Where are the Schools? Children, Families and Food Practices

Reducing childhood obesity is an international priority and children's diets, food knowledge and practices have come under intense scrutiny in both policy and popular discourse. Notwithstanding evidence that health interventions which resonate with children's own views are the most effective, there is still relatively little research which mobilises children's everyday perspectives on food to inform public health policy. We report key findings from a qualitative study with 53 children aged 9–10, attending two socio-economically contrasting schools in the UK. The study explored children's understandings of food in everyday life and their ideas about the relationship between food and health. Throughout the study, despite recent attempts to position schools as key sites for public health interventions, children consistently emphasised families as the locus for enduring food practices. The research highlights the value of listening to children and applying our understanding of their perspectives to ensure that public health initiatives work with the important influences on their diet and health that they themselves identify

Factors relating to the uptake of interventions for smoking cessation amongst pregnant women: a systematic review and qualitative synthesis

Introduction The review had the aim of investigating factors enabling or discouraging the uptake of smoking cessation services by pregnant women smokers. Methods The literature was searched for papers relating to the delivery of services to pregnant or recently pregnant women who smoke. No restrictions were placed on study design. A qualitative synthesis strategy was adopted to analyse the included papers. Results Analysis and synthesis of the 23 included papers suggested ten aspects of service delivery that may have an influence on the uptake of interventions. These were: whether or not the subject of smoking is broached by a health professional; the content of advice and information provided; the manner of communication; having service protocols; follow-up discussion; staff confidence in their skills; the impact of time and resource constraints; staff perceptions of ineffectiveness; differences between professionals; and obstacles to accessing interventions. Discussion The findings suggest variation in practice between services and different professional groups, in particular regarding the recommendation of quitting smoking versus cutting down, but also in regard to procedural aspects such as recording status and repeat advice giving. These differences offer the potential for a pregnant woman to receive contradicting advice. The review suggests a need for greater training in this area and the greater use of protocols, with evidence of a perception of ineffectiveness/pessimism towards intervention amongst some service providers

Sitting less at work : a qualitative study of barriers and enablers in organisations of different size and sector

Background: Prolonged sitting is associated with a range of chronic health conditions and working in office-based jobs is an important contributor to total daily sitting time. Consequently, interventions to reduce workplace sitting have been developed and tested; however, no single intervention strategy consistently produces reductions in workplace sitting time. Exploring barriers and enablers to sitting less at work has been shown to support the development of more effective interventions. In order to address these barriers and enablers during the development and implementation of sit less at work interventions, it is important to understand how they may differ in different types of organisation, an area which has not yet been explored. The main aim of this study was to determine whether barriers and enablers to sitting less at work varied between organisations of different size and sector. Methods: A qualitative study design was used. Four organisations of different sizes and sectors participated: a small business, a charity, a local authority and a large corporation. A total of ten focus groups comprising 40 volunteer employees were conducted. Focus groups were audio-recorded and transcribed verbatim. Transcripts were then thematically analysed using pre-defined themes, but analysis also allowed for emergence of additional themes. Results: Barriers and enablers which were consistently raised by participants across all four organisations primarily included: individual-level factors such as habits and routines, and personal motivations and preferences; and factors relating to the internal physical environment. Barriers and enablers that differed by organisation mainly related to: organisational-level factors such as organisational culture, organisation size, and ways of working; and factors relating to the broader social, economic and political context such as the idea of presenteeism, and the impact of wider economic and political issues. Conclusions: This study found that although some themes were consistently raised by participants from organisations of different size and sector, participants from these organisations also experienced some different barriers and enablers to sitting less at work. For future research or practice, the study findings highlight that organisation-specific barriers and enablers need to be identified and addressed during the development and implementation of sit less at work interventions

Exploring the factors that influence the public health impact of changes to the traditional housing officer’s role : insights from a logic modelling approach

