Tagged / public health

The slow process from public health research to law

We know that public health works and thinks long-term. We’ll typically see the population benefits of reducing health risks such as tobacco use, obesity and high alcohol intake in ten or twenty years’ time.  But we often forget that preceding public health research into the determinants of ill health and the possible public health solutions is also slow working.  Evidence-based public health solutions can be unpopular with voters, politicians or commercial companies (or all).  Hence these take time to get accepted by the various stakeholders and make their way into policies.

I was, therefore, glad to see that Scotland won the Supreme Court case today in favour of a minimum price for a unit of alcohol. As we know from the media, the court case took five years.  Before that the preparation and drafting of the legislation took years, and some of the original research took place long before that.  Together with colleagues at the Health Economic Research Unit at the University of Aberdeen, the University of York and Health Education Board for Scotland, we conducted a literature review on Effective & Cost-Effective Measures to Reduce Alcohol Misuse in Scotland as early as 2001 [1].  Some of the initial research was so long ago it was conducted for the Scottish Executive, before it was even renamed the Scottish Government.

 

Prof. Edwin van Teijlingen

CMMPH

 

Reference:

Research started years ago! Ludbrook et al.(2002) Effective & Cost-Effective Measures to Reduce Alcohol Misuse in Scotland: Lit Review, HERU, Univ. of Aberdeen. [ISBN: 0755932803] http://www.gov.scot/Resource/Doc/1124/0052548.pdf

Denyse King’s Health Education England project ‘NoObesity’

NoObesity

The government’s key priority of reducing childhood obesity through adult education (as announced by Jeremy Hunt in Sept 2015), prompted BU’s Denyse King to write a proposal to Health Education England. Denyse is a Midwifery Lecturer / Public Health Practitioner in the Centre for Midwifery, Maternal & Perinatal Health (CMMPH) at Bournemouth University. The proposal outlined her wish to develop a stand-alone mobile learning resource for health workers who care for families of overweight or obese children, and for families who need to identify individual needs to facilitate behavioural changes.

Afbeeldingsresultaat voor childhood obesity statistics uk, 2016

The development of this project pivoted on putting patients and the public in the centre of the process. Patients and the public were engaged through focus groups where insights were gathered to identify the challenges and issues to the problem. A series of online focus groups were undertaken with service users and professionals to understand the key challenges and issues respondents came across when trying to prevent/manage overweight and obesity. Key themes from the focus groups were:

  • Empowering – the solution needs to recognise the experiences people bring and therefore the tools need to be empowering in supporting families to address obesity.
  • Parenting tips – to address challenges with encouraging positive health behaviours with children.
  • Responding to barriers – from parent/carers who are being supported by health professionals.
  • Obesity isn’t a quick fix – recognising that sustained behaviour change takes time and support to overcoming barriers is vital.
  • Healthy snacks and activities – provide easy and simple ideas to support parents/carers and professionals to identify quick ways to support healthier eating and increase activity.
  • Portion size – understanding that portion size is important in addition to eating healthily.

Topic experts were identified and invited to join the project steering group where they provided the governance and steer of the overall development of this project whilst Denyse King wrote the content. The following Apps have been developed as a result and will be available to all as free download in IOS and Android platforms from late September 2017:

  • NoObesity Family Focused App – After consultation with a healthcare worker, families set health goals, identify potential barriers and strategies to overcome them, record their progress towards their goals, earning points and awards as they go. Families are encouraged to link accounts to healthcare professional accounts (see below). The tool also includes parenting tips, games and useful links.
  • NoObesity Professional Focused App– Healthcare professionals can see the goals, barriers, strategies, progress, points and awards of linked families, making them better able to provide tailored advice to the families, to help them achieve their goals. This is based on research findings that ‘one-size- fits-all’ health advice simply doesn’t work for most families. The tool also includes the Wessex MECC-based guidance on how to best support families, how to handle common objections, games and useful links.

Denyse would like to thank Dr. Joanne Newton project proposal support, Felicity Hargreaves and Helen Bingham for approval of the final project proposall. Thanks to all those who contributed to answering the research questions, as well as those who tested and fed back on the prototype, and also to Bournemouth University, University of Southampton, and NHS England for their support of this project.

