SCOTT PORTER Research & Marketing The Resource Needs of Primary Care Teams in Supporting Youth...

SCOTT PORTER

Research & Marketing

The Resource Needs of Primary Care Teams in Supporting

Youth Friendly ServicesFinal research debrief

Prepared for:NHS Health Scotland and Fast Forward

Woodburn HouseCanaan Lane, EDINBURGH

Sept 2007

2 SCOTT Porter

Presentation format

Background

The Service Provision Context

Existing Service Provision

Perceptions and Attitudes towards Youth Relevant Provision

Perceived Information and Resource Requirements

Considerations for Resource Development

Conclusions and Recommendations

Background

4 SCOTT PORTER

Background to research

Walk the Talk aims to reduce health inequalities in young people’s health and service provision supporting the development of relevant health services for young people aged 14 – 25.

Various studies have indicated a variety of barriers faced by young people in accessing mainstream services.

Research was commissioned by HS and Fast Forward to understand how to effectively meet the needs of mainstream service providers in order to achieve more youth friendly services.

5 SCOTT PORTER

Objectives

To identify the guidance and information support needs of primary care practitioners in enabling them to provide more youth friendly services.

Exploring the range and type of resources needed to most effectively support their work.

Gaining insight into their experiences and perspectives on the issues faced by young people accessing services, and any areas of best practice, in order to inform the development of such resources.

6 SCOTT PORTER

Methodology

A dual qualitative-quantitative methodology set out to explore and understand the issue,

and measure prevalence of opinion.

Qualitative phase

face to face depths, paired discussions, triads and mini groups – with the format

varied according to the availability of the target audience.

each session was 1 - 1 ½ hours in duration.

Quantitative phase

online survey disseminated via professional associations

Royal College of General Practitioners (RCGP)

Royal College of Nursing (RCN)

Royal Pharmaceutical Society (RPS)

Practice Manager’s Association (PMA)

Scottish Practice Nurses Association (SPNA)

Assoc. of Medical Secretaries, Practice Administrators & Receptionists (AMSPAR)

7 SCOTT PORTER

Sample

The audience included a range of primary care health professionals

Practice staff

GPs

Practice nurses

Practice managers

Practice receptionists

Community Pharmacists.

8 SCOTT PORTER

Qualitative phase

The sample was drawn from a range of locations focusing on urban, rural

and semi-rural areas of affluent and mid to high deprivation

Glasgow, Dundee and Tayside, Forth Valley and Dumfriesshire.

Respondents were screened on a battery of questions to ensure a mix of

‘youth friendly’ service provision across the sample.

Fieldwork was conducted in June 2007.

9 SCOTT PORTER

Qualitative sample composition

URBAN

Glasgow and Dundee

SEMI-RURAL

Forth Valley and Tayside

RURAL

Dumfriesshire

GPs 6 x depths 2 x depths 2 x depths

Practice nurses

2 x mini groups 1 x mini group 2 x paired depths

Practice managers

1 x triad - 2 x paired depths

Practice receptionists

1 x mini group 1 x mini group -

Community pharmacists

2 x paired depths 1 x mini group -

The qualitative sample structure achieved was as follows:

10 SCOTT PORTER

Quantitative phase

The online survey was publicised via various means

e-bulletins

emailed to individuals or cascaded via professional networks

website

trade magazine (RCGP’s ‘Hoolet’)

A staged approach to disseminating the survey was adopted to

accommodate publishing deadlines.

The survey was live from the 2nd July to 17th August 2007, with 395

responses achieved overall.

11 SCOTT PORTER

Quantitative sample composition

Total

395

%

OCCUPATION GPs 12

Practice Nurses 31

Practice Manager 42

Practice Receptionist 1

Community Pharmacist 8

Other professional 6

ASSOC. MEMBERSHIP RCGP 8

RCN 31

PMA 8

RPS 11

SPNA 11

AMSPAR 6

NPA 4

Other/ not stated 42

Quantitative sample by NHS region

Western Isles (1%)

Highland & Argyll (11%)

Grampian (3%)

Orkney (1%)

Shetland (2%)

Tayside (6%)

Fife (6%)

Lothian (15%)

Borders (1%)

Dumfries & Galloway

(6%)

Lanarkshire (8%)Ayrshire &

Arran (10%)

Glasgow & Clyde (22%)

Forth Valley (9%)

Source: Q1

Base: all respondents (n=395)

13 SCOTT PORTER

Quantitative sample composition

Total

395

%

PROPORTION OF 14 TO 25 YR OLDS ON ROSTER

Low (25% plus) 7

Medium (10 – 24%) 65

High (10% less) 17

Don’t know 11

REGULAR INTERNET ACCESS Yes 95

No 2

Not stated 3

Source: Q4

Source: Q5

The service provision context

15 SCOTT PORTER

Young people’s access to primary healthcare services

Claims that young people more aware of general health issues/ concerns

education in schools and public campaigns

influence from the media.

in addition to positive reports that public health initiatives have increased traffic from young people on sexual health issues

particularly with chlamydia testing.

