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Hoddinott P, O’Dolan C, Macaulay L, Dombrowski SU, Swingler J, Cotton S, Avenell A, Getaneh AM, Gray C, Hunt K, Kee F, MacLean A, McKinley M, Torrens C, Turner K, van der Pol M, MacLennan G. Text Messages With Financial Incentives for Men With Obesity: A Randomized Clinical Trial. JAMA 2024:2818966. [PMID: 38744430 PMCID: PMC11094620 DOI: 10.1001/jama.2024.7064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/09/2024] [Indexed: 05/16/2024]
Abstract
Importance Effective weight loss interventions are needed for men with obesity. Objective To determine whether an intervention that combined text messaging with financial incentives attained significant weight loss at the 12-month follow-up compared with the control group and whether an intervention of text messaging alone attained significant weight loss at the 12-month follow-up compared with the control group. Design, Setting, and Participants An assessor-blinded randomized clinical trial conducted in Belfast, Bristol, and Glasgow areas in the UK. A total of 585 men with body mass index (BMI) of 30 or more were enrolled between July 2021 and May 2022. Final follow-up occurred June 2023. Interventions Participants were randomly assigned to 12 months of behavioral focused text messages combined with financial incentives (n = 196), 12 months of behavioral focused text messages alone (n= 194), or a waiting list (control group; n= 195). The financial incentive consisted of a monetary reward that was lost if weight loss targets were not met. All participants received weight management information and a pedometer at baseline. Main Outcomes and Measures The 2 primary comparisons were the 12-month comparison of within-participant weight change between the text messaging with financial incentive group and the control group and the comparison between the text messaging alone group and the control group (minimum clinically important difference, 3%). The P value defined for statistical significance was P < .025 for each comparison. Results Of the 585 men (mean [SD] age, 50.7 [13.3] years; mean weight, 118.5 [19.9] kg; mean BMI, 37.7 [5.7]; 525 [90%] White), 227 (39%) lived in postal code areas with lower socioeconomic status, and 426 (73%) completed the 12-month follow-up. At the 12-month follow-up, compared with the control group, the mean percent weight change was significantly greater in the text messaging with financial incentive group (mean difference, -3.2%; 97.5% CI, -4.6% to -1.9%; P < .001) but was not significantly greater in the text messaging alone group (mean difference, -1.4%; 97.5% CI, -2.9% to 0.0, P = .05). The mean (SD) weight changes were -5.7 (7.4) kg for the text messaging with financial incentives group, -3.0 (7.5) kg for the text messaging alone group, and -1.5 (6.6) kg for the control group. The 12-month mean (SD) percentage weight changes from baseline were -4.8% (6.1%) for the text messaging with financial incentives group, -2.7% (6.3%) for text messaging alone group, and -1.3% (5.5%) for the control group. Of 366 adverse events reported, the most common were infections (83 [23%]). Of the 23 serious adverse events (6.3%), 12 (52%) occurred in the text messaging with financial incentives group, 5 (22%) in the texts messaging alone group, and 6 (26%) in the control group. None were considered related to participating in a trial group. Conclusion and Relevance Among men with obesity, an intervention with text messaging with financial incentive significantly improved weight loss compared with a control group, whereas text messaging alone was not significantly better than the control condition. These findings support text messaging combined with financial incentives to attain weight loss in men with obesity. Trial Registration isrctn.org Identifier: ISRCTN91974895.
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Affiliation(s)
- Pat Hoddinott
- NMAHP Research Unit, Pathfoot Building, Stirling University, United Kingdom
| | - Catriona O’Dolan
- NMAHP Research Unit, Pathfoot Building, Stirling University, United Kingdom
| | - Lisa Macaulay
- NMAHP Research Unit, Pathfoot Building, Stirling University, United Kingdom
| | | | - James Swingler
- Health Services Research Unit, University of Aberdeen, United Kingdom
| | - Seonaidh Cotton
- Centre for Healthcare Randomised Trials, University of Aberdeen, United Kingdom
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, United Kingdom
| | | | - Cindy Gray
- School of Social and Political Sciences, University of Glasgow, United Kingdom
| | - Kate Hunt
- Institute for Social Marketing and Health, University of Stirling, United Kingdom
| | - Frank Kee
- Centre for Public Health, Queen’s University Belfast, United Kingdom
| | - Alice MacLean
- Institute for Social Marketing and Health, University of Stirling, United Kingdom
| | | | - Claire Torrens
- NMAHP Research Unit, Pathfoot Building, Stirling University, United Kingdom
| | - Katrina Turner
- Centre for Academic Primary Care, University of Bristol, United Kingdom
| | | | - Graeme MacLennan
- Centre for Healthcare Randomised Trials, University of Aberdeen, United Kingdom
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Gallagher D, Spyreli E, Anderson AS, Bridges S, Cardwell CR, Coulman E, Dombrowski SU, Free C, Heaney S, Hoddinott P, Kee F, McDowell C, McIntosh E, Woodside JV, McKinley MC. Effectiveness and cost-effectiveness of a 12-month automated text message intervention for weight management in postpartum women with overweight or obesity: protocol for the Supporting MumS (SMS) multisite, parallel-group, randomised controlled trial. BMJ Open 2024; 14:e084075. [PMID: 38719295 PMCID: PMC11086389 DOI: 10.1136/bmjopen-2024-084075] [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] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION The reproductive years can increase women's weight-related risk. Evidence for effective postpartum weight management interventions is lacking and engaging women during this life stage is challenging. Following a promising pilot evaluation of the Supporting MumS intervention, we assess if theory-based and bidirectional text messages to support diet and physical activity behaviour change for weight loss and weight loss maintenance, are effective and cost-effective for weight change in postpartum women with overweight or obesity, compared with an active control arm receiving text messages on child health and development. METHODS AND ANALYSIS Two-arm, parallel-group, assessor-blind randomised controlled trial with cost-effectiveness and process evaluations. Women (n=888) with body mass index (BMI) ≥25 kg/m2 and within 24 months of giving birth were recruited via community and National Health Service pathways through five UK sites targeting areas of ethnic and socioeconomic diversity. Women were 1:1 randomised to the intervention or active control groups, each receiving automated text messages for 12 months. Data are collected at 0, 6, 12 and 24 months. The primary outcome is weight change at 12 months from baseline, compared between groups. Secondary outcomes include weight change (24 months) and waist circumference (cm), proportional weight gain (>5 kg), BMI (kg/m2), dietary intake, physical activity, infant feeding and mental health (6, 12 and 24 months, respectively). Economic evaluation examines health service usage and personal expenditure, health-related quality of life and capability well-being to assess cost-effectiveness over the trial and modelled lifetime. Cost-utility analysis examines cost per quality-adjusted life-years gained over 24 months. Mixed-method process evaluation explores participants' experiences and contextual factors impacting outcomes and implementation. Stakeholder interviews examine scale-up and implementation. ETHICS AND DISSEMINATION Ethical approval was obtained before data collection (West of Scotland Research Ethics Service Research Ethics Committee (REC) 4 22/WS/0003). Results will be published via a range of outputs and audiences. TRIAL REGISTRATION NUMBER ISRCTN16299220.
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Affiliation(s)
- Dunla Gallagher
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Eleni Spyreli
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Annie S Anderson
- Centre for Research into Cancer Prevention and Screening, Ninewells Medical School, Dundee, UK
| | - Sally Bridges
- Bradford Institute for Health Research, Bradford, UK
| | | | - Elinor Coulman
- Centre for Trials Research (CTR), Cardiff University School of Medicine, Cardiff, UK
| | - Stephan U Dombrowski
- Faculty of Kinesiology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Caroline Free
- Public Health Interventions Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Suzie Heaney
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Emma McIntosh
- Health Economics and Health Technology Assessment (HEHTA), University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Malcolm C, Hoddinott P, King E, Dick S, Kyle R, Wilson P, France E, Aucott L, Turner SW. Short-stay urgent hospital admissions of children with convulsions: A mixed methods exploratory study to inform out of hospital care pathways. PLoS One 2024; 19:e0301071. [PMID: 38557817 PMCID: PMC10984513 DOI: 10.1371/journal.pone.0301071] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/09/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE To inform interventions focused on safely reducing urgent paediatric short stay admissions (SSAs) for convulsions. METHODS Routinely acquired administrative data from hospital admissions in Scotland between 2015-2017 investigated characteristics of unscheduled SSAs (an urgent admission where admission and discharge occur on the same day) for a diagnosis of febrile and/or afebrile convulsions. Semi-structured interviews to explore perspectives of health professionals (n = 19) making referral or admission decisions about convulsions were undertaken. Interpretation of mixed methods findings was complemented by interviews with four parents with experience of unscheduled SSAs of children with convulsion. RESULTS Most SSAs for convulsions present initially at hospital emergency departments (ED). In a subset of 10,588 (11%) of all cause SSAs with linked general practice data available, 72 (37%) children with a convulsion contacted both the GP and ED pre-admission. Within 30 days of discharge, 10% (n = 141) of children admitted with afebrile convulsions had been readmitted to hospital with a further convulsion. Interview data suggest that panic and anxiety, through fear that the situation is life threatening, was a primary factor driving hospital attendance and admission. Lengthy waits to speak to appropriate professionals exacerbate parental anxiety and can trigger direct attendance at ED, whereas some children with complex needs had direct access to convulsion professionals. CONCLUSIONS SSAs for convulsions are different to SSAs for other conditions and our findings could inform new efficient convulsion-specific pre and post hospital pathways designed to improve family experiences and reduce admissions and readmissions.
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Affiliation(s)
- Cari Malcolm
- School of Health Sciences, University of Dundee, Dundee, United Kingdom
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, United Kingdom
| | - Emma King
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, United Kingdom
| | - Smita Dick
- Child Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Richard Kyle
- Academy of Nursing, Department of Health and Care Professions, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Philip Wilson
- Centre for Rural Health, University of Aberdeen, Aberdeen, United Kingdom
- Centre for Research and Education in General Practice, University of Copenhagen, København, Denmark
| | - Emma France
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, United Kingdom
| | - Lorna Aucott
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Stephen W. Turner
- Child Health, University of Aberdeen, Aberdeen, United Kingdom
- Women and Children Division, NHS Grampian, Aberdeen, United Kingdom
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Knox O, Parker D, Johnson D, Dombrowski SU, Thomson G, Clarke J, Hoddinott P, Jolly K, Ingram J. Text message conversations between peer supporters and women to deliver infant feeding support using behaviour change techniques: A qualitative analysis. Midwifery 2023; 127:103838. [PMID: 37839159 DOI: 10.1016/j.midw.2023.103838] [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] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To analyse text message conversations between peer supporters (called Infant Feeding Helpers - IFHs) and new mothers using qualitative methods to understand how peer support can influence and support women's feeding experiences. DESIGN Qualitative analysis of text messages conversations using both inductive thematic and deductive content approaches to coding. Thematic analysis of the text message transcripts and deductive content analysis was used to code if Behaviour Change Techniques (BCTs) were employed by IFHs in their interactions with women. BCTs coded in text messages were then compared with those tabulated from antenatal meeting recordings and documented in interview transcripts. PARTICIPANTS AND SETTING 18 primiparous women and 7 Infant Feeding Helpers from one community site in South-West England. FINDINGS Three key themes were identified in the18 text message conversations (1679 texts): 'breastfeeding challenges', 'mother-centred conversations', and 'emotional and practical support'. The core BCTs of 'social support' and 'changing the social environment' were found at least once in 17 (94 %) and 18 (100 %) text message conversations respectively. Meanwhile, 'instruction to perform the behaviour' was used at least once in over 50 % of conversations. Generally, the use of BCTs was greatest between birth and two weeks during a period of daily texts when women reported many feeding challenges. The number and range of BCTs used in text messages were similar to those documented in audio-recorded meetings and interview accounts. CONCLUSION AND IMPLICATIONS Infant Feeding Helpers were able to provide engaging and successful breastfeeding peer support through text messages. Messaging was shown to be an appropriate and accessible method of delivering BCTs focussing on 'social support' and 'changing the social environment'. Peer supporters delivering BCTs via text messages is acceptable and appropriate to use if in-person support is limited due to unforeseen circumstances such as the COVID-19 pandemic.
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Affiliation(s)
- Olivia Knox
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol UK
| | - Denise Parker
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol UK
| | - Debbie Johnson
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol UK
| | | | - Gill Thomson
- School of Community Health & Midwifery, University of Central Lancashire, UK
| | - Joanne Clarke
- Institute of Applied Health Research, University of Birmingham, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professionals Research Unit, University of Stirling, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, UK
| | - Jenny Ingram
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol UK.
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Clarke J, Dombrowski SU, Gkini E, Hoddinott P, Ingram J, MacArthur C, Moss N, Ocansey L, Roberts T, Thomson G, Sanders J, Sitch AJ, Stubbs C, Taylor B, Tearne S, Woolley R, Jolly K. Effectiveness and cost-effectiveness of Assets-based feeding help Before and After birth (ABA-feed) for improving breastfeeding initiation and continuation: protocol for a multicentre randomised controlled trial (Version 3.0). BMJ Open 2023; 13:e075460. [PMID: 37968005 PMCID: PMC10660903 DOI: 10.1136/bmjopen-2023-075460] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/04/2023] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION Breastfeeding has health benefits for infants and mothers, yet the UK has low rates with marked social inequalities. The Assets-based feeding help Before and After birth (ABA) feasibility study demonstrated the acceptability of a proactive, assets-based, woman-centred peer support intervention, inclusive of all feeding types, to mothers, peer supporters and maternity services. The ABA-feed study aims to assess the clinical and cost-effectiveness of the ABA-feed intervention compared with usual care in first-time mothers in a full trial. METHODS AND ANALYSIS A multicentre randomised controlled trial with economic evaluation to explore clinical and cost-effectiveness, and embedded process evaluation to explore differences in implementation between sites. We aim to recruit 2730 primiparous women, regardless of feeding intention. Women will be recruited at 17 sites from antenatal clinics and various remote methods including social media and invitations from midwives and health visitors. Women will be randomised at a ratio of 1.43:1 to receive either ABA-feed intervention or usual care. A train the trainer model will be used to train local Infant Feeding Coordinators to train existing peer supporters to become 'infant feeding helpers' in the ABA-feed intervention. Infant feeding outcomes will be collected at 3 days, and 8, 16 and 24 weeks postbirth. The primary outcome will be any breastfeeding at 8 weeks postbirth. Secondary outcomes will include breastfeeding initiation, any and exclusive breastfeeding, formula feeding practices, anxiety, social support and healthcare utilisation. All analyses will be based on the intention-to-treat principle. ETHICS AND DISSEMINATION The study protocol has been approved by the East of Scotland Research Ethics Committee. Trial results will be available through open-access publication in a peer-reviewed journal and presented at relevant meetings and conferences. TRIAL REGISTRATION NUMBER ISRCTN17395671.
