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.
- Adolescent health
- Adolescents and physical activity
- Computer game playing, violence and body image
Brooks, F., Michaelson, V., King, N., Inchley, J. & Pickett, W. 2018, 'Spirituality as a protective health asset for young people: an international comparative analysis from three countries.', International journal of public health.View/Download from: Publisher's site
Spirituality has been proposed as a potential health asset a 'developmental engine' that works by fostering the search for connectedness, meaning and purpose. The aim is to examine to what extent spiritual health might be protective of young people's overall health and well-being.In 2014, young people aged 11, 13, and 15 years in England, Scotland and Canada were surveyed as part of the HBSC study (n = 26,701). The perceived importance of spiritual health and domains (connections with self, others, nature, and the transcendent) was measured in these countries. Multi-level log-binomial models were used to explore relationships between spiritual health and three self-reported positive health outcomes: general health status, subjective life satisfaction and health complaints.Higher levels of perceptions of the importance of spiritual health, both overall and within the four domains, were associated with higher likelihoods of reporting each of the positive health outcomes.Spiritual health appears to operate as a protective health asset during adolescence and is significantly shaped by external relationships and connections.
Chester, K.L., Brooks, F.M., Magnusson, J., Klemera, E., Spencer, N. & Smeeton, N. 2017, 'The mitigating role of ecological health assets in adolescent cyberbullying victimization', Youth and Society.
Chester, K.L., Brooks, F.M., Whiting, L. & Spencer, N. 2017, 'Associations between relational bullying and health related quality of life in Adolescence', Journal of Adolescent Health.
Chester, K.L., Spencer, N., Whiting, L. & Brooks, F.M. 2017, 'Association Between Experiencing Relational Bullying and Adolescent Health Related Quality of Life', Journal of School Health, vol. 87, no. 11, pp. 865-872.View/Download from: Publisher's site
García-Moya, I., Bunn, F., Spencer & Brooks, F.M. 2017, 'School-level factors associated with teacher connectedness: A multilevel analysis of the structural and relational school determinants of young people's health', Journal of Public Health.View/Download from: UTS OPUS or Publisher's site
Conducting research on the antecedents of teacher connectedness (TC) is key to inform intervention and policy that can leverage the public health potential of teachers for young people's well-being. As part of the EU-funded Teacher Connectedness Project, this study aims to examine the contribution of a variety of school-level factors (including type of school, school size, student–teacher ratio, students per class and teacher gender).
Sample consisted of 5335 adolescents aged 11, 13 and 15 years that had participated in the HBSC study in England. Multilevel multinomial regression was used to examine the contributions of sociodemographic and school-level factors to TC.
TC was lower in older adolescents and those from less affluent families, but similar in boys and girls. Regarding school-level factors, it was not the size of the school but the ratio of students per teacher which was significantly associated to TC, with higher student–teacher ratio being significantly associated with lower odds of medium-to-high TC. Some differences between mixed and all-girls schools were also found.
Health promotion strategies targeting student–teacher relationships need to consider how TC changes by age and SES and give attention to school-level factors, in particular the student–teacher ratio.
Jay, A., Thomas, H. & Brooks, F.M. 2017, 'In labor or in limbo? The experiences of women undergoing induction of labor in hospital: findings of a qualitative study"', Birth.
Klemera, E., Chester, K.L., Magnusson, J., Spencer, N., Smeeton, N. & Brooks, F.M. 2017, 'Self-harm in Adolescence: Protective Health Assets in the Family, School and Community', International Journal of Public Health, vol. 62, no. 6, pp. 631-638.View/Download from: UTS OPUS or Publisher's site
The aim of this paper was to examine if the multiple environments of the adolescent including family, peers, school and neighbourhood might function as protective health assets against self-harming behaviour during adolescence.
The present study utilised data collected from 1608 respondents aged 15 years as part of the England WHO Health Behaviour in School-aged Children (HBSC) Study. Multilevel modelling was undertaken using the package MLwiN (version 2.33) to investigate the potential domains and dimensions of family life, school culture and environment, and neighbourhood factors that may operate as protective health assets.
The results indicated that while peer support did not appear to operate as a protective health asset in the context of self-harm, key dimensions of adolescent/parent interaction and adolescent experience of the school culture and their neighbourhood were associated with reduced likelihood of self-harming behaviours during adolescence.
