Search results

Many patients referred by their GP for an assessment by secondary mental health services are unlikely to ever meet eligibility thresholds for specialist treatment and support. A new service was developed to support people in primary care. “the authors evaluate” whether the phased introduction of the Lambeth Living Well Network (LWN) Hub to a population in south London led to: a reduction in the overall volume of patients referred from primary care for a secondary mental health care assessment; and an increase in the proportion of patients referred who met specialist service eligibility criteria, as indicated by the likelihood of being accepted in secondary care.

The evaluation applied a quasi-experimental interrupted time series design using electronic patient records data for a National Health Service (NHS) provider of secondary mental health services in south London.

Scale-up of the Hub to the whole of the population of Lambeth led to an average of 98 fewer secondary care assessments per month (95% CI −118 to −78) compared to an average of 203 assessments per month estimated in the absence of the Hub; and an absolute incremental increase in the probability of acceptance for specialist intervention of 0.20 (95% CI; 0.14 to 0.27) above an average probability of acceptance of 0.57 in the absence of the Hub.

Mental health outcomes for people using the service and system wide-service impacts were not evaluated preventing a more holistic evaluation of the effectiveness and cost-effectiveness of the LWN Hub.

Providing general practitioners with access to service infrastructure designed to help people whose needs cannot be managed within specialist mental health services can prevent unnecessary referrals into secondary care assessment teams.

Reducing unnecessary referrals through provision of a primary-care linked mental health service will reduce delay in access to professional support that can address specific mental-health related needs that could not be offered within the secondary care services and could prevent the escalation of problems.

The authors use NHS data to facilitate the novel application of a quasi-experimental methodology to deliver new evidence on whether an innovative primary care linked mental health service was effective in delivering on one of its key aims.

This study aims to co-develop a Frailty, Health and Care Needs Assessment (FHCNA) questionnaire for people experiencing homelessness and explore the feasibility of its use by non-clinical staff in homeless hostels.

The FHCNA, aimed at identifying frailty and other health and care priorities for people experiencing homelessness, was co-designed in workshops (online and in person) with homelessness and inclusion health staff. Its feasibility was tested by staff and their clients in two hostels, with pre- and post-study focus groups held with hostel staff to gain input and feedback.

The FHCNA was co-developed and then used to collect 74 pairs of resident and key worker inputted data (62% of eligible hostel residents). The mean age of clients was 48 years (range 22–82 years). High levels of unmet need were identified. Over half (53%) were identified as frail. Common concerns included difficulty walking (46%), frequent falls (43%), chronic pain (36%), mental health issues (57%) and dental concerns (50%). In total, 59% of clients reported difficulty in performing at least one basic activity of daily living, while only 14% had undergone a Care Act Assessment. Hostel staff found using the FHCNA to be feasible, acceptable and potentially useful in facilitating explorations of met and unmet health and social care needs of hostel clients. By identifying unmet needs, the FHCNA has the potential to support staff to advocate for access to health and social care support.

To the best of the authors’ knowledge, this is the first study to co-develop and feasibility test a questionnaire for use by non-clinically trained staff to identify frailty and other health and care needs of people experiencing homelessness in a hostel setting.

While it is essential to further research the growing diversity in western metropolitan cities, little is currently known about how the members of various ethnic communities acculturate to multicultural societies. The purpose of this paper is to explore immigrants’ cosmopolitanism and acculturation strategies through an analysis of the food consumption behaviour of ethnic consumers in multicultural London.

The study was set within the socio-cultural context of London. A number of qualitative methods such as in-depth interviews, observation and photographs were used to assess consumers’ acculturation strategies in a multicultural environment and how that is influenced by consumer cosmopolitanism.

Ethnic consumers’ food consumption behaviour reflects their acculturation strategies, which can be classified into four groups: rebellion, rarefaction, resonance and refrainment. This classification demonstrates ethnic consumers’ multi-directional acculturation strategies, which are also determined by their level of cosmopolitanism.

