Can lay health trainers increase uptake of NHS Health Checks in hard-to-reach populations? A mixed-method pilot evaluation

BACKGROUND

The NHS Health Check Programme was launched in England in 2009, offering a vascular risk assessment to people aged 40-74 years without established disease. Socio-economic deprivation is associated with higher risk of cardiovascular disease and lower uptake of screening. We evaluated the potential impact of a community-based health check service that sought to address health inequalities through the involvement of lay health trainers.

METHODS

Key stakeholder discussions (n = 20), secondary analysis of client monitoring data (n = 774) and patient experience questionnaires (n = 181).

RESULTS

The health check programme was perceived as an effective way of engaging people in conversations about their health. More than half (57.6%) of clients were aged under 50 years and a similar proportion (60.5%) were from socio-economically deprived areas. Only 32.7% from the least affluent areas completed a full health check in comparison with 44.4% from more affluent areas. Eligible men were more likely than eligible women to complete a health check (59.4 versus 33.8%).

CONCLUSIONS

A community-based, health trainer-led approach may add value by offering an acceptable alternative to health checks delivered in primary care settings. The service appeared to be particularly successful in engaging men and younger age groups. However, there exists the potential for intervention-generated inequalities.

An evidence synthesis of qualitative and quantitative research on component intervention techniques, effectiveness, cost-effectiveness, equity and acceptability of different versions of health-related lifestyle advisor role in improving health

BACKGROUND

There is a need to identify and analyse the range of models developed to date for delivering health-related lifestyle advice (HRLA), or training, for effectiveness and cost-effectiveness in improving the health and well-being of individuals and communities in the UK, with particular reference to the reduction of inequalities.

OBJECTIVES

To identify the component intervention techniques of lifestyle advisors (LAs) in the UK and similar contexts, and the outcomes of HRLA interventions.

DATA SOURCES

Stakeholder views, secondary analysis of the National Survey of Health Trainer Activity, telephone survey of health trainer leads/coordinators. A search of a range of electronic databases was undertaken [including the Applied Social Sciences Index and Abstracts (ASSIA), EMBASE, NHS Economic Evaluation Database (NHS EED), MEDLINE, Psyc INFO, etc.], as well searching relevant journals and reference lists, conducted from inception to September 2008.

REVIEW METHODS

Identified studies were scanned by two reviewers and those meeting the following criteria were included: studies carrying out an evaluation of HRLA; those taking place in developed countries similar to the UK context; those looking at adult groups; interventions with the explicit aim of health improvement; interventions that involved paid or voluntary work with an individual or group of peers acting in an advisory role; advice delivered by post, online or electronically; training, support or counselling delivered to patients, communities or members of the public. After quality assessment, studies were selected for inclusion in the review. Data were abstracted from each study according to an agreed procedure and narrative, and realist and economic approaches were used to synthesise the data. Cost-effectiveness analysis of interventions was undertaken.

RESULTS

In total, 269 studies were identified but 243 were excluded. The 26 included studies addressing chronic care, mental health, breastfeeding, smoking, diet and physical activity, screening and human immunodeficiency virus (HIV) infection prevention. Overall, there was insufficient evidence to either support or refute the use of LAs to promote health and improve quality of life (QoL), and thus uncertainty about the interventions' cost-effectiveness. However, the economic analysis showed that LA interventions were cost-effective in chronic care and smoking cessation, inconclusive for breastfeeding and mental health and not cost-effective for screening uptake and diet/physical activity. LA interventions for HIV prevention were cost-effective, but not in a UK context.

LIMITATIONS

The wide variety of LA models, delivery settings and target populations prevented the reviewers from establishing firm causal relationships between intervention mode and study outcomes.

CONCLUSIONS

Evidence was variable, giving only limited support to LAs having a positive impact on health knowledge, behaviours and outcomes. Levels of acceptability appeared to be high. LAs acted as translational agents, sometimes removing barriers to prescribed behaviour or helping to create facilitative social environments. Reporting of processes of accessing or capitalising on indigenous knowledge was limited. Ambiguity was apparent with respect to the role and impact of lay and peer characteristics of the interventions. A future programme of research on HRLA could benefit from further emphasis on identification of needs, the broadening of population focus and intervention aims, the measurement of outcomes and the reviewing of evidence.

FUNDING

This study was funded by the Health Technology Assessment programme of the National Institute for Health Research.

Medical and social factors associated with cognitive outcome in individuals with myelomeningocele

The interrelationship between biological and social risk factors and cognitive outcome in individuals with myelomeningocele was examined. The Kaufman Brief Intelligence Test (K-BIT) was administered to 65 children and young adults, age range 4 to 29 during a recent clinic visit. Unshunted individuals had scores in the average range and individuals with uncomplicated hydrocephalus in the low-average range. Although the level of lesion was found to be most strongly associated with total K-BIT score, examination of subscores indicated that socioeconomic status was the factor most strongly associated with Vocabulary score. The importance of both social and biological factors in predicting cognitive outcome in this population is useful in planning intervention strategies.

