Imperial College London

DrShaminiGnani

Faculty of MedicineSchool of Public Health

Senior Clinical Teaching Fellow
 
 
 
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Contact

 

+44 (0)20 7594 0823s.gnani

 
 
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Location

 

Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Publication Type
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47 results found

Nasar S, Shome R, Kabir S, Gnani S, Rao M, Rashid SFet al., 2024, Understanding the impacts of COVID-19 pandemic on mental health and well-being among university students in Dhaka, Bangladesh: A nested mixed-methods study., Heliyon, Vol: 10, ISSN: 2405-8440

BACKGROUND: University students are more at risk of mental illness compared with the general population. Declaration of a global COVID-19 pandemic led the Bangladesh government in March 2020 to implement a national lockdown, home quarantining, social distancing measures, and closure of educational institutions. We aimed to explore the impact of lockdown on the mental health and well-being of university students in Bangladesh. METHODS: A nested mixed-methods survey design was undertaken using a semi structured questionnaire and in-depth interviews conducted by telephone of 73 university students (mean age of 22 years, range 18 to 26-years-old) attending public and private academic institutions in Dhaka. A questionnaire was developed de-novo and pre-tested. Qualitative, open-ended questions were used to understand experiences regarding students' mental health and well-being, their perceptions of COVID-19, and coping strategies. RESULTS: Fifty nine percent of students reported that lockdown had a significant impact on their mental health and well-being. They described difficulties with social isolation and loneliness, motivation, and interpersonal conflict within families. Students' knowledge of COVID-19 were high with television, newspapers, online, and social media were main sources of information; few relied on government reports. Most pressing concerns were timely graduation and employment (83%), not being able to socialize (46%), being stuck at home (37%), and financial difficulties regarding university fees (29%). Additional underlying stressors included financial insecurity of respondents' households and parental health. Coping strategies included watching television or films, online meetings with friends, social media, as well interactions with family. CONCLUSION: As a result of Bangladesh's first national lockdown, university students experienced negative effects on their mental health and well-being. There is an urgent need for greater proactive measures with

Journal article

Lazzarino A, Salkind JA, Amati F, Robinson T, Gnani S, Nicholls D, Hargreaves Det al., 2024, Inequalities in mental health service utilisation by children and young people: a population survey using linked electronic health records from Northwest London, United Kingdom, Journal of Epidemiology and Community Health, Vol: 78, Pages: 191-198, ISSN: 0143-005X

Background: Mental healthcare services for children and young people (CYP) are a very limited resource in the UK. To prevent health inequalities, measures to increase overall capacity must sit alongside measures that ensure utilisation matches need.Aim: Our aim was to identify subgroups of CYP with unexpectedly low mental health service utilisation, presumably representing unmet need, and to assess whether there is area variation in the socioeconomic gradient of mental healthcare use.Methods: This is a cross-sectional population survey of CYP (aged 5–24 years) using electronic health records from the Discover Now research platform, covering approximately 95% of the Northwest London resident population of 2.4 million people.Results: The total sample comprised 764 327 CYP, of whom 2.1% attended a mental healthcare appointment in 2021 (95% CI 2.1% to 2.2%), our outcome measure. Lower socioeconomic status (our main exposure factor) was related to higher occurrence of mental healthcare appointments (+5% for each quintile increase in deprivation (95% CI 2% to 7%, p<0.001]). However, interaction analyses showed that the boroughs with unexpectedly low utilisation rates were also those not showing a clear trend between socioeconomic conditions and services utilisation (interaction p<0.001), suggesting that in these boroughs the occurrence of mental disorders in disadvantaged people was not captured by our analysis based on service utilisation. In some London boroughs, we found lower-than-expected activity for the most disadvantaged CYP.Conclusions: The mental healthcare needs of many CYP from socioeconomically deprived areas of Northwest London may be unmet. More information is needed to confirm our results.

Journal article

Dykxhoorn J, Osborn D, Walters K, Kirkbride JB, Gnani S, Lazzarino AIet al., 2024, Temporal patterns in the recorded annual incidence of common mental disorders over two decades in the United Kingdom: a primary care cohort study, Psychological Medicine, Vol: 5, Pages: 663-674, ISSN: 0033-2917

BACKGROUND: Common mental disorders (CMDs) including depression, anxiety, and stress are very common, but it is unclear whether the last decades of social, economic, and political change have impacted incidence of CMD. This study explored temporal trends in the recorded incidence of CMD in the United Kingdom. METHODS: We used data from general practices in the United Kingdom (Clinical Practice Research Datalink) to estimate the annual recorded incidence of CMD for 2000-2020, including symptoms, diagnosis, or pharmaceutical treatment. Trends were explored by sex, age, ethnicity, region, deprivation, and comorbidity. RESULTS: We included 29 480 164 individuals who were followed up for 12.5 years on average (s.d. = 6.4 years). The recorded incidence of CMD episodes was 55.9 per 1000 person-years in 2000 [95% confidence interval (CI) 55.8-56.1], increasing to 79.6 per 1000 person-years in 2019 (95% CI 79.5-79.8). Females had higher recorded incidence rates, as did those living in more deprived areas. We observed striking patterns by age over time, with rates in ages 16-24 increasing from 40.2 per 1000 in 2000 (95% CI 39.8-40.5), to 107.8 per 1000 in 2019 (95% CI 107.0-108.6). In contrast, the rates in those aged ≥55 years decreased since 2014. There were differing patterns of incidence by ethnic group, with a steeper increase in Asian, Black, and mixed groups in recent years. CONCLUSIONS: Overall, the incidence of recorded CMD in the UK general practice increased between 2000 and 2019 with a small decrease in 2020. The overall trends obscured important differences across population subgroups, which may have implications for prevention.

