Educational interventions for health professionals managing chronic obstructive pulmonary disease in primary care

© 2024 The Author(s). Published by Cambridge University Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Peer reviewe

How effective is community physical activity promotion in areas of deprivation for inactive adults? A pragmatic observational evaluation of the 'Active Herts' physical activity programme

Background There is a high prevalence of inactivity in UK adults and many suffer from comorbid conditions. These frequently co-exist in areas of higher socio-economic deprivation. There is a need to test the effectiveness, acceptability, and sustainability of physical activity programmes in this population. Method Active Herts recruited inactive adults (N=435) with one or more risk factors for cardiovascular disease and/or mild-to-moderate mental health conditions, and followed up at 3 and 6 months after baseline. In two areas programme-users received a behaviour change technique booklet, consultations, a booster phone call, motivational text messages, and signposting to 12 weeks of exercise classes (standard intervention). In another two areas programme-users also received 12 weeks of free tailored exercise classes, with optional exercise ‘buddies’ (enhanced intervention). Mixed ANOVAs analysed changes in physical activity, sporting participation, sitting (primary outcomes), mental wellbeing, health perception, and COM-B measures (secondary outcomes). Secondary analyses explored whether COM-B measures predicted moderate-to-vigorous physical activity (MVPA) at baseline, 3, and 6 months, and changes at 3 and 6 months using path analyses. Results At both timepoints, physical activity (3 months, η2 = .17; 6 months, η2 = .18), sporting participation (3 months, η2 = .22; 6 months, η2 = .17), sitting time (3 months, η2 = .08; 6 months, η2 = .06), and several secondary outcomes (e.g. wellbeing) improved regardless of group. COM-B related indicators explained MVPA performance better after 3 (R2=18%) and 6 (R2=15%) months than at baseline (R2=8%), but changes in MVPA were weakly predicted (3 months, R2=5%; 6 months, R2=7%). Self-monitoring was key in driving MVPA performance and change. Conclusions and Implications Active Herts improved activity levels at 3 and 6 months providing preliminary evidence that such interventions, delivered in real world settings, can change the behaviour and wellbeing of residents living in areas of deprivation.Peer reviewedFinal Published versio

How do people of South Asian origin understand and experience depression? A protocol for a systematic review of qualitative literature

This article was published in BMJ Open following peer review and can also be viewed on the journal’s website at http://bmjopen.bmj.comIntroduction: Individuals from Black and Asian Minority Ethnic (BAME) groups are less likely to receive a diagnosis and to engage with treatment for depression. This review aims to draw on international literature to summarise what is known about how people specifically of South Asian origin, migrants and non, understand and experience depressive symptoms. The resulting evidence base will further inform practices aimed at encouraging help seeking behaviour and treatment uptake. Methods and analysis: A systematic review and thematic synthesis of qualitative literature conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Using pre defined inclusion and exclusion criteria, electronic searches will be conducted across 16 databases. Study quality will be assessed using the Critical Appraisal Skills Programme (CASP). Data will be extracted independently by two reviewers. Ethics and dissemination: Ethical approval is not required. A comprehensive evidence base of how people from South Asian backgrounds both conceptualise and experience depression will better inform the design and delivery of mental health initiatives and advance directions for future research. Findings will be published in a peer-reviewed journal, and disseminated through existing networks for professionals, researchers, patients and the public. Review registration number: PROSPERO 2015 CRD42015026120 Available from: www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015026120 Strengths and limitations: - This will be the first comprehensive systematic review of how people of South Asian origin understand and experience depression. - This review will result in an evidence base that can be drawn on by mental health professionals and researchers working in multi-ethnic settings. - Analysis will only include literature that has been published in English due to the complexities involved in the translation and synthesis of data from multiple languages. - The synthesis will rely mainly on data from primary research papers.Peer reviewedFinal Published versio

A prospective study exploring the construct and predictive validity of the COM-B model for physical activity

The final, definitive version of this paper has been published in Journal of Health Psychology, November 2017, doi: https://doi.org/10.1177/1359105317739098, published by SAGE Publishing, All rights reserved.This study examined the constructs of Capability, Opportunity, and Motivation from the COM-B model and their influence on moderate-to-vigorous physical activity (MVPA). Using a prospective survey design, 186 healthy adults completed measures representing the Theoretical Domains Framework mapped to the COM-B, and MVPA one week later. The main indicators for the COM constructs were ‘habits’ (Capability), ‘subjective norms’ (Opportunity), and ‘exercise self-identity’ (Motivation). Motivation (77%) and MVPA (50%) were strongly predicted, with Capability and Motivation as key drivers of behaviour. Motivation was a strong mediator for Capability on behaviour. Future research should consider this approach for other populations and behaviours.Peer reviewe

