Evidence Of Promise Research Articles

Exploring the feasibility of evaluating a community alliance welfare advice programme co-located in primary care in Bradford: an uncontrolled before and after study

BackgroundWelfare advice services co-located in health settings are known to improve financial security. However, little is known on how to effectively evaluate these services. This study aims to explore the feasibility of evaluating a welfare advice service co-located in a primary care setting in a deprived and ethnically diverse population. It seeks to investigate whether the proposed evaluation tools and processes are acceptable and feasible to implement and whether they are able to detect any evidence of promise for this intervention on the mental health, wellbeing and financial security of participants.MethodsAn uncontrolled before and after study design was utilised. Data on mental health, wellbeing, quality of life and financial outcomes were collected at baseline prior to receiving welfare advice and at three months follow-up. Multiple logistic and linear regression models were used to explore individual differences in self-reported financial security and changes to mental health, wellbeing and quality of life scores before and after the provision of welfare advice.ResultsOverall, the majority of key outcome measures were well completed, indicating participant acceptability of the mental health, wellbeing, quality of life and financial outcome measures used in this population. There was evidence suggestive of an improvement in participant financial security and evidence of promise for improvements in measured wellbeing and health-related quality of life for participants accessing services in a highly ethnically diverse population. Overall, the VCS Alliance welfare advice programme generated a total of £21,823.05 for all participants, with participants gaining an average of £389.70 per participant for participants with complete financial outcome data.ConclusionsThis research demonstrates the feasibility of evaluating a welfare advice service co-located in primary care in a deprived and ethnically diverse setting utilising the ascribed mental health, wellbeing and quality of life and financial outcome tools. It provides evidence of promise to support the hypothesis that the implementation of a welfare advice service co-located in a health setting can improve health and wellbeing and reduce health inequalities.

Evaluation of a co-designed educational e-resource about oral health for community nurses: study protocol

BackgroundOral health is a crucial aspect of health and wellbeing for older people. Poor oral health has been found to significantly increase the risk of chronic health conditions and poor quality of life for older people. Nurses practicing in the community are well-placed to provide oral health care to older people in their own homes, yet there has been little research in this field to develop accessible support for them to do so. Previous literature, reviewed in an earlier phase of this work, revealed that there has, historically, been a paucity of oral health care education for nurses and very few educational resources have been developed in this field.MethodsThis study will evaluate an educational e-resource which has been co-designed by service users, carers and clinicians. In the first phase of research, evidence of promise will be evaluated by analysing quantitative data on community nurses’ oral health attitudes and self-efficacy for oral health assessments of older people. In the second phase of research, facilitators and barriers to community nurses’ provision of oral health care to older people and the acceptability of the educational e-resource will be evaluated.DiscussionThis research will investigate the potential of an educational e-resource to improve community nurses’ capabilities to deliver oral health care to older people in their own homes. This research will inform both future intervention design and understanding of community nurses’ knowledge and attitudes about oral health care. Facilitators and barriers to provision of this care for older people will also be explored.

Authentic Integration of Ethics and AI through Sociotechnical, Problem-Based Learning

Growing awareness of both the demand for artificial intelligence (AI) expertise and of the societal impacts of AI systems has led to calls to integrate learning of ethics alongside learning of technical skills in AI courses and pathways. In this paper, we discuss our experiences developing and piloting the TechHive:AI curriculum for high school youth that integrates AI ethics and technical learning. The design of the curriculum was guided by the following pedagogical goals: (1) to respond to the capacity-building need for critical sociotechnical competencies in AI workforce pathways; and (2) to broaden participation in AI pathways through intentional instructional design to center equity in learning experiences. We provide an overview of the 30-hour learning sequence’s instructional design, and our “4D Framework,” which we use as a heuristic to help students conceptualize and inspect AI systems. We then provide a focused description of one of three 8-hour modules that make up the sequence. Finally, we present evidence of promise from an exploratory study of TechHive:AI with a small sample of students, and discuss insights from implementation, including from our use of established resources for AI learning within the learning sequence as well as those created by our team.

