Workplace-based interventions to promote healthy lifestyles in the NHS workforce : a rapid scoping and evidence map

Background:The health and well-being of staff working in the NHS is a significant issue for UK health care. We sought to identify research relevant to the promotion of healthy lifestyles among NHS staff on behalf of NHS England. Objectives:To map existing reviews on workplace-based interventions to promote health and well-being, and to assess the scope for further evidence synthesis work. Design:Rapid and responsive scoping search and evidence map. Participants:Adult employees in any occupational setting and in any role. Interventions:Any intervention aimed at promoting or maintaining physical or mental health and well-being. Early intervention initiatives and those addressing violence against staff, workplace bullying or harassment were also included. Main outcome measures:Any outcome related to the effectiveness, cost-effectiveness or implementation of interventions.Data sources:A scoping search of nine databases was conducted to identify systematic reviews on health and well-being at work. Searches were limited by publication date (2000 to January/February 2019). Review methods:The titles and abstracts of over 8241 records were screened and a total of 408 potentially relevant publications were identified. Information on key characteristics were extracted from the titles and abstracts of all potentially relevant publications. Descriptive statistics (counts and percentages) for key characteristics were generated and data from reviews and ‘reviews of reviews’ were used to produce the evidence map. Results:Evidence related to a broad range of physical and mental health issues was identified across 12 ‘reviews of reviews’ and 312 other reviews, including 16 Cochrane reviews. There also exists National Institute for Health and Care Excellence guidance addressing multiple issues of potential relevance. A large number of reviews focused on mental health, changing lifestyle behaviour, such as physical activity, or on general workplace health/health promotion. Most of the reviews that focused only on health-care staff addressed mental health issues, and stress/burnout in particular. Limitations:The scoping search process was extensive and clearly effective at identifying relevant publications, but the strategy used may not have identified every potentially relevant review. Owing to the large number of potentially relevant reviews identified from the scoping search, it was necessary to produce the evidence map using information from the titles and abstracts of reviews only. Conclusions: It is doubtful that further evidence synthesis work at this stage would generate substantial new knowledge, particularly within the context of the NHS Health and Wellbeing Framework published in 2018. Additional synthesis work may be useful if it addressed an identifiable need and it was possible to identify one of the following: (1) a specific and focused research question arising from the current evidence map; it may then be appropriate to focus on a smaller number of reviews only, and provide a more thorough and critical assessment of the available evidence; and (2) a specific gap in the literature (i.e. an issue not already addressed by existing reviews or guidance); it may then be possible to undertake further literature searching and conduct a new evidence review

Informing NHS policy in 'digital-first primary care': a rapid evidence synthesis

Background In ‘digital-first primary care’ models of health-care delivery, a patient’s first point of contact with a general practitioner or other health professional is through a digital channel, rather than a face-to-face consultation. Patients are able to access advice and treatment remotely from their home or workplace via a number of different technologies. Objectives This rapid responsive evidence synthesis was undertaken to inform NHS England policy in ‘digital-first primary care’. It was conducted in two stages: (1) scoping the published evidence and (2) addressing a refined set of questions produced by NHS England from the evidence retrieved during the scoping stage. Data sources Searches were conducted of five electronic databases (MEDLINE, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, the Health Technology Assessment database and PROSPERO were searched in July 2018) and relevant research/policy and government websites, as well as the National Institute for Health Research Health Service and Delivery Research programme database of ongoing and completed projects. No date or geographical limitations were applied. Review methods After examining the initial scoping material, NHS England provided a list of questions relating to the potential effects of digital modes and models of engagement, and the contracting and integration of these models into primary care. Systematic reviews and evidence syntheses, including evidence on the use of digital (online) modes and models of engagement between patients and primary care, were examined more closely, as was ongoing research and any incidentally identified primary studies focused on the use of digital (online) modes and models of engagement. All records were screened by two reviewers, with disagreements resolved by consensus or consulting a third reviewer. Results Evidence suggests that uptake of existing digital modes of engagement is currently low. Patients who use digital alternatives to face-to-face consultations are likely to be younger, female and have higher income and education levels. There is some evidence that online triage tools can divert demand away from primary care, but results vary between interventions and outcome measures. A number of potential barriers exist to using digital alternatives to face-to-face consultations, including inadequate NHS technology and staff concerns about workload and confidentiality. There are currently insufficient empirical data to either substantiate or allay such concerns. Very little evidence exists on outcomes related to quality of care, service delivery, benefits or harms for patients, or on financial costs/cost-effectiveness. No studies examining how to contract and commission alternatives to face-to-face consultations were identified. Limitations The quality of the included reviews was variable. Poor reporting of methodology and a lack of adequate study details were common issues. Much of the evidence focused on exploring stakeholder views rather than on objective measurement of potential impacts. The current evidence synthesis is based on a rapid scoping exercise and cannot provide the breadth or depth of insight that might have been achieved with a full systematic review. Conclusions Rapid scoping of the literature suggests that there is little high-quality evidence relating to ‘digital-first primary care’ as defined by NHS England. The broader evidence on alternatives to face-to-face consultation addresses certain policy-maker concerns, such as the possible impact of new technologies on workload and workforce, inequalities, local implementation and integration with existing services. However, although this evidence gives an insight into the views and experiences of health professionals in relation to such concerns, quantitative empirical data are lacking

