Kathryn Hunt

A gender-sensitised weight loss and healthy living programme for overweight and obese men delivered by Scottish Premier League football clubs (FFIT): a pragmatic randomised controlled trial

BACKGROUNDnThe prevalence of male obesity is increasing but few men take part in weight loss programmes. We assessed the effect of a weight loss and healthy living programme on weight loss in football (soccer) fans.nnnMETHODSnWe did a two-group, pragmatic, randomised controlled trial of 747 male football fans aged 35-65 years with a body-mass index (BMI) of 28 kg/m(2) or higher from 13 Scottish professional football clubs. Participants were randomly assigned with SAS (version 9·2, block size 2-9) in a 1:1 ratio, stratified by club, to a weight loss programme delivered by community coaching staff in 12 sessions held every week. The intervention group started a weight loss programme within 3 weeks, and the comparison group were put on a 12 month waiting list. All participants received a weight management booklet. Primary outcome was mean difference in weight loss between groups at 12 months, expressed as absolute weight and a percentage of their baseline weight. Primary outcome assessment was masked. Analyses were based on intention to treat. The trial is registered with Current Controlled Trials, number ISRCTN32677491.nnnFINDINGSn374 men were allocated to the intervention group and 374 to the comparison group. 333 (89%) of the intervention group and 355 (95%) of the comparison group completed 12 month assessments. At 12 months the mean difference in weight loss between groups, adjusted for baseline weight and club, was 4·94 kg (95% CI 3·95-5·94) and percentage weight loss, similarly adjusted, was 4·36% (3·64-5·08), both in favour of the intervention (p<0·0001). Eight serious adverse events were reported, five in the intervention group (lost consciousness due to drugs for pre-existing angina, gallbladder removal, hospital admission with suspected heart attack, ruptured gut, and ruptured Achilles tendon) and three in the comparison group (transient ischaemic attack, and two deaths). Of these, two adverse events were reported as related to participation in the programme (gallbladder removal and ruptured Achilles tendon).nnnINTERPRETATIONnThe FFIT programme can help a large proportion of men to lose a clinically important amount of weight; it offers one effective strategy to challenge male obesity.nnnFUNDINGnScottish Government and The UK Football Pools funded delivery of the programme through a grant to the Scottish Premier League Trust. The National Institute for Health Research Public Health Research Programme funded the assessment (09/3010/06).

How information about other people's personal experiences can help with healthcare decision-making: A qualitative study ☆

OBJECTIVEnTo investigate peoples views of using general facts and information about other peoples personal experiences for health-related decision-making.nnnMETHODSnSixty-two people, who between them had experience of five different focal health issues, participated in 12 focus groups and 9 interviews. Exploration of uses of the two types of information was supported by discussion of illustrative excerpts.nnnRESULTSnThere was less discussion of general facts; participants thought it obvious that good decisions required these. Participants reported having used personal experiences information to: recognise decisions that needed consideration; identify options; appraise options and make selections (including by developing and reflecting on their reasoning about possible choices); and support coping strategies. Their inclination to use personal experiences information was apparently moderated by assessments of personal relevance, the motives of information providers and the balance of experiences presented.nnnCONCLUSIONnPeople can use personal experiences information in various ways to support their decision-making, and exercise some discrimination as they do.nnnPRACTICE IMPLICATIONSnPersonal experiences information may help people in a number of ways in relation to decision-making. However, personal experiences information does not replace the need for general facts and care should be taken when it is used in resources for patients.

How personal experiences feature in women's accounts of use of information for decisions about antenatal diagnostic testing for foetal abnormality

There has been a striking growth in the availability of health-related information based on personal experience in recent years and internet users are often drawn towards other peoples stories about their health. Accounts of other peoples experiences might convey social and emotional information that is not otherwise available but little is known about how it is used or the implications of its use in practice. This paper examines how people refer to information about other peoples experiences when accounting for decisions about antenatal diagnostic testing for foetal abnormality. We conducted a secondary analysis of 37 qualitative interviews undertaken across the UK with 36 women and nine of their male partners (eight couples were interviewed together) who talked about diagnostic testing for foetal abnormality in 55 pregnancies. When describing their decisions, respondents referred to examples of knowledge gleaned from their own and other individuals experiences as well as information based on biomedical or clinical-epidemiological research (usually about the probabilities of having a child affected by health problems or the probability of diagnostic tests causing miscarriage). Both forms of knowledge were employed in peoples accounts to illustrate the legitimacy and internal coherence of decisions taken. The analysis demonstrates the personally idiosyncratic ways that people reflect on and incorporate different types of information to add meaning to abstract ideas about risk, to imagine the consequences for their own lives and to help them to make sense of the decisions they faced.

