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Creation of consensus recommendations for collaborative practice in the Malaysian psychiatric system: a modified Delphi studyThere is strong evidence that collaborative practice in mental healthcare improves outcomes for patients. The concept of collaborative practice can include collaboration between healthcare workers of different professional backgrounds and collaboration with patients, families and communities. Most models of collaborative practice were developed in Western and high-income countries and are not easily translatable to settings which are culturally diverse and lower in resources. This project aimed to develop a set of recommendations to improve collaborative practice in Malaysia. In the first phase, qualitative research was conducted to better understand collaboration in a psychiatric hospital (previously published). In the second phase a local hospital level committee from the same hospital was created to act on the qualitative research and create a set of recommendations to improve collaborative practice at the hospital for the hospital. Some of these recommendations were implemented, where feasible and the outcomes discussed. These recommendations were then sent to a nationwide Delphi panel. These committees consisted of healthcare staff of various professions, patients and carers. The Delphi panel reached consensus after three rounds. The recommendations include ways to improve collaborative problem solving and decision making in the hospital, ways to improve the autonomy and relatedness of patients, carers and staff and ways to improve the levels of resources (e.g. skills training in staff, allowing people with lived experience of mental disorder to contribute). This study showed that the Delphi method is a feasible method of developing recommendations and guidelines in Malaysia and allowed a wider range of stakeholders to contribute than traditional methods of developing guidelines and recommendations.
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'I felt like I was doing something wrong': A qualitative exploration of mothers' experiences of breastfeedingDespite its multiple health benefits, rates of breastfeeding to 2 years and beyond remain low in the UK. This qualitative study explored the experiences of support provided by health professionals to mothers breastfeeding beyond infancy. A key finding of the study was that health services are effective at supporting breastfeeding in the postnatal period, but that beyond the 1-year review the focus shifts to rapid weaning. A new approach to support breastfeeding continuation alongside the introduction of complementary foods is needed in line with professional guidance and recommendations. As critical reflective practitioners, health visitors are ideally placed to support and educate women about the wider social complexities of breastfeeding. However, health service commissioners need to recognise the importance of investment in the profession to enable health visitors to use their skills fully.
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Using figured worlds to explore parents' attitudes and influences for choosing the content of primary school packed lunchesThis study aimed to explore parents' attitudes toward the content of their child's packed lunch, school healthy eating policies, and their child's wishes. Furthermore, in this context, it also aimed to explore perceptions of health promotional materials and how these interventions interplayed with issues parents felt were important. The ideology of ‘figured worlds’ was used as a stance to consider the relationship between bounding structures within society and the individual positional identity. Focus groups interviews obtained qualitative data of parents' multiple viewpoints. Iterative categorisation was employed as a method of analysis to observed findings in the data in relation to the individuals as intersubjective beings and their behaviour influenced by environmental conditions. A cross selection of local schools and parenting network were approached. Snowballing techniques were implemented highlighting the inclusion criteria. Participants were required to have a child attending primary school who they provided a packed lunch for on a regular basis. Three umbrella themes were identified: ‘The parents ideal’, ‘The child's desires’, and ‘Inconsistencies of the governing school’. A fourth theme, ‘The health promotional intrusion’ provides insight into the parents' reality when being presented with health promotional materials. This study has highlighted the complex, conflicting interplay between parents' ideal for their child's diet, their child's desires and the governing approaches to encouraging healthier choices. This understanding is vital when designing specific interventions to meet the needs of individuals, which prevent, protect and promote a healthy lifestyle for children and their families.