Clinical practice as research for a rare condition: Systematic research review of qualitative research exploring patients' experiences of penile cancer

Background: Penile cancer is a rare but destructive malignancy. The aim of this study was to identify published qualitative research exploring patients' experiences of being diagnosed and treated for penile cancer. As only one study met our inclusion criteria and yet there were five borderline studies, a secondary aim that emerged was to discuss those studies to see what, if anything, we could learn. Methods: We searched ASSIA, CINAHL, EMBASE, PUBMED/MEDLINE, PsycINFO & Web of Science and found 313 papers published since 1990. Two reviewers independently selected 17 papers for potential inclusion using titles and abstracts, which were obtained and independently assessed. A synthesis was not possible as only one study met our inclusion criteria. Five borderline studies, covering 4 countries, invited closer inspection because they are often reported in guidelines on penile cancer. Results: The 5 borderline studies reported using a mixed methods design combining a psychometric measure with interviews. Unfortunately, none of these studies reported the method or process used for analysing qualitative data or for integrating the interview and psychometric findings, making it difficult to understand the interview element of their research. Conclusions: If we are to understand and improve the long-term consequences of treatment for penile cancer, qualitative studies of patients’ experiences need to be conducted with high quality analysis and reporting. While pen-and-paper questionnaires may take up little of the time of clinicians conducting research about rare conditions, time could be better used by using methodologies that explore patients experiences

Peer support as a resilience building practice with men

Purpose The purpose of this paper is to present findings from an evaluation of a community mental health resilience intervention for unemployed men aged 45-60. The focus is on examining the place of facilitated peer support within a multi-dimensional men’s mental health programme, and exploring implications for resilience building delivery approaches for men. Design/methodology/approach The paper draws on a mixed methodology design involving before and after survey data and qualitative interviews, to report results concerning effectiveness in changing men’s perceived resilience, to consider project processes concerning peer support, and to situate these within wider community environments. Findings The programme significantly raised the perceived resilience of participants. Project activities promoted trusting informal social connections, gains in social capital arose through trusting relations and skill-sharing, and peer-peer action-focused talk and planning enhanced men’s resilience. Research limitations/implications The paper considers facilitated peer support on a programme, rather than on-going informal peer support or more formal peer support roles (a limitation reflecting the boundaries of the funded programme). Practical implications The paper discusses emerging considerations for resilience building, focusing on gender-sensitive approaches which can engage and retain men by focusing on doing and talking. It highlights the importance of peer support in community interventions which feature a social model of change. There is potential for encouraging further peer mentoring and peer led support beyond facilitated peer support in programme delivery. Social implications Potential exists for gender-aware programmes to sustain salutogenic change, co-producing social assets of peer support, male-friendly activities, and context sensitive course provision. Originality/value The paper adds fresh evidence of gendered intervention approaches with a specific focus on facilitated community peer support, including effects on male resilience. Little previous resilience research is gendered, there is little gendered research on peer support, and unemployed middle-aged men are a significant risk group

