Search

Background: Weight management services have not always benefitted everyone equally. People who live in more deprived areas, racially minoritised communities, those with complex additional needs (e.g., a physical or mental disability), and men are less likely to take part in weight management services. This can subsequently widen health inequalities. One way to counter this is to co-design services with under-served groups to better meet their needs. Using a case study approach, we explored how co-designed adult weight management services were developed, the barriers and facilitators to co-design, and the implications for future commissioning. Methods: We selected four case studies of adult weight management services in Southwest England where co-design had been planned, representing a range of populations and settings. In each case, we recruited commissioners and providers of the services, and where possible, community members involved in co-design activities. Interviews were conducted online, audio-recorded, transcribed verbatim, and analysed using thematic analysis. Results: We interviewed 18 participants (8 female; 10 male): seven commissioners, eight providers, and three community members involved in co-designing the services. The case studies used a range of co-design activities (planned and actualised), from light-touch to more in-depth approaches. In two case studies, co-design activities were planned but were not fully implemented due to organisational time or funding constraints. Co-design was viewed positively by participants as a way of creating more appropriate services and better engagement, thus potentially leading to reduced inequalities. Building relationships– with communities, individual community members, and with partner organisations– was critical for successful co-design and took time and effort. Short-term and unpredictable funding often hindered co-design efforts and could damage relationships with communities. Some commissioners raised concerns over the limited evidence for co-design, while others described having to embrace "a different way of thinking" when commissioning for co-design. Conclusions: Co-design is an increasingly popular approach to designing health in services but can be difficult to achieve within traditional funding and commissioning practices. Drawing on our case studies, we present key considerations for those wanting to co-design health services, noting the importance of building strong relationships, creating supportive organisational cultures, and developing the evidence base. [ABSTRACT FROM AUTHOR]

Background: Quality of life (QoL) is an important area for research during adolescence, due to its associations with (1) physical and mental health and (2) the emergence of health risk behaviours. A time that poses a particular threat to QoL is the transition from primary to secondary school. Aims: This study aimed to investigate changes in QoL immediately following the transition to secondary school. Using Self-Determination Theory (SDT) as a conceptual foundation, the relationship between QoL and satisfaction of the three basic psychological needs advanced by SDT (autonomy, competence and relatedness) was explored. Sample: The sample comprised 63 Year 7 students (age 11-12 years) attending a UK coeducational secondary school. Method: Data were collected using self-report questionnaires on three occasions over 10 weeks, starting on the second week of term. Change in need satisfaction was used to predict change in QoL, and the possible reciprocal relationship explored using regression analysis. Results: A meaningful improvement in QoL was recorded for 21% of students. Improvements in QoL were predicted by satisfaction of the needs for autonomy and relatedness, but not by competence, explaining 36% of the variance. QoL showed a weaker, but reciprocal effect on need satisfaction. Conclusions: The findings suggest that support for the needs for autonomy and relatedness would provide the most likely route to the enhancement of student QoL over the transition to senior school.