Journal article

Koly KN, Saba J, Rao M, Rasheed S, Reidpath DD, Armstrong S, Gnani Set al., 2024, Stakeholder perspectives of mental healthcare services in Bangladesh, its challenges and opportunities: a qualitative study., Glob Ment Health (Camb), Vol: 11, ISSN: 2054-4251

This study explores Bangladesh's mental health services from an individual- and system-level perspective and provides insights and recommendations for strengthening it's mental health system. We conducted 13 in-depth interviews and 2 focus group discussions. Thirty-one participants were recruited using a combination of purposive and snowball sampling methods. All interviews and group discussions were audio-recorded and transcribed, and key findings were translated from Bengali to English. Data were coded manually and analysed using a thematic and narrative analysis approach. Stakeholders perceived scarcity of service availability at the peripheral level, shortage of professionals, weak referral systems, lack of policy implementation and regulatory mechanisms were significant challenges to the mental health system in Bangladesh. At the population level, low levels of mental health literacy, high societal stigma, and treatment costs were barriers to accessing mental healthcare. Key recommendations included increasing the number of mental health workers and capacity building, strengthening regulatory mechanisms to enhance the quality of care within the health systems, and raising awareness about mental health. Introducing measures that relate to tackling stigma, mental health literacy as well as building the capacity of the health workforce and governance systems will help ensure universal mental health coverage.

Journal article

Baskin C, Duncan F, Adams EA, Oliver EJ, Samuel G, Gnani Set al., 2023, How co-locating public mental health interventions in community settings impacts mental health and health inequalities: a multi-site realist evaluation, BMC Public Health, Vol: 23, ISSN: 1471-2458

BACKGROUND: Public mental health interventions are non-clinical services that aim to promote wellbeing and prevent mental ill health at the population level. In England, the health, social and community system is characterised by complex and fragmented inter-sectoral relationships. To overcome this, there has been an expansion in co-locating public mental health services within clinical settings, the focus of prior research. This study evaluates how co-location in community-based settings can support adult mental health and reduce health inequalities. METHODS: A qualitative multi-site case study design using a realist evaluation approach was employed. Data collection took place in three phases: theory gleaning, parallel testing and refining of theories, and theory consolidation. We collected data from service users (n = 32), service providers (n = 32), funders, commissioners, and policy makers (n = 11), and members of the public (n = 10). We conducted in-depth interviews (n = 65) and four focus group discussions (n = 20) at six case study sites across England, UK, and two online multi-stakeholder workshops (n = 20). Interview guides followed realist-informed open-ended questions, adapted for each phase. The realist analysis used an iterative, inductive, and deductive data analysis approach to identify the underlying mechanisms for how community co-location affects public mental health outcomes, who this works best for, and understand the contexts in which co-location operates. RESULTS: Five overarching co-location theories were elicited and supported. Co-located services: (1) improved provision of holistic and person-centred support; (2) reduced stigma by creating non-judgemental environments that were not associated with clinical or mental health services; (3) delivered services in psychologically safe environments by creating a culture of empathy, friendliness and tru

Journal article

Steeg S, Mughal F, Kapur N, Gnani S, Robinson Cet al., 2023, Social services utilisation and referrals after seeking help from health services for self-harm: a systematic review and narrative synthesis, BMJ Public Health, Vol: 1, ISSN: 2753-4294

OBJECTIVES: Suicide prevention is a major public health challenge. Appropriate aftercare for self-harm is vital due to increased risks of suicide following self-harm. Many antecedents to self-harm involve social factors and there is strong rationale for social services-based self-harm aftercare. We aimed to review evidence for social service utilisation and referrals among people seeking help following self-harm. DESIGN: Systematic review with narrative synthesis. DATA SOURCES: PubMed, PsycINFO, AMED, Social Policy and Practice, EMBASE, Medline, Web of Science, Social Care Online, citation lists of included articles and grey literature. ELIGIBILITY CRITERIA: Studies of people of any age in contact with health services following self-harm, with study outcomes including referrals to or utilisation of social workers and social services. DATA EXTRACTION AND SYNTHESIS: Information was extracted from each included study using a proforma and quality was critically assessed by two reviewers. Narrative synthesis was used to review the evidence. RESULTS: From a total of 3414 studies retrieved, 10 reports of 7 studies were included. Study quality was generally high to moderate. All studies were based in emergency departments (EDs) and most were UK based. In studies based solely on ED data, low proportions were referred to social services (in most studies, 1%-4%, though it was up to 44% when social workers were involved in ED assessments). In one study using linked data, 15% (62/427) were referred to social services and 21% (466/2,205) attended social services over the subsequent 3-year period. CONCLUSIONS: Overall, few patients were referred to social services after self-harm. Higher reported referral rates may reflect greater service availability, involvement of social workers in psychosocial assessments or better capture of referral activity. Social services-based and integrated approaches for self-harm aftercare are important future directions for suicide prevention. Improv

