Children's missed healthcare appointments: professional and organisational responses

Aim. This National Society for the Prevention of Cruelty to Children (NSPCC) funded UK study sought to examine organisational and professional responses to children's missed healthcare appointments. Design/methods. The study comprised two parts: phase I was a web-based scoping and systematic analysis of UK National Health Service healthcare organisations' internal policies on missed appointments. Phase II involved a case study of how missed appointments were managed within one hospital trust, including interviews with hospital-based staff, review of organisational data and examination of policies and ‘systems’ in place. Results Policies. accessed were of variable quality when benchmarked against a predetermined set of evidence-based standards. Additional material (eg, board minutes) gleaned through the searches found an apparent disconnect between nationally determined safeguarding requirements and strategies to reduce the cost pressures arising from missed appointments. Findings from the case study included the continuing use of the adult-centric term ‘did not attend’ (DNA), the challenges that may be inherent in attending appointments (with concomitant sympathy for parents) and a need to further explore general practitioner responses to DNA notifications, particularly given the acknowledged association between missed appointments and child maltreatment. Conclusions. The web-based scoping exercise yielded a small number of organisational policies. These were of variable quality when rated against predetermined standards. Other material gathered through the search strategy found evidence that ‘missed appointment’ strategies aimed at reducing costs did not always acknowledge the discrete needs of children. The case study findings contribute to an understanding of the complexities and challenges of responding to a missed appointment and the importance of taking a child-centred approach

Associations between parenting and substance use, meal pattern and food choices: A cross-sectional survey of 13,269 Norwegian adolescents

Identifying factors that affect adolescent lifestyle behaviors is essential in order to develop effective generic prevention approaches. This study aimed to investigate the association between parental monitoring, parental emotional support, parental-adolescent conflict and adolescent substance use, meal pattern and food choices. The study included data from 13,269 Norwegian adolescents aged 13–16 years collected in 2016. Multivariable logistic regression models adjusted for gender, age and parental education were applied. Results show that low parental monitoring was associated with increased substance use (Odds ratios (OR) ranging from 2.8; 95% Confidence intervals (CI) 2.1–3.6 to OR 3.8; 95% CI, 2.7–5.3) and irregular meal patterns (1.7; 1.3–2.1 to 2.6; 2.1–3.3), low fish intake (1.3;1.0–1.7), and high intake of sugar-sweetened beverages, diet beverages and energy drinks (1.4;1.1–1.7 to 2.1;1.6–2.8). Low parental emotional support was associated with increased substance use (1.8;1.5–2.1 to 2.5;1.9–3.2), irregular meal patterns (2.0; 1.8–2.3 to 2.1;1.9–2.3), low intake of vegetables, fruits and fish (1.3; 1.1–1.5 to 1.5; 1.3–1.7) and high intake of salty snacks, candy, cakes, sugar-sweetened beverages, diet beverages and energy drinks (1.4; 1.2–1.6 to 2.1;1.7–2.5). Finally, high parent-adolescent conflict was associated with increased substance use (2.3; 2.0–2.7 to 2.7; 2.3–3.1), irregular meal patterns (1.6 ;1.5–1.8 to 1.9;1.7–2.1), low intake of fruits and fish (1.3; 1.1–1.5 to 1.5; 1.3–1.7) and high intake of salty snacks, candy, cakes, sugar-sweetened beverages, diet beverages and energy drinks (1.5; 1.3–1.7 to 2.1; 1.8–2.5). Overall, parenting was associated with a range of lifestyle outcomes among adolescents. Family-strengthening interventions may have an impact on multiple public health domains

Demonstrating the applicability of using GPS and interview data to understand changes in use of space in response to new transport infrastructure: the case of the Cambridgeshire Guided Busway, UK

