Providing recommendations for a workplace-initiated intervention to reduce alcohol use in retirement: views of older drinkers and occupational health professionals

Introduction and Aims The frequency and consumption of alcohol by older people is an increasing public health concern and literature suggests that retirement may influence this. The aims of this thesis were to explore alcohol use across retirement and to determine if and how an intervention could be implemented upon retiring to reduce the frequency of alcohol consumption. Design and Methods The thesis comprised three studies in order to fully answer my research questions. Study 1 was a systematic review of interventions to reduce alcohol use in later life. Study 1 informed the interview guides for Studies 2 and 3, which used semi-structured interviews with 17 individuals who were five years pre/post retirement (Study 2) and 10 individuals working in human Resources/Occupational Health (Study 3) to gain perspectives of alcohol use in retirement and recommendations for an intervention. Data were analysed using a Framework approach, with emergent themes being established throughout analysis. Results Study 1 consisted of a review of seven papers, examining the success of interventions aimed at older adults and found that there was varying success, and that interventions often lacked detail to establish exactly what worked and for whom. Results from Study 2 suggested that an intervention would be acceptable and should focus holistically on retirement; not solely on alcohol. Individuals also felt that delivering an intervention by smartphone or a computer application would be appropriate, providing there was some face-to-face support. Human Resources interviewees in Study 3 were open to an intervention and felt that incorporating more support for employees was their responsibility, but not their obligation. Conclusions This thesis presents novel findings related to alcohol use in retirement and has the potential to inform a future intervention that could be implemented in the workplace prior to retirement

Participatory systems mapping for population health research, policy and practice: guidance on method choice and design

Executive Summary: What is participatory systems mapping? Participatory systems mapping engages stakeholders with varied knowledge and perspectives in creating a visual representation of a complex system. Its purpose is to explore, and document perceived causal relations between elements in the system. This guidance focuses on six causal systems mapping methods: systems-based theory of change maps; causal loop diagrams; CECAN participatory systems mapping; fuzzy cognitive maps; systems dynamics models; and Bayesian belief networks. What is the purpose of this guidance? This guidance includes a Framework that aids the choice and design of participatory systems mapping approaches for population health research, policy and practice. It offers insights on different systems mapping approaches, by comparing them and highlighting their applications in the population health domain. This guidance also includes case studies, signposting to further reading and resources, and recommendations on enhancing stakeholder involvement in systems mapping. Who is this guidance for? This guidance is designed for anyone interested in using participatory systems mapping, regardless of prior knowledge or experience. It primarily responds to calls to support the growing demand for systems mapping (and systems-informed approaches more broadly) in population health research, policy and practice. This guidance can however also be applied to other disciplines. How was it developed? The guidance was created by an interdisciplinary research team through an iterative, rigorous fivestage process that included a scoping review, key informant interviews, and a consultation exercise with subject experts. What is the ‘Participatory Systems Design Framework’ included in this guidance? The Design Framework supports users to choose between different methods and enhance the design of participatory systems mapping projects. Specifically, it encourages users to consider: 1) the added value of adopting a participatory approach to systems mapping; 2) the differences between methods, including their relative advantages and disadvantages; and 3) the feasibility of using particular methods for a given purpose. An editable version of the Framework is available to download as a supplementary file. How will this guidance support future use of these methods? Participatory systems mapping is an exciting and evolving field. This guidance clarifies and defines the use of these methods in population health research, policy and practice, to encourage more thoughtful and purposeful project design, implementation, and reporting. The guidance also identifies several aspects for future research and development: methodological advancements; advocating for and strengthening participatory approaches; strengthening reporting; understanding and demonstrating the use of maps; and developing skills for the design and use of these methods

Development and application of the DePtH framework for categorising the agentic demands of population health interventions [Pre-print]

The ‘agentic demand’ of population health interventions may influence intervention effectiveness and equity, yet the absence of an adequate framework to classify agentic demands limits the fields’ advancement. We systematically developed the DEmands for PopulaTion Health Interventions (DePtH) framework identifying three constructs influencing agentic demand - exposure (initial contact with intervention), mechanism of action (how the intervention enables or discourages behaviour), and engagement (recipient response), combined into twenty classifications. We conducted expert qualitative feedback and reliability testing, revised the framework and applied it in a proof-of-concept review, combining it with data on overall effectiveness and equity of dietary and physical activity interventions. Intervention components were concentrated in a small number of classifications; DePtH classification appeared to be related to intervention equity but not effectiveness. This framework holds potential for future research, policy and practice, facilitating the design, selection, evaluation and synthesis of evidence

Development and application of the Demands for Population Health Interventions (Depth) framework for categorising the agentic demands of population health interventions

