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Cowap L, Riley V, Grogan S, Ellis NJ, Crone D, Cottrell E, Chambers R, Clark-Carter D, Gidlow CJ. "They are saying it's high, but I think it's quite low": exploring cardiovascular disease risk communication in NHS health checks through video-stimulated recall interviews with patients - a qualitative study. BMC Prim Care 2024; 25:126. [PMID: 38654245 PMCID: PMC11036616 DOI: 10.1186/s12875-024-02357-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/28/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND NHS Health Check (NHSHC) is a national cardiovascular disease (CVD) risk identification and management programme. However, evidence suggests a limited understanding of the most used metric to communicate CVD risk with patients (10-year percentage risk). This study used novel application of video-stimulated recall interviews to understand patient perceptions and understanding of CVD risk following an NHSHC that used one of two different CVD risk calculators. METHODS Qualitative, semi-structured video-stimulated recall interviews were conducted with patients (n = 40) who had attended an NHSHC using either the QRISK2 10-year risk calculator (n = 19) or JBS3 lifetime CVD risk calculator (n = 21). Interviews were transcribed and analysed using reflexive thematic analysis. RESULTS Analysis resulted in the development of four themes: variability in understanding, relief about personal risk, perceived changeability of CVD risk, and positive impact of visual displays. The first three themes were evident across the two patient groups, regardless of risk calculator; the latter related to JBS3 only. Patients felt relieved about their CVD risk, yet there were differences in understanding between calculators. Heart age within JBS3 prompted more accessible risk appraisal, yet mixed understanding was evident for both calculators. Event-free survival age also resulted in misunderstanding. QRISK2 patients tended to question the ability for CVD risk to change, while risk manipulation through JBS3 facilitated this understanding. Displaying information visually also appeared to enhance understanding. CONCLUSIONS Effective communication of CVD risk within NHSHC remains challenging, and lifetime risk metrics still lead to mixed levels of understanding in patients. However, visual presentation of information, alongside risk manipulation during NHSHCs can help to increase understanding and prompt risk-reducing lifestyle changes. TRIAL REGISTRATION ISRCTN10443908. Registered 7th February 2017.
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Affiliation(s)
- Lisa Cowap
- Staffordshire University, Stoke-on-Trent, UK
| | | | - Sarah Grogan
- Manchester Metropolitan University, Manchester, UK
| | | | - Diane Crone
- Cardiff Metropolitan University, Cardiff, UK
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Gidlow CJ, Sams L, Buckless K, Ellis NJ, Duffy HC, Lambley-Burke R, Campbell P, Cooke A, Dziedzic K, Brookes M, Chockalingam N, Devall P, Mallen C. "We have to change our mindsets": a qualitative study of barriers and facilitators in research collaboration across integrated care system organisations. BMC Health Serv Res 2024; 24:264. [PMID: 38429760 PMCID: PMC10908113 DOI: 10.1186/s12913-024-10760-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 02/20/2024] [Indexed: 03/03/2024] Open
Abstract
The introduction of Integrated Care Systems (ICS) in England aimed to increase joint planning and delivery of health and social care, and other services, to better meet the needs of local communities. There is an associated duty to undertake collaborative research across ICS partners to inform this new integrated approach, which might be challenging given that organisations span health, local authority, voluntary and community sector, and research. This study aimed to explore the appetite for collaborative Research and Innovation (R&I) across ICSs, potential barriers and solutions. This qualitative study involved semi-structured interviews with 24 stakeholders who held senior positions within organisations across two ICS areas (Staffordshire and Stoke-on-Trent; Shropshire, Telford and Wrekin). Interview transcripts were analysed using inductive and deductive analysis, first mapping to the Theoretical Domains Framework (TDF), then considering key influences on organisational behaviour in terms of Capability, Opportunity and Motivation from the COM-B Behaviour Change Wheel. There were fundamental limitations on organisational opportunities for collaborative R&I: a historical culture of competition (rather than collaboration), a lack of research culture and prioritisation, compounded by a challenging adverse economic environment. However, organisations were motivated to undertake collaborative R&I. They recognised the potential benefits (e.g., skill-sharing, staff development, attracting large studies and funding), the need for collaborative research that mirrors integrated care, and subsequent benefits for care recipients. Related barriers included negative experiences of collaboration, fear of failing and low confidence. Capability varied across organisations in terms of research skills and confidence, which reflected the range of partners (from local authorities to NHS Trusts, primary care, and academic institutions). These findings indicate a need to shift from a culture of competition to collaboration, and to help organisations across ICS to prioritise research, and share resources and skills to mitigate the limiting effects of a constrained economic environment. This could be further explored using a systems change approach, to develop the collaborative research efforts alongside the overarching move towards integrated care.
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Affiliation(s)
- Christopher J Gidlow
- Centre for Health and Development (CHAD), Staffordshire University, Ashley Building, Leek Road, ST4 2DF, Stoke-on-Trent, UK.
| | - Lorna Sams
- Centre for Health and Development (CHAD), Staffordshire University, Ashley Building, Leek Road, ST4 2DF, Stoke-on-Trent, UK
| | - Kim Buckless
- Centre for Health and Development (CHAD), Staffordshire University, Ashley Building, Leek Road, ST4 2DF, Stoke-on-Trent, UK
| | - Naomi J Ellis
- Centre for Health and Development (CHAD), Staffordshire University, Ashley Building, Leek Road, ST4 2DF, Stoke-on-Trent, UK
| | - Helen C Duffy
- Midlands Partnership University NHS Foundation Trust, St George's Hospital, Corporation Street, ST16 3AG, Stafford, UK
| | - Ruth Lambley-Burke
- Midlands Partnership University NHS Foundation Trust, St George's Hospital, Corporation Street, ST16 3AG, Stafford, UK
| | - Paul Campbell
- Midlands Partnership University NHS Foundation Trust, St George's Hospital, Corporation Street, ST16 3AG, Stafford, UK
- Keele University, ST5 5BG, Keele, Staffordshire, UK
| | - Alison Cooke
- Keele University, ST5 5BG, Keele, Staffordshire, UK
- University Hospitals of North Midlands NHS Trust, Newcastle Road, ST4 6QG, Stoke-on-Trent, UK
| | | | - Matthew Brookes
- University of Wolverhampton, Wolverhampton, UK
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - Nachiappan Chockalingam
- Centre for Health and Development (CHAD), Staffordshire University, Ashley Building, Leek Road, ST4 2DF, Stoke-on-Trent, UK
| | - Pam Devall
- NIHR Clinical Research Network West Midlands, New Cross Hospital, WV10 0QP, Wolverhampton, UK
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Fedorowicz S, Dempsey RC, Ellis NJ, Mulvey O, Gidlow CJ. Quantitative content analysis of Freedom of Information requests examining the extent and variations of tools and training for conducting suicide risk assessments in NHS Trusts across England. BMJ Open 2023; 13:e072004. [PMID: 37884387 PMCID: PMC10603533 DOI: 10.1136/bmjopen-2023-072004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/31/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVES Determining the risk for suicide is a difficult endeavour. Clinical guidance in the UK explicitly advises against using risk assessment tools and scales to determine suicide risk. Based on Freedom of Information (FoI) requests made to NHS Trusts in England, this study provides an overview of suicide risk assessment tools in use, training provided in how to use such assessments, and explores implementation of suicide risk assessment guidance in practice in English NHS Trusts. DESIGN A cross-sectional survey of suicide risk assessment tools and training gathered via FoI requests and subjected to a content analysis. SETTING FoI requests were submitted to NHS Trusts across England. RESULTS A wide variety of suicide risk assessments tools were identified as being used in practice, with several trusts reported using more than one tool to determine suicide risk. Forty-one trusts reported using locally developed, unvalidated, tools to assess risk of suicide and 18 stated they do not use a tool. Ten trusts stated they do not train their staff in suicide risk assessment while 13 reported use of specific suicide risk assessment training. Sixty-two trusts stated they do not centrally record the number of assessments conducted or how many individuals are identified as at risk. Content analysis indicated the frequent wider assessment of risk not restricted to suicide risk. CONCLUSIONS There is wide variation in suicide risk assessment tools being used in practice and some lack of specific training for healthcare staff in determining suicide risk. Few trusts routinely record the number of assessments being conducted or the number of individuals identified at high risk. Implementation of specific training is necessary for the suicide risk assessment process to identify patient needs and develop therapeutic engagement. Routinely recording how many assessments are conducted is a crucial step in improving suicide prevention.
