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Introduction
Jo is a social scientist with a background in applied health services research. Her research focuses on managing medical complexity and multi-morbidity, mental health, treatment decision-making, patient self-management, and children's palliative care.
Jo has methodological expertise in qualitative research methods, mixed methods research, participatory and co-design methods, intervention development, and patient and public involvement.
Jo is currently training to be a mental health nurse.
Current institution
Additional affiliations
January 2013 - January 2015
Publications
Publications (91)
Introduction
Biological disease-modifying antirheumatic drugs (bDMARDs) have revolutionised the treatment of inflammatory arthritis (IA). However, many people with IA still require planned orthopaedic surgery to reduce pain and improve function. Currently, bDMARDs are withheld during the perioperative period due to potential infection risk. However...
Background
Increasing numbers of children/adolescents experiencing gender dysphoria/incongruence are being referred to specialist gender services. Services and practice guidelines are responding to these changes.
Aim
This systematic review examines the numbers and characteristics of children/adolescents (under 18) referred to specialist gender or...
Background
Over the last 10-15 years, there has been an increase in the number of children and adolescents referred to gender services, particularly among adolescent birth-registered females. This population shows a higher prevalence of co-occurring mental health difficulties and neurodevelopmental conditions. Some countries have recently restricte...
Background
Increasing numbers of children and adolescents experiencing gender dysphoria or incongruence are being referred to specialist gender services. Historically, social transitioning prior to assessment was rare but it is becoming more common.
Aim
To identify and synthesise studies assessing the outcomes of social transition for children and...
Background
Clinical guidelines outline the use of hormones for masculinisation/feminisation in adolescents experiencing gender dysphoria or incongruence. Robust evidence concerning risks and benefits is lacking. There is a need to aggregate evidence as research becomes available.
Aim
Identify and synthesise studies assessing the outcomes of hormon...
Background
National and international guidelines recommend that psychosocial support should be a key component of the care offered to children and adolescents experiencing gender dysphoria/incongruence. However, specific approaches or interventions are not recommended.
Aim
To identify and summarise evidence on the outcomes of psychosocial support...
Background
Increasing numbers of children and adolescents experiencing gender dysphoria/incongruence are being referred to specialist gender services and there are various published guidelines outlining approaches to clinical care.
Aim
To examine the recommendations about the management of children and/or adolescents (age 0-18) experiencing gender...
Background
Increasing numbers of children and adolescents experiencing gender dysphoria/incongruence are being referred to specialist gender services. However, little is currently known about the proportions accessing different types of care and treatment following referral.
Aim
This systematic review examines the range of care pathways of childre...
Background
Treatment to suppress or lessen effects of puberty are outlined in clinical guidelines for adolescents experiencing gender dysphoria/incongruence. Robust evidence concerning risks and benefits is lacking and there is a need to aggregate evidence as new studies are published.
Aim
To identify and synthesise studies assessing the outcomes...
Background
Increasing numbers of children and adolescents experiencing gender dysphoria/incongruence are being referred to specialist gender services. There are various guidelines outlining approaches to the clinical care of these children and adolescents.
Aim
To examine the quality and development of published guidelines or clinical guidance cont...
Introduction
Involving people with lived experience is an important component in health research. Conducting public and patient involvement (PPI) within paediatric palliative care (PPC) research requires sensitivity and has specific ethical and practical considerations. As a research group, it was important to reflect on how we have worked with par...
Introduction
CompreHensive geriAtRician-led MEdication Review (CHARMER) is a behaviour change intervention to support geriatricians and pharmacists to proactively deprescribe inappropriate medicines with older adults in hospital. The intervention comprises: formulating a deprescribing action plan, workshops, benchmarking reports and weekly briefing...
Background
People with severe mental illness (SMI), such as schizophrenia, have higher rates of type 2 diabetes and worse outcomes, compared to those without SMI and it is not known whether diabetes self‐management interventions are effective for people who have both conditions. Research in this area has been impeded by a lack of consensus on which...
Objective
To assess the risks, benefits and resource implications of using home-blended food in children with gastrostomy tubes compared with currently recommended formula feeds.
Design
This is a cohort study. Data were collected at months 0, 12 and 18 from parents and clinicians using standardised measures.
Setting
32 sites across England: 28 Na...
Objectives
This study assessed the work-related resources and demands experienced by children’s hospice staff to help identify staff support systems and organizational practices that offer the most potential to prevent staff burnout and enhance well-being at work.
