• Placing care: the impact of the physical environment on experiences of providing and utilizing palliative care

      Agom, David; Sixsmith, Judith; Ominyi, Jude; Onyeka, Tonia; Agom, Joy C.; University of Bedfordshire; University of Dundee; University of Nigeria; Regent College, London (Lippincott, Williams & Wilkins, 2022-08-05)
      Environmental design in palliative and end-of-life care is known to improve care outcomes, service-user satisfaction, and the continuation of service uptake. No study in the literature has investigated the influence of the environment on palliative and end-of-life care in Nigeria or other African contexts. This study was designed to explore the impact of the physical environment (i.e., place and people) on staff and service users and how these influence the experiences of providing and using palliative and end-of-life care in a Nigerian hospital context. Ethnographic methodology was employed because this approach facilitates understanding of environmental realities. This study is part of a larger ethnographic research project developed to uncover aspects of organizational complexities related to the provision and use of palliative and end-of-life care in the Nigerian context. Three hundred fifty hours of participant observation was achieved, and semistructured interviews were used to gather data from 26 participants, including 10 patients, 11 members of a palliative care team, and five hospital managers. Informal chats and photographic capture were additional methods used in data collection. Thematic analysis was conducted to identify and analyze patterns within the collected data. Physical space, equipment, and placing staff were the three primary themes identified. The physical environment was untidy, and the ward layout prevented privacy, dignity, or comfort for patients and families. The equipment was old and inadequate, and the context of care was worsened by insufficient staffing and neglect of the environmental needs of the staff. Hospital design for palliative and end-of-life care in Nigeria is "autoinhibitory" (a negative feedback mechanism whereby hospital design detracts rather than promote quality of care), and a physical environment that supports the provision and utilization of care must be implemented to promote palliative and end-of-life care success. Urgent policy action is needed to improve environmental and staffing conditions to advance palliative and end-of-life care in Nigeria.
    • Influences on nurses’ engagement in antimicrobial stewardship behaviours: a multi-country survey using the Theoretical Domains Framework

      Chater, Angel M.; Family, Hannah; Abraao, Ligia Maria; Burnett, Emma; Castro-Sanchez, Enrique; Du Toit, Briëtte; Gallagher, Rose; Gotterson, Fiona; Manias, Elizabeth; Mcewen, Jo; et al. (Healthcare Infection Society, 2022-07-14)
      Background Antimicrobial resistance (AMR) is significantly affected by inappropriate antibiotic use, and is one of the greatest threats to human health. Antimicrobial stewardship (AMS) is a programme of actions promoting responsible antimicrobial use, and is essential for limiting AMR. Nurses have an important role to play in this context. Aim: This study investigated the determinants of nurse AMS behaviours and the impact of past training. Method A cross-sectional multi-country survey design with mixed methods was employed. Participants were 262 nurses (223 female; mean age = 44.45; SD = 10.77 years) from ten nationalities, with individual survey links sent via professional networks in 5 countries, alongside Twitter. Nine AMS behaviours and 14 behavioural determinants were quantitatively assessed using the Theoretical Domains Framework (TDF), and mapped to the COM-B (Capability, Opportunity, Motivation – Behaviour) model. Analysis identified differences between nurses with and without AMS training. The influence of COVID-19 on AMS behaviour was qualitatively investigated using free text data. Findings Nurses performed all nine AMS behaviours, which were significantly higher (t(238) = -4.14, p < .001), by those who had training (M = 53.15; SD = 7.40) compared to those who had not (M = 48.30; SD = 10.75). Those with AMS training scored significantly higher in all of the TDF domains. The TDF was able to explain 27% of the variance in behaviour, with ‘Skills’ and ‘Behavioural Regulation’ (e.g. ability to self-monitor and plan), shown to be the most predictive of AMS actions. Both of these domains are situated in the Capability construct of COM-B, which can be enhanced with the intervention strategies of education and training. An increase in AMS behaviours was reported since COVID-19, regardless of previous training. Six core themes were linked to AMS: 1) Infection prevention and control, 2) Antimicrobials and antimicrobial resistance, 3) The diagnosis of infection and the use of antibiotics, 4) Antimicrobial prescribing practice, 5) Person-centred care, and 6) Interprofessional collaborative practice. Conclusion This research, has identified the significant benefit of nurse training on AMS behaviour, and its determinants. Those who had training, scored higher in all TDF determinants of behaviour, compared to those who had had no training, resulting in higher Capability, Opportunity and Motivation to perform AMS behaviours. AMS education and training should be offered to nurses to enhance these factors. Future research should consider the optimal level of training to optimise AMS behaviour, with a focus on developing skills and behavioural regulation.
    • Evaluation of the over 50s alcohol helpline

