Health and social care delivery research最新文献

{"title":"Design and deployment of digital health interventions to reduce the risk of the digital divide and to inform development of the living with COVID recovery: a systematic scoping review.","authors":"Fiona L Hamilton, Sumayyah Imran, Aamina Mahmood, Joanna Dobbin, Katherine Bradbury, Shoba Poduval, Jamie Scuffell, Fred Thomas, Fiona Stevenson","doi":"10.3310/GJHG1331","DOIUrl":"10.3310/GJHG1331","url":null,"abstract":"<p><strong>Background: </strong>Digital health interventions can support health-related knowledge transfer, for example through websites or mobile applications, and may reduce health inequalities by making health care available, where access is difficult, and by translating content to overcome language barriers. However, digital health intervention can also increase health inequalities due to the digital divide. To reach digitally excluded populations, design and delivery mechanisms need to specifically address this issue. This review was conducted during the evolving COVID-19 pandemic and informed the rapid design, deployment and evaluation of a post-COVID-19 rehabilitation digital health intervention: 'Living with COVID Recovery' (LWCR). LWCR needed to be engaging and usable for patients and to avoid exacerbating health inequalities. LWCR was introduced as a service into 33 NHS clinics, was used by 7679 patients, and evaluation ran from August 2020 to December 2022.</p><p><strong>Objective: </strong>To identify evidence-based digital health intervention design and deployment features conducive to mitigating the digital divide.</p><p><strong>Methods: </strong>Cochrane Library, Epistemonikos, National Institute for Health and Care Excellence Evidence, PROSPERO, PubMed (with MEDLINE and Europe PMC) and Turning Research into Practice; OpenGrey and Google Scholar were searched for primary research studies published in English from 1 October 2011 to 1 October 2021. Adults who were likely to be affected by the digital divide, including older age, minority ethnic groups, lower income/education level and in any healthcare setting.</p><p><strong>Interventions: </strong>Any digital health intervention with features of design and/or deployment intended to enable access and engagement by the population of focus.</p><p><strong>Comparators: </strong>Any or none.</p><p><strong>Outcome measures: </strong>Any related to participants' access and/or use of digital health intervention and/or change in digital skills and confidence.</p><p><strong>Analysis: </strong>Data from studies that met the inclusion criteria were extracted, narratively synthesised and thematically analysed.</p><p><strong>Results: </strong>Twenty-two papers met the inclusion criteria. Digital health interventions evaluated included telehealth, text message interventions, virtual assistants, self-management programmes and decision aids. Co-development with end-users, user testing through iterative design cycles, digital health interventions that also helped improve digital skills and digital health literacy, tailoring for low literacy through animations, pictures, videos and writing for low reading ages; virtual assistants to collect information from patients and guide the use of a digital health intervention.</p><p><strong>Deployment themes included: </strong>Free devices and data, or signposting to sources of cheap/free devices and Wi-Fi, text message interventions, providing 'human support', ","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"29-46"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145369284","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":"Strategies to manage emergency ambulance telephone callers with sustained high needs: the STRETCHED mixed-methods evaluation with linked data.","authors":"Alan Watkins, Rabeea'h Aslam, Alex Dearden, Timothy Driscoll, Adrian Edwards, Bethan Edwards, Bridie Angela Evans, Angela Farr, Theresa Foster, Rachael Fothergill, Penny Gripper, Imogen M Gunson, Ann John, Ashrafunnesa Khanom, Tessa Noakes, Robin Petterson, Alison Porter, Nigel Rees, Andy Rosser, Jason Scott, Bernadette Sewell, Anna Tee, Helen Snooks","doi":"10.3310/PWGF6008","DOIUrl":"https://doi.org/10.3310/PWGF6008","url":null,"abstract":"<p><strong>Background: </strong>Emergency ambulance services aim to respond to patients calling with urgent healthcare needs, prioritising the sickest. A small minority make high use of the service, which raises clinical and operational concerns. Multidisciplinary 'case management' approaches combining emergency, primary and social care have been introduced in some areas but evidence about effectiveness is lacking.</p><p><strong>Aim: </strong>To evaluate effectiveness, safety and costs of case management for people frequently calling emergency ambulance services.</p><p><strong>Design: </strong>A mixed-methods 'natural experiment', evaluating anonymised linked routine outcomes for intervention ('case management') and control ('usual care') patient cohorts within participating ambulance services, and qualitative data. Cohorts met criteria for 'Frequent Callers' designation; we assessed effects of case management within 6 months on processes, outcomes, safety and costs. The primary outcome combined indicators on mortality, emergency hospital admission, emergency department attendance and emergency ambulance call. Focus groups and interviews elicited views of service providers on acceptability, successes and challenges of case management; interviews with service users examined their experiences.