Methods
The relationships between individual and organizational characteristics, wor...
Aim
To assess the risks, benefits, and resource implications of home‐blended food for children with gastrostomy tubes compared with a formula diet.
Method
This prospective cohort study of children (aged 0–18 years) collected baseline data on gastrointestinal symptoms, nutritional intake, anthropometric outcomes, parent and child quality of life, a...
Background
There is a workforce shortage in the children’s hospice sector, but there has been little research on the specific challenges of working in this setting and on how these challenges might be alleviated. To identify appropriate interventions to improve staff wellbeing, the drivers of wellbeing in children’s hospices need to be known and me...
Objectives
Poor psychological well-being among healthcare workers can have numerous negative impacts, but evidence about levels of burnout in children’s hospice care staff is limited. This study aimed to determine the prevalence of burnout and to explore the association between staff characteristics and support mechanisms with burnout among childre...
Introduction
Over 50% of older adults are prescribed a medicine where the risk of harm outweighs the chances of benefit. During a hospital admission, older adults and carers expect medicines to be reviewed for appropriateness and any inappropriate medicines proactively deprescribed. While the principle of proactive deprescribing is an expectation o...
Background
Delirium is a distressing condition often experienced by hospice in-patients. Increased understanding of current multidisciplinary care of delirium is needed to develop interventions in this setting.
Aim(s)
To explore hospice staff and volunteers’ practice, its influences and what may need to change to improve hospice delirium care.
De...
Background
Poor psychological well-being among healthcare staff has implications for staff sickness and absence rates, and impacts on the quality, cost and safety of patient care. Although numerous studies have explored the well-being of hospice staff, study findings vary and the evidence has not yet been reviewed and synthesised. Using job demands...
Introduction
Half of older people are prescribed unnecessary or harmful medication that are not routinely deprescribed in hospital. There is a need for trials of deprescribing interventions, and for these to adopt consistent measurement and reporting of outcomes(1).
Aim
To develop a Core Outcome Set (COS) for use in hospital deprescribing trials f...
Introduction
50% of older adults are prescribed a medicine that is unnecessary or harmful that should be deprescribed (1). CompreHensive geriAtRician-led MEdication Review (CHARMER) is a behaviour change intervention to equip geriatricians and pharmacists to proactively deprescribe. Five determinants of deprescribing have been prioritised and the f...
Background
Worldwide, around 21 million children would benefit from palliative care and over 7 million babies and children die each year. Whilst provision of paediatric palliative care is advancing, there major gaps between what should be done, and what is being done, in clinical practice. In 2017, the National Institute for Health and Care Excelle...
Background:
Trials of hospital deprescribing interventions have demonstrated limited changes in practitioner behaviour. Our previous research characterised four barriers and one enabler to geriatricians and pharmacists deprescribing in hospital that require addressing by a behaviour change intervention. Six behaviour change techniques (BCTs) have...
Background
An estimated 21 million children worldwide would benefit from palliative care input and over 7 million die each year. For parents of these children this is an intensely emotional and painful time through which they will need support. There is a lack of synthesised research about how parents experience the care delivered to their child at...
BACKGROUND
Type 2 diabetes is 2-3 times more common among people with severe mental illness (SMI). Self-management is crucial, with additional challenges faced by people with SMI. Therefore, it is essential that any diabetes self-management programme for people with SMI addresses the unique needs of people living with both conditions, and the inequ...
Background:
Type 2 diabetes is 2 to 3 times more common among people with severe mental illness (SMI). Self-management is crucial, with additional challenges faced by people with SMI. Therefore, it is essential that any diabetes self-management program for people with SMI addresses the unique needs of people living with both conditions and the ine...
Background
People with severe mental illness (SMI), such as schizophrenia, have higher rates of physical long-term conditions (LTCs), poorer health outcomes, and shorter life expectancy compared with the general population. Previous research exploring SMI and diabetes highlights that people with SMI experience barriers to self-management, a key com...
Background:
Half of older people are prescribed unnecessary/inappropriate medications that are not routinely deprescribed in hospital hence there is a need for deprescribing trials. We aimed to develop a Core Outcome Set (COS) for deprescribing trials for older people under the care of a geriatrician during hospital admission.
Methods:
We develo...
Context
Polypharmacy is often appropriate for children with life-limiting conditions but is associated with an increase in hospitalisations and inappropriate prescribing, and can affect the quality of life of children and their families as they manage complex medication schedules. Despite this, little is known about polypharmacy in this population....
