Public health interventions and behaviour change: reviewing the grey literature

Arts and creativity interventions for improving health and wellbeing in older adults: a systematic literature review of economic evaluation studies

BACKGROUND

As the population ages, older people account for a larger proportion of the health and social care budget. A significant body of evidence suggests that arts and creativity interventions can improve the physical, mental and social wellbeing of older adults, however the value and/or cost-effectiveness of such interventions remains unclear.

METHODS

We systematically reviewed the economic evidence relating to such interventions, reporting our findings according to PRISMA guidelines. We searched bibliographic databases (MEDLINE, EMBASE, Econlit and Web of Science and NHSEED), trial registries and grey literature. No language or temporal restrictions were applied. Two screening rounds were conducted independently by health economists experienced in systematic literature review. Methodological quality was assessed, and key information extracted and tabulated to provide an overview of the published literature. A narrative synthesis without meta-analysis was conducted.

RESULTS

Only six studies were identified which provided evidence relating to the value or cost-effectiveness of arts and creativity interventions to improve health and wellbeing in older adults. The evidence which was identified was encouraging, with five out of the six studies reporting an acceptable probability of cost-effectiveness or positive return on investment (ranging from £1.20 to over £8 for every £1 of expenditure). However, considerable heterogeneity was observed with respect to study participants, design, and outcomes assessed. Of particular concern were potential biases inherent in social value analyses.

CONCLUSIONS

Despite many studies reporting positive health and wellbeing benefits of arts and creativity interventions in this population, we found meagre evidence on their value or cost-effectiveness. Such evidence is costly and time-consuming to generate, but essential if innovative non-pharmacological interventions are to be introduced to minimise the burden of illness in this population and ensure efficient use of public funds. The findings from this review suggests that capturing data on the value and/or cost-effectiveness of such interventions should be prioritised; furthermore, research effort should be directed to developing evaluative methods which move beyond the confines of current health technology assessment frameworks, to capture a broader picture of 'value' more applicable to arts and creativity interventions and public health interventions more generally.

PROSPERO REGISTRATION

CRD42021267944 (14/07/2021).

Impacts of accreditation on the performance of primary health care centres: A systematic review

Introduction

Evidence on the impacts of accreditation on primary health care (PHC) services is inconsistent. Thus, this study aimed to assess the impacts of accreditation on the performance of PHC centres.

Method

This study systematically reviewed articles published from 2000 to 2019 in the Web of Science, Scopus, ScienceDirect, Springer, PubMed and ProQuest. The following keywords were used: ((primary care OR primary health care) AND (accreditation) AND (impact OR effect OR output OR outcome OR influence OR result OR consequences)). The database search yielded a total of41256 articles, among which 30 articles were finally included in the review.

Results

Accreditation showed the most positive impacts on the quality, effectiveness, human resource management and strategic management of PHC services. Accreditation also positively affected safety, responsiveness, accessibility, customer satisfaction, documentation, leadership, efficiency and continuity of care. Few negative impacts were noted, including the possibility of accreditation being used as a bureaucratic tool, high cost of acquiring accreditation, difficulties in understanding the accreditation process, high staff turnover rate in accredited PHC centres and weak sustainability of some accreditation programmes.

Conclusion

Given its numerous positive impacts, accreditation could be used to effectively improve the performance of PHC centres.

Psychological First Aid Training: A Scoping Review of Its Application, Outcomes and Implementation

Worldwide commitment to disseminate Psychological First Aid (PFA) training to enable frontline workers to support distressed individuals and/or manage their own self-care is increasing, but the evidence base of PFA training is uncertain. Method: a scoping review was undertaken by searching seven databases and hand-searching grey literature to maximise coverage of potential studies. Results: Twenty-three studies met the inclusion criteria. Three PFA training models were commonly used in research studies. A broad selection of PFA training outcomes were observed including learning, behavior, satisfaction and practice in crisis mental and behavior health preparedness. Conclusions: Research evidence of reasonable quality demonstrates that PFA training significantly improves knowledge of appropriate psychosocial response and PFA skills in supporting people in acute distress, thereby enhancing self-efficacy and promoting resilience. However, this review highlights inadequate guidance on how PFA training should be applied and adapted, significant shortcomings of reporting PFA training delivery, limited training evaluation and unclear training outcomes. Whilst behavioral, knowledge and system impact of the PFA training are promising, methodologically stronger evaluations which include systematic training adaptation and selection of sensitive outcome measures is needed to strengthen future implementation of PFA training and thereby enhance population preparedness for future emergencies.

