Gemma Teal

Integrating Evidence From Systematic Reviews, Qualitative Research, and Expert Knowledge Using Co-Design Techniques to Develop a Web-Based Intervention for People in the Retirement Transition

Background Integrating stakeholder involvement in complex health intervention design maximizes acceptability and potential effectiveness. However, there is little methodological guidance about how to integrate evidence systematically from various sources in this process. Scientific evidence derived from different approaches can be difficult to integrate and the problem is compounded when attempting to include diverse, subjective input from stakeholders. Objective The intent of the study was to describe and appraise a systematic, sequential approach to integrate scientific evidence, expert knowledge and experience, and stakeholder involvement in the co-design and development of a complex health intervention. The development of a Web-based lifestyle intervention for people in retirement is used as an example. Methods Evidence from three systematic reviews, qualitative research findings, and expert knowledge was compiled to produce evidence statements (stage 1). Face validity of these statements was assessed by key stakeholders in a co-design workshop resulting in a set of intervention principles (stage 2). These principles were assessed for face validity in a second workshop, resulting in core intervention concepts and hand-drawn prototypes (stage 3). The outputs from stages 1-3 were translated into a design brief and specification (stage 4), which guided the building of a functioning prototype, Web-based intervention (stage 5). This prototype was de-risked resulting in an optimized functioning prototype (stage 6), which was subject to iterative testing and optimization (stage 7), prior to formal pilot evaluation. Results The evidence statements (stage 1) highlighted the effectiveness of physical activity, dietary and social role interventions in retirement; the idiosyncratic nature of retirement and well-being; the value of using specific behavior change techniques including those derived from the Health Action Process Approach; and the need for signposting to local resources. The intervention principles (stage 2) included the need to facilitate self-reflection on available resources, personalization, and promotion of links between key lifestyle behaviors. The core concepts and hand-drawn prototypes (stage 3) had embedded in them the importance of time use and work exit planning, personalized goal setting, and acceptance of a Web-based intervention. The design brief detailed the features and modules required (stage 4), guiding the development of wireframes, module content and functionality, virtual mentors, and intervention branding (stage 5). Following an iterative process of intervention testing and optimization (stage 6), the final Web-based intervention prototype of LEAP (Living, Eating, Activity, and Planning in retirement) was produced (stage 7). The approach was resource intensive and required a multidisciplinary team. The design expert made an invaluable contribution throughout the process. Conclusions Our sequential approach fills an important methodological gap in the literature, describing the stages and techniques useful in developing an evidence-based complex health intervention. The systematic and rigorous integration of scientific evidence, expert knowledge and experience, and stakeholder input has resulted in an intervention likely to be acceptable and feasible.

Supporting visual assessment of food and nutrient intake in a clinical care setting

Monitoring nutritional intake is an important aspect of the care of older people, particularly for those at risk of malnutrition. Current practice for monitoring food intake relies on hand written food charts that have several inadequacies. We describe the design and validation of a tool for computer-assisted visual assessment of patient food and nutrient intake. To estimate food consumption, the application compares the pixels the user rubbed out against predefined graphical masks. Weight of food consumed is calculated as a percentage of pixels rubbed out against pixels in the mask. Results suggest that the application may be a useful tool for the conservative assessment of nutritional intake in hospitals.

Co-designing a Digital Directory of Services☆

Abstract The Digital Health and Care Institute is a new innovation centre in Scotland which aims to transform health and social care delivery using a dynamic model of innovation ( www.dhi-scotland.com ). Experience Laboratories are at the core of this model and are led and developed by the Institute of Design Innovation at The Glasgow School of Art. Experience Labs provide a new way of working collaboratively within health and social care contexts in Scotland through a process of exploration, co-design and co-creation, and rapid prototyping of ideas. Bring together academic, business and civic partners, Experience Labs provide the opportunity for extreme collaboration in a safe and realistic environment. Through a series of design-led activities, which position the user at the centre of the design process, the Labs enable the trialing of ideas and co-design of sustainable health and social care solutions, together with end-users. This paper presents the findings of a design-led project to co-design a new directory of services application for the Scottish Ambulance Service. The Experience Lab aimed to explore and develop a basic prototype of a Directory App to support ambulance clinicians to consider alternatives to Accident and Emergency where appropriate, and support initial small scale testing. The Experience Labs provided the opportunity to co-design, develop and test a solution with users. The design-led approach enabled the delivery of a set of user-driven requirements for the development of the Directory App. The safe space for trialling and testing provided by the Labs together with the design-led approach allowed users to share their ideas and experience, contributing to the design of the ideal Directory App.