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Affiliation(s)
- Joanne Clarke
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Stephan U Dombrowski
- Department of Kinesiology, University of New Brunswick Fredericton, Fredericton, New Brunswick, Canada
| | - Eleni Gkini
- Birmingham Clinical Trials Unit, University of Birmingham, Bimingham, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
| | - Jenny Ingram
- School of Social & Community Medicine, Bristol University, Bristol, UK
| | - Christine MacArthur
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ngawai Moss
- Centre for Public Health and Policy, Queen Mary University of London, London, UK
| | - Laura Ocansey
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Tracy Roberts
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Gillian Thomson
- School of Health, University of Central Lancashire, Preston, Lancashire, UK
| | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Alice J Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, Birmingham, UK
| | - Clive Stubbs
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Beck Taylor
- Warwick Medical School - Health Sciences, University of Warwick, Coventry, UK
| | - Sarah Tearne
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Rebecca Woolley
- Birmingham Clinical Trials Unit, University of Birmingham, Bimingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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King E, France E, Malcolm C, Kumar S, Dick S, Kyle RG, Wilson P, Aucott L, Turner S, Hoddinott P. Identifying and prioritising future interventions with stakeholders to improve paediatric urgent care pathways in Scotland, UK: a mixed-methods study. BMJ Open 2023; 13:e074141. [PMID: 37827745 PMCID: PMC10582902 DOI: 10.1136/bmjopen-2023-074141] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVES To identify and prioritise interventions, from the perspectives of parents and health professionals, which may be alternatives to current unscheduled paediatric urgent care pathways. DESIGN FLAMINGO (FLow of AdMissions in chIldren and youNG peOple) is a sequential mixed-methods study, with public and patient involvement (PPI) throughout. Data linkage for urgent admissions and three referral sources: emergency department, out of hours service and general practice, was followed by qualitative interviews with parents and professionals. Findings were presented and discussed at a stakeholder intervention prioritisation event. SETTING National Health Service in Scotland, UK. PARTICIPANTS Quantitative data: children with urgent medical admission to hospital from 2015 to 2017. Qualitative interviews: parents and health professionals with experiences of urgent short stay hospital admissions of children. PPI engagement was conducted with nine parent-toddler groups and a university-based PPI advisory group. Stakeholder event: parents, health professionals and representatives from Scottish Government, academia, charities and PPI attended. RESULTS Data for 171 039 admissions which included 92 229 short stay admissions were analysed and 48 health professionals and 21 parents were interviewed. The stakeholder event included 7 parents, 12 health professionals and 28 other stakeholders. Analysis and synthesis of all data identified seven interventions which were prioritised at the stakeholder event: (1) addressing gaps in acute paediatric skills of health professionals working in community settings; (2) assessment and observation of acutely unwell children in community settings; (3) creation of holistic children's 'hubs'; (4) adoption of 'hospital at home' models; and three specialised care pathways for subgroups of children; (5) convulsions; (6) being aged <2 years old; and (7) wheeze/bronchiolitis. Stakeholders prioritised interventions 1, 2 and 3; these could be combined into a whole population intervention. Barriers to progressing these include resources, staffing and rurality. CONCLUSIONS Health professionals and families want future interventions that are patient-centred, community-based and aligned to outcomes that matter to them.
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Affiliation(s)
- Emma King
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Emma France
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Cari Malcolm
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Simita Kumar
- Screening and Immunisation, Public Health Scotland, Edinburgh, UK
| | - Smita Dick
- Child Health, University of Aberdeen, Aberdeen, UK
| | - Richard G Kyle
- Academy of Nursing, Department of Health and Care Professions, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Philip Wilson
- Institute of Health and Wellbeing, University of Aberdeen, Aberdeen, UK
| | - Lorna Aucott
- Centre for Randomised Healthcare Trials, University of Aberdeen, Aberdeen, UK
| | | | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
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King E, Dick S, Hoddinott P, Malcolm C, France E, Kyle RG, Aucott L, Wilson P, Turner S. Regional variations in short stay urgent paediatric hospital admissions: a sequential mixed-methods approach exploring differences through data linkage and qualitative interviews. BMJ Open 2023; 13:e072734. [PMID: 37748848 PMCID: PMC10533722 DOI: 10.1136/bmjopen-2023-072734] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/23/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES The aim of this sequential mixed-methods study was to describe and understand how paediatric short stay admission (SSA) rates vary across Health Board regions of Scotland. DESIGN Exploratory sequential mixed-methods study. Routinely acquired data for the annual (per capita) SSA to hospital were compared across the 11 regions. Five diverse regions with different SSA per capita formed cases for qualitative interviews with health professionals and parents to explore how care pathways, service features and geography may influence decisions to admit. SETTING Scotland. PARTICIPANTS All children admitted to hospital 2015-2017. Healthcare staff (n=48) and parents (n=15) were interviewed. RESULTS Of 171 039 urgent hospital admissions, 92 229 were SSAs, with a fivefold variation between 14 and 69/1000 children/year across regions. SSAs were higher for children in the most deprived compared with the least deprived communities. When expressed as a ratio of highest to lowest SSA/1000 children/year for diagnosed conditions between regions, the ratio was highest (10.1) for upper respiratory tract infection and lowest (2.8) for convulsions. Readmissions varied between 0.80 and 2.52/1000/year, with regions reporting higher SSA rates more likely to report higher readmission rates (r=0.70, p=0.016, n=11). Proximity and ease of access to services, local differences in service structure and configuration, national policy directives and disparities in how an SSA is defined were recognised by interviewees as explaining the observed regional variations in SSAs. Socioeconomic deprivation was seldom spontaneously raised by professionals when reflecting on reasons to refer or admit a child. Instead, greater emphasis was placed on the wider social circumstances and parents' capacity to cope with and manage their child's illness at home. CONCLUSION SSA rates for children vary quantitatively by region, condition and area deprivation and our interviews identify reasons for this. These findings can usefully inform future care pathway interventions.
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Affiliation(s)
- Emma King
- Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Smita Dick
- Department of Child Health, University of Aberdeen, Aberdeen, UK
| | - Pat Hoddinott
- Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Cari Malcolm
- School of Health Science, University of Dundee, Dundee, UK
| | - Emma France
- Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | | | - Lorna Aucott
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Philip Wilson
- Institute of Health and Wellbeing, University of Aberdeen, Aberdeen, UK
| | - Stephen Turner
- Department of Child Health, University of Aberdeen, Aberdeen, UK
- Division of Women and Children, NHS Grampian, Aberdeen, UK
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Dick S, Kyle R, Wilson P, Aucott L, France E, King E, Malcolm C, Hoddinott P, Turner SW. Insights from and limitations of data linkage studies: analysis of short-stay urgent admission referral source from routinely collected Scottish data. Arch Dis Child 2023; 108:300-306. [PMID: 36719837 DOI: 10.1136/archdischild-2022-324171] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/14/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION This study identified the referral source for urgent short-stay admissions (SSAs) and compared characteristics of children with SSA stratified by different referral sources. METHODS Routinely acquired data from urgent admissions to Scottish hospitals during 2015-2017 were linked to data held by the three referral sources: emergency department (ED), out-of-hours (OOH) service and general practice (GP). RESULTS There were 171 039 admissions including 92 229 (54%) SSAs. Only 171 (19%) of all of Scotland's GP practices contributed data. Among the subgroup of 10 588 SSAs where GP data were available (11% all SSA), there was contact with the following referral source on the day of admission: only ED, 1853 (18%); only GP, 3384 (32%); and only OOH, 823 (8%). Additionally, 2165 (20%) had contact with more than one referral source, and 1037 (10%) had contact with referral source(s) on the day before the admission. When all 92 229 SSAs were considered, those with an ED referrer were more likely to be for older children, of white ethnicity, living in more deprived communities and diagnosed with asthma, convulsions or croup. The odds ratio for an SSA for a given condition differed by referral source and ranged from 0.07 to 1.9 (with reference to ED referrals). CONCLUSION This study yielded insights and potential limitations regarding data linkage in a healthcare setting. Data coverage, particularly from primary care, needs to improve further. Evidence from data linkage studies can inform future intervention designed to provide safe integrated care pathways.
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Affiliation(s)
- Smita Dick
- Child Health, University of Aberdeen, Aberdeen, UK
| | - Richard Kyle
- Academy of Nursing, University of Exeter, Exeter, UK
| | - Philip Wilson
- Institute of Health and Wellbeing, University of Aberdeen, Aberdeen, UK
| | - Lorna Aucott
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Emma France
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - E King
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Cari Malcolm
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Stephen W Turner
- Child Health, University of Aberdeen, Aberdeen, UK
- Women and Children Division, NHS Grampian, Aberdeen, UK
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Malcolm C, King E, France E, Kyle RG, Kumar S, Dick S, Wilson P, Aucott L, Turner SW, Hoddinott P. Short stay hospital admissions for an acutely unwell child: A qualitative study of outcomes that matter to parents and professionals. PLoS One 2022; 17:e0278777. [PMID: 36525432 PMCID: PMC9757586 DOI: 10.1371/journal.pone.0278777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Numbers of urgent short stay admissions (SSAs) of children to UK hospitals are rising rapidly. This paper reports on experiences of SSAs from the perspective of parents accessing urgent care for their acutely unwell child and of health professionals referring, caring for, or admitting children. METHODS A qualitative interview study was conducted by a multi-disciplinary team with patient and public involvement (PPI) to explore contextual factors relating to SSAs and better understand pre-hospital urgent care pathways. Purposive sampling of Health Board areas in Scotland, health professionals with experience of paediatric urgent care pathways and parents with experience of a SSA for their acutely unwell child was undertaken to ensure maximal variation in characteristics such as deprivation, urban-rural and hospital structure. Interviews took place between Dec 2019 and Mar 2021 and thematic framework analysis was applied. RESULTS Twenty-one parents and forty-eight health professionals were interviewed. In the context of an urgent SSA, the themes were centred around shared outcomes of care that matter. The main outcome which was common to both parents and health professionals was the importance of preserving the child's safety. Additional shared outcomes by parents and health professionals were a desire to reduce worries and uncertainty about the illness trajectory, and provide reassurance with sufficient time, space and personnel to undertake a period of skilled observation to assess and manage the acutely unwell child. Parents wanted easy access to urgent care and, preferably, with input from paediatric-trained staff. Healthcare professionals considered that it was important to reduce the number of children admitted to hospital where safe and appropriate to do so. CONCLUSIONS The shared outcomes of care between parents and health professionals emphasises the potential merit of adopting a partnership approach in identifying, developing and testing interventions to improve the acceptability, safety, efficiency, and cost-effectiveness of urgent care pathways between home and hospital.
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Affiliation(s)
- Cari Malcolm
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
- * E-mail: (PH); (CM)
| | - Emma King
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, United Kingdom
| | - Emma France
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, United Kingdom
| | - Richard G. Kyle
- Academy of Nursing, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Simita Kumar
- Screening and Immunisation, Public Health Scotland, Edinburgh, United Kingdom
| | - Smita Dick
- Child Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Philip Wilson
- Centre for Rural Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Lorna Aucott
- Centre for Randomised Healthcare Trials, University of Aberdeen, Aberdeen, United Kingdom
| | - Stephen W. Turner
- Child Health, University of Aberdeen, Aberdeen, United Kingdom
- NHS Grampian, Aberdeen, United Kingdom
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, United Kingdom
- * E-mail: (PH); (CM)
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McKell J, Harris FM, Sinclair L, Bauld L, Tappin DM, Hoddinott P. Usual care in a multicentre randomised controlled trial of financial incentives for smoking cessation in pregnancy: qualitative findings from a mixed-methods process evaluation. BMJ Open 2022; 12:e066494. [PMID: 36600364 PMCID: PMC9730354 DOI: 10.1136/bmjopen-2022-066494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Financial incentives are recommended by the UK's National Institute for Health and Care Excellence to aid smoking cessation in pregnancy. However, little is known about how implementation contexts might impact on their effectiveness. Variations in smoking cessation support (usual care) for pregnant women who smoke were examined qualitatively as part of a prospective process evaluation of the Cessation in Pregnancy Incentives Trial (CPIT III). DESIGN Longitudinal case studies of five CPIT III trial sites informed by realist evaluation. SETTING A stop smoking service (SSS) serving a maternity hospital constituted each case study, located in three UK countries. PARTICIPANTS Data collection included semistructured interviews with trial participants (n=22), maternity (n=12) and SSS staff (n=17); and site observations and perspectives recorded in fieldnotes (n=85). RESULTS Cessation support (usual care) for pregnant women varied in amount, location, staff capacity, flexibility and content across sites. SSS staff capacity was important to avoid gaps in support. Colocation and good working relationships between maternity and SSS professionals enabled prioritisation and reinforced the importance of smoking cessation. Sites with limited use of carbon monoxide (CO) monitoring reduced opportunities to identify smokers while inconsistency around automatic referral processes prevented the offer of cessation support. SSS professionals colocated within antenatal clinics were available to women they could not otherwise reach. Flexibility around location, timing and tailoring of approaches for support, facilitated initial and sustained engagement and reduced the burden on women. CONCLUSIONS Trial sites faced varied barriers and facilitators to delivering cessation support, reflecting heterogeneity in usual care. If financial incentives are more effective with concurrent smoking cessation support, sites with fewer barriers and more facilitators regarding this support would be expected to have more promising trial outcomes. Future reporting of trial outcomes will assist in understanding incentives' generalisability across a wide range of usual care settings. TRIAL REGISTRATION NUMBER ISRCTN15236311.
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Affiliation(s)
- Jennifer McKell
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Fiona M Harris
- School of Health and Life Sciences, University of the West of Scotland, Paisley, UK
| | - Lesley Sinclair
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Linda Bauld
- Usher Institute of Population Health Sciences and Informatics, and SPECTRUM Research Consortium, University of Edinburgh, Edinburgh, UK
| | | | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
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11
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Copeland L, Littlecott HJ, Couturiaux D, Hoddinott P, Segrott J, Murphy S, Moore G, Evans RE. Adapting population health interventions for new contexts: qualitative interviews understanding the experiences, practices and challenges of researchers, funders and journal editors. BMJ Open 2022; 12:e066451. [PMID: 36288840 PMCID: PMC9615984 DOI: 10.1136/bmjopen-2022-066451] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Research on the adaptation of population health interventions for implementation in new contexts is rapidly expanding. This has been accompanied by a recent increase in the number of frameworks and guidance to support adaptation processes. Nevertheless, there remains limited exploration of the real-world experiences of undertaking intervention adaptation, notably the challenges encountered by different groups of stakeholders, and how these are managed. Understanding experiences is imperative in ensuring that guidance to support adaptation has practical utility. This qualitative study examines researcher and stakeholder experiences of funding, conducting and reporting adaptation research. SETTING Adaptation studies. PARTICIPANTS Participants/cases were purposefully sampled to represent a range of adapted interventions, types of evaluations, expertise and countries. Semistructured interviews were conducted with a sample of researchers (n=23), representatives from research funding panels (n=6), journal editors (n=5) and practitioners (n=3). MEASURES A case study research design was used. Data were analysed using the framework approach. Overarching themes were discussed within the study team, with further iterative refinement of subthemes. RESULTS The results generated four central themes. The first three relate to the experience of intervention adaptation (1) involving stakeholders throughout the adaptation process and how to integrate the evidence base with experience; (2) selecting the intervention and negotiating the mismatch between the original and the new context; and (3) the complexity and uncertainty when deciding the re-evaluation process. The final theme (4) reflects on participants' experiences of using adaptation frameworks in practice, considering recommendations for future guidance development and refinement. CONCLUSION This study highlights the range of complexities and challenges experienced in funding, conducting and reporting research on intervention adaptation. Moving forward, guidance can be helpful in systematising processes, provided that it remains responsive to local contexts and encourage innovative practice.