 

List of the members of the steering group

Name Job Title Organisation Steering Group Role
Em Rahman Head of Public Health Workforce Development Programmes Health Education England (Wessex) Steering Group Chair
Alison Potter Technology Enhanced Learning Lead (South) Health Education England (South) Deputy-Chair
Dr. Jenny Godson (MBE) National Lead for Oral Health Improvement Public Health England Dental and dental aspects of nutrition
Prof. Edwin van Teijingen Professor – Centre for Midwifery, Maternal & Perinatal Health Bournemouth University Research supervision and education governance
Dr. Juliet McGrattan General Practitioner Cumbria Medical Chambers GP role governance
Kate King-Hicks Health and Wellbeing Programme Lead Public Health England (South East) Obesity governance
Tony Hewett Intervention Manager and behaviour change specialist Miltoncross Academy School staff role governance
Dr. Jo Walker Consultant Paediatrician Portsmouth Hospitals Trust Consultant doctors role governance
Dr. Wendy Marsh Lead Midwife for Safeguarding Portsmouth Hospitals Trust Safeguarding governance
Kate Lees Consultant in Public Health and Dietitian Lees & Latouze Nutrition governance
Denyse King Lecturer in Midwifery and Public Health Practitioner Bournemouth University Content author and governance

New BU publication in Public Health

This week the Oxford Encyclopaedia published our contribution on religious organisations and health promotion [1].  The paper in question ‘Faith Communities and the Potential for Health Promotion’ is co-authored by scholars based in England, Scotland and Canada. This new publication is part of a growing number of publications at Bournemouth University on the contribution of faith communities to public health.

Faith communities often have multiple resources, existing networks and an infrastructure that can be applied to health promotion programmes for their own membership or as an outreach to the wider community. Health programmes in a faith community in high-income countries may include targeted initiatives, ranging from walking groups or weight checks, health events, or health assessments, to diabetes self-management. These activities can be organised by charities and NHS organisation and held at local churches, synagogues or mosques which is referred to as faith-placed health promotion.  If the health promotion is part of the ministry of the religious organisation it is referred to as faith-based health promotion.

On top of this encyclopaedia entry, the Open Access journal African Health Sciences [Impact Factor 0.66] accepted our paper in the same field a few weeks ago.  This  paper ‘Influence of faith-based organisations on HIV prevention strategies in Africa: a systematic review’ formed part of the first author’s M.Sc. in Public Health [2]. Our previous papers reported on a study of faith-based and faith-placed health promotion in and around Dundee [3-4].

 

Professor Edwin van Teijlingen

Centre for Midwifery, Maternal & Prenatal Health

 

References

  1. Kiger, A., Fagan, D., van Teijlingen, E. (2017) Faith Communities and the Potential for Health Promotion. In: Encyclopedia of Health and Risk Message Design & Processing, Parrott, R. (ed.) New York, Oxford University Press. (http://communication.oxfordre.com/).
  2. Ochillo, M., van Teijlingen, E., Hind, M. (2017) Influence of faith-based organisations on HIV prevention strategies in Africa: a systematic review. African Health Sciences (accepted June).
  3. Fagan, D., Kiger, A., van Teijlingen E. (2010) A survey of faith leaders concerning health promotion and the level of healthy living activities occurring in faith communities in Scotland. Global Health Promotion 17(4): 15-23.
  4. Fagan, D., Kiger, A., van Teijlingen, E. (2012) Faith communities and their assets for health promotion: The views from health professionals and faith leaders in Dundee, Scotland, Global Health Promotion 19(2): 27-36.

Public lecture on ‘Getting the message across about Zika’

Public Lecture by Professor Jane Noyes, Bangor University

Date: Friday 12 May 2017
Time: 10.50 -12:00
Venue: B321, Bournemouth House

Getting the message across about Zika: using qualitative evidence to inform the global WHO risk communication guidelines for public health emergencies, and lessons learned for intervention development.

Jane is the Professor of Health and Social Services Research and Child Health at Bangor University. She specialises in child health and social care research. She is also an expert in methodology, including complex intervention development and evaluation, and qualitative and mixed method systematic review methodology.  Jane is Lead Convenor of the Cochrane Qualitative and Implementation Methods Group and Editor of the Journal of Advanced Nursing.

Jane’s talk will be followed by a short lecture by of Queen’s University Belfast on ‘Social technology solutions to postnatal care in Brazil’.

