Publications

Research papers published by our team

2021

Iqbal H. et al (2021) A systematic review to identify research priority setting in Black and minority ethnic health and evaluate their processes

Authors - Halima Iqbal, Jane West, Melanie Haith-Cooper, Rosemary R. C. McEachan

https://doi.org/10.1371/journal.pone.0251685

Background

Black, Asian and minority ethnic communities suffer from disproportionately poorer health than the general population. This issue has been recently exemplified by the large numbers of infection rates and deaths caused by covid-19 in BAME populations. Future research has the potential to improve health outcomes for these groups. High quality research priority setting is crucial to effectively consider the needs of the most vulnerable groups of the population.

Objective

The purpose of this systematic review is to identify existing research priority studies conducted for BAME health and to determine the extent to which they followed good practice principles for research priority setting.

Method

Included studies were identified by searching Medline, Cinnahl, PsychINFO, Psychology and Behavioral Sciences Collection, as well as searches in grey literature. Search terms included “research priority setting”, “research prioritisation”, “research agenda”, “Black and minority ethnic”, “ethnic group”. Studies were included if they identified or elicited research priorities for BAME health and if they outlined a process of conducting a research prioritisation exercise. A checklist of Nine Common Themes of Good Practice in research priority setting was used as a methodological framework to evaluate the research priority processes of each study.

Results

Out of 1514 citations initially obtained, 17 studies were included in the final synthesis. Topic areas for their research prioritisation exercise included suicide prevention, knee surgery, mental health, preterm birth, and child obesity. Public and patient involvement was included in eleven studies. Methods of research prioritisation included workshops, Delphi techniques, surveys, focus groups and interviews. The quality of empirical evidence was diverse. None of the exercises followed all good practice principles as outlined in the checklist. Areas that were lacking in particular were: the lack of a comprehensive approach to guide the process; limited use of criteria to guide discussion around priorities; unequal or no representation from ethnic minorities, and poor evaluation of their own processes.

Conclusions

Research priority setting practices were found to mostly not follow good practice guidelines which aim to ensure rigour in priority setting activities and support the inclusion of BAME communities in establishing the research agenda. Research is unlikely to deliver useful findings that can support relevant research and positive change for BAME communities unless they fulfil areas of good practice such as inclusivity of key stakeholders’ input, planning for implementation of identified priorities, criteria for deciding on priorities, and evaluation of their processes in research priority setting.

Pinot de Moira, A. et al (2021) The EU Child Cohort Network’s core data: establishing a set of findable, accessible, interoperable and re-usable (FAIR) variables

Authors - Angela Pinot de Moira, Sido Haakma, for the LifeCycle Project Group

https://link.springer.com/article/10.1007%2Fs10654-021-00733-9

Abstract

The Horizon2020 LifeCycle Project is a cross-cohort collaboration which brings together data from multiple birth cohorts from across Europe and Australia to facilitate studies on the influence of early-life exposures on later health outcomes. A major product of this collaboration has been the establishment of a FAIR (findable, accessible, interoperable and reusable) data resource known as the EU Child Cohort Network. Here we focus on the EU Child Cohort Network’s core variables. These are a set of basic variables, derivable by the majority of participating cohorts and frequently used as covariates or exposures in lifecourse research. First, we describe the process by which the list of core variables was established. Second, we explain the protocol according to which these variables were harmonised in order to make them interoperable. Third, we describe the catalogue developed to ensure that the network’s data are findable and reusable. Finally, we describe the core data, including the proportion of variables harmonised by each cohort and the number of children for whom harmonised core data are available. EU Child Cohort Network data will be analysed using a federated analysis platform, removing the need to physically transfer data and thus making the data more accessible to researchers. The network will add value to participating cohorts by increasing statistical power and exposure heterogeneity, as well as facilitating cross-cohort comparisons, cross-validation and replication. Our aim is to motivate other cohorts to join the network and encourage the use of the EU Child Cohort Network by the wider research community.

Taylor, K. et al (2021) Effect of Maternal Prepregnancy/Early-Pregnancy Body Mass Index and Pregnancy Smoking and Alcohol on Congenital Heart Diseases: A Parental Negative Control Study

Authors - Kurt Taylor, Ahmed Elhakeem, Johanna Lucia Thorbjørnsrud Nader, Tiffany C. Yang, Elena Isaevska, Lorenzo Richiardi, Tanja Vrijkotte, Angela Pinot de Moira, Deirdre M. Murray, Daragh Finn, Dan Mason, John Wright, Sam Oddie, Nel Roeleveld, Jennifer R. Harris, Anne‐Marie Nybo Andersen, Massimo Caputo, and Deborah A. Lawlor

https://www.ahajournals.org/doi/10.1161/JAHA.120.020051

Background

Congenital heart diseases (CHDs) are the most common congenital anomaly. The causes of CHDs are largely unknown. Higher prenatal body mass index (BMI), smoking, and alcohol consumption are associated with increased risk of CHDs. Whether these are causal is unclear.

Methods and Results

Seven European birth cohorts, including 232 390 offspring (2469 CHD cases [1.1%]), were included. We applied negative exposure paternal control analyses to explore the intrauterine effects of maternal BMI, smoking, and alcohol consumption during pregnancy, on offspring CHDs and CHD severity. We used logistic regression, adjusting for confounders and the other parent's exposure and combined estimates using a fixed‐effects meta‐analysis. In adjusted analyses, maternal overweight (odds ratio [OR], 1.15 [95% CI, 1.01–1.31]) and obesity (OR, 1.12 [95% CI, 0.93–1.36]), compared with normal weight, were associated with higher odds of CHD, but there was no clear evidence of a linear increase in odds across the whole BMI distribution. Associations of paternal overweight, obesity, and mean BMI were similar to the maternal associations. Maternal pregnancy smoking was associated with higher odds of CHD (OR, 1.11 [95% CI, 0.97–1.25]) but paternal smoking was not (OR, 0.96 [95% CI, 0.85–1.07]). The positive association with maternal smoking appeared to be driven by nonsevere CHD cases (OR, 1.22 [95% CI, 1.04–1.44]). Associations with maternal moderate/heavy pregnancy alcohol consumption were imprecisely estimated (OR, 1.16 [95% CI, 0.52–2.58]) and similar to those for paternal consumption.

Conclusions

We found evidence of an intrauterine effect for maternal smoking on offspring CHDs, but no evidence for higher maternal BMI or alcohol consumption. Our findings provide further support for the importance of smoking cessation during pregnancy.

Dunning, A. et al (2021) Exploring nurses' experiences of value congruence and the perceived relationship with wellbeing and patient care and safety: a qualitative study

Authors - Daniel D Bingham, Andy Daly-Smith, Jennifer Hall, Amanda Seims, Sufyan A. Dogra, Stuart J Fairclough, Mildred Ajebon, Brian Kelly, Bo Hou, Katy A Shire, Kirsty L Crossley, Mark Mon-Williams, John Wright, Kate Pickett, Rosemary McEachan, Josie Dickerson, Sally E Barber

https://www.medrxiv.org/content/10.1101/2021.02.26.21252543v2

Background

In England, the onset of COVID-19 and a rapidly increasing infection rate resulted in a lockdown (March-June 2020) which placed strict restrictions on movement of the public, including children. Using data collected from children living in a multi-ethnic city with high levels of deprivation, this study aimed to: (1) report childrens self-reported physical activity (PA) during the first COVID-19 UK lockdown and identify associated factors; (2) examine changes of childrens self-reported PA prior to and during the first UK lockdown.

Methods

This study is part of the Born in Bradford (BiB) COVID-19 Research Study. PA (amended Youth Activity Profile), sleep, sedentary behaviours, daily frequency/time/destination/activity when leaving the home, were self-reported by 949 children (9-13 years). A sub-sample (n=634) also self-reported PA (Physical Activity Questionnaire for Children) pre-pandemic (2017-February 2020). Univariate analysis assessed differences in PA between sex and ethnicity groups; multivariable logistic regression identified factors associated with children’s PA. Differences in children’s levels of being sufficiently active were examined using the McNemar test examined change in PA prior to and during the lockdown, and multivariable logistic regression to identify factors explaining change.

Results

During the pandemic, White British (WB) children were more sufficiently active (34.1%) compared to Pakistani Heritage children (PH) (22.8%) or ‘Other’ ethnicity children (O) (22.8%). WB children reported leaving the home more frequently and for longer periods than PH and O children. Modifiable variables related to being sufficiently active were frequency, duration, type of activity, and destination away from the home environment. There was a large reduction in children being sufficiently active during the first COVID-19 lockdown (28.9%) compared to pre-pandemic (69.4%).

Conclusions

Promoting safe extended periods of PA everyday outdoors is important for all children, in particular for children from ethnic minority groups. Children’s PA during the first COVID-19 UK lockdown has drastically reduced from before. Policy and decision makers, and practitioners should consider the findings in order to begin to understand the impact and consequences that COVID-19 has had upon children’s PA which is a key and vital behaviour for health and development.

Bingham, D. et al (2021) Covid-19 lockdown: Ethnic differences in children’s self-reported physical activity and the importance of leaving the home environment

Authors - Daniel D Bingham, Andy Daly-Smith, Jennifer Hall, Amanda Seims, Sufyan A. Dogra, Stuart J Fairclough, Mildred Ajebon, Brian Kelly, Bo Hou, Katy A Shire, Kirsty L Crossley, Mark Mon-Williams, John Wright, Kate Pickett, Rosemary McEachan, Josie Dickerson, Sally E Barber

https://www.medrxiv.org/content/10.1101/2021.02.26.21252543v2

Background

In England, the onset of COVID-19 and a rapidly increasing infection rate resulted in a lockdown (March-June 2020) which placed strict restrictions on movement of the public, including children. Using data collected from children living in a multi-ethnic city with high levels of deprivation, this study aimed to: (1) report childrens self-reported physical activity (PA) during the first COVID-19 UK lockdown and identify associated factors; (2) examine changes of childrens self-reported PA prior to and during the first UK lockdown.

