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Professor Fiona Brooks


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Professor Fiona Brooks is a medical sociologist and a professor of child and family health at UTS who has published widely on topics relating to young people’s health and well-being.

Since 2008, she has been principal investigator for England on the WHO Health Behaviour in School-aged Children study (HBSC). The study is undertaken in 43 countries and aims to gain new insights into young people’s health and well-being, health behaviours and their social context. Among the issues Fiona and other HBSC researchers are looking at are eating, sleeping, self harm and the use of social media by adolescents. 

In 2014, Fiona was invited by Public Health England to brief all head teachers, college principals, teachers and school governors in England on the relationship between health and well-being and attainment. She has also advised the UK Cabinet Office, Public Health England and the UK Department of Health.


I am associate editor of the international Journal Health and Social Care in the Community. I am a founder member of the UK charity The Association for Young People’s Health (AYPH).  

My research has been funded by the Department of Health UK, The British Academy, The Economic and Social Research Council, The Service Delivery Organisation (SDO), The European Union and national charities and local authorities.

Image of Fiona Brooks
Professor of Public Health, Faculty of Health
Member, Centre for Midwifery, Child and Family Health (CMCFH)
Core Member, CHSP - Health Services and Practice
+61 2 9514 5023

Research Interests

Research expertise

  • Adolescent health
  • Adolescents and physical activity
  • Computer game playing, violence and body image
Can supervise: Yes

Areas of research supervision:

  • Youth and adolescent health and well being
  • Social determinants of health

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Brooks, F. & Magnusson, J. 2011, 'Physical activity programmes in high schools' in Childhood Obesity Prevention: International Research, Controversies and Interventions.
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© Oxford University Press 2010. All rights reserved. Across the lifespan physical inactivity represents a key risk to health and well-being; the World Health Organization has estimated that physical inactivity is a major contributing factor in over 1.9 million deaths worldwide and a significant risk factor for the majority of cancers and long term conditions. Physical activity is a key component in the maintenance and attainment of healthy weight; as a consequence the reduction of sedentary lifestyles has featured in many countries as an important arm of policies designed to address childhood obesity. This chapter discusses how participation by young people in physical activity should not solely be seen as a means to address current concerns about childhood obesity; instead physical activity can provide a number of positive benefits that contribute to the well-being of young people. Participation in physical activity can offer a plethora of health benefits, not only impacting positively on physiological health and development but also psychological well-being, including having important social benefits. The relationship between physical activity and emotional and psychological well being is also addressed, as physical activity levels have been found to be one of the key healthrelated outcomes that is associated with overall life satisfaction among school-aged children. The importance of seeing benefits of activity in context of young people's here and now, rather than having the sole aim of benefiting their future health, has been recognized by the European Heart Health Initiative (2001).
Brooks, F. 2010, 'The health of children and young people' in Promoting Health and Wellbeing through Schools, pp. 8-23.
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Journal articles

Brooks, F., Chester, K., Smeeton, N. & Spencer, N. 2016, 'Video gaming in adolescence: factors associated with leisure time use', Journal of Youth Studies, vol. 19, no. 1, pp. 36-54.
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The geographies of the current generation of young people are markedly distinct from previous generations by virtue of their access to a virtual playground. The vast majority of young people now engage in video gaming as a leisure activity. Drawing on findings from the 2009/2010 WHO Health Behaviour in School-aged Children study this paper set out to investigate the factors that might be associated with higher levels of video gaming. Information was collected from 4404 school students aged 11, 13 and 15 years, using anonymised self-completed questionnaires. Higher usage was defined as game play exceeding two hours a day. Separate analyses were conducted for boys and girls. For both genders higher levels of game playing was associated with early adolescence, opposite sex friends and minimal parental mediation. Bullying and going to bed hungry were associated with higher usage for boys only, while life satisfaction and family activities were linked to girls game playing only. Parents were identified as effective mediators of young people's video game usage. The study identified gendered motivations for higher levels of game play, suggesting different interventions for boys and girls may be required in order for young people to create a balanced approach to video gaming.
Boyle, S., Thomas, H. & Brooks, F. 2016, 'Womens views on partnership working with midwives during pregnancy and childbirth.', Midwifery, vol. 32, pp. 21-29.
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to explore whether the UK Government agenda for partnership working and choice was realised or desired for women during pregnancy and childbirth.a qualitative study was used to explore womens experience of partnership working with midwives. Data was generated using a diary interview method throughout pregnancy and birth.16 women were recruited from two district general hospitals in the South East of England.three themes emerged from the data: organisation of care, relationships and choice. Women described their antenatal care as 'ticking the box', with midwives focusing on the bio-medical aspects of care but not meeting their psycho-social and emotional needs. Time poverty was a significant factor in this finding. Women rarely described developing a partnership relationship with midwives due to a lack of continuity of care and time in which to formulate such relationships. In contrast women attending birth centres for their antenatal care were able to form relationships with a group of midwives who shared a philosophy of care and had sufficient time in which to meet womens holistic needs. Most of the women in this study did not feel they were offered the choices as outlined in the national choice agenda (DoH, 2007).NHS Trusts should review the models of care available to women to ensure that these are not only safe but support womens psycho-social and emotional needs as well. Partnership case loading models enable midwives and women to form trusting relationships that empowers women to feel involved in decision making and to exercise choice. Group antenatal and postnatal care models also effectively utilise midwifery time whilst increasing maternal satisfaction and social engagement. Technology should also be used more effectively to facilitate inter-professional communication and to provide a more flexible service to women.
Michaelson, V., Brooks, F., Jirásek, I., Inchley, J., Whitehead, R., King, N., Walsh, S., Davison, C.M., Mazur, J. & Pickett, W. 2016, 'Developmental patterns of adolescent spiritual health in six countries', SSM - Population Health, vol. 2, pp. 294-303.
