8 results on '"Salway, S."'
Search Results
2. Adjusting a mainstream weight management intervention for people with intellectual disabilities: a user centred approach.
- Author
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Croot L, Rimmer M, Salway S, Hatton C, Dowse E, Lavin J, Bennett SE, Harris J, and O'Cathain A
- Subjects
- Adult, Feasibility Studies, Female, Focus Groups, Humans, Intellectual Disability complications, Obesity complications, Qualitative Research, Social Discrimination, Health Promotion methods, Health Services Accessibility statistics & numerical data, Intellectual Disability therapy, Obesity therapy
- Abstract
Background: People with intellectual disabilities (ID) may not be able to access and respond to uniformly delivered health interventions. Public bodies have a legal duty to make 'reasonable adjustments' to policies and practices to provide fair access and treatment for people with ID. This study aimed to identify adjustments to the Slimming World weight management programme to improve accessibility and assess acceptability and feasibility for this population., Methods: This user-centred qualitative study was carried out with a steering group of people with ID (n = 4). Barriers and facilitators to using Slimming World were identified through interviews and focus groups with people with ID (n = 54), carers (n = 12) current members with ID (n = 8) and Slimming World group leaders (n = 11). Adjustments were made and their feasibility and acceptability were explored in a before-and-after mixed methods study where people with ID attended Slimming World for eight weeks. Participants (n = 9), carers (n = 7) and Slimming World group leaders (n = 4) were interviewed to explore their experiences of the adjustments. Participants were weighed at baseline then each week., Results: Four key adjustments were identified and addressed by Slimming World who developed prototype Easy Read materials and a letter for carers. Six of the nine participants attended Slimming World for eight weeks and lost weight (1.4 kg to 6.6 kg, reduction in BMI between 0.5 and 1.7 kg/m2), indicating that the adjustments were feasible and acceptable. Two participants dropped out because they felt uncomfortable in a mainstream group and another left because they lacked control over food choice in their residential setting., Conclusions: This user-centred approach identified reasonable adjustments that were feasible to implement. In a small uncontrolled feasibility study, people with ID were positive about the adjustments and lost weight. However, issues in the wider context of people's lives, such as obesogenic environments and concerns about joining mainstream groups, limited the acceptability of Slimming World even with these adjustments. These findings have important implications for policy and suggest that environmental and organisational level interventions are needed alongside those targeting individual behaviour to tackle the obesogenic environment in which many people with ID spend their time, in order to reduce inequalities associated with the consequences of obesity.
- Published
- 2018
- Full Text
- View/download PDF
3. Determinants of uptake of hepatitis B testing and healthcare access by migrant Chinese in the England: a qualitative study.
- Author
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Lee ACK, Vedio A, Liu EZH, Horsley J, Jesurasa A, and Salway S
- Subjects
- Adolescent, Adult, Aged, Asian People statistics & numerical data, Communication Barriers, England, Female, Focus Groups, Hepatitis B diagnosis, Hepatitis B psychology, Humans, Male, Middle Aged, Qualitative Research, Social Stigma, Transients and Migrants statistics & numerical data, Young Adult, Asian People psychology, Health Services Accessibility, Hepatitis B ethnology, Mass Screening statistics & numerical data, Transients and Migrants psychology
- Abstract
Background: Global migration from hepatitis B endemic countries poses a significant public health challenge in receiving low-prevalence countries. In the UK, Chinese migrants are a high risk group for hepatitis B. However, they are an underserved population that infrequently accesses healthcare. This study sought to increase understanding of the determinants of hepatitis B testing and healthcare access among migrants of Chinese ethnicity living in England., Methods: We sought to obtain and integrate insights from different key stakeholders in the system. We conducted six focus group discussions and 20 in-depth interviews with community members and patients identifying themselves as 'Chinese', and interviewed 21 clinicians and nine health service commissioners. Data were thematically analysed and findings were corroborated through two validation workshops., Results: Three thematic categories emerged: knowledge and awareness, visibility of the disease, and health service issues. Low disease knowledge and awareness levels among community members contributed to erroneous personal risk perception and suboptimal engagement with services. Limited clinician knowledge led to missed opportunities to test and inaccurate assessments of infection risks in Chinese patients. There was little social discourse and considerable stigma linked to the disease among some sub-sections of the Chinese population. A lack of visibility of the issue and the population within the health system meant that these health needs were not prioritised by clinicians or commissioners. Service accessibility was also affected by the lack of language support. Greater use of community outreach, consultation aids, 'cultural competency' training, and locally adapted testing protocols may help., Conclusions: Hepatitis B among migrants of Chinese ethnicity in England can be characterised as an invisible disease in an invisible population. Multi-modal solutions are needed to tackle barriers within this population and the health system.
- Published
- 2017
- Full Text
- View/download PDF
4. Improving access to health care for chronic hepatitis B among migrant Chinese populations: A systematic mixed methods review of barriers and enablers.