</p><p><strong>Setting: </strong>Four United Kingdom ambulance services each with one intervention and one control area.</p><p><strong>Participants: </strong>Natural experiment: adults meeting criteria for 'frequent caller' classification by ambulance services during 2018. Service providers: service commissioners; emergency and non-acute health and social care providers. Service users: adults with experience of calling emergency ambulance services frequently.</p><p><strong>Interventions: </strong>Usual care comprised within-service management, typically involving: patient and general practitioner letters; call centre flags invoking care plans; escalation to other services, including police. Intervention care comprised usual care with optional 'case management' referral to cross-service multidisciplinary team to review and plan care for selected patients.</p><p><strong>Results: </strong>We found no differences in intervention (<i>n</i> = 550) and control (<i>n</i> = 633) patients in the primary outcome (adjusted odds ratio: 1.159; 95% confidence interval: 0.595 to 2.255) or its components. Nearly all patients recorded at least one outcome (95.6% intervention; 94.9% control). Mortality was high (10.5% intervention; 14.1% control). Less than 25% of calls resulted in conveyance (24.3% intervention; 22.3% control). The most common reasons for calling were 'fall' (6.5%), 'sick person' (5.2%) and acute coronary syndrome (4.7%). Case management models varied highly in provision, resourcing, leadership and implementation costs. We found no differences in costs per patient of healthcare resource utilisation (adjusted difference: £243.57; 95% confidence interval: -£1972.","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 37","pages":"1-76"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277024","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":"Pathways to specialist community perinatal mental health services: a two-site longitudinal retrospective service evaluation.","authors":"Nikolina Jovanović, Žan Lep, Jelena Janković, Aysegul Dirik, Anna Rees, Maev Conneely","doi":"10.3310/YTRK6337","DOIUrl":"10.3310/YTRK6337","url":null,"abstract":"<p><strong>Background: </strong>During pregnancy and the postpartum period, women's mental health can deteriorate quickly. Timely and easy access to services is critically important; however, little is known about the pathways women take to access services. Previous research has shown that women from ethnic minority groups in the United Kingdom experience more access issues compared to the White British women.</p><p><strong>Aim: </strong>To describe pathways taken to specialist community perinatal mental health services and explore how they vary across services and ethnic groups.</p><p><strong>Methods: </strong>This is a two-site, longitudinal retrospective service evaluation conducted in Birmingham and London during 6 months (1 July-31 December 2019). Electronic records of 228 women were accessed and data were extracted on help-seeking behaviour, referral process and the type of pathway (i.e. simple or complex). Data were collected using the adapted World Health Organization encounter form and analysed using uni- and multivariable analyses.</p><p><strong>Results: </strong>The median time from the start of perinatal mental illness to contact with perinatal mental health services was 20 weeks. The majority of patients accessed perinatal mental health services through primary care (69%) and their pathway was simple, that is they saw one service before perinatal mental health services (63%). The simple pathway was used as a proxy for accessible services. In Birmingham, compared to London, more referrals came from secondary care, more women were experiencing current deterioration in mental health, and more women followed a complex pathway. Despite differences between ethnic groups regarding type of pathway and duration of patient journey, there was no evidence of difference when models controlled for confounders such as clinical presentation, general characteristics and location. The service's location was the strongest predictor of the type of pathway and duration of patient journey.</p><p><strong>Limitations: </strong>The heterogeneity among categorised ethnic groups; data extracted from available electronic records and not validated with patient's own accounts of their pathways to care; unanalysed declined referrals; the study was conducted before the COVID-19 pandemic and pathways may be different in the post-COVID-19 period.</p><p><strong>Conclusion: </strong>The study provides important insights into how patients find their way to community perinatal mental health services. It shows that there is a great degree of variability in the time taken to get into these services, and the pathway taken. This variation does not come from different needs of patients or different clinical presentations but rather from service-level factors.