More haste, less speed? : an evaluation of fast track policies to tackle persistent youth offending in Scotland

In 2003 the Scottish Executive introduced a new 'Fast Track' policy on a pilot basis, which was intended to speed up the processing of persistent youth offending cases and reduce rates of persistent offending. Additional resources were provided to promote access to dedicated programmes, as well as quicker assessment, report delivery and decision making. This paper, based on a multi-stranded comparative evaluation, describes how the policy was welcomed by a wide range of practitioners, decision makers and managers involved with children's hearings who mostly thought it was a positive innovation consistent with the hearing system's commitment to a welfare-based approach. 'Fast Track' cases were handled more quickly than others. After two years, however, the policy was discontinued, largely because of negative evidence about re-offending

Process Evaluation Of The HealtheSteps™ Lifestyle Prescription Program

Background: Physical inactivity, sedentary behaviour, and poor diet are contributing to the rise in chronic disease rates throughout the world. HealtheSteps™ is a lifestyle prescription program focused on reducing risk factors for chronic disease through in-person coaching sessions, goal setting and tracking, and technology supports. Purpose:A process evaluation was conducted alongside a pragmatic randomized controlled trial to: a) explore the acceptability of HealtheSteps™ program from coach and participant perspectives; and b) identify where the program can be improved. Methods:Participants at risk or diagnosed with a chronic disease were recruited from five primary care/health services organizations into HealtheSteps™. Participants met with a trained coach bi-monthly for six months and set goals for physical activity (step counts), exercise (moderate to vigorous activity), and healthy eating. Coaches were interviewed at 6 months and participants at 12 months (6 months post-program). All coach interviews (n=12) were analyzed along with a purposeful sample of participant interviews (n=13). Results:Coaches found HealtheSteps™ was easy to deliver and recommendations for exercise and healthy eating were helpful. Including discussions on participant readiness to change, along with group sessions and more in-depth healthy eating resources were suggested by coaches to improve the program. Participants described the multiple avenues of accountability provided in the program as helpful. However, more feedback and interaction during and post-program from coaches was suggested by participants. Conclusions:HealtheSteps™ is an acceptable program from the perspectives of both coaches and participants with suggested improvements not requiring significant changes to the core program design

Immediate re-hydration post-exercise is not coincident with raised mean arterial pressure over a 30-minute observation period

This investigation assessed the effects of immediate or delayed re-hydration post-exercise, on mean arterial blood pressure ( MAP) and on blood plasma volume (PV) expansion post-exercise. It was hypothesised that fluid ingestion would raise MAP and attenuate PV expansion. On two occasions separated by seven days, eight males ( age 20.4 +/- 1.7 years, mass 79 +/- 5 kg [ means +/- SD]; VO2 max 48 +/- 11 mL center dot kg(-1) center dot minute(-1), [mean +/- SE]) cycled in the heat (35 degrees C, 50% relative humidity) at a power output associated with 50% VO2 max, until 1.0kg body mass was lost. 1L water was given either immediately thereafter, or two hours post-exercise by random assignment. On both occasions, MAP was calculated every five minutes for a period of 30-minutes post-exercise, and change in PV was calculated 24-hours post-exercise. Repeated measures ANOVA for MAP results suggested a low probability of a treatment effect ( p = 0.655), a high probability of a time effect ( p = 0.006), and a moderately high probability of a time x treatment interaction ( p = 0.076); MAP tended to be lower when fluid had been consumed. PV expansions 24-hours post-exercise were not significant changes with respect to zero, and were not significantly different by treatment condition. In conclusion: ( a) The exercise was not sufficient to elicit significant PV expansions; thus, we were unable to determine the effects of the timing of post-exercise re-hydration on PV expansion. (b) The hypothesis regarding MAP in response to drinking was not supported, rather there was a 92% probability that the inverse affect occurs.C

Plasma volume expansion 24-hours post-exercise: Effect of doubling the volume of replacement fluid

The effects of two volumes (1.5 L or 3.0 L) of commercially available electrolyte beverage (1.44 mM·L-1 Na+) taken during a 24-hour recovery period post-exercise, on plasma volume (PV) expansion 24-hours post-exercise were assessed. A simple random-order crossover research design was used. Subjects (n = 9 males: age 21 ± 4 years, body mass 80.0 ± 9.0 kg, peak incremental 60-second cycling power output 297 ± 45 W [means ± SD]) completed an identical exercise protocol conducted in hot ambient conditions (35°C, 50% relative humidity) on two occasions; separated by 7-days. On each occasion, subjects received a different volume of 24-hour fluid intake (commercial beverage) in random order. In each case, the fluid was taken in five equal aliquots over 24-hours. PV expansions 24-hours post-exercise were estimated from changes in haemoglobin and haematocrit. Dependent t-testing revealed no significant differences in PV expansions between trials, however a significant expansion with respect to zero was identified in the 3.0 L trial only. Specifically, PV expansions (%) were; 1.5 L trial: (mean ± SE) 2.3 ± 2.0 (not significant with respect to zero), 3.0 L trial: 5.0 ± 2.0 (p < 0.05, with respect to zero). Under the conditions imposed in the current study, ingesting the greater volume of the beverage lead to larger mean PV expansion.C