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© 2016 The Authors.The spiritual health of adolescents is a topic of emerging contemporary importance. Limited numbers of international studies provide evidence about developmental patterns of this aspect of health during the adolescent years. Using multidimensional indicators of spiritual health that have been adapted for use within younger adolescent populations, we therefore: (1) describe aspects of the perceptions of the importance of spiritual health of adolescents by developmental stage and within genders; (2) conduct similar analyses across measures related to specific domains of adolescent spiritual health; (3) relate perceptions of spiritual health to self-perceived personal health status. Cross-sectional surveys were administered to adolescent populations in school settings during 2013-2014. Participants (n=45,967) included eligible and consenting students aged 11-15 years in sampled schools from six European and North American countries. Our primary measures of spiritual health consisted of eight questions in four domains (perceived importance of connections to: self, others, nature, and the transcendent). Socio-demographic factors included age, gender, and country of origin. Self-perceived personal health status was assessed using a simple composite measure. Self-rated importance of spiritual health, both overall and within most questions and domains, declined as young people aged. This declining pattern persisted for both genders and in all countries, and was most notable for the domains of "connections with nature" and "connections with the transcendent". Girls consistently rated their perceptions of the importance of spiritual health higher than boys. Spiritual health and its domains related strongly and consistently with self-perceived personal health status. While limited by the 8-item measure of perceived spiritual health employed, study findings confirm developmental theories proposed from qualitative observation, provide foundational evidence ...
Klemera, E., Chester, K.L., Magnusson, J., Spencer, N., Smeeton, N. & Brooks, F.M. 2016, 'Self-harm in Adolescence: Protective Health Assets in the Family, School and Community', International Journal of Public Health.
Yassaee, A.A., Hargreaves, D.S., Chester, K., Lamb, S., Hagell, A. & Brooks, F.M. 2016, 'Experience of primary care services among early adolescents in England and association with health outcomes', Journal of Adolescent Health.
Chester, K.L., Brooks, F.M., Magnusson, J., Klemera, E., Spencer, N. & Smeeton, N. 2016, 'The mitigating role of ecological health assets in adolescent cyberbullying victimization', Youth and Society.
Chester, K.L., Brooks, F.M., Whiting, L. & Spencer, N. 2016, 'Associations between relational bullying and health related quality of life in Adolescence', Journal of Adolescent Health.
Procter, S., Brooks, F., Wilson, P., Crouchman, C. & Kendall, S. 2015, 'A case study of asthma care in school age children using nurse-coordinated multidisciplinary collaborative practices.', Journal of multidisciplinary healthcare, vol. 8, pp. 181-188.
AIM: To describe the role of school nursing in leading and coordinating a multidisciplinary networked system of support for children with asthma, and to analyze the strengths and challenges of undertaking and supporting multiagency interprofessional practice. BACKGROUND: The growth of networked and interprofessional collaborations arises from the recognition that a number of the most pressing public health problems cannot be addressed by single-discipline or -agency interventions. This paper identifies the potential of school nursing to provide the vision and multiagency leadership required to coordinate multidisciplinary collaboration. METHOD: A mixed-method single-case study design using Yin's approach, including focus groups, interviews, and analysis of policy documents and public health reports. RESULTS: A model that explains the integrated population approach to managing school-age asthma is described; the role of the lead school nurse coordinator was seen as critical to the development and sustainability of the model. CONCLUSION: School nurses can provide strategic multidisciplinary leadership to address pressing public health issues. Health service managers and commissioners need to understand how to support clinicians working across multiagency boundaries and to identify how to develop leadership skills for collaborative interprofessional practice so that the capacity for nursing and other health care professionals to address public health issues does not rely on individual motivation. In England, this will be of particular importance to the commissioning of public health services by local authorities from 2015.
Brooks, F., Zaborskis, A., Tabak, I., Carmen Granado Alcón, M.D., Zemaitiene, N., de Roos, S. & Klemera, E. 2015, 'Trends in adolescents' perceived parental communication across 32 countries in Europe and North America from 2002 to 2010.', European journal of public health, vol. 25 Suppl 2, pp. 46-50.
The quality of communication with parents is a determinant of health and well-being during adolescence, being predictive of self-esteem, self-rated health and the ability to navigate health risk behaviours.This article describes trends in adolescent's (aged 11, 13 and 15 years) perception of communication with mothers and fathers by gender across 32 European and North American countries from 2002 to 2010. Analyses were performed on 425 699 records employing a General Linear Model (MANOVA).In most countries, significant increases in the prevalence of ease of communication with both mothers and fathers were observed, with the greatest positive changes over time in Estonia, Denmark and Wales. In some countries, the opposite trend was found with the greatest negative changes occurring in France, Slovenia and Poland. Across the pooled dataset, a significant positive trend was observed for ease of communication with father, for both boys and girls and for ease of communication with mother for boys only.The temporal trends demonstrated an increase in a positive health asset for many young people, that of family communication. Positive trends may be a feature of the economic boom over the past decade coupled with cultural changes in attitudes to parenting, especially fathering.
Cavallo, F., Dalmasso, P., Ottová-Jordan, V., Brooks, F., Mazur, J., Välimaa, R., Gobina, I., Gaspar de Matos, M. & Raven-Sieberer, U. 2015, 'Trends in self-rated health in European and North-American adolescents from 2002 to 2010 in 32 countries.', European journal of public health, vol. 25 Suppl 2, pp. 13-15.
Self-rated health (SRH) in adolescence is known to be associated with health outcomes in later life. We carried out a trend analysis on data coming from three waves of data collected in 32 countries (mostly European) from 2002 to 2010 coming from the Health Behaviour in School-Aged Children surveys.SRH in adolescents was assessed using a Likert scale (excellent, good, fair and poor). Responses were dichotomized into 'excellent' vs. 'rest'. Country, age and gender groups were compared based on the odds ratio of declaring excellent SRH in 2010 with respect to 2002 and 2006.The trend for European adolescents indicates an improvement over the last decade, although, in the majority of countries, a higher proportion of adolescents rate their health as excellent during the period 2002-06 with respect to the second half of the decade (2006-10).Girls were found to constantly rate their health as poorer, compared to their male peers, in all countries. Age has also a very stable trend towards a decreasing rating of health with increasing age.Decreased rating of health in the period 2006-10 may be a signal of the socio-economic difficulties of Europe in the last part of this decade.
