Advancing understanding of effective exercise on referral: a mixed methods evaluation of the Northumberland scheme

Exercise on Referral Schemes (ERS) are a widespread community intervention in which health professionals refer patients to a programme of supervised exercise at leisure facilities. National guidance states routine data should be collected and made available for analyses, and that there is a need to better understand what elements of ERS work, for which subgroups of the population. This thesis examines what elements of behaviour change provision within ERS work, for whom and in what circumstances, in order to gain a better understanding of what influences referral to, engagement with, and adherence to such schemes. First the thesis presents a quantitative evaluation study of 2233 referrals to the 24-week Northumberland ERS in nine leisure facilities between July 2009 and September 2010. Main outcome measures were uptake, 12-week adherence, 24-week completion, and changes in self-reported physical activity, blood pressure, body mass index (BMI) and waist circumference. Two qualitative studies follow, one examining pre-scheme perceptions of 15 referrals and the second following them through the scheme. Data from semi-structured interviews conducted in both studies are presented as three narrative typologies of the referral journey. This research demonstrated that demographics and other factors related to referral minimally increased ability to predict engagement. Completion resulted in significant increases in self-reported physical activity and significant, but small, reductions in BMI and waist circumference. Participants had complex social circumstances, multiple personal reasons for referral and high expectations of positive health changes. Staff and peer support were influential to success, especially if expectations were not met. The narrative typologies help to identify those for whom ERS currently works well, those for whom ERS works but who may struggle with sustained behaviour change, and those for whom it does not work. This novel approach to classifying likelihood of success is used to discuss potential improvements to ERS

The impact of enrollment in a combined reading and learning strategies course on exceptional students\u27 FCAT Reading scale scores

Previous research has shown that because remediation and support replace required and career-defining courses, exceptional students fall behind, ill equipped to act in society as autonomous adults. No Child Left Behind requires reading proficiency, so students failing standardized tests must take remedial courses. Individualized education plans often require support courses. However, there remains an important gap in the literature regarding the usefulness of reading, standardized testing, and leadership research to solve this problem. A class combining reading and support for students with exceptionalities exists at 1 high school. Therefore, the purpose of this study was to explore the combined program to determine whether a specific program intended to meet federal and state performance-based standards affected test scores. This study used a single-group pretest-posttest design to analyze the 2007 and 2008 Florida Comprehensive Assessment Test Reading scale scores of 25 of the 30 students with exceptionalities enrolled in the combined course to determine whether a significant difference existed between these test scores. The paired-sample t test identified a significant difference between pretest and posttest scores, supporting the hypothesis that combining remediation and support increases progress. This study would be an important contribution to the existing literature by providing a viable solution to this problem by offering more opportunities for exceptional students to enroll in courses available to their mainstream peers. It also would enhance social change initiatives by facilitating the graduation and entry into productive adulthood of students with exceptionalities, allowing them to define career interests and remediate deficiencies simultaneously

An evaluation of the effectiveness of the instructional methods used with a Student Response System at a large university

This study investigates the adoption of student response systems (SRS) across a large university campus. The study sought to understand how faculty members were using the SRS and what instructional strategies student and faculty found to be most valuable to their learning. The term “helpful” and the concept of “helpfulness” is used in place of “valuable” as it more clearly communicates to students and faculty the concept of how an SRS is of worth to them. Students were generally positive about the helpfulness of the instructional methods professors were using. Students found the ability to receive immediate feedback on their learning as the most helpful aspect of the SRS. They also felt their comprehension of course material, attendance to lecture, attentiveness/engagement during lecture, participation in lecture, and achievement in the course had increased from using the SRS. The cost of SRS transmitters had a negative effect on many students’ perceptions of the system’s overall utility. The least positive students felt that the cost of purchasing the clicker outweighed the benefits of using a student response system. These students rated the instructional methods as less helpful and rated their comprehension, attendance, engagement, participation, and achievement increasing less than those that felt the cost was worth the benefit.This study investigates the adoption of student response systems (SRS) across a large university campus. The study sought to understand how faculty members were using the SRS and what instructional strategies student and faculty found to be most valuable to their learning. The term “helpful” and the concept of “helpfulness” is used in place of “valuable” as it more clearly communicates to students and faculty the concept of how an SRS is of worth to them. Students were generally positive about the helpfulness of the instructional methods professors were using. Students found the ability to receive immediate feedback on their learning as the most helpful aspect of the SRS. They also felt their comprehension of course material, attendance to lecture, attentiveness/engagement during lecture, participation in lecture, and achievement in the course had increased from using the SRS. The cost of SRS transmitters had a negative effect on many students’ perceptions of the system’s overall utility. The least positive students felt that the cost of purchasing the clicker outweighed the benefits of using a student response system. These students rated the instructional methods as less helpful and rated their comprehension, attendance, engagement, participation, and achievement increasing less than those that felt the cost was worth the benefit