The Findings highlight the significance of belonging and connectedness as important constituent elements of protective health assets for young people. Interventions that address the multiple environments of the young person, may offer an effective means to reduce the levels of self-harm.
Simon, A., Owen, C., O'Connell, R. & Brooks, F.M. 2017, 'Changing trends in young people's food behaviour and wellbeing in England in relation to family affluence between 2005 and 2014', Journal of Youth Studies, pp. 1-14.View/Download from: Publisher's site
Yassaee, A.A., Hargreaves, D.S., Chester, K., Lamb, S., Hagell, A. & Brooks, F.M. 2017, 'Experience of primary care services among early adolescents in England and association with health outcomes', Journal of Adolescent Health, vol. 60, no. 4, pp. 388-394.View/Download from: UTS OPUS or Publisher's site
The aim of this study was to investigate adolescents' (11–15 years) experience of their general practitioner (GP), whether poor reported GP experience was associated with worse physical and mental health measures and whether poor previous GP experience was linked to lower utilization of these services.
We used logistic regression to analyze data from the 2014 Health Behaviour in School-aged Children study. Four aspects of recent care experience were studied: feeling at ease, feeling treated with respect, satisfaction with doctor's explanation, and feeling able to discuss personal matters. Five dichotomized measures of health status were used: ever self-harmed; fair or poor self-reported health; frequent (at least weekly) low mood; sleeping problems; or headaches.
Of 5,335 students, 4,149 reported having visiting their GP within the past year. Of these, 91.8% felt treated with respect, 78.7% felt at ease, 85.7% were satisfied with explanation, and 53.9% felt able to discuss personal matters. After adjusting for ethnicity, age, gender, and family affluence score, poor experience on any indicator was strongly associated with increased risk of self-harm (adjusted odds ratio range, 2.01–2.70; all p < .001); feeling low (AOR range, 1.53–2.11; all p < .001); and sleeping problems (AOR range, 1.49–1.91; all p .001). Poor experience on all indicators, except discussing personal matters, was associated with worse self-reported health.
Nearly half of this large, national study of adolescents did not feel able to discuss personal matters with their doctor. There was a consistent, strong association between reported lack of good GP experience and poor health measures.
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.
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.View/Download from: UTS OPUS or Publisher's site
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.
Marsa-Sambola, F., Williams, J., Muldoon, J., Lawrence, A., Connor, M., Roberts, C., Brooks, F. & Currie, C. 2016, 'Sociodemographics of Pet Ownership among Adolescents in Great Britain: Findings from the HBSC Study in England, Scotland, and Wales', Anthrozoos, vol. 29, no. 4, pp. 559-580.View/Download from: UTS OPUS or Publisher's site
© 2016, © ISAZ 2016. The aim of this study was to assess the prevalence of pet ownership among adolescents in Great Britain and identify any sociodemographic differences between pet owners and non-pet owners. A total of 14,328 11-to 15-year-old adolescents from England, Scotland, and Wales were included in the analysis. Results revealed 15-year-old adolescents were significantly more likely than 11-year-old adolescents to own dogs (OR = 1.146, p < 0.001) but less likely to own fish, reptiles, or amphibians (OR = 0.629, p < 0.001), and small mammals (OR = 0.630, p < 0.001). Thirteen-year-olds were significantly more likely than 11-year-olds to own dogs (OR = 1.240, p = 0.021) and birds (OR = 1.299, p = 0.010), but significantly less likely to own fish, reptiles, or amphibians (OR = 0.795, p < 0.001). No gender differences were found. White adolescents were more likely than non-white adolescents to own all pet types. Those living in single-parent families were significantly more likely than those living with two parents to own dogs (OR = 1.186, p = 0.013) and cats (OR = 1.319, p < 0.001). Furthermore, those who reported living in stepfamilies were also more likely to own cats (OR = 1.428, p < 0.001). Adolescents with siblings were more likely to own cats (OR = 1.391, p = 0.001), fish, reptiles, or amphibians (OR = 1.220, p = 0.037) than adolescents without siblings. Adolescents with employed parents (both or one) were significantly more likely than those with unemployed parents to own dogs (OR = 1.414, p = 0.002) and birds (OR = 1.523, p = 0.018). Adolescents from high-affluence families were less likely than adolescents from low-affluence families to own dogs (OR = 0.888, p = 0.037), small mammals (OR = 0.832, p = 0.005), and birds (OR = 0.801, p = 0.046). Furthermore, family affluence differences were found in different pet types. Differences in all pet types and siblings were also found in a proxy measure of attachment to pets. This study provides ev...