Methods

This study is part of the Born in Bradford (BiB) COVID-19 Research Study. PA (amended Youth Activity Profile), sleep, sedentary behaviours, daily frequency/time/destination/activity when leaving the home, were self-reported by 949 children (9-13 years). A sub-sample (n=634) also self-reported PA (Physical Activity Questionnaire for Children) pre-pandemic (2017-February 2020). Univariate analysis assessed differences in PA between sex and ethnicity groups; multivariable logistic regression identified factors associated with children’s PA. Differences in children’s levels of being sufficiently active were examined using the McNemar test examined change in PA prior to and during the lockdown, and multivariable logistic regression to identify factors explaining change.

Results

During the pandemic, White British (WB) children were more sufficiently active (34.1%) compared to Pakistani Heritage children (PH) (22.8%) or ‘Other’ ethnicity children (O) (22.8%). WB children reported leaving the home more frequently and for longer periods than PH and O children. Modifiable variables related to being sufficiently active were frequency, duration, type of activity, and destination away from the home environment. There was a large reduction in children being sufficiently active during the first COVID-19 lockdown (28.9%) compared to pre-pandemic (69.4%).

Conclusions

Promoting safe extended periods of PA everyday outdoors is important for all children, in particular for children from ethnic minority groups. Children’s PA during the first COVID-19 UK lockdown has drastically reduced from before. Policy and decision makers, and practitioners should consider the findings in order to begin to understand the impact and consequences that COVID-19 has had upon children’s PA which is a key and vital behaviour for health and development.

Hinde, S. et al (2021) Delayed transfers of care for older people: a wider perspective, Age and Ageing

Authors - Sebastian Hinde, Laura Bojke, Gerry Richardson, Yvonne Birks, William Whittaker, Mark Wilberforce, Andrew Clegg

https://doi.org/10.1093/ageing/afab035

Abstract

Delayed transfers of care (DTOC), often unhelpfully referred to as ‘bed blocking’, has become a byword for waste and inefficiency in healthcare systems throughout the world. An estimated 2.7 million bed days are occupied each year in England by older people no longer in need of acute treatment, estimated to cost £820 million (2014/15) in inpatient care. Policy and media attention have often been drawn to this narrative of financial waste, resulting in policy setting that directly targets the level of DTOC, but has done little to put patient health first.

These figures and policies portray a misleading image of the delays as primarily of concern in terms of their financial burden on acute hospital care, with little consideration given to the quantification on patient health or wider societal impacts. In spite of the multi-factorial decision-making process that occurs for each patient discharge, current evaluation frameworks and national policy setting fail to reflect the complexity of the process.

In this commentary, we interrogate the current approach to the quantification of the DTOC impact and explore how policies and evaluation methods can do more to reflect the true impact of the delays.

Street, A. et al (2021) The use of linked routine data to optimise calculation of the Hospital Frailty Risk Score on the basis of previous hospital admissions: a retrospective observational cohort study

Authors - Prof Andrew Street, Laia Maynou, Thomas Gilbert, Tony Stone, Prof Suzanne Mason, Prof Simon Conroy

https://www.sciencedirect.com/science/article/pii/S2666756821000040?via%3Dihub

Background

The Hospital Frailty Risk Score (HFRS) has been widely but inconsistently applied in published studies, particularly in how diagnostic information recorded in previous hospital admissions is used in its construction. We aimed to assess how many previous admissions should be considered when constructing the HFRS and the influence of frailty risk on long length of stay, in-hospital mortality, and 30-day readmission.

Methods

This is a retrospective observational cohort study of patients aged 75 years or older who had at least one emergency admission to any of 49 hospital sites in the Yorkshire and Humber region of England, UK. We constructed multiple versions of the HFRS for each patient, each form incorporating diagnostic data from progressively more previous admissions in its construction within a 1-year or 2-year window. We assessed the ability of each form of the HFRS to predict long length of stay (>10 days), in-hospital death, and 30-day readmission.

Findings

Between April 1, 2013, and March 31, 2017, 282 091 patients had 675 155 hospital admissions. Regression analyses assessing the different constructions of HFRS showed that the form constructed with diagnostic information recorded in the current and previous two admissions within the preceding 2 years performed best for predicting all three outcomes. Under this construction, 263 432 (39·0%) of 674 615 patient admissions were classified as having low frailty risk, for whom 33 333 (12·7%) had a long length of stay, 10 145 (3·9%) died in hospital, and 45 226 (17·2%) were readmitted within 30 days. By contrast with those patients with low frailty risk, for those with intermediate frailty risk, the probability was 2·5-times higher (95% CI 2·4 to 2·6) for long length of stay, 2·17-times higher (2·1 to 2·2) for in-hospital death, and 0·7% higher (0·5 to 1) for readmission. For patients with high frailty risk, the probability was 4·3-times higher (4·2 to 4·5) for long length of stay, 2·48-times higher (2·4 to 2·6) for in-hospital death, and −1% (−1·2 to −0·5) lower for readmission than those with low frailty risk. The intermediate and high frailty risk categories were more important predictors of long length of stay than any of the other rich set of control variables included in our analysis. These categories also proved to be important predictors of in-hospital mortality, with only the Charlson Comorbidity Index offering greater predictive power.

Interpretation

We recommend constructing the HFRS with diagnostic information from the current admission and from the previous two admissions in the preceding 2 years. This HFRS form was a powerful predictor of long length of stay and in-hospital mortality, but less so of emergency readmissions.

Shoesmith, E. et al (2021) Supporting smoking cessation and preventing relapse following a stay in a smoke‐free setting: a meta‐analysis and investigation of effective behaviour change techniques

Authors - Emily Shoesmith, Lisa Huddlestone, Fabiana Lorencatto, Lion Shahab, Simon Gilbody, Elena Ratschen

https://onlinelibrary.wiley.com/doi/10.1111/add.15452

Background and Aims

Admission to a smoke-free setting presents a unique opportunity to encourage smokers to quit. However, risk of relapse post-discharge is high, and little is known about effective strategies to support smoking cessation following discharge. We aimed to identify interventions that maintain abstinence following a smoke-free stay and determine their effectiveness, as well as the probable effectiveness of behaviour change techniques (BCTs) used in these interventions.

Methods

Systematic review and meta-analyses of studies of adult smokers aged ≥ 18 years who were temporarily or fully abstinent from smoking to comply with institutional smoke-free policies. Institutions included prison, inpatient mental health, substance misuse or acute hospital settings. A Mantel–Haenszel random-effects meta-analysis of randomized controlled trials (RCTs) was conducted using biochemically verified abstinence (7-day point prevalence or continuous abstinence). BCTs were defined as ‘promising’ in terms of probable effectiveness (if BCT was present in two or more long-term effective interventions) and feasibility (if BCT was also delivered in ≥ 25% of all interventions).

Results

Thirty-seven studies (intervention n = 9041, control n = 6195) were included: 23 RCTs (intervention n = 6593, control n = 5801); three non-randomized trials (intervention n = 845, control n = 394) and 11 cohort studies (n = 1603). Meta-analysis of biochemically verified abstinence at longest follow-up (4 weeks–18 months) found an overall effect in favour of intervention [risk ratio (RR) = 1.27, 95% confidence interval (CI) = 1.08–1.49, I2 = 42%]. Nine BCTs (including ‘pharmacological support’, ‘goal-setting (behaviour)’ and ‘social support’) were characterized as ‘promising’ in terms of probable effectiveness and feasibility.

Conclusions

A systematic review and meta-analyses indicate that behavioural and pharmacological support is effective in maintaining smoking abstinence following a stay in a smoke-free institution. Several behaviour change techniques may help to maintain smoking abstinence up to 18 months post-discharge.

Eskyte, I. et al (2021) Organizational Barriers to Oral Health Conversations Between Health Visitors and Parents of Children Aged 9–12 Months Old

Authors - Ieva Eskytė, Kara A. Gray-Burrows, Jenny Owen, Bianca Sykes-Muskett, Sue H. Pavitt, Robert West, Zoe Marshman and Peter F. Day

https://www.frontiersin.org/articles/10.3389/fpubh.2021.578168/full

Background

Dental caries is the most prevalent preventable childhood disease and a major public health priority. Local authorities in England have a statutory responsibility to improve child health, including oral health, through the “Healthy Child Programme.” The “Healthy Child Programme,” which includes the provision of oral health advice is delivered by health visitors to parents of young children. To date, research has mainly concentrated on individual interactions between health visitors and parents, with less attention given to the broader context in which these oral health conversations between health visitor and parents take place.

Objective

Our study explored the organizational factors that obstruct health visitors from engaging in meaningful conversations with parents about young children's oral health.

Methods

Qualitative interviews and focus groups were held with health visiting teams (n = 18) conducting home visits with parents of 9–12-month olds in a deprived, urban area in England.

Results

The study revealed the wide variation in what and how oral health advice is delivered to parents at home visits. Several barriers were identified and grouped into four key themes: (1) Priority of topics discussed in the home visits; (2) Finance cuts and limited resources; (3) Oral health knowledge and skills; and (4) Collaborative working with other professionals. It was evident that organizational factors in current public health policy and service provision play an important role in shaping oral health practices and opportunities for behavior change.

Conclusion

Organizational practices and procedures play an important role in creating interaction patterns between health visiting teams and parents of young children. They often limit effective engagement with and positive change in oral health. For future oral health interventions to be effective, awareness of these barriers is essential alongside them being founded on evidence-based advice and underpinned by appropriate theory.

Crocker, T.F. et al (2021) Community-based complex interventions to sustain independence in older people, stratified by frailty: a protocol for a systematic review and network meta-analysis

Authors - Thomas F Crocker, Andrew Clegg, Richard D. Riley, Natalie Lam, Ram Bajpai, Magda Jordão, Eleftheria Patetsini, Ridha Ramiz, Joie Ensor, Anne Forster, John R F Gladman

https://bmjopen.bmj.com/content/11/2/e045637

Introduction

Maintaining independence is a primary goal of community health and care services for older people, but there is currently insufficient guidance about which services to implement. Therefore, we aim to synthesise evidence on the effectiveness of community-based complex interventions to sustain independence for older people, including the effect of frailty, and group interventions to identify the best configurations.