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Affiliation(s)
- Lauren Copeland
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - Hannah J Littlecott
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
- Pettenkofer School of Public Health (PSPH), Institute for Medical Information Processing, Biometry and Epidemiology, LMU, Munchen, Bayern, Germany
| | - Danielle Couturiaux
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
| | - Jeremy Segrott
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Simon Murphy
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - Graham Moore
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - Rhiannon E Evans
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
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12
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Tappin D, Sinclair L, Kee F, McFadden M, Robinson-Smith L, Mitchell A, Keding A, Watson J, Watson S, Dick A, Torgerson D, Hewitt C, McKell J, Hoddinott P, Harris FM, Boyd KA, McMeekin N, Ussher M, Bauld L. Effect of financial voucher incentives provided with UK stop smoking services on the cessation of smoking in pregnant women (CPIT III): pragmatic, multicentre, single blinded, phase 3, randomised controlled trial. BMJ 2022; 379:e071522. [PMID: 36261162 PMCID: PMC9580214 DOI: 10.1136/bmj-2022-071522] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To examine effectiveness, cost effectiveness, generalisability, and acceptability of financial incentives for smoking cessation during pregnancy in addition to variously organised UK stop smoking services. DESIGN Pragmatic, multicentre, single blinded, phase 3, randomised controlled trial (Cessation in Pregnancy Incentives Trial phase 3 (CPIT III)). SETTING Seven UK stop smoking services provided in primary and secondary care facilities in Scotland, Northern Ireland, and England. PARTICIPANTS 944 pregnant women (age ≥16 years) who self-reported as being smokers (at least one cigarette in the past week) when asked at first maternity visit, less than 24 weeks' gestation, and notified to the trial team by routine stop smoking services. INTERVENTIONS Participants in the control group were offered the standard stop smoking services, which includes the offer of counselling by specially trained workers using withdrawal orientated therapy and the offer of free nicotine replacement therapy. The intervention was the offer of usual support from the stop smoking services and the addition of up to £400 ($440; €455) of LoveToShop financial voucher incentives for engaging with current stop smoking services or to stop smoking, or both, during pregnancy. MAIN OUTCOME MEASURES Self-reported smoking cessation in late pregnancy (between 34 and 38 weeks' gestation) corroborated by saliva cotinine (and anabasine if using nicotine replacement products). Results were adjusted for age, smoking years, index of multiple deprivation, Fagerström score, before or after covid, and recruitment site. Secondary outcomes included point and continuous abstinence six months after expected date of delivery, engagement with stop smoking services, biochemically validated abstinence from smoking at four weeks after stop smoking date, birth weight of baby, cost effectiveness, generalisability documenting formats of stop smoking services, and acceptability to pregnant women and their carers. RESULTS From 9 January 2018 to 4 April 2020, of 4032 women screened by stop smoking services, 944 people were randomly assigned to the intervention group (n=471) or the control group (n=470). Three people asked for their data to be removed. 126 (27%) of 471 participants stopped smoking from the intervention group and 58 (12%) of 470 from the control group (adjusted odds ratio 2.78 (1.94 to 3.97) P<0.001). Serious adverse events were miscarriages and other expected pregnancy events requiring hospital admission; all serious adverse events were unrelated to the intervention. Most people who stopped smoking from both groups relapsed after their baby was born. CONCLUSIONS The offer of up to £400 of financial voucher incentives to stop smoking during pregnancy as an addition to current UK stop smoking services is highly effective. This bolt-on intervention supports new guidance from the UK National Institute for Health and Care Excellence, which includes the addition of financial incentives to support pregnant women to stop smoking. Continuing incentives to 12 months after birth is being examined to prevent relapse. TRIAL REGISTRATION ISRCTN Registry ISRCTN15236311.
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Affiliation(s)
- David Tappin
- Child Health, School of Medicine, Honorary Senior Research Fellow, University of Glasgow, UK
| | | | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Margaret McFadden
- National Health Service Lanarkshire Clinical Trials Unit, Airdrie, UK
| | | | | | - Ada Keding
- York Trials Unit, University of York, York, UK
| | | | - Sinead Watson
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Alison Dick
- York Trials Unit, University of York, York, UK
| | | | | | - Jennifer McKell
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Fiona M Harris
- School of Health and Life Sciences, University of the West of Scotland, Paisley, UK
| | - Kathleen A Boyd
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola McMeekin
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Michael Ussher
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
- Population Health Research Institute, St George's, University of London, London, UK
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, University of Edinburgh, Edinburgh, UK
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13
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Macaulay L, O'Dolan C, Avenell A, Carroll P, Cotton S, Dombrowski S, Elders A, Goulao B, Gray C, Harris FM, Hunt K, Kee F, MacLennan G, McDonald MD, McKinley M, Skinner R, Torrens C, Tod M, Turner K, van der Pol M, Hoddinott P. Effectiveness and cost-effectiveness of text messages with or without endowment incentives for weight management in men with obesity (Game of Stones): study protocol for a randomised controlled trial. Trials 2022; 23:582. [PMID: 35869503 PMCID: PMC9306253 DOI: 10.1186/s13063-022-06504-5] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity increases the risk of type 2 diabetes, heart disease, stroke, mobility problems and some cancers, and its prevalence is rising. Men engage less than women in existing weight loss interventions. Game of Stones builds on a successful feasibility study and aims to find out if automated text messages with or without endowment incentives are effective and cost-effective for weight loss at 12 months compared to a waiting list comparator arm in men with obesity. METHODS A 3-arm, parallel group, assessor-blind superiority randomised controlled trial with process evaluation will recruit 585 adult men with body mass index of 30 kg/m2 or more living in and around three UK centres (Belfast, Bristol, Glasgow), purposively targeting disadvantaged areas. Intervention groups: (i) automated, theory-informed text messages daily for 12 months plus endowment incentives linked to verified weight loss targets at 3, 6 and 12 months; (ii) the same text messages and weight loss assessment protocol; (iii) comparator group: 12 month waiting list, then text messages for 3 months. The primary outcome is percentage weight change at 12 months from baseline. Secondary outcomes at 12 months are as follows: quality of life, wellbeing, mental health, weight stigma, behaviours, satisfaction and confidence. Follow-up includes weight at 24 months. A health economic evaluation will measure cost-effectiveness over the trial and over modelled lifetime: including health service resource-use and quality-adjusted life years. The cost-utility analysis will report incremental cost per quality-adjusted life years gained. Participant and service provider perspectives will be explored via telephone interviews, and exploratory mixed methods process evaluation analyses will focus on mental health, multiple long-term conditions, health inequalities and implementation strategies. DISCUSSION The trial will report whether text messages (with and without cash incentives) can help men to lose weight over 1 year and maintain this for another year compared to a comparator group; the costs and benefits to the health service; and men's experiences of the interventions. Process analyses with public involvement and service commissioner input will ensure that this open-source digital self-care intervention could be sustainable and scalable by a range of NHS or public services. TRIAL REGISTRATION ISRCTN 91974895 . Registered on 14/04/2021.
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Affiliation(s)
- Lisa Macaulay
- NMAHP Research Unit, Stirling University, Pathfoot Building, Stirling, FK9 4LA, UK.
| | - Catriona O'Dolan
- NMAHP Research Unit, Stirling University, Pathfoot Building, Stirling, FK9 4LA, UK
| | - Alison Avenell
- Health Services Research Unit, 3Rd Floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Paula Carroll
- Department Sport & Exercise Science, Waterford Institute of Technology, Main Campus Cork RoadCo. Waterford, Waterford City, Ireland
| | - Seonaidh Cotton
- CHaRT, HRSU, 3Rd Floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Stephan Dombrowski
- Faculty of Kinesiology, University of New Brunswick, 3 Bailey Drive, P.O. Box 4400, Fredericton, NB, E3B 5A3, Canada
| | - Andrew Elders
- NMAHP Research Unit, Glasgow Caledonian University, Govan Mbeki Building, Cowcaddens Road, G4 0BA, Glasgow, UK
| | - Beatriz Goulao
- CHaRT, HRSU, 3Rd Floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Cindy Gray
- School of Social and Political Sciences, University of Glasgow, 25-29 Bute Gardens, Glasgow, G12 8RS, UK
| | - Fiona M Harris
- School of Health & Life Sciences, University of the West of Scotland, High Street, Paisley, Renfrewshire, PA1 2BE, UK
| | - Kate Hunt
- Institute for Social Marketing and Health, Pathfoot Building, University of Stirling, Stirling, FK9 4LA, UK
| | - Frank Kee
- Centre for Public Health, UKCRC Centre of Excellence for Public Health Research (NI), Institute Clinical Sciences A, Grosvenor Road, Belfast, BT12 6BJ, Northern Ireland
| | - Graeme MacLennan
- CHaRT, HRSU, 3Rd Floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | | | - Michelle McKinley
- Queen's University Belfast, University Road, Belfast, BT7 1NN, Northern Ireland
| | | | - Claire Torrens
- NMAHP Research Unit, Stirling University, Pathfoot Building, Stirling, FK9 4LA, UK
| | - Martin Tod
- Men's Health Forum, 49-51 East Rd, Hoxton, London, N1 6AH, UK
| | - Katrina Turner
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Marjon van der Pol
- Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Pat Hoddinott
- NMAHP Research Unit, Stirling University, Pathfoot Building, Stirling, FK9 4LA, UK
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14
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Moore G, Campbell M, Copeland L, Craig P, Movsisyan A, Hoddinott P, Littlecott H, O'Cathain A, Pfadenhauer L, Rehfuess E, Segrott J, Hawe P, Kee F, Couturiaux D, Hallingberg B, Evans R. Adapting interventions to new contexts-the ADAPT guidance. BMJ 2021; 374:n1679. [PMID: 34344699 PMCID: PMC8329746 DOI: 10.1136/bmj.n1679] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Graham Moore
- Centre for Development, Evaluation, Complexity and Implementation in Public Health improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Mhairi Campbell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Lauren Copeland
- Centre for Development, Evaluation, Complexity and Implementation in Public Health improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Ani Movsisyan
- Pettenkofer School of Public Health, Munich, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Hannah Littlecott
- Centre for Development, Evaluation, Complexity and Implementation in Public Health improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Alicia O'Cathain
- School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Lisa Pfadenhauer
- Pettenkofer School of Public Health, Munich, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
| | - Eva Rehfuess
- Pettenkofer School of Public Health, Munich, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
| | - Jeremy Segrott
- Centre for Development, Evaluation, Complexity and Implementation in Public Health improvement (DECIPHer), Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Penelope Hawe
- Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
| | - Frank Kee
- Centre for Public Health, Queens University Belfast, Belfast, UK
| | - Danielle Couturiaux
- Centre for Development, Evaluation, Complexity and Implementation in Public Health improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Britt Hallingberg
- Centre for Development, Evaluation, Complexity and Implementation in Public Health improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Rhiannon Evans
- Centre for Development, Evaluation, Complexity and Implementation in Public Health improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
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15
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Copeland L, Littlecott H, Couturiaux D, Hoddinott P, Segrott J, Murphy S, Moore G, Evans R. The what, why and when of adapting interventions for new contexts: A qualitative study of researchers, funders, journal editors and practitioners' understandings. PLoS One 2021; 16:e0254020. [PMID: 34242280 PMCID: PMC8270163 DOI: 10.1371/journal.pone.0254020] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/17/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The adaptation of interventions for new contexts is a rapidly developing research area. To date there is no consensus-based guidance to support decision-making and recommend adaptation processes. The ADAPT study is developing such guidance. This aim of the qualitative component of the study was to explore stakeholders' understandings of adaptation, as to date there has limited consideration of how different concepts and meanings shape decision-making and practice. METHODS A case study research design was used. Participants/cases were purposefully sampled based on study outcome, study design, expertise, context and country. Semi-structured interviews were conducted with a sample of researchers (n = 23); representatives from research funding panels (n = 6); journal editors (n = 5) and practitioners (n = 3). Data were analysed using the Framework approach. Overarching themes were discussed with the ADAPT study team, with further iterative refinement of subthemes. RESULTS The results generated four central themes. Four themes related to stakeholders' understanding: 1) definitions of adaptation and related concepts; 2) rationales for undertaking adaptation; 3) the appropriate timing for adaptation; and 4) ensuring fidelity when implementing adapted interventions. CONCLUSION The findings highlight the lack of clarity around key concepts and uncertainty about central decision-making processes, notably why interventions should be adapted, when and to what extent. This has informed the ADAPT study's guidance, shaping the scope and nature of recommendations to be included and surfacing key uncertainties that require future consideration.
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Affiliation(s)
- Lauren Copeland
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Hannah Littlecott
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Danielle Couturiaux
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Pat Hoddinott
- Primary Care, Stirling University, Stirling, Scotland, United Kingdom
| | - Jeremy Segrott
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Centre for Trials Research, Cardiff University, Cardiff, Wales, United Kingdom
| | - Simon Murphy
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Graham Moore
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Rhiannon Evans
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, Wales, United Kingdom
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16
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McDonald MD, Dombrowski SU, Skinner R, Calveley E, Carroll P, Elders A, Gray CM, Grindle M, Harris FM, Jones C, Hoddinott P. Recruiting men from across the socioeconomic spectrum via GP registers and community outreach to a weight management feasibility randomised controlled trial. BMC Med Res Methodol 2020; 20:249. [PMID: 33023501 PMCID: PMC7542377 DOI: 10.1186/s12874-020-01136-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/25/2020] [Indexed: 11/17/2022] Open
Abstract
Background Men, particularly those living in disadvantaged areas, are less likely to participate in weight management programmes than women despite similar levels of excess weight. Little is known about how best to recruit men to weight management interventions. This paper describes patient and public involvement in pre-trial decisions relevant to recruitment and aims to report on recruitment to the subsequent men-only weight management feasibility trial, including the: i) acceptability and feasibility of recruitment; and ii) baseline sample characteristics by recruitment strategy. Methods Men with BMI ≥30 kg/m2 and/or waist circumference ≥ 40 in. were recruited to the feasibility trial via two strategies; community outreach (venue information stands and word of mouth) and GP letters, targeting disadvantaged areas. Recruitment activities (e.g. letters sent, researcher venue hours) were recorded systematically, and baseline characteristics questionnaire data collated. Qualitative interviews (n = 50) were conducted three months post-recruitment. Analyses and reporting followed a complementary mixed methods approach. Results 105 men were recruited within four months (community n = 60, GP letter n = 45). Community outreach took 2.3 recruiter hours per participant and GP letters had an opt-in rate of 10.2% (n = 90/879). More men were interested than could be accommodated. Most participants (60%) lived in more disadvantaged areas. Compared to community outreach, men recruited via GP letters were older (mean = 57 vs 48 years); more likely to report an obesity-related co-morbidity (87% vs 44%); and less educated (no formal qualifications, 32% vs 10%, degree educated 11% vs 41%). Recruitment strategies were acceptable, a sensitive approach and trusting relationships with recruiters valued, and the ‘catchy’ study name drew attention. Conclusions Targeted community outreach and GP letters were acceptable strategies that successfully recruited participants to a men-only weight management feasibility trial. Both strategies engaged men from disadvantaged areas, a typically underserved population. Using two recruitment strategies produced samples with different health risk profiles, which could add value to research where either primary or secondary prevention is of interest. Further work is required to examine how these strategies could be implemented and sustained in practice. Trial registration ClinicalTrials.gov: NCT03040518, 2nd February 2017.
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Affiliation(s)
- Matthew D McDonald
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK. .,Physical Activity and Wellbeing Research Group, Curtin University, Perth, Australia. .,School of Psychology, Curtin University, Perth, Australia.
| | - Stephan U Dombrowski
- Faculty of Kinesiology, University of New Brunswick, Fredericton, New Brunswick, Canada.,Division of Psychology, University of Stirling, Stirling, UK
| | - Rebecca Skinner
- Division of Psychology, University of Stirling, Stirling, UK
| | - Eileen Calveley
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | | | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Cindy M Gray
- School of Social and Political Sciences, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Mark Grindle
- Institute for Health Research and Innovation, University of the Highlands and Islands, Inverness, UK
| | - Fiona M Harris
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Claire Jones
- Health Informatics Centre, University of Dundee, Dundee, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
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17
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Thomson G, Ingram J, Clarke JL, Johnson D, Trickey H, Dombrowski SU, Hoddinott P, Darwent K, Jolly K. Exploring the use and experience of an infant feeding genogram to facilitate an assets-based approach to support infant feeding. BMC Pregnancy Childbirth 2020; 20:569. [PMID: 32993544 PMCID: PMC7523065 DOI: 10.1186/s12884-020-03245-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 09/10/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND A lack of perceived social support influences women's infant feeding behaviours. The Infant Feeding Genogram is a visual co-constructed diagram which details people/services that can provide support to women and can facilitate a connection between mothers and their existing assets landscape. The aim of this study is to explore women's and infant feeding helpers' experiences and use of an infant feeding genogram delivered to the intervention group of the "Assets-based infant feeding help Before and After birth (ABA)" randomised feasibility trial. METHODS 103 primiparous mothers aged 16+ years were recruited to the trial (trial registration number) in two sites (Site A and Site B) with low breastfeeding prevalence in the UK. Infant feeding helpers (IFHs) co-constructed a genogram at the first antenatal meeting for the intervention group (n = 50), and then provided proactive, woman-centered support from ~ 32 weeks gestation to up to 5 months postnatal. Infant feeding helpers' and women's experiences of the infant feeding genogram were collected via interviews or focus groups. Completed genograms were shared with researchers. Content analysis of the genograms and qualitative data from the interviews and focus groups were analysed thematically. RESULTS Data comprised 32 completed genograms, and qualitative insights from all 13 infant feeding helpers (two focus groups; 4 interviews) and interviews with a purposive sample of 21 of 50 intervention group women between 4 and 21 weeks after birth. Content analysis of the genograms highlighted variations, with more personal, individualised genograms completed at Site B compared to Site A. The perceived impact of the genogram was related to the IFHs' application of the tool. The genogram was either used as intended to raise women's awareness of available assets and motivate help-seeking behaviour, or as a data collection tool with limited perceived utility. Negative and positive unintended consequences of genogram use were highlighted. CONCLUSIONS The genogram has the potential to offer a woman, family and community-centred approach that focusses on building assets for infant feeding. However, variations in genogram application indicate that revised training is required to clarify the purpose and ensure it is used as intended. TRIAL REGISTRATION ISRCTN ISRCTN14760978 ; Registered 30 January 2017.