An evaluation of the effectiveness of the instructional methods used with a Student Response System at a large university

This study investigates the adoption of student response systems (SRS) across a large university campus. The study sought to understand how faculty members were using the SRS and what instructional strategies student and faculty found to be most valuable to their learning. The term “helpful” and the concept of “helpfulness” is used in place of “valuable” as it more clearly communicates to students and faculty the concept of how an SRS is of worth to them. Students were generally positive about the helpfulness of the instructional methods professors were using. Students found the ability to receive immediate feedback on their learning as the most helpful aspect of the SRS. They also felt their comprehension of course material, attendance to lecture, attentiveness/engagement during lecture, participation in lecture, and achievement in the course had increased from using the SRS. The cost of SRS transmitters had a negative effect on many students’ perceptions of the system’s overall utility. The least positive students felt that the cost of purchasing the clicker outweighed the benefits of using a student response system. These students rated the instructional methods as less helpful and rated their comprehension, attendance, engagement, participation, and achievement increasing less than those that felt the cost was worth the benefit.This study investigates the adoption of student response systems (SRS) across a large university campus. The study sought to understand how faculty members were using the SRS and what instructional strategies student and faculty found to be most valuable to their learning. The term “helpful” and the concept of “helpfulness” is used in place of “valuable” as it more clearly communicates to students and faculty the concept of how an SRS is of worth to them. Students were generally positive about the helpfulness of the instructional methods professors were using. Students found the ability to receive immediate feedback on their learning as the most helpful aspect of the SRS. They also felt their comprehension of course material, attendance to lecture, attentiveness/engagement during lecture, participation in lecture, and achievement in the course had increased from using the SRS. The cost of SRS transmitters had a negative effect on many students’ perceptions of the system’s overall utility. The least positive students felt that the cost of purchasing the clicker outweighed the benefits of using a student response system. These students rated the instructional methods as less helpful and rated their comprehension, attendance, engagement, participation, and achievement increasing less than those that felt the cost was worth the benefit

Conducting Evaluation Research with Exercise Referral Schemes as an Insider

The case study aims to highlight key methodological and ethical challenges faced whilst conducting mixed methods evaluation research as an insider with a senior position in an exercise referral organization. This case derives from a PhD study exploring the expectations and experiences of participants in an exercise referral scheme for people with non-communicable diseases in northeast England. This case focuses mainly on the qualitative element of the evaluation and gives insight into the value of longitudinal semi-structured interviews as a research tool and the use of a framework approach to analyse the data. It explores some the benefits and dilemmas involved in conducting insider research, and discusses how using a reflective diary can raise awareness of bias; help develop research skills and aid analysis

A mixed method, embedded approach to exploring participation in an exercise referral scheme

The case aims to highlight the potential of using a mixed methods embedded design to understand the effects of an intervention and provide greater understanding of how participant circumstances influence engagement. This case derives from larger a Burdett Trust for Nursing funded project exploring gender perspectives of engagement/non-engagement in an exercise referral scheme in Scotland, United Kingdom. This case focuses on exercise referral participants and gives insight into the value of comparing results, predominantly quantitative longitudinal telephone interviews, with qualitative face-to-face semi-structured interviews. It discusses how writing field notes can add to data collection, raise awareness of bias and aid analysis

Global atrial fibrillation awareness week and the new European Society of Cardiology guidelines

Abstract not available

A modified Delphi study to gain consensus for a taxonomy to report and classify physical activity referral schemes (PARS)