Alexakis, C., Nash, A., Lloyd, M., Brooks, F., Lindsay, J.O. & Poullis, A. 2015, 'Inflammatory bowel disease in young patients: challenges faced by black and minority ethnic communities in the UK.', Health & social care in the community, vol. 23, no. 6, pp. 665-672.
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There is strong evidence indicating that inflammatory bowel disease (IBD) is increasing among black and minority ethnic (BME) communities. Despite this rise in prevalence, there is a paucity of research relating to ethnicity and IBD outside the USA. Furthermore, the symptoms of IBD are reported to start during childhood or adolescence in 20-25% of people with the condition. It is therefore important that young people's experiences of diagnosis, treatment and living with IBD are fully understood to ensure effective services and information provision. The study reported on in this paper was commissioned by a UK charity (Crohn's and Colitis UK) with the aim of increasing understanding of the specific issues and service needs of young people with IBD from BME communities. Empirical research entailed in-depth semi-structured interviews with 20 young people from BME groups accessed through gastroenterology departments at three collaborating NHS hospitals in England serving ethnically diverse populations. Interviews were carried out from June to December 2010 and sought to capture young people's views with IBD. A thematic analysis of their experiences identified many commonalities with other young people with IBD, such as the problematic route to formal diagnosis and the impact of IBD on education. The young people also experienced tensions between effective self-management strategies and cultural norms and practices relating to food. Moreover, the ability of parents to provide support was hampered for some young people by the absence of culturally competent services that were responsive to the families' communication needs. The findings highlight the need for more culturally appropriate information concerning IBD, and improved responsiveness to young people with IBD within primary care and the education system, as well as culturally competent messaging relating to the specific nature of the condition among the wider South Asian and black communities.
García-Moya, I., Brooks, F., Morgan, A. & Moreno, C. 2015, 'Subjective well-being in adolescence and teacher connectedness: A health asset analysis', Health Education Journal, vol. 74, no. 6, pp. 641-654.
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© 2014 The Author(s). Objectives: Teacher connectedness is an important factor for young people's well-being. The aim of this paper was to examine teacher connectedness in detail and its potential association with emotional well-being. More specifically, we set out to analyse whether teacher connectedness acted as a universal asset for boys and girls of different ages and countries as well as across adolescents with differing perceptions of their performance at school. Methods: The study sample consisted of 9,444 young people aged 11, 13 and 15 years who had taken part in the World Health Organization (WHO) collaborative survey Health Behaviour in School-aged Children in Spain and England. After examining differences in teacher connectedness associated with demographic factors, we used general linear models to analyse the relationship between teacher connectedness and emotional well-being (including interaction teacher connectedness by country) across different age and performance-derived groups. Results: Results indicated some significant differences in teacher connectedness associated with age, country and perceived performance, but a consistent positive association between teacher connectedness and emotional well-being regardless of demographic factors, country and perceptions of school performance. Older adolescents and low achievers reported lower level of connectedness to their teachers, but the association between teacher connectedness and emotional well-being operated irrespective of adolescents' age and perceived performance at school. Conclusion: Results support the perspective that teacher connectedness can act as a significant health asset that operates irrespective of key demographic factors, while they point to some inequalities in teacher connectedness associated with age and performance at school. These findings have significant implications for health promotion interventions.
Cavallo, F., Dalmasso, P., Ottová-Jordan, V., Brooks, F., Mazur, J., Välimaa, R., Gobina, I., De Matos, M.G. & Raven-Sieberer, U. 2015, 'Trends in life satisfaction in European and North-American adolescents from 2002 to 2010 in over 30 countries', European Journal of Public Health, vol. 25, pp. 80-82.
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© 2015 The Author. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. Background: Life satisfaction (LS) is an indicator which is widely used for assessing the perception of a child's feeling about his life. Methods: LS is assessed in Health Behaviour in School-aged Children via the Cantril ladder with 10 steps indicating the worst and best possible life. This range of values (0-10) was dichotomized into 'low' (0-5) vs. 'high' (6-10). Countries, age groups and genders were compared based on the odds ratio (OR) of declaring a higher LS in 2010 with respect to 2002. Results: Analyzing the difference between 2002 and 2010, six countries from Western Europe show decreasing LS: Austria, Canada, Switzerland, Denmark, Finland and Greenland. In contrast, a group of Eastern European Countries, that is, Estonia, Croatia, Lithuania, Latvia, Russia and Ukraine, show a significant increase in LS. Data on gender and age differences confirm the lower rating of LS in girls and a decreasing rating with age. Conclusion: The LS scale appears to be a tool capable of discriminating the level of wellbeing of adolescent population among countries.
Boniel-Nissim, M., Tabak, I., Mazur, J., Borraccino, A., Brooks, F., Gommans, R., van der Sluijs, W., Zsiros, E., Craig, W., Harel-Fisch, Y. & Finne, E. 2015, 'Supportive communication with parents moderates the negative effects of electronic media use on life satisfaction during adolescence.', International journal of public health, vol. 60, no. 2, pp. 189-198.
To examine the impact of electronic media (EM) use on teenagers' life satisfaction (LS) and to assess the potential moderating effect of supportive communication with parents (SCP).Data were drawn from the cross-national Health Behaviour in School-aged Children (HBSC) study (2009/2010) in Canada, England, Germany, Hungary, Italy, Israel, The Netherlands, Poland and Scotland. Sample size: 53,973 students aged 11-15 years.More hours per day spent on the computer were associated with lower LS; more EM communication with friends with higher LS. This relationship became negative if EM use reached and exceeded a certain threshold. SCP moderated the effect of EM communication with friends, but not computer use for the total sample. SCP seems to be more important than computer use or EM communication with friends for LS and it seems to buffer negative effects of EM use.Communication with parents seems to buffer the negative effects of EM use on LS during adolescence. Higher computer use was related to lower LS, but "optimal" frequency of EM communication with friends was country specific.
Brooks, F.M., Smeeton, N.C., Chester, K., Spencer, N. & Klemera, E. 2014, 'Associations between physical activity in adolescence and health behaviours, well-being, family and social relations', International Journal of Health Promotion and Education, vol. 52, no. 5, pp. 271-282.