Modified dietary fat intake for treatment of gallstone disease

Madden AM, Trivedi D, Smeeton NC, Culkin A., 'Modified dietary fat intake for treatment of gallstone disease', Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD012608, DOI: 10.1002/14651858.CD012608. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.Protocol: To assess the benefits and harms of modifying dietary fat intake in the treatment of gallstone disease.Peer reviewedFinal Published versio

Modified dietary fat intake for treatment of gallstone disease (Protocol)

© 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.This is a protocol for a Cochrane Review (Intervention). To assess the benefits and harms of modifying dietary fat intake in the treatment of gallstone disease.Peer reviewe

Nutritional education for community dwelling older people : a systematic review of randomised controlled trials

Original article can be found at : http://www.sciencedirect.com/ Copyright ElsevierObjectives : To evaluate the effectiveness of nutritional education or advice on physical function, emotional health, quality of life, nutritional indices, anthropometric indicators, mortality, service use and costs of care in people over 65 years of age living at home. Design : Systematic review of randomised controlled trials (RCTs). Data sources: PUBMED, CINAHL, PSYCINFO, the Cochrane Central Register of Controlled Trials and the National Research Register. Methods : We included studies evaluating nutritional education or advice for people aged 65 and over living in their own homes that measured one or more of the following outcomes: physical function, emotional well being, service use, dietary change and other anthropometric indicators. Studies were assessed for risk of bias on six domains. Due to high heterogeneity, results were not pooled but are reported narratively. Results : Twenty-three studies met our inclusion criteria. All but one of the interventions were delivered by health care professionals; ten were delivered by nurses. The review found evidence to suggest that nutritional education or advice can be used to positively influence diet and improve physical function. There was also evidence that some biochemical markers can be positively affected, although these are surrogate outcomes and are generally disease specific. Several studies indicated that complex interventions, with nutritional education as a component, also reduce depression. The evidence from this review on the impact on weight change was inconclusive. There was no evidence of an improvement in anxiety, quality of life, service use, costs of care or mortality. However, many studies were at moderate or high risk of bias, and for some outcomes the data were insufficient to make judgments about effectiveness. Conclusions : This review indicates that nutritional education or advice can positively affect physical function and diet, whilst complex interventions with nutritional education as a component, can reduce depression in people over 65 years who live at home. However, more research is needed to determine whether outcomes are influenced by types of intervention, morbidity, and socioeconomic circumstance of participants. Relevance to clinical practice: Nutritional education, alone or as part of a complex intervention, can improve diet and physical function and may reduce depression in the over 65s living at home.Peer reviewe

Modified dietary fat intake for treatment of gallstone disease in people of any age

© 2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.Background The prevalenceof gallstones varies between less than 1% and 64% in different populations andis thought to be increasing in response to changes in nutritional intake andincreasing obesity. Some people with gallstones have no symptoms butapproximately 2% to 4% develop them each year, predominantly including severeabdominal pain. People who experience symptoms have a greater risk ofdeveloping complications. The main treatment for symptomatic gallstones ischolecystectomy. Traditionally, a low-fat diet has also been advised to managegallstone symptoms, but there is uncertainty over the evidence to support this. Objectives To evaluatethe benefits and harms of modified dietary fat intake in the treatment ofgallstone disease in people of any age. Search methods We searchedthe Cochrane Hepato-Biliary Group Controlled Trials Register, the CochraneCentral Register of Controlled Trials in the Cochrane Library, MEDLINE ALLOvid, Embase Ovid, and three other databases to 17 February 2023 to identifyrandomised clinical trials in people with gallstones. We also searched onlinetrial registries and pharmaceutical company sources, for ongoing or unpublishedtrials to March 2023. Selectioncriteria We includedrandomised clinical trials (irrespective of language, blinding, or status) inpeople with gallstones diagnosed using ultrasonography or conclusive imagingmethods. We excluded participants diagnosed with another condition that maycompromise dietary fat tolerance. We excluded trials where data fromparticipants with gallstones were not reported separately from data from participantswho did not have gallstones. We included trials that investigated otherinterventions (e.g. trials of drugs or other dietary (non-fat) components)providing that the trial groups had received the same proportion of drug orother dietary (non-fat) components in the intervention. Data collectionand analysis We intended toundertake meta-analysis and present the findings according to Cochranerecommendations. However, as we identified only five trials, with dataunsuitable and insufficient for analyses, we described the data narratively. Main results We includedfive trials but only one randomised clinical trial (69 adults), published in1986, reported outcomes of interest to the review. The trial had four dietaryintervention groups, three of which were relevant to this review. We assessedthe trial at high risk of bias. The dietary fat modifications included amodified cholesterol intake and medium-chain triglyceride supplementation. Thecontrol treatment was a standard diet. The trial did not report on any of theprimary outcomes in this review (i.e. all-cause mortality, serious adverseevents, and health-related quality of life). The trial reported on gallstonedissolution, one of our secondary outcomes. We were unable to apply the GRADEapproach to determine certainty of evidence because the included trial did notprovide data that could be used to generate an estimate of the effect on thisor any other outcome. The trial expressed its finding as "no significant effectof a low-cholesterol diet in the presence of ursodeoxycholic acid on gallstonedissolution." There were no serious adverse events reported. The includedtrial reported that they received no funding that could bias the trial resultsthrough conflicts of interest. We found no ongoing trials. Authors'conclusions The evidenceabout the effects of modifying dietary fat on gallstone disease versus standard diet is scant. We lack results from high-quality randomised clinical trialswhich investigate the effects of modification of dietary fat and other nutrientintakes with adequate follow-up. There is a need for well-designed trials thatshould include important clinical outcomes such as mortality, quality of life,impact on dissolution of gallstones, hospital admissions, surgicalintervention, and adverse events.Peer reviewe

