Although there is existing activity within the NHS and local communities to support self-care there has been no previous attempt at integration across a Primary Care Trust (PCT). The Joining Up Self-Care (JUSC) study aimed to implement and evaluate such a programme.

Three self-care support modules for members of the public, together with a training course for primary care teams, were developed with, and implemented in, one PCT. The modules related to disease prevention (community-based coronary heart disease (CHD) prevention), care of people with long-term conditions (a disease-specific self-care skills training course for asthma) and the management of minor ailments aimed at mothers of children aged 3 months to 12 years (the ‘Pharmacy First’ service plus information booklets and campaigns). Postal questionnaires were completed by participants in CHD prevention (178), management of asthma (76) and minor ailments management (92), and by controls. A general population survey (n = 540) provided a comparison group for the CHD module and assessed general awareness of local self-care support. Four focus groups were held with mothers of young children. An audit of general practitioner (GP) records was conducted for consultations for minor ailments. Structured telephone interviews were conducted with 51 local health professionals and nine members of staff from the PCT.

Participants in the CHD module reported significantly more risk-reducing behaviours. Participants in a disease-specific Expert Patient Programme (EPP) for people with asthma rated the course positively, were subsequently more confident about discussing asthma with their doctor and had fewer concerns about their asthma medicines. Most users of the ‘Pharmacy First’ minor ailments scheme reported positive feedback and an intent to use the service again in the future. There were no significant differences in numbers of GP consultations for minor ailments between intervention and control groups. Health professionals were generally positive about encouraging self-care. Many felt they were already doing this but had insufficient time to implement it. A Local Enhanced Service (LES) was successful in engaging local general practices with self-care. Some organizational development relating to self-care occurred within the PCT but integration across different directorates was not achieved.

The JUSC programme was associated with changes in self-reported CHD risk reduction behaviours, in confidence to manage asthma and fewer concerns about medication, and with more positive attitudes towards consulting a pharmacist for minor ailments. Key principles for future PCT self-care strategies were identified. Further work is needed to embed support for self-care across the PCT as an organization.

The study sought to explore parents’ views of the injury risks to young children at home and their perceptions of supervision, targeting families living in economically deprived areas, including those living in black and minority ethnic communities.

Unintentional injury is a leading cause of death and disability in young children; most injury occurs in and around the home, and children from more deprived families are more vulnerable. Inadequate supervision is often cited as an important risk factor in childhood injury.

Qualitative semi-structured interviews were carried out with 34 families (23 white, 6 black, 5 South Asian) in economically deprived communities in Bristol, UK from September 2005 to July 2006.

The four main interview themes were perceptions of risk, coping with kitchen hazards, attitudes to supervision, and learning strategies. No major differences were seen between different ethnic groups in perceptions expressed or methods used by parents to keep children safe. The common practice of barring children from entering the kitchen when cooking by using stair gates is discussed. Reduced use of safety equipment and a perceived risk of burns from irons in the South Asian communities are highlighted. Constant supervision and learning by experience are common strategies employed by these parents to keep their children safe in often adverse living conditions. Parents need to be aware of the link between child development and injury risk, and also of differences in injury rate as a function of the child’s individual temperament and ability.

To explore parents’ perceptions of environmental household risks to their child’s asthma and to identify the strategies they adopt in relation to these perceived risks.

The prevalence of childhood asthma is increasing worldwide and especially in the UK. Asthma is more common in areas of socio-economic disadvantage. Household environmental factors have been implicated in some of this increase. A number of factors in the home environment have been found to act as triggers to asthma symptoms, including high humidity levels, poor ventilation, mould, second-hand tobacco smoke and pet allergens. Little is known about how parents, as the main care-givers and decision makers in the home, perceive and cope with the risks posed by these triggers.

Semi-structured interviews were conducted with a purposive sample of parents of 32 children with asthma aged 4 to 16 years and living in a socio-economically disadvantaged urban community in the North East of England. Interviews were audiotaped, transcribed verbatim and analysed using constant comparison techniques.

All parents were aware of some of the risks their children faced at home. Some appeared to know more than others and coping styles varied. A typology of three groups of parents was identified: those who actively seek advice and adopt clear preventative strategies (preventers); those who minimize the risks and only react when things go wrong (reactors); and those who engage in compensatory activities in an attempt to trade-off between harms and benefits (compensators). The unifying themes underpinning these different styles are that all parents are motivated to maintain normal family life but that they adopt different strategies to achieve this.

This study examined the factors related to whether or not school-based tobacco control efforts were associated with student smoking behaviour among two groups of students: Group 1 (15–17 years of age; grade 10 in 2000 and grade 11 in 2001) and Group 2 (16–19 years of age; grade 11 in 2000 and grade 12 in 2001).

Between 1999 and 2001, Prince Edward Island (PEI) introduced a province-wide initiative to implement both school-based policies banning smoking on school grounds and school-based smoking prevention programming, phased in over a three-year period, in all schools.

Data were collected from all 10 English-speaking secondary schools in PEI (Canada) over three years (1999–2001) using the Tobacco Module of the School Health Action, Planning and Evaluation System.

