Rachael Dixey

WATCH IT: Obesity management for children: A qualitative exploration of the views of parents

Abstract Childhood obesity has become a major concern of public health over the last decade. Obesity prevention programmes show limited success and the evidence base is weak. Experience with school-based obesity prevention research in Leeds highlighted the felt needs of children who were already obese, and a project was set up to attempt to meet those needs. WATCH IT has been running since 2003 and has involved 94 children. The quantitative data has been reported elsewhere, and this paper presents qualitative data from focus groups and interviews with participating children and their parents. These data show that WATCH IT has been successful in recruiting and retaining children, that children enjoy attending, and that it meets their emotional needs. Parents and children reported reduced self-harm, depression and better results at school for their children. The data also illustrate the effect of obesity on the family and that parents have a range of emotional and practical needs, which are partly being met by the programme. There needs to be a more systematic attempt to evaluate projects such as WATCH IT so that this can be added to the existing patchy evidence base. The data point to the importance of whole-family approaches.

“Ha ha, you’re fat, we’re strong”; a qualitative study of boys’ and girls’ perceptions of fatness, thinness, social pressures and health using focus groups

Presents results of focus group discussions held with 300 nine‐to‐11‐year old UK children. Questions were asked about whether it matters if someone is fat or thin; whether a fat child should take any action; what problems they might have; and the relationship between fatness, thinness and health. Considerable complexity emerged; children divided fat children into those for whom it was natural and those for whom it was self‐inflicted. They showed a great deal of sympathy for “naturally” fat children. However, they also felt that fat children would be bullied. Girls seemed less able than boys to resist the pressures to be thin, but also showed considerable ability to distance themselves from media images of thin women. Although children had learned the orthodoxy surrounding health, fat and overweight, they did not believe that “thin is good, fat is bad” and did not tend to link weight control with exercise.

Gender perspectives on food and cooking skills

Attempts to draw together some of the key themes which those attempting to promote food and cooking skills need to consider, with particular emphasis on issues affected by gender. Raises concerns about the construction of “eating disorders”, of diet and weight concerns among women, and of how food is managed in the household. Refers to some of the feminist literature in order to help to explain these patterns. Discusses how to tackle problems with food and eating in a preventive way in schools.

A systematic review of the effectiveness and cost-effectiveness of peer education and peer support in prisons

BackgroundPrisoners experience significantly worse health than the general population. This review examines the effectiveness and cost-effectiveness of peer interventions in prison settings.MethodsA mixed methods systematic review of effectiveness and cost-effectiveness studies, including qualitative and quantitative synthesis was conducted. In addition to grey literature identified and searches of websites, nineteen electronic databases were searched from 1985 to 2012.Study selection criteria were:Population: Prisoners resident in adult prisons and children resident in Young Offender Institutions (YOIs).Intervention: Peer-based interventions.Comparators: Review questions 3 and 4 compared peer and professionally led approaches.Outcomes: Prisoner health or determinants of health; organisational/process outcomes; views of prison populations.Study designs: Quantitative, qualitative and mixed method evaluations.ResultsFifty-seven studies were included in the effectiveness review and one study in the cost-effectiveness review; most were of poor methodological quality. Evidence suggested that peer education interventions are effective at reducing risky behaviours, and that peer support services are acceptable within the prison environment and have a positive effect on recipients, practically or emotionally. Consistent evidence from many, predominantly qualitative, studies, suggested that being a peer deliverer was associated with positive effects. There was little evidence on cost-effectiveness of peer-based interventions.ConclusionsThere is consistent evidence from a large number of studies that being a peer worker is associated with positive health; peer support services are also an acceptable source of help within the prison environment and can have a positive effect on recipients. Research into cost-effectiveness is sparse.Systematic review registrationPROSPERO ref: CRD42012002349.

Healthy Eating in Schools, Overweight and ‘Eating Disorders’: are they connected?

Abstract This paper raises questions about the increase in ‘eating disorders’ and the widespread preoccupation with diet and weight among girls in both primary and secondary schools. Obesity and overweight are also on the increase (in adults and children) and are seen as priorities to be tackled by health promotion. Empirical research is required to investigate the effects of educational messages aimed at children about fat in the diet and healthy eating, and their possible implication in the increase in both overweight and in pre‐occupation with body size. Is health education actually part of the problem, making girls more conscious of their weight? The paper reviews some of the relevant literature and also suggests practices in schools which may help or hinder true ‘healthy eating’ and healthy perceptions of self. Whilst teachers should not be expected to tackle clinical cases of ‘eating disorders’, there is much that can be achieved in schools to promote childrens self‐esteem and positive body image, ...