Determinants of weekly sitting time: Construct validation of an initial COM-B model and comparison of its predictive validity with the Theory of Planned Behaviour

© 2020 Taylor & Francis. This is an Accepted Manuscript of an article published by Taylor & Francis in Psychology & Health on 14 May 2020, available online: https://doi.org/10.1080/08870446.2020.1763994.Objective: In relation to sitting behaviour, to investigate which theoretical domains best formed the Capability, Opportunity, and Motivation constructs of the COM-B, and compare the predictive validity to the Theory of Planned Behaviour (TPB), taking habit strength into consideration. Design: Using a prospective design, 186 adults completed measures capturing domains from the Theoretical Domains Framework for the three COM-B constructs, and habit strength, which were examined using a formative measurement model. Predictive validity was then compared to the TPB.Main Outcome Measures: Self-reported sitting behaviour. Results: Self-monitoring (behavioural regulation domain) formed Capability; subjective norm (social influences domain) formed Opportunity; intention (intentions domain), positive affect (emotion domain), and perceived behavioural control (beliefs about capabilities domain), formed Motivation. The COM-B strongly predicted sitting behaviour (27% variance explained), with Capability, Opportunity, and habit strength as key drivers. The TPB explained a large amount of variance (23%) in sitting behaviour, with intention and habit strength as key drivers. Conclusions: The behavioural regulation domain of Capability, the social influences domain of Opportunity, and habit strength were important drivers of sitting behaviour, with comparable variance predicted in the COM-B and TPB. Future research should consider this approach to conceptualise the COM-B for specific populations and behaviours.Peer reviewe

Managing behavioural and psychological symptoms in community dwelling older people with dementia:1. A systematic review of the effectiveness of interventions

© 2018 The Author(s) This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence CC BY 4.0 (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Two-thirds of people living with dementia live at home in the UK and many experience distressing behavioural and psychological symptoms. This systematic review evaluates the effectiveness of non-pharmacological interventions for behavioural and psychological symptoms among community-dwelling people living with dementia. Methods: This two-stage review undertook an initial mapping of the literature followed by a systematic review of relevant randomised controlled trials. We searched electronic databases for pertinent studies reporting outcomes from interventions from January 2000 to March 2015 and updated searches in October 2016. We included studies that considered behavioural and psychological symptom management for older people living with dementia who live at home and excluded studies conducted in long-term care settings. This paper presents findings from a narrative synthesis of 48 randomised controlled trials evaluating interventions for people living with dementia alone, family carers alone and patient-carer dyads. Results: We retrieved 17,871 de-duplicated records and screened them for potential inclusion. Evidence from 48 randomised controlled trials suggests that family carer training and educational programmes that target problem behaviours and potential triggers can improve outcomes. Nurses and occupational therapists appear to help people with dementia with behavioural and psychological symptoms, but professional comparisons are lacking and there is no shared language about or understanding of behavioural and psychological symptoms amongst professionals, or between professionals and family carers. Conclusions: Future research should focus on the effectiveness of components of multi-faceted programmes and their cost effectiveness and include qualitative data to better target interventions for behavioural and psychological symptoms. It is important to consider family carer readiness to use non-pharmacological strategies and to develop a shared language about the inherent needs and communications of behavioural and psychological symptoms.Peer reviewe