Introduction: Changes to the built environment can contribute to behavioural changes at the population level, including increases in physical activity. Evidence for how such interventions affect behaviour through qualitative understanding complements quantitative evidence of effectiveness of interventions, and may help to strengthen the basis for causal inference. We demonstrate the use of objective data to measure changes in spatial patterning of behaviour and physical activity in response to new transport infrastructure, as well as complementary interview data to understand why changes may have occurred. With a case study approach, we show how study design and a combination of data types can afford a stronger, more contextual package of evidence to meet methodological challenges of evaluating changes to the built environment. Methods: Longitudinal questionnaire, GPS, physical activity monitor, and interview data from the Commuting and Health in Cambridge study (2009–2012) were used to understand changes in mobility and physical activity in response to an environmental intervention, the opening of the Cambridgeshire Guided Busway. Firstly, aggregate maps were derived to explore the spatial patterning of physical activity before and after the Busway opened. Secondly, changes in the size of activity spaces were described and associations with personal and environmental characteristics investigated to understand whose mobility patterns changed. Lastly, narrative data and maps of movement for two individuals as case studies were used to investigate mechanisms behind use of the intervention and related behavioural changes. Results and conclusion: The Busway provided an alternative route for commuting, an additional space for leisure activity, and a new route for accessing greenspaces which may lead to potential changes in physical activity and wellbeing. Findings from studies which draw on multiple data types may be useful for informing the design and delivery of future public health interventions, an area where methods for evaluation and identification of plausible pathways to behavioural change remain underdeveloped

Motivational interviewing for the prevention of alcohol misuse in young adults

Background Alcohol use and misuse in young people is a major risk behaviour for mortality and morbidity. Motivational interviewing (MI) is a popular technique for addressing excessive drinking in young adults. Objectives To assess the effects of motivational interviewing (MI) interventions for preventing alcohol misuse and alcohol‐related problems in young adults. Search methods We identified relevant evidence from the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 12), MEDLINE (January 1966 to July 2015), EMBASE (January 1988 to July 2015), and PsycINFO (1985 to July 2015). We also searched clinical trial registers and handsearched references of topic‐related systematic reviews and the included studies. Selection criteria We included randomised controlled trials in young adults up to the age of 25 years comparing MIs for prevention of alcohol misuse and alcohol‐related problems with no intervention, assessment only or alternative interventions for preventing alcohol misuse and alcohol‐related problems. Data collection and analysis We used the standard methodological procedures expected by Cochrane. Main results We included a total of 84 trials (22,872 participants), with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow‐up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short‐term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence. At four or more months follow‐up, we found effects in favour of MI for the quantity of alcohol consumed (standardised mean difference (SMD) −0.11, 95% confidence interval (CI) −0.15 to −0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD −0.14, 95% CI −0.21 to −0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD −0.12, 95% CI −0.20 to 0.05, or a reduction from 0.144% to 0.131%; moderate quality evidence). We found a marginal effect in favour of MI for alcohol problems (SMD −0.08, 95% CI −0.17 to 0.00 or a reduction in an alcohol problems scale score from 8.91 to 8.18; low quality evidence) and no effects for binge drinking (SMD −0.04, 95% CI −0.09 to 0.02, moderate quality evidence) or for average BAC (SMD −0.05, 95% CI −0.18 to 0.08; moderate quality evidence). We also considered other alcohol‐related behavioural outcomes, and at four or more months follow‐up, we found no effects on drink‐driving (SMD −0.13, 95% CI −0.36 to 0.10; moderate quality of evidence) or other alcohol‐related risky behaviour (SMD −0.15, 95% CI −0.31 to 0.01; moderate quality evidence). Further analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer‐term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants. None of the studies reported harms related to MI. Authors' conclusions The results of this review indicate that there are no substantive, meaningful benefits of MI interventions for preventing alcohol use, misuse or alcohol‐related problems. Although we found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias.info:eu-repo/semantics/publishedVersio

Contribution of the physical environment to socioeconomic gradients in walking in the Whitehall II study