Journal article

Baskin C, Duncan F, Oliver E, Samuel G, Adams A, Gnani Set al., 2022, Co-locating public mental health services in communities: a realist evaluation, European Journal of Public Health, Vol: 32, ISSN: 1101-1262

Journal article

Koly K, Baskin C, Ivy L, Rao M, Rasheed S, Law GR, Gnani Set al., 2022, Educational and training interventions aimed at healthcare workers in the detection and management of people with mental health conditions in South and Southeast Asia: systematic review protocol, BMJ Open, Vol: 11, ISSN: 2044-6055

Introduction: The mental health burden and treatment gap in South and South-East Asia is high and significant. Capacity building of healthcare workers is essential to support programmes related to the detection and management of patients with mental health conditions. We aim to conduct a systematic review to summarize the research on educational, training and capacity building interventions aimed at the healthcare workforce in detection and management of mental health conditions in South and South-East Asia.Objective: To synthesize evidence on (1) the types of educational and training interventions that have been used to improve the knowledge, skills and attitudes of healthcare workers in South and South-East Asian countries in the detection and management of mental health conditions, (2) the effectiveness, including cost effectiveness of the interventions and (3) the enabling factors and barriers that influence the effectiveness of these interventions. Methods and analysis: This review will be conducted in accordance with PRIMSA-SR guidelines. We will search six electronic databases: MEDLINE, EMBASE, PsycINFO, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Global Health for empirical studies published from 1 January 2000 to 31 August 2020. Search results from each database will be combined and uploaded in Covidence library. Title, abstract and full text screening, and data extraction of each included study will be performed by two independent reviewers. Disagreements between reviewers will be resolved by a third reviewer and study team. Quality of included studies will be assessed by the modified Cochrane Collaboration tool and ROBINS-I tool. Data will be synthesized and if a meta-analysis is not appropriate, a stepwise thematic analysis will be performed. Ethics and dissemination: Ethics approval is not required for this study. Findings will be disseminated through peer-reviewed publications, fact sheets, multimedia press

Journal article

Lee C, Kuhn I, McGrath M, Remes O, Cowan A, Duncan F, Baskin C, Oliver EJ, Osborn DPJ, Dykxhoorn J, Kaner E, Walters K, Kirkbride J, Gnani S, Lafortune Let al., 2022, A systematic scoping review of community-based interventions for the prevention of mental ill-health and the promotion of mental health in older adults in the UK, Health and Social Care in the Community, Vol: 30, Pages: 27-57, ISSN: 0966-0410

BackgroundMental health concerns in older adults are common, with increasing age-related risks to physical health, mobility and social isolation. Community-based approaches are a key focus of public health strategy in the UK, and may reduce the impact of these risks, protecting mental health and promoting wellbeing. We conducted a review of UK community-based interventions to understand the types of intervention studied and mental health/wellbeing impacts reported.MethodWe conducted a scoping review of the literature, systematically searching six electronic databases (2000–2020) to identify academic studies of any non-clinical community intervention to improve mental health or wellbeing outcomes for older adults. Data were extracted, grouped by population targeted, intervention type, and outcomes reported, and synthesised according to a framework categorising community actions targeting older adults.ResultsIn total, 1,131 full-text articles were assessed for eligibility and 54 included in the final synthesis. Example interventions included: link workers; telephone helplines; befriending; digital support services; group social activities. These were grouped into: connector services, gateway services/approaches, direct interventions and systems approaches. These interventions aimed to address key risk factors: loneliness, social isolation, being a caregiver and living with long-term health conditions. Outcome measurement varied greatly, confounding strong evidence in favour of particular intervention types.ConclusionThe literature is wide-ranging in focus and methodology. Greater specificity and consistency in outcome measurement are required to evidence effectiveness – no single category of intervention yet stands out as ‘promising’. More robust evidence on the active components of interventions to promote older adult's mental health is required.