- Author
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Vedio A, Liu EZH, Lee ACK, and Salway S
- Subjects
- Asian People, Health Knowledge, Attitudes, Practice, Humans, Patient Acceptance of Health Care, Social Stigma, Vaccination Coverage, Health Services Accessibility, Hepatitis B, Chronic diagnosis, Hepatitis B, Chronic drug therapy, Transients and Migrants
- Abstract
Migrant Chinese populations in Western countries have a high prevalence of chronic hepatitis B but often experience poor access to health care and late diagnosis. This systematic review aimed to identify obstacles and supports to timely and appropriate health service use among these populations. Systematic searches resulted in 48 relevant studies published between 1996 and 2015. Data extraction and synthesis were informed by models of healthcare access that highlight the interplay of patient, provider and health system factors. There was strong consistent evidence of low levels of knowledge among patients and community members; but interventions that were primarily focused on increasing knowledge had only modest positive effects on testing and/or vaccination. There was strong consistent evidence that Chinese migrants tend to misunderstand the need for health care for hepatitis B and have low satisfaction with services. Stigma was consistently associated with hepatitis B, and there was weak but consistent evidence of stigma acting as a barrier to care. However, available evidence on the effects of providing culturally appropriate services for hepatitis B on increasing uptake is limited. There was strong consistent evidence that health professionals miss opportunities for testing and vaccination. Practitioner education interventions may be important, but evidence of effectiveness is limited. A simple prompt in patient records for primary care physicians improved the uptake of testing, and a dedicated service increased targeted vaccination coverage for newborns. Further development and more rigorous evaluation of more holistic approaches that address patient, provider and system obstacles are needed., (© 2017 The Authors. Journal of Viral Hepatitis Published by John Wiley & Sons Ltd.)
- Published
- 2017
- Full Text
- View/download PDF
5. Addressing invisibility, inferiority, and powerlessness to achieve gains in maternal health for ultra-poor women.
- Author
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Mumtaz Z, Salway S, Bhatti A, and McIntyre L
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- Asia, Western, Delivery of Health Care methods, Female, Humans, Pregnancy, Social Class, Health Services Accessibility, Healthcare Disparities, Maternal Health Services, Maternal Welfare, Poverty, Power, Psychological, Social Stigma
- Published
- 2014
- Full Text
- View/download PDF
6. Improving maternal health in Pakistan: toward a deeper understanding of the social determinants of poor women's access to maternal health services.
- Author
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Mumtaz Z, Salway S, Bhatti A, Shanner L, Zaman S, Laing L, and Ellison GT
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- Female, Focus Groups, Health Services Accessibility standards, Humans, Interviews as Topic, Pakistan epidemiology, Poverty, Pregnancy, Qualitative Research, Quality Improvement, Social Class, Stereotyping, Health Services Accessibility organization & administration, Maternal Health Services supply & distribution, Maternal Welfare, Social Determinants of Health
- Abstract
Evidence suggests national- and community-level interventions are not reaching women living at the economic and social margins of society in Pakistan. We conducted a 10-month qualitative study (May 2010-February 2011) in a village in Punjab, Pakistan. Data were collected using 94 in-depth interviews, 11 focus group discussions, 134 observational sessions, and 5 maternal death case studies. Despite awareness of birth complications and treatment options, poverty and dependence on richer, higher-caste people for cash transfers or loans prevented women from accessing required care. There is a need to end the invisibility of low-caste groups in Pakistani health care policy. Technical improvements in maternal health care services should be supported to counter social and economic marginalization so progress can be made toward Millennium Development Goal 5 in Pakistan.
- Published
- 2014
- Full Text
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7. 'I never go anywhere': extricating the links between women's mobility and uptake of reproductive health services in Pakistan.
- Author
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Mumtaz Z and Salway S
- Subjects
- Adolescent, Adult, Age Factors, Contraception statistics & numerical data, Employment, Female, Humans, Marital Status, Middle Aged, Pakistan, Prenatal Care statistics & numerical data, Rural Population, Social Class, Health Services Accessibility, Personal Autonomy, Reproductive Health Services statistics & numerical data
- Abstract
An integrated analysis of large-scale survey data and detailed ethnography is presented to examine the patterns of women's mobility and their relationships with contraceptive and antenatal care use in Pakistan. Findings confirm that women's mobility is circumscribed but also illustrate the complex and contested nature of female movement. No direct relationship between a woman's unaccompanied mobility and her use of either contraception or antenatal care is found. In contrast, accompanied mobility does appear to play a role in the uptake of antenatal care, and is found to reflect the strength of a woman's social resources. Class and gender hierarchies interact to pattern women's experience. Poor women's higher unaccompanied mobility was associated with a loss of prestige and susceptibility to sexual violence. Among richer women, such movement did not constitute a legitimate target for male exploitation, nor did it lead to a loss of status on the part of their families. The findings caution against the use of western notions of 'freedom of movement' and associated quantitative indicators. At the same time, the wider impact of mobility restrictions on women's reproductive health is acknowledged and policy implications are identified.
- Published
- 2005
- Full Text
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8. Gender-based barriers to primary health care provision in Pakistan: the experience of female providers.
- Author
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Mumtaz Z, Salway S, Waseem M, and Umer N
- Subjects
- Employment, Family Characteristics, Family Planning Services organization & administration, Female, Hierarchy, Social, Humans, Male, Pakistan, Prejudice, Sex Factors, Workforce, Gender Identity, Health Services Accessibility organization & administration, Organizational Culture, Physicians, Women supply & distribution, Primary Health Care organization & administration, Women's Health Services organization & administration
- Abstract
In common with several countries in South Asia, the Pakistan government health system has introduced cadres of community-based female health and family planning workers as a response to gender-based constraints on women's access to services. However, the recruitment, training and retention of such female workers has been difficult. This finding points to the obvious but neglected fact that female health workers must operate within the same gender systems that necessitate their appointment in the first place. The present study used qualitative methods to increase our understanding of the experience of female staff working at the community level and in particular the gender-based constraints that they face. Important problems identified include: abusive hierarchical management structures; disrespect from male colleagues; lack of sensitivity to women's gender-based cultural constraints; conflict between domestic and work responsibilities; and poor infrastructural support. The findings highlight the interconnectedness of women's public and private lives and the interplay of class and gender hierarchies in the patterning of women's employment experiences. The study's conclusions suggest ways in which the organizational functioning of the government health services might be modified to better facilitate the work of female staff.
- Published
- 2003
- Full Text
- View/download PDF
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