Janet Withall

Families’ and health professionals’ perceptions of influences on diet, activity and obesity in a low-income community

This qualitative study examined reported barriers to consuming a healthy diet and engaging in regular physical activity among low-income families with existing issues of overweight or obesity. Parents and health professionals reported that issues of access, availability and cost were perceived as major barriers to a healthy lifestyle along with familial shape, metabolism and safety. Many felt their diet and activity levels were already good. The study concluded that improving access, availability and income may increase activity but only in some groups. Issues of perceived helplessness (genetics/metabolism) and high optimistic bias may provide rationalisations that undermine behaviour change. Together these issues may mask the more complex, less easily articulated influences (cultural, social and family influences and practices, knowledge and skill levels, and emotional status) that lead to unhealthy behaviours.

Objective Indicators of Physical Activity and Sedentary Time and Associations with Subjective Well-Being in Adults Aged 70 and Over

This study explored the associations of the volume and intensity of physical activity and the volume of sedentary time with subjective well-being in a diverse group of 228 older adults in the UK (111 female, mean age 78.2 years (SD 5.8)). Physical activity (PA) and sedentary behaviour were assessed by accelerometry deriving mean steps per day, mean moderate/vigorous PA minutes per hour (MVPA min·h−1) and minutes of sedentary time per hour (ST min·h−1). Lower limb function was assessed by the Short Physical Performance Battery. Subjective well-being was assessed using the SF-12 health status scale, the Ageing Well Profile and the Satisfaction with Life Scale. Linear regressions were used to investigate associations between the independent variables which included physical activity (steps and MVPA), sedentary time, participant characteristics (gender, age, BMI, education, number of medical conditions), and lower limb function and dependent variables which included mental and physical well-being. Steps, MVPA and lower limb function were independently and moderately positively associated with perceived physical well-being but relationships with mental well-being variables were weak. No significant associations between sedentary behaviours and well-being were observed. The association between objectively evaluated physical activity and function and subjective evaluations of physical well-being suggest that improving perceptions of physical health and function may provide an important target for physical activity programmes. This in turn may drive further activity participation.

The effect a of community-based social marketing campaign on recruitment and retention of low-income groups into physical activity programmes - a controlled before-and-after study

BackgroundThe beneficial effect of physical activity for the prevention of a range of chronic diseases is widely acknowledged. These conditions are most prevalent in low-income groups where physical activity levels are consistently lower. Social marketing is the government’s recommended approach to promoting physical activity but evidence of its effectiveness is limited. The purpose of this study was to examine the effect of a social marketing campaign on the monthly recruitment, attendance and retention levels at a community-based physical activity programme in a low income area.MethodsA six-month social marketing campaign was designed and delivered in a highly-deprived suburban neighbourhood. Analysis of variance was used to assess effects on recruitment and attendance. χ2 tests of independence were used to compare dropouts and adherers and effectiveness of recruitment mechanisms. Percentages were used to compare adherence rates at intervention, pre-existing sessions in the intervention area and control area sessions.ResultsAttendance data were collected weekly and presented and analysed monthly to provide a view of changing participation over the six month intervention period, as compared to attendance at pre-existing sessions in the intervention area and in a control area. Recruitment into intervention sessions was significantly greater than into pre-existing and control area sessions in Month 1 (18.13v1.04 p = .007, 18.13v.30 p=.005), Month 5 (3.45v.84 p=.007, 3.45v.30 p<.001) and Month 6 (5.60v.65 p<.001, 5.60v.25 p<.001). Attendance at intervention sessions was significantly greater in all six months than at pre-existing and control area sessions; Month 1 (38.83v7.17 p<.001, 38.83v4.67, p<.001), Month 2 (21.45v6.20 p<.001, 21.45v4.00, p<.001), Month 3 (9.57v6.15 p<.001, 9.57v3.77, p<.001), Month 4 (17.35v7.31 p<.001, 17.35v4.75, p<.001), Month 5 (20.33v8.81 p=.007, 20.33v4.54 p<.001) and Month 6 (28.72v8.28 p<.001, 28.72v.4.00 p<.001). Drop-out rates in the intervention area were similar to the control area (66.2%v69.9%), and considerably lower than in pre-existing sessions (83%). In months one and two, traditional marketing techniques (posters/outdoor banners/flyers) had the greatest influence on recruitment compared to word of mouth communication (84.5%v15.5%). In months five and six word of mouth influenced 57.5% of new recruits.ConclusionsDirect comparisons with other programmes were difficult due to a lack of standard definitions of recruitment and adherence and limited reporting of findings. However when compared to pre-existing sessions and sessions delivered in a control area, monthly attendance patterns indicated that a reasonably well funded social marketing campaign increased recruitment into exercise sessions, maintained good levels of attendance and reasonable levels of adherence. Good attendance levels support on-going campaign success by offering evidence of peer and social support for the activity and increasing opportunities for social interaction. They also increase the capacity and reach of the word of mouth communication channels, the most effective form of promotion. Further study into methods of improving exercise adherence is required.

But Is It a Normal Thing? Teenage Mothers' Experiences of Breastfeeding Promotion and Support.

