scholarly journals NHS Health Check programme: a protocol for a realist review

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e048937
Author(s):  
Claire Duddy ◽  
Geoff Wong ◽  
E W Gadsby ◽  
Janet Krska ◽  
Vivienne Hibberd
Keyword(s):  
Public Health ◽  
Adult Population ◽  
Realist Review ◽  
Health Check ◽  
Design Strategies ◽  
Cvd Risk ◽  
Increased Risk ◽  
Ethical Approval ◽  
Registration Number ◽  
Nhs Health Check

IntroductionThe NHS Health Check aims to identify individuals at increased risk of cardiovascular diseases (CVDs) among the adult population in England. The Health Check includes calculation of CVD risk and discussion of pharmacological and lifestyle approaches to manage risk, including referral to lifestyle support services. The programme is commissioned by Local Authorities (LAs) and is delivered by a range of different providers in different settings. There is significant variation in activity, with uptake ranging from 25% to 85% in different areas, and clear evidence of variation in implementation and delivery practice.Methods and analysisWe aim to understand how the NHS Health Check programme works in different settings, for different groups, so that we can recommend improvements to maximise intended outcomes. To do so, we will undertake a realist review and a survey of LA public health teams. Our review will follow Pawson’s five iterative stages: (1) locate existing theories, (2) search for evidence, (3) article selection, (4) extract and organise data and (5) synthesise evidence and draw conclusions. Our review will include documents describing local implementation alongside published research studies. We will recruit a stakeholder group (including Public Health England, commissioners and providers of Health Checks, plus members of the public and patients) to advise us throughout. Our survey will be sent to all 152 LAs in England to gather detailed information on programme delivery (including COVID-19-related changes) and available referral services. This will enable us to map delivery across England and relate these data to programme outcomes.Ethics and disseminationEthical approval is not required for this review. For the survey, we have received approval from the University of Kent Research Ethics Committee. Our findings will be used to develop recommendations on tailoring, implementation and design strategies to improve delivery of the NHS Health Check in different settings, for different groups.PROSPERO registration numberCRD42020163822.

scholarly journals Understanding how and why audits work: protocol for a realist review of audit programmes to improve hospital care

BMJ Open ◽  
2017 ◽  
Vol 7 (6) ◽  
pp. e015121 ◽  
Author(s):  
Lisanne Hut-Mossel ◽  
Gera Welker ◽  
Kees Ahaus ◽  
Rijk Gans
Keyword(s):  
Hospital Care ◽  
Evidence Synthesis ◽  
Realist Review ◽  
Local Context ◽  
Quality Improvements ◽  
Programme Theory ◽  
Meta Review ◽  
Ethical Approval ◽  
Registration Number ◽  
Improve Hospital

IntroductionMany types of audits are commonly used in hospital care to promote quality improvements. However, the evidence on the effectiveness of audits is mixed. The objectives of this proposed realist review are (1) to understand how and why audits might, or might not, work in terms of delivering the intended outcome of improved quality of hospital care and (2) to examine under what circumstances audits could potentially be effective. This protocol will provide the rationale for using a realist review approach and outline the method.Methods and analysisThis review will be conducted using an iterative four-stage approach. The first and second steps have already been executed. The first step was to develop an initial programme theory based on the literature that explains how audits are supposed to work. Second, a systematic literature search was conducted using relevant databases. Third, data will be extracted and coded for concepts relating to context, outcomes and their interrelatedness. Finally, the data will be synthesised in a five-step process: (1) organising the extracted data into evidence tables, (2) theming, (3) formulating chains of inference from the identified themes, (4) linking the chains of inference and formulating CMO configurations and (5) refining the initial programme theory. The reporting of the review will follow the ‘Realist and Meta-Review Evidence Synthesis: Evolving Standards’ (RAMESES) publication standards.Ethics and disseminationThis review does not require formal ethical approval. A better understanding of how and why these audits work, and how context impacts their effectiveness, will inform stakeholders in deciding how to tailor and implement audits within their local context. We will use a range of dissemination strategies to ensure that findings from this realist review are broadly disseminated to academic and non-academic audiences.PROSPERO registration numberCRD42016039882.