Methods and analysis

Systematic review and network meta-analysis (NMA). We will include randomised controlled trials (RCTs) and cluster RCTs of community-based complex interventions to sustain independence for older people living at home (mean age ≥65 years), compared with usual care or another complex intervention. We will search MEDLINE (1946 to September 2020), Embase (1947 to September 2020), CINAHL (1981 to September 2020), PsycINFO (1806 to September 2020), CENTRAL and clinical trial registries from inception to September 2020, without date/language restrictions, and scan included papers’ reference lists. Main outcomes were: living at home, activities of daily living (basic/instrumental), home-care services usage, hospitalisation, care home admission, costs and cost effectiveness. Additional outcomes were: health status, depression, loneliness, falls and mortality. Interventions will be coded, summarised and grouped. An NMA using a multivariate random-effects model for each outcome separately will determine the relative effects of different complex interventions. For each outcome, we will produce summary effect estimates for each pair of treatments in the network, with 95% CI, ranking plots and measures, and the borrowing of strength statistic. Inconsistency will be examined using a ‘design-by-treatment interaction’ model. We will assess risk of bias (Cochrane tool V.2) and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation for NMA approach.

Ethics and dissemination

This research will use aggregated, anonymised, published data. Findings will be reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. They will be disseminated to policy-makers, commissioners and providers, and via conferences and scientific journals.

Dickerson, J et al (2021) COVID-19 vaccine hesitancy in an ethnically diverse community: descriptive findings from the Born in Bradford study

Authors - Josie Dickerson, Rachael H. Moss, Charlotte Endacott, Brian Kelly, Sally Bridges, Kirsty L. Crossley, Maria Bryant, Trevor A. Sheldon, John Wright, Kate E. Pickett, Rosemary R.C. McEachan, Bradford Institute for Health Research COVID-19 Scientific Advisory Group

https://wellcomeopenresearch.org/articles/6-23/v1

Background

The roll out of coronavirus disease 2019 (COVID-19) vaccines are now underway in the UK, and ensuring good uptake in vulnerable communities will be critical to reducing hospital admissions and deaths. There is emerging evidence that vaccine hesitancy is higher in ethnic minorities and deprived areas, and that this may be caused by misinformation in the community. This study aims to understand COVID-19 vaccine hesitancy in an ethnically diverse and deprived population.

Methods

Questionnaire surveys were sent to parents in the Born in Bradford study. Cross tabulations explored variation by ethnicity and deprivation. Text from open-ended questions was analysed using thematic analysis.

Results

535 (31%) of 1727 invited between 29th October-9th December 2020 participated in the study. 154 (29%) of respondents do want a vaccine, 53 (10%) do not. The majority had not thought about it (N=154, 29%) or were unsure (N=161, 30%). Vaccine hesitancy differed significantly by ethnicity and deprivation: 43% (95% CIs: 37-54%) of White British and 60% (35-81%) in the least deprived areas do want a vaccine, compared to 13% (9-19%) of Pakistani heritage and 20% (15-26%) in the most deprived areas. Those that distrusted the NHS were more likely to not want a vaccine (30%, 15-50%). Reasons for not wanting a vaccine were commonly explained by confusion and distrust caused by prevalent misinformation.

Conclusions

There is a much higher level of vaccine hesitancy in ethnic minorities, those living in deprived areas and those that distrust the NHS. There is an urgent need to tackle the overwhelming misinformation about COVID-19 that is leading to this uncertainty and confusion about the vaccines. If not addressed there is a high risk of unequitable roll out of the vaccination programme in the UK.

Candio, P et al (2021) Copula Models for Addressing Sample Selection in the Evaluation of Public Health Programmes: An Application to the Leeds Let’s Get Active Study

Authors - Paolo Candio, Andrew J. Hill, Stavros Poupakis, Anni-Maria Pulkki-Brännström, Chris Bojke & Manuel Gomes

https://link.springer.com/article/10.1007%2Fs40258-020-00629-x

Abstract

Sample selectivity is a recurrent problem in public health programmes and poses serious challenges to their evaluation. Traditional approaches to handle sample selection tend to rely on restrictive assumptions. The aim of this paper is to illustrate a copula-based selection model to handle sample selection in the evaluation of public health programmes. Motivated by a public health programme to promote physical activity in Leeds (England), we describe the assumptions underlying the copula selection, and its relative advantages compared with commonly used approaches to handle sample selection, such as inverse probability weighting and Heckman’s selection model. We illustrate the methods in the Leeds Let’s Get Active programme and show the implications of method choice for estimating the effect on individual’s physical activity. The programme was associated with increased physical activity overall, but the magnitude of its effect differed according to adjustment method. The copula selection model led to a similar effect to the Heckman’s approach but with relatively narrower 95% confidence intervals. These results remained relatively similar when different model specifications and alternative distributional assumptions were considered. The copula selection model can address important limitations of traditional approaches to address sample selection, such as the Heckman model, and should be considered in the evaluation of public health programmes, where sample selection is likely to be present.

2020

Dickerson, J et al (2020) “When will this end? Will it end?” The impact of the March-June 2020 UK Covid-19 lockdown response on mental health: a longitudinal survey of mothers in the Born in Bradford study

Authors - Josie Dickerson, Brian Kelly, Bridget Lockyer, Sally Bridges, Christopher Cartwright, Kathryn Willan, Katy Shire, Kirsty Crossley, Marian Bryant, Najma Siddiqi, Trevor A Sheldon, Deborah A Lawlor, John Wright, Rosemary RC McEachan, Kate E Pickett

https://www.medrxiv.org/content/10.1101/2020.11.30.20239954v1

Objectives

To determine clinically important change in anxiety and depression from before to during the first UK Covid-19 lockdown and factors related to this change, including ethnic differences.

Design

Pre-Covid and lockdown surveys nested within two longitudinal Born in Bradford cohort studies.

Participants

1,860 mothers with a child aged 0-4 or 9-13, 48% Pakistani heritage

Main outcome measures

Odds ratios (OR) for a clinically important increase (5 points) in depression (PHQ-8) and anxiety (GAD-7) in unadjusted regression analyses, parsimonious multivariate modelling to explore ethnicity and mental ill health and lived experience of mothers captured in open text questions.

Results

Clinically important depression and anxiety increased from 11% to 19%, and 10% to 16% respectively from before to during the first Covid-19 lockdown. Loneliness during lockdown was most strongly associated with increases in depression (OR: 8.37, 95% CIs: 5.70-12.27) and anxiety (8.50, 5.71-12.65), followed by financial insecurity (6.23, 3.96-9.80; 6.03, 3.82-9.51). Other strongly associated variables included food and housing insecurity, a lack of physical activity and a poor partner relationship.

When level of financial insecurity was taken into account, Pakistani heritage mothers were less likely than White British mothers to experience an increase in depression (0.67, 0.51-0.89) and anxiety (0.73, 0.55-0.97).

Responses to open text highlighted a complex inter-play of health anxieties, mental load, loss of social support and coping strategies, and financial insecurity contributing to mental ill health. Positive aspects of lockdown were also reported, including a more relaxed pace of life.

Conclusions

Mental ill health has worsened with the Covid-19 lockdown, particularly in those who are lonely, economically insecure and/or of White British ethnicity. Mental health problems may have longer term consequences for public health. Strategies to mitigate adverse impacts of future lockdowns on mental health should focus on those factors we highlight as associated with worsening mental health.

Shire, K et al (2020) Developing and implementing a school-led motor intervention for children with handwriting difficulties

Authors - Katy A. Shire, Jo Atkinson, Emily A. Williams, John Pickavance, Sara Magallón, Liam JB. Hill, Amanda H. Waterman, David A. Sugden & Mark Mon-Williams

https://www.tandfonline.com/doi/full/10.1080/19411243.2020.1837047

ABSTRACT

We describe the development of an evidence-based motor intervention and an implementation pilot study in ten primary schools, involving 515 children (4–11 years). ‘Helping Handwriting SHINE’ (HHS) is a novel, school-led, group-based handwriting intervention. Teaching staff delivered HHS and provided feedback through a questionnaire, reporting that: (i) the children found the tasks enjoyable; (ii) the background and booklet instructions were easy to understand, (iii) there was a need for more comprehensive staff training. The teaching staff made recommendations about session duration, group size, resource availability, and age differentiation of tasks. These suggestions are applicable to the development of any school-based group-led motor intervention, and we used this feedback to refine the HHS intervention. This study shows that implementing school-led motor interventions at scale is possible. Moreover, the work provides insights into the factors to consider when developing school-based motor interventions prior to conducting randomized controlled trials (RCT). The process outlined in this manuscript has led to an RCT to test the effectiveness of HHS within primary schools.

Dickerson, J et al (2020) Experiences of lockdown during the Covid-19 pandemic: descriptive findings from a survey of families in the Born in Bradford study

Authors - Josie Dickerson, Brian Kelly, Bridget Lockyer, Sally Bridges, Christopher Cartwright, Kathryn Willan, Katy Shire, Kirsty Crossley, Trevor A. Sheldon, Deborah A. Lawlor, John Wright, Rosemary R C McEachan, Kate E. Pickett, on behalf of the Bradford Institute for Health Research Covid-19 Scientific Advisory Group

https://wellcomeopenresearch.org/articles/5-228/v1

Background

Lockdown measures implemented to contain the Covid-19 virus may be increasing health inequalities, with families from deprived and ethnically diverse backgrounds most likely to be adversely affected. This paper presents findings of the experiences of the Covid-19 lockdown on families living in the multi-ethnic and deprived city of Bradford, England.

Methods

Questionnaire surveys were sent during the Covid-19 UK lockdown (10th April to 30th June 2020) to parents in two prospective birth cohort studies. Cross tabulations explored variation by ethnicity and employment status. Text from open questions were analysed using thematic analysis.

