Moving to manage: A mixed methods study of later life relocation into supported housing.

This study describes relocation experiences of older people moving to supported housing in Scotland focusing on the nature of support. Using mixed methods, Phase one involved a Scottish cross-sectional survey of all people aged 65 and over moving into Coburg (Scotland) Housing Association supported accommodation during the first six months of 2008. A total of 122 respondents were included in the survey (59% response rate). People moved locally at advanced ages with moderate disability levels to achieve more manageable housing and support, suggesting ‘assistance migration’. Expectations were high, with many seeing it as a new start in life and generally positive views of moving were reported. In Phase two, five in-depth multiple-perspective longitudinal case studies were conducted to explore the experience of relocation into supported housing. In each case an older person, primary carer and the housing manager - all women – were interviewed over six months following relocation. Analysis was undertaken using a thematic framework approach (Ritchie et al., 2003). Findings suggested older women acted with agency to adapt to their new lives; recreating ‘normality’ through organising space and routines. It is argued that returning to normality formed the overarching objective of the older women as they sought to feel ‘in place’. Responsibilities for meeting assistance needs were often implicit, contested and shifting, leading to fragile, uncertain and transitory arrangements. Drawing on recent advances in developmental psychology it is argued ‘longings’ of older people, and others, to achieve an optimal life can relate and motivate towards actions such as relocation. Yet, personal ‘longings’ can be prioritised differently and may result in disputes over goal setting and ways needs are met. Further, utopian ideals must be reconciled with the reality of daily life. Policy and practitioners could adopt broader, dignity based objectives to assist older people to identify ways of aiding such reconciliation.

Mixed methods feasibility study for a trial of blood pressure telemonitoring for people who have had stroke/transient ischaemic attack (TIA).

Background Good blood pressure (BP) control reduces the risk of recurrence of stroke/transient ischaemic attack (TIA). Although there is strong evidence that BP telemonitoring helps achieve good control, none of the major trials have considered the effectiveness in stroke/TIA survivors. We therefore conducted a feasibility study for a trial of BP telemonitoring for stroke/ TIA survivors with uncontrolled BP in primary care. Method Phase 1 was a pilot trial involving 55 patients stratified by stroke/TIA randomised 3:1 to BP telemonitoring for 6 months or usual care. Phase 2 was a qualitative evaluation and comprised semi-structured interviews with 16 trial participants who received telemonitoring and 3 focus groups with 23 members of stroke support groups and 7 carers. Results Overall, 125 patients (60 stroke patients, 65 TIA patients) were approached and 55 (44%) patients were randomised including 27 stroke patients and 28 TIA patients. Fifty-two participants (95%) attended the 6-month follow-up appointment, but one declined the second daytime ambulatory blood pressure monitoring (ABPM) measurement resulting in a 93% completion rate for ABPM − the proposed primary outcome measure for a full trial. Adherence to telemonitoring was good; of the 40 participants who were telemonitoring, 38 continued to provide readings throughout the 6 months. There was a mean reduction of 10.1 mmHg in systolic ABPM in the telemonitoring group compared with 3.8 mmHg in the control group, which suggested the potential for a substantial effect from telemonitoring. Our qualitative analysis found that many stroke patients were concerned about their BP and telemonitoring increased their engagement, was easy, convenient and reassuring Conclusions A full-scale trial is feasible, likely to recruit well and have good rates of compliance and follow-up.

Self-management of coronary heart disease in angina patients after percutaneous coronary intervention: A mixed methods study.

After having elective percutaneous coronary intervention (PCI) patients are expected to self-manage their coronary heart disease (CHD) by modifying their risk factors, adhering to medication and effectively managing any recurring angina symptoms but that may be ineffective. Objective: Explore how patients self-manage their coronary heart disease (CHD) after elective PCI and identify any factors that may infl uence that. Design and method: This mixed methods study recruited a convenience sample of patients (n=93) approximately three months after elective PCI. Quantitative data were collected using a survey and were subject to univariate, bivariate and multi-variate analysis. Qualitative data from participant interviews was analysed using thematic analysis. Findings: After PCI, 74% of participants managed their angina symptoms inappropriately. Younger participants and those with threatening perceptions of their CHD were more likely to know how to effectively manage their angina symptoms. Few patients adopted a healthier lifestyle after PCI. Qualitative analysis revealed that intentional non-adherence to some medicines was an issue. Some participants felt unsupported by healthcare providers and social networks in relation to their self-management. Participants reported strong emotional responses to CHD and this had a detrimental effect on their self-management. Few patients accessed cardiac rehabilitation.

Reframing Scottish Football: Strategy and the short-term nature of the football industry.

Despite football being deeply entrenched in Scottish culture it is under-researched from a business perspective. This research develops a conceptual framework that views professional football clubs from a number of different perspectives. It draws on strategic management literature since this views the firm as the intersection between internal competence, customer perception and competition within an industry. A review of previous sports business research highlighted five main themes that were used to create a structure for the analysis: on-field performance, attendance, finance, the playing squad and the manager. These themes were used as frames to view the firms within the industry from a number of different perspectives. Each frame allows a different aspect of the firm to be considered singly in turn and then collectively to develop a deeper understanding of the existing frames in use within the industry. The research is based on a pragmatic philosophy that allows mixed methods to be combined to provide both an objective and subjective view of the industry. The subjective view was drawn from five interviews with senior figures within Scottish professional football. These participants were from a number of different roles and organisations within the industry to provide a balance of experiences. The views were triangulated with a descriptive analysis of secondary data from a number of industry sources to establish patterns within and between these frames. A peer group of six clubs was selected as they competed in the Scottish Premier League in each of the seasons within an eleven-year period (2000-2011). The peer group clubs selected were: Aberdeen, Dundee United, Heart of Midlothian (Hearts), Hibernian, Kilmarnock and Motherwell. By focussing on a small group of clubs with a similar on-field record a broad study across the five frames could be carried out in detail without the findings being influenced by the impact of relegation to a lower division or sustained participation in European football. Within each of the original five frames a number of sub-components were identified and linked to the framework; this expanded the content to reflect the findings of this project. There appeared to be little link between on-field performance and attendance although progress to the later stages of cup competitions allowed clubs to connect with fans who do not regularly attend. The relationship between a club’s income and wage bill should be expanded to include interest repayments since this expenditure can be used to highlight future financial problems caused by increased debt levels. Although all of the interview participants spoke with pride of the players that had progressed from the club’s youth academy to success at the highest level the peer group clubs only produced one player each season that played more than ten matches for the club. Almost half of the players signed from the youth academy left the club without playing for the 1st Team. The importance of the relationship between the manager and club chairman was highlighted, although the speed with which managers were appointed suggests that little consideration was given to this before offering a contract. Once appointed there appeared to be little clarity over the job description and areas of responsibility. Several of the interviewees brought experience from other businesses to football but admitted that short-term decision making and entrenched behaviour made change difficult. The conclusion of the research is that by taking a firm-wide view of the club, longer-term decisions can be taken within football. Player development and supporter relationships were both identified as long-term processes that are impacted by the current short-termism. With greater role clarity for managers and a mixture of short and long-term objectives those involved in the industry are more likely to have opportunities to learn from experience and performance, across the different frames, will improve as a result.