Understanding why some people do not use buses

First paragraph: The Scottish Government commissioned this research to explore in depth the reasons why some people do not use buses and what might encourage them to do so. While there is considerable existing research on bus travel in Scotland, much of this to date has been quantitative, relying on survey data. Although very useful in measuring use of buses and other modes, survey data can be limited in the level of detail it can provide on why people use particular modes rather than others. This research was intended to address that gap

Smoking prevention, peer support and social networks: diffusion of the ASSIST programme beyond the school setting

Background: A Stop Smoking in Schools Trial (ASSIST) is a social network intervention designed to disseminate non-smoking messages among secondary school children via student selected peer supporters. Message diffusion is restricted to the school year, with limited understanding of the extent and context of message diffusion in peer supporters’ wider social networks. The aim of this thesis was to address this gap by examining whether ASSIST had the potential to influence smoking behaviour, attitudes, and knowledge of smoking related harm, beyond the school year. Method: Two literature reviews and a systematic review were conducted to inform the empirical data collection phase, which employed a qualitative social network design using a mixed methods analytical approach. A novel research method to collect data from young people (egocentric sociograms using coloured dots and post-it notes to prompt further discussion) and recruitment approach were piloted with 16 peer supporters from two secondary schools. Network data was quantitatively analysed using Excel and qualitative data from the interviews was analysed thematically using NVivo and Framework. Results: The potential reach of message diffusion among the 16 peer supporter networks was large, with the combined number of people nominated being 151. The actual number of reported conversations was 103. Two-fifths (41%) of these conversations were with school friends and three-fifths (59%) with peer supporter family and friends outside of school. Thematic analysis of reported conversation content revealed three main types of conversation: protecting non-smokers from starting to smoke; encouraging smokers to stop; and protecting people from secondhand smoke in wider social networks. Peer supporters perceived impact with 37 people from their social networks, with examples of both positive and negative impact, focusing on the dynamics of a child speaking to an adult. Conclusions: Smoking prevention message diffusion was not limited to the school year, reaching into the wider networks of peer supporters. Future interventions using the ASSIST model should consider changing the guidance that message diffusion should be limited to students in their year group only, as this may reduce the extent of message diffusion. Peer supporters should be better supported to think about whom they could speak to in their social network and the associated potential risks and ethical implications carefully considered

Barriers and solutions to participation in exercise for moderately disabled people with multiple sclerosis not currently exercising: a consensus development study using nominal group technique

Background: Multiple sclerosis (MS) is a chronic, progressive neurological condition. The aim of this study was to explore consensus on the barriers and solutions to exercise for people with MS living in Scotland. Method: Thirty-five people with MS, not regularly exercising, were recruited and took part in five Nominal Group Technique groups throughout Scotland. Background information was collected on participants prior to each group. Participants individually and silently listed their barriers and solutions to participating in exercise. Group discussion then clarified, amended and merged ideas. Participants then ranked ideas by choosing five barriers and solutions to exercise participation. Data were analyzed using descriptive statistics and by carrying out a thematic grouping. Results: Consensus was that fatigue was a barrier to exercise participation . Other identified barriers were a lack of support and advice, the impairments arising from the condition and time. No single item achieved consensus for solutions but exercising with others, receiving support, having a positive attitude, finding time and minimizing environmental barriers were all suggested as solutions to assist in exercise participation. Conclusions: People with MS should be provided with information on how to manage their fatigue alongside any exercise prescription. Information and support should be given on how to personalize exercise to suit individual needs and abilities to overcome some of the barriers suggested within this study. Implications for rehabilitation More exercise opportunities are required. Exercise should be personalized to address the individual needs of the person with MS. Any identified barriers to exercise should be addressed

Regulatory Resistance?:Narratives and Uses of Evidence around "Black Market" Provision of Gambling during the British Gambling Act Review

Commercial gambling is increasingly viewed as being part of the unhealthy commodities industries, in which products contribute to preventable ill-health globally. Britain has one of the world’s most liberal gambling markets, meaning that the regulatory changes there have implications for developments elsewhere. A review of the British Gambling Act 2005 is underway. This has generated a range of actions by the industry, including mobilising arguments around the threat of the “black market”. We critically explore industry’s framing of these issues as part of their strategy to resist regulatory change during the Gambling Act review. We used a predefined review protocol to explore industry narratives about the “black market” in media reports published between 8 December 2020 and 26 May 2021. Fifty-five articles were identified and reviewed, and themes were narratively synthesised to examine industry framing of the “black market”. The black market was framed in terms of economic threat and loss, and a direct connection was made between its growth and increased regulation. The articles mainly presented gambling industry perspectives uncritically, citing industry-generated evidence (n = 40). Industry narratives around the “black market” speak to economically and emotionally salient concerns: fear, safety, consumer freedom and economic growth. This dominant framing in political, mainstream and industry media may influence political and public opinion to support the current status quo: “protecting” the existing regulated market rather than “protecting” people. Debates should be reframed to consider all policy options, especially those designed to protect public health

Grandmothers’ care practices in areas of high deprivation of Scotland:the potential for health promotion

