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Gobin M, Dhillon S, Kesten JM, Horwood J, Dean GL, Stockwell S, Denford S, Mear J, Cooper R, Copping J, Lawson L, Hayward S, Harryman L, Vera JH. Acceptability of digital vending machines to access STI and HIV tests in two UK cities. Sex Transm Infect 2024; 100:91-97. [PMID: 38302411 DOI: 10.1136/sextrans-2023-055969] [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: 08/18/2023] [Accepted: 12/02/2023] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES Prompt HIV and STI diagnosis and treatment is a public health priority and relies on accessible testing. Technology-based approaches to distribute test kits have the potential to increase access to testing. We evaluated the acceptability and uptake of vending machines in publicly available settings in Brighton and Hove (BH) and Bristol, North Somerset and South Gloucestershire (BNSSG), to distribute HIV rapid self-test and STI self-sample kits. METHODS Seven machines were installed in BH and four in BNSSG. User characteristics, proportion of kits returned and test results, taken from the machine database and clinic records, combined with online questionnaires completed by self-recruited users and analysed using Stata and SPSS. RESULTS 2536 kits were dispensed over 12 months (April 2022 to March 2023). The STI self-sample kits were most popular (74% of vends). 78% of kits dispensed were among users aged 16-35 years and 56% identified as male. 68% and 59% of users had either not tested in the last 12 months or never tested for HIV and STIs, respectively. 51% of STI kits were returned via post, lower than the local online service (65%). 208 users completed questionnaires. Convenience, desire for instant access and increased confidentiality were the most common reasons for using machines. 92% of respondents thought the machines were user-friendly and 97% would recommend the service. Concerns about safety and privacy while using the machine were reported by 42% and 66% of respondents. CONCLUSIONS This study demonstrates that vending machines are an acceptable and effective means of accessing infrequent or never testers in the general population and can act as a horizontal intervention to tackle HIV and STIs. Research is needed to understand optimal machine locations to assure privacy and safety along with the long-term impact on sexual health services.
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Affiliation(s)
- Maya Gobin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Syra Dhillon
- University Hospitals Sussex NHS Foundation Trust, Worthing, UK
- Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Joanna May Kesten
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jeremy Horwood
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Gillian Louise Dean
- HIV and GUM Medicine, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Sarah Stockwell
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sarah Denford
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - John Mear
- HIV and GUM Medicine, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Richard Cooper
- Sexual Health & HIV, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | | | - Samuel Hayward
- North Somerset Council, Weston-super-Mare, North Somerset, UK
| | - Lindsey Harryman
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jaime H Vera
- Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
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Scott J, Family H, Kesten JM, Hines L, Millar J. Understanding and learning from rural drug service adaptations to opioid substitution therapy during the COVID-19 pandemic: the What C-OST? study. Front Public Health 2023; 11:1240402. [PMID: 38098825 PMCID: PMC10720718 DOI: 10.3389/fpubh.2023.1240402] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/06/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction In April 2020, in response to government COVID-19 advice, changes were made to the way English drug services operated. Methadone and buprenorphine were typically dispensed in 1- to 2-week supplies, and key working was conducted by phone/online. Previous studies have examined the impact of these changes on people from urban settings. This study adds the experiences and perspectives of people receiving care from drug services in rural areas and makes suggestions for future emergency planning. Methods Telephone semi-structured interviews were conducted with 15 people receiving care in Somerset, Wiltshire, and Suffolk, rural counties in England. Reflexive thematic analysis was used. Results Three overarching themes were found. "Challenges of rural lockdown" (theme 1) describes how rural community challenges, especially reduced or no rural public transport, were experienced. This hampered some OST collections, with consequential drug use. It also impeded connections to loved ones, worsening isolation. For participants who were struggling pre-pandemic, the intersection between this and their experience of revised drug service operations is embodied in "Amplification of Social Disconnection: Cut off and unheard" (theme 2). They felt a lack of support, particularly from remote provision key working. Participants who had supportive relationships and time in the pandemic occupied in ways they found meaningful, and others who struggled with anxiety or depression, found pandemic changes "Fits better with my life" (theme 3). They experienced more freedom for other things, gained support by other means, such as family, or felt more comfortable with remote engagement. A cross-cutting sub-theme "Understandable Interruptions" showed acceptance of pandemic disruptions. Conclusion National guidance and organizational policy impacted participants in different ways. Those who had supportive relationships and occupied time were better able to make positive use of newfound freedoms and engage with community-level support. In contrast, those who had less stability, including mental health struggles and social isolation, felt cut off and unheard, particularly from key workers. Reduced rural transport was a significant community-level issue, which impeded OST collection and social support. We suggest emergency response plans be created for individuals taking account of their pre-existing personal situations.
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Affiliation(s)
- Jenny Scott
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Hannah Family
- NIHR Health Protection Research Unit in Behavioral Science and Evaluation, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- The National Institute for Health and Care Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Joanna May Kesten
- NIHR Health Protection Research Unit in Behavioral Science and Evaluation, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- The National Institute for Health and Care Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Lindsey Hines
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - Josie Millar
- Department of Psychology, University of Bath, Bath, United Kingdom
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Kesten JM, Redwood S, Pullyblank A, Tavare A, Pocock L, Brant H, Hill EM, Tutaev M, Shum RZ, Banks J. Using the recommended summary plan for emergency care and treatment (ReSPECT) in care homes: a qualitative interview study. Age Ageing 2022; 51:6770071. [PMID: 36273344 PMCID: PMC9588387 DOI: 10.1093/ageing/afac226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is an advance care planning process designed to facilitate discussion and documentation of preferences for care in a medical emergency. Advance care planning is important in residential and nursing homes. AIM To explore the views and experiences of GPs and care home staff of the role of ReSPECT in: (i) supporting, and documenting, conversations about care home residents' preferences for emergency care situations, and (ii) supporting decision-making in clinical emergencies. SETTING/PARTICIPANTS Sixteen GPs providing clinical care for care home residents and 11 care home staff in the West of England. METHODS A qualitative research design using semi-structured interviews. RESULTS Participants' accounts described the ReSPECT process as facilitating person-centred conversations about residents' preferences for care in emergency situations. The creation of personalised scenarios supported residents to consider their preferences. However, using ReSPECT was complex, requiring interactional work to identify and incorporate resident or relative preferences. Subsequent translation of preferences into action during emergency situations also proved difficult in some cases. Care staff played an important role in facilitating and supporting ReSPECT conversations and in translating it into action. CONCLUSIONS The ReSPECT process in care homes was positive for GPs and care home staff. We highlight challenges with the process, communication of preferences in emergency situations and the importance of balancing detail with clarity. This study highlights the potential for a multi-disciplinary approach engaging care staff more in the process.