Introduction: the DIAMONDS programme aims to evaluate a novel supported diabetes self-management intervention for people with severe mental illness (the “DIAMONDS intervention”). The purpose of this study is to test the feasibility of intervention delivery and data collection procedures to inform a definitive randomised controlled trial (RCT).
Met...
Introduction.
The DIAMONDS programme aims to evaluate a novel supported diabetes self-management intervention for people with severe mental illness (the “DIAMONDS intervention”). The purpose of this study is to test the feasibility of intervention delivery and data collection procedures to inform a definitive randomised controlled trial (RCT).
Meth...
Introduction
A large and growing number of patients with cancer have comorbid diabetes. Cancer and its treatment can adversely impact glycaemic management and control, and there is accumulating evidence that suboptimal glycaemic control during cancer treatment is a contributory driver of worse cancer-related outcomes in patients with comorbid diabe...
Introduction
The DIAMONDS programme aims to evaluate a novel supported diabetes self-management intervention for people with severe mental illness (the DIAMONDS intervention). The purpose of this study is to test the feasibility of intervention delivery and data collection procedures to inform a definitive randomised controlled trial (RCT).
Methods...
In the UK, the children’s hospice sector has become increasingly concerned about levels of work-related stress among its staff. This stems from increasing evidence that staff wellbeing is associated with the quality, cost and safety of patient care, and an acknowledgment of the important role of those working in children’s hospices.The SWiCH study,...
Background
People living with severe mental illness (SMI) have a reduced life expectancy by around 15–20 years, in part due to higher rates of long-term conditions (LTCs) such as diabetes and heart disease. Evidence suggests that people with SMI experience difficulties managing their physical health. Little is known, however, about the barriers, fa...
Behavioural interventions can support the adoption of healthier lifestyles and improve physical health outcomes, but it is unclear what factors might drive success of such interventions in people with serious mental illness (SMI). We systematically identified and reviewed evidence of the association between determinants of physical health self-mana...
Background: approximately 60,000 people in England have coexisting type 2 diabetes mellitus (T2DM) and severe mental illness (SMI). They are more likely to have poorer health outcomes and require more complex care pathways compared to those with T2DM alone. Despite increasing prevalence, little is known about the healthcare resource use and costs f...
Aims
To systematically review and synthesise qualitative evidence about determinants of self-management in adults with SMI. The goal is to use findings from this review to inform the design of effective self-management strategies for people with SMI and LTCs.
Background
People living with serious mental illness (SMI) have a reduced life expectancy...
Background
Children with a life-limiting condition often require extensive and complex care, much of which is provided by their parents at home. There is a growing body of research that aims to understand the experiences of these parents, but the majority of this research is from mothers’ perspectives, meaning that fathers’ experiences are not well...
Background
People with severe mental illness experience poorer health outcomes than the general population. Diabetes contributes significantly to this health gap.
Objectives
The objectives were to identify the determinants of diabetes and to explore variation in diabetes outcomes for people with severe mental illness.
Design
Under a social inequa...
Aim
To identify child and parent outcomes relevant to having a gastrostomy, and to specify outcomes believed to be particularly salient to type of diet (formula vs blended food).
Method
Twenty parents, two children (both 12y), and 41 professionals (dietitians [n=10]; nurses [n=12]; paediatricians [n=12]; speech and language therapists [n=7)]) were...
Background
Delirium is common in palliative care settings and is distressing for patients, their families and clinicians. To develop effective interventions, we need first to understand current delirium care in this setting.
Aim
To understand patient, family, clinicians’ and volunteers’ experience of delirium and its care in palliative care contex...
Aims: diabetes is 2-3 times more prevalent in people with severe mental illness, yet little is known about the challenges of managing both conditions from the perspectives of people living with the comorbidity, their family members or healthcare staff. Our aim was to understand these challenges and to explore the circumstances that influence access...
Background:
People with severe mental illnesses (SMI) have reduced life expectancy compared with the general population. Diabetes is a major contributor to this disparity with higher prevalence and poorer outcomes in people with SMI.
Aim:
To determine the impact of SMI on healthcare processes and outcomes for diabetes.
Design and setting:
Retr...
Background
Consistent evidence suggests that children’s palliative care is not equitable and managed clinical networks (MCNs) have been recommended as a solution. This study explored the perspectives of health professionals involved in the development of a children’s palliative care MCN, with an aim to identify barriers and enablers of successful i...
