There is a need to test new models of integrated health and social care, particularly due to increasing financial and epidemiological pressures on services. One critical component of testing new models is the acceptability to patients. Here, the aim was to understand the acceptability of a new model of care to patients by understanding their experience of being supported by a self-managing, community-based, integrated, health and social care team. The INCA service consisted of three support workers and three nurses in two teams. These teams were self-managing and had autonomy over service operations and care delivery. Eight interviews and satisfaction questionnaires were conducted with patients. Interviews were transcribed and analysed thematically. Patients found the service highly acceptable (mean overall satisfaction of 98%), self-reporting a variety of benefits to their wellbeing. Central to this acceptability was the autonomy of staff to adjust care frequency and duration to patients' needs, in addition to describing an active engagement and partnership within their support plans. Future work should aim to ascertain the experiences of staff working in this model and whether receiving support in this way improves clinical outcomes.
The UK Child Health Surveillance Programme (CHSP) reported that 8.6% of children born in Scotland in 2001 were obese (BMIP95th centile of the UK 1990 reference data) at 3.5 years of age compared to 7.9% of those born in 1995 (1) . There is growing policy maker and health professional interest in preschool weight management interventions to halt or reverse this trend (2,3) . In 2012, NHS Grampian commissioned formative research to inform the development of a pre-school weight management intervention planned for the region. Qualitative research was conducted with parents of pre-school aged children and health visitors (as the group of health professionals considered best placed to deliver such a programme) to explore their respective views and perceptions about the problem of obesity and overweight in this age group, and, the acceptability and feasibility of possible interventions. This paper presents the results of research which explored these issues with 34 parents and 15 health visitors based in the north-east of Scotland. The study took place between May 2012 and February 2013. Parents of preschool aged children were recruited by invitation through preschool nurseries, and health visitors were invited to participate through the community nursing service. Ethical approval was sought from and granted by the North of Scotland Research Ethics Committee. Nine focus groups were held with parents preschool children. The health visitors took part in individual in depth telephone interviews. Both the focus groups and interviews lasted between 45-90 mins, were audio-recorded, transcribed verbatim and analysed thematically.The research has revealed a rich picture of the variety of sources of information parents and healthy visitors use to make judgements about a pre-school age child's weight status, and the large areas of overlap and divergence that exist in those different perspectives. It also reveals interesting insights regarding parents' and health visitors' perspectives about the legitimacy and relevance of growth centile reference data and BMI charts in the context of 'real world' circumstances for this age group, and, the general resistance that exists amongst parents to the idea of programmes or health professional interventions targeting them about this issue. Despite parents' questioning of the relevance of a weight management programme for their preschool children, parents in this study described dealing with many significant challenges and pressures both within and from outside the family environment, as they struggle to 'get the balance right' in raising a healthy weight child. Furthermore, all parents who took part in this study expressed concern about their child's weight in the future. In particular parents described struggling with aspects of weaning and infant feeding.(e.g. deciding on portion size and over feeding), dealing with different perspectives within their families about appropriate foods and portion sizes for their children, managing different dietary preferences and energy requirements at f...
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