Fiona is a Lecturer in the School of Nursing and Midwifery and the Centre for Evidence and Social Innovation, Queen’s University Belfast. Her research focuses on enhancing maternal and child health and wellbeing. Her expertise includes conducting economic evaluations alongside intervention-based studies.

Complimentary lunch will be served at 12.30pm

Please RSVP to Sam Porter at porters@bournemouth.ac.uk

This lecture is part of the ‘Social technology solutions to postnatal care in Brazil’ project funded by the British Council through the Newton Fund.

Please share with your networks, this Flyer is available to send out.

MRC-AHRC Global Public Health: Partnership Awards Call

Closing date: 08 Jun 2017 16:00 GMT+1

The Global Challenges Research Fund (GCRF) offers a unique opportunity for the Arts and Humanities Research Council (AHRC) and the Medical Research Council (MRC) to launch a global public health initiative that responds to the challenge of bringing together expertise in medical science and health interventions in developing countries, with an understanding of local knowledge and history, cultural dynamics, community engagement, and trust.

The overarching driver of this partnership building activity is to develop inter-disciplinary research capacity and capability in both the UK and developing countries, jointly and collaboratively and across career stages. The aim is to generate reciprocal benefits through integrating understanding of cultures and histories into medical and public health challenges in a global context and to equip the next generation of researchers to work collaboratively and blend scientific, cultural and policy research.

The activity should catalyse the creation of sustainable, balanced relationships between UK based research organisations and researchers with those in developing countries. Learning and knowledge exchange should be reciprocal with clear mutuality of benefit for all collaborators.

This call is designed to complement previous GCRF foundational awards calls, including the cross-Council calls led by MRC on Global Infections and Non Communicable Diseases (NCD) and by ESRC on Anti-microbial Resistance (AMR). It seeks to add distinctive value to those calls through focusing on the development of inter-disciplinary research capability and innovation which combines expertise in the medical and health sciences with research in the arts and humanities and which strengthens international collaboration and partnerships.  This call is part of two consecutive partnership award calls that will run in 2017 with the second  opening in Autumn 2017.

Click here for further information about the scope, eligible activities, funding available, and the application process.

If you are interested in applying, please contact the RKEO Funding Development Team.

New Public Health paper on Christmas Eve

Douglas 2015 Men healthOur latest paper and the last one for 2015, published the day before Christmas.  The paper ‘Implementing Health Policy: Lessons from the Scottish Well Men’s Policy Initiative’ appeared in AIMS Public Health [1].  The paper draws on evaluation research led by Dr. Flora Douglas (University of Aberdeen).  This was a set of evaluations of the Well Men’s Health projects which were part of an initiative running in many health regions (or health boards as they are called in Scotland).

 

The focus of this particular paper centres around the fact that little is known about how health professionals translate government health policy into action [2]. Our paper examines that process using the  Scottish Well Men’s Services policy initiative as a ‘real world’ case study [1]. These Well Men’s Services were launched by the Scottish Government to address men’s health inequalities. Our analysis aimed to develop a deeper understanding of policy implementation as it naturally occurred.  We used an analytical framework that was developed to reflect the ‘rational planning’ principles health professionals are commonly encouraged to use for implementation purposes.

Our analysis revealed four key themes: (1) ambiguity regarding the policy problem and means of intervention; (2) behavioral framing of the policy problem and intervention; (3) uncertainty about the policy evidence base and outcomes, and; (4) a focus on intervention as outcome. This study found that mechanistic planning heuristics (as a means of supporting implementation) fails to grapple with the indeterminate nature of population health problems. A new approach to planning and implementing public health interventions is required that recognises the complex and political nature of health problems; the inevitability of imperfect and contested evidence regarding intervention, and, future associated uncertainties.

 

The paper is published in an Open Access journal, so it is easily and freely available to public health professionals, policy-makers and health workers across the globe.

Prof. Edwin van Teijlingen 

CMMPH

 

Reference:

  1. Douglas, F., van Teijlingen, E., Smith, W.C.S., Moffat, M. (2015) Implementing Health Policy: Lessons from the Scottish Well Men’s Policy Initiative, AIMS Public Health 2 (4): 887-905. http://www.aimspress.com/article/10.3934/publichealth.2015.4.887/fulltext.html
  2. Killoran, A., Kelly, M. (2004) Towards an evidence-based approach to tackling health inequalities: The English experience. Health Education Journal;63: 7-14.