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Affiliation(s)
- Gill Thomson
- Maternal and Infant Nutrition and Nurture Unit (MAINN), University of Central Lancashire, Preston, UK.
- School of Education, Health and Social Studies, Dalarna University, Högskolegatan 2, Falun, Sweden.
| | - Jenny Ingram
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Joanne L Clarke
- Institute of Applied Health Research, Murray Learning Centre, University of Birmingham, Birmingham, B15 2TT, UK
| | - Debbie Johnson
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Heather Trickey
- DECIPHER, Department of Social Medicine, Cardiff University, Cardiff, UK
| | - Stephan U Dombrowski
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
- Division of Psychology, University of Stirling, Stirling, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Kirsty Darwent
- Faculty of Science and Sport, University of Stirling, Stirling, UK
| | - Kate Jolly
- Institute of Applied Health Research, Murray Learning Centre, University of Birmingham, Birmingham, B15 2TT, UK
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18
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Dombrowski SU, McDonald M, van der Pol M, Grindle M, Avenell A, Carroll P, Calveley E, Elders A, Glennie N, Gray CM, Harris FM, Hapca A, Jones C, Kee F, McKinley MC, Skinner R, Tod M, Hoddinott P. Text messaging and financial incentives to encourage weight loss in men with obesity: the Game of Stones feasibility RCT. Public Health Res 2020. [DOI: 10.3310/phr08110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background
In 2016, 26% of UK men were estimated to be obese. Systematic reviews suggest that few men engage in formal weight loss interventions that support weight reduction and improve health.
Objective
To co-produce, with patient and public involvement, an acceptable and feasible randomised controlled trial design to test a men-only weight management intervention.
Design
This was a two-phase feasibility study. Phase 1 was the development of intervention components, study procedures and materials including a discrete choice experiment with survey questions. Phase 2 was an individually randomised three-arm feasibility trial over 12 months. Qualitative interviews were conducted at 3 and 12 months.
Setting
The setting was two sites in Scotland that had disadvantaged urban and rural areas and differed in employment levels and ethnic groups.
Participants
In phase 1, 1045 men with obesity were recruited by Ipsos MORI (London, UK; www.ipsos.com/ipsos-mori/en-uk) to represent the UK population. In phase 2, 105 men with obesity were recruited in the community or through general practice obesity registers. Qualitative interviews were conducted with 50 men at 3 months and with 33 men at 12 months.
Interventions
The trial arms were narrative short message service (SMS) for 12 months (SMS only), financial endowment incentive informed by loss aversion and linked to achievement of weight loss targets plus narrative SMS for 12 months (SMS + I), and waiting list control group for 12 months followed by 3 months of an alternative SMS style developed based on feedback from men who had received the narrative SMS (control).
Main outcome measures
The main outcome measures were acceptability and feasibility of recruitment, retention, engagement, intervention components and trial procedures. Outcomes were assessed by examining procedural, quantitative and qualitative data at 3, 6 and 12 months.
Results
The most acceptable incentive strategy, based on the discrete choice experiment results, was to verify weight loss of 5% at 3 months, verify weight loss of 10% at 6 months and maintain weight loss of 10% at 12 months. Overall, 105 men with obesity from across the socioeconomic spectrum were successfully recruited to target, 59% of whom lived in more disadvantaged areas. Retention at 12 months was acceptable (74%) and was higher among individuals from disadvantaged areas. Narrative SMS were acceptable to many men, with a minority reporting negative reactions. Incentives were acceptable but were not the primary motivation for behaviour change. Twelve men in the incentive arm (33%) secured at least some money and three (8%) secured the full amount. Both intervention arms lost some weight, with greater weight loss in the arm that received SMS and incentives. The alternative SMS based on men’s feedback received no strong negative reactions.
Limitations
Fewer participants from the SMS + I arm (64%) completed the study at 12 months than did those in the SMS-only (79%) and control (83%) arms. The reasons for this difference were complex.
Conclusions
The men-only weight management intervention consisting of narrative SMS and financial incentives was acceptable and feasible, meeting the progression criteria for a full trial. Tailoring of SMS may improve acceptability and retention.
Future work
Minor refinements to the intervention components based on the study findings will be made prior to testing in a multisite definitive randomised controlled trial.
Trial registration
ClinicalTrials.gov NCT03040518.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Stephan U Dombrowski
- Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Matthew McDonald
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | | | - Mark Grindle
- Division of Rural Health and Wellbeing, University of the Highlands and Islands, Inverness, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Eileen Calveley
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Nicola Glennie
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Cindy M Gray
- Institute of Health & Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
| | - Fiona M Harris
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Adrian Hapca
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Claire Jones
- Health Informatics Centre, University of Dundee, Dundee, UK
| | - Frank Kee
- Centre for Public Health, Institute of Clinical Sciences, Queen’s University Belfast, Belfast, UK
| | | | - Rebecca Skinner
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | | | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
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19
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Ingram J, Thomson G, Johnson D, Clarke JL, Trickey H, Hoddinott P, Dombrowski SU, Jolly K. Women's and peer supporters' experiences of an assets-based peer support intervention for increasing breastfeeding initiation and continuation: A qualitative study. Health Expect 2020; 23:622-631. [PMID: 32198797 PMCID: PMC7321743 DOI: 10.1111/hex.13042] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/12/2019] [Accepted: 02/07/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND CONTEXT Breastfeeding peer support is valued by women, but UK trials have not demonstrated efficacy. The ABA feasibility trial offered proactive peer support underpinned by behaviour change theory and an assets-based approach to women having their first baby, regardless of feeding intention. This paper explores women's and infant feeding helpers' (IFHs) views of the different components of the ABA intervention. SETTING AND PARTICIPANTS Trained IFHs offered 50 women an antenatal meeting to discuss infant feeding and identify community assets in two English sites-one with a paid peer support service and the other volunteer-led. Postnatally, daily contact was offered for the first 2 weeks, followed by less frequent contact until 5 months. METHODS Interviews with 21 women and focus groups/interviews with 13 IFHs were analysed using thematic and framework methods. RESULTS Five themes are reported highlighting that women talked positively about the antenatal meeting, mapping their network of support, receiving proactive contact from their IFH, keeping in touch using text messaging and access to local groups. The face-to-face antenatal visit facilitated regular text-based communication both in pregnancy and in the early weeks after birth. Volunteer IFHs were supportive of and enthusiastic about the intervention, whereas some of the paid IFHs disliked some intervention components and struggled with the distances to travel to participants. CONCLUSIONS This proactive community assets-based approach with a woman-centred focus was acceptable to women and IFHs and is a promising intervention warranting further research as to its effect on infant feeding outcomes.
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Affiliation(s)
- Jenny Ingram
- Centre for Academic Child HealthUniversity of BristolBristolUK
| | - Gill Thomson
- Maternal and Infant Nutrition and Nurture Unit (MAINN)University of Central LancashirePrestonUK
| | - Debbie Johnson
- Centre for Academic Child HealthUniversity of BristolBristolUK
| | - Joanne L. Clarke
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Heather Trickey
- DECIPHERDepartment of Social MedicineCardiff UniversityCardiffUK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research UnitUniversity of StirlingStirlingUK
| | - Stephan U. Dombrowski
- Faculty of KinesiologyUniversity of New BrunswickFrederictonNBCanada
- Division of PsychologyUniversity of StirlingStirlingUK
| | - Kate Jolly
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
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20
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Skinner R, Gonet V, Currie S, Hoddinott P, Dombrowski SU. A systematic review with meta-analyses of text message-delivered behaviour change interventions for weight loss and weight loss maintenance. Obes Rev 2020; 21:e12999. [PMID: 32043809 DOI: 10.1111/obr.12999] [Citation(s) in RCA: 11] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/05/2019] [Accepted: 12/20/2019] [Indexed: 12/11/2022]
Abstract
Short Message Service (SMS)-delivered behaviour change interventions are frequently used to support weight management. This systematic review examines the effectiveness of SMS-delivered behaviour change interventions for weight management. Electronic databases were searched for randomised controlled trials (RCTs) comparing SMS-delivered adult weight management interventions to control groups, published between 1990 and 2018. Weight change was examined using random effects meta-analyses at intervention cessation and postintervention follow-up. Subgroup analyses examined intervention duration, SMS frequency, theory use, SMS interactivity, and SMS tailoring. Fifteen studies met inclusion criteria (2705 participants). For weight loss interventions (n = 12, 1977 participants), the mean difference in weight change was -2.28 kg (95% confidence interval [CI] -3.17 to -1.36 kg). No studies reported postintervention follow-up. For weight loss maintenance interventions (n = 3, 728 participants), the mean difference in weight change was -0.68 kg (95% CI, -1.31 to -0.05 kg), and postintervention follow-up (n = 2, 498 participants) effects were -0.57 kg (95% CI, -1.67 to 0.53 kg). No subgroup differences were found. SMS-delivered behaviour change interventions for weight loss led to significant small to moderate weight loss and weight loss maintenance compared with control groups. Evidence on long-term effects is limited. SMS-delivered behaviour change interventions are a potentially effective and scalable intervention option for obesity treatment.
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Affiliation(s)
- Rebecca Skinner
- Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Veronica Gonet
- Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Sinéad Currie
- Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Pat Hoddinott
- Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
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21
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Duncan E, O'Cathain A, Rousseau N, Croot L, Sworn K, Turner KM, Yardley L, Hoddinott P. Guidance for reporting intervention development studies in health research (GUIDED): an evidence-based consensus study. BMJ Open 2020; 10:e033516. [PMID: 32273313 PMCID: PMC7245409 DOI: 10.1136/bmjopen-2019-033516] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [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] [Received: 08/08/2019] [Revised: 01/10/2020] [Accepted: 02/19/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To improve the quality and consistency of intervention development reporting in health research. DESIGN This was a consensus exercise consisting of two simultaneous and identical three-round e-Delphi studies (one with experts in intervention development and one with wider stakeholders including funders, journal editors and public involvement members), followed by a consensus workshop. Delphi items were systematically derived from two preceding systematic reviews and a qualitative interview study. PARTICIPANTS Intervention developers (n=26) and wider stakeholders (n=18) from the UK, North America and Europe participated in separate e-Delphi studies. Intervention developers (n=13) and wider stakeholders (n=13) participated in a 1-day consensus workshop. RESULTS e-Delphi participants achieved consensus on 15 reporting items. Following feedback from the consensus meeting, the final inclusion and wording of 14 items with description and explanations for each item were agreed. Items focus on context, purpose, target population, approaches, evidence, theory, guiding principles, stakeholder contribution, changes in content or format during the development process, required changes for subgroups, continuing uncertainties, and open access publication. They form the GUIDED (GUIDance for the rEporting of intervention Development) checklist, which contains a description and explanation of each item, alongside examples of good reporting. CONCLUSIONS Consensus-based reporting guidance for intervention development in health research is now available for publishers and researchers to use. GUIDED has the potential to lead to greater transparency, and enhance quality and improve learning about intervention development research and practice.
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Affiliation(s)
- Edward Duncan
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
| | - Alicia O'Cathain
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Nikki Rousseau
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
- Leeds Institute of Clinical Trials, School of Medicine, University of Leeds, Leeds, UK
| | - Liz Croot
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Katie Sworn
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Lucy Yardley
- Psychology, University of Southampton, Southampton, UK
- School of Health Sciences, University of Bristol, Bristol, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
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22
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Clarke JL, Ingram J, Johnson D, Thomson G, Trickey H, Dombrowski SU, Sitch A, Dykes F, Feltham MG, MacArthur C, Roberts T, Hoddinott P, Jolly K. An assets-based intervention before and after birth to improve breastfeeding initiation and continuation: the ABA feasibility RCT. Public Health Res 2020. [DOI: 10.3310/phr08070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The UK has low levels of breastfeeding initiation and continuation, with evident socioeconomic disparities. To be inclusive, peer-support interventions should be woman-centred rather than breastfeeding-centred. Assets-based approaches to public health focus on the positive capabilities of individuals and communities, rather than their deficits and problems. The Assets-based feeding help Before and After birth (ABA) intervention offers an assets-based approach based on behaviour change theory.
Objective
To investigate the feasibility of delivering the ABA infant feeding intervention in a randomised controlled trial.
Design
This was an individually randomised controlled feasibility trial; women were randomised in a 1 : 1 ratio to either the intervention group or the comparator (usual care) group.
Setting
Two separate English sites were selected because they had an existing breastfeeding peer support service, relatively high levels of socioeconomic disadvantage and low rates of breastfeeding.
Participants
Women aged ≥ 16 years who were pregnant with their first child, irrespective of feeding intention (n = 103), were recruited by researchers in antenatal clinics.
Interventions
Proactive, woman-centred support, using an assets-based approach and including behaviour change techniques, was provided by an infant-feeding helper (a breastfeeding peer supporter trained in the ABA intervention) and delivered through face-to-face contact, telephone conversations and text messages. The intervention commenced at around 30 weeks’ gestation and could continue until 5 months postnatally.
Main outcome measures
The main outcome measures were feasibility of intervention delivery with the requisite intensity and duration; acceptability to women, infant-feeding helpers and maternity services; and feasibility of a future randomised controlled trial. Outcomes included recruitment rates and follow-up rates at 3 days, 8 weeks and 6 months postnatally, and outcomes for a future full trial were collected via participant questionnaires. A mixed-methods process evaluation included qualitative interviews with women, infant-feeding helpers and maternity services; infant-feeding helper logs; and audio-recordings of antenatal contacts to check intervention fidelity.
Results
Of the 135 eligible women approached, 103 (76.3%) agreed to participate. The study was successful in recruiting teenagers (8.7%) and women living in areas of socioeconomic disadvantage (37.3% resided in the most deprived 40% of small areas in England). Postnatal follow-up rates were 68.0%, 85.4% and 80.6% at 3 days, 8 weeks and 6 months, respectively. Feeding status at 8 weeks was obtained for 95.1% of participants. Recruitment took place from February 2017 until August 2017. It was possible to recruit and train existing peer supporters to the infant-feeding helper role. The intervention was delivered to most women with relatively high fidelity. Among the 50 women in the intervention group, 39 received antenatal visits and 40 received postnatal support. Qualitative data showed that the intervention was acceptable. There was no evidence of intervention-related harms.
Limitations
Birth notification delays resulted in delays in the collection of postnatal feeding status data and in the offer of postnatal support. In addition, the intervention needs to better consider all infant-feeding types and did not adequately accommodate women who delivered prematurely.
Conclusion
It is feasible to deliver the intervention and trial.
Future work
The intervention should be tested in a fully powered randomised controlled trial.