Spirulina (Arthrospira spp) as a Complementary COVID-19 Response Option: Early Evidence of Promise

The COVID-19 pandemic poses a profound threat to human health across the world. A growing body of evidence suggests that dietary choice can support pandemic response efforts. This paper asks whether spirulina, a type of edible microalgae, may offer a means of reducing COVID-19 risk. This question follows from spirulina’s observed antiviral effects vis-à-vis other viral diseases. Questions about possible complementary therapies remain important due to the ongoing threat posed by COVID-19, given major gaps to vaccine rollout and the proliferation of mutant variants. The paper is based on a narrative review of the academic literature relevant to this question. The 25 papers identified were grouped and summarised, then discussed. The evidence reported suggests spirulina may have prophylactic and therapeutic efficacy against SARS-CoV-2 via several pathways, though further investigation is needed to verify the linkages identified. Incorporating spirulina into diet might thus offer a way to lower COVID-19 risk. This option may moreover be particularly helpful for at-risk populations, such as those in the Global South where many remain unvaccinated and food insecurity is widespread. This review reports findings in non-technical language and could inform actions by diverse stakeholders, including researchers, governments and households.

Teaching self‐management strategies to upper‐elementary students: Evidence of promise from the We Have Choices program

AbstractStudent behavior problems in general‐education classrooms present a major barrier to effective teaching. Behavior challenges, such as disruptions, noncompliance, and peer conflicts, reduce instructional time, whereas prosocial behaviors, such as paying attention, being ready to work, asking for help, participating in class, and completing homework, improve academic performance. Most interventions developed to address student behavior problems were not designed for general‐education students in typical classrooms. The purpose of this paper is to present preliminary results from a novel intervention developed to enhance behavioral self‐management skills among all upper‐elementary students in general‐education classrooms. We Have Choices, a universal intervention, was designed to increase students' capacity to make appropriate behavioral choices and decrease teachers' responsibility by transferring behavior management to students. An initial randomized controlled trial with 86 fourth‐ to sixth‐grade teachers and 2055 students suggested that We Have Choices was associated with improvements in student‐reported use of self‐management strategies, teacher‐reported student prosocial behavior, and teacher‐reported self‐efficacy in behavior management and instruction. Teachers gave the program high scores for social validity, suggesting a good fit for their classrooms.

Peer-led physical activity intervention for girls aged 13 to 14 years: PLAN-A cluster RCT

