Alcohol dependent patients have weak negative rather than strong positive implicit alcohol associations.

Rationale: Alcohol dependence is characterised by motivational conflict (or ambivalence) in controlled cognitive processes, but it is unclear if ambivalence also exists within automatic cognitive processes, and if ambivalence operates between controlled and automatic processes.

Objective: To investigate ambivalence operating within and between controlled and automatic processes in alcohol dependence.

Method: Alcohol-dependent patients who had recently completed inpatient alcohol detoxification (N = 47) and social drinking controls (N = 40) completed unipolar implicit association tests and self-report measures of alcohol approach and avoidance motivation and alcohol outcome expectancies.

Integrating telecare for chronic disease management in the community: what needs to be done?

Background: Telecare could greatly facilitate chronic disease management in the community, but despite government promotion and positive demonstrations its implementation has been limited. This study aimed to identify factors inhibiting the implementation and integration of telecare systems for chronic disease management in the community.

Methods: Large scale comparative study employing qualitative data collection techniques: semi-structured interviews with key informants, task-groups, and workshops; framework analysis of qualitative data informed by Normalization Process Theory.

Established users and the making of telecare work in long term condition management: implications for health policy.

Increasingly policy for long term condition management is focussing on new technologies. Telecare is viewed as a means of making services more responsive, equitable, cost and clinically-effective and able to play a central part in mediating between service users, professionals, and service providers. It has also been identified as helping to establish patient self-management for long term conditions.

Are some more equal than others? Social comparison in self-management skills training for long-term conditions.

Background: Social comparisons influence self-evaluation and social and psychological adjustment to illness but are under-explored in relation to self-skills training group situations.

Methods: A longitudinal qualitative study embedded within an RCT of a national programme of lay led self-care support in England (Department of Health, 2001). In-depth interviews were undertaken with a purposeful maximum variation sample of recruits.

Creating 'good' self-managers?: facilitating and governing an online self care skills training course.

Background: In chronic disease management, patients are increasingly called upon to undertake a new role as lay tutors within self-management training programmes. The internet constitutes an increasingly significant healthcare setting and a key arena for self-management support and communication. This study evaluates how a new quasi-professional health workforce - volunteer tutors - engage, guide and attempt to manage people with long-term conditions in the ways of 'good' self-management within the context of an online self-management course.

The United Kingdom Expert Patients Programme: results and implications from a national evaluation.

The Expert Patients Programme (EPP) is a central element of chronic disease management policy in the United Kingdom. It aims to deliver self-care support by developing peoples' self-care skills, confidence and motivation to take more effective control over their long-term conditions. A large, national randomised controlled trial found that the EPP's lay-led skills training was effective in improving self-efficacy and energy levels among patients with long-term conditions, and was likely to be cost-effective.

What outcomes are important to patients with long term conditions? A discrete choice experiment.

Objective: To assess how much patients with long-term conditions value self-efficacy (i.e., confidence in their ability to manage their condition) compared with other health outcomes, including measures of quality of life, and process outcomes including access to General Practitioners.

Integration of devices into long-term condition management: a synthesis of qualitative studies.

Background: Understanding peoples' responses to and ability to incorporate technology for managing long-term conditions into their everyday lives is relevant for informing the development and implementation of new technologies as part of future long-term condition management in domestic environments. Future research and theory building can be facilitated by the synthesis of existing qualitative studies.

Methods: A systematic search for qualitative studies of health technologies at home was undertaken on OVID CINAHL, OVID Medline and CSA databases for the period 1996-2006.

Predicting who will benefit from an Expert Patients Programme self-management course.

Background: In England, the Expert Patients Programme, a lay-led chronic disease self-management course, was developed to improve self-care support and skills. The course is designed for anyone with a self-defined long-term condition, and attracts a heterogeneous group of patients. A randomised controlled trial has demonstrated effectiveness in improving subjective health.

More than jobs and houses: mental health, quality of life and the perceptions of locality in an area undergoing urban regeneration.

Background: Urban regeneration initiatives are considered to be one means of making a contribution to improving people's quality of life and mental health. This paper considers the relationship between lay perceptions of locality adversity, mental health and social capital in an area undergoing urban regeneration.

Methods: Using qualitative methods as part of a larger multi-method study, perceptions of material, and non-material aspects of the locality and the way in which people vulnerable to mental health problems coped with living in adversity were identified as being more highly valued than intended or actual changes to structural elements such as the provision of housing or employment.

Planning for end of life care within lay-led chronic illness self-management training: the significance of 'death awareness' and biographical context in participant accounts.

UK health policy dictates that Advance Care Planning (ACP), including the use of living wills, promotes choice and quality regarding end of life care for those with chronic and life-threatening conditions and it has been incorporated in self-management training. This paper reports a qualitative evaluation based on in-depth interviews with 31 respondents who had completed a UK-based lay-led self-management course (The Expert Patients Programme), and 12 respondents who had completed the same course adapted for people who are HIV positive. We draw upon previous social research on 'death awareness' and the biographical context of illness experience and management in examining the impact of incorporating this subject within a self-management intervention.

Identifying the patient perspective of the quality of mental healthcare for common chronic problems: a qualitative study.

Objectives: To identify which aspects of quality are important to individual patients with common chronic mild-to-moderate mental health problems presenting to general practice and the best method of involving patients with chronic mental health problems in the research process, and to contrast the relevance of a generic questionnaire developed previously with these individual patient narratives.

Methods: Qualitative interviews with 16 patients in Chester and Manchester were subjected to thematic analysis.