Tabletop Board Game Elements and Gamification Interventions for Health Behavior Change: Realist Review and Proposal of a Game Design Framework

Background

Games, when used as interventional tools, can influence behavior change by incentivizing, reinforcing, educating, providing feedback loops, prompting, persuading, or providing meaning, fun, and community. However, not all game elements will appeal to all consumers equally, and different elements might work for different people and in different contexts.

Objective

The aim of this study was to conduct a realist review of tabletop games targeting behavior change and to propose a framework for designing effective behavior change games.

Methods

A realist review was conducted to inform program theory in the development of tabletop games for health behavior change. The context, mechanisms used to change behavior, and outcomes of included studies were reviewed through a realist lens.

Results

Thirty-one papers met the eligibility criteria and were included in the review. Several design methods were identified that enhanced the efficacy of the games to change behavior. These included design by local teams, pilot testing, clearly defined targets of behavior change, conscious attention to all aspects of game design, including game mechanics, dynamics, aesthetics, and the elicitation of emotions. Delivery with other mediums, leveraging behavioral insights, prior training for delivery, and repeated play were also important. Some design elements that were found to reduce efficacy included limited replayability or lack of fun for immersive engagement.

Conclusions

Game designers need to consider all aspects of the context and the mechanisms to achieve the desired behavior change outcomes. Careful design thinking should include consideration of the game mechanics, dynamics, aesthetics, emotions, and contexts of the game and the players. People who know the players and the contexts well should design the games or have significant input. Testing in real-world settings is likely to lead to better outcomes. Careful selection and purposeful design of the behavior change mechanisms at play is essential. Fun and enjoyment of the player should be considered, as without engagement, there will be no desired intervention effect.

Facilitators of healthy life style behaviors in persons with schizophrenia-A qualitative feasibility pilot study

INTRODUCTION

Persons with schizophrenia experience high rates of cardio metabolic disorders and have a 20-25% shorter life expectancy than the general population. Health professionals led life style modification behavior programs have shown improvements, in managing aspects of metabolic problems. This study sought to identify the life style modification by exploring (1) facilitators that help persons with schizophrenia to adopt the lifestyle modification behaviors and (2) factors that help to adhere to life style modification behaviors.

METHODS

A qualitative study utilizing face to face interviews was conducted for five persons (n = 5) diagnosed as schizophrenia (ICD 10) and their caregivers (n = 13) receiving inpatient mental health services in a tertiary level psychiatry centre, in South India. Qualitative data was collected, organized and analyzed with thematic analysis using ATLAS.ti software.

RESULTS

The study results identified four major themes as facilitators. (1) Factors of increased self- confidence, and personal development. (2) The need for social support and conducive environment; (3) level of self motivation (4) encouragement from health professional and availability of health services. Participants believed that engaging with programs of physical activity, dietary modification, and illness support from family would motivate them to live more healthily.

CONCLUSION

Individuals with serious mental illnesses such as schizophrenia encounter physical health related problems, facilitators of lifestyle change behavior help them to adhere to change in their routine life. Lifestyle change interventions also motivate individuals to eat healthy diet and exercise regularly to prevent premature mortality.

A scoping study of interventions to increase the uptake of physical activity (PA) amongst individuals with mild-to-moderate depression (MMD)

Background

Depression is the largest contributor to disease burden globally. The evidence favouring physical activity as a treatment for mild-to-moderate depression is extensive and relatively uncontested. It is unclear, however, how to increase an uptake of physical activity amongst individuals experiencing mild-to-moderate depression. This leaves professionals with no guidance on how to help people experiencing mild-to-moderate depression to take up physical activity. The purpose of this study was to scope the evidence on interventions to increase the uptake of physical activity amongst individuals experiencing mild-to-moderate depression, and to develop a model of the mechanisms by which they are hypothesised to work.

Methods

A scoping study was designed to include a review of primary studies, grey literature and six consultation exercises; two with individuals with experience of depression, two pre-project consultations with physical activity, mental health and literature review experts, one with public health experts, and one with community engagement experts.

Results

Ten papers met the inclusion criteria and were included in the review. Consultation exercises provided insights into the mechanisms of an uptake of physical activity amongst individuals experiencing mild-to-moderate depression; evidence concerning those mechanisms is (a) fragmented in terms of design and purpose; (b) of varied quality; (c) rarely explicit about the mechanisms through which the interventions are thought to work. Physical, environmental and social factors that may represent mediating variables in the uptake of physical activity amongst people experiencing mild-to-moderate depression are largely absent from studies.