Management of male obesity: The qualitative evidence (BMJ Open)

BMJ Open 2015Yesterday BMJ Open published our latest article on the weight management in obese men, under the title A qualitative evidence synthesis on the management of male obesity.[1]  To the best of our knowledge, this is the first synthesis of qualitative studies investigating men’s perceptions and experiences of weight management services.  The interdisciplinary study was conducted between the three research centres at the University of Aberdeen, namely the Health Services Research Unit (HSRU), the Health Economics Research Unit (HERU) and the Rowett Institute of Health & Nutrition, the University of Stirling’s NMAHP Research Unit, the University of Edinburgh’s Scottish Collaboration for Public Health Research & Policy (SCPHRP) and Bournemouth University.

Studies published between 1990 and 2012 reporting qualitative research with obese men, or obese men in contrast to obese women and lifestyle or drug weight management were included. The studies included men aged 16 years or over, with no upper age limit, with a mean or median body mass index of 30 kg/m2 in all settings. In total 22 studies were identified.

Health concerns and the perception that certain programmes had ‘worked’ for other men were the key factors that motivated men to engage with weight management programmes. Barriers to engagement and adherence with programmes included: men not problematizing their weight until labelled ‘obese’; a lack of support for new food choices by friends and family, and reluctance to undertake extreme dieting. Retaining some autonomy over what is eaten; flexibility about treats and alcohol, and a focus on physical activity were attractive features of programmes. Group interventions, humour and social support facilitated attendance and adherence. Men were motivated to attend programmes in settings that were convenient, non-threatening and congruent with their masculine identities, but men were seldom involved in programme design.

The paper concluded that men’s perspectives and preferences within the wider context of family, work and pleasure should be sought when designing weight management services. Qualitative research is needed with men to inform all aspects of intervention design, including the setting, optimal recruitment processes and strategies to minimise attrition.  This paper grew out of the larger ROMEO study which was published in our full HTA (Health Technology Assessment) report, which is also freely available on line, click here! [2]

 

Prof. Edwin van Teijlingen

CMMPH

 

Reference:

  1. Archibald, D., Douglas, F., Hoddinott, P., van Teijlingen, E., Stewart, F., Robertson, C., Boyers, D., Avenell, A. (2015) A qualitative evidence synthesis on the management of male obesity. BMJ Open 5: e008372. doi:10.1136/bmjopen-2015-008372 http://bmjopen.bmj.com/content/5/10/e008372.full.pdf+html
  2. Robertson, C., Archibald, D., Avenell, A., Douglas, F., Hoddinott, P., van Teijlingen, E., Boyers, D., Stewart, F., Boachie, C., Fioratou, E., Wilkins, D., Street, T., Carroll, P., Fowler, C. (2014) Systematic reviews of & integrated report on the quantitative, qualitative & economic evidence base for the management of obesity in men. Health Technology Assessment 18(35): 1-424.  http://www.journalslibrary.nihr.ac.uk/__data/assets/pdf_file/0019/118180/FullReport-hta18350.pdf

Paper ahead of its time?

Presentation1Sometimes my co-authors and I wonder why a particular paper get more cited after a few years of publication.  Is is because the paper and the research were are ahead of their time?  Or is there simply a lag time between publication and other researchers publishing in the field finding your paper (or stumbling upon it perhaps)?

Take for example the following paper published in 2006 when I was still based in the Department of Public Health at the University of Aberdeen: Promoting physical activity in primary care settings: Health visitors’ and practice nurses’ views and experiences in  the Journal of Advanced Nursing.[1]

 

Published in 2006 our paper was first cited in Scopus in 2007 (just once),three time in the following year (2008), five times in 2009 and then just a few times per year until this year. In 2015 we have six citations already and the year is not even finished.

We really wonder what lies behind that increased popularity of this 2006 paper.

citations JAN

Prof. Edwin van Teijlingen

CMMPH

 

Reference:

  1. Douglas, F., van Teijlingen E.R., Torrance, N., Fearn, P., Kerr, A., Meloni, S. (2006) Promoting physical activity in primary care settings: Health visitors’ and practice nurses’ views and experiences Journal of Advanced Nursing, 55(2): 159-168.

Fusion Investment Fund: Neuroscience has found that emotions are a primary factor in learning to change behaviour: A project to apply and study these findings in many areas of practice (for example, public health, sports science, youth work, neurological rehabilitation, special education, and potentially many others).

