Recent Submissions

  • Exploring children's physical activity behaviours according to location: A mixed-methods case study

    Khawaja, Irfan; Woodfield, Lorayne; Collins, Peter; Benkwitz, Adam; Nevill, Alan (MDPI AG, 2019-11-18)
    The school environment is ideally placed to facilitate physical activity (PA) with numerous windows of opportunity from break and lunch times, to lesson times and extracurricular clubs. However, little is known about how children interact with the school environment to engage in PA and the other locations they visit daily, including time spent outside of the school environment i.e., evening and weekend locations. Moreover, there has been little research incorporating a mixed-methods approach that captures children's voices alongside objectively tracking children's PA patterns. The aim of this study was to explore children's PA behaviours according to different locations. Sixty children (29 boys, 31 girls)-35 key stage 2 (aged 9-11) and 25 key stage 3 (aged 11-13)-wore an integrated global positioning systems (GPS) and heart rate (HR) monitor over four consecutive days. A subsample of children (n = 32) were invited to take part in one of six focus groups to further explore PA behaviours and identify barriers and facilitators to PA. Children also completed a PA diary. The KS2 children spent significantly more time outdoors than KS3 children (p = 0.009). Boys engaged in more light PA (LPA) when on foot and in school, compared with girls (p = 0.003). KS3 children engaged in significantly more moderate PA (MPA) at school than KS2 children (p = 0.006). Focus groups revealed fun, enjoyment, friends, and family to be associated with PA, and technology, costs, and weather to be barriers to PA. This mixed methodological study highlights differences in the PA patterns and perceptions of children according to age and gender. Future studies should utilize a multi-method approach to gain a greater insight into children's PA patterns and inform future health policies that differentiate among a range of demographic groups of children.
  • ‘There is anointing everywhere': An interpretative phenomenological analysis of the role of religion in the recovery of black African service users in England

    Tuffour, Isaac (Wiley, 2020-01-08)
    Introduction Religion is an important impetus for recovery. However, there has been little work examining the role of religion in recovery for black African service users (BASUs) in England. Aim The aim of this study is to explore how religion influences recovery from mental illness for BASUs in England. Method 12 black African service users were purposively selected and interviewed using face‐to‐face semi‐structured interviews. Data was analysed using interpretative phenomenological analysis (IPA). Results The study generates fascinating insights that BASUs views about mental illness and recovery are influenced by Pentecostalism and traditional African healing systems. Discussion The participants' perceptions of their mental illness experiences and recovery which are characterised by the pragmatism of Pentecostalism and cultural beliefs are consistent with what is reported in the literature. Implications for Practice The findings of the study show that broad changes are needed to accommodate the religious coping of BASUs in their recovery journey.
  • Afraid to leave the house: issues leading to social exclusion and loneliness for people with a learning disability

    Tilly, L (Emerald, 2019-09-26)
    © 2019, Emerald Publishing Limited. Purpose: Tackling social exclusion, which can lead to social isolation and loneliness, is an important current issue. People with a learning disability have a right to be full members of their communities, yet often experience social exclusion. Community connections play a key role in people developing reciprocal relationships. It is therefore important to know the barriers to full inclusion. The paper aims to discuss this issue. Design/methodology/approach: This paper builds on an inclusive research project exploring these issues (Mooney et al., 2019) and aims to place that study’s main findings in a broader academic, policy and practice context. Findings: Whilst there is a wide range of literature about social exclusion, lack of friendships and loneliness experienced by people with a learning disability, there is a gap in knowledge regarding some of the specific social barriers that prevent wider social inclusion, and therefore opportunities to make and keep friends. Originality/value: This paper relates the findings of an inclusive research project to the current literature. It identifies the social barriers that limit community involvement and draws on the experience of people with a learning disability to find possible ways forward.
  • Why does ethics matter in participatory health?

