Now showing items 1-20 of 1163

    • Food choice motives, attitude towards and intention to adopt personalised nutrition

      Rankin, A.; Bunting, B.P.; Poinhos, R.; van der Lans, I.A.; Fischer, A.R.H.; Kuznesof, S.; Almeida, M.D.V.; Markovina, Jerko; Frewer, L.J.; Stewart-Knox, Barbara (2018-10)
      The present study explored associations between food choice motives, attitudes towards and intention to adopt personalised nutrition, to inform communication strategies based on consumer priorities and concerns. Design/Setting: A survey was administered online which included the Food Choice Questionnaire (FCQ) and items assessing attitudes towards and intention to adopt personalised nutrition. Subjects: Nationally representative samples were recruited in nine EU countries (n 9381). Results: Structural equation modelling indicated that the food choice motives ‘weight control’, ‘mood’, ‘health’ and ‘ethical concern’ had a positive association and ‘price’ had a negative association with attitude towards, and intention to adopt, personalised nutrition. ‘Health’ was positively associated and ‘familiarity’ negatively associated with attitude towards personalised nutrition. The effects of ‘weight control’, ‘ethical concern’, ‘mood’ and ‘price’ on intention to adopt personalised nutrition were partially mediated by attitude. The effects of ‘health’ and ‘familiarity’ were fully mediated by attitude. ‘Sensory appeal’ was negatively and directly associated with intention to adopt personalised nutrition. Conclusions: Personalised nutrition providers may benefit from taking into consideration the importance of underlying determinants of food choice in potential users, particularly weight control, mood and price, when promoting services and in tailoring communications that are motivationally relevant.
    • Comparing proxy rated quality of life of people living with dementia in care homes

      Robertson, S.; Cooper, C.; Hoe, J.; Lord, Kathryn; Rapaport, P.; Marston, L.; Cousins, S.; Lyketsos, C.G.; Livingston, G. (2020-01)
      Background. Improving quality of life (QOL) for people with dementia is a priority. In care homes, we often rely on proxy ratings from staff and family but we do not know if, or how, they differ in care homes. Methods. We compared 1056 pairs of staff and family DEMQOL-Proxy ratings from 86 care homes across England. We explored factors associated with ratings quantitatively using multilevel modelling and, qualitatively, through thematic analysis of 12 staff and 12 relative interviews. Results. Staff and family ratings were weakly correlated (ρs = 0.35). Median staff scores were higher than family’s (104 v. 101; p < 0.001). Family were more likely than staff to rate resident QOL as ‘Poor’ (χ2 = 55.91, p < 0.001). Staff and family rated QOL higher when residents had fewer neuropsychiatric symptoms and severe dementia. Staff rated QOL higher in homes with lower staff:resident ratios and when staff were native English speakers. Family rated QOL higher when the resident had spent longer living in the care home and was a native English. Spouses rated residents’ QOL higher than other relatives. Qualitative results suggest differences arise because staff felt good care provided high QOL but families compared the present to the past. Family judgements centre on loss and are complicated by decisions about care home placement and their understandings of dementia. Conclusion. Proxy reports differ systematically between staff and family. Reports are influenced by the rater:staff and family may conceptualise QOL differently
    • Developing the New Interventions for independence in Dementia Study (NIDUS) theoretical model for supporting people to live well with dementia at home for longer: a systematic review of theoretical models and Randomised Controlled Trial evidence