Background Increasing physical activity among girls is a public health priority. Peers play a central role in influencing adolescent behaviour. Peer-led interventions may increase physical activity in adolescent girls, and a feasibility trial had shown that PLAN-A (Peer-led physical Activity iNtervention for Adolescent girls) had evidence of promise to increase physical activity in adolescent girls. Objective The objective was to test whether or not PLAN-A can increase adolescent girls’ physical activity, relative to usual practice, and be cost-effective. Design This was a two-arm, cluster-randomised controlled trial, including an economic evaluation and a process evaluation. Participants State-funded secondary schools in the UK with girls in Year 9 (aged 13–14 years) participated in the trial. All Year 9 girls in participating schools were eligible. Randomisation Schools were the unit of allocation. They were randomised by an independent statistician, who was blinded to school identities, to the control or intervention arm, stratified by region and the England Index of Multiple Deprivation score. Intervention The intervention comprised peer nomination (i.e. identification of influential girls), train the trainers (i.e. training the instructors who delivered the intervention), peer supporter training (i.e. training the peer-nominated girls in techniques and strategies underpinned by motivational theory to support peer physical activity increases) and a 10-week diffusion period. Outcomes The primary outcome was accelerometer-assessed mean weekday minutes of moderate to vigorous physical activity among Year 9 girls. The follow-up measures were conducted 5–6 months after the 10-week intervention, when the girls were in Year 10 (which was also 12 months after the baseline measures). Analysis used a multivariable, mixed-effects, linear regression model on an intention-to-treat basis. Secondary outcomes included weekend moderate to vigorous physical activity, and weekday and weekend sedentary time. Intervention delivery costs were calculated for the economic evaluation. Results A total of 33 schools were approached; 20 schools and 1558 pupils consented. Pupils in the intervention arm had higher Index of Multiple Deprivation scores than pupils in the control arm. The numbers randomised were as follows: 10 schools (n = 758 pupils) were randomised to the intervention arm and 10 schools (n = 800 pupils) were randomised to the control arm. For analysis, a total of 1219 pupils provided valid weekday accelerometer data at both time points (intervention, n = 602; control, n = 617). The mean weekday moderate to vigorous physical activity was similar between groups at follow-up. The central estimate of time spent engaging in moderate to vigorous physical activity was 2.84 minutes lower in the intervention arm than in the control arm, after adjustment for baseline mean weekday moderate to vigorous physical activity, the number of valid days of data and the stratification variables; however, this difference was not statistically significant (95% confidence interval –5.94 to 0.25; p = 0.071). There were no between-arm differences in the secondary outcomes. The intervention costs ranged from £20.85 to £48.86 per pupil, with an average cost of £31.16. Harms None. Limitations The trial was limited to south-west England. Conclusions There was no evidence that PLAN-A increased physical activity in Year 9 girls compared with usual practice and, consequently, it was not cost-effective. Future work Future work should evaluate the utility of whole-school approaches to promote physical activity in schools. Trial registration This trial is registered as ISRCTN14539759. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 6. See the NIHR Journals Library website for further project information. This trial was designed and delivered in collaboration with the Bristol Randomised Trials Collaboration (BRTC), a United Kingdom Clinical Research Commission (UKCRC)-registered Clinical Trials Unit that, as part of the Bristol Trials Centre, is in receipt of NIHR Clinical Trials Unit support funding. The sponsor of this trial was University of Bristol, Research and Enterprise Development www.bristol.ac.uk/red/. The costs of delivering the intervention were funded by Sport England.

Examining the effects of students' self-efficacy and prior knowledge on learning and visual behavior in a physics game

Research has provided evidence of the significant promise of using educational games for learning. However, there is limited understanding of how individual differences (e.g., self-efficacy and prior knowledge) affect visual processing of game elements and learning from an educational game. This study aimed to address these gaps by: a) examining the effects of students' self-efficacy and prior knowledge on learning from a physics game; and b) exploring how learners with distinct levels of self-efficacy and prior knowledge differ in their visual behavior with respect to the game elements. The visual behavior of 69 undergraduate students was recorded as they played an educational game focusing on Newtonian mechanics. Individual differences in self-efficacy in learning physics and prior knowledge were assessed prior to the game, while a comprehension test was administered immediately after gameplay. Wilcoxon signed-rank tests showed that all participants significantly improved in their understanding of Newtonian mechanics. Mann-Whitney U tests indicated learning gains were not significantly different between the groups with varying levels of prior knowledge or self-efficacy. Additionally, a series of Mann-Whitney U tests of the eye tracking data suggested the learners with high self-efficacy tended to pay more attention to the motion map - a critical navigation component of the game. Further, the high prior knowledge individuals excelled in attentional control abilities and exhibited effective visual processing strategies. The study concludes with important implications for the future design of educational games and developing individualized instructional support in game-based learning.

Preliminary evidence of promise of a sexual violence risk reduction intervention for female students in South African tertiary education institutions

ABSTRACT Campus sexual violence risk reduction and resistance interventions have been developed and tested among female students in the global North and proven effective. Evidence-based interventions to prevent sexual violence tested amongst female students in the global South and in South African campuses are lacking. We present preliminary evidence of promise of Ntombi Vimbela! (NV!), a sexual violence prevention intervention piloted amongst first year female students in eight purposively selected campuses in South Africa. Focus group discussions were conducted with 118 female students who participated in NV! workshops. Most students found the content of NV! relevant and reported having experienced its positive effects. They perceived that NV! empowered them with skills to assess and deal with sexual assault risky situations. NV! changed their attitudes and beliefs about gender, shifted their acceptance of rape myths and beliefs, improved communication skills, enhanced self-esteem, and confidence to defend oneself in risky sexual assault situations. Few participants were unsure whether they will be able to use the skill in real life. These findings indicate a range of short-term positive outcomes which we anticipate would reduce the risk of sexual assault among first year female students. This suggests that NV! should be subject to further evaluation.