      Wadd, Sarah; Dutton, Maureen; Wilson, Fiona; Drink Wise Age Well; University of Bedfordshire (Drink Wise Age Well, 2022-07-13)
      This report is the evaluation of a over 50s Alcohol Helpline that was part of the Drink Wise Age Well programme that was specifically aimed at helping older adults, people aged 50 years or over with issues they may have experienced caused by their alochol use. The programme ran for 5 years and when the face to face delivery of help and guidance stopped. An alcohol helpline for the over 50s was provided. This report is an evaluation of that helpline.
    • Adaptations to mindfulness-based interventions for neurological impairment: the SMALL PROMPTS approach

      Finlay, K. A.; Hearn, J.H.; Gillett, J.L.; Ratwatte, P.; Morton-Bye, J.; Chater, Angel M.; ; University of Reading; Manchester Metropolitan University; University of Buckingham; et al. (American Psychological Association, 2022-07-07)
      Purpose/Objective: Standardized mindfulness-based interventions (MBIs), used for the management of physical and psychological symptoms associated with neurological impairment/injury (NI), have been problematized as lacking accessibility due to their focus on sensory presence and mindful walking. Research is needed to generate formalized recommendations regarding how MBIs may be best adapted to enhance their suitability for people with NI. ResearchMethod/Design: A two-phase qualitative study was completed. First, semistructured interviews were undertaken with eight accredited mindfulness teachers with NI. Interviews reviewed the adaptations participants made in their personal and teaching practice, using thematic analysis, and generated recommendations for adaptations to MBIs specific to people with NI. Second, using the DELPHI method, the adapted practice recommendations were reviewed and revised via three rounds, following cognitive interviews with an expert panel (N = 5 trained mindfulness teachers with NI). Results: Ten core areas for adaptation are proposed and validated, acting as SMALL PROMPTS which can be used to adapt mindfulness-based teaching techniques to the specific requirements of people with NI: (a) Skin/bladder/bowel management; (b) mindful Movement; (c) Accessible training; (d) Language Leadership; (e) Permissive pRactice; (f) Optimizing timelines; (g) Management of posture; (h) inclusion of Pacing; (i) Teaching from experience; and (j) body Scanning. Conclusion/Implications:Mindfulness is a highly applicable approach for people with sensory loss, however significant, specific adaptations are required to improve inclusivity and accessibility. The SMALL PROMPTS adaptations increase the accessibility, applicability, and utility ofMBIs for populations living with NI, enhancing effectivemanagement of physical and psychological wellbeing, and optimizingMBI delivery.
    • Barriers toward deceased organ donation among Indians living globally: An integrative systematic review using narrative synthesis

