A qualitative assessment of using lay trainers with type 2 diabetes in an intervention programme for people at risk of type 2 diabetes

Objective: More knowledge is needed on the impact of expert patients within health intervention programmes. The University of East Anglia Impaired Fasting Glucose (UEA-IFG) feasibility programme was a structured dietary and exercise intervention to reduce the risk of type 2 diabetes mellitus (T2DM) in susceptible individuals. Lay volunteers with T2DM (T2 trainers) were recruited to support participants in adopting healthier lifestyles. This study aimed to explore the acceptability, perceived effectiveness and sustainability of lay trainers within the programme. Design: A qualitative focus group study. Setting: A clinical research unit in Norwich, United Kingdom (UK). Method: Focus groups were conducted with: (1) T2 trainers (n = 15); (2) programme participants who had received their support (n = 11); and (3) salaried staff facilitators who had worked alongside the T2 trainers (n = 3). Framework analysis was applied to identify the different experiences of the lay trainer role. Results: All groups perceived advantages for peer support, particularly in sharing the day-to-day experiences of living with T2DM. However, staff facilitators raised the importance of role boundaries, emphasizing that T2 trainers should not provide medical advice. Acceptability of T2 trainers was enhanced by contacting participants at a convenient time and before substantial lifestyle changes had been made. Conclusion: Lay trainers were seen as a complementary method to motivate individuals to reduce their risks of T2DM. A less prescriptive approach needs to be adopted to enable full integration of lay trainers, allowing them a greater level of contribution. To sustain effective use of lay trainers, health professionals need to work alongside volunteers and be trained to encourage peer involvement

Restoring Health to Health Reform: Integrating Medicine and Public Health to Advance the Population\u27s Wellbeing

The Patient Protection and Affordable Care Act is a major achievement in improving access to health care services. However, evidence indicates that the nation could achieve greater improvements in health outcomes, at a lower cost, by shifting its focus to public health. By focusing nearly exclusively on health care, policy makers have chronically starved public health of adequate and stable funding and political support. The lack of support for public health is exacerbated by the fact that health care and public health are generally conceptualized, organized, and funded as two separate systems. In order to maximize gains in health status and to spend scarce health resources most effectively, health care and public health should be treated as two interactive parts of a single, unified health system. The core purpose of health reform ought to be the improvement of the population’s health. We propose five criteria that would significantly advance this goal: prevention and wellness, human resources, a strong and sustainable health infrastructure, robust performance measurement, and reduction of health disparities. Although the Patient Protection and Affordable Care Act includes provisions addressing these criteria, population health is not a central focus of the reform. In order to guide health reform implementation and to inform future health reform efforts, we offer three major policy reforms: changing the environment to incentivize healthy behavioral choices, strengthening the public health infrastructure at the state and local levels, and developing a health-in-all policies strategy that would engage multiple agencies in improving health incomes. Adopting these reforms would facilitate integration and dramatically improve the population’s health, particularly when compared to the health gains likely to be realized from a continued focus on access to health care services

Optimising workplace interventions for health and wellbeing: a commentary on the limitations of the public health perspective within the workplace health arena [forthcoming]

Purpose: This paper discusses contemporary approaches to workplace health and well-being, articulating key differences in the intervention architecture between public and workplace health contexts and implications for intervention design. Approach: Contemporary practice is discussed in light of calls for a paradigm shift in occupational health from a treatment orientation to an holistic approach focused on mitigation of the causes of ill health and the promotion of well-being. In practice, relatively few organizations have or seem able to engage with a broader perspective that encompasses challenges to health and well-being associated with contextual organizational drivers, e.g. job design/role, workload, systems of reward, leadership style and the underpinning climate. Drawing upon insights from public health and the workplace safety tradition, the scope for broadening the perspective on intervention (in terms of vectors of harm addressed, theory of change and intervention logic) is discussed. Findings: There are important differences in scope and options for intervention between public health and workplace health contexts. While there is scope to emulate public health practice, this should not constrain thinking over intervention opinions. Increased awareness of these key differences within work organizations, and an evidence-based epidemiological approach to learning has the potential to strengthen and broaden the approach to workplace health and well-being management. Originality/Value: We argue that approaches to workplace well-being interventions that selectively cross-fertilise and adapt elements of public health interventions offer promise for realising a broader change agenda and for building inherently healthy workplaces