Objective
Increasingly the views of young people are sought when improving healthcare; however, it is unclear how they shape policy or practice. This paper presents a consultation with young people commissioned by the National Institute for Health and Care Excellence (NICE) to inform clinical guidelines for paediatric palliative care (end-of-life c...
This qualitative study collected stakeholders’ views on adapting an existing online psychotherapy programme, ‘Tame Your Gut’, to the needs of patients with inflammatory bowel disease (IBD) and comorbid anxiety and/or depression. Adult patients ( n = 13) and health professionals ( n = 12) participated in semi-structured focus groups or interviews, a...
Background Consistent evidence suggests that children’s palliative care is not equitable and managed clinical networks have been recommended as a solution. This study explored the development of a managed clinical network for children’s palliative care in England, with an aim to identify barriers and enablers of successful implementation.
Methods T...
Background
Consistent evidence suggests that children’s palliative care is not equitable and managed clinical networks (MCNs) have been recommended as a solution. This study explored the perspectives of health professionals involved in the development of a children’s palliative care MCN, with an aim to identify barriers and enablers of successful i...
Background Consistent evidence suggests that children’s palliative care is not equitable and managed clinical networks (MCNs) have been recommended as a solution. This study explored the perspectives of health professionals involved in the development of a children’s palliative care MCN, with an aim to identify barriers and enablers of successful i...
Background/Aims
Polypharmacy, which refers to taking several medications concurrently, is often appropriate for children and young people (CYP) with life-limiting conditions (LLCs) but can increase the risk of drug-drug and drug-disease interactions, medication errors and non-adherence, and cause unnecessary burden for families as they manage compl...
Background
Staff shortages in children’s palliative care and uncertainty about how to promote the wellbeing of staff who work in the sector are increasing concerns. The SWiCH (Staff Wellbeing in Children’s Hospices) study aims to increase understanding about the work-related stressors and rewards experienced by staff working in children’s hospices,...
This study explored the lived experience of people with inflammatory bowel disease (IBD) and anxiety/depression. It utilised a deductive biopsychosocial framework. Overall, 24 patients and 20 healthcare professionals from two countries participated. In the UK, the main themes included: 1) Bidirectional relationship between IBD and mental health, 2)...
Background
Specialist paediatric palliative care services are promoted as an important component of palliative care provision, but there is uncertainty about their role for children with cancer.
Aim
To examine the impact of specialist paediatric palliative care for children and young people with cancer and explore factors affecting access.
Design...
In the UK, the children’s hospice sector has become increasingly concerned about levels of work-related stress among its staff. This stems from increasing evidence that staff wellbeing is associated with the quality, cost and safety of patient care, and also an acknowledgment of the important role of those working in children’s hospices. It is ther...
AIMS
The life expectancy of people living with severe mental illness (SMI) is reduced by ~15 years compared to the general population. A higher prevalence of diabetes and its associated complications contribute significantly to this health inequality. While diabetes has significant psychosocial impact in the general population, little is known abou...
Introduction
Increasing numbers of children require having all, or part, of their nutritional intake via gastrostomy. More parents are using home-blended meals to feed their children, with many reporting beneficial effects such as improved gastro-oesophageal reflux, less constipation and less distress in their child.
This study aims to identify the...
Background:
over 50% of older people in hospital are prescribed a pre-admission medicine that is potentially inappropriate; however, deprescribing by geriatricians and pharmacists is limited. This study aimed to characterise geriatricians' and pharmacists' barriers and enablers to deprescribing in hospital. It also intended to develop a framework...
People with mental illness have an increased risk of physical disease, as well as reduced access to adequate health care. Physical-health disparities are observed across all mental illnesses in all countries. The high rate of physical comorbidity, which often has poor clinical management, reduces life expectancy for people with mental illness, and...
Background:
As the role of Patient and Public Involvement contributors expands to all stages of the research cycle, there is increasing demand for training that meets the needs of this diverse population. To help meet this demand the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, Yorkshire...
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
To assess the effects of pharmacological, behaviour change, and organisational interventions compared to comparator intervention in preventing diabetes among people with mental illness in LMICs.
BACKGROUND
The average life expectancy for people with a severe mental illness (SMI) such as schizophrenia or bipolar disorder is 15-20 years less than for the population as a whole. Diabetes contributes significantly to this inequality, being 2-3 times more prevalent in people with SMI. Various risk factors have been implicated, including side eff...
