Birmingham, West Midlands’ Young Persons’ Physical Activity Pathway: Evaluation Report

The Birmingham, West Midlands’ Young Persons’ Physical Activity Pathway (YPPAP) is a pilot six week behavioural intervention (a physical activity pathway) aimed at increasing physical activity levels in school-aged children in school years 6 and 7 (ages 10-12 yrs). It builds on the experiences of the South Staffordshire (SS) Physical Activity Care Pathway (PACP), but was developed specifically to focus on school-age young people in an urban city setting. For the purposes of the evaluation a mixed-methods approach including a quantitative and qualitative component was employed. Data analysis revealed that of the 239 eligible participants, 99 entered the pathway (31.2%). Ninety-three participants set physical goals at baseline and 3 were lost to follow up representing a pathway completion rate of 97% (n = 90). Overall, the results indicated that the increase in ‘spare time’ physical activity was statistically significant (t(95)=-2.88, p=.005), but the differences were not significant for overall physical activity (t(95)=-.096, p=.924), or mean frequency of physical activity (t(95)=-.414, p=.680). Analysis also revealed that the correlation between change in physical activity between baseline and follow up and the number of goals set by participants was not significant (r = 0.08, p =.436). Qualitative findings revealed that participants perceived that the pathway had helped to educate them about the relationship between physical activity and health and had provided a means of engaging with physical activity in a way that was fun and non-threatening. Delivery costs were also calculated taking into account management and delivery costs, including resources, training and support, the total cost per child of delivering the intervention was £143. The high completion rate might point to the utility of using school settings for physical activity interventions. Problematically, the limited sample size prevented the meaningful investigation of any relationship between the physical activity options chosen by young participants and outcomes in terms of potential increases in levels of physical activity. Similarly, it was not possible to fully investigate the potential effects of gender, class, ethnicity, disability status on adherence to the pathway or physical activity behaviour. More usefully, data analysis revealed that the pathway attracted a range of participants which demonstrated potential for securing the interest and motivation of participants. This finding underpins the importance of understanding the number, variety and availability of local physical activity opportunities and delivering the intervention in a way that is engaging and supportive

Alcohol and physical activity screening in the National Health Service Health Check programme: Comparison of medical records and actual practice

Objectives National data for the National Health Service (NHS) Health Check programme (in England), collected by University College London, Public Health England and NHS Digital, found that physical activity and alcohol was recorded in just 64.5% and 38.3% of patient records, respectively. We examined video recorded NHS Health Checks from the RIsk COmmunication in NHS Health Check study (collected 2018–19) to explore alcohol and physical activity measurement, comparing recorded and actual activity. Study design Observational study. Methods Anonymised medical records and transcripts of 130 video-recorded NHS Health Checks from 12 general practices were compared to understand use of alcohol (Alcohol Use Disorders Identification Test, Alcohol Use Disorders Identification Test-Concise, Fast Alcohol Screening Test) and physical activity (General Practitioner Physical Activity Questionnaire) measures. Results Findings showed considerable discrepancies between how alcohol measurement was recorded in the patient's medical record and how it was assessed in practice. Equally, practitioners completed or partially completed AUDIT in fewer than half of patients who were perceived to be eligible for further screening. There was more consistency in physical activity assessment. Omitted questions, related to physical activity, were largely around work-related physical activity. Conclusions Overall, inconsistent use of recommended tools for screening alcohol and physical activity in NHS Health Check suggests that some practitioners do not follow recommended national guidance. Omission of certain questions led to missed opportunities for practitioners to discuss alcohol consumption, particularly with those who reported apparently excessive alcohol consumption (>14 units per week). Interviews with NHS Health Check practitioners may help to understand barriers to following recommended practice and identify areas for improvement

Birmingham, West Midlands’ Young Persons’ Physical Activity Pathway: Evaluation Report