Conclusions

An explanatory model was developed. This represents mild-to-moderate depression as interfering with (a) the motivation to take part in physical activity and (b) the volition that it is required to take part in physical activity. Therefore, both motivational and volitional elements are important in any intervention to increase physical activity in people with mild-to-moderate depression. Furthermore, mild-to-moderate depression-specific factors need to be tackled in any physical activity initiative, via psychological treatments such as Cognitive Behavioural Therapy. We argue that the social and environmental contexts of interventions also need attention.

Searching and synthesising 'grey literature' and 'grey information' in public health: critical reflections on three case studies

BACKGROUND

Grey literature includes a range of documents not controlled by commercial publishing organisations. This means that grey literature can be difficult to search and retrieve for evidence synthesis. Much knowledge and evidence in public health, and other fields, accumulates from innovation in practice. This knowledge may not even be of sufficient formality to meet the definition of grey literature. We term this knowledge 'grey information'. Grey information may be even harder to search for and retrieve than grey literature.

METHODS

On three previous occasions, we have attempted to systematically search for and synthesise public health grey literature and information-both to summarise the extent and nature of particular classes of interventions and to synthesise results of evaluations. Here, we briefly describe these three 'case studies' but focus on our post hoc critical reflections on searching for and synthesising grey literature and information garnered from our experiences of these case studies. We believe these reflections will be useful to future researchers working in this area.

RESULTS

Issues discussed include search methods, searching efficiency, replicability of searches, data management, data extraction, assessing study 'quality', data synthesis, time and resources, and differentiating evidence synthesis from primary research.

CONCLUSIONS

Information on applied public health research questions relating to the nature and range of public health interventions, as well as many evaluations of these interventions, may be predominantly, or only, held in grey literature and grey information. Evidence syntheses on these topics need, therefore, to embrace grey literature and information. Many typical systematic review methods for searching, appraising, managing, and synthesising the evidence base can be adapted for use with grey literature and information. Evidence synthesisers should carefully consider the opportunities and problems offered by including grey literature and information. Enhanced incentives for accurate recording and further methodological developments in retrieval will facilitate future syntheses of grey literature and information.

Recreational Drowning Prevention Interventions for Adults, 1990-2012: A Review

Drowning is a frequently occurring and preventable public health issue. Internationally, drowning literature has focussed on children under 5 years, however, evidence based interventions to prevent adult drowning are needed to reduce deaths on a global scale. The aim of this paper is to systematically identify and analyse the evidence for drowning interventions with an adult focus. A systematic search was undertaken for peer-reviewed articles which were published in English between 1990 and 2012, focused on adults and described a drowning intervention. After quality appraisal by expert reviewers using a purposively tailored checklist, a final total of six studies were included for review. The six studies were all conducted in high income countries. Four were drowning interventions, two were retrospective analyses. The drowning interventions duration ranged from 10 days to 5 years, the analysis studies from 6 to 21 years. Two of the studies reviewed used behaviour change theory to inform development, and two reported formative evaluation. Prevention strategies included education (n = 3), technology (n = 1) and environmental (n = 1). Positive short term effects and significant behaviour change in life jacket use was reported (n = 2). A mixed effect was observed in the six studies. The complexity of the issues surrounding drowning requires the collection of robust data and evaluation of preventative measures to support the development of targeted and tailored prevention interventions. This review reinforces the need for a genuine and sustained global approach to addressing adult drowning prevention. Drowning is a serious public health issue and should receive the same attention as other public health priorities .

Facilitators for the development and implementation of health promoting policy and programs - a scoping review at the local community level

BACKGROUND

Health promotion, with a focus on multidimensional upstream factors and an ecological, life-course approach, is establishing itself as the guiding philosophy for addressing public health. Action at the political and programmatic level on the Social Determinants of Health has proven effective for promoting and building public health at all levels but has been particularly evident at the national and international levels - due in large part to available documents and guidelines. Although research and experience establish that health promotion is most effective when settings-based, the development of health promoting policies and programs at the local level is still difficult. This study intended to investigate available knowledge on the development and implementation of health promoting policies and programs at the local level and identify factors most important for facilitating capacity building and outcome achievement.