Casualty reduction or danger reduction: conflicting approaches or means to achieve the same ends?

Casualty reduction versus danger reduction : Conflicting approaches or means to achieve the same ends?

Prisoners’ perspectives on the transition from the prison to the community: implications for settings-based health promotion

Through qualitative exploration with soon-to-be released men in three prisons in England, this article examines the difficulties that prisoners envisage on returning back to community settings, entering other settings such as workplaces, and the implications the transition may have for their health. Interviews and focus groups were conducted with 36 prisoners, some of whom were convicted of sexual offences and based on a vulnerable prisoner unit. While not all prisoners offered the information, approximately two-thirds of the sample had offended previously. The transition that individuals make from the prison setting to the community can be potentially complex and often detrimental to health. Accommodation issues were forecast as a major concern for those men without family ties. Temporarily residing with friends or living in hostel residences were viable options for many prisoners, but both had drawbacks which could increase the probability of engaging in substance misuse. Resettlement issues were perceived to be more difficult for sex-offenders; their ‘identity’ provided an additional burden which created further reintegration difficulties. Employment opportunities, for example, were predicted to be drastically reduced as the men had signed the sex-offenders’ register. This article suggests that opportunities for successful transition could be enhanced by a more ‘joined-up’ settings perspective and proposes that a settings-based approach to health promotion, which emphasises the synergy between social settings and addressing wider determinants of health, should be applied to prisons to reduce, rather than exacerbate, inequalities.

Socio-cultural factors surrounding mental distress during the perinatal period in Zambia: a qualitative investigation

BackgroundThe presence of mental distress during pregnancy and after childbirth imposes detrimental developmental and health consequences for families in all nations. In Zambia, the Ministry of Health (MoH) has proposed a more comprehensive approach towards mental health care, recognizing the importance of the mental health of women during the perinatal period.AimThe study explores factors contributing to mental distress during the perinatal period of motherhood in Zambia.MethodsA qualitative study was conducted in Lusaka, Zambia with nineteen focus groups comprising 149 women and men from primary health facilities and schools respectively.FindingsThere are high levels of mental distress in four domains: worry about HIV status and testing; uncertainty about survival from childbirth; lack of social support; and vulnerability/oppression.ConclusionIdentifying mental distress and prompt referral for interventions is critical to improving the mental health of the mother and prevent the effects of mental distress on the baby.RecommendationStrategies should be put in place to ensure pregnant women are screened for possible perinatal mental health problems during their visit to antenatal clinic and referral made to qualified mental health professionals. In addition further research is recommended in order to facilitate evidence based mental health policy formulation and implementation in Zambia.

Moving prison health promotion along: towards an integrative framework for action to develop health promotion and tackle the social determinants of health

The majority of prisoners are drawn from deprived circumstances with a range of health and social needs. The current focus within ‘prison health’ does not, and cannot, given its predominant medical model, adequately address the current health and well-being needs of offenders. Adopting a social model of health is more likely to address the wide range of health issues faced by offenders and thus lead to better rehabilitation outcomes. At the same time, broader action at governmental level is required to address the social determinants of health (poverty, unemployment and educational attainment) that marginalise populations and increase the likelihood of criminal activities. Within prison, there is more that can be done to promote prisoners’ health if a move away from a solely curative, medical model is facilitated, towards a preventive perspective designed to promote positive health. Here, we use the Ottawa Charter for health promotion to frame public health and health promotion within prisons and to set out a challenging agenda that would make health a priority for everyone, not just ‘health’ staff, within the prison setting. A series of outcomes under each of the five action areas of the Charter offers a plan of action, showing how each can improve health. We also go further than the Ottawa Charter, to comment on how the values of emancipatory health promotion need to permeate prison health discourse, along with the concept of salutogenesis.

After Nairobi: can the international community help to develop health promotion in Africa?

The Nairobi Conference presaged a surge of interest in the development of health promotion in sub-Saharan Africa. A number of Africans have asserted that health promotion is underdeveloped in the continent, with the principles of the Ottawa Charter not widely adopted. This paper does not presume to say how health promotion could be developed in Africa, as that is for Africans to decide for themselves. Rather, it debates some issues which the international epistemic health promotion community could address in order to work in solidarity with African colleagues in taking forward the health promotion agenda in their continent. These issues include the Eurocentric nature of health promotion discourse, the different disease burden of Africa and the lack of training capacity in African universities.