Yes / Loneliness in older people is associated with poor health-related quality of life (HRQoL). We undertook a parallel-group randomised controlled trial to evaluate the effectiveness and cost-effectiveness of telephone befriending for the maintenance of HRQoL in older people. An internal pilot tested the feasibility of the trial and intervention. Methods: Participants aged >74 years, with good cognitive function, living independently in one UK city were recruited through general practices and other sources, then randomised to: (1) 6 weeks of short one-to-one telephone calls, followed by 12 weeks of group telephone calls with up to six participants, led by a trained volunteer facilitator; or (2) a control group. The main trial required the recruitment of 248 participants in a 1-year accrual window, of whom 124 were to receive telephone befriending. The pilot specified three success criteria which had to be met in order to progress the main trial to completion: recruitment of 68 participants in 95 days; retention of 80% participants at 6 months; successful delivery of telephone befriending by local franchise of national charity. The primary clinical outcome was the Short Form (36) Health Instrument (SF-36) Mental Health (MH) dimension score collected by telephone 6 months following randomisation. Results: We informed 9,579 older people about the study. Seventy consenting participants were randomised to the pilot in 95 days, with 56 (80%) providing valid primary outcome data (26 intervention, 30 control). Twenty-four participants randomly allocated to the research arm actually received telephone befriending due to poor recruitment and retention of volunteer facilitators. The trial was closed early as a result. The mean 6-month SF-36 MH scores were 78 (SD 18) and 71 (SD 21) for the intervention and control groups, respectively (mean difference, 7; 95% CI, −3 to 16). Conclusions: Recruitment and retention of participants to a definitive trial with a recruitment window of 1 year is feasible. For the voluntary sector to recruit sufficient volunteers to match demand for telephone befriending created by trial recruitment would require the study to be run in more than one major population centre, and/or involve dedicated management of volunteers. Trial registration: ISRCTN28645428.

Yes / Social isolation in older adults is associated with morbidity. Evaluating interventions to promote social engagement is a research priority. Methods: A parallel-group randomised controlled trial was planned to evaluate whether telephone friendship (TF) improves the well-being of independently living older people. An internal pilot aimed to recruit 68 participants by 30 September 2012, with 80% retained at 6 months. Randomisation was web based and only analysts were blind to allocation. A service provider was contracted to train 10 volunteer facilitators by 1 April 2012 and 10 more by 1 September 2012. Participants were aged > 74 years with good cognitive function and living independently in an urban community. The intervention arm of the trial consisted of manualised TF with standardised training: (1) one-to-one befriending (10- to 20-minute calls once per week for up to 6 weeks made by volunteer facilitators) followed by (2) TF groups of six participants (1-hour teleconferences once per week for 12 weeks facilitated by the same volunteer). Friendship groups aimed to enhance social support and increase opportunities for social interaction to maintain well-being. This was compared with usual health and social care provision. The primary clinical outcome was the Short Form questionnaire-36 items (SF-36) mental health dimension score at 6 months post randomisation. Qualitative research assessing intervention acceptability (participants) and implementation issues (facilitators) and an intervention fidelity assessment were also carried out. Intervention implementation was documented through e-mails, meeting minutes and field notes. Acceptability was assessed through framework analysis of semistructured interviews. Two researchers coded audio recordings of telephone discussions for fidelity using a specially designed checklist. Results: In total, 157 people were randomised to the TF group (n = 78) or the control group (n = 79). Pilot recruitment and retention targets were met. Ten volunteers were trained by 1 September 2012; after volunteer attrition, three out of the 10 volunteers delivered the group intervention. In total, 50 out of the 78 TF participants did not receive the intervention and the trial was closed early. A total of 56 people contributed primary outcome data from the TF (n = 26) and control (n = 30) arms. The mean difference in SF-36 mental health score was 9.5 (95% confidence interval 4.5 to 14.5) after adjusting for age, sex and baseline score. Participants who were interviewed (n = 19) generally declared that the intervention was acceptable. Participant dissatisfaction with closure of the groups was reported (n = 4). Dissatisfaction focused on lack of face-to-face contact and shared interests or attitudes. Larger groups experienced better cohesion. Interviewed volunteers (n = 3) expressed a lack of clarity about procedures, anxieties about managing group dynamics and a lack of confidence in the training and in their management and found scheduling calls challenging. Training was 91–95% adherent with the checklist (39 items; three groups). Intervention fidelity ranged from 30.2% to 52.1% (28–41 items; three groups, three time points), indicating that groups were not facilitated in line with training, namely with regard to the setting of ground rules, the maintenance of confidentiality and facilitating contact between participants. Conclusions: Although the trial was unsuccessful for a range of logistical reasons, the experience gained is of value for the design and conduct of future trials. Participant recruitment and retention were feasible. Small voluntary sector organisations may be unable to recruit, train and retain adequate numbers of volunteers to implement new services at scale over a short time scale. Such risks might be mitigated by multicentre trials using multiple providers and specialists to recruit and manage volunteers. / Funding for this study was provided by the Public Health Research programme of the National Institute for Health Research.

