Evaluation of the DigiBete App, a Self-Management App for Type 1 Diabetes: Experiences of Young People, Families and Healthcare Professionals

Abstract: Type 1 Diabetes (T1DM) is a public health issue for children, young people, and families (CYPF) requiring innovative interventions. The DigiBete app is a self-management and educa-tional app to help CYPF and healthcare professionals (HCPs) manage T1DM and features edu-cational advice and resources such as, guidance, quizzes, and educational and instructional videos on how to manage T1DM. To assess the impact and implementation of the app, the service level evaluation deployed a mixed-methods design. App data was captured via the DigiBete platform and an online survey with a non-probability sample of HCPs (N=178) and CYPF (N=1,165) = 1,343. Overall, 55.7% (n=512/919) of app users were female and 4,855 videos had been viewed across the participating areas, with an average of 1,213 videos per site (range 776-1,679) and 4.4 videos per app user. The most popular videos were how to give a glucagon injection and ‘My Sick Day Rules’ showing what to do when CYPF were unwell due to T1DM. Interviews (n=63) were undertaken with 38 CYPF and 25 HCPs. The findings indicate that CYPF and HCPs found the app an essential tool in the management of T1DM. CYPF. HCPs felt the app provided a val-uable educational resource in a central location and was invaluable in an emergency or unknown situation. The app was a trusted and bona-fide source of information that could be accessed at any time. HCPs validated DigiBete in helping CYPF to manage their T1DM. At the same time, the app saved services time and money and helped CYPF take back some of the control for managing their diabetes

Investigating the delivery of health improvement interventions through professional football club community trusts-strengths and challenges

This study audits health improvement provision delivered in/by English professional Football Club Community Trusts and reports the strengths and challenges around the implementation of interventions. Multi-methods design: Data were collected through (i) a review of trust websites (n ​= ​72), (ii) an online survey (n ​= ​34/47.2%) and (iii) semi-structured interviews (n ​= ​11/32.3%) with a sub-sample of trust managers. The review of websites confirms all trusts provided physical activity-led interventions. The online survey showed most managers were male (n ​= ​23/67.7%) and white British (n ​= ​30/88.2%). Two thirds held management roles, (n ​= ​23/67.6%) and represented Championship (n ​= ​12/35.2%), League 1 (n ​= ​13/38.2%) and League 2 clubs (n ​= ​9/26.5%). Trusts provided physical activity and most provided diet (n ​= ​31/91.2%) as well as smoking (n ​= ​20/58.8%) and alcohol (n ​= ​19/55.9%) interventions. Weight management, (n ​= ​25/73.5%), mental health interventions (n ​= ​28/82.4%) were offered. Trusts provided male-specific (n ​= ​20/58.8%), with fewer providing female-specific interventions (n ​= ​15/44.1%). Most trusts (n ​= ​30/88.2%) evaluated interventions. 80.8% (n ​= ​21/26) used public health guidance for programme design, 69.2% (n ​= ​18/26) delivery, 57.7% (n ​= ​15/26) needs assessment and 50% (n ​= ​13/26) evaluation. Interviews and qualitative reports identified strengths including, using football, the ‘club brand’, ‘meeting health needs’ and ‘working as a strategic collaboration with partners’. Challenges included ‘short-term funding staffing, mainstreaming, and evaluating interventions’. Football Community Trusts deliver interventions, but challenges were encountered when implementing these programmes.This research was supported by Leeds Beckett University who received funding from the Football League Trust, UK

How prepared are healthcare professionals for delivering physical activity guidance to those with diabetes? A formative evaluation

Physical activity is recognised as important for diabetes management and improved overall health of individuals with diabetes, yet many adults with diabetes are inactive. Healthcare professionals have been identified as key to promoting physical activity, including individuals with diabetes, but are ill-prepared to deliver this. Our paper evaluates the barriers/facilitators of healthcare professionals’ delivery of physical activity guidance to adults with diabetes and aims to inform efforts to investigate and enhance their preparedness to promote physical activity. A sequential mixed method, two-phase design was adopted involving a purposeful sample of healthcare professionals. Phase one was an online pilot survey designed to test assumptions around healthcare professionals’ knowledge, training and preparedness to deliver physical activity guidance. Phase two comprised eighteen semi-structured interviews, thematically analysed to provide an in-depth exploration of healthcare professionals’ experiences of delivering physical activity guidance to adults with diabetes. Healthcare professionals are committed to promoting physical activity to adults with diabetes and are reasonably confident in giving basic, generic guidance. Yet, significant challenges prevent them from achieving this in their practice, including: lack of education and training around physical activity, diabetes and health; ignorance of recommended physical activity and diabetes guidelines; lack of awareness of referral options; limited time and accessibility to appropriate resources. Nevertheless, healthcare professionals believed discussions around physical activity needed to be an integral part of consultations, incorporating improved communication strategies for conveying key physical activity messages. HCPs have a key role in the promotion of physical activity to people with long-term conditions such as diabetes and they are identified within both the strategic policy context and national interventions for physical activity. Yet, this study indicated that HCPs face multiple and at times complex barriers to physical activity promotion generally and with diabetes patients. Conversely HCPs also reported what works, why and how, when promoting physical activity. Rich information derived from the day-to-day, working healthcare professional is integral to shaping future practices going forward. The bottom up, iterative design adopted in this study provides an approach to tap into this information.Funding was received by School of Sport, Leeds Beckett Universit