scholarly journals Public attitudes to, and behaviours taken during, hot weather by vulnerable groups: results from a national survey in England

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bob Erens ◽  
Lorraine Williams ◽  
Josephine Exley ◽  
Stefanie Ettelt ◽  
Tommaso Manacorda ◽  
...  
Keyword(s):  
Public Health ◽  
Adult Population ◽  
Group Discussion ◽  
Ultra Violet ◽  
Vulnerable Groups ◽  
Protective Measures ◽  
Increased Risk ◽  
Level 3 ◽  
Hot Weather ◽  
Vulnerable Adults

Abstract Background Hot weather leads to increased illness and deaths. The Heatwave Plan for England (HWP) aims to protect the population by raising awareness of the dangers of hot weather, especially for those most vulnerable. Individuals at increased risk to the effects of heat include older adults, particularly 75+, and those with specific chronic conditions, such as diabetes, respiratory and heart conditions. The HWP recommends specific protective actions which relate to five heat-health alert levels (levels 0–4). This study examines the attitudes to hot weather of adults in England, and the protective measures taken during a heatwave. Methods As part of a wider evaluation of the implementation and effects of the HWP, a survey (n = 3153) and focus groups, a form of group interview facilitated by a researcher, were carried out after the June 2017 level 3 heat-health alert. Survey respondents were categorised into three groups based on their age and health status: ‘vulnerable’ (aged 75+), ‘potentially vulnerable’ (aged 18–74 in poor health) and ‘not vulnerable’ (rest of the adult population) to hot weather. Multivariable logistic regression models identified factors associated with these groups taking protective measures. In-person group discussion, focused on heat-health, were carried out with 25 people, mostly aged 75 + . Results Most vulnerable and potentially vulnerable adults do not consider themselves at risk of hot weather and are unaware of the effectiveness of important protective behaviours. Only one-quarter of (potentially) vulnerable adults reported changing their behaviour as a result of hearing hot weather-related health advice during the level 3 alert period. Focus group findings showed many vulnerable adults were more concerned about the effects of the sun’s ultra-violet radiation on the skin than on the effects of hot temperatures on health. Conclusions Current public health messages appear to be insufficient, given the low level of (potentially) vulnerable adults changing their behaviour during hot weather. In the context of increasingly warmer summers in England due to climate change, public health messaging needs to convince (potentially) vulnerable adults of all the risks of hot weather (not just effects of sunlight on the skin) and of the importance of heat protective measures.

scholarly journals A qualitative exploration of two risk calculators using video-recorded NHS health check consultations

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Victoria Riley ◽  
Naomi J. Ellis ◽  
Lisa Cowap ◽  
Sarah Grogan ◽  
Elizabeth Cottrell ◽  
...  
Keyword(s):  
Risk Communication ◽  
Health Check ◽  
Risk Calculator ◽  
Cvd Risk ◽  
Missed Opportunities ◽  
Coping Responses ◽  
Practitioner Training ◽  
The Uk ◽  
And Coping ◽  
Nhs Health Check