Results

Of 7,652 families invited, 2,144 (28%) participated. Ethnicity of respondents was: 957 (47%) Pakistani heritage, 715 (35%) White British and 356 (18%) other. 971 (46%) live in the most deprived decile of material deprivation in England. 2,043 (95%) were mothers and 101 were partners. The results summarised below are based on the mothers’ responses. Many families live in poor quality (N=574, 28%), and overcrowded (N=364, 19%) housing; this was more common in families of Pakistani heritage and other ethnicities. Financial (N=738 (37%), food (N=396, 20%), employment (N=728, 37%) and housing (N=204, 10%) insecurities were common, particularly in those who were furloughed, self-employed not working or unemployed. Clinically significant depression and anxiety symptoms were reported by 372 (19%) and 318 (16%) of the mothers and were more common in White British mothers and those with economic insecurity. Open text responses corroborated these findings and highlighted high levels of anxiety about becoming ill or dying from Covid-19.

Conclusions

The experiences of the Covid-19 lockdown in this ethnically diverse and deprived population highlight a large number of families living in poor housing conditions, suffering from economic insecurity and poor mental health. There is a need for policy makers and commissioners to better support these families.

Sherry, A.P et al (2020) Impacts of a Standing Desk Intervention within an English Primary School Classroom: A Pilot Controlled Trial

Authors - Aron P. Sherry, Natalie Pearson, Nicola D. Ridgers, William Johnson, Sally E. Barber, Daniel D. Bingham, Liana C. Nagy and Stacy A. Clemes

https://www.mdpi.com/1660-4601/17/19/7048

Abstract

Traditional classroom furniture dictates that children predominantly sit during class time. This study evaluated the impact of providing standing desks within a deprived UK primary school setting over 8 months using mixed-method approaches. All children within a Year 5 class (9–10-year-olds, n = 30) received an adjustable sit–stand desk, while another Year 5 class (n = 30) in a nearby school retained traditional furniture as a control classroom. At baseline, 4 months, and 8 months, activPAL monitors (PAL Technologies, Glasgow, UK) were worn for 7 days to provide time spent sitting and standing. Behavior-related mental health, musculoskeletal discomfort surveys, and a cognitive function test battery were also completed at all three timepoints. Intervention experiences from pupils and the teacher were captured using focus groups, interviews, and classroom observations. At both 4 months and 8 months, multi-level models revealed a reduction in class time sitting in the intervention group compared to the control group ((β (95%CI) 4 months −25.3% (−32.3, −18.4); 8 months −19.9% (−27.05, −12.9)). Qualitative data revealed challenges to teaching practicalities and a gradual decline in behavior-related mental health was observed (intervention vs. control: 4 months +5.31 (+2.55, +8.08); 8 months +7.92 (+5.18, +10.66)). Larger trials within similar high-priority settings are required to determine the feasibility and cost-effectiveness of providing standing desks to every child in the classroom.

Kaczmarczyk, K.H et al (2020) Oral Health Promotion Apps: an assessment of message and behaviour change potential

Authors - Katherine H KACZMARCZYK, Kara A GRAY-BURROWS, Karen VINALL-COLLIER, Peter F DAY

https://academic.oup.com/intqhc/article-abstract/33/1/mzaa112/5903600?redirectedFrom=fulltext

Background

Oral health worldwide needs improving: untreated dental caries is the most common health condition affecting people globally. Mobile applications (apps) have potential to provide preventative oral health interventions. This study aimed to investigate the quality of available oral health promotion apps, assessing information provided and the barriers to oral health addressed using psychological frameworks.

Methods

A content assessment of oral health promotion apps targeted at adults in the UK iTunes store was conducted. The quality of 22 apps was assessed against 3 objective indices derived from the Delivering Better Oral Health toolkit, Theoretical Domains Framework and Behaviour Change Technique Taxonomy. Index scores were calculated and descriptive analyses were completed.

Results

On average, four Delivering Better Oral Health messages, seven Theoretical Domains Framework components and eight Behaviour Change Technique Taxonomy components were addressed per app. The most common components were: ‘take at least two minutes to brush’ for the Delivering Better Oral Health index, ‘goals’ and ‘intentions’ for the Theoretical Domains Framework index and ‘goal setting (behaviour)’ for the Behaviour Change Technique Taxonomy index.

Conclusion

The quality of information available in oral health apps requires improvement with the majority addressing only a few barriers to oral health. Currently, there is no recognized scale for evaluating oral health apps: this study provides a suggested method for future app evaluation. There is opportunity for a new app to be created based on health behaviour change theory which includes all the Delivering Better Oral Health messages.

Nelson, P et al Is Childhood Obesity a Child Protection Concern?

Authors - Peter Nelson, Paul Bissell, Catherine Homer, Lee Pollard, Vanessa Powell-Hoyland

https://academic.oup.com/bjsw/advance-article-abstract/doi/10.1093/bjsw/bcaa100/5892777?redirectedFrom=fulltext

Abstract

Childhood obesity is a key public health concern. Obesity has an impact on morbidity and mortality, child development, and has links to child sexual abuse. The costs of childhood obesity on the health service and society are well recognised. Whether childhood obesity should also be a child protection concern has divided commentators and professionals. They pose a juxtaposition questioning whether childhood obesity is a consequence of neglect and obese children should potentially be removed from parents who do not seek to reduce their child’s weight, whilst expressing resistance to a role focused on bodily surveillance. This research sought to identify existing practice, through interviews (N23) and focus groups (N3:24) with key professional stakeholders, from social care, health and education, in one area in the UK. The research aimed to explore the decision-making, views and experiences of those working with obesity and the child protection system. The data were subject to Framework Analysis. Key findings include multi-agency working, personal and professional standpoint, and the complex and nuanced impact of individual and agency thresholds on practice. The research demonstrates how the tensions surrounding a child protection paradigm impact on individual and agency practice, potentially inhibiting the support offered to service users.

Eddy, L. H et al (2020). The validity and reliability of observational assessment tools available to measure fundamental movement skills in school-age children: A systematic review.

Authors - Lucy H. Eddy, Daniel D. Bingham, Kirsty L. Crossley, Nishaat F. Shahid, Marsha Ellingham-Khan, Ava Otteslev, Natalie S. Figueredo, Mark Mon-Williams, Liam J. B. Hill

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237919

Background

Fundamental Movement Skills (FMS) play a critical role in ontogenesis. Many children have insufficient FMS, highlighting the need for universal screening in schools. There are many observational FMS assessment tools, but their psychometric properties are not readily accessible. A systematic review was therefore undertaken to compile evidence of the validity and reliability of observational FMS assessments, to evaluate their suitability for screening.

Methods

A pre-search of ‘fundamental movement skills’ OR ‘fundamental motor skills’ in seven online databases (PubMed, Ovid MEDLINE, Ovid Embase, EBSCO CINAHL, EBSCO SPORTDiscus, Ovid PsycINFO and Web of Science) identified 24 assessment tools for school-aged children that: (i) assess FMS; (ii) measure actual motor competence and (iii) evaluate performance on a standard battery of tasks. Studies were subsequently identified that: (a) used these tools; (b) quantified validity or reliability and (c) sampled school-aged children. Study quality was assessed using COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklists.

Results

Ninety studies were included following the screening of 1863 articles. Twenty-one assessment tools had limited or no evidence to support their psychometric properties. The Test of Gross Motor Development (TGMD, n = 34) and the Movement Assessment Battery for Children (MABC, n = 37) were the most researched tools. Studies consistently reported good evidence for validity, reliability for the TGMD, whilst only 64% of studies reported similarly promising results for the MABC. Twelve studies found good evidence for the reliability and validity of the Bruininks-Oseretsky Test of Motor Proficiency but poor study quality appeared to inflate results. Considering all assessment tools, those with promising psychometric properties often measured limited aspects of validity/reliability, and/or had limited feasibility for large scale deployment in a school-setting.

Conclusion

There is insufficient evidence to justify the use of any observational FMS assessment tools for universal screening in schools, in their current form.

McEachan, R et al (2020) The Born in Bradford COVID-19 Research Study: Protocol for an adaptive mixed methods research study to gather actionable intelligence on the impact of COVID-19 on health inequalities amongst families living in Bradford

Authors - Rosemary R C McEachan, Josie Dickerson, Sally Bridges, Maria Bryant, Christopher Cartwright, Shahid Islam, Bridget Lockyer, Aamnah Rahman, Laura Sheard, Jane West, Deborah A. Lawlor, Trevor A. Sheldon, John Wright, Kate E. Pickett, on behalf of the Bradford Institute for Health Research COVID-19 Scientific Advisory Group

https://wellcomeopenresearch.org/articles/5-191/v1

Abstract

The UK COVID-19 lockdown has included restricting social movement and interaction to slow the spread of disease and reduce demand on NHS acute services. It is likely that the impacts of restrictions will hit the least advantaged disproportionately and will worsen existing structural inequalities amongst deprived and ethnic minority groups.

The aim of this study is to deliver rapid intelligence to enable an effective COVID-19 response, including co-production of interventions, that address key issues in the City of Bradford, UK, and nationally. In the longer term we aim to understand the impacts of the response on health trajectories and inequalities in these.

In this paper we describe our approach and protocol. We plan an adaptive longitudinal mixed methods approach embedded with Born in Bradford (BiB) birth cohorts which have rich existing data (including questionnaire, routine health and biobank). All work packages (WP) interact and are ongoing. WP1 uses co-production and engagement methods with communities, decision-makers and researchers to continuously set (changing) research priorities and will, longer-term, co-produce interventions to aid the City’s recovery. In WP2 repeated quantitative surveys will be administered during lockdown (April-June 2020), with three repeat surveys until 12 months post-lockdown with an ethnically diverse pool of BiB participants (parents, children aged 9-13 years, pregnant women: total sample pool N=7,652, N=5,154, N=1,800). A range of health, social, economic and education outcomes will be assessed. In WP3 priority topics identified in WP1 and WP2 will be explored qualitatively. Initial priority topics include children’s mental wellbeing, health beliefs and the peri/post-natal period. Feedback loops will ensure findings are fed directly to decision-makers and communities (via WP1) to enable co-production of acceptable interventions and identify future priority topic areas. Findings will be used to aid development of local and national policy to support recovery from the pandemic and minimise health inequalities.