Journal article

Baskin C, Koly Nahar K, Khanam MI, Rao M, Rasheed S, Law GR, Sarkar F, Gnani Set al., 2021, Educational and training interventions aimed at healthcare workers in the detection and management of people with mental health conditions in South and South-East Asia: A systematic review, Frontiers in Psychiatry, Vol: 12, Pages: 1-29, ISSN: 1664-0640

Background: To bridge significant mental health treatment gaps, it is essential that the healthcare workforce is able to detect and manage mental health conditions. We aim to synthesize evidence of effective educational and training interventions aimed at healthcare workers to increase their ability to detect and manage mental health conditions in South and South-East Asia. Methods: Systematic review of six electronic academic databases from January 2000 to August 2020 was performed. All primary research studies were eligible if conducted among healthcare workers in South and South-East Asia and reported education and training interventions to improve detection and management of mental health conditions. Quality of studies were assessed using Modified Cochrane Collaboration, ROBINS-I, and Mixed Methods Appraisal Tools and data synthesized by narrative synthesis. Results are reported according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. A review protocol was registered with the PROSPERO database (CRD42020203955).Findings: We included 48 of 3654 screened articles. Thirty-six reported improvements in knowledge and skills in the detection and management of mental health conditions. Training was predominantly delivered to community and primary care health workers to identify and manage common mental health disorders. Commonly used training included the World Health Organization’s mhGAP guidelines (n=9) and Cognitive Behavioural Therapy (n=8) and were successfully tailored and delivered to healthcare workers. Digitally delivered training was found to be acceptable and effective. Only one study analyzed cost effectiveness. Few targeted severe mental illnesses and upskilling mental health specialists or offered long-term follow-up or supervision. We found 21 studies were appraised as low/moderate and 19 as high/ critical risk of bias. Interpretation: In low resource country settings, upskilling and capacity building of primary car

Journal article

Duncan F, Baskin C, McGrath M, Coker JF, Lee C, Dykxhoorn J, Adams EA, Gnani S, Lafortune L, Kirkbride JB, Kaner E, Jones O, Samuel G, Walters K, Osborn D, Oliver EJet al., 2021, Community interventions for improving adult mental health: mapping local policy and practice in England, BMC PUBLIC HEALTH, Vol: 21

Journal article

McGrath M, Duncan F, Dotsikas K, Baskin C, Crosby L, Gnani S, Hunter RM, Kaner E, Kirkbride JB, Lafortune L, Lee C, Oliver E, Osborn DP, Walters KR, Dykxhoorn Jet al., 2021, Effectiveness of community interventions for protecting and promoting the mental health of working-age adults experiencing financial uncertainty: a systematic review, Journal of Epidemiology and Community Health, Vol: 75, Pages: 665-673, ISSN: 0143-005X

Background The COVID-19 pandemic has created a period of global economic uncertainty. Financial strain, personal debt, recent job loss and housing insecurity are important risk factors for the mental health of working-age adults. Community interventions have the potential to attenuate the mental health impact of these stressors. We examined the effectiveness of community interventions for protecting and promoting the mental health of working-age adults in high-income countries during periods of financial insecurity.Methods Eight electronic databases were systematically screened for experimental and observational studies published since 2000 measuring the effectiveness of community interventions on mental health outcomes. We included any non-clinical intervention that aimed to address the financial, employment, food or housing insecurity of participants. A review protocol was registered on the PROSPERO database (CRD42019156364) and results are reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Results From 2326 studies screened, 15 met our inclusion criteria. Five categories of community intervention were identified: advice services colocated in healthcare settings; link worker social prescribing; telephone debt advice; food insecurity interventions; and active labour market programmes. In general, the evidence for effective and cost-effective community interventions delivered to individuals experiencing financial insecurity was lacking. From the small number of studies without a high risk of bias, there was some evidence that financial insecurity and associated mental health problems were amenable to change and differences by subpopulations were observed.Conclusion There is a need for well-controlled studies and trials to better understand effective ingredients and to identify those interventions warranting wider implementation.

Journal article

Baskin C, Zijlstra G, McGrath M, Lee C, Duncan F, Oliver E, Osborn D, Dykxhoorn J, Kaner E, Lafortune L, Walters K, Kirkbride J, Gnani Set al., 2021, Community-centred interventions for improving public mental health among adults from minority ethnic populations in the United Kingdom: a scoping review, BMJ Open, Vol: 11, ISSN: 2044-6055

Objectives Undertake a scoping review to determine the effectiveness of community-centred interventions designed to improve the mental health and well-being of adults from ethnic minority groups in the UK.Methods We searched six electronic academic databases for studies published between January 1990 and September 2019: Medline, Embase, PsychINFO, Scopus, CINAHL and Cochrane. For intervention description and data extraction we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist and Template for Intervention Description and Replication guide. Quality was assessed using Cochrane risk of bias tools. Grey literature results were deemed beyond the scope of this review due to the large number of interventions and lack of available outcomes data.Results Of 4501 studies, 7 met the eligibility criteria of UK-based community interventions targeting mental health in adults from ethnic minority populations: four randomised controlled trials, one pre/post-pilot study, one cross-sectional study and one ethnographic study. Interventions included therapy-style sessions, peer-support groups, educational materials, gym access and a family services programme. Common components included a focus on tackling social isolation, using lay health workers from within the community, signposting and overcoming structural barriers to access. Four studies reported a statistically significant positive effect on mental health outcomes and six were appraised as having a high risk of bias. Study populations were ethnically heterogeneous and targeted people mainly from South Asia. No studies examined interventions targeting men.Conclusions There is a paucity of high-quality evidence regarding community-centred interventions focused on improving public mental health among ethnic minority groups. Decision makers need scientific evidence to inform effective approaches to mitigating health disparities. Our next steps are to map promising comm