METHODS

We used a scoping review in order to review the current literature on local policy development and program implementation. Keywords were chosen based on results of a previous literature review. A total of 53 articles were divided into two categories: policy and implementation. Critical analysis was conducted for each article and a summary assembled. Data was charted with specific focus on the aims of the study, data acquisition, key theories/concepts/frameworks used, outcome measures, results, and conclusions.

RESULTS

The articles included in this study primarily focused on discussing factors that facilitate the development of health promoting policy and the implementation of health promotion programs. Most significant facilitators included: collaborative decision-making, agreement of objectives and goals, local planning and action, effective leadership, building and maintaining trust, availability of resources, a dynamic approach, a realistic time-frame, and trained and knowledgeable staff. Within each of these important facilitating factors, various elements supporting implementation were discussed and highlighted in this study.

CONCLUSION

Our results indicate that clear and consistent facilitators exist for supporting health promoting policy development and program implementation at the local level. These results offer a starting point for local action on the Social Determinants of Health and have the potential to contribute to the development of a framework for improving action at the local level.

Initiatives promoting seamless care in medication management: an international review of the grey literature

BACKGROUND

Patients' transition between hospital and community is a high-risk period for the occurrence of medication-related problems.

AIM OF THE REVIEW

The objective was to review initiatives, implemented at national and regional levels in seven selected countries, aiming at improving continuity in medication management upon admission and hospital discharge.

METHOD

We performed a structured search of grey literature, mainly through relevant websites (scientific, professional and governmental organizations). Regional or national initiatives were selected. For each initiative data on the characteristics, impact, success factors and barriers were extracted. National experts were asked to validate the initiatives identified and the data extracted.

RESULTS

Most initiatives have been implemented since the early 2000 and are still ongoing. The principal actions include: development and implementation of guidelines for healthcare professionals, national information campaigns, education of healthcare professionals and development of information technologies to share data across settings of care. Positive results have been partially reported in terms of intake into practice or process measures. Critical success factors identified included: leadership and commitment to convey national and local forces, tailoring to local settings, development of a regulatory framework and information technology support. Barriers identified included: lack of human and financial resources, questions relative to responsibility and accountability, lack of training and lack of agreement on privacy issues.

CONCLUSION

Although not all initiatives are applicable as such to a particular healthcare setting, most of them convey very interesting data that should be used when drawing recommendations and implementing approaches to optimize continuity of care.

A qualitative study exploring facilitators for improved health behaviors and health behavior programs: mental health service users' perspectives

Objective. Mental health service users experience high rates of cardiometabolic disorders and have a 20–25% shorter life expectancy than the general population from such disorders. Clinician-led health behavior programs have shown moderate improvements, for mental health service users, in managing aspects of cardiometabolic disorders. This study sought to potentially enhance health initiatives by exploring (1) facilitators that help mental health service users engage in better health behaviors and (2) the types of health programs mental health service users want to develop. Methods. A qualitative study utilizing focus groups was conducted with 37 mental health service users attending a psychosocial rehabilitation center, in Northern British Columbia, Canada. Results. Four major facilitator themes were identified: (1) factors of empowerment, self-value, and personal growth; (2) the need for social support; (3) pragmatic aspects of motivation and planning; and (4) access. Participants believed that engaging with programs of physical activity, nutrition, creativity, and illness support would motivate them to live more healthily. Conclusions and Implications for Practice. Being able to contribute to health behavior programs, feeling valued and able to experience personal growth are vital factors to engage mental health service users in health programs. Clinicians and health care policy makers need to account for these considerations to improve success of health improvement initiatives for this population.

Time availability and preference for e-health communication channels for nutrition and physical activity

The aim of this study was to examine the relationship between time availability and preference for computer-based (e-health) communication channels when receiving nutrition and physical activity information, two key behaviors related to cancer prevention. Students from a large, diverse, urban university (n = 397) completed a web-based survey indicating their usage patterns and preferences for multiple eHealth channels. Bivariate analyses were performed based on a measure of time availability, comprised of working status (25 h/week or more, 1-24 h/week, or not working) and enrollment status (full-time or part-time). Most e-health channels were broadly used by students and did not differ according to time availability. Those with the most amount of time available preferred receiving nutrition and physical activity information via social networking more frequently compared to those with the least amount of time available (60 versus 43%, P ≤ 0.05). Our study suggests that time availability may be another important factor to consider when planning cancer prevention programs.