Socioeconomic gradients in walking are well documented but the underlying reasons remain unclear. We examined the contribution of objective measures of the physical environment at residence to socioeconomic gradients in walking in 3363 participants (50-74years) from the Whitehall II study (2002-2004). Individual-level socioeconomic position was measured as most recent employment grade. The contribution of multiple measures of the physical environment to socioeconomic position gradients in self-reported log transformed minutes walking/week was examined by linear regression. Objective measures of the physical environment contributed only to a small extent to socioeconomic gradients in walking in middle-aged and older adults living in Greater London, UK. Of these, only the number of killed and seriously injured road traffic casualties per km of road was predictive of walking. More walking in areas with high rates of road traffic casualties per km of road may signal an effect not of injury risk but of more central locations with multiple destinations within short distances ('compact neighbourhoods'). This has potential implications for urban planning to promote physical activity

Utilizing Technology for Diet and Exercise Change in Complex Chronic Conditions Across Diverse Environments (U-DECIDE): Protocol for a Randomized Controlled Trial

BACKGROUND: The metabolic syndrome is common across many complex chronic disease groups. Advances in health technology have provided opportunities to support lifestyle interventions. OBJECTIVE: The purpose of this study is to test the feasibility of a health technology-assisted lifestyle intervention in a patient-led model of care. METHODS: The study is a single-center, 26-week, randomized controlled trial. The setting is specialist kidney and liver disease clinics at a large Australian tertiary hospital. The participants will be adults with a complex chronic condition who are referred for dietetic assessment and display at least one feature of the metabolic syndrome. All participants will receive an individualized assessment and advice on diet quality from a dietitian, a wearable activity monitor, and standard care. Participants randomized to the intervention group will receive access to a suite of health technologies from which to choose, including common base components (text messages) and optional components (online and mobile app–based nutrition information, an online home exercise program, and group-based videoconferencing). Exposure to the optional aspects of the intervention will be patient-led, with participants choosing their preferred level of engagement. The primary outcome will be the feasibility of delivering the program, determined by safety, recruitment rate, retention, exposure uptake, and telehealth adherence. Secondary outcomes will be clinical effectiveness, patient-led goal attainment, treatment fidelity, exposure demand, and participant perceptions. Primary outcome data will be assessed descriptively and secondary outcomes will be assessed using an analysis of covariance. This study will provide evidence on the feasibility of the intervention in a tertiary setting for patients with complex chronic disease exhibiting features of the metabolic syndrome. RESULTS: The study was funded in 2019. Enrollment has commenced and is expected to be completed by June 2022. Data collection and follow up are expected to be completed by December 2022. Results from the analyses based on primary outcomes are expected to be submitted for publication by June 2023. CONCLUSIONS: The study will test the implementation of a health technology–assisted lifestyle intervention in a tertiary outpatient setting for a diverse group of patients with complex chronic conditions. It is novel in that it embeds patient choice into intervention exposure and will inform health service decision-makers in regards to the feasibility of scale and spread of technology-assisted access to care for a broader reach of specialist services. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry ACTRN12620001282976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378337 INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/3755

Needs assessment for cultural adaptation of Strengthening Families Program (SFP 10-14-UK) in Brazil

This study sought to evaluate the cultural adequacy of materials and procedures of the Strengthening Families Program (SFP 10-14-UK) and to identify requirements for its cultural adaptation to Brazilian families. The descriptive study had 33 informants, including external observers, managers, multipliers, facilitators, adolescents, and parents. The data were collected at a pilot application in the Federal District. Direct observation was applied to four intervention groups, with seven meetings of 150 min for families, parents/guardians and adolescents, and mixed nominal groups at the end of the interventions. The results, analyzed through content analysis and descriptive statistics, provided evidence that SFP was perceived as sufficiently appealing, culturally relevant, and partially clear. Recommendations for cultural adaptation of linguistic aspects of the materials and procedures were made, considering the cultural and educational differences of the participant families. Focus on implementation quality, including infrastructure, families’ mobilization and continuous planning, was recommended. Replication studies in other Brazilian regions and analyses of contextual and political dimensions are suggested