Trial registration
Current Controlled Trials ISRCTN14760978.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Joanne L Clarke
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jenny Ingram
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Debbie Johnson
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Gill Thomson
- Maternal and Infant Nutrition and Nurture Unit (MAINN), University of Central Lancashire, Preston, UK
| | - Heather Trickey
- Development and Evaluation of Complex Public Health Interventions (DECIPHeR), Department of Social Medicine, Cardiff University, Cardiff, UK
| | - Stephan U Dombrowski
- Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada
- Department of Psychology, University of Stirling, Stirling, UK
| | - Alice Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Fiona Dykes
- Maternal and Infant Nutrition and Nurture Unit (MAINN), University of Central Lancashire, Preston, UK
| | - Max G Feltham
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Christine MacArthur
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tracy Roberts
- Health Economic Unit, University of Birmingham, Birmingham, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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23
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McGirr C, Rooney C, Gallagher D, Dombrowski SU, Anderson AS, Cardwell CR, Free C, Hoddinott P, Holmes VA, McIntosh E, Somers C, Woodside JV, Young IS, Kee F, McKinley MC. Text messaging to help women with overweight or obesity lose weight after childbirth: the intervention adaptation and SMS feasibility RCT. Public Health Res 2020. [DOI: 10.3310/phr08040] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background
There is a need to develop weight management interventions that fit seamlessly into the busy lives of women during the postpartum period.
Objective
The objective was to develop and pilot-test an evidence- and theory-based intervention, delivered by short message service, which supported weight loss and weight loss maintenance in the postpartum period.
Design
Stage 1 involved the development of a library of short message service messages to support weight loss and weight loss maintenance, with personal and public involvement, focusing on diet and physical activity with embedded behaviour change techniques, and the programming of a short message service platform to allow fully automated intervention delivery. Stage 2 comprised a 12-month, single-centre, two-arm, pilot, randomised controlled trial with an active control.
Setting
This study was set in Northern Ireland; women were recruited via community-based approaches.
Participants
A total of 100 women with overweight or obesity who had given birth in the previous 24 months were recruited.
Interventions
The intervention group received an automated short message service intervention about weight loss and weight loss maintenance for 12 months. The active control group received automated short message service messages about child health and development for 12 months.
Main outcome measures
The main outcomes measured were the feasibility of recruitment and retention, acceptability of the intervention and trial procedures, and evidence of positive indicative effects on weight. Weight, waist circumference and blood pressure were measured by the researchers; participants completed a questionnaire booklet and wore a sealed pedometer for 7 days at baseline, 3, 6, 9 and 12 months. Outcome assessments were collected during home visits and women received a voucher on completion of each of the assessments. Qualitative interviews were conducted with women at 3 and 12 months, to gather feedback on the intervention and active control and the study procedures. Quantitative and qualitative data were used to inform the process evaluation and to assess fidelity, acceptability, dose, reach, recruitment, retention, contamination and context.
Results
The recruitment target of 100 participants was achieved (intervention, n = 51; control, n = 49); the mean age was 32.5 years (standard deviation 4.3 years); 28 (28%) participants had a household income of < £29,999 per annum. Fifteen women became pregnant during the follow-up (intervention, n = 9; control, n = 6) and withdrew from the study for this reason. At the end of the 12-month study, the majority of women remained in the study [85.7% (36/42) in the intervention group and 90.7% (39/43) in the active control group]. The research procedures were well accepted by women. Both groups indicated a high level of satisfaction with the short message service intervention that they were receiving. There was evidence to suggest that the intervention may have a positive effect on weight loss and prevention of weight gain during the postpartum period.
Limitations
The interviews at 3 and 12 months were conducted by the same researchers who collected other outcome data.
Conclusions
An evidence- and theory-based intervention delivered by short message service was successfully developed in conjunction with postpartum women with overweight and obesity. The intervention was acceptable to women and was feasible to implement in the 12-month pilot randomised controlled trial. The progression criteria for a full randomised controlled trial to examine effectiveness and cost-effectiveness were met.
Future work
Some minor refinements need to be made to the intervention and trial procedures based on the findings of the pilot trial in preparation for conducting a full randomised controlled trial.
Trial registration
Current Controlled Trial ISRCTN90393571.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 4. See the NIHR Journals Library website for further project information. The intervention costs were provided by the Public Health Agency, Northern Ireland.
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Affiliation(s)
- Caroline McGirr
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Ciara Rooney
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Dunla Gallagher
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | | | - Annie S Anderson
- Centre for Research into Cancer Prevention and Screening, Cancer Division, Medical Research Institute, Ninewells Medical School, Dundee, UK
| | - Christopher R Cardwell
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Caroline Free
- Clinical Trials Unit, Department for Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Valerie A Holmes
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Camilla Somers
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jayne V Woodside
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Ian S Young
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Frank Kee
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Michelle C McKinley
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
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Dombrowski SU, McDonald M, van der Pol M, Grindle M, Avenell A, Carroll P, Calveley E, Elders A, Glennie N, Gray CM, Harris FM, Hapca A, Jones C, Kee F, McKinley MC, Skinner R, Tod M, Hoddinott P. Game of Stones: feasibility randomised controlled trial of how to engage men with obesity in text message and incentive interventions for weight loss. BMJ Open 2020; 10:e032653. [PMID: 32102807 PMCID: PMC7045214 DOI: 10.1136/bmjopen-2019-032653] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Received: 07/02/2019] [Revised: 12/06/2019] [Accepted: 01/08/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To examine the acceptability and feasibility of narrative text messages with or without financial incentives to support weight loss for men. DESIGN Individually randomised three-arm feasibility trial with 12 months' follow-up. SETTING Two sites in Scotland with high levels of disadvantage according to Scottish Index for Multiple Deprivation (SIMD). PARTICIPANTS Men with obesity (n=105) recruited through community outreach and general practitioner registers. INTERVENTIONS Participants randomised to: (A) narrative text messages plus financial incentive for 12 months (short message service (SMS)+I), (B) narrative text messages for 12 months (SMS only), or (C) waiting list control. OUTCOMES Acceptability and feasibility of recruitment, retention, intervention components and trial procedures assessed by analysing quantitative and qualitative data at 3, 6 and 12 months. RESULTS 105 men were recruited, 60% from more disadvantaged areas (SIMD quintiles 1 or 2). Retention at 12 months was 74%. Fewer SMS+I participants (64%) completed 12-month assessments compared with SMS only (79%) and control (83%). Narrative texts were acceptable to many men, but some reported negative reactions. No evidence emerged that level of disadvantage was related to acceptability of narrative texts. Eleven SMS+I participants (31%) successfully met or partially met weight loss targets. The cost of the incentive per participant was £81.94 (95% CI £34.59 to £129.30). Incentives were acceptable, but improving health was reported as the key motivator for weight loss. All groups lost weight (SMS+I: -2.51 kg (SD=4.94); SMS only: -1.29 kg (SD=5.03); control: -0.86 kg (SD=5.64) at 12 months). CONCLUSIONS This three-arm weight management feasibility trial recruited and retained men from across the socioeconomic spectrum, with the majority from areas of disadvantage, was broadly acceptable to most participants and feasible to deliver. TRIAL REGISTRATION NUMBER NCT03040518.
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Affiliation(s)
- Stephan U Dombrowski
- Department of Kinesiology, University of New Brunswick Fredericton, Fredericton, New Brunswick, Canada
- Division of Psychology, University of Stirling, Stirling, UK
| | - Matthew McDonald
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
| | | | - Mark Grindle
- Institute for Health Research and Innovation, University of the Highlands and Islands, Inverness, Highland, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Eileen Calveley
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Nicola Glennie
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
| | - Cindy M Gray
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Fiona M Harris
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
| | - Adrian Hapca
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Claire Jones
- Health Informatics Centre, University of Dundee, Dundee, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Rebecca Skinner
- Division of Psychology, University of Stirling, Stirling, UK
| | | | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
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Sinclair L, McFadden M, Tilbrook H, Mitchell A, Keding A, Watson J, Bauld L, Kee F, Torgerson D, Hewitt C, McKell J, Hoddinott P, Harris FM, Uny I, Boyd K, McMeekin N, Ussher M, Tappin DM. The smoking cessation in pregnancy incentives trial (CPIT): study protocol for a phase III randomised controlled trial. Trials 2020; 21:183. [PMID: 32059684 PMCID: PMC7023794 DOI: 10.1186/s13063-019-4042-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/30/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Eighty per cent of UK women have at least one baby, making pregnancy an opportunity to help women stop smoking before their health is irreparably compromised. Smoking cessation during pregnancy helps protect infants from miscarriage, still birth, low birth weight, asthma, attention deficit disorder and adult cardiovascular disease. UK national guidelines highlight lack of evidence for effectiveness of financial incentives to help pregnant smokers quit. This includes a research recommendation: within a UK context, are incentives an acceptable, effective and cost-effective way to help pregnant women who smoke to quit? METHODS The Cessation in Pregnancy Incentives Trial (CPIT) III is a pragmatic, 42-month, multi-centre, parallel-group, individually randomised controlled superiority trial of the effect on smoking status of adding to usual Stop Smoking Services (SSS) support, the offer of up to £400 of financial voucher incentives, compared with usual support alone, to quit smoking during pregnancy. Participants (n = 940) are pregnant smokers (age > 16 years, < 24 weeks pregnant, English speaking), who consent via telephone to take part and are willing to be followed-up in late pregnancy and 6 months after birth. The primary outcome is cotinine/anabasine-validated abstinence from smoking in late pregnancy. Secondary outcomes include engagement with SSS, quit rates at 4 weeks from agreed quit date and 6 months after birth, and birth weight. Outcomes will be analysed by intention to treat, and regression models will be used to compare treatment effects on outcomes. A meta-analysis will include data from the feasibility study in Glasgow. An economic evaluation will assess cost-effectiveness from a UK NHS perspective. Process evaluation using a case-study approach will identify opportunities to improve recruitment and learning for future implementation. Research questions include: what is the therapeutic efficacy of incentives; are incentives cost-effective; and what are the potential facilitators and barriers to implementing incentives in different parts of the UK? DISCUSSION This phase III trial in Scotland, England and Northern Ireland follows a successful phase II trial in Glasgow, UK. The participating sites have diverse SSS that represent most cessation services in the UK and serve demographically varied populations. If found to be acceptable and cost-effective, this trial could demonstrate that financial incentives are effective and transferable to most UK SSS for pregnant women. TRIAL REGISTRATION Current Controlled Trials, ISRCTN15236311. Registered on 9 October 2017.
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Affiliation(s)
- Lesley Sinclair
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Margaret McFadden
- Clinical R&D, Dykebar Hospital, Grahamstone Road, Paisley, PA2 7DE UK
| | - Helen Tilbrook
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Alcuin Research Resource Centre, Heslington, York, YO10 5DD UK
| | - Alex Mitchell
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Alcuin Research Resource Centre, Heslington, York, YO10 5DD UK
| | - Ada Keding
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Alcuin Research Resource Centre, Heslington, York, YO10 5DD UK
| | - Judith Watson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Alcuin Research Resource Centre, Heslington, York, YO10 5DD UK
| | - Linda Bauld
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Frank Kee
- Centre of Excellence for Public Health, Queen’s University Belfast, University Road, Belfast, BT7 1NN UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Alcuin Research Resource Centre, Heslington, York, YO10 5DD UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Alcuin Research Resource Centre, Heslington, York, YO10 5DD UK
| | - Jennifer McKell
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA UK
| | - Pat Hoddinott
- NMAHP Research Unit, University of Stirling, Stirling, FK9 4LA UK
| | - Fiona M. Harris
- NMAHP Research Unit, University of Stirling, Stirling, FK9 4LA UK
| | - Isabelle Uny
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA UK
| | - Kathleen Boyd
- Health Economics & Health Technology Assessment, Institute of Health & Wellbeing, 1 Lilybank Gardens, University of Glasgow, Glasgow, G12 8RZ UK
| | - Nicola McMeekin
- Health Economics & Health Technology Assessment, Institute of Health & Wellbeing, 1 Lilybank Gardens, University of Glasgow, Glasgow, G12 8RZ UK
| | - Michael Ussher
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA UK
- Population Health Research Institute, St George’s, University of London, Cranmer Terrace, London, SW17 0RE UK
| | - David M. Tappin
- Scottish Cot Death Trust, West Glasgow Ambulatory Care Hospital, Glasgow University, 5th Floor, Glasgow, G3 8SJ UK
| | - for the CPIT III local research teams
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
- Clinical R&D, Dykebar Hospital, Grahamstone Road, Paisley, PA2 7DE UK
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Alcuin Research Resource Centre, Heslington, York, YO10 5DD UK
- Centre of Excellence for Public Health, Queen’s University Belfast, University Road, Belfast, BT7 1NN UK
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA UK
- NMAHP Research Unit, University of Stirling, Stirling, FK9 4LA UK
- Health Economics & Health Technology Assessment, Institute of Health & Wellbeing, 1 Lilybank Gardens, University of Glasgow, Glasgow, G12 8RZ UK
- Population Health Research Institute, St George’s, University of London, Cranmer Terrace, London, SW17 0RE UK
- Scottish Cot Death Trust, West Glasgow Ambulatory Care Hospital, Glasgow University, 5th Floor, Glasgow, G3 8SJ UK
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Clarke JL, Ingram J, Johnson D, Thomson G, Trickey H, Dombrowski SU, Sitch A, Dykes F, Feltham M, MacArthur C, Roberts T, Hoddinott P, Jolly K. The ABA intervention for improving breastfeeding initiation and continuation: Feasibility study results. Matern Child Nutr 2019; 16:e12907. [PMID: 31793233 PMCID: PMC7038877 DOI: 10.1111/mcn.12907] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 09/09/2019] [Accepted: 09/30/2019] [Indexed: 11/30/2022]
Abstract
The UK has low breastfeeding rates, with socioeconomic disparities. The Assets-based feeding help Before and After birth (ABA) intervention was designed to be inclusive and improve infant feeding behaviours. ABA is underpinned by the behaviour change wheel and offers an assets-based approach focusing on positive capabilities of individuals and communities, including use of a Genogram. This study aimed to investigate feasibility of intervention delivery within a randomised controlled trial (RCT). Nulliparous women ≥16 years, (n = 103) from two English sites were recruited and randomised to either intervention or usual care. The intervention - delivered through face-to-face, telephone and text message by trained Infant Feeding Helpers (IFHs) - ran from 30-weeks' gestation until 5-months postnatal. Outcomes included recruitment rates and follow-up at 3-days, 8-weeks and 6-months postnatal, with collection of future full trial outcomes via questionnaires. A mixed-methods process evaluation included qualitative interviews with 30 women, 13 IFHs and 17 maternity providers; IFH contact logs; and fidelity checking of antenatal contact recordings. This study successfully recruited women, including teenagers, from socioeconomically disadvantaged areas; postnatal follow-up rates were 68.0%, 85.4% and 80.6% at 3-days, 8-weeks and 6-months respectively. Breastfeeding at 8-weeks was obtained for 95.1% using routine data for non-responders. It was possible to recruit and train peer supporters to deliver the intervention with adequate fidelity. The ABA intervention was acceptable to women, IFHs and maternity services. There was minimal contamination and no evidence of intervention-related harm. In conclusion, the intervention is feasible to deliver within an RCT, and a definitive trial required.
