Assessing feasibility and acceptability of study procedures : getting ready for implementation of national stroke guidelines in out-patient health care

BACKGROUND: Even though Swedish national guidelines for stroke care (SNGSC) have been accessible for nearly a decade access to stroke rehabilitation in out-patient health care vary considerably. In order to aid future interventions studies for implementation of SNGSC, this study assessed the feasibility and acceptability of study procedures including analysis of the context in out-patient health care settings. METHODS: The feasibility and acceptability of recruitment, observations and interviews with managers, staff and patients were assessed, as well as the feasibility of surveying health care records. RESULTS: To identify patients from the the hospitals was feasible but not from out-patient care where a need to relieve clinical staff of the recruitment process was identified. Assessing adherence to guidelines and standardized evaluations of patient outcomes through health care records was found to be feasible and suitable assessment tools to evaluate patient outcome were identified. Interviews were found to be a feasible and acceptable tool to survey the context of the health care setting. CONCLUSION: In this feasibility study a variety of qualitative and quantitative data collection procedures and measures were tested. The results indicate what can be used as a set of feasible and acceptable data collection procedures and suitable measures for studying implementation of stroke guidelines in an out-patient health care context.

A multicentre randomized controlled trial of an empowerment-inspired intervention for adolescents starting continuous subcutaneous insulin infusion : a study protocol

Background. Continuous subcutaneous insulin infusion (CSII) treatment among children with type 1 diabetes is increasing in Sweden. However, studies evaluating glycaemic control in children using CSII show inconsistent results. Omitting bolus insulin doses using CSII may cause reduced glycaemic control among adolescents. The distribution of responsibility for diabetes self-management between children and parents is often unclear and needs clarification. There is much published support for continued parental involvement and shared diabetes management during adolescence. Guided Self-Determination (GSD) is an empowerment-based, person-centred, reflection and problem solving method intended to guide the patient to become self-sufficient and develop life skills for managing difficulties in diabetes self-management. This method has been adapted for adolescents and parents as Guided Self-Determination-Young (GSD-Y). This study aims to evaluate the effect of an intervention with GSD-Y in groups of adolescents starting on insulin pumps and their parents on diabetes-related family conflicts, perceived health and quality of life (QoL), and metabolic control. Here, we describe the protocol and plans for study enrolment. Methods. This study is designed as a randomized, controlled, prospective, multicentre study. Eighty patients between 12-18 years of age who are planning to start CSII will be included. All adolescents and their parents will receive standard insulin pump training. The education intervention will be conducted when CSII is to be started and at four appointments in the first 4 months after starting CSII. The primary outcome is haemoglobin A1c levels. Secondary outcomes are perceived health and QoL, frequency of blood glucose self-monitoring and bolus doses, and usage of carbohydrate counting. The following instruments will be used to evaluate perceived health and QoL: Disabkids, 'Check your health', the Diabetes Family Conflict Scale and the Swedish Diabetes Empowerment Scale. Outcomes will be evaluated within and between groups by comparing data at baseline, and at 6 and 12 months after starting treatment. Results and discussion. In this study, we will assess the effect of starting an insulin pump together with the model of Guided Self-Determination to determine whether this approach leads to retention of improved glycaemic control, QoL, responsibility distribution and reduced diabetes-related conflicts in the family. Trial registration: Current controlled trials: ISRCTN22444034

Attitudes towards the minority variety Caló in the south of Spain : a sociolinguistic study

Caló is a variety spoken by the Spanish Calé (i.e. the Roma). It belongs to a group of languages referred to as “Para-Romani”, characterized by Romani vocabulary, but largely non-Romani morphology, phonology and syntax, in the case of Caló deriving from Spanish. According to previous research carried out – with focus on the vocabulary and the grammar of this variety – Caló is on its way to extinction. However, there is an expressed interest in reintroducing a form called “Romanó-Caló”. Attitudes play an important role in minority language maintenance as well as in order for a revitalization project to be successful. The aim of this study is to measure the attitudes that both Calé and non-Calé have towards Caló and Caló speakers, a type of study never carried out in the past. The methods applied are both direct and indirect. In total, 231 informants listened to different recordings of voices acting as either a “Spanish speaking person” or a “Caló speaking person”, a technique referred to as ‘matched guise’, answering questions related to the voices on attitude scales. Furthermore, 182 of the informants rated their agreement or disagreement to positive and negative items towards Caló and its speakers on a Likert scale. The results of the analysis indicate that the attitudes differ towards Caló and Caló speakers, depending on the informant’s (a) ethnicity (b) contact with Caló as well as with Caló speakers, and (c) gender. It is those who – in their own opinion – belong to the ethnic group Calé, as well as those who claim that they have some contact with the variety and its speakers, who show positive attitudes in both parts of the study. The women also show more positive attitudes than the men. It is also possible to note positive attitudes towards the variety and its speakers among the subjects with a high level of knowledge of Caló words, as well as among those with the highest willingness to use Caló. These observations suggest that a revitalization project of the variety Caló has a clear chance of being successful.