Biomedical subjects
Publications and source records attributed to R Wiles.
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OBJECTIVE: To examine the beliefs of women of above average weight about appropriate levels of weight gain in pregnancy. DESIGN: An in-depth qualitative study of 37 women. SETTING: Women recruited from a city hospital, a rural hospital and by community midwives in the south of England. PARTICIPANTS: Women were identified via hospital notes or by community midwives. Over a one-year period all women identified who attained the weight of 90 kg by the 30th week of pregnancy were eligible to participate. The sample comprised 37 women. The sample was varied in terms of age, social class, household composition and number of children. MEASUREMENT: Two in-depth interviews were carried out with each interviewee: during late pregnancy and six weeks following childbirth. FINDINGS: Interviewees were concerned not to weigh more after pregnancy than before. Their perceived ability to control weight gain during pregnancy was varied. In the perceived absence of specific advice from health professionals, they constructed their own views about appropriate levels of weight gain. These were informed by their desire to minimise weight gain and to provide adequate nourishment for the growth and development of their baby. Comments and advice from health professionals were interpreted within the women's own understandings of appropriate levels of weight gain. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: (1) the desire to return to their pre-pregnancy weight was a strong motivating factor among pregnant women of above average weight, but some women lacked confidence in their ability to control weight gain; (2) the health and well-being of their unborn baby is often a central concern in women's decisions about appropriate weight gain; (3) health professionals need to explore the beliefs of women of above average weight about appropriate weight gain in pregnancy; and (4) written information about weight gain may assist women of above average weight in understanding what might be an appropriate level of weight gain during pregnancy.
Secondary prevention of heart disease is widely viewed as likely to be more successful and cost effective than primary prevention. However, people's willingness to adopt lifestyle change is a complex issue in which people's perceptions of disease causation and risk as well as a range of socio-economic factors are important. This paper reports on a qualitative study of people following heart attack which examines their understandings of heart attack and the salience that lifestyle advice has in the light of these understandings. In-depth, qualitative interviews were conducted with 25 people recovering from heart attack. Each person was interviewed twice: at around two weeks and five months following their heart attack. The study found that information about recovery provided by health professionals was based on a simplified version of epidemiological evidence. This information played a central role in people's understandings about the nature of heart attack and their future risk in the early weeks following heart attack. However, as interviewees came to terms with the shock of the event, they tended to lose their trust in "official" accounts of cause and recovery and evidence from lay epidemiology that contradicted official accounts tended to emerge. This evidence encouraged interviewees to question the explanatory power of official accounts and to view the adoption of long-term lifestyle change as an action that would not guarantee protection from a further heart attack. This was true whether or not people's experiences of recovery reflected those "predicted" by health professionals although those awaiting further surgery or tests tended to maintain trust in official accounts over a longer period. It is concluded that the failure of official accounts to acknowledge the random nature of the occurrence of heart attack, the severity of heart attack and the level of recovery from heart attack is a central feature in people's reluctance to view lifestyle change as a rational action to take to prevent a further cardiac event.
This paper reports on a study which sought to identify the information needs of patients and their informal carers at various stages post-stroke with the aim of developing a database from which individualized information packages could be provided. The study used in-depth qualitative interviews with a total of 31 interviewees (both patients and carers) to explore information needs at three different points post-stroke: during hospitalization; up to 1 month post-discharge; and 2-12 months post-discharge. The information needs identified related to: recovery, treatment and prognosis; practical caring tasks; social activities; and resources available in the community. The study indicated that the information needs of patients and carers following stroke are not currently met and a desire for individualized information was identified. It is concluded that it may not be possible to meet patients' and carers' desire for information about recovery and prognosis but that a customized database covering the other areas highlighted by this study would facilitate improved information provision. It is anticipated that the process of providing such packages would improve communication within the rehabilitation team.
This paper reports on the views of patients with established heart disease of a structured programme of follow-up care provided by practice nurses (PNs) in general practice in England. It is based on in-depth interviews with 22 patients receiving an integrated primary and secondary care intervention being developed and piloted for patients following heart attack or diagnosis of angina. Patients identified the important features of follow-up care to be easy access to a health professional who possessed knowledge and social and emotional skills. A range of views about the ability of PNs to provide such care emerged from patients' accounts. Patients' perceptions about the seriousness of their condition and the way PN follow-up care was provided in practices emerged as important issues affecting patients' views. In addition, perceptions about the practice nurse's role, status and knowledge, existing relationships with general practitioners, and issues of communication were also important factors. It is concluded that in order to develop high-quality PN-led services for patients with established heart disease, four issues need to be taken into account: practice nurse training; continuity of follow-up care; the integration of the primary and secondary care interface; and development of the practice nurse's status within the primary health care team.
This paper reports on findings from a study of teamwork in primary care in one family health services authority in England. It is based on interviews using a semi-structured questionnaire with practice nurses, district nurses, health visitors and midwives in 20 practices. Six topics emerged as important in relation to the views of nurses, midwives and health visitors and their experiences of teamwork: team identity; leadership; access to general practitioners; philosophies of care; understanding of team members' roles and responsibilities; and, disagreement regarding roles and responsibilities. Differences in the various views and experiences of teamwork were identified. Midwives and health visitors emerged as the least integrated members of the primary health care team. Recent changes to the organization of primary health care services, as well as professional changes, are seen as accounting for the different experiences of the nursing groups. The potential for teamwork in the future is discussed.
A counselling scheme has been set up in general practices in Salisbury Health District by Wiltshire FHSA. Rose Wiles and colleagues give details of the findings of an audit of the scheme and Wiltshire FHSA's responses.
Patients who go private do so because their negative judgements of the NHS are based on media reports and hearsay, not facts or direct experience. To compete, say Joan Higgins and Rose Wiles, the NHS is going to have to unscramble its messages.
A questionnaire survey was carried out in 1991 in Wessex regional health authority of a sample of private patients having inpatient treatment in eight independent hospitals, and in pay beds in three National Health Service hospitals. A total of 649 patients replied (response rate 60.7%). Sixty respondents to the questionnaire were also interviewed. The aim of the study was to discover which groups of people chose private care rather than using the NHS, and why. In view of the current emphasis on consumerism in health care, the study also aimed to examine how patients exercised choice in a market situation and how well informed they were when they did so. The questionnaire asked about the role and influence of the general practitioner in patients' decisions to use private health care for treatment. The largest group of respondents were in the 36-50 years age group (34.2%). Of the respondents 59.9% were women, 54.1% were in social class 2 and 77.3% were married or cohabiting. The most common reason for using private health care for treatment was to avoid NHS waiting lists (61.5% of respondents) although they did not necessarily know how long that wait would have been. Patients sought their general practitioner's opinion about whether to use private health care in 187 cases (28.8%). The majority of the 649 patients (71.2%) had decided to use private health care before consulting the general practitioner. However, patients were influenced by their general practitioner's advice on the choice of consultant and choice of hospital.(ABSTRACT TRUNCATED AT 250 WORDS)
A study of private patients (n = 649) was carried out in Wessex Region in January 1991 to discover why patients decide to go private rather than use the NHS for in-patient treatment. Relatively few patients complained of the attitudes of nurses in the NHS, but just over one third mentioned nursing as a significant problem in the NHS and, of this group, over half were critical of nurses' attitudes. Further analysis revealed that these perceptions were not based on direct experience (of those who said that nursing was a problem, only 5 per cent had been NHS in-patients since 1985), but alarm about the public image of nursing remains.