A lifestyle change, not a forever diet: one service user’s experience of accessing a local health trainer service

Carol Scurr accessed her local health trainer service in Newcastle-upon-Tyne between 2009 and 2011. Here, Carol and Shelina Visram, from Durham University, tell us how she learnt to manage her weight with the help of Choose 2 Lose, a group set up by health trainers in the east end of Newcastle. This group has recently been redesigned and relaunched in the west end of the city and is currently led by the HealthWORKS physical activity team, with health trainer support. My issues with food started from a young age. I’ve lived in Newcastle my whole life, but my mum grew up in Ireland as one of six children. Food was scarce and they would steal from the nearby farmer’s field just so they could live. As a result, the whole family is food obsessed. Even though we didn’t have much money and I was dressed in hand-me-down clothes, we ate like kings and queens. The cupboards were always full and as long as the family were well fed, my mum was happy. She loved to feed people and I’m the same. People always say, “Oh, you’re never short of a meal

Building capacity for mental health resilience – local impact of the UK Better Mental Health Fund

BackgroundCOVID-19 as a public mental health emergency has exacerbated existing mental health inequalities. The UK government invited local authorities with areas of high deprivation to apply for a year of funding, in order to address the mental health impacts of COVID-19 and incentivize investment in prevention and promotion interventions for better mental health. South Tyneside Council in North East England made a successful bid to the Better Mental Health Fund (BMHF), and distributed grants to 7 organisations delivering 13 programs. A qualitative evaluation of these programs aimed to answer the following questions:1. How were the funded programs implemented?2. What difference did they make to local beneficiaries?3. How might these programs and their impacts be sustained into the future?4. Has the BMHF led to any wider impacts on organisations and local communities?MethodsIn-depth interviews with individuals, pairs and groups were conducted online or in person with service providers and beneficiaries. Non-verbatim transcripts were made from recordings, checked with verbatim transcripts from Teams and Zoom, and analyzed thematically to generate a coding frame. Throughout the analysis, comparisons were made between organizations and programs.ResultsFifteen interviews involving 22 participants lasting up to an hour each were conducted. The main themes identified as impactful were 1) community approaches based on supportive and good relationships between the local authority public health lead and participating organizations (mainly voluntary agencies), enabling 2) capacity-building for mental health resilience and 3) community empowerment. This was despite the short turnaround of the grant application process, limited time to deliver on targets, and anxieties about future sustainability.Conclusionsindividuals, pairs and groups were conducted online or in person with service providers and beneficiaries. Non-verbatim transcripts were made from recordings, checked with verbatim transcripts from Teams and Zoom, and analyzed thematically to generate a coding frame. Throughout the analysis, comparisons were made between organizations and programs.ConclusionsShort-term funding can build capacity in mental health resilience in deprived areas if administered by public health leaders who relate well with provider organizations.Key messages• Public health leaders who relate well with provider organizations are key drivers of community health promotion strategies that include mental health capacity building.• Qualitative methods used in evaluations can inform public health commissioning by capturing the benefits and challenges of short-term funding for interventions promoting community mental health

P60 “It's like the service that was never there” : a qualitative longitudinal study of lay health trainer services in the North East of England

Background: Despite considerable improvements in the overall health of the UK population, the gap between the richest and poorest groups in society continues to widen. Health Trainers are a new workforce introduced in the 2004 ‘Choosing Health’ White Paper to adress these inequalities by targeting individuals from the poorest groups and supporting them to make healthy lifestyle choices. The largely grass-roots development of Health Trainers has resulted in a diversity of local service models that lack sound theoretical or empirical basis. However, the role provides an opportunity to enhance our understanding of the needs of typically ‘hard-to-reach’ communities and develop tailored behaviour change interventions. Objectives: To conduct an in-depth exploratory study of the ways in which contrasting Health Trainer models influence behaviour change. Design: Qualitative longitudinal study, involving serial interviews conducted over a 12-month period. The interviews have been audio-recorded, transcribed verbatim and analysed using the constant comparative method associated with grounded theory. Setting and Participants: 26 clients, 13 Health Trainers and 5 managers theoretically sampled from 3 local Health Trainer Services in the North East of England. Results: The Health Trainer services are characterised by diversity in terms of the main target groups, modes of client engagement and degree of emphasis on individual behaviour change. This has implications for the extent to which they are integrated (or not) into local public health systems, and also for the experiences of staff and service users. An emerging theme is the perception that these services are more flexible and holistic than similar lifestyle interventions, and that they address multiple priorities for clients. The importance of delivering interventions in appropriate settings was emphasised, particularly where clients have limited or negative experience of accessing other forms of support. The fact that Health Trainers tend to be members of the local community was often perceived to act as a facilitator of clients’ ongoing engagement with the service. Conclusions: These preliminary findings highlight the potential role for Health Trainers in engaging with individuals from disadvantaged areas and attempting to facilitate their access into the health care system. Health Trainers are being embedded as an integral part of regional and local work on tackling health inequalities, as well as addressing a cross-Government agenda. The findings of this study will be used to inform the development and evaluation of the role, as well as generating new evidence to assist practitioners in overcoming the barriers to successfully working with local communities

Tell me about your childhood...using life grids to gather information on health-related behaviours and experiences across the life course