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Affiliation(s)
- Joanna May Kesten
- Address correspondence to: Joanna May Kesten, NIHR ARC West at University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol BS1 2NT, UK.
| | - Sabi Redwood
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK,Population Health Sciences, Bristol Medical School, University of Bristol
| | - Anne Pullyblank
- West of England Academic Health Science Network (West of England AHSN), Bristol, UK,North Bristol NHS Trust, Bristol, UK
| | - Alison Tavare
- West of England Academic Health Science Network (West of England AHSN), Bristol, UK
| | - Lucy Pocock
- Population Health Sciences, Bristol Medical School, University of Bristol
| | - Heather Brant
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK,Population Health Sciences, Bristol Medical School, University of Bristol
| | - Elizabeth M Hill
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK,Population Health Sciences, Bristol Medical School, University of Bristol
| | | | - Rui Zhi Shum
- Population Health Sciences, Bristol Medical School, University of Bristol
| | - Jon Banks
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK,Population Health Sciences, Bristol Medical School, University of Bristol
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Kesten JM, Holder E, Ayres R, Ellis P, Taylor S, Hickman M, Henderson G. Changes in the development of opioid tolerance on re-exposure among people who use heroin: A qualitative study. PLoS One 2022; 17:e0269379. [PMID: 35737700 PMCID: PMC9223324 DOI: 10.1371/journal.pone.0269379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 05/19/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND AIMS This qualitative study aimed to explore how the development of tolerance to both the psychoactive and respiratory depressant effects of heroin on re-exposure are experienced by people who use heroin. METHODS Semi-structured one-to-one interviews were conducted with 20 adults who currently or previously used heroin (for at least 6 months), with any type of administration (injected, smoked) and experience of abstinence (at least 2 weeks) and relapse. Topic guides explored the participants understanding of tolerance, their experience of developing tolerance to heroin and of tolerance following relapse. Interviews were audio-recorded and transcribed. Thematic analysis was used to generate salient themes. RESULTS The analysis produced three broad themes: lay understanding of tolerance; tolerating tolerance; and rapid tolerance development following relapse. Tolerance was defined as the body adapting to regular drug use, so that the drug no longer produced the same level of effect. Tolerance was experienced as interacting and co-developing with physical dependence and the symptoms of withdrawal. Indeed, several participants did not differentiate between tolerance and dependence. Most participants did not notice tolerance to respiratory depression. Tolerance levels fluctuated-increasing over periods of regular use and reducing when abstinent. Using more drug was the most common response to increasing tolerance to the desired effects. On re-use following abstinence, tolerance was experienced as developing more quickly in the most recent relapse compared to the first. Tolerance was also perceived to return more quickly with each abstinence-relapse cycle. CONCLUSIONS Qualitative accounts of tolerance report that tolerance returns more quickly with each relapse episode. By elucidating the mechanism(s) involved and potentially discovering how they could be switched on prior to relapse occurring we might be able to develop a beneficial harm reduction treatment for people in abstinence that would protect against overdose occurring on subsequent relapse.
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Affiliation(s)
- Joanna May Kesten
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Oakfield House, Oakfield Grove, Bristol, United Kingdom
- NIHR Applied Research Collaboration (ARC) West at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | - Ed Holder
- Bristol Drugs Project, Bristol, United Kingdom
| | | | - Pete Ellis
- Bristol Drugs Project, Bristol, United Kingdom
- Developing Health and Independence, Brunswick Court, Bristol, United Kingdom
| | - Steve Taylor
- Alcohol & Drugs Treatment & Recovery, Office for Health Improvement and Disparities, Department of Health and Social Care, London, United Kingdom
| | - Matthew Hickman
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Oakfield House, Oakfield Grove, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Graeme Henderson
- School of Physiology, Pharmacology & Neuroscience, University of Bristol, University Walk, Bristol, United Kingdom
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5
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Lorenc A, Nicholls J, Kesten JM, Macgregor L, Speare N, Harryman L, Turner KM, Horner P, Horwood J. Human Immunodeficiency Virus Preexposure Prophylaxis Knowledge, Attitudes and Perceptions of Sexual Health Risk in an Age of Sexually Transmitted Infection Antimicrobial Resistance. Sex Transm Dis 2021; 48:685-692. [PMID: 33534406 PMCID: PMC8360657 DOI: 10.1097/olq.0000000000001384] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/14/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) has helped reduce new HIV infections. However, bacterial sexually transmitted infections (STIs) have increased among PrEP users. We examined PrEP knowledge, access, and risk perceptions in an age of antimicrobial resistance (AMR). METHODS An online anonymous survey was distributed to all cisgender men/transpersons who have sex with men attending a sexual health clinic in Bristol, United Kingdom (October 2018 to November 2019). Interviews with a sample identified at increased risk of HIV were analyzed thematically and integrated with survey data. RESULTS Five hundred and seventy-eight (95%) of 617 cisgender men/transpersons who have sex with men survey respondents were HIV-negative/unknown, of these, 202 (34.9%) had ever used PrEP. Interviewees (n = 24) reported widespread awareness of and enthusiasm for PrEP. Among nonusers, 39% (146/376) were unaware how to access PrEP, and 27% (103/376) could not access PrEP through the national "impact" trial of whom 79% (81/103) were eligible. The PrEP was described as "life-changing," but expense was the main barrier to use. Sixty-two percent (358/578) of HIV-negative/unknown respondents on PrEP were more likely to have condomless anal intercourse with someone they thought was HIV-negative. Interviewees used PrEP with other risk-reduction strategies. Sexually transmitted infections were seen as "curable" and AMR rarely influenced risk perception or sexual decision making. CONCLUSIONS The PrEP awareness was high, but purchase cost limited access. PrEP may increase condomless anal intercourse, but interviewees used PrEP as one of many risk-reduction tools. Reduced fear of HIV transmission and testing was highly valued. Sexually transmitted infection AMR was not seen as an immediate threat and did not influence risk perception or sexual decision making.
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Affiliation(s)
- Ava Lorenc
- From the National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University of Bristol, University Hospitals Bristol NHS Foundation Trust
| | | | - Joanna May Kesten
- From the National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University of Bristol, University Hospitals Bristol NHS Foundation Trust
| | - Louis Macgregor
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol
| | - Nathan Speare
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust
| | - Lindsey Harryman
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust
| | - Katy M.E. Turner
- Bristol Veterinary School, University of Bristol, Langford, United Kingdom
| | - Patrick Horner
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust
| | - Jeremy Horwood
- From the National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University of Bristol, University Hospitals Bristol NHS Foundation Trust
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6
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MacGregor L, Speare N, Nicholls J, Harryman L, Horwood J, Kesten JM, Lorenc A, Horner P, Edelman NL, Muir P, North P, Gompels M, Turner KME. Evidence of changing sexual behaviours and clinical attendance patterns, alongside increasing diagnoses of STIs in MSM and TPSM. Sex Transm Infect 2021; 97:507-513. [PMID: 34413201 PMCID: PMC8543230 DOI: 10.1136/sextrans-2020-054588] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 11/08/2020] [Indexed: 11/27/2022] Open
Abstract
Background Due to rising numbers of STI diagnosis and increasing prevalence of antimicrobial resistance, we explored trends in STI testing frequency and diagnoses, alongside sexual decision making and attitudes concerning condom use and HIV pre-exposure prophylaxis (PrEP) at a large urban UK sexual health clinic. Methods We examined 66 528 electronic patient records covering 40 321 attendees between 2016 and 2019, 3977 of whom were men who have sex with men or trans persons who have sex with men (MSM/TPSM). We also explored responses from MSM/TPSM attendees sent an electronic questionnaire between November 2018 and 2019 (n=1975) examining behaviours/attitudes towards PrEP. We measured trends in STI diagnoses and sexual behaviours including condomless anal intercourse (CAI), using linear and logistic regression analyses. Results Tests resulting in gonorrhoea, chlamydia or syphilis diagnoses increased among MSM/TPSM from 13.5% to 18.5% between 2016 and 2019 (p<0.001). The average MSM/TPSM STI testing frequency increased from 1.5/person/year to 2.1/person/year (p=0.017). Gay MSM/TPSM had the highest proportions of attendances resulting in diagnoses, increasing from 15.1% to 19.6% between 2016 and 2019 (p<0.001) compared with bisexual/other MSM/TPSM increasing from 6.9% to 14.5% (p<0.001), alongside smaller but significant increases in non-MSM/TPSM from 5.9% to 7.7% (p<0.001). The proportion of MSM/TPSM clinic attendees reporting CAI in the previous 3 months prior to at least one appointment in a given year increased significantly from 40.6% to 45.5% between 2016 and 2019 (p<0.0001) and average number of partners from 3.8 to 4.5 (p=0.002). Of 617 eligible questionnaire responses, 339/578 (58.7%) HIV-negative and 29/39 (74.4%) HIV-positive MSM/TPSM indicated they would be more likely to have CAI with someone on PrEP versus not on PrEP. 358/578 (61.9%) HIV-negative respondents said that PrEP use would make them more likely to have CAI with HIV-negative partners. Conclusion Rising numbers of STI diagnoses among MSM/TPSM are not attributable to increased testing alone. Increased CAI and number of partners may be attributable to evolving sexual decision making among PrEP users and their partners. Proportionally, bisexual/other MSM/TPSM have the steepest increase in STI diagnoses.
