Lincolnshire exercise referral evaluation

This document reports on evaluation work completed by the University of Lincoln through the School of Sport and Exercise Science. It examines data stored on the Lincolnshire Sports Partnership’s parachute system regarding patients attending Lincolnshire’s Exercise Referral (ER) Programme, a service funded by Public Health. The analysis was in response to specific questions determined by exercise practitioners, the Lincolnshire Sports Partnership and Public Health Lincolnshire. Data was analysed via a number of statistical methods including Chi-squared and Logistic Regression. The data spanned a period of 3.5 years and included all patients in the database starting a 12-week ER programme between 10th March 2009 through to 22nd August 2012. There were 6637 eligible patients, of which 62.3% completed a 12-week ER programme. Headline findings from the evaluative research identified; 1) There was a significant relationship between those patients who completed the referral programme and a reduction in body mass index (BMI); 2) Those patients completing nine or more (out of 12) weeks of the referral programme were significantly more likely to complete. The number of sessions within a week did not influence completion; 3) There was a significantly increased likelihood for those patients who pay for exercise referral to complete the programme. This was regardless of the deprivation score of their home postcode and 4) There was no significant relationship between the way a referral is initiated and a patient completing a referral programme. More than half of these data were missing; however, hence the validity of this finding is impaired. These findings were used to generate recommendations regarding the data that is currently collected via the parachute system and the processes that are employed by the ER programmes

An evaluation of the success of the ‘Heart-Fit’ phase IV cardiac rehabilitation programme in Newark, Nottinghamshire: a mixed-method approach

Cardiovascular disease (CVD) is the most common cause of death in England and Wales, with cardiac rehabilitation being one of the best examples of long term condition management for CVD patients (Pluss et al., 2011: Clinical Rehabilitation, 25, 79-87). Phase IV cardiac rehabilitation involves the long term maintenance of health in the form of exercise programmes, such as ‘Heart-Fit’. It has been recommended that mixed methods are required to evaluate CVD prevention programmes (National Institute for Health and Clinical Excellence, 2010), therefore this case study aimed to evaluate the success of a phase IV cardiac rehabilitation programme, both qualitatively and quantitatively, outlining the impact on participants. After ethical clearance from an institutional committee, eleven members (age = 71.2, stature = 1.71m, weight = 79.8kg) of the programme (male = 6, female = 5) volunteered to take part in the study. For eligibility purposes, participants attended the programme once a week. Physical measurements of blood pressure (BP), resting heart rate (RHR), Body Mass Index (BMI) were recorded before and after a twelve week intervention period. Both physical activity levels and smoking status were also recorded by a lifestyle questionnaire. Two focus groups (n = 6 & 5) were held to gain participant perceptions on their experiences relating to the performance of the programme. Paired-sample t-tests indicated statistically significant differences (P = 0.05) pre and post intervention. Using a process of thematic analysis, participants revealed six main themes as being important factors during the 12-week programme. These included the instructor’s influence, the social nature of the group, the availability of clinical observation, psychological development and the perceived beneficial physical improvements made. The CVD risk factors influenced by the programme, in accordance to past literature, were systolic and diastolic BP and BMI. Similar themes have been identified in studies that have evaluated the effectiveness of other exercise referral schemes. Qualitative data collection should be considered alongside quantitative measures in evaluations of similar interventions. Future phase IV cardiac rehabilitation programmes need to gain a greater insight into the patient experience. This will enable health planners and policy makers to generate a sense of context on how these programmes operate at local levels and develop models of best-practice

A qualitative evaluation of a regional obesity prevention programme

ABSTRAC

Women Writers of Film & Television Project: Nancy Meyers

The suppression of women’s voices in the film industry is of no secret to our society. For over a hundred years, many women have been placed in the background and were not given credit for their work in the industry, and only recently have the gates of Hollywood been open to more representation. In the 1980s, many women screenwriters were in creative partnerships with their husbands, and it was difficult for a woman screenwriter to be recognized for her own work and talents aside from the man in her life. One screenwriter, Nancy Meyers was able to garner more fame and notability than her ex-husband, Charles Shyer. Meyers and Shyer began working together in the late 1970s, initially writing together and eventually co-writing with Shyer directing. Meyers’ work is renowned for featuring a focus on the female gaze, the woman’s perspective in a story, rather than the widely common male gaze. In Baby Boom (1987), J.C. Wiatt, a stern businesswoman played by Diane Keaton, inherits a baby from a relative. She is forced to give up her New York life for a calmer environment, an old cottage in Vermont. Taking the reins of her life into her own hands, J.C. starts her own business that becomes a great success. This is one of many Meyers creations that represent a woman being more than what society, and the woman herself, expected her to be. In this presentation, I discuss Private Benjamin (1980), Irreconcilable Differences (1984), Baby Boom (1987), and The Parent Trap (1998) and how the presence of a female central gaze represents a woman with agency

