Purpose Language plays a complex role in coaching, facilitating communication, comprehension and meaning construction. Yet, the implications of coaching in a non-native language are uncertain and ...under-researched. This study explores the role of non-native language (NNL) in dyadic workplace coaching practice. Specifically, it explores how working in a NNL influences the coaching experience from the coach’s perspective. Design/methodology/approach A qualitative approach was chosen to explore the way coaches view coaching in a NNL. Twenty-three semi-structured interviews were conducted with coaches experienced in coaching in NNL. Reflexive thematic analysis (RTA) was applied for data analysis. Findings NNL coaching presents a paradoxical mix of negative and positive tensions for the coach and coachee in communication, relationship and insight. NNL coaching is nuanced and may be accommodated using coaching competencies to mitigate the potential for misunderstanding and relationship rupture. It offers alternative perspectives to existing worldviews, eliciting deeper insights. Coaches’ confidence in coaching in a NNL varies from a challenging struggle that perceptually hinders performance, through ambivalence, to a sense of greater resourcefulness. Originality/value The study contributes to the stream of literature on language in international business, sociolinguistic research and how meaning is constructed in a coaching process. First, the work develops a distinction between coaching in a native language (NL) and a NNL. Second, study results indicate that the context of NNL creates challenges as well as opportunities in a dyadic coaching process, particularly regarding aspects of the coach–coachee relationship and insight elicitation via alternative perspectives. Moreover, several practical implications of the study for the coaching practice are discussed.
Demand for urgent and emergency health care in England has grown over the last decade, for reasons that are not clear. Changes in population demographics may be a cause. This study investigated ...associations between individuals' characteristics (including socioeconomic deprivation and long term health conditions (LTC)) and the frequency of emergency department (ED) attendances, in the Norfolk and Waveney subregion of the East of England.
The study population was people who were registered with 91 of 106 Norfolk and Waveney general practices during one year from 1 April 2022 to 31 March 2023. Linked primary and secondary care and geographical data included each individual's sociodemographic characteristics, and number of ED attendances during the same year and, for some individuals, LTCs and number of general practice (GP) appointments. Associations between these factors and ED attendances were estimated using Poisson regression models.
1,027,422 individuals were included of whom 57.4% had GP data on the presence or absence of LTC, and 43.1% had both LTC and general practitioner appointment data. In the total population ED attendances were more frequent in individuals aged under five years, (adjusted Incidence Rate Ratio (IRR) 1.25, 95% confidence interval 1.23 to 1.28) compared to 15-35 years); living in more socioeconomically deprived areas (IRR 0.61 (0.60 to 0.63)) for least deprived compared to most deprived,and living closer to the nearest ED. Among individuals with LTC data, each additional LTC was also associated with increased ED attendances (IRR 1.16 (1.15 to 1.16)). Among individuals with LTC and GP appointment data, each additional GP appointment was also associated with increased ED attendances (IRR 1.03 (1.026 to 1.027)).
In the Norfolk and Waveney population, ED attendance rates were higher for young children and individuals living in more deprived areas and closer to EDs. In individuals with LTC and GP appointment data, both factors were also associated with higher ED attendance.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
We aim to explore the barriers to accessing primary care for socio-economically disadvantaged older people in rural areas.
Using a community recruitment strategy, fifteen people over 65 years, living ...in a rural area, and receiving financial support were recruited for semi-structured interviews. Four focus groups were held with rural health professionals. Interviews and focus groups were audio-recorded and transcribed. Thematic analysis was used to identify barriers to primary care access.
Older people's experience can be understood within the context of a patient perceived set of unwritten rules or social contract-an individual is careful not to bother the doctor in return for additional goodwill when they become unwell. However, most found it difficult to access primary care due to engaged telephone lines, availability of appointments, interactions with receptionists; breaching their perceived social contract. This left some feeling unwelcome, worthless or marginalised, especially those with high expectations of the social contract or limited resources, skills and/or desire to adapt to service changes. Health professionals' described how rising demands and expectations coupled with service constraints had necessitated service development, such as fewer home visits, more telephone consultations, triaging calls and modifying the appointment system.
