work, the way they interact with families and children and with the wider community and other service providers. Health visiting services are organised, delivered and experienced differently in different places, with little evidence to suggest what works best, for whom and in what contexts.</p><p><strong>Objective: </strong>To synthesise the evidence on changes during the pandemic to identify the potential for improving health visiting services and their delivery in the United Kingdom.</p><p><strong>Methods: </strong>This realist review engaged professional stakeholders (<i>N</i> = 28) and those caring for babies during the pandemic (<i>N</i> = 6) throughout the process. We searched five electronic databases for publications on health visiting during the COVID-19 pandemic from October 2022 to April 2023. This was followed by citation searching and review of organisational websites. Programme theory was iteratively refined through discussions with the team, professional stakeholders and people with lived experience and was translated into key findings and recommendations.</p><p><strong>Results: </strong>One hundred and eighteen documents informed this review; most focused on health visiting in England (56%) or the United Kingdom (34%), with relatively few from Wales (6%), Scotland (3%) and Northern Ireland (1%). Documents highlighted the widespread, uneven and lasting impact of the COVID-19 pandemic on babies and families. Findings revealed significant concerns expressed by both families and practitioners and corresponding actions taken by health visiting services. These concerns and responses emphasised the flexibility and resourcefulness of health visitors, the vital role of trusting relationships between health visitors and families and the importance of holistic assessments for early intervention. Changes in service delivery were varied and were not always evaluated or sustainable. While the data illuminated some of the hidden complexities of health visiting practice, limited evidence was found on decision-making at organisational and managerial levels during the pandemic response.</p><p><strong>Evidence limitations: </strong>Included papers were predominantly from an advocacy or practitioner perspective, and few focused on health visiting in Scotland, Wales and Northern Ireland. Our focus on the universal health visiting pathways meant that documents pertaining to additional support received by the most vulnerable families might have been excluded. Experiences of Black, Asian and minority ethnic families and staff were illustrated in several papers.</p><p><strong>Conclusions: </strong>The COVID-19 pandemic highlighted the essential role of health visitors in safeguarding child and family well-being in the United Kingdom. While digital adaptations provide necessary continuity, face-to-face interactions remain essentia","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 42","pages":"1-28"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145703672","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":"Witness to Harm-Holding to Account. Improving patient, family and colleague experiences of Fitness to Practise proceedings: A mixed-methods study.","authors":"Louise Wallace, Sara Ryan, Rosalind Searle, Gemma Hughes, Annie Sorbie, Gemma Ryan-Blackwell, Sharif Haider, Richard West","doi":"10.3310/SSPP1118","DOIUrl":"https://doi.org/10.3310/SSPP1118","url":null,"abstract":"<p><strong>Background: </strong>In the United Kingdom, over 2.5 million health and social care professionals are registered by 13 statutory professional regulators. When professional conduct falls below standard, registered professionals may face an investigation into matters such as their conduct, health or competence via fitness to practise processes. Very serious cases are heard in public by an independent adjudication panel. The public, the largest source of concerns, may be asked by the regulator to be cross-examined in a hearing where their evidence may be crucial. Witness cross-examination is known to be distressing in the criminal context, where the victim is questioned about the harm they experienced and how they faced the alleged perpetrator. In fitness to practise, retelling stories could be similarly retraumatising. Our research focuses on the public (and colleagues) who raise concerns, including that they have been harmed by a professional, and examines their experience of engaging with fitness to practise processes.