Health and Social Care Delivery Research

Background Minority ethnic patients are less likely to access timely and effective palliative and end-of-life care and, as a consequence, more likely to experience poorer symptom management and receive more intensive treatments at the end of life. Research activity has the potential to address the aforementioned barriers to improve access. However, there is a need to develop capacity and capability, particularly within underserved communities, to provide an infrastructure that can drive research activity informed by the community to benefit the community. Objective To build and develop a robust, inclusive and representative research partnership to facilitate improved research activity committed to addressing inequity in access to palliative and end-of-life care among ethnically diverse communities. Design An inclusive and representative KEEch research Partnership NETwork was established, comprised over 80 partner organisations that represent the local diverse and multifaith communities. Interviews ( n = 11) with service providers and face-to-face roundtable workshops with community stakeholders, service providers, informal carers and faith leaders were conducted to understand needs, challenges and research priorities. Setting Bedfordshire, Hertfordshire and Milton Keynes, United Kingdom. Results Developing KEEch research Partnership NETwork required a flexible and agile approach to engage effectively with institutionalised and non-institutionalised stakeholders. Sharing a joint purpose of learning, managing partners’ expectations and providing transparency and accountability within the network were all essential in building trust and equity within the research partnership. The overarching findings revealed a range of sociocultural and structural barriers that negatively impact access and experience among minority ethnic groups. Discussions centred on the disconnect between informal care and support within the community, which many ethnic minority communities rely upon, and ‘institutional’ medical services. KEEch research Partnership NETwork uncovered that while service providers and communities acknowledge they need to engage with each other more, they remain uncertain of the best way to achieve this. There was also consensus that services need to deliver more effective, culturally competent, person-centric care that promotes compassion and gives weight to non-medical needs to better meet the needs of the diverse population. These findings and priorities have informed the submission of a co-produced research funding proposal. Beyond that, KEEch research Partnership NETwork has also provided a platform for further unplanned spin-off research projects and collaboration, including the implementation of an innovative ‘community connector’ role to facilitate better integration of community and voluntary services in palliative and end-of-life care. Conclusions KEEch research Partnership NETwork has provided valuable insight into factors that can facilitate the successful collaboration between multifaith and diverse community stakeholders. Through KEEch research Partnership NETwork, we offer our observations as an opportunity for shared learning for others who want to adopt a similar approach when in the planning stages of establishing a research partnership network. The mutual benefit of developing this partnership and working collectively with communities to address inequalities in accessing palliative and end-of-life care could provide a useful approach and way of solving other important priorities to reduce wider health inequalities. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research as award number NIHR135381.

Erica J Cook

Elaine Tolliday

Nasreen Ali

Mehrunisha Suleman

Emma Wilkinson

Gurch Randhawa

Exploratory study from an end-of-life research partnership network to improve access for ethnically diverse communities in one region

