Related Research Evidence Research Articles

Brain metastasis from non-small cell lung cancer: management and prognosis of primary lung tumor resection

Brain metastases (BM) will develop in 30-50% of non-small cell lung cancer (NSCLC) patients in the course of their illness. Systemic treatment is recommended for most advanced-stage NSCLC patients with BM but the prognosis remains poor. The prognosis and management of primary lung tumor resection are still a debated topic in this complex clinical setting. The present study will gather and review related research evidence. The survival benefit, patient selection and proper surgical strategy of primary lung tumor resection will be summarized and discussed in the treatment for NSCLC patients with BM.

Filling the gap between research evidence and clinical practice to promote cardiovascular nursing-related knowledge

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The journal club is intended to improve nurses' understanding of the research process and their capacity to analyse and synthesise research studies, serve as a forum for discussing research evidence in relation to clinical practice, disseminate research results into practice, and reinforce the need for evidence-based practice. The journal club encourages nurses to engage in evidence-based activities and to perform nurse-driven research investigations. The application of new knowledge gained via participation can improve the quality of care provided to patients and their families. Aim Filling the gap between research evidence, clinical practice, and promoting nursing-related knowledge. Process Nursing Journal Club commenced in AHC on July 28, 2022; by the end of 2022, the total number of sessions held was 12. All topics presented and discussed are nursing-focused, evidence-based practise research that enhances or changes the practice. Since the launch of the club, all AHC nursing units have participated in presenting various topics. The club met twice a month, where two nursing units presented recent research evidence based on current related practice, issues, areas for improvement, and/or areas of interest. Data Analysis The questionnaire was filled out by 55 nurses. Five nurses from each nursing department were chosen at random to fill it out. The survey's goal is to determine the effectiveness of using journal club in cardiac healthcare facilities. (Chart 1) The survey reported that 96.4% of participants sensed that the club promoted interest in research and promoted the ability to apprise nurses of nursing research, 90.9% confirmed that the club strengthened the nurse's ability to analyse current evidence-based research; 94.5% agreed that the club allowed open discussions, 96.4% were disclosed that the club enhanced the chance to change practise to reflect the highest and most updated evidence; and 89.1% of participants reveled that the club answered dilemmas related to daily practice. The journal club was a main place to discuss the current research and evidence in nursing; as 98.2% of participants reported. Eventually, 94.5% of participants exposed that the club was a suitable educational method. The participants were asked one open-ended interview question; the majority responded that the club allowed nurses to have a vision for nursing research, expand knowledge, and was a useful approach for education in bridging the gap between research and daily practise. Conclusion Nurses' critical-thinking skills were sustained by the introduction of the journal club into cardiac healthcare facilities, which increased their familiarity with the latest research and strengthened their ability to evaluate the quality of published studies. Moreover, it encourages the use of newly acquired knowledge in clinical practice, which should enhance patient outcomes.The survey results

United Kingdom national media representations of medications used in dementia: a systematic content analysis

Abstract Introduction Newspapers contribute to public understanding and perceptions of health-related issues (1,2). Examination of news media reporting to elucidate how the public conceptualise and understand medicines use in dementia has been limited to date. Aim To investigate communication to the public about medications used in dementia via newspaper articles. Methods A systematic content analysis explored communication in the 10 highest circulated UK newspapers about medications used in dementia, over a 10-year period from 2010 to 2019. LexisNexis UK was searched using terms relating to medications and treatment in dementia (both for dementia and for other co-morbid conditions), and articles relating to medicines use in dementia were identified for inclusion. A standardised coding frame was developed, piloted, and used to code all included articles across three domains: structure (bibliographic details); content (information within each article); and judgement and rating (subjective variable related to information presented, and scored from 0-10). Where an article was linked to a scientific journal article, this was retrieved, and the content cross-checked. A second researcher independently coded a random sample (10%) of articles. Level of intercoder agreement was determined by calculation of Cohen’s kappa value. Results One hundred articles satisfied the inclusion criteria. The newspapers which most frequently contained relevant articles were: the Daily Mail (n = 33) and the Daily Express (n = 30), followed by the Daily Mirror (n = 12), the Guardian (n = 11), the Mail on Sunday (n = 5), the Sunday Express (n = 3), the i (n = 3), the Metro (n = 1), the Daily Star (n = 1) and the People (n = 1). The largest numbers of articles were published in 2011 and 2012 (n=18) and the smallest number in 2019 (n = 4), with no apparent trend observed over the study period. Main article themes were: benefits and effectiveness, risk and harm, lack of diagnosis, and funding and potential future drug developments. Starting therapy early and continuing in later stages of dementia were reported to maintain function and independence and slow decline. Antipsychotics, sedatives and opioid analgesics were considered to worsen symptoms and increase risk of death. Lack of dementia diagnosis resulted in inability to obtain dementia medication when people needed and would benefit from it. Lack of funding was highlighted as a barrier to research. Most articles were written from a clinical perspective (n=82). Half had a negative slant, 46% had a positive slant and 4% were neutral. Almost half were judged to be excellent quality (45%), 35% were considered average and 20% were judged as poor quality. Cohen’s kappa values ranged from 0.63 to 1.00, indicating satisfactory agreement between coders. Conclusion There remains scope for improvement in quality of mass media communication regarding medications used in dementia. Strengths of this study include the systematic approach employed in content analysis, while limitations include exclusion of the Sun, the Times and the Telegraph due to lack of availability of circulation figures, and exclusion of media sources other than newspapers. References (1) Akintola O, Lavis JN, Hoskins, R. Print media coverage of primary healthcare and related research evidence in South Africa. Health Res Policy Syst. 2015;13:68. (2) Stanford FC, Tauqeer Z, Kyle TK. Media and its influence on obesity. Curr Obes Rep. 2018; 7(2):186–92.