    Bond, Carol; DENECKE, Kerstin; LUQUE, Luis Fernandez; GABARRON, Elia; LOPEZ-CAMPOS, Guillermo (European Federation of Medical Informatics, 2020-04-28)
    Social media and participatory health has emerged as a promising tool for health, including developing diagnostic tools and therapeutic interventions. In the realm of online health care delivery, artificial intelligence based counseling apps now enable patients to consult with a chatbot instead of an actual therapist. However, several ethical issues and implications became relevant with this shift to digital interventions and healthcare delivery. This panel will describe ethical issues related to recent developments in participatory health and social media including the digital exposome, importance of involving patients in the design of AI-based applications and ethics of social media research in healthcare.
  • Does psychological functioning mediate the relationship between bullying involvement and weight loss preoccupation in adolescents? A two-stage cross-sectional study

    Lee, Kirsty; Guy, Alexa; Dale, Jeremy; Wolke, Dieter (Springer Science and Business Media LLC, 2017-03-24)
    Background Adolescent bullying is associated with a range of adversities for those who are bullied i.e., victims and bully-victims (e.g., those who bully others and get victimised), including reduced psychological functioning and eating disorder symptoms. Bullies are generally well-adjusted psychologically, but previous research suggests that bullies may also engage in problematic diet behaviours. This study investigates a) whether adolescents involved in bullying (bullies, victims, bully-victims) are at increased risk of weight loss preoccupation, b) whether psychological functioning mediates this relationship and c) whether sex is a key moderator. Method A two-stage design was used. In stage 1, adolescents (n = 2782) from five UK secondary schools were screened for bullying involvement using self and peer reports. In stage 2, a sample of bullies, victims, bully-victims and uninvolved adolescents (n = 767) completed a battery of assessments. The measures included the eating behaviours component of the Child and Adolescent Psychiatric Assessment, which was reduced to one factor (weight loss preoccupation) and used as the outcome variable. Measures of self-esteem, body-esteem and emotional problems were reduced to a latent (mediator) variable of psychological functioning. Multi-group analysis examined the effects of sex and all models were adjusted for covariates (BMI, pubertal stage, age, parental education and ethnicity). Results Bullies, victims and bully-victims were at increased risk of weight loss preoccupation compared to adolescents uninvolved in bullying. The mechanism by which bullying involvement related to increased weight loss preoccupation varied by bullying role: in bullies the effect was direct, in victims the effect was indirect (via reduced psychological functioning) and in bully-victims the effect was both direct and indirect. Sex significantly moderated the relationship in bullies: weight loss preoccupation was only statistically significant in bullies who were boys. Conclusion Bullying involvement during adolescence is associated with weight loss preoccupation. Bullies are likely driven by a desire to increase attractiveness and social status; whereas weight loss preoccupation in bullied adolescents may have maladaptive influences on diet and exercise behaviours due to its association with reduced psychological functioning. Future research should consider peer victimisation as a potential modifiable risk factor for reduced psychological functioning and weight loss preoccupation, which if targeted, may help to prevent maladaptive diet and exercise behaviours.
  • Bullying and negative appearance feedback among adolescents: Is it objective or misperceived weight that matters?

    Lee, Kirsty; Dale, Jeremy; Guy, Alexa; Wolke, Dieter (Elsevier BV, 2017-12-28)
    This study investigated (1) whether involvement in bullying as a bully, victim or bully-victim was associated with objectively measured overweight or underweight, or whether it was related to weight misperception (i.e., inaccurate perceptions), and (2) whether appearance-specific feedback mediated the relationship between bullying and weight misperception. In Stage 1, 2782 adolescents aged 11–16 years from British secondary schools were screened for peer bullying and victimisation. In Stage 2, 411 adolescents with weight and height data (objective n = 319, self-report n = 92) also self-reported on their weight perception and appearance-specific feedback. Neither bullying nor victimisation were related to objective underweight or overweight. Victims were at increased odds of overweight misperception, while bully-victims were at increased odds of underweight misperception. Additionally, there was an indirect effect of appearance feedback on overweight misperception in bully-victims. Both victims and bully-victims are at increased risk of weight misperception, posing further detrimental effects to their health and wellbeing.
  • Adolescent desire for cosmetic surgery