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Affiliation(s)
- Joanne L Clarke
- Institute of Applied Health Research, University of Birmingham, UK
| | - Jenny Ingram
- Centre for Academic Child Health, University of Bristol, UK
| | - Debbie Johnson
- Centre for Academic Child Health, University of Bristol, UK
| | - Gill Thomson
- Maternal and Infant Nutrition and Nurture Unit (MAINN), University of Central Lancashire, UK
| | - Heather Trickey
- DECIPHER, Department of Social Medicine, Cardiff University, UK
| | - Stephan U Dombrowski
- Faculty of Kinesiology, University of New Brunswick, Canada.,Division of Psychology, University of Stirling, UK
| | - Alice Sitch
- Institute of Applied Health Research, University of Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, UK
| | - Fiona Dykes
- Maternal and Infant Nutrition and Nurture Unit (MAINN), University of Central Lancashire, UK
| | - Max Feltham
- Birmingham Clinical Trials Unit, University of Birmingham, UK
| | | | | | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, UK
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Croot L, O'Cathain A, Sworn K, Yardley L, Turner K, Duncan E, Hoddinott P. Developing interventions to improve health: a systematic mapping review of international practice between 2015 and 2016. Pilot Feasibility Stud 2019; 5:127. [PMID: 31720005 PMCID: PMC6839208 DOI: 10.1186/s40814-019-0512-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 05/09/2019] [Accepted: 10/15/2019] [Indexed: 12/18/2022] Open
Abstract
Background Researchers publish the processes they use to develop interventions to improve health. Reflecting on this endeavour may help future developers to improve their practice. Methods Our aim was to collate, describe, and analyse the actions developers take when developing complex interventions to improve health. We carried out a systematic mapping review of empirical research studies that report the development of complex interventions to improve health. A search was undertaken of five databases over 2015–2016 using the term ‘intervention dev*’. Eighty-seven journal articles reporting the process of intervention development were identified. A purposive subset of 30 articles, using a range of published approaches to developing interventions, was selected for in-depth analysis using principles of realist synthesis to identify the actions of intervention development and rationales underpinning those actions. Results The 87 articles were from the USA (39/87), the UK (32/87), continental Europe (6/87), and the rest of the world (10/87). These mainly took a pragmatic self-selected approach (n = 43); a theory- and evidence-based approach, e.g. Intervention Mapping, Behaviour Change Wheel (n = 22); or a partnership approach, e.g. community-based participatory research, co-design (n = 10). Ten actions of intervention development were identified from the subset of 30 articles, including identifying a need for an intervention, selecting the intervention development approach to follow, considering the needs of the target population, reviewing published evidence, involving stakeholders, drawing or generating theory, and designing and refining the intervention. Rationales for these actions were that they would produce more engaging, acceptable, feasible, and effective interventions. Conclusions Developers take a variety of approaches to the international endeavour of complex intervention development. We have identified and described a set of actions taken within this endeavour regardless of whether developers follow a published approach or not. Future developers can use these actions and the rationales that underpin them to help them make decisions about the process of intervention development. Trial registration PROSPERO, CRD42017080545.
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Affiliation(s)
- Liz Croot
- 1Medical Care Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Alicia O'Cathain
- 1Medical Care Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Katie Sworn
- 1Medical Care Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Lucy Yardley
- 2Population Health Sciences, University of Bristol, Bristol, UK
| | - Katrina Turner
- 2Population Health Sciences, University of Bristol, Bristol, UK
| | - Edward Duncan
- 3NMAHP Research Unit, University of Stirling, Stirling, UK
| | - Pat Hoddinott
- 3NMAHP Research Unit, University of Stirling, Stirling, UK
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28
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Rousseau N, Turner KM, Duncan E, O’Cathain A, Croot L, Yardley L, Hoddinott P. Attending to design when developing complex health interventions: A qualitative interview study with intervention developers and associated stakeholders. PLoS One 2019; 14:e0223615. [PMID: 31613913 PMCID: PMC6793869 DOI: 10.1371/journal.pone.0223615] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 06/28/2019] [Accepted: 09/24/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Guidance and frameworks exist to assist those developing health interventions but may offer limited discussion of 'design', the part of development concerned with generating ideas for and making decisions about an intervention's content, format and delivery. The aim of this paper is to describe and understand the views and experiences of developers and associated stakeholders in relation to how design occurs in health intervention development. METHODS Semi-structured interviews were conducted with 21 people who had developed complex interventions to improve health and/or who were relevant stakeholders (e.g. funders and publishers of intervention development work), regarding their views, experiences and approaches to intervention design. Sampling was purposive in terms of maximising diversity. A thematic inductive analysis was conducted. RESULTS Approaches to design varied substantially between intervention developers. This contrasted with consistency in other activities undertaken during development, such as literature review. Design also posed more challenges than other parts of development. We identified six 'modes' of design: informed; negotiated; structured; delegated; 'my baby'; and creative partnership. In understanding the differences between these different modes, and the challenges posed by intervention design, we identified three key themes: enabling creativity during the design process; working with different types of knowledge; and 'stabilising' (developing clear shared understandings of) the intervention development to enable design. CONCLUSIONS Design has received less attention than other activities undertaken when developing interventions to improve health. Developers take a variety of approaches to design and often find it challenging. Guidance for intervention development in health has tended to see design as proceeding in a predictable and controlled manner from acquired knowledge. Our study suggests that design rarely reflects this rational ideal. Future guidance on intervention development in healthcare should support developers to work effectively with different types of knowledge, to help design progress more smoothly and to maximise creativity.
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Affiliation(s)
- Nikki Rousseau
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP-RU), University of Stirling, Stirling, United Kingdom
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom
| | - Katrina M. Turner
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Edward Duncan
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP-RU), University of Stirling, Stirling, United Kingdom
| | - Alicia O’Cathain
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Liz Croot
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP-RU), University of Stirling, Stirling, United Kingdom
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Abstract
OBJECTIVE To provide researchers with guidance on actions to take during intervention development. SUMMARY OF KEY POINTS Based on a consensus exercise informed by reviews and qualitative interviews, we present key principles and actions for consideration when developing interventions to improve health. These include seeing intervention development as a dynamic iterative process, involving stakeholders, reviewing published research evidence, drawing on existing theories, articulating programme theory, undertaking primary data collection, understanding context, paying attention to future implementation in the real world and designing and refining an intervention using iterative cycles of development with stakeholder input throughout. CONCLUSION Researchers should consider each action by addressing its relevance to a specific intervention in a specific context, both at the start and throughout the development process.
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Affiliation(s)
- Alicia O'Cathain
- Medical Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Liz Croot
- Medical Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Edward Duncan
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
| | - Nikki Rousseau
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
| | - Katie Sworn
- Medical Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Katrina M Turner
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Lucy Yardley
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Psychology, University of Southampton, Southampton, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
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France E, Hoskins G, Hoddinott P, Hagen S, Williams B, Main E, Treweek S, Glasscoe C, Dhouieb E, Cunningham S, Semple K. P357 A before-and-after feasibility study of an intervention to increase chest physiotherapy adherence among young children with cystic fibrosis. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30649-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Evans RE, Craig P, Hoddinott P, Littlecott H, Moore L, Murphy S, O'Cathain A, Pfadenhauer L, Rehfuess E, Segrott J, Moore G. When and how do 'effective' interventions need to be adapted and/or re-evaluated in new contexts? The need for guidance. J Epidemiol Community Health 2019; 73:481-482. [PMID: 30787038 PMCID: PMC6581090 DOI: 10.1136/jech-2018-210840] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Rhiannon E Evans
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU), University of Stirling, Stirling, UK
| | - Hannah Littlecott
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Laurence Moore
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Simon Murphy
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Alicia O'Cathain
- Medical Care Research Unit, School of Health and Related Research (SHARR), University of Sheffield, Sheffield, UK
| | - Lisa Pfadenhauer
- Institute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - Eva Rehfuess
- Institute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - Jeremy Segrott
- DECIPHer, Centre for Trials Research (CTU), Cardiff University, Cardiff, UK
| | - Graham Moore
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
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Turner KM, Rousseau N, Croot L, Duncan E, Yardley L, O’Cathain A, Hoddinott P. Understanding successful development of complex health and healthcare interventions and its drivers from the perspective of developers and wider stakeholders: an international qualitative interview study. BMJ Open 2019; 9:e028756. [PMID: 31152042 PMCID: PMC6549621 DOI: 10.1136/bmjopen-2018-028756] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 11/22/2022] Open
Abstract
OBJECTIVE Identify how individuals involved in developing complex health and healthcare interventions (developers), and wider stakeholders in the endeavour, such as funders, define successful intervention development and what factors influence how interventions are developed. DESIGN In-depth interviews with developers and wider stakeholders to explore their views and experiences of developing complex health and healthcare interventions. SETTING Interviews conducted with individuals in the UK, Europe and North America. PARTICIPANTS Twenty-one individuals were interviewed: 15 developers and 6 wider stakeholders. Seventeen participants were UK based. RESULTS Most participants defined successful intervention development as a process that resulted in effective interventions that were relevant, acceptable and could be implemented in real-world contexts. Accounts also indicated that participants aimed to develop interventions that end users wanted, and to undertake a development process that was methodologically rigorous and provided research evidence for journal publications and future grant applications. Participants' ambitions to develop interventions that had real-world impact drove them to consider the intervention's feasibility and long-term sustainability early in the development process. However, this process was also driven by other factors: the realities of resource-limited health contexts; prespecified research funder priorities; a reluctance to deviate from grant application protocols to incorporate evidence and knowledge acquired during the development process; limited funding to develop interventions and the need for future randomised controlled trials (RCTs) to prove effectiveness. Participants expressed concern that these drivers discouraged long-term thinking and the development of innovative interventions, and prioritised evaluation over development and future implementation. CONCLUSIONS Tensions exist between developers' goal of developing interventions that improve health in the real world, current funding structures, the limited resources within healthcare contexts, and the dominance of the RCT for evaluation of these interventions. There is a need to review funding processes and expectations of gold standard evaluation.
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Affiliation(s)
| | - Nikki Rousseau
- Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Liz Croot
- MCRU, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Lucy Yardley
- Psychology, University of Southampton, Southampton, UK
- School of Health Sciences, University of Bristol, Bristol, UK
| | - Alicia O’Cathain
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
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McInnes RJ, Gillespie N, Crossland N, Hall Moran V, Hoddinott P. Women's views about a free breast pump service: Online survey informing intervention development. Matern Child Nutr 2019; 15:e12745. [PMID: 30381867 PMCID: PMC7198920 DOI: 10.1111/mcn.12745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 03/27/2018] [Revised: 10/10/2018] [Accepted: 10/16/2018] [Indexed: 11/30/2022]
Abstract
Improving breastfeeding outcomes is a global priority; however, in the United Kingdom, continuation of breastfeeding remains low. Growing empirical evidence suggests a free breast pump service might be an acceptable and feasible incentive intervention to improve breastfeeding outcomes and reduce heath inequalities. To inform intervention development, we conducted an online survey with women recruited via social media using snowball sampling. Data were analysed descriptively (closed questions) with qualitative thematic analysis (free text). The survey was completed by 666 women, most of whom had recently breastfed and used a breast pump. Participants agreed that free pump hire (rental/loan; 567 women; 85.1%) or a free pump to keep (408; 61.3%) should be provided. Free text comments provided by 408 women (free pump) and 309 women (free hire) highlighted potential benefits: helping women to continue breastfeeding; express milk; overcome difficulties; and pump choice. Concerns are possible effect on breast milk supply, reduced breastfeeding, pumps replacing good support for breastfeeding, and pump hire hygiene. Personal and societal costs are important issues. Some suggested a pump service should be for low-income mothers, those with feeding difficulties or sick/preterm infants. A one-size service would not suit all and vouchers were proposed. Some suggested fees and deposits to prevent waste. To our knowledge, this is the first study reporting views about the acceptability of providing a free breast pump hire service. Mothers support and wish to have a say in breast pump service development. Future evaluations should address impact on feeding outcomes, professional support, hygiene for hired pumps, and costs.
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Affiliation(s)
- Rhona J. McInnes
- Associate Professor in Maternal Health & Consultant Midwife for NHS Lothian, School of Health and Social CareEdinburgh Napier University (ENU)EdinburghScotland
| | - Nicola Gillespie
- Research Midwife, Nursing Midwifery Allied Health Professions Research UnitGlasgow Caledonian UniversityGlasgowScotland
| | - Nicola Crossland
- Research Associate, Maternal and Infant Nutrition and Nurture Unit, College of Health and WellbeingUniversity of Central LancashirePrestonUK
| | - Victoria Hall Moran
- Associate Professor, Maternal and Infant Nutrition and Nurture Unit, College of Health and WellbeingUniversity of Central LancashirePrestonUK
| | - Pat Hoddinott
- Chair in Primary Care, Nursing Midwifery and Allied Health Professions Research UnitUniversity of StirlingStirlingUK
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O'Cathain A, Croot L, Sworn K, Duncan E, Rousseau N, Turner K, Yardley L, Hoddinott P. Taxonomy of approaches to developing interventions to improve health: a systematic methods overview. Pilot Feasibility Stud 2019; 5:41. [PMID: 30923626 PMCID: PMC6419435 DOI: 10.1186/s40814-019-0425-6] [Citation(s) in RCA: 160] [Impact Index Per Article: 32.0] [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: 09/24/2018] [Accepted: 02/24/2019] [Indexed: 12/04/2022] Open
Abstract
Background Interventions need to be developed prior to the feasibility and piloting phase of a study. There are a variety of published approaches to developing interventions, programmes or innovations to improve health. Identifying different types of approach, and synthesising the range of actions taken within this endeavour, can inform future intervention development. Methods This study is a systematic methods overview of approaches to intervention development. Approaches were considered for inclusion if they described how to develop or adapt an intervention in a book, website or journal article published after 2007, or were cited in a primary research study reporting the development of a specific intervention published in 2015 or 2016. Approaches were read, a taxonomy of approaches was developed and the range of actions taken across different approaches were synthesised. Results Eight categories of approach to intervention development were identified. (1) Partnership, where people who will use the intervention participate equally with the research team in decision-making about the intervention throughout the development process. (2) Target population-centred, where the intervention is based on the views and actions of the people who will use it. (3) Evidence and theory-based, where the intervention is based on published research evidence and existing theories. (4) Implementation-based, where the intervention is developed with attention to ensuring it will be used in the real world. (5) Efficiency-based, where components of an intervention are tested using experimental designs to select components which will optimise efficiency. (6) Stepped or phased, where interventions are developed with an emphasis on following a systematic set of processes. (7) Intervention-specific, where an approach is constructed for a specific type of intervention. (8) Combination, where existing approaches to intervention development are formally combined. The actions from approaches in all eight categories were synthesised to identify 18 actions to consider when developing interventions. Conclusions This overview of approaches to intervention development can help researchers to understand the variety of existing approaches, and to understand the range of possible actions involved in intervention development, prior to assessing feasibility or piloting the intervention. Findings from this overview will contribute to future guidance on intervention development. Trial registration PROSPERO CRD42017080553. Electronic supplementary material The online version of this article (10.1186/s40814-019-0425-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alicia O'Cathain
- 1Medical Care Research Unit, Health Services Research, School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Liz Croot
- 1Medical Care Research Unit, Health Services Research, School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Katie Sworn
- 1Medical Care Research Unit, Health Services Research, School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Edward Duncan
- 2NMAHP Research Unit, University of Stirling, Stirling, FK9 4NF UK
| | - Nikki Rousseau
- 2NMAHP Research Unit, University of Stirling, Stirling, FK9 4NF UK
| | - Katrina Turner
- Population Health Sciences, Canynge Hall, 39 Whatley Road, University of Bristol, Bristol, BS8 2PS UK
| | - Lucy Yardley
- Population Health Sciences, Canynge Hall, 39 Whatley Road, University of Bristol, Bristol, BS8 2PS UK
| | - Pat Hoddinott
- 2NMAHP Research Unit, University of Stirling, Stirling, FK9 4NF UK
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Newlands RSN, Ntessalen M, Clark J, Fielding S, Hoddinott P, Heys SD, McNeill G, Craig LCA. Pilot randomised controlled trial of Weight Watchers® referral with or without dietitian-led group support for weight loss in women treated for breast cancer: the BRIGHT (BReast cancer weIGHT loss) trial. Pilot Feasibility Stud 2019; 5:24. [PMID: 30805199 PMCID: PMC6373055 DOI: 10.1186/s40814-019-0405-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/17/2017] [Accepted: 01/24/2019] [Indexed: 12/24/2022] Open
Abstract
Background Being overweight or obese following breast cancer diagnosis can increase cancer recurrence and mortality, so effective interventions for weight loss in this group could enhance survival. A pilot randomised controlled trial was conducted to assess whether a weight loss programme comprising generic Weight Watchers® referral offered to women treated for breast cancer with or without additional breast cancer-tailored dietetic support is feasible and shows promise for improving weight and quality of life (QoL). Methods Participants were randomly allocated to 3 groups: Weight Watchers® referral (for 12 sessions of meetings and digital tools) plus 5 breast cancer-tailored dietitian-led group support sessions (WW Plus: n = 14), Weight Watchers® referral only (WW: n = 16) or control (Weight Watchers® referral after 3 months, n = 15). Feasibility was assessed based on retention rate, recruitment and randomisation process, meeting attendance, suitability of the setting and outcome measurement tools, unintended consequences, cost and observations of the dietetic sessions. Outcomes were measured at 0, 3 (‘trial exit’) and 12 months post intervention. Results The response rate to the invitation was 43% (140/327) of whom 58 were eligible and 45 (median age 61.0 years; body mass index 30.2 kg/m2) were randomised. Data from 38 (84%) and 30 (67%) participants were available at trial exit and 12 months respectively. Feasibility issues included slow recruitment process, lack of blinding throughout, weighing scales not measuring > 150 kg, lack of clear instructions for completing QoL questionnaire and workload and time pressures in delivering dietetic sessions. Participants had good attendance rate at group meetings and no serious unintended consequences were reported. WW Plus was most expensive to run. Mean (95% CI) weight change at trial exit was − 3.67 kg (− 5.67, − 2.07) in WW Plus, − 6.03 kg (− 7.61, − 4.44) in WW group and + 0.19 kg (− 1.45, + 1.83) in control group. About 40% of the WW Plus, 64% of the WW group and 56% of the control group lost ≥ 5% of their baseline weight by 12 months. All groups showed promise for improving QoL at trial exit but only the WW group maintained significant improvements from baseline at 12 months. Conclusions The trial procedures were feasible, with some modifications. This pilot trial indicates the benefits of providing free WW vouchers for weight loss maintenance and improving QoL but provided no evidence that including additional dietetic support would add any extra value. Further research with WW with long-term follow-up should be undertaken to assess weight loss sustainability and benefit on health outcomes in this patient group. Trial registration ISRCTN-29623418. Electronic supplementary material The online version of this article (10.1186/s40814-019-0405-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rumana S N Newlands
- 1Health Services Research Unit, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, 3rd floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Maria Ntessalen
- 1Health Services Research Unit, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, 3rd floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Julia Clark
- 2NHS Grampian Department of Nutrition and Dietetics, Aberdeen, UK
| | - Shona Fielding
- 3Medical Statistics Team, Institute of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Pat Hoddinott
- 4Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, FK9 4LA UK
| | - Steven D Heys
- 5School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD UK.,6NHS Grampian, Scotland, UK
| | - Geraldine McNeill
- 7Institute of Applied Health Sciences & The Rowett Institute, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Leone C A Craig
- 7Institute of Applied Health Sciences & The Rowett Institute, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD UK
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Whitford H, Hoddinott P, Amir LH, Chamberlain C, East CE, Jones L, Renfrew MJ. Routinely collected infant feeding data: Time for global action. Matern Child Nutr 2018; 14:e12616. [PMID: 29781212 PMCID: PMC6866076 DOI: 10.1111/mcn.12616] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/09/2018] [Accepted: 03/15/2018] [Indexed: 12/11/2022]
Abstract
The importance of breastfeeding is clear. However, global action to support breastfeeding is hindered by the lack of reliable standard data, which continues to impede progress. Routinely collected data can monitor the effectiveness of health policy, evaluate interventions, and enhance international research collaboration and comparisons. Use of routine data to support effective public health initiatives such as smoking cessation has been demonstrated. However, the data collected about infant feeding practices worldwide is inconsistent in timing, methods, definitions, detail, storage, and consistency. Improvements to the reach and quality of routinely collected data about infant feeding are needed to strengthen the global evidence and policy base. An international collaborative effort is called for to progress this.