Axford, N et al (2020) The effectiveness of a therapeutic parenting program for children aged 6-11 years with behavioral or emotional difficulties: results from a randomized controlled trial

Authors - Nick Axford, Gretchen Bjornstad, Justin Matthews, Sarah Heilmann, Anam Raja, Obioh C.Ukoumunne, Vashti Berry, Tom Wilkinson, Luke Timmons, Tim Hobbs, TimEames, Angeliki Kallitsoglou, SarahBlower, Georgina Warner

https://www.sciencedirect.com/science/article/abs/pii/S0190740920303170?via%3Dihub

Objective

The aim of the study was to evaluate the implementation and effectiveness of a therapeutic parenting program that targets parents of children aged 6 to 11 years identified as having behavioral and emotional difficulties. The intervention comprises two parts, delivered sequentially: a 10–12-week group-based program for all parents, and one-to-one sessions for up to 12 weeks with selected parents from the group-based element.

Methods/Design

In a randomized controlled trial, 264 participants were allocated to the Inspiring Futures program (intervention) or services as usual (control) arms with follow-up assessments at 16 (post-group program) and 32 (post-one-to-one sessions) weeks. The primary outcome was the parent-rated Strengths and Difficulties Questionnaire (SDQ) Total Difficulties score at 32 weeks. Secondary outcomes included parent-rated SDQ subscales, parent coping strategies, empathy in parenting and parenting skills.

Results

All 264 participants were included in outcome analyses. There was no statistically significant effect on SDQ Total Difficulties (standardized mean difference: −0.07; 95% CI: −0.30 to 0.16; p = 0.54). There were no sub-group effects. Only 1 of 40 comparisons between the trial arms for secondary outcomes across both follow-ups was statistically significant at the 5% level. The mean number of group sessions attended by intervention arm participants was 6.1 (out of 10 to 12) and only 1 in 20 intervention arm participants received one-to-one support. Independent observation indicated scope to improve fidelity in terms of adherence, quality and participant responsiveness.

Conclusions

The intervention is not more effective than services as usual at improving targeted outcomes. This may be related, in part, to implementation issues but arguably more to the inability of a non-behavioral intervention to improve caregiving adequately, particularly when it is not targeted at new parents who have experienced trauma or deprivation early in life or subsequently.

Blower, S et al (2020) Children and young people’s concerns and needs relating to their use of health technology to self-manage long-term conditions: a scoping review

Authors - Sarah Blower, Veronica Swallow, Camila Maturana, Simon Stones, Robert Phillips, Paul Dimitri, Zoe Marshman, Peter Knapp, Alexandra Dean, Steven Higgins, Ian Kellar, Penny Curtis, Nathaniel Mills

https://adc.bmj.com/content/105/11/1093

Background

The use of patient-facing health technologies to manage long-term conditions is increasing; however, children and young people may have particular concerns or needs before deciding to use different health technologies.

Aims

To identify children and young people’s reported concerns or needs in relation to using health technologies to self-manage long-term conditions.

Methods

A scoping review was conducted. We searched MEDLINE, PsycINFO and CINAHL in February 2019. Searches were limited to papers published between January 2008 and February 2019. We included any health technology used to manage long-term conditions. A thematic synthesis of the data from the included studies was undertaken. We engaged children with long-term conditions (and parents) to support review design, interpretation of findings and development of recommendations.

Results

Thirty-eight journal articles were included, describing concerns or needs expressed by n=970 children and/or young people aged 5–18 years. Most included studies were undertaken in high-income countries with children aged 11 years and older. Studies examined concerns with mobile applications (n=14), internet (n=9), social media (n=3), interactive online treatment programmes (n=3), telehealth (n=1), devices (n=3) or a combination (n=5). Children and young people’s main concerns were labelling and identity; accessibility; privacy and reliability; and trustworthiness of information.

Discussion

This review highlights important concerns that children and young people may have before using technology to self-manage their long-term condition. In future, research should involve children and young people throughout the development of technology, from identifying their unmet needs through to design and evaluation of interventions.

Santorelli, G et al (2020) COVID-19 in-patient hospital mortality by ethnicity

Authors - Gillian Santorelli, Trevor Sheldon, Jane West, Chris Cartwright, John Wright

https://wellcomeopenresearch.org/articles/5-86/v1

Abstract

There is debate about the extent to which COVID-19 affects ethnic groups differently. We explored if there was variation in hospital mortality in patients with COVID. Mortality rates in 1,276 inpatients in Bradford with test results for COVID-19 were analysed by ethnic group. The age-adjusted risk of dying from COVID-19 was slightly lower in South Asian compared to White British patients. (RR =0.87, 95% CI: 0.41 to 1.84).

Clemes, S.A. et al (2020) Stand Out in Class: restructuring the classroom environment to reduce sitting time – findings from a pilot cluster randomised controlled trial

Authors - Stacy A. Clemes, Daniel D. Bingham, Natalie Pearson, Yu-Ling Chen, Charlotte L. Edwardson, Rosemary R. C. McEachan, Keith Tolfrey, Lorraine Cale, Gerry Richardson, Mike Fray, James Altunkaya, Stephan Bandelow, Nishal Bhupendra Jaicim, Jo Salmon, David W. Dunstan & Sally E. Barber

https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-020-00958-z

Background

Excessive sedentary behaviour (sitting) is a risk factor for poor health in children and adults. Incorporating sit-stand desks in the classroom environment has been highlighted as a potential strategy to reduce children’s sitting time. The primary aim of this study was to examine the feasibility of conducting a cluster randomised controlled trial (RCT) of a sit-stand desk intervention within primary school classrooms.

Methods

We conducted a two-armed pilot cluster RCT involving 8 primary schools in Bradford, United Kingdom. Schools were randomised on a 1:1 basis to the intervention or usual practice control arm. All children (aged 9–10 years) in participating classes were eligible to take part. Six sit-stand desks replaced three standard desks (sitting 6 children) in the intervention classrooms for 4.5-months. Teachers were encouraged to use a rotation system to ensure all pupils were exposed to the sit-stand desks for > 1 h/day on average. Trial feasibility outcomes (assessed using quantitative and qualitative measures) included school and participant recruitment and attrition, intervention and outcome measure completion rates, acceptability, and preliminary effectiveness of the intervention for reducing sitting time. A weighted linear regression model compared changes in weekday sitting time (assessed using the activPAL accelerometer) between trial arms.

Results

School and child recruitment rates were 33% (n = 8) and 75% (n = 176). At follow-up, retention rates were 100% for schools and 97% for children. Outcome measure completion rates ranged from 63 to 97%. A preliminary estimate of intervention effectiveness revealed a mean difference in change in sitting of − 30.6 min/day (95% CI: − 56.42 to − 4.84) in favour of the intervention group, after adjusting for baseline sitting and wear time. Qualitative measures revealed the intervention and evaluation procedures were acceptable to teachers and children, except for some problems with activPAL attachment.

Conclusion

This study provides evidence of the acceptability and feasibility of a sit-stand desk intervention and evaluation methods. Preliminary evidence suggests the intervention showed potential in reducing children’s weekday sitting but some adaptations to the desk rotation system are needed to maximize exposure. Lessons learnt from this trial will inform the planning of a definitive trial.

Aliakbari E et al (2020) Home-based toothbrushing interventions for parents of young children to reduce dental caries

Authors - Elnaz Aliakbari, Kara A. Gray-Burrows, Karen A. Vinall-Collier, Sakina Edwebi, Zoe Marshman, Rosemary R. C. McEachan, Peter F. Day

https://onlinelibrary.wiley.com/doi/10.1111/ipd.12658

Background

Dental caries is the most prevalent preventable condition in children. A key preventive home-based oral health behaviour is the adoption and maintenance of parental supervised toothbrushing until 8 years of age.

Aim

To examine interventions promoting parental supervised toothbrushing practices to reduce dental caries in young children (<8 years old).

Design

Interventions promoting parental involvement in home-based toothbrushing in children under 8 years old and their impact on caries were subjected to review. Electronic databases (MEDLINE, EMBASE, PubMed, Web of Science, PsycINFO, Scopus, and the Cochrane Library), references, and unpublished literature databases were searched for relevant literature.

Results

Of the 10 176 articles retrieved, forty-two articles were included. The Theoretical Domains Framework was used to code intervention content, with the main domains addressed being knowledge (41/42), skills (35/42), and environmental context and resources (22/42). Sufficient descriptions of the intervention development, delivery, and evaluation were lacking, with only 18 studies being underpinned by theory. Twenty-nine studies explored the impact on caries yielding mixed results.

Conclusions

There are few interventions targeting home-based oral health behaviours underpinned by theory and methodological rigour in their development and evaluation. This demonstrates a clear need for future interventions to be guided by complex intervention methodology.

Shire K et al (2020) Starting School: a large-scale start of school assessment within the ‘Born in Bradford’ longitudinal cohort

Authors - Katy Shire, Elizabeth Andrews, Sally Barber, Alison Bruce, John Corkett, Liam J. B. Hill, Brian Kelly, Rosemary R C McEachan, Louise Tracey, Amanda H. Waterman, John Wright

https://wellcomeopenresearch.org/articles/5-47/v1

Abstract

The Born in Bradford (BiB) cohort of 13,776 children born between 2007-2011 and their parents provides a rich data resource for researchers exploring protective and risk factors influencing long-term developmental and health outcomes. Educational attainment is a critical factor related to later health. Literacy and communication, fine motor skills and social and emotional health are key ‘early’ predictors of educational attainment and can be used to identify children in need of additional support. We describe our BiB ‘Starting School’ data collection protocol which assessed literacy and communication, fine motor skills and social and emotional health on 3,444 BiB children aged 4-5 years old. These measures supplement the existing dataset, and complement the routine educational, health and social care data available for the cohort.

Collings P.J et al (2020) Maternal Physical Activity and Neonatal Cord Blood Lipid Levels: Findings From a Prospective Pregnancy Cohort

Authors - Paul J. Collings, Diane Farrar, Joanna Gibson, Jane West, Sally E. Barber, and John Wright

https://journals.humankinetics.com/view/journals/jpah/17/2/article-p236.xml

Background

Physical activity performed while pregnant is beneficially associated with maternal cardiovascular health. It is unknown if benefits extend to neonatal cardiovascular health. This study investigated associations of maternal physical activity with neonatal cord blood lipid and lipoprotein concentrations.

