Facilitators and challenges in delivering a peer-support physical activity intervention for older adults: a qualitative study with multiple stakeholders

Insights and recommendations into service model structure, staff roles and qualifications in a UK cancer specific clinical exercise service: a multi-method qualitative study

PURPOSE

Clinical exercise delivery in the United Kingdom is disparate in terms of service structure, staff roles and qualifications, therefore it is difficult to evaluate and compare across services. Our aim was to explore, in a purposely selected cancer exercise service that was recognised as effective; (i) how staff knowledge, skills and competencies contribute to the provision of the service, (ii) how these components assist in creating effective services, and (iii) to identify existing challenges from staff and service user perspectives.

METHODS

The Consolidated Framework for Implementation Research was used as an overarching guide to review the Prehab4Cancer service. Exercise specialists and service user perspectives were explored using a multi-method approach (online semi-structured interviews, online focus group and in-person observation) and data triangulation.

RESULTS

Exercise specialists were educated to a minimum of undergraduate degree level with extensive cancer-specific knowledge and skills, equivalent to that of a Registration Council for Exercise Physiologist (RCCP) Clinical Exercise Physiologist. Workplace experience was essential for exercise specialist development in behaviour change and communications skills.

CONCLUSIONS

Staff should be educated to a level comparable with the standards for registered RCCP Clinical Exercise Physiologists, which includes workplace experience to develop knowledge, skills and competencies in real-world settings.

The mediation role of social network size and perception in the association between physical activity and depressive symptoms: a prospective analysis from the SHARE study

OBJECTIVES

To investigate the mediating role of social network size and perceived quality in the associations of physical activity with quality of life and depressive symptoms in middle-aged and older adults.

METHOD

We analyzed information of 10,569 middle-aged and older adults from waves 2 (2006-2007), 4 (2011-2012), and 6 (2015) of the Survey of Health, Ageing, and Retirement in Europe study (SHARE). Data on physical activity (moderate and vigorous intensities), social network (size and quality), depressive symptoms (EURO-D scale), and quality of life (CASP) were self-reported. Sex, age, country of residency, schooling, occupational status, mobility, and baseline values of the outcome were used as covariates. We created mediation models to test the mediating effect of social network size and quality in the association between physical activity and depressive symptoms.

RESULTS

Social network size partly mediated the association between vigorous physical activity and depressive symptoms (7.1%; 95%CI: 1.7-12.6) as well as the association between moderate (9.9%; 1.6-19.7) and vigorous (8.1%; 0.7-15.4) physical activity and quality of life. Social network quality did not mediate any of the associations tested.

CONCLUSION

We conclude that social network's size, but not satisfaction, mediates part of the association of physical activity with depressive symptoms and quality of life in middle-aged and older adults. Future physical activity interventions among middle-aged and older adults should consider increasing social interactions to facilitate benefits for mental health-related outcomes.

An Intensive Care Unit peer support group: Participants' views on format, content and the impact on recovery journeys

Background

Peer support groups reduce psychological morbidity and increase social support for Intensive Care Unit (ICU) survivors. Group formats differ and research, although emerging, is limited. This study explores a continuously running ICU Expert by Experience group, which has a dual role of support and service-user consultative, from attendees' perspectives.

Methods

A thematic analysis was conducted on interviews with current and past members of an ICU Expert by Experience group. 11 participants took part in online and telephone interviews. Three provided written responses. Final themes were created following a process of data validation with participants.

Results

Four main themes emerged: (1) Support in the difficult recovery journey (2) Relationships and shared experiences (3) Value of professional facilitation (4) Practical considerations.

Conclusion

Patients highlighted the help gained from the group as an integral part of their recovery journey. Results also identified practical implications for those considering setting up similar support groups.

"More than just a walk in the park": A multi-stakeholder qualitative exploration of community-based walking sport programmes for middle-aged and older adults

In spite of the large-scale growth of walking sport (WS) programmes globally, limited research has explored the experiences of the key stakeholders involved in such programmes (i.e. decision-makers, facilitators, and players). We aimed to explore stakeholder experiences of community-based WS programmes to better understand the appeal of such sport options for middle-aged and older adults, and propose tentative recommendations for the feasibility and sustainability of these types of programmes. We conducted semi-structured interviews with 21 stakeholders who were involved with WS programmes in Australia as decision-makers, facilitators, and/or players. Data were analysed with reflexive thematic analysis. Four key themes pertaining to the WS experience were identified - 'a renewed lease of life', 'navigating ageing stereotypes', 'tension between organisational demands and players' needs', and 'WS facilitators as catalysts of success'. Specifically, we found that WS participation enabled a positive ageing discourse for middle-aged and older adults. WS players had to negotiate stereotypes that, at times, were perceived as participation barriers. We also noted some tensions between the demands of sport organisations and the needs of middle-aged and older adults regarding sport participation. Finally, we also noted the importance of the facilitators' role in increasing accessibility of, and long-term participation in, such programmes. We suggest that to offer feasible and sustainable community-based WS programmes across Australia, incompatibilities across various stakeholders' perspectives need to be addressed.

Influence of social distancing on physical activity among the middle-aged to older population: Evidence from the nationally representative survey in China

Background

Group-based physical activity is an important positive factor assisting the middle-aged to older population to be regularly physically active, especially inside a society with a large population and highly sociable environment. However, when group-based physical activity is restricted during a public health crisis such as the infectious disease pandemic, the influence of social distancing on physical activity among this vulnerable group needs to be recognized.