Masked analysis for small-scale cluster randomized controlled trials.

Researchers conducting small-scale cluster randomized controlled trials (RCTs) during the pilot testing of an intervention often look for evidence of promise to justify an efficacy trial. We developed a method to test for intervention effects that is adaptive (i.e., responsive to data exploration), requires few assumptions, and is statistically valid (i.e., controls the type I error rate), by adapting masked visual analysis techniques to cluster RCTs. We illustrate the creation of masked graphs and their analysis using data from a pilot study in which 15 high school programs were randomly assigned to either business as usual or an intervention developed to promote psychological and academic well-being in 9th grade students in accelerated coursework. We conclude that in small-scale cluster RCTs there can be benefits of testing for effects without a priori specification of a statistical model or test statistic.

What happens after high school? A review of independent living practices to support youth with disabilities transitioning to adult life

BACKGROUND: Centers for Independent Living (CILs) can help out-of-school youth with disabilities. CIL services may be particularly important for minority youth with disabilities that face additional transition barriers. OBJECTIVE: This literature review documents existing practices that might aid CILs as they seek to help youth, including minority youth, with disabilities transition to adult life. METHODS: First, we conducted a literature search to identify practices that might help CILs assist youth with disabilities transition to independent living (IL) in early adult life. Then we examined various literature syntheses of postsecondary transition interventions with evidence of promise or efficacy for any IL-related outcome—regardless of whether the intervention targeted youth with disabilities. RESULTS: We discovered a variety of practices CILs might learn from or consider adopting to help youth with disabilities transition to adult life. However, the practices rarely focused on minority youth and usually had limited or no evidence about whether they improved IL outcomes. CONCLUSIONS: The limitations of the evidence we found suggest the need to develop and test interventions that help transition age youth with disabilities—especially minority youth with disabilities—achieve their IL goals.

O26 Testing an intervention to reduce fatigue impact in inflammatory arthritis: design and outcomes of a single-arm feasibility study

Abstract Background/Aims Patients with inflammatory arthritis report that fatigue can be a challenging symptom to manage, with little support available. In response, we developed a brief one-to-one cognitive-behavioural manualised intervention, delivered by rheumatology health professionals (RHPs), to help patients manage their fatigue. Methods We designed a single-arm feasibility study called FREE-IA (Fatigue - Reducing its Effects through individualised support Episodes in Inflammatory Arthritis). Patients were eligible if they were ≥18 years, had a clinician confirmed diagnosis of inflammatory arthritis, scored ≥6/10 on the BRAF NRS Fatigue Impact with fatigue that they considered recurrent, frequent, and/or persistent, and were not accessing support for their fatigue. Following training, RHPs delivered 2-4 one-to-one sessions to participants. The initial two core sessions were delivered face-to-face in clinic; participants then had the option of up to two further sessions, either in clinic, by telephone or online. We proposed delivering sessions 1 and 2 within two weeks of each other, and sessions 3 and 4 in the following two weeks. Baseline data were collected before the first session (T0), and outcomes at six weeks (T1) and six months (T2). The primary outcome was fatigue impact (BRAF NRS Fatigue Effect), collected by telephone. Secondary outcomes included fatigue severity, fatigue coping, multi-dimensional impact of fatigue, disease impact and disability and measures of therapeutic mechanism (self-efficacy, and perceived confidence and autonomy to manage health). These outcomes were collected by post. This study allowed us to test the feasibility and acceptability of RHP training, study design and materials, intervention delivery and outcome collection, ahead of a possible RCT to determine intervention effectiveness. Results Eight RHPs at five hospitals delivered 113 sessions to 46 participants. Four sessions were delivered by phone and none online. Session 2 was only delivered within the two-week time frame for 37% of participants attending both core sessions. Out of a potential 138 primary and secondary outcome responses at T0, T1 and T2, there were 13 missing primary outcome responses and 27 missing secondary outcome responses. Results indicated improvements in all measures except disability at either T1 or T2, or both, with confidence intervals supporting an interpretation of improvement. Conclusion We were able to design and deliver FREE-IA training to RHPs, deliver FREE-IA sessions to patients, and collect outcomes at three time points with low levels of attrition. Outcomes in all measures except disability were in a direction to suggest improvement at T1, T2, or both. Study numbers were small, there was no control group and regression to the mean was a possibility. However, outcomes were in the direction to cautiously suggest benefit, and there is evidence of promise of the intervention. A definitive RCT is the next step to test clinical and cost effectiveness of the intervention. Disclosure S. Bridgewater: None. J. Lomax: None. B. Abbott: None. J. Adams: None. A. Berry: None. S. Creanor: None. P. Ewings: None. S. Hewlett: None. L. McCracken: None. M. Ndosi: None. J. Thorn: None. M. Urban: None. E. Dures: None.