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Affiliation(s)
- Louis MacGregor
- Department of Population Health Sciences, University of Bristol, Bristol, UK .,National Institute for Health Research, Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation, Bristol, UK
| | | | - Jane Nicholls
- Department of Population Health Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research, Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation, Bristol, UK.,Bristol Sexual Health Centre, Bristol, UK.,Cardiff and Vale Sexual Health Service, Cardiff, UK
| | | | - Jeremy Horwood
- Department of Population Health Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research, Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation, Bristol, UK.,National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University of Bristol, Bristol, UK
| | - Joanna May Kesten
- Department of Population Health Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research, Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation, Bristol, UK.,National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University of Bristol, Bristol, UK
| | - Ava Lorenc
- Department of Population Health Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University of Bristol, Bristol, UK
| | - Patrick Horner
- Department of Population Health Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research, Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation, Bristol, UK.,Bristol Sexual Health Centre, Bristol, UK
| | | | - Peter Muir
- National Institute for Health Research, Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation, Bristol, UK.,Public Health England South Region, Bristol, UK
| | - Paul North
- Public Health England South Region, Bristol, UK
| | - Mark Gompels
- North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Katy M E Turner
- Department of Population Health Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research, Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation, Bristol, UK.,Bristol Veterinary School, University of Bristol, Bristol, UK
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Lorenc A, Kesten JM, Kidger J, Langford R, Horwood J. Reducing COVID-19 risk in schools: a qualitative examination of secondary school staff and family views and concerns in the South West of England. BMJ Paediatr Open 2021; 5:e000987. [PMID: 34192194 DOI: 10.1101/2020.10.25.20216937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/09/2021] [Accepted: 01/14/2021] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE To investigate student, parent/carer and secondary school staff attitudes towards school COVID-19 mitigation measures. METHODS Recruitment used school communication, community organisations and snowball sampling in South West England. Audio recorded online or phone individual/group semi-structured interviews were conducted in July-Septtember 2020 and lasted 30-60 min. Interviews focused on views towards social distancing, hand hygiene and testing. Framework analysis was performed on interview notes/transcripts. RESULTS Participants were 15 staff, 20 parents and 17 students (11-16 years) from 14 diverse schools. Concerns about COVID-19 risk at school, especially to vulnerable individuals, were outweighed by perceived risks of missed learning. Some staff felt guilt around being a potential 'spreader' by teaching multiple classes. Findings highlighted a wide variety of school COVID-19 mitigation measures being deployed due to ambiguous government guidance. Participants generally saw mitigation measures as an acceptable and pragmatic solution to the perceived impossibility of social distancing in crowded schools, although anticipated challenges changing habitual behaviour. Participants supported school COVID-19 testing but identified the need to consider data security and stigma around COVID-19 diagnosis. Staff were concerned about unintended consequences of risk-reduction strategies on student behaviour, learning and pastoral care, particularly for those with Special Educational Needs or mental health issues who may find the measures especially challenging, and resultant widening inequalities. CONCLUSION Families and staff supported COVID-19 mitigation measures in schools and would welcome the roll out school COVID-19 testing. Clear messaging and engendering collective responsibility are important for compliance and success of COVID-19 mitigation measures. However, schools and policy-makers should consider unintended consequences of measures, providing extra support for vulnerable students and those with additional needs, and consider ways to avoid widening educational and health inequalities. Findings demonstrate the acceptability of school COVID-19 infection control measures is likely to be influenced by the balance of risks and benefits to students.
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Affiliation(s)
- Ava Lorenc
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
- NIHR Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, Bristol, UK
| | - Joanna May Kesten
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
- NIHR Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, Bristol, UK
- NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol, Bristol, UK
| | - Judi Kidger
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
| | - Rebecca Langford
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
| | - Jeremy Horwood
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
- NIHR Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, Bristol, UK
- NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol, Bristol, UK
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Lorenc A, Kesten JM, Kidger J, Langford R, Horwood J. Reducing COVID-19 risk in schools: a qualitative examination of secondary school staff and family views and concerns in the South West of England. BMJ Paediatr Open 2021; 5:e000987. [PMID: 34192194 PMCID: PMC7948157 DOI: 10.1136/bmjpo-2020-000987] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/09/2021] [Accepted: 01/14/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To investigate student, parent/carer and secondary school staff attitudes towards school COVID-19 mitigation measures. Methods Recruitment used school communication, community organisations and snowball sampling in South West England. Audio recorded online or phone individual/group semi-structured interviews were conducted in July-Septtember 2020 and lasted 30-60 min. Interviews focused on views towards social distancing, hand hygiene and testing. Framework analysis was performed on interview notes/transcripts. Results Participants were 15 staff, 20 parents and 17 students (11-16 years) from 14 diverse schools. Concerns about COVID-19 risk at school, especially to vulnerable individuals, were outweighed by perceived risks of missed learning. Some staff felt guilt around being a potential 'spreader' by teaching multiple classes. Findings highlighted a wide variety of school COVID-19 mitigation measures being deployed due to ambiguous government guidance. Participants generally saw mitigation measures as an acceptable and pragmatic solution to the perceived impossibility of social distancing in crowded schools, although anticipated challenges changing habitual behaviour. Participants supported school COVID-19 testing but identified the need to consider data security and stigma around COVID-19 diagnosis. Staff were concerned about unintended consequences of risk-reduction strategies on student behaviour, learning and pastoral care, particularly for those with Special Educational Needs or mental health issues who may find the measures especially challenging, and resultant widening inequalities. Conclusion Families and staff supported COVID-19 mitigation measures in schools and would welcome the roll out school COVID-19 testing. Clear messaging and engendering collective responsibility are important for compliance and success of COVID-19 mitigation measures. However, schools and policy-makers should consider unintended consequences of measures, providing extra support for vulnerable students and those with additional needs, and consider ways to avoid widening educational and health inequalities. Findings demonstrate the acceptability of school COVID-19 infection control measures is likely to be influenced by the balance of risks and benefits to students.