Journal article

Gardiner T, Abraham S, Clymer O, Rao M, Gnani Set al., 2021, Racial and ethnic health disparities in healthcare settings, BMJ: British Medical Journal, Vol: 372, Pages: 1-2, ISSN: 0959-535X

Journal article

Younan H-C, Junghans C, Harris M, Majeed A, Gnani Set al., 2020, Maximising the impact of social prescribing on population health in the era of COVID-19, Journal of the Royal Society of Medicine, Vol: 113, Pages: 377-382, ISSN: 0141-0768

Journal article

Baskin C, Zijlstra G, McGrath M, Lee C, Duncan F, Oliver E, Osborn D, Dykxhoorn J, Kaner E, Gnani Set al., 2020, Community interventions improving mental health in minority ethnic adults in the UK: a scoping review, 13th European Public Health Conference, Publisher: OXFORD UNIV PRESS, Pages: V920-V920, ISSN: 1101-1262

Conference paper

Lee C, McGrath M, Remes O, Dyxhoorn J, Gnani S, Oliver EJ, Osborne D, Walters K, Lafortune L, Kuhn I, Duncan F, Baskin C, Kaner E, Kirkbride JBet al., 2020, A SYSTEMATIC SCOPING REVIEW OF COMMUNITY-BASED INTERVENTIONS FOR THE PREVENTION OF POOR MENTAL HEALTH IN OLDER ADULTS, Publisher: BMJ PUBLISHING GROUP, Pages: A66-A66, ISSN: 0143-005X

Conference paper

Wang C, Bakhet M, Roberts D, Gnani S, El-Osta Aet al., 2020, The efficacy of microlearning in improving self-care capability: a systematic review of the literature, PUBLIC HEALTH, Vol: 186, Pages: 286-296, ISSN: 0033-3506

Journal article

Duncan FH, McGrath M, Baskin C, Osborn D, Dykxhoorn J, Kaner EFS, Gnani S, LaFortune L, Lee C, Walters KR, Kirkbride J, Fischer L, Jones O, Pinfold V, Stansfield J, Oliver EJet al., 2020, Delivery of community-centred public mental health interventions in diverse areas in England: a mapping study protocol, BMJ Open, Vol: 10, Pages: 1-7, ISSN: 2044-6055

Background Public mental health (PMH) is a global challenge and a UK priority area for action. However, to progress, practitioners require a stronger evidence base regarding the effectiveness of approaches, particularly regarding promotion and prevention through community-centred interventions. In addition, policy-makers need to understand what is being delivered, particularly in areas of high need, to identify promising practices or gaps in PMH provision. Finally, and importantly, the public need better information regarding what approaches and services are available to them. We report a protocol designed to (1) identify the types of community-centred interventions used in purposively selected diverse geographical areas of England to improve PMH outcomes and (2) describe the type, target population, content and outcome measures of each intervention.Methods and analysis Five local authority areas of England were selected based on either high social deprivation or differing ethnic population statistics and geographical locations. Community-centred interventions in each area will be identified through: (1) desk-based data capture from standardised searches of publicly-available information (eg, policy, strategy and intervention advertising), (2) established professional networks and service contacts, (3) chain-referral sampling of individuals involved in local mental health promotion and prevention and (4) peer researchers, who will use their personal experience and local knowledge to help identify potentially relevant organisations. Data on the key features of the interventions will be extracted from individuals either by structured interviews or by electronic questionnaires with information regarding the intervention(s) of which they have knowledge. Initial data analysis will involve tabulating descriptive information and grouping interventions according to intervention type, target population, risk/protective factor and intended primary outcome. A descriptive compa

Journal article

Pang HY, Bakhet M, Gnani S, Majeed A, El-Osta Aet al., 2019, Leveraging community assets to tackle social isolation and loneliness: a needs assessment of the London Borough of Hammersmith & Fulham, Imperial SCARU, Publisher: Imperial College Business School, #19IC538

This study is an investigation of factors that influence the routine adoption and diffusion of evidence-based asset-based community development (ABCD) initiatives to combat social isolation and loneliness in the contemporary setting (using LBH&F as a case study)

Report

El-Osta A, Webber D, Gnani S, Mummery D, Majeed A, Smith Pet al., 2019, The Self-Care Matrix: a unifying frameowrk for self-care, SelfCare, Vol: 10, Pages: 38-56, ISSN: 2042-7018