      Lord, Kathryn; Beresford-Dent, Jules; Rapaport, P.; Burton, A.; Leverton, M.; Walters, K.; Lang, I.; Downs, Murna G.; Manthorpe, J.; Boex, S.; et al. (2020-01)
      Purpose: To build an evidence-informed theoretical model describing how to support people with dementia to live well or for longer at home. Methods: We searched electronic databases to August 2018 for papers meeting predetermined inclusion criteria in two reviews that informed our model. We scoped literature for theoretical models of how to enable people with dementia to live at home independently, with good life quality or for longer. We systematically reviewed Randomised Controlled Trials (RCTs) reporting psychosocial intervention effects on time lived with dementia at home. Two researchers independently rated risk of bias. We developed our theoretical model through discussions with experts by personal, clinical and academic experiences, informed by this evidence base. Results: Our scoping review included 52 studies. We divided models identified into: values and approaches (relational and recovery models; optimising environment and activities; family carer skills and support); care strategies (family carer-focused; needs and goal-based; self-management); and service models (case management; integrated; consumer-directed). The 11 RCTs included in our systematic review, all judged at low risk of bias, described only two interventions that increased time people with dementia lived in their own homes. These collectively encompassed all these components except for consumer-directed and integrated care. We developed and revised our model, using review evidence and expert consultation to define the final model. Conclusions: Our theoretical model describes values, care strategies and service models that can be used in the design of interventions to enable people with dementia to live well and for longer at home.
    • "I just keep thinking that I don't want to rely on people." a qualitative study of how people living with dementia achieve and maintain independence at home: stakeholder perspectives

      Rapaport, P.; Burton, A.; Leverton, M.; Herat-Gunaratne, R.; Beresford-Dent, Jules; Lord, Kathryn; Downs, Murna G.; Boex, S.; Horsley, R.; Giebel, C.; et al. (2020-01)
      BACKGROUND: Most people living with dementia want to remain in their own homes, supported by family and paid carers. Care at home often breaks down, necessitating transition to a care home and existing interventions are limited. To inform the development of psychosocial interventions to enable people with dementia to live well for longer at home, we qualitatively explored the views of people living with dementia, family carers and health and social care professionals, on how to achieve and maintain independence at home and what impedes this. METHODS: We conducted an inductive thematic analysis of qualitative interviews with 11 people living with dementia, 19 professionals and 22 family carers in England. RESULTS: We identified four overarching themes: being in a safe and familiar environment, enabling not disabling care, maintaining relationships and community connectedness, and getting the right support. For people living with dementia, the realities of staying active were complex: there was a tension between accepting support that enabled independence and a feeling that in doing so they were accepting dependency. Their and professionals' accounts prioritised autonomy and 'living well with dementia', while family carers prioritised avoiding harm. Professionals promoted positive risk-taking and facilitating independence, whereas family carers often felt they were left holding this risk. DISCUSSION: Psychosocial interventions must accommodate tensions between positive risk-taking and avoiding harm, facilitating autonomy and providing support. They should be adaptive and collaborative, combining self-management with flexible support. Compassionate implementation of rights-based dementia care must consider the emotional burden for family carers of supporting someone to live positively with risk.
    • Online information and support for carers of people with young-onset dementia: A multi-site randomised controlled pilot study

      Metcalfe, A.; Jones, B.; Mayer, J.; Gage, H.; Oyebode, Jan R.; Boucault, S.; Aloui, S.; Schwertel, U.; Böhm, M.; Tezenas du Montcel, S.; et al. (2019-10)
      The European RHAPSODY project sought to develop and test an online information and support programme for caregivers of individuals diagnosed with young onset dementia. The objectives were to assess user acceptability and satisfaction with the programme and to test outcome measures for a larger effectiveness study. DESIGN: A pilot randomised controlled trial in England, France, and Germany was conducted with 61 caregivers for adults with young onset Alzheimer's disease or frontotemporal degeneration. Evaluations at baseline, week 6, and week 12 assessed user acceptability and satisfaction. Use of the programme was measured from online back-end data. Qualitative feedback on user experiences was collected via semi-structured interviews. Measures of caregiver well-being (self-efficacy, stress, burden, frequency of patient symptoms, and caregiver reactions) were explored for use in a subsequent trial. RESULTS: Participants logged in online on average once a week over a 6-week period, consulting approximately 31% of programme content. Seventy percent of participants described the programme as useful and easy to use. Eighty-five percent expressed intent to use the resource in the future. Reductions in reported levels of stress and caregivers' negative reactions to memory symptoms were observed following use of the programme. CONCLUSIONS: Results indicated that the RHAPSODY programme was acceptable and useful to caregivers. The programme may be complementary to existing services in responding to the specific needs of families affected by young onset dementia. Distribution of the programme is underway in England, France, Germany, and Portugal.
    • A need-based, multi-level, cross-sectoral framework to explain variations in satisfaction of care needs among people living with dementia

