International Festival of Public Health

LT 4 - Health Promotion and Improvement

All Learners Public Health - Capturing the Mood for Health Promotion

Presenter: Jan Sinclair (Stockport NHSFT)

Other Author(s): Sarah Booth

Abstract Text:

At Stockport we were keen to develop a new initiative that would strengthen, promote and formalise the public health experience for students and provide them with a deeper understanding of the wider issues involved, when caring holistically for their patients. We are now in our fourth year of some great partnership working between Stockport NHS Foundation Trust, Stockport MBC Public Health Services, our local Universities (Manchester Metropolitan University and University of Manchester) and also one of our local Private & Voluntary Organisations (Nuffield Health), having gained a Student Nursing Times award two years ago for the innovative initiative. The Public Health Study Day has a unique blend of morning presentations and interactive learning with a focus of practical application of public health for the students. This is followed by a Market Stall style of public health community providers "selling" their services and providing the opportunity for students to book in spoke placements on the day having previously offered up to seventy placements in total. Evaluation of the day has always been very positive with comments from the studentssuch as: •“the market-stall event was amazing! with really good opportunities” •“I now have the knowledge to make a difference” •“Fantastic, I loved it! Very informative” •“It was very informative and I loved the opportunity to maintain this learning via the spoke placements” •“I feel more confident about promoting good health and have a better understanding about people’s motivations or things that might inhibit their ability to change” A "Tookit" has been compiled which is a summary of the planning processes for the day enabling complete transferability of the initiative for any other facility wanting to replicate the day. Health Education England have also included the initiative in their Public Health Outreach Projects as an example of excellent working partnership practice.

Exploring implementation of the Manchester Healthy Schools Programme: A qualitative study

Presenter: Joanna Goldthorpe (The University of Manchester)

Other Author(s): Tracy Epton, Chris Keyworth, Rachel Calam, Christopher J. Armitage

Abstract Text:

Primary schools have face validity as effective settings for anti-obesity interventions, however effect sizes for reductions in children’s weight are small. Intervention effectiveness could be improved by identifying the mechanisms associated with implementation. The aim of this study was to explore implementation of the Manchester Healthy Schools (MHS) programme (an intervention focusing on improving diet and increasing physical activity in primary school-aged children). We recruited 7 schools, conducted 14 focus groups (with children aged 5-10 years), 19 interviews with staff members and 17 interviews with parents. The primary data analysis was inductive, using qualitative thematic analysis followed by a secondary deductive analysis, drawing on Normalisation Process Theory (NPT). From the primary analysis we developed five themes: Perceptions of health; Responsibility and control; Social norms; Contextual features and Techniques. Our secondary analysis contributed to a deeper understanding of the mechanisms of implementation. This is the first study to use NPT to inform the implementation of a health behaviour change intervention in a school setting and all stakeholder groups have contributed to the rich body of evidence. We have highlighted implications for practice and recommendations for action and our results offer guidance in improving implementation and engagement which is vital to the ability of programmes such as MHS to positively affect health and weight outcomes for children. Our findings may also have resonance for other health promotion interventions delivered in primary schools, such as mental health support initiatives.

Experiences of Early Years Workers and Health Visitors When Having Conversations with Mothers of Pre-school Children about Their Child’s Weight and Providing Advice about Feeding Practices in the Multicultural City of Bradford.

Presenter: Marena Ceballos Rasgado (University of York)

Other Author(s): Rosie McEachan, Kate Pickett

Abstract Text:

Background: Early years workers and health visitors have a prime position in the identification and prevention of childhood overweight of preschool children . However, few studies have explored the experiences of these professionals when promoting healthy feeding practices in multicultural and deprived areas in England.

Aim: This study explores the experiences that early years workers and health professionals working in Bradford have when having conversations with the mothers about their child’s weight and providing advice about adequate feeding practices.

Methods: Early years workers (N=9) and health visitors (N=8) working in Bradford took part in one-to-one semi-structured interviews. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was applied using an inductive, semantic, contextualist approach.

Results: Three themes were identified: 1) Perceptions of mothers’ attitudes towards their child’s health and feeding practices, 2) Challenges and opportunities to offer support; and 3) Overweight and obesity as a sensitive topic. Participants perceived that mothers do not often identify overweight in their children or do not consider overweight as a health concern. These intrapersonal factors were seen as barriers to offer support.

Conclusions: Health professionals and early years workers need to be offered opportunities to gain confidence when raising concerns about the child’s weight and feeding practices with the mothers. Future research should explore how conversations between professionals and mothers could be optimised.

Introducing brief interventions for physical activity to an inner city general practice: a service evaluation

Presenter: Neil Cockburn (Lancashire Teaching Hospitals Trust)

Other Author(s): Surabhika Lunawat

Abstract Text:

Intro: The health benefits of physical activity are widely recognised, independently of weight loss. Brief physical activity interventions have also been shown to have impressive effect sizes in improving levels of physical activity, with better outcomes than brief smoking interventions, already a widely delivered intervention in all healthcare settings. PHE have now invested in GP physical activity clinical champions to improve the 'prescribing' levels of physical activity, and following a training workshop by a clinical champion 2 FY2s attempted to implement this practice.

Methods: A brief physical activity intervention was discussed, role played and implemented by doctors in the practice. Posters and materials were placed in waiting areas and the attached pharmacy with information on activity benefits and local opportunities. A pre-intervention questionnaire was given to patients to gather baseline perceptions and experiences for 2 weeks, and post intervention opinions were gathered from patients who had undergone an exercise intervention.

Aims: Did the brief physical activity intervention implemented in the practice increase patients' intentions to be active? Outcome A series of statements was given to patients based on the stages of the Trans-Theoretical Model of Behaviour Change and patients were asked which best reflected their current self-opinion. Secondary outcomes included self assessment of how much activity patients did and ought to do and appropriateness of the intervention.

Results: 55 patients answered the baseline questionnaire and 27 answered the intervention questionnaire. No change between baseline and intervention groups was noted in intention to be physically active. Most patients felt positively about the appropriateness of the intervention.

Discussion: The sample of this evaluation was small, but given the effect sizes of brief physical activity interventions in the literature, we would have expected some change in intentions to be active. Given longer to develop the intervention we would have followed up intentions and perceptions of activity at a later date and altered the intervention to focus on how to be more active, over the benefits of being active. Given the time constraints of GP appointments, crucial motivational interviewing and shared decision making techniques are difficult to use.