</p><p><strong>Design and methods: </strong>The study employed multiple qualitative methods. Public website materials were analysed using thematic content analysis, accessibility and readability algorithms and a useability survey about submitting a complaint (<i>n</i> = 11). The views of the public and those with personal experience of fitness to practise validated our analysis of the web content (<i>n</i> = 15). Sociolegal analysis was conducted of the United Kingdom's social work/social care regulators' conceptualisations of witness vulnerability and special measures. Twenty-seven registrants' employers were approached, and 25 were interviewed about organisational support for registrants, patients and service users. Data collection via regulators (<i>n</i> = 285) with small numbers via social media included surveys, (<i>n</i> = 64 in total) across 9 regulators, interviews (<i>n</i> = 47) across 10 regulators, ethnographic observation of hearings (<i>n</i> = 22) with 81 days of observation across 9 regulators, and documentary analysis of hearings determinations and witness statements across 13 regulators (<i>n</i> = 207). Project recommendations were coproduced through six formative workshops involving public members, legal, health and social care professionals, regulatory staff and lawyers and academics. Analytic methods included institutional ethnography, thematic analysis and narrative portraits.</p><p><strong>Results: </strong>The website information for the public was often too much or too little, in inaccessible formats, and requiring high literacy and digital skills. The social care regulators' conceptions of vulnerability largely relied on inherent factors (e.g. disability), or misconduct categories, rather than being situationally sensitive to witnesses' diverse needs. The experience of those who had been harmed was found to be profoundly distressing for most participants at each stage of the fitness to practise","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 44","pages":"1-40"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145807010","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":"Integration of specialised services for eating disorders and functional symptom disorders in children and young people: discrete choice experiments and qualitative study.","authors":"Stephen Morris, Efthalia Massou, Josefine Magnusson, Saheli Gandhi, Pei Li Ng, Angus Ig Ramsay, Naomi J Fulop","doi":"10.3310/CLHA1094","DOIUrl":"10.3310/CLHA1094","url":null,"abstract":"<p><strong>Background: </strong>Evidence suggests that centralising specialist healthcare services can improve outcomes for patients but increase travel distances and times. Traditionally, people requiring specialist health care were cared for by a single specialist, with mental and physical health care delivered by separate services. Recent trends involve greater collaboration between specialists. Integrated care is the highest level of collaboration, including shared access to medical records and multidisciplinary care.</p><p><strong>Objectives: </strong>To investigate how centralisation of specialised healthcare services can be characterised. To examine the proposed integration between physical and mental health services in the care of children and young people with eating disorders and functional symptom disorders in one region of England.</p><p><strong>Design: </strong>Mixed-methods study comprising: a scoping review (conducted in November 2020) of four databases to characterise centralisation of specialised healthcare services; a systematic literature review (conducted in August 2022, updated in July 2024) of three databases to evaluate integration of physical and mental health services for children and young people with eating disorders and functional symptom disorders; an interview study of parents (<i>n</i> = 10 participants), healthcare professionals (<i>n</i> = 14 participants) and a project lead (<i>n</i> = 1 participants) to understand perspectives on integration, which analysed data in themes organised within the Consolidated Framework for Implementation Research; and two discrete choice experiments of preferences using online surveys (<i>n</i> = 400 participants).</p><p><strong>Results: </strong>The scoping review (<i>n</i> = 93 studies) found that definitions of centralisation commonly lacked detail but, where available, covered centralisation's form, objectives, mechanisms and drivers. Limited evidence suggests centralisation could be linked to better outcomes, but many important outcomes were rarely examined. The systematic review of integration found one low-quality (uncontrolled) pre-post study of eating disorders in Australia. Findings from the interviews suggest that service redesign should ensure the concept of 'integration' has shared meaning among professionals, and that agreement is reached over roles and responsibilities. From the discrete choice experiments, the main things that mattered to parents when thinking about integration were days missed from school in the case of eating disorders and time to diagnosis for functional symptom disorders.</p><p><strong>Limitations: </strong>Limited, poor-quality literature in the reviews; small numbers of interview participants; difficulties engaging parents, carers and healthcare professionals for the discrete choice experiment.