</p><p><strong>Future work: </strong>The studied community perinatal mental health services in the United Kingdom operate with a significant degree of variability in the types and characteristics of patient pathways. Futu","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"23-40"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570902","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":"Effectiveness and cost-effectiveness of community perinatal mental health services on access, experience, recovery/relapse and obstetric and neonate outcomes: the ESMI-II mixed-methods study.","authors":"Heather O'Mahen, Louise Howard, Helen Sharp, Antoinette Davey, Louise Fisher, Ipek Gurol-Urganci, Margaret Heslin, Julia Langham, Ebun Makinde, Emma Tassie, Silia Vitoratou, Jo Brook, Gina Collins, Chris McCree, Dharmintra Pasupathy, Andrew Pickles, Sarah Morgan-Trimmer, Geoffrey Wong, Katie Atmore, Debra Bick, Laura Bozicevic, Clare Dolman, Jill Domoney, Jessica Gay, Chloe Hayes, Jennifer Holly, Miriam Refberg, Sarah Byford, Jan van der Meulen","doi":"10.3310/RRAP0011","DOIUrl":"https://doi.org/10.3310/RRAP0011","url":null,"abstract":"<p><strong>Background: </strong>Perinatal mental health disorders affect one in five mothers during pregnancy or within 2 years post childbirth. These disorders can lead to poor pregnancy and childbirth outcomes and maternal deaths. Additionally, they negatively affect a child's cognitive, social and emotional development. Stigma and a lack of specialised services have limited access to mental health care. National Health Service England invested £365M in community perinatal mental health teams, but their impact on women and infants' outcomes are not known. Develop a taxonomy of community perinatal mental health teams (work package 1). Compare and validate two assessments of quality of mother-infant interaction for use by community perinatal mental health teams (work package 2). Evaluate the effectiveness and cost-effectiveness of community perinatal mental health teams (work packages 3 and 4).</p><p><strong>Design: </strong>Mixed-methods study.</p><p><strong>Setting: </strong>Community perinatal mental health teams in England.</p><p><strong>Participants: </strong>Women who were pregnant or within 2 years postnatal.</p><p><strong>Methods and outcome measures: </strong>Work package 1: Typology of community perinatal mental health teams in England. Work package 2: Reliability and validity of two observational assessments of parent-infant interaction. Work package 3: Realist evaluation interviews with women, partners/close others, and staff to determine effective community perinatal mental health team components. Work package 4: Analysis of linked data: Association of community perinatal mental health teams with access to secondary care mental health services. Risk of acute relapse and improved obstetric and neonate outcomes for women with pre-existing severe disorders in areas with community perinatal mental health teams compared to generic services. Economic analysis of cost of community perinatal mental health teams.</p><p><strong>Results: </strong>Objective 1: Community perinatal mental health team typologies revealed in 2020, 84% had basic staffing levels and 63% had more multi-professionals. Objective 2: The 'Parent Infant Interaction Observation Scale' and 'National Institute of Child Health and Human Development' assessments of mother-infant interaction were reliable and valid; the National Institute of Child Health and Human Development is more suitable for community perinatal mental health teams. Objective 3: Work package 3: Interviews with 139 women, 55 partners/close others and 80 health workers highlighted the importance of specialist perinatal knowledge, responding in a warm and non-judgemental way, working closely with other healthcare providers, optimising medication, supporting mothers to reduce conflict and improve social support, helping mother-infant bonding, and teaching emotional management. Work package 4: Analysis of linked health data revealed higher risks for obstetric and neonate problems in women with severe mental health","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 38","pages":"1-92"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314414","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":"'Come and work here!' Qualitative research exploring community-led initiatives to improve healthcare recruitment and retention in remote and rural areas.","authors":"Louise Locock, Andrew S Maclaren, Zoë Skea, Lorraine Angell, Jennifer Cleland, Topher Dawson, Alan Denison, Christina Dobson, Rosemary Hollick, Peter Murchie, Diane Skåtun, Verity Watson","doi":"10.3310/DJGR6622","DOIUrl":"10.3310/DJGR6622","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Recruitment and retention of healthcare staff in rural and remote areas is a significant problem for the National Health Service. Some communities have experimented with initiatives to support recruitment and retention, but these actions are often ad hoc and undocumented.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To explore the experiences of remote and rural community members and organisations of trying to attract healthcare staff and their families. To map local context and describe initiatives they have undertaken to improve recruitment. To understand how community initiatives have been received by those staff and families who have been attracted to work and live in a rural area as a result. To assess which initiatives seem to have been more or less successful and why. To provide resources for other communities and the National Health Service based on this learning.