      De Poli, C.; Oyebode, Jan R.; Airoldi, M.; Glover, R. (2020-07)
      BACKGROUND: Provision of care and support for people with dementia and family carers is complex, given variation in how dementia manifests, progresses and affects people, co-morbidities associated with ageing, as well as individual preferences, needs, and circumstances. The traditional service-led approach, where individual needs are assessed against current service provision, has been recognised as unfit to meet such complexity. As a result, people with dementia and family members often fail to receive adequate support, with needs remaining unmet. Current research lacks a conceptual framework for explaining variation in satisfaction of care needs. This work develops a conceptual framework mapped onto the care delivery process to explain variations in whether, when and why care needs of people with dementia are met and to expose individual-, service-, system-level factors that enable or hinder needs satisfaction. METHODS: Data collected through 24 in-depth interviews and two focus groups (10 participants) with people with dementia and family carers living in the North East of England (UK) were analysed thematically to develop a typology of care needs. The need most frequently reported for people with dementia (i.e. for support to go out and about) was analysed using themes stemming from the conceptual framework which combined candidacy and discrepancy theories. RESULTS: The operationalisation of the framework showed that satisfaction of the need to go out was first determined at the point of service access, affected by issues about navigation, adjudication, permeability, users' resistance to offers, users' appearance, and systems-level operating conditions, and, subsequently, at the point of service use, when factors related to service structure and care process determined (dis)satisfaction with service and, hence, further contributed to met or unmet need. CONCLUSION: The conceptual framework pinpoints causes of variations in satisfaction of care needs which can be addressed when designing interventions and service improvements.
    • International consensus on quality indicators for comprehensive assessment of dementia in young adults using a modified e-Delphi approach

      O'Malley, M.; Parkes, J.; Stamou, Vasileios; La Fontaine Papadopoulos, Jenny H.; Oyebode, Jan R.; Carter, J. (2020-11)
      Objective: To develop guidance for clinicians about essential elements that can support clinical decision-making in the diagnostic workup of young onset dementia. Methods/design: Three iterations of a modified e-Delphi consensus survey comprising 23 international expert clinicians specialising in diagnosis of young onset dementia. Outcome measures: A priori consensus was pre-defined as 80% of experts ranking statements in the upper threshold on a seven-point Likert scale that ranged from “not important at all” to “absolutely essential” to diagnosis. Results: 80% consensus was reached on 48 statements that were rated as “absolutely essential” or “very important” to a comprehensive assessment of dementia in a younger adult. In order to inform a subsequent audit of clinical records in which compliance with these statements was assessed, the statements were divided into a Minimum Standard, (consisting of the 15 statements voted by all experts as being “absolutely essential” or “very important”) and a Gold Standard where 48 statements were voted by 80% of the experts as being “absolutely essential” or “very important”. The experts’ response rate across the three rounds was 91.3%. Conclusion: A Minimum Standard and Gold Standard have been created for the diagnostic workup of young onset dementia. The standards provide a clinically useful tool for decision-making, particularly for generalists and those with less experience in the field. The standards will be used to inform a UK case note audit of recently diagnosed patients with young onset dementia.
    • Six mechanisms behind carer wellbeing effects: A qualitative study of healthcare delivery