    Lee, Kirsty; Guy, Alexa; Dale, Jeremy; Wolke, Dieter (Ovid Technologies (Wolters Kluwer Health), 2017-05-31)
    Background: Adolescent bullying may be a key driver of interest in cosmetic surgery. This study examined the extent of such interest and whether any effect was sex-specific, and examined psychological functioning as a potential mechanism through which bullying involvement may lead to a wish for cosmetic surgery. Methods: A two-stage design was used. In the first stage, 2782 adolescents (aged 11 to 16 years) were screened for bullying involvement using self-reports and peer nominations. In the second stage, 752 adolescents who were bullies, victims, bully-victims, or uninvolved in bullying reported their desire for cosmetic surgery. Psychological functioning was constructed as a composite of self-esteem and emotional problems (assessed at stage 1) and body-esteem scores (assessed at stage 2). Results: Adolescents involved in bullying in any role were significantly more interested in cosmetic surgery than uninvolved adolescents. Desire for cosmetic surgery was greatest in adolescents who were bullied (victims and bully-victims) and girls. Desire for cosmetic surgery was highest in girls, but sex did not interact with bullying role. Being victimized by peers resulted in poor psychological functioning, which increased desire for cosmetic surgery. In contrast, desire for cosmetic surgery in bullies was not related to psychological functioning, which was in the normal range. Conclusions: Bullying victimization is related to poor psychological functioning, and both are related to a greater desire for cosmetic surgery in adolescents. Cosmetic surgeons should screen candidates for psychological vulnerability and may want to include a short screening questionnaire for a history of peer victimization.
  • Cyberbullying: a storm in a teacup?

    Wolke, Dieter; Lee, Kirsty; Guy, Alexa (Springer Science and Business Media LLC, 2017-02-10)
    Cyberbullying has been portrayed as a rising ‘epidemic’ amongst children and adolescents. But does it create many new victims beyond those already bullied with traditional means (physical, relational)? Our aim was to determine whether cyberbullying creates uniquely new victims, and whether it has similar impact upon psychological and behavioral outcomes for adolescents, beyond those experienced by traditional victims. This study assessed 2745 pupils, aged 11–16, from UK secondary schools. Pupils completed an electronic survey that measured bullying involvement, self-esteem and behavioral problems. Twenty-nine percent reported being bullied but only 1% of adolescents were pure cyber-victims (i.e., not also bullied traditionally). Compared to direct or relational victims, cyber-victimization had similar negative effects on behavior (z = −0.41) and self-esteem (z = −0.22) compared to those not involved in bullying. However, those bullied by multiple means (poly-victims) had the most difficulties with behavior (z = −0.94) and lowest self-esteem (z = −0.78). Cyberbullying creates few new victims, but is mainly a new tool to harm victims already bullied by traditional means. Cyberbullying extends the reach of bullying beyond the school gate. Intervention strategies against cyberbullying may need to include approaches against traditional bullying and its root causes to be successful.
  • Differences in the early stages of social information processing for adolescents involved in bullying

    Guy, Alexa; Lee, Kirsty; Wolke, Dieter (Wiley, 2017-06-07)
    Bullying victimization has commonly been associated with deficiencies in social information processing (SIP). In contrast, findings regarding bullying perpetration are mixed, with some researchers claiming that bullies may have superior SIP abilities than victimized or uninvolved youth. This study investigated the effects of bullying and victimization on early SIP; specifically the recognition and interpretation of social information. In stage 1, 2,782 adolescents (11–16 years) were screened for bullying involvement, and in stage 2, 723 of these participants (mean age = 13.95) were assessed on measures of emotion recognition, hostile attribution bias, and characterological self‐blame (CSB). No associations between bullying and early SIP were found. In contrast, victimization was associated with more hostile attribution bias and CSB attributions. Girls performed better than boys on the emotion recognition task while boys showed greater hostile attribution biases. No interaction effects of bullying or victimization with gender were found. Follow‐up categorical analyses that considered pure victims versus victims who also bullied (bully‐victims) on SIP, found a similar pattern of findings. These findings suggest that those who purely bully others are neither superior nor deficient in the early stages of SIP. Victimized adolescents, however, show biases in their interpretations of social situations and the intentions of others. These biases may lead to maladaptive responses and may increase risk for further victimization by peers.
  • Comparisons between adolescent bullies, victims, and bully-victims on perceived popularity, social impact, and social preference