16 SCOTT PORTER

Despite this, professionals reported a low penetration of young people using mainstream primary care services, particularly noticeable with teenagers aged 14 – 18 and young men.

It was felt that practices and pharmacies were not the preferred ‘first port of call’ for young people due to limited perception of the range of services practices offered a perception of a ‘formal’ and less accessible environment compared to more relaxed

youth service settings and a lack of trust surrounding confidentiality

some recognised that young people required added reassurance an additional barrier for those in small or rural communities, where practitioner

and other staff members are integrated into the community.

“It might be someone else’s mum handing [the prescription] to them”

[Practice receptionist


17 SCOTT PORTER

Experiences of young people accessing services were often tinged with frustration in terms of:

delayed access – often in an emergency

poor negotiation of appointment systems

difficulties with establishing rapport

poor communication of their needs

repeated risky behaviour.


18 SCOTT PORTER

Thus there was minimal exposure to young people in the primary care setting

with the effect of lower consideration of their needs, particularly where they represented a minority proportion of the practice population.

“Because you don’t see young people as much, they aren’t on the radar as much as they could be.”

[Practice Nurse]

The overall evidence suggests this may contribute to a lack of awareness among professionals of their knowledge gaps in meeting young people’s needs.


19 SCOTT PORTER

Experience of young people- Practice setting -

Reports from colleagues are that GPs tend to be regarded as distant authority figures by young people, compared to nurses

contributing to a heightened awareness of consulting room time constraints

patients wary of wasting doctor’s time.

Even with the best intentions, consulting room time pressures can result in a reluctance from the GP to probe further beyond reason for initial visit.

Most GPs claim good rapport with young people -

however, criticisms from colleagues of some GPs being ‘out of touch’ with young people and with a inappropriate ‘bedside manner’ suggests that GPs can be over-confident and unaware they are not fully meeting young people’s needs.

20 SCOTT PORTER


Nurses deemed more approachable:

less formal consulting room setting facilitates easier rapport

e.g. first name terms, informal dress

slightly longer consultations & perception of more relaxed time constraints by patient

opportunities afforded for discussing or eliciting a wider variety of issues not related to the specific visit

e.g. new patient registrations, Wellwoman clinics.

Indications are that nurses are particularly confident and at ease with breaking down practitioner-patient barriers and initiating discussion on sensitive issues

but good intentions to draw out patients on more complex issues often thwarted by time constraints

with real reasons for visit often not revealed until end of consultation!

21 SCOTT PORTER


“Quite often the doctors – their attitude is what they come in with and don’t ask any questions…but not all of them”

[Practice Manager]“It’s a big problem trying to care

when you are always watching the clock”

[GP]

“We don’t make ever make them feel we’re rushing them out the door”

“Doctors don’t tend to look at patients in a holistic way like we do…nurses are more likely to say, ‘is there something you need to tell me about?’

[Practice Nurses]

22 SCOTT PORTER

Experience of young people- Community setting -

Pharmacists seemed keen to embrace their wider health promotions remit and advisory role.

Often welcome young people requesting advice on contraception and STI’s

more accessible than GPs

no appointments required

fewer time constraints

a discrete option.

However, acknowledged that existing set-up not conducive to dealing with young people

lack of privacy/ consultation rooms

don’t yet feel fully equipped for consultation role

information requirements desired for more proactive patient advice

welcome guidance on patient handling.

23 SCOTT PORTER

Experience of young people- Community setting -

Furthermore, the general public’s expectations of their role still lagging behind the reality

pharmacists hope minor ailments contract will continue to broaden out perceptions of their role.

In comparison to the adult population, it was felt that young people were less aware of the pharmacists’ broader advisory role

the new health promotions contract was felt by some to be a good opportunity to target young people and make them more aware of the service available.