Aim: To explore teenagers’ experiences of the breastfeeding promotion and support delivered by health professionals. Design: A qualitative study conducted in an English city. Methods: Pregnant teenagers and teenage mothers (n = 29) took part in semi-structured interviews and focus groups between March and July 2009. Results: Breastfeeding is presented by health professionals as incontrovertibly the best choice of feeding method, but teenagers experience an array of conflicting norms which influence their infant feeding choices and behaviours. Conclusions: The social barriers to continuing breastfeeding are insufficiently recognized and addressed by health professionals. It is likely that teenage mothers would breastfeed for longer if they perceived that breastfeeding was a normal way to feed baby in their social milieu.

Who attends physical activity programmes in deprived neighbourhoods

Objective: Physical activity can reduce the risk of several chronic diseases. Such diseases are most prevalent in economically-disadvantaged groups where physical activity levels are consistently lower. There is a need to engage disadvantaged groups in programmes to increase physical activity. This case study examined programmes on offer in a deprived area and the characteristics of those who participated. Design: Case study. Setting: The setting for this study was Southmead, a highly deprived suburb of Bristol with the city’s lowest life expectancy (75.3 years). Method: Desk research and venue visits were used to assess provision of physical activity sessions. A questionnaire covering demographics, attendance patterns and communications channels was completed by 152 adult and adolescent session participants. Results: In the study area, 37 activity sessions were offered. Only 45.4 per cent of attendees were resident in the study area. A mean of 17.5 attended community generated sessions, 22.6 special interest sessions and 6.7 local authority/trust classes. Locals were more likely to attend community generated sessions (49.3 per cent; 87.7 per cent of men) than those provided by the local authority (34.8 per cent; 13.3 per cent of men) (χ2 = 27.8, df = 2, P < .001). Word of mouth was the most common mechanism for building session awareness (local 57.8 per cent; non-local 62.9 per cent). Conclusions: Local authority driven physical activity sessions in low-income communities have low levels of participation. Activities with roots in the community are most effective at attracting local participants, particularly men. The most common communication mechanism is word of mouth but whether this is due to lack of investment and expertise in other promotional techniques is not clear.

Participant and Public Involvement in Refining a Peer-Volunteering Active Aging Intervention: Project ACE (Active, Connected, Engaged).

Abstract Background Evidence for the health benefits of a physically active lifestyle among older adults is strong, yet only a small proportion of older people meet physical activity recommendations. A synthesis of evidence identified “best bet” approaches, and this study sought guidance from end-user representatives and stakeholders to refine one of these, a peer-volunteering active aging intervention. Methods Focus groups with 28 older adults and four professional volunteer managers were conducted. Semi-structured interviews were conducted with 9 older volunteers. Framework analysis was used to gauge participants’ views on the ACE intervention. Results Motives for engaging in community groups and activities were almost entirely social. Barriers to participation were lack of someone to attend with, lack of confidence, fear of exclusion or “cliquiness” in established groups, bad weather, transport issues, inaccessibility of activities, ambivalence, and older adults being “set in their ways”. Motives for volunteering included “something to do,” avoiding loneliness, the need to feel needed, enjoyment, and altruism. Challenges included negative events between volunteer and recipient of volunteering support, childcare commitments, and high volunteering workload. Conclusion Peer-volunteering approaches have great potential for promotion of active aging. The systematic multistakeholder approach adopted in this study led to important refinements of the original ACE intervention. The findings provide guidance for active aging community initiatives highlighting the importance of effective recruitment strategies and of tackling major barriers including lack of motivation, confidence, and readiness to change; transport issues; security concerns and cost; activity availability; and lack of social support.

Using social marketing to encourage teenage mothers to breastfeed

Purpose – This purpose of this paper is to report on a study of the possible role of social marketing in encouraging breastfeeding amongst teenage mothers. UK teenage mothers are particularly prone to low levels of breastfeeding and there has been a lack of response to traditional health education approaches. The purpose of this paper is to report on an in‐depth, qualitative exploration into the use of social marketing to address this problem.Design/methodology/approach – Qualitative interviews were conducted in 2009 with 58 pregnant teenagers, young mothers and their influencers to explore feeding decisions and examine social marketing options. The Theory of Planned Behaviour (TPB) emerged as the most appropriate framework to explain the major influences on breastfeeding. This was used to structure a solution that highlighted three strategic priorities for social marketing based on the TPBs three components: changing attitudes, altering social norms and increasing confidence.Findings – Health benefits o...

Implementing Physical Activity Programmes for Community-Dwelling Older People with Early Signs of Physical Frailty

Postponing or reducing physical frailty in older people yields immediate economic, personal, and societal benefits. Maintaining mobility in older age can reduce the need for health and social services. It contributes to quality of life characterised by independence and productive engagement with community. This chapter critically reviews the evidence on the challenges for implementing physical activity programmes for community-dwelling older adults with early signs of physical frailty. It discusses new evidence about promising approaches in programme design and implementation, with particular focus on uptake and maintained participation. It concludes with practical tips for policymakers and programme developers highlighting the need for multidisciplinary partnerships for implementation of effective physical activity programmes targeting older adults and particularly people with early signs of physical frailty.