      Al-Janabi, H.; McLoughlin, C.; Oyebode, Jan R.; Efstathiou, N.; Calvert, M. (2019-08)
      Health and care services for patients may improve or harm the wellbeing of their family carers. Formal consideration of these effects (also known as spillovers) in decision-making is advocated, but, to date, little is known about how they occur. This paper presents the first empirical study to determine the mechanisms by which health and care services affect family carers' wellbeing. The study focused on three major health conditions: dementia, stroke, and mental health. Focus groups and interviews were conducted with 49 purposefully sampled care professionals and family carers in the UK between December 2016 and September 2017. Transcripts were coded and analysed thematically, using descriptive accounts and an explanatory account. The analysis generated six over-arching mechanisms by which health and care services affect family carers' wellbeing, through: (i) information (degree to which service delivery informs and trains family carers); (ii) management of care (shifts of responsibility for care between formal and family sectors); (iii) patient outcomes (services changing patient outcomes); (iv) alienation (feelings of alienation or inclusion created by service delivery); (v) compliance (barriers to patients complying and engaging with services); and (vi) timing or location (changes in the timing or location of services). Each mechanism was associated with sub-themes relating to both positive and negative spillovers on the family carers. The six mechanisms can be summarised with the mnemonic ‘IMPACT’. The IMPACT mechanisms may be useful in designing and evaluating services to optimise the wellbeing of carers as well as patients.
    • A pedometer-based physically active learning intervention: The importance of using preintervention physical activity categories to assess effectiveness

      Morris, J.L.; Daly-Smith, Andrew; Defeyter, M.A.; McKenna, J.; Zwolinsky, S.; Lloyd, S.; Fothergill, M.; Graham, P.L. (2019-08)
      Purpose: To assess physical activity outcomes of a pedometer-based physically active learning (PAL) intervention in primary school children. Methods: Six paired schools were randomly allocated to either a 6-week teacher-led pedometer-based physically active learning intervention or a control (n = 154, female = 60%, age = 9.9 [0.3] y). Accelerometers assessed total daily sedentary time, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). Preintervention mean daily MVPA minutes grouped participants as Low Active (<45 min/d) and High Active (≥45 min/d). Results: From the final sample size, the intervention (n = 52) significantly improved LPA versus control (n = 31, P = .04), by reducing sedentary time. More intervention (+10%) than control (+3%) pupils met the 60 minutes per day guidelines. In both intervention subgroups, pupils spent less time in LPA (P < .05) versus control. The greatest nonsignificant increase was found in the Low Active pupils MVPA levels. Conclusions: Improvements in LPA were statistically significant in the intervention versus control group. In subgroup analysis, Low Active pupils in the intervention showed the greatest beneficial effects and the Most Active pupils may have replaced MVPA and sedentary time with LPA. The intervention group housed clusters of pupils showing variable responsiveness, justifying routine examination of subgroup variability in future studies.
    • Commentary on a recent article on the effects of the 'Daily Mile' on physical activity, fitness and body composition: addressing key limitations

      Daly-Smith, Andrew; Morris, J.L.; Hobbs, M.; McKenna, J. (2019-05-22)
      A recent pilot study by Chesham et al. in BMC Medicine established some initial effects of the Daily Mile™ using a quasi-experimental repeated measures design, with valid and reliable outcome assessments for moderate-to-vigorous physical activity, fitness and body composition. Their contribution is important and welcome, yet, alone, it is insufficient to justify the recent UK-wide adoption of the Daily Mile within the Childhood Obesity Plan. The study concluded that the Daily Mile had positive effects on moderate-to-vigorous physical activity, fitness and body composition, suggesting that intervention effectiveness was confirmed. However, only some of the significant limitations of the work were addressed. Herein, we identify and discuss six key limitations, which, combined, suggest a more tentative conclusion. In summary, evidence supporting the effectiveness of the Daily Mile is in its infancy and requires refinement to fully justify its widespread adoption. Further, we need to be cautious considering that the full range of its impacts, both positive and negative, remain to be fully established.
    • Introducing physically active lessons in UK secondary schools: feasibility study and pilot cluster-randomised controlled trial