This thesis describes a two part research program in which the applicability of subjective ratings to the selection of independent variables was evaluated. The first portion of the research reviewed a case study involving the application of complex system investigation to the development of a telephone inquiry system. A telephone inquiry system is one in which users seek information in a data base by calling the system, listening to information presented by a synthetic voice, and directing movement through the database with commands on the telephone keypad keys. The complex system investigation method used included identifying the independent variables by brainstorming, then reducing the list by subjecting the variables to literature review, feasibility analysis, relevance analysis, and subjective ratings of the factors based on a prototype system. Variables which were not likely to have an immediate impact on human performance in the system were set to a constant value. The use of subjective ratings to select independent variables stems from the need to reduce large numbers of independent variables to a list which can be used as candidates for a screening study. The result of the case study was a list of 19 candidate factors suggested for implementation in a screening study. The second portion of the research describes an experiment in which 5 independent variables ( number of steps in a search, adapting speech rate, transaction summary, native/non-native, and sex of the voice) were chosen to represent the 19 candidate factors in an experiment testing the validity of the ·subjective ratings technique. The results indicated that the subjective ratings of the prototype system were effective in predicting performance and subjective ratings. The impact of these results on the methodology and telephone inquiry systems is also discussed. / M.S.

Thirty-six drivers of both genders from three different age groups performed auditory cognitive tasks while driving an instrumented vehicle. The tasks were of two types. The first type of task was the selection of a driving route from a list presented as a recorded sound. These tasks represented the use of In-Vehicle Information Systems (IVIS). The second type of task consisted of a conversation like series of questions designed to replicate the use of a cellular telephone while driving. The IVIS tasks consisted of two levels of information density (short-term memory load) and four element types (complexity levels) including listening, interpretation, planning, and computation. The effects of age, information density, and element type on driving performance were assessed using a composite set of performance measures. Primary measures of driving performance included lateral tracking, longitudinal control and eye glances. Secondary task performance was assessed by task completion time, skipped tasks and task errors. Additionally, subjective assessment was done using a situational awareness probe question and a modified NASA-TLX question set. Results showed that drivers demonstrated a general decrease in their ability to maintain their lateral position with increased task complexity. Additionally, speed and following distance were less stable during tasks. During tasks, drivers glanced less at their mirrors and instruments and left their lane more often than during baseline driving periods. Even during difficult tasks, drivers had high self-confidence in their awareness of surroundings. One result of particular interest was an increase in lane deviations and headway variance coupled with increased forward eye glance durations. It is believed that this is evidence of a condition called "Cognitive Capture" in which a driver, though looking more extensively at the forward roadway, is having difficulty tracking the lead vehicle and lane position. High cognitive load is causing the driver to disregard or shed visual information to allow processing of auditory task-related information. Another result of concern is the inability of drivers to assess their own impairment while performing in vehicle tasks. During tasks drivers demonstrated reduced scanning of mirrors and vehicle instrumentation. This clearly demonstrates reduced situational awareness. Additionally, during tasks lane tracking and headway maintenance performance decreased as well. However, during all tasks drivers assessed their workload higher than baseline driving even though they rated it near the bottom of the scale. Also, drivers perceived no decrease in their situational awareness. The results of this study show that driving performance can be negatively impacted by even fairly simple cognitive tasks while a driver is looking at the road with their hands on the wheel. Even while viewing the road, a driver may perform an auditory task and be cognitively overloaded to the point of safety concerns. An additional concern is that drivers underestimate the degree of their cognitive load and its impact on their driving performance. / Master of Science