    Guy, Alexa; Lee, Kirsty; Wolke, Dieter (Frontiers Media SA, 2019-11-22)
    This study investigated the effect of bullying role, i.e., bully, victim, and bully-victim, on three measures of peer status; perceived popularity, social preference, and social impact. In addition to completing peer nominations for these measures of peer status, adolescents (n = 2,721) aged 11 to 16 years from 5 secondary schools completed an online survey that assessed bullying involvement (self- and peer-reported), self-esteem, and behavioral difficulties. Compared to uninvolved adolescents, all bullying roles had a greater social impact. Bullies scored higher than all other roles for perceived popularity, whereas victims and bully-victims were the lowest in social preference. These significant group comparisons remained when controlling for demographic variables, behavioral difficulties, self-esteem and prosocial behavior. Overall, the perceived popularity found for bullies suggests that these adolescents are socially rewarded by peers for their victimization of others. These findings highlight the need to address the whole peer system in raising the social status of those who are victimized, whilst reducing the rewards received by bullies for their behavior.
  • The effects of physical activity or sport-based interventions on psychological factors in adults with intellectual disabilities: a systematic review

    Bondár, RZ; di Fronso, S; Bortoli, L; Robazza, C; Metsios, GS; Bertollo, M (Wiley, 2019-12-12)
    © 2019 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd Background: Inactivity is a major factor contributing to adverse health in people with intellectual disabilities (IDs). While it is generally agreed that physical activity (PA)/sport-based interventions promote cognitive and social development in the general population, little is known about their specific benefits in adults with ID. The aims of this systematic review were (a) to examine the effects of PA/sport-based interventions on intention, motivation and attitude regarding PA/sport participation in adults with ID and (b) to investigate the influence of these psychological factors on behavioural change (e.g. PA level) and quality of life. Methods: A systematic review has been conducted searching four electronic databases (i.e. SCOPUS, Web of Science, PubMed and Cochrane Library). Studies were included if written in English, peer reviewed, had primary research data, and measured intention, motivation, attitude, behavioural outcomes or quality of life. Results: Thirteen articles met our inclusion criteria of which 10 explored the effects of PA/sport as part of a multi-component intervention. Most investigated outcomes were exercise self-efficacy and quality of life. Five studies measured exercise self-efficacy, and four of them found significant changes. One study found a significant improvement in quality of life and another study in life satisfaction. We observed lack of sport-based interventions, few data about people with severe ID and limited psychological measures. Conclusions: Personal and environmental factors are key components of behavioural change. Support of caregivers and individualised instructions may benefit exercise self-efficacy. There is lack of information about the effects of psychological factors on behavioural change and quality of life in adults with ID.
  • Introduction to the second special edition of upfront and onside

    Williams, J (Informa UK Limited, 2019-11-10)
    While the first special edition dedicated to women’s football came out at the beginning of the Women’s World Cup 2019 tournament, held in France, this second edition is released as the legacy of that tournament is being debated. FIFA is a janus-faced institution. It both governs and develops world soccer. Many analysts think that the governance and developmental roles should be separated because the organisaton has proven that it lacks transparency, an ethical code and progressive policies. FIFA is also a central command economic regulator – it has a monopoly on international tournament soccer from girl scouts to the world cup, and it makes its own rules. But since the 1980s it has increasingly neglected development in favour of a governance strategy that commercializes its assets for maximum financial benefits.
  • The effects of exercise on cardiovascular disease risk factors and cardiovascular physiology in rheumatoid arthritis

    Metsios, GS; Moe, RH; van der Esch, M; van Zanten, JJCSV; Fenton, SAM; Koutedakis, Y; Vitalis, P; Kennedy, N; Brodin, N; Bostrom, C; et al. (Springer Science and Business Media LLC, 2019-12-04)
    © 2019, Springer-Verlag GmbH Germany, part of Springer Nature. Cardiovascular disease (CVD) morbidity and mortality is highly prevalent in patients with rheumatoid arthritis (RA) with debilitating effects for the individual as well as significant healthcare impact. Current evidence demonstrates that engaging in aerobic and resistance exercise (i.e. structured physical activity) can significantly improve patient-reported and clinical index-assessed outcomes in RA. In addition to this, engagement in exercise programmes improves, in a dose-dependent manner, the risk of developing CVD as well as CVD symptoms and outcomes. The present narrative review uses evidence from systematic reviews and meta-analyses as well as controlled trials, to synthesize the current state-of-the-art on the potential effects of aerobic and resistance exercise on CVD risk factors as well as on cardiac and vascular function and structure in people with RA. Where there is a lack of evidence in RA to explain potential mechanisms, relevant studies from the general population are also discussed and linked to RA.
  • Getting involved in the community—What stops us? Findings from an inclusive research project

