Aim.  To report on a study which developed a knowledge of the experiences of South Asian people with diabetes in the UK in relation to socio-cultural and dietary practices, religion and ageing influences on the perception and understanding of risks. Background.  South Asian people have enhanced vulnerability to poor health as a result of diabetes. Risk perception and management is culturally mediated, yet imperative to the behaviour adjustments required for diabetes management. Method.  A grounded theory study with data collected by focus group with ethnic health development workers and individual interviews with 20 older people with diabetes. Where necessary, interpreters were involved in data collection. Findings.  A number of issues influence the perception of risk among South Asian older people with diabetes: beliefs about its cause, perceived severity and its visibility, food and its social function, religion and beliefs about external control over their life span and diabetes management. People weighed up the risks in making decisions about issues such as dietary management and the emphasis placed on diabetes as a pathology. Conclusion.  Good risk communication will maintain the current trend of improving patient's choice and self-management in health care, and there is a need for this to be sensitive to the particular issues faced by South Asians with diabetes in the UK.

Background. South Asians living in the UK have an increased predisposition to developing Type 2 diabetes. It usually occurs later in life and has significant long-term risks that are preventable with life-style changes. Changes in life-style practices are likely to be influenced by an individual's perception of control over his/her health yet perceptions of risk are influenced by sociocultural factors, religious beliefs and gender. Method. In this Grounded Theory study, data collection involved: two focus group interviews with health development workers representing ethnic minorities; seven individual interviews with practitioners (three physicians, three nurse specialists and a dietitian); 20 interviews with UK-resident older South Asians (nine men and eleven women) with Type 2 diabetes together with analysis of their medical records. Data for the study were collected between March 2004-February 2005. Findings. Those participants who demonstrated an internal locus of control were proactive in managing their diabetes-related risks. Participants with an external locus of control in perceiving and managing their risks related to diabetes believed that their diabetes was due to fate, bad luck, divine planning or familial predisposition and were reactive in engaging with diabetes-related risks. Relevance to clinical practice. This study demonstrates the role of affect and external locus of control in risk engagement among older South Asians with Type 2 Diabetes. The appropriateness of the concordance and empowerment model of diabetes care for minority ethnic groups such as the South Asians who engage with diabetes-related risks reactively driven by external locus of control needs to be carefully assessed.Funded by PhD Studentship from Northumbria University, Newcastle upon Tyne, United Kingdo

ObjectivesTo explore the pharmaceutical care needs of, and service provision to, older people with sensory impairment (visual, hearing and dual impairment) on prescribed polypharmacy (≥4 medicines) in Scotland.DesignInterviews were conducted with older people with sensory impairment and community pharmacy personnel, which informed the content of a subsequent national cross-sectional survey of community pharmacists.SettingScotland, 2015–2016.ParticipantsOlder people with sensory impairment and community pharmacy personnel.ResultsInterviews were completed with 23 older people with sensory impairment (dual impairment n=13, visual or hearing impairment n=5 of each) and 30 community pharmacy personnel from eight of 14 Scottish Health Boards. A total of 171 survey responses were received.Older people reported that they did not always disclose their sensory impairment to pharmacy personnel. They also reported that medicines were difficult to identify particularly when their name, shape or colour changed. Pharmacy personnel relied on visible cues such as white canes or guide dogs to identify visual impairment and suggested that hearing loss was less visible and more difficult to identify. Many assistive aids in support of medicine management, such as dosette boxes, seemed inadequate for complex medication regimens. Few community pharmacy personnel reported receiving training in the care of people with sensory impairment.ConclusionsThis is the first comprehensive, multistakeholder, in-depth exploration of the pharmaceutical care needs of older people with sensory impairment. Strategies are needed to enable people with sensory impairment to disclose their impairment to pharmacy personnel (and other healthcare providers). Community pharmacy personnel require training to deliver person-centred pharmaceutical care for older people with sensory impairment particularly regarding communication with individuals in this vulnerable population.

There was a significant improvement in the knowledge (p<0.001) and practice (p<0.003) of nurses in the experimental group following the educational programme.

BackgroundThe Scottish Government’s ambition is to ensure that health services are co-designed with the communities they serve. Crohn’s and Colitis UK and the Scottish Government acknowledged the need to review and update the current IBD care model. An online survey was conducted asking IBD patients about their experiences of the NHS care they receive. This survey was the first step of co-designing and developing a national strategy for IBD service improvement in Scotland.Aim: To explore IBD patients’ experiences of current services and make recommendations for future service development.MethodsThis study was part of a wider cross-sectional on-line survey. Participants were patients with IBD across Scotland. 777 people with IBD took part in the survey. Thematic analysis of all data was conducted independently by two researchers.ResultsThree key themes emerged:Quality of life: Participants highlighted the impact the disease has on quality of life and the desperate need for IBD services to address this more holistically.IBD clinicians and access: Participants recognised the need for more IBD nurses and gastroenterologists along with better access to them. Those with a named IBD nurse reported to be more satisfied with their care.An explicit IBD care pathway: Patients with IBD identified the need of making the IBD care pathway more explicit to service users.ConclusionsParticipants expressed the need for a more holistic approach to their IBD care. This includes integrating psychological, counselling and dietetic services into IBD care with better access to IBD clinicians and a more explicit IBD care pathway.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1490-7) contains supplementary material, which is available to authorized users.