Melatonin improves brain function in a model of chronic Gulf War Illness with modulation of oxidative stress, NLRP3 inflammasomes, and BDNF-ERK-CREB pathway in the hippocampus

Persistent cognitive and mood dysfunction is the primary CNS symptom in veterans afflicted with Gulf War Illness (GWI). This study investigated the efficacy of melatonin (MEL) for improving cognitive and mood function with antioxidant, antiinflammatory, and pro-cognitive effects in a rat model of chronic GWI. Six months after exposure to GWI-related chemicals and stress, rats were treated with vehicle or MEL (5, 10, 20, 40, and 80 mg/kg) for eight weeks. Behavioral tests revealed cognitive and mood dysfunction in GWI rats receiving vehicle, which were associated with elevated oxidative stress, reduced NRF2, catalase and mitochondrial complex proteins, astrocyte hypertrophy, activated microglia with NLRP3 inflammasomes, elevated proinflammatory cytokines, waned neurogenesis, and synapse loss in the hippocampus. MEL at 10 mg/kg alleviated simple and associative recognition memory dysfunction and anhedonia, along with reduced oxidative stress, enhanced glutathione and complex III, and reduced NLRP3 inflammasomes, IL-18, TNF-α, and IFN-γ. MEL at 20 mg/kg also normalized NRF2 and catalase and increased microglial ramification. MEL at 40 mg/kg, in addition, reduced astrocyte hypertrophy, activated microglia, NF-kB-NLRP3-caspase-1 signaling, IL-1β, MCP-1, and MIP-1α. Moreover, MEL at 80 mg/kg activated the BDNF-ERK-CREB signaling pathway, enhanced neurogenesis and diminished synapse loss in the hippocampus, and improved a more complex hippocampus-dependent cognitive function. Thus, MEL therapy is efficacious for improving cognitive and mood function in a rat model of chronic GWI, and MEL's effect was dose-dependent. The study provides the first evidence of MEL's promise for alleviating neuroinflammation and cognitive and mood impairments in veterans with chronic GWI.

Doing justice to your child: a Dutch pilot intervention for parents in high‐conflict divorces

This study examines the feasibility of a Dutch intervention for parents in high‐conflict divorces. The intervention consisted of a high‐intensity programme in which parents undergo a series of therapeutic interventions on five consecutive days. Data were collected from up to ten parents at three moments in time (prior to, immediately after, and about one year after the intervention). We showed that the intervention yielded high expectations with participating parents immediately after the intervention. One year after the intervention, however, these high expectations had not been consolidated into a perceived reduction of conflict. A comparison of pre‐ and post‐intervention conflict levels, on the other hand, suggested a decrease in conflict as well as improvement in relationship quality, although these improvements were not as high as parents had anticipated directly after the intervention. Parents might be unaware of their progress due to unmet expectations.Practitioner points This study offers evidence of promise for Doing Justice to Your Child, an intensive, mixed‐intervention treatment programme for parents in high‐conflict divorces Lawyers were also involved in the programme Parents in high‐conflict divorces may be unable to see positive progress from this intervention themselves

Teaching Together: Pilot study of a tiered language and literacy intervention with Head Start teachers and linguistically diverse families

• We examine a tiered, language and literacy supplemental program at school and home. • The most intensive tiered intervention positively impacted proximal word learning. • The least intensive intervention showed evidence of promise on distal word learning. • There were unexpected negative literacy impacts, particularly for DLL. • DLL did not respond differentially on language measures.