Adolescent socio-economic and school-based social status, health and well-being

Studies of adults and adolescents suggest subjective socio-economic status (SES) is associated with health/well-being even after adjustment for objective SES. In adolescence, objective SES may have weaker relationships with health/well-being than at other life stages; school-based social status may be of greater relevance. We investigated the associations which objective SES (residential deprivation and family affluence), subjective SES and three school-based subjective social status dimensions (“SSS-peer”, “SSS-scholastic” and “SSS-sports”) had with physical symptoms, psychological distress and anger among 2503 Scottish 13–15 year-olds. Associations between objective SES and health/well-being were weak and inconsistent. Lower subjective SES was associated with increased physical symptoms and psychological distress, lower SSS-peer with increased psychological distress but reduced anger, lower SSS-scholastic with increased physical symptoms, psychological distress and anger, and lower SSS-sports with increased physical symptoms and psychological distress. Associations did not differ by gender. Objective and subjective SES had weaker associations with health/well-being than did school-based SSS dimensions. These findings underline the importance of school-based SSS in adolescence, and the need for future studies to include a range of school-based SSS dimensions and several health/well-being measures. They also highlight the need for a focus on school-based social status among those working to promote adolescent health/well-being.

Social media as a space for support: Young adults’ perspectives on producing and consuming user-generated content about diabetes and mental health

Social media offer opportunities to both produce and consume content related to health experiences. However, peoples social media practices are likely to be influenced by a range of individual, social and environmental factors. The aim of this qualitative study was to explore how engagement with user-generated content can support people with long-term health conditions, and what limits users adoption of these technologies in the everyday experience of their health condition. Forty semi-structured interviews were conducted with young adults, aged between 18 and 30 years, with experience of diabetes or a common mental health disorder (CMHD). We found that the online activities of these young adults were diverse; they ranged from regular production and consumption (‘prosumption’) of health-related user-generated content to no engagement with such content. Our analysis suggested three main types of users: ‘prosumers’; ‘tacit consumers’ and ‘non-engagers’. A key determinant of participants engagement with resources related to diabetes and CMHDs in the online environment was their offline experiences of support. Barriers to young adults participation in online interaction, and sharing of content related to their health experiences, included concerns about compromising their presentation of identity and adherence to conventions about what content is most appropriate for specific social media spaces. Based on our analysis, we suggest that social media do not provide an unproblematic environment for engagement with health content and the generation of supportive networks. Rather, producing and consuming user-generated content is an activity embedded within individuals specific health experiences and is impacted by offline contexts, as well as their daily engagement with, and expectations, of different social media platforms.

Imagined futures: how experiential knowledge of disability affects parents' decision making about fetal abnormality.

Backgroundu2002 Knowledge of disability is considered key information to enable informed antenatal screening decisions by expectant parents. However, little is known about the role of experiential knowledge of disability in decisions to terminate or continue with a pregnancy diagnosed with a fetal abnormality.

Can the draw of professional football clubs help promote weight loss in overweight and obese men? A feasibility study of the Football Fans in Training programme delivered through the Scottish Premier League

Objective The UK prevalence of male obesity is among the highest in Europe. Excess weight is associated with ill-health, but while 5-10% weight loss can significantly improve future health, men are reluctant to engage in traditional weight management programmes. This study examines the potential of professional football clubs to engage overweight and obese men in weight loss. Football Fans in Training (FFIT) is a 12 week, gender-sensitised weight management and physical activity programme delivered to groups of men at Scottish Premier League (SPL) clubs. Design A mixed-method feasibility study including a pilot randomised trial and process evaluation involving focus groups with participants and coaches delivering FFIT. Setting Two SPL clubs: one large, city-based; one smaller, town-based. Participants 103 men, aged 35–65 years, body mass index (BMI) ≥ 27 kg/m2, randomly assigned to the intervention (receiving FFIT immediately, N=51) or comparison group (receiving FFIT 4 months later, N=52). Main outcome measures The primary outcomes were viability of the recruitment procedures and participant attrition. Process outcomes included acceptability of physical and questionnaire measurement to participants, and acceptability of FFIT to men and coaches. Secondary outcomes included indications of percentage weight loss at 12 weeks, and changes in independently-measured BMI, waist circumference, and self-reported physical activity, eating habits and psychological status post-programme. Results The recruitment target (N=60) was achieved in the large, but not smaller, club, suggesting additional measures may be needed to increase participation at smaller clubs. Attrition was low; 83.5% took part in 12-week measurements. Participants were comfortable with research procedures and very positive about FFIT. The football setting proved to be a particular draw; many indicated they would not have attended a similar programme elsewhere. Similarly positive feedback was received from coaches. The intervention group achieved a mean 4.6% weight loss (SD 2.8) while the comparison group recorded a mean 0.6% weight gain (SD 2.0); and BMI and waist circumference showed a similar pattern (all p<0.001). The intervention group also reported: significant increases in self-esteem and 12-Item Short Form Health Survey (SF-12) scores, physical activity, and consumption of breakfast, fruit and vegetables; and significant decreases in consumption of burgers, pies, crisps, biscuits and chocolate (these changes were significantly different from those reported by the comparison group, p=0.001 to 0.048). Conclusion Professional football clubs can encourage men (a traditionally hard-to-reach group) to engage in gender-sensitised weight management programmes and to make positive lifestyle changes. Follow-up assessments will determine if short-term improvements are maintained.