by Ng Tou-Kun. / Thesis (M.B.A.)--Chinese University of Hong Kong, 1997. / Includes bibliographical references (leaves 64). / ABSTRACT --- p.iii / TABLE OF CONTENTS --- p.iv / LIST OF FIGURES AND TABLES --- p.vi / ACKNOWLEDGEMENTS --- p.vii / Chapter / Chapter I. --- INTRODUCTION --- p.1 / What is Calling Number Display Service --- p.1 / Benefits of CND --- p.2 / Disadvantages of CND --- p.4 / Launch of CND Service in Hong Kong --- p.5 / Research Objectives --- p.8 / Scope of Study --- p.8 / Structure of Report --- p.9 / Chapter II. --- LITERATURE REVIEW --- p.10 / Launch of CND Service in Foreign Countries --- p.10 / The Adoption Process --- p.12 / The Diffusion Process --- p.13 / Implications to Marketers --- p.14 / Strategy for Introductory Stage --- p.15 / Market Segmentation --- p.17 / Chapter III. --- RESEARCH METHODOLOGY --- p.19 / Survey Method --- p.19 / Sample Design --- p.20 / Questionnaire Design --- p.20 / Pilot Test --- p.22 / Data Collection --- p.22 / Data Analysis --- p.22 / Chapter IV. --- RESULTS OF SURVEY --- p.23 / Demographic Information --- p.23 / Subscriber Line Information --- p.25 / Classification of Respondents --- p.26 / Awareness of CND Service --- p.27 / People Interested in CND Service --- p.29 / People Intended to Subscribe CND Service --- p.29 / CND Subscribers --- p.30 / Attitude towards CND Service --- p.30 / Attitude towards Hongkong Telecom as Service Provider --- p.32 / Association between Consumer Attitude with Service Adoption --- p.34 / Association between Demographics and Subscriber Usage Information with Service Application --- p.37 / Chapter V. --- CONCLUSION AND RECOMMENDATION --- p.39 / Market Situation --- p.39 / Market Planning --- p.40 / Market Segmentation Strategy --- p.40 / Product Development Strategy --- p.41 / Promotional Strategy --- p.43 / Pricing Strategy --- p.44 / Limitations --- p.44 / Epilogue --- p.47 / APPENDICES --- p.48 / Chapter I. --- Network Service License of Hong Kong Telephone Company : Extracted Clause on Confidentially of Customer Information --- p.48 / Chapter II. --- Questionnaire of Survey --- p.49 / Chapter III. --- Association of CND Benefit Malicious Call Reduction with Service Adoption --- p.57 / Chapter IV --- Association of CND Benefit Warmer Greeting to Friends with Service Adoption --- p.58 / Chapter V. --- Association of Importance of Selective Call Answering with Service Adoption --- p.59 / Chapter VI. --- Association of Importance of Back Calling with Service Adoption --- p.60 / Chapter VII. --- Association of Importance of Warmer Greeting to Friends with Service Adoption --- p.61 / Chapter VIII. --- Association of Importance of Ease of Service Operation with Service Adoption --- p.62 / Chapter IX. --- Association of Education Level with Service Adoption --- p.63 / BIBLIOGRAPHY --- p.64

<p>Telefonen har blivit ett redskap för människor som söker kontakt med hälso- och sjukvården vilket har medfört krav på ökad tillgänglighet till den telefonrådgivning som ges vid hälsocentraler. Telefonrådgivning på hälsocentral utförs av distriktssköterskor och är en svår, viktig och ansvarsfull arbetsuppgift som dessutom kräver tålamod och flexibilitet. Telefonrådgivning medför ibland svåra prioriteringar för distriktssköterskan. Arbetsuppgiften upptar mera av distriktssköterskans arbetstid än tidigare. Syftet med studien var att få kunskap om hur distriktssköterskorna upplever telefonrådgivning som arbetsuppgift och hur de upplever att dokumentera i samband med telefonrådgivning. Tio distriktssköterskor intervjuades. I resultat framkom att informanterna upplevde att arbetet i telefonrådgivning innebär att ta snabba beslut, en del beslut är svåra och vissa beslut upplevdes som obekväma. Informanterna upplevde att de alltid måste balansera olika krav. Informanterna beskrev att de känner tacksamhet för sin egen kompetens och erfarenhet som kommer väl till användning vid de ständiga prioriteringarna och den fördelning av resurser som förekommer. Informanterna beskrev flera olika känslomässiga upplevelser. Informanterna menade att tiden ofta är för begränsade för varje patientärende och finns tidsutrymme för noggrann dokumentation, känns det som en bonus.</p> / <p>The phone has become an important tool för people seeking contact in health services this has led to greater demands on the availability of telephone advice given at the health centers. Telephone counseling at health centers conducted by the district nurses, is a difficult, important and responsible task which requires both patience and flexibility. Telephone counseling involves sometimes difficult priorities for the district nurse. Telephone counseling has resulted in a change of district nurse tasks and occupies more of the district nurse working hour than before. The purpose of this study was to gain insight into how district nurses experience working with telephone advice and how they experience the ability to write in the patient records. Ten district nurses were interviewed for the study, all working in health center with telephone counseling and with home nursing, reception work or child health. The results found that the informants experienced that working in a telephone counseling means above all, to make quick decisions, some difficult decisions and some decisions are perceived as inconvenient. The informants experienced that they always have to balance various demands. The informants described that they feel gratitude for their own skills and their own experiences for use at all these priorities and allocation of resources at the present. The informants had various emotional experiences. The informants believed that time is often too limited for each patient case and if time is sufficient for careful documentation, it feels like a bonus.</p>