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Affiliation(s)
- Heather Whitford
- Mother and Infant Research Unit, School of Nursing and Health SciencesUniversity of DundeeDundeeUK
| | - Pat Hoddinott
- Nursing Midwifery and Allied Health Professions Research UnitUniversity of StirlingStirlingUK
| | - Lisa H. Amir
- Judith Lumley CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | | | - Christine E. East
- School of Nursing and MidwiferyMonash University and Monash Women's Maternity ServicesClaytonVictoriaAustralia
| | - Leanne Jones
- Cochrane Pregnancy and Childbirth, Department of Women's and Children's HealthUniversity of Liverpool, Liverpool Women's NHS Foundation TrustLiverpoolUK
| | - Mary J. Renfrew
- Mother and Infant Research Unit, School of Nursing and Health SciencesUniversity of DundeeDundeeUK
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Hoddinott P, Pollock A, O'Cathain A, Boyer I, Taylor J, MacDonald C, Oliver S, Donovan JL. How to incorporate patient and public perspectives into the design and conduct of research. F1000Res 2018; 7:752. [PMID: 30364075 PMCID: PMC6192439 DOI: 10.12688/f1000research.15162.1] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [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] [Accepted: 06/08/2018] [Indexed: 11/25/2022] Open
Abstract
International government guidance recommends patient and public involvement (PPI) to improve the relevance and quality of research. PPI is defined as research being carried out 'with' or 'by' patients and members of the public rather than 'to', 'about' or 'for' them ( http://www.invo.org.uk/). Patient involvement is different from collecting data from patients as participants. Ethical considerations also differ. PPI is about patients actively contributing through discussion to decisions about research design, acceptability, relevance, conduct and governance from study conception to dissemination. Occasionally patients lead or do research. The research methods of PPI range from informal discussions to partnership research approaches such as action research, co-production and co-learning. This article discusses how researchers can involve patients when they are applying for research funding and considers some opportunities and pitfalls. It reviews research funder requirements, draws on the literature and our collective experiences as clinicians, patients, academics and members of UK funding panels.
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Affiliation(s)
- Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, UK
| | - Alex Pollock
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, G4 0BA, UK
| | - Alicia O'Cathain
- Medical Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Isabel Boyer
- PPI member of NIHR/HTA General Board, NIHR Evaluation, Trials and Studies Coordinating Centre, Southampton, SO16 7NS, UK
| | - Jane Taylor
- Chair of Patient Insight Group, Arthritis Research UK, Chesterfield, S41 7TD, UK
| | - Chris MacDonald
- Research Involvement Manager, Arthritis Research UK, Chesterfield, S41 7TD, UK
| | - Sandy Oliver
- Department of Social Science, Social Science Research Unit, UCL Institute of Education, University College London, London, WC1H 0AL, UK
| | - Jenny L. Donovan
- School of Social and Community Medicin, University of Bristol, Bristol, BS8 2PS, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8HW, UK
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38
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Berlin N, Goldzahl L, Bauld L, Hoddinott P, Berlin I. Public acceptability of financial incentives to reward pregnant smokers who quit smoking: a United Kingdom-France comparison. Eur J Health Econ 2018; 19:697-708. [PMID: 28646249 PMCID: PMC5948294 DOI: 10.1007/s10198-017-0914-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 02/19/2017] [Accepted: 06/06/2017] [Indexed: 08/15/2023]
Abstract
A substantial amount of research has been conducted on financial incentives to increase abstinence from smoking among pregnant smokers. If demonstrated to be effective, financial incentives could be proposed as part of health care interventions to help pregnant smokers quit. Public acceptability is important; as such interventions could be publicly funded. Concerns remain about the acceptability of these interventions in the general population. We aimed to assess the acceptability of financial incentives to reward pregnant smokers who stop smoking using a survey conducted in the UK and then subsequently in France, two developed countries with different cultural and social backgrounds. More French than British respondents agreed with financial incentives for rewarding quitting smoking during pregnancy, not smoking after delivery, keeping a smoke-free household, health service payment for meeting target and the maximum amount of the reward. However, fully adjusted models showed significant differences only for the two latter items. More British than French respondents were neutral toward financial incentives. Differences between the representative samples of French and British individuals demonstrate that implementation of financial incentive policies may not be transferable from one country to another.
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Affiliation(s)
- Noémi Berlin
- Department of Economics, European University Institute, Villa la Fonte, Via delle Fontanelle, 18, 50014 San Domenico Di Fiesole, Italy
| | | | - Linda Bauld
- UK Centre for Tobacco and Alcohol Studies and Institute for Social Marketing, University of Stirling, Stirling, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Ivan Berlin
- Department of Pharmacology, Hôpital Pitié-Salpetrière, Faculté de médecine-Université P. & M. Curie, INSERM U1018, Paris, France
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Ericson J, Eriksson M, Hoddinott P, Hellström-Westas L, Flacking R. Breastfeeding and risk for ceasing in mothers of preterm infants-Long-term follow-up. Matern Child Nutr 2018; 14:e12618. [PMID: 29733102 PMCID: PMC6175451 DOI: 10.1111/mcn.12618] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/12/2018] [Accepted: 03/15/2018] [Indexed: 12/04/2022]
Abstract
Breastfeeding is challenging for mothers of preterm infants. The aim of this paper is to describe risk factors for ceasing breastfeeding and methods of feeding until 12 months postnatal age in mothers who breastfed their preterm infants at discharge from neonatal intensive care units (NICUs). The data come from a randomised controlled trial, which evaluated the effectiveness on exclusive breastfeeding at 8 weeks of proactive telephone support compared with reactive support offered to mothers of preterm infants following discharge from NICU. Six NICUs across Sweden randomised a total of 493 mothers. We used regression and survival analyses to assess the risk factors for ceasing breastfeeding and the long‐term outcomes of the intervention. The results showed that 305 (64%) of the infants were breastfed at 6 months and 49 (21%) at 12 months. Partial breastfeeding at discharge, low maternal educational level, and longer length of stay in the NICU increased the risk for ceasing breastfeeding during the first 12 months. Furthermore, the Kaplan–Meier analysis showed that the proportion of mothers who ceased breastfeeding did not differ between the intervention (n = 231) and controls (n = 262) during the first 12 months (log‐rank test p = .68). No difference was found between groups on method of feeding. More than 85% of the infants were fed directly at the breast. These findings provide important insights for health professionals who are supporting mothers of preterm infants to breastfeed long term. Registered in http://www.clinicaltrials.gov (NCT01806480).
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Affiliation(s)
- Jenny Ericson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Centre for Clinical Research Dalarna, Falun, Sweden.,Department of Paediatrics, Falu Hospital, Falun, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professionals Research Unit, University of Stirling, Stirling, UK
| | | | - Renée Flacking
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Ericson J, Eriksson M, Hellström-Westas L, Hoddinott P, Flacking R. Proactive telephone support provided to breastfeeding mothers of preterm infants after discharge: a randomised controlled trial. Acta Paediatr 2018; 107:791-798. [PMID: 29405368 PMCID: PMC5947616 DOI: 10.1111/apa.14257] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 12/04/2017] [Accepted: 01/29/2018] [Indexed: 12/20/2022]
Abstract
Aim The aim was to evaluate the effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants after discharge from neonatal intensive care units (NICU). Methods Between March 2013 and December 2015, a randomised controlled trial was conducted at six NICUs across Sweden. At each NICU, a breastfeeding support team recruited, randomised and delivered the support to participating mothers. The intervention group received a daily proactive telephone call up to 14 days after discharge from the support team. The control group could initiate telephone contact themselves. Primary outcome was exclusive breastfeeding eight weeks after discharge. Secondary outcomes were maternal satisfaction with breastfeeding, attachment, quality of life and parental stress. Results In total, 493 mothers were randomised, 231 to intervention group and 262 to control group. There were no differences between the groups for exclusive breastfeeding, odds ratio 0.96, 95% CI 0.66–1.38, nor for maternal satisfaction with breastfeeding, attachment or quality of life. The intervention group reported significantly less parental stress than the controls, t = 2.44, 95% CI 0.03–0.23, effect size d = 0.26. Conclusion In this trial, proactive telephone support was not associated with increased exclusive breastfeeding prevalence eight weeks following discharge. However, intervention group mothers showed significantly lower parental stress.
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Affiliation(s)
- Jenny Ericson
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
- Centre for Clinical Research Dalarna; Falun Sweden
- Department of Paediatrics; Falu Hospital; Falun Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health; School of Health Sciences; Örebro University; Örebro Sweden
| | | | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professionals Research Unit; University of Stirling; Stirling UK
| | - Renée Flacking
- School of Education, Health and Social Studies; Dalarna University; Falun Sweden
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Jolly K, Ingram J, Clarke J, Johnson D, Trickey H, Thomson G, Dombrowski SU, Sitch A, Dykes F, Feltham MG, Darwent K, MacArthur C, Roberts T, Hoddinott P. Protocol for a feasibility trial for improving breast feeding initiation and continuation: assets-based infant feeding help before and after birth (ABA). BMJ Open 2018; 8:e019142. [PMID: 29362263 PMCID: PMC5786123 DOI: 10.1136/bmjopen-2017-019142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Received: 08/13/2017] [Accepted: 08/21/2017] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Breast feeding improves the health of mothers and infants; the UK has low rates, with marked socioeconomic inequalities. While trials of peer support services have been effective in some settings, UK trials have not improved breast feeding rates. Qualitative research suggests that many women are alienated by the focus on breast feeding. We propose a change from breast feeding-focused interactions to respecting a woman's feeding choices, inclusion of behaviour change theory and an increased intensity of contacts in the 2 weeks after birth when many women cease to breast feed. This will take place alongside an assets-based approach that focuses on the positive capability of individuals, their social networks and communities.We propose a feasibility study for a multicentre randomised controlled trial of the Assets feeding help Before and After birth (ABA) infant feeding service versus usual care. METHODS AND ANALYSIS A two-arm, non-blinded randomised feasibility study will be conducted in two UK localities. Women expecting their first baby will be eligible, regardless of feeding intention. The ABA infant feeding intervention will apply a proactive, assets-based, woman-centred, non-judgemental approach, delivered antenatally and postnatally tailored through face-to-face contacts, telephone and SMS texts. Outcomes will test the feasibility of delivering the intervention with recommended intensity and duration to disadvantaged women; acceptability to women, feeding helpers and professionals; and feasibility of a future randomised controlled trial (RCT), detailing recruitment rates, willingness to be randomised, follow-up rates at 3 days, 8 weeks and 6 months, and level of outcome completion. Outcomes of the proposed full trial will also be collected. Mixed methods will include qualitative interviews with women/partners, feeding helpers and health service staff; feeding helper logs; and review of audio-recorded helper-women interactions to assess intervention fidelity. ETHICS AND DISSEMINATION Study results will inform the design of a larger multicentre RCT. The National Research Ethics Service Committee approved the study protocol. TRIAL REGISTRATION NUMBER ISRCTN14760978; Pre-results.
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Affiliation(s)
- Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jenny Ingram
- Centre for Child and Adolescent Health, University of Bristol, Bristol, UK
| | - Joanne Clarke
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Debbie Johnson
- Centre for Child and Adolescent Health, University of Bristol, Bristol, UK
| | - Heather Trickey
- Department of Social Medicine, University of Cardiff, Cardiff, UK
| | - Gill Thomson
- University of Central Lancashire, Preston, Lancashire, UK
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, UK
| | | | - Alice Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Fiona Dykes
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, UK
| | - Max G Feltham
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Kirsty Darwent
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
| | - Christine MacArthur
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tracy Roberts
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
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Zakarija‐Grković I, Puharić D, Malički M, Hoddinott P. Breastfeeding booklet and proactive phone calls for increasing exclusive breastfeeding rates: RCT protocol. Matern Child Nutr 2017; 13:e12249. [PMID: 26990672 PMCID: PMC6866199 DOI: 10.1111/mcn.12249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 07/28/2015] [Revised: 10/22/2015] [Accepted: 10/27/2015] [Indexed: 12/29/2022]
Abstract
Breastfeeding is associated with infant and maternal health benefits and considerable potential savings to health services. Despite this, only 37% of infants globally are exclusively breastfed for 6 months. Interventions are needed to improve breastfeeding rates. The aim of this study is to determine whether written breastfeeding information in pregnancy and proactive breastfeeding-focused support phone calls, provided by a health professional educated in breastfeeding management, increase exclusive breastfeeding rates at 3 months compared with general birth-related information with proactive support calls or standard care. This is a single-centre, randomised, controlled, three-arm, superiority study with blind outcome assessment. Eligible participants will include primigravidae with singleton pregnancies who speak Croatian, attending six primary care obstetric practices. We estimate a total sample size of 459, with computer generated stratified randomisation of 153 women per arm. Participants in the intervention and active control groups will receive booklets in pregnancy, phone calls 2 weeks later, and 2, 6 and 10 weeks after birth. The primary outcome will be the proportion of women exclusively breastfeeding at 3 months. Secondary outcomes will compare: infant feeding practices and attitudes, social support, breastfeeding difficulties, breastfeeding self efficacy and utilisation of breastfeeding support services. Follow-up at 6 months will compare exclusive and any breastfeeding and utilised support services. Analysis will be by intention to treat. This trial will contribute to future evidence syntheses identifying the most effective forms of breastfeeding support.
