The role of community readiness in the prevention of overweight and obesity in pre-adolescent girls

Overweight and obesity prevention efforts focused on pre-adolescent girls are justified because the health of future mothers can significantly impact the health of their future offspring. Aims and Objectives This thesis aimed to investigate the role of community readiness in the prevention of overweight and obesity in pre-adolescent girls within the Charnwood Borough (Leicestershire) community. Specifically the objectives of this research were to: 1) further the understanding of the concept of community , 2) identify, using focus groups, the key informants and other ecological influences acting on pre-adolescent girls health behaviours, 3) employ the Community Readiness Model (CRM), using key informant interviews, to assess the Charnwood Borough community s knowledge, awareness and readiness to adopt behaviours associated with the prevention of overweight and obesity in pre-adolescent girls, 4) evaluate the usefulness of the CRM for this task and 5) form recommendations for a tailored intervention. Methods This research used focus groups with pre-adolescent girls to identify the key informants who influence their lifestyle choices regarding dietary and physical activity behaviours. The study recruited 56 female participants aged between 6-11 years from 8 primary schools. In total 13 focus groups with between 2 to 7 participants per group were performed. To assess the level of community readiness, 33 key informants identified as informing the health behaviours of pre-adolescent girls were recruited. Semi-structured interviews followed an adapted version of the CRM. The model consists of six dimensions: community efforts; community knowledge of efforts; leadership; community climate; community knowledge of the issue and resources which are scored on a scale of 1 (no awareness) to 9 (high level of community readiness). The average of these scores is the community readiness stage. Findings In relation to the first objective, the definition of a community given by those residing in the Charnwood Borough community included: people and groups of people (e.g. school; religious and parents community groups); characteristics (i.e. geographical area; where people reside; buildings; institutions and the size of the community); sense of belonging and the attempt to improve the community for its members. By valuing the perspectives of pre-adolescent girls, a deepened understanding of the broad range of key informants (Dinner staff, Doctors and dentists, Head teachers, Girl Guide leaders, Government, Grandparents, Neighbours, Parents, Peer group, School cooks, Shop keepers, Siblings, Sports Coaches and Teachers) acting on their health behaviours was achieved (Objective 2). The community readiness score relating to healthy eating and drinking corresponded to the Preparation Stage (Objective 3), whereby influential community members have begun planning efforts by deciding what to do and who will do it and the community offers modest support of efforts promoting healthy dietary behaviours. The community readiness score for physical activity was higher corresponding to the Initiation Stage where there is enough information available to justify efforts and activities are underway to support healthy physical activity behaviours. Qualitatively, the key findings from applying the CRM are that: the effectiveness of community initiatives promoting healthy behaviours can be improved; there are varying levels of concern and awareness regarding unhealthy behaviours and child weight status in the community; social disparities are perceived to exist in community health behaviours; communication between schools and parents are seen as important for the success of school policies; parental attitudes and behaviours inform child behaviours; enjoyment is an important predictor of girls activity levels and aspects of the Charnwood Borough s environment do not support healthy behaviours. The CRM was shown to be an appropriate tool for assessing community readiness (Objective 4) providing the qualitative strengths of the model are emphasised. The community readiness score and the qualitative analysis informed the recommendations for an intervention in the Charnwood Borough (Objective 5). Key aspects of these recommendations include: raising the community s awareness of pre-adolescent girls health behaviours; ensuring all initiatives are accessible and appealing to low income families by working directly with these groups; fostering a greater sense of community through increased community cohesion and social interaction; placing social interaction and enjoyment at the centre of all activities, and attempting to make the healthier option the easier choice through modifications to the environment. Conclusions This thesis is the first to apply the Community Readiness Model to the prevention of overweight and obesity in pre-adolescent girls in the UK and has demonstrated the value of applying a community readiness assessment prior to the implementation of interventions

A critical discussion of the Community Readiness Model using a case study of childhood obesity prevention in England

Recent reforms to the public health system in England aim to generate co-ordinated action between local authorities, healthcare systems and communities to target local health priorities. To support this effort, researchers must contribute and evaluate appropriate strategies for designing interventions tailored to community-specific needs. One strategy is to apply the Community Readiness Model (CRM), which uses key informant interviews to assess a community's readiness to address local issues. This article presents a critical discussion of the CRM developed from a case study of obesity prevention in pre-adolescent girls within a community in the United Kingdom. Data were collected between February and November 2011. We offer lessons learnt and recommendations relating to (i) modifications to the interview guide; (ii) key informant identification; (iii) conducting interviews to theoretical saturation; (iv) using key informants to define their community; (v) key informant's ability to respond on behalf of the community; (vi) using a qualitative model with a quantitative scoring system; and (vii) the optimum application of transcript scoring. In conclusion, the CRM can help researchers, health professionals and local authorities identify the priorities of a community. It is recommended that users of the model be careful to identify and recruit suitable key informants with the help of the community under study, select an appropriate ‘community’ and utilise the qualitative findings to strengthen the interpretation of the readiness score

Development of a universal approach to increase physical activity among adolescents: the GoActive intervention.

