Charlotte Clarke

Durham University

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Research Field

Short and medium term effects of a community-based intervention to address social inequalities in health

Journal of Epidemiology & Community Health (2011)

Shelina Visram Charlotte Clarke Martin White

Background

Health Trainers were introduced in the 2004 ‘Choosing Health’ White Paper with the aim of promoting healthy lifestyle behaviours among people living in disadvantaged areas. This is achieved through the use of techniques based on evidence and theories from health psychology. The initiative also aims to combat social exclusion by recruiting and training local people as Health Trainers. The evidence to support the effectiveness of behaviour change interventions delivered by non-professional or lay workers is mixed. Furthermore, there is a tendency to emphasise individual behaviour change outcomes rather than assessing the effects of community-based programmes across the breadth of their activities. Qualitative research can help to shed light on these effects and inform the successful replication and sustainability of interventions.

Objectives

To explore staff and service user views, experiences and perceptions of the Health Trainers intervention in order to evaluate its perceived effects on individuals, organisations and communities.

Design

A longitudinal qualitative research approach was used to provide insight into the participants9 experiences and social contexts. In-depth interviews with service users were conducted at 0, 3, 6 and 12 months, and with staff at 0 and 12 months. The interviews were audio-recorded, transcribed verbatim and analysed using the constant comparative method associated with grounded theory.

Setting and Participants

26 service users and 18 staff members theoretically sampled from 3 Health Trainer Services in the north east of England.

Findings

Analyses of the interview data identified an array of short- and medium- effects perceived as arising from participation in the Health Trainers intervention. These have been grouped into four categories using Nutbeam9s outcome model for health promotion. Health promotion actions: Community members were successfully recruited as Health Trainers and perceived to be delivering interventions that are inclusive and acceptable to local people. Health promotion outcomes: Service users reported changes in knowledge, attitudes and personal skills relating to key lifestyle issues, as well as increased self-efficacy. Intermediate health outcomes: In the majority of cases, health-related behaviour changes made by 3 months were reportedly sustained at 6 and 12 months. Health and social outcomes: Longer-term effects included improvements in existing conditions, reduced medication usage and enhanced quality of life.

Conclusion

This study adds to the evidence base for the evaluation of community-based interventions designed to improve health and reduce health inequalities. Use of a longitudinal qualitative approach was successful in capturing the complexity of the Health Trainers intervention and identifying its short- and medium-term effects.

Disadvantaged

Trainer

10.1136/jech.2011.143586.38

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Seeing need and developing care: exploring knowledge for and from practice

International Journal of Nursing Studies (2002)

Charlotte Clarke Jane Wilcockson

10.1016/s0020-7489(01)00038-4

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Citations (36)

DISCUSSION. THE MANAPOURI POWER PROJECT, NEW ZEALAND.

ICE Proceedings (1972)

J. A. Langbein D PAUSCH Nils Borg D J D REID B T SEDDON

Keywords POWER, TECHNIQUES, ROCKS, LABOUR, CONCRETE, INDUSTRIAL, TAILRACE, LAYOUT, IMPACT, EARTHQUAKES, PROJECTS, INTAKES, METHODS, RELATIONS, TURBINES, DESIGN, EXCAVATIONS, POWER HOUSES, CONDITIONS, CONSTRUCTION, EXPLOSIVES, HYDROELECTRICITY, POWER STATIONS, SHAFTS, TUNNELS, GROUTING, ENVIRONMENTAL, ASEISMIC MANAPOURI NEW ZEALAND... Show All

Hydroelectricity

Hydro power

10.1680/iicep.1972.5301

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Health Risk & Society (2009)

John Keady Charlotte Clarke Heather Wilkinson Catherine E. Gibb Linda Williams

Abstract To date, the voice and experience of people with alcohol-related brain damage has been silent in the literature. Using narrative research methodology and a focus on risk and quality of life, this paper outlines the analysis of interviews with six people with alcohol-related brain damage who were resident on a specialist care unit for the condition. Of the six participants, four were interviewed twice in line with the study protocol and separate interviews were conducted with a key worker on the unit, a social worker and a relative of one of the female participants. Analysis of the interviews revealed three dominant, narrative storylines: Five Minute Memory; Fractured Lives; and Believing in Recovery. Risk was constructed and experienced in a variety of ways under each of these narrative storylines, but each participant was particularly vulnerable to the assimilation of alcohol-related brain damage as a component and projection of self and identity. In addition, the process of 'prompting' emerged as a way that care staff constructed and discharged their rehabilitative function on the care unit and worked to minimise risk factors. A more co-ordinated, robust and transparent funding, policy, education and service structure for people with alcohol-related brain damage is called for. Keywords: riskrisk constructionalcoholnarrative Acknowledgements We would especially like to thank the people with alcohol-related brain damage for sharing their experiences and time with us. Dr. Sion Williams, University of Wales Bangor for his helpful and insightful comments on drafts of this paper. The study was supported by a grant from The Health Foundation.

10.1080/13698570903015743

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Citations (20)

Contents

Policy Press eBooks (2004)

Jan Reed David Stanley Charlotte Clarke

10.56687/9781447342397-toc

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The discipline of improvement: something old, something new?