Background: Nurses constitute a major portion of the health care workforce in India. A priority to develop pre and post registration nurse education in India has increasingly been highlighted in nursing and health policy imperatives in recent years. Nurses are often the only health care professionals in primary and secondary care within rural and remote healthcare settings in India. They are confronted with the dual challenge of resource constraints and rapidly changing disease profile with little or no access to continuing professional development. Objectives: 1) To identify key continuing professional development priorities of registered nurses working in remote and rural health care settings in India. 2) To identify barriers and facilitators to continuing professional development as perceived by registered nurses working in these settings. 3) To identify preferred modes of continuing professional development by registered nurses working in remote and rural health care settings in India. Design: Quantitative Design. Setting: Two large health care facilities in remote and rural parts of India. Participants: Registered Nurses working in two large not for profit health care organisations participated in the study. Nursing assistants and student nurses were excluded from the study. 368 participants consented to participate in the survey and 271 (73.6%) participants completed the survey. Methods: A questionnaire based cross sectional survey was undertaken as part of the Continuing Professional Development needs assessment among registered How to cite this paper: Macaden, L., Washington, M., Smith, A., Thooya, V., Selvam, S.P., George, N.

BackgroundMindfulness-based interventions have shown to improve depression and anxiety symptoms as well as quality of life in patients with inflammatory bowel disease (IBD). However, little is known about the experiences of this group of patients participating in mindfulness interventions. This paper sets out to explore the perspectives of patients with IBD recruited to a pilot randomised controlled trial (RCT) of mindfulness-based cognitive therapy (MBCT) about the intervention.MethodsIn a qualitative study nested within a parallel two-arm pilot RCT of mindfulness-based cognitive therapy for patients with IBD, two focus group interviews (using the same schedule) and a free text postal survey were conducted. Data from both were analysed using thematic analysis. Data and investigator triangulation was performed to enhance confidence in the ensuing findings.Forty-four patients with IBD were recruited to the pilot RCT from gastroenterology outpatient clinics from two Scottish NHS boards. Eighteen of these patients (ten from mindfulness intervention and eight from control group) also completed a postal survey and participated in two focus groups after completing post intervention assessments.ResultsThe major themes that emerged from the data were the following: perceived benefits of MBCT for IBD, barriers to attending MBCT and expectations about MBCT. Participants identified MBCT as a therapeutic, educational and an inclusive process as key benefits of the intervention. Key barriers included time and travel constraints.ConclusionsThis qualitative study has demonstrated the acceptability of MBCT in a group of patients with IBD. Participants saw MBCT as a therapeutic and educational initiative that transformed their relationship with the illness. The inclusive process and shared experience of MBCT alleviated the sense of social isolation commonly associated with IBD. However, time commitment and travel were recognised as a barrier to MBCT which could potentially influence the degree of therapeutic gain from MBCT for some participants.Electronic supplementary materialThe online version of this article (doi:10.1186/s40814-015-0041-z) contains supplementary material, which is available to authorized users.

Background In most developed countries there is an increasing ageing population living in the community with long-term conditions and sensory impairment (sight; hearing; dual impairment). Community pharmacy personnel are key providers of pharmaceutical care to this patient population. Objective This study explored community pharmacy personnel's experiences with providing pharmaceutical care for older people with sensory impairment. Methods Semi-structured telephone interviews were conducted with community pharmacy personnel across Scotland between 2015 and 2016. Results Thirty interviews were completed with community pharmacists (n = 17) and other pharmacy personnel (n = 13). Two overarching themes emerged: safety and communication. Interviewees reported patients' reluctance to disclose their impairment “patients are very good at hiding it” and had considerable safety concerns “ it's a fear that they're going to take too much … accidentally taking the same medicine twice ”. Difficulties in communication were cited “ no matter what you do or how you label things, leaflets and telling people, things can go wrong ”. Additionally, interviewees identified training needs to increase their disability awareness and to identify strategies to provide safe and reliable pharmaceutical care to this vulnerable group “We don't specifically have anything in place to deal with anyone with impairments of that kind”. Conclusions This is the first in-depth exploration of providing pharmaceutical care to older people with sensory impairment from the perspective of community pharmacy personnel. Strategies are needed to encourage older people to disclose their sensory impairment. Education and training are also needed to optimise the provision of pharmaceutical care to this vulnerable population.