</p><p><strong>Conclusions: </strong>There is a lack of evidence around integrated care for children and young people affected by eating disorders and fu","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 43","pages":"1-20"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806986","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":"Proactive Integrated Consultation-Liaison Psychiatry for older medical inpatients: The HOME Study RCT of its effectiveness and cost-effectiveness.","authors":"Michael Sharpe, Jane Walker, Maike van Niekerk, Mark Toynbee, Nicholas Magill, Chris Frost, Ian R White, Simon Walker, Ana Duarte, Colm Owens, Chris Dickens, Annabel Price, Rowan Harwood, Sarah E Lamb, Daniel Lasserson, Sasha Shepperd","doi":"10.3310/KGFS3671","DOIUrl":"10.3310/KGFS3671","url":null,"abstract":"<p><strong>Background: </strong>Older medical inpatients have complex biopsychosocial problems, which often lead to prolonged hospital stays. Proactive Integrated Consultation-Liaison Psychiatry was designed to help ward teams manage biopsychosocial complexity and thereby reduce the time that older medical inpatients spend in hospital.</p><p><strong>Objectives: </strong>To assess the experience, effectiveness and cost-effectiveness of enhancing medical care with Proactive Integrated Consultation-Liaison Psychiatry in The HOME Study.</p><p><strong>Design and setting: </strong>A parallel-group, multicentre, individually randomised controlled trial with process and economic evaluations in 24 medical wards of three National Health Service hospitals.</p><p><strong>Participants: </strong>Patients aged ≥ 65 years, admitted in an emergency and expected to remain in hospital for at least 2 days from the time of enrolment.</p><p><strong>Interventions: </strong>Proactive Integrated Consultation-Liaison Psychiatry clinicians (consultation-liaison psychiatrists supported by assisting clinicians) made proactive biopsychosocial assessments of patients' problems, then delivered discharge-focused care as integrated members of ward teams. Usual care was provided by ward teams.</p><p><strong>Process evaluation: </strong>Observations on training Proactive Integrated Consultation-Liaison Psychiatry clinicians and the care they provided; Proactive Integrated Consultation-Liaison Psychiatry clinicians' experiences of working in the new service model; patients' and ward staff members' experiences of Proactive Integrated Consultation-Liaison Psychiatry.</p><p><strong>Primary outcome: </strong>Time spent as an inpatient (during the index admission and any emergency re-admissions) in the 30 days post randomisation.</p><p><strong>Secondary outcomes: </strong>Rate of discharge for the total length of the index admission; discharge destination; length of the index admission post randomisation truncated at 30 days; number of emergency re-admissions, number of days in hospital and rate of death in the year post randomisation; the patient's experience of the hospital stay and view on its length; anxiety; depression; cognitive function; independent functioning; health-related quality of life; overall quality of life.</p><p><strong>Economic evaluation: </strong>Cost-effectiveness of Proactive Integrated Consultation-Liaison Psychiatry over 1, 3 and 12 months from a hospital perspective.</p><p><strong>Results: </strong>Two thousand seven hundred and forty-four participants were enrolled (1399 male, 1345 female; mean age 82.3 years; 2565 White; 1373 Proactive Integrated Consultation-Liaison Psychiatry, 1371 usual care). Proactive Integrated Consultation-Liaison Psychiatry was experienced positively by patients (43 interviews) and ward staff (54 interviews). The mean time spent in hospital in the 30 days post randomisation was 11.37 days (standard deviation 8.74) with Proactive Integ","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 41","pages":"1-85"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145703682","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":"Evidence of the impact on and views of NHS staff following a colleague's suicide to inform postvention guidance: a multi-methods study.","authors":"Ruth Riley, Johanna Spiers, Hilary Causer, Jill Maben, Carolyn Chew-Graham, Nikolaos Efstathiou, Anya Gopfert, Kathryn Grayling, Maria van Hove","doi":"10.3310/GFTA1212","DOIUrl":"10.3310/GFTA1212","url":null,"abstract":"<p><strong>Background: </strong>Healthcare professionals are 24% more likely to die by suicide than the general population. The impact of such deaths on National Health Service colleagues is unclear. Early post-suicide support (postvention) is beneficial for those affected, yet little is known about how to offer this support within the National Health Service.