    Mooney, F; Rafique, N; Tilly, L (Wiley, 2019-07-08)
    © 2019 John Wiley & Sons Ltd Feeling alone and not connected to other people where you live affects many people and especially people with a learning disability. The government and the newspapers are talking a lot about this, they want to understand who is affected and what can be done. Our group did a research project to find out some of the things that stop us getting involved in local places with local people where we can make and keep friends. The people in the research project mainly lived independently and did not use learning disability services, so needed to use local community organisations. Pictorial cards, made by one of the group members, using photographs were used to sort out all the things we talked about into groups. These included transport, fear and anxiety, limits on our choice and control, risks and personal safety. We then talked about what could be done, this included more easy read information, so people know what is available locally, more support to go to places and advocacy to get involved. There also needs to be better community safety including more Safe Places in the community. Abstract: Background Social isolation is an issue that affects many people and especially people with a learning disability. There is an association between social exclusion and feeling lonely, an issue currently highlighted as a growing concern which needs to be addressed both in the media and by the government. Methods The Building Bridges Research Group do inclusive research projects about the issues that are important to them. Over the summer of 2018, the research group undertook an inclusive research project to identify some of the specific barriers that prevent community inclusion and the opportunity to develop friends. The people involved mainly lived independently and did not use learning disability services, with the exception of evening clubs, so needed to use universal services. Results Pictorial cards, made by one of the group, using photographs were used to organise the data into themes. These included transport, fear and anxiety, limits on choice and control, risks and personal safety. Conclusion The inclusive research design enabled people with a learning disability to contribute to all stages of the research project, from identifying the issue, gathering data, the analysis and writing up. They also made suggestions of ways to increase social networks, friendships and well-being and so decrease loneliness. These include more access to easy read information, more support and advocacy and measures to address community safety including a wider roll-out of the Safe Places scheme. There also needs to be further research undertaken with other people with a learning disability in different areas to widen the understanding of the impact of these barriers on people's lives.
  • The relationship between vitamin D levels, injury and muscle function in adolescent dancers

    de Rezende Araújo, Iris Iasmine; Sampaio, Lucas Henrique Ferreira; Bittar, Adriano Jabur; da Silva Hamu, Tânia Cristina Dias; Wyon, Matthew; Formiga, Cibelle Kayenne Martins Roberto (Thieme, 2020-03-31)
    Vitamin D has been shown to benefit a diverse range of health functions including muscle function. The aim of the present study was to identify serum 25(OH)D3 levels in a sample of adolescent dancers and compare them to muscle function and injury incidence. We incorporated a cross-sectional design to study 49 pre-professional male and female dancers (17±4.44yrs, 52.1±6.72kg, 1.63±0.07m) in full-time training in Brazil. Serum 25[OH]D3 was analyzed by Enzyme-linked Immunosorbent Assay; quadriceps and hamstring peak torque and muscle fatigue were measured by isokinetic dynamometer at 60 and 300° s-1. Injury type and location in the previous 6- months were determined by self-report questionnaire. Participants were categorized into 2 groups: normal or insufficient/deficient (>or<30 ng/ml 25[OH]D3). Results indicated the normal serum 25[OH]D3 group had significantly lower fatigue rates than the insufficient/deficient group (p<0.05) but not for the other muscle function parameters. Fifty-seven percent of participants reported at least 1 injury. The most common were sprains (33%) and tendinopathies (19%). Injured dancers had significantly lower peak torque at 60°/s. The link between serum 25[OH]D3 and reduced muscle fatigue resistance has not been shown before, though the underlying mechanisms aren’t apparent and the link between muscular strength and injury has been previously evidenced.
  • The visual non-verbal memory trace is fragile when actively maintained but endures passively for tens of seconds