The taxonomy presented in this paper advances current acculturation scholarship by suggesting a multi-directional model for acculturation strategies as opposed to the existing uni-directional and bi-directional perspectives and explicates the role of consumer cosmopolitanism in consumer acculturation. The paper did not engage host communities and there is hence a need for future research on how and to what extent host communities are acculturated to the multicultural environment.

The findings have direct implications for the choice of standardisation vs adaptation as a marketing strategy within multicultural cities. Whilst the rebellion group are more likely to respond to standardisation, increasing adaptation of goods and service can ideally target members of the resistance and resonance groups and more fusion products should be exclusively earmarked for the resonance group.

The paper makes original contribution by introducing a multi-directional perspective to acculturation by delineating four-group taxonomy (rebellion, rarefaction, resonance and refrainment). This paper also presents a dynamic model that captures how consumer cosmopolitanism impinges upon the process and outcome of multi-directional acculturation strategies.

The purpose of this paper is to assess frailty, geriatric conditions and multimorbidity in people experiencing homelessness (PEH) using holistic evaluations based on comprehensive geriatric assessment (CGA) and draw comparisons with general population survey data.

Cross-sectional observational study conducted in a London-based hostel for single PEH over 30 years old in March–April 2019. The participants and key workers completed health-related questionnaires, and geriatric conditions were identified using standardised assessments. Frailty was defined according to five criteria in Fried’s phenotype model and multimorbidity as the presence of two or more long-term conditions (LTCs). Comparisons with the general population were made using data from the English Longitudinal Study of Ageing and the Health Survey for England.

A total of 33 people participated with a mean age of 55.7 years (range 38–74). Frailty was identified in 55% and pre-frailty in 39%. Participants met an average of 2.6/5 frailty criteria, comparable to 89-year-olds in the general population. The most common geriatric conditions were: falls (in 61%), visual impairment (61%), low grip strength (61%), mobility impairment (52%) and cognitive impairment (45%). All participants had multimorbidity. The average of 7.2 LTCs (range 2–14) per study participant far exceeds the average for even the oldest people in the general population.

To the best of authors’ knowledge, this is the first UK-based study measuring frailty and geriatric conditions in PEH and the first anywhere to do so within a CGA-type evaluation. It also demonstrates the feasibility of conducting holistic evaluations in this setting, which may be used clinically to improve the health outcomes for PEH.

A decline in participation in research studies as people age is inevitable as health declines. This paper aims to address this by collecting data from a group of participants to examine their reasons for declining attendance and suggestions for maintaining attendance as participants age.

This research used a postal self-completed questionnaire including open and closed questions. The questionnaire was sent to those participants who have declined to attend further clinic visits. Results were analysed using thematic content analysis.

The study had a 51% response rate. Participants reported difficulty with travelling to the clinic, and health as the main issues in addition to family demands and a lack of understanding regarding the continuing participation of a singleton twin.

This study could only include data from responding participants, answers to open question also included comments from participants regarding their twin.

An anonymous questionnaire was sent to all individuals in the Keeping Together project. It was therefore not possible to identify if responses were from both members of a twin pair.

Maintaining participation in longitudinal studies is of crucial importance to enhance the value of data. Retention of participants in studies may change as people age and health becomes impaired. Suggestions for maintaining and improving the retention of older participants have been identified and are generalisable to other longitudinal studies of ageing.

The purpose of this paper is to introduce an empirical model for house price spillovers between real estate markets. The model is presented by using data from the US-UK and London-New York housing markets over a period of 1975Q1-2016Q1 by employing both static and dynamic methodologies.

The research analyzes long-run static and dynamic spillover elasticity coefficients by employing three methods, namely, autoregressive distributed lag, the fully modified ordinary least square and dynamic ordinary least squares estimator under a Kalman filter approach. The empirical method also investigates dynamic correlation between the house prices by employing the dynamic control correlation method.

The paper shows how a dynamic spillover pricing analysis can be applied between real estate markets. On the empirical side, the results show that country-level causality in housing prices is running from the USA to UK, whereas city-level causality is running from London to New York. The model outcomes suggest that real estate portfolios involving US and UK assets require a dynamic risk management approach.