OBJECTIVES: To develop a physical activity (PA) promotion intervention for adolescents using a process addressing gaps in the literature while considering participant engagement. We describe the initial development stages; (1) existing evidence, (2) large scale opinion gathering and (3) developmental qualitative work, aiming (A) to gain insight into how to increase PA among the whole of year 9 (13-14 years-old) by identifying elements for intervention inclusion (B) to improve participant engagement and (C) to develop and refine programme design. METHODS: Relevant systematic reviews and longitudinal analyses of change were examined. An intervention was developed iteratively with older adolescents (17.3 ± 0.5 years) and teachers, using the following process: (1) focus groups with (A) adolescents (n=26) and (B) teachers (n=4); (2) individual interviews (n=5) with inactive and shy adolescents focusing on engagement and programme acceptability. Qualitative data were analysed thematically. RESULTS: Limitations of the existing literature include lack of evidence on whole population approaches, limited adolescent involvement in intervention development, and poor participant engagement. Qualitative work suggested six themes which may encourage adolescents to do more PA; choice, novelty, mentorship, competition, rewards and flexibility. Teachers discussed time pressures as a barrier to encouraging adolescent PA and suggested between-class competition as a strategy. GoActive aims to increase PA through increased peer support, self-efficacy, group cohesion, self-esteem and friendship quality, and is implemented in tutor groups using a student-led tiered-leadership system. CONCLUSIONS: We have followed an evidence-based iterative approach to translate existing evidence into an adolescent PA promotion intervention. Qualitative work with adolescents and teachers supported intervention design and addressed lack of engagement with health promotion programmes within this age group. Future work will examine the feasibility and effectiveness of GoActive to increase PA among adolescents while monitoring potential negative effects. The approach developed is applicable to other population groups and health behaviours. TRIAL REGISTRATION NUMBER: ISRCTN31583496.Funding for this development study and the work of all authors was supported, wholly or in part, by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence (RES 590 28 0002). Funding from the British Heart Foundation, Department of Health, Economic and Social Research Council, Medical Research Council, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. The work of Kirsten Corder, Joanna Kesten and Esther M F van Sluijs was supported by the Medical Research Council (MC_UU_ 12015/7 and MC_UU_12015/6).This is the final version of the article. It first appeared from the BMJ Publishing Group via http://dx.doi.org/10.1136/bmjopen-2015-00861

Drug Use in Street Sex worKers (DUSSK) study – results of a mixed methods feasibility study of a complex intervention to reduce illicit drug use in drug dependent female sex workers

OBJECTIVES: The majority of female street-based sex workers (SSWs) are dependent on illicit drugs and sell sex to fund their drug use. They typically face multiple traumatic experiences, starting at a young age, which continue through sex work involvement. Their trauma-related symptoms tend to increase when drug use is reduced, hindering sustained reduction. Providing specialist trauma care to address post-traumatic stress disorder (PTSD) alongside drug treatment may therefore improve treatment outcomes. Aims to (1) evaluate recruitment and retention of participants; (2) examine intervention experiences and acceptability; and (3) explore intervention costs using a mixed methods feasibility study. SETTING: Female SSW charity premises in a large UK inner city. PARTICIPANTS: Females aged 18 years or older, who have sold sex on the street and used heroin and/or crack cocaine at least once a week in the last calendar month. INTERVENTION: Female SSW-only drug treatment groups in a female SSW-only setting delivered by female staff. Targeted PTSD screening then treatment of positive diagnoses with eye movement desensitisation and reprocessing (EMDR) therapy by female staff from a specialist National Health Service trauma service. RESULTS: (1) Of 125 contacts, 11 met inclusion criteria and provided informed consent, 4 reached the intervention final stage, (2) service providers said working in collaboration with other services was valuable, the intervention was worthwhile and had a positive influence on participants. Participants viewed recruitment as acceptable and experienced the intervention positively. The unsettled nature of participant's lives was a key attendance barrier. (3) The total cost of the intervention was £11 710, with staff costs dominating. CONCLUSIONS: Recruitment and retention rates reflected study inclusion criteria targeting women with the most complex needs. Two participants received EMDR demonstrating that the three agencies working together was feasible. Staff heavy costs highlight the importance of supporting participant attendance to minimise per participant costs in a future trial

