Shahid Islam, Neil Small, Maria Bryant, Tiffany Yang, Anna Cronin de Chavez, Fiona Saville and Josie Dickerson
Participation in community programmes by the Roma community is low, whilst this community presents with high risk of poor health and low levels of wellbeing. To improve rates of…
Abstract
Purpose
Participation in community programmes by the Roma community is low, whilst this community presents with high risk of poor health and low levels of wellbeing. To improve rates of participation in programmes, compatibility must be achieved between implementation efforts and levels of readiness in the community. The Community Readiness Model (CRM) is a widely used toolkit which provides an indication of how prepared and willing a community is to take action on specific issues. The purpose of this paper is to present findings from a CRM assessment for the Eastern European Roma community in Bradford, UK, on issues related to nutrition and obesity.
Design/methodology/approach
The authors interviewed key respondents identified as knowledgeable about the Roma community using the CRM. This approach applies a mixed methodology incorporating readiness scores and qualitative data. A mean community readiness score was calculated enabling researchers to place the community in one of nine possible stages of readiness. Interview transcripts were analysed using a qualitative framework analysis to generate the contextual information.
Findings
An overall score consistent with vague awareness was achieved, which indicates a low level of community readiness. This score suggests that there will be a low likelihood of participation in currently available nutrition and obesity programmes.
Originality/value
To our knowledge, this is the first study to apply the CRM in the Roma community for any issue. The authors present the findings for each of the six dimensions that make up the CRM together with salient qualitative findings.
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Maddy Power, Neil Small, Bob Doherty and Kate E. Pickett
Foodbank use in the UK is rising but, despite high levels of poverty, Pakistani women are less likely to use food banks than white British women. The purpose of this paper is to…
Abstract
Purpose
Foodbank use in the UK is rising but, despite high levels of poverty, Pakistani women are less likely to use food banks than white British women. The purpose of this paper is to understand the lived experience of food in the context of poverty amongst Pakistani and white British women in Bradford, including perspectives on food aid.
Design/methodology/approach
A total of 16 Pakistani and white British women, recruited through community initiatives, participated in three focus groups (one interview was also held as a consequence of recruitment difficulties). Each group met for two hours aided by a moderator and professional interpreter. The transcripts were analysed thematically using a three-stage process.
Findings
Women in low-income households employed dual strategies to reconcile caring responsibilities and financial obligations: the first sought to make ends meet within household income; the second looked to outside sources of support. There was a reported near absence of food insecurity amongst Pakistani women which could be attributed to support from social/familial networks, resource management within the household, and cultural and religious frameworks. A minority of participants and no Pakistani respondents accessed charitable food aid. There were three reasons for the non-use of food aid: it was not required because of resource management strategies within the household and assistance from familial/social networks; it was avoided out of shame; and knowledge about its existence was poor.
Originality/value
This case study is the first examination of varying experiences of food insecurity amongst UK white British and Pakistani women. Whilst the sample size is small, it presents new evidence on perceptions of food insecurity amongst Pakistani households and on why households of varying ethnicities do not use food aid.
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In 1996 and 1997 authoritative reports identified the absence of a research culture in primary care. This article reviews progress since then in the context of the wider…
Abstract
In 1996 and 1997 authoritative reports identified the absence of a research culture in primary care. This article reviews progress since then in the context of the wider development of evidence based medicine. The article considers critiques of the meaning of evidence and focuses on both service delivery and policy. An argument is made that “knowledge”, “not evidence”, offers a better basis for primary care practice.
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Merryn Gott, Tony Stevens, Neil Small and Sam Hjelmeland Ahmedzai
Facilitating user involvement is regarded as a significant factor in advancing the overall quality of health care provision. The wish to develop user involvement is present in…
Abstract
Facilitating user involvement is regarded as a significant factor in advancing the overall quality of health care provision. The wish to develop user involvement is present in White Papers, government reports and policy guidance. The reform of cancer services consequent on the implementation of the Calman Hine Report creates opportunities for meaningful user involvement in cancer care. Draws on research conducted in the Trent Region of the NHS and examines how far user groups have been involved, which groups may be excluded and what remains to be done to elevate user views in planning and evaluation of cancer services. Many commissioners and providers of health care are currently establishing the infrastructure to encourage the development of user involvement. Suggests the experience in relation to cancer can offer a model for others.
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Matthew J. Walsh and Neil Small
The experience of implementing clinical governance in Bradford South and West Primary Care Group illustrates how an emphasis on cultural change rather than on target setting…
Abstract
The experience of implementing clinical governance in Bradford South and West Primary Care Group illustrates how an emphasis on cultural change rather than on target setting, scrutiny and enforcement is both more consistent with the primary care context and more likely to create lasting improvements. The emerging focus on governance is reviewed and its implementation in one PCG via baseline assessment, strategic planning and innovative practice is presented. Linking clinical governance with a reduction in medical autonomy, as some commentators have done, does not allow for the complexity of power and responsibility characteristic of primary care. Alternative analytic models that draw on organizational theory and on sociology are offered.