In many families grandparents play an essential role by providing secondary care for grandchildren. The family is a key setting for promoting children’s health; however, studies describing health initiatives with grandparents are rare. Grandparents could play an important role in promoting health for their grandchildren within their families and communities. The aim of this study was to examine the care practices of grandparents in families living in areas of high deprivation, and to consider the extent to which grandparents could be at the centre of health-promoting initiatives for children. A family practices approach was used to examine care practices within the framework of family resource (assets/capitals) use. In-depth interviews were carried out with grandmothers (n = 15) and mothers (n = 15) living in areas of high deprivation in Scotland. The results are presented as three economies of family living—political, moral and emotional. Grandparent care was described as a form of social capital, central to the wellbeing of the families, and enabled parents to access education and employment. Grandparent care was supported through families’ ability to access cultural amenities and green space (political). Grandparents’ care practices were described as either being responsible or fun (moral). Love appeared to be at the centre of grandparents’ care (emotional). The strengths and weaknesses of this framework were examined in relation to developing initiatives with grandparents. With further development work, grandparents could be the focus of health initiatives with their grandchildren with the support of appropriate policies and resources within their communities

Behaviour Change Intervention for Smokeless Tobacco (ST) Cessation Delivered through Dentists in Dental Settings: A pragmatic pilot trial

Introduction: Evidence on smokeless tobacco (ST) cessation interventions is scarce. The South Asian (SA) region which shares more than 90% of the burden of ST use, is grossly underrepresented in research on ST cessation. This study aimed to assess the feasibility of delivering and investigating a behavioural support intervention for ST cessation in dental settings in Pakistan.Methods: A multi-centre, pilot, 2-armed parallel group, individually randomised control trial, with a 1:1 allocation ratio, was conducted at two dental hospitals. Eligibility criteria included: being a ST user; seeking dental treatment and; not currently accessing cessation support. All participants were provided written self-help, ST cessation material. The intervention group also received a dentist-delivered, bespoke behavioural support intervention for ST cessation developed for users of SA origin. Participants were followed up telephonically at three and six months. Self-reported six month abstinence was verified by salivary cotinine. Analysis was descriptive, with 95% confidence intervals presented where appropriate.Results: 100 participants were successfully recruited from the selected hospitals. Of these 78% continued to engage throughout the study duration and provided primary outcome data, whereas, 63% completed all hospital visits. The outcome measures were successfully collected. Biochemically verified six-month abstinence in the intervention and control group was 10% and 4%.Conclusions: It was feasible to deliver and evaluate a dentist-delivered behavioural support intervention for ST cessation in Pakistan. The data suggested that the intervention may improve ST quit rates. The findings of this study will be useful in informing the design of future definitive studies

Behaviour change intervention for smokeless tobacco (ST) cessation delivered through dentists within a dental setting:a feasibility study protocol

OBJECTIVES/AIM: To adapt a structured behavioural support intervention for smokeless tobacco (ST) cessation and to assess the feasibility and acceptability of delivering the intervention via dentists within dental settings in Pakistan. MATERIAL AND METHODS: The study will have 3 phases: (1) Adapt a previously developed intervention to make it suitable for delivery in a clinical/dental setting through qualitative interviews with dental patients and dentists; (2) A multi-centre, pilot randomised control trial in two teaching dental hospitals in Pakistan. Participants (dental patients) will be randomly assigned to intervention or control group in a 1:1 allocation ratio to receive either a structured behavioural support intervention involving face to face counselling or self-help material plus usual care. Each participant will be in the study for approximately 6 months and the overall study is expected to run for 12 months; (3) An embedded qualitative process evaluation. All trial participants will be followed up at 3 and 6 months to assess self-reported ST use. Outcome measures will include: rates of eligibility, recruitment and retention, randomisation group cross-over rates, the provision of data on ST use behaviour, fidelity to the intervention and qualitative assessment of acceptability and feasibility. DISCUSSION: Despite the high use of ST in Pakistan, users are offered negligible cessation support. The findings of this multi-centre, mixed-method feasibility study will inform the scope for a larger trial on ST cessation delivered through the existing dental health system

Attitudes towards bystander cardiopulmonary resuscitation:Results from a cross-sectional general population survey

Survival from out-of-hospital cardiac arrest (OHCA) varies across the developed world. Although not all OHCA are recoverable, the survival rate in Scotland is lower than in comparable countries, with higher average survival rates of 7.9% in England and 9% across Europe. The purpose of this paper is to explore the barriers, facilitators and public attitudes to administering bystander cardiopulmonary resuscitation (CPR) which could inform future policy and initiatives to improve the rate of bystander CPR. Data was collected via a cross-sectional general population survey of 1027 adults in Scotland. 52% of respondents had been trained in CPR. Of those who were not trained, two fifths (42%) expressed a willingness to receive CPR training. Fewer than half (49%) felt confident administering CPR, rising to 82% if they were talked through it by a call handler. Multivariate analyses identified that people in social grade C2DE were less likely than those in social grade ABC1 to be CPR trained and less confident to administer CPR if talked through by a call handler. The older a person was, the less likely they were to be CPR trained, show willingness to be CPR trained or be confident to administer bystander CPR with or without instruction from an emergency call handler. These findings are particularly relevant considering that most OHCA happen in the homes of older people. In a developed country such as Scotland with widely available CPR training, only half of the adult population reported feeling confident about administering bystander CPR. Further efforts tailored specifically for people who are older, unemployed and have a lower social grade are required to increase knowledge, confidence and uptake of training in bystander CPR