Dr Amy Halls


Research Fellow
PhD; MA Social Research Methods (Sociology); BA Sociology

Academic and research departments

Faculty of Health and Medical Sciences.

Biography

Dr Amy Halls is a Research Fellow within Health Sciences and her research focuses on the use of qualitative methods as applied to health research, specifically within primary care.

Through her PhD in Sociology ('Marginal Men: Men with breast cancer negotiating gender', University of Durham, 2014) she developed an interest in people's illness experiences and how these can be explored using a variety of data sources and qualitative methodological approaches.  As a postdoctoral researcher in Primary Care and Population Sciences, University of Southampton, Dr Halls worked on a number of research studies: these used qualitative methods to explore different aspects of people's experiences of health and wellbeing, with a focus on antibiotic stewardship.

Dr Halls is currently working on an exploratory mixed-methods research study funded by Health Education England Kent, Surrey and Sussex looking at improving care of the acutely ill patient in primary care by enhancing interprofessional working, using in-situ simulation.

My teaching

My publications

Publications

Halls A, Uprichard E, Jackson C (2017) Changing girlhoods ? Changing Girl Guiding, The Sociological Review 66 (1) pp. 257-272 Wiley
This article discusses the changing nature of girlhood over the last century as it is depicted through an empirical study of all editions of Girl Guide handbooks since 1910. The article describes three strands of change, which we describe as ?stringy?, insofar as they are co-occur together and are difficult to untangle from one another; yet they are also stories of change that are nevertheless visible as strands in and of themselves through the empirical material. We illustrate the importance of incorporating children and childhood into more general theories of social change, in order to better understand how they are intrinsic to the mechanisms of intergenerational change.
Objective

To explore parents? perspectives, concerns and experiences of the management of lower respiratory tract infections (LRTIs) in children in primary care.

Design

Qualitative semistructured interview study.

Setting

UK primary care.

Participants

23 parents of children aged 6 months to 10 years presenting with LRTI in primary care.

Method

Thematic analysis of semistructured interviews (either in person or by telephone) conducted with parents to explore their experiences and views on their children being prescribed antibiotics for LRTI.

Results

Four major themes were identified and these are perspectives on: (1) infection, (2) antibiotic use, (3) the general practitioner (GP) appointment and (4) decision making around prescribing. Symptomatic relief was a key concern: the most troublesome symptoms were cough, breathing difficulty, fever and malaise. Many parents were reluctant to use self-care medication, tended to support antibiotic use and believed they are effective for symptoms, illness duration and for preventing complications. However, parental expectations varied from a desire for reassurance and advice to an explicit preference for an antibiotic prescription. These preferences were shaped by: (1) the age of the child, with younger children perceived as more vulnerable because of their greater difficulty in communicating, and concerns about rapid deterioration; (2) the perceived severity of the illness; and (3) disruption to daily routine. When there was disagreement with the GP, parents described feeling dismissed, and they were critical of inconsistent prescribing when they reconsult. When agreement between the parent and the doctor featured, parents described a feeling of relief and legitimation for consulting, feeling reassured that the illness did indeed warrant a doctor?s attention

Conclusion

Symptomatic relief is a major concern for parents. Careful exploration of expectations, and eliciting worries about key symptoms and impact on daily life will be needed to help parents understand when a no antibiotic recommendation or delayed antibiotic recommendation is made.

Objective
To explore the experience and perceptions of illness, the decision to consult a general practitioner and the use of self-management approaches for chronic or recurrent sinusitis.

Design

Qualitative semistructured interview study.

Setting

UK primary care.

Participants

32 participants who had been participating in the ?SNIFS? (Steam inhalation and Nasal Irrigation For recurrent Sinusitis) trial in the South of England.

Method

Thematic analysis of semistructured telephone interviews.

Results

Participants often reported dramatic impact on both activities and their quality of life. Participants were aware of both antibiotic side effects and resistance, but if they had previously been prescribed antibiotics, many patients believed that they would be necessary for the future treatment of sinusitis. Participants used self-help treatments for short and limited periods of time only. In the context of the trial, steam inhalation used for recurrent sinusitis was described as acceptable but is seen as having limited effectiveness. Nasal irrigation was viewed as acceptable and beneficial by more patients. However, some participants reported that they would not use the treatment again due to the uncomfortable side effects they experienced, which outweighed any symptom relief, which may have resulted had they continued.

Conclusions

Steam inhalation is acceptable but seen as having limited effectiveness. Nasal irrigation is generally acceptable and beneficial for symptoms, but detailed information on the correct procedure and potential benefits of persisting may increase acceptability and adherence in those patients who find it uncomfortable.

McDermott L, Leydon G, Halls A, Kelly J, Nagle A, White J, Little P (2017) Qualitative interview study of antibiotics and self-management strategies for respiratory infections in primary care, BMJ Open 7 (11) e016903 BMJ Publishing Group
Objective

To explore perceptions of illness, the decisions to consult and the acceptability of delayed antibiotic prescriptions and self-help treatments for respiratory tract infections (RTIs).

Design

Qualitative semistructured interview study.

Setting

UK primary care.

Participants

20 adult patients who had been participating in the ?PIPS? (Pragmatic Ibuprofen Paracetamol and Steam) trial in the South of England.

Method

Semistructured telephone interviews were conducted with participants to explore their experiences and views on various treatments for RTI.

Results

Participants had concerns about symptoms that were not clinically serious and were mostly unaware of the natural history of RTIs, but were aware of the limitations of antibiotics and did not expect them with every consultation. Most viewed delayed prescriptions positively and had no strong preference over which technique is used to deliver the delayed antibiotic, but some patients received mixed messages, such as being told their infection was viral then being given an antibiotic, or were sceptical about the rationale. Participants disliked self-help treatments that involved taking medication and were particularly concerned about painkillers in combination. Steam inhalation was viewed as only moderately helpful for mild symptoms.

