Development and psychometric evaluation of a new team effectiveness scale for all types of community adult mental health teams:a mixed-methods approach

Defining 'effectiveness' in the context of community mental health teams (CMHTs) has become increasingly difficult under the current pattern of provision required in National Health Service mental health services in England. The aim of this study was to establish the characteristics of multi-professional team working effectiveness in adult CMHTs to develop a new measure of CMHT effectiveness. The study was conducted between May and November 2010 and comprised two stages. Stage 1 used a formative evaluative approach based on the Productivity Measurement and Enhancement System to develop the scale with multiple stakeholder groups over a series of qualitative workshops held in various locations across England. Stage 2 analysed responses from a cross-sectional survey of 1500 members in 135 CMHTs from 11 Mental Health Trusts in England to determine the scale's psychometric properties. Based on an analysis of its structural validity and reliability, the resultant 20-item scale demonstrated good psychometric properties and captured one overall latent factor of CMHT effectiveness comprising seven dimensions: improved service user well-being, creative problem-solving, continuous care, inter-team working, respect between professionals, engagement with carers and therapeutic relationships with service users. The scale will be of significant value to CMHTs and healthcare commissioners both nationally and internationally for monitoring, evaluating and improving team functioning in practice.

Mixed methods research:don't "just do it"

Purpose The purpose of this paper is to identify some of the dilemmas involved in the debate on the how, when and why of mixed methods research. Design/methodology/approach The authors' starting point is formed by developments in the philosophy of science literature, and recent publications on mixed methods research outside of the management accounting domain. Findings Contrary to recent claims made in the management accounting literature, the authors assert that uncovering points of disagreement between methods may be as far as researchers can go by combining them. Being reflexive can help to provide a deeper understanding of the research process and the researcher's role in this process. Research limitations/implications The paper should extend the debate among management accounting researchers about mixed methods research. One of the lessons drawn is that researchers are actively immersed in the research process and cannot purge their own interests and views. Accepting this lesson casts doubt on what the act of research may imply and achieve. Practical implications The paper shows that combinations of research methods should not be made based on a "whatever works" attitude, since this approach ultimately is still infused with ontological and epistemological considerations that researchers have, and should try to explicate. Originality/value The value of this paper lies in the provision of philosophical underpinnings that have not been widely considered in the management accounting literature on mixed methods to date. © 2011 Emerald Group Publishing Limited. All rights reserved.

Foundations of an intervention package to improve communication in residential care settings:a mixed methods study

Background: The prevalence of hearing loss is considerably higher in individuals in residential care than in people within the community-dwelling population, and yet hearing aids and hearing services are relatively underused. Care staff have a key role in supporting access to services. Objectives: This study identifies staff perspectives on hearing loss and their views about potential hearing service improvements. Study design: A four-stage mixed methods study was used, made up of qualitative interviews, observation, a survey and a stakeholder involvement meeting. Results: The qualitative stages indicated that staff were concerned about their levels of interaction with residents. Staff considered maximizing communication as part of their professional role. The quantitative survey indicated that these views were widely held by staff, and the stakeholder stage identified the need for social support and dedicated staff training opportunities. Conclusion: Care home staff regard communication as a shared issue. Future interventions could enhance access to hearing services and provide care home staff with training in hearing loss and hearing aid management. © 2013 Informa Healthcare.

A mixed methods investigation of parental factors in non-attendance at general paediatric hospital outpatient appointments

Non-attendance at paediatric outpatient appointments results in delayed diagnosis and treatment, putting children at risk of avoidable ill health, and incurring considerable health service costs. Links between missed appointments and clinical, socio-demographic, and access-related factors have been indicated, but parental cognitions associated with non-attendance have yet to be investigated. The aims of this project were to evaluate the effectiveness and theoretical bases of existing interventions designed to reduce non-attendance; to consider the ways in which missed appointments are managed by healthcare providers; to explore parents’ beliefs and experiences of attending and missing appointments; and to investigate the factors underlying these beliefs. A systematic literature review focusing on non-attendance interventions was conducted Within a mixed methods framework, interviews were conducted with healthcare professionals, subsequent interviews were conducted with parents who had attended or missed a General Paediatric outpatient appointment, and a cross-sectional questionnaire study of parents’ beliefs was implemented. The systematic review revealed that text message appointment reminders are effective at reducing non-attendance rates, but that no interventions have thus far been developed using theories of behaviour. Healthcare professionals recognised both barriers and parents’ beliefs as influences on attendance, but also believed there were ‘types’ of families who miss appointments. Healthcare professionals disagreed somewhat about how non-attendance should best be managed. The parent interview study found six themes. The findings reflect parents’ perceptions about the importance of attending and of their ability to attend. The results of the questionnaire study corroborate this structure of beliefs as the analysis produced two factors, the perceived ‘worth’ of attending and anticipated ‘worry’ when attending. This thesis demonstrates an original approach to investigating non-attendance at children’s outpatient appointments, using mixed methods and adopting a psychological rather than service-use perspective. The findings contribute to Health Psychology theory and offer recommendations for healthcare providers.

