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Understanding patient experiences of a community-based intervention to improve bowel screening uptake: a mixed-method evaluation of Call for a Kit clinics

Por: Hanif · S. · Jefferson · R. · Kerrison · R. · Stoffel · S. T. · Rowley · S. · Morris · L. · von Wagner · C. · Hirst · Y.
Objectives

The study explored patient experiences of the Call for a Kit (CFAK) intervention, a community-based initiative designed to improve bowel cancer screening uptake and examined the mechanisms that may support participation among non-responders.

Design

A convergent parallel mixed-methods design was employed, combining quantitative surveys and qualitative interviews.

Setting

The evaluation was conducted in general practices across Lancashire and South Cumbria, Northwest England, where CFAK clinics were delivered by an external health promotion team based within the Community Voluntary Services. These clinics target practices with low screening uptake.

Participants

A total of 113 CFAK attendees aged 54 and above, and who had missed their most recent screening invitation, completed a patient experience survey. 12 participants were purposively sampled for follow-up interviews.

Outcome measures

Statistical analyses examined associations between patient experience and screening behaviours, including kit ordering and intention to complete the screening kit. Thematic analysis explored barriers and facilitators to participation, as well as experiences of CFAK clinics.

Results

Patient experience scores were significantly higher among women than men and were positively associated with intention to complete the kit, though not with kit ordering. Qualitative findings indicated that CFAK addressed key barriers such as low awareness, confusion and emotional discomfort by providing personalised education, reassurance and culturally sensitive support. Participants particularly valued the relational aspects of the intervention, including the face-to-face delivery and communication in preferred languages.

Conclusions

CFAK clinics appear to enhance psychological capability and motivation for bowel screening by offering tailored, inclusive and supportive care. These findings highlight the value of patient-centred approaches in addressing inequalities in cancer screening and offer insights for the design of future community-based interventions.

Re‐Engaging in Activities of Daily Living After Critical Illness: A Qualitative Review

ABSTRACT

Aim

To explore the qualitative literature regarding the experiences of survivors of critical illness re-engaging in activities of daily living.

Design

Qualitative systematic review.

Methods

Databases were searched with three broad categories of search terms: (1) critical illness, (2) activities of daily living, and (3) participant experiences. Articles were included if they reported qualitative data on the experiences of adults who were re-engaging with activities of daily living after admission to an intensive care unit. The findings from these studies were thematically analysed.

Data Sources

A search of Medline, Embase, CINAHL, PsycINFO and AMED was conducted on the 9th September 2024.

Results

After removing duplicates, the literature search identified 6267 articles. The full texts of 120 articles were reviewed, and 44 were included for data extraction. Thematic analysis identified three themes: (1) loss of autonomy, (2) striving to reclaim independence, and (3) shifting familial dynamics and imposing a burden.

Conclusion

Survivors of critical illness face significant challenges when re-engaging with daily activities. The effort to regain autonomy often leads to feelings of helplessness and a reluctance to engage in both daily tasks and social activities. The emotional burden of dependence and the perception of being a burden further complicate their recovery.

Implications for the Profession

Health services should focus on integrating physical rehabilitation, mealtime support, and cognitive and psychological therapy to effectively cater to the diverse needs of critical illness survivors and their families.

Impact

This review highlights the complex challenges of re-engaging in activities of daily living after critical illness and emphasises the need for multidisciplinary rehabilitation to improve physical, cognitive, and emotional recovery.

Reporting Method

Reporting of this review followed the ENTREQ checklist, in accordance with EQUATOR guidelines.

Patient or Public Contribution

No Patient or Public Contribution.

Breastfeeding and later depression and anxiety in mothers in Ireland: a 10-year prospective observational study

Por: McNestry · C. · OReilly · S. L. · Twomey · P. J. · Crowley · R. K. · Callanan · S. · Kasemiire · A. · Douglass · A. · Delahunt · A. · McAuliffe · F. M.
Objectives

Although breastfeeding is associated with lower postnatal depression and anxiety, limited research exists regarding long-term maternal mental health outcomes. This study examined the association between breastfeeding and depression and anxiety in women of later reproductive age (mid 30s to menopause).

Design

This was a 10-year prospective longitudinal cohort study. Self-reported questionnaires were used to collect lifetime breastfeeding behaviour at 10 years, and health history including depression, anxiety and medication use was collected at each study timepoint.

Setting

A tertiary level maternity hospital in Dublin, Ireland.

Participants

168 parous women from the ROLO Longitudinal Cohort with lifetime breastfeeding behaviour and health history data available at 10 years were included (22% of total cohort). Women currently pregnant or breastfeeding at 10-year follow-up were excluded.

Results

Mean (SD) age at study end was 42.4 (3.8) years. 72.6% (n=122) of women reported ever breastfeeding. Median lifetime exclusive breastfeeding was 5.5 weeks (IQR 35.8, range 0–190). 37.5% of women (n=63) breastfed for ≥12 months over their lifetime. 13.1% (n=22) reported depression or anxiety at 10 years, and 20.8% (n=35) reported depression or anxiety over the whole study period. Ever breastfeeding was associated with less depression and anxiety at 10 years (OR 0.34, 95% CI 0.12 to 0.94, p=0.04). Ever breastfeeding, longer exclusive breastfeeding and lifetime breastfeeding ≥12 months were associated with lower depression and anxiety over the whole study period (ever breastfeeding OR 0.4, p=0.03; exclusive breastfeeding OR 0.98/week, p=0.03; lifetime breastfeeding ≥12 months OR 0.38, p=0.04).

Conclusion

There may be a protective association between breastfeeding and self-reported depression and anxiety. Further studies are required to confirm the findings.

Trial registration number

ISRCTN54392969.

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