Multiple barriers to accessing primary care exist for this group. As primary care is re-organised to reduce costs, commissioners and practitioners must not lose sight of the perceived social contract and models of care that form the basis of how many older people interact with the service.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Realist approaches seek to answer questions such as 'how?', 'why?', 'for whom?', 'in what circumstances?' and 'to what extent?' interventions 'work' using context-mechanism-outcome (CMO) ...configurations. Quantitative methods are not well-established in realist approaches, but structural equation modelling (SEM) may be useful to explore CMO configurations. Our aim was to assess the feasibility and appropriateness of SEM to explore CMO configurations and, if appropriate, make recommendations based on our access to primary care research. Our specific objectives were to map variables from two large population datasets to CMO configurations from our realist review looking at access to primary care, generate latent variables where needed, and use SEM to quantitatively test the CMO configurations.
A linked dataset was created by merging individual patient data from the English Longitudinal Study of Ageing and practice data from the GP Patient Survey. Patients registered in rural practices and who were in the highest deprivation tertile were included. Three latent variables were defined using confirmatory factor analysis. SEM was used to explore the nine full CMOs. All models were estimated using robust maximum likelihoods and accounted for clustering at practice level. Ordinal variables were treated as continuous to ensure convergence.
We successfully explored our CMO configurations, but analysis was limited because of data availability. Two hundred seventy-six participants were included. We found a statistically significant direct (context to outcome) or indirect effect (context to outcome via mechanism) for two of nine CMOs. The strongest association was between 'ease of getting through to the surgery' and 'being able to get an appointment' with an indirect mediated effect through convenience (proportion of the indirect effect of the total was 21%). Healthcare experience was not directly associated with getting an appointment, but there was a statistically significant indirect effect through convenience (53% mediated effect). Model fit indices showed adequate fit.
SEM allowed quantification of CMO configurations and could complement other qualitative and quantitative techniques in realist evaluations to support inferences about strengths of relationships. Future research exploring CMO configurations with SEM should aim to collect, preferably continuous, primary data.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Primary care access can be challenging for older, rural, socio-economically disadvantaged populations. Here we report the I-ACT cluster feasibility trial which aims to assess the feasibility of trial ...design and context-sensitive intervention to improve primary care access for this group and so expand existing theory.
Four general practices were recruited; three randomised to intervention and one to usual care. Intervention practices received £1500, a support manual and four meetings to develop local, innovative solutions to improve the booking system and transport. Patients aged over 64 years old and without household car access were recruited to complete questionnaires when booking an appointment or attending the surgery. Outcome measures at 6 months included: self-reported ease of booking an appointment and transport; health care use; patient activation; capability; and quality of life. A process evaluation involved observations and interviews with staff and participants.
Thirty-four patients were recruited (26 female, eight male, mean age 81.6 years for the intervention group and 79.4 for usual care) of 1143 invited (3% response rate). Most were ineligible because of car access. Twenty-nine participants belonged to intervention practices and five to usual care. Practice-level data was available for all participants, but participant self-reported data was unavailable for three. Fifty-six appointment questionnaires were received based on 150 appointments (37.3%). Practices successfully designed and implemented the following context-sensitive interventions: Practice A: a stacked telephone system and promoting community transport; Practice B: signposting to community transport, appointment flexibility, mobility scooter charging point and promoting the role of receptionists; and Practice C: local taxi firm partnership and training receptionists. Practices found the process acceptable because it gave freedom, time and resource to be innovative or provided an opportunity to implement existing ideas. Data collection methods were acceptable to participants, but some found it difficult remembering to complete booking and appointment questionnaires. Expanded theory highlighted important mechanisms, such as reassurance, confidence, trust and flexibility.
Recruiting older participants without access to a car proved challenging. Retention of participants and practices was good but only about a third of appointment questionnaires were returned. This study design may facilitate a shift from one-size-fits-all interventions to more context-sensitive interventions.