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Affiliation(s)
- Ava Lorenc
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
- NIHR Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, Bristol, UK
| | - Joanna May Kesten
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
- NIHR Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, Bristol, UK
- NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol, Bristol, UK
| | - Judi Kidger
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
| | - Rebecca Langford
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
| | - Jeremy Horwood
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
- NIHR Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, Bristol, UK
- NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol, Bristol, UK
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Hancock E, Ward Z, Ayres R, Neale J, Hussey D, Kesten JM, Hickman M, Vickerman P. Detachable low dead space syringes for the prevention of hepatitis C among people who inject drugs in Bristol, UK: an economic evaluation. Addiction 2020; 115:702-713. [PMID: 31633849 PMCID: PMC7725423 DOI: 10.1111/add.14849] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 01/25/2019] [Revised: 04/30/2019] [Accepted: 09/27/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Traditional detachable syringes used by people who inject drugs (PWID) retain larger volumes of blood when the plunger is depressed than syringes with fixed needles-referred to as high (HDSS) and low dead space syringes (LDSS), respectively. Evidence suggests that using HDSS may result in greater hepatitis C virus (HCV) transmission risk than LDSS. We evaluated the cost-effectiveness of an intervention to introduce detachable LDSS in a needle and syringe programme (NSP). DESIGN HCV transmission and disease progression model with cost-effectiveness analysis using a health-care perspective. Detachable LDSS are associated with increased costs (£0.008) per syringe, yearly staff training costs (£536) and an estimated decreased risk (by 47.5%) of HCV transmission compared with HDSS. The intervention was modelled for 10 years, with costs and health benefits (quality-adjusted life-years: QALYs) tracked over 50 years. SETTING Bristol, UK. PARTICIPANTS AND CASES PWID attending NSP. INTERVENTION AND COMPARATOR Gradual replacement of HDSS at NSP, with 8, 58 and 95% of HDSS being replaced by detachable LDSS in 2016, 2017 and 2018, respectively. Comparator was continuing use of HDSS. MEASUREMENTS Net monetary benefit. Benefits were measured in QALYs. FINDINGS Introducing detachable LDSS was associated with a small increase in intervention costs (£21 717) compared with not introducing detachable LDSS, but considerable savings in HCV-related treatment and care costs (£4 138 118). Overall cost savings were £4 116 401 over 50 years and QALY gains were 1000, with an estimated 30% reduction in new infections over the 10-year intervention period. In all sensitivity analyses, detachable LDSS resulted in cost savings and additional QALYs. Threshold analyses suggested that detachable LDSS would need to reduce HCV transmission risk of HDSS by 0.26% to be cost-saving and 0.04% to be cost-effective. CONCLUSIONS Replacing high dead space syringes with detachable low dead space syringes in needle and syringe programmes in the United Kingdom is likely to be a cost-saving approach for reducing hepatitis C virus transmission.
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Affiliation(s)
| | - Zoe Ward
- Population Health Sciences, University of Bristol, UK
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10
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Hussey D, Trinder-Widdess Z, Dee C, Bagnall D, Bojangles T, Kesten JM. Co-design of harm reduction materials for people who inject drugs to implement research findings. Harm Reduct J 2019; 16:36. [PMID: 31174536 PMCID: PMC6555749 DOI: 10.1186/s12954-019-0300-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/12/2019] [Indexed: 11/30/2022] Open
Abstract
Background Equipment used by people who inject drugs (PWID) either has a needle which is fixed to the syringe or can be detached and replaced. Detachable low dead space syringes (LDSS) have been developed, with less space between the needle and plunger (referred to as dead space) than traditional detachable equipment. This equipment can help protect PWID from harm of infection as less blood is transferred if equipment is shared. Our previous research found that detachable LDSS are likely to be acceptable to PWID, and we produced recommendations for their introduction in needle and syringe programmes (NSP) in the United Kingdom (UK). We held a national stakeholder meeting to discuss how to accelerate the pace and scale of the rollout and uptake of detachable LDSS. This commentary reflects on the involvement of PWID as co-designers of harm reduction materials to implement these research findings in a way that supports the uptake of LDSS equipment by NSP and service users. We present the user-centred design process, peer reflections on the project, and lessons learnt by the team working with the peers. Main body Peers and stakeholders translated the research into easy to understand messages following a consultation with NSP across the UK. Working with Linnell Publications over three workshops, peers selected their preferred design style and informed the language, messages, and overall look of the designs. The peers ensured the designs avoided images and language with negative connotations, humour, and unequivocal language. Peers said that they found the process enjoyable and informative—leading to increased awareness of harm reduction practices. The facilitators took steps to ensure the views of the peers were heard throughout. They reflected on the importance of involving PWID meaningfully throughout the project. Without the peers, the designs would be less effective and engaging to their target audience. Conclusion We conclude that placing peers at the heart of this research implementation project was essential to ensure the materials are appropriate and engaging and do not stigmatise or alienate the intended audience unintentionally. We recommend that others planning similar work include peers within the entire project to support their meaningful contribution.
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Affiliation(s)
- Deborah Hussey
- Bristol Drugs Project, 11 Brunswick Square, Bristol, BS2 8PE, UK.,National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Zoe Trinder-Widdess
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Bristol Health Partners, Bristol, UK
| | - Cassie Dee
- Bristol Drugs Project, 11 Brunswick Square, Bristol, BS2 8PE, UK
| | - Darren Bagnall
- Bristol Drugs Project, 11 Brunswick Square, Bristol, BS2 8PE, UK
| | - Tatty Bojangles
- Bristol Drugs Project, 11 Brunswick Square, Bristol, BS2 8PE, UK
| | - Joanna May Kesten
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK. .,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. .,National Institute for Health Research Health Protection Research Unit (HPRU) in Evaluation of Interventions, University of Bristol, Bristol, UK.
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11
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Kesten JM, Flannagan C, Ruane-McAteer E, Merriel SWD, Nadarzynski T, Shapiro G, Rosberger Z, Prue G. Mixed-methods study in England and Northern Ireland to understand young men who have sex with men's knowledge and attitudes towards human papillomavirus vaccination. BMJ Open 2019; 9:e025070. [PMID: 31092645 PMCID: PMC6530382 DOI: 10.1136/bmjopen-2018-025070] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Men who have sex with men (MSM) are at greater risk for human papillomavirus (HPV)-associated cancers. Since 2016, MSM have been offered the HPV vaccination, which is most effective when received prior to sexual debut, at genitourinary medicine clinics in the UK. In September 2019, the national HPV vaccination programme will be extended to boys. This study aimed to understand young MSM's (YMSM) knowledge and attitudes towards HPV vaccination. DESIGN Questionnaires assessed YMSM demographics, sexual behaviour, culture, knowledge and attitudes towards HPV vaccination and stage of vaccine decision-making using the precaution adoption process model. Focus groups explored sexual health information sources, attitudes, barriers and facilitators to vaccination and strategies to support vaccination uptake. Questionnaire data were analysed using descriptive statistics and focus group data were analysed thematically. SETTING Questionnaires were completed online or on paper. Focus groups were conducted within Lesbian Gay Bisexual Transgender Queer organisational settings and a university student's union in England and Northern Ireland. PARTICIPANTS Seventeen YMSM (M=20.5 years) participated in four focus groups and 51 (M=21.1 years) completed questionnaires. RESULTS Over half of YMSM were aware of HPV (54.9%), yet few (21.6%) had previously discussed vaccination with a healthcare professional (HCP). Thematic analyses found YMSM were willing to receive the HPV vaccine. Vaccination programmes requiring YMSM to request the vaccine, particularly prior to sexual orientation disclosure to family and friends, were viewed as unfeasible. Educational campaigns explaining vaccine benefits were indicated as a way to encourage uptake. CONCLUSIONS This study suggests that to effectively implement HPV vaccination for YMSM, this population requires clearer information and greater discussion with their HCP. In support of the decision made by the Joint Committee on Vaccination and Immunisation, universal vaccination is the most feasible and equitable option. However, the absence of a catch-up programme will leave a significant number of YMSM at risk of HPV infection.