Background: The COVID-19 pandemic led to the UK government enforcing lockdown restrictions to control virus transmission. Such restrictions present opportunities and barriers for physical activity and healthy eating. Emerging research suggests that in the early stages of the pandemic, physical activity levels decreased, consumption of unhealthy foods increased, while levels of mental distress increased. Our aims were to understand patterns of diet, physical activity, and mental health during the first lockdown, how these had changed twelve-months later, and the factors associated with change.Methods: An online survey was conducted with UK adults (N = 636; 78% female) during the first national lockdown (May-June 2020). The survey collected information on demographics, physical activity, diet, mental health, and how participants perceived lifestyle behaviours had changed from before the pandemic. Participants who provided contact details were invited to complete a twelve-month follow-up survey (May-June 2021), 160 adults completed the survey at both time-points. Descriptive statistics, T-tests and McNemar Chi Square statistics were used to assess patterns of diet, physical activity, and mental health at baseline and change in behaviours between baseline and follow-up. Linear regression models were conducted to explore prospective associations between demographic and psycho-social variables at baseline with change in healthy eating habit, anxiety, and wellbeing respectively.Results: Between baseline and follow-up, healthy eating habit strength, and the importance of and confidence in eating healthily reduced. Self-rated health (positively) and confidence in eating healthily (negatively) were associated with change in healthy eating habit. There were no differences between baseline and follow-up for depression or physical activity. Mean anxiety score reduced, and wellbeing increased, from baseline to follow-up. Living with children aged 12-17 (compared to living alone) was associated with an increase in anxiety, while perceiving mental health to have worsened during the first lockdown (compared to staying the same) was associated with reduced anxiety and an increase in mental wellbeing.Conclusions: While healthy eating habits worsened in the 12 months since the onset of the pandemic, anxiety and mental wellbeing improved. However, anxiety may have increased for parents of secondary school aged children. [ABSTRACT FROM AUTHOR]

This cross-sectional survey study explored associations between perceived bodyweight norms, psychological need satisfaction and motivation for weight control among 500 adult residents of two countries with different overweight/obesity prevalence: the UK (63% prevalence) and the Netherlands (50%). A hypothesised model of the effects of descriptive norms (i.e. perceptions of what is typical for most people) and injunctive norms (i.e. perceptions of what is typically approved by others) on autonomous motivation, mediated through basic psychological need satisfaction, was analysed using structural equation modelling. Descriptive norms did not differ between countries, yet UK adults reported a lower-weight injunctive norm. Perceiving higher bodyweights to be normal negatively predicted motivation to manage one's bodyweight mediated through an undermining effect on psychological need satisfaction. Perceiving higher bodyweights to be normal may have the potential to reduce individual motivation for weight control, but the sensitivity of people's perceptions to objective differences in overweight prevalence appears limited. [ABSTRACT FROM AUTHOR]

To record parents' awareness of the UK soft drinks industry levy (SDIL) and explore associations between negative psychological reactance to the levy and motivation and intentions to change consumption and purchasing. A cross-sectional online survey with UK-based parents of children aged 5–11 years (n = 237). Regression analyses were used to test associations between psychosocial responses to the levy and behavioral intentions to change family consumption and purchasing. A total of 92% of responding parents were aware of the SDIL. Of the responding parents, 57% supported its aims, but 29% felt it threatened their freedom of choice. A total of 41% expressed intention to change shopping habits or restrict their child's intake as a result. Reactance and motivation were poorer in low-income families, and intentions to change were positively predicted by motivation. This snapshot suggests that the UK SDIL is largely supported by parents and associated with intentions to change their children's intake. [ABSTRACT FROM AUTHOR]

Background: Engagement of men with commercial and UK National Health Service (NHS) weight loss services is low, and few studies report on why this may be. However, evidence shows that men who do participate in weight loss programmes tend to lose as much, or more weight than women. The present study aimed to explore men's experiences and expectations of mainstream weight loss services in the UK, following referral from a medical professional, particular in relation to barriers and motivators.Methods: Semi-structured interviews were conducted with 18 men with a BMI over 25 kg/m2 including those who had, and had not, attended group-based or one-to-one weight loss services. Interviews were analysed using thematic analysis.Results: Two themes were identified; 'Fear as a motivation for change' (1) and 'Attitudes towards existing weight loss services' (2). Within theme two, two subthemes were identified; 'Female dominated services' and 'Incompatibility of existing services for men'. The findings suggest that fear, as a result of a medical diagnosis or referral is a mechanism for motivating men to engage with weight loss services. This was often augmented by awareness of other people's experiences of poor health due to their weight. The gender imbalance and attitudes towards existing weight loss services deterred men from engaging with or continuously attending sessions. This imbalance resulted in feelings of self-consciousness, shame and a perceived stigma for men using weight loss services. These experiences highlighted the importance of providing services which align with men's preferences to promote engagement.Conclusions: A medical diagnosis or referral serves as a strong motivator for men to engage with weight loss services by invoking fear of negative consequences of not losing weight. Men perceived weight loss services to be feminised spaces, in which they felt self-conscious and out of place. As a result, men were deterred from engaging and considered their options were limited. Implications for service design and commissioning are discussed. Involving men in research, service design and evaluation is key to improving their engagement and weight loss. [ABSTRACT FROM AUTHOR]