Socio-economic status and conditions are known to be key determinants of health and inequality. These factors exert influence over the life course, with both past and present health experiences being shaped by the wider social, economic and cultural context. Numerous epidemiological studies have employed a life course approach to investigate the ways in which health-damaging exposures or health-promoting opportunities contribute to social inequalities in health. Individual responses to these exposures are socially patterned and also influenced by experience. Qualitative research can be used to explore life experiences by emphasising a temporal and social perspective. This paper examines the role of biography and context in shaping the health experiences of individuals living in socio-economically disadvantaged communities. In-depth interviews were conducted with a purposive sample of 23 participants in a lay-led health improvement intervention. A life grid approach was used to explore associations between past experiences and present health-related behaviours, and to reach a holistic understanding of different aspects of behaviour change. This paper will describe the life grid as a data collection method, present findings to offer insight into the participants’ biographies, and discuss the contribution of multiple, cumulative disadvantage across the life course to contemporary health inequalities. Improved understanding of the factors that influence health behaviours and the likelihood of successful behaviour change will be of interest to policy makers and service planners. This paper also highlights the advantages and disadvantages of using a life grid approach in social (as opposed to epidemiological) research

A qualitative longitudinal approach to exploring service user experiences of lay-led heath improvement interventions

Lay health advisors (LHAs) have been widely used to deliver primary care and health promotion programmes. Although there is some data to support their efficacy, reviews have consistently found insufficient evidence to assess which LHA strategies are likely to be most effective. Furthermore, there is a dearth of research exploring service user views and perceptions. This paper aims to contribute to evidence and theory in relation to lay-led models of working with health deprived communities. By adopting an interpretive, longitudinal approach informed by grounded theory, the intention was to provide insight into the users’ experiences and the mechanisms underlying the intervention outcomes. In-depth interviews with service users (n=26) were conducted at 0, 3, 6 and 12 months, and with LHAs and supervisors (n=18) at 0 and 12 months. The interviews were audio-recorded, transcribed verbatim and analysed using the constant comparative method. LHAs were found to employ a holistic, asset-based approach that takes into account the context of a person’s life and their access to resources for health. This builds upon the salutogenic theory of health, and is in direct contrast to the paternalistic, deficit model traditionally found in public health medicine. This research is one of few qualitative studies investigating the role of LHAs in the UK. Furthermore, the use of a longitudinal approach is innovative and likely to produce results that have high policy relevance. It represents an important application of a user-focused perspective affording new insights which may also be applied to other complex health interventions

Consumption of energy drinks by children and young people: a systematic review examining evidence of physical effects and consumer attitudes

ObjectiveTo update an earlier review, published in 2016, on the health and other outcomes associated with children and young people's consumption of energy drinks (EDs).Study designReview article.Systematic reviewSystematic searches of nine databases (ASSIA, CINAHL, Cochrane Library, DARE, Embase, ERIC, MEDLINE, PsycINFO and Web of Science) retrieved original articles reporting the effects of EDs experienced by children and young people up to the age of 21 years. Searches were restricted by publication dates (January 2016 to July 2022) and language (English). Studies assessed as being weak were excluded from the review. Included studies underwent narrative synthesis.ResultsA total of 57 studies were included. Boys consumed EDs more than girls. Many studies reported a strong positive association between ED consumption and smoking, alcohol use, binge drinking, other substance use and the intentions to initiate these behaviours. Sensation-seeking and delinquent behaviours were positively associated with ED consumption, as were short sleep duration, poor sleep quality and low academic performance. Additional health effects noted in the updated review included increased risk of suicide, psychological distress, attention-deficit hyperactivity disorder symptoms, depressive and panic behaviours, allergic diseases, insulin resistance, dental caries and erosive tooth wear.ConclusionsThis review adds to the growing evidence that ED consumption by children and young people is associated with numerous adverse physical and mental health outcomes. Where feasible and ethical, additional longitudinal studies are required to ascertain causality. The precautionary principle should be considered in regulatory policy and restriction of ED sales to this population

Factors influencing pharmacists’ roles in preventing prescription and over-the-counter opioid misuse: a systematic review and narrative synthesis

BackgroundThe prescribing rate of opioids is increasing and is a main contributor to opioid misuse. Community pharmacists can help reduce opioid misuse rates by carrying out prescription and over-the-counter (OTC) opioid misuse prevention services. Understanding the barriers and facilitators to community pharmacists’ involvement has the potential to improve these services.ObjectiveTo review the literature on the barriers and facilitators of community pharmacists’ involvement in prescription and OTC opioid misuse prevention.MethodsA systematic review of primary research was carried out in MEDLINE, Embase, Scopus, Web of Science, CINAHL, and APA PsycINFO from January 2022 to March 2022. Narrative synthesis underpinned by the COM-B model was used to analyse findings from the included articles. Studies were included if they used qualitative or mixed methods; published in English and focussed on OTC or prescription opioids.ResultsTen studies were included in the review. Barriers and facilitators were grouped into individual, environmental, and system-level factors. Based on the COM-B model, these factors were classified as capabilities (knowledge and skill), opportunities (e.g. relationship with prescribers, time), and motivation (pharmacists’ attitude).ConclusionImproving pharmacists’ capabilities and opportunities might improve pharmacists’ motivation to offer opioid misuse services. This could improve pharmacists’ behaviour, that is, their role in preventing prescription and OTC opioid misuse. The findings of this review were based on information obtained from primary evidence from qualitative studies; However. further empirical work is needed to identify how pharmacists can be supported