Sarah Cotterill

Mobilizing citizen effort to enhance environmental outcomes: A randomized controlled trial of a door-to-door recycling campaign

This paper uses a randomized controlled trial to test whether doorstep canvassing can raise participation in kerbside recycling. Existing research shows that canvassing can confront negative attitudes, increase understanding and resolve structural obstacles, but there is less known about the longitudinal effects of such interventions, which may fall away over time. 194 streets in Trafford, in the North West of England, UK were randomly assigned into a treatment and a control group. All households in the treatment group were visited by canvassers who were trained to promote and encourage recycling. Recycling participation rates for all households were measured by observing bin set out rates over a three-week period. Measurement was done before and after the canvassing campaign and then again three months later to see if the intervention had been effective in raising participation rates. Random-effects multilevel regression models, controlling for baseline recycling, street size, deprivation and size of ethnic minority population, show that the canvassing raised recycling participation rates for the treatment group compared to the control group, but there was a decline in the impact of the intervention over time. The intervention was more effective on streets with low levels of recycling at baseline.

The Use of Feedback to Enhance Environmental Outcomes: A Randomized Controlled Trial of a Food Waste Scheme

Food waste makes up about 20% of general waste that goes to the landfill every year in the UK. Encouraging the public to engage in food waste recycling and separating more food from general waste could help local governments promote a better environment. Appeals to collective norms, by giving people feedback on their streets food waste recycling rate compared with others, could promote recycling. To test this, we carried out a randomised controlled trial in Oldham, Greater Manchester. We randomly assigned 318 streets to a treatment and control group. Households in the treatment group were sent two postcards that provided feedback on how their street performed on food waste recycling compared with the average for their neighbourhood. Participation in the food waste scheme was measured for all households on three occasions: at baseline, and after the receipt of the first- and second-feedback cards. We estimated the effect of our treatment using cross-classified multilevel logistic regression models, controlling for baseline, street size and the interaction of treatment and baseline. We show that feedback had a positive effect on the food waste participation with an effect size of 2.8% compared with a control group that received no treatment.

G16 The Paediatric Observation Priority Score (POPS): a more accurate predictor of admission risk from the Emergency Department than the Manchester Children’s Early Warning System (ManChEWS)

Background The Paediatric Observation Priority Score (POPS) is a specific Emergency Department (ED) physiological and observational aggregate scoring system, with scores of 0–18. A higher score indicates greater likelihood of admission. The Manchester Children’s Early Warning System (ManChEWS) assesses six physiological observations to create a trigger score, classified as Green, Amber or Red. Methods Prospectively collected data were used to calculate POPS and ManChEWS on 2068 patients aged under 16 (mean 5.6 years, SD 4.6) presenting over one month to a UK District General Hospital Paediatric ED. Logistic regression and ROC comparison, using STATA 11, were used to investigate the ability of ManChEWS and POPS to predict admission to hospital within 72 h of presentation to the ED. Results Comparison of the area under the Receiver Operating Characteristics (ROC) curve indicates that the ManChEWS ROC is 0.67 (95% CI 0.65 to 0.70), SE 0.02, and the POPS ROC is 0.72 (95% CI 0.69 to 0.75), SE 0.02. The difference is statistically significant (p < 0.01). At a POPS cut-off of ≥2, 80% of patients had their admission risk correctly classified (Positive Predictive Value (PPV) of POPS 2, 38.94%) whereas for ManChEWS with a cut off of ≥Amber only 71% of patients were correctly classified (PPV of ManChEWS Amber, 29.06%). Conclusions POPS is a more accurate predictor of admission risk from the ED than ManChEWS and is more suitable to use in an ED setting. Replacing ManChEWS with POPS would appear to be clinically appropriate in a Paediatric ED and multi-centre validation of this proposal would be helpful.

Behaviour change among people with impaired glucose tolerance: Comparison of telephone-based and face-to-face advice.

Objectives To develop, implement and compare two lifestyle services for people at risk of developing type 2 diabetes. Methods Two localities were selected to implement two different service delivery models, telephone-based and face-to-face, supporting people at risk of developing type 2 diabetes. Impact was assessed by comparing weight, fasting plasma glucose and oral glucose tolerance test (OGTT) results at baseline and six months later. Results Both services were associated with an improvement in OGTT 2-h plasma glucose and weight. In the telephone intervention, 47.3% of participants who completed the project achieved both normal fasting plasma glucose (≤6.0 mmol/l) and normal plasma glucose levels (≤7.7 mmol/l). Participants had a mean weight loss of 3.3 kg (SD 4.3), equating to 3.4% of body weight (p < 0.001). In the face-to-face intervention, 46.3% of participants achieved normal plasma glucose (≤7.7 mmol/l) and a mean weight loss of 2.9 kg (SD 4.5), equating to 3.1% of bodyweight (p < 0.001). Conclusions Local health providers can adapt existing service provision and tailor it to provide lifestyle programmes for people with impaired glucose tolerance. Both service delivery models offer effective diabetes prevention although each model may cater for different population needs and a choice of services might be the preferred option.