Building Content Knowledge to Boost Comprehension in the Primary Grades

ABSTRACTWell‐established theoretical models and a body of empirical research elucidate the critical role of content knowledge in comprehending texts. However, the potential of supporting knowledge in service of enhancing linguistic and reading comprehension has been a relatively neglected topic in the science of reading. The authors explicate why knowledge building in English language arts instruction (i.e., content‐rich instruction) can support language and content knowledge, leading to better linguistic and reading comprehension, based on theoretical arguments and empirical studies. In particular, the authors review the evidence on this claim, paying special attention to experimental trials conducted in K–2 settings. The authors also share preliminary findings from a novel intervention study testing one instantiation of a widely used content‐rich English language arts curriculum. Whereas this growing literature base demonstrates evidence of promise, further rigorous trials are needed to examine the efficacy of this integrative approach to teaching reading for understanding.

A revised teaching assistant-led extracurricular physical activity programme for 8- to 10-year-olds: the Action 3:30R feasibility cluster RCT

Background Many children do not meet the recommended guidelines for physical activity. The after-school period may be a critical time for children to participate in physical activity. Teaching assistants are important within the school system and could be trained to deliver after-school physical activity programmes. Our previous work showed that a teaching assistant-led after-school physical activity intervention held promise. Objectives To examine the feasibility, evidence of promise and cost of Action 3:30R, a revised after-school physical activity intervention. Design A cluster-randomised feasibility study, including process and economic evaluations. Setting The setting was 12 primary schools in south-west England. Participants The participants were Year 4 and 5 children (aged 8–10 years). Intervention Two teaching assistants from each intervention school attended a 25-hour (5-day) training course focused on how to deliver an after-school physical activity programme. As Action 3:30 is grounded in self-determination theory, the training focused on promoting children’s autonomy, belonging and competence. Teaching assistants received resources to aid them in delivering a 60-minute after-school physical activity programme twice per week for 15 weeks (i.e. 30 sessions). Main outcome measures Measures focused on feasibility outcomes and evidence of promise. Feasibility measures included the recruitment of schools and pupils and the attendance at the after-school programme. Evidence of promise was measured by comparing accelerometer-determined minutes of moderate to vigorous physical activity between the arms at follow-up. Process evaluation measures were conducted using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. The cost of delivery was also assessed. Results Twelve primary schools were recruited and 41% of eligible pupils consented, 49% of whom were girls. Schools were randomised after baseline measures: six to the intervention arm (n = 170 pupils) and six to the control arm (n = 165 pupils). Two schools allocated to the intervention arm withdrew from the study before the start of the intervention, leaving 111 pupils in the intervention arm. The intervention training was well attended and positively received; eight out of nine teaching assistants attended 100% of the sessions. Action 3:30R clubs were well attended; 74% of pupils attended at least 50% of the 30 sessions. Mean weekday moderate to vigorous physical activity did not differ between the arms at follow-up (–0.5 minutes, 95% confidence interval –4.57 to 3.57 minutes). The process evaluation revealed that Action 3:30R was received positively by pupils, teaching assistants and key contacts in intervention schools. Pupils enjoyed Action 3:30R, and teaching assistants and pupils perceived the teaching style to be autonomy-supportive. Economic evaluation showed that Action 3:30R is inexpensive; the estimated cost of the programme after 1 year was £1.64 per pupil per session. Limitations A reason for withdrawing was given by one school but not by the other. The reason given was an inability to release staff for training. Conclusions Action 3:30R is a low-cost, feasible after-school programme that engages a range of pupils and offers continuing professional development to teaching assistants. However, Action 3:30R does not show evidence of promise in increasing levels of moderate to vigorous physical activity and does not warrant a trial evaluation. Future work Future research should focus on improving the quality of current after-school provision in primary schools to increase physical activity. Trial registration Current Controlled Trials ISRCTN34001941. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 19. See the NIHR Journals Library website for further project information.

