Sjc Taylor

The Olympic Regeneration in East London (ORiEL) study: protocol for a prospective controlled quasi-experiment to evaluate the impact of urban regeneration on young people and their families

Introduction Recent systematic reviews suggest that there is a dearth of evidence on the effectiveness of large-scale urban regeneration programmes in improving health and well-being and alleviating health inequalities. The development of the Olympic Park in Stratford for the London 2012 Olympic and Paralympic Games provides the opportunity to take advantage of a natural experiment to examine the impact of large-scale urban regeneration on the health and well-being of young people and their families. Design and methods A prospective school-based survey of adolescents (11–12 years) with parent data collected through face-to-face interviews at home. Adolescents will be recruited from six randomly selected schools in an area receiving large-scale urban regeneration (London Borough of Newham) and compared with adolescents in 18 schools in three comparison areas with no equivalent regeneration (London Boroughs of Tower Hamlets, Hackney and Barking & Dagenham). Baseline data will be completed prior to the start of the London Olympics (July 2012) with follow-up at 6 and 18 months postintervention. Primary outcomes are: pre–post change in adolescent and parent mental health and well-being, physical activity and parental employment status. Secondary outcomes include: pre–post change in social cohesion, smoking, alcohol use, diet and body mass index. The study will account for individual and environmental contextual effects in evaluating changes to identified outcomes. A nested longitudinal qualitative study will explore families’ experiences of regeneration in order to unpack the process by which regeneration impacts on health and well-being. Ethics and dissemination The study has approval from Queen Mary University of London Ethics Committee (QMREC2011/40), the Association of Directors of Childrens Services (RGE110927) and the London Boroughs Research Governance Framework (CERGF113). Fieldworkers have had advanced Criminal Records Bureau clearance. Findings will be disseminated through peer-reviewed publications, national and international conferences, through participating schools and the study website (http://www.orielproject.co.uk).

OP43 Changes in physical activity in East London’s adolescents following the 2012 Olympic Games: findings from the prospective Olympic Regeneration in East London (ORiEL) cohort study

Background The London 2012 Olympic Games aimed to “inspire a generation” by increasing participation in sport through ‘demonstration effects’ – where individuals’ motivations are influenced by observing the actions of others. Here we evaluate whether adolescents’ participation in Olympic-related sports increased post-games, and whether changes were mediated by level of engagement with the Olympic experience. Methods The Olympic Regeneration in East London (ORiEL) study is a longitudinal controlled quasi-experimental study of a sample of Year 7 adolescents from 25 schools in four East London boroughs. Respondents were surveyed 6 months pre-Games and were followed-up 6 months post-Games (n = 2727). Games engagement was assessed on a 10-point scale ranging from not excited (0) to very excited (10). The Youth Physical Activity Questionnaire (Y-PAQ) assessed participation in ten Olympic sports over the past seven days (cycling, basketball, football, gymnastics, hockey, martial arts, running, swimming, horse riding, racquet sports) transformed to a binary ‘ever/never’ response. Sedentary activities (computer gaming, online browsing, TV viewing) were analysed by duration. Random effects logistic regression estimated the odds of participation in Olympic sports post-Games compared to pre-Games. Changes in the duration of sedentary activities were estimated with random effects linear regression. The effect of engagement was assessed by stepwise inclusion to the model along with confounding variables. Results Overall there was a statistically significant decline in the odds of participating in eight of the ten Olympic sports post-Games controlling for co-variates. The largest decreases were observed for swimming (OR: 0.51 [0.40, 0.64]), gymnastics (0.61 [0.45, 0.81]) and racquet sports (0.65 [0.51, 0.83]. There were no significant differences in pre-post participation in cycling and running. There was a significant increase in the duration per week spent online (p < 0.01), with no significant differences for time spent gaming/watching television. However individuals who were most excited by the prospect of the Olympics pre-games were more likely than the least excited to participate in nine of the ten sports post-games compared to pre-games, though this was only significant for basketball, football, racquet sports and running. Time spent online decreased significantly in the engaged group (p < 0.01). Conclusion Adolescents who were positively engaged with the London 2012 Olympic Games reported a higher frequency of physical activity and less sedentary time spent online than those less engaged. Sporting mega-event demonstration effects are unlikely to motivate population-level increases in sporting participation unless engagement strategies can excite the interest of a greater proportion of young people.