A qualitative exploration of social motivational influences in determining the physical activity of 30–60 year old adults

Introduction: Adults over 60–65 years old are a group considered vulnerable to the risks of sedentary lifestyle causing decreased quality of life and poor health. Australian government figures estimate the number of over 65s will reach 8.1 million by 2056, and 11.2 million by 2101. One key opportunity to prevent sedentary lifestyles in older adults is to understand and promote motivation towards physical activity in middle-aged adults. This study qualitatively examined the motivationally relevant behaviours (‘motivational atmosphere’) of key social agents towards physical activity and sedentary lifestyles in adults between 30 and 60 years of age. Methodology: Twenty participants (32–60 years old) of varying activity levels were recruited from local workplaces and a GP referral scheme. Participants took part in semi-structured interviews to examine which social agents affected their motivation towards PA and how/why. A critical rationalist philosophy was deployed in the gathering and analysis of data. Results: Using inductive content analysis, 307 raw themes were coded into 38 categories and five higher dimensions, labelled: (1) providing information and impetus; (2) supporting progress and competence; (3) affiliation and belongingness; (4) logistical considerations; and (5) emotional support. Spouses, close family, work colleagues, GPs and the media were perceived to be highly influential social agents, with many others listed (e.g., personal trainers, local government). Whilst spouses, family and work colleagues influenced motivation through ‘leading-by-example’, ‘reminding/persuading’ and ‘support/encouragement’, GPs and the media were more likely to exert an influence by offering advice, guidance and recommendations, or in some cases ‘sounding-the-alarm-bell’. The consistency of messages from these different agents (media, health professionals, friends/family) was also noted as a key determinant of attitudes and actions. Whilst health was often central to participants’ responses, social interactions and friendships were also key reasons people gave for becoming or staying active (and for being sedentary). Further, there was preliminary evidence that the sources and types of influence changed as a function of current activity level. Conclusion: The results facilitate future interventions by suggesting specific behavioural recommendations in relation to known social agents, as well as guiding theoretical development/ refinement. The findings suggest that interventions should encompass psychological and social as-well-as health considerations, and that health professionals must understand the ‘motivational atmosphere’ of each client. Finally, the findings suggest that future research and modelling should adopt methodologies that better address the complexity inherent in the social determination of motivation

Platform for Health and Wellbeing pilot study: provision of weight management support via the workplace

Introduction: The role of the workplace as an opportunity for improving health has been highlighted in recent reports. The East Midlands Platform for Health and Wellbeing is a network of private, public and voluntary sector organisations working to improve health and reduce obesity. Member organisations commit to undertake actions to improve health and wellbeing of employees, individuals and/or communities. As part of Slimming World’s commitment, this pilot assessed the merits of providing weight management support via the workplace at two large regional employers. Methods: 278 British Gas and Nottingham University Hospitals NHS Trust employees were offered 12 weeks’ support at either a bespoke workplace group or established community-based Slimming World group. Weight change was recorded weekly. Dietary and physical activity behaviours, along with aspects of psychological health were assessed by questionnaire pre and post-programme. Results: 121 employees (meeting inclusion criteria) joined a workplace-based group and 114 a community-based group. Weight and attendance: Mean joining BMI was 32.4kg/m2. 138 (59%) participants completed the programme (attended within final 4 weeks).Behaviour changes: Participants who completed both questionnaires (n=87), reported positive changes in dietary and physical activity behaviours (all p<.001) (figure 1), and psychological health (mental wellbeing, self-worth and self-esteem, all p<0.05). There were no significant differences between worksite and community intervention groups for any outcomes. Conclusion: Providing weight management support via the workplace significantly reduced weight of participants (-3.9%). Completer analysis also revealed positive changes in healthy eating habits and activity levels, and also importantly psychological health, which may impact on working life. The Slimming World programme works effectively within both the work setting and via community-based provision when employees are recruited via the workplace

Time and Difficulty with Tasks and Illness Characteristics Among Caregivers of Individuals Receiving Daily Home Hemodialysis

poster abstractEnd Stage Renal Disease (ESRD) affected approximately 594,374 people in 2010. Patients receiving dialysis often need help with activities of daily living and tasks outside dialysis treatments. The burden of providing assistance and support for such patients can be overwhelming for caregivers, regardless of the modality. This study examined several factors that may be associated with time and difficulty of tasks experienced by caregivers of individuals receiving daily home hemodialysis (HHD). Examining relationships between caregivers age, caregiver income, length of time on dialysis, and patient co-morbidities with perceived time and difficulty with tasks may assist with focusing interventions within specific demographic groups. The purpose of this study is to examine these relationships. This study used existing data from a mixed-methods study. The original study examined needs, concerns, strategies, and advice of daily home hemodialysis caregivers. Participants included 16 caregivers, recruited from a large daily home hemodialysis program in a Mid-western city. There was no relationship between length of time the patient was receiving HHD and time or difficulty with tasks. There was no relationship between age of the caregiver and time or difficulty with tasks. There was no relationship between income and time or difficulty with tasks. There was no relationship between the number of patient comorbidities and time or difficulty with tasks. One important limitation of this study, and possibly the reason that no significant results were discovered, is the small sample size. This study was designed to look at possible factors that may increase perceived caregiver burden. Although there were no relationships found between selected demographic or clinical variables and perceived time expenditure and difficulty with tasks, future research should examine other variables such as relationship of caregiver to patient, caregiver health and comorbidities, and level of involvement of home dialysis staff