Objectives

This study aimed to investigate the influence of social distancing on physical activity among the middle-aged to older Chinese population at the national level.

Methods

Data from a nationally representative social follow-up survey (China Family Panel Studies, CFPS) for 2018 and 2020 were used. Physical activity level in year 2018 was set as the baseline to be compared with that for each individual in 2020, when China implemented social distancing during the COVID-19. Chinese population with an age greater than 45 years were included, and three levels of physical activity were established. Logistic models were developed to identify sociodemographic characteristic that may be associated with a higher probability of worse PA behaviors during the social distancing.

Results

Over 46% respondents could be described as being Physically Inactivity during 2018 and this proportion increased to 67.2% in 2020. Respondents who live in the Northeast or rural regions, having a spouse, being employed, having a low level of education, and being of low-income level showed a higher decrease in physical activity compared to other groups. However, individuals living with chronic diseases emerge as being more likely to maintain positive habits with respect to physical activity in this context.

Conclusion

Social distancing during the COVID-19 pandemic has significantly influenced the extent of physical activity among middle-aged to older Chinese residents. This is especially true in respect to middle-aged and elderly people who are at increased risk of chronic diseases. Given this, there is a clear need to consider effective modalities for physical activity in the context of social distancing based on home quarantine and city lockdown. Furthermore, specific health-related strategies need to be considered in relation to different regions and populations.

Peer-led interventions to reduce alcohol consumption in college students: A scoping review

Risky alcohol consumption among college students is a significant public health issue. In the college setting, students can collaborate in the implementation of peer-led interventions. To date, evidence of peer-led programmes in reducing harmful alcohol consumption in this population is inconclusive. The aim of the current scoping review is to provide a broad overview by systematically examining and mapping the literature on peer-led interventions for preventing risky alcohol consumption by college students. The specific aims were to (1) identify the underlying focus of the interventions and assess their (2) effectiveness and (3) feasibility. A comprehensive search was conducted in PubMed, PsycINFO, CINAHL, Cochrane Library, Web of Science, DART-Europe, RCAAP, Trove and ProQuest. The inclusion criteria were peer-led interventions that exclusively addressed alcohol consumption, college students as the target population and interventional studies (randomised controlled trials, quasi-experimental studies, systematic reviews and meta-analyses of interventions). The methodological quality of the articles was evaluated. From 6654 potential studies, 13 were included. Nine interventions were described within these studies: Voice of Reason programme, Brief Advice sessions, Peer Theatre, Alcohol Education programme, Perceptions of Alcohol Norms intervention, Motivational Intervention, Alcohol Skills Training programme, Lifestyle Management Class and the Brief Alcohol Screening and Intervention for College Students. Only the last showed significant reductions in three of the four outcome measures: quantity and frequency of drinking, estimated peak blood alcohol concentration and alcohol-related consequences. It did not significantly decrease the number of heavy-drinking episodes. Peer interventions may be effective in preventing alcohol use among college students, although the evidence is weak and scarce. Further research is needed to strengthen the findings about peer-led interventions.

Adapting a social network intervention for use in secondary mental health services using a collaborative approach with service users, carers/supporters and health professionals in the United Kingdom

Background

Social integration, shared decision-making and personalised care are key elements of mental health and social care policy. Although these elements have been shown to improve service user and service-level outcomes, their translation into practice has been inconsistent and social isolation amongst service users persists.

Aim

To co-adapt, with service users, carers/supporters and health professionals, a web-based social network intervention, GENIE™, for use in secondary mental health services. The intervention is designed to support social activity and preference discussions between mental healthcare professionals and service users as a means of connecting individuals to local resources.

Methods

In Phase 1 (LEARN), we completed two systematic reviews to synthesise the existing evidence relating to the i) effectiveness and ii) the implementation of social network interventions for people with mental health difficulties. We undertook semi-structured interviews with a convenience sample of 15 stakeholders previously involved in the implementation of the intervention in physical healthcare settings. Interviews were also conducted with 5 national key stakeholders in mental health (e.g., policy makers, commissioners, third sector leads) to explore wider implementation issues.

In Phase 2 (ADAPT), we worked iteratively with eight service users, nine carers, six professionals/volunteers and our patient and public advisory group. We drew on a framework for experience-based co-design, consisting of a series of stakeholder consultation events, to discuss the use of the social network intervention, in mental health services. Participants also considered factors that could serve as enablers, barriers, and challenges to local implementation.

Results

Across the stakeholder groups there was broad agreement that the social network intervention had potential to be useful within mental health services. In terms of appropriate and effective implementation, such an intervention was predicted to work best within the care planning process, on discharge from hospital and within early intervention services. There were indications that the social connection mapping and needs assessment components were of most value and feasible to implement which points to the potential utility of a simplified version compared to the one used in this study. The training provided to facilitators was considered to be more important than their profession and there were indications that service users should be offered the opportunity to invite a carer, friend, or family member to join them in the intervention.

Conclusion

The GENIE™ intervention has been co-adapted for use in mental health services and a plan for optimal implementation has been co-produced. The next phase of the programme of work is to design and implement a randomised controlled trial to evaluate clinical and cost effectiveness of a simplified version of the intervention.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08521-1.