Results showed an increase in both occasional and regular smoking behaviour with Group 1 showing an 18% increase in occasional smoking compared to 3.9% for Group 2. The characteristic associated with an increased likelihood of regular and occasional smoking for 2000 and 2001 was students overestimating the percentage of youth their age who smoke. However, students’ knowledge and awareness of smoking policies and enforcement, students’ perceptions of schools having clear rules, and that students who break the rules get into trouble increased from 2000 to 2001. The findings from this study provide important information about how groups of students within schools experience tobacco control efforts differently. Addressing student misperceptions and policy implementation within schools may provide direction for tobacco control.

This paper explores the variable provision of English health visiting services, despite government emphasis on the need to reduce health inequalities through early interventions and provide support to families with pre-school children.

There is increasing evidence of the importance to later health of early child development; that is from prenatal to eight years of age. In this population group, the strongest evidence for health improvement emphasizes support for families (especially mothers) until the infant is at least two to three years of age. In the last four to five years, English government policy has focused strongly on this important life stage, particularly noting its relevance in reducing health inequalities. Simultaneously, the health visiting workforce, arguably the occupational group most closely associated with this form of work, has reduced by 10%; and there is evidence of extreme variability in the way services are provided across the country.

Three sources of data were analysed to discover whether the variation in health visiting services relates to need, levels of deprivation or whether other factors are influential in planning provision. The ratio of health visitors to pre-school children was mapped to indices of multiple deprivations across 144 Primary Care Trusts. Survey data were examined for evidence of links, or not, to levels of deprivation and, finally, 30 Children and Young People’s Plans (CYPPs) were analysed to explore strategic planning about the distribution and type of services.

Health visiting service provision appears unrelated to areas of deprivation; although, the survey data offered some evidence that individual practitioners focused efforts on the most deprived clients on their caseloads, regardless of location. At a strategic level, the CYPPs made little mention of pre-school children or their needs and offered only limited descriptions of preventive health services. Policy recommendations are made about strengthening service provision in this field.

To investigate knee-related and comorbid consultations in a sample of community-dwelling older adults with knee pain.

Knee pain affects 25–37% of people aged over 50 years. Previous studies suggest a minority will consult their general practitioner (GP) about it. One reason might be the relatively low priority given to this problem in the context of multi-morbidity.

Adults aged over 50 years, registered with three local general practices reporting knee pain within the last 12 months, were recruited to an observational cohort. Consultation data were reviewed for the three-year period following study entry. All knee-related consultations, including those for knee osteoarthritis (OA), were identified. Contacts for non-knee-related morbidity were also identified. Consultation patterns were summarized as incidence rates using exact person–time and cumulative incidences.

Seven hundred and forty-two people (mean age 65.5 years (SD 8.6); 54% female) were included and provided 1917 person–years of observation. The rate of knee-related consultations was 38.5 per 100 person–years (95% CI 35.8, 41.3), of knee OA consultations 10.6 (9.2, 12.1), and of comorbid contacts 790.6 (778.0, 803.3). The cumulative incidence of knee-related consultation at three years was 41.0%. Knee-related consultation was related to severity of knee pain but almost 50% with high levels of pain intensity did not visit the GP about their knee problem. Contrastingly, within six months of study entry 85.6% of participants had contacted the practice about other comorbid illness (predominately circulatory disease or other musculoskeletal complaints). By three years, 99.6% participants had consulted about comorbid illness. Incidence rates for knee-related consultations and comorbid contacts were associated with the relative importance the patient gave to their knee problem. For every knee-related consultation there were 20 comorbid contacts. There is considerable scope for opportunistic care of knee pain and for further research on how patients and GPs prioritize health conditions in the context of multi-morbidity.

This paper explores the impact of space and time on interprofessional teamwork in three primary health care centres and the implications for Canadian and other primary health care reform.

Primary health care reform in Canada has emphasized the creation of interprofessional teams for the delivery of collaborative patient-centred care. This involves the expansion and transformation of existing primary health care centres into interprofessional family health teams (FHT) promising to provide patients better access, more comprehensive care, and improved utilization of individual health professionals. Benefits for providers include improved workplace satisfaction and organizational efficiencies. Currently, there is little evidence for how effective interprofessional teamwork happens and little is known about how to create high-functioning teams in the primary health care setting.

We used ethnographic observations and interviews to gain a deep understanding of the nature of interprofessional teamwork. Three academic family health centres participated in a total of 139 h of observation and 37 interviews. Team members in all three centres from the disciplines of medicine, nursing, physiotherapy, occupational therapy, social work, dietetics, pharmacy, and office administration participated in this study.

We found that both the quantity and quality of interprofessional communication and collaboration in primary health care is significantly impacted by space and time. Across our research sites, the physical layout of clinical space and the temporal organization of clinical practice led to different approaches to, and degrees of success with, interprofessional teamwork. Varied models of interprofessional collaboration resulted when these factors came together in different ways. These findings have important implications for the transition to interprofessional family health teams in Canada and beyond.