ISRCTN18321951 , Registered on 6 March 2017.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Life expectancy in the UK stopped increasing in 2010. To identify possible causes, we explored changes in life expectancy by age, sex, and condition.
Using the Global Burden of Disease (GBD) study ...2016, we determined estimates of life expectancy, death rates, and premature mortality (years of life lost YLL) from 1990 to 2016 in the UK by sex and age. Annual change in YLL and death rates were calculated for the following leading causes of premature death in 2016: ischaemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, dementia, lower respiratory tract infections, colorectal and breast cancers, self-harm, and diseases due to alcohol use and related diseases.
Combined mean improvements in life expectancy were 0·26% per year (75·72–80·99) and death rates were 0·98% (195427·59–154351·73) from 1990 to 2010; improvements stalled after 2010. The slowdown was seen across all age groups and in both sexes, with a slightly more marked slowdown in men (0·04%, 72·85–78·92) than in women (0·03%, 78·47–82·86). The conditions that showed the greatest changes in YLL since 2010 were ischaemic heart disease, stroke, lower respiratory tract infections, and lung and colon cancer. YLL reduction rates from ischaemic heart disease fell from 2·94% (205098·90–84411·42) to 1·77% (84411·42–75449·83) per year and stroke 2·03% (78921·56–46918·77) to 1·17% (46918·77–43638·12). YLL rates from lung and colon cancer increased in the over 85 year age group with lung cancer at 1·03% (5718·47–6072·65) per year and colon cancer 0·44% (5423·75–5568·14). YLL rates from lower respiratory tract infections increased 1·25% (27984·06–30086·93) per year after 2010 following yearly reductions for the previous 16 years. The YLL rate for lower respiratory tract infections increased more in England than in the other three UK countries.
The slowdown in UK life expectancy since 2010 appears to have been driven largely by declining improvements in YLL from ischaemic heart disease and stroke, with increasing YLL from lower respiratory tract infections and cancer also contributing. Further research is needed into the causes of these condition-specific changes, including the effects of austerity and international comparisons to explore the extent to which further improvements in life expectancy are biologically possible.
None.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
About half of melanoma skin cancers are diagnosed in people aged over 65 years. In the past decade, incidence in the UK has increased by 45%. Ultraviolet radiation is associated with 86% of UK ...malignant melanomas. We aimed to identify associations between skin cancer diagnosis and demographic, socioeconomic, and behavioural risk factors.
The English Longitudinal Study of Ageing is a large cohort study of 17 980 people over the age of 50 years. Our analysis included all participants reporting melanoma or other skin cancer (excluding minor skin cancers) between March 1, 2002, and March 1, 2012. We tested the association between skin cancer and prespecified potential risk factors, including age, sex, education, health literacy, income, wealth, socioeconomic status, holidays abroad and in the UK, marriage, isolation, disability, body-mass index, physical activity, asthma, hormone replacement therapy, and smoking. Unadjusted, age-adjusted, and sex-adjusted logistic regression models were used to identify associations.
245 participants reported melanoma or other skin cancer diagnosis. A diagnosis of melanoma or other skin cancer was associated with each extra year of age (adjusted odds ratio 1·03, 95% CI 1·02–1·04) and being a current smoker versus being a non-smoker (0·50, 0·31–0·80). Holidaying in the UK was associated with melanoma or other skin cancer (1·44, 1·08–1·91), but holidaying abroad was not (1·19, 0·90–1·57). The UK holiday results persisted after further adjustment for wealth (1·38, 1·03–1·86) and socioeconomic status (1·38, 1·02–1·86). There was no association in the adjusted analysis for the other factors.
Major skin cancer was associated with being a current smoker, which may be due to the carcinogenic impact. Our results also showed that holidaying in the UK, but not holidaying abroad, was associated with major skin cancer, which might be because of low perceived risk of skin damage when in the UK or other confounders. Public health advice should highlight the importance of skin protection even when in the UK.
None.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
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