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design and setting: &lt;/strong&gt;Qualitative case studies, three in Scotland and two in England. A case description of each site was developed, and interviews were analysed thematically. Documentary framework analysis of published job adverts for remote and rural healthcare posts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Case studies: 22 individuals, including community members, healthcare practitioners and family members, took part in interviews and focus groups. Job adverts: 270 from &lt;i&gt;British Medical Journal&lt;/i&gt;, and National Health Service Scotland websites for general practitioner and general National Health Service vacancies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Case studies: communities engaged in a range of activities, such as making promotional videos, social media campaigns, help finding accommodation and informal social integration efforts. They drew on multiple local 'assets' to encourage healthcare staff to move to the area, including showcasing beautiful local landscapes; outdoor activities; a safe, cohesive community for children; and high quality of life. Often a small number of people drove these efforts. While this worked well in some communities, the burden of responsibility could be unsustainable, and not all communities have people with the necessary skills and time. There was less focus on retention than recruitment. Where this worked well, it relied on informal networks of key individuals who created social links for incoming families. Communities struggle with the absence of some key assets, including housing; schools; employment opportunities for family members; cultural activities. Job adverts: different emphases on job details, place and wider area. Only 18/49 advertisers (of 189 approached) reported positive outcome in terms of appointments. We suggest greater use of photographs and place descriptions in future advertisements.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;This is a small exploratory study. Sampling was constrained by the small number of eligible communities and people involved. Planned ethnographic fieldwork was impacted","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 34","pages":"1-70"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145067236","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":"Post-pandemic planning for maternity care for local, regional, and national maternity systems across the four nations: a mixed-methods study.","authors":"Hiten D Mistry, Sergio A Silverio, Emma Duncan, Abigail Easter, Peter von Dadelszen, Laura A Magee","doi":"10.3310/HHTE6611","DOIUrl":"10.3310/HHTE6611","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;During the COVID-19 pandemic, significant reconfigurations were made to maternity care, to deliver this essential service while minimising the risk of infection for pregnant/post partum women and their infants, initially considered to be more vulnerable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This mixed-methods study had three work packages. Work package 1 used quantitative methods to analyse pregnancy outcomes over time, considering service reconfiguration and inequalities, using routinely collected maternity and offspring data from three diverse South London trusts. Work package 2 involved in-depth interviews with a diverse sample of pregnant/post partum women, partners, healthcare professionals and policy-makers, and used thematic framework analysis. Systematic reviews were undertaken of women's experiences of receiving maternity care during the pandemic, and healthcare professionals' experiences of providing that care. Questionnaires (October-December 2021 and August-September 2022) were administered nationally via the King's College London COVID Symptom Study Biobank, to evaluate vaccine uptake among women who were planning pregnancy, pregnant or post partum. Work package 3 engaged stakeholders within maternity systems through regional Listening Events and a national Policy Lab.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among women of reproductive age (8 December 2020-15 February 2021), older age, white ethnicity and a lack of social deprivation were associated with higher vaccine uptake, although ethnicity exerted the strongest effect (Office for National Statistics data). Across pre-pandemic, pandemic with and pandemic without lockdowns, pregnancy outcomes, over time, largely followed pre-pandemic trends (record linkage, South London). However, virtual antenatal care in the second and third trimesters was associated with an excess of adverse pregnancy outcomes (and increased costs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Work package 2: &lt;/strong&gt;Our systematic reviews of experiences of receiving (by women) or delivering (by healthcare professionals) maternity care during the pandemic identified the need for personalised care adapted to service users and communities, including those who are marginalised, and including provision of information; and co-design