BACKGROUND: There is resurgent interest in the concept and practice of self-care as a means to improve the health, wellness and wellbeing of individuals, and as an avenue to mitigate financial pressures and growing demands on health and social care systems worldwide. An ongoing challenge has been the lack of clarity on the specific nature and entire scope of self-care, coupled to a lack of a universal or widely accepted framework that could support the conceptualisation and study of selfcare in its totality, in all settings and from different perspectives. OBJECTIVES: To advance a comprehensive yet pragmatic and widely accessible framework to support the conceptualisation of self-care in its totality, in order to facilitate the development, commissioning, evaluation and study of self-care initiatives across a variety of settings. METHOD AND FRAMEWORK DEVELOPMENT: A pragmatic review of the academic and lay literature was undertaken to identify extant theories and conceptual models of self-care. Following a content analysis, the models were characterised, and a configuration matrix was constructed to illustrate the key components and main themes of each model. These themes were organised into a number of domains which were grouped together into cardinal dimensions of self-care. The dimensions of self-care were consolidated in an inclusive framework and visually depicted on a schema to illustrate their inter-relationship. RESULTS: We identified a total of 32 candidate models, theories and frameworks of self-care. Characterising these models led to the identification of various themes and domains. These were found to naturally group into four cardinal dimensions of self-care: (1) Activities, (2) Behaviours, (3) Context, and (4) Environment. A new model was synthesised to illustrate the relationship between each dimension on a configuration matrix resulting in the creation of the Self-Care Matrix (SCM). CONCLUSION: The Self-Care Matrix (SCM) is a useful framework that ca

Journal article

El-Osta A, Webber D, Gnani S, Banarsee R, Mummery D, Majeed A, Smith Pet al., 2019, The Self-Care Matrix: a unifying framework for self-care, Self-Care, Vol: 10, Pages: 38-56, ISSN: 2042-7018

backgroundThere is resurgent interest in the concept and practice of self-care as a means to improve the health, wellness and wellbeing of individuals, and as an avenue to mitigate financial pressures and growing demands on health and social care systems worldwide. An ongoing challenge has been the lack of clarity on the specific nature and entire scope of self-care, coupled to a lack of a universal or widely accepted framework that could support the conceptualisation and study of self-care in its totality, in all settings and from different perspectives.objectivesTo advance a comprehensive yet pragmatic and widely accessible framework to support the conceptualisation of self-care in its totality, in order to facilitate the development, commissioning, evaluation and study of self-care initiatives across a variety of settings.Method and framework developmentA pragmatic review of the academic and lay literature was undertaken to identify extant theories and conceptual models of self-care. Following a content analysis, the models were characterised, and a configuration matrix was constructed to illustrate the key components and main themes of each model. These themes were organised into a number of domains which were grouped together into cardinal dimensions of self-care. The dimensions of self-care were consolidated in an inclusive framework and visually depicted on a schema to illustrate their inter-relationship.resultsWe identified a total of 32 candidate models, theories and frameworks of self-care. Characterising these models led to the identification of various themes and domains. These were found to naturally group into four cardinal dimensions of self-care: (1) Activities, (2) Behaviours, (3) Context, and (4) Environment. A new model was synthesised to illustrate the relationship between each dimension on a configuration matrix resulting in the creation of the Self-Care Matrix (SCM).conclusionThe Self-Care Matrix (SCM) is a useful framework that can be used to

Journal article

Bacon L, Gnani S, Wingfield D, Durack C, Khan Set al., 2017, Are we stripping the care out of care plans?, BRITISH JOURNAL OF GENERAL PRACTICE, Vol: 67, Pages: 181-182, ISSN: 0960-1643

In 2013, NHS England specified that: "‘... every person with a long-term condition or disability has a personalised care plan supporting them to develop the knowledge, skills and confidence to manage their own health’.1"Around 40% of the UK population experience a long-term condition while 65% of people aged 65–84 years have two or more.2 This is an all-time high, with figures set to rise. This places significant personal, social, and economic burden on individuals, their families, and the community.The use of care plans to manage multiple long-term conditions — by assessing individual behaviour, setting joint goals, supporting self-management, and ensuring proactive follow-up — is based on Wagner’s Chronic Care Model.3 The model takes into account the need to provide support and structure to patients, and the fact that all long-term conditions have common challenges.Care planning has received extraordinary interest in the NHS. Policymakers endorse care planning as a way of containing high costs, encouraging a more person-centred approach, improving quality of life, and reducing mortality rates and emergency admissions to hospitals. But are care plans effective in this regard and what challenges do GP practices face in implementation?

Journal article

Morton S, Hames R, Kelso I, Newth A, Gnani Set al., 2017, Does attending general practice prior to the emergency department change patient outcomes? A descriptive, observational study of one central London general practice, London Journal of Primary Care, Vol: 9, Pages: 28-32, ISSN: 1757-1480

Background: The challenge of keeping Emergency Department (ED) attendances down continues and timely access to general practice (GP) is often portrayed as a potential solution.Setting: One London general practice (registered population = 4900)Question: Does seeing a GP before attending the ED affect the outcome of a patient’s ED care?Methods: Routine clinical data were extracted using SystmOne primary care computer system for all registered patients with an ED attendance between 1 October 2014 and 31 September 2015. The scanned discharge summaries from the ED and GP notes were reviewed and outcome measures extracted.Results: 227 patients (121 female; 104 male) attended the ED. The most common presentation was abdominal pain (n = 11). 25% of patients had seen (n = 50), or contacted by phone (n = 6), a GP about the same presenting complaint before attending the ED. Of those, 73% (n = 41/56) were referred to the ED and 49% (n = 20/41) were admitted versus 33% (n = 60/184) who self-presented (statistically significant, p = 0.05). An additional 32% of those who saw the GP first (n = 13/41) received specialist ED treatment.Discussion/Conclusion: Only 25% of patients see their GP prior to attending the ED. The majority of patients who were referred by their GP required admission or specialised ED treatment. It remains unclear why the majority of patients did not choose to contact their GP prior to attending the ED, despite urgent appointments being offered; research into patients’ health beliefs in this group is required for greater understanding.

