The Good Night Out Campaign: evaluation of a nightlife worker training programme to prevent sexual violence in Liverpool

In 2019, Good Night Out Campaign (GNOC) facilitators (from Liverpool Local Authority and RASA Merseyside) worked with 11 nightlife venues to engage them in the GNOC, providing guidance on preventing and responding to sexual violence, training for over 150 nightlife workers, and materials to display in venues to raise awareness of the GNOC and encourage nightlife patrons to report incidents. This report provides a summary of findings from an evaluation of the GNOC training. Findings suggest that the GNOC training programme is associated with: improvements in knowledge; improved attitudes towards sexual violence; and, greater readiness and confidence to intervene in sexual violence, amongst nightlife workers

Scoping the impact of COVID-19 on the nexus of statelessness and health in Council of Europe member states.

Background: Stateless communities in Europe include ethnic Russians in the Baltic States, recent migrants, refugees, Roma, and other members of minority groups.Increases in COVID19 infection have been observed in many European countries, including reported outbreaks in groups that include people and communities affected by statelessness, who often live in congested and sub-standard unhygienic conditions, work in informal sectors which hampers their adherence to public health measures (self-isolation/physical distancing/hand sanitation), or who are detained in immigration detention centres. The impact of COVID-19 on stateless people in Europe (estimated to be at least 600,000) is currently under researched, and there is an imperative to understand their experiences and situation, in order to generate evidence based measures, responses and actions to protect those most at risk. Method: In order to better understand their unique position during the COVID-19 pandemic, we conducted a scoping review to explore and assess the nexus between statelessness and health during COVID-19 in Europe. Literature was found representing ten Council of Europe countries (Bulgaria, Denmark, Greece, Italy, Romania, Russia, Slovakia, Ireland, Ukraine and the United Kingdom), with 15 publications representing multiple countries. Four publications specifically focused on stateless people. The remainder focused on populations which include people disproportionately affected by statelessness both in the migratory context and those in situ (minority groups including Roma and ethnic Russians, and refugees and migrants). Results: Three themes emerged from the analysis (Environmental determinants of health; access to healthcare services; and racism and vilification), with higher level abstraction centring on the nexus between existing adverse environmental determinants of health, compounded barriers to access healthcare during COVID-19; and the concerning rise in hate crime and scapegoating of minority populations during the COVID-19 emergency. Whilst the right to healthcare is a fundamental human right, with universal application and with access to healthcare services ensured to every human being without regards to race, religion or other criteria, including nationality status, this appears not to be the case for populations affected by statelessness during the COVID-19 health and state emergency. The right to a nationality (and realisation of the right to health and access to healthcare/public services) in the current pandemic times is crucial in a targeted effective and culturally sensitive public health response. Conclusion: The hidden nature of statelessness, coupled with the marginalisation of stateless people, exacerbates the structural underpinning and interplay between statelessness, human rights, health rights and right to nationality during the COVID-19 pandemic. The review further highlights the need to protect stateless people. We further cannot underestimate the need for sensitive legal, health and social response measures to tackle disease transmission in vulnerable groups, continued statelessness of people in Europe, and hate crime, xenophobia and discrimination of those perceived to be at risk of contagion

Systems leadership in practice: thematic insights from three public health case studies.

BACKGROUND: 'Systems leadership' has emerged as a key concept in global public health alongside such related concepts as 'systems thinking' and 'whole systems approaches.' It is an approach that is well suited to issues that require collective action, where no single organisation can control the outcomes. While there is a growing literature on the theory of systems leadership in a number of fields, there remains a lack of published empirical studies of public health systems leadership for professionals to learn from. The aim of the current project was to conduct cases studies in UK public health to provide empirical evidence on the nature of effective systems leadership practice. METHODS: Three system leadership case studies were identified in the key domains of public health: health protection, healthcare public health and health improvement. A total of 27 semi-structured interviews were conducted. Data were thematically analysed to identify the components of effective systems leadership in each case and its impact. RESULTS: The thematic analysis identified themes around 'getting started,' 'maintaining momentum' and 'indicators of success' in systems leadership. In terms of getting started, the analysis showed that both a compelling 'call to action' and assembling an effective 'coalition of the willing' are important. To maintain momentum, the analysis identified themes relating to system structure, culture and the people involved. Regarding culture, the main themes that emerged were the importance of nurturing strong relationships, curiosity and a desire to understand the system, and promoting resilience. The analysis identified three components that could be used as indicators of success; these were a sense of enjoyment from the work, resource gains to the system and shifts in data indicators at the population level. CONCLUSIONS: This study has provided insight into the nature of systems leadership in public health settings in the UK. It has identified factors that contribute to effective public health systems leadership and offers a thematic model in terms of establishing a systems leadership approach, maintaining momentum and identifying key success indicators

