Experiences, attitudes, barriers and facilitators of physical activity among first-generation Somali migrants aged 40+ years in Bristol, United Kingdom

Physical inactivity is a significant public health issue among adults and older adults from Black African and other racially minoritised groups, including the Somali community. Lack of physical activity is an important contributor to high levels of inequalities among the Somali community in Bristol. There is insufficient evidence on what works to improve physical activity levels among the Somali community. Therefore, this thesis aims to explore the experiences, barriers and facilitators of physical activity among adults and older adults from the Somali community in Bristol, United Kingdom. A systematic review of qualitative studies on the barriers and facilitators of physical activity among adults and older adults from racially minoritised groups was undertaken first to establish the scope and nature of existing evidence. An explanatory sequential mixed-methods approach involving a survey to determine physical activity levels among the target group and investigate awareness, barriers and facilitators of physical activity was subsequently undertaken. A follow-up qualitative study was conducted with ten members of the Somali community to further explore the critical issues identified in the survey. The findings from the research show that, although members of the Somali community in Bristol are generally aware of the health benefits of physical activity, there are important environmental, sociocultural and practical barriers that prevent them from engaging in physical activity. These factors range from lack of suitable outdoor spaces to lack of culturally appropriate facilities within the local environment. This study demonstrates the importance of designing targeted and culturally appropriate interventions to improve uptake of physical activity. Community-led initiatives can improve participation in physical activity among members of the Somali community. Findings also highlight the need for adopting a whole-systems approach to dealing with physical inactivity among racially minoritised communities

Built and natural environment planning principles for promoting health: An umbrella review

© 2018 The Author(s). Background: The built and natural environment and health are inextricably linked. However, there is considerable debate surrounding the strength and quality of the evidence base underpinning principles of good practice for built and natural environment design in promoting health. This umbrella review aimed to assess relationships between the built and natural environment and health, concentrating on five topic areas: neighbourhood design, housing, food environment, natural and sustainable environment, and transport. Methods: A structured search was conducted for quantitative systematic reviews and stakeholder reviews published between January 2005 and April 2016. Seven databases and the websites of 15 relevant and respected stakeholder organisations known to publish review-level documentation were searched. Searches were limited to English-language publications and duplicate references were removed. Evidence quality and strength was appraised using validated techniques. Findings were used to develop a diagram for each topic area, illustrating relationships between built and natural environment planning principles and health-related outcomes. Results: A total of 117 systematic reviews and review-level documents were eligible for inclusion. The quality of evidence was mixed; much of the evidence examined relied on findings from cross-sectional studies, making it difficult to draw clear causal links between built environment exposures and health-related impacts and outcomes. Fourteen actionable planning principles associated with positive health-related outcomes were identified across the five topic areas. For example, neighbourhoods that enhanced walkability, were complete and compact in design, and those which enhanced connectivity through safe and efficient infrastructure were associated with better health-related outcomes relating to physical activity, social engagement, mental health, perceptions of crime, and road traffic collisions. Evidence for the effectiveness of planning principles across different topic areas and on reducing health inequalities was sparse and inconclusive. Conclusions: Findings provide an up-to-date overview of relationships between the built and natural environment and health and present logical, evidence-based messages to aid communication between public health and planning professionals