</p><p><strong>Objectives: </strong>We set out to: (1) review existing research on suicide impact and postvention interventions in workplace settings; (2) explore the impact of colleague suicide on staff well-being; (3) examine staff perceptions of contributing factors to their colleague's suicide; (4) identify what supports or hinders bereaved colleagues in seeking help, and gather staff preferences for future support; (5) explore how managers currently support workers following a death by suicide; and (6) use the findings to develop evidence-based postvention guidance for National Health Service organisations.</p><p><strong>Methods: </strong>This study had four work packages: (1) an integrative review of primary research to review the impact of suicide in the workplace; (2) a qualitative interview study with National Health Service staff affected by a colleague's suicide or involved in supporting others (<i>n</i> = 29 affected staff, <i>n</i> = 22 supporters). Data were analysed using grounded theory and thematic analysis; (3) a co-production workshop with key stakeholders to review research findings and generate recommendations; and (4) a synthesis of all findings and recommendations to develop evidence-based postvention guidance.</p><p><strong>Results: </strong>The integrative review revealed that existing postvention guidance often lacks empirical support and does not address how workplace culture affects staff after a suicide. Those tasked with delivering postvention face stigma and complex challenges, and current support does not fully meet the needs of affected staff. In the interview study, two theories were developed. First, staff affected by a colleague's suicide faced cultural and behavioural barriers to accessing support. Some devised strategies to overcome these barriers, while others fell through the gaps. Second, those providing postvention support also encountered barriers and required emotional and practical backing to effectively support others. Thematic analysis generated key recommendations for National Health Service trusts: (1) promote staff mental health and encourage open discussions about suicide; (2) establish trained teams to deliver timely support; (3) share information swiftly and compassionately, giving staff space to reflect together; (4) offer ongoing emotional support and staff-led activities like memorials and (5) ensure support teams also receive emotional and practical assistance. All findings and recommendations were discussed during our co-design workshop. Stakeholder attendees supported the recommendations. Findings informed our guidance, which emphasi","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 40","pages":"1-87"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497793","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":"Development and implementation of a digital health intervention in routine care for long COVID patients: a comprehensive synopsis.","authors":"Henry Goodfellow, Ann Blandford, Katherine Bradbury, Manuel Gomes, Fiona Hamilton, William Henley, Fiona Stevenson, Delmiro Fernandez-Reyes, John Hurst, Melissa Heightman, Paul Pfeffer, William Ricketts, Richa Singh, Hannah Hylton, Stuart Linke, Julia Bindman, Chris Robson, Sarah Walker, Hadiza Ismaila","doi":"10.3310/GJHG0331","DOIUrl":"10.3310/GJHG0331","url":null,"abstract":"<p><strong>Background: </strong>By July 2020, large numbers of post-COVID patients were experiencing symptoms for weeks or months, but traditional National Health Service models of rehabilitation service delivery could not meet demand.</p><p><strong>Objectives: </strong>Design and deploy a digital health intervention to provide digitally delivered, remotely supported rehabilitation to long COVID patients on complicated and evolving pathways.</p><p><strong>Methods: </strong>The multidisciplinary team combined established research methods based on engineering and computer science (considering safety, stability and user requirements) with those based on biomedical and health service research (considering effectiveness and population impact). Qualitative data comprised recordings of meetings between study team members and clinicians and semistructured interviews with clinician and patient users. Quantitative data comprised referral, registration and usage rates; demographic and clinical characteristics of patients; and patient-reported outcome measures.</p><p><strong>Results: </strong>We created a modifiable digital health intervention, 'Living With COVID Recovery<sup>TM</sup> developed by Living With Ltd', London, UK, that continues to be used by National Health Service trusts. The digital health intervention included integration into a clinical pathway, a clinician-facing dashboard, two-way messaging and a patient-facing app with information and evidence-based treatments. We aimed to register 1000 users. By study completion on 20 December 2022, there were 9781 patients invited, of whom 7679 (78.5%) had registered, at 33 National Health Service clinics.