探索性研究：通过生命终结研究伙伴关系网络改善一个地区种族多样性社区的医疗资源获取

Background As milder cases of adolescent depression do not meet treatment thresholds for specialist mental health services, young people often receive support from non-qualified professionals in third-sector/voluntary agencies. Early psychological interventions to meet growing demand with limited resources are crucial. Objectives The study aimed to explore the effectiveness and cost effectiveness of interpersonal counselling for adolescents by (1) assessing the feasibility and acceptability of trial procedures; (2) exploring the delivery of, and differences between, interpersonal counselling for adolescents and treatment as usual; (3) evaluating the extent of contamination of the control arm and if it should be mitigated against in a future trial; and (4) investigating whether the interval estimate of benefit of interpersonal counselling for adolescents over treatment as usual in depression post treatment includes a clinically significant effect. Design This was a feasibility randomised controlled trial. Non-qualified professionals from non-specialist mental health services received interpersonal counselling for adolescent training. Participants were randomised to receive either interpersonal counselling for adolescents plus treatment as usual or treatment as usual only. Assessments occurred at baseline and were followed up at weeks 5, 10 and 23. A health economics component was included to inform the design of the economic evaluation in a future study. A process evaluation examined implementation of the intervention across settings, acceptability and contamination. Interviews, observations and focus groups were analysed using thematic analysis. Session recordings were analysed using conversation analysis. Setting The trial was conducted in 13 non-speicialist mental health services across Norfolk and Suffolk. Participants Help-seeking adolescents aged 12–18 years with mild depression as the primary difficulty were eligible to participate. Comorbid presentations were not an exclusion criterion. Of a target of 60, 16 participants were randomised, and 2 participants withdrew following study suspensions related to COVID-19. Of the remaining 14 participants, 7 received an intervention, with 3 receiving interpersonal counselling for adolescents and 4 receiving treatment as usual. The rest either disengaged, withdrew or were signposted. Interventions Participants were randomised to receive either interpersonal counselling for adolescents plus treatment as usual or treatment as usual only. Main outcome measures The primary outcome was the Revised Children’s Anxiety and Depression Scale, although the proposed study was not designed to assess efficacy. The primary output of the feasibility trial was to design a subsequent full-scale trial. Results Feasibility outcomes did not meet the estimated progression criteria. Despite efforts to increase referrals, the 80% recruitment rate was not achieved. Interpersonal counselling for adolescents' attendance rates at 10 weeks were less than the 70% progression criteria estimation, impacting intervention feasibility. Retention was high, with 85.7% of participants reaching 23-week follow-up. The health economic measures appeared to perform well and were completed. Implementation and theoretical fidelity of interpersonal counselling for adolescents were analysed from four participant recordings. Adherence to the principles of interpersonal counselling for adolescents was identified, with 100% satisfactory fidelity and no indication of contamination in the control arm. The two interventions were clinically non-significant due to the study being underpowered. Limitations The feasibility of the randomised controlled trial was impacted by COVID-19. Services had to change standard practices, disrupting trial procedures. Challenges were identified when implementing a randomised controlled trial in non-specialist services. Conclusions Findings indicate a randomised controlled trial of interpersonal counselling for adolescents in non-specialist services is not feasible, yet the data collection and outcome measures were suitable. COVID-19 challenges, sites’ lack of familiarity with research procedures and the research team’s unfamiliarity with how different early intervention services operate led to challenges. High staff shortages, turnover and inconsistent training could have been considered. This study demonstrated the difficulties in conducting a randomised controlled trial in this service setting. Further work is needed to improve the feasibility of conducting such trials before they are attempted in future. Trial registration This trial is registered as ISRCTN82180413. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/112/16) and is published in full in Health and Social Care Delivery Research ; Vol. 12, No. 48. See the NIHR Funding and Awards website for further award information.

Jon Wilson

Viktoria Cestaro

Eirini Charami-Roupa

Timothy Clarke

Aoife Dunne

Brioney Gee

Sharon Jarrett

Thando Katangwe-Chigamba

Andrew Laphan

Susie McIvor

Richard Meiser-Stedman

Jamie Murdoch

Thomas Rhodes

Carys Seeley

Lee Shepstone

David Turner

Paul Wilkinson

Interpersonal counselling for adolescent depression delivered by youth mental health workers without core professional training: the ICALM feasibility RCT