Abstract Background The aim of the study was to explore practitioner-patient interactions and patient responses when using QRISK®2 or JBS3 cardiovascular disease (CVD) risk calculators. Data were from video-recorded NHS Health Check (NHSHC) consultations captured as part of the UK RIsk COmmunication (RICO) study; a qualitative study of video-recorded NHSHC consultations from 12 general practices in the West Midlands, UK. Participants were those eligible for NHSHC based on national criteria (40–74 years old, no existing diagnoses for cardiovascular-related conditions, not on statins), and practitioners, who delivered the NHSHC. Method NHSHCs were video-recorded. One hundred twenty-eight consultations were transcribed and analysed using deductive thematic analysis and coded using a template based around Protection Motivation Theory. Results Key themes used to frame the analysis were Cognitive Appraisal (Threat Appraisal, and Coping Appraisal), and Coping Modes (Adaptive, and Maladaptive). Analysis showed little evidence of CVD risk communication, particularly in consultations using QRISK®2. Practitioners often missed opportunities to check patient understanding and encourage risk- reducing behaviour, regardless of the risk calculator used resulting in practitioner verbal dominance. JBS3 appeared to better promote opportunities to initiate risk-factor discussion, and Heart Age and visual representation of risk were more easily understood and impactful than 10-year percentage risk. However, a lack of effective CVD risk discussion in both risk calculator groups increased the likelihood of a maladaptive coping response. Conclusions The analysis demonstrates the importance of effective, shared practitioner-patient discussion to enable adaptive coping responses to CVD risk information, and highlights a need for effective and evidence-based practitioner training. Trial registration ISRCTN ISRCTN10443908. Registered 7th February 2017.

scholarly journals Deconditioning in people living with dementia during the COVID-19 pandemic: qualitative study from the Promoting Activity, Independence and Stability in Early Dementia (PrAISED) process evaluation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Claudio Di Lorito ◽  
Tahir Masud ◽  
John Gladman ◽  
Maureen Godfrey ◽  
Marianne Dunlop ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Process Evaluation ◽  
Cognitive Abilities ◽  
Activity Levels ◽  
People With Dementia ◽  
Increased Risk ◽  
Early Dementia ◽  
Ethical Approval ◽  
Registration Number ◽  
Study Participants

Abstract Background Restrictions introduced in response to the COVID-19 pandemic led to increased risk of deconditioning in the general population. No empirical evidence of this effect however has been gathered in people living with dementia. This study aims to identify the causes and effects of COVID-19-related deconditioning in people living with dementia. Methods This is a longitudinal phenomenological qualitative study. Participants living with dementia, their caregivers and therapists involved in the Promoting Activity, Independence and Stability in Early Dementia (PrAISED) process evaluation during the COVID-19 pandemic were qualitatively interviewed at two time points: the baseline 2 months after the national lockdown was imposed in England (i.e., May 2020), the follow up 2 months after the first set (i.e. July 2020). The data were analysed through deductive thematic analysis. Results Twenty-four participants living with dementia, 19 caregivers and 15 therapists took part in the study. Two themes were identified: Causes of deconditioning in people living with dementia during the COVID-19 pandemic and effects of deconditioning in people living with dementia during the COVID-19 pandemic. A self-reinforcing pattern was common, whereby lockdown made the person apathetic, demotivated, socially disengaged, and frailer. This reduced activity levels, which in turn reinforced the effects of deconditioning over time. Without external supporters, most participants lacked the motivation / cognitive abilities to keep active. Provided the proper infrastructure and support, some participants could use tele-rehabilitation to combat deconditioning. Conclusion The added risks and effects of deconditioning on people with dementia require considerable efforts from policy makers and clinicians to ensure that they initiate and maintain physical activity in prolonged periods of social distancing. Delivering rehabilitation in the same way as before the pandemic might not be feasible or sustainable and innovative approaches must be found. Digital support for this population has shown promising results but remains a challenge. Trial registration The PrAISED trial and process evaluation have received ethical approval number 18/YH/0059 from the Bradford/Leeds Ethics Committee. The ISRCTN Registration Number for PrAISED is 15320670.

scholarly journals Cardiovascular disease risk communication in NHS health checks: video-stimulated recall interviews with practitioners

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0049
Author(s):  
Christopher J. Gidlow ◽  
Naomi Jane Ellis ◽  
Victoria Riley ◽  
Lisa Cowap ◽  
Diane Crone ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Risk Communication ◽  
Disease Risk ◽  
Health Check ◽  
Risk Calculator ◽  
Cvd Risk ◽  
Stimulated Recall ◽  
Practitioner Training ◽  
Nhs Health Check ◽  
Heart Age