      Vincent, Britzer Paul; Randhawa, Gurch; Cook, Erica Jane; ; University of Bedfordshire (British Medical Journal Open, 2022-05-27)
      Objectives: To understand the barriers towards deceased organ donation among Indians living globally. Design: Integrative systematic review using narrative synthesis. Data sources: CINAHL, Medline full-text, PsycInfo, Scopus, Global Health, Web of Science, and PubMed Central, Indian Journal of Transplantation and Google Scholar. Time period: 1 January 1994 to 31 December 2021. Participants: Individuals of Indian origin living globally. Results: Eighty-nine studies were included with more than 29 000 participants and quality of the studies were assessed using Joanna Briggs Institute's critical appraisal tool. Though majority of the participants had knowledge toward organ donation with a positive influence on willingness, the gap between knowledge and willingness was huge, with minimal registration influenced by the complex sociocultural constructs. Various sociocultural constructs such as family, fear and mistrust, religion, and bodily issues play a vital role. Differences were identified in willingness to donate and register between southern and other regions of India. Indian's organ donation behaviour in other geographical locations differed based on the socioreligious background of the country they lived in such as in Malaysia, Canada and the UK. However, they were collective in decision-making and had complex sociocultural interference irrespective of the country the individual lived which differed only in their next generations. Conclusion: Though this study showed the complex relationship, and its influences on organ donation behaviour, lacunae were identified to further understand how such complex interactions determine or inform the behaviour. Also, methodological issues were identified, where this particular population outside India were collectively studied with their neighbouring population which are not homogenous. Studies in India majorly addressed a similar aim using similar methods which produced repetition of studies leading to lack of diversified, wider and in-depth research. Therefore, while this systematic review addressed the barriers toward organ donation among Indians living globally, it also informs various gaps in research and also methodological issues.
    • Psycho-behavioral responses of Nigerian health workers to an initial human-to-human transmission of the coronavirus disease

      Onu, Justus; Onyeka, Tonia; Unaogu, Ngozichukwu Nneka; Mohammed, Alhassan Datti; Okunade, Kehinde; Oriji, Sunday; Agom, David; Edewuba, Dorothy; Alumona, Cajetan Okwudili; Echieh, Chidiebere Peter; et al. (PAGEPress, 2022-05-24)
      Previous pandemics have had significant impact on psychological well-being of front-line health care workers. Issues such as fear of contracting the disease, high workload as a result of high numbers of infected cases, increased job stress and unavailability of personal protective equipment have been implicated in development of psychological distress in this subset of individuals. The aim of the present paper is to describe psychobehavioral responses of health care workers and potential predictors of emotional response at onset of COVID-19 outbreak in Nigeria. Cross-sectional web-based survey and 7-item Generalized Anxiety Disorder Questionnaire (GAD-7) were administered anonymously to 444 respondents comprising various categories of frontline healthcare workers. Stepwise multiple linear regression was used to determine predictors of anxiety scores. Participants were mostly young adults (mean age 38 years), females (57%), living with a partner (78.2%) and medical doctors (56.8%). Restrictions in clinical activities and use of hand sanitizers were commonest precautionary behaviors. Commonest emotional responses were anger and despair (27.0% and 25.7%), respectively. About 42.8% had clinically significant anxiety symptoms with highest burden among nurses. Perception of likelihood of 2nd wave (p=0.03), self-preparedness (p=0.04), gender (p=0.01) and cadre (p=0.02) were significant predictors of emotional response of anxiety. Study findings highlighted diverse psychological reactions of health care workers with a large proportion screening positive for significant anxiety symptoms. This has implications for planning a comprehensive psychosocial response to COVID-19 pandemic and for future pandemics among frontline health care workers in lowresource settings.
    • The Sign 4 Big Feelings intervention to improve early years outcomes in preschool children: outcome evaluation

      Davidson, Rosemary; Randhawa, Gurch; ; University of Bedfordshire (JMIR Publications, 2022-05-20)
      Any delays in language development may affect learning, profoundly influencing personal, social, and professional trajectories. The effectiveness of the Sign 4 Big Feelings (S4BF) intervention was investigated by measuring changes in early years outcomes (EYOs) after a 3-month period. This study aims to determine whether children's well-being and EYOs significantly improve (beyond typical, expected development) after the S4BF intervention period and whether there are differences between boys and girls in progress achieved. An evaluation of the S4BF intervention was conducted with 111 preschool-age children in early years settings in Luton, United Kingdom. Listening, speaking, understanding, and managing feelings and behavior, in addition to the Leuven well-being scale, were assessed in a quasi-experimental study design to measure pre- and postintervention outcomes. Statistically and clinically significant differences were found for each of the 7 pre- and postmeasures evaluated: words understood and spoken, well-being scores, and the 4 EYO domains. Gender differences were negligible in all analyses. Children of all abilities may benefit considerably from S4BF, but a language-based intervention of this nature may be transformational for children who are behind developmentally, with English as an additional language, or of lower socioeconomic status. ISRCTN Registry ISRCTN42025531; https://doi.org/10.1186/ISRCTN42025531.
    • Mentoring at times of crises: personal reflections on mentoring relationships during COVID-19