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Affiliation(s)
- Joanna May Kesten
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West, University of Bristol, Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Carrie Flannagan
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Newtownabbey, UK
| | - Eimear Ruane-McAteer
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | | | - Tom Nadarzynski
- School of Social Sciences, University of Westminster, London, UK
| | - Gilla Shapiro
- Department of Psychology, McGill University, Montreal, Canada
| | - Zeev Rosberger
- Department of Psychology, McGill University, Montreal, Canada
| | - Gillian Prue
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
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12
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Schneider A, Cabral C, Herd N, Hay A, Kesten JM, Anderson E, Lane I, Beck C, Michie S. Reducing Primary Care Attendance Intentions for Pediatric Respiratory Tract Infections. Ann Fam Med 2019; 17:239-249. [PMID: 31085528 PMCID: PMC6827624 DOI: 10.1370/afm.2392] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 01/21/2019] [Accepted: 02/12/2019] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate a theory and evidence-based, parent-targeted online intervention, combining microbiological local syndromic surveillance data, symptom information, and home-care advice, to reduce primary care attendance for self-limiting, low-risk pediatric respiratory tract infections (RTIs). METHODS The effect of this novel intervention on primary care attendance intentions was evaluated in an online experimental study. A representative sample of mothers (n = 806) was randomly assigned to receive the intervention material before (intervention) or after (control) answering questions concerning attendance intentions for an RTI illness scenario and mediating factors. Both groups provided feedback on the material. Group comparisons, linear regression, and path analyses were conducted. RESULTS Intervention participants reported lower attendance intentions compared with control participants (d = 0.69, 95% CI, 0.55-0.83), an effect that remained when controlling for demographic and clinical characteristics (B = -1.62, 95% CI, -1.97 to -1.30). The path model highlighted that the intervention effect (B = -0.33, 95% CI, -0.40 to -0.26) was mostly indirect and mediated by infection and antibiotic knowledge, symptom severity concerns, and social norm perceptions concerning attendance. Information on when to attend was rated as the most important intervention component 227 times, followed by symptoms rated 186 times. Information on circulating viruses was rated as least important 274 times. CONCLUSIONS The intervention was effective in reducing primary care attendance intentions by increasing knowledge, lowering attendance motivation, and reducing the need for additional resources. The contribution of individual intervention components and effects on behavioral outcomes requires further testing.
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Affiliation(s)
- Annegret Schneider
- University College London, London, United Kingdom .,NIHR Health Protection Research Unit in Evaluation of Interventions, Bristol, United Kingdom
| | | | - Natalie Herd
- University College London, London, United Kingdom.,NIHR Health Protection Research Unit in Evaluation of Interventions, Bristol, United Kingdom
| | - Alastair Hay
- NIHR Health Protection Research Unit in Evaluation of Interventions, Bristol, United Kingdom.,University of Bristol, Bristol, United Kingdom
| | - Joanna May Kesten
- NIHR Health Protection Research Unit in Evaluation of Interventions, Bristol, United Kingdom.,University of Bristol, Bristol, United Kingdom.,NIHR Collaboration for Leadership in Applied Health Research and Care West, Bristol, United Kingdom
| | - Emma Anderson
- NIHR Health Protection Research Unit in Evaluation of Interventions, Bristol, United Kingdom.,University of Bristol, Bristol, United Kingdom
| | - Isabel Lane
- University of Bristol, Bristol, United Kingdom
| | | | - Susan Michie
- University College London, London, United Kingdom.,NIHR Health Protection Research Unit in Evaluation of Interventions, Bristol, United Kingdom
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13
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Anderson EC, Kesten JM, Lane I, Hay AD, Moss T, Cabral C. Primary care clinicians' views of paediatric respiratory infection surveillance information to inform clinical decision-making: a qualitative study. BMJ Paediatr Open 2019; 3:e000418. [PMID: 31321318 PMCID: PMC6597489 DOI: 10.1136/bmjpo-2018-000418] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/15/2019] [Accepted: 03/26/2019] [Indexed: 11/30/2022] Open
Abstract
AIM To investigate primary care clinicians' views of a prototype locally relevant, real-time viral surveillance system to assist diagnostic decision-making and antibiotic prescribing for paediatric respiratory tract infections (RTI). Clinicians' perspectives on the content, anticipated use and impact were explored to inform intervention development. BACKGROUND Children with RTIs are overprescribed antibiotics. Pressures on primary care and diagnostic uncertainty can lead to decisional biases towards prescribing. We hypothesise that real-time paediatric RTI surveillance data could reduce diagnostic uncertainty and help reduce unnecessary antibiotic prescribing. METHODOLOGY Semistructured one-to-one interviews with 21 clinicians from a range of urban general practitioner surgeries explored the clinical context and views of the prototype system. Transcripts were analysed using thematic analysis. RESULTS Though clinicians self-identified as rational (not over)prescribers, cognitive biases influenced antibiotic prescribing decisions. Clinicians sought to avoid 'anticipated regret' around not prescribing for a child who then deteriorated. Clinicians were not aware of formal infection surveillance information sources (tending to assume many viruses are around), perceiving the information as novel and potentially useful. Perceptions of surveillance information as presented included: not relevant to decision-making/management; useful to confirm decisions post hoc; and increasing risks of missing sick children. Clinicians expressed wariness of using population-level data to influence individual patient decision-making and expressed preference for threat (high-risk) information identified by surveillance, rather than reassuring information about viral RTIs. CONCLUSIONS More work is needed to develop a surveillance intervention if it is to beneficially influence decision-making and antibiotic prescribing in primary care. Key challenges for developing interventions are how to address cognitive biases and how to communicate reassuring information to risk-oriented clinicians.
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Affiliation(s)
- Emma C Anderson
- Centre for Academic Child Health, Bristol Medical School: Population Health Sciences, University of Bristol School of Social and Community Medicine, Bristol, UK
| | - Joanna May Kesten
- NIHR Collaboration for Leadership in Applied Health Research and Care West and NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol School of Social and Community Medicine, Bristol, UK
| | - Isabel Lane
- Centre for Academic Primary Care, NIHR School for Primary Care Research, University of Bristol School of Social and Community Medicine, Bristol, UK
| | - Alastair D Hay
- NIHR Health Protection Research Unit in Evaluation of Interventions, Centre for Academic Primary Care, University of Bristol School of Social and Community Medicine, Bristol, UK
| | - Timothy Moss
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Christie Cabral
- Centre for Academic Primary Care, University of Bristol School of Social and Community Medicine, Bristol, UK
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14
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Moore THM, Kesten JM, López-López JA, Ijaz S, McAleenan A, Richards A, Gray S, Savović J, Audrey S. The effects of changes to the built environment on the mental health and well-being of adults: Systematic review. Health Place 2018; 53:237-257. [PMID: 30196042 DOI: 10.1016/j.healthplace.2018.07.012] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [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: 09/27/2017] [Revised: 06/01/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
Abstract
There is increasing interest in the influence of place on health, and the need to distinguish between environmental and individual level factors. For environmental-level factors, current evidence tends to show associations through cross-sectional and uncontrolled longitudinal analyses rather than through more robust study designs that can provide stronger causal evidence. We restricted this systematic review to randomised (or cluster) randomised controlled trials and controlled before-and-after studies of changes to the built environment. Date of search was December 2016. We identified 14 studies. No evidence was found of an effect on mental health from 'urban regeneration' and 'improving green infrastructure' studies. Beneficial effects on quality-of-life outcomes from 'improving green infrastructure' were found in two studies. One 'improving green infrastructure' study reported an improvement in social isolation. Risk-of-bias assessment indicated robust data from only four studies. Overall, evidence for the impact of built environment interventions on mental health and quality-of-life is weak. Future research requires more robust study designs and interdisciplinary research involving public health, planning and urban design experts.