“Sometimes they come in because they don’t want to go to the GP”

“They’re not really aware of what a pharmacist is there for…they’re afraid of asking something silly”

[Practice Pharmacists]

24 SCOTT PORTER

Experience of young people’s health topic areas

Existing research in this field has highlighted a broad range of unmet needs faced by young people ranging from acne, appearance related and family concerns, mental health, alcohol, smoking to family planning and sexual health.

Other than general medical issues, the culture of young people’s health appears to be dominated by family planning and sexual health, as this is where practitioners have greatest exposure

the only area where health promotion, identification, and treatment fully converge in terms of perceived relevance to the primary care practitioner’s role

the most common and unstated benchmark for assessing one’s ‘youth friendliness’.

25 SCOTT PORTER


With the exception of pharmacists, GPs and nurses claimed confidence and skill in putting young patients at ease and dealing with their concerns through direct intervention or referral.

Practitioner's ability and awareness depended on a number of factors: length of professional experience and skill/confidence in patient

handling regularity of professional exposure to young people and variety/ type of

issues degree of empathy and understanding of young people

e.g. through experience of working with young people and/or being a parent of children in the target age group

training or experience in a specialist health topic area the potential seriousness and sensitivity of the issue (e.g. sexual

abuse).

“You get an impression that someone comes in with a problem they don’t want to discuss…but you don’t want to pry.”

[GP]

26 SCOTT PORTER

Health topic areas can be broadly divided into three levels based on practitioners’ regularity of exposure and familiarity


Outer layers indicate less exposure and

understanding

moving away from perceived core remit of

practitioners.

Peripheral layers more associated with

unidentified knowledge gaps and

information needs.

STI’s

teen pregnancy

contraception & family planning

acne

general health concerns/ illnesses

smoking cessation

mental healthdrug misuse

alcohol misuse

bullying

eating disorders

gender and identity

abuse

27 SCOTT PORTER


The findings suggest that confidence in dealing had some correlation with exposure

for example, those with a higher proportion of young people on their roster reported greater confidence in dealing with mental health and teenage pregnancy.

Claimed confidence across the sample was highest on areas that practitioners were used to dealing with on a regular basis :

Smoking cessation (90% ‘very’/ ‘quite’ confident)

Sexual health and activity (78% ‘very’/ ‘quite’ confident)

Teenage pregnancy (67% ‘very’/ ‘quite’ confident)

Alcohol misuse (60% ‘very’/ ‘quite’ confident).

N.B. Given the relatively low numbers by occupation, breakdown figures have not been provided.

Source: Q8

Base: (n=315)

28 SCOTT PORTER


Lower confidence levels were evident for issues where there was less exposure:

43% very/ quite confident on drug misuse – nurses were significantly less confident than GPS and pharmacists

44% very/ quite confident on mental health – with pharmacists appearing to be least confident on this subject matter.

Whilst there was general recognition that underlying concerns or emotional issues can present as physical ailments, emotional/ mental issues were perceived as requiring a highly specialised intervention that fell outwith the ‘general practitioner’ remit

practitioners have less exposure to issues such as self-harm, eating disorders, depression, gender identity - and therefore confidence can be lower

early identification and handling is less ingrained in their repertoire of skills and as such likely to emerge over a period of consultations, or be flagged up by a family member or colleague.

Existing service provision

30 SCOTT PORTER


There was a mixed appreciation of the barriers young people face in accessing primary care services

the online sample reinforced this with 48% who felt young people faced few barriers with seeking help from accessing primary care services.

Indeed patient audits and surveys provided little evidence to indicate they were not meeting young people’s needs

with the online survey revealing that only a minority (16%) who were directly consulting with young people to determine whether access was an issue and how best to meet their needs.

Source: Q9

Base: (n=391)

Source: Q6

Base: (n=366)

31 SCOTT PORTER


The findings indicated that the level of ‘youth friendly’ services being provided vary significantly with those who provide a greater number of services more likely to have a higher proportion of young people on their patient roster (i.e. 25%+)

The chart overleaf indicates level of service provision ranged from: limited or no consideration of young people’s needs, e.g.

seeing young person without a parent providing contraception services to under 16s

an ad hoc approach taking into account accessibility issues and more specific information needs, e.g.:

special appointment systems targeted information provision (e.g. ‘youth corners’ and Summer holiday

bags with sun cream and safe sex/ drinking advice) health promotion visits to schools

to a more structured, holistic approach, among the minority, where service has been tailored or reorganised around young people’s needs:

consulting with young people on their service needs longer consultations opening a drop-in clinic.

