Nicki Thorogood

Perceptions of childhood immunization in a minority community: qualitative study.

Summary Objective To assess reasons for low uptake of immunization amongst orthodox Jewish families. Design Qualitative interviews with 25 orthodox Jewish mothers and 10 local health care workers. Setting The orthodox Jewish community in North East London. Main outcome measures Identification of views on immunization in the orthodox Jewish community. Results In a community assumed to be relatively insulated from direct media influence, word of mouth is nevertheless a potent source of rumours about vaccination dangers. The origins of these may lie in media scares that contribute to anxieties about MMR. At the same time, close community cohesion leads to a sense of relative safety in relation to tuberculosis, with consequent low rates of BCG uptake. Thus low uptake of different immunizations arises from enhanced feelings of both safety and danger. Low uptake was not found to be due to the practical difficulties associated with large families, or to perceived insensitive cultural practices of health care providers. Conclusions The views and practices of members of this community are not homogeneous and may change over time. It is important that assumptions concerning the role of religious beliefs do not act as an obstacle for providing clear messages concerning immunization, and community norms may be challenged by explicitly using its social networks to communicate more positive messages about immunization. The study provides a useful example of how social networks may reinforce or challenge misinformation about health and risk and the complex nature of decision making about childrens health.

A pragmatic randomised controlled trial in primary care of the Camden Weight Loss (CAMWEL) programme

Objectives To evaluate effectiveness of a structured one-to-one behaviour change programme on weight loss in obese and overweight individuals. Design Randomised controlled trial. Setting 23 general practices in Camden, London. Participants 381 adults with body mass index ≥25 kg/m2 randomly assigned to intervention (n=191) or control (n=190) group. Interventions A structured one-to-one programme, delivered over 14 visits during 12 months by trained advisors in three primary care centres compared with usual care in general practice. Outcome measures Changes in weight, per cent body fat, waist circumference, blood pressure and heart rate between baseline and 12 months. Results 217/381 (57.0%) participants were assessed at 12 months: missing values were imputed. The difference in mean weight change between the intervention and control groups was not statistically significant (0.70 kg (0.67 to 2.17, p=0.35)), although a higher proportion of the intervention group (32.7%) than the control group (20.4%) lost 5% or more of their baseline weight (OR: 1.80 (1.02 to 3.18, p=0.04)). The intervention group achieved a lower mean heart rate (mean difference 3.68 beats per minute (0.31 to 7.04, p=0.03)) than the control group. Participants in the intervention group reported higher satisfaction and more positive experiences of their care compared with the control group. Conclusions Although there is no significant difference in mean weight loss between the intervention and control groups, trained non-specialist advisors can deliver a structured programme and achieve clinically beneficial weight loss in some patients in primary care. The intervention group also reported a higher level of satisfaction with the support received. Primary care interventions are unlikely to be sufficient to tackle the obesity epidemic and effective population-wide measures are also necessary. Clinical trial registration number Trial registrationClincaltrials.gov NCT00891943.

Global differences between women and men in the prevalence of obesity: is there an association with gender inequality?

Background/objectives:In most populations the prevalence of obesity is greater in women than in men; however, the magnitude of the difference between the sexes varies significantly by country. We considered the role of gender inequality in explaining these disparities.Subjects/methods:We undertook an ecological analysis of internationally comparable obesity prevalence data to examine the association between indicators of gender inequality and the differences between men and women in obesity prevalence. Gender inequality was assessed using three measures: the Gender Inequality Index, the Global Gender Gap Index and the Social Institutions and Gender Index. We fitted multiple regression models to examine the association.Results:We found that the prevalence of obesity across countries shows gendered patterning with greater prevalence and greater heterogeneity in women than in men (P<0.001). We also found that two of three measures of gender inequality were significantly associated with the sex differences in obesity prevalence across countries.Conclusions:The patterning of obesity across countries is gendered. However, the association between global measures of gender inequality and the sex gap in obesity is dependent on the measure used. Further research is needed to investigate the mechanisms that underpin the gendered nature of obesity prevalence.

