Depression and resilience mediate the relationship between traumatic life events and ill physical health: results from a population study.

We set out to investigate the mediating roles of depression, resilience, smoking, and alcohol use, in the relationship between potentially traumatic life events and objective and subjective, physical and mental health in a single study. A face-to-face, population-based survey was conducted in Hong Kong (N = 1147). Information on health conditions and traumatic life events was obtained, and participants completed measures of subjective physical and mental health, depression, and resilience. Smoking and drinking were not significant mediators of the relationship between life events and both objective and subjective health. Depressive symptomatology was found to mediate the relationship between life threatening illness and subjective physical health, the relationship between abuse (physical and sexual) and subjective mental health, and the relationship between the death of a parent/partner and subjective mental health. Resilience was found to mediate the relationships between multiple traumatic life events and subjective physical and mental health. Our results indicate that psychological factors rather than biological are important mediators of the relationship between life events exposure and health. Our findings provide evidence that depressive symptomatology has a mediating role only in the case of specific potentially traumatic life events and that resilience is only a critical factor in the face of exposure to multiple traumatic events, rather than single events. Our results also indicate that behavioural factors, such as smoking and drinking, are not significant mediators of the relationship between life events and health.

Self-management of coronary heart disease in older patients after elective percutaneous transluminal coronary angioplasty.

OBJECTIVE: To explore how older patients self-manage their coronary heart disease (CHD) after undergoing elective percutaneous transluminal coronary angioplasty (PTCA). METHODS: This mixed methods study used a sequential, explanatory design and recruited a convenience sample of patients (n = 93) approximately three months after elective PTCA. The study was conducted in two phases. Quantitative data collected in Phase 1 by means of a self-administered survey were subject to univariate and bivariate analysis. Phase 1 findings informed the purposive sampling for Phase 2 where ten participants were selected from the original sample for an in-depth interview. Qualitative data were analysed using thematic analysis. This paper will primarily report the findings from a sub-group of older participants (n = 47) classified as 65 years of age or older. RESULTS: 78.7% (n = 37) of participants indicated that they would manage recurring angina symptoms by taking glyceryl trinitrate and 34% (n = 16) thought that resting would help. Regardless of the duration or severity of the symptoms 40.5% (n = 19) would call their general practitioner or an emergency ambulance for assistance during any recurrence of angina symptoms. Older participants weighed less (P = 0.02) and smoked less (P = 0.01) than their younger counterparts in the study. Age did not seem to affect PTCA patients' likelihood of altering dietary factors such as fruit, vegetable and saturated fat consumption (P = 0.237). CONCLUSIONS: The findings suggest that older people in the study were less likely to know how to correctly manage any recurring angina symptoms than their younger counterparts but they had fewer risk factors for CHD. Age was not a factor that influenced participants' likelihood to alter lifestyle factors.

Professional role identity in shaping community nurses' reactions to nursing policy.

AIM: To establish the extent to which professional role identity shapes community nurses' reactions before the implementation of a policy that sought to introduce a generic role. BACKGROUND: Many countries seek to alter community nurse roles to address changes in population health and health workforce. We know little about the influences that might shape nurses' reaction to these policies before their implementation and our theoretical understanding is poorly developed at this point in the policy-making cycle. METHOD: Self completed cross-sectional survey of 703 community nurses before the introduction of a generic Community Health Nurse role in Scotland. RESULT: The minority (33%) supported the new role. The professional role identity of those who were supportive differed significantly from those who did not support the policy or were uncertain of it. CONCLUSION: It is possible that the new policy acted to increase the value of the professional role identity of those who were supportive and conversely devalued the professional role identity of those who were unsupportive or uncertain of it. IMPLICATIONS: Professional role identity should be considered by policy makers in any country seeking to introduce policies that aim to radically change the role of community nurses and that this is acknowledged at an early stage in the policy-making cycle.

Partnership working and improved service delivery: views of staff providing sexual health services.

OBJECTIVES: Successful partnership working has theoretically been linked to improvements in service delivery and is dependent on the strength of the partnership, trust, communication, professional roles and resource sharing. Empirical evidence to confirm the relationships between these factors and improved service provision, however, is lacking. Our aim was to assess the views of staff as to the conditions required for partnership working. METHODS: This study was a cross-sectional survey of 687 staff offering sexual health education, information or support to young people in the Healthy Respect intervention area in Scotland. Views of each variable were scored and structural equation modelling was used to assess the theoretical model. RESULTS: Responses were received from 284 (41%) staff. Greater strength of partnership was directly associated with increasing the number of referrals. Establishing professional roles between organizations was also associated with increasing the number of referrals. Strength of partnership was indirectly associated with working more effectively with young people and this relationship depended on clear communication, trust, established professional roles and shared resources. Effective partnership working depends on a number of interdependent relationships between organizations, which act synergistically to improve organizational outcomes. CONCLUSIONS: Effective partnership working leads to improved service delivery though there is a need for better controlled studies which demonstrate the effect on health outcomes.

Knowledge creation and the use of secondary data.

