• Ethnic differences in risk factors for adverse birth outcomes between Pakistani, Bangladeshi, and White British mothers

      Garcia, Rebecca; Ali, Nasreen; Guppy, Andrew; Griffiths, Malcolm; Randhawa, Gurch (Blackwell Publishing Ltd, 2019-09-30)
      Aim: Reducing poor maternal and infant outcomes in pregnancy is the aim of maternity care. Adverse health behaviours lead to increased risk and can adversely mediate birth outcomes. This study examines whether risk factors are similar, different, or clustered according to maternal ethnicity. Design: Retrospective analysis of routinely collected data (2008−2013). Methods: We analysed data routinely collected data from a local University Hospital Ciconia Maternity information System (CMiS), for White British, Pakistani, and Bangladeshi women (N = 15,211) using cross-tabulations, ANCOVA, adjusted standardized residuals (ASR), and Pearson's chi-squared statistics. Results: The results demonstrate distinct clusters of risk factors between White British, Pakistani, and Bangladeshi mothers. Additionally, Pakistani mothers had the highest number of statistically significant risk factors, according to maternal ethnicity, showing that 49% of women in this cohort that were diagnosed with diabetes were Pakistani, 21.5% of White British women smoked and results showed that Bangladeshi mothers delivered the lightest weight infants (adjusted mean: 3,055.4 g). Conclusions: This study showed differences in the risk factors between White British, Pakistani, and Bangladeshi mothers. The identified risk factors were clustered by maternal ethnicity. Impact: Identification of these risk factor clusters can help policymakers and clinicians direct resources and may help reduce ethnic variation found in these populations that might be attributed to adverse health behaviours and increased risk factors.
    • The prescribing needs of community practitioner nurse prescribers: a qualitative investigation using the theoretical domains framework and COM-B.

      Chater, Angel M.; Williams, Jane; Courtenay, Molly; University of Bedfordshire; University College London; Cardiff University (Wiley, 2019-08-18)
      With several qualified community practitioner nurse prescribers (CPNPs) not prescribing, this research aimed to understand what influences this behaviour. A qualitative research design. Semi-structured interviews, based on the theoretical domains framework (TDF) were conducted with 20 CPNPs. Data collection took place between March-July 2018 and continued until data saturation was reached. Nine themes inductively explained prescribing behaviour: 1) 'Knowledge and experience'; 2) 'Consultation and communication skills'; 3) 'Professional confidence and identity'; 4) 'Wanting the best outcome'; 5) 'NHS versus patient cost'; 6) 'Emotion-led decisions'; 7) 'Time allocation'; 8) 'Formulary access' and 9) 'Supporting environment for patient-centred care'. Themes were then deductively mapped to the TDF and COM-B. There is an ongoing need to support community practitioner nurse prescribers' 'Capability' to prescribe in terms of knowledge and aquired skills; 'Opportunity' to make prescribing easier, such as access to a wider and up to date nurse formulary alongside effective clinical support; and 'Motivation' to feel confident in prescribing behaviour, highlighting positive patient outcomes while reducing perceived issues such as cost and non-adherence. Findings show that Capability, Opportunity and Motivation all influence the decision to prescribe. Those responsible for professional regulation and training should ensure community practitioner nurse prescribers have access to the relevant knowledge, skills and formulary to facilitate their prescribing behaviour. Professional confidence and identity as a prescriber should be encouraged, with acknowledgment of influences such as cost and emotion. An environment that allows for patient-centred care and the best outcome should be supported, this may mean increasing time allocated to consultations. AIM DESIGN METHODS RESULTS CONCLUSION IMPACT