Conclusion

Delayed prescribing is acceptable no matter how the delay is operationalised, but explanation of the rationale is needed and care taken to minimise mixed messages about the severity of illnesses and causation by viruses or bacteria. Better access is needed to good natural history information, and the signs and symptoms requiring or not requiring general practitioner advice. Significant concerns about paracetamol, ibuprofen and steam inhalation are likely to need careful exploration in the consultation.

Williams S, Halls A, Tonkin-Crine S, Moore M, Latter S, Little P, Eyles C, Postle K, Leydon G (2017) General practitioner and nurse prescriber experiences of prescribing antibiotics for respiratory tract infections in UK primary care out-of-hours services (the UNITE study), Journal of Antimicrobial Chemotherapy dkx429 Oxford University Press
Background
Interventions are needed to reduce unnecessary antibiotic prescribing for respiratory tract infections (RTIs). Although community antibiotic prescribing appears to be decreasing in the UK, figures for out-of-hours (OOH) prescribing have substantially increased. Understanding the factors influencing prescribing in OOH and any perceived differences between general practitioner (GP) and nurse prescriber (NP) prescribing habits may enable the development of tailored interventions promoting optimal prescribing in this setting.

Objectives
To explore UK GP and NP views on and experiences of prescribing antibiotics for RTIs in primary care OOH services.

Methods
Thirty semi-structured interviews were conducted with GPs and NPs working in primary care OOH services. Inductive thematic analysis was used to analyse data.

Results
The research shows that factors particular to OOH influence antibiotic prescribing, including a lack of patient follow-up, access to patient GP records, consultation time, working contracts and implementation of feedback, audit and supervision. NPs reported perceptions of greater accountability for their prescribing compared with GPs and reported they had longer consultations during which they were able to discuss decisions with patients. Participants agreed that more complex cases should be seen by GPs and highlighted the importance of consistency of decision making, illness explanations to patients as well as a perception that differences in clinical training influence communication with patients and antibiotic prescribing decisions.

Conclusions
Environmental and social factors in OOH services and a mixed healthcare workforce provide unique influences on antibiotic prescribing for RTIs, which would need to be considered in tailoring interventions that promote prudent antibiotic prescribing in OOH services.

Halls Amy, Nunes Dale, Muller Ingrid, Angier Elizabeth, Grimshaw Kate, Santer Miriam (2018) ?Hope you find your ?eureka? moment soon?: a qualitative study of parents/carers? online discussions around allergy, allergy tests and eczema, BMJ Open 8 (11) e022861 pp. e022861-1 BMJ Publishing Group

Objectives To explore understandings and concerns surrounding allergy, food intolerances and their potential impact on eczema among parents and carers of children with eczema who had posted messages in online forums.

Methods We conducted a scoping review for active UK-based discussion forums that did not require password/registration to view posts and identified two parenting discussion forums with high activity and frequent use. We used their internal search functions to identify and export discussion threads relating to allergy and allergy testing for eczema from 2011 to 2016. We carried out an inductive thematic analysis of the 120 exported discussion threads.

Results 246 pages of text were analysed. Analysis led to three main themes: (1) confusion over the language surrounding ?allergy? and ?intolerance?; (2) diverse beliefs about allergy testing in relation to eczema and (3) parents? frustrations with perceptions of health professionals as uninterested and unhelpful about allergy testing. Forum users were concerned about immediate and delayed-type allergies but showed confusion in how terms were used, as well as different approaches to testing. Parents sought experiences of others, seeking social support as well as practical guidance.

Conclusions The confusion around allergy-related terminology and its possible relationship with eczema means that it is essential healthcare professionals are able to signpost parents to accurate, accessible information. The lack of consistent information currently available means parents may use online discussion forums as an important source of information. This study suggests that the confused nature of discussions on these forums is inaccurate at best, and detrimental at worst.

Halls A., Kanagasundaram M., Lau-Walker M., Diack H., Bettles S. (2019) Using in situ simulation to improve care of the acutely ill patient by enhancing interprofessional working: a qualitative proof of concept study in primary care in England, BMJ Open 2019 (9) e028572 pp. 1-9 BMJ Publishing Group

Objectives

Acutely unwell patients in general practice are uncommon, but their management requires intervention from staff (clinical and non-clinical) working as a team. Despite the advantages of interprofessional education being well documented, there is little research evidence of this in the primary care setting. This study aimed to improve care of the acutely ill patient by enhancing interprofessional working, using in-situ simulation.

Methods

Mixed methods evaluation study. Phase 1 scoped education provision in GP practices within Health Education England Kent, Surrey and Sussex (HEEKSS) via questionnaire to 668 practices. In Phase 2 a simulation of cardiac arrest occurred in three HEEKSS practices; all staff participated in interviews.

Results

Phase 1 showed the majority of practices ran sessions involving all staff, predominantly focusing on basic life support (BLS) (63 practices) and practice-specific areas such as managing difficult patients (28 practices). 61 said simulation was not used; 41 responded that it was, 37 specifying for BLS training. Qualitative thematic analysis identified four themes: 1) apprehension, anxiety, and (un)willing participation, 2) reflection on the simulation design, 3) experiences of the scenario and 4) training.

Conclusions

Practices made changes in their workplace, potentially benefitting the future management of acutely ill patients. The use of actors and involvement of clinical and non-clinical members of staff contributes to a fuller understanding of how in-situ simulation can benefit both workforce and patients.