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

A narrative review of global and national physical activity and sedentary behaviour guidelines development processes - The GUidelines Standards (GUS) project

Background: Clinical and public health guidelines serve to direct clinical practice and policy, based on the best available evidence. The World Health Organization (WHO) and national health bodies of many countries have released physical activity and sedentary behaviour guidelines. Despite significant overlap in the body of evidence reviewed, the guidelines differ across jurisdictions. This study aimed to review the processes used to develop global and national physical activity and sedentary behaviour guidelines and examine the extent to which they conform with a recommended methodological standard for the development of guidelines. Methods: We extracted data on nine sets of guidelines from seven jurisdictions (WHO, Australia, Canada, Japan, the Netherlands, United Kingdom, and United States). We rated each set of guidelines as high, medium, or low quality on criteria related to the rigour of the development process. Results: We observed variation in the quality of guidelines development processes across jurisdictions and across different criteria. Guidelines received the strongest overall ratings for criteria on clearly describing the evidence selected and stating an explicit link between the recommendations and the supporting evidence. Guidelines received the weakest overall ratings for criteria related to clearly describing the methods used to formulate the recommendations and reporting external review by experts prior to publication. Evaluated against the selected criteria, the strongest processes were undertaken by the WHO and Canada. Conclusions: Reaching agreement on acceptable guideline development processes, as well as the inclusion and appraisal procedures of different types of evidence, would help to strengthen and align future guidelines

Risk Factors for Leg Ulceration in People Who Inject Drugs: A Cross-Sectional Study

Aims and ObjectivesThe aim of this study was to assess, for the first time in a hard-to-reach population, the risk factors for leg ulceration among PWID, with the objective of making improvements to prevention and care. Background An estimated 4.8 million people globally inject drugs with potential for injecting related harm. Skin and vein damage associated with drug injecting is increasing. Leg ulceration is a chronic condition which in the UK has a prevalence of 15% amongst people who have injected drugs (PWID) compared to 1% in the general population. Glasgow has the highest rate of problematic drug use in Scotland with approximately 13,900 individuals, about 50% of whom are thought to inject. However, the reasons for high prevalence of leg ulceration among PWID are unknown. To support improvements in prevention and care, the dearth of evidence around risk factors for leg ulceration in PWID needs to be addressed.Design A cross-sectional survey of 200 current and former injectors recruited from drugs services in Glasgow, Scotland, to measure skin problems, leg ulceration and injecting habits is reported following STROBE guidelines. Logistic regression modelling examined whether demographics and injecting habits predicted leg ulceration. Results: The likelihood of leg ulceration was increased for those who injected in the groin and the leg. Additionally, injecting in the groin and leg were associated with having a DVT.Conclusion The primary risk factors for leg ulceration in PWID are injecting in the groin and the legs and these are clinically linked to deep vein thrombosis. Injecting into the femoral vein is increasingly common practice for PWID and healthcare practitioners should advise injectors of the increased risk of leg ulceration and DVT and discourage injecting into these areas

Gender differences in uptake, adherence and experiences: a longitudinal, mixed methods study of a physical activity referral scheme in Scotland, UK

Physical activity referral schemes (PARS) are implemented internationally to increase physical activity (PA) but evidence of effectiveness for population subgroups is equivocal. We examined gender differences for a Scottish PARS. This mixed-method, concurrent longitudinal study had equal status quantitative and qualitative components. We conducted 348 telephone interviews across three time points (pre-scheme, 12 and 52 weeks). These included validated self-reported PA and exercise self-efficacy measures, and open-ended questions about experiences. We recruited 136 participants, 120 completed 12-week and 92 completed 52-week interviews. PARS uptake was 83.8% (114/136) and 12-week adherence for those who started was 43.0% (49/114). Living in less deprived areas was associated with better uptake (p=0.021) and 12-week adherence (p=0.020), and with male uptake (p=0.024) in gender-stratified analysis. Female adherers significantly increased self-reported PA at 12 weeks (p=0.005) but not 52 weeks. Males significantly increased exercise self-efficacy between baseline and 52 weeks (p=0.009). Three qualitative themes and eight subthemes developed; gender perspectives, personal factors (health, social circumstances, transport and attendance benefits) and scheme factors (communication, social/staff support, individualisation and age appropriateness). Both genders valued the PARS. To increase uptake, adherence and PA, PARS should ensure timely, personalized communication, individualised, affordable PA and include mechanisms to re-engage those who disengage temporarily

Atrial fibrillation self-management: a mobile telephone app scoping review and content analysis

Atrial fibrillation (AF) affects over 1.4 million people in the UK, resulting in a five-fold increased stroke risk and a three to four times greater risk of severe, disabling stroke. Atrial fibrillation, a chronic disease, requires monitoring, medication, and lifestyle measures. A self-management approach supported by mobile health (mHealth) may empower AF self-care. To assess the need to develop new mHealth self-management interventions for those with AF this review aimed to identify commercially available AF self-management apps, analyse, and synthesize (i) characteristics, (ii) functions, (iii) privacy/security, (iv) incorporated behaviour change techniques (BCTs), and (v) quality and usability. We searched app stores for ‘atrial fibrillation’ and ‘anticoagulation’, and included apps focused on AF self-management in the review. We examined app functions, privacy statements against best practice recommendations, the inclusion of BCTs using the App Behaviour Change Scale, and app quality/usability using the Mobile App Rating Scale. From an initial search of 555 apps, five apps were included in the review. Common functions were educational content, medication trackers, and communication with healthcare professionals. Apps contained limited BCTs, lacked intuitive functions and were difficult to use. Privacy policies were difficult to read. App quality rated from poor to acceptable and no app had been evaluated in a clinical trial. The review reports a lack of commercially available AF self-management apps of sufficient standard for use in healthcare settings. This highlights the need for clinically validated mHealth interventions incorporating evidence-based BCTs to support AF self-management

Parenting and oral health in an inner-city environment: a qualitative pilot study

Background Preventable oral diseases such as dental caries remain common in the United Kingdom. Clustering of poor health is observed within deprived communities, such as inner-city areas, where elevated levels of dental need are associated with lower uptake of dental care. Successful oral health promotion (OHP) initiatives are contingent upon effective community engagement. The aim of this pilot study was to engage with families with young children to explore community views on oral health and dental care and thus tailor OHP initiatives more effectively to their needs. Methods Qualitative research, involving individual interviews and triad focus groups with parents/caregivers, was conducted in a south London inner-city community as part of a ‘Well London’ programme initiative. Results Seventeen parents/caregivers participated in this pilot study. Parents/caregivers described a spectrum of oral health behaviours based on their social history, past dental experiences and cultural influences. All parents described a clear desire to create healthy lives for their children; however, two broad groups were apparent, termed ‘Oral Health Prioritisers’ and ‘Oral Health Non-prioritisers’. The former reported regularly accessing dental care for their children, believing that oral health contributes to systemic health. Non-prioritisers, however, preferentially used key services considered most beneficial to their child’s wellbeing. Dental services were considered a low priority for this group, where oral health was synonymous with absence of pain. Participants in both groups favoured OHP initiatives involving a range of health and social care services, with schools at the epicentre of programmes. First-time parents were proposed as an important group requiring support in future OHP initiatives with evidence suggesting that first-born children may have delayed presentation to a dentist. Conclusions The findings suggest that this inner-city community may contain sub-groups with contrasting perspectives on oral health and oral health behaviours; nevertheless, there was support for a systems approach to oral health promotion initiatives involving a range of health and social care services, including a critcal role for schools, and actively connecting with first-time parents. The findings provide the basis for further research