Hull healthline: a description of a telephone health information and promotion service

The development and use of a telephone health information service, Hull Healthline, is described. The local circumstances which make the Hull service different from, and it is argued more effective than, national schemes are detailed. The relevance of such a service to a health promotion strategy is discussed.

Microcirculatory dysfunction following perfusion with hyperkalemic, hypothermic, cardioplegic solutions and blood reperfusion. Effects of adenosine

BACKGROUND

Cardioplegic solutions have been used to enhance myocardial preservation during cardiac surgery. The benefits derived from preventing myocardial ischemia with cardioplegic solutions may, however, be countered by tissue damage that occurs when the myocardium is reperfused with oxygenated blood. Furthermore, cardioplegia-induced endothelial dysfunction may contribute to depressed myocardial function postoperatively. The endothelium of coronary arteries and vein grafts is damaged by crystalloid cardioplegic solutions. There is less known about the effects of cardioplegic solutions on the microvasculature.

METHODS AND RESULTS

The hypothesis that microvascular damage occurs following perfusion with hyperkalemic, crystalloid, cardioplegic solutions and blood reperfusion, leading to decreased blood flow and increased neutrophil accumulation, was tested in a model system. Intravital microscopic observations were performed during a 20-minute perfusion of the hamster cremaster muscle with cardioplegic solutions (10 degrees C) via the femoral artery with the iliac occluded and during a subsequent 2-hour blood reperfusion period (iliac open). Arteriolar vasoconstriction (27% decrease in diameter, p less than 0.05) and a 25% decrease in the density of perfused capillaries (p less than 0.05) occurred during reperfusion in hamsters receiving crystalloid cardioplegic solution (16 meq K+) compared to control hamsters (no cardioplegic solution given). Neutrophils accumulated on venular endothelium in treated animals (250% increase, p less than 0.05) and extravascularly (myeloperoxidase levels 2.0 +/- 0.4 U/g versus 1.3 +/- 0.3 U/g in control, p less than 0.05). The addition of adenosine (10(-4) M) and albumin (2 g%) to the cardioplegic perfusate, accompanied by the administration of adenosine (10(-4) M) during reperfusion, produced arteriolar vasodilation (34% diameter increase, p less than 0.05) and inhibited extravascular neutrophil accumulation (myeloperoxidase level of 1.5 +/- 0.2 U/g, p greater than 0.05 versus control). Capillary perfusion, however, was still significantly diminished (28% decrease, p less than 0.05.)

CONCLUSIONS

We conclude that injury manifest by decreased microvascular blood flow and increased neutrophil accumulation in tissues occurs after perfusion with hypothermic, hyperkalemic, crystalloid cardioplegic solutions and blood reperfusion. Adenosine seems to partially attenuate this injury by dilating arterioles and decreasing extravascular neutrophil accumulation.

A rate-responsive pacemaker controlled by right ventricular blood temperature

To demonstrate the capabilities of a rate-responsive pacemaker controlled by right ventricular blood temperature, a prototype pacemaker was developed and tested in dogs with complete atrioventricular (AV) block. Using a previously obtained data base of right ventricular blood temperature recorded both during rest and during treadmill exercise from dogs with either induced AV block or normal AV conduction, a control algorithm which identified periods of exercise was developed. This algorithm was implemented in a microprocessor-based, rate-responsive pacemaker which generates two pacing rates: a basal rate (86 bpm) during rest and a higher rate (113 bpm) during moderate exercise. With repeated trials of submaximal treadmill exercise (2.25, 3.0, 5.0 mph, 16% grade) the pacemaker correctly detected the onset and cessation of exercise with latencies ranging from 35 to 124 seconds. Pacemaker rate increase latency decreased as the exercise level was increased. Pacemaker response latency was not affected by the choice of resting or exercise pacing rate. These preliminary data indicate that right ventricular blood temperature can provide a reliable index to control pacemaker rate. An implantable temperature-controlled pacemaker using this algorithm is presently under long-term evaluation in dogs performing untethered exercise.

A chest rehabilitation program that emphasizes the rural patient

This paper describes the multifaceted chest rehabilitation program at a referral-teaching hospital in Saskatchewan. The program was developed following recognition of the special needs of rural patients undergoing treatment for chronic obstructive pulmonary disease (COPD). It has evolved to include three aspects. The first is concerned with the rural patient as an inpatient who participates in chest, exercise and education classes, in conjunction with medical treatment, and whose discharge needs are recognized and acted upon while in hospital. The second aspect is that of the one-day educational workshop aimed at outpatients not yet requiring hospitalization. The third aspect pertains to the educational seminars organized to help the rural health professional in fulfilling a role in his or her community, whether assisting patients with COPD at home or in hospital. In the future, in order to assess the efficacy of this multifaceted program, a formal research study devised according to the data obtained through a preliminary survey of 101 of the program's inpatients should be undertaken.