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© 2014 © 2014 Institute of Health Promotion and Education. Across Europe and North America, few young people meet the recommended levels of physical activity (PA) of 1 hour of moderate to vigorous PA per day. However, the lives of young people cannot simply be polarised as either completely sedentary or active. Drawing on findings from the World Health Organization Health Behaviour in School-aged Children cross sectional international study, this paper examines the domains of adolescent life associated with young people's participation in overall PA, including health behaviours, social relationships and family activities. Consideration is also given to gender differences. Information in England was collected from 4404 students aged 11, 13 and 15 years, using anonymised self-completed questionnaires. Physical aspects of lifestyle were determined using internationally validated items for measuring PA that met international guidelines for activity and the frequency and duration of vigorous exercise undertaken during leisure activities. Separate analyses were conducted for boys and girls. Levels of PA and vigorous exercise were compared using the chi-squared test for trend. The findings draw attention to the value for the health and well-being of young people participating in some form of PA, even if they do not meet the recommended levels. Medium levels of PA appear to be associated with high levels of life satisfaction, self-rated health and an improved sense of body image. Significant health gains are likely to be made for adolescents in encouraging sedentary young people to undertake some form of PA.
Peckham, S., Wilson, P., Williams, L., Smiddy, J., Kendall, S., Brooks, F., Reay, J., Smallwood, D. & Bloomfield, L. 2014, 'Commissioning for long-term conditions: hearing the voice of and engaging users – a qualitative multiple case study', Health Services and Delivery Research, vol. 2, no. 44, pp. 1-204.
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Ikioda, F., Kendall, S., Brooks, F. & Reidy, C. 2014, 'Developing an online community of practice to empower health visitors: Findings from a pilot study', Journal of Health Visiting, vol. 2, no. 8, pp. 436-440.
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Brooks, F., Bloomfield, L., Offredy, M. & Shaughnessy, P. 2013, 'Evaluation of services for children with complex needs: mapping service provision in one NHS Trust.', Primary health care research & development, vol. 14, no. 1, pp. 52-62.
AIM: The aim of this paper is to identify and descriptively map the key characteristics of the model of service delivery in operation, and to explore the user, carer and professional experience of service provision. This included an exploration of congruity and mismatch between the different stakeholder groups. BACKGROUND: In the United Kingdom (UK), 15% of the children under five years of age and 20% of the 5 to 15-year age group are reported to have a complex long-term condition, with the likelihood of having a condition increasing according to socio-economic circumstances. An increasing number of young people with complex needs are now surviving into late adolescence and early adulthood. However, service provision for children with complex needs is an area that, nationally, has been underdeveloped. METHODS: An exploratory single-site case study was undertaken across one Primary Care Trust in the UK. Documentary and policy review were undertaken along with in-depth qualitative exploration. Eighteen in-depth interviews were undertaken with relevant stakeholders and professionals across the multidisciplinary teams. Families with children between 12 months and 16 years of age who have continuing complex care needs were invited to take part in an interview to give their views about the care they receive. Interviews focused on the family experience and understanding of the child's condition, transition between secondary and primary care, effectiveness of admission and discharge planning and the overall contribution of different professionals. Professionals were also asked about their experiences of delivering care. Findings This study highlighted issues of communication between professionals and with parents and children as a major factor in determining the quality of service provision. Key aspects relating to the model of service provision, namely, paucity of communication, interagency collaboration and the parent as health worker, are highlighted. CONCLUSIONS: Pa...
Ramos, P., Brooks, F., García-Moya, I., Rivera, F. & Moreno, C. 2013, 'Eating habits and physical activity in dieter and non-dieter youth: A gender analysis of English and Spanish adolescents', Social Science Journal, vol. 50, no. 4, pp. 575-582.
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A high prevalence of youth is overweight or obese, and a frequent lack of monitoring of their weight control strategies is observed. Consequently, this paper compares the eating habits and physical activities of male and female dieters and non-dieters. Data are obtained from the large cross-national WHO collaborative study "Health Behavior in School-aged Children 2010". The current sample consists of 9,444 students aged 11, 13 and 15 years from England and Spain. Participants are asked about dieting, vigorous and moderate-to-vigorous physical activity, breakfast frequency and fruit, vegetable, sweet and soft drink consumption. A logistic regression is used to examine the differences between dieters and non-dieters with regard to the aforementioned eating and physical activity habits. Differences between genders, countries, and those associated with BMI (body mass index) are also considered. The results suggest that the reality of weight control differs from the major health promotion recommendations during adolescence. © 2013 Western Social Science Association.
Brooks, F. & Kendall, S. 2013, 'Making sense of assets: What can an assets based approach offer public health?', Critical Public Health, vol. 23, no. 2, pp. 127-130.
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Procter, S., Wilson, P.M., Brooks, F. & Kendall, S. 2013, 'Success and failure in integrated models of nursing for long term conditions: multiple case studies of whole systems.', International journal of nursing studies, vol. 50, no. 5, pp. 632-643.
BACKGROUND: Current projections indicate that the UK faces a 252% increase in people aged over 65 with one or more long term conditions (LTC) by 2050. Nurses, managing their own caseloads and clinics, working across sectors and organisational boundaries and as part of a wider multi-disciplinary team, are frequently seen as key to managing this growing demand. However, the evidence base informing the nursing role in managing LTC, the most effective configuration of the multi-disciplinary team and the policy evidence relating to the infrastructure required to support cross organisational working, remains weak. OBJECTIVES: To explore, identify and characterise the origins, processes and outcomes of effective chronic disease management models and the nursing contributions to such models. DESIGN: Case study whole systems analysis using qualitative interview methods. SETTINGS: Two community matron services, two primary care (GP) practice nursing services, two hospital based specialist nursing services were purposefully sampled from across England and Wales. PARTICIPANTS: Selection criteria were derived using a consensus conference. The nurses in the service, all patients and carers on the caseload, members of the multi-disciplinary team and stakeholders were invited to participate. METHODS: Semi-structured interviews with all participants, thematic analysis within a whole system framework. RESULTS: The study found high levels of clinical nursing expertise which in the case of the community matrons was meeting the aim of reducing hospital admissions. Both the primary care and hospital nurse specialist indicate similar levels of clinical expertise which was highly valued by medical colleagues and patients. Patients continued to experience fragmented care determined by diagnostic categories rather than patient need and by the specific remit of the clinic or service the patient was using. Patient data systems are still organised around the impact on services and prevalenc...
