A systematic review of hand-hygiene and environmental-disinfection interventions in settings with children

Background: Helping adults and children develop better hygiene habits is an important public health focus. As infection causing bacteria can live on one’s body and in the surrounding environment, more effective interventions should simultaneously encourage personal-hygiene (e.g. hand-hygiene) and environmental-disinfecting (e.g. cleaning surfaces). To inform the development of a future multi-faceted intervention to improve public health, a systematic literature review was conducted on behavior change interventions designed to increase hand-hygiene and environmental-disinfecting in settings likely to include children. Methods: The search was conducted over two comprehensive data-bases, Ebsco Medline and Web of Science, to locate intervention studies that aimed to increase hand-hygiene or environmental-disinfecting behavior in settings likely to include children. Located article titles and abstracts were independently assessed, and the full-texts of agreed articles were collaboratively assessed for inclusion. Of the 2893 titles assessed, 29 met the eligibility criteria. The extracted data describe the Behavior Change Techniques (version 1) that the interventions employed and the interventions’ effectiveness. The techniques were then linked to their associated theoretical domains and to their capability-opportunity-motivation (i.e., COM-B model) components, as described in the Behavior Change Wheel. Due to the heterogeneity of the studies’ methods and measures, a meta-analysis was not conducted. Results: A total of 29 studies met the inclusion criteria. The majority of interventions were designed to increase hand-hygiene alone (N = 27), and the remaining two interventions were designed to increase both hand-hygiene and environmental-disinfecting. The most used techniques involved shaping knowledge (N = 22) and antecedents (N = 21). Interventions that included techniques targeting four or more theoretical domains and all the capabilityopportunity-motivation components were descriptively more effective. Conclusions: In alignment with previous findings, the current review encourages future interventions to target multiple theoretical domains, across all capability-opportunity-motivation components. The discussion urges interventionists to consider the appropriateness of interventions in their development, feasibility/pilot, evaluation, and implementation stages. Registration: Prospero ID - CRD4201913373

Addressing Health Disparities: Action Research in the Design and Development of Health Promotion Programmes for Young People

Introduction: Hearty Lives (HL) is a £1.2 million programme established by the British Heart Foundation which aims to reduce health inequalities, particularly by supporting those ‘at greatest risk’ of Cardiovascular Disease (CVD). Six programmes have been set up (Adur, Glasgow, Liverpool, Manchester, Renfrewshire & Wolverhampton) to reduce the incidence of CVD risk factors in children and young people (aged 11-18 years old). Leeds Beckett University (LBU) is conducting the national three-year evaluation of the HL programmes. Objectives: The national evaluation aims to extract key learnings and provide recommendations for working with vulnerable populations (at greater risk of CVD). This is done through an action research methodology. Methods: Within this action research approach, a case study methodology has been used to recognise the uniqueness of each HL project. Impact and process outcomes are being collected to assess HL intervention effectiveness and to establish what processes led to the success or shortcomings of each approach. Key stakeholders views towards HL interventions were captured. Results: The evidence produced from the first year fed into the refinement and development of each of the six HL interventions in the second year. The 6 HL interventions have considered stakeholders views in order to develop tailored and flexible HP interventions. This is considered key when addressing health disparities (Jacobs et al., 2012). All HL interventions recognise the importance of planning for sustainability and putting strategies in place to ensure that they can be continued beyond the three year funding. Developing links with partners, delivering training to multiple stakeholders and accessing other sources of funding are key to consider in the sustainability of such HP interventions. Conclusion: This research highlights the benefits of a collaborative action research approach. It identifies the value of evaluation teams working alongside stakeholders to refine and develop feasible, acceptable and efficacious HP interventions

A Qualitative Exploration of Key Stakeholders Views towards Designing Health Promotion Interventions for Looked After Children