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Madeleine Power, Neil Small, Bob Doherty, Barbara Stewart-Knox and Kate E. Pickett
This paper uses data from a city with a multi-ethnic, multi-faith population to better understand faith-based food aid. The paper aims to understand what constitutes faith-based…
Abstract
Purpose
This paper uses data from a city with a multi-ethnic, multi-faith population to better understand faith-based food aid. The paper aims to understand what constitutes faith-based responses to food insecurity, compare the prevalence and nature of faith-based food aid across different religions and explore how community food aid meets the needs of a multi-ethnic, multi-faith population.
Design/methodology/approach
The study involved two phases of primary research. In Phase 1, desk-based research and dialogue with stakeholders in local food security programmes were used to identify faith-based responses to food insecurity. Phase 2 consisted of 18 semi-structured interviews involving faith-based and secular charitable food aid organizations.
Findings
The paper illustrates the internal heterogeneity of faith-based food aid. Faith-based food aid is highly prevalent and the vast majority is Christian. Doctrine is a key motivation among Christian organizations for their provision of food. The fact that the clients at faith-based, particularly Christian, food aid did not reflect the local religious demographic is a cause for concern in light of the entry-barriers identified. This concern is heightened by the co-option of faith-based organizations by the state as part of the “Big Society” agenda.
Originality/value
This is the first academic study in the UK to look at the faith-based arrangements of Christian and Muslim food aid providers, to set out what it means to provide faith-based food aid in the UK and to explore how faith-based food aid interacts with people of other religions and no religion.
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Zeynep Aksehirli, Yakov Bart, Kwong Chan and Koen Pauwels
In the context of changes in the priority given to ensuring that health care is evidence‐based, and that service quality should be maximised, there is a new emphasis on quality…
Abstract
Purpose
In the context of changes in the priority given to ensuring that health care is evidence‐based, and that service quality should be maximised, there is a new emphasis on quality improvement programmes in the UK National Health Service (NHS). It is not clear how far these programmes can be categorised using the paradigms of research and audit. Making a distinction between what constitutes audit, quality improvement and research is important in the context of enhanced clinical and research governance requirements and in an environment of both sensitivity in relation to the ethics of research and concern about the efficacy of ethics committees. This study aims to address this issue.
Design/methodology/approach
This article reviews the literature on how quality improvement differs from audit and research. It considers different ways of considering ethics in research and questions how far one can rely on professional judgement as an alternative to formal ethics committee procedures. The factors that characterise different sorts of activity are reworked to enable a template to be devised. The template, presented in the form of a flow‐chart, enables health care workers to better categorise a variety of activities and highlights the necessary procedural requirements that follow.
Findings
Key factors are identified in the existing literature that help differentiate between quality improvement, audit and research. These factors range from intent in undertaking the activity, through sample/site selection, choice of methodology, analysis, patterns and speed of dissemination.
Originality/value
If quality improvement is to continue to be a central theme in the NHS agenda, it is important that both the Central Office for Ethical Review and NHS organisations review the categorisation system to include quality improvement in their clinical effectiveness structures.
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Neil Small and Russell Mannion
Mainstream health economics labours under a misleading understanding of the nature of the topic area and suffers from a concomitant poverty of thinking about theory and method…
Abstract
Purpose
Mainstream health economics labours under a misleading understanding of the nature of the topic area and suffers from a concomitant poverty of thinking about theory and method. The purpose here is to explore this critical position and argue that health economics should aspire to being more than a technical discipline. It can, and should, engage with transformative discourse.
Design/methodology/approach
It is argued that the hermeneutic sciences, emphasising interpretation not instrumentality or domination, offer a route into the change to which one seeks to contribute. The article specifically focuses on the way Habermas provides insights in his approach to knowledge, reason and political economy. How he emphasises complexity and interaction within cultural milieu is explored and primacy is given to preserving the life‐world against the encroachments of a narrow rationalization.
Findings
The argument for a critical re‐imagining of health economics is presented in three stages. First, the antecedents, current assumptions and critical voices from contemporary economics and health economics are reviewed. Second, the way in which health is best understood via engaging with the complexity of both the subject itself and the society and culture within which it is embedded is explored. Third, the contribution that hermeneutics, and Habermas's critical theory, could make to a new health economics is examined.
Originality/value
The paper offers a radical alternative to health economics. It explores the shortcomings of current thinking and argues an optimistic position. Progress via reason is possible if one reframes both in the direction of communication and in the appreciation of reflexivity and communality. This is a position that resonates with many who challenge prevailing paradigms, in economics and elsewhere.