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Affiliation(s)
- T H M Moore
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, UK; Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK.
| | - J M Kesten
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, UK; The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, Bristol Medical School, University of Bristol, UK
| | - J A López-López
- Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
| | - S Ijaz
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, UK; Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
| | - A McAleenan
- Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
| | - A Richards
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, UK
| | - S Gray
- Department of Health and Applied Social Science, University of the West of England, Bristol BS16 1QY, UK
| | - J Savović
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, UK; Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
| | - S Audrey
- Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
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15
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Kesten JM, Audrey S, Holding M, Coope C, Young N, Brown CS, Harries J, Hickman M, Oliver I. Qualitative study of Ebola screening at ports of entry to the UK. BMJ Glob Health 2018; 3:e000788. [PMID: 29989094 PMCID: PMC6035509 DOI: 10.1136/bmjgh-2018-000788] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 11/04/2022] Open
Abstract
Introduction In response to the 2013-2016 West African outbreak of the Ebola virus disease (EVD), Public Health England introduced enhanced screening at major UK ports of entry. Our aim was to explore screeners' and screened travellers' perceptions of screening as part of an evaluation of the screening programme. Methods We undertook qualitative focus groups and semistructured interviews with screeners and travellers who had returned from affected countries before and after the introduction of screening in England. The study was conducted in two airports: one international rail terminal and one military airport. Research topic guides explored perceptions of the purpose and implementation of the process, potential improvements and reactions to screening. The data were analysed using the framework method. Results Twenty-four screeners participated in 4 focus groups (one for each port of entry) and 23 travellers participated in interviews. Three themes are presented: 'Context', 'Screeners' experience of the programme' and 'Screening purpose and experiences'. The programme was implemented rapidly, refined over time and adapted to individual ports. Screeners reported diverse experiences of screening including negative impacts on their normal roles, difficult interactions with passengers and pressure to identify positive EVD cases. Screening was considered unlikely to identify individuals with symptoms of EVD, and some participants suggested it was driven by political concerns rather than empirical evidence. The screening process was valued for its provision of information and reassurance. Conclusion This qualitative study found that the UK EVD screening process was perceived to be acceptable to assess individual risk and provide information and advice to travellers. Future programmes should have clear objectives and streamlined processes to minimise disruption, tailored to the nature of the threat and developed with the needs of humanitarian workers as well as general travellers in mind.
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Affiliation(s)
- Joanna May Kesten
- NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK.,The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Suzanne Audrey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Maya Holding
- NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK.,Field Epidemiology Service, National Infection Service, Public Health England, Bristol, UK.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Caroline Coope
- NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK.,Field Epidemiology Service, National Infection Service, Public Health England, Bristol, UK
| | - Nick Young
- Public Health England South West Centre, Public Health England, Bristol, UK
| | - Colin S Brown
- National Infection Service, Public Health England, Bristol, UK
| | - Jenny Harries
- Public Health England South of England Regional Office, Public Health England, London, UK
| | - Matthew Hickman
- NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Isabel Oliver
- NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK.,Field Epidemiology Service, National Infection Service, Public Health England, Bristol, UK
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16
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Kesten JM, Bhattacharya A, Ashiru-Oredope D, Gobin M, Audrey S. The Antibiotic Guardian campaign: a qualitative evaluation of an online pledge-based system focused on making better use of antibiotics. BMC Public Health 2017; 18:5. [PMID: 28693462 PMCID: PMC5504645 DOI: 10.1186/s12889-017-4552-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Antibiotic Guardian Campaign was developed to increase commitment to reducing Antimicrobial Resistance (AMR), change behaviour and increase knowledge through an online pledge system for healthcare professionals and members of the public to become Antibiotic Guardians (AG). This qualitative evaluation aimed to understand AG experiences of the campaign and perceived impact on behaviour. METHODS Ninety-four AGs (48 via a survey and 46 who had agreed to future contact) were invited to participate in a telephone semi-structured interview. The sample was based on self-identification as a healthcare professional or a member of the public, pledge group (e.g. adults, primary care prescribers etc.), pledge and gender. Interviews explored how participants became aware of the campaign, reasons for joining, pledge choices, responses to joining and views about the campaign's implementation. Interviews were analysed using the Framework Method. RESULTS Twenty-two AGs (10 healthcare professionals and 12 members of the public) were interviewed. AGs became aware of the campaign through professional networks and social media, and were motivated to join by personal and professional concern for AMR. Choice of pledge group and pledge were attributed to relevance and potential impact on AMR and the behaviour of others through pledge enactment and promotion of the campaign. Most AGs could not recall their pledge unprompted. Most felt they fulfilled their pledge, although this reflected either behaviour change or the pledge reinforcing pre-existing behaviour. The campaign triggered AGs to reflect on AMR related behaviour and reinforced pre-existing beliefs. Several AGs promoted the campaign to others. Responding collectively as part of the campaign was thought to have a greater impact than individual action. However, limited campaign visibility was observed and the campaign was perceived to have restricted ability to reach those unaware of AMR. CONCLUSIONS AGs were motivated to reduce AMR and most felt they fulfilled their pledges although for many this appeared to be through reinforcement of existing behaviours. We recommend that the campaign engages those without pre-existing knowledge of AMR by increasing its visibility, capitalising on the diffusion of its message and including more awareness-raising content for those with limited AMR knowledge.
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Affiliation(s)
- Joanna May Kesten
- The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, School of Social and Community Medicine, University of Bristol, Bristol, UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Alex Bhattacharya
- Antimicrobial Resistance Programme, Public Health England, London, UK
| | | | - Maya Gobin
- The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Field Epidemiology Service, Public Health England, Bristol, UK
| | - Suzanne Audrey
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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17
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Kesten JM, Anderson EC, Lane I, Hay AD, Cabral C. Parent views on the content and potential impact of respiratory tract infection surveillance information: semistructured interviews to inform future research. BMJ Paediatr Open 2017; 1:e000036. [PMID: 29637100 PMCID: PMC5843006 DOI: 10.1136/bmjpo-2017-000036] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/26/2017] [Accepted: 07/20/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study explored the potential value of real-time information regarding respiratory tract infections (RTIs) circulating in the community by eliciting parent views on illustrative surveillance information and its possible impact on primary care consultations. DESIGN Semistructured interviews were conducted with parents of children (>3 months-15 years). Participants were presented with example information on circulating viruses, symptoms and symptom duration and asked about its potential impact on perceptions of child illness and management practices. Interviews were analysed using the framework method. SETTING Parents participating in a cohort study were selected purposefully using index of multiple deprivation and child age. PARTICIPANTS 30 mothers of children (>3 months-15years). RESULTS Parents anticipated using the information to inform lay diagnoses particularly when child symptoms were severe and thought normal symptom duration awareness might extend the time prior to seeking medical advice, but it also may encourage consultations when symptoms exceed the given duration. The information was not expected to change consultation behaviour if parents felt their child needed a medical evaluation and they felt unable to manage the symptoms. Most parents felt that the information could provide reassurance that could reduce intention to consult, but some felt it could raise concerns, by heightening awareness of circulating viruses. Lastly, parents wanted advice about protecting children from circulating viruses and felt that general practitioners using the information to diagnose child RTIs with greater certainty was acceptable. CONCLUSIONS Diverse responses to the surveillance information were elicited, and there was some support for the intended outcomes. This study has important implications for the design of interventions to modify consulting behaviour. Future piloting to measure behaviour change in response to infection surveillance information are needed.