      Gammon, C.; Morton, K.; Atkin, A.; Corder, K.; Daly-Smith, Andrew; Quarmby, T.; Suhrcke, M.; Turner, D.; van Sluijs, E. (2019-05)
      Assess feasibility, acceptability and costs of delivering a physically active lessons (PAL) training programme to secondary school teachers and explore preliminary effectiveness for reducing pupils' sedentary time. Secondary schools in East England; one school participated in a pre-post feasibility study, two in a pilot cluster-randomised controlled trial. In the pilot trial, blinding to group assignment was not possible. Across studies, 321 randomly selected students (51% male; mean age: 12.9 years), 78 teachers (35% male) and 2 assistant head teachers enrolled; 296 (92%) students, 69 (88%) teachers and 2 assistant head teachers completed the studies. PAL training was delivered to teachers over two after-school sessions. Teachers were made aware of how to integrate movement into lessons; strategies included students collecting data from the environment for class activities and completing activities posted on classroom walls, instead of sitting at desks. Quantitative and qualitative data were collected to assess feasibility and acceptability of PAL training and delivery. Outcomes were assessed at baseline and ~8 weeks post-training; measures included accelerometer-assessed activity, self-reported well-being and observations of time-on-task. Process evaluation was conducted at follow-up. In the feasibility study, teachers reported good acceptability of PAL training and mixed experiences of delivering PAL. In the pilot study, teachers' acceptability of training was lower and teachers identified aspects of the training in need of review, including the outdoor PAL training and learning challenge of PAL strategies. In both studies, students and assistant head teachers reported good acceptability of the intervention. Preliminary effectiveness for reducing students' sedentary time was not demonstrated in either study. No evidence of preliminary effectiveness on the primary outcome and mixed reports of teachers' acceptability of PAL training suggest the need to review the training. The results do not support continuation of research with the current intervention. ISRCTN38409550.
    • The Daily Mile™ initiative: Exploring physical activity and the acute effects on executive function and academic performance in primary school children

      Morris, J.L.; Daly-Smith, Andrew; Archbold, V.S.J.; Wilkins, E.L.; McKenna, J. (2019-11)
      For schools to consider physical activity (PA) interventions, improvements must be shown in PA and additional educational benefits such as executive function (EF) and academic performance (AP). Over 8800 schools worldwide have implemented The Daily Mile™ (TDM), without any formal assessments of its impact. Rigorous and high-quality studies are needed to explore TDM's contribution to moderate-to-vigorous PA (MVPA) guidelines and potential impact on EFs and AP. Methods: Children (14 classes, n = 303, age mean = 8.99 ± 0.5) from 11 primary schools already implementing TDM consented. At the individual level, children were randomly assigned using a 4-block process to either TDM or continued academic lessons (TDM n = 158, control n = 145). Children completed pre and post, EF tests (Trail Making Task; Digit Recall; Flanker; Animal Stroop) and a maths fluency test (Maths Addition and Subtraction, Speed and Accuracy Test). Accelerometers assessed MVPA using 15-s-epochs and Evenson cut-points. Results: Using multi-level modelling, TDM revealed significantly greater MVPA (+10.23 min) and reduced sedentary time (−9.28 min) compared to control (p ≤ 0.001, d = 4.92, 3.61 retrospectively). Maths fluency interacted with condition and time (p = 0.031, d = 0.25); post hocs revealed no significances over time (p > 0.05). No differences in EFs (all p > 0.05). Conclusions: This study is the first assessing the acute effects of TDM compared to continued academic lessons. TDM revealed no significant improvements in maths fluency or EF. These findings question justifying the widespread adoption of TDM based on enhanced cognition claims. Nonetheless, TDM may provide 10 min of MVPA, achieving a third of the daily in school recommendations to meet overall daily recommendations.
    • Systematic review of acute physically active learning and classroom movement breaks on children's physical activity, cognition, academic performance and classroom behaviour: understanding critical design features.