Background: The ‘agentic demand’ of population health interventions (PHIs) refers to the capacity, resources and freedom to act that interventions demand of their recipients to benefit, which have a socio-economical pattern. Highly agentic interventions, e.g. information campaigns, rely on recipients noticing and responding to the intervention and thus might affect intervention effectiveness and equity. The absence of an adequate framework to classify agentic demands limits the fields’ ability to systematically explore these associations. Methods: We systematically developed the Demands for Population Health Interventions (Depth) framework using an iterative approach: (1) Developing the Depth framework by systematically identifying examples of PHIs aiming to promote healthier diets and physical activity, coding of intervention actors and actions and synthesising the data to develop the framework; (2) Testing the Depth framework in online workshops with academic and policy experts and a quantitative reliability assessment. We applied the final framework in a proof-of-concept review, extracting studies from three existing equity focused systematic reviews on framework category, overall effectiveness and differential socioeconomic effects and visualised the findings in Harvest Plots. Results: The Depth framework identifies three constructs influencing agentic demand: exposure - initial contact with intervention (2 levels), mechanism of action - how the intervention enables or discourages behaviour (5 levels), and engagement - recipient response (2 levels). When combined, these constructs form a matrix of twenty possible classifications. In the proof-of-concept review, we classified all components of 31 interventions according to the Depth framework. Intervention components were concentrated in a small number of Depth classifications; Depth classification appeared to be related to intervention equity but not effectiveness. Conclusions: This framework holds potential for future research, policy and practice, facilitating the design, selection and evaluation of interventions and evidence synthesis

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Interventions to reduce the negative effects of alcohol consumption in older adults: a systematic review

Background - Older individuals are consuming alcohol more frequently yet there is limited evidence on the effectiveness of current interventions. This systematic review aims to investigate interventions that target alcohol use in individuals aged 55 + . Methods - CINAHL, ERIC, MEDLINE, Science Direct, PsychInfo, SCOPUS, Web of Science and socINDEX were searched using terms devised from the PICO (Population, Intervention, Comparison and Outcome) tool. Studies using pharmaceutical interventions, or those that investigated comorbidities or the use of other substances were excluded. Peer reviewed empirical studies written in the English language that compared the outcomes of alcohol related interventions to standard care were included in this review. Studies were appraised and assessed for quality using the relevant Critical Appraisal Skills Programme checklist. Results - Seven papers were included in this review. Six were conducted in the United States of America and one in Denmark. The interventions were carried out in primary care centres and in community based groups. The studies included in this review showed varying levels of success. Participants showed improvements in at least one area of alcohol consumption or frequency of consumption however, these did not always reach significance. Conclusion - Individuals in this age group appear to respond well to interventions aimed at reducing alcohol consumption. However, included studies had limitations, in particular many did not include a clear intervention description; leaving us unable to fully investigate the components required for success. Further research is needed on the effective components of alcohol interventions targeting older people

Stakeholder experiences of using online spatial data visualisation tools for local public health decision support: a qualitative study

The distribution of food outlets within towns and cities and the provision of active travel infrastructure have been associated with health behaviours that can contribute to obesity risk. Decision-makers describe a lack of local data and research evidence as a barrier to policy adoption to improve the public’s health. Online spatial data visualisation tools created by researchers can help to bridge this gap. We explored stakeholder experiences of using such tools for decision-support, with a focus on facilitators and barriers to use. We conducted 16 qualitative interviews with Public Health, Planning and Transport Planning professionals, who had used two recently-developed tools. Participants described the importance of tools being open access; their use in “story-telling”, particularly to non-experts; and more broadly their use even when imperfect. They expressed that ‘robustness’ of underpinning data was important, however this was not easily defined. Participants employed personal heuristics, principally based on endorsement and developer credibility, to determine suitability for use. We present key learning points for future developers to maximise engagement and impact.RAM and TB were funded by the National Institute for Health Research (NIHR) School for Public Health Research (SPHR) (grant number: PD-SPH-2015). TB and MW were funded by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged (grant number: MR/K023187/1). This work was also supported by the Medical Research Council (grant numbers: MC_UU_00006/7)

Adolescents' perspectives on soft drinks after the introduction of the UK Soft Drinks Industry Levy: A focus group study using reflexive thematic analysis.