One of the findings is that the dynamic conditional correlation between the US and the UK housing prices is broken during the crisis period. The paper does not discuss the reasons for that break, which requires further empirical tests by applying Markov switching regime shifts. The timing of the causality between the house prices is not empirically tested. It can be examined empirically by applying methods such as wavelets.

The authors observed a unidirectional causality from London to New York house prices, which is opposite to the aggregate country-level causality direction. This supports London’s specific power in the real estate markets. London has a leading role in the global urban economies residential housing markets and the behavior of its housing prices has a statistically significant causality impact on the house prices of New York City.

The house price co-integration observed in this research at both country and city levels should be interpreted as a continuity of real estate and financial integration in practice.

The paper is the first research which applies a dynamic spillover analysis to examine the causality between housing prices in real estate markets. It also provides a long-term empirical evidence for a dynamic causal relationship for the global housing markets.

The purpose of this paper is to explore factors affecting implementing the National Institute for Health and Care Excellence (NICE) quality standard on alcohol misuse (QS11) and barriers and facilitators to its implementation.

Qualitative interview study analysed using directed and conventional content analyses. Participants were 38 individuals with experience of commissioning, delivering or using alcohol healthcare services in Southwark, Lambeth and Lewisham.

QS11 implementation ranged from no implementation to full implementation across the 13 statements. Implementation quality was also reported to vary widely across different settings. The analyses also uncovered numerous barriers and facilitators to implementing each statement. Overarching barriers to implementation included: inherent differences between specialist vs generalist settings; poor communication between healthcare settings; generic barriers to implementation; and poor governance structures and leadership.

QS11 was created to summarise alcohol-related NICE guidance. The aim was to simplify guidance and enhance local implementation. However, in practice the standard requires complex actions by professionals. There was considerable variation in local alcohol commissioning models, which was associated with variation in implementation. These models warrant further evaluation to identify best practice.

Little evidence exists on the implementing quality standards, as distinct from clinical practice guidelines. The authors present direct evidence on quality standard implementation, identify implementation shortcomings and make recommendations for future research and practice.

This paper aims at exploring the relations amongst the concepts of customer relationship management (CRM), convenience, trust, perceived service quality, satisfaction, perceived value, loyalty, image and purchase intention in the hotel sector.

The research was conducted using interviews with hospitality managers and guests who had a direct connection with the hotel industry. According to the qualitative study results and literature review, the authors designed a model that was examined via structural equation modelling and fuzzy set qualitative comparative analysis.

This paper presents a conceptual framework that enhances existing research in the field of study, as it was implemented to measure the antecedent and consequences of perceived service quality. Based on the results from New York and London, the authors found that CRM and convenience have significant impact on perceived service quality. Interestingly, the aggregated data illustrate the negative relationship between image, loyalty and purchase intention.

The approach used by this study is partially in line with previous theoretical analyses and shows appealing patterns in international service quality perception. Besides, the paper adds insights into the realm, linking together different dimensions in order to reach an in-depth understanding and complex analysis of each item that affects and is affected by perceived service quality in the hotel industry.

The Mental Wellbeing Impact Assessment (MWIA) is an evidence-based tool that guides decision makers, such as policy makers and service managers, about the potential impacts of a new programme or policy change. It was initially used in urban regeneration but has subsequently been used in housing, children’s centres and education. The purpose of this paper is to report, for the first time, on the strengths and weaknesses of using the MWIA in the workplace.

Feedback was collected from staff who participated in stakeholder workshops as part of the MWIA process at two different public sector organisations.

The MWIA can be used as an effective workplace assessment tool and is valuable as both a diagnostic tool and as an intervention in its own right. The MWIA generates tailored action plans focussed on addressing the organisation or team-specific issues. The weaknesses of the MWIA in the workplace are mainly focussed around management cooperation and commitment to the process which should be screened for prior to engaging in the full stakeholder workshop.

This is the first report of MWIA’s use in the workplace but suggests that it is a useful tool which can be used to support workplace wellbeing, especially in relation to a policy or organisational change. Further studies should be carried out to fully understand the impact of the MWIA in the workplace.