青少年抑郁的人际关系咨询：由无核心专业培训的青年心理健康工作者实施的ICALM可行性随机对照试验

Background Lesbian, gay, bisexual, trans, queer/questioning, plus young people have a higher risk of poor mental health in comparison to cisgendered heterosexual young people, and they underutilise mental health services and support. In addition, there is a paucity of research conducted in United Kingdom examining mental health early intervention provision for lesbian, gay, bisexual, trans, queer/questioning, plus young people. Objectives To produce a model of what works for early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people and increase understanding of lesbian, gay, bisexual, trans, queer/questioning, plus young people’s access to, navigation of, and engagement with mental health support. Method This was a multi-methods theory-led case study evaluation with three distinct stages: (1) a meta-narrative review of existing literature to develop a theoretical framework to explain effective mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people; (2) an online and offline service mapping exercise to locate current mental health early intervention support for lesbian, gay, bisexual, trans, queer/questioning, plus young people in the United Kingdom in order to produce a service typology; and (3) a theory-led case study evaluation of 12 case study sites selected from the service typology produced in stage 2, to establish the components of appropriate quality, early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people. Results Stage 1 produced an interdisciplinary theoretical framework indicating that early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus youth must prioritise addressing normative environments that marginalise youth, lesbian, gay, bisexual, trans, queer/questioning, plus identities and mental health problems. Stage 2 mapping found 111 services, the majority in urban settings in England. There was an absence of mainstream National Health Service support that specifically addressed the needs of lesbian, gay, bisexual, trans, queer/questioning, plus young people. The majority of lesbian, gay, bisexual, trans, queer/questioning, plus youth mental health support was provided by voluntary/community organisations. Stage 3 case study evaluation found that an intersectional, youth-rights approach is the most appropriate way to deliver early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people. Youth rights should underpin mental health support to address the multiple marginalisation, isolation and stigmatisation that lesbian, gay, bisexual, trans, queer/questioning, plus young people may experience and to enable them to make informed independent decisions about their own bodies and lives, and for the right to freedom of safe self-expression to be upheld. The model that we have produced contains 13 principles that are necessary to the provision of mental health support, and to improve access to, engagement with, and navigation of mental health services. Conclusions In the United Kingdom, a rights-based approach to mental health service provision is not prominent. In addition, at the time of writing, lesbian, gay, bisexual, trans, queer/questioning, plus young people are facing active legislative and policy attacks on their human rights. This study provides the first large-scale theory-led evaluation of early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people with common mental health problems. The resulting intersectional, youth-rights approach provides evidence on ways of improving lesbian, gay, bisexual, trans, queer/questioning, plus young people’s mental health. Further research on the implementation of an intersectional, youth-rights approach to early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people with mental health problems is required. Study registration This study is registered as PROSPERO CRD42019135722. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/09/04) and is published in full in Health and Social Care Delivery Research ; Vol. 12, No. 47. See the NIHR Funding and Awards website for further award information.

Elizabeth McDermott

Rachael Eastham

Elizabeth Hughes

Emily Pattison

Katherine Johnson

Stephanie Davis

Steven Pryjmachuk

Ceu Mateus

Olu Jenzen

Felix McNulty

Early mental health intervention and supported self-care for LGBTQ+ young people in the UK: a mixed-methods study

英国LGBTQ+青年早期心理健康干预与支持性自我护理：一项混合方法研究

Background During pregnancy and the postpartum period, women’s mental health can deteriorate quickly. Timely and easy access to services is critically important; however, little is known about the pathways women take to access services. Previous research has shown that women from ethnic minority groups in the United Kingdom experience more access issues compared to the White British women. Aim To describe pathways taken to specialist community perinatal mental health services and explore how they vary across services and ethnic groups. Methods This is a two-site, longitudinal retrospective service evaluation conducted in Birmingham and London during 6 months (1 July–31 December 2019). Electronic records of 228 women were accessed and data were extracted on help-seeking behaviour, referral process and the type of pathway (i.e. simple or complex). Data were collected using the adapted World Health Organization encounter form and analysed using uni- and multivariable analyses. Results The median time from the start of perinatal mental illness to contact with perinatal mental health services was 20 weeks. The majority of patients accessed perinatal mental health services through primary care (69%) and their pathway was simple, that is they saw one service before perinatal mental health services (63%). The simple pathway was used as a proxy for accessible services. In Birmingham, compared to London, more referrals came from secondary care, more women were experiencing current deterioration in mental health, and more women followed a complex pathway. Despite differences between ethnic groups regarding type of pathway and duration of patient journey, there was no evidence of difference when models controlled for confounders such as clinical presentation, general characteristics and location. The service’s location was the strongest predictor of the type of pathway and duration of patient journey. Limitations The heterogeneity among categorised ethnic groups; data extracted from available electronic records and not validated with patient’s own accounts of their pathways to care; unanalysed declined referrals; the study was conducted before the COVID-19 pandemic and pathways may be different in the post-COVID-19 period. Conclusion The study provides important insights into how patients find their way to community perinatal mental health services. It shows that there is a great degree of variability in the time taken to get into these services, and the pathway taken. This variation does not come from different needs of patients or different clinical presentations but rather from service-level factors. Future work The studied community perinatal mental health services in the United Kingdom operate with a significant degree of variability in the types and characteristics of patient pathways. Future research should explore these issues on the national and international levels. Additionally, future research should explore the reasons for the different pathways taken and the outcomes and risks associated with them. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number 17/105/14.