How parents perceive screen viewing in their 5-6 year old child within the context of their own screen viewing time:a mixed-methods study

Abstract Background Few studies have examined parental perceptions of their child’s screen-viewing (SV) within the context of parental SV time. This study qualitatively examined parents’ perceptions of their 5–6-year-old child’s SV within the context of their own quantitatively measured SV. Methods A mixed-methods design employed semi-structured telephone interviews, demographic and SV questionnaires, objectively-measured physical activity and sedentary time. Deductive content analysis was used to explore parents’ perceptions of, and concerns about, their child’s SV, and management of their child’s SV. Comparisons were made between parent-child dyads reporting low (<2-h per day) versus high SV time. Results Fifty-three parents were interviewed (94.3% mothers), with 52 interviews analysed. Fifteen parent-child dyads (28.8%) exceeded the 2-h SV threshold on both weekdays and weekend days; 5 parent-child dyads (9.6%) did not exceed this threshold. The remaining 32 dyads reported a combination of parent or child exceeding/not exceeding the SV threshold on either weekdays or weekend days. Three main themes distinguished the 15 parent-child dyads exceeding the SV threshold from the 5 dyads that did not: 1) parents’ personal SV-related views and behaviours; 2) the family SV environment; and 3) setting SV rules and limits. Parents in the dyads not exceeding the SV threshold prioritized and engaged with their children in non-SV behaviours for relaxation, set limits around their own and their child’s SV-related behaviours, and described an environment supportive of physical activity. Parents in the dyads exceeding the SV threshold were more likely to prioritise SV as a shared family activity, and described a less structured SV environment with minimal rule setting, influenced their child’s need for relaxation time. Conclusions The majority of parents in this study who exceeded the SV threshold expressed minimal concern and a relaxed approach to managing SV for themselves and their child(ren), suggesting a need to raise awareness amongst these parents about the time they spend engaging in SV. Parents may understand their SV-related parenting practices more clearly if they are encouraged to examine their own SV behaviours. Designing interventions aimed to create environments that are less supportive of SV, with more structured approaches to SV parenting strategies are warranted

In vitro rooting of regenerants of blue poplar

The article presents the research results of the influence of hormonal composition of the culture medium and cultivation duration on regenerants of Populus pruinosa at the stage of rooting in vitro. 98,3±1,7 % of regenerants rooted on MS culture medium with 1,0 mg L−1 IMА during 8 weeks of cultivation.Приведены результаты исследований влияния гормонального состава питательной среды и длительности культивирования на растения-регенеранты тополя сизолистного на этапе укоренения in vitro; 98,3±1,7 % регенерантов укоренялись на питательной среде МС, дополненной 1,0 мг/л ИМК, в течение 8 недель культивирования

Using the Recommended Summary Plan for Emergency care and Treatment (ReSPECT) in care homes:a qualitative interview study

BACKGROUND: The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is an advance care planning process designed to facilitate discussion and documentation of preferences for care in a medical emergency. Advance care planning is important in residential and nursing homes. AIM: To explore the views and experiences of GPs and care home staff of the role of ReSPECT in: (i) supporting, and documenting, conversations about care home residents’ preferences for emergency care situations, and (ii) supporting decision-making in clinical emergencies. SETTING/PARTICIPANTS: Sixteen GPs providing clinical care for care home residents and 11 care home staff in the West of England. METHODS: A qualitative research design using semi-structured interviews. RESULTS: Participants’ accounts described the ReSPECT process as facilitating person-centred conversations about residents’ preferences for care in emergency situations. The creation of personalised scenarios supported residents to consider their preferences. However, using ReSPECT was complex, requiring interactional work to identify and incorporate resident or relative preferences. Subsequent translation of preferences into action during emergency situations also proved difficult in some cases. Care staff played an important role in facilitating and supporting ReSPECT conversations and in translating it into action. CONCLUSIONS: The ReSPECT process in care homes was positive for GPs and care home staff. We highlight challenges with the process, communication of preferences in emergency situations and the importance of balancing detail with clarity. This study highlights the potential for a multi-disciplinary approach engaging care staff more in the process