Statistical Differences Related to Migration Problems and Drug Use - Book Report/Review Example

Running Head: EVIDENCE BASED PRACTICE AND CRITICAL AWARENESS Evidence Based Practice and critical Awareness of the of the institution] Evidence Based Practice and critical Awareness Tompkins, C. Wright, N. Sheard, L. Associations between migrancy, health and homelessness: a cross-sectional study. Health & Social Care in the Community. 2003. Sep. 11(5). p446-52. Abstract/aims of study Tompkins et al (2003) aims are as stated in the title, they sought to identify statistical differences between problematic drug/alcohol use, and mental health problems (independent variables) associated with migrancy patterns (dependent variables). They state that the patterns of migrancy are different for problematic alcohol users and problematic drug users, with no significant difference for the migration for mental health (p. 446). The objective of the study was to help in the improvement of planning for appropriate health and social needs for these varying groups. Precise aims and criteria are set out in the abstract with 4 key factors: Place of birth (PLOB), drugs, alcohol and mental health. Whilst looking at interactions of factors and an overview of their interdependence. Literature review. The primary purpose for reviewing literature is to gain a broad background and understanding of information that is available to support the study intention (Burns & Grove 1999). The authors identify the limits of defining homelessness in its broadest sense (p.446) and are not limited to those in priority needs, as set out in the homeless act (2002). They look at migrancy as opposed to mobility and the literature review gives a comprehensive account of homelessness and differentiates between aspects of migrancy to that of mobility. It looks at the difficulties of providing continuity of social and primary healthcare with these complex groups. and provides the background for which the present study is based. They also give a clear definition of homeless, along with supportive material, Shelter, Royal College of Practioners (RCP), HMSO etc with variable statistics and key journal publications,. with the majority of the material referred to being within ten years of the paper being published. Good use of comparative illustrations, with clear definitions of the terms they are using e.g. migrancy including acknowledging the limitations of this article and that limited research has been done between health status and migrancy in homeless populations (p.447) They state how this article fits into a wider understanding of the interrelationships of the key factors and why this study is important. . From this Tompkins et al provides the rationale for the study with the need to identify migrancy behaviour from place of birth (PLOB) and measured. In this context the authors are concerned with identifying PLOB as an important aspect of information regarding migratory behaviour that can be readily elicited and recorded in a primary care consultation, with overall findings leading to a more informed health policy, and improved health/social services for homeless people. (447) Methodology As no hypothesis was stated the aims influenced the research method and with this type of study, an appropriate research method was used (cross-sectional design) it allowed the researchers the flexibility of collecting data from the different groups at various stages of their homelessness. It also allows a comparatively large amount of information to be collected over a relatively short space of time, with lower financial implications (Parahoo 1997). It focuses on numerical data and is a valid tool for the proposed study undertaken. The inclusion criteria was a random sample of 522 consecutive new homeless patients (over16yrs) registering to a health centre for homeless people in Leeds, over 18 months period with PLOB recorded on a Computerised Medical information System. The sample size being large enough over the time period for any sampling error to decrease over time, with any differences existing between the groups detected statistically. (Tab 3) They addressed the ethical nature of this means of data collection by taking advice from the local research ethics committee; they gain approval by the fact that the data was anonymous and not of a sensitive nature. Although advice was taken from the ethical committee there was no clear statement about gaining informed consent from the client groups. The diagnostic categories' were based on self reporting in the consultation records, although a detailed description of the questions asked are not given, and how sensitive a manor was the self reporting based To signify the value for this type of data collection, they used the Chi- squared test, which allows them to see if the results of the experiment differ from those expected from the original aim by random chance. With low P values in all categories their data matched the expected findings, and with a t-test for the difference between age as a continuous variable (Ogiers 2002) The reader is informed how statistics are allowed for and validity on measures used (p448) Table 1 gives the variables, numbers and percentages (descriptive statistics), but does not state why there are more men than women in the survey. Also there is a precise breakdown of ages but not by gender. They state that heroin is the main problematic drug with cannabis second but their percentage figures are different (p449) Table 2 (Age and sex statistics by health factors) give a breakdown of figures into precise groupings, plus allowing for variables and controls. Table 3 (Place of birth by patient characteristics) as with the previous points, showing breakdown of factors and their interrelationships. There is inadequate awareness of the link between conflicting health problems and migrancy of homeless people. The present cross-sectional study sought to measures the area of migrancy of homeless people from their place of birth (PLOB) and appraise whether a history of challenging drug use, alcohol misuse or enduring mental health problems were linked with migrancy from their PLOB. The research was carried out at an inner- city health centre for the homeless in the north of