Journal of Nursing Management (2004)

Charlotte Clarke Jan Reed David Wainwright S. H. McClelland Veronica Swallow

In response to calls to improve the efficacy of health care services, there is an increasing focus on the processes of achieving a continuous improvement of services and practices. One specific response is that of the NHS Modernization Agency and National Health Service University in relation to the Discipline of Improvement in Health and Social Care. This paper draws on a study that explored the underpinning knowledge base of the Discipline of Improvement and focuses on describing the framework that was developed. The two-dimensional framework is composed of five primary categories, which cross-link to 11 competencies. The study concludes that the Discipline of Improvement draws together a group of ideas that together cohere to form a distinctive model to aid the improvement of health care. While some of these ideas are well-established, the way in which the Discipline of Improvement makes connections between them offers something new to our understanding of change in the complex world of health care provision, and to nursing management.

Underpinning

Nursing management

10.1111/j.1365-2834.2004.00463.x

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Citations (26)

The manager's role in mobilizing and nurturing development: entrenched and engaged approaches to change

Journal of Nursing Management (2010)

Susan Carr Charlotte Clarke

carr s.m. & clarke c.l. (2010) Journal of Nursing Management 18, 332–338The manager's role in mobilizing and nurturing development: entrenched and engaged approaches to change Aims Drawing on findings from the evaluation of a Health Action Zone (HAZ), this paper explores the manager’s role in promoting and nurturing learning. Background Initiating practice development is a core function of the manager’s role. Learning must be nurtured to reach beyond individual to organizational learning and address knowledge exchange as well as creation. In the United Kingdom, HAZs were established to reduce health inequalities. They embraced a variety of service delivery approaches, all with an emphasis on developing new ways of working and innovation. Methods Qualitative interviews of the HAZ coordinators, performance manager and staff delivering services. Results Two alternative ways of engagement and entrenchment to practice were identified to developing new ways of working and learning from experience. Conclusions Development of sustainable and enduring structures which facilitate learning at both individual and organizational levels are key to utilization of knowledge and accumulation of learning. Implications for nursing management When entrenched and engaged experiential learning in practice are pursued, the role of the manager as a catalyst needs to be highlighted. A tool is proposed to facilitate reflection and promote action plan development. This tool has potential general application, but our experience is that it makes a specific contribution to public health and primary care.

Management development

Leadership Development

10.1111/j.1365-2834.2010.01092.x

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Citations (11)

Living in families and communities

Policy Press eBooks (2004)

Jan Reed David Stanley Charlotte Clarke

10.51952/9781447342397.ch007

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Specialist services for older people: issues of negative and positive ageism

Ageing and Society (2006)

Jan Reed Margaret Cook Glenda Cook Pamela Inglis Charlotte Clarke

This paper reports findings of a study in 2004 of the development of specialist services for older people in the National Health Service (NHS) in England, as recommended in the Department of Health's National Service Framework for Older People (NSF-OP). The study was funded by the Department of Health as part of a programme of research to explore the Framework's implementation. Information was collected through a questionnaire survey about the nature of specialist developments at three levels of the NHS: strategic health authorities (SHAs), provider Trusts, and service units. This produced an overview of developments and a frame from which to select detailed case studies. Analysis of the survey data showed that there were variations in the way that the NSF-OP was being interpreted and implemented. In particular, there was inconsistency in the interpretation of the NSF-OP's anti-ageism standard; some concluded that the strategy discouraged services exclusively for older people, others that it encouraged dedicated provision for them. The tension between creating age-blind and age-defined services was played out in the context of existing service structures, which had been shaped over decades by many local and national influences. These conceptual and historical factors need to be taken into account if services are to change, as developments are shaped by ‘bottom-up’ local processes as well as ‘top-down’ policy initiatives. In particular, the tension inherent in the NSF-OP between negative and positive ageism, and its varied interpretations at local levels needs to be taken into account when evaluating progress in implementation.

National Service Framework

10.1017/s0144686x06004855

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Citations (9)

Risky and resilient life with dementia: review of and reflections on the literature

Health Risk & Society (2013)

Catherine Bailey Charlotte Clarke Catherine E. Gibb Shona Haining Heather Wilkinson

Abstract In this article, we report on our interpretation of past and current literature on negotiating risk and resilience in the everyday lives of people living with dementia. We undertook the literature review on which this article is based as part of an ongoing qualitative study designed to explore issues of risk and resilience from the point of view of people living with dementia in urban and rural communities. We carried out a search of international, peer-reviewed publications in 2012 with an emphasis on UK policy and practice. We also accessed UK Government documents and reports for background detail. We found that there is a personal, collective, practice and policy-based will to secure robust and positive responses to risk and to work with individual and collective notions of resilience. However, there is a competing practice narrative of vulnerability and protection, and a concern with litigation that undermines positive responses to risk. There is some recognition that for community dementia services to be responsive and proactive to the needs and wishes of their users, risk and resilience need to be considered from within complex and diverse, local perspectives and lifelong knowledge. We would add to this by emphasising that an understanding of local context is also needed to fully appreciate complex and nuanced positioning of the person living with dementia. Resources may or may not be in place, but how and why they are used (or not used), and how the person with dementia may be influenced (or not) by others and by localised contexts, may have far-reaching implications for policy and practice. Keywords: riskresiliencedementiasense of placecitizenshipliterature review

Vulnerability

10.1080/13698575.2013.821460

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Citations (44)