Background: Physical Activity Referral Schemes (PARS), including exercise referral schemes, are a popular approach to health improvement, but understanding of effectiveness is limited by considerable heterogeneity in reporting and evaluation. We aimed to gain consensus for a PARS taxonomy as a comprehensive method for reporting and recording of such schemes. Methods: We invited 62 experts from PARS policy, research and practice to complete a modified Delphi study. In round one, participants rated the need for a PARS taxonomy, the suitability of three proposed classification levels and commented on proposed elements. In round two, participants rated proposed taxonomy elements on an 11-point Likert scale. Elements scoring a median of ≥7, indicating high agreement, were included in the final taxonomy. Results: Of those invited, 47 (75.8%) participated in round one, with high retention in round two (n = 43; 91.5%). 42 were UK-based, meaning the resultant taxonomy has been scrutinised for fit to the UK context only. The study gained consensus for a three-level taxonomy: Level 1: PARS classification (primary classification, provider, setting, conditions accepted [have or at risk of], activity type and funding). Level 2: scheme characteristics (staff structure, staff qualifications, behaviour change theories, behaviour change techniques, referral source, referrers, referral process, scheme duration, session frequency, session length, session times, session type, exit routes, action in case of non-attendance, baseline assessment, exit assessment, feedback to referrer and exclusion criteria) and Level 3: participant measures (demographics, monitoring and evaluation, and measures of change). Conclusion: Using a modified Delphi method, this study developed UK-based consensus on a PARS classification taxonomy. We encourage PARS practitioners and public health colleagues, especially those working with similar service models internationally, to test, refine and use this taxonomy to inform policy and practice

Green Health Partnerships in Scotland; Pathways for Social Prescribing and Physical Activity Referral

Increased exposure to green space has many health benefits. Scottish Green Health Partnerships (GHPs) have established green health referral pathways to enable community-based interventions to contribute to primary prevention and the maintenance of health for those with established disease. This qualitative study included focus groups and semi-structured telephone interviews with a range of professionals involved in strategic planning for and the development and provision of green health interventions (n = 55). We explored views about establishing GHPs. GHPs worked well, and green health was a good strategic fit with public health priorities. Interventions required embedding into core planning for health, local authority, social care and the third sector to ensure integration into non-medical prescribing models. There were concerns about sustainability and speed of change required for integration due to limited funding. Referral pathways were in the early development stages and intervention provision varied. Participants recognised challenges in addressing equity, developing green health messaging, volunteering capacity and providing evidence of success. Green health interventions have potential to integrate successfully with social prescribing and physical activity referral. Participants recommended GHPs engage political and health champions, embed green health in strategic planning, target mental health, develop simple, positively framed messaging, provide volunteer support and implement robust routine data collection to allow future examination of success

What do spontaneous coronary artery dissection survivors want to support their recovery? A qualitative study

Aims: Spontaneous Coronary Artery Dissection (SCAD) is increasingly recognised as an important cause of myocardial infarction predominantly affecting women aged under 50 years. There is limited research addressing female and male SCAD survivors’ experience of, or requirements for, support post-SCAD. This study explored what SCAD survivors wanted to support recovery. Methods and Results: A qualitative study using semi-structured video and telephone interviews. Data were analysed through thematic analysis using the framework approach. We interviewed 20 participants (19 females) with a mean age of 54.6 (+/-SD 8.5 years). Three overarching themes encapsulated participants’ views about support requirements. 1) Education and information. Participants thought healthcare professionals involved in diagnosis and supporting recovery required greater awareness of SCAD and the psychological effect of SCAD. They wanted accessible SCAD information immediately post-event and during the educational component of cardiac rehabilitation. 2) Physical Activity. Requirements were for advice tailored to individuals’ specific needs, physical capabilities, and physical activity preferences. Participants suggested that utilising wearable technology was helpful to encourage a safe return to activity. 3) Psychosocial Support. Participants wanted formal psychosocial support immediately post-event, during cardiac rehabilitation and in the longer term. Conclusion: Better healthcare professional training may improve diagnosis and increase support and awareness of SCAD. SCAD support programmes should provide early SCAD specific education utilising online sources, individually tailor physical activity prescription, offer wearable technology to support a return to being active, and provide short- and longer-term psychosocial support. As SCAD is predominately a female condition, programmes should consider female physical activity preferences