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.View/Download from: Publisher's site
© 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 ...
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.View/Download from: UTS OPUS or Publisher's site
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.
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.View/Download from: UTS OPUS or Publisher's site
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., 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.View/Download from: UTS OPUS or Publisher's site
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.
Brooks, F.M. 2015, 'Associations between adolescents' experience of general practitioners and health outcomes in England: a cross-sectional study of national data', The Lancet, vol. 386, no. S82.View/Download from: UTS OPUS or Publisher's site
Adolescence is a key stage of the life course when lifelong health behaviours and attitudes to health care can be established. Poor experience of consultations with a general practitioner (GP) is common among adolescents, but little is known about whether poor experience in this group is associated with worse health status or outcomes. This study aimed to investigate this association with data from the 2014 Health Behaviour in School-Aged Children (HBSC) survey (England).
We used logistic regression to analyse data for 5335 participants aged 10–17 years in the HBSC survey. Four aspects of recent GP experience were studied: feeling at ease, being treated with respect, quality of GP explanation, and feeling able to talk about personal matters. Five dichotomised measures of health status or outcome were used (ever self-harmed; fair or poor self-reported health; frequent [at least weekly] low mood, sleeping problems, or headaches). We adjusted for participants' sex, age, ethnicity, and family affluence score. Of 5178 participants, 1187 (23%) had not visited their GP within the past year and were excluded from the analysis.
Of 3991 adolescents, 3632 (91%) felt treated with respect, 2091 (52%) could talk about personal matters, 1600 (40%) were satisfied with explanations, and 1221 (31%) felt at ease. Participants who reported poor experience of GP care were more likely to have poor health outcomes than were those who reported a good experience. For example, adolescents who did not feel at ease with their GP were more likely to report self-harm (adjusted odds ratio [AOR] 265, 95% CI 169–415; fair or poor health 164, 128–210; low mood 151, 125–182) and sleeping problems (141, 119–166). All GP indicators were associated with self-harm (AOR range 164–270; quality of GP explanation p=0006, all others p<0001) and feeling low (146–211, all p<0001). The association with GP experience was less consistent for the other three healt...
Cavallo, F., Dalmasso, P., Ottová-Jordan, V., Brooks, F., Mazur, J., Välimaa, R., Gobina, I., Gaspar de Matos, M., Raven-Sieberer, U. & Positive Health Focus Group 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 Suppl 2, pp. 80-82.View/Download from: Publisher's site
Life satisfaction (LS) is an indicator which is widely used for assessing the perception of a child's feeling about his life.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.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.The LS scale appears to be a tool capable of discriminating the level of wellbeing of adolescent population among countries.
Cavallo, F., Dalmasso, P., Ottová-Jordan, V., Brooks, F., Mazur, J., Välimaa, R., Gobina, I., Gaspar de Matos, M., Raven-Sieberer, U. & Positive Health Focus Group 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.View/Download from: UTS OPUS or Publisher's site
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.
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.View/Download from: Publisher's site
© 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.
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.View/Download from: UTS OPUS or Publisher's site
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.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.View/Download from: UTS OPUS or Publisher's site
© 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.
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.View/Download from: UTS OPUS or Publisher's site
The Burdett Trust for Nursing funded a 2-year project to pilot an online community of practice to enable health visitors to share, manage and co-produce knowledge in a virtual space. The aim of the project was to develop a robust web-based tool to allow practitioners to share expertise and promote learning to empower them to exchange professional knowledge and best practice with other practitioners across organisational boundaries. In this paper, the authors reflect on the process of developing an online community of practice for health visiting, and report some initial findings and challenges from the pilot study.
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. 1-234.View/Download from: UTS OPUS or Publisher's site
Background: Some 15 million people in England have a long-term condition (LTC) but there is concern
about whether or not the NHS meets their needs. To address this, consecutive governments have
developed policies aimed at improving service delivery and patient and public engagement and
involvement (PPEI). There has been little research that examines the impact or benefit of PPEI in
commissioning. This project explored the role and impact of PPEI in commissioning for people with LTCs.
The research was undertaken during a period of substantial change in the English NHS, which enabled us
to observe how the NHS reforms in England impacted on approaches to PPEI.