The role of home adaptations in improving later life

This report summarises the findings of a systematic review of the best, available scientific evidence on how home adaptations can contribute to improving later life. Living in a suitable home is crucially important to a good later life. The right home environment can maintain or improve people’s physical and mental health, wellbeing and social connections,enable them to carry out day-to-day activities safely and comfortably, and help them to do thethings that are important to them. More than 90% of older people in England live in mainstream housing, as opposed to specialist housing or residential care. However, current UK housing stock is often not accessible or adapted to meet people’s needs as they get older, with small room sizes, steep internal stairs, baths rather than showers and steps outside.While many people will maintain good health and fitness for much of their later years, the likelihood of having one or more long-term condition, physical impairments,disabilities and frailty that make day-to-day life at home more difficult does increase with age. The percentage of people who have difficulty with at least one activity of daily living (basic routine activities like eating, bathing and dressing) increases dramatically from 16% at age 65 to around half of those aged 85. By people’s late 80s, more than one in three people have difficulty undertaking fiveor more activities of daily living unaided (Marmot et al 2016). Installing aids and adaptations into people’s homes, such as grab rails and level access showers, can improve the accessibility and usability of a person’s home environment, maintaining or restoring their ability to carryout day-to-day activities safely and comfortably.The last comprehensive review of the evidence on home adaptations was published in 2007. Since then, there has been increasing policy attention paid to the benefits of home adaptations, particularly in relation to how they can reduce health and social care costs, many of which are outlined in this review. However, there should be much greater focus and action given to the widely acknowledged and unsustainable pressures on our health and social care systems, coupled with the fact that we are living for longer and the proportion of older people in our society is growing. In the last Spending Review, the budget for the Disabled Facilities Grant was increased to enable greater access to home adaptations for more people, yet there is still an unacceptable and under-reported number of people not getting the equipment and support they need. This review aims to provide an up-to-date analysis of evidence of the importance and effectiveness of home adaptations

Healthy people healthy places evidence tool: Evidence and practical linkage for design, planning and health

This project was commissioned by Public Health England to address the need for a UK centric evidence review which analyses and demonstrates the links between health and the built and natural environment. This umbrella review attempts to provide an overview, based on umbrella review methodology outlined in this document, of the strength of the evidence of the impacts on health of the built and natural environment with the purpose to inform action and policy

Designing healthier neighbourhoods: A systematic review of the impact of the neighbourhood design on health and wellbeing

Several studies have investigated the impact of neighbourhood design on health and wellbeing, yet there are limited reviews investigating the quality of the evidence and the most effective interventions at a population level. This systematic review aims to clarify the impact of the neighbourhood design on health and wellbeing and evaluate the quality of the evidence underpinning such associations. Eight electronic databases were searched for studies conducted between 2000 and 2016. Additional searches were conducted on Google to identify potentially eligible grey literature. A total of 7694 studies were returned from the literature search, and a final selection of 39 studies were deemed eligible for inclusion. Quality appraisal was conducted using the Quality Assessment Tool for Quantitative Studies. Findings from the studies showed important associations between neighbourhood design principles such as walkability, access to green space and amenities on health and wellbeing. Findings from this review also highlight areas with inconsistent findings and gaps in the evidence for future research

Estimating the prevalence, hospitalisation and mortality from type 2 diabetes mellitus in Nigeria: a systematic review and meta-analysis

Background There is not yet a comprehensive evidence-based epidemiological report on type 2 diabetes mellitus (T2DM) in Nigeria. We aimed to estimate country-wide and zonal prevalence, hospitalisation and mortality rates of T2DM in Nigeria. Methods We searched MEDLINE, EMBASE, Global Health, Africa Journals Online (AJOL) and Google Scholar for population and hospital-based studies on T2DM in Nigeria. We conducted a random-effects meta-analysis on extracted crude estimates, and applied a meta-regression epidemiological model, using the United Nations demographics for Nigeria in 1990 and 2015 to determine estimates of diabetes in Nigeria for the two years. Results 42 studies, with a total population of 91 320, met our selection criteria. Most of the studies selected were of medium quality (90.5%). The age-adjusted prevalence rates of T2DM in Nigeria among persons aged 20–79 years increased from 2.0% (95% CI 1.9% to 2.1%) in 1990 to 5.7% (95% CI 5.5% to 5.8%) in 2015, accounting for over 874 000 and 4.7 million cases, respectively. The pooled prevalence rate of impaired glucose tolerance was 10.0% (95% CI 4.5% to 15.6%), while impaired fasting glucose was 5.8% (95% CI 3.8% to 7.8%). Hospital admission rate for T2DM was 222.6 (95% CI 133.1 to 312.1) per 100 000 population with hyperglycaemic emergencies, diabetic foot and cardiovascular diseases being most common complications. The overall mortality rate was 30.2 (95% CI 14.6 to 45.8) per 100 000 population, with a case fatality rate of 22.0% (95% CI 8.0% to 36.0%). Conclusion Our findings suggest an increasing burden of T2DM in Nigeria with many persons currently undiagnosed, and few known cases on treatment

Healthy buildings for a healthy city: Is the public health evidence base informing current building policies?