Fast Track Children's Hearings Pilot : Final Report of the Evaluation of the Pilot

The Scottish Executive decided that a Fast Track approach to the children's hearings system would be introduced in early 2003 on a pilot basis in selected parts of Scotland. The aim was to improve practice and outcomes with respect to the ways that the hearings system and associated services dealt with young people who persistently offend. Particular objectives were to: • reduce the time taken both overall and at each stage of decision-making • promote more comprehensive assessments which include appraisals of offending risk • ensure that all young people who persistently offend and who require an appropriate programme have access to one • reduce re-offending rates as a result of the concerted efforts made in such cases

Men’s Experiences with the Hockey Fans in Training Weight Loss and Healthy Lifestyle Program

Background: Increasing rates of chronic disease, especially in men, have led to an increased effort to implement lifestyle interventions focusing on healthy eating and physical activity. Men are underrepresented in lifestyle programs and some studies have observed that males prefer men-only programs that occur in the context of sports. This paper reviews men’s feedback regarding motivation for joining and overall experience in a 12-week lifestyle intervention in the context of junior level ice hockey teams. Methods: Men age 35-65 with a BMI ?28 were recruited from local ice hockey team fan bases in London and Sarnia Ontario, Canada and randomized to the 12-week lifestyle intervention or control group. Those who attended at least 6 of the 12 weekly sessions, including at least one session in the final six weeks (n=30) were asked to complete an online questionnaire upon finishing the active phase of the intervention. The questionnaire elicited reasons for joining the program, changes seen following their participation, and the usefulness of specific components of the program. Results: For the 27 men who completed the questionnaire, weight loss and a desire to increase physical activity were the two main reasons cited for joining the program. After the intervention, 100% of the men reported eating a healthier diet and 78% increased their activity level. Program satisfaction was high and 96% of men believed both the classroom and exercise components were useful. Conclusion: Our results support previous research showing increased levels of satisfaction in men when lifestyle interventions are run in...

Designing and implementing two facilitation interventions within the 'Facilitating Implementation of Research Evidence (FIRE)' study: A qualitative analysis from an external facilitators' perspective

Acknowledgement: We extend our sincere thanks to FIRE project team colleagues, in particular lead investigators and research fellows involved in data collection and analysis that contributed to the current paper. We also acknowledge the facilitators and their buddy colleagues that we were worked with during the course of the study.Background The 'Facilitating Implementation of Research Evidence' study found no significant differences between sites that received two types of facilitation support and those that did not on the primary outcome of documented compliance with guideline recommendations. Process evaluation highlighted factors that influenced local, internal facilitators' ability to enact the roles as envisaged. In this paper, the external facilitators responsible for designing and delivering the two types of facilitation intervention analyse why the interventions proved difficult to implement as expected, including the challenge of balancing fidelity and adaptation. Methods Qualitative data sources included notes from monthly internal-external facilitator teleconference meetings, from closing events for the two facilitation interventions and summary data analyses from repeated interviews with 16 internal facilitators. Deductive and inductive data analysis was led by an independent researcher to evaluate how facilitation in practice compared to the logic pathways designed to guide fidelity in the delivery of the interventions. Results The planned facilitation interventions did not work as predicted. Difficulties were encountered in each of the five elements of the logic pathway: recruitment and selection of appropriate internal facilitators; preparation for the role; ability to apply facilitation knowledge and skills at a local level; support and mentorship from external facilitators via monthly teleconferences; working collaboratively and enabling colleagues to implement guideline recommendations. Moreover, problems were cumulative and created tensions for the external facilitators in terms of balancing the logic pathway with a more real-world, flexible and iterative approach to facilitation. Conclusion Evaluating an intervention that is fluid and dynamic within the methodology of a randomised controlled trial is complex and challenging. At a practical level, relational aspects of facilitation are critically important. It is essential to recruit and retain individuals with the appropriate set of skills and characteristics, explicit support from managerial leaders and accessible mentorship from more experienced facilitators. At a methodological level, there is a need for attention to the balance between fidelity and adaptation of interventions. For future studies, we suggest a theoretical approach to fidelity, with a focus on mechanisms, informed by prospective use of process evaluation data and more detailed investigation of the context-facilitation dynamic.Funding: The research leading to these results has received funding from the European Union's Seventh Framework Programme (FP7/2007-2013) under grant agreement n° 223646. The funder had no role in designing, conducting, or interpreting study findings.Funder: FP7 Health, Grants: 223646https://implementationscience.biomedcentral.com/articles13pubpub

The feasibility and effectiveness of a web-based personalised feedback and social norms alcohol intervention in UK university students: A randomised control trial