Telefonen har blivit ett redskap för människor som söker kontakt med hälso- och sjukvården vilket har medfört krav på ökad tillgänglighet till den telefonrådgivning som ges vid hälsocentraler. Telefonrådgivning på hälsocentral utförs av distriktssköterskor och är en svår, viktig och ansvarsfull arbetsuppgift som dessutom kräver tålamod och flexibilitet. Telefonrådgivning medför ibland svåra prioriteringar för distriktssköterskan. Arbetsuppgiften upptar mera av distriktssköterskans arbetstid än tidigare. Syftet med studien var att få kunskap om hur distriktssköterskorna upplever telefonrådgivning som arbetsuppgift och hur de upplever att dokumentera i samband med telefonrådgivning. Tio distriktssköterskor intervjuades. I resultat framkom att informanterna upplevde att arbetet i telefonrådgivning innebär att ta snabba beslut, en del beslut är svåra och vissa beslut upplevdes som obekväma. Informanterna upplevde att de alltid måste balansera olika krav. Informanterna beskrev att de känner tacksamhet för sin egen kompetens och erfarenhet som kommer väl till användning vid de ständiga prioriteringarna och den fördelning av resurser som förekommer. Informanterna beskrev flera olika känslomässiga upplevelser. Informanterna menade att tiden ofta är för begränsade för varje patientärende och finns tidsutrymme för noggrann dokumentation, känns det som en bonus. / The phone has become an important tool för people seeking contact in health services this has led to greater demands on the availability of telephone advice given at the health centers. Telephone counseling at health centers conducted by the district nurses, is a difficult, important and responsible task which requires both patience and flexibility. Telephone counseling involves sometimes difficult priorities for the district nurse. Telephone counseling has resulted in a change of district nurse tasks and occupies more of the district nurse working hour than before. The purpose of this study was to gain insight into how district nurses experience working with telephone advice and how they experience the ability to write in the patient records. Ten district nurses were interviewed for the study, all working in health center with telephone counseling and with home nursing, reception work or child health. The results found that the informants experienced that working in a telephone counseling means above all, to make quick decisions, some difficult decisions and some decisions are perceived as inconvenient. The informants experienced that they always have to balance various demands. The informants described that they feel gratitude for their own skills and their own experiences for use at all these priorities and allocation of resources at the present. The informants had various emotional experiences. The informants believed that time is often too limited for each patient case and if time is sufficient for careful documentation, it feels like a bonus.