The Birmingham, West Midlands’ Young Persons’ Physical Activity Pathway (YPPAP) is a pilot six week behavioural intervention (a physical activity pathway) aimed at increasing physical activity levels in school-aged children in school years 6 and 7 (ages 10-12 yrs). It builds on the experiences of the South Staffordshire (SS) Physical Activity Care Pathway (PACP), but was developed specifically to focus on school-age young people in an urban city setting. For the purposes of the evaluation a mixed-methods approach including a quantitative and qualitative component was employed. Data analysis revealed that of the 239 eligible participants, 99 entered the pathway (31.2%). Ninety-three participants set physical goals at baseline and 3 were lost to follow up representing a pathway completion rate of 97% (n = 90). Overall, the results indicated that the increase in ‘spare time’ physical activity was statistically significant (t(95)=-2.88, p=.005), but the differences were not significant for overall physical activity (t(95)=-.096, p=.924), or mean frequency of physical activity (t(95)=-.414, p=.680). Analysis also revealed that the correlation between change in physical activity between baseline and follow up and the number of goals set by participants was not significant (r = 0.08, p =.436). Qualitative findings revealed that participants perceived that the pathway had helped to educate them about the relationship between physical activity and health and had provided a means of engaging with physical activity in a way that was fun and non-threatening. Delivery costs were also calculated taking into account management and delivery costs, including resources, training and support, the total cost per child of delivering the intervention was £143. The high completion rate might point to the utility of using school settings for physical activity interventions. Problematically, the limited sample size prevented the meaningful investigation of any relationship between the physical activity options chosen by young participants and outcomes in terms of potential increases in levels of physical activity. Similarly, it was not possible to fully investigate the potential effects of gender, class, ethnicity, disability status on adherence to the pathway or physical activity behaviour. More usefully, data analysis revealed that the pathway attracted a range of participants which demonstrated potential for securing the interest and motivation of participants. This finding underpins the importance of understanding the number, variety and availability of local physical activity opportunities and delivering the intervention in a way that is engaging and supportive

A qualitative investigation of non-response in NHS health checks

Background Improving uptake of NHS Health Checks has become a priority in England, but there is a lack of data on the perceptions of programme non-attenders. This study aimed to explore how non-attenders of NHS Health Checks perceive the programme, identify reasons for non-attendance and inform strategies to improve uptake. Method This qualitative study involved individuals registered at four general practices in Stoke-on-Trent, UK, who had not taken up their invitation to a NHS Health Check. Semi-structured face-to-face and telephone interviews were audio-recorded and transcribed verbatim for Thematic Analysis. Results Interviews were completed with 19 males and 22 females (mean age 52.9 ± 8.5 years), who were socio-demographically representative of the non-attender population. Four main themes identified related to: the positive perception of the Health Check concept among non-attenders; the perceived lack of personal relevance; ineffective invitation method and appointment inconvenience were common barriers; previous experience of primary care can influence uptake. Conclusions Fundamental requirements for improving uptake are that individuals recognise the personal relevance of Health Checks and that attendance is convenient. Incorporating more sophisticated and personalised risk communication as part of the invitation could increase impact and promote candidacy. Flexibility and convenience of appointments should be considered by participating general practices. Keywords Health check Mass screening Cardiovascular diseases Qualitative researc

A systematic review of the relationship between socio-economic position and physical activity

Objective \ud The aim of the present review was to examine epidemiological evidence to determine if there is strong evidence of a positive gradient of increasing physical activity across the socio-economic strata, and how relationships are affected by socio-economic measurement.\ud \ud Design \ud Systematic review.\ud \ud Method \ud A search of major databases was conducted to identify published studies that reported physical activity in relation to socio-economic position (SEP) in adults.\ud Results Twenty-eight cross-sectional and five longitudinal studies met the inclusion criteria. Approximately half of these were American. Consequently education and income were most commonly used to represent SEP. The majority of studies were secondary analyses of existing health survey data, which could explain the generally large sample sizes and methodological weaknesses in physical activity and SEP measurement. There was consistent evidence of a higher prevalence or higher levels of leisure-time or moderate-vigorous intensity physical activity in those at the top of the socio-economic strata compared with those at the bottom. Evidence for positive gradients across the socio-economic strata was less consistent. Education produced the most stable relationships, less susceptible to confounding effects of ethnicity and the environment.\ud \ud Conclusion \ud Those at the top of the socio-economic scale appear to perform more leisure-time activity than those at the bottom. Diverse and often crude physical activity and socio-economic measurement made it difficult to distinguish between artefact and true effect in a relationship with so many potential confounding influences. Further studies using up-to-date methods of socio-economic and physical activity measurement are necessary to further explore this relationship and its confounders

A systematic review of the relationship between socio-economic position and physical activity