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Affiliation(s)
- Sophia Fedorowicz
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Robert C Dempsey
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Naomi J Ellis
- Faculty of Health Sciences, Staffordshire University, Stoke-on-Trent, UK
| | - Olivia Mulvey
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Christopher J Gidlow
- Centre for Sport, Health and Exercise Research, Staffordshire University, Stoke on Trent, UK
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Roberts M, Colley K, Currie M, Eastwood A, Li KH, Avery LM, Beevers LC, Braithwaite I, Dallimer M, Davies ZG, Fisher HL, Gidlow CJ, Memon A, Mudway IS, Naylor LA, Reis S, Smith P, Stansfeld SA, Wilkie S, Irvine KN. The Contribution of Environmental Science to Mental Health Research: A Scoping Review. Int J Environ Res Public Health 2023; 20:5278. [PMID: 37047894 PMCID: PMC10094550 DOI: 10.3390/ijerph20075278] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/22/2023] [Accepted: 02/28/2023] [Indexed: 06/19/2023]
Abstract
Mental health is influenced by multiple complex and interacting genetic, psychological, social, and environmental factors. As such, developing state-of-the-art mental health knowledge requires collaboration across academic disciplines, including environmental science. To assess the current contribution of environmental science to this field, a scoping review of the literature on environmental influences on mental health (including conditions of cognitive development and decline) was conducted. The review protocol was developed in consultation with experts working across mental health and environmental science. The scoping review included 202 English-language papers, published between 2010 and 2020 (prior to the COVID-19 pandemic), on environmental themes that had not already been the subject of recent systematic reviews; 26 reviews on climate change, flooding, air pollution, and urban green space were additionally considered. Studies largely focused on populations in the USA, China, or Europe and involved limited environmental science input. Environmental science research methods are primarily focused on quantitative approaches utilising secondary datasets or field data. Mental health measurement was dominated by the use of self-report psychometric scales. Measures of environmental states or exposures were often lacking in specificity (e.g., limited to the presence or absence of an environmental state). Based on the scoping review findings and our synthesis of the recent reviews, a research agenda for environmental science's future contribution to mental health scholarship is set out. This includes recommendations to expand the geographical scope and broaden the representation of different environmental science areas, improve measurement of environmental exposure, prioritise experimental and longitudinal research designs, and giving greater consideration to variation between and within communities and the mediating pathways by which environment influences mental health. There is also considerable opportunity to increase interdisciplinarity within the field via the integration of conceptual models, the inclusion of mixed methods and qualitative approaches, as well as further consideration of the socio-political context and the environmental states that can help support good mental health. The findings were used to propose a conceptual model to parse contributions and connections between environmental science and mental health to inform future studies.
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Affiliation(s)
- Michaela Roberts
- Social, Economic and Geographical Sciences Department, The James Hutton Institute, Craigiebuckler, Aberdeen, Scotland AB15 8QH, UK
| | - Kathryn Colley
- Social, Economic and Geographical Sciences Department, The James Hutton Institute, Craigiebuckler, Aberdeen, Scotland AB15 8QH, UK
| | - Margaret Currie
- Social, Economic and Geographical Sciences Department, The James Hutton Institute, Craigiebuckler, Aberdeen, Scotland AB15 8QH, UK
| | - Antonia Eastwood
- Social, Economic and Geographical Sciences Department, The James Hutton Institute, Craigiebuckler, Aberdeen, Scotland AB15 8QH, UK
| | - Kuang-Heng Li
- Social, Economic and Geographical Sciences Department, The James Hutton Institute, Craigiebuckler, Aberdeen, Scotland AB15 8QH, UK
| | - Lisa M. Avery
- Environmental and Biochemical Sciences Department, The James Hutton Institute, Craigiebuckler, Aberdeen, Scotland AB15 8QH, UK
| | - Lindsay C. Beevers
- Institute of Infrastructure and Environment, School of Energy, Geoscience, Infrastructure and Society, Heriot-Watt University, Edinburgh EH14 4AS, UK
| | - Isobel Braithwaite
- UCL Institute of Health Informatics, 222 Euston Road, London NW1 2DA, UK
| | - Martin Dallimer
- Sustainability Research Institute, School of Earth and Environment, University of Leeds, Leeds LS2 9JT, UK
| | - Zoe G. Davies
- Durrell Institute of Conservation and Ecology (DICE), School of Anthropology and Conservation, University of Kent, Canterbury, Kent CT2 7NR, UK
| | - Helen L. Fisher
- King’s College London, Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London SE5 8AF, UK
- Economic & Social Research Council (ESRC) Centre for Society and Mental Health, King’s College London, 44-46 Aldwych, London WC2B 4LL, UK
| | - Christopher J. Gidlow
- Centre for Health and Development (CHAD), Staffordshire University, Leek Road, Stoke-on-Trent ST4 2DF, UK
| | - Anjum Memon
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton BN1 9PH, UK
| | - Ian S. Mudway
- MRC Centre for Environment and Health, Imperial College London, White City Campus, London W12 0BZ, UK
- NIHR Health Protection Research Units in Environmental Exposures and Health, and Chemical and Radiation Threats and Hazards, Imperial College London, White City Campus, London W12 0BZ, UK
| | - Larissa A. Naylor
- School of Geographical & Earth Sciences, East Quadrangle, University of Glasgow, Glasgow G12 8QQ, UK
| | - Stefan Reis
- UK Centre for Ecology & Hydrology, Bush Estate, Penicuik EH26 0QB, UK
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Truro, Cornwall TR1 3HD, UK
| | - Pete Smith
- Institute of Biological and Environmental Sciences, University of Aberdeen, 23 St Machar Drive, Aberdeen AB24 3UU, UK
| | - Stephen A. Stansfeld
- Centre for Psychiatry, Barts and the London School of Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Stephanie Wilkie
- School of Psychology, Murray Library, City Campus, University of Sunderland, Sunderland SR1 3SD, UK
| | - Katherine N. Irvine
- Social, Economic and Geographical Sciences Department, The James Hutton Institute, Craigiebuckler, Aberdeen, Scotland AB15 8QH, UK
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Fedorowicz S, Riley V, Cowap L, Ellis NJ, Chambers R, Grogan S, Crone D, Cottrell E, Clark-Carter D, Roberts L, Gidlow CJ. Using social media for patient and public involvement and engagement in health research: The process and impact of a closed Facebook group. Health Expect 2022; 25:2786-2795. [PMID: 36134468 DOI: 10.1111/hex.13515] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 03/10/2022] [Accepted: 04/11/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND As part of a multifaceted approach to patient and public involvement and engagement (PPIE), alongside traditional methods, a closed Facebook group was established to facilitate PPIE feedback on various aspects of a project that used video-recording to examine risk communication in NHS Health Checks between June 2017 and July 2019. OBJECTIVE To explore the process and impact of conducting PPIE through a closed Facebook group and to identify the associated benefits and challenges. METHODS Supported by reflections and information from project meetings used to document how this engagement informed the project, we describe the creation and maintenance of the Facebook Group and how feedback from the group members was obtained. Facebook data were used to investigate levels and types of engagement in the closed Facebook group. We reflect on the challenges of using this method of engaging the public in health research. RESULTS A total of 289 people joined the 'Risk Communication of Cardiovascular disease in NHS Health Checks' PPIE closed Facebook group. They provided feedback, which was used to inform aspects of the study, including participant-facing documents, recruitment, camera position and how the methodology being used (video-recorded Health Checks and follow-up interviews) would be received by the public. DISCUSSION Using a closed Facebook group to facilitate PPIE offered a flexible approach for both researchers and participants, enabled a more inclusive method to PPIE (compared with traditional methods) and allowed rapid feedback. Challenges included maintaining the group, which was more labour intensive than anticipated and managing members' expectations. Suggestions for best practice include clear communication about the purpose of the group, assigning a group co-ordinator to be the main point of contact for the group, and a research team who can dedicate the time necessary to maintain the group. CONCLUSION The use of a closed Facebook group can facilitate effective PPIE. Its flexibility can be beneficial for researchers, patients and public who wish to engage in the research process. Dedicated time for sustained group engagement is important. PATIENT OR PUBLIC CONTRIBUTION Patient representatives were engaged with the development of the research described in this paper and a patient representative reviewed the manuscript.
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Affiliation(s)
- Sophia Fedorowicz
- The Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Victoria Riley
- The Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Lisa Cowap
- The Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Naomi J Ellis
- The Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Ruth Chambers
- Technology Enabled Care Programme, Staffordshire Sustainability and Transformation Partnership's Digital Workstream, Stoke-on-Trent Clinical Commissioning Group, Stoke-on-Trent, UK
| | - Sarah Grogan
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Diane Crone
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cardiff, UK
| | | | - David Clark-Carter
- The Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Lesley Roberts
- Member Governor of Midlands Partnership NHS Foundation Trust, Patient Representative, Stoke-on-Trent, UK
| | - Christopher J Gidlow
- The Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
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Darcy PM, Taylor J, Mackay L, Ellis NJ, Gidlow CJ. Understanding the Role of Nature Engagement in Supporting Health and Wellbeing during COVID-19. Int J Environ Res Public Health 2022; 19:ijerph19073908. [PMID: 35409590 PMCID: PMC8997429 DOI: 10.3390/ijerph19073908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/17/2022] [Accepted: 03/23/2022] [Indexed: 12/04/2022]
Abstract
The importance of natural environments in supporting health and wellbeing has been well evidenced in supporting positive mental and physical health outcomes, including during periods of crisis and stress. Given the disproportionate impacts of the COVID-19 pandemic have been greatest for those who are most vulnerable, understanding the role of natural environment and alternative forms of nature engagement in supporting health and wellbeing for vulnerable groups is important. This study explored how nature engagement supported health and wellbeing in those with a pre-existing health condition during the first UK lockdown. Semi-structured interviews were conducted with 17 adults with a pre-existing health condition and analysed using Interpretative Phenomenological Analysis (IPA). Four themes were identified: COVID-19 versus nature; Nature as an extension and replacement; Nature connectedness; and Therapeutic nature. The findings show the importance of nature in supporting health and wellbeing in those with a pre-existing health condition through engagement with private and public natural environments, micro-restorative opportunities, nature connection as an important pathway, and the therapeutic benefits of nature engagement. The present research extends the evidence-base beyond patterns of nature engagement to a deeper understanding of how those with existing health conditions perceived and interacted with nature in relation to their health and wellbeing during the first UK lockdown. Findings are discussed in relation to health supporting environments, micro-restorative opportunities, and policy implications.
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Affiliation(s)
- Patricia M. Darcy
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent ST4 2DF, UK; (N.J.E.); (C.J.G.)