    McKeown, Denis; Mercer, Thomas; Bugajska, Kinga; Duffy, Paul; Barker, Emma (Springer Nature, 2019-12-23)
    Despite attempts at active maintenance in the focus of attention, the rather fragile nature of the visual non-verbal memory trace may be revealed when the retention interval between target memoranda and probed recall on a trial is extended. In contrast, a passively maintained, or unattended visual memory trace may be revealed as persisting proactive interference extending across quite extended intervals between trials in a recent probes task. The present study, comprising five experiments, used this task to explore the persistence of such a passive visual memory trace over time. Participants viewed some target visual items (for example, abstract colored patterns) followed by a variable retention interval and a probe item. The task was to report whether the probe matched one of the targets or not. A decaying active memory trace was indicated by poorer performance as the memory retention interval was extended on a trial. However, when the probe was a member of the target set from the preceding trial, task performance was poorer than a comparison novel probe, demonstrating proactive interference. Manipulations of the inter-trial interval revealed that the temporal persistence of the passive memory trace of an old target was impressive, and proactive interference was largely resilient to a simple ‘cued forgetting’ manipulation. These data support the proposed two-process memory conception (active-passive memory) contrasting fragile active memory traces decaying over a few seconds with robust passive traces extending to tens of seconds.
  • Workload intensity and rest periods in professional ballet: Connotations for injury

    Kozai, Andrea; Twitchett, Emily; Morgan, Sian; Wyon, Matthew (Thieme, 2020-03-31)
    Fatigue and overwork have been cited as the main cause of injury with the dance profession. Previous research has shown a difference in workload between professional dancers of different rank, but the role of sex has not been examined. The purpose of this study was to determine workload intensity, rest, and sleep profiles of professional ballet dancers. 48 professional ballet dancers (M=25, F=23) took part in an observational design over 7-14 days using triaxial accelerometer devices. Minutes in METS at different intensities, total time asleep and rest breaks were analysed. Significant main effects for rank (p<0.001) and rank by sex (p=0.003) for total PA, working day activity, post work activity and sleep. Sleep ranged between 2.4-9.6 hours per night. All participants spent more time between 1.5-3 METS outside of work. Significant amounts of exercise where carried out outside of their work day, therefore when injury is reported per 1000 hours dance activity, this extra-curricular activity might need to be included. When looking at potential causes of injury in dance, a global perspective of physical activity is required that includes activity outside of work and sleep patterns, all activities that influence physiological recovery.
  • Weight-management in children living with asthma: a qualitative study of the experiences of paediatric healthcare professionals

    Clarke, R; Heath, G; Pattison, H; Farrow, C; Department of Psychology, Aston University , Birmingham , UK. (Taylor & Francis, 2018-11-16)
    © 2018, © 2018 Taylor & Francis Group, LLC. Objective: Weight loss has been found to improve the symptoms of asthma in children who are overweight. However, many paediatric weight management programmes do not address the challenges associated with living with asthma. The aim of this study was to explore the views and experiences of paediatric healthcare professionals concerning weight management advice and support offered to families of children living with asthma. Methods: In-depth individual interviews with 10 healthcare professionals who work with a paediatric asthma population (n = 4 Respiratory Consultants, 3 Respiratory Nurses, 3 General Paediatricians). Data were analysed using a Framework approach. Results: Healthcare professionals highlighted that families’ perceptions of weight, their approach to physical activity and nutrition, the family’s social context and perceptions of asthma and asthma treatment all influence weight management in children living with asthma. Initiating weight management conversations and referring to weight management support were perceived as challenging. It was thought that tailoring weight management to the needs of children living with asthma and locating support within the community were important to the success of a family-centred intervention. Conclusions: The results highlight the added complexity of responding to excessive weight in a paediatric population with asthma. Training and referral guidance for healthcare professionals may help overcome weight management support challenges. Addressing family beliefs about the factors influencing paediatric asthma and exploring families’ motivations for behaviour change may enhance engagement with weight management.
  • Perceptions and experiences of the implementation, management, use and optimisation of electronic prescribing systems in hospital settings: Protocol for a systematic review of qualitative studies