Nikolina Jovanović

Žan Lep

Jelena Janković

Aysegul Dirik

Anna Rees

Maev Conneely

Pathways to specialist community perinatal mental health services: a two-site longitudinal retrospective service evaluation

专科社区围产期心理健康服务路径：一项两地点纵向回顾性服务评估

Background People in prison are generally in poorer health than their peers in the community, often living with chronic illness and multimorbidity. Healthcare research in prisons has largely focused on specific problems, such as substance use; less attention has been paid to conditions routinely managed in primary care, such as diabetes or hypertension. It is important to understand how primary care in prisons is currently delivered in the United Kingdom and how it can be improved, in order to reduce health inequalities. Objective To understand the quality of primary care in prison, including gaps and variations in care, in order to recommend how quality of prison health care can be improved. Design A mixed-methods study with six interlinked work packages. Setting Predominantly the North of England. Methods Between August 2019 and June 2022, we undertook the following work packages: (1) International scoping review of prison healthcare quality indicators. (2) Stakeholder consensus process to identify United Kingdom focused prison healthcare quality indicators. (3) Qualitative interview study with 21 people who had been in prison and 22 prison healthcare staff. (4) Quantitative analysis of anonymised, routinely collected data derived from prison healthcare records (~ 25,000 records across 13 prisons). (5) Stakeholder deliberation process to identify interventions to improve prison health care. (6a) Secondary analysis of the qualitative data set, focusing on mental health and (6b) analysis of the quantitative data set, focusing on health care of three mental health subgroups Findings Our scoping review found predominantly only papers from the United States of America and of variable rigour with the main finding being that performance measurement is very challenging in the prison healthcare setting. In collaboration with stakeholders, we prioritised, refined and applied a suite of 30 quality indicators across several healthcare domains. We found considerable scope for improvement in several indicators and wide variations in indicator achievement that could not be attributed to differences in prison population characteristics. Examples of indicators with scope for improvement included: diabetes care, medicines reconciliation and epilepsy review and control. Longer length of stay in prison was generally associated with higher achievement than shorter stays. Indicator achievement was generally low compared to that of community general practice. We found some encouraging trends and relatively good performance for a minority of indicators. Our qualitative interviews found that quality of health care is related to factors that exist at several levels but is heavily influenced by organisational factors, such as understaffing, leading to a reactive and sometimes crisis-led service. Our stakeholder deliberations suggested opportunities for improvement, ideally drawing on data to assess and drive improvement. Our mental health work package found that coded mental illness had mixed associations with indicator achievement, while the interviews revealed that mental distress is viewed by many as an inevitable facet of imprisonment. Limitations Our analyses of indicator achievement were limited by the quality and coverage of available data. Most study findings are localised to England so international applicability may differ. Conclusions Marked variations in the quality of primary care in prisons are likely to be attributable to the local organisation and conditions of care delivery. Routinely collected data may offer a credible driver for change. Study registration This study is registered at researchregistry.com (Ref: 5098). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/05/26) and is published in full in Health and Social Care Delivery Research ; Vol. 12, No. 46. See the NIHR Funding and Awards website for further award information.

Sue Bellass

Krysia Canvin

Tracey Farragher

Kate McLintock

Nat Wright

Pip Hearty

Nicola Seanor

Marie Cunningham

Robbie Foy

Laura Sheard

Understanding and improving the quality of primary care for people in prison: a mixed-methods study