Aim: The aim was to examine how commissioners enable voice and engagement of people with LTCs and
identify what impact this has on the commissioning process and pattern of services. Our specific objectives
were to (1) critically analyse the relationship between the public/patient voice and the impact on the
commissioning process; (2) determine how changes in the commissioning process reshape local services;
(3) explore whether or not any such changes in services impact on the patient experience; (4) identify if
and how commissioners enable the voice and engagement of people with LTCs; and (5) identify how
patient groups/patient representatives get their voice heard and what mechanisms and processes patients
and the public use to make their voice heard.
Methods: We used a case study design examining the experience of PPEI in three LTC groups – diabetes,
rheumatoid arthritis and neurological conditions – through three in-depth case studies. Our approach
involved reviewing practice across the UK and then focusing on three geographical areas to examine
practices of commissioning health care for people with LTCs, approaches to PPEI, patterns of services for
people with LTCs and the activities of local patient and voluntary organisations for people with LTCs. The
research had five phases and involved participatory a...
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.View/Download from: Publisher's site
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.View/Download from: UTS OPUS or Publisher's site
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.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.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.Parents experienced both health and social se...
Mazur, J., Sentenac, M., Brooks, F., Małkowska-Szkutnik, A., Gajewski, J. & Gavin, A. 2013, 'Burden of chronic health conditions in adolescence measured by school surveys.', Medycyna wieku rozwojowego, vol. 17, no. 2, pp. 157-164.View/Download from: UTS OPUS
The Chronic Conditions Short Questionnaire (CCSQ) included as an optional package in the Health Behaviour in School-aged Children (HBSC) study protocol identifies adolescents with chronic conditions, and helps to understand the psychosocial impact of such illnesses. However, reliability of the results depends on the proper definition of the group with chronic conditions.of this paper is to report on the validity of self-reported data on chronic conditions obtained from the CCSQ questionnaire used in a large school-based population study.The data was obtained from the 2010 HBSC study conducted in Poland in a group of 4570 pupils aged 13-17. The CCSQ includes three questions about chronic illness or disabilities occurrence diagnosed by a physician, and its selected consequences (missing school classes, medication). Four complex continuous scales were used as validation modules: the subjective complaints checklist and three sub-scales from the abbreviated Child Health and Illness Profile (CHIP-AE) questionnaire. The oldest age group was additionally asked about functional difficulties in: seeing, hearing, speaking, moving and breathing. Analysis of Variance with the post hoc test was used to compare subgroups of students defined according to CCSQ and functional difficulties.Chronic conditions were reported by 20.3% of young respondents (95% confidence interval 19.2-21.5%). A statistically significant difference was found between the mean indexes of all validation scales when comparing healthy and chronically-ill students meeting criteria of CCSQ. The difference increases in comparison with chronically-ill students with functional difficulties, missing classes or taking medication.The CCSQ questionnaire is an appropriate tool for assessing the occurrence of long-term health problems from the perspective of adolescents. The instrument also importantly allows for an assessment of the impact of chronic and long-term conditions on medication usage and hindered access to ...
Pickett, W., Molcho, M., Elgar, F.J., Brooks, F., de Looze, M., Rathmann, K., ter Bogt, T.F.M., 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.View/Download from: UTS OPUS or Publisher's site
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.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).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.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.
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.View/Download from: UTS OPUS or Publisher's site
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.To explore, identify and characterise the origins, processes and outcomes of effective chronic disease management models and the nursing contributions to such models.Case study whole systems analysis using qualitative interview methods.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.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.Semi-structured interviews with all participants, thematic analysis within a whole system framework.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 prevalence of disease at an individual level and not around the patient experience of dise...
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.View/Download from: UTS OPUS or Publisher's site
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.
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.View/Download from: UTS OPUS or Publisher's site
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.View/Download from: UTS OPUS or Publisher's site
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.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.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.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.
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.View/Download from: UTS OPUS or Publisher's site
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 chroni...
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.View/Download from: UTS OPUS or Publisher's site
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.View/Download from: Publisher's site
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.View/Download from: Publisher's site
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.View/Download from: Publisher's site
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.
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...
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.View/Download from: Publisher's site
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 interactiona...