- Correspondence:
| | - Jennifer Taylor
- School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent ST4 2DE, UK; (J.T.); (L.M.)
| | - Lorna Mackay
- School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent ST4 2DE, UK; (J.T.); (L.M.)
| | - Naomi J. Ellis
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent ST4 2DF, UK; (N.J.E.); (C.J.G.)
| | - Christopher J. Gidlow
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent ST4 2DF, UK; (N.J.E.); (C.J.G.)
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Gidlow CJ, Ellis NJ, Riley V, Cowap L, Crone D, Cottrell E, Grogan S, Chambers R, Calvert S, Clark-Carter D. Cardiovascular disease risk communication in NHS Health Checks: a qualitative video-stimulated recall interview study with practitioners. BJGP Open 2021; 5:BJGPO.2021.0049. [PMID: 34172476 PMCID: PMC8596312 DOI: 10.3399/bjgpo.2021.0049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND NHS Health Check (NHSHC) is a national programme to identify and manage cardiovascular disease (CVD) risk. Practitioners delivering the programme should be competent in discussing CVD risk, but there is evidence of limited understanding of the recommended 10-year percentage CVD risk scores. Lifetime CVD risk calculators might improve understanding and communication of risk. AIM To explore practitioner understanding, perceptions, and experiences of CVD risk communication in NHSHCs when using two different CVD risk calculators. DESIGN & SETTING Qualitative video-stimulated recall (VSR) study with NHSHC practitioners in the West Midlands. METHOD VSR interviews were conducted with practitioners who delivered NHSHCs using either the QRISK2 10-year risk calculator (n = 7) or JBS3 lifetime CVD risk calculator (n = 8). Data were analysed using reflexive thematic analysis. RESULTS In total, nine healthcare assistants (HCAs) and six general practice nurses (GPNs) were interviewed. There was limited understanding and confidence of 10-year risk, which was used to guide clinical decisions through determining low-, medium-, or high-risk thresholds, rather than as a risk communication tool. Potential benefits of some JBS3 functions were evident, particularly heart age, risk manipulation, and visual presentation of risk. CONCLUSION There is a gap between the expectation and reality of practitioners' understanding, competencies, and training in CVD risk communication for NHSHCs. Practitioners would welcome heart age and risk manipulation functions of JBS3 to promote patient understanding of CVD risk, but there is a more fundamental need for practitioner training in CVD risk communication.
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Affiliation(s)
- Christopher J Gidlow
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Naomi J Ellis
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Victoria Riley
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Lisa Cowap
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Diane Crone
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Elizabeth Cottrell
- School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Sarah Grogan
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Ruth Chambers
- Stoke-on-Trent Clinical Commissioning Group, Stoke-on-Trent, UK
| | - Sian Calvert
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - David Clark-Carter
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
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Gidlow CJ, Ellis NJ, Cowap L, Riley V, Crone D, Cottrell E, Grogan S, Chambers R, Clark-Carter D. Cardiovascular disease risk communication in NHS Health Checks using QRISK®2 and JBS3 risk calculators: the RICO qualitative and quantitative study. Health Technol Assess 2021; 25:1-124. [PMID: 34427556 DOI: 10.3310/hta25500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The NHS Health Check is a national cardiovascular disease prevention programme. There is a lack of evidence on how health checks are conducted, how cardiovascular disease risk is communicated to foster risk-reducing intentions or behaviour, and the impact on communication of using different cardiovascular disease risk calculators. OBJECTIVES RIsk COmmunication in Health Check (RICO) study aimed to explore practitioner and patient understanding of cardiovascular disease risk, the associated advice or treatment offered by the practitioner, and the response of the patients in health checks supported by either the QRISK®2 or the JBS3 lifetime risk calculator. DESIGN This was a qualitative study with quantitative process evaluation. SETTING Twelve general practices in the West Midlands of England, stratified on deprivation of the local area (bottom 50% vs. top 50%), and with matched pairs randomly allocated to use QRISK2 or JBS3 during health checks. PARTICIPANTS A total of 173 patients eligible for NHS Health Check and 15 practitioners. INTERVENTIONS The health check was delivered using either the QRISK2 10-year risk calculator (usual practice) or the JBS3 lifetime risk calculator, with heart age, event-free survival age and risk score manipulation (intervention). RESULTS Video-recorded health checks were analysed quantitatively (n = 173; JBS3, n = 100; QRISK2, n = 73) and qualitatively (n = 128; n = 64 per group), and video-stimulated recall interviews were undertaken with 40 patients and 15 practitioners, with 10 in-depth case studies. The duration of the health check varied (6.8-38 minutes), but most health checks were short (60% lasting < 20 minutes), with little cardiovascular disease risk discussion (average < 2 minutes). The use of JBS3 was associated with more cardiovascular disease risk discussion and fewer practitioner-dominated consultations than the use of QRISK2. Heart age and visual representations of risk, as used in JBS3, appeared to be better understood by patients than 10-year risk (QRISK2) and, as a result, the use of JBS3 was more likely to lead to discussion of risk factors and their management. Event-free survival age was not well understood by practitioners or patients. However, a lack of effective cardiovascular disease risk discussion in both groups increased the likelihood of a maladaptive coping response (i.e. no risk-reducing behaviour change). In both groups, practitioners often missed opportunities to check patient understanding and to tailor information on cardiovascular disease risk and its management during health checks, confirming apparent practitioner verbal dominance. LIMITATIONS The main limitations were under-recruitment in some general practices and the resulting imbalance between groups. CONCLUSIONS Communication of cardiovascular disease risk during health checks was brief, particularly when using QRISK2. Patient understanding of and responses to cardiovascular disease risk information were limited. Practitioners need to better engage patients in discussion of and action-planning for their cardiovascular disease risk to reduce misunderstandings. The use of heart age, visual representation of risk and risk score manipulation was generally seen to be a useful way of doing this. Future work could focus on more fundamental issues of practitioner training and time allocation within health check consultations. TRIAL REGISTRATION Current Controlled Trials ISRCTN10443908. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 50. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Christopher J Gidlow
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Naomi J Ellis
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Lisa Cowap
- Centre for Psychological Research, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Victoria Riley
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Diane Crone
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Elizabeth Cottrell
- School of Primary, Community and Social Care, Keele University, Keele, Newcastle-under-Lyme, UK
| | - Sarah Grogan
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Ruth Chambers
- Stoke-on-Trent Clinical Commissioning Group, Stoke-on-Trent, UK
| | - David Clark-Carter
- Centre for Psychological Research, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
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9
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Paskins Z, Bullock L, Crawford-Manning F, Cottrell E, Fleming J, Leyland S, Edwards JJ, Clark E, Thomas S, Chapman SR, Ryan S, Lefroy JE, Gidlow CJ, Iglesias C, Protheroe J, Horne R, O'Neill TW, Mallen C, Jinks C. Improving uptake of Fracture Prevention drug treatments: a protocol for Development of a consultation intervention (iFraP-D). BMJ Open 2021; 11:e048811. [PMID: 34408051 PMCID: PMC8375717 DOI: 10.1136/bmjopen-2021-048811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Prevention of fragility fractures, a source of significant economic and personal burden, is hindered by poor uptake of fracture prevention medicines. Enhancing communication of scientific evidence and elicitation of patient medication-related beliefs has the potential to increase patient commitment to treatment. The Improving uptake of Fracture Prevention drug treatments (iFraP) programme aims to develop and evaluate a theoretically informed, complex intervention consisting of a computerised web-based decision support tool, training package and information resources, to facilitate informed decision-making about fracture prevention treatment, with a long-term aim of improving informed treatment adherence. This protocol focuses on the iFraP Development (iFraP-D) work. METHODS AND ANALYSIS The approach to iFraP-D is informed by the Medical Research Council complex intervention development and evaluation framework and the three-step implementation of change model. The context for the study is UK fracture liaison services (FLS), which enact secondary fracture prevention. An evidence synthesis of clinical guidelines and Delphi exercise will be conducted to identify content for the intervention. Focus groups with patients, FLS clinicians and general practitioners and a usual care survey will facilitate understanding of current practice, and investigate barriers and facilitators to change. Design of the iFraP intervention will be informed by decision aid development standards and theories of implementation, behaviour change, acceptability and medicines adherence. The principles of co-design will underpin all elements of the study through a dedicated iFraP community of practice including key stakeholders and patient advisory groups. In-practice testing of the prototype intervention will inform revisions ready for further testing in a subsequent pilot and feasibility randomised trial. ETHICS AND DISSEMINATION Ethical approval was obtained from North West-Greater Manchester West Research Ethics Committee (19/NW/0559). Dissemination and knowledge mobilisation will be facilitated through national bodies and networks, publications and presentations. TRIAL REGISTRATION NUMBER researchregistry5041.