Appraising qualitative research for inclusion in systematic reviews:A quantitative and qualitative comparison of three methods

Objective: Qualitative research is increasingly valued as part of the evidence for policy and practice, but how it should be appraised is contested. Various appraisal methods, including checklists and other structured approaches, have been proposed but rarely evaluated. We aimed to compare three methods for appraising qualitative research papers that were candidates for inclusion in a systematic review of evidence on support for breast-feeding. Method: A sample of 12 research papers on support for breast-feeding was appraised by six qualitative reviewers using three appraisal methods: unprompted judgement, based on expert opinion; a UK Cabinet Office quality framework; and CASP, a Critical Appraisal Skills Programme tool. Papers were assigned, following appraisals, to 1 of 5 categories, which were dichotomized to indicate whether or not papers should be included in a systematic review. Patterns of agreement in categorization of papers were assessed quantitatively using κ statistics, and qualitatively using cross-case analysis. Results: Agreement in categorizing papers across the three methods was slight (κ =0.13; 95% CI 0.06-0.24). Structured approaches did not appear to yield higher agreement than that by unprompted judgement. Qualitative analysis revealed reviewers' dilemmas in deciding between the potential impact of findings and the quality of the research execution or reporting practice. Structured instruments appeared to make reviewers more explicit about the reasons for their judgements. Conclusions: Structured approaches may not produce greater consistency of judgements about whether to include qualitative papers in a systematic review. Future research should address how appraisals of qualitative research should be incorporated in systematic reviews. © The Royal Society of Medicine Press Ltd 2007.

The experience of living with age related macular degeneration:A longitudinal study into the impact of age related macular degeneration on quality of life

In this thesis I contribute to the understanding of the experience of living with Age-Related Macular Degeneration (AMD) and its impact on quality of life through the use of a pragmatically guided mixed methods approach. AMD is a condition resulting in the loss of central vision in old age which can have a huge impact on the lives of patients. This thesis includes: literature reviewing; qualitative meta-synthesis; surveys and descriptive statistics; observation; and analysis of in-depth interviewing, in order to build a picture of what it is like for older people to live with AMD. I present the findings from six separate studies each designed to answer specific research questions. I begin with a mixed methods study to determine how well the most commonly used measure of quality of life for AMD patients’ represents patient experiences. I then go on to investigate the experiences of patients with AMD through a meta-synthesis of qualitative research and finally present four of my own empirical studies three of which investigate the experiences of patients with different types of AMD: early dry AMD, treatable wet AMD and advanced wet AMD and the final study investigates what it is like for a couple living together with AMD. Throughout the qualitative studies I use Interpretative Phenomenological Analysis (IPA) to develop an understanding of the experiences and life contexts of patients with AMD. Through rigorous analysis, I identify a range of themes which highlight the shared and divergent experiences of individuals with AMD and the need to acknowledge patients’ past, present and potential future life contexts and experiences when providing services to older people with AMD. I relate the findings of the six studies to the wider psychological literature on chronic illness and make recommendations for services for patients with AMD to be provided holistically within a lifeworld-led health care model.