Pickett, W., Molcho, M., Elgar, F.J., Brooks, F., de Looze, M., Rathmann, K., ter Bogt, T.F., Nic Gabhainn, S., Sigmundová, D., Gaspar de Matos, M., Craig, W., Walsh, S.D., Harel-Fisch, Y. & Currie, C. 2013, 'Trends and socioeconomic correlates of adolescent physical fighting in 30 countries.', Pediatrics, vol. 131, no. 1, pp. e18-e26.
BACKGROUND AND OBJECTIVES: No recent international studies provide evidence about its prevalence, trends, or social determinants of physical fighting in adolescents. We studied cross-national epidemiologic trends over time in the occurrence of frequent physical fighting, demographic variations in reported trends, and national wealth and income inequality as correlates. METHODS: Cross-sectional surveys were administered in school settings in 2002, 2006, and 2010. Participants (N = 493874) included eligible and consenting students aged 11, 13, and 15 years in sampled schools from 30 mainly European and North American countries. Individual measures included engagement in frequent physical fighting, age, gender, participation in multiple risk behaviors, victimization by bullying, and family affluence. Contextual measures included national income inequality, absolute wealth and homicide rates. Temporal measure was survey cycle (year). RESULTS: Frequent physical fighting declined over time in 19 (63%) of 30 countries (from descriptive then multiple Poisson regression analyses). Contextual measures of absolute wealth (relative risk 0.96, 95% confidence interval 0.93-0.99 per 1 SD increase in gross domestic product per capita) but not income inequality (relative risk 1.01, 95% confidence interval 0.98-1.05 per 1 SD increase) related to lower levels of engagement in fighting. Other risk factors identified were male gender, younger age (11 years), multiple risk behaviors, victimization by bullying, and national homicide rates. CONCLUSIONS: Between 2002 and 2010, adolescent physical fighting declined in most countries. Specific groups of adolescents require targeted violence reduction programs. Possible determinants responsible for the observed declines are discussed.
Ikioda, F., Kendall, S., Brooks, F., De Liddo, A. & Buckingham Shum, S. 2013, 'Factors That Influence Healthcare Professionals' Online Interaction in a Virtual Community of Practice', Social Networking, vol. 02, no. 04, pp. 174-184.
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Wilson, P.M., Brooks, F., Procter, S. & Kendall, S. 2012, 'The nursing contribution to chronic disease management: a case of public expectation? Qualitative findings from a multiple case study design in England and Wales.', International journal of nursing studies, vol. 49, no. 1, pp. 2-14.
BACKGROUND: The global response to the rise in prevalence of chronic disease is a focus on the way services are managed and delivered, in which nurses are seen as central in shaping patient experience. However, there is relatively little known on how patients perceive the changes to service delivery envisaged by chronic care models. OBJECTIVES: The PEARLE project aimed to explore, identify and characterise the origins, processes and outcomes of effective chronic disease management models and the nursing contributions to the models. Design, settings and participants Case study design of seven sites in England and Wales ensuring a range of chronic disease management models. Participants included over ninety patients and family carers ranging in age from children to older people with conditions such as diabetes, respiratory disease, epilepsy, or coronary heart disease. METHODS: Semi-structured interviews with patients and family carers. Focus groups were conducted with adolescents and children. A whole systems approach guided data collection and data were thematically analysed. RESULTS: Despite nurses' role and skill development and the shift away from the acute care model, the results suggested that patients had a persisting belief in the monopoly of expertise continuing to exist in the acute care setting. Patients were more satisfied if they saw the nurse as diagnostician, prescriber and medical manager of the condition. Patients were less satisfied when they had been transferred from an established doctor-led to nurse-led service. While nurses within the study were highly skilled, patient perception was guided by the familiar rather than most appropriate service delivery. Most patients saw chronic disease management as a medicalised approach and the nursing contribution was most valued when emulating it. CONCLUSIONS: Patients' preferences and expectations of chronic disease management were framed by a strongly biomedical discourse. Perceptions of nurse-led chron...
Brooks, F.M., Magnusson, J., Spencer, N. & Morgan, A. 2012, 'Adolescent multiple risk behaviour: an asset approach to the role of family, school and community.', Journal of public health (Oxford, England), vol. 34 Suppl 1, pp. i48-i56.
BACKGROUND: Engagement in risk behaviours may pose a significant threat to health if involvement spans multiple behaviours. The asset model suggests that contextual aspects of young people's lives, such as factors related to family, school and community, serve as a protective function against health risk behaviours. METHODS: A risk-taking index was created from the English health behaviour in school-aged children study on 15 years olds, substance use and sexual activity. Using a multinomial regression, potential asset variables relating to school, family, peers, community and family affluence were tested for their association with levels of risk behaviours. RESULTS: Sense of neighbourhood belonging, strong school belonging and parental involvement in decision-making about leisure time were related to lower engagement in health risk behaviours. A weaker sense of family belonging was associated with increased risk behaviours if connectedness with teachers was also low. Factors related to school and community played a greater role in adolescent participation in health-related risk behaviours than family-related factors, including family affluence. CONCLUSIONS: Feelings of safety and belonging in the out-of-home settings of adolescents were positively associated with reduced risk behaviours, and indicate the importance of the wider community alongside parents and school as protective assets for health.
Valaitis, R.K., Akhtar-Danesh, N., Brooks, F., Binks, S. & Semogas, D. 2011, 'Online communities of practice as a communication resource for community health nurses working with homeless persons.', Journal of advanced nursing, vol. 67, no. 6, pp. 1273-1284.