Auditing the socio-environmental determinants of motivation towards physically activity or sedentariness in work-aged adults: a qualitative study

Background: There is a lack of understanding of work aged adults’ (30-60 years old) perspectives on the motivation of physical activity versus sedentariness. This study aims to: (1) identify which socio-environmental factors motivate physical activity and/or sedentary behavior, in adults aged 30-60 years; and (2) explore how these motivators interact and combine. Method: Fifteen work-aged adults who were able to engage in physical activity (Mean age = 43.9 years; SD 9.6, range 31-59) participated in semi-structured interviews. Inductive content analysis was used to generate an inventory of socio-environmental factors and their specific influences on motivation towards physical activity or sedentariness. Results: Key socio-environmental agents found to influence motivation included: Spouse/partner, parents, children, siblings, whole family, grandchildren, friends, work-mates, neighbors, strangers, team-mates and class-mates, instructors, health care professionals, employers, gyms and health companies, governments, media and social media, cultural norms, and the physical environment. Mechanisms fell into five broad themes of socio-environmental motivation for both physical activity and sedentariness: (1) competence and progress; (2) informational influences, (3) emotional influences, (4) pragmatics and logistics, and (5) relationships. Similar socio-environmental factors were frequently reported as able to motivate both activity and sedentariness. Likewise, individual categories of influence could also motivate both behaviors, depending on context. Conclusion: The findings of this paper ‘unpack’ theoretical concepts into specific and targeted behavioral recommendations. The data suggested no simple solutions for promoting physical activity or reducing sedentariness, but rather complex and interacting systems surrounding work-aged adults. Findings also suggest that health professionals should be encouraged to support adults’ health by examining the socio-environmental motivational influences, or 'motivational atmosphere

Intended actions, unintended consequences: towards a processual understanding of exercise referral schemes

Whilst the benefits of physical activity have been well documented, many in the UK population remain insufficiently active to substantively benefit their health, placing individuals at greater risk of developing a range of non-communicable diseases and conditions. As a large percentage of the population accesses primary care, at least on an annual basis, the use of this health care sector to advocate increased physical activity has become widespread. Exercise referral schemes (ERSs) have enabled primary care professionals to refer their patients, typically to a local leisure facility, for supervised exercise. ERSs have seen prolific growth across the UK since their conception in the 1990s and yet their effectiveness has remained in question. Despite a variety of research designs being employed, evidence regarding schemes’ effectiveness continues to be inconclusive. Within the existing research literature, the complexity of context within which ERSs operate has remained largely overlooked; specifically, how individual interpretations of ERSs might be co-produced according to the interactions between those central to the service, and how this might influence both service delivery and impact. This study, therefore, aimed to address these lacunae by exploring participants’ understanding of ERSs, and how these perceptions contoured ERS service provision. The research focused on one case-study ERS in the East of England. Semi-structured interviews were employed through a combination of group and one-to-one interviews, with 27 participants (15 patients, 7 exercise practitioners, 5 health professionals) who were central to the ERS at a delivery level, and a further 5 (1 ii district manager, 2 representatives from the County Sports Partnership and 2 representatives from Public Health) one-to-one interviews were conducted with individuals who represented the strategic management of ERSs. A process sociological lens was adopted to provide novel insights into participants’ perceptions of ERSs, their role and their ability to influence ERS service provision. Data were also supported by self-elicited reflections born from the researcher’s ‘insider’ position to the County’s ERS. Thematic analysis generated salient themes that showed conflicting interpretations of ERS service provision, and perceptions of scheme receipt and impact. Data highlighted that the networks of relationships in which individuals were situated not only contoured participant experiences but shaped the delivery processes of ERSs. Individual ‘I’ identities were situated within interdependent networks of ‘we’ and ‘they’ relationships, where identifiable groups were formed according to individuals’ perceived role within the scheme. Relationships between individuals and groups were in a tensile state, marked by power balances that had impacted on service provision but also the associated meaning of ERSs, producing interesting, yet unexpected and unintended outcomes. Such findings could prove useful to policy-makers, those responsible for commissioning ERSs, and practitioners, as well as those in similar roles for other multi-agency interventions. By facilitating enhanced understanding of the complexities of this physical activity intervention, findings suggest how the actions and interpretations of those central to a service can fundamentally alter delivery mechanisms and receipt, potentially influencing the very existence of the intervention, or in this case ERSs