Encouraging stair walking

A motivational poster placed at a choice point between escalator and stair use, in a city centre underground station, doubled stair use. The study also showed that men and boys used the stairs more than women and girls both before and after the poster intervention, but there was no obvious explanation of this finding. Follow up interviews with 200 stair users or escalator users showed that motivational posters can change the behaviour of people who are not very active as not all those using the stairs were regularly active. The barriers to stair use were time, laziness, and effort, while the motivations for stair use were saving time and improving health. Women cited laziness as the key barrier to stair climbing and in comparison with men perceived stair climbing as requiring more effort

Qualitative evaluation of the Safety and Improvement in Primary Care (SIPC) pilot collaborative in Scotland: perceptions and experiences of participating care teams

Objectives: To explore general practitioner (GP) team perceptions and experiences of participating in a large-scale safety and improvement pilot programme to develop and test a range of interventions that were largely new to this setting. Design: Qualitative study using semistructured interviews. Data were analysed thematically. Subjects and setting: Purposive sample of multiprofessional study participants from 11 GP teams based in 3 Scottish National Health Service (NHS) Boards. Results: 27 participants were interviewed. 3 themes were generated: (1) programme experiences and benefits, for example, a majority of participants referred to gaining new theoretical and experiential safety knowledge (such as how unreliable evidence-based care can be) and skills (such as how to search electronic records for undetected risks) related to the programme interventions; (2) improvements to patient care systems, for example, improvements in care systems reliability using care bundles were reported by many, but this was an evolving process strongly dependent on closer working arrangements between clinical and administrative staff; (3) the utility of the programme improvement interventions, for example, mixed views and experiences of participating in the safety climate survey and meeting to reflect on the feedback report provided were apparent. Initial theories on the utilisation and potential impact of some interventions were refined based on evidence. Conclusions: The pilot was positively received with many practices reporting improvements in safety systems, team working and communications with colleagues and patients. Barriers and facilitators were identified related to how interventions were used as the programme evolved, while other challenges around spreading implementation beyond this pilot were highlighted

The utility of the Theories of Change approach within the evaluation of the Scottish National CHID Health Demonstration Project (Have a Heart Paisley)

The Scottish Executive (SE) commissioned the first phase of a National Coronary Heart Disease (CHD) Demonstration Project, Have a Heart Paisley (HaHP), in 2000. HaHP was a complex community-based partnership intervention. An independent evaluation of HaHP (phase one) was commissioned by the SE in 2001. This thesis presents the learning from the evaluation. The first aim is to identify the key implementation, evaluation and policy lessons to result from the evaluation. The second is to contribute to learning about how best to evaluate complex community-based interventions. The evaluation consisted of four approaches: a theory-based approach (the Theories of Change); the mapping of the context; a quasi-experimental survey; and, a range of integrated case studies. This thesis uses the programme logic (the intervention’s Theories of Change) articulated by the HaHP stakeholders to integrate the results from each of the evaluation approaches. HaHP (phase one) did not achieve significant changes in population level CHD risk factors, behaviours, morbidity or mortality. Like many previous community-based CHD interventions HaHP did not fully implement its intended Theories of Change. HaHP’s activities were not consistently based on best practice. It did not articulate or implement clear strategies for addressing health inequalities. The project delivered mainly individually focussed, ‘downstream’ interventions and struggled to achieve wide-scale local service, policy and agenda changes. It did, however, make progress with regard to improving partnerships and jointly delivering interventions. The findings from HaHP add to existing evidence that large-scale behaviour and cultural change will only be achieved through national action and the increasing use of ‘upstream’, legislative, or policy solutions, or changes in mainstream services and organisations. Activity in localised demonstration projects can add to such change rather than create it. The Theories of Change approach claims to improve planning and implementation, enhance evaluation, and address attribution. The approach (as applied within this evaluation) provided substantial amounts of formative feedback that was of use for improving programme implementation. This learning, however, was not always acted upon

Getting the inactive active : implications for public health policy

Epidemiological data have established that a sedentary lifestyle increases the incidence of at least 17 medical conditions. The evidence is strongest for coronary heart disease. A sedentary lifestyle is now the normal lifestyle for the majority of the populations in developed countries and relapse from regular physical activity is also high. Thus there is clear need for public policy aimed at increasing the physical activity levels in the population. Policy makers have begun to respond to this need and recently Scottish and English plans for increasing physical activity levels in the populations have been published

West End Walkers 65+: using programme theory to enhance outcome assessment in a randomised controlled trial

Background: Walking has great potential to engage people in physical activity (PA), and could address health problems associated with sedentary living. Previous research showed increasing walking behaviour in inactive adults aged 18-65 years is feasible 1. However, a systematic review showed that evidence on how to encourage older adults to increase walking is lacking 2. This study aims to test a pedometer-based walking programme in combination with a PA consultation with adults aged 65 years+ in a primary care setting and to design a study protocol that enables shared learning outcomes. Methods: Over 12 months, West End Walkers 65+ will recruit 46 participants, aged 65 years+. Participants will be allocated to: Group 1 PA consultation, individualised walking programme and pedometer; or Group 2 a waiting list control group. Step counts, activity patterns and psychological measures will be assessed pre and post intervention. Focus groups and interviews will be completed with participants and stakeholders post intervention. Programme Theory: Feasibility of the intervention will be assessed using a programme theory. A programme’s theory conceptualises what must be done to bring about desired outcomes. This allows comparison between project planning and design and programme processes3. A triangulation of qualitative and quantitative research measures will inform this assessment. Feasibility will be assessed using goals designed to promote shared and transferrable learning outcomes

The utility of the theories of change approach within the evaluation of the Scottish National CHD health demonstration project (Have a Heart Paisley)

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Multi-method evaluation of a national clinical fellowship programme to build leadership capacity for quality improvement

Background: This paper reports the results of the evaluation of the Scottish Quality and Safety Fellowship (SQSF)—a 10-month, lead-level international educational programme established in 2008 with the overarching aim of developing clinicians with advanced quality improvement knowledge, technical ability and essential leadership skills. The evaluation explores four levels of educational and practice outcomes associated with (1) the reaction of fellows to SQSF participation, (2) learning gained, (3) subsequent behaviour changes and (4) the overall impact on national and international level capability and capacity building. Methods: A theory-informed multi-method design was applied using (1) a search and review of the SQSF organisational database to tabulate personal, professional and demographic characteristics; (2) semi-structured telephone interviews with 16 participants using purposive and self-selected sampling; and (3) a cross-sectional online evaluation survey across all 10 cohorts involving 222 fellows Results: SQSF was positively perceived as a high-quality learning experience containing a well-balanced mix of theory and practice, with a majority of respondents reporting career changing benefits. Most participants reported improved social, behavioural and emotional skills, knowledge and attitudes and, with sustained support of their host organisations, were able to apply and share learning in their workplace. The impact of the SQSF on a wider national and international level capability and capacity was both mediated and moderated by a wide range of interrelated contextual factors. Conclusions: This multi-method evaluation demonstrates that SQSF has achieved significant positive outcomes for the great majority of participants. Some tentative recommendations are provided with the aim of further enhancing fellowship content, delivery, transfer and future evaluations of wider impacts at regional, national and international health system levels