Right Here Right Now (RHRN) pilot study: testing a method of near-real-time data collection on the social determinants of health

Background Informing policy and practice with up-to-date evidence on the social determinants of health is an ongoing challenge. One limitation of traditional approaches is the time-lag between identification of a policy or practice need and availability of results. The Right Here Right Now (RHRN) study piloted a near-real-time data-collection process to investigate whether this gap could be bridged. Methods A website was developed to facilitate the issue of questions, data capture and presentation of findings. Respondents were recruited using two distinct methods – a clustered random probability sample, and a quota sample from street stalls. Weekly four-part questions were issued by email, Short Messaging Service (SMS or text) or post. Quantitative data were descriptively summarised, qualitative data thematically analysed, and a summary report circulated two weeks after each question was issued. The pilot spanned 26 weeks. Results It proved possible to recruit and retain a panel of respondents providing quantitative and qualitative data on a range of issues. The samples were subject to similar recruitment and response biases as more traditional data-collection approaches. Participants valued the potential to influence change, and stakeholders were enthusiastic about the findings generated, despite reservations about the lack of sample representativeness. Stakeholders acknowledged that decision-making processes are not flexible enough to respond to weekly evidence. Conclusion RHRN produced a process for collecting near-real-time data for policy-relevant topics, although obtaining and maintaining representative samples was problematic. Adaptations were identified to inform a more sustainable model of near-real-time data collection and dissemination in the future.

Intervening to improve wellbeing retirement: The LiveWell programme

Background: Many psycho-oncology studies use posttraumatic growth (PTG) measures designed for general trauma experiences, and as such they may not take into account life changes associated with a health-related context. Method: Study 1, a thematic analysis of written narratives (N = 209), emphasised cancer survivors’ newfound compassion. Study 2, with 504 prostate cancer survivors, measured the Posttraumatic Growth Inventory including five additional items derived from Study 1 to represent increased compassion. Findings: A Principal Components Analysis revealed a six-component structure after deleting eight items. Components related to compassion, new possibilities, relating to others, personal strength, appreciation of life, and spiritual change. Compassion accounted for 48.9% of variance, with the overall model accounting for 79.9% of variance. Strong factorability, internal consistency, and convergent validity were demonstrated. Discussion: The salience of newfound compassion after cancer was demonstrated. This research has important implications for accurately assessing the post-diagnosis trajectory of adjustment after cancer.Special Issue: Abstracts supplement: “Well-being, quality of life and caregiving” : 27th Conference of the European health psychology society, Bordeaux, France, 16th – 20th July 2013Background: Self-affirmation (i.e., focusing on a valued aspect of the self-concept) can promote health behaviour change. This study aimed to see if self-affirmation increased physical activity (PA) regardless of threat level presented in health messages. Methods: Sixty-eight participants were randomly allocated to condition in a 2 (self-affirmation, no affirmation) x 2 (high threat, low threat) between-participants design. Participants completed the Godin Leisure-Time Exercise Questionnaire at baseline and one week later to assess PA. Findings: A two-way ANCOVA with affirmation condition and threat level as predictor variables, controlling for baseline PA, was performed on follow up PA. Baseline PA was a significant predictor (F(1,63) = 399.63, p<0.001) and the main effect of affirmation condition approached significance (F(1,63) = 3.55, p=0.06). There were no other significant effects. Discussion: This study provides further evidence that self-affirmation can increase PA, but found no interaction between self-affirmation and threat level presented in health messages.Background: Contemporary alcohol research suggests that implicit attitudes are important predictors of drinking behaviour and there is growing interest surrounding factors influencing them. Research suggests that evaluative conditioning (EC) influences implicit attitudes and at a population level the most obvious and prolific use of EC is advertising. Methods: Participants (n= 51, mean age= 22.43) completed alcohol- and chocolate-related Implicit Association Tests (IAT) before viewing an advertisement for either chocolate or beer. Participants then completed post-test IATs before being provided with chocolate and beer products and asked to consume as much as they wanted. Findings: Viewing a beer advertisement produced a significant positive shift in alcohol-related implicit attitudes from pre- to post-test. No other significant effects on implicit attitudes or behaviour were found. Discussion: Alcohol advertisements are effective in changing alcohol-related implicit attitudes; however the influence on behaviour requires further investigation. Implications for the manipulation of alcohol-related implicit attitudes are discussed.Background: Recent research has highlighted the importance of automatic processes in predicting impulsive health risk behaviour. This has led to the creation of health behaviour models such as the Prototype Willingness Model (PWM) which take into account dual processes when predicting health behaviour. The current research argues that individuals are more likely to engage in impulsive drinking behaviour on a weekend as opposed to a weekday as there are fewer constraints placed upon drinking behaviour. Methods: Participants (n= 61, mean age= 22) completed an alcohol Implicit Association Test as well as a questionnaire assessing variables on the PWM and drinking behaviour. Findings: More positive alcohol-related automatic cognitions were significantly related to increased levels of both frequency and quantity of self-reported weekend drinking behaviour but were not significantly related to weekday drinking behaviour. Discussion: Automatic processes successfully predicted drinking behaviour when there were fewer constraints placed upon individuals.Background: The Prototype Willingness Model (PWM) suggests that there are two separate antecedents to behaviour: intention and willingness. Whereas intention is suggested to be rational and deliberative, willingness is more automatic and impulsive. The current study used a cross-cultural sample in order to examine the differing predictive power of the PWM for drinking behaviour. Methods: A sample of 193 individuals from Australia (n=108) and Singapore (n=85) completed a questionnaire measuring alcohol consumption and variables on the PWM. Findings: Willingness to drink significantly predicted alcohol consumption in Singaporeans. Both willingness and intention to drink significantly predicted frequency of alcohol consumption Discussion: The antecedents of the PWM differentially predict alcohol consumption in culturally different samples. Implications for health interventions aimed to reduce drinking across cultures are discussed.Background. Parenting has been associated with child weight status. This study aims to evaluate the effects on parenting skills and BMI-SDS of the BBOFT+ overweight prevention program, compared to care-as-usual (CAU). Method. In a cluster-randomized trial, 2500 parents participated. Parent-reported weight and length were used. Parenting was measured with subscales control and reinforcement of the parenting strategies for eating and activity scale (PEAS) and the warmth subscale from the Child Rearing Questionnaire. Results. The first univariate analyses show that at age 15 months, no statistically significant differences in BMI- SDS, parental control, reinforcement or warmth were found between the BBOFT+ and the CAU group. Further cluster analyses need to be conducted. Results from age 36 months will be presented during the conference, which will include all subscales of the PEAS and an assessment of parenting styles. Conclusion. The intervention does not seem to have an effect on BMI-SDS or parenting.Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. 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Redesigning food service for vulnerable older adult hospital patients

