Women's perspectives on human papillomavirus self-sampling in the context of the UK cervical screening programme.

Background: Testing for human papillomavirus (HPV) is being incorporated into the cervical screening programme, with the probable future introduction of HPV as a primary test and a possibility of HPV self-sampling. In anticipation of this development, we sought to inform future policy and practice by identifying potential barriers to HPV self-sampling.

Methods: A cross-sectional survey of 194 women aged 20-64 years was conducted.

'Distributed health literacy': longitudinal qualitative analysis of the roles of health literacy mediators and social networks of people living with a long-term health condition.

Background: The role of one's social network in the process of becoming health literate is not well understood. We aim to explain the 'distributed' nature of health literacy and how people living with a long-term condition draw on their social network for support with health literacy-related tasks such as managing their condition, interacting with health professionals and making decisions about their health.

Design: This paper reports a longitudinal qualitative interview and observation study of the development and practice of health literacy in people with long-term health conditions, living in South Wales, UK.

How hard can it be to include research evidence and evaluation in local health policy implementation? Results from a mixed methods study.

Background: Although an evidence-based approach is the ideal model for planning and delivering healthcare, barriers exist to using research evidence to implement and evaluate service change. This paper aims to inform policy implementation and evaluation by understanding the role of research evidence at the local level through implementation of a national chronic conditions management policy.

Methods: We conducted a national email survey of health service commissioners at the most devolved level of decision-making in Wales (Local Health Boards - LHBs) followed by in-depth interviews with representatives of LHBs, purposively selecting five to reflect geographic and economic characteristics.

Framing patient consent for student involvement in pelvic examination: a dual model of autonomy.

Patient consent has been formulated in terms of radical individualism rather than shared benefits. Medical education relies on the provision of patient consent to provide medical students with the training and experience to become competent doctors. Pelvic examination represents an extreme case in which patients may legitimately seek to avoid contact with inexperienced medical students particularly where these are male.

The development of health literacy in patients with a long-term health condition: the health literacy pathway model.

Background: Inadequate health literacy has been associated with poor management of long-term health conditions and has been identified as a key social determinant of health outcomes. However, little is understood about how health literacy might develop over time or the processes by which people may become more health literate. Our objectives were to describe how patients with a long-term condition practice health literacy in the management of their health and communication with health professionals, how they become more health literate over time and their experience of using health services.

What constitutes consent when parents and daughters have different views about having the HPV vaccine: qualitative interviews with stakeholders.

Objective: The UK Human Papillomavirus (HPV) vaccine programme commenced in the autumn of 2008 for year 8 (age 12-13 years) schoolgirls. We examine whether the vaccine should be given when there is a difference of opinion between daughters and parents or guardians.

Design: Qualitative study using semi-structured interviews.

Can promoting patient decision making be exclusionary? Moral expectations and cultural difference in the narratives of UK maternity clinicians.

Patient autonomy in health care decision making is increasingly advocated as a means of promoting patients' 'responsibilities' for treatments and costs. However, little is known with regard to clinicians' understanding of patients' potential responsibilities in decision making. We explore how clinicians may view decision making as a 'moral' obligation and examine how moral virtue is discursively constructed in this context and in the face of ethnic and social difference.

The health, social care and housing needs of lesbian, gay, bisexual and transgender older people: a review of the literature.

This paper reports the findings of a literature review of the health, social care and housing needs of older lesbian, gay, bisexual and transgender (LGBT) adults undertaken in 2006 for the Welsh Assembly Government. Peer-reviewed literature was identified through database searches of BNI, PubMed, CINAHL, DARE, ASSIA and PsychInfo. Follow-up searches were conducted using references to key papers and journals as well as specific authors who had published key papers.

What are the external influences on information exchange and shared decision-making in healthcare consultations: a meta-synthesis of the literature.

Objective: To review the literature to identify external influences on information exchange and shared decision-making in healthcare consultations and conceptualise how information is used both outside and within a consultation.

Methods: A 'meta-study' approach (meta-data-analysis, meta-theory, meta-method, and meta-synthesis) was used to locate, review, synthesise and summarise the findings, methodology, theoretical orientation and interpretation of qualitative research papers.

Results: In a model of external influences on information exchange within healthcare consultations, practitioner influences were: receptiveness to informed patients and patient choice, lack of knowledge of cultural difference, patient centredness vs.

Advocating mandatory patient 'autonomy' in healthcare: adverse reactions and side effects.

Promoting patient autonomy has become a key imperative in health service encounters. We will examine the potential negative effects of over-promoting patient autonomy and consider the impact on patient access, their experience and the provision of equitable services by focusing on an extreme manifestation of this trend, i.e.

Referral management centres: promising innovations or Trojan horses?

Referral management centres are intended to improve referrals between primary and secondary care. The aim is good but so far we have little evidence that they can deliver