Purpose: To examine the potential confounding effect of biological maturation on the relations between chronological age and health-related quality of life in adolescent British females.Methods: Biological maturation, chronological age, and health-related quality of life were assessed in 366 British female students in years 7-10 (M = 13.0 years, SD = 0.8). The Kid-Screen 10 was used to assess health-related quality of life. Percentage of predicted adult height attained at measurement was used as an estimate of biological maturation.Results: Pearson product moment correlation demonstrated a statistically significant inverse relation between chronological age and health-related quality of life. This relation was, however, attenuated and non-significant once biological maturation was controlled for.Conclusions: Researchers studying health-related quality of life in youth should consider and/or control for the potential confounding effect of biological maturation. [ABSTRACT FROM AUTHOR]

Background: Images depicting morbidly obese models [i.e. body mass index (BMI) >40] often accompany media articles about the health risks of being overweight (i.e. BMI 25–30). Little is known about the effect of this mismatch on people’s understanding of risk, and perceptions of message relevance. Methods: In total, 563 participants (291 overweight/obese and 272 healthy weight) were randomly allocated to read a health message about the risk of heart disease posed by being overweight, presented alongside (i) a photo of an overweight model, (ii) a morbidly obese model or (iii) no photo. Between-group differences in the primary outcomes of message relevance, and the body size perceived to be ‘at risk’, were assessed, and the potential moderating effects of motivation, weight concern and existing risk knowledge explored. Results: Overweight and obese participants in the exaggerated (morbidly obese) image condition interpreted health risks to relate to a larger body size than those who saw no image (F(2, 290) = 4.06, P = 0.02). There was no experimental effect on perceived personal relevance (F(2, 290) = 0.25, P = 0.38). No significant moderation effects were detected, and there was no effect of study condition in healthy weight participants for either outcome. Conclusion: The findings suggest that the use of morbidly obese models in messages regarding the health risks of being overweight may undermine the impact of these messages among those who they most aim to reach; the reader may perceive a reduced risk of being ‘only’ overweight, and that a higher weight is needed for the negative effects of excess weight to occur. [ABSTRACT FROM AUTHOR]

ObjectiveIncreasing parental awareness of childhood obesity is an important part of tackling the issue. However, parents’ negative reactions to being informed that their children are overweight or obese can hinder their engagement with relevant services. The present study aimed to develop a deeper understanding of why parents react negatively, to help commissioners and service providers design services that are more acceptable to them.DesignOpen, qualitative responses to a survey were collected using a postal questionnaire. Responses were analysed using content analysis.SettingOne local authority in south-west England.SubjectsThe sample frame included all parents receiving letters informing them that their child was overweight (91st–98th centile) or very overweight (98th–100th centile) through the UK National Child Measurement Programme in 2012.ResultsForty-five of 313 eligible parents (14 %) responded to the survey, of whom forty-three rejected either to the judgement that their child was overweight and/or being provided with this feedback. Primary reasons for objection included: lack of trust in the measures used, lack of belief that being overweight is important for children's health (relative to a healthy lifestyle), and fear that discussing weight with children will trigger eating disorders. In addition, parents’ responses suggested that they considered receiving this feedback to be a criticism of their parenting skills.ConclusionsOverall, three areas for improving communication with parents were suggested: tailoring letters; providing information about the importance of weight independently of lifestyle; and addressing parents’ concerns about the risks of talking to children about their weight. [ABSTRACT FROM PUBLISHER]