      Wassif, Hoda; Wake, Charlotte; University of Bedfordshire (Wiley, 2022-05-06)
      COVID-19 presented a huge challenge for practice, education and all interactions, and mentorship was no different. The purpose of this commentary is to reflect on the juxtaposition between mentors and mentees in dental education during COVID-19. This commentary will focus on the interaction between mentor/mentee outside clinical practice and in relation to supporting and mentoring dental practitioners in the context of postgraduate education. The aim is to share our learning from this experience with other dental educators beyond COVID-19.
    • Workplace intervention for reducing sitting time in sedentary workers: protocol for a pilot study using the Behavior Change Wheel

      Ojo, Samson Oluseye; Bailey, Daniel Paul; Chater, Angel M.; Hewson, David; University of Bedfordshire; Northampton General Hospital NHS Trust; Brunel University; University College London (Frontiers, 2022-04-12)
      The workplace is a major contributor to excessive sitting in office workers. There are a wide array of adverse effects of high volumes of sitting time, including an increased risk of type 2 diabetes and depression. Active workstations can be used in effective interventions to decrease workplace sitting. However, there are a lack of interventions that have been developed using a systematic process that is informed by participant needs and a framework for identifying the most appropriate content for the intervention. Applying these methods could increase adherence and potential effectiveness of the intervention. Therefore, the purpose of this pilot study is to examine the feasibility, acceptability, and efficacy of a tailored workplace intervention to reduce and break up sitting in office workers that has been developed using the Behavior Change Wheel and the APEASE (Acceptability, Practicability, Effectiveness/cost-effectiveness, Affordability, Safety/side-effects, Equity) criteria. This article reports the protocol for this study that is currently ongoing. Participants will be cluster-randomized (by offices) to control and intervention groups. The evaluation of the intervention includes determining feasibility by assessing participant recruitment, retention and data completion rates. Adherence to the intervention will be assessed based on daily sitting and standing time relative to guidelines provided to participants as part of the intervention. Outcome measures also include productivity measured using Ecological Momentary Assessment, absenteeism, presenteeism, cardiometabolic risk markers, and wellbeing. The findings of this study will inform the effective design and implementation of interventions for reducing and breaking up sitting in office workers.
    • A systematic review of the evidence on the effect of parental communication about health and health behaviours on children's health and wellbeing

      Grey, E.B,; Atkinson, L.; Chater, Angel M.; Gahagan, A,; Tran, A.; Gillison, Fiona B.; ; University of Bath; Aston University; University of Bedfordshire; et al. (Elsevier, 2022-04-08)
      Parents report feeling unsure how best to talk with their children about sensitive health topics and may avoid such conversations; yet if children have questions or concerns about their health, talking to a parent could enhance their health and wellbeing. We investigated the effects of parental communications about health and health behaviours on children's health and wellbeing, and explored what strategies can encourage parents to communicate about health. We conducted a systematic review and narrative synthesis of research published between January 2008 and April 2020 from five databases. Of 14,007 articles identified, 16 met inclusion criteria focusing on five topics: diet and weight (n = 5), body image (n = 2), sexual health (n = 7), physical activity (n = 1) and bullying (n = 1). Positive child outcomes were associated with positive general parent-child communication characterised by warmth, openness and allowing children choice. Conversely, hostility, negative and inconsistent messaging were associated with poorer outcomes. Interventions to increase parent-child communication could be classified as providing single directive messages, media campaigns or intensive support. Single messages increased communication frequency; media campaigns and intensive interventions showed mixed outcomes. No differences in outcomes were found according to child's gender or socio-economic status. Generally, parents were less confident in initiating, rather than continuing, conversations and were more likely to initiate conversations when they felt they had good topic knowledge. While the relatively small, diverse sample limits the strength of these findings, this review provides provisional support for approaches to promote positive parent-child communication about health that are associated with better child health and wellbeing.
    • Development and validation of a simple risk model for predicting metabolic syndrome (MetS) in midlife: a cohort study

