Condom machines in hospitals: do we practice what we preach?
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Condoms↗
Biomedical subjects
R T McEwan
Publications and source records attributed to R T McEwan.
A review of the costs and effectiveness of assessing the elderly in general practice.
The 1990 contract for general practitioners made annual health checks for people aged 75 and over compulsory. We review the costs and effects of different approaches to the health check, focusing on the method advised in the 1990 contract. This involves an annual home-based functional assessment by a member of the primary health care team, known as a blanket assessment. Our review of published randomized controlled trials shows such assessments have few consistent benefits. Data on the costs of assessment are usually reported in summary form, with little or no information on which costs are included. In studies where average costs are given for assessments, because of salary and travel expenses, the costs are high. Several promising methods for reducing costs in assessment, and a method with potential to improve effectiveness, are currently outside the terms of the 1990 contract. These methods are described. Revision of the 1990 contract should incorporate the flexibility to encourage more cost-effective approaches to assessing the elderly such as a two-stage assessment or using volunteers. A monitoring group is needed to establish how health checks are being implemented. This group could co-ordinate and advise on standardized criteria for methods of costing and assessing effectiveness in assessment programmes.
Aged↗
Perceptions about blood donation, transfusion and the risk of HIV infection: implications for the blood transfusion service.
To assess perceptions of risk of AIDS/HIV infection from donation to, and receipt of, blood from the British Blood Transfusion Service, we undertook self completion surveys (n = 1874, response rate 74%) and an interview survey (n = 300, response rate 77%) of students in three higher/further education establishments in the North East of England. In the postal survey 20.9% perceived a risk of acquiring HIV/AIDS after blood donation, and 4.8% perceived the risk to be moderate or high. Explanations for the perceived risk were usually inaccurate. Most people (62.3%) perceived that blood transfusion had a risk of HIV infection, and 13.4% reported this risk to be moderate or high. The explanations for the risk were generally correct. The interview survey largely confirmed the results of the postal survey. The perceived risk of contracting HIV infection on blood donation is not an artefact of survey method; a substantial minority perceive a risk where there is none. Some people remain unaware of the risk of HIV infection after blood transfusion and among others the risk is perceived as higher than is realistic. Further research and educational initiatives to help safeguard the efficient gathering and use of blood are warranted.
Adolescent↗
Social surveys in HIV/AIDS: telling or writing? A comparison of interview and postal methods.
We compare a probability sample postal questionnaire survey and a quota controlled interview survey, and review the literature on these subjects. In contrast to other studies, where quota samples were not representative because of biased selection of respondents by interviewers, our quota sample was representative. Response rates were similar in our postal and interview surveys (74 and 77%, respectively), although many previous similar postal surveys had poor response rates. As in other comparison studies, costs were higher in our interview survey, substantive responses and the quality of responses to closed-ended questions were similar, and responses to open-ended questions were better in the interview survey. 'Socially unacceptable' responses on sexual behaviour were less likely in interviews. Quota controlled surveys are appropriate in surveys on HIV/AIDS under certain circumstances, e.g. where the population parameters are well known, and where interviewers can gain access to the entire population. Postal questionnaires are better for obtaining information on sexual behaviour, if adequate steps are taken to improve response rates, and when in-depth answers are not needed. For most surveys in the HIV/AIDS field we recommend the postal method.
Acquired Immunodeficiency Syndrome↗
Sex and the risk of HIV infection: the role of alcohol.
To investigate sexual behaviour under the influence of alcohol and the relationship between drinking habits and unsafe sex we carried out a postal and interview survey of 2174 students in the North East of England. Drinking habits were classified as non, light, medium and heavy, and cross-tabulated against sexual and other risk taking behaviour. Response rates of 74% and 77% were obtained in the postal and interview surveys respectively. In the postal survey, heavier drinkers were more likely to have unsafe sex such as casual sex without a condom, and sex with someone know to have many partners. Respondents associated alcohol with sexual risk taking; because of drinking too much, in the last year, 19% had not taken contraceptive precautions during sex. The interview survey largely confirmed postal survey results. There are three possible explanations of the association between drinking habits and unsafe sex: alcohol might disinhibit safer sex; young risk-takers may also drink more; or, drinking might be associated with unsafe sex by coincidence because sexual encounters often begin in licensed premises. Drinking habits should therefore be a priority issue for future HIV/AIDS related research, policy debate, and health education endeavour.
Adult↗
Screening elderly people in primary care: a randomized controlled trial.
A randomized controlled trial was carried out to test the effectiveness of a screening programme carried out by nurses for elderly people aged 75 years and over in a general practice. A total of 151 people were randomly allocated to the test group and 145 to the control group. The test group received a home visit from a nurse at which an assessment lasting 45 minutes was made of: activities of daily living, social functioning, sensory functions, mental and emotional problems, current medical problems, blood pressure, urinalysis, haemoglobin level and compliance with medication. Both groups completed a selection of items from four health indices before and 20 months after the intervention. At follow up, the test group scored significantly better than the control group on a morale scale. However, this trial provided no evidence for better resolution of physical problems or finding activities of daily living easier in the test group compared with the control group. It is suggested that the main benefit of such a screening process is that the special attention and education provided improves adaptation to old age and awareness of the support systems available. The government has proposed an annual review of elderly people in their own home and this study suggests that the objectives of this scheme should be clarified.
Aged↗
Issues in evaluation: evaluating assessments of elderly people using a combination of methods.
In evaluating a health service, individuals will give differing accounts of its performance, according to their experiences of the service, and the evaluative perspective they adopt. The value of a service may also change through time, and according to the particular part of the service studied. Traditional health care evaluations have generally not accounted for this variability because of the approaches used. Studies evaluating screening or assessment programmes for the elderly have focused on programme effectiveness and efficiency, using relatively inflexible quantitative methods. Evaluative approaches must reflect the complexity of health service provision, and methods must vary to suit the particular research objective. Under these circumstances, this paper presents the case for the use of multiple triangulation in evaluative research, where differing methods and perspectives are combined in one study. Emphasis is placed on the applications and benefits of subjectivist approaches in evaluation. An example of combined methods is provided in the form of an evaluation of the Newcastle Care Plan for the Elderly.
Aged↗