Level of ‘Youth friendly’ service provision

Consult with young people on tailored service (15%)

See under 16s without adult (78%)

Special appointment system (23%)

Promote emergency contraception in public areas (42%)

Young persons’ drop-in service (11%)

Provide contraception to young people under 16 (65%)

Display confidentiality policy (59%)

Longer consultations (5%)

Train staff to deal with young people/ relevant issues (18%)

Links with schools/ colleges etc. (22%)

Texting/email service (6%)

Source: Q6

Base: all respondents (n=395)

HOLISTIC

LIMITED

AD HOC

33 SCOTT PORTER

Meeting the needs of young people

However, some disparity between perception and reality was evident:

despite the low level of tailored service provision, the majority (70%) felt their service catered well for the needs of young people as much as other patient groups.

Ownership of the issue also varied:

some appreciated the complementary role primary care services can play in meeting young people’s needs, via provision of ‘discrete’/more convenient alternative to specialist service provision

in other cases, an efficient and well established culture of referral had an effect of diminishing responsibility beyond ‘sign posting’ to services.

furthermore, the pressure of contract work meant there was little incentive among some to explore the issue where young people were not perceived as a priority audience.

The combination of these factors with known barriers among young people (e.g. poor recognition of service offering) serve to compound the lack of provision for this target audience.

(Source: Q7)

Meeting the needs of young people- The service provision gap -

ACCESS BARRIERS(YOUNG PEOPLE)

- reluctance to come forward- poor recognition of service

offering

- not forthcoming about concerns due to

embarrassment and fears over confidentiality

- may have issues in accessing specialist

youth services (trust and stigma)

SERVICE PROVISION BARRIERS(PRIMARY CARE)

- practices are contract focused (YP not priority group)

- limited exposure/experience- little or no evidence to suggest

their service is not meeting needs of YP

- time restraints in consultation may reduce

probing on sensitive issues

- positive culture of referral- specialist services regarded

as more appropriate/ desirable for YP’s needs

Access for young people is not embedded or fully integrated into primary care culture

Perceptions and attitudes towards youth relevant provision

36 SCOTT PORTER

The provision of ‘youth friendly’ services- Attitudinal variations -

Attitudinal variations were evident throughout the research demonstrating a spectrum of awareness and outlook to the barriers young people faced in accessing primary care.

The online survey suggests part of the reason for this may be low awareness of the national picture, with low awareness of the Walk the Talk initiative (74% of the online sample)1

The qualitative research revealed three clear attitudinal segments:

‘Enlightened’

‘Uninitiated’

‘Conscientious Objectors’.

Applying our qualitative understanding of the attitudinal segments and the level of service provision associated with them, we have been able to identify the size of these segments within our online sample population (c.f. chart overleaf).

1 Source: Q13 Base: all respondents (n=395)

37 SCOTT PORTER

The provision of ‘youth friendly’ services- Attitudinal segmentation -

THE UNINITIATED

“You think you’re doing ok and it’s only when you speak to

someone you maybe think - well we’re not doing ok”

CONSCIENTOUS OBJECTORS

“I don’t think GP surgeries is the right place for all this”

• limited appreciation of YP’s needs outside of immediate experience and exposure

• may have some youth relevant provision - but no coherent strategy

• likely to be in areas where specialist provision is already strong

• question what more primary care services can offer beyond referral

THE ENLIGHTENED

“Opening up our service to young adults needs to

be very well directed”

• perceived inadequacies in local service offering and greater recognition of barriers can prompt development of a youth focused strategy

• driven by an individual with strong interest

• benefited directly from other’s experience and expertise

• belief that Primary care is integral to the mix reinforced by successes

•has both exposure and strong interest to the target age group

•personal experience or prompting on issues can lead to further consideration

• held back by barriers and lack of practical experience/ resources

• responsive to ideas for enhancing service offering

•welcome more to enhance their knowledge/understanding

The provision of ‘youth friendly’ services- Segmentation by service provision -

Consult with young people on tailored service provision

See under 16s without an adult

Special appointment system

Promote emergency contraception in public areas

Young persons’ drop-in service

Provide contraception to young people under 16

Display confidentiality policy

Longer consultations

Train staff on young people/ relevant issues

Links with schools/ colleges etc.

Texting/email service

ENLIGHTENED*

UNINITIATED

CONSCIENTIOUS OBJECTORS

* Those counted as ‘Enlightened’ from the online sample have attained 1-3 services within this category

39 SCOTT PORTER

MOTIVATING FORCES gaps in local specialist youth provision

a high youth population with prevalence of specific health concerns e.g.

chlamydia, teen pregnancy, drug/ alcohol misuse driven by a champion with a strong background in youth provision

support from management in terms of time and resources access to influencers with expertise and experience.

