Service user involvement in mental health care: an evolutionary concept analysis.

BACKGROUND: The concept of service user involvement is an evolving concept in the mental health-care literature. OBJECTIVE: This study sought to explore and analyse the concept of service user involvement as used in within the field of mental health care. METHODOLOGICAL APPROACH: An evolutionary concept analysis was conducted using a literature-based sample extracted from an electronic database search. One hundred and thirty-four papers met the inclusion criteria and were analysed to discover key attributes, antecedents and consequences of service user involvement and to produce a definition of the concept. FINDINGS: Five key attributes of service user involvement within the context of mental health care were identified: a person-centred approach, informed decision making, advocacy, obtaining service user views and feedback and working in partnership. DISCUSSION AND CONCLUSIONS: Clarity of the attributes and definition of the concept of service user involvement aims to promote understanding of the concept among key stakeholders including mental health professionals, service users and community and voluntary organizations. The findings of the research have utility in the areas of theory and policy development, research on service user involvement in mental health care and service user involvement in mental health practice. Directions for further research regarding the concept are identified.

Promoting positive attitudes to breastfeeding: the development and evaluation of a theory-based intervention with school children involving a cluster randomised controlled trial.

The objective of this study was to design, implement and evaluate an intervention based on the theory of planned behaviour (TPB) to enhance young peoples' motivations to breastfeed/support a partner to breastfeed. Six semi-structured focus groups were first conducted with 48 13-14-year-olds from two schools in Northern Ireland. The salient beliefs elicited were subsequently used to design a TPB-based questionnaire that was then administered to 2021 13-14-year-old pupils (852 males; 1169 females) from 36 post-primary schools to identify the most important determinants of breastfeeding. The results were used to inform the design and implementation of an intervention package that was subsequently evaluated using a cluster randomised controlled trial involving 44 randomly selected schools across Northern Ireland. Questionnaires were administered to 18 intervention and 26 control schools at baseline and again at 1 and 6 months post-intervention to evaluate its effectiveness. Multi-level modelling was employed to analyse the data. The results revealed significant effects on women's intention to breastfeed, ß = 0.208, t(1275) = 2.715, P = 0.007; attitudes, ß = 0.223, t(1275) = 4.655, P < 0.001; moral attitudes, ß = 0.231, t(1275) = 4.211, P < 0.001; subjective norm, ß = 0.118, t(1275) = 2.521, P = 0.012; and knowledge, ß = 0.109, d.f. (1275) = 7.843, P < 0.001. However, for men, the results revealed significant effects on only the construct of knowledge, ß = 0.104, t(541) = 4.345, P < 0.001.The research has provided evidence to support the need for breastfeeding education in schools and has shown how a theoretical framework may be used to inform the design and evaluation of a health behaviour intervention.

Evaluation of a theory of planned behaviour-based breastfeeding intervention in Northern Irish schools using a randomized cluster design.

OBJECTIVE: The aim of this research was to evaluate the effectiveness of a school-based intervention designed to enhance young people's motivations to breastfeed. DESIGN: A cluster randomized controlled trial was conducted involving 50 post-primary schools from across Northern Ireland. However, dropout and exclusion criteria utilized for the current study resulted in an effective sample size of 42 schools. METHODS: The intervention was delivered in two 35-min classroom sessions targeting those beliefs identified by the theory of planned behaviour (TPB) as significant in predicting motivation to breastfeed. Questionnaires incorporating the key components of the TPB were administered to all intervention and control schools at baseline, 1 and 6 months post-intervention. Multi-level modelling was used to analyse the data. RESULTS: Findings suggest that the intervention was effective in that it increased females' intentions to breastfeed, expanded their knowledge and led to more favourable attitudes and perceptions of subjective norms. Notably, females' knowledge increased more in secondary schools than in grammar schools irrespective of whether they were control or intervention schools. CONCLUSION: The research has provided evidence to support the use of the TPB in the design and evaluation of an intervention to increase females' intentions to breastfeed.

Western Australian dental graduates' perception of preparedness to practice: a five-year follow-up.

The School of Dentistry in Western Australia developed a pregraduation intern year in which final-year students, having completed their didactic education, undertook a focused clinical experiential program (CEP) over an extended year. This program was implemented for the first time in 2002. The aim of this study was to identify the strengths and weaknesses of the curriculum as perceived by graduates and to compare the perceptions of those graduates who did the CEP to those who did not. A survey with questions based on the graduate outcomes of the dental school was mailed to all graduates from 2000, 2001 (did not complete CEP), and 2004 (completed CEP). The response rate was 66 percent (n=57) and included twenty-nine respondents who graduated before implementation of the CEP and twenty-eight who completed the CEP. Most respondents (80 percent) were in the twenty to twenty-nine age group, and there were slightly more males (53 percent). Learning outcome items with the highest mean scores were practicing universal precautions (4.2), behaving ethically (4.2), and demonstrating a satisfactory level of core dental knowledge (4.2). Practical skills outcomes with the highest scores were amalgam restorations (4.3), anterior endodontics (4.3), and single crowns (3.9). When comparing the respondents who did CEP (51 percent) with those who did not (49 percent), there were few significant differences. The general findings from this survey were that most graduates, whether completing the CEP or not, perceived themselves to be prepared, competent, and confident to practice as dentists and were most confident in managing problems that they most frequently encountered during training.