Verkerke, G.J. & Lee, T.C. 2008, 'Basic biomechanics.', Technology and health care : official journal of the European Society for Engineering and Medicine, vol. 16, no. 3, pp. 219-221.View/Download from: Publisher's site
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.View/Download from: Publisher's site
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. & 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.View/Download from: Publisher's site
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. 3, pp. 226-234.View/Download from: Publisher's site
The aim of this article is to explore how the development of the theoretical and strategic basis of school nursing offers a vehicle for the delivery of an effective public health strategy for children and adolescents.Through a critical examination of the status and scope of school nursing within the UK and US health care systems it is clear that a deficiency exists regarding the theoretical and strategic basis for the functioning of school nursing. Consideration is given to the concept of the school nurse as 'navigator 7 for the child along the trajectory of the school health journey. This novel approach to school nursing needs to be developed theoretically and evaluated for effectiveness. A rapid review of the evidence to support school nursing interventions has revealed that the evidence base for school nursing interventions/actions remains very weak, thereby challenging the ability of school nurses to deliver desired outcomes for the present ambitious public health agenda. We argue that a planned approach to developing the evidence for school nursing, based on the UK Medical Research Council (MRC, 2000) framework for the evaluation of complex interventions, could help to ensure a robust role for the school nurse.This acknowledgement and development of a novel approach to school nursing could contribute to policy implementation around public health goals for the school-aged population. © 2007, Cambridge University Press. All rights reserved.
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.
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.
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.View/Download from: Publisher's site
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.
Brooks, F. & Magnusson, J. 2006, 'Taking part counts: adolescents' experiences of the transition from inactivity to active participation in school-based physical education.', Health education research, vol. 21, no. 6, pp. 872-883.View/Download from: Publisher's site
Identifying ways to increase and sustain active living among young people represents a priority for health promotion interventions. This qualitative study explored the experiences of adolescent boys and girls in the United Kingdom (aged 14-15 years) who had made the transition from inactivity to active participation in physical education (PE). The setting was a secondary school that had modified the PE programme, with the aim of increasing participation rates. Thirty-one, self-identified, formerly 'PE adverse' students were interviewed in focus groups in the school setting. Previously, respondents felt that they had been constructed as physically marginal individuals. Having a physically 'marginal body' was perceived as being detrimental to emotional health. The new PE resulted in respondents possessing a performing and achieving physical identity. Boys gained a sense of security in their physical identity and cultural change had removed the aggression from interacting with other physically active peers. Girls spoke of increased self-confidence, including acquiring the psychological resources to participate in community-based activities. Effective health promotion interventions for inactive adolescents are likely to move beyond solely endorsing the benefits of physical activity or increasing choice and instead address the potential emotional risks and value of participation from the adolescents' perspective.
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.View/Download from: Publisher's site
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.
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.View/Download from: Publisher's site
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.View/Download from: Publisher's site
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.
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.View/Download from: Publisher's site
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.
Christian, S., Ross, F., Brooks, F. & Drennan, V. 2005, 'School nurses' contribution to young people's future health.', Nursing times, vol. 101, no. 47, pp. 19-20.
This article explores how risks around health are managed in UK schools. It is suggested that school nurses could play a pivotal role in driving the health agenda forward in the school environment.
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.View/Download from: Publisher's site
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.View/Download from: Publisher's site
Pugh, J., Mitchell, M. & Brooks, F. 2000, 'Insider/outsider partnerships in an ethnographic study of shared governance.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 14, no. 27, pp. 43-44.View/Download from: Publisher's site
The benefits of research being undertaken by more than one researcher cannot be underestimated. Having one researcher with intimate knowledge of the organisation and another who could provide a dispassionate view, paid dividends in this study into shared governance from an ethnographic perspective.
Mitchell, M., Brooks, F. & Pugh, J. 1999, 'Balancing nurse empowerment with improved practice and care: An evaluation of the impact of shared governance', Journal of Research in Nursing, vol. 4, no. 3, pp. 192-200.View/Download from: Publisher's site
This paper reports on the preliminary findings of a two-year ethnographic study of the implementation of shared governance at Kettering General Hospital NHS Trust. Key aims of the study were to identify the impact of shared governance on clinical practice and patient care, and the effects of its implementation on nurses and midwives. The findings suggest that the early impact of shared governance related primarily to effects on the professional environment and culture of nursing, particularly increased information-sharing and feelings of empowerment. Impact on patient care and service delivery was limited, with key obstacles to successful implementation including poor communication systems, lack of a means of publicising the work of shared governance councils, and difficulties finding the best ways of managing time spent away from clinical areas on practice and professional development issues. There was evidence that shared governance could have an indirect impact on patient care in the longer term. We suggest that it may have to be accepted that, initially, the early impact of shared governance is felt mainly by health professionals, and that the desired impacts on service delivery are the indirect benefits of more empowered and professionally accountable nurses and midwives in the longer term.