      Daly-Smith, Andrew; Zwolinsky, S; McKenna, J.; Tomporowski, P.D.; Defeyter, M.A.; Manley, A. (2018)
      To examine the impact of acute classroom movement break (CMB) and physically active learning (PAL) interventions on physical activity (PA), cognition, academic performance and classroom behaviour. Systematic review. PubMed, EBSCO, Academic Search Complete, Education Resources Information Center, PsycINFO, SPORTDiscus, SCOPUS and Web of Science. Studies investigating school-based acute bouts of CMB or PAL on (PA), cognition, academic performance and classroom behaviour. The Downs and Black checklist assessed risk of bias. Ten PAL and eight CMB studies were identified from 2929 potentially relevant articles. Risk of bias scores ranged from 33% to 64.3%. Variation in study designs drove specific, but differing, outcomes. Three studies assessed PA using objective measures. Interventions replaced sedentary time with either light PA or moderate-to-vigorous PA dependent on design characteristics (mode, duration and intensity). Only one study factored individual PA outcomes into analyses. Classroom behaviour improved after longer moderate-to-vigorous (>10 min), or shorter more intense (5 min), CMB/PAL bouts (9 out of 11 interventions). There was no support for enhanced cognition or academic performance due to limited repeated studies. Low-to-medium quality designs predominate in investigations of the acute impacts of CMB and PAL on PA, cognition, academic performance and classroom behaviour. Variable quality in experimental designs, outcome measures and intervention characteristics impact outcomes making conclusions problematic. CMB and PAL increased PA and enhanced time on task. To improve confidence in study outcomes, future investigations should combine examples of good practice observed in current studies. CRD42017070981.
    • Implementing physically active learning: Future directions for research, policy, and practice

      Daly-Smith, Andrew; Quarmby, T.; Archbold, V.S.J.; Routen, A.C.; Morris, J.L.; Gammon, C.; Bartholomew, J.B.; Resaland, G.K.; Llewellyn, B.; Allman, R.; et al. (2020-01)
      To identify co-produced multi-stakeholder perspectives important for successful widespread physically active learning (PAL) adoption and implementation. A total of 35 stakeholders (policymakers n = 9; commercial education sector, n = 8; teachers, n = 3; researchers, n = 15) attended a design thinking PAL workshop. Participants formed 5 multi-disciplinary groups with at least 1 representative from each stakeholder group. Each group, facilitated by a researcher, undertook 2 tasks: (1) using Post-it Notes, the following question was answered: within the school day, what are the opportunities for learning combined with movement? and (2) structured as a washing-line task, the following question was answered: how can we establish PAL as the norm? All discussions were audio-recorded and transcribed. Inductive analyses were conducted by 4 authors. After the analyses were complete, the main themes and subthemes were assigned to 4 predetermined categories: (1) PAL design and implementation, (2) priorities for practice, (3) priorities for policy, and (4) priorities for research. The following were the main themes for PAL implementation: opportunities for PAL within the school day, delivery environments, learning approaches, and the intensity of PAL. The main themes for the priorities for practice included teacher confidence and competence, resources to support delivery, and community of practice. The main themes for the policy for priorities included self-governance, the Office for Standards in Education, Children's Services, and Skill, policy investment in initial teacher training, and curriculum reform. The main themes for the research priorities included establishing a strong evidence base, school-based PAL implementation, and a whole-systems approach. The present study is the first to identify PAL implementation factors using a combined multi-stakeholder perspective. To achieve wider PAL adoption and implementation, future interventions should be evidence based and address implementation factors at the classroom level (e.g., approaches and delivery environments), school level (e.g., communities of practice), and policy level (e.g., initial teacher training).
    • ‘You get some very archaic ideas of what teaching is … ’: primary school teachers’ perceptions of the barriers to physically active lessons

      Quarmby, T.; Daly-Smith, Andrew; Kime, N. (2019-04)
      Physically active lessons present a key paradigm shift in educational practice. However, little is known about the barriers to implementing physically active lessons. To address this, 31 practising primary teachers (23 = female) from 9 primary schools across West Yorkshire, England, were engaged in focus group interviews. Drawing on the socio-ecological model, findings revealed that barriers influencing the implementation of physically active lessons are multifaceted. Teacher’s confidence and competence, concerns over classroom space, preparation time and resources, coupled with the wider school culture that is influenced by governors and parents, reinforce a didactic approach and act as barriers to physically active lessons.
    • Using a multi-stakeholder experience-based design process to co-develop the Creating Active Schools Framework

