Alison McKinlay

Bio: Alison McKinlay is an academic researcher from University College London. The author has contributed to research in topics: Mental health & Thematic analysis. The author has an hindex of 5, co-authored 22 publications receiving 122 citations. Previous affiliations of Alison McKinlay include King's College London.

Psychosocial impact on frontline health and social care professionals in the UK during the COVID-19 pandemic: a qualitative interview study.

Abstract: Objectives To explore the psychosocial well-being of health and social care professionals working during the COVID-19 pandemic. Design This was a qualitative study deploying in-depth, individual interviews, which were audio-recorded and transcribed verbatim. Thematic analysis was used for coding. Participants This study involved 25 participants from a range of frontline professions in health and social care. Setting Interviews were conducted over the phone or video call, depending on participant preference. Results From the analysis, we identified 5 overarching themes: communication challenges, work-related stressors, support structures, personal growth and individual resilience. The participants expressed difficulties such as communication challenges and changing work conditions, but also positive factors such as increased team unity at work, and a greater reflection on what matters in life. Conclusions This study provides evidence on the support needs of health and social care professionals amid continued and future disruptions caused by the pandemic. It also elucidates some of the successful strategies (such as mindfulness, hobbies, restricting news intake, virtual socialising activities) deployed by health and social care professionals that can support their resilience and well-being and be used to guide future interventions.

The psychosocial impact on frontline health and social care professionals in the UK during the COVID-19 pandemic: a qualitative interview study.

Abstract: Objectives To explore the psychosocial well-being of health and social care professionals working during the COVID-19 pandemic. Design This was a qualitative study deploying in-depth, individual interviews, which were audio-recorded and transcribed verbatim. Thematic analysis was used for coding. Participants This study involved 25 participants from a range of frontline professions in health and social care. Setting Interviews were conducted over the phone or video call, depending on participant preference. Results From the analysis, we identified 5 overarching themes: communication challenges, work-related stressors, support structures, personal growth, and individual resilience. The participants expressed difficulties such as communication challenges and changing work conditions, but also positive factors such as increased team unity at work, and a greater reflection on what matters in life. Conclusions This study provides evidence on the support needs of health and social care professionals amid continued and future disruptions caused by the pandemic. It also elucidates some of the successful strategies (such as mindfulness, hobbies, restricting news intake, virtual socialising activities) deployed by health and social care professionals that can support their resilience and well-being and be used to guide future interventions. Strengths and limitations of this study This is the first study in the UK to interview both health and social care professionals working in a range of settings on their experiences working through COVID-19. This study used a strong theoretical approach to inform the topic guide, and one-to-one interviews allowed in-depth analysis of the psychosocial experiences of health and social care professionals, complementing the wider availability of quantitative evidence. We interviewed a wide range of professions, which provided breadth of experience but might limit the specificity of findings. Given the fluctuating nature of the pandemic, attitudes of health and social care professionals may change over time. This can be challenging to capture during a single interview, however we did ask questions on how their experience had progressed longitudinally. Our sample may have been biased towards people who had more free time to participate and so were coping better than others. However, our sample still described a number of stressful experiences during the pandemic, and it is also possible that workers who were frustrated or stressed wished to express their views.

A qualitative study about the mental health and wellbeing of older adults in the UK during the COVID-19 pandemic.

Abstract: OBJECTIVES: The objective of this study was to examine factors that threatened and protected the wellbeing of older adults living in the UK during social distancing restrictions due to the COVID-19 pandemic. METHODS: Semi-structured telephone or video interviews with 20 adults aged over 70. Purposive sampling methods were used to increase diversity within the group. Transcripts were analysed using reflexive thematic analysis. RESULTS: Participants described potential threats to their wellbeing during the pandemic, including fears for mortality, grieving normal life, and concerns for the future. Participants also described activities and behaviours that helped to protect their mental health, including adopting a slower pace of life, maintaining routine, socialising, and using past coping skills. Many participants drew on their resilience and life experience to self-manage fear and uncertainty associated with the pandemic, using their time during lockdown to reflect or organise end-of-life affairs. DISCUSSION: This study provides UK-based evidence that while some older adults experienced challenges during the first wave of COVID-19, many were resilient throughout social distancing restrictions despite early reported concerns of mental health consequences among the older adult population. Our findings highlight the importance of maintaining access to essentials to promote feelings of normality and use of social support to help reduce uncertainty in times of pandemics.

