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

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

Action Research in the Design, Development and Delivery of a Sustainable, School-based, Health Promotion Intervention for Children and Young People

Introduction: Interventions are often developed without the guidance of the target group to be worked with. Action research (programme development with the input of researchers and clients) has been highlighted as a useful method for increasing programme engagement and achieving programme outcomes [1]. Hearty Lives Renfrewshire (HLR), is a British Heart Foundation a community-based intervention aiming to increase knowledge and awareness of CVD risk factors in young people, adopted an action research methodology. HLR delivers a school-based intervention to young people aged 13-16; this intervention was developed by the young people, with elements of the intervention delivered by the young people. Objectives: To evaluate the use of an action research approach to designing, developing and delivering HLR. Method: Semi-structured interviews with stakeholders (n = 5, 22-56 minutes), and focus groups interviews with participants [attending the HLR intervention] (n = 9, 15 minutes). Interviews were recorded and transcribed verbatim. Thematic analysis was used to analyse the data. Results: Students suggested they felt empowered when consulted with about improving and refining the programme. The HLR delivery team were responsive to participant ideas and facilitated the implementation of ideas. Intervention content was also refined to become more engaging – this was a product of participant feedback. To increase programme reach, a Parkour (acrobatic free running) club was set up which had health messages embedded in its design. All participants cited an improved knowledge, yet behaviour change was less apparent. Conclusion: HLR successfully engaged with participants in all stages of the intervention. Moreover, the programme expanded using alternate modes of delivery (e.g. Parkour) to engage a traditionally hard-to-engage demographic. Action Research should be considered when designing, developing and refining an intervention rather than a traditional problem-solution orientated approach

A qualitative study of stakeholders' perspectives on the social network service environment

Over two billion people are using the Internet at present, assisted by the mediating activities of software agents which deal with the diversity and complexity of information. There are, however, ethical issues due to the monitoring-and-surveillance, data mining and autonomous nature of software agents. Considering the context, this study aims to comprehend stakeholders' perspectives on the social network service environment in order to identify the main considerations for the design of software agents in social network services in the near future. Twenty-one stakeholders, belonging to three key stakeholder groups, were recruited using a purposive sampling strategy for unstandardised semi-structured e-mail interviews. The interview data were analysed using a qualitative content analysis method. It was possible to identify three main considerations for the design of software agents in social network services, which were classified into the following categories: comprehensive understanding of users' perception of privacy, user type recognition algorithms for software agent development and existing software agents enhancement

Development of network simplification techniques for water hammer modeling

Behaviour of water distribution systems under transient conditions is complex, making them inherently difficult to model. By developing ways of simplifying a pipe network model, the time taken to create an efficient and accurate transient model can be reduced. Interviews conducted with water hammer modellers from around the world, both academics and consultants, identified a number of simplification techniques currently employed. Such techniques are often applied without appropriate justification, with their effectiveness assessed solely on maximum and minimum pressures. Using the transient analysis program, TransAM, a number of case studies were conducted to determine the validity and effectiveness of such simplifications. Experimental tests were performed on the single pipe network in the Robin Hydraulics Laboratory at The University of Adelaide, to investigate the effects of truncating sub-networks. These tests validated the TransAM model developed and strengthened the conclusion that it is better to truncate sub-networks partially rather than back to the main pipeline. Effects of network skeletonisation were investigated on the Willunga water distribution network, identifying that it is possible to reduce the number of pipes in the system by half without significantly affecting the global maximum and minimum pressures in the system. An investigation of the Clare Valley network identified that tanks and sometimes pumping stations act to segregate networks, allowing them to be split-up into a number of smaller sub-systems.Joshua Cantone, Benjamin Furness, Timothy Nicholls, Phillip Staniford, Angus Simpsonhttp://trove.nla.gov.au/version/4006791

Employees’ experiences of participating in a workplace supported weight management service : A qualitative inquiry

Purpose: This study explored Public Health employees experiences of participating in a commercial weight management programme funded through their employers over a 12 week period. Design/methodology/approach: Semi-structured interviews were conducted with 28 employees who had participated in the programme (group-based or online). Findings: The main motivators for enquiring about and attending the programme were: the offer to attend the programme free of charge, the opportunity to kick start their weight loss efforts, to take part in an academic research study, and the opportunity for ‘shared experience’s’ with their colleagues. Practical Implications: Employers should facilitate their employees efforts to lead a healthier lifestyle in the long-term creating employer health and safety policies that actively encourage healthy living and weight management. Improving employee health can contribute to increasing productivity, reducing stress and absenteeism. Originality/value: This paper presents a novel approach to facilitating employees weight management. Employees perceived their employer supported participation in a commercial weight management programme outside of their work setting as a positive experience that assisted their weight management efforts suggesting the acceptability and feasibility of this approach to addressing weight in the workplace. Keywords: Weight management, workplace, qualitative inquiry, employee health promotio

Analyzing Intensive Intrusion Alerts Via Correlation

Traditional intrusion detection systems (IDSs) focus on low-level attacks or anomalies, and raise alerts independently, though there may be logical connections between them. In situations where there are intensive intrusions, not only will actual alerts be mixed with false alerts, but the amount of alerts will also become unmanageable. As a result, it is difficult for human users or intrusion response systems to understand the alerts and take appropriate actions