Methods

Cord blood lipids were measured at birth in a pseudorandomly selected subgroup of Born in Bradford birth cohort participants (N = 1634). Pregnant women were grouped into 4 activity categories (inactive/somewhat active/moderately active/active) based on their self-reported physical activity at 26- to 28-weeks gestation. Regression was used to calculate adjusted mean differences in neonatal cord blood lipid concentrations among the 4 groups of physical activity.

Results

Maternal physical activity was associated with higher neonatal cord blood high-density lipoprotein cholesterol. Cord blood high-density lipoprotein cholesterol was higher in neonates of women who were somewhat and moderately active compared with neonates of women who were inactive. There were no associations of pregnancy physical activity with triglycerides, low-density lipoprotein, very low-density lipoprotein cholesterol, or adiponectin levels.

Conclusions

Maternal physical activity is favorably associated with neonatal cord blood high-density lipoprotein cholesterol levels. This novel beneficial finding highlights the potential for physical activity in pregnancy to aid the early prevention of cardiovascular disease.

Collings P.J et al (2020) Objectively-measured sedentary time and physical activity in a bi-ethnic sample of young children: variation by socio-demographic, temporal and perinatal factors

Authors - Paul J. Collings, Sufyan A. Dogra, Silvia Costa, Daniel D. Bingham & Sally E. Barber

https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-8132-z

Background

Evidence suggests that South Asian school-aged children and adults are less active compared to the white British population. It is unknown if this generalises to young children. We aimed to describe variability in levels of physical activity and sedentary time in a bi-ethnic sample of young children from a deprived location.

Methods

This observational study included 202 South Asian and 140 white British children aged 1.5 to 5y, who provided 3181 valid days of triaxial accelerometry (Actigraph GT3X+). Variability in sedentary time and physical activity levels were analysed by linear multilevel modelling. Logistic multilevel regression was used to identify factors associated with physical inactivity (failing to perform ≥180 min of total physical activity including ≥60 min moderate-to-vigorous physical activity (MVPA) per day).

Results

There were no significant ethnic differences in the overall levels of behaviours; South Asian and white British children spent half of daily time sedentary, just over 40% in light physical activity, and the remaining 7.5 to 8% of time in MVPA. Sedentary time was lower and physical activity levels were higher in older children, and levels of MVPA and vector magnitude counts per minute (CPM) were higher on weekends compared to weekdays. In South Asian children, sedentary time was lower on weekends. Sedentary time was lower and physical activity levels were higher in spring compared to winter in white British children, and in all seasons compared to winter in South Asian children. South Asian children born at high birth weight performed more MVPA, and in both ethnicities there was some evidence that children with older mothers were more sedentary and less active. Sedentary time was higher and light physical activity was lower in South Asian children in the highest compared to the lowest income families. South Asian girls performed less MVPA, registered fewer vector magnitude CPM, and were 3.5 times more likely to be physically inactive than South Asian boys.

Conclusions

Sedentary time and physical activity levels vary by socio-demographic, temporal and perinatal characteristics in young children from a deprived location. South Asian girls have the most to gain from efforts to increase physical activity levels.

Pettinger, K.J et al (2020) Starting school: educational development as a function of age of entry and prematurity

Authors - Katherine J Pettinger, Brian Kelly, Trevor A Sheldon, Mark Mon-Williams, John Wright and Liam J B Hill

https://adc.bmj.com/content/105/2/160

Objective

To estimate the impact on early development of prematurity and summer birth and the potential ‘double disadvantage’ created by starting school a year earlier than anticipated during pregnancy, due to being born preterm.

Design, setting and patients

We investigated the impact of gestational and school-entry age on the likelihood of failing to achieve a ‘Good Level of Development’ (GLD) on the Early Years Foundation Stage Profile in 5-year-old children born moderate-to-late preterm using data from the Born in Bradford longitudinal birth cohort. We used hierarchical logistic regression to control for chronological maturity, and perinatal and socioeconomic factors.

Results

Gestational age and school-entry age were significant predictors of attaining a GLD in the 10 337 children who entered school in the correct academic year given their estimated date of delivery. The odds of not attaining a GLD increased by 1.09 (95% CI 1.06 to 1.11) for each successive week born early and by 1.17 for each month younger within the year group (95% CI 1.16 to 1.18). There was no interaction between these two effects. Children starting school a year earlier than anticipated during pregnancy were less likely to achieve a GLD compared with (1) other children born preterm (fully adjusted OR 5.51 (2.85–14.25)); (2) term summer births (3.02 (1.49–6.79)); and (3) preterm summer births who remained within their anticipated school-entry year (3.64 (1.27–11.48)).

Conclusions

These results confirm the developmental risks faced by children born moderate-to-late preterm, and—for the first time—illustrate the increased risk associated with ‘double disadvantage’.

Dickerson, J et al (2020) Experiences of lockdown during the Covid-19 pandemic: descriptive findings from a survey of families in the Born in Bradford study

Authors - Josie Dickerson, Brian Kelly, Bridget Lockyer, Christopher Cartwright, Kathryn Willan, Katy Shire, Kirsty Crossley, Trevor A Sheldon, Deborah A, John Wright, Rosemary R C McEachan, Kate E Pickett, on behalf of the Bradford Institute for Health Research Covid-19 Scientific Advisory Group

https://wellcomeopenresearch.org/articles/5-228

Background

Lockdown measures implemented to contain the Covid-19 virus may be increasing health inequalities, with families from deprived and ethnically diverse backgrounds most likely to be adversely affected. This paper presents findings of the experiences of the Covid-19 lockdown on families living in the multi-ethnic and deprived city of Bradford, England.

Methods

Questionnaire surveys were sent during the Covid-19 UK lockdown (10th April to 30th June 2020) to parents in two prospective birth cohort studies. Cross tabulations explored variation by ethnicity and employment status. Text from open questions were analysed using thematic analysis.

Results

Of 7,652 families invited, 2,144 (28%) participated. Ethnicity of respondents was: 957 (47%) Pakistani heritage, 715 (35%) White British and 356 (18%) other. 971 (46%) live in the most deprived decile of material deprivation in England. 2,043 (95%) were mothers and 101 were partners. The results summarised below are based on the mothers’ responses. Many families live in poor quality (N=574, 28%), and overcrowded (N=364, 19%) housing; this was more common in families of Pakistani heritage and other ethnicities. Financial (N=738 (37%), food (N=396, 20%), employment (N=728, 37%) and housing (N=204, 10%) insecurities were common, particularly in those who were furloughed, self-employed not working or unemployed. Clinically significant depression and anxiety symptoms were reported by 372 (19%) and 318 (16%) of the mothers and were more common in White British mothers and those with economic insecurity. Open text responses corroborated these findings and highlighted high levels of anxiety about becoming ill or dying from Covid-19.

Conclusions

The experiences of the Covid-19 lockdown in this ethnically diverse and deprived population highlight a large number of families living in poor housing conditions, suffering from economic insecurity and poor mental health. There is a need for policy makers and commissioners to better support these families

Buck, E.T et al (2020) Use of a modified World Café process to discuss and set priorities for a Community of Practice supporting implementation of ReQoL a new mental health and quality of life Patient Reported Outcome Measure (PROM)

Authors - Elizabeth Taylor Buck, Christine M. Smith, Amanda Lane, Anju Devianee Keetharuth, Tracey Young and Jo Cooke

https://link.springer.com/article/10.1186/s41687-020-00202-z?wt_mc=Internal.Event.1.SEM.ArticleAuthorIncrementalIssue

Background

Patient reported outcome measures (PROMs) are a means of assessing the quality and effectiveness of care from the patient’s perspective. However, the routine use of PROMs in clinical practice can be difficult to implement. New challenges arise at different stages of the implementation process and organisations need to invest time and financial resources into designing an appropriate strategy, information systems, providing technical support and preparing staff.

Recovering Quality of Life (ReQoL) is a PROM that was specifically designed to measure mental health service users’ perspectives of recovery and quality of life. It is a co-produced, service user-centred outcome measure tested by over 6000 mental health service users. It is able to detect change across a broad spectrum of mild to severe mental health conditions.

In May 2016 a licence to use the ReQoL measures became freely available to the NHS and publicly funded research. At the time of publication, 149 licences had been issued worldwide and eleven official translations had been made available. The team that developed ReQoL has continued to collaborate with mental health trusts across the country to support the implementation of ReQoL. The National Institute for Health Research and Applied Research Collaboration (NIHR ARC YHFootnote1), and the preceding NIHR CLAHRC-YH, along with the ReQoL development team have helped to guide and fund this work. The NIHR CLAHRC-YH supported two national events, the first of which was the launch of ReQoL at the Houses of Parliament in October 2016. More recently in November 2018, over 70 people, from 23 organisations, attended a second event focused on the development of a ReQoL Community of Practice.

Community of Practices (CoPs) have existed in sectors such as education and business for over 30 years [9], operating as networks and support groups for people who share a common set of problems or interests. Members of CoPs maintain and build links with each other for the purposes of social interaction, knowledge sharing, knowledge creation and identity building.