Evidence from big data in obesity research: international case studies

Obesity is thought to be the product of over 100 different factors, interacting as a complex system over multiple levels. Understanding the drivers of obesity requires considerable data, which are challenging, costly and time-consuming to collect through traditional means. Use of 'big data' presents a potential solution to this challenge. Big data is defined by Delphi consensus as: always digital, has a large sample size, and a large volume or variety or velocity of variables that require additional computing power (Vogel et al. Int J Obes. 2019). 'Additional computing power' introduces the concept of big data analytics. The aim of this paper is to showcase international research case studies presented during a seminar series held by the Economic and Social Research Council (ESRC) Strategic Network for Obesity in the UK. These are intended to provide an in-depth view of how big data can be used in obesity research, and the specific benefits, limitations and challenges encountered

Can ‘English Premier League’ funding for PE and school sport achieve its aims?

There are a number of assertions being made for a £10 m investment by the English Premier League for primary school sport. For example, it is claimed that Physical Education plus school sport can improve cognitive functioning, concentration, behaviour, educational attainment and overall physical health. However, far from being sufficient in helping to achieve these benefits and sustain long-term activity participation, for some children, Physical Education and competitive sport may actually be counterproductive. In some instances, it may switch them off from activity altogether. Therefore, we need to understand more about which elements of this scheme work, who they work for and which circumstances they work in. Fundamentally, this will only be achieved through hard evidence and robust evaluation

Designing programmes of physical activity through sport: Learning from a widening participation intervention, 'City of Football'

Background: Implementation profoundly influences how well new audiences engage with sport-based physical activity programmes. Recognising that effective implementation relies on concurrently generating supportive contexts, systems and networks for the least engaged ‘target’ groups; this paper aims to address what underpins children’s (non) engagement with football-based physical activity. Methods: An observational research design, using a non-probability sample of N=594 primary and secondary schoolchildren assessed outcomes of a three-year ‘City of Football’ (CoF) programme. Pupils self-reported football participation, personal friendship networks and exposure to six concurrent sources of influence (SoI). A 2-step hierarchical cluster analysis and univariate analyses assessed between-cluster differences. Results: Girls played football least regularly (χ2 [4] = 86.722, p = 0.000). Overall, participation was significantly associated with personal networks engaged in football. Boys’ personal networks were more stable and structurally effective. Football participation was also positively and linearly association with SoI scores. Girls and pupils with no personal networks around football reported the lowest SoI scores. Three clusters emerged, dominated by social network influences. The Traditional Market (n=157, 27.7%) comprised 81.7% boys; they regularly played football, had the most effective network structure and scored highly across all six domains of SoI. The Sporadically Engaging Socialisers (n=190, 33.5%) comprised 52.9% girls who rarely played football, reported low SoI scores and an inferior network structure. In the Disconnected cluster (n=220, 38.8%), 59.3% were non-footballing girls who reported the lowest motivation and ability SoI scores; and no personal networks engaged in football. Conclusions: This study reveals new insights about the primacy of social network effects for engaging children in football-based physical activity programmes. With little or no attention to these social-oriented issues, such interventions will struggle to attract ‘target’ children, but will readily engage already well-connected, experienced football-playing boys. The challenge for drawing non-footballing children into football-based interventions lies with engaging children – especially girls - whose social networks are not football-focused, while they also find football neither personally motivating nor easy to do

Sustaining health improvement activities delivered in English professional football clubs using evaluation: a short communication

It has been suggested that football and communities are inextricably linked. Healthy lifestyles are an important component in maintaining the sustainability of local communities, not least, because a convincing evidence base supports the holistic benefits that can be derived from health-enhancing behaviours, such as regular physical activity. As such, efforts to promote health improvement through sport and physical activity include those interventions delivered in professional sporting settings. Johnman and colleagues (Johnman and Mackie, ‘The Beautiful Game’) have heralded sports clubs as important venues for the delivery of health improvement interventions for a range of groups across local communities. This includes health improvement activities delivered in professional football club community schemes. While exemplary practice shows how health improvement programmes can be implemented and evaluated, our experience and engagement with professional football club community schemes supports the notion that more needs to be undertaken to help clubs develop monitoring and evaluation strategies in order to assess the impact of their health improvement programmes. In our short communication, we share our plans for helping two professional football clubs develop their monitoring and evaluation strategies for their community health promotion programmes. Potential outcomes emerging from this process are twofold. (1) To help club community schemes in-build and sustain monitoring and evaluation practices within their future health improvement provision. (2) To use the impact and process outcomes emerging from programme evaluations, to successfully secure the necessary resources to sustain future health improvement activities for their local communities. Outcomes emerging from this study will be of interest to football clubs and evaluators alike, as they seek to develop evaluation strategies for their health improvement programmes