Evaluating the impact of institutional logic on the corporate Internet reporting by Egyptian listed companies

This study explores the institutional logic(s) governing the Corporate Internet Reporting (CIR) by Egyptian listed companies. In doing so, a mixed methods approach was followed. The qualitative part seeks to understand the perceptions, believes, values, norms, that are commonly shared by Egyptian companies which engaged in these practices. Consequently, seven cases of large listed Egyptian companies operating in different industries have been examined. Other stakeholders and stockholders have been interviewed in conjunction with these cases. The quantitative part consists of two studies. The first one is descriptive aiming to specify whether the induced logic(s) from the seven cases are commonly embraced by other Egyptian companies. The second study is explanatory aiming to investigate the impact of several institutional and economic factors on the extent of CIR, types of the online information, quality of the websites as well as the Internet facilities. Drawing on prior CIR literature, four potential types of logics could be inferred: efficiency, legitimacy, technical and marketing based logics. In Egypt, legitimacy logic was initially embraced in the earlier years after the Internet inception. latter, companies confronted radical challenges in their internal and external environments which impelled them to raise their websites potentialities to defend their competitive position; either domestically or internationally. Thus, two new logics emphasizing marketing and technical perspectives have emerged, in response. Strikingly, efficiency based logic is not the most prevalent logic driving CIR practices in Egypt as in the developed countries. The empirical results support this observation and show that almost half of Egyptian listed companies 115 as on December 2010 possessed an active website, half of them 62 disclosed part of their financial and accounting information, during December 2010 to February 2011. Less than half of the websites 52 offered latest annual financial statements. Fewer 33(29%) websites provided shareholders and stock information or included a separate section for corporate governance 25 (22%) compared to 50 (44%) possessing a section for news or press releases. Additionally, the variations in CIR practices, as well as timeliness and credibility were also evident even at industrial level. After controlling for firm size, profitability, leverage, liquidity, competition and growth, it was realized that industrial companies and those facing little competition tend to disclose less. In contrast, management size, foreign investors, foreign listing, dispersion of shareholders and firm size provided significant and positive impact individually or collectively. In contrast, neither audit firm, nor most of performance indicators (i.e. profitability, leverage, and liquidity) did exert an influence on the CIR practices. Thus, it is suggested that CIR practices are loosely institutionalised in Egypt, which necessitates issuing several regulative and processional rules to raise the quality attributes of Egyptian websites, especially, timeliness and credibility. Beside, this study highlights the potency of assessing the impact of institutional logic on CIR practices and suggests paying equal attention to the institutional and economic factors when comparing the CIR practices over time or across different institutional environments in the future.

Illness perceptions, beliefs and prevention of Type 2 Diabetes among British Pakistani mothers and young British Pakistani women

The prevalence rates of type2 diabetes mellitus (T2DM) continues to rise among British Pakistanis. The aim of this project was to explore T2DM perceptions and any preventative intentions among British Pakistani women and to discover whether they are doing anything to prevent the onset in themselves and their families. Initially a systematic review was conducted to investigate 20 existing prevention interventions and to assess their effectiveness (n=12,419). Mixed methods approach was adopted and three studies were conducted. The first study consisted of two focus groups with T2DM mothers (n=8) and three focus groups with non-T2DM mothers (n=17). The second study consisted of four focus groups young British Pakistani females (n=11). All focus groups were transcribed verbatim and analysed using thematic analysis. Following these a quantitative study was undertaken comprising of a questionnaire survey; 12 prevention-perception items (derived from the qualitative data) and the Illness-Perception Questionnaire Revised (IPQ-R) using participants from the same populations: T2DM mothers (n=41), non-T2DM mother (n=47) and young women (n=42). Results were analysed using multiple/hierarchical regression. The systematic review highlighted that the most effective prevention programmes focussed on behaviour and lifestyle with a combination of support and education to participants. The research studies demonstrated that T2DM was seen as an older person’s disease to be dealt with if/when it happens. T2DM mothers demonstrated knowledge and prevention understanding. There were non-significant relationships between prevention perceptions and T2DM illness perceptions across all three groups. The finding of this thesis emphasised that lifestyle interventions are crucial to aiding T2DM preventions as a good healthy diet and regular physical activity are the key components to T2DM prevention, and the importance of personal experience in perceived severity and lay-beliefs regarding T2DM and on family/cultural influences in British-Pakistanis. The findings of this project can be used to design culturally specific interventions towards preventing T2DM in the British Pakistani community.