THE PAEDIATRIC OBSERVATION PRIORITY SCORE (POPS): A USEFUL TOOL TO PREDICT LIKELIHOOD OF ADMISSION FROM THE EMERGENCY DEPARTMENT

Objectives & Background No specific early warning score universally validated for use in all children presenting to the Emergency Department (ED) exists. POPS is a novel aggregate scoring system, designed for ED use. Methods Prospectively collected physiological and observational data were used to calculate POPS on 2068 patients aged under 16 presenting over one month to a UK District General Hospital Paediatric ED. Logistic regression was used to investigate the effect of POPS at first presentation on admission to hospital within the subsequent 72 hours. Results 46% of patients were diagnosed with trauma and 54% with a medical condition. Mean age was 5.6 years (SD 4.6). 15.3% were admitted on first presentation. 76 re-presented within 72 hours of discharge from the ED and 19.7% were admitted. The mean POPS on first presentation was 0.87 (SD 1.58) overall (medical patients 1.03 (SD 1.70), trauma patients 0.68 (SD 1.41), p<0.001). POPS had a statistically significant positive effect on admission. A one point increase in POPS was associated with a 70% increase in the odds ratio (OR) of admission (p<0.001), with an area under the ROC of 0.72 (medical patients OR 1.67, area under ROC 0.73, p<0.001; trauma patients OR 1.77, area under ROC 0.69, p<0.001). The sensitivity and specificity of POPS to predict admission likelihood were: POPS≥2 (sensitivity 50%, specificity 85%), POPS≥3 (sensitivity 36%, specificity 93%). Conclusion POPS is a useful tool to predict the admission likelihood from the ED. POPS≥2 correctly predicts 50% of children who should be admitted and 85% of children who should be discharged. Multi-centre validation would help to refine POPS, increasing its sensitivity and specificity to admission likelihood, to improve the safety of discharge decisions and healthcare resource utilisation.

Expanding the Use of Experiments on Civic Behavior: Experiments with Local Government as a Research Partner:

Despite the acknowledged benefits of experimental methods and growing policy and academic interest in evidence-based policy, few researchers have attempted to undertake experiments at a local level in cooperation with policymakers and public service providers. This paper discusses the challenges of implementing and delivering experiments in these contexts, drawing on four successfully completed experiments and two current experiments and referring to four proposed experiments that did not take place. The completed and ongoing experiments investigated canvassing to increase household recycling, Internet deliberation to change civic attitudes, education to change children’s environmental attitudes, community support to improve quality of life for drug users, citizen pledging to donate to charity, and letter writing to influence the response of councilors to citizen interest groups. The paper concludes by assessing the benefits of co-produced field experiments against the challenges and argues that, overall, co-production has the potential to expand the scope, range, and depth of possible experiments; improve access to citizens and to data; and lead to research that is more credible to policymakers.

Getting messier with TIDieR: embracing context and complexity in intervention reporting

BackgroundThe Template for Intervention Description and Replication (TIDieR) checklist and guide was developed by an international team of experts to promote full and accurate description of trial interventions. It is now widely used in health research. The aim of this paper is to describe the experience of using TIDieR outside of trials, in a range of applied health research contexts, and make recommendations on its usefulness in such settings.Main bodyWe used the TIDieR template for intervention description in six applied health research projects. The six cases comprise a diverse sample in terms of clinical problems, population, settings, stage of intervention development and whether the intervention was led by researchers or the service deliverers. There was also variation in how the TIDieR description was produced in terms of contributors and time point in the project. Researchers involved in the six cases met in two workshops to identify issues and themes arising from their experience of using TIDieR.We identified four themes which capture the difficulties or complexities of using TIDieR in applied health research: (i) fidelity and adaptation: all aspects of an intervention can change over time; (ii) voice: the importance of clarity on whose voice the TIDieR description represents; (iii) communication beyond the immediate context: the usefulness of TIDieR for wider dissemination and sharing; (iv) the use of TIDieR as a research tool.ConclusionWe found TIDieR to be a useful tool for applied research outside the context of clinical trials and we suggest four revisions or additions to the original TIDieR which would enable it to better capture these complexities in applied health research:An additional item, ‘voice’ conveys who was involved in preparing the TIDieR template, such as researchers, service users or service deliverers.An additional item, ‘stage of implementation’ conveys what stage the intervention has reached, using a continuum of implementation research suggested by the World Health Organisation.A new column, ‘modification’ reminds authors to describe modifications to any item in the checklist.An extension of the ‘how well’ item encourages researchers to describe how contextual factors affected intervention delivery.