A peer-led physical activity intervention in schools for adolescent girls: a feasibility RCT

BackgroundGirls are less active than boys and few adolescent girls meet physical activity (PA) guidelines. Peers are an important influence on the views and behaviours of adolescent girls, yet many PA interventions involving peers use formal approaches that may not harness the power of peer groups. More informal peer-led PA interventions, which work within proximal peer groups, may hold promise for increasing girls’ PA.ObjectivesTo examine the feasibility, evidence of promise and cost of the Peer-Led physical Activity iNtervention for Adolescent girls (PLAN-A), a peer-led PA intervention.DesignPhase 1 comprised formative work and a pilot study conducted in one secondary school. Phase 2 was a feasibility study comprising a pilot randomised controlled trial in six secondary schools, including process and economic evaluations.SettingSix secondary schools in South Gloucestershire and Wiltshire, recruited from schools above the median local Pupil Premium (i.e. more deprived).ParticipantsYear 8 girls (aged 12–13 years).InterventionYear 8 girls nominated other girls in their year who are likely to be influential (e.g. who they look up to, are good listeners); the 18% most nominated were invited to be peer supporters (PSs). PSs attended 2 consecutive days of training (plus a top-up day 5 weeks later) outside the school site, led by pairs of PS trainers, to increase their knowledge about PA and their capabilities and confidence to promote PA in their friendship group.Main outcome measuresMeasures focused on establishing evidence for feasibility and promise: recruitment and retention of Year 8 girls and PSs, data provision rates [accelerometer and questionnaire collected pre randomisation/beginning of Year 8 (T0), end of Year 8 (T1) and beginning of Year 9 (T2)], intervention acceptability, PS training attendance, intervention cost, and the between-arm difference in weekday minutes of moderate to vigorous PA (MVPA). A process evaluation was conducted.ResultsSix schools were recruited: four PLAN-A (n = 269) and two control (n = 158). In total, 94.7% of Year 8 girls participated. A total of 55 (17–24% of Year 8 girls) PSs were trained (attendance rate 91–100%). Five girls were trained as PS trainers. Questionnaire data provision exceeded 92% at all time points. Accelerometer return rates were > 85% and wear-time criteria were met by 83%, 71% and 62% of participants at T0, T1 and T2, respectively. Mean weekday MVPA did not differ between intervention arms at T1 (1.1 minutes, 95% CI –4.3 to 6.5 minutes) but did at T2 (6.1 minutes, 95% CI 1.4 to 10.8 minutes), favouring PLAN-A. The mean cost of intervention delivery was £2685 per school or £37 per Year 8 girl. Process evaluation identified good fidelity, engagement and enjoyment of the PS training and peer-support strategies. PSs needed more guidance on how to start conversations.LimitationsAccelerometer data provision was lowest at T2, suggesting a need for strategies to increase compliance.ConclusionsInformal peer-led intervention approaches, such as PLAN-A, hold promise as a means of promoting PA to adolescent girls.Future workA definitive randomised controlled trial of PLAN-A is warranted.Trial registrationCurrent Controlled Trials ISRCTN12543546.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 7, No. 16. See the NIHR Journals Library website for further project information. The work was undertaken with the support of the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UK Clinical Research Collaboration (UKCRC) Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UKCRC, is gratefully acknowledged. This study was designed and delivered in collaboration with the Bristol Randomised Trials Collaboration (BRTC), a UK CRC-registered clinical trials unit in receipt of NIHR clinical trials unit support funding. The intervention costs were jointly funded by South Gloucestershire Council and Wiltshire Council.

A Mobile App to Support Parents Making Child Mental Health Decisions: Protocol for a Feasibility Cluster Randomized Controlled Trial.