 

We were very fortunate to receive Fusion funding for our collaboration between colleagues and students in Health and Social Sciences, Sports Science, and a variety of external practice partners. Essentially the funding will enable us to obtain psychophysiological recording equipment to be used to measure emotional responses in a wide variety of learning and training settings. Below is a screenshot of a typical recording from this kind of equipment.

 

Image-1

 

Huge progress has been made over the last couple of decades in our understanding of emotion and feelings. A compelling conclusion from this enormous body of work is the primacy of emotion in how we operate in the world. Darwin knew this, as did Freud, but many still cling to the notion of the achievements of homo sapiens (“wise man”!) as founded on cognition and rational thinking. For them, feelings are a vestigial remnant of our evolutionary past, not dissimilar to the appendix – no longer having any purpose, and also potentially a threat to our well being.

Affective neuroscience completely opposes this so-called rational approach: emotions and feelings guided our survival in our evolutionary past, but the big news is that they still do! Accumulations of theory and research from fields such as affective neuroscience, positive psychology, and health psychology support this simple but crucial switch in emphasis. Some everyday practice reveals the primacy of emotion, for example emotionally skilled doctors tend to bring about better health outcomes for their patients, children are taught to pay attention to their ‘uh oh’ signs (involuntary emotional responses of sweaty palms and heart beating faster) to keep them safe. So emotions are not the redundant and fickle “appendix” of our behavioural systems, but in fact are their driving force.

Despite an array of pragmatic findings about the way emotions and feelings work, this largely ‘pure’ body of neuroscience has not been directly applied to any particular field of practice. This project aims to correct that omission. The applications of affective science to how we learn and change our behaviour are potentially enormous, as the physiological emotional measures offer a straightforward ‘window’ into the person’s emotional responses.

The Fusion funding enables us to build on one of the applications, through running a study developing a previous pilot. This will be based on a form of training using natural horsemanship that has been demonstrated to be very successful in behaviour change for young offenders and young people who do not engage with school. This is an example of what it looks like (thanks to TheHorseCourse for the picture):

 

TheHorseCourse picture

 

The equipment, and experience gained through carrying out the initial study, will also allow for projects with other practice partners to go ahead, for example, work with people with acquired brain injuries, and children with profound learning disabilities. If any of this interests you, please get in touch with Sid Carter or Emma Kavanagh, and we’d be glad to tell you more.

 

New paper on obesity research

Colleagues associated with the Health Economics Research Unit (HERU), Health Services Research Unit (HSRU) and the Rowett Institute of Nutrition and Health (all based at the University of Aberdeen), the Nursing, Midwifery & Allied Health Professional Research Unit (University of Stirling), the Scottish Collaboration for Public Health Research & Policy (SCPHRP) based at the University of Edinburgh and the Centre for Midwifery, Maternal and Perinatal Health (CMMPH) at Bournemouth University published their latest paper on obesity research.  The paper ‘A systematic review of the cost-effectiveness of non-surgical obesity interventions in men’ is published in the journal: Obesity Research & Clinical Practice.  This systematic review summarises the literature reporting the cost-effectiveness of non-surgical weight-management interventions for men. Studies were quality assessed against a checklist for appraising decision modelling studies.  This research is part of the larger ROMEO study.

 

Prof. Edwin van Teijlingen

Faculty of Health & Social Sciences

 

Reference:

Boyers, D., Avenell, A., Stewart, F., Robertson, C., Archibald, D., Douglas, F., Hoddinott, P., van Teijlingen, E., A systematic review of the cost-effectiveness of non-surgical obesity interventions in men, Obesity Research & Clinical Practice (online first)

Congratulations to HSC student Mr. Jib Acharya

HSC PhD student Jib Acharya presented the preliminary results of his thesis research in a poster presentation entitled “A Comparative Study on Nutritional Problems in Preschool Aged Children of Nepal”

The poster was accepted at the 3rd World Congress of Public Health Nutrition Conference in Gran Canaria,  Spain, 2014.

Mr. Acharya’s poster was displayed as a traditional paper poster but also a digital poster on television screens around the conference.  The thesis work is supervised in the School of Health & Social Care by Dr. Jane Murphy, Dr. Martin Hind and Prof. Edwin van Teijlingen.  The attendance of this conference was made possible due to the support of a Santander award.

Congratulations

Prof. Edwin van Teijlingen

CMMPH