Syftet med föreliggande litteraturstudie var att beskriva rådgivningssamtalet vid centrala sjukvårdsrådgivningar. Studien har gjorts som en litteraturstudie med deskriptiv design. Studien har baserats på 12 vetenskapliga artiklar som har sökts fram via Cinahl och PubMed. Resultatet visade att rådgivningssamtalet innehöll en gemensam interaktion och bedömningsprocess, där sjuksköterskan analyserade och tolkade det objektiva och subjektiva i den vårdsökandes hälsoproblem för att nå fram till samförstånd i beslut och åtgärd. Processen skedde i ett ansiktslöst icke fysiskt vårdmöte mellan sjuksköterskan och den vårdsökande och kunde beskrivas utifrån fyra faser 1) att samla information 2) att analysera och tolka 3) att bedöma 4) att åtgärda. Sjuksköterskans möjligheter med samtalet var att skapa en bra relation och god kontakt, analysera hälsoproblemet och bedöma behov av vård och tolka den vårdsökandes känslor av upplevelsen runt symtom och situation. Sjuksköterskorna upplevde svårigheter med att ställa de rätta frågorna och att hantera känslor hos den vårdsökande. De vårdsökandes möjligheter var att bli vägledda och lotsade, hjälp att hantera oro och stöd till egen förmåga att hantera hälsoproblemet samt att bli tagen på allvar och att få vara delaktig. Att inte få respekt och bekräftelse av känslor och önskningar runt hälsoproblemet samt att bli behandlad som ett objekt var svårigheter för den vårdsökande i rådgivningssamtalet. Rådgivningssamtalets innehåll kan beskrivas som en process med fyra faser liknande vårdprocessen med en gemensam interaktion och beslutsprocess mellan sjuksköterskan och den vårdsökande för att nå fram till samförstånd i beslut och åtgärd. / The aim of the present literature studie was to describe the process of telephone nursing at the central medical care help line. Article search was performed through PubMed and Cinahl. The results showed that counseling call could be described by four phases 1) collect and disseminate information 2) analysis and interpretation 3) assessment 4)proceed. Opportunities for the nurse were to create a good relationship and good contact, analyze health problem and assess care needs and interpret the care seekers feelings of experience of the symptoms and situation. Results showed that nurses experienced difficulty in asking the right questions and to manage emotions of the care seekers. The care seekers opportunities in counseling call were to get their health assessed and guidance in managing their health problems, both practical and emotional. Not getting the respect and acknowledgment of feelings and desires around health problem were difficulties for the care seekers in the counseling call. The conclusion from this study is that the call may be described as a process with four phases similar to the care process with an interaction and decision-making with the nurse and the care seekers together to reach consensus in decision and action.

published_or_final_version / Public Administration / Master / Master of Social Sciences

Bakgrund: Telefonrådgivning är en växande verksamhet och utgör en stor del av distriktssköterskans arbete på vårdcentral. För vårdsökande innebär det att få råd, information och stöd för att öka tryggheten i vardagslivet. Det behövs ökad kunskap om äldres erfarenheter av telefonrådgivning för att bättre kunna förstå de vårdsökandes behov och för att vidare utveckla verksamheten. Syfte: Syftet är att beskriva äldre vårdsökandes erfarenheter av telefonrådgivning på vårdcentral. Metod: I studien har en kvalitativ deskriptiv design med induktiv ansats använts. Datainsamling har skett via tio intervjuer med äldre vårdsökare som har fått telefonrådgivning via vårdcentral och materialet analyserades med kvalitativ innehållsanalys. Resultat: I analysen framträdde två teman Få kontakt och Kommunikation.  I Få kontakt presenteras kategorierna: Telefonsystemet och Strategier för kontakt med tillhörande underkategorier. I Kommunikation presenteras kategorierna: Bemötande och Förutsättningar med tillhörande underkategorier. Slutsats: Telefonsystemet som används för att få kontakt kan ses både som en tillgång och ett hinder för kontakt. Äldre vårdsökande använder olika strategier för att underlätta kontakt med vårdcentral. Kommunikation mellan telefonsjuksköterskan och den äldre vårdsökanden kräver att det finns bra förutsättningar. Om kommunikationen dem emellan är god och den vårdsökande får vara i centrum blir vårdmötet tillfredsställande och den vårdsökande känner sig hjälpt. Om kommunikationen brister och den vårdsökande inte får vara i centrum kan vårdmötet bli otillfredsställande och leda till att vårdsökanden istället känner sig stjälpt. Slutsatsen är att telefonrådgivning på vårdcentralen kan både hjälpa och stjälpa den äldre vårdsökande. / Background: Telephone nursing is a large part of the nurse's work at the health center. The caller wants to get advice, information and support in everyday life. With this work we want to enhance the understanding of older people's experiences of telephone nursing at health center to further develop the telephone nursing from elderlies perspective. Aim: The aim is to describe the elderly caller’s experiences of telephone nursing at health center. Method: The study has a qualitative descriptive design with an inductive approach. Data was collected through 10 interviews with elderly callers who had received telephone nursing and the data was analyzed by a qualitative content analysis. Results: The analysis resulted in to two themes Get Contact and Communication. In Get Contact the following categories appeared: Phone system and Strategies for Contact with related subcategories. In term Communication the following categories appeared: Treatment and Conditions with related subcategories. Conclusion: The telephone system that is used for contact with the health center can be seen both as an asset and obstacle. Elderly callers use different strategies to facilitate the contact. It is important that there are good preconditions for the communication. If the communication between the nurse and elderly caller is good and the caller is in focus, the caller will feel helped and satisfied with the telephone meeting. If there is lack of communication and the caller is not in focus, the telephone meeting can be unsatisfied and lead to a feeling of being overturned.