      Ibrahim, Musa Saulawa; Pang, Dong; Randhawa, Gurch; Pappas, Yannis; ; University of Bedfordshire (Dove Press, 2022-04-06)
      To develop and validate a simple risk model for predicting metabolic syndrome in midlife using a prospective cohort data. Prospective cohort study. A total of 7626 members of the 1958 British birth cohort (individuals born in the first week of March 1958) participated in the biomedical survey at age 45 and have completed information on metabolic syndrome. Variables utilised were obtained prospectively at birth, 7, 16, 23 and 45 years. Multivariable logistic regression was used to develop a total of ten (10) MetS risk prediction models taking the life course approach. Measures of discrimination and calibration were used to evaluate the performance of the models. A pragmatic criteria developed was used to select one model with the most potential to be useful. The internal validity (overfitting) of the selected model was assessed using bootstrap technique of Stata. Metabolic syndrome was defined based on the NCEP-ATP III clinical criteria. There is high prevalence of MetS among the cohort members (19.6%), with males having higher risk as compared to females (22.8% vs 16.4%, P &lt; 0.001). Individuals with MetS are more likely to have higher levels of HbA1c and low HDL-cholesterol. Similarly, regarding the individual components of MetS, male cohort members are more likely to have higher levels of glycaemia (HbA1c), BP and serum triglycerides. In contrast, female cohort members have lower levels of HDL-cholesterol and higher levels of waist circumference. Furthermore, a total of ten (10) MetS risk prediction models were developed taking the life course approach. Of these, one model with the most potential to be applied in practical setting was selected. The model has good accuracy (AUROC 0.91 (0.90, 0.92)), is well calibrated (Hosmer-Lemeshow 6.47 (0.595)) and has good internal validity. Early life factors could be included in a risk model to predict MetS in midlife. The developed model has been shown to be accurate and has good internal validity. Therefore, interventions targeting socioeconomic inequality could help in the wider prevention of MetS. However, the validity of the developed model needs to be further established in an external population.
    • Enacting whole-school relationships and sexuality education in England: context matters

      Bragg, Sara; Ponsford, Ruth; Meiksin, Rebecca; Lohan, Maria; Melendez-Torres, G. J.; Hadley, Alison; Young, Honor; Barter, Christine; Taylor, Bruce; Bonell, Chris; et al. (Wiley, 2022-03-30)
      Evidence from intervention evaluations suggests that achieving meaningful and lasting social, behavioural and attitudinal change from relationships, sex and health education (RSHE) in schools requires more than just a curriculum. Whole-school approaches appear particularly promising since they work at multiple levels. For instance, they may: engage with carers, communities and local services; address iniquitous cultures and norms; change school policies and practices; and actively involve young people themselves. They have also been advocated to tackle sexual harassment and abuse in schools. Currently, however, such approaches have not been rigorously evaluated in the UK. This article focuses on the whole-school elements of two recent RSHE pilot studies conducted in English secondary schools. We describe how these elements were variably enacted in different settings. We analyse contextual factors that help account for these differences, including: teacher and departmental professional identity and autonomy; broader education policy including high-stakes testing and school inspection judgements; the significance of support staff; and staff–student relationships and partnerships. We argue that the likely impact of whole-school approaches and RSHE in schools more generally will depend on attending to all of these factors. The paper contributes firstly to debates about the theory and practice of RSHE by highlighting the significance of processes and cultures beyond the classroom in enabling or constraining positive change. Secondly it contributes to scholarship that elucidates the role of contexts, broadly defined, in understanding the enactment of policy and practice.
    • Life-course influence of adolescent behaviour problems on type 2 diabetes in midlife: results from 1958 British Birth Cohort Study