Barriers to the use of dental services by individuals from minority ethnic communities living in the United Kingdom: findings from focus groups.

Objective To describe the barriers identified by individuals from minority ethnic communities resident in the United Kingdom to their use of dental services. Method Focus group discussions were held with individuals from minority ethnic groups. Data were analysed using the technique of content analysis on the basis of categories defined by the researchers. Findings Barriers to regular attendance identified by participants included: language, a mistrust of dentists, cost, anxiety, cultural misunderstandings, concern about standards of hygiene. The type of barrier identified differed between ethnic groups, though mistrust of dentists was common to all groups. Conclusions The findings confirm previous research identifying barriers to the use of dental services. However, for the first time in the United Kingdom, it has been suggested that the nature of the perceived barriers varies across ethnic groups. These findings have implications for attempts to increase use of dental services among individuals from minority ethnic communities.

Analysing Health Policy: A Sociological Approach

Introduction 1. Health Policy and Sociology 2. Public Health and Health Promotion 3. Equity in Health and Health Care 4. Primary Care 5. Health Care Organisation 6. Researching Health Policy

The domestication of an everyday health technology: A case study of electric toothbrushes

Using the electric toothbrush as an example, this article examines the growing acceptability of domestic health technologies that blur the traditional boundaries between health, aesthetics and consumption. By using empirical material from individual and household interviews about people’s oral health practices, this research explores the relationships between an everyday artefact, its users and their environments. It investigates the ways in which oral health technologies do, or do not, become domesticated in the home environment. We conclude that the domestication of oral health technologies is not inevitable, with the electric toothbrush often becoming an ‘unstable object’ in the domestic setting.

Mental health impact of social capital interventions: a systematic review

PurposeMental disorders are a major contributor to the global burden of disease and disability, and can be extremely costly at both individual and community level. Social capital, (SC) defined as an individual’s social relationships and participation in community networks, may lower the risk of mental disorders while increasing resilience capacity, adaptation and recovery. SC interventions may be a cost-effective way of preventing and ameliorating these conditions. However, the impact of these SC interventions on mental health still needs research.MethodsWe conducted a systematic review of SC-based interventions to investigate their effect on mental health outcomes from controlled, quasi-experimental studies or pilot trials. We searched twelve academic databases, three clinical trials registries, hand-searched references and contacted field experts. Studies’ quality was assessed with the Cochrane Risk of Bias tools for randomized and non-randomized studies.ResultsSeven studies were included in the review, published between 2006 and 2016. There was substantial heterogeneity in the definitions of both SC and mental disorders among the studies, preventing us from calculating pooled effect sizes. The interventions included community engagement and educative programs, cognitive processing therapy and sociotherapy for trauma survivors, and neighbourhood projects.ConclusionsThere are paucity of SC interventions investigating the effect on mental health outcomes. This study showed that both SC scores and mental health outcomes improved over time but there was little evidence of benefit compared to control groups in the long term. Further high-quality trials are needed, especially among adverse populations to assess sustainability of effect.

A Qualitative Study of Participant Engagement With a Weight Loss Intervention.

Background. Overweight and obesity are major public health problems and an increasing global challenge. In lieu of wider policy changes to tackle the obesogenic environment in which we presently reside, improving the design of individual-level weight loss interventions is important. Aim. To identify which aspects of the Camden Weight Loss randomized controlled trial weight loss intervention participants engaged with, with the aim of improving the design of future studies and maximizing retention. Method. A qualitative study comprising semistructured interviews (n = 18) and a focus group (n = 5) with intervention participants. Results. Two important aspects of participant engagement with the intervention consistently emerged from interviews and focus group: the advisor–participant relationship and the program structure. Some materials used during the program sessions were important in supporting the intervention; however, others were not well received by participants. Conclusion. An individual-level weight loss intervention should be acceptable from the patient perspective in order to ensure participants are engaged with the program for as long as possible to maximize favorable results. Providing ongoing support in a long-term program with a trained empathetic advisor may be effective at engaging with people trying to lose weight in a weight loss intervention.