BackgroundShared decision making (SDM) is recognized as a person-centered approach to improving health care quality and outcomes. Few digital interventions to improve SDM have been tested in child and adolescent mental health (CAMH) settings. One such intervention is Power Up, a mobile phone app for young people (YP), which has shown some evidence of promise that YP who received Power Up reported greater levels of SDM. However, even though parents play a critical role in CAMH care and treatment, they often feel excluded from services.ObjectiveThis protocol is for a pilot trial to determine the feasibility of a large-scale randomized trial to develop and evaluate a Web app called Power Up for Parents (PUfP) to support parents and promote involvement in CAMH decisions.MethodsA 2-stage process, consisting of the development stage and pilot-testing stage of the initial PUfP prototype, will be conducted. At the development stage, a qualitative study with parents and clinicians will be conducted. The interviews will aim to capture the experience of making CAMH decisions, preferences for involvement in SDM, and determine situations within which PUfP can be useful. At the pilot-testing stage, up to 90 parents and their clinicians will be invited to participate in the testing of the prototype. Parents will be randomly allocated to receive the intervention or be part of the control group. This study design will allow us to assess the acceptability and usefulness of PUfP in addition to examining the feasibility of a prospective randomized trial. Clinicians’ perceptions of the prototype and how it has influenced parents’ involvement in SDM will also be examined.ResultsRecruitment began in January 2019 and is scheduled to last for 10 months. Interviews and baseline data collection are currently in progress. To date, 11 CAMH sites have been recruited to take part in the study. It is anticipated that data collection will be completed by October 2019.ConclusionsThe lack of parents’ involvement in CAMH care and treatment can lead to higher rates of dropout from care and lower adherence to therapeutic interventions. There are significant benefits to be gained globally if digital SDM interventions are adopted by parents and shown to be successful in CAMH settings.Trial RegistrationISRCTN Registry ISRCTN39238984; http://www.isrctn.com/ISRCTN39238984International Registered Report Identifier (IRRID)DERR1-10.2196/14571

(Re)framing Resistance to Culturally Relevant Education as a Multilevel Learning Problem

Despite evidence of promise, the adoption of culturally relevant educational (CRE) approaches to teaching and learning remains sporadic and underwhelming. In this chapter, we question this state of affairs by investigating teacher resistance to CRE. Through our examination of the literature, we have come to understand teacher resistance to CRE as a multilevel learning problem that stems from (a) limited understanding and belief in the efficacy of CRE and (b) a lack of know-how needed to execute it. We therefore characterize resistance as a learning problem, rather than a problem of individual compliance, and view contextual variation in its take up as an opportunity to learn. Framing teacher resistance to CRE as a multilevel learning problem provides a way forward by shifting the perception of resistance as simply negative to an understanding of resistance as a diagnostic tool, or warning signal about when, where, for whom, and why a change can be particularly difficult. By representing our review of the literature as a problem space map, we offer a tool that can be used to pinpoint, anticipate, and preemptively address the multilevel factors that contribute to teachers’ resistance to CRE.

Action 3:30R: Results of a Cluster Randomised Feasibility Study of a Revised Teaching Assistant-Led Extracurricular Physical Activity Intervention for 8 to 10 Year Olds.

Many children are not sufficiently physically active. We conducted a cluster-randomised feasibility trial of a revised after-school physical activity (PA) programme delivered by trained teaching assistants (TAs) to assess the potential evidence of promise for increasing moderate-to-vigorous physical activity (MVPA). Participants (n = 335) aged 8–10 years were recruited from 12 primary schools in South West England. Six schools were randomised to receive the intervention and six acted as non-intervention controls. In intervention schools, TAs were trained to deliver an after-school programme for 15 weeks. The difference in mean accelerometer-assessed MVPA between intervention and control schools was assessed at follow-up (T1). The cost of programme delivery was estimated. Two schools did not deliver the intervention, meaning four intervention and six control schools were analysed at T1. There was no evidence for a difference in MVPA at T1 between intervention and control groups. Programme delivery cost was estimated at £2.06 per pupil per session. Existing provision in the 12 schools cost £5.91 per pupil per session. Action 3:30 was feasible to deliver and considerably cheaper than existing after-school provision. No difference in weekday MVPA was observed at T1 between the two groups, thus progression to a full trial is not warranted.