Jane Frankland

A controlled evaluation of an intensive, peer- led, schools-based, anti-smoking programme

There is increasing interest in health promotion interventions which seek to change behaviour through local cultural diffusion by trained opinion-formers. This study adapted this approach to schools settings. Popular pupils in years 8 and 9 (aged 12 to 14) were recruited for intensive training by specialist staff on how to intervene effectively in everyday situations to promote smoking cessation and prevention of smoking uptake among their peers. Data on smoking behaviour, plus saliva samples for cotinine testing, were collected pre-intervention, immediately post-intervention, and three months post-intervention in two intervention and two control schools. Most differences in behaviour between intervention and control schools were not statistically significant. However, baseline ex-smokers (11 per cent of the sample and a larger group than baseline regular smokers) were significantly more likely still to be abstinent in the intervention, as opposed to the control, schools. Given the relative paucity of evidence of effective anti-smoking programmes in schools, these results are sufficiently encouraging to justify a full-scale randomised controlled trial evaluation.

Living into old age with the consequences of breast cancer

PURPOSE OF THE RESEARCH Breast cancer survival rates are improving with over 60% likely to live 20 years. As 30% diagnoses occur in women over 70 the prevalence of breast cancer survivors living into older age is increasing. The specific needs and experiences of this group have rarely been addressed. This study aimed to explore older womens experience of living with breast cancer alongside other health conditions, and to identify their information and support needs and preferences. METHODS AND SAMPLE Data were collected from 28 semi-structured qualitative interviews and 2 focus groups (n = 14), with breast cancer survivors aged 70-90, and were analysed using thematic analysis. KEY RESULTS These older breast cancer survivors experienced a range of long-term physical problems resulting from treatment, including poor cosmetic results and poor shoulder movements, and bras and prostheses were often unsuitable. Many were keen to preserve their body image ideal irrespective of age. Reconstruction was rarely discussed, but all would have liked this option. Older women wanted to be treated as individuals rather than uniformly as older people, with their personal physical and social needs (including co-morbidities) taken into account. They expressed a preference for information direct from health professionals. CONCLUSIONS Many breast cancer survivors will live into advanced old age with permanent physical and emotional consequences of their treatment. Holistic and personalized assessment of needs becomes increasingly important with age, particularly with comorbidity. Effective rehabilitative care is important to reduce the impact of breast cancer into old age.

Sex education for parents

Finds research shows that while parents are potentially an important source of information and support to their children on sexual issues, in practice many parents feel that they lack the skills and confidence to play a direct role in these matters. Presents findings from a pilot project undertaken by Health Promotion Wales and FPA Cymru to enhance parents’ sex education skills. Details a series of workshops which were run for groups of parents with differing needs in relation to their children’s sex education. Describes how participants took part in pre‐workshop interviews to identify their concerns and in post‐workshop interviews to assess the impact of the workshops. Presents findings from the workshop evaluations, together with some lessons learned from the project. Advises that the long‐term outcome of the project, a resource pack on sex education for parents, is now available.

A survey of health promotion in Welsh primary schools, 1993

This paper presents data from a 1993 self-completion questionnaire survey of primary schools in Wales on the organisation and provision of health education teaching, the implementation of health-related policies and the involvement of outside agencies and professionals in the planning and delivery of health promotion. The results from the 308 schools (62 per cent) which returned questionnaires show a widespread commitment to, and a sound base for the further expansion of, health promotion activity. It is recommended that greater attention should be given to the continuing education of primary school teachers in health promotion, the develop ment of policies on smoking, nutrition and sex education and the planned integration of community resources into school health promotion programmes.

Evaluating HIV prevention for women prostitutes in Cardiff

This paper presents an evaluation of a pilot project aimed at reducing HIV transmission risks among women prostitutes and their clients in Cardiff. The project was implemented by the South Glamorgan Community Drug Team, and was funded and monitored by Health Promotion Wales. The paper reviews the projects success in meeting its objectives in terms of building contacts with the client group; assessing their needs in terms of HIV prevention; carrying out an appropriate programme of health education; and achieving referrals to other health and welfare agencies. It concludes with a discussion of the lessons that can be learned from the project.

The True NTH Prostate Cancer Survivorship Care programme: Development and evaluation of a model for delivering follow-up care to men with prostate cancer.

42 Background: Increasing use of prostate specific antigen (PSA), improvements in treatment and aging population have led to the escalating incidence of prostate cancer. 5 year survival rate is relatively high and men who have completed treatment require long-term follow-up to detect recurrence or progression of disease, monitor adverse effects of treatment and identify and address psychosocial needs. Studies demonstrate men have a range of unmet physical and psychosocial needs, and health services are struggling to cope with the growing numbers. Changes is critical for long-term sustainability of the health system in many developed nations Methods: This presentation presents a model of follow up care centered on remote surveillance of PSA combined with promoting patient self-management. This initiative is part of the True NTH programme of developments initiated in the UK with funding from Movember Foundation and Prostate Cancer UK. Traditional face to face clinic follow up consultations are replaced with: patient directed individually tailored care and surveillance programme which involves: a 4 hour preparatory patient workshop, remote assessment of unmet needs and symptoms and surveillance of PSA, patient information resources, survivorship care plan, communication of treatment summary and management plan to primary care, and rapid recall system for assessment in secondary care should the need arise. The care programme is mediated through clinician and patient access to an IT portal enabling communication. RESULTS The second part of the presentation will describe the evaluation protocol. A historical cohort design is comparing a group of men receiving clinic follow up care (N = 300) with men enrolled on the care programme (N = 300) in 3 centers. Patient-reported outcomes are collected at baseline, 4 months and 8 months. Health economic evaluation will compare costs of clinic based follow up with those of the care programme from both a health service and patient perspective. CONCLUSIONS The evaluation will generate data on impact, acceptability and cost of this model of follow-up care.

Follow-up care after treatment for prostate cancer: protocol for an evaluation of a nurse-led supported self-management and remote surveillance programme

BackgroundAs more men survive a diagnosis of prostate cancer, alternative models of follow-up care that address men’s enduring unmet needs and are economical to deliver are needed. This paper describes the protocol for an ongoing evaluation of a nurse-led supported self-management and remote surveillance programme implemented within the secondary care setting.Methods/designThe evaluation is taking place within a real clinical setting, comparing the outcomes of men enrolled in the Programme with the outcomes of a pre-service change cohort of men, using a repeated measures design. Men are followed up at four and 8 months post recruitment on a number of outcomes, including quality of life, unmet need, psychological wellbeing and activation for self-management. An embedded health economic analysis and qualitative evaluation of implementation processes are being undertaken.DiscussionThe evaluation will provide important information regarding the effectiveness, cost effectiveness and implementation of an integrated supported self-management follow-up care pathway within secondary care.