Prioritising prevention: Implementation of IGT Care Call, a telephone based service for people at risk of developing type 2 diabetes

AIM To design, deliver and evaluate IGT Care Call, a telephone service providing a 6 month lifestyle education programme for people with impaired glucose tolerance (IGT). METHODS An observational study of IGT Care Call, a programme providing motivational support and education using electronic scripts. The service was delivered to 55 participants, all of whom completed the course (an information pack and at least five telephone calls over 6 months). Clinical measurements were undertaken in General Practice at baseline, on completion of the programme and one year later. RESULTS Among the 40 participants for whom we have complete data available, one year after discharge, participants showed improvements in fasting plasma glucose (0.29 mmol/l, 95% CI 0.07 to 0.51), weight (2.81 kg, 95% CI 1.20 to 4.42) and BMI (1.06 kg/m(2), 95% CI 0.49 to 1.63). All differences were statistically significant (p < 0.01). CONCLUSION Whilst an uncontrolled observational study with a small sample size, this pilot suggests IGT Care Call may be effective in promoting positive and sustained lifestyle changes to prevent type 2 diabetes, which warrants further investigation. A telephone method of service delivery was acceptable, convenient and may have improved self confidence in how to reduce risk of type 2 diabetes.

Diagnostic accuracy of PAT-POPS and ManChEWS for admissions of children from the emergency department.

Background The Pennine Acute Trust (PAT) Paediatric Observation Priority Score (PAT-POPS) is a specific emergency department (ED) physiological and observational aggregate scoring system, with scores of 0–18. A higher score indicates greater likelihood of admission. The Manchester Childrens Early Warning System (ManChEWS) assesses six physiological observations to create a trigger score, classified as Green, Amber or Red. Methods Prospectively collected data were used to calculate PAT-POPS and ManChEWS on 2068 patients aged under 16 years (mean 5.6 years, SD 4.6) presenting over 1 month to a UK District General Hospital Paediatric ED. Receiver operating characteristics (ROC) comparison, using STATA V.13, was used to investigate the ability of ManChEWS and PAT-POPS to predict admission to hospital within 72 h of presentation to the ED. Results Comparison of the area under the ROC curve indicates that the ManChEWS ROC is 0.67 (95% CI 0.64 to 0.70) and the PAT-POPS ROC is 0.72 (95% CI 0.68 to 0.75). The difference is statistically significant. At a PAT-POPS cut-off of ≥2, 80% of patients had their admission risk correctly classified (positive likelihood ratio 3.40, 95% CI 2.90 to 3.98) whereas for ManChEWS with a cut off of ≥Amber only 71% of patients were correctly classified (positive likelihood ratio 2.18, 95% CI 1.94 to 2.45). Conclusions PAT-POPS is a more accurate predictor of admission risk than ManChEWS. Replacing ManChEWS with PAT-POPS would appear to be clinically appropriate in a paediatric ED. This needs validation in a multicentre study.

Responsible Citizens and Accountable Service Providers? Renegotiating The Contract Between Citizen and State

New forms of governance, conditional approaches to public service access, and initiatives to engage citizens in taking on new responsibilities are being developed in the context of the scaling down of the welfare state. We examine the extent to which collaboration and multidirectional accountability can be developed between the state and citizens, with a focus on a case study of Community Contracts in England. These quasi-legal agreements, operationalised at the local level, involve citizens and service providers cooperating in tackling social problems through agreed responsibilities and behaviour. Findings from interviews and focus group research suggest that Community Contracts represent an innovation in governance. Citizens are given a voice and there are new pathways for effective service delivery and accountability; conditionality applies to citizens and service providers. However, although there was evidence of increased service accountability, the impact on civic responsibility and conditionality beyond already active citizens and beyond certain issues was less apparent. Although citizens and service providers were ready to take on new roles, the legal status of the contract was only loosely defined. Challenges remain concerning how contract-based approaches can be fully realised in practice.