      Daly-Smith, Andrew; Quarmby, T.; Archbold, V.S.J.; Corrigan, N.; Wilson, D.; Resaland, G.K.; Bartholomew, J.B.; Singh, A.; Tjomsland, H.E.; Sherar, L.B.; et al. (2020-02)
      UK and global policies recommend whole-school approaches to improve childrens' inadequate physical activity (PA) levels. Yet, recent meta-analyses establish current interventions as ineffective due to suboptimal implementation rates and poor sustainability. To create effective interventions, which recognise schools as complex adaptive sub-systems, multi-stakeholder input is necessary. Further, to ensure 'systems' change, a framework is required that identifies all components of a whole-school PA approach. The study's aim was to co-develop a whole-school PA framework using the double diamond design approach (DDDA). Fifty stakeholders engaged in a six-phase DDDA workshop undertaking tasks within same stakeholder (n = 9; UK researchers, public health specialists, active schools coordinators, headteachers, teachers, active partner schools specialists, national organisations, Sport England local delivery pilot representatives and international researchers) and mixed (n = 6) stakeholder groupings. Six draft frameworks were created before stakeholders voted for one 'initial' framework. Next, stakeholders reviewed the 'initial' framework, proposing modifications. Following the workshop, stakeholders voted on eight modifications using an online questionnaire. Following voting, the Creating Active Schools Framework (CAS) was designed. At the centre, ethos and practice drive school policy and vision, creating the physical and social environments in which five key stakeholder groups operate to deliver PA through seven opportunities both within and beyond school. At the top of the model, initial and in-service teacher training foster teachers' capability, opportunity and motivation (COM-B) to deliver whole-school PA. National policy and organisations drive top-down initiatives that support or hinder whole-school PA. To the authors' knowledge, this is the first time practitioners, policymakers and researchers have co-designed a whole-school PA framework from initial conception. The novelty of CAS resides in identifying the multitude of interconnecting components of a whole-school adaptive sub-system; exposing the complexity required to create systems change. The framework can be used to shape future policy, research and practice to embed sustainable PA interventions within schools. To enact such change, CAS presents a potential paradigm shift, providing a map and method to guide future co-production by multiple experts of PA initiatives 'with' schools, while abandoning outdated traditional approaches of implementing interventions 'on' schools.
    • QualDash: Adaptable Generation of Visualisation Dashboards for Healthcare Quality Improvement

      Elshehaly, Mai; Randell, Rebecca; Brehmer, M.; McVey, L.; Alvarado, Natasha; Gale, C.P.; Ruddle, R.A. (2021-02)
      Adapting dashboard design to different contexts of use is an open question in visualisation research. Dashboard designers often seek to strike a balance between dashboard adaptability and ease-of-use, and in hospitals challenges arise from the vast diversity of key metrics, data models and users involved at different organizational levels. In this design study, we present QualDash, a dashboard generation engine that allows for the dynamic configuration and deployment of visualisation dashboards for healthcare quality improvement (QI). We present a rigorous task analysis based on interviews with healthcare professionals, a co-design workshop and a series of one-on-one meetings with front line analysts. From these activities we define a metric card metaphor as a unit of visual analysis in healthcare QI, using this concept as a building block for generating highly adaptable dashboards, and leading to the design of a Metric Specification Structure (MSS). Each MSS is a JSON structure which enables dashboard authors to concisely configure unit-specific variants of a metric card, while offloading common patterns that are shared across cards to be preset by the engine. We reflect on deploying and iterating the design of QualDash in cardiology wards and pediatric intensive care units of five NHS hospitals. Finally, we report evaluation results that demonstrate the adaptability, ease-of-use and usefulness of QualDash in a real-world scenario.
    • The effects of inter-organisational information technology networks on patient safety: a realist synthesis