OBJECTIVE Alcohol misuse amongst University students is a serious concern, and research has started to investigate the feasibility of using e-health interventions. This study aimed to establish the effectiveness of an electronic web-based personalised feedback intervention through the use of a randomised control trial (RCT). METHODS 506 participants were stratified by gender, age group, year of study, self-reported weekly consumption of alcohol and randomly assigned to either a control or intervention condition. Intervention participants received electronic personalised feedback and social norms information on their drinking behaviour which they could access by logging onto the website at any time during the 12-week period. CAGE score, average number of alcoholic drinks consumed per drinking occasion, and alcohol consumption over the last week were collected from participants at pre- and post-survey. RESULTS A significant difference in pre- to post-survey mean difference of alcohol consumed per occasion was found, with those in the intervention condition displaying a larger mean decrease when compared to controls. No intervention effect was found for units of alcohol consumed per week or for CAGE scores. Sixty-three percent of intervention participants agreed that the feedback provided was useful. Those intervention participants who were above the CAGE cut off were more likely to report that the website would make them think more about the amount they drank. CONCLUSIONS Delivering an electronic personalised feedback intervention to students via the World Wide Web is a feasible and potentially effective method of reducing student alcohol intake. Further research is needed to replicate this outcome, evaluate maintenance of any changes, and investigate the process of interaction with web-based interventions

Optimization Of The Hockey Fans In Training (Hockey FIT) Weight Loss And Healthy Lifestyle Program For Male Hockey Fans

BACKGROUND: The health outcomes of men continue to be poorer than women globally. Challenges in addressing this problem include difficulties engaging men in weight loss programs as they tend to view these programs as contrary to the masculine narrative of independence and self-reliance. Researchers have been turning towards sports fans to engage men in health promotion programs as sports fans are typically male, and tend to have poor health habits. METHODS: Developed from the highly successful gender-sensitized Football Fans in Training program, Hockey Fans in Training (Hockey FIT) recruited 80 male hockey fans of the London Knights and Sarnia Sting who were overweight or obese into a weekly, 90-minute classroom education and group exercise program held over 12 weeks; a 40-week minimally-supported phase followed. A process evaluation of the Hockey FIT program was completed alongside a pragmatic randomized controlled trial and outcome evaluation in order to fully explore the acceptability of the Hockey FIT program from the perspectives of coaches delivering and participants engaged in the program. Data sources included attendance records, participant focus groups, coach interviews, assessment of fidelity (program observations and post-session coach reflections), and 12-month participant interviews. RESULTS: Coaches enjoyed delivering the program and found it simple to deliver. Men valued being among others of similar body shape and similar weight loss goals, and found the knowledge they gained through the program helped them to make and maintain health behaviour changes. Suggested improvements include having more hockey-related information and activities, greater flexibility with timing of program delivery, and greater promotion of technology support tools. CONCLUSIONS: We confirmed Hockey FIT was an acceptable gender-sensitized health promotion program for male hockey fans who were overweight or obese. Minor changes were required for optimization, which will be evaluated in a future definitive trial

Hockey Fans in Training: A Pilot Pragmatic Randomized Controlled Trial

Introduction&nbsp; Hockey Fans in Training (Hockey FIT) is a gender-sensitized weight loss and healthy lifestyle program. We investigated 1) feasibility of recruiting and retaining overweight and obese men into a pilot pragmatic randomized controlled trial and 2) potential for Hockey FIT to lead to weight loss and improvements in other outcomes at 12 wk and 12 months.&nbsp; Methods&nbsp; Male fans of two ice hockey teams (35-65 yr; body mass index &ge;28 kg&middot;m-2) located in Ontario (Canada) were randomized to intervention (Hockey FIT) or comparator (wait-list control). Hockey FIT includes a 12-wk active phase (weekly, coach-led group meetings including provision of dietary information, practice of behavior change techniques, and safe exercise sessions plus incremental pedometer walking) and a 40-wk minimally supported phase (smartphone app for sustaining physical activity, private online social network, standardized e-mails, booster session/reunion). Measurement at baseline and 12 wk (both groups) and 12 months (intervention group only) included clinical outcomes (e.g., weight) and self-reported physical activity, diet, and self-rated health.&nbsp; Results&nbsp; Eighty men were recruited in 4 wk; trial retention was &gt;80% at 12 wk and &gt;75% at 12 months. At 12 wk, the intervention group lost 3.6 kg (95% confidence interval, -5.26 to -1.90 kg) more than the comparator group (P &lt; 0.001) and maintained this weight loss to 12 months. The intervention group also demonstrated greater improvements in other clinical measures, physical activity, diet, and self-rated health at 12 wk; most sustained to 12 months.&nbsp; Conclusions&nbsp; Results suggest feasible recruitment/retention of overweight and obese men in the Hockey FIT program. Results provide evidence for the potential effectiveness of Hockey FIT for weight loss and improved health in at-risk men and, thus, evidence to proceed with a definitive trial