BackgroundNHS Health Check (NHSHC) is a national programme to identify and manage cardiovascular disease (CVD) risk. Practitioners delivering the programme should be competent in discussing CVD risk, but there is evidence of limited understanding of the recommended 10 year/centage CVD risk scores. Lifetime CVD risk calculators might improve understanding and communication of risk.AimTo explore practitioner understanding, perceptions and experiences of CVD risk communication in NHSHCs when using two different CVD risk calculators.Design & settingQualitative video-stimulated recall (VSR) study with NHSHC practitioners.MethodVSR interviews were conducted with practitioners who delivered NHSHCs using either the QRISK2 10-year risk calculator (n=7) or JBS3 lifetime CVD risk calculator (n=8). Data were analysed using reflexive thematic analysis.ResultsFindings from analysis of VSR interviews with 15 practitioners (9 Healthcare Assistants, 6 General Practice Nurses) are presented by risk calculator. There was limited understanding and confidence of 10-year risk, which was used to guide clinical decisions through determining low/medium/high risk thresholds, rather than as a risk communication tool. Potential benefits of some JBS functions were evident, particularly heart age, risk manipulation and visual presentation of risk.ConclusionsThere is a gap between the expectation and reality of practitioners’ understanding, competencies and training in CVD risk communication for NHS Health Check. Practitioners would welcome heart age and risk manipulation functions of JBS3 to promote patient understanding of CVD risk, but there is a more fundamental need for practitioner training in CVD risk communication.

scholarly journals NHS Health Checks: Equity and outcomes 2009-17: An observational study

2021 ◽  
pp. BJGP.2020.1021
Author(s):  
John Robson ◽  
Cesar Garriga ◽  
Carol Coupland ◽  
Julia Hippisley-Cox
Keyword(s):  
Type 2 Diabetes ◽  
Ethnic Groups ◽  
South Asian ◽  
Cardiovascular Prevention ◽  
Health Check ◽  
Cvd Risk ◽  
Health Checks ◽  
Nhs Health Checks ◽  
Nhs Health Check

Background: The NHS Health Check cardiovascular prevention programme is now 10 years old. Aim: We describe NHS Heath Check attendance, new diagnoses and treatment in relation to equity indicators. Design and Setting: Using a national general practice database 2009-17, we compared NHS Health Check attendance and new diagnoses and treatments, by age, gender, ethnic group and deprivation. Results: In 2013-17, 590,218 eligible people age 40-74 years attended an NHS Health Check (16.9%) and 2,902,598 (83.1%) did not attend. South Asian ethnic groups were most likely to attend and women more than men. New diagnoses were more likely in attendees than non-attendees; hypertension 25/1000 attendees vs 9/1000 in non-attendees; type 2 diabetes 8/1000 vs 3/1000; chronic kidney disease 7/1000 vs 4/1000. In people aged 65 or older, new atrial fibrillation was diagnosed in 5/1000 attendees and 3/1000 non-attendees and for dementia 2/1000 versus 1/1000 respectively. Type 2 diabetes, hypertension and CKD were more likely in more deprived groups, South Asian and black African/Caribbean ethnic groups. Attendees were more likely to be prescribed statins, 26/1000, than non-attendees 8/1000; and anti-hypertensive medicines, 25/1000 vs 13/1000 non-attendees. However, of the 117,963 people with 10% or greater CVD risk eligible for statins only 9,785 (8.3%) were prescribed them. Conclusions: NHS Health Checks uptake remains low. Attendees were more likely than non-attendees to be diagnosed with type 2 diabetes, hypertension and CKD and receive treatment with statins and antihypertensives. Most attendees received neither treatment nor referral. Of those eligible for statins, fewer than 10% were treated.

scholarly journals Risk of infection associated with intravenous iron preparations: protocol for updating a systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e024618 ◽  
Author(s):  
Akshay Shah ◽  
Anita Sugavanam ◽  
Jack Reid ◽  
Antony J Palmer ◽  
Edward Dickson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Intravenous Iron ◽  
Cochrane Collaboration ◽  
Assessment Development ◽  
Evaluation Approach ◽  
Increased Risk ◽  
Ethical Approval ◽  
Registration Number ◽  
Randomised Controlled