      Keen, J.; Abdulwahid, M.; King, N.; Wright, J.; Randell, Rebecca; Gardner, P.; Waring, J.; Longo, R.; Nikolova, S.; Sloan, C.; et al. (2020)
      Health services in many countries are investing in inter-organisational networks, linking patients’ records held in different organisations across a city or region. The aim of the systematic review was to establish how, why, and in what circumstances these networks improve patient safety, fail to do so, or increase safety risks, for people living at home. Design Realist synthesis, drawing on both quantitative and qualitative evidence, and including consultation with stakeholders in nominal groups and semi-structured interviews. Eligibility criteria The co-ordination of services for older people living at home, and medicine reconciliation for older patients returning home from hospital. Information sources 17 sources including Medline, Embase, CINAHL, Cochrane Library, Web of Science, ACM Digital Library and Applied Social Sciences Index and Abstracts (ASSIA). Outcomes Changes in patients’ clinical risks. Results We did not find any detailed accounts of the sequences of events that policy makers and others believe will lead from the deployment of interoperable networks to improved patient safety. We were, though, able to identify a substantial number of theory fragments, and these were used to develop programme theories. There is good evidence that there are problems with the co-ordination of services in general, and the reconciliation of medication lists in particular, and it indicates that most problems are social and organisational in nature. There is also good evidence that doctors and other professionals find interoperable networks difficult to use. There was limited high quality evidence about safety-related outcomes associated with the deployment of interoperable networks. Conclusions Empirical evidence does not currently justify claims about the beneficial effects of interoperable networks on patient safety. There appears to be a mismatch between technology-driven assumptions about the effects of networks and the socio-technical nature of co-ordination problems. Review registration: PROSPERO CRD42017073004
    • The association between the nationality of nurses and safety culture in maternity care units of Oman

      Al Nadabi, Waleed; Faisal, Muhammad; Muhammed, Muhammed A. (2020)
      Background: Patient safety culture/climate in maternity units has been linked to better safety outcomes. Nurses have a crucial role in patient safety and represent the majority of staff in maternity units. In many countries, nurses are recruited from abroad, bringing their own perceptions of patient safety culture. Nonetheless, little is known about the relationship between perceptions of patient safety culture and nurses’ nationality. Understanding this relationship will assist stakeholders in designing a responsive programme to improve patient safety culture. Aims: To investigate the association between nurses’ nationality and their perceptions about patient safety culture in maternity units in Ministry of Health hospitals in Oman. Methods: In 2017, the Safety Attitude Questionnaire (SAQ) was distributed to all staff (892 distributed, 735 returned) in 10 maternity units. Results: About three-quarters (74%, 541/735) of the returned SAQs were completed by nurses, of whom 34% were non-Omani, 21.8% were Omani and 44.7% did not report their nationality (missing). Overall, the mean safety score for non-Omani nurses was significantly higher than for the Omani nurses: 3.9 (SD 1.3) vs 3.6 (SD 1.2) (P < 0.001). The mean safety score for stress recognition was significantly lower for non-Omani nurses: 2.8 (SD 1.5) vs 3.2 (SD 1.3) (P < 0.001). Conclusion: Non-Omani nurses have a more positive perception of patient safety culture than Omani nurses except in respect of stress recognition. Decision-makers, directors, and clinicians should consider these differences when designing interventions to improve patient safety culture.
    • Patient safety culture in Oman: A national study

      Al Nadabi, Waleed; Faisal, Muhammad; Mohammed, Mohammed A. (2020-10)
      Rational, aim, and objectives: A positive patient safety culture in maternity units is linked to higher quality of care and better outcomes for mothers. However, safety culture varies across maternity units. Analyses of variation in safety culture using statistical process control (SPC) methods may help provider units to learn from each other's performance. This study aims to measure patient safety culture across maternity units in Oman using SPC methods. Methods: The 36-item Safety Attitude Questionnaire (SAQ) was distributed to all doctors, nurses, and midwifes working in ten maternity care units in Oman's hospitals and analysed using SPC methods. The SAQ considers six domains: job satisfaction, perception of management, safety climate, stress recognition, teamwork, and work condition. Results: Of the 892 targeted participants, 735 (82%) questionnaires were returned. The overall percentage of positive safety responses in all hospitals ranged from 53% to 66%, but no hospital had the targeted response of above 75%. Job satisfaction had the highest safety score (4.10) while stress recognition was the lowest (3.17). SPC charts showed that the overall percentage of positive responses in three maternity units (H1, H7, and H10) was above and one (H4) was below the control limits that represent special cause variation that merits further investigation. Conclusion: Generally, the safety culture in maternity units in Oman is below target and suggests that considerable work is required to enhance safety culture. Several maternity units showed evidence of high/low special cause variation that may offer a useful starting point for understanding and enhancing safety culture.