and coproduction of services with service users and staff, to reflect their collective lived experiences. This has the potential to improve workplace well-being for maternity care staff and facilitate inclusive and equitable care for service users. Interviews about COVID-19 vaccination in pregnancy identified a legacy of mistrust, lack of information, and confusing guidance that contributed to vaccine hesitancy for pregnant women during the pandemic. In our national survey, women of reproductive age (including pregnant/post partum women) reported being promptly vaccinated, but with angst and despite having received misinformation and discouragement from some healthcare professionals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 35","pages":"1-25"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056541","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":"Remote and digital services in UK general practice 2021-2023: the Remote by Default 2 longitudinal qualitative study synopsis.","authors":"Trisha Greenhalgh, Anica Alvarez Nishio, Aileen Clarke, Richard Byng, Francesca Dakin, Stuart Faulkner, Isabel Hanson, Nina Hemmings, Gemma Hughes, Laiba Husain, Asli Kalin, Emma Ladds, Ellen MacIver, Lucy Moore, Sarah O'Rourke, Rebecca Payne, Tabitha Pring, Rebecca Rosen, Sarah Rybczynska-Bunt, Sara E Shaw, Nadia Swann, Sietse Wieringa, Joseph Wherton","doi":"10.3310/QQTT4411","DOIUrl":"10.3310/QQTT4411","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Remote services (in which the patient and staff member are not physically colocated) and digital services (in which a patient encounter is digitally mediated in some way) were introduced extensively when the COVID-19 pandemic began in 2020. We undertook a longitudinal qualitative study of the introduction, embedding, evolution and abandonment of remote and digital innovations in United Kingdom general practice. This synoptic paper summarises study design, methods, key findings, outputs and impacts to date.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Overview of the study and key findings: &lt;/strong&gt;From September 2021 to December 2023, we collected &gt; 500 hours of ethnographic observation from a diverse sample of 12 general practices. Other data sources included over 200 interviews (with practice staff, patients and wider stakeholders), 4 multi-stakeholder workshops (184 participants), grey literature (e.g. Care Quality Commission reports) and safety incident reports. Patient involvement included digitally excluded individuals from disadvantaged backgrounds (e.g. homeless, complex needs). Data were de-identified, uploaded to NVivo (QSR International, Warrington, UK), coded thematically and analysed using various theoretical lenses. Despite an adverse context for general practice including austerity, workforce shortages, rising demand, rising workload and procurement challenges, all 12 participating practices adjusted to some extent to a 'new normal' of hybrid (combined traditional and remote/digital) provision following the external shock of the pandemic. By late 2023, practices showed wide variation in digital maturity from a 'trailblazer' practice which used digital technologies extensively and creatively to 'strategically traditional' practices offering mainly in-person services to deprived and vulnerable populations. We explained practices' varied fortunes using diffusion of innovations theory, highlighting the extensive work needed to embed and routinise technologies and processes. Digitally enabled patients often, but not always, found remote and digital services convenient and navigable, but vulnerable groups experienced exclusion. We explored these inequities through the lenses of digital candidacy, fractured reflexivity and intersectionality. For staff, remote and digital tasks and processes were often complex, labour-intensive, stressful and dependent on positive interpersonal relations - findings that resonated with theories of technostress, suffering and relational co-ordination. Our initial plan for workshop-based co-design of access pathways with patients was unsuccessful due to dynamic complexities; shifting to a more bespoke and agile design process generated helpful resources for patients and staff.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;This study has confirmed previous findings from sociotechnical research showing that new technologies are never 'plug and play' and that appropriate solutions vary with context. Much variation in dig","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 31","pages":"1-50"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008643","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":"Team-based motivational engagement intervention in young people with first-episode psychosis: the EYE-2 cluster RCT with economic and process evaluation.","authors":"Kathryn Greenwood, Christopher Iain Jones, Nahel Yaziji, Andy Healey, Carl May, Stephen Bremner, Richard Hooper, Shanaya Rathod, Peter Phiri, Richard de Visser, Tanya Mackay, Gergely Bartl, Iga Abramowicz, Jenny Gu, Rebecca Webb, Sunil Nandha, Belinda Lennox, Louise Johns, Paul French, Jo Hodgekins, Heather Law, James Plaistow, Rose Thompson, David Fowler, Philippa Garety, Anastacia O'Donnell, Michelle Painter, Rebecca Jarvis, Stuart Clark, Emmanuelle Peters","doi":"10.3310/WDWG4102","DOIUrl":"10.3310/WDWG4102","url":null,"abstract":"<p><strong>Background: </strong>Early Intervention in Psychosis services improves outcomes for young people with psychosis, but 25% disengage in the first 12 months with costs to their mental health.