AIMS: This study explored community health nurses' viewpoints about a Canadian online community of practice to support their practice with homeless or under-housed populations. BACKGROUND: Community health nurses who specifically work with homeless and marginally housed populations often report feelings of isolation and stress in managing complex problems in resource constraints. To strengthen intra-professional ties and enhance information access, an online community of practice was designed, implemented and evaluated by and for them. METHODS: Q-methodology was used. Sixty-six statements about the community of practice were collected from an online survey and focus groups, refined and reduced to 44 statements. In 2009, sixteen participants completed the Q-sort activity, rating each statement relative to the others. Scores for each participant were subjected to by-person factor analysis. RESULTS: Respondents fell into two groups -tacit knowledge warriors and tacit knowledge communicators. Warriors strongly believed that the community of practice could combat stigma associated with homelessness and promote awareness of homelessness issues, and valued its potential to validate and improve practice. Communicators would have used the community of practice more with increased discussion, facilitation and prompt responses. Generally, nurses viewed the community of practice as a place to share stories, validate practice and adapt best practices to their work context. CONCLUSIONS: Online communities of practice can be valuable to nurses in specialized fields with limited peer support and access to information resources. Tacit knowledge development is important to nurses working with homeless populations: this needs to be valued in conjunction with scientifically based knowledge.
Fenton, C., Brooks, F., Spencer, N.H. & Morgan, A. 2010, 'Sustaining a positive body image in adolescence: an assets-based analysis.', Health & social care in the community, vol. 18, no. 2, pp. 189-198.
The increasing impetus to provide an effective response to childhood obesity has generated a corresponding concern that weight management interventions may lead to emotional problems among young people, notably in relation to the development of a negative body image. However, currently the processes and factors that contribute to the acquisition of body image among young people is poorly understood. Drawing on salutogenic theory, this paper employs an assets-based approach that focuses on health promoting and protective factors to identify how young people may create or sustain positive body images. Secondary data analysis was undertaken from the WHO Health Behaviour in School Aged Children Study. During the spring term of 2002, information was collected from 6425 English adolescents aged 11-15 using a self-administered questionnaire. The data were analysed using stepwise multinomial logistic regression to determine which factors were associated with positive body image; a total of 2898 students were included in the final analysis. Adolescents who self-identified as having a positive body image were more likely to report ease of talking with a father figure, feeling intelligent, perceiving that their family were well off and a belief that their teachers were interested in them as people. Body Mass Index, age, gender and living within a household containing a father were also significant predictors of body image. The discussion provides an exploration of how the construction of young people's emotional health is in part linked with the attainment of a secure and positive body image. The implications for health promotion and educational programmes are then examined. By considering the assets, which support or sustain a positive body image during adolescence, obesity prevention programmes could be better tailored to meet the needs of young people. In the future, a salutogenic curriculum might provide an alternative to unsustainable levels of deficit led, targeted pr...
Brooks, F., Bunn, F. & Morgan, J. 2009, 'Transition for adolescents with long-term conditions: event to process.', British journal of community nursing, vol. 14, no. 7, pp. 301-304.
This paper maps out the evidence relating to quality and user experience of transition services for young people with long-term conditions. The review identified that good quality transition was universally seen as a process as opposed to a single event, supported by effective interagency communication and coordination, with the young person occupying a central place in the decision-making process. Conversely, poor communication and an absence of a designated professional to support the transition were barriers to an effective process. Gaps in the evidence base were most notable when concerned with the relationship between general practice, secondary care and social care. Overall, greater shared learning of the generic components of an effective transition process needs to occur across long-term conditions.
Trivedi, D., Brooks, F., Bunn, F. & Graham, M. 2009, 'Early fatherhood: a mapping of the evidence base relating to pregnancy prevention and parenting support.', Health education research, vol. 24, no. 6, pp. 999-1028.
Teenage pregnancy prevention programmes targeted at young women have received considerable attention from researchers and programme developers. However, to date, relatively limited information is available on preventing teenage fatherhood or improving outcomes for young fathers. A notable gap is concerned with understanding the forms of sexual health programmes that are most effective from the perspective of young men. We conducted a systematic mapping to identify studies involving young men aimed at preventing teenage pregnancy, improving outcomes for teenage fathers or exploring the perspectives of young men around pregnancy and fatherhood. We searched a wide range of electronic databases from January 1996 to August 2008. Three quantitative and 15 qualitative studies were identified, of which nine were UK based. Key themes related to the inappropriateness of current sexual health promotion to respond to the needs of young men. While young men often possessed very similar ideals to young women, existing programmes were problematic when they negatively stereotyped young men and ineffectively addressed models of masculinity or the difficulties young men may have forming meaningful relationships. Further investigations are required on programme development for young men, particularly on sexual health promotion interventions for 'looked-after' young men and those from unstable childhoods.
Wills, W.J., Appleton, J.V., Magnusson, J. & Brooks, F. 2008, 'Exploring the limitations of an adult-led agenda for understanding the health behaviours of young people.', Health & social care in the community, vol. 16, no. 3, pp. 244-252.
Public health and health promotion agendas are usually determined by adults, even when the 'target' population is children and young people. Adult-centred frameworks for health maintenance and the promotion of well-being risk ignoring young people's conceptualizations and experiences of health and health-relevant behaviours. However, the current policy emphasis in the UK and elsewhere apparently seeks to position young people at the centre of their own health-related decisions. Building on the United Nations Convention on the Rights of the Child, this paper examines and critiques policies relating to young people in UK, European and worldwide contexts. This paper then introduces data from two qualitative studies conducted in the UK. These studies illustrate that young people's definitions of health often run counter to prevailing public health and health promotion discourses. Young people do, however, often exhibit strategies for managing their health, even though they are frequently restricted by the perceptions that adults have about their lives and behaviour. This paper argues that the new policy discourse is not yet being systematically turned into action to give all young people a voice. This is important to begin to understand young people's perspectives about what matters to them and what really influences their health behaviours.
Brooks, F. 2008, 'Nursing and public participation in health: an ethnographic study of a patient council.', International journal of nursing studies, vol. 45, no. 1, pp. 3-13.
BACKGROUND: Conceptualisations of the nurse-patient relationship tend to view nursing as embodying an empowering approach to patients, one that places the service user perspective at the centre of decision-making. However, the relationship of nursing to public participation in health service planning and development has been under examined. AIMS: The aim is to explore the relationship of the nursing profession to public participation as enacted through a UK-based patient and public council, located in an acute hospital. The council was developed by nursing staff and aimed to achieve service user participation in strategic level health care decision-making. The views and experiences of participants and the applicability of the 'nurse-patient partnership' construct to public participation are considered. METHODS: The study employed integrative ethnography, involving multiple field methods: non-participant observation of council meetings, i.e. fourteen 3 h meetings (n=42 h); in-depth interviews with councillors (n=17) and with key hospital staff (n=18). A documentary review and mapping of the actions of the council was undertaken. RESULTS: A nurse-patient partnership was not initially intrinsic to the operation of the council or embedded in the perspectives of the nurse or patient participants. Professional vulnerability and the organisational context constrained the nursing response. Councillors and nursing staff moved to create a shared set of understandings in order to progress change in service organisation and delivery. Nurses' repositioning vis-à-vis the credibility of user experiences and status was central to the effective progression of the council. CONCLUSIONS: Partnership in public participation requires a shift by nurses' towards acceptance of members of the public functioning as informed, critical and powerful agents in health care decision-making. Equipping nurses with the skills to communicate with patient representatives in a position of interaction...
Brooks, F. & Shemmings, D. 2008, 'Health and social care needs of children and young people.', Health & social care in the community, vol. 16, no. 3, pp. 219-221.
Brooks, F. 2008, '»When I was on the ward«: The contribution of patient narratives to public involvement in health care decision-making', Neurologie und Rehabilitation, vol. 14, no. 1, pp. 24-30.
Aims: This paper sets out to provide an account of the forms of knowledge and expertise participants brought to a representational form of public involvement in healthcare. The findings are drawn from a two-year ethnographic study of an initiative by an acute hospital in the UK that aimed to involve members of the local community in health care decision-making, through the creation of a patient and public council. Methods: Data triangulation was achieved by a multi-method approach to the conduct of the fieldwork. The methods consisted of: a) Observation of all council meetings (42 hours), b) Individual and focus group interviews with councillors (n = 17) and c) Interviews with hospital staff and managers (n = 35). Results: Councillors drew almost exclusively from their experiential knowledge to construct and advance their agendas for the work of the council. Experiential knowledge and narratives was found to be very influential in constructing the types of contributions from the patient councillors. The patient councillors narratives provided a direct and largely unanticipated challenge to the agendas promoted by the health care workers. This resulted in particular tensions between the patient councillors and professionals concerned with the nature of expertise and the form of patients' contribution to health care delivery. The paper outlines these contested areas and describes the ways in which both patients and staff moved to create a shared set of understandings in order to progress the work of the council. Conclusions: The paper highlights the contribution of personal narratives to public participation and the value that knowledge derived from personal experiences can have for service development. A key finding relates to the importance of professional repositioning and training vis-à-vis the credibility of patients' narratives, as a starting point for shared understandings and the development of improvements in service organisation. However situated and expe...
Wilson, P.M., Kendall, S. & Brooks, F. 2007, 'The Expert Patients Programme: a paradox of patient empowerment and medical dominance.', Health & social care in the community, vol. 15, no. 5, pp. 426-438.
Self-care is seen as a key element in managing resource demand in chronic disease and is also perceived as an empowering right for patients. The Chronic Disease Self-Management Programme developed in the USA has been adopted in a number of countries and in the UK has been as adapted as the Expert Patients Programme. However, despite its potential as a lay-led empowering initiative, the Expert Patients Programme has been criticised as perpetuating the medical model and failing to reach those in most need. This paper revisits a critique of the Expert Patients Programme, and drawing upon a qualitative study seeks to explore whether the Expert Patients Programme enables empowerment or replicates traditional patterns of the patient-professional relationship. A grounded-theory approach was adopted utilising focus groups, in-depth interviews and participant observation. Data were analysed through the constant comparative method and the development of codes and categories. Conducted in the relatively affluent area of the south-east of England, this paper draws on data from 66 individuals with a chronic illness who were knowledgeable, active and informed. The study revealed a number of characteristics common to expert patients that were linked to a systematic, proactive and organised approach to self-management, a clear communication style and the ability to compartmentalise emotion. The study included participant observation of an Expert Patients Programme and a professional-led self-management course. The paradoxical nature of the Expert Patients Programme was revealed, for whilst there was evidence that it reinforced the medical paradigm, there was a concurrent acknowledgement and support for the subjective experience of living with a long-term condition. Furthermore, whilst the policy emphasis has been on individual empowerment within the Expert Patients Programme, there is some evidence that it may be triggering a health consumer movement.
Munday, P., Buchan, A., Ravenhill, G., Wiggs, A. & Brooks, F. 2007, 'A qualitative study of women with vulvodynia: II. Response to a multidisciplinary approach to management.', The Journal of reproductive medicine, vol. 52, no. 1, pp. 19-22.
OBJECTIVE: To evaluate the response of a group of women with vulvodynia who were participating in an integrated, multidisciplinary management program comprising medical evaluation and treatment, psychotherapy, physiotherapy and dietary advice. STUDY DESIGN: Retrospective, qualitative, in-depth interview study. RESULTS: Twenty-seven of 29 women reported a significant benefit, and 9 who had completed the program were pain free. All women appreciated the integrated approach, and even those who were not completely pain free found that they were able to manage their condition satisfactorily. CONCLUSION: Further evaluation of this program is warranted to assess whether it would be helpfulfor other women with this problem.
Buchan, A., Munday, P., Ravenhill, G., Wiggs, A. & Brooks, F. 2007, 'A qualitative study of women with vulvodynia: I. The journey into treatment.', The Journal of reproductive medicine, vol. 52, no. 1, pp. 15-18.
OBJECTIVE: To evaluate women's experiences of accessing help and treatment for vulvodynia. STUDY DESIGN: Women who had participated in a vulvar pain management program were evaluated in a retrospective, qualitative, in-depth interview study. RESULTS: The women described their distressing symptoms of vulvodynia and their previous experiences of seeking help. The women thought that the delay to diagnosis contributed to the severity of their symptoms and that achieving a diagnosis was the first step on a path toward the acceptance of a chronic condition and a commitment to a management program. CONCLUSION: Vulvodynia is poorly recognized, and the delay to diagnosis adversely affects patients, exacerbating the severity of their symptoms.
Brooks, F. & Magnusson, J. 2007, 'Physical activity as leisure: the meaning of physical activity for the health and well-being of adolescent women.', Health care for women international, vol. 28, no. 1, pp. 69-87.