理解和改善监狱中人员初级保健质量的混合方法研究

Background Older people living in care homes are at high risk of poor health outcomes and mortality if they contract coronavirus disease 2019. Protective measures include social distancing and isolation, although implementation is challenging. Objectives To explore the real-life experiences of social distancing and isolation in care homes for older people, and to develop a toolkit of guidance and resources. Design A mixed-methods, phased design. Setting Six care homes in England caring for older adults. Participants Care home staff ( n = 31), residents ( n = 17), family members ( n = 17), senior health and care leaders ( n = 13). Methods A rapid review to assess the social distancing and isolation measures used by care homes to control the transmission of coronavirus disease 2019 and other infectious diseases (phase 1), in-depth case studies of six care homes, involving remote individual interviews with staff, residents and families, collection of policies, protocols and routinely collected care home data, remote focus groups with senior health and care leaders (phase 2) and stakeholder workshops to co-design the toolkit (phase 3). Interview and focus group data and care home documents were analysed using thematic analysis and care home data using descriptive statistics. Results The rapid review of 103 records demonstrated limited empirical evidence and the limited nature of policy documentation around social distancing and isolation measures in care homes. The case studies found that social distancing and isolation measures presented moral dilemmas for staff and often were difficult, and sometimes impossible to implement. Social distancing and isolation measures made care homes feel like an institution and denied residents, staff and families of physical touch and other forms of non-verbal communication. This was particularly important for residents with cognitive impairment. Care homes developed new visiting modalities to work around social distancing measures. Residents and families valued the work of care homes to keep residents safe and support remote communication. Social distancing, isolation and related restrictions negatively impacted on residents’ physical, psychological, social and cognitive well-being. There were feelings of powerlessness for families whose loved ones had moved into the care home during the pandemic. It was challenging for care homes to capture frequent updates in policy and guidance. Senior health and care leaders shared that the care home sector felt isolated from the National Health Service, communication from government was described as chaotic, and trauma was inflicted on care home staff, residents, families and friends. These multiple data sources have informed the co-design of a toolkit to care for residents, families, friends and care home staff. Limitations The review included papers published in English language only. The six care homes had a Care Quality Commission rating of either ‘good’ or ‘outstanding’. There was a lack of ethnic diversity in resident and family participants. Conclusions Care homes implemented innovative approaches to social distancing and isolation with varying degrees of success. A legacy of learning can help rebuild trust at multiple levels and address trauma-informed care for residents, families, friends and staff. Future work can include evaluation of the toolkit, research to develop a trauma-informed approach to caring for the care home sector and co-designing and evaluating an intervention to enable residents with different needs to transition to living well in a care home. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132541) and is published in full in Health and Social Care Delivery Research ; Vol. 12, No. 45. See the NIHR Funding and Awards website for further award information.

Joanne M Fitzpatrick

Anne Marie Rafferty

Shereen Hussein

Richard Adams

Lindsay Rees

Sally Brearley

Sarah Sims

Amit Desai

Ruth Harris

Challenges and guidance for implementing social distancing for COVID-19 in care homes: a mixed methods rapid review

COVID-19疫情期间在养老院实施社交距离的挑战与指导：一项混合方法快速综述

Publication Information	Publisher: NIHR Journals Library，Publishing cycle: ，Journal Type: journal，Open Access Journals: Yes
Basic data	Year of publication: 2022，Proportion of original research papers: ，Self Citation Rate:， Gold OA Rate:
Average review cycle	75 weeks

Health and Social Care Delivery Research

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Exploratory study from an end-of-life research partnership network to improve access for ethnically diverse communities in one region

Interpersonal counselling for adolescent depression delivered by youth mental health workers without core professional training: the ICALM feasibility RCT

Early mental health intervention and supported self-care for LGBTQ+ young people in the UK: a mixed-methods study

Pathways to specialist community perinatal mental health services: a two-site longitudinal retrospective service evaluation

Understanding and improving the quality of primary care for people in prison: a mixed-methods study

Exploratory study from an end-of-life research partnership network to improve access for ethnically diverse communities in one region

Interpersonal counselling for adolescent depression delivered by youth mental health workers without core professional training: the ICALM feasibility RCT

Understanding and improving the quality of primary care for people in prison: a mixed-methods study

Challenges and guidance for implementing social distancing for COVID-19 in care homes: a mixed methods rapid review

Pathways to specialist community perinatal mental health services: a two-site longitudinal retrospective service evaluation

ISSN	2755-0060, 2755-0079
h-index	3