HIGHLY TAILORED SERVICE PROVISION

establishing trust and credibility with local youth population

proactive targeting and legitimisation of a broad range of youth relevant concerns (e.g. bullying, bereavement)

‘open door’ access (e.g. drop-in service)

13% of primary care service professionals in our online sample

The provision of ‘youth friendly’ services- The Enlightened -

40 SCOTT PORTER

“I went on the best conference I had [with Walk the Talk]. I so loved it – you were meeting all the different health professionals and you got into these groups and it was just so inspiring and humbling. It was fantastic to find out what works without trying X amount of things as that can be a disaster.”

[‘Enlightened’]

“I think you’ll find in general, GPs are motivated by money.”

[GP ‘Enlightened’]

The provision of ‘youth friendly’ services- The Enlightened -

41 SCOTT PORTER

MOTIVATING FORCES a high youth population compounded by a prevalence of specific health

concerns - e.g. chlamydia, teen pregnancy, drug/ alcohol misuse practice nurses with a strong interest or background in teenage health

good access and support from specialist services

AD HOC SERVICE PROVISION

accessible and targeted information

outreach health promotion activity


The provision of ‘youth friendly’ services- The Uninitiated -

42 SCOTT PORTER

“Advertising would be quite good in raising awareness of the profession as a whole so that when the new [public health initiative] contract comes in, people will be more

aware of what they can go to the pharmacy for.”[Community Pharmacist ‘Uninitiated’]

“I don’t think we would run a young person’s clinic. I think you’re as well fitting them in when they want to come in, rather than say, ‘come to a young person’s

clinic’ which I can imagine no one would go to.”[GP ‘Uninitiated’]

“It has become a tick box mentality having to meet certain targets and having to gather information of a nature we didn’t have to before – checking people’s weight, blood pressure…a lot of time in surgery is now spent managing chronic disease”

[GP ‘Uninitiated’]

The provision of ‘youth friendly’ services- The Uninitiated -

43 SCOTT PORTER

BARRIERS likely to have limited exposure to range of youth health concerns

low knowledge, awareness and understanding of youth mindset and

barriers to access service pressures contribute to low prioritisation of youth audiences

LIMITED SERVICE PROVISION

little or no allowances made for youth population

reactive approach to provision

Here we have so much access to other agencies that it’s not an issue.

[GP ‘Conscientious objector’]


The provision of ‘youth friendly’ services- The Conscientious Objectors -

44 SCOTT PORTER

‘Youth friendly’ accreditation

Receptiveness to steps that can be taken at the national level to overcome the issue also varied across the segments, with mixed reactions to the idea of accreditation on service provision emerging from the online survey:

whilst 38% were in favour overall1 interest was highest among those most aware of service provision gaps2

52% ‘Enlightened’, 40% ‘Uninitiated’ vs 28% ‘Conscientious objectors’.

Where reservations were expressed, this was in response to a perceived overemphasis by the NHS on an ‘assessment’ culture

almost half the sample (48%) ‘unsure’ of the benefits proffered to their service with doubts expressed in the qualitative research as to its a profile among young people.

56% ‘Conscientious objectors’ vs 46% ‘Uninitiated’ and 35% ‘Enlightened’.

Should it be introduced, it was felt that accreditation criteria needed to be achievable to encourage uptake by services.

1 Source: Q12 Base: all respondents (n=395) 2 Base: all those within each attitudinal segment

Preferredresource requirements

46 SCOTT PORTER

Preferred resource requirements - Overview -

In the qualitative phase, staff information and guidance needs in this area were rarely top of mind and considered at a spontaneous level. Initial responses were often:

a good idea for new entrants but not for experienced practitioners

and, in eliciting response from young people on sensitive issues, practitioners emphasised need for quality of patient handling skills and time available in consultation.

Rather than directing efforts at professionals, many felt a public campaign to encourage young people into mainstream services was better placed to address the issue.

47 SCOTT PORTER

Preferred resource requirements - Overview -

Pharmacists were more likely to volunteer information and guidance needs due to their increasing advisory and health promotions role and limited consultation experience: receptive to training on soft skills (e.g. establishing rapport, handling sensitive

issues, identification of vulnerable individuals) service relevant information

access/ point of referral/ what is involved to be able to offer advice and added value to patients

child protection issues consultation tools to support patient handling on specific issues e.g. flow charts/

templates.

