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author:("Pill, raisin")
1.  Qualitative study of views of health professionals and patients on guided self management plans for asthma 
BMJ : British Medical Journal  2000;321(7275):1507-1510.
Objectives
To explore the views held by general practitioners, practice nurses, and patients about the role of guided self management plans in asthma care.
Design
Qualitative study using nine focus groups that each met on two occasions.
Setting
South Wales.
Subjects
13 asthma nurses, 11 general practitioners (six with an interest in asthma), and 32 patients (13 adults compliant with treatment, 12 non-compliant adults, and seven teenagers).
Results
Neither health professionals nor patients were enthusiastic about guided self management plans, and, although for different reasons, almost all participants were ambivalent about their usefulness or relevance. Most professionals opposed their use. Few patients reported sustained use, and most felt that plans were largely irrelevant to them. The attitudes associated with these views reflect the gulf between the professionals' concept of the “responsible asthma patient” and the patients' view.
Conclusions
Attempts to introduce self guided management plans in primary care are unlikely to be successful. A more patient centred, patient negotiated plan is needed for asthma care in the community.
PMCID: PMC27554  PMID: 11118179
2.  Qualitative study of decisions about infant feeding among women in east end of London 
BMJ : British Medical Journal  1999;318(7175):30-34.
Objective
To improve understanding of how first time mothers who belong to a socioeconomic group with particularly low rates of breast feeding decide whether or not to initiate breast feeding.
Design
Qualitative semistructured interviews early in pregnancy and 6-10 weeks after birth.
Setting
Women’s homes in east end of London.
Subjects
21 white, low income women expecting their first baby were interviewed mostly at home, often with their partner or a relative. Two focus groups were conducted.
Results
Women who had regularly seen a relative or friend successfully breast feed and described this experience positively were more confident about and committed to breast feeding. They were also more likely to succeed. Exposure to breast feeding, however, could be either a positive or a negative influence on the decision to breast feed, depending on the context. Women who had seen breast feeding only by a stranger often described this as a negative influence, particularly if other people were present. All women knew that breast feeding has health benefits. Ownership of this knowledge, however, varied according to the woman’s experience of seeing breast feeding.
Conclusions
The decision to initiate breast feeding is influenced more by embodied knowledge gained from seeing breast feeding than by theoretical knowledge about its benefits. Breast feeding involves performing a practical skill, often with others present. The knowledge, confidence, and commitment necessary to breast feed may be more effectively gained through antenatal apprenticeship to a breastfeeding mother than from advice given in consultations or from books.
Key messagesWomen who have seen successful breast feeding as part of their daily lives and perceive this as a positive experience are more likely to initiate breast feedingEmbodied knowledge gained through seeing breast feeding may be more influential than theoretical knowledge about the health benefits for women of lower social classListening to pregnant women talking about breast feeding could help clinicians assess the relative importance of theoretical and embodied knowledge for each womanWomen hoping to breast feed but with little exposure to breast feeding may benefit from an antenatal apprenticeship with a breastfeeding motherIdeally apprenticeship would be with a breastfeeding mother from her social network to minimise the potential barriers of embarrassment and lack of confidence with strangers
PMCID: PMC27674  PMID: 9872883
3.  Understanding the culture of prescribing: qualitative study of general practitioners’ and patients’ perceptions of antibiotics for sore throats 
BMJ : British Medical Journal  1998;317(7159):637-642.
Objectives: To better understand reasons for antibiotics being prescribed for sore throats despite well known evidence that they are generally of little help.
Design: Qualitative study with semi-structured interviews.
Setting: General practices in South Wales.
Subjects: 21 general practitioners and 17 of their patients who had recently consulted for a sore throat or upper respiratory tract infection.
Main outcome measures: Subjects’ experience of management of the illness, patients’ expectations, beliefs about antibiotic treatment for sore throats, and ideas for reducing prescribing.
Results: Doctors knew of the evidence for marginal effectiveness yet often prescribed for good relationships with patients. Possible patient benefit outweighed theoretical community risk from resistant bacteria. Most doctors found prescribing “against the evidence” uncomfortable and realised this probably increased workload. Explanations of the distinction between virus and bacterium often led to perceived confusion. Clinicians were divided on the value of leaflets and national campaigns, but several favoured patient empowerment for self care by other members of the primary care team. Patient expectations were seldom made explicit, and many were not met. A third of patients had a clear expectation for antibiotics, and mothers were more likely to accept non-antibiotic treatment for their children than for themselves. Satisfaction was not necessarily related to receiving antibiotics, with many seeking reassurance, further information, and pain relief.
Conclusions: This prescribing decision is greatly influenced by considerations of the doctor-patient relationship. Consulting strategies that make patient expectations explicit without damaging relationships might reduce unwanted antibiotics. Repeating evidence for lack of effectiveness is unlikely to change doctors’ prescribing, but information about risk to individual patients might. Emphasising positive aspects of non-antibiotic treatment and lack of efficacy in general might be helpful.