    Farre, A; Bem, D; Heath, G; Shaw, K; Cummins, C; Institute of Applied Health Research, University of Birmingham, Birmingham, UK Research and Development, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK. (BMJ, 2016-07-08)
    © 2016 Published by the BMJ Publishing Group Limited. For permission to use. Introduction: There is increasing evidence that electronic prescribing (ePrescribing) or computerised provider/physician order entry (CPOE) systems can improve the quality and safety of healthcare services. However, it has also become clear that their implementation is not straightforward and may create unintended or undesired consequences once in use. In this context, qualitative approaches have been particularly useful and their interpretative synthesis could make an important and timely contribution to the field. This review will aim to identify, appraise and synthesise qualitative studies on ePrescribing/CPOE in hospital settings, with or without clinical decision support. Methods and analysis: Data sources will include the following bibliographic databases: MEDLINE, MEDLINE In Process, EMBASE, PsycINFO, Social Policy and Practice via Ovid, CINAHL via EBSCO, The Cochrane Library (CDSR, DARE and CENTRAL databases), Nursing and Allied Health Sources, Applied Social Sciences Index and Abstracts via ProQuest and SCOPUS. In addition, other sources will be searched for ongoing studies ( and grey literature: Healthcare Management Information Consortium, Conference Proceedings Citation Index (Web of Science) and Sociological abstracts. Studies will be independently screened for eligibility by 2 reviewers. Qualitative studies, either standalone or in the context of mixed-methods designs, reporting the perspectives of any actors involved in the implementation, management and use of ePrescribing/CPOE systems in hospital-based care settings will be included. Data extraction will be conducted by 2 reviewers using a piloted form. Quality appraisal will be based on criteria from the Critical Appraisal Skills Programme checklist and Standards for Reporting Qualitative Research. Studies will not be excluded based on quality assessment. A postsynthesis sensitivity analysis will be undertaken. Data analysis will follow the thematic synthesis method. Ethics and dissemination: The study does not require ethical approval as primary data will not be collected. The results of the study will be published in a peer-reviewed journal and presented at relevant conferences.
  • How do stakeholders experience the adoption of electronic prescribing systems in hospitals? A systematic review and thematic synthesis of qualitative studies

    Farre, Albert; Heath, Gemma; Shaw, Karen; Bem, Danai; Cummins, Carole; School of Nursing and Health Sciences, University of Dundee, Dundee, UK. (BMJ, 2019-07-29)
    BACKGROUND:Electronic prescribing (ePrescribing) or computerised provider/physician order entry (CPOE) systems can improve the quality and safety of health services, but the translation of this into reduced harm for patients remains unclear. This review aimed to synthesise primary qualitative research relating to how stakeholders experience the adoption of ePrescribing/CPOE systems in hospitals, to help better understand why and how healthcare organisations have not yet realised the full potential of such systems and to inform future implementations and research. METHODS:We systematically searched 10 bibliographic databases and additional sources for citation searching and grey literature, with no restriction on date or publication language. Qualitative studies exploring the perspectives/experiences of stakeholders with the implementation, management, use and/or optimisation of ePrescribing/CPOE systems in hospitals were included. Quality assessment combined criteria from the Critical Appraisal Skills Programme Qualitative Checklist and the Standards for Reporting Qualitative Research guidelines. Data were synthesised thematically. RESULTS:79 articles were included. Stakeholders' perspectives reflected a mixed set of positive and negative implications of engaging in ePrescribing/CPOE as part of their work. These were underpinned by further-reaching change processes. Impacts reported were largely practice related rather than at the organisational level. Factors affecting the implementation process and actions undertaken prior to implementation were perceived as important in understanding ePrescribing/CPOE adoption and impact. CONCLUSIONS:Implementing organisations and teams should consider the breadth and depth of changes that ePrescribing/CPOE adoption can trigger rather than focus on discrete benefits/problems and favour implementation strategies that: consider the preimplementation context, are responsive to (and transparent about) organisational and stakeholder needs and agendas and which can be sustained effectively over time as implementations develop and gradually transition to routine use and system optimisation.

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