Objectives. To identify an evidence-based intervention to promote changes in diet and physical activity and adapt it for a UK primary care setting for people with high cardiovascular risk. Design. A three-stage mixed-methods design was used to facilitate a strategic approach to programme selection and adaptation. Method. Stage 1: Criteria for scientific quality and local appropriateness were developed for the selection/adaptation of an intervention to promote lifestyle change in people of high cardiovascular risk through (1) patient interviews, (2) a literature search to extract evidence-based criteria for behavioural interventions, and (3) stakeholder consultation. Stage 2: Potential interventions for adaptation were identified and ranked according to their performance against the criteria developed in Stage 1. Stage 3: Intervention mapping (IM) techniques were used to (1) specify the behavioural objectives that participants would need to reach in order to attain programme outcomes, and (2) adapt the selected intervention to ensure that evidence-based strategies to target all identified behavioural objectives were included. Results. Four of 23 potential interventions identified met the 11 essential criteria agreed by a multi-disciplinary stakeholder committee. Of these, the Greater Green Triangle programme (Laatikainen et al., 2007) was ranked highest and selected for adaptation. The IM process identified 13 additional behaviour change strategies that were used to adapt the intervention for the local context. Conclusions. IM provided a useful set of techniques for the systematic adaptation of an existing lifestyle intervention to a new population and context, and facilitated transparent working processes for a multi-disciplinary team. [ABSTRACT FROM AUTHOR]

Purpose/Objective: The objective of this cross-sectional study was to assess how psychosocial variables predict U.K. military veterans' level of engagement in bespoke recovery pathways (Aim 1) and a sports-specific recovery pathway (Aim 2). A further purpose of this study was to test whether predictor variables indirectly predict outcome variables of physical health (Aim 3), mental health (Aim 4), and subjective vitality (Aim 5), when mediated through level of engagement with all recovery pathways and the sport recovery pathway. Research Method/Design: A cross-sectional battery of questionnaires were completed by 514 military veterans who had been enrolled in Help for Heroes recovery pathways (e.g., sports recovery pathway) from 3 months to 10 years. Data were analyzed by multinomial logistic and multiple linear regressions and mediation analyses using the PROCESS SPSS macro. Results: Engagement in all recovery pathways (i.e., frequency and duration of attendance) was predicted by basic psychological needs frustration and perceived social support (Nagelkerke R² = .16). Sport-related social support (p < .05) and competence satisfaction (p < .001) were directly positively associated with mental health, and competence satisfaction with physical health (p < .001) and well-being (p < .001) on the sport recovery pathway. While perceived stress was directly negatively associated with mental health and well-being (p < .001). Mediation analyses revealed no significant, indirect effects of psychosocial variables on health and wellbeing through level of engagement. Conclusions/Implications: In sum, engagement in recovery pathways does not mediate the effects of psychosocial variables on veterans' health and well-being. Perceived social support, satisfaction of veterans' needs, and perceived stress were better predictors of health and well-being outcomes and should be an important focus of future research and recovery. [ABSTRACT FROM AUTHOR]

There are national and international expectations for nurses to be healthy role models. This study aimed to investigate student nurses', nurse educators' and registered nurses' experiences and perceptions about being healthy role models and to explore whether nurse education prepares students to become healthy role models. The study used an exploratory qualitative design and was based in the south of England. Participants (n = 39) included student nurses, nurse lecturers and registered nurses. Data collection was conducted through focus groups and data were analysed using thematic analysis. The themes highlighted nurses' understanding of the key features of being a healthy role model, and perceptions that working as nurses does not support individuals to be healthy. Participants had varied views about whether they should be healthy role models or mirror society and share the same struggles with their health. Students and registered nurses reported inadequate understanding of health promotion and that there was a lack of healthy lifestyle content within undergraduate nurse education. Participants also considered that role modelling healthy behaviour would not in itself influence behaviour change. In conclusion, there needs to be preparation and support for student nurses to be healthy role models from the outset of nurse education. • Nurses in the United Kingdom may lack awareness of professional expectations to be healthy role models. • Nurses in this study held varied views about the expectation for them to be healthy role models. • Healthcare settings in the United Kingdom do not always support a healthy lifestyle for nurses and students. • Nurse education may not prepare student nurses to be healthy role models. [ABSTRACT FROM AUTHOR]