      Saad, Sadiq M.; Iwundu, Chukwuma; Ibrahim, Musa Saulawa; Randhawa, Gurch; Pang, Dong; ; University of Bedfordshire (Dove Press, 2022-03-29)
      To assess whether there is a long-term relationship between childhood behaviour problems and type 2 diabetes in midlife. The study will also investigate whether any of such relationship is independent of other factors which may be associated with type 2 diabetes. Cohort study. A total of 9377 members of the 1958 British birth cohort participated in the biomedical survey at age 45 years. The cohort has been followed up at regular intervals in childhood (age 7, 11 and 16 years) and adulthood (23, 33, 42 and 45 years). Information regarding childhood behaviour collected during follow-ups at ages 7, 11 and 16 years. Type 2 diabetes assessed using HbA1c at age 45 years. Unadjusted estimates show that teachers reported adolescent behaviour problems at age of 16 are associated with increased risk of type 2 diabetes in midlife. After adjustment for potential confounders and mediators in childhood and adulthood, a relationship was observed between the severity of adolescent behaviour problems and type 2 diabetes risk in midlife (mild behaviour problems: OR 2.17, 95% CI 1.11-4.23; severe behaviour problems: OR 4.40, 95% CI 1.14-16.99). However, no such relationship was observed between behaviour problems at 7 and 11 years and type 2 diabetes in midlife. There is an association between adolescent behaviour problems and an increased risk of type 2 diabetes in midlife. Further molecular/genetic studies are required to understand the biological basis for this observed association.
    • Interventions to promote physical distancing behaviour during infectious disease pandemics or epidemics: a systematic review

      Epton, Tracy; Ghio, Daniela; Ballard, Lisa M.; Allen, Sarah F.; Kassianos, Angelos P.; Hewitt, Rachael; Swainston, Katherine; Fynn, Wendy Irene; Rowland, Vickie; Westbrook, Juliette; et al. (Elsevier, 2022-03-26)
      Physical distancing, defined as keeping 1-2m apart when co-located, can prevent cases of droplet or aerosol transmitted infectious diseases such as SARS-CoV2. During the COVID-19 pandemic, distancing was a recommendation or a requirement in many countries. This systematic review aimed to determine which interventions and behavior change techniques (BCTs) are effective in promoting adherence to distancing and through which potential mechanisms of action (MOAs). Six databases were searched. The review included studies that were (a) conducted on humans, (b) reported physical distancing interventions, (c) included any comparator (e.g., pre-intervention versus post-intervention; randomized controlled trial), and (d) reported actual distancing or predictors of distancing behavior. Risk of bias was assessed using the Mixed Methods Appraisal Tool. BCTs and potential MoAs were identified in each intervention. Six articles (with seven studies and 19 comparisons) indicated that distancing interventions could successfully change MoAs and behavior. Successful BCTs (MoAs) included feedback on behavior (e.g., motivation); information about health consequences, salience of health consequences (e.g., beliefs about consequences), demonstration (e.g., beliefs about capabilities), and restructuring the physical environment (e.g., environmental context and resources). The most promising interventions were proximity buzzers, directional systems, and posters with loss-framed messages that demonstrated the behaviors. The evidence indicates several BCTs and potential MoAs that should be targeted in interventions and highlights gaps that should be the focus of future research.
    • Feasibility and acceptability of a whole-school social-marketing intervention to prevent unintended teenage pregnancies and promote sexual health: evidence for progression from a pilot to a phase III randomised trial in English secondary schools