Journal article

Morton S, Igantowicz A, Gnani S, Majeed A, Greenfield Get al., 2016, Describing team development within a novel GP-led urgent care centre model: a qualitative study, BMJ Open, Vol: 6, ISSN: 2044-6055

Objective: Urgent care centres (UCCs) co-located within an Emergency Department were developed to reduce the numbers of inappropriate emergency department admissions. Since then various UCCmodels have developed, including a novel general practitioner (GP)-led UCC that incorporates bothGPs and Emergency Nurse Practitioners (ENPs). Traditionally these two groups do not workalongside each other within an emergency setting. Although good teamwork is crucial to better patient outcomes, there is little within the literature about the development of a team consisting of different healthcare professionals in a novel healthcare setting. Our aim was therefore to describe staff members’ perspectives of team development within the GP-led UCC model.Design: Open-ended semi-structured interviews, analysed using thematic content analysis.Setting: GP-led urgent care centres in two academic teaching hospitals in London.Participants: Fifteen UCC staff members including six GPs, four ENPs, two receptionists and threemanagers.Results: Overall participants were positive about the inter-professional team that had developedand recognised that this process had taken time. Hierarchy within the UCC setting has diminishedwith time, although some residual hierarchical beliefs do appear to remain. Staff appreciated interdisciplinarycollaboration was likely to improve patient care. Eight key facilitating factors for theteam were identified: appointment of leaders, perception of fair workload, education on roles/skillsets and development of these, shared professional understanding, inter-disciplinary working, EDcollaboration, clinical guidelines and social interactions.Conclusions: A strong inter-professional team has evolved within the GP-led UCCs over time,breaking down traditional professional divides. Future implementation of UCC models should proactivelyincorporate the eight facilitating factors identified from the outset, to enable effectiveteams to develop more quickly.

Journal article

Gnani S, Morton S, Ramzan F, Davison M, Ladbrooke T, Majeed F, Saxena Set al., 2016, Healthcare use among preschool children attending GP-led urgent care centres: a descriptive, observational study, BMJ Open, Vol: 6, ISSN: 2044-6055

Objective: Urgent Care Centres (UCCs) hours were developed with the aim of reducing inappropriate Emergency Department (ED) attendances in England. We aimed to examine the presenting complaint and outcomes of care in two General Practitioner (GP)-led UCCs with extended opening times. Design: Retrospective observational epidemiological study using routinely collected data.Setting: Two GP-led UCCs in London, co-located with a hospital ED.Participants: All children aged under 5 years attending two GP-led UCCs over a 3 year period. Outcomes: Outcomes of care for the children including; primary diagnosis; registration status with a GP; destination following review within the UCC and any medication prescribed. Comparison between GP-led UCC visit rates and routine general practices was also made.Results: 3% (n=7,747/282,947) of all attenders at the GP-led UCCs were children aged under 5 years. The most common reason for attendance was a respiratory illness (27%), followed by infectious illness (17%). 18% (n=1428) were either upper respiratory tract infections or viral infections. The majority (91%) of children attending were registered with a GP and over two thirds of attendances were ‘out of hours’. Overall 79% were seen and discharged home. Preschool children were more likely to attend their GP (47.0 per 100) than a GP-led UCC (9.4 per 100; 95% confidence interval: 8.9-10.0).Conclusions: Two thirds of preschool children attending GP-led UCCs do so out of hours, despite the majority being registered with a GP. The case mix is comparable to those presenting to an ED setting, with the majority managed exclusively by the GPs in the UCC before discharge home. Further work is required to understand the benefits of a GP-led urgent system in influencing future use of services especially emergency care.

