jennifer maclellan - Academia.edu (original) (raw)

Papers by jennifer maclellan

British Journal of General Practice

Background: Each woman’s experience of the peri/menopause is individual and unique. Research show... more Background: Each woman’s experience of the peri/menopause is individual and unique. Research shows ethnic minority women often have different experiences from their white peers, and these are not being considered in conversations about the menopause. Ethnic minority women already face barriers to help-seeking in primary care, and clinicians have expressed challenges in cross cultural communication including the risk that ethnic minority women’s peri/menopause health needs are not being met. Aim: To explore primary care practitioners’ experiences of peri/menopause help-seeking among ethnic minority women. Design and setting: Qualitative study design in the primary care setting of England, with PPI consultations. Methods: We sampled 46 primary care practitioners across 35 practices in England. Using an exploratory approach, we conducted online/telephone interviews and analysed the data thematically. We presented our findings to three groups of ethnic minority women, to inform our inte...

Sociology of Health and Illness, Nov 29, 2022

BMC Medical Research Methodology

Background The failure of randomised controlled trials to adequately reflect areas of highest hea... more Background The failure of randomised controlled trials to adequately reflect areas of highest health need have been repeatedly highlighted. This has implications for the validity and generalisability of findings, for equity and efficiency, but also for research capacity-building. Rai et al. (BMC Med Res Methodol 21:80, 2021) recently argued that the poor alignment between UK clinical research activity (specifically multi-centre RCTs) and local prevalence of disease was, in part, the outcome of behaviour and decision-making by Chief Investigators involved in trial research. They argued that a shift in research culture was needed. Following our recent multi-site mixed methods evaluative study about NHS 111 online we identify some of the additional structural barriers to delivering health research “where populations with the most disease live”, accounting for the Covid-19 disruption to processes and delivery. Methods The NHS 111 study used a mixed-method research design, including inte...

Baseline characteristics of the 346 participants, with column percentages. (DOCX 30 KB)

Study Questionnaire. The study questionnaire captured social and medical history, demographic fac... more Study Questionnaire. The study questionnaire captured social and medical history, demographic factors, information about HBV vaccination status and reasons for incomplete vaccination if applicable. It was completed by individuals consenting to participate in a randomised controlled trial of a peer intervention to promote engagement with hepatitis C services. (DOCX 824 KB)

Regression analysis of effectiveness of peer support intervention in Hepatitis C Virus-positive i... more Regression analysis of effectiveness of peer support intervention in Hepatitis C Virus-positive individuals, adjusted for potential confounding. Tabulated additional analyses. (DOCX 19 kb)

Baseline characteristics of individuals who withdrew or were lost to follow up. Tabulated baselin... more Baseline characteristics of individuals who withdrew or were lost to follow up. Tabulated baseline information for study participants who were lost to follow-up or who withdrew. (DOCX 22 kb)

Detailed methodology. Detailed methods for the trial. (DOCX 27 kb)

Study questionnaire. Copy of questionnaire used during study. (DOCX 771 kb)

The International journal on drug policy, 2021

BACKGROUND Peer support has been used as a mechanism to facilitate active engagement with healthc... more BACKGROUND Peer support has been used as a mechanism to facilitate active engagement with healthcare amongst underserved populations. The HepCare project upskilled experienced peer support workers (PSWs) to become equal members of a service provider team, taking on advanced clinical roles normally carried out by medical or nursing specialists. METHOD A participatory case study approach was taken to the study following the methodological guidance of Merriam (1998). The subject of the case in our study is the advanced peer support workers (APSWs) functioning in the HepCare project as service providers. The object of the case is an exploration of their transition to service provider in the HCV screening and treatment support service. Five peer led in-depth interviews with APSWs were supplemented by a survey of health professionals, interviews with service users, documentary evidence in the form of job descriptions, observational notes and a blog from the field. Thematic analysis of the...

Despite knowledge and policy support of the positive contributors to a woman’s birth experience a... more Despite knowledge and policy support of the positive contributors to a woman’s birth experience and awareness of the lasting impact of her interpretation of the event, there is a distinct lack of acknowledgement in the childbirth literature of the woman’s exposure to a vulnerability characteristic of birth. I feel that this transient experience of vulnerability exposes a woman’s identity to subliminal messages about her body, her competence and her social positioning, while the physicality of birth is foregrounded. I believe women use the telling of their birth stories to make meaning out of their experience. To analyse the identity work of the story, I selected 20 birth stories from a popular ‘mums’ internet forum. Using a multi component narrative analysis technique, comprising structural, thematic and discourse analyses, I have been able to explore the influence of competing discourses upon woman’s experience of birth in the UK. In complement I have woven my story of transition t...

Journal of Advanced Nursing

Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine

Birth narratives have been found to provide women with the most accessible and often utilised mea... more Birth narratives have been found to provide women with the most accessible and often utilised means for giving voice to their exploration of meaning in their births. The stories women tell of their birth come out of their pre- and post-experience bodies, reproducing society through the sharing of cultural meanings. I recruited a selection of 20 birth stories from a popular ‘mums’ Internet forum in the United Kingdom. Using structural and thematic analyses, I set out to explore how women tell the story of their body in childbirth. This project has contributed evidence to the discussion of women’s experiences of subjectivity in the discursive landscape of birth, while uncovering previously unacknowledged sites of resistance. The linguistic restrictions, sustained by the neoliberal control mechanisms on society and the self, act to shape the reality, feelings, and expressions of birthing women. Naming these silencing strategies, as I have done through the findings of this project, and ...