S111 Understanding reasons for patient attendance and non-attendance in pulmonary rehabilitation and COPD self-management programmes. A qualitative synthesis and application of theory

Introduction and Objectives Reviews have suggested that demographic and clinical factors are insufficient to understand poor attendance at interventions that promote self-management. An adapted version of the Attitude-Social Influence-Self-efficacy (ASE) health behaviour model has been used previously to explain participation in asthma self-management (Lemaigre, 2005). In this model, ‘attitude’ refers to the sum of positive and negative beliefs and evaluation of the behaviour; ‘social influence’ refers to the perceived social pressure an individual may feel to perform a particular behaviour; and ‘external barriers’ are structural or physical barriers. A systematic review of qualitative studies looking at factors influencing attendance, non-attendance and non-completion in pulmonary rehabilitation (PR) and self-management (SM) programmes amongst patients with chronic obstructive pulmonary disease (COPD) was conducted, and we examined if the adapted ASE model might explain participation behaviour. Methods We searched eight electronic databases including MEDLINE (1984–2011). Thematic framework synthesis identified emergent themes and sub-themes which were then mapped, where applicable, onto each construct of the adapted ASE model. Results Six studies were identified, PR (n=5), SM (n=1). Three main themes, ‘reasons for attending’, ‘reasons for not attending’ and ‘reasons for dropping out’ and 33 sub-themes (including psychological, social themes and practical barriers) emerged following data synthesis. Participants’ reasons for attending mainly related to improving health or increasing sense of control, whilst reasons for not attending were commonly structural barriers perceived as difficult to overcome. Advice from health care professionals on whether the programme may or may not be beneficial was influential on attendance. Drop out was commonly explained by not seeing improvement in health. Overall the subthemes identified under ‘reasons for attending’ and ‘reasons for dropping out’ commonly mapped onto the ‘attitude’ construct of the adapted ASE model (see Figure) whilst subthemes identified under ‘reasons for not attending’ more commonly mapped onto the ‘external barriers’ construct. Abstract S111 Figure 1 Figure Example of a few mapped subthemes onto constructs of the adapted ASE model that explain ‘Reasons for attending’ Conclusion Patients attitudes and structural barriers are important in explaining participation behaviour in PR and SM interventions and hence theory based interventions directed at these have potential to improve COPD outcomes.

OP77 Proxy Reporting of Health-Related Quality of Life using the Euroqol-5D in Care Home Residents; how Good is it and how should we Deal with Clustering Effects?

Background Some care home residents are unable to complete the measures of health utility needed for cost-utility analyses. Proxy measures are an alternative source of data; however, the level of agreement in the EQ-5D between residents and care home staff and the impact of clustering on this agreement has not been investigated previously. Using data nested in a large clinical trial, we aimed to (1) identify inter-rater agreement levels for the reporting of EQ-5D by care home residents and carers, (2) investigate whether proxies have a greater tendency to choose ‘some problems’ at the domain level and (3) investigate factors influencing agreement. Methods Kappa statistics were used to examine the level of agreement between proxy and self-completed responses at the domain level and intraclass correlation coefficients (ICCs) were used for EQ-5D index scores, visual analogue scales and total quality-adjusted life-years (QALYs). Importantly, the calculation of the Kappa and ICC relies on the assumption of independence of the observations, so the impact that clustering might have upon our results was also examined. The percentage of residents and proxies choosing each level of each domain was compared to examine whether responders have a consistent preference for one of the levels. Finally, a mixed model was used to consider the extent to which the difference in EQ-5D-S and EQ-5D-P was affected by other variables at baseline. Results We found slight to fair agreement at the domain level (cluster-adjusted Kappa 0.02–0.30) and fair agreement at the score level (cluster-adjusted ICC 0.30–0.32) and for QALYs (cluster-adjusted ICC 0.38). Proxies had a greater tendency to use the ‘some problems’ compared to self-report. The random effect mixed model showed that a higher GDS-15 (and likelihood of depression) and lower MMSE score (and lower cognitive impairment) were both associated with greater discrepancy between proxy and self-completed scores. Conclusion Proxies appear to be a reliable source of data for QALY scores but may be less reliable if individual domains are considered. As expected, the presence of more severe depression or cognitive impairment in residents reduced their agreement with proxy scores. The frequent reporting of ‘some problems’ by proxies suggests that a 4-level measure would counter this tendency to choose the ‘middle’ option.