Results: Six key themes were identified in relation to the individual patient experience set against a generic patient experience: (1) the healthcare system provides a generic 'one size fits all' service, which is incompatible with an individual patient's experience and sense of being as an individual and that privileges medical over social care; (2) patients with mild-to-moderate mental health problems often have feelings of powerlessness and of being 'lost' in a system that is more responsive to severe and acute episodes of illness than to chronic morbidity; (3) patients often have unmet needs in relation to the distress of living with mild-to-moderate mental health problems; (4) there are substantial quality deficits in primary care for people with mild-to-moderate chronic mental health problems; (5) general practitioners are rated highly, and the attributes of a good general practitioner can be identified; patients also value continuity of care; (6) engaging people with common chronic mental health problems in the research/policy process requires generic assessment of quality using questionnaires supplemented with more in-depth methods, such as interviews and focus groups.

Re-thinking the relationship between long-term condition self-management education and the utilisation of health services.

Encouraging self-management has been viewed as one means of reducing health service utilisation and contributing to improved demand management. However, the processes and imputed relationship between self-management education skills and health service contact are poorly understood. This paper reports on data from an embedded qualitative study which ran alongside a randomised controlled trial in England designed to test the clinical and cost effectiveness of a self-care support policy which found no statistically significant reductions in health service utilisation.

The effectiveness and cost effectiveness of a national lay-led self care support programme for patients with long-term conditions: a pragmatic randomised controlled trial.

Objective: Supporting patients' self care could have a major effect on the management of long-term conditions, which has led to worldwide interest in effective self care interventions. In England, self care support is being developed through the "Expert Patients Programme", which provides lay-led generic courses to improve patients' self care skills. However, the clinical and cost effectiveness of such courses remains unclear.

A qualitative study of GPs' attitudes to self-management of chronic disease.

Background: Improving the quality of care for patients living with a chronic illness is a key policy goal. Alongside systems to ensure care is delivered according to evidence-based guidelines, an essential component of these new models of care is the facilitation of self-management. However, changes to the way professionals deliver care is complex, and it is important to understand the key drivers and barriers that may operate in the primary care setting.

Mental health, burnout and job satisfaction among mental health social workers in England and Wales.

Background: Previous research suggests that social workers experience high levels of stress and burnout but most remain committed to their work.

Aims: To examine the prevalence of stress and burnout, and job satisfaction among mental health social workers (MHSWs) and the factors responsible for this.

Method: A postal survey incorporating the General Health Questionnaire, Maslach Burnout Inventory, Karasek Job Content Questionnaire and a job satisfaction measure was sent to 610 MHSWs in England and Wales.

Recruitment to a trial of self-care skills training in long-term health conditions: analysis of the impact of patient attitudes and preferences.

The rise of evidence-based practice has highlighted the importance of effective recruitment to randomised controlled trials if studies are to be adequately powered and valid. However, there are also increasing concerns about patient preferences and choice within trials. The current authors are involved in a trial of a programme to provide self-care skills training for people with long-term health conditions (the 'Expert Patients Programme'), and during the design stage there were significant concerns about the impact of patient preferences on the feasibility and validity of the study, because recruitment required that patients risk randomisation to a waiting list control group.

Staff shortages in the mental health workforce: the case of the disappearing approved social worker.

Approved social worker (ASW) numbers in England and Wales were compared on the basis of two national surveys conducted in 1992 and 2002. These data were supplemented by reports published by the Employers' Organisation in the intervening years. Although raw numbers suggested a modest absolute increase over this time, rates of ASW's per 100,000 population declined by over 50%.

From patients to providers: prospects for self-care skills trainers in the National Health Service.

Changes in the National Health Service (NHS) workforce and user involvement have been key areas of contemporary health care policy. Potentially, the current separation of the agendas for patient participation and reconfiguration of the workforce are being brought closer together in the NHS through the Expert Patients Programme (EPP), and its potential to create a new community health 'workforce' of self-management and self-care skills trainers and tutors. The aim of the present paper is to assess the establishment and prospects of these trainers as a new workforce role in the EPP and the NHS.

Assessment of quality of life in later life: development and validation of the QuiLL.

The aim was to develop a quality of life (QOL) instrument, informed by older people, carers and professionals in older peoples' services, for use by community care staff as part of their assessment, care-planning and outcome monitoring procedures. The multi-phase development project involved: qualitative interviews to generate the item pool; pre-testing; preliminary field-testing; and final testing in a community survey and in health and social care settings. The process was informed by over 100 interviews with older people, carers, professionals, academics and policy-makers.

Housing improvement and self-reported mental distress among council estate residents.

This paper is concerned with how housing improvements instigated either publicly or privately influence the degree of psychological stress reported by council estate residents in South Manchester. Stress is measured on the GHQ12 scale containing standard symptomatic items. Potential sources of variation in this indicator are analysed within a geographical setting where repeated samples of residents were drawn from two adjacent suburban council housing estates before and after the implementation of a single regeneration budget (SRB) housing initiative in late 1999.

The impact of 'statutory duties' on mental health social workers in the UK.

In the UK, applications for involuntary admission to psychiatric units are made mainly by specially trained approved social workers (ASWs). Proposed changes in the legislation will permit other professionals to undertake these statutory duties. This study aimed to examine how ASW status impacts upon work pattern and workload stresses by comparing ASWs with other mental health social workers who did not carry statutory responsibilities.

State-event relations among indicators of susceptibility to mental distress in Wythenshawe in the UK.

This paper explores the utility of concepts drawn from psychosocial theory as predictors of the proneness to mental distress among the residential population of a large suburban council estate (Wythenshawe, South Manchester). In this respect, items are selected and tested to form composite variables measuring individual ratings with regard to notions of structural risk, personal vulnerability, goal-setting behaviour, quality of life, and the frequency of life events and restricted opportunities. Mental distress is enumerated on the standard GHQ12-point scale.