Research has demonstrated that housing quality is a key urban intervention in reducing health risks and improving climate resilience, addressing a key ambition of the United Nations Sustainable Development Goals. Yet housing quality remains a problem even in high income countries such as England. In particular, hazards such as excess cold, excess heat and lack of ventilation leading to damp and mould have been identified as a major issue in homes. Research shows that these hazards can lead to a range of health conditions, such as respiratory and cardiovascular disease, infections and mental health problems. This article explores the use of public health research and evidence in policy to regulate new buildings in England to deliver improved public health, climate resilience and a reduced carbon footprint, in particular exploring the policy drivers and awareness of the public health evidence. Findings show that public health evidence is hardly referenced in policy and that the focus on other evidence bases such as on climate mitigation in building regulations results in both positive and negative impacts on health. This reflects a lack of a systems approach around urban interventions leading to weaknesses in standards regulating the private development sector. In conclusion, this paper recommends: 1. the consideration of health impact in future building regulations; 2. the integration and coordination of key policies covering various scales and phases of the development processes and 3. the better education of residents to understand advances in new energy performance technologies

Recruitment, employability and career development for international students undertaking the UWE MSc Public Health: Final report

Executive SummaryBackgroundOver the last decade, the MSc Public Health at UWE has successfully recruited many international students. An issue for the university in promoting the benefits of the programme internationally is that there is a good career structure in UK public health for those from backgrounds other than medicine, but this is not necessarily the case for international students.Aims and objectivesThe aims were (1) to inform the career guidance we give our international MSc PH students to better enable them to pursue their individual careers and (2) to contribute to developing the Public Health and Wellbeing Research Group’s research on international public health workforce capacity development. To achieve these aims we had two more specific objectives: (1) to map the public health career development of UWE international MSc PH alumni and (2) to map the public health career structures, professional bodies and registration requirements of countries from which students are recruited.MethodsThis was a mixed methods research project based on an online survey, telephone and face-to-face semi-structured interviews and web-searching. Element 1 focused on the public health career experiences of our MSc international students over the last ten years. A purposive sample of 97 international alumni was emailed with a request to participate in the online survey. The survey included an option to consent for a further follow up interview. Element 2 involved mapping public health career structures, professional bodies and registration in countries from which international students attended over the last ten years. For each country, an internal search was conducted for national public health bodies, associations and registers, and key informants were contacted.4ResultsForty-seven alumni responded and answered at least one question in the online survey. The majority of participants were employed by international organisations, academic institutions, and state agencies or were at different stages of PhD studies. Participants reported increased public health career experiences in public health research roles, public health leadership, and policy analysis and in planning, implementing and evaluating public health programmes. Participants had confidence in applying public health skills, especially research, critical thinking, academic writing as well as demonstrating public health leadership skills and the application of multidisciplinary approaches to address public health issues. Recommendations included provision of longer public health placements, optional courses on project management and advanced statistics, and continued internationalisation of the curriculum. Overall, alumni satisfaction was high in relation to the relevance and impact of the skills and knowledge they acquired during their MSc Public Health at UWE.Discussion and conclusionsThe results of this study were consistent with other studies of alumni of MSc Public Health programmes. The study has provided useful feedback on the UWE MSc Public Health programme and a number of helpful recommendations were made by alumni which will be addressed by the programme team. Implications for further research include studies of international employers’ perspectives on the value and limitations of the MSc Public Health and on public health registratio