IntroductionThe benefits and risk of intravenous iron have been documented in previous systematic reviews and continue to be the subject of randomised controlled trials (RCTs). An ongoing issue that continues to be raised is the relationship between administering iron and developing infection. This is supported by biological plausibility from animal models. We propose an update of a previously published systematic review and meta-analysis with the primary focus being infection.Methods and analysisWe will include RCTs and non-randomised studies (NRS) in this review update. We will search the relevant electronic databases. Two reviewers will independently extract data. Risk of bias for RCTs and NRS will be assessed using the relevant tools recommended by The Cochrane Collaboration. Data extracted from RCTs and NRS will be analysed and reported separately. Pooled data from RCTs will be analysed using a random effects model. We will also conduct subgroup analyses to identify any patient populations that may be at increased risk of developing infection. We will provide a narrative synthesis on the definitions, sources and responsible pathogens for infection in the included studies. Overall quality of evidence on the safety outcomes of mortality and infection will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach.Ethics and disseminationThis systematic review will only investigate published studies and therefore ethical approval is not required. The results will be broadly distributed through conference presentations and peer-reviewed publications.Trial registration numberPROSPERO (CRD42018096023).

scholarly journals Development of a questionnaire to evaluate patients’ awareness of cardiovascular disease risk in England’s National Health Service Health Check preventive cardiovascular programme

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e014413 ◽  
Author(s):  
Maria Woringer ◽  
Jessica Jones Nielsen ◽  
Lara Zibarras ◽  
Julie Evason ◽  
Angelos P Kassianos ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Health Service ◽  
Healthy Eating ◽  
Perceived Risk ◽  
Health Check ◽  
Risk Awareness ◽  
Cvd Risk ◽  
Item Questionnaire ◽  
Intention To Change ◽  
Nhs Health Check

BackgroundThe National Health Service (NHS) Health Check is a cardiovascular disease (CVD) risk assessment and management programme in England aiming to increase CVD risk awareness among people at increased risk of CVD. There is no tool to assess the effectiveness of the programme in communicating CVD risk to patients.AimsThe aim of this paper was to develop a questionnaire examining patients’ CVD risk awareness for use in health service research evaluations of the NHS Health Check programme.MethodsWe developed an 85-item questionnaire to determine patients’ views of their risk of CVD. The questionnaire was based on a review of the relevant literature. After review by an expert panel and focus group discussion, 22 items were dropped and 2 new items were added. The resulting 65-item questionnaire with satisfactory content validity (content validity indices≥0.80) and face validity was tested on 110 NHS Health Check attendees in primary care in a cross-sectional study between 21 May 2014 and 28 July 2014.ResultsFollowing analyses of data, we reduced the questionnaire from 65 to 26 items. The 26-item questionnaire constitutes four scales: Knowledge of CVD Risk and Prevention, Perceived Risk of Heart Attack/Stroke, Perceived Benefits and Intention to Change Behaviour and Healthy Eating Intentions. Perceived Risk (Cronbach’s α=0.85) and Perceived Benefits and Intention to Change Behaviour (Cronbach’s α=0.82) have satisfactory reliability (Cronbach’s α≥0.70). Healthy Eating Intentions (Cronbach’s α=0.56) is below minimum threshold for reliability but acceptable for a three-item scale.ConclusionsThe resulting questionnaire, with satisfactory reliability and validity, may be used in assessing patients’ awareness of CVD risk among NHS Health Check attendees.