“I’d like to know what to do with the information because the more we are promoting ourselves as health professionals, the more people will come in”

“Something to help you spot the signs.”

“It’s knowing where to refer and when to refer...it’s good to be able to say, this is what will happen, then they’ll get the same message from the GP.”

[Community Pharmacists]

48 SCOTT PORTER

Preferred resource requirements- Overview -

Experienced GPs tended to be the most resistant to guidance and information on practice and procedure:

often feeling they are given obvious or commonsensical information easily gained from on-the-job experience

wary of being ‘bombarded’ by materials and information - ‘a waste of resources’

little inclination to absorb detailed information unless of direct relevance

Resources received often have very short ‘shelf life’ or not used at all.

“GPs are overwhelmed by the information coming in”

[Practice Manager]

49 SCOTT PORTER

Preferred resource requirements- Overview -

However, the online survey indicated that when prompted on the issue and offered suggestions for support in this area, the potential value of guidance in this area was more patently recognised:

with 81% agreeing that they could improve their knowledge and understanding of young people and related issues1

85% of nurses, 83% of practice managers, 65% of GPs

89% agreeing that information and guidance to improve the service they provide to young people would be valued1

89% of nurses, 91% of practice managers, 78% of GPs

and 82% would appreciate training1

86% of nurses, 84% of practice managers, 55% of GPs.

Findings suggest a hunger for filling knowledge gaps, with few (3%) claiming no need for support2

1 Source: Q7 Base: all respondents (n=395) 2 Source: Q10 Base: all respondents (n=395)

50 SCOTT PORTER

The findings indicate that perceived information and resource needs do differ with variations also emerging across the segments:

72% would value practical considerations for making their service more youth friendly1

with demand highest among the ‘Uninitiated’ (75% ‘Uninitiated’ vs 70% ‘Conscientious objectors’ and 65% ‘Enlightened’2)

69% would value information on local youth relevant services or initiatives1:

with demand significantly higher among the ‘Conscientious objectors’ who are less motivated to make changes to their own service to meet need (79% ‘Conscientious objectors’ vs 67% ‘Uninitiated’ and 50% ‘Enlightened’2)

Preferred resource requirements- Practical considerations for service provision -

1 Source: Q10 Base: all respondents (n=395) 2 Base: all those within each attitudinal segment

51 SCOTT PORTER

Preferred resource requirements- Practical considerations for service provision -

Demand for support and guidance is also high for more specialist information on the youth population: 69% for information on how to promote services to young people 57% on improving their understanding and ability to identify the needs

of vulnerable groups1.

A significant proportion (48%) indicated the need for guidance on how to consult with young people to meet their service needs.

Relative to other support requirements: fewest felt they would benefit from guidance on soft skills (building

rapport) with young people (34%) given high practitioner confidence in patient handling

and a similar sized proportion (37%) saw the need for guidance on developing partnership approaches with schools and colleges.

Whilst these low perceived needs are indicative of high confidence levels, underlying this may be an under-developed appreciation of the impact best practice can have on easing access.

Source: Q10 Base: all respondents (n=395)

52 SCOTT PORTER

Preferred resource requirements- Topic areas -

29% of the online sample claimed they would appreciate detailed literature to refresh or enhance their knowledge - the qualitative research suggests this may be with regards to information on services, or more niche requirements such as information on different faiths and religions.

Most support was valued (83%1), however, in terms of topic-specific information, with most popular requests where confidence and exposure was lowest: 84% mental health (e.g. depression, self harm, eating disorders) 70% drug misuse 62% alcohol misuse 49% Teenage pregnancy 47% sexual health and sexual activity 28% smoking cessation2.

There were little differences in resource needs across the three attitudinal segments, with equal value placed on the topic areas of greatest need such as mental health and drug misuse.

1 Source: Q9 Base: all respondents (n=395) 2 Source: Q9 Base: those who coded one or more topic (n=326)

53 SCOTT PORTER

Information resource requirements by topic

84% mental health

70% drug misuse

62% alcohol misuse

49% pregnancy

47% sexual health

28% smoking

increasing information

needs

higher levels of exposure

and confidence

54 SCOTT PORTER

Preferred resource requirements- Patient materials -

In terms of addressing the type of resource requirements, the greatest emphasis was on the provision of patient materials with a practical focus:

‘show and tell’ literature (60%)

with perceived value in terms of enhancing communication and more efficient use of consultation time

and waiting room literature (56%)

posters and leaflets promoting services or ‘lifestyle’ booklets

There was evidence of much lower demand for less accessible mediums such as DVDs for patients to take away (25%)

There was also less demand for prompting tools (e.g. picture cards and dictionaries) to facilitate communication with young patients (20%)

indicating perhaps the nature of our sample in terms of a low perceived need for guidance in interpersonal/ communication skills.