The discretionary role of the line manager in inspiring work engagement and innovative behaviour:a study of social exchange and job resources in the public sector

This thesis is about the discretionary role of the line manager in inspiring the work engagement of staff and their resulting innovative behaviour examined through the lens of Social Exchange Theory (Blau, 1964) and the Job Demands-Resources theory (Bakker, Demerouti, Nachreiner & Schaufeli, 2001). The study is focused on a large British Public Sector organisation undergoing a major organisational shift in the way in which they operate as part of the public sector. It is often claimed that people do not leave organisations; they leave line managers (Kozlowski & Doherty, 1989). Regardless of the knowledge in the literature concerning the importance of the line manager in organisations (Purcell, 2003), the engagement literature in particular is lacking in the consideration of such a fundamental figure in organisational life. Further, the understanding of the black box of managerial discretion and its relationship to employee and organisation related outcomes would benefit from greater exploration (Purcell, 2003; Gerhart, 2005; Scott, et al, 2009). The purpose of this research is to address these gaps with relation to the innovative behaviour of employees in the public sector – an area that is not typically associated with the public sector (Bhatta, 2003; McGuire, Stoner & Mylona, 2008; Hughes, Moore & Kataria, 2011). The study is a CASE Award PhD thesis, requiring academic and practical elements to the research. The study is of one case organisation, focusing on one service characterised by a high level of adoption of Strategic Human Resource Management activities and operating in a rather unique manner for the public sector, having private sector competition for work. The study involved a mixed methods approach to data collection. Preliminary focus groups with 45 participants were conducted, followed by an ethnographic period of five months embedded into the service conducting interviews and observations. This culminated in a quantitative survey delivered within the wider directorate to approximately 500 staff members. The study used aspects of the Grounded Theory (Glaser & Strauss, 1967) approach to analyse the data and developed results that highlight the importance of the line manager in an area characterised by SHRM and organisational change for engaging employees and encouraging innovative behaviour. This survey was completed on behalf of the organisation and the findings of this are presented in appendix 1, in order to keep the focus of the PhD on theory development. Implications for theory and practice are discussed alongside the core finding. Line managers’ discretion surrounding the provision of job resources (in particular trust, autonomy and implementation and interpretation of combined bundles of SHRM policies and procedures) influenced the exchange process by which employees responded with work engagement and innovative behaviour. Limitations to the research are the limitations commonly attributed to cross-sectional data collection methods and those surrounding generalisability of the qualitative findings outside of the contextual factors characterising the service area. Suggestions for future research involve addressing these limitations and further exploration of the discretionary role with regards to extending our understanding of line manager discretion.

Broadening the evidence base and the mind when thinking about mixed methods research

On behalf of my coauthors, Dr Michael Larkin and Professor Paul Flowers, and I would like to thank Dr Pierre Pluye for his letter in response to our article.1 Dr Pluye supported our argument that a broader evidence base is needed in evidence-based healthcare. He provided the readers of this journal with important additional information which updates them on the progress in the area of mixed studies reviews and further detail about the Mixed Methods Appraisal Tool (MMAT).2 Since writing our …

Public scientific communication on Twitter:visual analytic approach

Purpose - The purpose of this paper is to assess high-dimensional visualisation, combined with pattern matching, as an approach to observing dynamic changes in the ways people tweet about science topics. Design/methodology/approach - The high-dimensional visualisation approach was applied to three scientific topics to test its effectiveness for longitudinal analysis of message framing on Twitter over two disjoint periods in time. The paper uses coding frames to drive categorisation and visual analytics of tweets discussing the science topics. Findings - The findings point to the potential of this mixed methods approach, as it allows sufficiently high sensitivity to recognise and support the analysis of non-trending as well as trending topics on Twitter. Research limitations/implications - Three topics are studied and these illustrate a range of frames, but results may not be representative of all scientific topics. Social implications - Funding bodies increasingly encourage scientists to participate in public engagement. As social media provides an avenue actively utilised for public communication, understanding the nature of the dialog on this medium is important for the scientific community and the public at large. Originality/value - This study differs from standard approaches to the analysis of microblog data, which tend to focus on machine driven analysis large-scale datasets. It provides evidence that this approach enables practical and effective analysis of the content of midsize to large collections of microposts.