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Affiliation(s)
- Joanna May Kesten
- The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, School of Social and Community Medicine, University of Bristol, Bristol, UK.,The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Emma C Anderson
- The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, School of Social and Community Medicine, University of Bristol, Bristol, UK.,Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Isabel Lane
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.,NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alastair D Hay
- The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, School of Social and Community Medicine, University of Bristol, Bristol, UK.,Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Christie Cabral
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Anderson EC, Ingle SM, Muir P, Beck C, Finn A, Leeming JP, Cabral C, Kesten JM, Hay AD. Community paediatric respiratory infection surveillance study protocol: a feasibility, prospective inception cohort study. BMJ Open 2016; 6:e013017. [PMID: 27580839 PMCID: PMC5013365 DOI: 10.1136/bmjopen-2016-013017] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Paediatric respiratory tract infections (RTIs) are common reasons for primary care consultations and antibiotic prescribing. Locally relevant syndromic and microbiological surveillance information has the potential to improve the care of children with RTIs by normalising illness (parents) and reducing uncertainty (clinicians). Currently, most RTI studies are conducted at the point of healthcare service consultation, leaving the community burden, microbiology, symptom duration and proportion consulting largely unknown. This study seeks to establish the feasibility of (mainly online) participant recruitment and retention, and the acceptability/comparability of parent versus nurse-collected microbiological sampling, to inform the design of a future surveillance intervention study. Evidence regarding consultation rates and symptom duration is also sought. METHODS AND ANALYSIS A community-based, feasibility prospective inception cohort study, recruiting children aged ≥3 months and <16 years and their parents via general practitioner surgery invitation letter, aiming to collect data on 300 incident RTIs by July 2016. Following informed consent, parents provide baseline (demographic) data online, and respond to weekly emails to confirm the absence/presence of new RTI symptoms. Once symptomatic, parents provide daily data online (RTI symptoms, school/day-care attendance, time off work, health service use, medication), and a research nurse visits to collect clinical examination data and microbiological (nasal and saliva) swabs. Parents are invited to provide symptomatic (at nurse visit, but without nurse assistance) and asymptomatic (alone) swabs on recovery. A review of primary care medical notes will gather medical history, health service utilisation, referral and antibiotic prescribing rates. Feasibility will be assessed using recruitment and retention rates, data completeness; and acceptability by quantitative survey and qualitative interviews. Symptomatic parent and nurse swab pairs will be compared for microbe isolation.
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Affiliation(s)
- Emma C Anderson
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) on Evaluation of Interventions, University of Bristol, Bristol, UK School of Social and Community Medicine, University of Bristol, Bristol, UK Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Suzanne Marie Ingle
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) on Evaluation of Interventions, University of Bristol, Bristol, UK School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Peter Muir
- Public Health England, Specialist Virology Centre, Bristol, UK
| | - Charles Beck
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) on Evaluation of Interventions, University of Bristol, Bristol, UK School of Social and Community Medicine, University of Bristol, Bristol, UK Field Epidemiology Service, Public Health England, Bristol, UK
| | - Adam Finn
- Schools of Clinical Sciences and Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - John Peter Leeming
- North Bristol NHS Trust, Bristol Centre for Antimicrobial Research and Evaluation (BCARE), Bristol, UK
| | - Christie Cabral
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) on Evaluation of Interventions, University of Bristol, Bristol, UK School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Joanna May Kesten
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) on Evaluation of Interventions, University of Bristol, Bristol, UK School of Social and Community Medicine, University of Bristol, Bristol, UK The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Alastair D Hay
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) on Evaluation of Interventions, University of Bristol, Bristol, UK School of Social and Community Medicine, University of Bristol, Bristol, UK
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Jago R, Zahra J, Edwards MJ, Kesten JM, Solomon-Moore E, Thompson JL, Sebire SJ. Managing the screen-viewing behaviours of children aged 5-6 years: a qualitative analysis of parental strategies. BMJ Open 2016; 6:e010355. [PMID: 26932143 PMCID: PMC4785319 DOI: 10.1136/bmjopen-2015-010355] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES The present study used qualitative methods to: (1) examine the strategies that were used by parents of children aged 5-6 years to manage screen viewing; (2) identify key factors that affect the implementation of the strategies and (3) develop suggestions for future intervention content. DESIGN Telephone interviews were conducted with parents of children aged 5-6 years participating in a larger study. Interviews were transcribed verbatim and analysed using an inductive and deductive content analysis. Coding and theme generation was iterative and refined throughout. SETTING Parents were recruited through 57 primary schools located in the greater Bristol area (UK). PARTICIPANTS 53 parents of children aged 5-6 years. RESULTS Parents reported that for many children, screen viewing was a highly desirable behaviour that was difficult to manage, and that parents used the provision of screen viewing as a tool for reward and/or punishment. Parents managed screen viewing by setting limits in relation to daily events such as meals, before and after school, and bedtime. Screen-viewing rules were often altered depending on parental preferences and tasks. Inconsistent messaging within and between parents represented a source of conflict at times. Potential strategies to facilitate reducing screen viewing were identified, including setting screen-viewing limits in relation to specific events, collaborative rule setting, monitoring that involves mothers, fathers and the child, developing a family-specific set of alternative activities to screen viewing and developing a child's ability to self-monitor their own screen viewing. CONCLUSIONS Managing screen viewing is a challenge for many parents and can often cause tension in the home. The data presented in this paper provide key suggestions of new approaches that could be incorporated into behaviour change programmes to reduce child screen viewing.
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Affiliation(s)
- R Jago
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - J Zahra
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - M J Edwards
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - J M Kesten
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - E Solomon-Moore
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - J L Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - S J Sebire
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
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Kesten JM, Guell C, Cohn S, Ogilvie D. From the concrete to the intangible: understanding the diverse experiences and impacts of new transport infrastructure. Int J Behav Nutr Phys Act 2015; 12:72. [PMID: 26041652 PMCID: PMC4470025 DOI: 10.1186/s12966-015-0230-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 05/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Changes to the environment that support active travel have the potential to increase population physical activity. The Cambridgeshire Guided Busway is an example of such an intervention that provides new traffic-free infrastructure for walking, cycling and public transport. This qualitative investigation explored the diverse experiences of new transport infrastructure and its impacts on active travel behaviours. METHODS Thirty-eight adult participants from the Commuting and Health in Cambridge natural experimental study were purposively selected according to their demographic and travel behaviour change characteristics and invited to participate in semi-structured interviews between February and June 2013. A mixed-method, following-a-thread approach was used to construct two contrasting vignettes (stories) to which the participants were asked to respond as part of the interviews. Inductive thematic qualitative analysis of the interview data was performed with the aid of QSR NVivo8. RESULTS Perceptions of the busway's attributes were important in shaping responses to it. Some participants rarely considered the new transport infrastructure or described it as unappealing because of its inaccessibility or inconvenient routing. Others located more conveniently for access points experienced the new infrastructure as an attractive travel option. Likewise, the guided buses and adjacent path presented ambiguous spaces which were received in different ways, depending on travel preferences. While new features such as on board internet access or off-road cycling were appreciated, shortcomings such as overcrowded buses or a lack of path lighting were barriers to use. The process of adapting to the environmental change was discussed in terms of planning and trialling new behaviours. The establishment of the busway in commuting patterns appeared to be influenced by whether the anticipated benefits of change were realised. CONCLUSIONS This study examined the diverse responses to an environmental intervention that may help to explain small or conflicting aggregate effects in quantitative outcome evaluation studies. Place and space features, including accessibility, convenience, pleasantness and safety relative to the alternative options were important for the acceptance of the busway. Our findings show how environmental change supporting active travel and public transport can encourage behaviour change for some people in certain circumstances.