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Affiliation(s)
- Zoe Paskins
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | | | - Fay Crawford-Manning
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | | | - Jane Fleming
- Cambridge Public Health, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Cambridge, UK
| | | | | | - Emma Clark
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Simon Thomas
- School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, UK
| | | | - Sarah Ryan
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
- School of Medicine & School of Nursing and Midwifery, Keele University, Stoke-on-Trent, UK
| | - J E Lefroy
- School of Medicine, Keele University, Keele, UK
| | | | - C Iglesias
- Department of Health Sciences, University of York, York, UK
- Danish Centre for Healthcare Improvements, Aalborg Universitet, Aalborg, Denmark
| | | | - Robert Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, UK
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Clare Jinks
- School of Medicine, Keele University, Keele, UK
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10
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Ho JY, Zijlema WL, Triguero-Mas M, Donaire-Gonzalez D, Valentín A, Ballester J, Chan EYY, Goggins WB, Mo PKH, Kruize H, van den Berg M, Gražuleviciene R, Gidlow CJ, Jerrett M, Seto EYW, Barrera-Gómez J, Nieuwenhuijsen MJ. Does surrounding greenness moderate the relationship between apparent temperature and physical activity? Findings from the PHENOTYPE project. Environ Res 2021; 197:110992. [PMID: 33705766 DOI: 10.1016/j.envres.2021.110992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 02/21/2021] [Accepted: 03/04/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Physical activity can be affected by both meteorological conditions and surrounding greenness, but few studies have evaluated the effects of these environmental factors on physical activity simultaneously. This multi-city comparative study aimed to assess the synergetic effects of apparent temperature and surrounding greenness on physical activity in four European cities. Specifically, we aimed to identify an interaction between surrounding greenness and apparent temperature in the effects on physical activity. METHODS Data were collected from 352 adult residents of Barcelona (Spain), Stoke-on-Trent (United Kingdom), Doetinchem (The Netherlands), and Kaunas (Lithuania) as part of the PHENOTYPE study. Participants wore a smartphone for seven consecutive days between May-December 2013 and provided additional sociodemographic survey data. Hourly average physical activity (Metabolic Equivalent of Task (MET)) and surrounding greenness (NDVI) were derived from the Calfit mobile application collecting accelerometer and location data. Hourly apparent temperature was calculated from temperature and relative humidity, which were obtained from local meteorological stations along with other meteorological covariates (rainfall, windspeed, and sky darkness). We assessed the interaction effects of apparent temperature and surrounding greenness on hourly physical activity for each city using linear mixed models, while adjusting for meteorological, demographic, and time-related variables. RESULTS We found significant interactions between apparent temperature and surrounding greenness on hourly physical activity in three of four cities, aside from the coastal city of Barcelona. Significant quadratic effects of apparent temperature were found in the highest level of surrounding greenness for Stoke-on-Trent and Doetinchem, with 4% decrease in median MET observed for a 10°C departure from optimal temperature (15.2°C and 14.6°C, respectively). Significant linear effects were found for higher levels of surrounding greenness in Kaunas, whereby an increase of 10°C was associated with ∼4% increase in median MET. CONCLUSION Apparent temperature and surrounding greenness interacted in the effect on hourly physical activity across three of four European cities, with varying effect between cities. While quadratic effects of temperature suggest diminishing levels of physical activity in the highest greenness levels in cities of temperate climates, the variation in surrounding greenness between cities could be further explored, particularly by looking at indoor-outdoor locations. The study findings support the need for evidence-based physical activity promotion and urban design.
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Affiliation(s)
- Janice Y Ho
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Wilma L Zijlema
- Instituto de Salud Global Barcelona (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Margarita Triguero-Mas
- Instituto de Salud Global Barcelona (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Institute for Environmental Science and Technology, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Barcelona Lab for Urban Environmental Justice and Sustainability, Barcelona, Spain
| | - David Donaire-Gonzalez
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia; Institute for Risk Assessment Sciences (IRAS), Division of Environmental Epidemiology (EEPI), Utrecht University, Utrecht, the Netherlands
| | - Antònia Valentín
- Instituto de Salud Global Barcelona (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Joan Ballester
- Instituto de Salud Global Barcelona (ISGlobal), Barcelona, Spain
| | - Emily Y Y Chan
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - William B Goggins
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Phoenix K H Mo
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Hanneke Kruize
- Centre for Sustainability, Environment and Health, RIVM, Bilthoven, the Netherlands
| | | | | | - Christopher J Gidlow
- Centre for Sport, Health and Exercise Research, Staffordshire University, Stoke-on-Trent, UK
| | - Michael Jerrett
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Edmund Y W Seto
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Jose Barrera-Gómez
- Instituto de Salud Global Barcelona (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mark J Nieuwenhuijsen
- Instituto de Salud Global Barcelona (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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11
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Gidlow CJ, Ellis NJ, Cowap L, Riley VA, Crone D, Cottrell E, Grogan S, Chambers R, Clark-Carter D. Quantitative examination of video-recorded NHS Health Checks: comparison of the use of QRISK2 versus JBS3 cardiovascular risk calculators. BMJ Open 2020; 10:e037790. [PMID: 32978197 PMCID: PMC7520846 DOI: 10.1136/bmjopen-2020-037790] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Quantitatively examine the content of National Health Service Health Check (NHSHC), patient-practitioner communication balance and differences when using QRISK2 versus JBS3 cardiovascular disease (CVD) risk calculators. DESIGN RIsk COmmunication in NHSHC was a qualitative study with quantitative process evaluation, comparing NHSHC using QRISK2 or JBS3. We present data from the quantitative process evaluation. SETTING AND PARTICIPANTS Twelve general practices in the West Midlands (England) conducted NHSHC using JBS3 or QRISK2 (6/group). Patients were eligible for NHSHC based on national criteria (aged 40-74, no existing cardiovascular-related diagnoses, not taking statins). Recruitment was stratified by patients' age, gender and ethnicity. METHODS Video recordings of NHSHC were coded, second-by-second, to quantify who was speaking and what was being discussed. Outcomes included consultation duration, practitioner verbal dominance (ratio of practitioner:patient speaking time (pr:pt ratio)) and proportion of time discussing CVD risk, risk factors and risk management. RESULTS 173 video-recorded NHSHC were analysed (73 QRISK, 100 JBS3). The sample was 51% women, 83% white British, with approximately equal proportions across age groups. NHSHC duration varied greatly (6.8-38.0 min). Most (60%) lasted less than 20 min. On average, CVD risk was discussed for less than 2 min (9.06%±4.30% of consultation time). There were indications that, compared with NHSHC using JBS3, those with QRISK2 involved less CVD risk discussion (JBS3 M=10.24%, CI: 8.01-12.48 vs QRISK2 M=7.44%, CI: 5.29-9.58) and were more verbally dominated by practitioners (pr:pt ratio JBS3 M=3.21%, CI: 2.44-3.97 vs QRISK2=2.35%, CI: 1.89-2.81). The largest proportion of NHSHC time was spent discussing causal risk factors (M=37.54%, CI: 32.92-42.17). CONCLUSIONS There was wide variation in NHSHC duration. Many were short and practitioner-dominated, with little time discussing CVD risk. JBS3 appears to extend CVD risk discussion and patient contribution. Qualitative examination of how it is used is necessary to fully understand the potential benefits of these differences. TRIAL REGISTRATION NUMBER ISRCTN10443908.
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Affiliation(s)
| | - Naomi J Ellis
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Lisa Cowap
- Department of Psychology, Staffordshire University, Stoke on Trent, UK
| | - Victoria A Riley
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Diane Crone
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Elizabeth Cottrell
- School of Primary, Community and Social Care, Keele University, Staffordshire, UK
| | - Sarah Grogan
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Ruth Chambers
- Stoke-on-Trent Clinical Commissioning Group, Stoke on Trent, UK
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12
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Kondo MC, Triguero-Mas M, Donaire-Gonzalez D, Seto E, Valentín A, Hurst G, Carrasco-Turigas G, Masterson D, Ambròs A, Ellis N, Swart W, Davis N, Maas J, Jerrett M, Gidlow CJ, Nieuwenhuijsen MJ. Momentary mood response to natural outdoor environments in four European cities. Environ Int 2020; 134:105237. [PMID: 31677802 DOI: 10.1016/j.envint.2019.105237] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 05/11/2023]
Abstract
Exposure to natural outdoor environments (NOE) has been shown in population-level studies to reduce anxiety and psychological distress. This study investigated how exposure to one's everyday natural outdoor environments over one week influenced mood among residents of four European cities including Barcelona (Spain), Stoke-on-Trent (United Kingdom), Doetinchem (The Netherlands) and Kaunas (Lithuania). Participants (n = 368) wore a smartphone equipped with software applications to track location and mood (using mobile ecological momentary assessment (EMA) software), for seven consecutive days. We estimated random-effects ordered logistic regression models to examine the association between mood (positive and negative affect), and exposure to green space, represented by two binary variables indicating exposure versus no exposure to NOE using GPS tracking and satellite and aerial imagery, 10 and 30 min prior to participants' completing the EMA. Models were adjusted for home city, day of the week, hour of the day, EMA survey type, residential NOE exposure, and sex, age, education level, mental health status and neighbourhood socioeconomic status. In addition, we tested for heterogeneity of effect by city, sex, age, residential NOE exposure and mental health status. Within 10 min of NOE exposure, compared to non-exposure, we found that overall there was a positive relationship with positive affect (OR: 1.39, 95% CI: 1.06, 1.81) of EMA surveys, and non-significant negative association with negative affect (OR: 0.80, 95% CI: 0.58, 1.10). When stratifying, associations were consistently found for Stoke-on-Trent inhabitants and men, while findings by age group were inconsistent. Weaker and less consistent associations were found for exposure 30 min prior to EMA. Our findings support increasing evidence of psychological and mental health benefits of exposure to natural outdoor environments, especially among urban populations such as those included in our study.
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Affiliation(s)
- Michelle C Kondo
- USDA Forest Service, Northern Research Station, Philadelphia, PA, USA.
| | - Margarita Triguero-Mas
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Institute for Environmental Science and Technology, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Barcelona Lab for Urban Environmental Justice and Sustainability, Barcelona, Spain.
| | - David Donaire-Gonzalez
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia; Institute for Risk Assessment Sciences (IRAS), Division of Environmental Epidemiology (EEPI), Utrecht University, Utrecht, the Netherlands
| | | | - Antònia Valentín
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Gemma Hurst
- School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, United Kingdom
| | - Glòria Carrasco-Turigas
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Daniel Masterson
- Centre for Health and Development (CHAD), Staffordshire University, Stoke-on-Trent, United Kingdom; Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Albert Ambròs
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Naomi Ellis
- Centre for Health and Development (CHAD), Staffordshire University, Stoke-on-Trent, United Kingdom
| | - Wim Swart
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Nora Davis
- USDA Forest Service, Pacific Southwest Research Station, Los Angeles, CA, USA
| | | | - Michael Jerrett
- University of California at Los Angeles, School of Public Health, Los Angeles, CA, USA
| | - Christopher J Gidlow
- Institute for Risk Assessment Sciences (IRAS), Division of Environmental Epidemiology (EEPI), Utrecht University, Utrecht, the Netherlands
| | - Mark J Nieuwenhuijsen
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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13
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Zijlema WL, Christian H, Triguero-Mas M, Cirach M, van den Berg M, Maas J, Gidlow CJ, Kruize H, Wendel-Vos W, Andrušaitytė S, Grazuleviciene R, Litt J, Nieuwenhuijsen MJ. Dog ownership, the natural outdoor environment and health: a cross-sectional study. BMJ Open 2019; 9:e023000. [PMID: 31138578 PMCID: PMC6549751 DOI: 10.1136/bmjopen-2018-023000] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Dog owners walking their dog in natural outdoor environments (NOE) may benefit from the physical activity facilitated by dog walking and from time spent in nature. However, it is unclear whether dog owners receive additional health benefits associated with having access to NOE above the physical activity benefit of walking with their dog. We investigated associations between dog ownership, walking, time spent in NOE and health and whether these associations differed among those with good and poor access to NOE and those living in green and less green areas. DESIGN Cross-sectional study. SETTING The Positive Health Effects of the Natural Outdoor Environment in Typical Populations in Different Regions in Europe project. PARTICIPANTS n=3586 adults from Barcelona (Spain), Doetinchem (the Netherlands), Kaunas (Lithuania) and Stoke-on-Trent (UK). DATA COLLECTION AND ANALYSIS We calculated access to NOE with land maps and residential surrounding greenness with satellite data. Leisure time walking, time spent in NOE and general and mental health status were measured using validated questionnaires. Associations were estimated using multilevel analysis with a random intercept defined at the neighbourhood level. RESULTS Dog ownership was associated with higher rates of leisure time walking and time spending in NOE (OR 2.17, 95% CI 1.86 to 2.54 and 2.37, 95% CI 2.02 to 2.79, respectively). These associations were stronger in those living within 300 m of a NOE and in greener areas. No consistent associations were found between dog ownership and perceived general or mental health status. CONCLUSIONS Compared with non-dog owners, dog owners walked more and spent more time in NOE, especially those living within 300 m of a NOE and in greener areas. The health implications of these relationships should be further investigated. In a largely physically inactive society, dog walking in NOE may be a simple way of promoting physical activity and health.
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Affiliation(s)
- Wilma L Zijlema
- Instituto de Salud Global Barcelona, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Hayley Christian
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Margarita Triguero-Mas
- Instituto de Salud Global Barcelona, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Marta Cirach
- Instituto de Salud Global Barcelona, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Magdalena van den Berg
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Jolanda Maas
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Christopher J Gidlow
- Centre for Sport, Health and Exercise Research, Staffordshire University, Stoke-on-Trent, UK
| | - Hanneke Kruize
- Centre of Environmental Health Research, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Wanda Wendel-Vos
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Sandra Andrušaitytė
- Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania
| | | | - Jill Litt
- Instituto de Salud Global Barcelona, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Environmental Studies Program, University of Colorado Boulder, Boulder, Colorado, USA
| | - Mark J Nieuwenhuijsen
- Instituto de Salud Global Barcelona, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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14
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Gidlow CJ, Ellis NJ, Riley V, Chadborn T, Bunten A, Iqbal Z, Ahmed A, Fisher A, Sugden D, Clark-Carter D. Randomised controlled trial comparing uptake of NHS Health Check in response to standard letters, risk-personalised letters and telephone invitations. BMC Public Health 2019; 19:224. [PMID: 30791884 PMCID: PMC6385450 DOI: 10.1186/s12889-019-6540-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 02/13/2019] [Indexed: 12/22/2022] Open
Abstract
Background NHS Health Check is a primary prevention programme offering cardiovascular disease (CVD) risk assessment to adults in England aged 40–74. Uptake remains a challenge and invitation method is a strong predictor of uptake. There is evidence of low uptake when using invitation letters. Telephone invitations might increase uptake, but are not widely used. We explored the potential to improve uptake through personalising letters to patient’s CVD risk, and to compare this with generic letters and telephone invitations. Methods HEalth Check TRial (HECTR) was a three-arm randomised controlled trial in nine general practices in Staffordshire (UK). Eligible patients were randomised to be invited to a NHS Health Check using one of three methods: standard letter (control); telephone invitation; letter personalised to the patient’s CVD risk. The primary outcome was attendance/non-attendance. Data were collected on a range of patient- and practice-level factors (e.g., patient socio-demographics, CVD risk, practice size, Health Checks outside usual working hours). Multi-level logistic regression estimated the marginal effects to explore whether invitation method predicted attendance. Invitation costs were collated from practices to estimate cost benefit. Results In total, 4614 patients were included in analysis (mean age 50.2 ± 8.0 yr.; 52.4% female). Compared with patients invited by standard letter (30.9%), uptake was significantly higher in those invited by telephone (47.6%, P < .001), but not personalised letter (31.3%, p = .812). In multi-level analysis, compared with the standard letter arm, likelihood of attendance was 18 percentage points higher in the telephone arm and 4 percentage points higher in the personalised letter arm. The effect of telephone calls appeared strongest in patients who were younger and had lower CVD risk. We estimated per 1000 patients invited, risk-personalised letters could result in 40 additional attended Health Checks (at no extra cost) and telephone invitations could result in 180 additional Health Checks at an additional cost of £240. Conclusions Telephone invitations should be advocated to address the substantial deficit between current and required levels of NHS uptake, and could be targeted at younger and lower CVD risk adults. Risk-personalised letters should be explored further in a larger sample of high risk individuals. Trial registration Registration number: ISRCTN15840751 date of registration: 24/10/2017. Electronic supplementary material The online version of this article (10.1186/s12889-019-6540-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christopher J Gidlow
- Centre for Health and Development (CHAD), Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF, England.
| | - Naomi J Ellis
- Centre for Health and Development (CHAD), Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF, England
| | - Victoria Riley
- Centre for Health and Development (CHAD), Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF, England
| | - Tim Chadborn
- Public Health England, Skipton House, 80 London Road, London, SE1 6LH, England
| | - Amanda Bunten
- Public Health England, Skipton House, 80 London Road, London, SE1 6LH, England
| | - Zafar Iqbal
- Midlands Partnership NHS Foundation Trust, St George's Hospital, Corporation Street, Stafford, ST16 3AG, England
| | - Aliko Ahmed
- Public Health England East of England, Victoria House, Capital Park, Fulbourn, Cambridge, CB21 5XA, England
| | - Alistair Fisher
- Stoke-on-Trent City Council, Glebe Street, Stoke-on-Trent, ST4 1HH, England
| | - David Sugden
- Staffordshire County Council, 1 Staffordshire Place, Stafford, ST16 2LP, England
| | - David Clark-Carter
- Centre for Psychological Research, Staffordshire University, The Science Centre, Leek Road, Stoke-on-Trent, ST4 2DF, England
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15
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Gidlow CJ, Ellis NJ, Cowap L, Riley V, Crone D, Cottrell E, Grogan S, Chambers R, Clark-Carter D. A qualitative study of cardiovascular disease risk communication in NHS Health Check using different risk calculators: protocol for the RIsk COmmunication in NHS Health Check (RICO) study. BMC Fam Pract 2019; 20:11. [PMID: 30642267 PMCID: PMC6332912 DOI: 10.1186/s12875-018-0897-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 12/26/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND NHS Health Check is a national cardiovascular disease (CVD) risk assessment programme for 40-74 year olds in England, in which practitioners should assess and communicate CVD risk, supported by appropriate risk-management advice and goal-setting. This requires effective communication, to equip patients with knowledge and intention to act. Currently, the QRISK®2 10-year CVD risk score is most common way in which CVD risk is estimated. Newer tools, such as JBS3, allow manipulation of risk factors and can demonstrate the impact of positive actions. However, the use, and relative value, of these tools within CVD risk communication is unknown. We will explore practitioner and patient CVD risk perceptions when using QRISK®2 or JBS3, the associated advice or treatment offered by the practitioner, and patients' responses. METHODS RIsk COmmunication in NHS Health Check (RICO) is a qualitative study with quantitative process evaluation. Twelve general practices in the West Midlands of England will be randomised to one of two groups: usual practice, in which practitioners use QRISK®2 to assess and communicate CVD risk; intervention, in which practitioners use JBS3. Twenty Health Checks per practice will be video-recorded (n = 240, 120 per group), with patients stratified by age, gender and ethnicity. Post-Health Check, video-stimulated recall (VSR) interviews will be conducted with 48 patients (n = 24 per group) and all practitioners (n = 12-18), using video excerpts to enhance participant recall/reflection. Patient medical record reviews will detect health-protective actions in the first 12-weeks following a Health Check (e.g., lifestyle referrals, statin prescription). Risk communication, patient response and intentions for health-protective behaviours in each group will be explored through thematic analysis of video-recorded Health Checks (using Protection Motivation Theory as a framework) and VSR interviews. Process evaluation will include between-group comparisons of quantitatively coded Health Check content and post-Health Check patient outcomes. Finally, 10 patients with the most positive intentions or behaviours will be selected for case study analysis (using all data sources). DISCUSSION This study will produce novel insights about the utility of QRISK®2 and JBS3 to promote patient and practitioner understanding and perception of CVD risk and associated implications for patient intentions with respect to health-protective behaviours (and underlying mechanisms). Recommendations for practice will be developed. TRIAL REGISTRATION ISRCTN ISRCTN10443908 . Registered 7th February 2017.
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Affiliation(s)
| | - Naomi J. Ellis
- Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF UK
| | - Lisa Cowap
- Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF UK
| | - Victoria Riley
- Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF UK
| | - Diane Crone
- Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD UK
| | | | - Sarah Grogan
- Manchester Metropolitan University, Manchester Campus, Bonsall Street, Manchester, M15 6GX UK
| | - Ruth Chambers
- Stoke-on-Trent Clinical Commissioning Group, Smithfield One Building, Stoke-on-Trent, ST1 4FA UK
| | - David Clark-Carter
- Staffordshire University, The Science Centre, Leek Road, Stoke-on-Trent, ST4 2DF UK
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McEachan RRC, Yang TC, Roberts H, Pickett KE, Arseneau-Powell D, Gidlow CJ, Wright J, Nieuwenhuijsen M. Availability, use of, and satisfaction with green space, and children's mental wellbeing at age 4 years in a multicultural, deprived, urban area: results from the Born in Bradford cohort study. Lancet Planet Health 2018; 2:e244-e254. [PMID: 29880156 DOI: 10.1016/s2542-5196(18)30119-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/26/2018] [Accepted: 05/16/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND It is unknown whether the quantity or quality of green space is more important for mental wellbeing. We aimed to explore associations between availability of, satisfaction with, and use of green space and mental wellbeing among children aged 4 years in a multi-ethnic sample. METHODS We did a 4-year follow-up assessment of participants in the Born in Bradford longitudinal cohort study, which recruited children and mothers at the city's main maternity unit from 2007 to 2011. The primary outcome was parent-reported mental wellbeing for children aged 4 years, assessed with the standardised Strengths and Difficulties Questionnaire. Total, internalising, and externalising behavioural difficulties and prosocial behaviour scales were computed (with higher scores indicating greater difficulties or more prosocial behaviour). Residential green space around participants' home addresses and distance to major green spaces were computed with the normalised difference vegetation index (NDVI). A subsample of participants completed additional questionnaires on measures of satisfaction with, and use of, local green spaces. Multiple regressions examined associations between green space and children's mental wellbeing and explored moderation by ethnicity (white British vs south Asian) and socioeconomic status. FINDINGS Between Oct 1, 2012, and June 30, 2015, 2594 mothers attended a follow-up appointment during which they completed a detailed questionnaire assessing the health of their child. 1519 (58%) participants were of south Asian origin, 740 (29%) of white British origin, and 333 (13%) of another ethnicity. Data on ethnicity were missing for two participants. 832 (32%) of 2594 participants completed additional questionnaires. Ethnicity moderated associations between residential green space and mental wellbeing (p<0·05 for total and internalising difficulties). After adjusting for all relevant variables, more green space was associated with fewer internalising behavioural difficulties (mean NDVI 100 m: β -2·35 [95% CI -4·20 to -0·50]; 300 m: -3·15 [-5·18 to -1·13]; 500 m: -2·85 [-4·91 to -0·80]) and with fewer total behavioural difficulties (100 m: -4·27 [-7·65 to -0·90]; 300 m: -5·22 [-8·91 to -1·54]; 500 m: -4·82 [-8·57 to -1·07]) only for south Asian children across all three buffer zones. In the subsample of participants, the effect of NDVI on wellbeing was rendered non-significant after controlling for satisfaction with, and use of, green space. Among south Asian children, satisfaction with green space was significantly associated with fewer total behavioural difficulties across all three buffer zones (β -0·59 [95% CI -1·11 to -0·07]), fewer internalising behavioural difficulties within 100 m (-0·28 [95% CI -0·56 to -0·003]) and 300 m buffer zones (-0·28 [-0·56 to -0·002]), and greater prosocial behaviour across all three buffer zones (0·20 [0·02 to 0·38]); no such associations were observed among white British children. INTERPRETATION Positive effects of green space on wellbeing differ by ethnicity. Satisfaction with the quality of green space appears to be a more important predictor of wellbeing than does quantity of green space. Public health professionals and urban planners need to focus on both quality and quantity of urban green spaces to promote health, particularly among ethnic minority groups. FUNDING European Community's Seventh Framework Programme.
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Affiliation(s)
- Rosemary R C McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
| | - Tiffany C Yang
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK; Department of Health Sciences, Seebohm Rowntree Building, University of York, York, UK
| | - Hannah Roberts
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Kate E Pickett
- Department of Health Sciences, Seebohm Rowntree Building, University of York, York, UK
| | - Diana Arseneau-Powell
- Department of Health Sciences, Seebohm Rowntree Building, University of York, York, UK
| | - Christopher J Gidlow
- Centre for Health and Development (CHAD), Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, Staffordshire, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Mark Nieuwenhuijsen
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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17
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Triguero-Mas M, Donaire-Gonzalez D, Seto E, Valentín A, Martínez D, Smith G, Hurst G, Carrasco-Turigas G, Masterson D, van den Berg M, Ambròs A, Martínez-Íñiguez T, Dedele A, Ellis N, Grazulevicius T, Voorsmit M, Cirach M, Cirac-Claveras J, Swart W, Clasquin E, Ruijsbroek A, Maas J, Jerret M, Gražulevičienė R, Kruize H, Gidlow CJ, Nieuwenhuijsen MJ. Natural outdoor environments and mental health: Stress as a possible mechanism. Environ Res 2017; 159:629-638. [PMID: 28938204 DOI: 10.1016/j.envres.2017.08.048] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Better mental health has been associated with exposure to natural outdoor environments (NOE). However, comprehensive studies including several indicators of exposure and outcomes, potential effect modifiers and mediators are scarce. OBJECTIVES We used novel, objective measures to explore the relationships between exposure to NOE (i.e. residential availability and contact) and different indicators of mental health, and possible modifiers and mediators. METHODS A nested cross-sectional study was conducted in: Barcelona, Spain; Stoke-on-Trent, United Kingdom; Doetinchem, Netherlands; Kaunas, Lithuania. Participants' exposure to NOE (including both surrounding greenness and green and/or blue spaces) was measured in terms of (a) amount in their residential environment (using Geographical Information Systems) and (b) their contact with NOE (using smartphone data collected over seven days). Self-reported information was collected for mental health (psychological wellbeing, sleep quality, vitality, and somatisation), and potential effect modifiers (gender, age, education level, and city) and mediators (perceived stress and social contacts), with additional objective NOE physical activity (potential mediator) derived from smartphone accelerometers. RESULTS Analysis of data from 406 participants showed no statistically significant associations linking mental health and residential NOE exposure. However, NOE contact, especially surrounding greenness, was statistically significantly tied to better mental health. There were indications that these relationships were stronger for males, younger people, low-medium educated, and Doetinchem residents. Perceived stress was a mediator of most associations, and physical activity and social contacts were not. CONCLUSIONS Our findings indicate that contact with NOE benefits mental health. Our results also suggest that having contact with NOE that can facilitate stress reduction could be particularly beneficial.
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Affiliation(s)
- Margarita Triguero-Mas
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - David Donaire-Gonzalez
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Physical Activity and Sports Sciences Department, Fundació Blanquerna, Ramon Llull University, Barcelona, Catalonia, Spain.
| | - Edmund Seto
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, USA.
| | - Antònia Valentín
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - David Martínez
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Graham Smith
- Centre for Sport Health and Exercise Research, Staffordshire University, Stoke-on-Trent, United Kingdom.
| | - Gemma Hurst
- Centre for Sport Health and Exercise Research, Staffordshire University, Stoke-on-Trent, United Kingdom.
| | - Glòria Carrasco-Turigas
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Daniel Masterson
- Centre for Sport Health and Exercise Research, Staffordshire University, Stoke-on-Trent, United Kingdom.
| | - Magdalena van den Berg
- Department of Public and Occupational Health, Institute for Health and Care Research, VU University Medical Centre (VUMC), Amsterdam, The Netherlands.
| | - Albert Ambròs
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Tania Martínez-Íñiguez
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Audrius Dedele
- Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania.
| | - Naomi Ellis
- Centre for Sport Health and Exercise Research, Staffordshire University, Stoke-on-Trent, United Kingdom.
| | - Tomas Grazulevicius
- Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania.
| | - Martin Voorsmit
- Department of Public and Occupational Health, Institute for Health and Care Research, VU University Medical Centre (VUMC), Amsterdam, The Netherlands.
| | - Marta Cirach
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Judith Cirac-Claveras
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Wim Swart
- Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Eddy Clasquin
- Department of Public and Occupational Health, Institute for Health and Care Research, VU University Medical Centre (VUMC), Amsterdam, The Netherlands.
| | - Annemarie Ruijsbroek
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Jolanda Maas
- Department of Public and Occupational Health, Institute for Health and Care Research, VU University Medical Centre (VUMC), Amsterdam, The Netherlands.
| | - Michael Jerret
- Department of Environmental Health Sciences and Center for Occupational and Environmental Health, University of California, Los Angeles, USA.
| | - Regina Gražulevičienė
- Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania.
| | - Hanneke Kruize
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Christopher J Gidlow
- Centre for Sport Health and Exercise Research, Staffordshire University, Stoke-on-Trent, United Kingdom; Centre for Health and Development, Staffordshire University, Stoke-on-Trent, United Kingdom.
| | - Mark J Nieuwenhuijsen
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
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18
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Ruijsbroek A, Droomers M, Kruize H, van Kempen E, Gidlow CJ, Hurst G, Andrusaityte S, Nieuwenhuijsen MJ, Maas J, Hardyns W, Stronks K, Groenewegen PP. Does the Health Impact of Exposure to Neighbourhood Green Space Differ between Population Groups? An Explorative Study in Four European Cities. Int J Environ Res Public Health 2017; 14:ijerph14060618. [PMID: 28594390 PMCID: PMC5486304 DOI: 10.3390/ijerph14060618] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/30/2017] [Accepted: 06/05/2017] [Indexed: 01/22/2023]
Abstract
It has been suggested that certain residents, such as those with a low socioeconomic status, the elderly, and women, may benefit more from the presence of neighbourhood green space than others. We tested this hypothesis for age, gender, educational level, and employment status in four European cities. Data were collected in Barcelona (Spain; n = 1002), Kaunas (Lithuania; n = 989), Doetinchem (The Netherlands; n = 847), and Stoke-on-Trent (UK; n = 933) as part of the EU-funded PHENOTYPE project. Surveys were used to measure mental and general health, individual characteristics, and perceived neighbourhood green space. Additionally, we used audit data about neighbourhood green space. In Barcelona, there were positive associations between neighbourhood green space and general health among low-educated residents. In the other cities and for the other population groups, there was little evidence that the association between health and neighbourhood green space differed between population groups. Overall, our study does not support the assumption that the elderly, women, and residents who are not employed full-time benefit more from neighbourhood green space than others. Only in the highly urbanised city of Barcelona did the low-educated group benefit from neighbourhood green spaces. Perhaps neighbourhood green spaces are more important for the health of low-educated residents in particularly highly urbanised areas.
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Affiliation(s)
- Annemarie Ruijsbroek
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands.
| | - Mariël Droomers
- Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, 1100 DD Amsterdam, The Netherlands.
| | - Hanneke Kruize
- Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands.
| | - Elise van Kempen
- Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands.
| | - Christopher J Gidlow
- Centre for Sport, Health and Exercise Research, Staffordshire University, Staffordshire, Stoke-on-Trent ST4 2DF, UK.
| | - Gemma Hurst
- Centre for Sport, Health and Exercise Research, Staffordshire University, Staffordshire, Stoke-on-Trent ST4 2DF, UK.
| | | | - Mark J Nieuwenhuijsen
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), E-08003 Barcelona, Spain.
- University Pompeu Fabra (UPF), 08002 Barcelona, Spain.
- CIBER Epidemiology y Salud Publica (CIBERESP), 08036 Barcelona, Spain.
| | - Jolanda Maas
- Department of Social and Organisational Psychology, Faculty of Psychology and Education, Vrije Universiteit (VU), 1081 HV Amsterdam, The Netherlands.
| | - Wim Hardyns
- Department of Criminology, Criminal Law and Social Law, Ghent University, 9000 Ghent, Belgium.
- Faculty of Law, University of Antwerp, 2000 Antwerpen, Belgium.
| | - Karien Stronks
- Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, 1100 DD Amsterdam, The Netherlands.
| | - Peter P Groenewegen
- NIVEL (Netherlands Institute for Health Services Research), 3500 BN Utrecht, The Netherlands.
- Department of Human Geography and Department of Sociology, Utrecht University, 3584 CS Utrecht, The Netherlands.
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19
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Triguero-Mas M, Gidlow CJ, Martínez D, de Bont J, Carrasco-Turigas G, Martínez-Íñiguez T, Hurst G, Masterson D, Donaire-Gonzalez D, Seto E, Jones MV, Nieuwenhuijsen MJ. The effect of randomised exposure to different types of natural outdoor environments compared to exposure to an urban environment on people with indications of psychological distress in Catalonia. PLoS One 2017; 12:e0172200. [PMID: 28248974 PMCID: PMC5331968 DOI: 10.1371/journal.pone.0172200] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/02/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Experimental studies have reported associations between short-term exposure to natural outdoor environments (NOE) and health benefits. However, they lack insight into mechanisms, often have low external and ecological validity, and have rarely focused on people with some psycho-physiological affection. The aim of this study was to use a randomized, case-crossover design to investigate: (i) the effects of unconstrained exposure to real natural and urban environments on psycho-physiological indicators of people with indications of psychological distress, (ii) the possible differential effects of 30 and 30+180 minutes exposures, and (iii) the possible mechanisms explaining these effects. Material and methods People (n = 26) with indications of psychological distress were exposed to green (Collserola Natural Park), blue (Castelldefels beach) and urban (Eixample neighbourhood) environments in Catalonia. They were exposed to all environments in groups for a period of 30+180 minutes between October 2013 and January 2014. During the exposure period, participants were instructed to do what they would usually do in that environment. Before, during (at 30 and 30+180 minutes) and after each exposure, several psycho-physiological measures were taken: mood (measured as Total Mood Disturbance, TMD), attention capacity (measured as backwards digit-span task), stress levels (measures as salivary cortisol), systolic and diastolic blood pressure, heart rate, autonomous nervous system (assessed as heart rate variability and the indicators: low frequency power (LF), high frequency power (HF), ratio between LF and HF (LF:HF), and coefficients of component variance of LF, HF, and LF:HF). We also measured several potential mediators: air pollution, noise, physical activity, social interactions, and self-perceived restoration experience. Results When compared with responses to urban environment, we found statistically significantly lower TMD [-4.78 (-7.77, -1.79) points difference], and salivary cortisol [-0.21 (-0.34, -0.08) log nmol/L] in the green exposure environment, and statistically significantly lower TMD [-4.53 (-7.57, -1.49) points difference], and statistically significant favourable changes in heart rate variability indicators (specifically LF:HF and CCV-LF:HF with around -0.20 points of difference of the indicators) in the blue exposure environment. Physical activity and self-perceived restoration experience partially mediated the associations between NOE and TMD. Physical activity and air pollution partially mediated the associations between NOE and heart rate variability. Discussion and conclusions This study extends the existing evidence on the benefits of NOE for people's health. It also suggests NOE potential as a preventive medicine, specifically focusing on people with indications of psychological distress. Trial registration Clinicaltrials.gov NCT02624921
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Affiliation(s)
- Margarita Triguero-Mas
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- * E-mail:
| | - Christopher J. Gidlow
- Centre for Sport Health and Exercise Research, Staffordshire University, Stoke-on-Trent, United Kingdom
| | - David Martínez
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Jeroen de Bont
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Glòria Carrasco-Turigas
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Tania Martínez-Íñiguez
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Gemma Hurst
- Centre for Sport Health and Exercise Research, Staffordshire University, Stoke-on-Trent, United Kingdom
| | - Daniel Masterson
- Centre for Sport Health and Exercise Research, Staffordshire University, Stoke-on-Trent, United Kingdom
| | - David Donaire-Gonzalez
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Physical Activity and Sports Sciences Department, Fundació Blanquerna, Ramon Llull University, Barcelona, Catalonia, Spain
| | - Edmund Seto
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, United States of America
| | - Marc V. Jones
- Centre for Sport Health and Exercise Research, Staffordshire University, Stoke-on-Trent, United Kingdom
| | - Mark J. Nieuwenhuijsen
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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20
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Dadvand P, Wright J, Martinez D, Basagaña X, McEachan RRC, Cirach M, Gidlow CJ, de Hoogh K, Gražulevičienė R, Nieuwenhuijsen MJ. Inequality, green spaces, and pregnant women: roles of ethnicity and individual and neighbourhood socioeconomic status. Environ Int 2014; 71:101-8. [PMID: 24997306 DOI: 10.1016/j.envint.2014.06.010] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 03/12/2014] [Accepted: 06/09/2014] [Indexed: 05/24/2023]
Abstract
Evidence of the impact of green spaces on pregnancy outcomes is limited with no report on how this impact might vary by ethnicity. We investigated the association between residential surrounding greenness and proximity to green spaces and birth weight and explored the modification of this association by ethnicity and indicators of individual (maternal education) and neighbourhood (Index of Multiple Deprivation) socioeconomic status. Our study was based on 10,780 singleton live-births from the Born in Bradford cohort, UK (2007-2010). We defined residential surrounding greenness as average of satellite-based Normalized Difference Vegetation Index (NDVI) in buffers of 50 m, 100 m, 250 m, 500 m and 1000 m around each maternal home address. Residential proximity to green spaces was defined as living within 300 m of a green space with an area of ≥ 5000 m(2). We utilized mixed effects models to estimate adjusted change in birth weight associated with residential surrounding greenness as well as proximity to green spaces. We found a positive association between birth weight and residential surrounding greenness. Furthermore, we observed an interaction between ethnicity and residential surrounding greenness in that for White British participants there was a positive association between birth weight and residential surrounding greenness whereas for participants of Pakistani origin there was no such an association. For surrounding greenness in larger buffers (500 m and 1000 m) there were some indications of stronger associations for participants with lower education and those living in more deprived neighbourhoods which were not replicated for surrounding greenness in smaller buffer sizes (i.e. 50 m, 100 m, and 250 m). The findings for residential proximity to a green space were not conclusive. Our study showed that residential surrounding greenness is associated with better foetal growth and this association could vary between different ethnic and socioeconomic groups.
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Affiliation(s)
- Payam Dadvand
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain.
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - David Martinez
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Xavier Basagaña
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Rosemary R C McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Marta Cirach
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Christopher J Gidlow
- Centre for Research in Sport, Health and Exercise, Staffordshire University, Leek Road Campus, Stoke on Trent, United Kingdom
| | - Kees de Hoogh
- Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, St. Mary's Campus, London, United Kingdom
| | - Regina Gražulevičienė
- Department of Environmental Sciences, Vytauto Didziojo Universitetas, Kaunas, Lithuania
| | - Mark J Nieuwenhuijsen
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
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21
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Owens CS, Crone D, De Ste Croix MBA, Gidlow CJ, James DVB. Physical activity and screen time in adolescents transitioning out of compulsory education: a prospective longitudinal study. J Public Health (Oxf) 2013; 36:599-607. [PMID: 24365762 DOI: 10.1093/pubmed/fdt123] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Within the UK context, it is unclear whether physical activity and screen time changes between completing compulsory education and the period afterwards, and the factors associated with any change. METHODS A prospective population-based longitudinal design among adolescents (n = 2204 at baseline) was adopted. A self-report questionnaire was administered at baseline (final year of compulsory education) and follow-up (i.e. post compulsory education) to measure physical activity over the previous 7 days and screen time (weekday and weekend) in relation to recommended guidelines. Magnitude of change in physical activity and screen time and key influencing variables associated with changes were analysed. RESULTS For physical activity, there was a significant change in participants meeting guidelines at baseline but not meeting guidelines at follow-up with 81.0% not meeting guidelines at baseline and follow-up. For screen time, there was no significant change between baseline and follow-up, with 70.6% not meeting guidelines at baseline and follow-up. Gender was associated with the change in physical activity with a decline less likely in females. CONCLUSIONS Findings reinforce the importance of reducing physical inactivity and sedentary behaviour during this transition. Factors associated with changes in physical inactivity and sedentary behaviour need further investigation.
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Affiliation(s)
- C S Owens
- Faculty of Medicine and Health Sciences, School of Medicine, Division of Epidemiology and Public Health, University of Nottingham, Nottingham NG5 1PB, UK
| | - D Crone
- Faculty of Applied Sciences, School of Sport and Exercise, University of Gloucestershire, Gloucester GL2 9HW, UK
| | - M B A De Ste Croix
- Faculty of Applied Sciences, School of Sport and Exercise, University of Gloucestershire, Gloucester GL2 9HW, UK
| | - C J Gidlow
- Centre for Sport, Health and Exercise Research, Staffordshire University, Stoke-on-Trent ST4 2DF, UK
| | - D V B James
- Faculty of Applied Sciences, School of Sport and Exercise, University of Gloucestershire, Gloucester GL2 9HW, UK
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22
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Gidlow CJ, Cochrane T, Davey R, Beloe M, Chambers R, Kumar J, Mawby Y, Iqbal Z. One-year cardiovascular risk and quality of life changes in participants of a health trainer service. Perspect Public Health 2013; 134:135-44. [PMID: 23656746 DOI: 10.1177/1757913913484419] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS To explore 12-month changes in cardiovascular disease (CVD) risk and health-related quality of life (HRQoL) in participants of a health trainer (HT) programme. METHODS Participants were 994 adults with at least one established CVD risk factor who were referred to a HT programme. The primary outcome was 12-month change in Framingham 10 year CVD risk score. Secondary outcomes included change in individual risk factors and HRQoL. Intention to treat analysis was used to explore 12-month changes for the overall population and those classified 'high risk' (≥20% CVD risk) at baseline. RESULTS At baseline, 33.6% of participants were classified as 'high CVD risk' and 95.7% were overweight or obese. There were modest 12-month improvements in most modifiable CVD risk factors, but not overall CVD risk (-0.25±6.50%). In 'high-risk' participants significant reductions were evident for overall CVD risk (-2.34±8.13%) and individual risk factors. Small, significant 12-month HRQoL improvements were observed, but these were not associated with CVD risk change. CONCLUSIONS Significant CVD risk reductions in participants in this HT programme with high baseline CVD risk (.20%) in HRQoL in the population as a whole indicated that the programme in its current form should target high-risk patients.
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Affiliation(s)
- Christopher J Gidlow
- Centre for Sport, Health and Exercise Research, Staffordshire University, Stoke-on-Trent, UK
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23
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Cochrane T, Gidlow CJ, Kumar J, Mawby Y, Iqbal Z, Chambers RM. Cross-sectional review of the response and treatment uptake from the NHS Health Checks programme in Stoke on Trent. J Public Health (Oxf) 2013; 35:92-8. [PMID: 23104892 PMCID: PMC3580053 DOI: 10.1093/pubmed/fds088] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 09/14/2012] [Accepted: 09/28/2012] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND As part of national policy to manage the increasing burden of chronic diseases, the Department of Health in England has launched the NHS Health Checks programme, which aims to reduce the burden of the major vascular diseases on the health service. METHODS A cross-sectional review of response, attendance and treatment uptake over the first year of the programme in Stoke on Trent was carried out. Patients aged between 32 and 74 years and estimated to be at ≥20% risk of developing cardiovascular disease were identified from electronic medical records. Multi-level regression modelling was used to evaluate the influence of individual- and practice-level factors on health check outcomes. RESULTS Overall 63.3% of patients responded, 43.7% attended and 29.8% took up a treatment following their health check invitation. The response was higher for older age and more affluent areas; attendance and treatment uptake were higher for males and older age. Variance between practices was significant (P < 0.001) for response (13.4%), attendance (12.7%) and uptake (23%). CONCLUSIONS The attendance rate of 43.7% following invitation to a health check was considerably lower than the benchmark of 75%. The lack of public interest and the prevalence of significant comorbidity are challenges to this national policy innovation.
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Affiliation(s)
- Thomas Cochrane
- Centre for Research and Action in Public Health, Faculty of Health, University of Canberra, ACT 2601, Australia.
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24
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Babatunde OO, Forsyth JJ, Gidlow CJ. A meta-analysis of brief high-impact exercises for enhancing bone health in premenopausal women. Osteoporos Int 2012; 23:109-19. [PMID: 21953474 DOI: 10.1007/s00198-011-1801-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 09/14/2011] [Indexed: 11/27/2022]
Abstract
UNLABELLED A snapshot of current evidence from 6 randomised controlled trials for the effects of short bouts of high-impact exercises in 256 women via meta-analysis reveals that ample osteogenic response could be realised at the femoral neck and trochanter of premenopausal women with rest-inserted bouts of few mechanical bone loading cycles. INTRODUCTION Exercise is an important means of improving bone health and preventing osteoporosis. Brief bouts of simple exercises may be useful for aiding lifestyle compliance to physical activity. This study aimed to review the evidence on the effect of brief, high-impact exercise on bone health among premenopausal women. METHODS A structured and comprehensive search of databases was undertaken along with hand searching of key journals and reference lists to locate relevant studies published and unpublished up to January 2011. Six randomised controlled trials met predetermined inclusion criteria. Brief high-impact exercises (<30 min) were examined for their effect on bone mineral density (BMD) among premenopausal women. Trial quality was assessed using the Effective Public Health Practice Project quality assessment tool. Study outcomes for analysis, absolute change (grams per square centimetre) or relative change (in percent) in BMD at femoral neck, trochanter and lumbar spine were compared by calculating standardised mean difference (SMD) using fixed- and random effects models. RESULTS Quality of included trials varied from medium to high on a scale of 1 to 3. Brief bouts of exercise led to significant increases in femoral neck BMD (SMD = 0.64, 95% confidence interval (CI) = 0.38, 0.90, overall effect Z value = 4.84, p = 0.001); a modest increase in trochanteric BMD (SMD = 0.36, 95% CI = 0.10, 0.61, Z value = 2.08, p = 0.04) and no increase in spinal BMD (SMD = 0.04, 95% CI= -0.23, 0.31, Z value = 0.26, p = 0.79). CONCLUSION Based on the meta-analysis, brief high-impact exercise improves BMD at the hip but not at the lumbar spine. Effectiveness of this form of exercise as a lifestyle physical activity for prevention of osteoporosis should be explored in larger populations.
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Affiliation(s)
- O O Babatunde
- Centre for Sport, Health and Exercise Research, Staffordshire University, Leek Road, Stoke on Trent ST4 2DF, UK.
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Abstract
The aim of this study was to compare in-school and out-of-school physical activity within a representative sample. Socio-demographic, physical activity, and anthropometric data were collected from a random sample of children (250 boys, 253 girls) aged 3-16 years attending nine primary and two secondary schools. Actigraph GT1M accelerometers, worn for seven days, were used to estimate physical activity levels for in-school (typically 09.00-15.00 h), out-of-school (weekday), and weekend periods. Physical activity as accelerometer counts per minute were lower in school versus out of school overall (in school: 437.2 +/- 172.9; out of school: 575.5 +/- 202.8; P < 0.001), especially in secondary school pupils (secondary: 321.6 +/- 127.5; primary: 579.2 +/- 216.3; P < 0.001). Minutes of moderate-to-vigorous physical activity accumulated in school accounted for 29.4 +/- 9.8% of total weekly moderate-to-vigorous physical activity overall but varied by sector (preschool: 37.4 +/- 6.2%; primary: 33.6 +/- 8.1%; secondary: 23.0 +/- 9.3%; F = 114.3, P < 0.001). Approximately half of the children with the lowest in-school activity compensated out of school during the week (47.4%) and about one-third at the weekend (30.0%). Overall, physical activity during the school day appears to be lower than that out of school, especially in secondary school children, who accumulate a lower proportion of their total weekly moderate-to-vigorous physical activity at school than younger children. As low in-school activity was compensated for beyond the school setting by less than half of children, promoting physical activity within the school day is important, especially in secondary schools.
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Affiliation(s)
- Christopher J Gidlow
- Centre for Sport and Exercise Research, Staffordshire University, Stoke-on-Trent, UK.
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