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Affiliation(s)
| | | | | | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research UnitUniversity of StirlingUK
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Avenell A, Robertson C, Stewart F, Boyers D, Douglas F, Archibald D, van Teijlingen E, Hoddinott P, Boachie C. Sex can affect participation, engagement, and adherence in trials. BMJ 2016; 355:i6754. [PMID: 28039151 DOI: 10.1136/bmj.i6754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Alison Avenell
- Health Services Research Unit, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Clare Robertson
- Health Services Research Unit, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Fiona Stewart
- Health Services Research Unit, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Dwayne Boyers
- Health Services Research Unit and Health Economics Research Unit, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Flora Douglas
- Rowett Institute of Nutrition and Health, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Daryll Archibald
- Scottish Collaboration for Public Health Research and Policy (SCPHRP), Centre for Population Health Sciences (CPHS), University of Edinburgh, Edinburgh EH8 9DX, UK
| | - Edwin van Teijlingen
- Centre for Midwifery, Maternal and Perinatal Health, Faculty of Health and Social Sciences, Bournemouth House, Bournemouth University, Bournemouth BU1 3LH, UK
| | - Pat Hoddinott
- NMAHP Research Unit, Unit 13, Scion House, Stirling University Innovation Park, Stirling FK9 4NF, UK
| | - Charles Boachie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9QQ, UK
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Crossland N, Thomson G, Morgan H, MacLennan G, Campbell M, Dykes F, Hoddinott P. Breast pumps as an incentive for breastfeeding: a mixed methods study of acceptability. Matern Child Nutr 2016; 12:726-39. [PMID: 27502101 PMCID: PMC5096021 DOI: 10.1111/mcn.12346] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/27/2016] [Accepted: 05/30/2016] [Indexed: 11/30/2022]
Abstract
Increasing breastfeeding rates would improve maternal and child health, but multiple barriers to breastfeeding persist. Breast pump provision has been used as an incentive for breastfeeding, although effectiveness is unclear. Women's use of breast pumps is increasing and a high proportion of mothers express breastmilk. No research has yet reported women's and health professionals' perspectives on breast pumps as an incentive for breastfeeding. In the Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS) study, mixed methods research explored women's and professionals' views of breast pumps as an incentive for breastfeeding. A survey of health professionals across Scotland and North West England measured agreement with ‘a breast pump costing around £40 provided for free on the NHS’ as an incentive strategy. Qualitative interviews and focus groups were conducted in two UK regions with a total of 68 participants (pregnant women, new mothers, and their significant others and health professionals) and thematic analysis undertaken. The survey of 497 health professionals found net agreement of 67.8% (337/497) with the breast pump incentive strategy, with no predictors of agreement shown by a multiple ordered logistic regression model. Qualitative research found interrelated themes of the ‘appeal and value of breast pumps’, ‘sharing the load’, ‘perceived benefits’, ‘perceived risks’ and issues related to ‘timing’. Qualitative participants expressed mixed views on the acceptability of breast pumps as an incentive for breastfeeding. Understanding the mechanisms of action for pump type, timing and additional support required for effectiveness is required to underpin trials of breast pump provision as an incentive for improving breastfeeding outcomes. © 2016 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.
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Affiliation(s)
- Nicola Crossland
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom.
| | - Gill Thomson
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Heather Morgan
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Fiona Dykes
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, United Kingdom
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Morgan H, Hoddinott P, Thomson G, Crossland N, Farrar S, Yi D, Hislop J, Moran VH, MacLennan G, Dombrowski SU, Rothnie K, Stewart F, Bauld L, Ludbrook A, Dykes F, Sniehotta FF, Tappin D, Campbell M. Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS): a mixed-methods study to inform trial design. Health Technol Assess 2016; 19:1-522, vii-viii. [PMID: 25897655 DOI: 10.3310/hta19300] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Smoking in pregnancy and/or not breastfeeding have considerable negative health outcomes for mother and baby. AIM To understand incentive mechanisms of action for smoking cessation in pregnancy and breastfeeding, develop a taxonomy and identify promising, acceptable and feasible interventions to inform trial design. DESIGN Evidence syntheses, primary qualitative survey, and discrete choice experiment (DCE) research using multidisciplinary, mixed methods. Two mother-and-baby groups in disadvantaged areas collaborated throughout. SETTING UK. PARTICIPANTS The qualitative study included 88 pregnant women/recent mothers/partners, 53 service providers, 24 experts/decision-makers and 63 conference attendees. The surveys included 1144 members of the general public and 497 health professionals. The DCE study included 320 women with a history of smoking. METHODS (1) Evidence syntheses: incentive effectiveness (including meta-analysis and effect size estimates), delivery processes, barriers to and facilitators of smoking cessation in pregnancy and/or breastfeeding, scoping review of incentives for lifestyle behaviours; (2) qualitative research: grounded theory to understand incentive mechanisms of action and a framework approach for trial design; (3) survey: multivariable ordered logit models; (4) DCE: conditional logit regression and the log-likelihood ratio test. RESULTS Out of 1469 smoking cessation and 5408 breastfeeding multicomponent studies identified, 23 smoking cessation and 19 breastfeeding studies were included in the review. Vouchers contingent on biochemically proven smoking cessation in pregnancy were effective, with a relative risk of 2.58 (95% confidence interval 1.63 to 4.07) compared with non-contingent incentives for participation (four studies, 344 participants). Effects continued until 3 months post partum. Inconclusive effects were found for breastfeeding incentives compared with no/smaller incentives (13 studies) but provider commitment contracts for breastfeeding show promise. Intervention intensity is a possible confounder. The acceptability of seven promising incentives was mixed. Women (for vouchers) and those with a lower level of education (except for breastfeeding incentives) were more likely to disagree. Those aged ≤ 44 years and ethnic minority groups were more likely to agree. Agreement was greatest for a free breast pump and least for vouchers for breastfeeding. Universal incentives were preferred to those targeting low-income women. Initial daily text/telephone support, a quitting pal, vouchers for > £20.00 per month and values up to £80.00 increase the likelihood of smoking cessation. Doctors disagreed with provider incentives. A 'ladder' logic model emerged through data synthesis and had face validity with service users. It combined an incentive typology and behaviour change taxonomy. Autonomy and well-being matter. Personal difficulties, emotions, socialising and attitudes of others are challenges to climbing a metaphorical 'ladder' towards smoking cessation and breastfeeding. Incentive interventions provide opportunity 'rungs' to help, including regular skilled flexible support, a pal, setting goals, monitoring and outcome verification. Individually tailored and non-judgemental continuity of care can bolster women's capabilities to succeed. Rigid, prescriptive interventions placing the onus on women to behave 'healthily' risk them feeling pressurised and failing. To avoid 'losing face', women may disengage. LIMITATIONS Included studies were heterogeneous and of variable quality, limiting the assessment of incentive effectiveness. No cost-effectiveness data were reported. In surveys, selection bias and confounding are possible. The validity and utility of the ladder logic model requires evaluation with more diverse samples of the target population. CONCLUSIONS Incentives provided with other tailored components show promise but reach is a concern. Formal evaluation is recommended. Collaborative service-user involvement is important. STUDY REGISTRATION This study is registered as PROSPERO CRD42012001980. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Heather Morgan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Pat Hoddinott
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Gill Thomson
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, UK
| | - Nicola Crossland
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, UK
| | - Shelley Farrar
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Deokhee Yi
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jenni Hislop
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Victoria Hall Moran
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Kieran Rothnie
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Linda Bauld
- The Institute of Social Marketing, University of Stirling, Stirling, UK
| | - Anne Ludbrook
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Fiona Dykes
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, UK
| | - Falko F Sniehotta
- Institute of Health and Society, University of Newcastle, Newcastle, UK
| | - David Tappin
- Perinatal Epidemiology and Child Health Unit, School of Medicine, University of Glasgow, Glasgow, UK
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Morgan H, Thomson G, Crossland N, Dykes F, Hoddinott P. Combining PPI with qualitative research to engage 'harder-to-reach' populations: service user groups as co-applicants on a platform study for a trial. Res Involv Engagem 2016; 2:7. [PMID: 29062508 PMCID: PMC5611582 DOI: 10.1186/s40900-016-0023-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 02/13/2016] [Indexed: 05/22/2023]
Abstract
PLAIN ENGLISH SUMMARY It is recommended that research studies are carried out with or by patients and the public through their involvement from the beginning and in as many stages as possible (known as PPI). Some studies formally invite patients and the public to participate in interviews and focused group discussions to collect views about topics (known as qualitative research). In our study on financial incentives for giving up smoking in pregnancy and breastfeeding, we combined both PPI and qualitative research to include the views of women with a range of experiences of smoking and breastfeeding. We involved two mother and baby groups in disadvantaged areas of North East Scotland and North West England as research partners on our team. First, we asked members to comment on our research plans and documents, which is standard PPI. Second, we asked members to participate in voice recorded discussions, contributing to qualitative research data. These discussions revealed different views from those that we heard through research interviews. They allowed us to develop more relevant research tools and resources. Members also helped us to identify people outside the groups who we could interview. Combining involvement and participation helped us to include the views of a wide range of women from 'harder-to-reach' groups who don't usually take part in research. This was important because the research was intended for women who could benefit from incentives to stop smoking in pregnancy and breastfeed, often present in such groups. Positive continuing relationships and trust improved on involvement or participation alone. BACKGROUND Patient and public involvement (PPI) in all research studies is recommended from the earliest point and in as many stages as possible. Qualitative research is also recommended in the early stages of designing complex intervention trials. Combining both together might enable inclusion of 'harder-to-reach' perspectives from the target population(s), particularly when the research is intended for their benefit. However, the interface between PPI and qualitative research has received little attention. In a multi-disciplinary, mixed methods study to inform the design of incentive trials for smoking cessation in pregnancy and breastfeeding, we combined PPI and qualitative research, with some overlap. Mother and baby groups from two geographically separate disadvantaged areas, with diverse experiences of the smoking and breastfeeding, but no training or previous involvement in research, were recruited as PPI research grant co-applicants. An iterative partnership approach facilitated involvement in research conduct and design across all project phases. Group PPI members were also invited to contribute to more formal qualitative data collection, as and when indicated by the research questions, and emerging analysis. RESULTS We engaged with 'harder-to-reach' women in mother and baby group settings, rather than in academic or home environments. These settings were relaxed and informal, which facilitated rapport-building, disclosures of unexpected information and maintained trust. Twenty-one women participated in standard PPI activities: feedback on study protocols and documents; piloting questionnaires and interview schedules. PPI members voiced some different perspectives from those captured within the qualitative dataset. Nineteen participated in focused qualitative research. Novel aspects were audio recorded PPI discussions, which contributed qualitative data; first, to interpret systematic review findings and construct intervention vignettes for use in the qualitative research; second, to assist with recruitment to improve sample diversity in the formal qualitative dataset; and third, to translate theory and findings presented in a researcher generated logic model into a lay tool. This had face validity for potential trial participants and used the metaphor of a ladder. CONCLUSIONS Combining and overlapping PPI and qualitative research added 'harder-to-reach' contributions, sample diversity, trust and engagement in creative approaches beyond what could be achieved through PPI or qualitative research alone.
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Affiliation(s)
- Heather Morgan
- Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD Scotland, UK
| | - Gill Thomson
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, PR1 2HE England, UK
| | - Nicola Crossland
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, PR1 2HE England, UK
| | - Fiona Dykes
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, PR1 2HE England, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, FK9 4LA Scotland, UK
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Hoddinott P, O'Cathain A, Boyer I, Oliver S. Qualitative methods and patient and public involvement in trials: opportunities and pitfalls. Trials 2015. [PMCID: PMC4660118 DOI: 10.1186/1745-6215-16-s2-p75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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O'Cathain A, Hoddinott P, Lewin S, Thomas K, Young B, Adamson J, Jansen Y, Mills N, Moore G, Donovan J. Maximising the impact of qualitative research in feasibility studies for randomised controlled trials: guidance for researchers. Trials 2015. [PMCID: PMC4659339 DOI: 10.1186/1745-6215-16-s2-o88] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Hoddinott P, Thomson G, Morgan H, Crossland N, MacLennan G, Dykes F, Stewart F, Bauld L, Campbell MK. Perspectives on financial incentives to health service providers for increasing breast feeding and smoking quit rates during pregnancy: a mixed methods study. BMJ Open 2015; 5:e008492. [PMID: 26567253 PMCID: PMC4654300 DOI: 10.1136/bmjopen-2015-008492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To explore the acceptability, mechanisms and consequences of provider incentives for smoking cessation and breast feeding as part of the Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS) study. DESIGN Cross-sectional survey and qualitative interviews. SETTING Scotland and North West England. PARTICIPANTS Early years professionals: 497 survey respondents included 156 doctors; 197 health visitors/maternity staff; 144 other health staff. Qualitative interviews or focus groups were conducted with 68 pregnant/postnatal women/family members; 32 service providers; 22 experts/decision-makers; 63 conference attendees. METHODS Early years professionals were surveyed via email about the acceptability of payments to local health services for reaching smoking cessation in pregnancy and breastfeeding targets. Agreement was measured on a 5-point scale using multivariable ordered logit models. A framework approach was used to analyse free-text survey responses and qualitative data. RESULTS Health professional net agreement for provider incentives for smoking cessation targets was 52.9% (263/497); net disagreement was 28.6% (142/497). Health visitors/maternity staff were more likely than doctors to agree: OR 2.35 (95% CI 1.51 to 3.64; p<0.001). Net agreement for provider incentives for breastfeeding targets was 44.1% (219/497) and net disagreement was 38.6% (192/497). Agreement was more likely for women (compared with men): OR 1.81 (1.09 to 3.00; p=0.023) and health visitors/maternity staff (compared with doctors): OR 2.54 (95% CI 1.65 to 3.91; p<0.001). Key emergent themes were 'moral tensions around acceptability', 'need for incentives', 'goals', 'collective or divisive action' and 'monitoring and proof'. While provider incentives can focus action and resources, tensions around the impact on relationships raised concerns. Pressure, burden of proof, gaming, box-ticking bureaucracies and health inequalities were counterbalances to potential benefits. CONCLUSIONS Provider incentives are favoured by non-medical staff. Solutions which increase trust and collaboration towards shared goals, without negatively impacting on relationships or increasing bureaucracy are required.
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Affiliation(s)
- Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Gill Thomson
- Maternal and Infant Nutrition and Nurture Unit (MAINN), University of Central Lancashire, Preston, UK
| | - Heather Morgan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Nicola Crossland
- Maternal and Infant Nutrition and Nurture Unit (MAINN), University of Central Lancashire, Preston, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Fiona Dykes
- Maternal and Infant Nutrition and Nurture Unit (MAINN), University of Central Lancashire, Preston, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Linda Bauld
- Department of Health Policy and Social Marketing, University of Stirling, Stirling, UK
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Abstract
This editorial introduces a new special series on intervention development in the on-line open access journal Pilot and Feasibility Studies. An intervention development study reports the rationale, decision-making processes, methods and findings which occur between the idea or inception of an intervention until it is ready for formal feasibility, pilot or efficacy testing prior to a full trial or evaluation. This editorial begins to explore some of the challenges associated with this early research stage. It commences a debate about how to produce novel interventions which are fit for purpose and which solve important health and social care problems. By transparently reporting more intervention development studies, scientific rigour will be improved and everyone can learn from the experiences of others.
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Affiliation(s)
- Pat Hoddinott
- Chair in Primary Care, Nursing, Midwifery and Allied Health Professions Research Unit, Unit 13 Scion House, Stirling Innovation Park, Stirling, FK9 4NF UK
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