      Ponsford, Ruth; Bragg, Sara; Meiksin, Rebecca; Tilouche, Nerissa; Van Dyck, Laura; Sturgess, Joanna; Allen, Elizabeth; Elbourne, Diana; Hadley, Alison; Lohan, Maria; et al. (BMC, 2022-03-04)
      Reducing unintended teenage pregnancy and promoting adolescent sexual health remains a priority in England. Both whole-school and social-marketing interventions are promising approaches to addressing these aims. However, such interventions have not been rigorously trialled in the UK and it is unclear if they are appropriate for delivery in English secondary schools. We developed and pilot trialled Positive Choices, a new whole-school social marketing intervention to address unintended teenage pregnancy and promote sexual health. Our aim was to assess the feasibility and acceptability of the intervention and trial methods in English secondary schools against pre-defined progression criteria (relating to randomisation, survey follow-up, intervention fidelity and acceptability and linkage to birth/abortion records) prior to carrying out a phase III trial of effectiveness and cost-effectiveness.Pilot RCT with integral process evaluation involving four intervention and two control schools in south-east England. The intervention comprised a student needs survey; a student/staff-led school health promotion council; a classroom curriculum for year-9 students (aged 13-14); whole-school student-led social-marketing activities; parent information; and a review of local and school-based sexual health services. Baseline surveys were conducted with year 8 (aged 12-13) in June 2018. Follow-up surveys were completed 12 months later. Process evaluation data included audio recording of staff training, surveys of trained staff, staff log books and researcher observations of intervention activities. Survey data from female students were linked to records of births and abortions to assess the feasibility of these constituting a phase III primary outcome. All six schools were successfully randomised and retained in the trial. Response rates to the survey were above 80% in both arms at both baseline and follow-up. With the exception of the parent materials, the fidelity target for implementation of essential elements in three out of four schools was achieved. Student surveys indicated 80% acceptability among those who reported awareness of the programme and interviews with staff suggested strong acceptability. Linkage to birth/abortion records was feasible although none occurred among participants. The criteria for progression to a phase III trial were met. Our data suggest that a whole-school social-marketing approach may be appropriate for topics that are clearly prioritised by schools. A phase III trial of this intervention is now warranted to establish effectiveness and cost-effectiveness. Births and terminations are not an appropriate primary outcome measure for such a trial. ISRCTN65324176.
    • Association between self-rated health and depressive symptoms in rural Chinese adults: a cohort study based on propensity score matching

      Wang, Yang; Lin, Jinlong; Crabbe, M. James C.; Yue, Xiao-Guang; Peking University; University of Oxford; University of Bedfordshire; Shanxi University; European University Cyprus (Tech Science Press, 2022-02-10)
      Health status is widely regarded as a correlate of depressive symptoms. However, health assessments based on clinical diagnosis in rural areas with poor medical conditions are very limited. Self-rated health (SRH) serves as a simple and convenient evaluation indicator, which may be used as an independent predictor of depressive symptoms. To confirm the relationship between SRH and depressive symptoms in rural adults, a longitudinal survey of rural households in China was conducted using the China Family Panel Studies (CFPS) from 2012 to 2016. Propensity score matching and logistic regression analysis were used to explore the association. After data cleansing, 3,127 pairs (6,254 participants) aged 16 and older followed for 4 years were enrolled, of which the average age was (50.02 ± 14.19) years old, and the proportions of male and female were 48.64% and 51.36%, respectively. The incidence rate of depressive symptoms within 4 years was 30.86% (95%CI: 29.24–32.48) in the group with fair or poor SRH, and 21.59% (95%CI: 20.14–23.03) in the group with good SRH. The difference between the two groups was statistically significant (χ2 = 69.51, P &lt; 0.001). The results of univariate unconditional logistic regression analysis showed that there was a correlation between SRH and depressive symptoms in rural adults aged 30 and above (OR = 1.65, 95%CI: 1.46–1.85, P &lt; 0.001). Thus, a simple and practical assessment tool based on SRH and other indicators should be established for early prevention and intervention in rural primary mental health care.
    • Using behavioural science in public health settings during the COVID-19 pandemic: the experience of public health practitioners and behavioural scientists