Franklin, M et al (2020) Conducting Value for Money Analyses for Non-randomised Interventional Studies Including Service Evaluations: An Educational Review with Recommendations

Authors - Matthew Franklin, James Lomas, Gerry Richardson

https://link.springer.com/article/10.1007%2Fs40273-020-00907-5

Abstract

This article provides an educational review covering the consideration of conducting ‘value for money’ analyses as part of non-randomised study designs including service evaluations. These evaluations represent a vehicle for producing evidence such as value for money of a care intervention or service delivery model. Decision makers including charities and local and national governing bodies often rely on evidence from non-randomised data and service evaluations to inform their resource allocation decision-making. However, as randomised data obtained from randomised controlled trials are considered the ‘gold standard’ for assessing causation, the use of this alternative vehicle for producing an evidence base requires careful consideration. We refer to value for money analyses, but reflect on methods associated with economic evaluations as a form of analysis used to inform resource allocation decision-making alongside a finite budget. Not all forms of value for money analysis are considered a full economic evaluation with implications for the information provided to decision makers. The type of value for money analysis to be conducted requires considerations such as the outcome(s) of interest, study design, statistical methods to control for confounding and bias, and how to quantify and describe uncertainty and opportunity costs to decision makers in any resulting value for money estimates. Service evaluations as vehicles for producing evidence present different challenges to analysts than what is commonly associated with research, randomised controlled trials and health technology appraisals, requiring specific study design and analytic considerations. This educational review describes and discusses these considerations, as overlooking them could affect the information provided to decision makers who may make an ‘ill-informed’ decision based on ‘poor’ or ‘inaccurate’ information with long-term implications. We make direct comparisons between randomised controlled trials relative to non-randomised data as vehicles for assessing causation; given ‘gold standard’ randomised controlled trials have limitations. Although we use UK-based decision makers as examples, we reflect on the needs of decision makers internationally for evidence-based decision-making specific to resource allocation. We make recommendations based on the experiences of the authors in the UK, reflecting on the wide variety of methods available, used as documented in the empirical literature. These methods may not have been fully considered relevant to non-randomised study designs and/or service evaluations, but could improve and aid the analysis conducted to inform the relevant value for money decision problem.

McHugh, S.K et al (2020) Does team reflexivity impact teamwork and communication in interprofessional hospital-based healthcare teams? A systematic review and narrative synthesis

Authors - Siobhan Kathleen McHugh, Rebecca Lawton, Jane Kathryn O'Hara and Laura Sheard

https://qualitysafety.bmj.com/content/qhc/early/2020/03/10/bmjqs-2019-009921.full.pdf

Background

Teamwork and communication are recognised as key contributors to safe and highquality patient care. Interventions targeting process and relational aspects of care may therefore provide patient safety solutions that reflect the complex nature of healthcare. Team reflexivity is one such approach with the potential to support improvements in communication and teamwork, where reflexivity is defined as the ability to pay critical attention to individual and team practices with reference to social and contextual information.

Objective

To systematically review articles that describe the use of team reflexivity in interprofessional hospitalbased healthcare teams.

Methods

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, six electronic databases were searched to identify literature investigating the use of team reflexivity in interprofessional hospital-based healthcare teams. The review includes articles investigating the use of team reflexivity to improve teamwork and communication in any naturally occurring hospital-based healthcare teams. Articles’ eligibility was validated by two second reviewers (5%).

Results

Fifteen empirical articles were included in the review. Simulation training and video-reflexive ethnography (VRE) were the most commonly used forms of team reflexivity. Included articles focused on the use of reflexive interventions to improve teamwork and communication within interprofessional healthcare teams. Communication during interprofessional teamworking was the most prominent focus of improvement methods. The nature of this review only allows assessment of team reflexivity as an activity embedded within specific methods. Poorly defined methodological information relating to reflexivity in the reviewed studies made it difficult to draw conclusive evidence about the impact of reflexivity alone.

Conclusion

The reviewed literature suggests that VRE is well placed to provide more locally appropriate solutions to contributory patient safety factors, ranging from individual and social learning to improvements in practices and systems.

Sattar, R et al (2020) The views and experiences of patients and health‐care professionals on the disclosure of adverse events: A systematic review and qualitative meta‐ethnographic synthesis

Authors - Raabia Sattar, Judith Johnson and Rebecca Lawton

https://onlinelibrary.wiley.com/doi/full/10.1111/hex.13029

Objective

To synthesize the literature on the views and experiences of patients/family members and health‐care professionals (HCPs) on the disclosure of adverse events.

Methods

Systematic review of qualitative studies. Searches were conducted in MEDLINE, Embase, PubMed, CINAHL and PsycINFO. Study quality was evaluated using the Critical Appraisal Skills Programme tool. Qualitative data were analysed using a meta‐ethnographic approach, comprising reciprocal syntheses of ‘patient’ and ‘health‐care professional’ studies, combined to form a lines‐of‐argument synthesis embodying both perspectives.

Results

Fifteen studies were included in the final syntheses. The results highlighted that there is a difference in attitudes and expectations between patients and HCPs regarding the disclosure conversation. Patients/family members expressed a need for information, the importance of sincere regret and a promise of improvement. However, HCPs faced several barriers, which hindered appropriate disclosure practices. These included difficulty of disclosure in a blame culture, avoidance of litigation, lack of skills on how to conduct disclosure and inconsistent guidance. A lines‐of‐argument synthesis is presented that identified both the key elements of an ideal disclosure desired by patients and the facilitators for HCPs, which can increase the likelihood of this taking place.

Conclusions

Although patients/family members and HCPs both advocate disclosure, several barriers prevent HCPs from conducting disclosure effectively. Both groups have different needs for disclosure. To meet patients’ requirements, training on disclosure for HCPs and the development of an open, transparent culture within organizations are potential areas for intervention.

Hinde, S et al. (2020) Quantifying the impact of delayed delivery of cardiac rehabilitation on patients’ health

Authors -Sebastian Hinde, Alexander Harrison, Laura Bojke, Patrick Doherty

https://journals.sagepub.com/doi/abs/10.1177/2047487320912625

Background

Despite its role as an effective intervention to improve the long-term health of patients with cardiovascular disease and existence of national guidelines on timeliness, many health services still fail to offer cardiac rehabilitation in a timely manner after referral. The impact of this failure on patient health and the additional burden on healthcare providers in an English setting is quantified in this article.

Methods

Two logistic regressions are conducted, using the British Heart Foundation National Audit of Cardiac Rehabilitation dataset, to estimate the impact of delayed cardiac rehabilitation initiation on the level of uptake and completion. The results of these regressions are applied to a decision model to estimate the long-term implications of these factors on patient health and National Health Service expenditure.

Results

We demonstrate that the failure of 43.6% of patients in England to start cardiac rehabilitation within the recommended timeframe results in a 15.3% reduction in uptake, and 7.4% in completion. These combine to cause an average lifetime loss of 0.08 years of life expectancy per person. Scaled up to an annual cohort this implies 10,753 patients not taking up cardiac rehabilitation due to the delay, equating to a loss of 3936 years of life expectancy. We estimate that an additional £12.3 million of National Health Service funding could be invested to alleviate the current delay.

Conclusions

The current delay in many patients starting cardiac rehabilitation is causing quantifiable and avoidable harm to their long-term health; policy and research must now look at both supply and demand solutions in tackling this issue.

Hinde, S et al. (2020) Complex programme evaluation of a ‘new care model’ vanguard: a shared commitment to quality improvement in an integrated health and care context

Authors -Sebastian Hinde, Sally Fowler Davis, Steven Ariss

https://bmjopen.bmj.com/content/10/3/e029174

Abstract

NHS vanguards, under-pressure to perform, required better contracting and data management arrangements with evaluation teams, to ensure that integrated service outcomes could be reported effectively. This communication reflects the experience of evaluating an NHS vanguard and suggests how academic teams can improve capacity for complex programme evaluation of rapid improvements in integrated services. This should be based on a shared commitment to data collection and management. Also, robust knowledge exchange processes can enable systems change and sustainability. The identifying features of the particular site have been withheld.

Daly-Smith A et al (2020) Using a multi-stakeholder experience-based design process to co-develop the Creating Active Schools Framework

Authors - Andy Daly-Smith, Thomas Quarmby, Victoria S. J. Archbold, Nicola Corrigan, Dan Wilson, Geir K. Resaland, John B. Bartholomew, Amika Singh, Hege E. Tjomsland, Lauren B. Sherar, Anna Chalkley, Ash C. Routen, Darren Shickle, Daniel D. Bingham, Sally E. Barber, Esther van Sluijs, Stuart J. Fairclough & Jim McKenna

https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-020-0917-z

Background

UK and global policies recommend whole-school approaches to improve childrens’ inadequate physical activity (PA) levels. Yet, recent meta-analyses establish current interventions as ineffective due to suboptimal implementation rates and poor sustainability. To create effective interventions, which recognise schools as complex adaptive sub-systems, multi-stakeholder input is necessary. Further, to ensure ‘systems’ change, a framework is required that identifies all components of a whole-school PA approach. The study’s aim was to co-develop a whole-school PA framework using the double diamond design approach (DDDA).

Methodology

Fifty stakeholders engaged in a six-phase DDDA workshop undertaking tasks within same stakeholder (n = 9; UK researchers, public health specialists, active schools coordinators, headteachers, teachers, active partner schools specialists, national organisations, Sport England local delivery pilot representatives and international researchers) and mixed (n = 6) stakeholder groupings. Six draft frameworks were created before stakeholders voted for one ‘initial’ framework. Next, stakeholders reviewed the ‘initial’ framework, proposing modifications. Following the workshop, stakeholders voted on eight modifications using an online questionnaire.

Results

Following voting, the Creating Active Schools Framework (CAS) was designed. At the centre, ethos and practice drive school policy and vision, creating the physical and social environments in which five key stakeholder groups operate to deliver PA through seven opportunities both within and beyond school. At the top of the model, initial and in-service teacher training foster teachers’ capability, opportunity and motivation (COM-B) to deliver whole-school PA. National policy and organisations drive top-down initiatives that support or hinder whole-school PA.

Summary

To the authors’ knowledge, this is the first time practitioners, policymakers and researchers have co-designed a whole-school PA framework from initial conception. The novelty of CAS resides in identifying the multitude of interconnecting components of a whole-school adaptive sub-system; exposing the complexity required to create systems change. The framework can be used to shape future policy, research and practice to embed sustainable PA interventions within schools. To enact such change, CAS presents a potential paradigm shift, providing a map and method to guide future co-production by multiple experts of PA initiatives ‘with’ schools, while abandoning outdated traditional approaches of implementing interventions ‘on’ schools.

2019

Pettinger, K.J. et al (2019) Starting school: educational development as a function of age of entry and prematurity.