Effect of a health-improvement pilot programme for older adults delivered by a professional football club: the Burton Albion case study

Older adults are a priority within policy designed to facilitate healthy lifestyles through physical activities. Golden Goal is a pilot programme of physical activity-led health improvement for older adults, 55 years and older. Activities were delivered at Burton Albion Football Club. Sessions involved weekly moderate to vigorous intensity exercise sessions including exer-gaming (exercise-orientated video-games), indoor bowls, cricket, new age curling, walking football, and traditional board games and skittles. Secondary analysis of data collected through the original programme evaluation of Golden Goal investigated the impact of the intervention on participants. Older adults completed self-reports for demographics, health screening/complications and quality of life. Attendees, n = 23 males (42.6%) and n = 31 females (57.4%) with a mean age of 69.38 (±5.87) (n = 40), ranging from 55-85 years took part. The mean attendance was 7.73 (±3.12) sessions for all participants, (n = 51). Older adults with two or more health complications (n = 22, 42.3%) attended fewer sessions on average (6.91 ± 3.322) compared to those reporting less than two health complications (8.65 ± 2.694). Self-rated health was higher for women (87.32 ± 9.573) vs. men (80.16 ± 18.557), although this was not statistically significant (U = 223.500, p = 0.350). Results support the potential of football-led health interventions for recruiting older adults, including those reporting health problems. © 2014 © 2014 Taylor & Francis

Prevalence, Co-Occurrence and Clustering of Lifestyle Risk Factors Among UK Men

Objective: Men – more than women - engage in unhealthy lifestyle practices that place them at greater risk of developing non-communicable disease. This paper aims to explore the prevalence, co-occurrence and clustering of four core lifestyle risk factors and examine the socio demographic variation of their distribution, among men living in two central London boroughs. Method: A stratified street survey was undertaken with N=859 men. Prevalence odds ratios calculated risk factor clustering and a multinomial logistic regression model examined the socio-demographic variation. Results: Over 72% of men presented with combinations of lifestyle risk factors. Physical inactivity combined with a lack of fruit and vegetables was the most common combination. Co-occurrence was more prominent for unemployed, widowed, divorced/separated and white British men. Clustering was evident for adherence and non-adherence to UK health recommendations. Conclusion: Men may benefit from targeted health interventions that address multiple – rather than single – health related behaviours

A mixed-methods evaluation of care (cancer and rehabilitation exercise): a physical activity and health intervention, delivered in a community football trust

With increasing cancer survivorship has come an increased necessity to support people living with cancer (PLWC) to have a good quality of life including being physically active. Using mixed methods, the current study aimed to use the RE-AIM evaluation framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) to determine how the football community trust delivered CARE (Cancer and Rehabilitation Exercise) intervention was able to increase participants’ physical activity in order to improve their quality of life and regain physiological and psychological function. Quantitative outcome data were collected at baseline, 3 and 6 months using the Cancer Physical Activity Standard Evaluation Framework questionnaire. Semi-structured focus groups (n = 5) captured participants’ (n = 40) lived experience of the reach, effectiveness, adoption, implementation, and maintenance of CARE. Questionnaire data were analysed using repeated measures ANOVAs and qualitative data were thematically analysed. Following diagnosis, CARE was successful in providing participants with a unique and accessible opportunity to become or restart physically activity, by providing a local, socially supportive, and inclusive environment. This resulted in significant increases in physical activity (F(1.58, 23) = 5.98, p = 0.009), quality of life (QoL) (F(2,36) = 13.12, p = 0.000) and significant reductions in fatigue (F(1.57,31) = 11.19, p = 0.000) over 6 months. Participants also reported becoming more active, recovering physical function, regaining independence, and enhanced psychological well-being as a result of attending CARE. Key design features of CARE were also identified across RE-AIM. CARE, a football community trust delivered physical activity intervention was successful in significantly improving participants’ QoL and in regaining the physical and psychological functioning of people living with cancer. Results suggest that maintaining engagement in CARE for 6 months and beyond can support people to maintain these changes. Engaging in robust evaluations such as this can help organizations to successfully secure future funding for their programs.This research was supported by Leeds Beckett University who received funding from Notts County Foundation