Background: In response to the COVID-19 pandemic, the UK imposed a national lockdown prompting change to daily routines. Among behaviours impacted by the lockdown, diet and physical activity may be particularly important due to their association with mental health and physical health. The aim of this study was to explore people's experiences of how lockdown impacted their physical activity, dietary behaviours and mental health, with a view to informing public health promotion., Methods: This phenomenological qualitative study used semi-structured telephone interviews. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted, guided by the Framework Approach., Results: Forty participants (28 female) completed an interview (mean duration: 36 min) between May and July 2020. The overarching themes identified were (i) Disruption (loss of routines, social interaction and cues to physical activity) and (ii) Adaptation (structuring the day, accessing the outdoor environment, finding new ways for social support). The disruption to daily routines altered people's cues for physical activity and eating; some participants spoke of comfort eating and increased alcohol intake in the early days of lockdown, and how they consciously tried to change these when restrictions lasted longer than first anticipated. Others spoke of adapting to the restrictions using food preparation and meals to provide both routine and social time for families. Disruptions from the closure of workplaces resulted in flexible working times for some, allowing for physical activity to be built into the day. In later stages of restrictions, physical activity became an opportunity for social interaction and several participants reported intending to continue to replace sedentary means of socialising (e.g., meeting in cafes) with more active, outdoor activities (e.g., walking) once restrictions were lifted. Staying active and building activity into the day was seen as important to support physical and mental health during the challenging times of the pandemic., Conclusions: Whilst many participants found the UK lockdown challenging, adaptations to cope with the restrictions presented some positive changes related to physical activity and diet behaviours. Helping people sustain their new healthier activities since restrictions have lifted is a challenge but presents an opportunity for public health promotion., (© 2023. The Author(s).)

Objectives: UK exercise referral schemes (ERSs) have been criticised for focusing too much on exercise prescription and not enough on sustainable physical activity (PA) behaviour change. Previously, a theoretically grounded intervention (coproduced PA referral scheme, Co-PARS) was coproduced to support long-term PA behaviour change in individuals with health conditions. The purpose of this study was to investigate the effectiveness of Co-PARS compared with a usual care ERS and no treatment for increasing cardiorespiratory fitness., Design: A three-arm quasi-experimental trial., Setting: Two leisure centres providing (1) Co-PARS, (2) usual exercise referral care and one no-treatment control., Participants: 68 adults with lifestyle-related health conditions (eg, cardiovascular, diabetes, depression) were recruited to co-PARS, usual care or no treatment., Intervention: 16-weeks of PA behaviour change support delivered at 4, 8, 12 and 18 weeks, in addition to the usual care 12-week leisure centre access., Outcome Measures: Cardiorespiratory fitness, vascular health, PA and mental well-being were measured at baseline, 12 weeks and 6 months (PA and mental well-being only). Fitness centre engagement (co-PARS and usual care) and behaviour change consultation attendance (co-PARS) were assessed. Following an intention-to-treat approach, repeated-measures linear mixed models were used to explore intervention effects., Results: Significant improvements in cardiorespiratory fitness ( p =0.002) and vascular health ( p =0.002) were found in co-PARS compared with usual care and no-treatment at 12 weeks. No significant changes in PA or well-being at 12 weeks or 6 months were noted. Intervention engagement was higher in co-PARS than usual care, though this was not statistically significant., Conclusion: A coproduced PA behaviour change intervention led to promising improvements in cardiorespiratory and vascular health at 12 weeks, despite no effect for PA levels at 12 weeks or 6 months., Trial Registration Number: NCT03490747., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)