Background Complex interventions can be challenging to summarise and interpret. One approach to attempt to succinctly describe such complexity is through the development of a logic model. This study considers a complex intervention that aimed to widen the role and responsibilities of housing officers, through a neighbourhood-based system. Methods We developed a logic model using both primary and secondary data collection alongside expert opinion in order to understand the complex relationships between the intervention being delivered and the actual and potential outcomes. Development of the model was supported by a range of data generation methods, including a scoping review of the literature, telephone survey with housing tenants, in-depth interviews with tenants and housing staff, and workshops with key stakeholders to help to develop and then validate the model. Results Our logic model highlights the key role of interpersonal relationships in building coherent neighbourhoods through intervention success and tenant satisfaction. We developed our initial model from analysis of documents relating to the intervention, along with wider literature, which detailed the policy context, theoretical approach and the expected outcomes. Conclusions The process of defining our final logic model generated insights that would not have emerged from a more narrative synthesis of secondary and primary data. The most important of these was a clear message about the central role of relationships between neighbourhood officers and tenants. In similar interventions, thought needs to be given on how a relationship can be built between a tenant and a neighbourhood officer

What factors facilitate the engagement with flipped classrooms used in the preparation for postgraduate medical membership examinations?

Background: The “flipped classroom,” a pedagogical model where typical lecture and homework elements are reversed, is being advocated in medical education to support the teaching of a large curriculum. However, research into the use of this model in postgraduate medical education, which requires the application of acquired knowledge, is limited. The aim of this study was to explore the barriers and facilitators to engagement with the flipped classroom model in preparation for the written element of postgraduate membership examinations. Methods: Three focus groups (n=14) were held between February and June 2016. Participants were drawn from a membership examination preparation course, run by the University of Sheffield. Two of the groups (n=10) involved “students” (public health registrars) while the other focus group (n=4) was held with “tutors” (experienced registrars and consultants). The focus groups were audiorecorded and transcribed verbatim. Transcripts were thematically analyzed by using both predetermined and emergent themes. Results: Key themes that emerged from the data included variation in learning and teaching styles of individuals as well as the feasibility and flexibility of the overall course design. However, management of students’ expectations was found to be the fundamental factor, which underpinned the engagement. Conclusion: The complex interaction of factors affecting engagement in this study highlights the need to consider the appropriateness of the flipped classroom model. However, this must be balanced by the potential benefits of the approach for delivering a large curriculum. Recognizing the central importance of managing expectations at the outset would be useful when considering this model in postgraduate medical education

Health promotion interventions for increasing stroke awareness in ethnic minorities: a systematic review of the literature

Abstract Background: Stroke places a significant burden to all affected individuals, but it is perhaps more significant amongst members of black, minority and ethnic communities, who may experience poorer awareness of stroke symptoms than the general population. Recently, several initiatives tried to improve public awareness that symptoms of stroke need to be treated as a medical emergency. However, ethnic communities present cultural barriers, requiring tailored health promotion interventions, whose effectiveness remains uncertain. Our systematic review aimed to identify relevant published evidence, synthesize the main study components and identify evidence of the effectiveness of the interventions. Methods: MEDLINE, EMBASE, CINAHL, and PsycInfo were searched for journal articles on health promotion interventions for increasing stroke awareness in ethnic minorities, published in English between 1995 and 2012. Search results were collaboratively assessed by the authors; included studies were analysed to identify their main characteristics, and a thematic analysis of their content was conducted. No meta-analysis was performed, due to the heterogeneity of results. Results: Eighteen studies were included, reporting 15 interventions conducted in the US, for African-Americans or Hispanics; populations sizes differed between interventions. Interventions were mostly carried out in community settings with different educational techniques, focussing on experiential methods. Health professionals usually organized the programs, delivered by nurses, other health professionals or volunteers. The few theory-based interventions focussed on individual-level behavioural change. Practical cultural adaptation strategies were not linked to specific theoretical frameworks. Interventions widely differed as for target populations, settings, delivery methods, contents and professional roles involved. All study designs were quantitative, and the emerging evidence of effectiveness was inconclusive. Such interventions operate in very complex scenarios, and several variables may influence their effectiveness. Therefore, qualitative or mixed-methods study designs may shed light on barriers and facilitators, experiential education strategies and community involvement. Network- and community-level theories may help improving design and evaluation of interventions. Conclusions: Eleven case reports and four RCTs provide evidence about stroke awareness interventions organized in the US. The studies provide only partial and inconclusive evidence about the effectiveness of the interventions. Hence, further research is needed on different countries and ethnic minorities