Introduction: Looked After Children (LAC) are some of the most vulnerable and socially excluded in society (Golding, 2008). Hearty Lives (HL) is £1.2 million British Heart Foundation project designed to reduce health inequalities by supporting those at greatest risk of cardiovascular disease. Two of the six sites focussed on addressing inequalities specifically in children in the social care context. Objectives: The research aimed to gather stakeholders’ views in the design, development and refinement of the HL, health promotion intervention (HP based interventions) to ensure they were acceptable and feasible for LAC and/or carers. Method: 14 qualitative semi-structured interviews were conducted with stakeholders. Interviews explored views towards the HL intervention and what they felt were the key factors to consider in designing HP interventions in the social care context. Results: Stakeholder views revealed two approaches to working with LAC. One approach was to develop an in-house intervention that targeted LAC and care home workers in a safe, familiar environment. Stakeholders believed the key to this approach was taking time to build trust and rapport with the children which increased the likelihood of children engaging and adhering to the HP intervention. Stakeholders suggested a second, more cost and time effective, approach was to target LAC carers and home workers directly. The carers could then filter and transfer the healthy lifestyle/educational messages to LAC. This removed barriers to accessing LAC. Conclusions: Stakeholders views suggest that both in-house interventions and interventions targeted at LAC workers are acceptable and feasible approaches to working with LAC. Their views suggest that targeting LAC workers could be a more sustainable method of delivering HP interventions. Further research is needed to establish the effectiveness of different approaches to engaging LAC in health promotion

“What’s the Point when you only lose a pound?” Reasons for attrition from a multi-component childhood obesity treatment interventions: a qualitative inquiry.

This study explored the causes of drop-out from a community-based multicomponent childhood obesity treatment intervention (MCTI), considering parent and child perspectives in order to develop future interventions which manage potential attrition more effectively. Semi-structured interviews explored attrition amongst a sample of children (n=10) and their parents (n=10) who dropped out of a community-based MCTI. Parents and children highlighted psychological and motivational issues (e.g. misaligned expectations, lack of desire to make behaviour changes and perceived costs of change outweigh the perceived gains) as the driving factor for their attrition alongside attitudinal, environmental, interpersonal and treatment variables. The complexity and interaction of factors associated with attrition identified in this study points to the challenges associated with reducing drop-out in MCTI’s. The views of families’ should be a key consideration in the design and implementation of treatment interventions to harness and sustain commitment to the treatment process

Comparative performance of a parallel implementation of an internet-scale zero-day worm epidemiology simulator

The threat posed by fast-spreading malware is significant, particularly given the fact that network operator/administrator intervention is not likely to take effect within the typical epidemiological timescale of such infections. The cost of zero-day network worm outbreaks has been estimated to be up to US $2.6 billion for a single worm outbreak. Zero-day network worm outbreaks have been observed that spread at a significant pace across the global Internet, with an observed rate of reaching more than 90 percent of vulnerable hosts within 10 minutes. An accepted technology that is used in addressing the security threat presented by zero-day worms is the use of simulation systems, and a common factor determining their efficacy is their performance. An empirical comparison of a sequential and parallel implementation of a novel simulator, the Internet Worm Simulator (IWS), is presented detailing the impact of a selection of parameters on its performance. Experimentation demonstrates that IWS has the capability to simulate up to 91.8 million packets transmitted per second (PTS) for an IPv4 address space simulation on a single workstation computer, comparing favourably to previously reported metrics. It is concluded that in addition to comparing PTS performance, simulation requirements should be taken into consideration when assessing the performance of such simulators

Shared decision-making between people with experience of psychosis and mental health professionals: A discourse analysis.