scholarly journals Psychosocial impacts on the Christchurch Muslim community following the 15 March terrorist attacks: a mixed-methods study protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e055413
Author(s):  
Ruqayya C. Sulaiman-Hill ◽  
Richard Porter ◽  
Sandila Tanveer ◽  
Joseph Boden ◽  
Ben Beaglehole ◽  
...  
Keyword(s):  
New Zealand ◽  
Mental Disorders ◽  
Terrorist Attack ◽  
Diagnostic Interview ◽  
Self Report ◽  
Muslim Community ◽  
Target Sample Size ◽  
Increased Risk ◽  
Ethical Approval ◽  
Registration Number

IntroductionOn 15 March 2019, a white supremacist gunman opened fire in two mosques in Christchurch, New Zealand, during Friday prayers, killing 51 people and injuring 40. The event was witnessed by at least 250 survivors and also live streamed on social media, leading to widespread and repeated exposure within the community. It is expected that survivors, families and community members will be at increased risk of developing mental disorders due to the scale and violence of these attacks.This protocol describes the first phase of a proposed longitudinal study to screen and assess the long-term impacts of the terrorist attack on members of the Christchurch Muslim community, to determine clinical need and facilitate access to appropriate interventions and to gain insights into working with such a traumatised, ethnically diverse population. It has been developed in close collaboration with members of that community.Methods and analysisA mixed-method design is described, combining self-report measures with a clinician-administered diagnostic interview. Participants include Christchurch Muslims aged 18 years and over, with a target sample size of n=200. Analyses will determine prevalence of major mental disorders, while regression analyses will model the relationship between pre-event features, trauma exposure and mental disorders. A small number of participants, stratified by exposure type, will also take part in a qualitative interview in English. All study information and self-report measures are provided in translations based on the ethnolinguistic composition of the group and are available in paper and online versions.Ethics and disseminationEthical approval was granted by the New Zealand Health and Disability Ethics Committee 19/NTA/147. All participants provide informed consent, either written or online via REDCap software. The study is registered with the Australian New Zealand Clinical Trials Registry. Findings will be disseminated initially to the impacted community, then by publication in scientific journals, presentations and to government agencies.Trial registration numberACTRN12620000909921.

scholarly journals Explaining variations in test ordering in primary care: protocol for a realist review

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e023117 ◽  
Author(s):  
Claire Duddy ◽  
Geoffrey Wong
Keyword(s):  
Primary Care ◽  
Realist Review ◽  
Programme Theory ◽  
Dissemination Strategy ◽  
Care Protocol ◽  
Ethical Approval ◽  
Registration Number ◽  
Primary Care Doctors ◽  
Generative Mechanisms ◽  
Test Ordering

IntroductionStudies have demonstrated the existence of significant variation in test-ordering patterns in both primary and secondary care, for a wide variety of tests and across many health systems. Inconsistent practice could be explained by differing degrees of underuse and overuse of tests for diagnosis or monitoring. Underuse of appropriate tests may result in delayed or missed diagnoses; overuse may be an early step that can trigger a cascade of unnecessary intervention, as well as being a source of harm in itself.Methods and analysisThis realist review will seek to improve our understanding of how and why variation in laboratory test ordering comes about. A realist review is a theory-driven systematic review informed by a realist philosophy of science, seeking to produce useful theory that explains observed outcomes, in terms of relationships between important contexts and generative mechanisms.An initial explanatory theory will be developed in consultation with a stakeholder group and this ‘programme theory’ will be tested and refined against available secondary evidence, gathered via an iterative and purposive search process. This data will be analysed and synthesised according to realist principles, to produce a refined ‘programme theory’, explaining the contexts in which primary care doctors fail to order ‘necessary’ tests and/or order ‘unnecessary’ tests, and the mechanisms underlying these decisions.Ethics and disseminationEthical approval is not required for this review. A complete and transparent report will be produced in line with the RAMESES standards. The theory developed will be used to inform recommendations for the development of interventions designed to minimise ‘inappropriate’ testing. Our dissemination strategy will be informed by our stakeholders. A variety of outputs will be tailored to ensure relevance to policy-makers, primary care and pathology practitioners, and patients.Prospero registration numberCRD42018091986

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