'Language is the source of misunderstandings'–impact of terminology on public perceptions of health promotion messages

Background: The high level of premature death due to non-communicable diseases has been associated with unhealthful lifestyles, including poor diet. The effectiveness of public health strategies designed to promote health via messages focusing on food and diets depends largely on the perception of the messages by the public. The aim of this study was to explore public perceptions of language commonly used to communicate concepts linking health, food and the diet.<p></p> Methods: This study is a qualitative and semi-quantitative cross-sectional survey exploring public perceptions of terms used to improve eating habits within public health strategies. We recruited adults with no background in nutrition or health-care, from May to July 2013, from urban areas of varying deprivation (n = 12) in Glasgow and Edinburgh, UK. Four key prompt-terms used to convey the idea of improving health through diet were selected for testing: Healthy Eating, Eating for Health, Balanced Diet and Nutritional Balance. Consumer understanding of these terms was explored using mixed-methods, including qualitative focus groups (n = 17) and an interviewer-led word-association exercise (n = 270).<p></p> Results: The word-association exercise produced 1,386 individual responses from the four prompt-terms, with 130 unique responses associated with a single term. Cluster analysis revealed 16 key themes, with responses affected by prompt-term used, age, gender and socio-economic status. Healthy Eating was associated with foods considered ‘healthy’ (p <0.05); Eating for Health and Balanced Diet with negative connotations of foods to avoid (both p <0.001) and Nutritional Balance with the benefits of eating healthily (p <0.01). Focus groups revealed clear differences in perceptions: Eating for Health = positive action one takes to manage existing medical conditions, Healthy Eating = passive aspirational term associated with weight management, Balanced Diet = old fashioned, also dieting for weight loss, Nutritional Balance = maximising physical performance. Food suppliers use Healthy Eating terminology to promote weight management products. Focus group participants welcomed product reformulation to enhance food health properties as a strategy to overcome desensitisation to health-messages.<p></p> Conclusions: Public perceptions of messages communicating concepts linking health, food and the diet are influenced by terminology, resulting in confusion. To increase individual commitment to change eating habits in the long term, public health campaigns need strengthening, potentially by investing in tailored approaches to meet the needs of defined groups of consumers

Shared Value in Chile: Increasing Private Sector Competitiveness by Solving Social Problems

Over the last few decades, Chile has experienced rapid and sustained economic, social, and institutional development. Crucial challenges remain, however, in the form of social inequity, lack of opportunity, mistrust, and social unrest. The Chilean private sector is at an inflection point in its relationship with society. The corporate sector has both contributed to and benefited from the growth and development of the last decades, but remaining social challenges pose significant constraints to the continued growth of the private sector. High levels of mistrust regarding the role of business in society reflect a widespread belief that profit making activities are merely a demonstration of corporate greed. The Chilean private sector faces a frequently antagonistic relationship with government and civil society that will likely worsen unless companies are able to find ways to authentically link their businesses to efforts to solve Chile's social problems. On the other hand, if government and civil society conclude that the private sector has no contribution to make to the country's social and economic development strategy, Chile will squander an important engine for creating shared prosperity. The good news is that there does not need to be a trade-off between private sector competitiveness and greater prosperity for all Chileans. Shared value, a concept explained in Harvard Professor Michael Porter and Mark Kramer's Harvard Business Review articles, suggests an approach for companies to increase their competitiveness and profitability by helping to solve social problems. The public sector and civil society can increase the social benefits from shared value by thoughtfully partnering with the private secto

Childhood Obesity: The Role of Health Policy

This first policy report from the CPRC and the NICHQ Childhood Obesity Action Network was released on March 18, 2008 in Miami Florida as part of the Second Childhood Obesity Congress

The experiences of women with polycystic ovary syndrome on a very low-calorie diet

The research was funded by an educational grant from LighterLife. Broom was the Medical Director for LighterLife at the time of the research. Johnson is the Head of Nutrition and Research at LighterLife. The authors report no other conflicts of interest in this work.Peer reviewedPublisher PD