Ideas about shared decision making (SDM) began to emerge in the 1970s as a challenge to the tradition of paternalism in healthcare. Theoretical models have focused on delineating this process and identifying discrete stages including exploration of service-user preferences, deliberation in relation to possible interventions and an emphasis on interactional, two-way communication processes that prioritise collaboration. There are particular challenges in terms of enacting the principles of shared decision-making with those with more complex mental health needs including experience of psychosis. Types of experience (unusual beliefs, intrusions, suspiciousness, changes to cognitive processes) along with issues of capacity, consent and the legal framework of the Mental Health Act (MHA; 1983) make it more challenging to implement these principles, even though they are laid out in best practice guidelines, and consistently correlate with positive outcomes for service-users. This study focused on the construction of SDM in routine clinical practice by video-recording consultations involving decisions between service-users with experience of psychosis and mental health staff in a community setting. This was with a view to moving beyond exploration of the experience of SDM to look at the enactment of these ideas in practice. Three separate clinical meetings were recorded, which captured seven decisions related to different aspects of care and treatment. The final sample comprised 3 service-users, 1 carer and 5 professionals. Participants then watched the recording with the researcher, and reflective interviews were conducted to facilitate exploration of their experience in the meeting. The study proceeded from a social constructionist perspective, drawing from the principles of Discourse Analysis, more specifically Discursive Psychology. Analysis focused on constructions of psychosis, key features of participant talk and discursive and rhetorical features in order to examine impact on SDM. The findings highlighted different ways of sharing opinions, directing or redirecting the dialogue, expressing agreement or disagreement and the challenge for staff in terms of promoting choice whilst also fulfilling legal and clinical responsibility. The findings also pointed to some important differences between physical and mental health SDM, and supported previous findings indicating that dominant discourses of psychosis impact collaboration at the micro-level of interactions between speakers in individual meetings. Based on these findings, I offer some reflections on implications for clinical practice, including consideration of idiosyncratic and decision-specific approaches to SDM with this population that account for the nuanced experience of psychosis. I also make some suggestions for directions for future research, including repeating the study in acute inpatient settings

How useful is the DSM-5 severity indicator in bulimia nervosa? A clinical study including a measure of impairment

The severity criterion used in DSM-5 for bulimia nervosa (BN) was investigated in 214 individuals referred for treatment at a regional eating disorders service in the UK. In addition to comparing eating disorder symptoms, impairment secondary to these symptoms was also assessed. According to guidance in DSM-5, 94 individuals were classified as mild (43.9%), 70 as moderate (32.7%), 32 as severe (15.0%), and 8 as extreme (3.7%) levels of BN severity. Due to small numbers in the latter two groups, it was necessary to combine these to form one ‘severe/extreme’ group. Analyses on these three groups suggested no group effect on demographic variables but differences were seen on measures of eating pathology, psychological distress, and psychosocial impairment between the mild group and other groups. Individuals in the moderate and severe/extreme groups scored comparably on most measures of pathology and impairment. The results are broadly consistent with past studies on community samples although together question the demarcation between moderate and more severe groups of individuals with BN

Engaging Families in Weight Management

Purpose: Approximately 50% of families who initiate a weight management programme (WMP) will not complete. It is fundamental to understand why participants initiate and complete a programme, and to ensure that programmes are effectively designed and delivered. This study examined the reasoning for family (young person and parent) engagement in three different and diverse WMPs. Methods: A multiple instrumental case study approach was employed. Three community-based WMPs participated: MoreLife, SHINE, and Weigh to Go. Clear design and implementation differences existed between WMPs. Multiple WMPs were recruited to examine the generalisability of research findings, and extract key features associated with participant engagement. Thirty families took part (~10 per programme). Data were collected early in the programme (0-2 weeks) and immediately after completion or dropout (within two weeks). Young people took part in a Participatory Action Research (PAR) session (interactive activities to generate meaningful information), and parents completed semi-structured interviews. A deductive line of inquiry was used; questions were based upon participant characteristics, environmental interactions, psychological processes and programme interactions. Interview data was transcribed verbatim and analysed alongside the PAR data using content and thematic analysis (themes presented in italics). Results: Preliminary findings indicate that families often engage in a WMP for non-weight related reasons. Such reasons include: management of mental health, to improve self -esteem, and to create friendships. Families remain in a WMP when: the programme suits their needs, they fit in amongst other participants, strong relationships are fostered with staff, and have strong support networks. Numerous families completing programmes prioritised WMP attendance above other leisure activities, and had plans in place to ensure they could attend each session. Low engagement was due to situational factors (e.g. logistic barriers [transport, timing…]) rather than programme dissatisfaction. Conclusions: Families attend community-based WMPs for reasons beyond weight management. Additionally, the families identified unique WMP features (e.g. maintenance programmes and non-clinical staff) which encourage programme attendance. Such features can be replicated in multiple, diverse settings. Understanding participant engagement is critical to designing and implementing efficacious WMPs