BACKGROUND: The UK Soft Drinks Industry Levy (SDIL), announced in March 2016 and implemented in April 2018, is a fiscal policy to incentivise reformulation of eligible soft drinks. We aimed to explore perceptions of sugar, sugary drinks and the SDIL among adolescents in the UK post-implementation. METHODS: 23 adolescents aged 11-14 years participated in four focus groups in 2018-2019. A semi-structured topic guide elicited relevant perspectives and included a group task to rank a selection of UK soft drinks based on their sugar content. Braun and Clarke's reflexive thematic analysis was used to undertake inductive analysis. RESULTS: Four main themes were present: 1) Sweetened drinks are bad for you, but some are worse than others; 2) Awareness of the SDIL and ambivalence towards it 3) The influence of drinks marketing: value, pricing, and branding; 4) Openness to population-level interventions. Young people had knowledge of the health implications of excess sugar consumption, which did not always translate to their own consumption. Ambivalence and a mixed awareness surrounding the SDIL was also present. Marketing and parental and school restriction influenced their consumption patterns, as did taste, enjoyment and consuming drinks for functional purposes (e.g., to give them energy). Openness to future population-level interventions to limit consumption was also present. CONCLUSIONS: Our findings suggest that adolescents are accepting of interventions that require little effort from young people in order to reduce their sugar consumption. Further education-based interventions are likely to be unhelpful, in contexts where adolescents understand the negative consequences of excess sugar and SSB consumption

Explaining differential socioeconomic effects in population health interventions: development and application of a new tool to classify intervention agentic demand

Background: The agentic demand of population health interventions (PHIs) might influence how interventions work. Highly agentic interventions (eg, information campaigns) rely on recipients noticing and responding to the intervention. Resources required for individuals to benefit from highly agentic interventions have a socioeconomical pattern, thus agentic demand might affect intervention effectiveness and equity. Systematic evidence exploring these associations is missing due to the absence of adequate tools to classify agentic demands. We aimed to develop such a tool and test its application. Methods: Our iterative development process involved: (1) systematic identification of diet and physical activity PHIs; (2) coding of intervention actors and actions; (3) data synthesis; (4) expert qualitative feedback; and (5) reliability assessment. We searched nine databases for articles published between Jan 1, 2010, and Aug 17, 2020. For all included articles, we coded the actors (people required to act within an intervention) and their actions (what they were required to do for the intervention to have its intended effects). We combined these codes for similar intervention types to develop overarching schematic flow chart diagrams used to identify concepts, and we organised these into a draft tool. After expert feedback, and we assessed inter-rater reliability of the final version. We applied the final tool in a proof-of-concept review, extracting studies from three existing equity-focused systematic reviews on tool category, overall intervention effect, and differential socioeconomic effects and visualised findings. Findings: We identified three concepts affecting agentic demands of intervention components: exposure, two levels (how recipients encounter the intervention); mechanism of action, five levels; and engagement, two levels (how recipients respond to the intervention). We then combined these concepts to form 20 categories that grouped together interventions with similar agentic demands. In the review, we applied the tool to 26 PHIs that included 163 components. Intervention components were concentrated in a small number of categories, and their categorisation was related to intervention equity but not to effectiveness. Interpretation: We present a novel tool to classify the agentic demand of PHIs and demonstrate its feasibility within a systematic review. Linking intervention types to their effect on inequalities enables these factors to be considered when designing or selecting interventions. Users of the tool can avoid implementing intervention types that are likely to widen inequalities or implement them alongside counter-strategies to minimise any adverse equity effects. Applying this tool within future research, policy, and practice to design, select, evaluate, and synthesise evidence from PHIs has the potential to advance our understanding of how interventions work and their effect on socioeconomic inequalities

Development and application of the Demands for Population Health Interventions (Depth) framework for categorising the agentic demands of population health interventions

Acknowledgements: We would like to thank all participants who contributed to depth framework testing.Abstract Background The ‘agentic demand’ of population health interventions (PHIs) refers to the capacity, resources and freedom to act that interventions demand of their recipients to benefit, which have a socio-economical pattern. Highly agentic interventions, e.g. information campaigns, rely on recipients noticing and responding to the intervention and thus might affect intervention effectiveness and equity. The absence of an adequate framework to classify agentic demands limits the fields’ ability to systematically explore these associations. Methods We systematically developed the Demands for Population Health Interventions (Depth) framework using an iterative approach: (1) developing the Depth framework by systematically identifying examples of PHIs aiming to promote healthier diets and physical activity, coding of intervention actors and actions and synthesising the data to develop the framework; (2) testing the Depth framework in online workshops with academic and policy experts and a quantitative reliability assessment. We applied the final framework in a proof-of-concept review, extracting studies from three existing equity-focused systematic reviews on framework category, overall effectiveness and differential socioeconomic effects and visualised the findings in harvest plots. Results The Depth framework identifies three constructs influencing agentic demand: exposure — initial contact with intervention (two levels), mechanism of action — how the intervention enables or discourages behaviour (five levels) and engagement — recipient response (two levels). When combined, these constructs form a matrix of 20 possible classifications. In the proof-of-concept review, we classified all components of 31 interventions according to the Depth framework. Intervention components were concentrated in a small number of Depth classifications; Depth classification appeared to be related to intervention equity but not effectiveness. Conclusions This framework holds potential for future research, policy and practice, facilitating the design, selection and evaluation of interventions and evidence synthesis. </jats:sec