Objective The aim of the present review was to examine epidemiological evidence to determine if there is strong evidence of a positive gradient of increasing physical activity across the socio-economic strata, and how relationships are affected by socio-economic measurement. Design Systematic review. Method A search of major databases was conducted to identify published studies that reported physical activity in relation to socio-economic position (SEP) in adults. Results Twenty-eight cross-sectional and five longitudinal studies met the inclusion criteria. Approximately half of these were American. Consequently education and income were most commonly used to represent SEP. The majority of studies were secondary analyses of existing health survey data, which could explain the generally large sample sizes and methodological weaknesses in physical activity and SEP measurement. There was consistent evidence of a higher prevalence or higher levels of leisure-time or moderate-vigorous intensity physical activity in those at the top of the socio-economic strata compared with those at the bottom. Evidence for positive gradients across the socio-economic strata was less consistent. Education produced the most stable relationships, less susceptible to confounding effects of ethnicity and the environment. Conclusion Those at the top of the socio-economic scale appear to perform more leisure-time activity than those at the bottom. Diverse and often crude physical activity and socio-economic measurement made it difficult to distinguish between artefact and true effect in a relationship with so many potential confounding influences. Further studies using up-to-date methods of socio-economic and physical activity measurement are necessary to further explore this relationship and its confounders

Editorial: Human-Nature Interactions: Perspectives on Conceptual and Methodological Issues

Urban agglomerations expose citizens to ever-increasing risks from heat, air pollution, noise stress, and reduced nature connectedness. Concurrently, accumulating evidence suggests various health benefits by exposure to urban natural spaces (World Health Organization, 2016a; Bratman et al., 2019). Existing research suggests an array of benefits of contact with nature which are linked to physical activity (e.g., green exercise), active travel, and residential proximity to greenspace. Psychological benefits appear to be related to mood, well-being, attention and pro-environmental behavior; physiological benefits have been described in terms of increased physical activity, improved cardiovascular parameters, reduced stress hormones, and enhanced immune resources (Bowler et al., 2010; Li, 2010; Park et al., 2010; Calogiuri and Chroni, 2014; Hartig et al., 2014; van den Bosch and Sang, 2017)

Associations between park features, park satisfaction and park use in a multi-ethnic deprived urban area

Parks are increasingly understood to be key community resources for public health, particularly for ethnicminority and low socioeconomic groups. At the same time, research suggests parks are underutilised by thesegroups. In order to design effective interventions to promote health, the determinants of park use for thesegroups must be understood.This study examines the associations between park features, park satisfaction andpark use in a deprived and ethnically diverse sample in Bradford, UK. 652 women from the Born in Bradfordcohort completed a survey on park satisfaction and park use. Using a standardised direct observation tool, 44parks in the area were audited for present park features. Features assessed were: access, recreational facilities,amenities, natural features, significant natural features, non-natural features, incivilities and usability. Size andproximity to the park were also calculated. Multilevel linear regressions were performed to understand asso-ciations between park features and (1) park satisfaction and (2) park use. Interactions between park features,ethnicity and socioeconomic status were explored, and park satisfaction was tested as a mediator in the re-lationship between park features and park use.More amenities and greater usability were associated with in-creased park satisfaction, while more incivilities were negatively related to park satisfaction. Incivilities, accessand proximity were also negatively associated with park use. Ethnicity and socioeconomic status had no mod-erating role, and there was no evidence for park satisfaction as a mediator between park features and parkuse.Results suggest diverse park features are associated with park satisfaction and park use, but this did not varyby ethnicity or socioeconomic status. The reduction of incivilities should be prioritised where the aim is toencourage park satisfaction and park us

Factors associated with physical activity referral uptake and participation

The aim of this study was to examine participant and scheme characteristics in relation to access, uptake, and participation in a physical activity referral scheme (PARS) using a prospective population-based longitudinal design. Participants (n = 3762) were recruited over a 3-year period. Logistic regression analyses identified the factors associated with the outcomes of referral uptake, participation, and completion (>= 80% attendance). Participant's age, sex, referral reason, referring health professional, and type of leisure provider were the independent variables. Based on binary logistic regression analysis (n=2631), only primary referral reason was associated with the PARS coordinator making contact with the participants. In addition to the influence of referral reason, females were also more likely (odds ratio 1.250, 95% confidence interval 1.003-1.559, P = 0.047) to agree to be assigned to a leisure provider. Referral reason and referring health professional were associated with taking up a referral opportunity. Older participants (1.016, 1.010-1.023, P = 0.001) and males were more likely to complete the referral. In conclusion, the PARS format may be less appropriate for those more constrained by time (women, young adults) and those with certain referral reasons (overweight/obesity, mental health conditions). More appropriate targeting at the point of referral could improve participation rates by revealing or addressing barriers that might later result in dropout