It's a WRAP: Delivering Wellness for Women in the UK

Wellness Recovery Action Planning (WRAP) was first created by Mary Ellen Copeland in 1997 and reinforced the concept of people taking individual responsibility for their health status and wellbeing. To fuel personal responsibility for one's health status, Mary Ellen purported that it was necessary for the person to tap into their inner drive and resources with a view to owning their health. This concept has been widely accepted and disseminated within the field of mental health but has not yet been fully embraced by other professions, such as midwifery. In this piece, the authors highlight the recovery and wellness ethos inherent in the current zeitgeist of healthcare and discuss how WRAP could be utilised by midwives to facilitate the wellness of women during the antenatal period and beyond.

Defining the content and delivery of an intervention to Change AdhereNce to treatment in BonchiEctasis (CAN-BE): a qualitative approach incorporating the Theoretical Domains Framework, behavioural change techniques and stakeholder expert panels

Background
Low patient adherence to treatment is associated with poorer health outcomes in bronchiectasis. We sought to use the Theoretical Domains Framework (TDF) (a framework derived from 33 psychological theories) and behavioural change techniques (BCTs) to define the content of an intervention to change patients’ adherence in bronchiectasis (Stage 1 and 2) and stakeholder expert panels to define its delivery (Stage 3).

Methods
We conducted semi-structured interviews with patients with bronchiectasis about barriers and motivators to adherence to treatment and focus groups or interviews with bronchiectasis healthcare professionals (HCPs) about their ability to change patients’ adherence to treatment. We coded these data to the 12 domain TDF to identify relevant domains for patients and HCPs (Stage 1). Three researchers independently mapped relevant domains for patients and HCPs to a list of 35 BCTs to identify two lists (patient and HCP) of potential BCTs for inclusion (Stage 2). We presented these lists to three expert panels (two with patients and one with HCPs/academics from across the UK). We asked panels who the intervention should target, who should deliver it, at what intensity, in what format and setting, and using which outcome measures (Stage 3).

Results
Eight TDF domains were perceived to influence patients’ and HCPs’ behaviours: Knowledge, Skills, Beliefs about capability, Beliefs about consequences, Motivation, Social influences, Behavioural regulation and Nature of behaviours (Stage 1). Twelve BCTs common to patients and HCPs were included in the intervention: Monitoring, Self-monitoring, Feedback, Action planning, Problem solving, Persuasive communication, Goal/target specified:behaviour/outcome, Information regarding behaviour/outcome, Role play, Social support and Cognitive restructuring (Stage 2). Participants thought that an individualised combination of these BCTs should be delivered to all patients, by a member of staff, over several one-to-one and/or group visits in secondary care. Efficacy should be measured using pulmonary exacerbations, hospital admissions and quality of life (Stage 3).

Conclusions
Twelve BCTs form the intervention content. An individualised selection from these 12 BCTs will be delivered to all patients over several face-to-face visits in secondary care. Future research should focus on developing physical materials to aid delivery of the intervention prior to feasibility and pilot testing. If effective, this intervention may improve adherence and health outcomes for those with bronchiectasis in the future.

Improving appropriate polypharmacy for older people in primary care: selecting components of an evidence-based intervention to target prescribing and dispensing.

Background
The use of multiple medicines (polypharmacy) is increasingly common in older people. Ensuring that patients receive the most appropriate combinations of medications (appropriate polypharmacy) is a significant challenge. The quality of evidence to support the effectiveness of interventions to improve appropriate polypharmacy is low. Systematic identification of mediators of behaviour change, using the Theoretical Domains Framework (TDF), provides a theoretically robust evidence base to inform intervention design. This study aimed to (1) identify key theoretical domains that were perceived to influence the prescribing and dispensing of appropriate polypharmacy to older patients by general practitioners (GPs) and community pharmacists, and (2) map domains to associated behaviour change techniques (BCTs) to include as components of an intervention to improve appropriate polypharmacy in older people in primary care.