Journal of Clinical Nursing

AIM This article explores the literature on women's expectations for birth, the sociocultural... more AIM This article explores the literature on women's expectations for birth, the sociocultural context from which these expectations originate and their impact on the interpretation of birth experience. BACKGROUND Childbirth is associated with specific expectations from women with the potential for dissatisfaction if these expectations are not met. DESIGN This paper presents a systematic analysis of the concept of vulnerability in childbirth. FINDINGS A framework was extracted from the literature that linked the themes of a Discourse of control, Construction of inadequacy, and Shame of exposure to explain the sociocultural origin of dominant childbirth expectations in the literature. The experience of vulnerability unique to the birthing event is suggested as exposing the woman to this underlying contextual framework and impacting the interpretation of her birth. CONCLUSION This synthesis has exposed the transient experience of vulnerability during birth as a significant contributor to the birthing woman's interpretation of the birth and her place within it. RELEVANCE TO CLINICAL PRACTICE An explanatory framework is offered to clinicians that could increase their awareness of sociocultural and historical factors impacting a woman's expectations for birth. Appreciation of the woman's vulnerability in birth, exposing her to the influence of this framework, can assist clinicians to facilitate a quality birth experience for women. Furthermore, supporting women and midwives to accept this experience of birth vulnerability as a 'negative capability', can facilitate an empowering birth experience.

BMC Infectious Diseases

Background: In the UK, hepatitis B virus (HBV) incidence is associated with migrants from particu... more Background: In the UK, hepatitis B virus (HBV) incidence is associated with migrants from particular high-burden countries and population groups deemed 'hard-to-reach' by standard healthcare services: the homeless, people who inject drugs and ex-prisoners. Currently, there is a national targeted HBV vaccine policy for such at-risk groups, but there is limited recent evidence about 1) the levels of vaccine uptake, 2) the factors associated with incomplete vaccination, and 3) reasons for incomplete vaccination. Methods: A questionnaire capturing social and medical history, demographic factors and information about HBV vaccination status was completed by individuals deemed hard-to-reach due to socio-structural factors that criminalise, isolate and stigmatise who consented to participate in a randomised controlled trial of a peer intervention to promote engagement with hepatitis C services. The questionnaire also captured the reasons for incomplete vaccination. Descriptive, univariable and multivariable regression analyses were undertaken. Results: Three hundred fourty six participants completed the questionnaire. 1) 52.3% (n = 181) reported full HBV vaccination. 2) Within a multivariable model adjusting for sociodemographic variables, the presence of one or two or more socio-structural factors that are included in the national targeted vaccination policy was associated with protection against incomplete HBV vaccination (51.7% vaccine coverage in those with one factor, odds ratio 0.43 [95% confidence interval 0.20-0.92]); 70.1% coverage with two or more factors, 0.19 [0.09-0.39]; overall p-value < 0.001). Being female was also associated with lower vaccine uptake (2.37 [1.24-4.57], 0.01). Examining the socio-structural factors individually, intravenous drug use was associated with protection against incomplete HBV vaccination. 3) The most common reasons declared for incomplete vaccination were never being offered the vaccine or not returning for further doses. Conclusion: Within this study of HBV vaccination uptake among hard-to-reach population groups in London, UK, we document 52.3% coverage of the full vaccine course. Critically, although participants recommended for immunisation within national guidelines had an increased likelihood of receiving a complete vaccine course, we note surprisingly low coverage in the presence of the risk factors that are national indicators for vaccination. Public health bodies should make additional efforts to improve coverage in the hard-to-reach through improved vaccine delivery systems.

BMC Medicine

Background: Peer support can enable patient engagement with healthcare services, particularly for... more Background: Peer support can enable patient engagement with healthcare services, particularly for marginalised populations. In this randomised controlled trial, the efficacy of a peer support intervention at promoting successful engagement with clinical services for chronic hepatitis C was assessed. Methods: In London, UK, potential participants were approached through outreach services for problematic drug use and homelessness. Individuals positive for hepatitis C virus (HCV) after confirmatory testing were randomised using an online service to the intervention (peer support) or standard of care. The primary outcome of interest was successful engagement with clinical hepatitis services. The study was non-blinded. Absolute differences were calculated using a generalised linear model and the results compared to logistic regression. Results: Three hundred sixty-four individuals consented to participate. One hundred one had chronic hepatitis C and were randomised, 63 to receive the intervention (peer support). A successful outcome was achieved by 23 individuals in this arm (36.5%) and seven (18.4%) receiving the standard of care, giving an absolute increase of 18.1% (95% confidence interval 1.0-35.2%, p value = 0.04). This was mirrored in the logistic regression (odds ratio 2.55 (0.97-6.70), p = 0.06). No serious adverse events were reported. Conclusions: Peer support can improve the engagement of patients with chronic HCV with healthcare services. Trial registration: ISRCTN24707359. Registered 19th October 2012.