1 Source: Q11 (Total mentions) Base: all respondents (n=395)

55 SCOTT PORTER

Preferred resource requirements- Staff materials -

With regards staff focused resources:

aide memoirs on protocol or procedure was most popular, with 31% perceiving this to be of value for quick reference purposes1.

26% would appreciate web-based tools or CD Roms providing access to downloadable templates and toolkits

demand for this was significantly higher among the ‘Enlightened’ segment (at 40%) suggesting a more sophisticated identification of support needs and a greater willingness to provide tailored services.


56 SCOTT PORTER

Preferred resource requirements- Training and other support -

The research evidence indicated that Practice Managers were most receptive to training support suggesting the potentially valuable role they have to play in disseminating resources and training at the local level.

The most popular form of training was face-to-face presentations (41%1)

if delivered effectively, a potentially compelling way of engaging a range of staff.

However, other resources to facilitate in-house training were valued given some of the known challenges associated with releasing staff for externally based training:

26% responsive to e-learning packages (enabling staff to learn at their own pace)

20% amenable to interactive CD Roms for staff training purposes

17% requesting training DVDs, perceived to be useful by managers for training new entrants (e.g. patient rapport)1.


Considerations for resource development

58 SCOTT PORTER

Resource development- Practical considerations -

Those moving towards a ‘paperless environment’ value option of electronic based formats

But hard copies are also desirable

Higher production values/ durability can enhance shelf-life of printed materials (e.g. laminated cover)

Style of format can increase point of differentiation and less likely to be filed away (e.g. RCGP tip card).

“You need something that grabs your attention straight away”

[Community Pharmacist]

FORMAT

59 SCOTT PORTER

Resource development- Practical considerations -

Advantages offered by both staff and patient resources that are flexible and adaptable for use (e.g. templates or flow charts for procedure and protocol, patient literature which can be printed on a per needs basis)

With many having regular access to the internet at work, web-based resources were desirable providing: reassurance of up-to-date information a potential ‘one stop shop’ for all patient and practitioner information

requirements

CD Rom based formats can be useful for supporting management and administrative work.

“You have so many leaflets that end up in a drawer, but a graph I can put on the shelf and see it all the time.”

[Practice Nurse]

FUNCTION

60 SCOTT PORTER

Resource development- Content considerations -

Offers practical tips and suggestions

Information resources designed for dual patient/ practitioner purpose

Comprehensive with information readily to hand (e.g. contact names, opening hours and telephone details of services)

Of local as well as national relevance.

“Straightforward, not too wordy and with practical things you can think about…if you’re starting from zero in your practice, then simple ideas that

are proven to work.”

[Practice Nurse]

PRAGMATIC FOCUS

61 SCOTT PORTER

Resource development- Content considerations -

Clearly demarcated sections for quick reference

Key points highlighted easing navigation of detail (headings, bullet points, bolded text)

if website - user friendly and easily navigable

Offering detail where sought in addition to economised information for time-starved seeking quick message absorption

Graphics and illustrations to break up text and facilitate digestion of information.

“Something you can look at quickly and reminds you… keep it simple”

[Practice Nurse]

“I like colour coding so you don’t have to spend ages looking at it.”

[GP]

SIMPLE AND STRAIGHTFORWARD

62 SCOTT PORTER

Resource development- Tonal considerations -

respectfulsupportive

non-judgemental

professionalcredible

trustworthy

stimulatinginformativepragmatic

persuasiveencouragingfacilitating

Tonal positioning

Content requirements

63 SCOTT PORTER

Learnings from existing resources- RCN ‘Getting it Right’ -

Well received

• Eye catching and visually relevant to subject matter

•Offers practical ideas and suggestions

• Succinct – facilitating quick message absorption

• Mini-audit encourages thinking about level of service offered

• Offers a good starting point for discussion among influencers within the practice or community setting with potential to prompt action

64 SCOTT PORTER

Mixed reactions to content

•A distinctive and handy format offering a point of differentiation – more likely to be kept close to hand rather than filed away

• Higher production values (e.g. lamination) facilitating a longer shelf-life

• Practical focus with key points for consideration for simple message absorption

• However, experienced practitioners can feel nature of content adds little to existing knowledge and tone can be perceived to be patronising and dogmatic.