England. Place of birth was shaped as an entry on the computerized registration proceedings. The PLOB was composed and confirmation for each homeless person record with the service over the study period. Information was also taken regarding analysis of problematic banned drug use, problematic alcohol use and continuing mental health problems for each homeless person. The study recognized statistically important dissimilarity for the migration of homeless people from their PLOB for age, challenging drug use and problematic alcohol use. Problematic alcohol use is separately associated with an improved likelihood of migration from the PLOB. On the other hand, a history of illicit drug use is connected with a reduced option of migration from the PLOB when analyzing primary healthcare services. There was no important variation for resettlement from the PLOB for mental health. Not all homeless people migrate from their PLOB and health harms of drug use, mental health or alcohol use are separately associated with different outline of migration. Understanding the migrancy of homeless people is significant when preparation and objective suitable health and social services to address their unstable health, social and mental needs. This research needed to quantify the level of migrancy of homeless people from their place of birth and assess whether a history of challenging drug abuse, alcohol abuse or continuing mental health problems were associated with migration. The research recognized statistically important differences for migrancy in relation to age, drug use (lower) and alcohol use (higher). Yet there was no important difference in relation to mental health. Not all dispossessed people travel from place of birth and health harms were separately related with different patterns of immigration. Understanding migrancy of homeless people was significant to local preparation and objective of health and social services This work regularly composed the place of birth for each homeless person record with the service. Information was also extracted concerning diagnoses of problematic illegal drug use, problematic alcohol use and continuing mental health problems. Statistically important differences were recognized for the migration of homeless people from their POB for age, problematic drug use and challenging alcohol use. Understanding the migrancy of homeless people is essential when planning and targeting suitable health and social services to address their unstable health, social and psychological needs. The authors make points that health needs are based upon patient's ideas rather than diagnosed by professionals and points out possibly criticism e.g. study only looks at single homeless in urban locations, therefore only limited comparisons can be made. They state (p450) the major methodological limitations being the social desirability bias, but validates this with the bias being under-reported (false negative) rather than over-reported (false positive) Perhaps a statistician would know if they overcome this. Results/ findings Parts of the research are validated by other authors' findings with references given. However no study of a similar nature towards migrancy had been done prior to this study, so it cannot be judged against similar findings. It says ultimately that there is a need for greater communication between differing agencies, and the implementation of appropriate information technology (electronic transfer of records) for the availability of patients' records. Tompkins stated the difficulty in verifying alcohol dependency which could question the validity, accuracy and possibly bias due to the subject being alcohol misuse; shame guilt and stigma may inhibit a person from disclosing the reality of their situation. Asking this client group to divulge information that is deemed socially unpopular may have a diverse effect on their future housing requirements (Polit 1997). Conclusion The article achieves what it sets out to do from its initial aim, and identifies the priority of homeless people (as defined by the authors for this research) with problematic alcohol use having less social support than substance and mental health homeless. Tompkins et al identifies that more research is needed on the relationship of migrancy and other key factors and states precise recommendations for improved care in light of this study. (p452) The article raises question with their research findings that are relevant, and their potential for implications The research methods that the authors have used for their study intention appear to meet the criteria required within the process of quantitative research. However could this paper have been influenced by the RCGPs concerns for a more informed health policy via development of information technology support, and electronic transfer of patient's records as the research falls in line with their statements Subsequently, could this research be for a future government analysis on housing, social and psychological needs and will it be a part of a government publication on the issues raised Implications for practice This paper could have some implication for practice as previously out- lined. The use of electronic resources for GPs who generally are the first point of contact, could use this system to improve his/her communications with the array of social networks targeted at these specific groups. As to whether it would ultimately be a direct benefit to the particular client groups would have to be seen. However it would allow Health authorities in planning appropriate services. From reading this research paper it gives a greater understanding of homeless and the interrelationship with migratory factors associated with drug/alcohol and mental health problems. It gives the reader more confidence to be able to read, understand and appraise further nursing research, to work positively towards enhancing the quality of care given to patients, and to find and apply evidence to enlighten their practice in the present NHS climate. Furthermore rresearch within nursing practice allows for the opportunity for medical professionals to ask questions about their practice and seek answers by producing data that can encourage decision-making (Crookes & Davis 1999). Read More