</p><p><strong>Objectives: </strong>To refine a toolkit and training and evaluate effectiveness, implementation, and cost-effectiveness of the Early Youth Engagement-2 intervention to reduce disengagement.</p><p><strong>Design: </strong>Cluster randomised controlled trial with economic and process evaluation.</p><p><strong>Randomisation: </strong>Randomisation at team level stratified by site.</p><p><strong>Masking: </strong>Research assistants, outcome assessors and statisticians were masked to treatment allocation for the primary disengagement and cost-effectiveness outcomes. Participants and teams administering the interventions were unmasked.</p><p><strong>Setting: </strong>Twenty Early Intervention in Psychosis teams in five sites across England.</p><p><strong>Participants: </strong>A total of 1027 young people (14-35 years) with first-episode psychosis (F20-29, 31; ICD-10); 20-282 Early Intervention in Psychosis staff.</p><p><strong>Intervention: </strong>Team-based motivational engagement (Early Youth Engagement-2) intervention, delivered by Early Intervention in Psychosis clinicians alongside standardised Early Intervention in Psychosis, supported by the implementation toolkit (training, website and booklet series).</p><p><strong>Comparison: </strong>Standardised Early Intervention in Psychosis, including National Institute for Health and Care Excellence guidelines approved interventions.</p><p><strong>Main outcome measures: </strong>Primary outcome - time to disengagement over 26 months (days from date of allocation to care co-ordinator to date of last contact following refusal to engage with service, or lack of response to contact for consecutive 3-month period). Secondary outcomes - mental health, recovery, quality of life, service use, at 6 and 12 months. Economic outcomes - National Health Service mental healthcare costs, wider societal care costs, clinical and social outcomes over 12 months; cost-effectiveness. Process evaluation outcomes - fidelity to the Early Youth Engagement-2 model, implementation process scores, therapeutic alliance, qualitative outcomes.</p><p><strong>Results: </strong>Disengagement was 16% across both arms. The multivariable Cox regression on 1005 participants estimated an adjusted hazard ratio for Early Youth Engagement-2 + standardised Early Intervention in Psychosis (<i>n</i> = 652) versus standardised Early Intervention in Psychosis service alone (<i>n</i> = 375) of 1.07 (95% confidence interval 0.76 to 1.49; <i>p</i> = 0.713). There were no observed differences between arms for any secondary outcomes. The health economic evaluation indicated lower mean mental healthcare costs of -£788 (95% CI -£3571 to £1994) and marginally improved mental health states for intervention participants. Early Youth Engagement-2","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 33","pages":"1-221"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145067253","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":"Identifying acceptable and effective methods of assessing perinatal anxiety: the MAP study.","authors":"Susan Ayers, Rose Meades, Andrea Sinesi, Helen Cheyne, Margaret Maxwell, Catherine Best, Julie Jomeen, James Walker, Judy Shakespeare, Fiona Alderdice","doi":"10.3310/RRHD1124","DOIUrl":"https://doi.org/10.3310/RRHD1124","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Anxiety is a common mental illness that can occur during and after pregnancy, which is associated with an increased risk of adverse outcomes for women and their infants. Despite this, there is no consensus on the best method of assessing anxiety.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The methods of assessing perinatal anxiety (MAP) study aimed to identify the most acceptable, effective and feasible method for assessing anxiety in pregnancy and after birth.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design and methods: &lt;/strong&gt;The MAP study had four work packages: a qualitative and cognitive interview study (work package 1); a prospective longitudinal cohort study of women during pregnancy (early, mid- and late pregnancy) and post partum, with nested diagnostic interviews (work package 2) and implementation case studies (work package 3). Secondary analysis of cohort data was commissioned as an add-on project to examine the impact of socioeconomic deprivation on perinatal anxiety (work package 4). The MAP study evaluated four assessment measures based on clinical criteria and research evidence: the General Anxiety Disorder Questionnaire, 2-item, or 7-item version scale, Whooley questions, Stirling Antenatal Anxiety Scale and Clinical Outcomes in Routine Evaluation - 10 item version scale.