Background:
The average life expectancy for people with a severe mental illness (SMI) such as schizophrenia or bipolar disorder is 15 to 20 years less than that for the population as a whole. Diabetes contributes significantly to this inequality, being 2 to 3 times more prevalent in people with SMI. Various risk factors have been implicated, inclu...
Holt et al show that a lifestyle intervention did not reduce weight in people with schizophrenia. The STEPWISE trial casts a critical focus on the challenges of improving physical health in people with schizophrenia. The trial underpins efforts to maintain momentum in overcoming the unacceptable health inequalities in this population.
Declaration...
Introduction
Delirium is a distressing condition which is commonly experienced by hospice patients. Although delirium can be prevented by around one-third in hospital inpatients (Siddiqi et al. 2016) there has been little research into effective strategies to prevent and manage delirium in hospices. Greater insight into the current practice attitud...
Background:
Children's hospices are a key provider of palliative care for children and young people with life-limiting and life-threatening conditions. However, despite recent policy attention to the provision of paediatric palliative care, little is known about the role of children's hospice staff and the factors that may impact on their wellbein...
Background
Paediatric palliative care plays an important role in the lives of children and young people with life-limiting conditions and their families. However, the views of young people are rarely sought when improving these services.
Aims
This consultation explored the views and experiences of young people, with an aim to inform clinical guide...
Policy makers in the UK are looking to technology such as telehealth as a solution to the increasing demand for long term health care. Telehealth uses digital home monitoring devices and mobile applications to measure vital signs and symptoms that health professionals interpret remotely. The take up of telehealth in community health care is slow be...
In this editorial, we discuss a UK-based cohort study examining the mortality gap for people with schizophrenia and bipolar disorder from 2000 to 2014. There have been concerted efforts to improve physical and mental healthcare for this population in recent decades. Have these initiatives reduced mortality and ‘closed the gap’?
Background: Paediatric palliative care plays an important role in the lives of children and young people with life-limiting conditions and their families. However, the views of young people are rarely sought when improving these services. Aims: This consultation explored the views and experiences of young people, with an aim to inform clinical guid...
Background
People with diabetes and comorbid severe mental illness (SMI) form a growing population at risk of increased mortality and morbidity compared to those with diabetes or SMI alone. There is increasing interest in interventions that target diabetes in SMI in order to help to improve physical health and reduce the associated health inequalit...
People with severe mental illness (SMI) have reduced life expectancy compared with the general population, which can be explained partly by their increased risk of diabetes. We conducted a meta-analysis to determine the clinical effectiveness of pharmacological and non-pharmacological interventions for improving glycaemic control in people with SMI...
Background
People diagnosed with schizophrenia and other severe mental illness (SMI) have a reduced life expectancy compared to the general population, which can partly be explained by their increased risk of diabetes and associated poor diabetes management. A growing number of interventions are targeting this patient group to reduce physical healt...
People with severe mental illness (SMI) have a reduction in life expectancy of around 15-20 years. A higher prevalence of diabetes and its complications contributes to this health inequality. The risk of diabetes and barriers to managing the condition alongside SMI require more tailored lifestyle interventions, regular monitoring of risk from the o...
Adoption of telehealth has been slower than anticipated, and little is known about the service improvements that help to embed telehealth into routine practice or the role of frontline staff in improving adoption. This paper reports on participatory action research carried out in four community health settings using telehealth for patients with Chr...
Background:
Telehealth is used to help people manage their heath and maintain independence, but has proved difficult to integrate into routine practice.
Aim:
To explore the barriers to telehealth and find out what helps to improve its adoption among nursing staff.
Method:
Case studies were compiled from four community health services in the Yo...
Introduction: Telehealth and other technology enabled care services are increasingly aligned with policies promoting self-care and independence in older age, yet there is little evidence that telehealth actually increases self-care behaviour. In fact, emerging evidence suggests that people with long-term health conditions can become fixated on moni...
AimsTo examine frontline staff acceptance of telehealth and identify barriers to and enablers of successful adoption of remote monitoring for patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure.Background
The use of telehealth in the UK has not developed at the pace and scale anticipated by policy. Many existing studies re...
Recent research shows a rising national prevalence of Life Limiting Conditions in children identifying an escalating need for paediatric palliative care services in the UK.(1) Hospice services must ensure quality, sustainable care and essential to providing this is the careful documentation and consideration of all referred patients. The services o...