Key messages Doctors know that antibiotics do not help most sore throat sufferers but try not to jeopardise relationships with patients over this issue Patients’ expectations are seldom explicit, and satisfaction is not necessarily related to receiving an antibiotic: information and reassurance are sometimes more important Consulting techniques that make expectations explicit, preserve relationships, and facilitate acceptable management are important Opportunities for empowering patients who are not acutely ill could be better used, and emphasising positive aspects of non-antibiotic treatment, especially in children, could be fruitful Risks to individuals from unnecessary antibiotics (rather than trial evidence for marginal benefit) should be emphasised
PMCID: PMC28658  PMID: 9727992
4.  Qualitative study of patients’ perceptions of doctors’ advice to quit smoking: implications for opportunistic health promotion 
BMJ : British Medical Journal  1998;316(7148):1878-1881.
Objectives: To determine the effectiveness and acceptability of general practitioners’opportunistic antismoking interventions by examining detailed accounts of smokers’ experiences of these.
Design: Qualitative semistructured interview study.
Setting: South Wales.
Subjects: 42 participants in the Welsh smoking intervention study were asked about initial smoking, attempts to quit, thoughts about future smoking, past experiences with the health services, and the most appropriate way for health services to help them and other smokers.
Results: Main emerging themes were that subjects already made their own evaluations about smoking, did not believe doctors’ words could influence their smoking, believed that quitting was down to the individual, and felt that doctors who took the opportunity to talk about smoking should focus on the individual patient. Smokers anticipated that they would be given antismoking advice by doctors when attending for health care; they reacted by shrugging this off, feeling guilty, or becoming annoyed. These reactions affected the help seeking behaviour of some respondents. Smokers were categorised as “contrary,” “matter of fact,” and “self blaming,” depending on their reported reaction to antismoking advice.
Conclusions: Doctor-patient relationships can be damaged if doctors routinely advise all smokers to quit. Where doctors intervene, a patient centred approach—one that considers how individual patients view themselves as smokers and how they are likely to react to different styles of intervention—is the most acceptable.
Key messages Many patients who smoke are sceptical about the power of doctors’ words to influence smoking since most know about the dangers, make their own evaluations, and feel that quitting is down to the individual Opportunistic antismoking interventions should be sympathetic, not preaching, and centred on the patient as an individual Repeated ritualistic intervention on the part of doctors may deter patients from seeking medical help when they need it Smokers can be categorised as “contrary,” “matter of fact,” or “self blaming” in their reaction to antismoking advice Doctors can tailor their approach according to the type of patient
PMCID: PMC28587  PMID: 9632409
5.  General practitioners' use of written materials during consultations 
Russell et al have shown that the compliance of patients can be enhanced by general practitioners' providing them with written materials.' We examined what educational materials for patients were used by general practitioners and where the materials came from.
PMCID: PMC2546296  PMID: 3129070
6.  Invitation to attend a health check in a general practice setting: comparison of attenders and non-attenders 
A sample of 1570 men and women aged 20-45 years registered with an inner-city Cardiff practice were offered the opportunity by their general practitioner to have a health check at the surgery. The demographic characteristics, attitudes, beliefs and preventive health behaviour and past contact with the practice were compared for a sample of 259 non-attenders and 216 attenders. The results showed that attenders were generally better educated, better motivated to look after their health, had fewer ties and commitments, performed more healthapproved practices, had had more recent contact with their own practice and accepted the legitimacy of a general practitioner's interest in his patients' lifestyle. Offering cohorts of patients additional screening services is unlikely to be efficient or effective since it is the low-risk people already known to the doctor who are most likely to attend. The onus lies on primary health care to provide services in a way which permits appropriate screening of the high-risk groups as they attend for other reasons.
PMCID: PMC1711284  PMID: 3204565
7.  Invitation to attend a health check in a general practice setting: the views of a cohort of non-attenders 
Two hundred and fifty-nine men and women aged 20-45 years who did not respond to an offer from their general practitioner for a health check were interviewed at home to explore the reasons for non-response. There was no support for the view that the invitation aroused anxiety or that the administrative arrangements had been a barrier to acceptance. Many subjects were not really interested (44%) or just forgot to attend (24%). Crises at work or home (26%) and current attendance at a doctor (16%) were other reasons offered, while 11% felt screening to be in appropriate. There is little that can be done to change these rates except by a shift of public opinion to more consumer demand for health checks or by more opportunistic health checks when people attend their doctors for other reasons. The dangers of marketing health checks to increase consumer demand are discussed in the light of these findings and other work.
PMCID: PMC1711246  PMID: 3204566

Results 1-7 (7)