      Byrne-Davis, Lucie; Turner, R.R.; Amatya, S.; Ashton, C.; Bull, Eleanor; Chater, Angel M.; Lewis, Lesley; Shorter, Gillian; Whittaker, Ellie; Hart, Jo; et al. (Elsevier, 2022-02-07)
      Introduction The emergence of COVID-19 and the importance of behaviour change to limit its spread created an urgent need to apply behavioural science to public health. Knowledge mobilisation, the processes whereby research leads to useful findings that are implemented to affect positive outcomes, is a goal for researchers, policy makers and practitioners alike. This study aimed to explores the experience of using behavioural science in public health during COVID-19, to discover barriers and facilitators and whether the rapidly changing context of COVID-19 influenced knowledge mobilisation. Methods We conducted a semi-structured interview study, with ten behavioural scientists and seven public health professionals in England, Scotland, Wales, The Netherlands and Canada. We conducted an inductive thematic analysis. Results We report three key themes and 10 sub-themes: 1.Challenges and facilitators of translation of behavioural science into public health (Methods and frameworks supported translation, Lack of supportive infrastructure, Conviction and sourcing of evidence and Embracing behavioural science) 2. The unique context of translation (Rapid change in context, the multi-disciplinary team and the emotional toll). 3. Recommendations to support future behavioural science translation (Embedding experts into teams, Importance of a collaborative network and showcasing the role of behavioural science). Discussion Barriers and facilitators included factors related to relationships between people, such as networks and teams; the expertise of individual people; and those related to materials, such as the use of frameworks and an overwhelming amount of evidence and literature. Conclusion People and frameworks were seen as important in facilitating behavioural science in practice. Future research could explore how different frameworks are used. We recommend a stepped competency framework for behavioural science in public health and more focus on nurturing networks to facilitate knowledge mobilisation in future emergencies.
    • The psychological effects of working in the NHS during a pandemic on final-year students: part II

      Kane, Claire; Wareing, Mark; Rintakorpi, Esa (Mark Allen, 2022-01-29)
      This study explored the psychological experience of a small cohort of nursing and midwifery students who had been deployed to work in the NHS during the COVID-19 pandemic. The students were employed on band 4 contracts within an acute NHS Trust in the South of England. Overall, students found the experience of being deployed into clinical practice during a major public health emergency a valuable and unique experience that strengthened their resilience. However, students reported a significant level of personal obligation to opt-in to deployment. Working within clinical areas caused heightened anxiety and uncertainty, which was alleviated by managerial support.
    • Investigating the association between unhealthy dietary habits and obesity among Libyan adults

      Lemamsha, Hamdi Abdulla A.; Randhawa, Gurch; Papadopoulos, Chris; ; University of Omar Al-Mukhtar; University of Bedfordshire (MDPI, 2022-01-19)
      The findings of the study reveal areas of action for Libyan researchers, clinicians, policymakers, and government officials about UEHs in the Libyan context. This could inform establishing and developing new interventions for preventing and controlling the obesity epidemic through food system improvements.
    • Understanding the experience of service users in an integrated care programme for obesity and mental health: a qualitative investigation of Total Wellbeing Luton

      Liapi, Fani; Chater, Angel M.; Pescheny, Julia Vera; Randhawa, Gurch; Pappas, Yannis; University of Bedfordshire (MDPI, 2022-01-12)
      Obesity is a complex public health issue with multiple contributing factors. The emphasis on joined care has led to the development and implementation of a number of integrated care interventions targeting obesity and mental health. The purpose of this study was to examine user experience in an integrated care programme for obesity and mental health in Luton, UK. Semistructured interviews were conducted with a purposeful sample of service users (N = 14). Interview transcripts were analysed using thematic analysis. Analysis of the interviews identified six main themes for understanding service users’ experiences of integrated care: (1) ‘A user-centered system’, (2) ‘Supports behaviour change’, (3) ‘Valued social support’, (4) ‘Communication is key’, (5) ‘Flexible referral process’, and (6) ‘Positive impact on life’. These themes describe how the service is operated, evidence perceived value service users place on social support in behavior change intervention, and address which service areas work well and which require improvement. The findings of these interviews have offered a significant contribution to understanding what service users value the most in an integrated healthcare setting. Service users value ongoing support and being listened to by healthcare professionals, as well as the camaraderie and knowledge acquisition to support their own behaviour change and promote self-regulation following their participation in the programme.