Methods
Semi-structured interviews were conducted with members of each healthcare professional (HCP) group using tailored topic guides based on TDF version 1 (12 domains). Questions covering each domain explored HCPs’ perceptions of barriers and facilitators to ensuring the prescribing and dispensing of appropriate polypharmacy to older people. Interviews were audio-recorded and transcribed verbatim. Data analysis involved the framework method and content analysis. Key domains were identified and mapped to BCTs based on established methods and discussion within the research team.

Results
Thirty HCPs were interviewed (15 GPs, 15 pharmacists). Eight key domains were identified, perceived to influence prescribing and dispensing of appropriate polypharmacy: ‘Skills’, ‘Beliefs about capabilities’, ‘Beliefs about consequences’, ‘Environmental context and resources’, ‘Memory, attention and decision processes’, ‘Social/professional role and identity’, ‘Social influences’ and ‘Behavioural regulation’. Following mapping, four BCTs were selected for inclusion in an intervention for GPs or pharmacists: ‘Action planning’, ‘Prompts/cues’, ‘Modelling or demonstrating of behaviour’ and ‘Salience of consequences’. An additional BCT (‘Social support or encouragement’) was selected for inclusion in a community pharmacy-based intervention in order to address barriers relating to interprofessional working that were encountered by pharmacists.

Conclusions
Selected BCTs will be operationalised in a theory-based intervention to improve appropriate polypharmacy for older people, to be delivered in GP practice and community pharmacy settings. Future research will involve development and feasibility testing of this intervention.

Anticipatory Planning Reveals Segmentation of Cortical Motor Output During Action Observation

It has been argued that the variation in brain activity that occurs when observing another person reflects a representation of actions that is indivisible, and which plays out in full once the intent of the actor can be discerned. We used transcranial magnetic stimulation to probe the excitability of corticospinal projections to 2 intrinsic hand muscles while motions to reach and grasp an object were observed. A symbolic cue either faithfully indicated the required final orientation of the object and thus the nature of the grasp that was required, or was in conflict with the movement subsequently displayed. When the cue was veridical, modulation of excitability was in accordance with the functional role of the muscles in the action observed. If however the cue had indicated that the alternative grasp would be required, modulation of output to first dorsal interosseus was consistent with the action specified, rather than the action observed-until the terminal phase of the motion sequence during which the object was seen lifted. Modulation of corticospinal output during observation is thus segmented-it progresses initially in accordance with the action anticipated, and if discrepancies are revealed by visual input, coincides thereafter with that of the action seen.

Aligning conservation priorities across taxa in Madagascar with high-resolution planning tools

Globally, priority areas for biodiversity are relatively well known, yet few detailed plans exist to direct conservation action within them, despite urgent need. Madagascar, like other globally recognized biodiversity hot spots, has complex spatial patterns of endemism that differ among taxonomic groups, creating challenges for the selection of within-country priorities. We show, in an analysis of wide taxonomic and geographic breadth and high spatial resolution, that multitaxonomic rather than single-taxon approaches are critical for identifying areas likely to promote the persistence of most species. Our conservation prioritization, facilitated by newly available techniques, identifies optimal expansion sites for the Madagascar government's current goal of tripling the land area under protection. Our findings further suggest that high-resolution multitaxonomic approaches to prioritization may be necessary to ensure protection for biodiversity in other global hot spots.

