Birmingham, West Midlands’ Young Persons’ Physical Activity Pathway: Evaluation Report

The Birmingham, West Midlands’ Young Persons’ Physical Activity Pathway (YPPAP) is a pilot six week behavioural intervention (a physical activity pathway) aimed at increasing physical activity levels in school-aged children in school years 6 and 7 (ages 10-12 yrs). It builds on the experiences of the South Staffordshire (SS) Physical Activity Care Pathway (PACP), but was developed specifically to focus on school-age young people in an urban city setting. For the purposes of the evaluation a mixed-methods approach including a quantitative and qualitative component was employed. Data analysis revealed that of the 239 eligible participants, 99 entered the pathway (31.2%). Ninety-three participants set physical goals at baseline and 3 were lost to follow up representing a pathway completion rate of 97% (n = 90). Overall, the results indicated that the increase in ‘spare time’ physical activity was statistically significant (t(95)=-2.88, p=.005), but the differences were not significant for overall physical activity (t(95)=-.096, p=.924), or mean frequency of physical activity (t(95)=-.414, p=.680). Analysis also revealed that the correlation between change in physical activity between baseline and follow up and the number of goals set by participants was not significant (r = 0.08, p =.436). Qualitative findings revealed that participants perceived that the pathway had helped to educate them about the relationship between physical activity and health and had provided a means of engaging with physical activity in a way that was fun and non-threatening. Delivery costs were also calculated taking into account management and delivery costs, including resources, training and support, the total cost per child of delivering the intervention was £143. The high completion rate might point to the utility of using school settings for physical activity interventions. Problematically, the limited sample size prevented the meaningful investigation of any relationship between the physical activity options chosen by young participants and outcomes in terms of potential increases in levels of physical activity. Similarly, it was not possible to fully investigate the potential effects of gender, class, ethnicity, disability status on adherence to the pathway or physical activity behaviour. More usefully, data analysis revealed that the pathway attracted a range of participants which demonstrated potential for securing the interest and motivation of participants. This finding underpins the importance of understanding the number, variety and availability of local physical activity opportunities and delivering the intervention in a way that is engaging and supportive

Understanding well-being outcomes in primary care arts on referral interventions: a mixed method study

Background: Arts on Prescription programmes are designed to support mental health and well-being of patients with a variety of clinical needs within the community. Despite a number of studies reporting benefits, there are some patients that do not see improvements in well-being. Yet, there is limited research investigating the reasons for this. Methods: Using a sequential mixed-methods design the present study sought to understand why some participants (N=312) experienced an increase in well-being and others did not (N=95) after attending an Arts on Prescription intervention based in the South West of England between 2009 and 2016. Results: Quantitative comparisons between the two groups identified little differences, aside from age and baseline well-being (WEMWBS scores), with those that improved being slightly younger, and having lower well-being at the outset compared with those that did not improve. A process model depicting the perceived facilitative and inhibitive factors of attending the programme was developed from the qualitative findings. This model suggests that the social aspect of the course may be implicated in the participants differential outcomes; with those that showed a decrease in well-being reporting difficulties in interacting with others during the intervention. Further, the participants who reported an increase in well-being felt vulnerable to “relapse” when finishing the course due to uncertainties regarding future support and at their ability to maintain their well-being without the provision of the programme. Conclusions: This research suggests a need to promote communication amongst groups in such interventions with the hope that this will provide a more facilitative environment for all participants to benefit. Also, such programmes should consider follow-on options to ensure the participants feel supported and confident in managing their well-being once the course comes to an end. Findings will be pertinent to those commissioning primary care art interventions, ensuring that referral policies and pathways are designed for optimal effectiveness and for potentially tailoring social prescribing programmes to suit the participants specific needs

Patients' perceptions of a NHS Health Check in the primary care setting

The NHS Health Checks is a cardiovascular disease (CVD) risk assessment and management programme for individuals in England aged between 40 and 74 with the aim of identifying previously unassessed individuals that are at high risk of CVD. Little research to date has explored patient perceptions and opinions of Health Checks. This paper aims to investigate the perceptions and opinions of patients who had attended a Health Check appointment within a cohort of 83 General Practices in Gloucestershire. A cross sectional survey of patients who had completed a Health Check appointment during the period May to June 2012 within a single county in England. Quantitative and qualitative data were acquired from 1,011 standardised and anonymised patient surveys sent out by a Health Check Commissioner and GPs. Data gathered included perceptions concerning all aspects of the Health Checks process and actual appointment. Descriptive analysis was used to interrogate the quantitative data. Inductive content analysis was used to analyse qualitative data. Concerns about health were a principal driver of attendance. Reassurance, access to health information and guidance, and the identification of CVD risk and CVD diagnosis were perceived as key benefits of attending the appointment. Principal disadvantages included inconsistencies in the Health Check process, administration of appointments and a lack of appropriate follow up advice. Health Checks are popular with patients and provide useful outcomes but greater consistency is needed in engaging patients and describing its purpose

Motivations and barriers to engagement with a technology-enabled community wide physical activity intervention

Previous physical activity interventions have failed to create population change and an alternative approach is needed to support a World Health Organization target of a 15% reduction in global levels of inactivity by 2030. There is growing evidence that gamification-based interventions can reach substantial portions of the community. However, to date, these studies have been predominantly quantitative and as such there is a paucity of research in the area on motivations and barriers to engagement with these programs. Four focus groups conducted with N = 26 players who participated in a gamification-based intervention ‘Beat the Street’ revealed several varied motives to engagement, including collective reward; social influence; game reinvention; exploration; accessibility and awareness. However, several barriers specific to the Beat the Street intervention and outdoor gamification interventions more generally were also identified. This study provides novel insight into the motives which engage individuals into physical activity interventions and the design principles which need to be considered when implementing interventions of this nature