AIMS AND OBJECTIVES: To expose problems of using bespoke questionnaire-based surveys to create knowledge and to advance the use of secondary data as an alternative research approach. BACKGROUND: Many researchers from students undertaking dissertations to those who attempt to create knowledge to advance society collect data by using questionnaires. But this raises reliability and validity concerns as a consequence of low response rates and non-response bias. This constrains knowledge creation. DESIGN AND METHOD: First, the value of questionnaire-based research will be discussed. Then, it is argued that much can be accomplished using secondary data. The paper concludes by presenting a case study developed from the Scottish Health Survey. RESULTS AND CONCLUSION: We demonstrate that there may be an alternative for creating bespoke questionnaires by researchers. The data to answer their research questions may already exist in official surveys whose data are available to students and researchers. By analysing a case study, we demonstrate the value of one of these secondary sources - the Scottish Health Survey. RELEVANCE TO CLINICAL PRACTICE: We show that clinical practitioners in their training and in any professional research should consider alternative methods of collecting data for undertaking quantitative research. We advance the use of analysis of data collected by official surveys. Using secondary data can be more efficient in training students in research methods and make dissertations produced more meaningful.

Understanding complex interactions using social network analysis.

AIMS AND OBJECTIVES: The aim of this paper is to raise the awareness of social network analysis as a method to facilitate research in nursing research. BACKGROUND: The application of social network analysis in assessing network properties has allowed greater insight to be gained in many areas including sociology, politics, business organisation and health care. However, the use of social networks in nursing has not received sufficient attention. DESIGN: Review of literature and illustration of the application of the method of social network analysis using research examples. METHODS: First, the value of social networks will be discussed. Then by using illustrative examples, the value of social network analysis to nursing will be demonstrated. RESULTS: The method of social network analysis is found to give greater insights into social situations involving interactions between individuals and has particular application to the study of interactions between nurses and between nurses and patients and other actors. CONCLUSION: Social networks are systems in which people interact. Two quantitative techniques help our understanding of these networks. The first is visualisation of the network. The second is centrality. Individuals with high centrality are key communicators in a network. RELEVANCE TO CLINICAL PRACTICE: Applying social network analysis to nursing provides a simple method that helps gain an understanding of human interaction and how this might influence various health outcomes. It allows influential individuals (actors) to be identified. Their influence on the formation of social norms and communication can determine the extent to which new interventions or ways of thinking are accepted by a group. Thus, working with key individuals in a network could be critical to the success and sustainability of an intervention. Social network analysis can also help to assess the effectiveness of such interventions for the recipient and the service provider.

Cohesive subgroups and drug user networks in Dhaka City, Bangladesh.

The purpose of this paper was to explore group drug taking behaviour in a slum area of Dhaka, Bangladesh. We set out to examine the relationships between those who met, at least weekly, to take illegal drugs together, and how these relationships might shape their drug behaviour. Sociometric and behavioural data were collected using questionnaires via semi-structured interviews. We found that the likelihood of injecting drugs and sharing needles increased with age, duration of group membership and length of drug use. Drug users were classified into two clusters: one was more cohesive and comprised longer-term users, who were more likely to inject drugs and had poorer physical and mental health. The other cluster comprised younger, better educated members who were more transient, less cohesive, less likely to inject drugs and had better health. Qualitative data suggested that members of the first cluster were less accepting of outsiders and confirmed more to group norms. We conclude that emotionally bonded cohesive subgroups acquire norms, which reinforce problematic drug-using behaviour. Thus, health initiatives need to consider group relationships and norms and those initiatives which work with networks may be more effective and more appropriate for low-income countries.

Social networks and contraception practice of women in rural Bangladesh.

This paper analyzed the association of social networks with contraceptive use using both structural and attitudinal properties of social networks. Data were collected from seven villages in rural Bangladesh by face-to-face interviews using a structured questionnaire (N = 694). Sociometric data and the centrality positions of women in their social networks were analyzed as proxies for structural properties, and the perception of network members' approval and encouragement towards family planning as attitudinal properties. The perception of network members' attitude towards family planning and power within networks was found to be positively associated with contraception use. The strong association of the social network members' encouragement of contraception and the significance over both in-degree (number of nominations received by the participant from other village women) and out-degree centrality (number of nominations given by a participant) provides further confirmation that immediate network members' attitude is important to explain current contraceptive use of women in rural Bangladesh.

Social networks, normative influence and health delivery in rural Bangladesh.

This paper examines the association of social networks with the experience of neonatal death and the type of assistance that a woman obtains at childbirth in rural Bangladesh. Data were collected by interviewing 694 women from seven villages using a structured questionnaire. From the use of both social network analysis and statistical methods, we find that the experience of neonatal death and the type of assistance that a woman gets at childbirth are associated with the characteristics of their social networks along with a set of socioeconomic factors that are usually considered to be important. The higher the degree of centrality of a woman in her social network, the less likely it is that she will experience neonatal death, and the experience of neonatal death is significantly associated with the type of assistance she obtained at giving birth. Using a multivariate multinomial logistic regression model to explore the likelihood of using different types of birth assistance, we find that the higher the degree centrality of a woman, the less likely she will be attended by professional assistance. Further investigations reveal that the dominant norm in villages is to use traditional birth attendants and the perception about professional birth assistance is that it is 'not needed'. Moreover, the respondents' network members were also interviewed, and from the sociograms we find that there was an inward connectivity between the same types of assistance users. These findings have implications for norm change interventions among the village women using a network approach and in particular using opinion leaders.

Communication and contraception in rural Bangladesh.

This paper examines the association of communication in explaining the decision of women in rural Bangladesh to use or not to use contraception. Using survey data from villages in Bangladesh, we found that communication is an important influence on the ideational change for a smaller family norm and the practice of contraception. This is evident even when socioeconomic and cultural variables are controlled for. We recommend that to foster the use of contraception, communication factors should be given greater emphasis, especially to target husbands in the family planning program and to improve the image of female children.