Regulating and inspecting integrated health and social care in the UK : scoping the literature

Background: The integration of care, particularly across the health and social care sectors, has been a long-standing policy objective in the UK. We sought to scope the evidence related to the regulation and inspection of integrated care. Objective(s): To identify and classify published material that could potentially address four key questions: 1. What models of regulation and inspection of integrated care have been proposed? (Including approaches taken in other countries) 2. What evidence is available on the effectiveness of such models? 3. What are the barriers and enablers of effective regulation and inspection of integrated care? 4. Can barriers to effective regulation and inspection be overcome without legislative change? Design: Rapid scoping review. Publication type and focus: Both empirical and non-empirical publications related to the regulation and inspection of integrated care were included. Setting: Publications focused on the integration of health and social care services, or provision delivered across other settings/sectors by different professional groups working together. Outcomes: Empirical studies reporting on any outcome relevant to the regulation and/or inspection of integrated care. Non-empirical publications focusing on any relevant issue including proposed models of regulation or outcome frameworks. Data sources: A targeted search of five databases was undertaken. Additionally, we conducted supplementary searches of the websites of key organisations and searched for other grey literature using the advanced search function of Google. Key contacts were also approached, and a request made for relevant documents. Review methods: The title and abstracts of 5380 records were screened and a total of 166 publications were included. Documents were coded based on key characteristics, and a descriptive summary of the literature produced. No attempt was made to assess the quality or synthesise the findings of the retrieved evidence. Results Out of the 166 included publications, 71 were identified from database searches and 95 were included from supplementary website searches. While there were records that could be classified as relevant to one or more of the research questions identified through the stakeholder consultation, there was a notable absence of evidence relating to (a) effectiveness of regulatory/inspection strategies and (b) professional regulation. Conclusions and future work The evidence base relating to the regulation or inspection of integrated care is relatively small. There may be an opportunity to synthesise some of the existing views and experience data on system regulation and inspection identified in a more formal systematic review. However, before a useful evidence base can be developed, policy makers and researchers need to agree what constitutes ‘effective’ regulation, how this can be measured, and which study designs are most appropriate for evaluation. Related questions about what constitutes ‘successful’ integration of care should also be taken into account when planning such research. While potentially useful reforms have been proposed, empirical evidence in relation to professional regulation appears particularly scarce. Organisations responsible for regulating professionals might therefore consider incorporating some form of evaluation into any planned strategic reforms. Limitations The degree of focus on integration or regulation was a difficult criterion to apply with strict consistency

Pornography use and sexting amongst children and young people : a systematic overview of reviews

BACKGROUND: Young people's use of pornography and participation in sexting are commonly viewed as harmful behaviours. This paper reports findings from a 'review of reviews', which aimed to systematically identify and synthesise the evidence on pornography and sexting amongst young people. Here, we focus specifically on the evidence relating to young people's use of pornography; involvement in sexting; and their beliefs, attitudes, behaviours and wellbeing to better understand potential harms and benefits, and identify where future research is required. METHODS: We searched five health and social science databases; searches for grey literature were also performed. Review quality was assessed and findings synthesised narratively. RESULTS: Eleven reviews of quantitative and/or qualitative studies were included. A relationship was identified between pornography use and more permissive sexual attitudes. An association between pornography use and stronger gender-stereotypical sexual beliefs was also reported, but not consistently. Similarly, inconsistent evidence of an association between pornography use and sexting and sexual behaviour was identified. Pornography use has been associated with various forms of sexual violence, aggression and harassment, but the relationship appears complex. Girls, in particular, may experience coercion and pressure to engage in sexting and suffer more negative consequences than boys if sexts become public. Positive aspects to sexting were reported, particularly in relation to young people's personal relationships. CONCLUSIONS: We identified evidence from reviews of varying quality that linked pornography use and sexting amongst young people to specific beliefs, attitudes and behaviours. However, evidence was often inconsistent and mostly derived from observational studies using a cross-sectional design, which precludes establishing any causal relationship. Other methodological limitations and evidence gaps were identified. More rigorous quantitative studies and greater use of qualitative methods are required