Purpose: The food service for older adult hospital patients contributing to significant problems in the UK resulting in unacceptable levels of malnutrition. The design team (DT) working within a three-year multi-disciplinary research project mappmal (1), funded by the cross-council New Dynamics of Ageing programme, concerned with redesigning the food service (2) for vulnerable older hospital patients, particularly stroke, dementia and hip fracture, discuss how opportunities for - and principles to guide - service redesign and associated products and environments have been established. Methods: The DT worked with mappmal’s other specialist teams (i.e. food science, dietetics, medical sociology, ergonomics, technology) in the design of a series of interactive workshops (3) (WS) for the many individuals (i.e. key stakeholders (KS) and the ‘food family’ (FF)) involved in the process of assessment and care of patients, and in preparing and delivering their food. Activities within these workshops were designed to i) develop understanding of the food service from the patient’s perspective, ii) ‘map’ the food service and iii) identify opportunities for improving the service through using the collective experience of the KS and FF. Evidence to identify the opportunities for service redesign and the principles to guide these were triangulated through i) literature and best practice case study reviews, ii) analysis of interviews of the KS and FF and iii) analysis of further evidence from the KS and FF during the WSs. Simultaneously, an audit was conducted of the ergonomic requirements and opportunities for system support through electronic information transfer. Results and discussion: From the WS five major opportunities for service redesign to be guided by six service principles were identified. From their audit the DT also identified a number of opportunities for the improved design in the four areas of tableware, the patient environment, the ward environment and the electronic system required to handle the type of patient-centred information so crucial to the particular needs of these vulnerable individuals. The DT are currently synthesising findings and developing the specifications for designs in all these areas as a precursor to a design process where the service redesign prototype will be iteratively evaluated by the FF and KS in future WS. Early evidence suggests that some improvements designed for the project’s identified vulnerable older adults would result in improvements generally in the food service for other patients.