Exploring Explanations for Local Reductions in Teenage Pregnancy Rates in England: An Approach Using Qualitative Comparative Analysis.

Teenage pregnancy rates in the UK are high compared with many other countries but there is marked variation across local areas, including those with high deprivation. This study uses the method of Qualitative Comparative Analysis to identify conditions associated with the presence or absence of a narrowing gap in teenage pregnancy rates as measured by the differences between deprived local authority areas and the national average. A higher proportion of black and minority ethnic groups in the local population is found to be a sufficient although not necessary condition for narrowing to have occurred. Surprisingly, a good assessment of commissioning practice - combined with other conditions - was associated with areas where the gap has not been narrowing.

Care robots for the supermarket shelf: a product gap in assistive technologies.

The literature on the development of assistive robots is dominated by technological papers with little consideration of how such devices might be commercialised for a mass market at a price that is affordable for older people and their families as well as public services and care insurers. This article argues that the focus of technical development in this field is too ambitious, neglecting the potential market for an affordable device that is aleady in the realm of the 'adjacent possible' given current technology capabilities. It also questions on both ethical and marketing grounds the current effort to develop assistive robots with pet-like or human-like features. The marketing literature on 'really new products' has so far not appeared to inform the development of assistive robots but has some important lessons. These include using analogies with existing products and giving particular attention to the role of early adopters. Relevant analogies for care robots are not animals or humans but useful domestic appliances and personal technologies with attractive designs, engaging functionality and intuitive usability. This points to a strategy for enabling mass adoption - which has so far eluded even conventional telecare - of emphasising how such an appliance is part of older people's contemporary lifestyles rather than a sign of age-related decline and loss of independence.

Framing health inequalities for local intervention: comparative case studies.

This article explores how health inequalities are constructed as an object for policy intervention by considering four framings: politics, audit, evidence and treatment. A thematic analysis of 197 interviews conducted with local managers in England, Scotland and Wales is used to explore how these framings emerge from local narratives. The three different national policy regimes create contrasting contexts, especially regarding the different degrees of emphasis in these regimes on audit and performance management. We find that politics dominates how health inequalities are framed for intervention, affecting their prioritisation in practice and how audit, evidence and treatment are described as deployed in local strategies.

A Qualitative Comparative Analysis of factors associated with trends in narrowing health inequalities in England.

This study explores why progress with tackling health inequalities has varied among a group of local authority areas in England that were set targets to narrow important health outcomes compared to national averages. It focuses on premature deaths from cancers and cardiovascular disease (CVD) and whether the local authority gap for these outcomes narrowed. Survey and secondary data were used to create dichotomised conditions describing each area. For cancers, ten conditions were found to be associated with whether or not narrowing occurred: presence/absence of a working culture of individual commitment and champions; spending on cancer programmes; aspirational or comfortable/complacent organisational cultures; deprivation; crime; assessments of strategic partnership working, commissioning and the public health workforce; frequency of progress reviews; and performance rating of the local Primary Care Trust (PCT). For CVD, six conditions were associated with whether or not narrowing occurred: a PCT budget closer or further away from target; assessments of primary care services, smoking cessation services and local leadership; presence/absence of a few major programmes; and population turnover. The method of Qualitative Comparative Analysis was used to find configurations of these conditions with either the narrowing or not narrowing outcomes. Narrowing cancer gaps were associated with three configurations in which individual commitment and champions was a necessary condition, and not narrowing was associated with a group of conditions that had in common a high level of bureaucratic-type work. Narrowing CVD gaps were associated with three configurations in which a high assessment of either primary care or smoking cessation services was a necessary condition, and not narrowing was associated with two configurations that both included an absence of major programmes. The article considers substantive and theoretical arguments for these configurations being causal and as pointing to ways of improving progress with tackling health inequalities.

Involving persons with dementia in the evaluation of outdoor environments.

Using virtual reality (VR), we examined the barriers to and facilitators of functioning outdoors in persons with dementia (PwD) and investigated the generalizability of findings in VR to the real world. An existing town center was modeled in VR. PwD took part in both real-world and VR walks. Based on the results, the model was redesigned and then tested again. Performance on the walks improved, and potentially beneficial adaptations to outdoor environments were identified, but limitations of VR as a representation of the real world were also identified. We conclude that VR models, together with a rigorous behavioral testing method, can be a useful tool for the evaluation of outdoor environments and for identifying improvements for PwD.

Change in adult health following medical priority rehousing: a longitudinal study.

BACKGROUND: Over 90 per cent of local housing authorities in England allocate medical priority for rehousing (MPR) to applicants with medical or care needs but very few studies have been undertaken to investigate the health effects of this practice. This longitudinal study compares the change in health status of adult applicants for MPR who were rehoused with applicants who were not rehoused. METHODS: A total of 566 households applying for MPR were interviewed before any rehousing, and of these 253 households were re-interviewed between 9 and 12 months later. Data from initial and follow-up interviews were analysed for 227 adults, of whom 104 were rehoused. The rehoused and not rehoused groups were not significantly different in terms of health status, gender, education, income or housing conditions, but participants who were not rehoused were more likely to report mobility problems and to be aged over 50. Health data were collected by interview using the Short Form 36 (SF-36) questionnaire. Questions were also asked about housing conditions and the local neighbourhood, instrumental activities of daily living (IADL) and health-related behaviour. RESULTS: The health status of adult applicants for MPR was very poor. Those who were not rehoused experienced a slight improvement in five dimensions of the SF-36 whereas those who were rehoused experienced much larger improvements in six dimensions. For those who were rehoused, significant net improvements occurred in reports of tiredness, feeling depressed, sleeplessness, use of prescribed medication, use of medical services and problems with IADL. No changes occurred in reports of respiratory problems, longstanding illness or disability, use of antidepressants, sleeping pills or tranquillizers, smoking or social support. CONCLUSIONS: MPR was associated with improvements in mental health status and mobility, and among respondents aged 50 years or under with a reduced use of prescribed medication and medical services. Whereas most applicants applied for MPR because of mobility problems, they were less likely than other applicants to be rehoused. The health improvements that appeared to occur should be qualified by the extent of unmet need for appropriately adapted housing and the high level of ill-health that persisted even among adults who were rehoused.

Developing a virtual reality-based methodology for people with dementia: a feasibility study.

The aim of this study was to examine the feasibility of virtual reality (VR) technology for use by persons with dementia (PWD). Data were obtained directly from six PWD regarding their experiences with a virtual environment (VE) of a large outdoor park. A user-centered method was developed to assess: (a) presence; (b) user inputs; (c) display quality; (d) simulation fidelity; and (e) overall system usability. The extent to which PWD could perform four functional activities in the VE was also investigated (e.g., mailing a letter). In addition, physical and psychological well-being of PWD while interacting with the VE was assessed objectively by recording heart rate during the VR sessions and subjectively with discrete questionnaire items and real-time prompts. Symptom profiles associated with simulator sickness were assessed with an adapted version of the Simulator Sickness Questionnaire. The study found that PWD to some extent experienced presence; perceived that objects were realistic and moved naturally; generally felt in control of the interaction; and demonstrated little difficulty using a joystick for navigation. The study also demonstrated that VR is an appropriate medium for assessing functional behavior within the context of an ecologically valid VE. PWD did not experience any significant increase in symptoms associated with simulator sickness, or detriments to their psychological and physical well-being. These findings demonstrated that it is feasible to work in VEs with PWD.