Authors - Katherine J Pettinger, Brian Kelly, Trevor A Sheldon, Mark Mon-Williams, John Wright, Liam J B Hill

https://adc.bmj.com/content/105/2/160

Objective

To estimate the impact on early development of prematurity and summer birth and the potential ‘double disadvantage’ created by starting school a year earlier than anticipated during pregnancy, due to being born preterm.

Design, setting and patients

We investigated the impact of gestational and school-entry age on the likelihood of failing to achieve a ‘Good Level of Development’ (GLD) on the Early Years Foundation Stage Profile in 5-year-old children born moderate-to-late preterm using data from the Born in Bradford longitudinal birth cohort. We used hierarchical logistic regression to control for chronological maturity, and perinatal and socioeconomic factors.

Results

Gestational age and school-entry age were significant predictors of attaining a GLD in the 10 337 children who entered school in the correct academic year given their estimated date of delivery. The odds of not attaining a GLD increased by 1.09 (95% CI 1.06 to 1.11) for each successive week born early and by 1.17 for each month younger within the year group (95% CI 1.16 to 1.18). There was no interaction between these two effects. Children starting school a year earlier than anticipated during pregnancy were less likely to achieve a GLD compared with (1) other children born preterm (fully adjusted OR 5.51 (2.85–14.25)); (2) term summer births (3.02 (1.49–6.79)); and (3) preterm summer births who remained within their anticipated school-entry year (3.64 (1.27–11.48)).

Conclusions

These results confirm the developmental risks faced by children born moderate-to-late preterm, and—for the first time—illustrate the increased risk associated with ‘double disadvantage’.

Hinde, S et al. (2019) The Relevant Perspective of Economic Evaluations Informing Local Decision Makers: An Exploration in Weight Loss Services

Authors - Sebastian Hinde, Louise Horsfield, Laura Bojke, Gerry Richardson

https://doi.org/10.1007/s40258-019-00538-8

Abstract

Since 2013, obesity services in the UK National Health Service (NHS) have focused on a tiered structure, with tiers 3 (specialist weight management services) and 4 (primarily bariatric surgery) commissioned by Clinical Commissioning Groups (CCGs) and widely reported as cost effective and recommended by national guidelines. However, CCGs have been reluctant to fully conform to the guidance. We explore how the different evaluative perspective of those generating evidence from local decision makers has contributed to this failure of the CCGs to provide services considered cost effective. We explore four elements where the conventional economic evaluation framework, as applied by the National Institute for Health and Care Excellence (NICE), differ from the reality faced by local decision makers: the cost-effectiveness threshold, the implications of decision uncertainty and budgetary excess, the valuation of future costs and outcomes, and the scope of included costs. We argue that the failure of the conventional framework to reflect the reality faced by local decision makers is rendering much of the existing literature and guidance inappropriate to the key commissioners. Our analysis demonstrates that it is not reasonable to assume that the framework of economic evaluation used to inform national guidance applies to local decision makers, such as in the commissioning of weight loss services. This failure is likely to apply to the majority of cases where evidence is generated to inform national decision makers but commissioning is at a local level.

Hinde, S et al. (2019) Understanding and addressing the challenges of conducting quantitative evaluation at a local level: a worked example of the available approaches

Authors - Sebastian Hinde, Laura Bojke and Gerry Richardson

https://bmjopen.bmj.com/content/9/11/e029830

Objectives

In the context of tightening fiscal budgets and increased commissioning responsibility, local decision-makers across the UK healthcare sector have found themselves in charge of the implementation and evaluation of a greater range of healthcare interventions and services. However, there is often little experience, guidance or funding available at a local level to ensure robust evaluations are conducted. In this paper, we evaluate the possible scenarios that could occur when seeking to conduct a quantitative evaluation of a new intervention, specifically with regards to the availability of evidence.

Design

We outline the full set of possible data scenarios that could occur if the decision-maker seeks to explore the impact of the launch of a new intervention on some relevant quantifiable outcomes. In each case we consider the implicit assumptions associated with conducting an evaluation, exploring possible situations where such scenarios may occur. We go on to apply the scenarios to a simulated dataset to explore how each scenario can result in different conclusions as to the effectiveness of the new intervention.

Results

We demonstrate that, across the full set of scenarios, differences in the scale of the estimated effectiveness of a new intervention and even the direction of effect are possible given different data availability and analytical approaches.

Conclusions

When conducting quantitative evaluations of new interventions, the availability of data on the outcome of interest and the analytical approach can have profound effects on the conclusions of the evaluation. Although it will not always be possible to obtain a complete set of data and conduct extensive analysis, it is vital to understand the implications of the data used and consider the implicit assumptions made through its use.

Mishu, P M et al. (2019) Factors associated with regular physical activity participation among people with severe mental ill health

Authors - Masuma Pervin Mishu, Emily J. Peckham, Paul N. Heron, Garry A. Tew, Brendon Stubbs, Simon Gilbody

Mishu, M.P., Peckham, E.J., Heron, P.N. et al. Factors associated with regular physical activity participation among people with severe mental ill health. Soc Psychiatry Psychiatr Epidemiol 54, 887–895 (2019). https://doi.org/10.1007/s00127-018-1639-2

Purpose

People with severe mental ill health (SMI) are less physically active and more sedentary than the general population. There is limited research investigating the correlates of physical activity (PA) in people with SMI impeding the development of successful interventions. This study aimed to assess the factors associated with regular participation of PA among a large sample of people with SMI.

Methods

The data for this study were collected from the ‘Closing the Gap: Lifestyle Health and Wellbeing’ (HWB) cohort that collected data through self-administered questionnaire from participants with SMI. Self-reported participation in regular PA was the main outcome variable. Potential predictors of PA were grouped as demographic, biological, psychological and behavioural variables. Multivariable logistic regressions were conducted considering PA participation as the dependent variable adjusted for possible correlated predictors.

Results

In total, 3287 people with SMI [mean (SD) age 47.7 (14.58) years, 59% male] were included; 38% reported undertaking regular PA and 61% wanted to undertake more physical activity. Multivariable logistic regressions showed that the following factors were associated with undertaking more regular PA: being male, aged 18–65 years, having a body mass index between 18.5 and 30 kg/m2, having better self-perceived general health condition, not having a health problem that limits activity, giving higher importance to maintain a healthy lifestyle, and eating more fruit and vegetables.

Conclusions

Having a better self-perceived general health and placing importance on maintaining a healthy lifestyle were important predictors of regular PA. Lifestyle interventions targeting increased PA among people with SMI should be shaped by their health perception and informed by their needs.

Louch, G et al. (2019) Validation of revised patient measures of safety: PMOS-30 and PMOS-10

Authors - Gemma Louch, Caroline Reynolds, Sally Moore, Claire Marsh, Jane Heyhoe, Abigail Albutt, Rebecca Lawton, on behalf of the Yorkshire Quality and Safety Research Group

https://bmjopen.bmj.com/content/bmjopen/9/11/e031355.full.pdf

Objectives

There is growing evidence that patients can provide feedback on the safety of their care. The 44-item Patient Measure of Safety (PMOS) was developed for this purpose. While valid and reliable, the length of this questionnaire makes it potentially challenging for routine use. Our study aimed to produce revised, shortened versions of PMOS (PMOS-30 and PMOS-10), which retained the psychometric properties of the longer version.

Participants

To produce a shortened diagnostic measure, we analysed data from 2002 patients who completed PMOS-44, and examined the reliability of the revised measure (PMOS-30) in a sample of 751 patients. To produce a brief standalone measure, we again analysed data from 2002 patients who completed PMOS-44, and tested the reliability and validity of the brief standalone measure (PMOS-10) in a sample of 165 patients.

Methods

The process of shortening the questionnaire involved a combination of secondary data analysis (eg, Standard Deviation and inter-item correlations) and a consensus group exercise to produce PMOS-30 and examine face validity. Analysis of PMOS-30 data examined reliability (eg, Cronbach’s alpha). Further secondary data analysis (ie, corrected item-total correlations) produced PMOS-10, and primary data collection assessed its reliability and validity (eg, Cronbach’s alpha, analysis of variance).

Results

Fourteen items were removed to produce PMOS30 and the percentage of negatively worded items was reduced from 57% to 33%. PMOS-30 demonstrated good internal reliability (α=0.89). The 10 items with the highest corrected item-total correlations across both PMOS-44 and PMOS-30 composed PMOS-10. PMOS-10 had good internal reliability (α=0.79), demonstrated convergent validity; however, discriminant validity was not established.

Conclusions

Two revised, shortened versions of the original PMOS-44 (PMOS-30 and PMOS-10) were produced to capture patient feedback about safety in hospital. The measures demonstrated good reliability and validity, and preserved the psychometric properties of the original measure.

Heyhoe, J et al. (2019) The early diagnosis of cancer in primary care: A qualitative exploration of the patient's role and acceptable safety-netting strategies

Authors - Jane Heyhoe, Caroline Reynolds and Rebecca Lawton

https://onlinelibrary.wiley.com/doi/pdf/10.1111/ecc.13195

Objectives

The study had two aims—to assess the components considered important for patient involvement in diagnosing cancer earlier in primary care and to assess the acceptability, feasibility, cost and burden of three safety-netting interventions in terms of their potential to become a sustainable component of standard care and improve diagnostic outcomes for cancer in a primary care setting.

Method

Fifteen interviews were conducted with patients and GPs/Nurse Practitioners. Findings were fed back at a workshop with 18 stakeholders who helped to conceptualise an intervention. Interviews were analysed using thematic analysis. Stakeholder discussions were captured through group feedback sessions.

Results

Three key themes around stakeholders' views on patient involvement emerged from the interviews. These were keeping the door open, roles and responsibilities and fear of cancer. Interview findings and workshop feedback identified the intervention should include a verbal discussion and plan, written information and a patient prompt option.

Conclusion

Patient involvement in diagnosing cancer in primary care is considered acceptable to patients and HCPs. Factors that facilitate or hinder involvement have been identified. Components deemed important in a safety-netting intervention, and potential costs and benefits were established. This knowledge can direct future research and the development of safety-netting interventions.