An examination of the UK community pharmacist's role in facilitating patient self-management of cardiovascular disease through lifestyle behaviours

The progression of cardiovascular disease (CVD) is largely modifiable through lifestyle behaviours. UK pharmacists are contractually obliged to facilitate patient self-management of chronic conditions such as CVD. Pharmacists are easily accessible health professionals who are well placed to identify “at risk” patients through medication regimes. Research has identified varying attitudes towards and levels of involvement in pharmacist-led health promotion activity. Given the diverse and exploratory nature of the work, a pragmatic, mixed methods approach was used to explore community pharmacists’ role in facilitating patient self-management of CVD. The thesis presents four studies: a qualitative study with pharmacists; a cross sectional questionnaire of community pharmacists; a systematic review and a qualitative study with patients with CVD. The qualitative study with pharmacists gave an insight into pharmacists’ experiences of giving patients with CVD lifestyle advice and the factors underpinning commonly cited barriers to providing public health services. This informed the development of the cross-sectional questionnaire which identified the predictors of pharmacists’ intentions to give two different types of advice to facilitate patient self-management. The systematic review identified a small number of interventions to prepare pharmacists to facilitate patient lifestyle behaviour change and evaluated the theories and behaviour change techniques used in successful interventions; however due to poor study quality and poor reporting of the interventions limited conclusions about the efficacy of the interventions could reliably be drawn. Finally, the qualitative study gave an insight into the experiences of patients with CVD using community pharmacy services and their expectations of the service they receive from community pharmacists. Recommendations about changes to pharmacy policy and practice in order to support pharmacists’ provision of CVD self-management advice are made.

Reviewing the evidence base for the Children and Young People Safety Thermometer (CYPST):a mixed studies review

The objective was to identify evidence to support use of specific harms for the development of a children and young people's safety thermometer (CYPST). We searched PubMed, Web of Knowledge, and Cochrane Library post-1999 for studies in pediatric settings about pain, skin integrity, extravasation injury, and use of pediatric early warning scores (PEWS). Following screening, nine relevant articles were included. Convergent synthesis methods were used drawing on thematic analysis to combine findings from studies using a range of methods (qualitative, quantitative, and mixed methods). A review of PEWS was identified so other studies on this issue were excluded. No relevant studies about extravasation injury were identified. The synthesized results therefore focused on pain and skin integrity. Measurement and perception of pain were complex and not always carried out according to best practice. Skin abrasions were common and mostly associated with device related injuries. The findings demonstrate a need for further work on perceptions of pain and effective communication of concerns about pain between parents and nursing staff. Strategies for reducing device-related injuries warrant further research focusing on prevention. Together with the review of PEWS, these synthesized findings support the inclusion of pain, skin integrity, and PEWS in the CYPST.

Interorganizational innovation and collaboration in the UK medical device sector

Interorganizational team research is a growing body of literature and research has started toexamine team related factors such as interorganizational trust (i.e. Stock, 2006) in theinterorganizational setting. This research applies insights from the intraorganizational teamfield into the interorganizational team setting in order to determine the team related factorspertaining to effective collaboration in medical device innovation projects.Interorganizational collaboration has been a persistent feature within the interorganizationalrelations literature, due to the added benefits that can come with working collaborativelytowards a common goal (Berg-Weger & Schnieder, 1998). While much research has exploredthe structures and performance outcomes of engaging in this cross-boundary working, theliterature is sparse with respect to interpersonal relationships, practices and processes leadingto effective collaboration (Bergenholtz & Waldstrom, 2011; Majchrzak, Jarvenpaa & Bargherz,2015). An interpretivist perspective has informed an exploratory mixed methods approach to datacollection, with contextual insights informing each phase of data collection. Three exploratoryphases of data collection have provided (1) qualitative ethnography data, (1i) qualitativeinterview data and (2) quantitative survey data. The NHS has recently set out agendas to increase innovative procurement (Department ofHealth, 2008), work more closely with industry and SMEs (Innovation and Procurement Plan:Department of Health, 2009) and to increase innovative practice (IHW: NHS, 2011). SMEsdeveloping novel medical devices require input from the NHS to ensure that their devices areclinically applicable and therefore will be adopted by the NHS. These contextual insightsprovide the backdrop for Studies 1i and 2. The findings suggest that the intraorganizational team literature can be extended into theinterorganizational collaboration literature, whilst also explaining the factors relating toeffectiveness and success of interorganizational team innovation.