Birmingham, West Midlands’ Young Persons’ Physical Activity Pathway: Evaluation Report

The Birmingham, West Midlands’ Young Persons’ Physical Activity Pathway (YPPAP) is a pilot six week behavioural intervention (a physical activity pathway) aimed at increasing physical activity levels in school-aged children in school years 6 and 7 (ages 10-12 yrs). It builds on the experiences of the South Staffordshire (SS) Physical Activity Care Pathway (PACP), but was developed specifically to focus on school-age young people in an urban city setting. For the purposes of the evaluation a mixed-methods approach including a quantitative and qualitative component was employed. Data analysis revealed that of the 239 eligible participants, 99 entered the pathway (31.2%). Ninety-three participants set physical goals at baseline and 3 were lost to follow up representing a pathway completion rate of 97% (n = 90). Overall, the results indicated that the increase in ‘spare time’ physical activity was statistically significant (t(95)=-2.88, p=.005), but the differences were not significant for overall physical activity (t(95)=-.096, p=.924), or mean frequency of physical activity (t(95)=-.414, p=.680). Analysis also revealed that the correlation between change in physical activity between baseline and follow up and the number of goals set by participants was not significant (r = 0.08, p =.436). Qualitative findings revealed that participants perceived that the pathway had helped to educate them about the relationship between physical activity and health and had provided a means of engaging with physical activity in a way that was fun and non-threatening. Delivery costs were also calculated taking into account management and delivery costs, including resources, training and support, the total cost per child of delivering the intervention was £143. The high completion rate might point to the utility of using school settings for physical activity interventions. Problematically, the limited sample size prevented the meaningful investigation of any relationship between the physical activity options chosen by young participants and outcomes in terms of potential increases in levels of physical activity. Similarly, it was not possible to fully investigate the potential effects of gender, class, ethnicity, disability status on adherence to the pathway or physical activity behaviour. More usefully, data analysis revealed that the pathway attracted a range of participants which demonstrated potential for securing the interest and motivation of participants. This finding underpins the importance of understanding the number, variety and availability of local physical activity opportunities and delivering the intervention in a way that is engaging and supportive

Uptake and participation in physical activity referral schemes in the UK: an investigation of patients referred with mental health problems

The study compared outcomes of uptake, attendance, and completion between two patient groups (mental health, n = 134 and physical health, n = 2767) in a physical activity referral scheme in the UK during 2000 to 2003. Despite similar rates for the physical health and mental health groups for initial progression (94% vs. 90%), referral uptake (60% vs. 69%; p < 0.001) and programme completion (22% vs. 34%; p < 0.001) were significantly lower in the mental health referrals. In conclusion, physical activity referral schemes appear to be less well suited to the needs of the mental health patient. Further research is recommended

A systematic review of the relationship between socio-economic position and physical activity

Objective \ud The aim of the present review was to examine epidemiological evidence to determine if there is strong evidence of a positive gradient of increasing physical activity across the socio-economic strata, and how relationships are affected by socio-economic measurement.\ud \ud Design \ud Systematic review.\ud \ud Method \ud A search of major databases was conducted to identify published studies that reported physical activity in relation to socio-economic position (SEP) in adults.\ud Results Twenty-eight cross-sectional and five longitudinal studies met the inclusion criteria. Approximately half of these were American. Consequently education and income were most commonly used to represent SEP. The majority of studies were secondary analyses of existing health survey data, which could explain the generally large sample sizes and methodological weaknesses in physical activity and SEP measurement. There was consistent evidence of a higher prevalence or higher levels of leisure-time or moderate-vigorous intensity physical activity in those at the top of the socio-economic strata compared with those at the bottom. Evidence for positive gradients across the socio-economic strata was less consistent. Education produced the most stable relationships, less susceptible to confounding effects of ethnicity and the environment.\ud \ud Conclusion \ud Those at the top of the socio-economic scale appear to perform more leisure-time activity than those at the bottom. Diverse and often crude physical activity and socio-economic measurement made it difficult to distinguish between artefact and true effect in a relationship with so many potential confounding influences. Further studies using up-to-date methods of socio-economic and physical activity measurement are necessary to further explore this relationship and its confounders

Gender perceptions and their impact when referring obese patients for exercise

Obesity trends in the UK have shown a steady increase over the past 20 years, yet differences have been identified in the uptake and adherence data for obese men and women attending exercise referral schemes (ERS). Moreover, evidence suggests that health professionals (HPs) may hold preconceived gender specific views about their patients and this has been identified as a potential barrier to male patients seeking help from their GPs for chronic conditions. The aim of this paper is to examine the gender dynamics associated with health profession/patient interactions in relation to the uptake of an ERS for obese patients. The ERS in question was based in a Primary Care Health Centre in the South West of England. The respondent cohort comprised 12 patients (8 women, 4 men) aged 55-74 years and their 6 referring HPs (4 women, 2 men). Semi-structured interviews were conducted with patients and HPs over an eight month period and the data were analysed via a grounded theory approach. The study found that HP gender specific perceptions of their patients had an impact on the methods used to encourage patients to participate. HPs typically adopted a direct interactional approach with obese men and a more cautious approach with obese women. Irrespective of gender, male and female patients found being informed of their obesity difficult to accept. The paper concludes that there is a need for a degree of care to be taken when communicating such health concerns and that this kind of approach may lead to increased ERS attendance (and adherence) by men