Tackling gambling related harms as a public health issue

Gambling is a highly profitable commercial activity, with providers including international corporations and governments. However, there is growing international recognition that gambling is a source of serious harm, and that there is inequity in the distribution of this harm, which has led to demands for action to protect public health. These concerns are reflected in the recent report from the UK All-Party Parliamentary Group, which calls for stronger action on regulation of online gambling. Although there is largely a consensus on the need for developing and implementing strategies to reduce gambling-associated harms, to date, the stated need for a public health approach to preventing harm has not been widely or effectively translated into action in the UK. The barriers and facilitators to effective public health action need to be understood to enable good intentions to be translated into effective action. The current context represents real opportunities for policy implementation, but also the threats to effective action that need to be addressed

Limitations of Internet searching for understanding the commissioning and delivery of health services: findings from a systematic review of diagnostic ultrasound services

Background Diagnostic ultrasound services are commonly provided by direct access to hospital-based facilities for GPs. Services may also be delivered in primary care or community settings, for example by appropriately trained GPs or mobile services. As part of a larger project, we used an Internet and grey literature search to identify current providers and models of service in the UK NHS (primarily England). Methods Internet searches were performed using the Google search engine. We also searched OpenGrey (European grey literature database) and the website of the National Institute for Health Research (NIHR) Diagnostic Evidence Co-Operative (DEC) Oxford, which specialises in diagnostic tests suitable for use in primary care. The first 100 results from Google searches were examined. Websites of companies providing diagnostic ultrasound services in NHS community settings and of ‘NHS community diagnostic centres’ (providing diagnostic ultrasound alongside other tests) were searched for evaluations or fuller descriptions of the services and any information on governance, accreditation and similar issues. Results We identified details of 22 companies providing diagnostic ultrasound services, one of which appeared to be an exclusively private service. Details available on the company websites were highly variable. Commonly reported features included time standards for appointments and report delivery and patient satisfaction ratings. Links to the NHS were emphasised by most of the companies. It appeared that many staff worked part-time for the companies and the remainder of the time for NHS organisations. Services were generally commissioned through the ‘any qualified provider’ (AQP) system. All the services appeared to follow the model of a mobile service operating through GP surgeries and other community sites. Services were staffed by radiographers (and healthcare assistants) with access to consultant radiologists as required. We also identified websites for four ‘community diagnostic centres’ and five ‘primary care centres’ (diagnostic services integrated with GP surgeries). We did not identify any listings of what types of services are being commissioned and by whom or any reports of evaluations of services. Conclusion Community-based services run by non-NHS providers with links to the NHS for governance and quality control are common. However, our findings should be regarded as a snapshot rather than a comprehensive list. At present it appears difficult to compile information about service delivery and evaluation from Internet sources. There is an urgent need for more comprehensive information to support commissioning decisions and inform the public

The impact of a local sugar sweetened beverage health promotion and price increase on sales in public leisure centre facilities

BACKGROUND: We aimed to evaluate the impact of a local sugar sweetened beverages (SSB) health promotion and 20p price increase in leisure centre venues and estimate the impact on consumption. METHOD: Monthly cold drinks sales data and attendance at leisure centres across the city of Sheffield were analysed over the period January 2015-July 2017. Interrupted time-series methods were employed to estimate changes in consumption per attendance of SSB and non-SSB cold drinks following the introduction of the SSB policy from August 2016 adjusting for seasonal variation and autocorrelation. SSB price elasticities were estimated with fixed effects log-log models by SSB product type (soda can, soda bottle, soda post mix, energy drinks, juice from concentrate). FINDINGS: We estimated a 31% (95% CI 4%, 59%) reduction in units of SSB sold per attendance in the year since the policy was introduced. We did not observe substitution effects to fruit juice or water but found sales of other artificially sweetened non-SSB products increased by 27% (95% CI 6%, 47%) after the introduction of the tax. Price elasticity analysis identified that a 1% increase in price alongside health promotion leads to a 3.8% (95% CI 3.1% 4.4%) decrease in demand for SSB's. Price elasticity of demand was highest for child friendly and high caffeine energy drinks. INTERPRETATION: Demand for SSB drinks at leisure centre venues is highly responsive to the policy, particularly for child-friendly and high caffeine energy drinks, compared with other SSB tax policy evaluations. The policy also increased purchases of carbonated non-SSB