Learnings from existing resources- RCGP tip card -

Conclusions and recommendations

66 SCOTT PORTER


This research echoes evidence which suggests young people’s access of mainstream healthcare is limited.

An appreciation among staff of the barriers young people face in accessing mainstream healthcare is, as yet, under-developed:

good practice is evident but appears to be patchy and fragmented

both service provision and attitudinal stances vary widely

acknowledgement of information and guidance needs is rarely top of mind.

experience of young people’s health issues is dominated by sexual health and family planning suggesting opportunities to promote understanding of the topic areas less top of mind.

With prompting, the evidence suggests professionals are likely to be receptive to the barriers faced by young people and the value of resource provision - indicating that with the appropriate support, more will feel confident and motivated to be proactive in this area.

67 SCOTT PORTER


The research evidence points to a need for resources to fulfil three key functions:

1. prompting awareness of the barriers young people face in accessing primary care services and stimulating discussion on the issue

2. meeting specific information needs (e.g. staff and patient literature

particularly topic areas where practitioners have less exposure and confidence such as mental health, drug misuse and emotional wellbeing (e.g. gender identity and bullying)

3. organisational/ management resource needs (e.g. tools and templates, promoting young people’s services)

Addressing these areas will ensure that a full spectrum of needs are met in relation to attitudes, prior knowledge, experience and confidence (c.f. chart overleaf).

ATTITUDINAL

MINDSET

TACTIC EXAMPLE OF PROVISION TYPE KEY TARGET AUDIENCE

FOR DISSEMINATION

‘Conscientious

objectors’

AND

‘The Uninitiated’

- Raise profile of issue

- Challenge perception about

service provision

- Enhance appreciation of

young people and vulnerable

groups

- Provide a simple starting

point for discussion within

practice/ network

- Equip practitioners with

necessary tools to prompt

action and to keep issues top

of mind

- Promotional materials to raise

awareness of service offering

among young people.

Practice managers,

professional trainers, senior

practice partners and

pharmacist champions for

tailored dissemination via

formal training/ CPD, internal

staff training days, protected

learning time etc.

‘The Enlightened’ In addition to above:

Guidance and tools to assist

with efficient set-up and

development of services

E.g. policy guidance documents, templates for clerical / clinical/

promotional use etc.

Practice Managers and

Practice Nurses

Conclusions and recommendationsConclusions and recommendations

Resource/ materials to prompt thought, discussion

and sharing of experiences – e.g. face to face presentations,

training support documents

Resources to facilitate circulation among decision

makers and influencers at practice/pharmacy level

– e.g. leaflets with practical suggestions/checklists/

mini-audit tools

E.g. patient/practitioner information and promotional

literature (electronic/ web/ paper), info and guidance

on specialist service provision, practical guidance on

identification and handling of vulnerable groups, aide

memoirs etc.

69 SCOTT PORTER


The provision of resources need to be combined with a communications strategy to generate and sustain momentum on the issue across the primary care community:

targeting of influencers such as GP trainers, Practice Managers and Pharmacist champions may assist with enhancing message penetration and optimising resource dissemination at the micro and macro level

endorsement by professional bodies and associations (e.g. Family Planning Association, RCGP, RCN, SPNA) may assist with raising the profile of the issue with the respective professions.

70 SCOTT PORTER

EMOTIONAL FUNCTIONAL FEATURES MESSAGE/ TARGET

- engages

- inspires

- motivates

- provokes

- stimulates

- challenges perceptions

- informs

- demonstrates

- involves

- arrests attention

- raises profile of the issue

- encourages dialogue

- triggers thought & debate

- keeps at the forefront of people’s minds

-increases confidence in taking action

- sustains momentum

Delivered from a credible youth perspective

Persuasive/ evidence based information on unmet needs

Offers practical, realistic solutions to overcome barriers

‘Young people’s needs are not met’

[CONSCIENTIOUS OBJECTORS]

‘Primary care is integral to the mix of accessible healthcare’

[UNINITIATED]

‘You can make a difference’

[ENLIGHTENED]


To address the needs of primary care teams, the following summary considerations are required to fulfil both strategic communication needs and

tactical needs (i.e. resource materials provided).

SCOTT PORTER Research & Marketing The Resource Needs of Primary Care Teams in Supporting Youth...

Documents

Transcript of SCOTT PORTER Research & Marketing The Resource Needs of Primary Care Teams in Supporting Youth...