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Affiliation(s)
- Joanna May Kesten
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box, 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
| | - Cornelia Guell
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box, 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
| | - Simon Cohn
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - David Ogilvie
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box, 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
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Edwards MJ, Jago R, Sebire SJ, Kesten JM, Pool L, Thompson JL. The influence of friends and siblings on the physical activity and screen viewing behaviours of children aged 5-6 years: a qualitative analysis of parent interviews. BMJ Open 2015; 5:e006593. [PMID: 25976759 PMCID: PMC4442207 DOI: 10.1136/bmjopen-2014-006593] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The present study uses qualitative data to explore parental perceptions of how their young child's screen viewing and physical activity behaviours are influenced by their child's friends and siblings. DESIGN Telephone interviews were conducted with parents of year 1 children (age 5-6 years). Interviews considered parental views on a variety of issues related to their child's screen viewing and physical activity behaviours, including the influence that their child's friends and siblings have over such behaviours. Interviews were transcribed verbatim and analysed using deductive content analysis. Data were organised using a categorisation matrix developed by the research team. Coding and theme generation was iterative and refined throughout. Data were entered into and coded within N-Vivo. SETTING Parents were recruited through 57 primary schools located in Bristol and the surrounding area that took part in the B-ProAct1v study. PARTICIPANTS Fifty-three parents of children aged 5-6 years. RESULTS Parents believe that their child's screen viewing and physical activity behaviours are influenced by their child's siblings and friends. Friends are considered to have a greater influence over the structured physical activities a child asks to participate in, whereas the influence of siblings is more strongly perceived over informal and spontaneous physical activities. In terms of screen viewing, parents suggest that their child's friends can heavily influence the content their child wishes to consume, however, siblings have a more direct and tangible influence over what a child watches. CONCLUSIONS Friends and siblings influence young children's physical activity and screen viewing behaviours. Child-focused physical activity and screen viewing interventions should consider the important influence that siblings and friends have over these behaviours.
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Affiliation(s)
- M J Edwards
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - R Jago
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - S J Sebire
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - J M Kesten
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - L Pool
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - J L Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Kesten JM, Griffiths PL, Cameron N. A critical discussion of the Community Readiness Model using a case study of childhood obesity prevention in England. Health Soc Care Community 2015; 23:262-271. [PMID: 25429845 DOI: 10.1111/hsc.12139] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2014] [Indexed: 06/04/2023]
Abstract
Recent reforms to the public health system in England aim to generate co-ordinated action between local authorities, healthcare systems and communities to target local health priorities. To support this effort, researchers must contribute and evaluate appropriate strategies for designing interventions tailored to community-specific needs. One strategy is to apply the Community Readiness Model (CRM), which uses key informant interviews to assess a community's readiness to address local issues. This article presents a critical discussion of the CRM developed from a case study of obesity prevention in pre-adolescent girls within a community in the United Kingdom. Data were collected between February and November 2011. We offer lessons learnt and recommendations relating to (i) modifications to the interview guide; (ii) key informant identification; (iii) conducting interviews to theoretical saturation; (iv) using key informants to define their community; (v) key informant's ability to respond on behalf of the community; (vi) using a qualitative model with a quantitative scoring system; and (vii) the optimum application of transcript scoring. In conclusion, the CRM can help researchers, health professionals and local authorities identify the priorities of a community. It is recommended that users of the model be careful to identify and recruit suitable key informants with the help of the community under study, select an appropriate 'community' and utilise the qualitative findings to strengthen the interpretation of the readiness score.
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Affiliation(s)
- Joanna May Kesten
- Centre for Global Health and Human Development, Loughborough University, Loughborough, UK
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Kesten JM, Cameron N, Griffiths PL. Assessing community readiness for overweight and obesity prevention in pre-adolescent girls: a case study. BMC Public Health 2013; 13:1205. [PMID: 24359213 PMCID: PMC3878181 DOI: 10.1186/1471-2458-13-1205] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 12/13/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childhood overweight and obesity is a global public health concern. For girls in particular, being overweight or obese during pre-adolescence (aged 7-11 years) has intergenerational implications for both the mother and her future offspring. In the United Kingdom (UK) there is increasing interest in community targeted interventions but less is known about how to tailor these approaches to the needs of the community. This study applied the Community Readiness Model (CRM), for the first time in the UK, to demonstrate its applicability in designing tailored interventions. METHODS Community readiness assessment was conducted using semi-structured key informant interviews. The community's key informants were identified through focus groups with pre-adolescent girls. The interviews addressed the community's efforts; community knowledge of the efforts; leadership; community climate; community knowledge of the issue and resources available to support the issue. Interviews were conducted until the point of theoretical saturation and questions were asked separately regarding physical activity (PA) and healthy eating and drinking (HED) behaviours. The interviews were transcribed verbatim and were firstly analysed thematically and then scored using the assessment guidelines produced by the CRM authors. RESULTS Readiness in this community was higher for PA than for HED behaviours. The lowest scores related to the community's 'resources' and the 'community knowledge of the issue'; affirming these two issues as the most appropriate initial targets for intervention. In terms of resources, there is also a need for resources to support the development of HED efforts beyond the school. Investment in greater physical education training for primary school teachers was also identified as an intervention priority. To address the community's knowledge of the issue, raising the awareness of the prevalence of pre-adolescent girls' health behaviours is a priority at the local community level. Inconsistent school approaches contributed to tensions between schools and parents regarding school food policies. CONCLUSIONS This study has identified the readiness level within a UK community to address the behaviours related to overweight and obesity prevention in pre-adolescent girls. The focus of an intervention in this community should initially be resources and raising awareness of the issue within the community.
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Affiliation(s)
- Joanna May Kesten
- Centre for Global Health and Human Development, Loughborough University, LE11 3TU, Loughborough, UK
| | - Noel Cameron
- Centre for Global Health and Human Development, Loughborough University, LE11 3TU, Loughborough, UK
| | - Paula Louise Griffiths
- Centre for Global Health and Human Development, Loughborough University, LE11 3TU, Loughborough, UK
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Kesten JM, Griffiths PL, Cameron N. A systematic review to determine the effectiveness of interventions designed to prevent overweight and obesity in pre-adolescent girls. Obes Rev 2011; 12:997-1021. [PMID: 21848919 DOI: 10.1111/j.1467-789x.2011.00919.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [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] [Indexed: 11/29/2022]
Abstract
Childhood overweight/obesity is recognized as an increasing health problem. The objective of this review was to determine the effectiveness of interventions designed to prevent overweight and obesity in pre-adolescent girls. The papers included were those studying children (must include results for girls) from within the 7-11 years age range from any country and ethnic background. The included interventions lasted at least 12 weeks and modified a combination of nutrition, physical activity, knowledge, attitudes or health-related behaviours associated with the development of childhood overweight and obesity. Effect sizes were calculated where possible using Cohen's classifications of small (0.2-0.5), medium (0.5-0.8) and large (>0.8) effect sizes. Thirty studies met the inclusion criteria of which four were cluster randomized controlled trials, 14 were randomized controlled trials, 11 were controlled trials and one was a cohort pre-post trial. There were four weak, 11 moderate and 15 strong quality studies. Eleven studies were considered short term and 19 long term (≥12 months). There were 66 effect sizes less than 0.2, 56 categorized as low, 16 as medium and two as high. There is the potential for interventions aimed at pre-adolescent girls to reduce the risk factors associated with childhood overweight and obesity, although the sustainability of the effects of such interventions is less clear.
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Affiliation(s)
- J M Kesten
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK.
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