Teenagers’ understandings of and attitudes towards vaccines and vaccine-preventable diseases: a qualitative study

Highlights • Explored understandings of diseases and knowledge and experiences of vaccination.• Teenagers had limited knowledge and little direct experience of the diseases.• Participants attitudes towards receiving vaccines’ varied.• The success of mass immunisation programmes is associated with disease perceptions.• Need to engage with teenagers to address misconceptions about vaccines and diseases.

How Does Sex Influence Multimorbidity? Secondary Analysis of a Large Nationally Representative Dataset.

Multimorbidity increases with age and is generally more common in women, but little is known about sex effects on the “typology” of multimorbidity. We have characterized multimorbidity in a large nationally representative primary care dataset in terms of sex in ten year age groups from 25 years to 75 years and over, in a cross-sectional analysis of multimorbidity type (physical-only, mental-only, mixed physical and mental; and commonest conditions) for 1,272,685 adults in Scotland. Our results show that women had more multimorbidity overall in every age group, which was most pronounced in the 45–54 years age group (women 26.5% vs. men 19.6%; difference 6.9 (95% CI 6.5 to 7.2). From the age of 45, physical-only multimorbidity was consistently more common in men, and physical-mental multimorbidity more common in women. The biggest difference in physical-mental multimorbidity was found in the 75 years and over group (women 30.9% vs. men 21.2%; difference 9.7 (95% CI 9.1 to 10.2). The commonest condition in women was depression until the age of 55 years, thereafter hypertension. In men, drugs misuse had the highest prevalence in those aged 25–34 years, depression for those aged 35–44 years, and hypertension for 45 years and over. Depression, pain, irritable bowel syndrome and thyroid disorders were more common in women than men across all age groups. We conclude that the higher overall prevalence of multimorbidity in women is mainly due to more mixed physical and mental health problems. The marked difference between the sexes over 75 years especially warrants further investigation.

What parents say about disclosing the end of their pregnancy due to fetal abnormality

OBJECTIVEnto describe mens and womens experiences of deciding whether to tell people in their social network, including their children, about their pregnancy loss following a termination for fetal abnormality.nnnDESIGNnsecondary analysis of qualitative narrative interview data informed by a critical realist approach.nnnSETTINGnrespondents were recruited throughout the United Kingdom and interviewed at home between 2004 and 2005.nnnPARTICIPANTSntwenty-eight women and nine men who had ended a pregnancy diagnosed with a fetal abnormality and who talked about disclosing or not disclosing the termination to others.nnnFINDINGSnfew respondents reported having any advice or information about whether or how to disclose their termination. None said they completely concealed their decision from adults in their social network; most said they disclosed selectively, telling close friends and family they had terminated and acquaintances they had miscarried. Most respondents reported telling their young children that the baby had died but did not reveal that they had chosen to end the pregnancy. A minority had not told their existing offspring about the pregnancy loss. Common reasons given for (partially) concealing a termination were: guilt over the decision; to avoid being judged; and to protect other peoples feelings. Common reasons for disclosure were: others knew of the pregnancy; needing time off work; needing practical help and/or emotional support during diagnosis and termination; and wanting recognition of their loss. Positive consequences of disclosure were said to be getting more support and less criticism than expected; negative consequences included not getting the anticipated support and empathy; and encountering disapproval. Some respondents felt that concealing their pregnancy loss from their children had resulted in their confusion over the cause of their parents distress. Some men said they found it hard to access emotional support from their social networks because of expectations about how men should deal with emotions.nnnKEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICEnmidwives have to make difficult judgements about what, how and when to provide information when trying to support and advise parents who have ended a pregnancy due to fetal abnormality. Further education and training in this area could be of benefit. Midwives could signpost parents to existing sources of advice around disclosure, taking into account parents individual preferences, help parents to consider the potential implications of disclosure and concealment and different ways of disclosing. They could also recommend alternative sources of emotional support, bearing in mind that men in particular may find it harder to access support from their social networks.