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Biomass smoke exposure is a threat to child and maternal health in many resource-limited countries and is associated with poor pregnancy outcomes and serious lung diseases in the offspring. We aimed to assess the feasibility, acceptability and impact of a midwife-led education programme on biomass risks and prevention for women attending maternity clinics in Uganda. Education materials were co-developed through an iterative process by midwives and other stakeholders. The materials were serially tested and approved by the Ministry of Health and used by midwives and village health teams (VHTs). The district health team, 12 midwives and 40 VHTs were sensitised on biomass smoke. Two hundred and forty-four women were educated about biomass smoke by midwives; pre- and post-session questionnaires showed major improvements in knowledge of biomass smoke risks. Qualitative interviews with women three months after the sessions showed that they made behavioural changes such as avoiding smoke while cooking, using dry wood, solar power for lighting and improved ventilation. The major barrier to behavioural changes was poverty, but some improvements cost no money. The programme delivered by midwives was feasible and acceptable; implementing this programme has the potential to reduce exposure to smoke with major benefits to mother, foetus, and children throughout their lives.

IntroductionVery Brief Advice (VBA) on smoking is an evidence-based intervention and a recommended clinical practice for all healthcare professionals in the UK.AimsWe report on experience from the FRESH AIR project in adapting the VBA model and training in three low-resource settings: Greece, Vietnam and Kyrgyzstan.MethodsUsing a participatory research process, UK experts and local stakeholders conducted an environmental scan and needs assessment to examine the VBA intervention model, training materials and recommend adaptations to the local context. Two VBA training sessions were piloted in each country to inform adaptation. A final training tool kit was developed in the local language.ResultsIn each country, the VBA on smoking intervention model remained primarily intact. The lack of a formal smoking cessation system to refer motivated clients in two countries required adaptation of the ACT component of the model. A range of local adaptations to the training resources were made in all three countries to ensure cultural appropriateness as well as enhance key messages including expanding training on nicotine addiction, second-hand smoke and pharmacotherapy.ConclusionsImplementation of VBA requires sensitive, collaborative, local and cultural adaptation if it is to be achieved successfully.Trial registrationTrial ID# NTR5759Critical appraisal toolsThe Standards for Reporting Implementation Studies (StaRI) statement: https://www.equator-network.org/reporting-guidelines/stari-statement/

Background: Chronic lung disease (CLD) is a growing burden in Uganda. There is no useful treatment, but sufferers have poor health status and often are stigmatised. We aimed to test feasibility of a pulmonary rehabilitation (PR) programme in Kampala, Uganda, and adapted traditional PR for patients with post-TB lung disease and COPD. Methods: In a development study, respiratory specialists, nurses and physiotherapists formed a PR team. The exercise regime was based on conventional PR; the education programme covered normal lungs, post TB damage and COPD including breathlessness, exercise, nutrition, smoking and drug treatments. Qualitative and quantitative assessment of the programme included recruitment, retention and outcome measures including exercise capacity and health status questionnaires. Results: In March 2015- December 2015, 4 groups were conducted. In total we screened 193 (Post-TB 113 and 80 COPD) patients, 72 were assessed 46 were suitable and 44 started rehab (17 male; mean age 44 years, range 17-83) with 42 (95%) completing and 39 followed 6 weeks after. Main outcomes in Table 1. Conclusion: PR is feasible and appears effective in CLD and post TB patients in Uganda, but an adequately powered controlled trial is needed to confirm this. PR offers a new and sustainable therapy for the neglected problem of chronic lung disease in low to middle income countries. This study provides patient and stakeholder feedback to inform design and implementation of a full trial planned for Zambia, Kenya and Tanzania.

Rates of non-attendance within IAPT are 45-48%. Non-attendance has negative implications for patients, staff and services.This research aimed to identify service-related factors that contribute to non-attendance.Qualitative interviews with 14 patients recruited from six IAPT services in the South West. These were individuals who, having been referred to IAPT, never attended, or only attended one treatment contact. They were interviewed face-to-face or by telephone using semi-structured interview schedules. The resulting data were analysed thematically through an iterative qualitative analysis using data mapping sheets.Five themes emerged from an analysis of the data including: the waiting process, the relationship between IAPT services and GPs, expectations of assessment and treatment, rigidity of service and practitioner contributions to the relationship.The analysis identifies ways in which IAPT services could reduce non-attendance. It also highlights areas of interest for future non-attendance in healthcare research, particularly collaborative care and protocolisation of treatment.

Objective. To investigate the psychometric properties of the Work and Social Adjustment Scale (WSAS) as an outcome measure for the Improving Access to Psychological Therapy programme, assessing its value as an addition to the Patient Health (PHQ-9) and Generalised Anxiety Disorder questionnaires (GAD-7). Little research has investigated these properties to date. Methods. Reliability and responsiveness to change were assessed using data from 4,835 patients. Principal components analysis was used to determine whether the WSAS measures a factor distinct from the PHQ-9 and GAD-7. Results. The WSAS measures a distinct social functioning factor, has high internal reliability, and is sensitive to treatment effects. Conclusions. The WSAS, PHQ-9 and GAD-7 perform comparably on measures of reliability and sensitivity. The WSAS also measures a distinct social functioning component suggesting it has potential as an additional outcome measure.