Instituting order: the limitations of Nasser’s post-colonial planning visions for Cairo in the case of the indigenous quarter of Bulaq (1952–1970)

This paper investigates the limitations of postcolonial planning practices that aimed to modernise Cairo’s urban spaces during Gamal Abdel Nasser rule (1952–70). Following the Free Officers revolution of 1952, ambition to display urban order through forceful change in the city’s built environment was in action. Nasser’s visions of modernity were explicit in a series of attempts to reshape several prime locations in central Cairo, which included the old traditional waterfront quarter, in Bulaq Abul Ela. An analysis of the Bulaq planning scheme drafted in 1966 reveals insights into how notions of order were spatialised to integrate with Cairo’s complex urban fabric. The official plans to regularise Bulaq also strongly demonstrates how this was a top-down, centralised process in terms of governance, with full utilisation of state resources, namely the military and the media. From a wider perspective, planning practices under Nasser demonstrated an evident break with the past to eliminate memories of colonisation and disorder. Drawing on original resources, archival material, meeting minutes and maps of this historical but dilapidated quarter of Cairo, this paper gives an insight into how Nasser’s government attempted to convey a sense of order in a revolutionary country without, however, having an understanding of order as a coherent, multilayered and sequential process of change.

PROBLEM-SOLVING IN SCHIZOPHRENIA - A SPECIFIC DEFICIT IN PLANNING ABILITY

The study investigated problem solving ability in schizophrenia. Thirty DSM-IIIR schizophrenic patients and 27 matched normal controls were tested on the Three-Dimensional Computerised Tower of London Test (3-D CTL Test) (Morris et al., 1993). The patients took significantly more moves to solve a series of problems and solved significantly fewer problems in the predetermined minimum number of moves. The patients response times, as measured using a control version of the task (the 3-D CTL Control), were longer than those of the controls. However, when latencies were adjusted to take into account the slower responses overall, the patients planning times were not significantly increased. Inaccurate planning, as defined by taking more moves, did not correlate with either positive or negative symptoms, but the response times tended to be longer in patients who had more negative symptoms. The findings suggest that there is a deficit in problem solving activity in schizophrenia that may be associated with translating 'willed intentions' into action, independent of slower motor speed.

You’re Wha…? Including young men in reproductive planning

The importance of including fathers in reproductive planning, pregnancy and childbirth cannot be overstated and it is increasingly recognised that addressing their sense of exclusion from maternity services requires further action. One very overlooked area, however, is in helping young men, alongside their partners, in preventing an unintended teenage pregnancy. The UK has the highest rate of teenage pregnancy in Western Europe and, while teenage men are seen as half of the problem, they are rarely regarded as half of the solution. We argue that education is an essential part of the process of increasing men's sense of inclusion and describe If I were Jack, an educational resource about unintended teenage pregnancy which has been developed specifically for young men.

Participatory Action Research with and within community activist groups: capturing the collective experience of Ireland's Community and Voluntary Pillar

The inclusion of community activists in policy planning is increasingly recognized at the highest international level. This article shows how the use of Participatory Action Research (PAR) can present a deeper and more holistic picture of the experiences of Civil Society Organizations (CSOs) in shaping national-level social policy. By utilizing action-based research, the Community and Voluntary Pillar (CVP) of Ireland’s system of social partnership is shown to be an important agent in deliberating national bargaining outcomes (known as the Towards 2016 national agreement). The key contribution of this research is the reflective methodological considerations in terms of PAR design, execution and participant integration in the research process as a way to enrich and develop a deeper and more informed community of practice.

Wind Power Planning: Problems and Perceptions in Practice and Procedure

Despite the fact that the UK has highest potential in the EU to generate renewable energy from wind, it lags behind its European partners. The departure point for this study is provided by the fact that the land use planning system has been perceived by some to create difficulties in pursuit of the achievement of National Action Plan targets. In the course of a review of literature, legislation, policy and case files a number of issues emerge relating not only to operational practice but structural concerns regarding knowledge, legitimacy and ethics. These are scrutinised in an empirical investigation which provides insights into the ontologies behind how knowledge is used and abused. Concerns are highlighted regarding the tactical manipulation of knowledges and the difficulties associated with objectifying evidence so that it can be understood, validated and authenticated. The paper concludes by reflecting on the implications for the regulatory framework, the legitimisation of decisions and the ethics of the profession and how these, in turn, are conditioned by the production, use and transparency of planning knowledge.