This paper provides an exploration of the gendered nature of the working experience of women within a high status and predominantly male dominated medical specialty, that of general practice or primary care physician. Women currently represent just over a third of all general practitioners in the U.K. and their numbers have been increasing. Women now account for 60% of new recruits into general practice. Despite this increase, consideration of the experience and role of women within medicine has largely focused on hospital medicine. The findings presented are derived from a three year project, that aimed to develop an understanding of the role women health workers play in the U.K. in the construction and provision of primary health care services for women. The methods employed consisted of a series of postal surveys and qualitative interviews conducted with GPs, female nurses and women service users. The first section of the discussion provides an exploration of the nature and impact of the sexual division of labour within general practice and the resulting occupational marginalisation of women GPs. Attention is given to identifying the key processes whereby the sexual division of labour is maintained and reproduced, particularly through the normative expectations of colleagues, patients and women GPs themselves. The final section presents a typology of the differing strategies the sampled women GPs adopted for managing their working roles in response to the existence of a sexual division of labour. The conclusion highlights the possible impact of the differing strategies upon the functioning of women within general practice and their relationship with women users of the service.
Brooks, F., Mitchell, M. & Pugh, J. 1998, 'Shared governance as a way to involve staff in decision-making.', Nursing times, vol. 94, no. 46, pp. 56-57.
Increasing the involvement of clinicians in decision-making is a key part of recent NHS policy. One model designed to increase involvement is shared governance. This article describes the approach to shared governance developed at Kettering General Hospital. Ongoing evaluation of the scheme suggests benefits in terms of personal and professional development for those involved.
Phillips, D. & Brooks, F. 1998, 'Age differences in women's verdicts on the quality of primary health care services.', The British journal of general practice : the journal of the Royal College of General Practitioners, vol. 48, no. 429, pp. 1151-1154.
BACKGROUND: One aim of the Patients' Charter initiative is to ensure that general practitioner (GP) services become more sensitive to the expressed needs of patients. Most studies in this area have concentrated on the personal and professional attributes of the GP, and few studies have explored in detail the specific views of women patients. AIM: To examine age differences in the views of women under the age of 65 years on the quality of different aspects of primary health care services. METHOD: A random sample of 1251 women aged 16-65 years was surveyed by postal questionnaire on their use of and satisfaction with primary health care services. Analyses were undertaken of women's verdicts on the best and worst aspects of the services provided. RESULTS: There is a strong inverse relationship between age and negative evaluations of primary health care services. On each of 20 items ['what are the worst things about the GP surgery?'], older women consistently scored lower than younger women. The results were not so clear-cut among the 20 positive items ('what are the best things about the GP surgery'). On nine items, there was a significant positive association with age (the highest being on 'receptionists are approachable' and 'practice nurse is approachable and easy to talk to'). On nine items, there was no significant age difference, and on the item with the highest overall positive ranking, 'not far to travel to GP surgery', the association was in the opposite direction to that expected, i.e., a larger proportion of women under 40 years of age (72.5%) answered positively than did women over the age of 40 years (64.9%). CONCLUSIONS: It is likely that the relationship between age and positive evaluations of primary health care service is less straightforward than has been assumed previously. Although older women are consistently less willing to criticize primary health care services across the board, they are more discriminating in giving and withholding praise.
OBJECTIVE: We aimed to investigate general preferences to see a male or female GP either some or all of the time, and specific preferences to see a female primary health care (PHC) worker for individual health issues; to compare these preferences with reported consultation behaviour; and to explore women's evaluations of the quality of PHC services in relation to their preferences and consultation behaviour. METHOD: Results are reported on 881 women aged 16-65 years who had consulted their GP in the previous 6 months. Logistical regression analysis was undertaken to evaluate whether a general preference to see another woman is more important than specific women's health issues in determining why some women regularly choose to consult a female GP. RESULTS: General preference was 2.6 times more important than specific health issues in predicting choice of a female GP in a mixed-sex practice. Nearly a half (49.1 %) of women attending male-only practices stated that they wanted to see a female GP in at least some circumstances, compared with 63.8% of women in mixed-sex practices. In total, 65.5% of the sample stated that there was at least one specific health issue for which they would only want to be seen by a woman PHC worker. The most positive evaluations of the quality of GP services were made by women normally seeing a male GP in mixed-sex practices and the least positive evaluations were given by women in male-only GP practices CONCLUSIONS: In order to meet women's expressed preferences, every GP practice should have at least one female GP available at least some of the time and every GP practice should employ a female PHC worker.