</p><p><strong>Limitations: </strong>Data came from patients at long COVID clinics, however data were unlikely to be representative of people with long COVID. We could not observe clinics under lockdown and had limited access to patient digital health intervention users or to people not engaging with the digital health intervention. Patient user data were incomplete, with inconsistent patient-reported outcome measure and other questionnaire data completion and no data on initial severity of disease, vaccination status, comorbidities or other individual circumstances.</p><p><strong>Conclusions: </strong>Long COVID can be extremely debilitating, comparable to stage IV lung cancer in relation to fatigue and health-related quality of life. Care and rehabilitation should address the management of fatigue and reflect the impact of social disadvantage on symptom severity. With sufficient resources, a digital health intervention can be developed quickly and effectively using agile methodology and bringing together a genuinely multidisciplinary team, including, importantly, an industry partner. Digital health intervention product design and deployment are both important in getting National Health Service trusts, healthcare professionals and patients to engage with a digital health intervention. Projects should","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 39","pages":"1-28"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145491401","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":"Accessibility and acceptability of perinatal mental health services for women from ethnic minority groups: a synopsis of the PAAM study.","authors":"Nikolina Jovanović, Maev Conneely, Sarah Bicknell, Jelena Janković","doi":"10.3310/TDAS1298","DOIUrl":"10.3310/TDAS1298","url":null,"abstract":"<p><strong>Background: </strong>Ethnic minority women face worse maternity outcomes and increased risk of perinatal mental health issues, yet research on the accessibility and acceptability of perinatal mental health services for these groups is limited.</p><p><strong>Objectives: </strong>(1) To explore access to and utilisation of mental health services during the perinatal period among ethnic minority women; (2) to explore care pathways to community and inpatient perinatal mental health services; (3) to explore the attitudes, experiences and service improvement suggestions of ethnic minority women with perinatal mental health problems, as well as those of their partners, family members and healthcare professionals and (4) to produce recommendations for improving clinical practice.</p><p><strong>Methods: </strong>Mixed-methods study was conducted during 2018-23, encompassing four studies aligned with specific aims: (1) a population-based study of 615,092 women who gave birth in National Health Services hospitals in England, using data from the National Commissioning Data Repository; (2) a retrospective evaluation of patients accessing community perinatal mental health services in Birmingham and London (<i>n</i> = 228) and inpatient services in Birmingham, London and Nottingham (<i>n</i> = 198) using an adapted World Health Organization care pathways questionnaire; (3) a qualitative study with four cohorts across England: service users (<i>n</i> = 37), non-users or those who disengaged (<i>n</i> = 23), partners/family (<i>n</i> = 15) and healthcare professionals (<i>n</i> = 24); (4) findings informed recommendations for practice improvements, coproduced with individuals with lived experience of perinatal mental illness and of being in a minoritised ethnic group. Data were analysed using quantitative and qualitative approaches.</p><p><strong>Results: </strong>Access issues to mental health services were evident for Black African, Asian and White other women compared to White British women. Variability in patient journeys to community perinatal mental health services seem to stem from service-level factors rather than patient needs. Asian patients had more emergency admissions to Mother and Baby Units, while Black patients were less likely to experience multiple services before Mother and Baby Unit admission. Barriers to access included limited service awareness, fear of child removal, stigma, remote clinical appointments and unresponsive services. Despite these challenges, many women found services helpful. Family members noted gaps in family-focused care. Recommendations for improvement include raising awareness, monitoring access for different ethnic groups and addressing concerns about child removal, with a focus on consistent care, family involvement and cultural sensitivity.</p><p><strong>Conclusion: </strong>These findings shed light on health inequalities in perinatal mental health care for ethnic minority women. The results can be utilised","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 36","pages":"1-22"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277004","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}