Journal article

Thomas S, Jenkins R, Burch T, Nasir LC, Fisher B, Giotaki G, Gnani S, Hertel L, Marks M, Mathers N, Millington-Sanders C, Morris D, Ruprah-Shah B, Stange K, Thomas P, White R, Wright Fet al., 2016, Promoting mental health and preventing mental illness in general practice, London Journal of Primary Care, Vol: 8, Pages: 3-9, ISSN: 1757-1472

This paper calls for the routine integration of mental health promotion and prevention into UK General Practice in order to reduce the burden of mental and physical disorders and the ensuing pressure on General Practice. The proposals & the resulting document (https://ethicscharity.files.wordpress.com/2015/09/rcgp_keymsg_150925_v5.pdf) arise from an expert ‘Think Tank’ convened by the London Journal of Primary Care, Educational Trust for Health Improvement through Cognitive Strategies (ETHICS Foundation) and the Royal College of General Practitioners. It makes 12 recommendations for General Practice: (1) Mental health promotion and prevention are too important to wait. (2) Work with your community to map risk factors, resources and assets. (3) Good health care, medicine and best practice are biopsychosocial rather than purely physical. (4) Integrate mental health promotion and prevention into your daily work. (5) Boost resilience in your community through approaches such as community development. (6) Identify people at increased risk of mental disorder for support and screening. (7) Support early intervention for people of all ages with signs of illness. (8) Maintain your biopsychosocial skills. (9) Ensure good communication, interdisciplinary team working and inter-sectoral working with other staff, teams and agencies. (10) Lead by example, taking action to promote the resilience of the general practice workforce. (11) Ensure mental health is appropriately included in the strategic agenda for your ‘cluster’ of General Practices, at the Clinical Commissioning Groups, and the Health and Wellbeing Board. (12) Be aware of national mental health strategies and localise them, including action to destigmatise mental illness within the context of community development.

Journal article

Greenfield G, Ignatowicz A, Gnani S, Bucktowonsing M, Ladbrooke T, Millington H, Car J, Majeedet al., 2016, Staff perceptions on patient motives for attending GP-led urgent care centres in London: A qualitative study, BMJ Open, Vol: 6, ISSN: 2044-6055

Objectives General practitioner (GP)-led urgent care centres were established to meet the growing demand for urgent care. Staff members working in such centres are central in influencing patients’ choices about which services they use, but little is known about staff perceptions of patients’ motives for attending urgent care. We hence aimed to explore their perceptions of patients’ motives for attending such centres.Design A phenomenological, qualitative study, including semistructured interviews. The interviews were analysed using thematic content analysis.Setting 2 GP-led urgent care centres in 2 academic hospitals in London.Participants 15 staff members working at the centres including 8 GPs, 5 emergency nurse practitioners and 2 receptionists.Results We identified 4 main themes: ‘Confusion about choices’, ‘As if increase of appetite had grown; By what it fed on’, ‘Overt reasons, covert motives’ and ‘A question of legitimacy’. The participants thought that the centres introduce convenient and fast access for patients. So convenient, that an increasing number of patients use them as a regular alternative to their community GP. The participants perceived that patients attend the centres because they are anxious about their symptoms and view them as serious, cannot get an appointment with their GP quickly and conveniently, are dissatisfied with the GP, or lack self-care skills. Staff members perceived some motives as legitimate (an acute health need and difficulties in getting an appointment), and others as less legitimate (convenience, minor illness, and seeking quicker access to hospital facilities).Conclusions The participants perceived that patients attend urgent care centres because of the convenience of access relative to primary care, as well as sense of acuity and anxiety, lack self-care skills and other reasons. They perceived some motives as more legitimate than others. Attention to unmet ne

Journal article

Greenfield G, Ramzan FA, Newson RB, Majeed A, Gnani Set al., 2015, Frequent attendances to National Health Service general practitioner-led urgent care centres in London: an observational study, Publisher: ELSEVIER SCIENCE INC, Pages: S40-S40, ISSN: 0140-6736

Conference paper

Cowling TE, Ramzan F, Ladbrooke T, Millington H, Majeed F, Gnani Set al., 2015, Referral outcomes of attendances at general practitioner-led urgent care centres in London, England: retrospective analysis of hospital administrative data, Emergency Medicine Journal, Vol: 33, Pages: 200-207, ISSN: 1472-0213

ABSTRACTObjective To identify patient and attendance characteristics that are associated with onwards referral to co-located emergency departments (EDs) or other hospital specialty departments from general practitioner-led urgent care centres (UCCs) in northwest London, England.Methods We conducted a retrospective analysis of administrative data recorded in the UCCs at Charing Cross and Hammersmith Hospitals, in northwest London, from October 2009 to December 2012. Attendances made by adults resident in England were included. Logistic regression was used to model the associations between the explanatory variables – age; sex; ethnicity; socioeconomic status; area of residence; distance to UCC; general practitioner registration; time, day, quarter, year, and UCC of attendance – and the outcome of onwards referral to the co-located EDs or other hospital specialty departments.Results Of 243 042 included attendances, 74.1% were managed solely within the UCCs; without same-day referral to the EDs (16.8%) or other hospital specialty departments (5.7%), or deferred referral to a fracture, hand management, or soft tissue injury management clinic (3.3%). The adjusted odds of onwards referral was estimated to increase by 19% (OR 1.19, 95% CI 1.18 to 1.19) for a ten year increase in a patient’s age. Males, patients registered with a GP, and residents of less socioeconomically deprived areas were also more likely to be referred onwards from the UCCs.Conclusions The majority of patients, across each category of all explanatory variables, were managed solely within the UCCs, though a large absolute number of patients were referred onwards each year. Several characteristics of patients and their attendances were associated with the outcome variable.

Journal article

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