Phillips, D. & Brooks, F. 1998, 'Women users' views on the role and value of the practice nurse.', Health & social care in the community, vol. 6, no. 3, pp. 164-171.View/Download from: Publisher's site
Aspects of the views of women aged 16-65 years on practice nurses in the primary health care setting are explored. The extent to which women consult practice nurses and the reasons for consultation are first identified. Women's assessments of practice nurses are then examined. The findings are from a 3-year research project where 1251 women completed a postal questionnaire and 70 women were interviewed in depth about issues concerning women's perceptions and experiences of both general practitioners (GPs) and practice nurses. Two thirds of the sample had consulted the practice nurse; 22% about specific women's health issues (including 13% for cervical screening). For most women's health issues, more women expressed a preference to be seen by a general practitioner (GP) than a practice nurse, except for breast examination among women aged 49 to 65 years where 57% expressed a preference for a practice nurse compared with 43% for a GP. Women gave similarly positive evaluations of the approachability of practice nurses and GPs. Positive views of practice nurses were high among older women, women who saw practice nurses in well-women clinics and women who saw practice nurses in relation to women's health issues. Among women who had not consulted a practice nurse, there was both a lack of awareness of the level and range of expertise of practice nurses, and a perception that in the main they offered only minor routine services. Health promotion, disease prevention and family planning do not appear to feature centrally in women's expectations of services provided by the practice nurse.
Brooks, F. & Phillips, D. 1996, 'Do women want women health workers? Women's views of the primary health care service.', Journal of advanced nursing, vol. 23, no. 6, pp. 1207-1211.View/Download from: Publisher's site
This paper sets out to explore key aspects of women's views of women GPs and practice nurses within primary health care settings. The extent to which women actively seek female health workers for the provision of their primary health care needs, including preventive health care, is examined. The findings presented in this paper are from a 3-year research project employing both quantitative and qualitative methods, which aimed to develop an understanding of the role women primary health care workers play in the construction and provision of primary health care services for women. The findings indicate that for specific 'women's health issues' the gender of the worker is clearly important for women. However, for other health needs factors such as the personal approach of the provider become paramount. Consideration of the role of the practice nurse suggests that there is considerable potential for practice nurses to further develop a specific role with women. Although lack of awareness among women of nursing skills and expertise raises issues for the presentation of the role of the practice nurse within the primary health care service. In conclusion the paper highlights that women's views should be understood in terms of a complex range of preferences and needs.
Brooks, F. & Magnusson, J. 2010, 'Physical activity programmes in high schools' in Childhood Obesity Prevention: International Research, Controversies and Interventions, Oxford University Press, UK, pp. 380-388.View/Download from: Publisher's site
© 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.M., Chester, K.L., Klemera, E. & Magnusson, J. 2017, Cyberbullying: (2017) an analysis of data from the HBSC survey for England, 2014.
Brooks, F.M., Chester, K.L., Klemera, E. & Magnusson, J. 2017, Intentional self-harm in adolescence: an analysis of data from the HBSC survey for England, 2014 Public Health England.
Brooks, F.M., Chester, K.L., Klemera, E. & Magnusson, J. 2017, Wellbeing of adolescent girls: an analysis of data from the HBSC survey for England, 2014.
This briefing outlines evidence to show that pupils who are positive about the PSHE lessons they receive at school are more likely to have positive relationships at school, as well as a strong feeling of belonging at school.
using data from the Health Behaviour in School-aged Children (HBSC) research study which surveyed 5,335 English school children aged 11, 13 and 15 in 2014.
The analysis suggests that pupils who report that topics relating to personal safety, health and wellbeing, and sex and relationships were covered well in their PSHE education were also less likely to have been bullied or to have bullied others, and more likely to have positive relationships with other pupils and feelings of belonging.
While these associations alone do not prove causation, we believe they add to the compelling case for schools to focus on PSHE education in the context of wider evidence of positive outcomes from school-based programmes, in areas ranging from healthy eating to social and emotional skills. Much of this evidence is outlined in the Department for Education PSHE evidence review.
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: