Understanding parents’ school travel choices: A qualitative study using the Theoretical Domains Framework

© 2017 Elsevier Ltd Traffic related air pollution is detrimental to health and creates a substantial attributable mortality burden. It is suggested that a shift from motorised transport to active forms of travel will therefore have significant health benefits. Currently 46% of school journeys for primary aged children are made by car and this figure has risen steadily. Understanding barriers to active school travel (AST) is an important first step in developing behavioural interventions to increase active travel. The purpose of this study was to explore parents’ experiences of school travel and their choices regarding travel mode with a focus on identifying barriers and facilitators to AST. Twenty parents of primary school children (4–12 years) in the West Yorkshire region took part in semi-structured interviews regarding school travel, informed by the Theoretical Domains Framework. Framework Analysis was used to identify key themes in the data and to develop a comprehensive picture of parents’ experiences of school travel at both individual and structural levels. Distance was the biggest barrier to AST. Time constraints were reported as the main barrier to parents accompanying children in AST, while concerns about safety deterred parents from allowing children to travel independently. The need to incorporate multiple jouneys, such as the work commute and/or multiple school drop-offs, placed demands on parents’ time, while difficulty getting children into local schools meant further to travel for a number of parents. Findings suggest that interventions to promote AST may be particularly effective if tailored towards working parents. However, also addressing factors such as distance to school and school travel at a policy level may produce more significant shifts in behaviour

Contrasting Distributions of Urban Green Infrastructure across Social and Ethno-racial Groups

Links between urban green infrastructure (UGI) and public health benefits are becoming well established. Despite this, how UGI is distributed varies widely. Although not a universal finding, sectors of society that are disadvantaged often suffer from poor provision, something which might be due to which UGI are examined. We assess the distribution of street trees and public greenspaces (two types of publicly-owned and accessible UGI) across the city of Bradford, UK which is characterised by high levels of inequality and variation in ethno-racial background. We do this through statistical and spatial analyses. Street tree density was distributed unevenly and was highest in neighbourhoods with a high proportion of Asian/Asian British residents and with lower socio-economic status. Conversely, neighbourhoods with better access to public greenspaces were characterised by high income and/or a high proportion of White households. While the quality of public greenspace was spatially clustered, there were only limited spatial associations with ethno-racial group or socio-economic status. Population density was a key determinant of the distribution of UGI, suggesting understanding UGI distributions should also focus on urban form. Nevertheless, within the same city we show that equitable distribution of UGI differs according to the form and characteristics of UGI. To fully realise the public health benefits of UGI, it is necessary to map provision and understand the causal drivers of unequal distributions. This would facilitate interventions that promote equitable distributions of UGI based on the needs of the target populations

Basis of Intentions as a Moderator of the Intention–Health Behavior Relationship

Objective: Previous research has shown that the degree to which individuals base their intentions on particular underlying cognitions (i.e., motives) significantly moderates the intention– behavior relationship. Studies have individually examined the moderating effect of intentions based on overall attitude, affective attitudes, injunctive norms, and moral norms. The present research used a within-persons approach to simultaneously test the moderating effects of intentions based on instrumental attitude, affective attitude, anticipated affective reactions, injunctive norms, descriptive norms, and moral norms on the intention– behavior relationship and the impact of controlling for intention stability, self-efficacy, and past behavior. Method: The main outcome measures were the self-reported performance of 20 health behaviors. Adults (N 366) completed questionnaires assessing instrumental attitude, affective attitude, anticipated affective reactions, injunctive norms, descriptive norms, moral norms, self-efficacy and past behavior at baseline; intentions at baseline and 1-month follow-up; and behavior at 2-month follow-up for 20 health behaviors. Results: When tested simultaneously using multilevel modeling the only significant moderator of the intention– behavior relationship was the extent to which intentions were based on anticipated affective reactions (intentions more strongly based on anticipated affective reactions were significantly stronger predictors of behavior). This effect remained when we also controlled for intention stability (which also moderated the intention– behavior relationship), self-efficacy, and past behavior. Conclusions: Intentions based on anticipated affective reactions may be particularly important predictors of health behaviors. Studies manipulating such intentions to test their effects on behavior change are required

Locked volar plating for complex distal radius fractures: Patient reported outcomes and satisfaction

<p>Abstract</p> <p>Background</p> <p>Distal radius fractures are common. The increasing prevalence of osteoporosis contributes to frequently complex articular injuries sustained even after low energy falls. The best method of treating complex type C distal radius fractures is debated. Locked volar plating and external fixation are both widely used with good reported results. Measures of success are traditionally based on technical measurements or the perception of the surgeon. Patient reported measures of outcome are increasingly recognised as important markers of surgical success. We report our experience using locked volar plating for complex type C distal radius fractures as well as patient reported measures of success and satisfaction.</p> <p>Methods</p> <p>Over a 12 month period we treated 21 patients with type C distal radius fractures using locked volar plating. These patients were followed up for at least 12 months and the outcome was assessed using clinical examination, grip strength measurements, radiographs and Patient Rated Wrist Evaluation (PRWE) scoring.</p> <p>Results</p> <p>The 21 patients studied had an average age of 48 years. There were 8 men and 13 women. All of the fractures had united by 3 months. There were no cases of wound infection or tendon injury/irritation. Patients reported low pain scores, good patient rated wrist evaluation scores and high levels of satisfaction.</p> <p>Conclusions</p> <p>Locked volar plating for complex distal radius fractures produces good results when assessed using patient reported measures of outcome. Further work should address whether locked volar plating offers superior outcomes and patient satisfaction compared to external fixation.</p

Nothing about us without us: A co-production strategy for communities, researchers and stakeholders to identify ways of improving health and reducing inequalities