Globally, low participation in physical activity by adolescent young women is a major health concern. While the barriers to activity for this group are well documented, little is known about the views and experiences of nonathlete, but active, young women. In order to gain an understanding of young women's lived experiences of the relationship between physical activity as leisure and health, data were collected through focus groups. Active nonathlete young women in the United Kingdom attached significant meaning to physical activity as a space for leisure, and used it to enhance their health and well-being.
Brooks, F., Kendall, S., Bunn, F., Bindler, R. & Bruya, M. 2007, 'The school nurse as navigator of the school health journey: developing the theory and evidence for policy', Primary Health Care Research and Development, vol. 8, no. 03, pp. 226-226.
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Brooks, F. & Scott, P. 2006, 'Exploring knowledge work and leadership in online midwifery communication.', Journal of advanced nursing, vol. 55, no. 4, pp. 510-520.
AIM: This paper reports a study to answer the following question: if given a user-friendly online system, that enabled communication across the practice community, would midwives function as knowledge workers? BACKGROUND: Globally, the demand for quality-led and innovative service delivery requires that nurses and midwives shift from being 'information workers', or passive receivers of managerial and organizational decisions, to become 'knowledge workers' who are able to create, lead and communicate service innovation and practice development. New communication technologies may offer a means for healthcare professionals to interact as knowledge workers and develop supportive communities of practice. METHODS: An online discussion forum was implemented as a low-cost technological intervention, deploying existing hardware and a standard hospital intranet. The evaluation of the forum was constructed as case-study organizational research. The totality of online communication, both traffic and content, was analysed over a 3-month period (193 messages downloaded 2003/2004), and 15 in-depth interviews were undertaken with forum users. FINDINGS: Given simple, facilitative, innovative technology, supported by a positive working culture and guided by effective leadership, midwives could function as 'knowledge workers', critically reflecting upon their practice and translating knowledge into action designed to achieve change in practice. Participation occurred across all staff grades, and midwives were predominantly supportive and facilitative towards the contributions made by colleagues. CONCLUSION; Midwives may be well placed to exemplify the 'ideal' characteristics of the knowledge worker being demanded of modern healthcare professionals. The deployment of online interactive technologies as part of strategic vision to enhance knowledge work among healthcare professionals should be given attention within health systems.
Wilson, P.M., Kendall, S. & Brooks, F. 2006, 'Nurses' responses to expert patients: the rhetoric and reality of self-management in long-term conditions: a grounded theory study.', International journal of nursing studies, vol. 43, no. 7, pp. 803-818.
BACKGROUND: Against the backdrop in the western world of increasing prevalence of chronic disease, active and informed patients and a policy emphasis on self-management, this English study explored health professionals' responses to expert patients. OBJECTIVES: To: DESIGN: A grounded theory approach was utilised with two concurrent data strands. SETTING: A relatively affluent English county including community, primary and secondary care settings. PARTICIPANTS: Via purposeful and theoretical sampling 100 health professionals (nurses, doctors, physiotherapists) and 100 adults affected by chronic disease participated. METHODS: Focus groups, interviews and observation. RESULTS: Nurses were found to be most anxious about expert patients when compared to other professionals, which appeared to be linked with a lack of professional confidence and unfounded fears regarding litigation. However, nurse specialists often provided a negative case for this. As a whole, nurses were most able to meet the emotional needs of patients, but apart from nurse specialists did not articulate this as a skill. CONCLUSION: Apart from nurse specialists the majority of nurses appeared limited in appropriately facilitating self-management. It is suggested that this is linked to an ongoing nursing culture of patient as passive, an over-emphasis on empirical knowledge and a feeling of vulnerability on the nurses' part towards expert patients. The findings also indicate a rhetoric rather than reality of autonomous nursing roles within the chronic disease management agenda.
Brooks, F. & Scott, P. 2006, 'Knowledge work in nursing and midwifery: an evaluation through computer-mediated communication.', International journal of nursing studies, vol. 43, no. 1, pp. 83-97.
Recent changes in policy and culture require health workers to incorporate "knowledge work" as a routine component of professional practice. Innovative computer-mediated communication technologies provide the opportunity to evaluate the nature of "knowledge work" within nursing and midwifery. This study embedded an online discussion system into an acute NHS Trust to support interaction within communities of practice. The complete record of online communications was analysed. Nurses were found to predominantly engage in information work with knowledge work restricted to senior-to-senior level exchanges. In contrast, midwives were observed to employ the technology to support knowledge work between all grades. The study indicates that technology can support knowledge work, including conveying tacit knowledge effectively.
Mead, M., Brooks, F., Windle, K., Kukielka, M. & Boyd, D. 2005, 'Evaluation of a midwifery support service for pregnant teenagers', British Journal of Midwifery, vol. 13, no. 12, pp. 762-766.
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Brooks, F., Rospopa, C. & Scott, P. 2004, 'Midwifery on the net: new communication technology', British Journal of Midwifery, vol. 12, no. 2, pp. 107-110.
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Brooks, F. 2004, 'The spirit of 'health for all': the shape of primary health care, past, present and future', Primary Health Care Research and Development, vol. 5, no. 4, pp. 281-283.
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Brooks, F.M. 2001, 'Masculinity and femininity: the taboo dimension of national cultures', Social Science & Medicine, vol. 52, no. 4, pp. 653-653.
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Pugh, J., Mitchell, M. & Brooks, F. 2000, 'Insider/outsider partnerships in an ethnographic study of shared governance', Nursing Standard, vol. 14, no. 27, pp. 43-44.
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Brooks, F. 1998, 'Women in general practice: Responding to the sexual division of labour?', Social Science & Medicine, vol. 47, no. 2, pp. 181-193.
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Phillips, D. & Brooks, F. 1998, 'Women users' views on the role and value of the practice nurse', Health and Social Care in the Community, vol. 6, no. 3, pp. 164-171.
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I have worked extensively with colleagues across Europe and North America, notably: The University of Seville, Spain - Queen’s University Kingston, Canada -Washington State University,  Spokane, USA -  McMaster University, Ontario, Canada. 

My work has regularly features in press reports and media interviews, recent media reports including for example: