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Breslin G, Wills W, Bontoft C, Fakoya O, Greco HA, Lloyd N, Wagner AP, Wellings A, Harding S, Brown KE. Whole systems approach to diet and healthy weight: a longitudinal process evaluation in East Scotland. Perspect Public Health 2023; 143:347-357. [PMID: 37902308 PMCID: PMC10683340 DOI: 10.1177/17579139231203858] [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] [Indexed: 10/31/2023]
Abstract
AIMS Obesity contributes to morbidity and early mortality, affecting people of all ages and sociodemographic backgrounds. Despite attempts to address obesity, efforts to date have only had limited success. Adopting a whole systems approach (WSA) may potentially address obesity and emphasise complex inter-relating factors beyond individual choice. This study aimed to assess implementation of WSA to diet and healthy weight in two council areas of Scotland, longitudinally exploring enablers and barriers. One area followed a Leeds Beckett WSA model (LBM) of implementation, while the other used a hybrid model incorporating existing working systems. METHODS To assess the process of implementing a WSA, interviews and focus groups were conducted after initiation and 1 year later. RESULTS Main enablers included: belief in WSA effectiveness; positive relationships between key personnel; buy-in at community and national levels; funding availability; the working group responsible for coordinating the system development comprising individuals with diverse expertise; good communication; and existing governance structures. Barriers included: insufficient funding; high staff turnover; inadequate training in WSA methodology; engaging all relevant stakeholders and reverting to 'old ways' of non-WSA working. The LBM provided a framework for system setup and generating an action plan. CONCLUSION This study provides the first independent longitudinal process evaluation of WSAs that have incorporated Leeds Beckett methodology, and offers insights into how a WSA can be implemented to address diet and healthy weight.
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Affiliation(s)
- G Breslin
- School of Psychology, Queen’s University Belfast, Belfast, UK
| | - W Wills
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK; Applied Research Collaboration (ARC) East of England, National Institute for Health and Care Research (NIHR), London, UK
| | - C Bontoft
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, College Lane, Hatfield AL10 9AB, UK
| | - O Fakoya
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - H-A Greco
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - N Lloyd
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - AP Wagner
- Applied Research Collaboration (ARC) East of England, National Institute for Health and Care Research (NIHR), London, UK; Norwich Medical School, University of East Anglia, Norwich, UK
| | - A Wellings
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - S Harding
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - KE Brown
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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Lloyd N, Wills W, Bartington S, Bontoft C, Breslin G, Fakoya O, Freethy I, Garcia-Iglesias J, Howlett N, Jones J, Newby K, Smeeton N, Wagner A, Wellings A, Wellsted D, Brown K. Evaluation of the move to remote delivery of drug and alcohol services during the COVID-19 pandemic: A study protocol. J Public Health Res 2022; 11:22799036221106583. [PMID: 35958802 PMCID: PMC9358564 DOI: 10.1177/22799036221106583] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Substance misuse is a significant global health concern. In the UK, the prevalence of substance misuse has increased over the past decade and the number of alcohol and drug related deaths are increasing. Individuals with substance dependency issues are entitled to access treatment services. However, the COVID-19 pandemic created significant challenges for public services, including drug and alcohol treatment, and resulted in significant service reconfiguration and a shift from in-person to remote delivery. This study aims to evaluate the delivery of drug and alcohol services in a large metropolitan area in Northern England during the COVID-19 pandemic. It aims to understand the impact of service reconfiguration for services, staff and service users, and to use this understanding to inform the future optimised design of services. Design and methods: The study has five workstreams within a mixed methods framework: (1) Systematic review of literature; (2) Qualitative process evaluation with service providers (digital timelines, focus groups and interviews); (3) Qualitative process evaluation with service users (interviews, focus groups, text based conversations and case studies); (4) Quantitative outcomes and health economic analysis; and (5) Data synthesis and dissemination. Expected Impact of the study for Public Health: The breadth of the study, its novel nature, and the importance of substance misuse as a public health issue, mean that this study will provide valuable findings for those who commission, deliver and use drug and alcohol treatment services nationally and internationally. There will also be important learning for the effective remote delivery of services in sectors beyond drug and alcohol treatment.
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Breslin G, Wills W, Bartington S, Bontoft C, Fakoya O, Freethy I, Garcia-Iglesias J, Howlett N, Jones J, Lebcir R, Lloyd N, Newby K, Smeeton N, Wagner AP, Wellings A, Wellsted D, Brown K. Evaluation of a whole system approach to diet and healthy weight in the east of Scotland: Study protocol. PLoS One 2022; 17:e0265667. [PMID: 35324971 PMCID: PMC8947017 DOI: 10.1371/journal.pone.0265667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/04/2022] [Indexed: 11/18/2022] Open
Abstract
Obesity is a global epidemic affecting all age groups, populations and income levels across continents. The causes of obesity are complex and are routed in health behaviours, environmental factors, government policy and the cultural and built environment. Consequently, a Whole System Approach (WSA) which considers the many causes of obesity and shifts the focus away from individuals as points of intervention and puts an emphasis on understanding and improving the system in which people live in is required. This protocol describes a programme of research that will: critically evaluate the evidence for WSAs; assess longitudinally the implementation of a WSA to diet and healthy weight to explore the range of levers (drivers) and opportunities to influence relevant partnerships and interventions to target obesity in East Scotland. The programme consists of four workstreams within a mixed methods framework: 1) Systematic review of reviews of WSAs to diet and healthy weight; 2) Longitudinal qualitative process evaluation of implementing two WSAs in Scotland; 3) Quantitative and Qualitative momentary analysis evaluation of a WSA; and 4) the application of System Dynamics Modelling (SDM) methodology to two council areas in Scotland. A Public Involvement in Research group (PIRg) have informed each stage of the research process. The research programme’s breadth and its novel nature, mean that it will provide valuable findings for the increasing numbers who commission, deliver, support and evaluate WSAs to diet and healthy weight nationally and internationally.
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Affiliation(s)
- Gavin Breslin
- Bamford Centre for Mental Health and Wellbeing, School of Psychology, Ulster University, Coleraine, Northern Ireland
- * E-mail:
| | - Wendy Wills
- School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England (EoE), Cambridge, United Kingdom
| | - Suzanne Bartington
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Charis Bontoft
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Olujoke Fakoya
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Imogen Freethy
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Jaime Garcia-Iglesias
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Neil Howlett
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Julia Jones
- School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Reda Lebcir
- Hertfordshire Business School, University of Hertfordshire, Hatfield, United Kingdom
| | - Nigel Lloyd
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Katie Newby
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Nigel Smeeton
- School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Adam P. Wagner
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England (EoE), Cambridge, United Kingdom
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Amander Wellings
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - David Wellsted
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Katherine Brown
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
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