‘You’re just there, alone in your room with your thoughts’: a qualitative study about the psychosocial impact of the COVID-19 pandemic among young people living in the UK

Abstract: Objectives Adolescents and young adults have been greatly affected by quarantine measures during the COVID-19 pandemic, but little is understood about how restrictions have affected their well-being, mental health, and social life. We therefore aimed to learn more about how UK quarantine measures affected the social lives, mental health and well-being of adolescents and young adults. Design Qualitative interview study. The data were analysed using reflexive thematic analysis, with particular attention paid to contextual factors (such as age, gender, ethnicity and health status) when analysing each individual transcript. Setting Data collection took place remotely across the UK via audio or video call, between June 2020 and January 2021. Participants We conducted semi-structured interviews with 37 participants (aged 13–24 years) to elicit their views. Results Authors generated four themes during the qualitative analysis: (a) concerns about disruption to education, (b) missing social contact during lockdown, (c) changes to social relationships and (d) improved well-being during lockdown. Many participants said they struggled with a decline in mental health during the pandemic, lack of support and concern about socialising after the pandemic. However, some participants described experiences and changes brought on by the pandemic as helpful, including an increased awareness of mental health and feeling more at ease when talking about it, as well as stronger relationship ties with family members. Conclusions Findings suggest that young people may have felt more comfortable when talking about their mental health compared with prepandemic, in part facilitated by initiatives through schools, universities and employers. However, many were worried about how the pandemic has affected their education and social connections, and support for young people should be tailored accordingly around some of these concerns.

Self-Management education for adults with poorly controlled epILEpsy [SMILE (UK)]: a randomised controlled trial.

Abstract: Background Epilepsy is a common neurological condition resulting in recurrent seizures. Research evidence in long-term conditions suggests that patients benefit from self-management education and that this may improve quality of life (QoL). Epilepsy self-management education has yet to be tested in a UK setting. Objectives To determine the effectiveness and cost-effectiveness of Self-Management education for people with poorly controlled epILEpsy [SMILE (UK)]. Design A parallel pragmatic randomised controlled trial. Setting Participants were recruited from eight hospitals in London and south-east England. Participants Adults aged ≥ 16 years with epilepsy and two or more epileptic seizures in the past year, who were currently being prescribed antiepileptic drugs. Intervention A 2-day group self-management course alongside treatment as usual (TAU). The control group received TAU. Main outcome measures The primary outcome is QoL in people with epilepsy at 12-month follow-up using the Quality Of Life In Epilepsy 31-P (QOLIE-31-P) scale. Other outcomes were seizure control, impact of epilepsy, medication adverse effects, psychological distress, perceived stigma, self-mastery and medication adherence. Cost-effectiveness analyses and a process evaluation were undertaken. Randomisation A 1 : 1 ratio between trial arms using fixed block sizes of two. Blinding Participants were not blinded to their group allocation because of the nature of the study. Researchers involved in data collection and analysis remained blinded throughout. Results The trial completed successfully. A total of 404 participants were enrolled in the study [SMILE (UK), n = 205; TAU, n = 199] with 331 completing the final follow-up at 12 months [SMILE (UK), n = 163; TAU, n = 168]. In the intervention group, 61.5% completed all sessions of the course. No adverse events were found to be related to the intervention. At baseline, participants had a mean age of 41.7 years [standard deviation (SD) 14.1 years], and had epilepsy for a median of 18 years. The mean QOLIE-31-P score for the whole group at baseline was 66.0 out of 100.0 (SD 14.2). Clinically relevant levels of anxiety symptoms were reported in 53.6% of the group and depression symptoms in 28.0%. The results following an intention-to-treat analysis showed no change in any measures at the 12-month follow-up [QOLIE-31-P: SMILE (UK) mean: 67.4, SD 13.5; TAU mean: 69.5, SD 14.8]. The cost-effectiveness study showed that SMILE (UK) was possibly cost-effective but was also associated with lower QoL. The process evaluation with 20 participants revealed that a group course increased confidence by sharing with others and improved self-management behaviours. Conclusions For people with epilepsy and persistent seizures, a 2-day self-management education course is cost-saving, but does not improve QoL after 12-months or reduce anxiety or depression symptoms. A psychological intervention may help with anxiety and depression. Interviewed participants reported attending a group course increased their confidence and helped them improve their self-management. Future work More research is needed on self-management courses, with psychological components and integration with routine monitoring. Trial registration Current Controlled Trials ISRCTN57937389. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 21. See the NIHR Journals Library website for further project information.

Chronic Health Conditions: Changing Prevalence in an Aging Population and Some Implications for the Delivery of Health Care Services

Abstract: Since the prevalence of many chronic health conditions increases with age we might anticipate that as the population ages the proportion with one or more such conditions would rise, as would the cost of treatment. We ask three questions: How much would the overall prevalence of chronic conditions increase in a quarter century if age-specific rates of prevalence did not change? How much would the requirements for health care resources increase in those circumstances? How much difference would it make to those requirements if people had fewer chronic conditions? We conclude that the overall prevalence rates for almost all conditions associated mostly with old age would rise by more than 25 percent and that health care requirements would grow more rapidly than the population – more than twice as rapidly in the case of hospital stays – if the rates for each age group remained constant. We conclude also that even modest reductions in the average number of conditions at each age could result in substantial savings.