Knowledge, attitudes, perceptions and practices towards cardiovascular disease risk prevention and management in patients living with HIV in Sub-Saharan Africa: A scoping review of qualitative literature

Background: Cardiovascular diseases are projected to bypass HIV as the most common cause of death in sub-Saharan Africa (SSA) by 2030. People living with HIV (PLHIV) are more likely to develop complications of cardiovascular disease. This poses a major developmental challenge. Methods: A scoping review of qualitative literature mapped what is known about cardiovascular disease awareness, prevention, and management from the perspectives of PLHIV in SSA. Six qualitative studies from Malawi, Kenya, and South Africa were charted and analysed thematically. Results: Patients were aware of cardiovascular diseases but had varied attitudes and practices towards prevention. Social support and fear of developing life-threatening complications motivated some PLHIV to change their health behaviours. Financial hardship, unavailability of medication, and hearsay prevented adherence to lifestyle measures and medical treatment. Conclusions: Targeted prevention initiatives are critical in response to the unique needs of PLHIV and improve overall health indices in the SSA region

A legal-realist assessment of the Zimbabwean correctional system response to COVID-19 during state disaster measures

Purpose The first prison system case in Zimbabwe was notified in July 2020 shortly after State declaration of disaster. We conducted a legal-realist assessment of the Zimbabwean correctional system response to COVID-19 during state disaster measures, with a focus on right to health, infectious disease mitigation and the extent to which minimum State obligations complied with human and health rights standards. Design/Methodology/Approach The Zimbabwean correctional system operations during COVID-19 disaster measures are scrutinized using a range of international, African and domestic human rights instruments in relation to the right to health of prisoners. We focused particularly on standards of care, environmental conditions of detention, and right of access to healthcare. Findings Systemic poor standards of detention are observed, where prisoners experience power outages, water shortages and a lack of access to clean drinking water and water for ablution purposes, a severe lack of safe space and adequate ventilation, poor quality food and malnutrition, and a lack of sufficient supply of food, medicines, clothing and bedding. Whilst access to healthcare of prisoners in Zimbabwe has greatly improved in recent times, the standard of care was severely stretched during COVID-19 due to lack of government resourcing and reliance on NGO and faith based organisations to support demand for personal protective equipment (PPE), disinfection products and medicines. Originality Prison conditions in Zimbabwe are conducive to chronic ill health and the spread of many transmissible diseases, not limited to COVID-19. The developed legal-realist account considers whether Zimbabwe had a culture of respect for the rule of law pertinent to human and health rights of those detained during COVID-19 disaster measures, and whether minimum standards of care were upheld

Evaluation of Lancashire and South Cumbria's suicide prevention training programmes and community-based projects

Suicide is a serious public health problem, accounting for half of all violence-related deaths globally. Across England, Lancashire and South Cumbria had the second highest suicide rate in 2012-14 (12.6 per 100,000 population). The high level of suicide in Lancashire and South Cumbria has been recognised as a key priority and a suicide prevention strategy has been developed with the aim of reducing the number of people taking their own life by 10% by 2021 compared to 2016/17 rates. This study evaluated two of the key activities implemented as part of the broader piece of work: a suite of training programmes on suicide prevention, self-harm intervention and, mental health and resilience; and, an Innovation Fund to support community-based projects. Key findings from the study suggested that the training programmes were associated with significant improvements in trainees’: attitudes to intervention work; confidence to intervene with at risk individuals; knowledge on suicide/self-harm; and, skills in appropriate clinical responses to disclosures from pre to post-training measurement. Reported outcomes from the Innovation Fund community projects suggested increased awareness of suicide risk and support services amongst project participants and their wider communities, and improved mental wellbeing. Such outcomes represent a vital step in achieving the long-term aim of a reduction in suicide rates across Lancashire and South Cumbria by 2021

Women living with HIV, diabetes and/or hypertension multi-morbidity in Uganda: a qualitative exploration of experiences accessing an integrated care service

Purpose: Women experience a triple burden of ill-health spanning non-communicable diseases (NCDs), reproductive and maternal health conditions and human immunodeficiency virus (HIV) in sub-Saharan Africa. Whilst there is research on integrated service experiences of women living with HIV (WLHIV) and cancer, little is known regarding those of WLHIV, diabetes and/or hypertension when accessing integrated care. Our research responds to this gap. Design/methodology/approach: The INTE-AFRICA project conducted a pragmatic parallel arm cluster randomised trial to scale up and evaluate “one-stop” integrated care clinics for HIV-infection, diabetes and hypertension at selected primary care centres in Uganda. A qualitative process evaluation explored and documented patient experiences of integrated care for HIV, diabetes and/or hypertension. In-depth interviews were conducted using a phenomenological approach with six WLHIV with diabetes and/or hypertension accessing a “one stop” clinic. Thematic analysis of narratives revealed five themes: lay health knowledge and alternative medicine, community stigma, experiences of integrated care, navigating personal challenges and health service constraints. Findings: WLHIV described patient pathways navigating HIV and diabetes/hypertension, with caregiving responsibilities, poverty, travel time and cost and personal ill health impacting on their ability to adhere to multi-morbid integrated treatment. Health service barriers to optimal integrated care included unreliable drug supply for diabetes/hypertension and HIV linked stigma. Comprehensive integrated care is recommended to further consider gender sensitive aspects of care. Originality/value: This study whilst small scale, provides a unique insight into the lived experience of WLHIV navigating care for HIV and diabetes and/or hypertension, and how a “one stop” integrated care clinic can support them (and their children) in their treatment journeys