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting and participants: &lt;/strong&gt;Qualitative and cognitive interviews (work package 1) were conducted with 41 pregnant and postpartum women, recruited through patient and public involvement representative organisations and social media. The MAP cohort (work package 2) included 2243 women recruited through 12 National Health Service Trusts in England and 5 National Health Service Boards in Scotland. Diagnostic interviews were conducted with a consecutive subsample of 403 participants. Implementation case studies (work package 3) were conducted with two National Health Service sites in England and one in Scotland.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Routine assessment of perinatal anxiety was acceptable to women and was viewed positively, although this was qualified by the extent to which the process was informed and personalised. Results from cognitive interviews found that all measures were acceptable and easy to use. Diagnostic accuracy was greatest for the Stirling Antenatal Anxiety Scale and Clinical Outcomes in Routine Evaluation - 10 item version. Increased anxiety on all measures was associated with greater difficulties with daily living, poorer quality of life and participants wanting treatment. Early pregnancy (i.e. the first trimester) was the optimal time for identifying participants with anxiety disorders who wanted treatment. Two measures met criteria for implementation: the Stirling Antenatal Anxiety Scale and the Clinical Outcomes in Routine Evaluation - 10 item version. The Stirling Antenatal Anxiety Scale was preferred by stakeholders (41 women and 55 health professionals), so it was implemented. Acceptability to health professionals (","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 32","pages":"1-44"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071328","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":"Optimising the delivery and impacts of interventions to improve hospital doctors' workplace wellbeing in the NHS: The Care Under Pressure 3 realist evaluation study.","authors":"Daniele Carrieri, Alison Pearson, Anna Melvin, Charlotte Bramwell, Jason Hancock, Chrysanthi Papoutsi, Mark Pearson, Geoff Wong, Karen Mattick","doi":"10.3310/PASQ1155","DOIUrl":"https://doi.org/10.3310/PASQ1155","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The key role of medical workforce well-being in the delivery of excellent and equitable care is recognised internationally. However, doctors are known to experience significant mental ill health and erosion of their well-being due to challenging demands and pressurised work environments. Existing workplace support strategies often have limited effect and do not consider the multiple factors contributing to poor well-being in doctors (e.g. individual, organisational and social), nor whether interventions have been implemented effectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To work with, and learn from, diverse hospital settings to understand how to optimise strategies to improve doctors' workplace well-being and reduce negative impacts on the workforce and patient care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design and method: &lt;/strong&gt;Three inter-related sequential phases of research activity: Phase 1: a typology of interventions and mapping tool to improve hospital doctors' workplace well-being based on iterative cycles of analysis of published and in-practice interventions and informed by relevant theories and frameworks and engagement with stakeholders. Phase 2: realist evaluation consistent with Realist And MEta-narrative Evidence Syntheses: Evolving Standards quality standards of existing strategies to improve hospital doctors' workplace well-being in eight purposively selected acute National Health Service trusts in England based on 124 interviews with doctors, well-being intervention implementers/practitioners and leaders. Phase 3: codeveloped implementation guidance for all National Health Service trusts to optimise their strategies to improve hospital doctors' workplace well-being - drawing on phases 1 and 2, and engagement with stakeholders in three online national workshops.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Phase 1: although many sources did not clarify their underlying assumptions about causal pathways or the theoretical basis of interventions, we were able to develop a typology and mapping tool which can be used to conceptualise interventions by type (e.g. whether they are designed to be largely preventative or 'curative'). Phase 2: key findings from our realist interviews were that: (1) solutions needed to align with problems to support doctor's well-being and avoid harm to doctors; (2) involving doctors in creating solutions was important to address their well-being problems; (3) doctors often do not know what well-being support is available and (4) there were physical and psychological barriers to accessing well-being support. Phase 3: our 'Workplace well-being MythBuster's guide' provides constructive evidence-based implementation guidance, while authentically representing the predominantly negative experiences reported in phase 2.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Although we sampled for diversity, the eight trusts we worked with may not be representative of all trusts in England.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Misaligned ","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"13 30","pages":"1-35"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985381","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}