Understanding different trajectories of mental health across the general population during the COVID-19 pandemic.

Abstract: BACKGROUND: The COVID-19 pandemic and nationally mandated restrictions to control the virus have been associated with increased mental health issues. However, the differential impact of the pandemic and lockdown on groups of individuals, and the personal characteristics associated with poorer outcomes are unknown. METHOD: Data from 21 938 adults in England who participated in a stratified cohort study were analysed. Trajectories of depression and anxiety symptoms were identified using growth mixture modelling. Multinomial and logistic regression models were constructed to identify sociodemographic and personality-related risk factors associated with trajectory class membership. RESULTS: Four trajectories of depression and five for anxiety were identified. The most common group presented with low symptom severity throughout, other classes were identified that showed: severe levels of symptoms which increased; moderate symptoms throughout; worsening mental health during lockdown but improvements after lockdown ended; and for anxiety only, severe initial anxiety that decreased quickly during lockdown. Age, gender, ethnicity, income, previous diagnoses, living situation, personality factors and sociability were associated with different trajectories. CONCLUSIONS: Nearly 30% of participants experienced trajectories with symptoms in the clinical range during lockdown, and did not follow the average curve or majority group, highlighting the importance of differential trajectories. Young, female, outgoing and sociable people and essential workers experienced severe anxiety around the announcement of lockdown which rapidly decreased. Younger individuals with lower incomes and previous mental health diagnoses experienced higher and increasing levels of symptoms. Recognising the likely symptom trajectories for such groups may allow for targeted care or interventions.

The Construction of Optimal Stated Choice Experiments: Theory and Methods

Abstract: Dean reviews The Construction of Optimal Stated Choice Experiments: Theory and Methods by Deborah J. Street and Leonie Burgess.

Strategies for improving adherence to antiepileptic drug treatment in people with epilepsy

Abstract: Background Poor adherence to antiepileptic medication is associated with increased mortality, morbidity and healthcare costs. In this review, we focus on interventions designed and tested in randomised controlled trials and quasi-randomised controlled trials to assist people with adherence to antiepileptic medication. This is an updated version of the original Cochrane review published in the Cochrane Library, Issue 1, 2010. Objectives To determine the effectiveness of interventions aimed at improving adherence to antiepileptic medication in adults and children with epilepsy. Search methods For the latest update, on 4 February 2016 we searched the Cochrane Epilepsy Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Register of Studies Online (CRSO), MEDLINE (Ovid 1946 to 4 February 2016), CINAHL Plus (EBSCOhost 1937 to 4 February 2016), PsycINFO (EBSCOhost 1887 to 4 February 2016), ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform. We also searched the reference lists of relevant articles. Selection criteria Randomised and quasi-randomised controlled trials of adherence-enhancing interventions aimed at people with a clinical diagnosis of epilepsy (as defined in individual studies), of any age and treated with antiepileptic drugs in a primary care, outpatient or other community setting. Data collection and analysis All review authors independently assessed lists of potentially relevant citations and abstracts. At least two review authors independently extracted data and performed quality assessment of each study according to the Cochrane tool for assessing risk of bias. We graded the level of evidence for each outcome according to the GRADE working group scale.The studies differed widely according to the type of intervention and measures of adherence; therefore combining data was not appropriate. Main results We included 12 studies reporting data on 1642 participants (intervention = 833, control = 809). Eight studies targeted adults with epilepsy, one study included participants of all ages, one study included participants older than two years, one study targeted caregivers of children with epilepsy, and one study targeted families of children with epilepsy. We identified six ongoing trials. Follow-up time was generally short in most trials, ranging from one to 12 months. The trials examined three main types of interventions: educational interventions, behavioural interventions and mixed interventions. All studies compared treatment versus usual care or 'no intervention', except for two studies. Due to heterogeneity between studies in terms of interventions, methods used to measure adherence and the way the studies were reported, we did not pool the results and these findings were inappropriate to be included in a meta-analysis. Education and counselling of participants with epilepsy resulted in mixed success (moderate-quality evidence). Behavioural interventions such as use of intensive reminders provided more favourable effects on adherence (moderate-quality evidence). The effect on adherence to antiepileptic drugs described by studies of mixed interventions showed improved adherence in the intervention groups compared to the control groups (high-quality evidence). Authors' conclusions Behavioural interventions such as intensive reminders and the use of mixed interventions demonstrate some positive results; however, we need more reliable evidence on their efficacy, derived from carefully-designed randomised controlled trials before we can draw a firm conclusion. Since the last version of this review, none of the new relevant studies have provided additional information that would lead to significant changes in our conclusions. This current update includes 12 studies, of which six came from the latest searches.