A scoping review of women 's navigation of co-morbid HIV and non-communicable disease (NCD) health conditions and integrated HIV/NCD health services in sub-Saharan Africa.

Background: The 2030 Agenda for Sustainable Development recognises the importance of addressing HIV and NCDs, and establishes the need to address female and child specific health outcomes as a whole. Women experience a triple burden of ill-health spanning non-communicable diseases (NCDs), reproductive and maternal health conditions and human immune deficiency virus (HIV) in sub-Saharan Africa (SSA). Method: A scoping review methodology was used to map and describe what is known about the health needs, service experiences and health outcomes of women living with HIV (WLHIV), diabetes and/or hypertension in SSA. Results: The final data set of 15 records represented seven SSA countries (Kenya, South Africa, Tanzania, Uganda, Ghana, Malawi and Zimbabwe). Following final charting and analysis of the data, four themes emerged: Prevalence of NCD and related co-morbidities; Environmental, biological and cultural determinates of health; Access to healthcare services and medication; and Integrated HIV.NCD care. Conclusion: The evidence base with detail on this gendered health topic within the African sustainable development agenda is limited. subject is small. Further research which involves women in the community and female patients receiving integrated care for HIV and NCDs at hospital and primary care levels in SSA is warranted on a larger scale

Evaluation of the good night out campaign: a sexual violence bystander training programme for nightlife workers in England

Aim: Sexual violence is global public health, human rights and gender equality issue. Sexual violence bystander programmes for nightlife workers are emerging across a few countries and further examination of such programmes is required. This exploratory study evaluates the potential effectiveness of the Good Night Out Campaign, a sexual violence bystander programme for nightlife workers. Subject and methods: Two hundred and seven trainees attending the 1.5 hour training programme across two cities in England were recruited opportunistically, immediately prior to training delivery. Sexual violence myth acceptance and readiness and confidence to intervene in sexual violence were measured at baseline and post-intervention. Analyses used paired-sample tests to examine differences in the three measurements pre to post-training and effect sizes were quantified using Cohen’s d. Results: Compared to pre-training, post-training participants were significantly (p < 0.001) less likely to agree with sexual violence myths, and more likely to be confident and ready to intervene in sexual violence or incidents of vulnerability. Effect sizes were small–medium. Conclusions: The study adds to emergent evidence suggesting that sexual violence bystander programmes may be promising in decreasing sexual violence myths and barriers to bystander intervention, and increasing willingness to intervene amongst nightlife workers. Findings can support the emergence of sexual violence prevention activities implemented in nightlife spaces. Further programme implementation and evaluation using experimental designs is needed to explore outcomes in greater depth, considering the complexity of the nightlife environment

Welsh Primary Schoolchildren's Perceptions of Electronic Cigarettes: A Mixed Methods Study.

There are concerns that the growing popularity of e-cigarettes promotes experimentation among children. Given the influence of the early years on attitude and habit formation, better understanding of how younger children perceive vaping before experimentation begins is needed, to prevent uptake and inform tobacco control strategies. We explored Welsh primary schoolchildren's (aged 7-11) awareness of e-cigarettes relative to tobacco smoking, their understanding of the perceived risks and benefits and their intentions and beliefs about vaping. Data was collected using a mix of methods in June and July 2017 from 8 purposively selected primary schools across Wales. Four hundred and ninety-five children (52% female) aged 7 years (n = 165), 9 years (n = 185) and 11 years (n = 145) completed a class-administered booklet encompassing a draw and write exercise and survey. Ninety-six children participated in 24 peer discussion groups comprised of 2 boys and 2 girls from each year group. Data were analysed independently and findings triangulated. Survey analyses used frequencies, descriptive statistics and chi-squared tests. Content analysis was undertaken on the draw and write data and peer discussion groups were analysed thematically. Study findings highlight that primary schoolchildren have general awareness of e-cigarettes. Vaping was perceived to be healthier than smoking and there was some recognition that e-cigarettes were used for smoking cessation. Understanding of any health harms was limited. Few children intended to smoke or vape in the future but almost half thought it was okay for grownups. Children's perceptions were influenced by exposure through family and friends. Findings suggest a need for e-cigarette education in primary schools, to highlight the associated risks of e-cigarette experimentation including the potential for tobacco initiation