Treatment and rehabilitation of Long COVID:A scope of the literature. Update July 2024

We identified 19 randomised controlled trials published between March and June 2024 that were focused on Long COVID treatment or rehabilitation. Across our nine reports produced to date, we have identified and assessed 140 trials published between January 2022 and June 2024. • Eight of the 19 trials focused on treating generalised or multiple symptoms of Long COVID. Four trials focused specifically on respiratory or cardiovascular function or physical fitness. Four other trials focused solely on treating persistent problems with the sense of smell or taste (olfactory/gustatory dysfunction) and three trials evaluated treatments for fatigue. • Two trials were rated positively for 10 out of the 13 quality criteria that we assessed. The other 17 trials gained a positive rating for between four and nine criteria

Reviews on Long COVID: A scope of the literature:Update January 2024

• For this update, we identified 42 published reviews and 42 review protocols for Long COVID. The number of published reviews Is less than in October (n=46) but more than in July (n=31) and April (n=37), 2023. • Most published reviews were focused on the prevalence of symptoms or effects (18/42), which remains consistent with the earlier reports. • This update includes more published reviews with a primary focus on Long COVID risk factors (n=9) than in each of the previous reports. We identified fewer on treatment or rehabilitation (n=7) than in the October 2023 report (n=11), but more than in the four previous reports (n=5). • We identified fewer reviews on pathobiology or mechanisms (n=2), than for the October 2023 report (n=6), but a similar number to previous reports (e.g., July 2023, n=1). • Similar numbers of protocols were focused on the prevalence of symptoms or effects (15/42), and treatment or rehabilitation (13/42). These have consistently been the largest two categories across all the previous reports. • Seven protocols were focused on risk factors with or without prevalence; the same number as in the October 2023 report

Treatment and rehabilitation of Long COVID:A scope of the literature. Update January 2024

Summary • We identified 21 randomised controlled trials published between September and December 2023 that were focused on Long COVID treatment or rehabilitation. Across our seven reports produced to date, we have identified and assessed 106 trials published between January 2022 and December 2023. • Eight of the 21 trials focused on treating generalised or multiple symptoms of Long COVID/Post COVID condition. Four trials had a primary focus on persistent problems with the sense of smell or taste (olfactory/gustatory dysfunction) and three others evaluated treatments specifically for fatigue. Two trials had a focus on respiratory or cardiovascular function and physical fitness; one of which also focused on post COVID anxiety and depression. Other trials focused on individuals with post COVID depressive symptoms (n=1); post COVID gastro-oesophageal reflux disease (n=1); and persistent memory impairment (n=1). One trial focused on improving the resilience and quality of life of individuals with Long COVID. • Two trials were rated positively for 12 out of the 13 quality criteria that we assessed. Three trials met 11 criteria and three others met ten criteria. The remaining 13 trials gained a positive rating for between three and nine criteria

Reviews on Long COVID: A scope of the literature:Update July 2024

• For this update, we identified 33 published reviews and 43 review protocols for Long COVID. • The number of reviews (n=33) is fewer than in April 2024 (n=36), January 2024 (n=42), and October 2023 (n=46), but more than in July 2023 (n=31). • The largest category of reviews focused on treatment or rehabilitation (13/33), whereas the prevalence of symptoms or effects (n=7, for this update) was the largest category within all previous reports. • We identified four reviews on risk factors with or without prevalence, three on pathobiology or mechanisms, and two on prevention; the other four were on treatment with: prevalence (n=2), prevention (n=1), or risk factors (n=1). • We identified fewer protocols (n=43) than in the previous update (April 2024, n=63) and July 2023 (n=53), but a similar number to January 2024 (n=42) and October 2023 (n=44). • As in previous reports, the largest two categories of protocols focused on the prevalence of symptoms or effects (16/43), and treatment or rehabilitation (11/43). • Six protocols were focused on risk factors with or without prevalence, and four were on prevention; these numbers are similar to those in previous reports. Three protocols were on experiences of Long COVID with or without prevalence, and three protocols were on pathobiology; pathobiology and treatment; and prevalence and treatment