Introduction: Co-production with communities is increasingly seen as best practice that can improve the quality, relevance and effectiveness of research and service delivery. Despite this promising position, there remains uncertainty around definitions of co-production and how to operationalize it. The current paper describes the development of a co-production strategy to guide the work of the ActEarly multistakeholder preventative research programme to improve children's health in Bradford and Tower Hamlets, UK. Methods: The strategy used Appreciative Inquiry (AI), an approach following a five-step iterative process: to define (Step 1) scope and guide progress; to discover (Step 2) key issues through seven focus groups (N = 36) and eight in-depth interviews with key stakeholders representing community groups, and the voluntary and statutory sectors; to dream (Step 3) best practice through two workshops with AI participants to review findings; to design (Step 4) a co-production strategy building on AI findings and to deliver (Step 5) the practical guidance in the strategy. Results: Nine principles for how to do co-production well were identified: power should be shared; embrace a wide range of perspectives and skills; respect and value the lived experience; benefits should be for all involved parties; go to communities and do not expect them to come to you; work flexibly; avoid jargon and ensure availability of the right information; relationships should be built for the long-term; co-production activities should be adequately resourced. These principles were based on three underlying values of equality, reciprocity and agency. Conclusion: The empirical insights of the paper highlight the crucial importance of adequate resources and infrastructure to deliver effective co-production. This documentation of one approach to operationalizing co-production serves to avert any misappropriations of the term ‘co-production’ by listening to service users, stakeholders and other relevant groups, to develop trust and long-term relationships, and build on the learning that already exists amongst such groups. Patient or Public Contribution: The work was overseen by a steering group (N = 17) of individuals, both professional and members of the public with experience in undertaking co-production, and/or with some knowledge of the context of the two ActEarly field sites, who provided regular oversight and feedback on the AI process

Role of affective attitudes and anticipated affective reactions in predicting health behaviors

Objective: Two measures of affect-affective attitude (AA) and anticipated affective reaction (AAR)- have frequently been used individually, but rarely simultaneously, in correlational studies predicting health behaviors. This research assessed their individual and combined impact in predicting intention and action for a range of health behaviors, controlling for theory of planned behavior (TPB) variables. Method: Self-reported intentions and performance of health behaviors were the main outcome measures. Design: Study 1 is a meta-analysis of published studies (k = 16) measuring the relevant variables. In Study 2, adults (N = 426) completed questionnaires assessing TPB variables, past behavior, AA, AAR, and subsequent behavior for a range of health behaviors. Results: Across both studies, AA and AAR were only moderately intercorrelated, although both had significant correlations with both intentions and behavior. AA was a significant predictor of intentions and behavior after controlling for TPB variables (Studies 1 and 2) plus past behavior (Study 2). In Study 1, AAR was a significant predictor of behavior, but not intentions, when controlling for TPB variables. In Study 2, AAR was a significant predictor of intentions when controlling for both TPB variables plus past behavior (Study 2), but was not a significant predictor of behavior when controlling for either of these variables. Several relationships were moderated by health-behavior category. Conclusions: Both AA and AAR are important predictors of health behaviors and can have independent effects on intentions and action. Studies manipulating both variables to test their independent and combined effects on behavior change are required

Tackling student binge drinking: pairing incongruent messages and measures reduces alcohol consumption

Objectives: Excessive alcohol consumption is a persistent problem in Northern European cultures. Across a 2-week period, we tested the effect of varying message frames, message types, and response measures, in reducing alcohol consumption. Design: Three hundred and twenty-three respondents were allocated to a 2 (message frame: gain vs. loss) × 2 (message type: health vs. social) × 2 (response type: engaging vs. refraining) mixed design. Method: Binge drinking and units consumed were measured at Time 1 and Time 2 (2 weeks later). Participants read (following Time 1) a gain- or loss-framed message on binging emphasizing either social or health consequences and answered engaging in or refraining from drinking attitude measures. Results: No main effects were identified. The key finding was that gain-framed messages, when used in conjunction with engage response measures (an incongruous pairing), were highly effective in reducing alcohol consumption 2 weeks later compared with the other message frame/response measure combinations. Conclusions: We suggest that for prevention behaviours, gain-framed messages, when paired with engage response measures, initiate an inconsistency resolution process. Together, our findings emphasize the importance of message frame and response type when seeking to reduce alcohol consumption using persuasive health messages

Evidence, Theory and Context: Using intervention mapping to develop a worksite physical activity intervention

<p>Abstract</p> <p>Background</p> <p>The workplace is an ideal setting for health promotion. Helping employees to be more physically active can not only improve their physical and mental health, but can also have economic benefits such as reduced sickness absence. The current paper describes the development of a three month theory-based intervention that aims to increase levels of moderate intensity physical activity amongst employees in sedentary occupations.</p> <p>Methods</p> <p>The intervention was developed using an intervention mapping protocol. The intervention was also informed by previous literature, qualitative focus groups, an expert steering group, and feedback from key contacts within a range of organisations.</p> <p>Results</p> <p>The intervention was designed to target awareness (e.g. provision of information), motivation (e.g. goal setting, social support) and environment (e.g. management support) and to address behavioural (e.g. increasing moderate physical activity in work) and interpersonal outcomes (e.g. encourage colleagues to be more physically active). The intervention can be implemented by local facilitators without the requirement for a large investment of resources. A facilitator manual was developed which listed step by step instructions on how to implement each component along with a suggested timetable.</p> <p>Conclusion</p> <p>Although time consuming, intervention mapping was found to be a useful tool for developing a theory based intervention. The length of this process has implications for the way in which funding bodies allow for the development of interventions as part of their funding policy. The intervention will be evaluated in a cluster randomised trial involving 1350 employees from 5 different organisations, results available September 2009.</p