Is Individualism Suicidogenic? Findings From a Multinational Study of Young Adults From 12 Countries.

The associations of individualistic versus collectivistic value orientations with suicidal ideation and attempts, attitudes towards suicide and towards suicidal individuals, and psychological distress were investigated across 12 nations (N = 5572 university students). We expected differential associations of value orientations with suicidal behavior and moderating effects of the prevailing value orientations in the various countries. Findings showed that intermediate levels of individualism appeared protective against suicide attempts across all investigated nations, but that, otherwise, there seemingly are no universal associations of individualism and collectivism with suicidal behaviors. High collectivism was associated with less suicidal ideation only in individualistic countries. Low individualism appeared to be a risk factor for suicidal ideation specifically in Muslim collectivistic cultures, whereas high individualism in Asian collectivistic cultures. Collectivistic values are uniformly associated with less permissive attitudes to suicide, whereas individualistic values with a more stigmatized view of suicidal behavior. Both individualistic and collectivistic values were associated with socially accepting attitudes to a suicidal peer, helping a suicidal friend, and emotional involvement. The associations of individualistic and collectivistic values with disapproving attitudes to suicidal disclosure were complex. Beliefs in punishment after death for suicide, seeing suicide as mental illness, and emotional involvement with a suicidal friend were lower in high-suicide-rate countries. These evidence patterns are discussed in the light of related research evidence, along with directions for future research in this area.

Do researchers have their heads in the clouds, bogged down with scientific medical detail? [art therapy maybe a simpler alternative

This art work depicts a woman with her head in the clouds. Researchers can at times have their heads in the clouds, bogged down in theoretical details related to medication options when art therapy may offer solutions with benefits outweighing that of medication. Not dissimilar to the idiom wood for the trees definition where someone doesn’t see the wood(s) made by the grouping of the trees, as they are concentrating on individual trees so can’t get a general understanding of a situation because they are concentrating on detail. People with diverse medical illnesses at times maybe shuffled to different GPs or specialists, prescribed medications, with variable likelihood of effectiveness or adverse event possibilities and hence outcomes maybe on a continuum of positive to negative. Clinical trials monitor objective and subjective outcomes over time. This scientific way of treating illness is generally accepted, but maybe over medicalized, complicated and burdensome with information overload, multiple prescriptions, forms, documents, appointments, time and cost commitments. Alternatively, people with mental health disorders [trauma], other psychological disorders, loss of memory, early dementia, or post stroke may benefit from art therapy and research evidence in relation to art therapy effectiveness in these realms mentioned report benefit.

Community forensic psychiatric services in England and Wales.

Forensic psychiatry is an established medical specialty in England and Wales. Although its origins lie in the 19th century, the development of secure hospitals accelerated in the late 20th century. Services for mentally disordered offenders in the community have developed most recently and it is these services, which are the focus of this article. We have looked broadly at community services and have included criminal justice liaison and diversion services in our remit. We have also considered partnerships between health and justice agencies as well as mental health and criminal legislation. We consider the limited research evidence in relation to community forensic services and the discussion this has provoked.

Expert consensus statement on Diemailing~® Kudiezi Injection in clinical practice

Diemailing~® Kudiezi Injection( DKI) is widely used in the treatment of cerebral infarction,coronary heart disease and angina pectoris. Long-term clinical application and related research evidence showed that DKI has a good effect in improving the clinical symptoms of cardiovascular and cerebrovascular diseases. However,this injection has not been included in any clinical practice guideline. It has been found that the use of DKI is in wrong way in clinical practice in recent years. Therefore,clinical experts from the field of cardiovascular and cerebrovascular diseases nationwide are invited to compile this expert consensus in order to guide clinicians.GRADE system is used to grade the quality of evidence according to different outcomes according to degrading factors. Then it forms the recommendation or consensus suggestion through the nominal group method. The formation of expert consensus mainly considers six factors: quality of evidence,economy,efficacy,adverse reactions,patient acceptability and others. Based on these six aspects,if the evidence is sufficient,a " recommendation" supported by evidence is formed,and GRADE grid voting rule is adopted. If the evidence is insufficient,a " consensus suggestions" will be formed,using the majority voting rule. In this consensus,the clinical indications,efficacy,safety evidences and related preliminary data of DKI were systematically and comprehensively summarized in a concise and clear format,which could provide valuable reference for the clinical use of DKI. This consensus has been approved by China association of Chinese medicine which is numbered GS/CACM 202-2019.

Using health psychology to help patients: theories of behaviour change.

Behaviour change theories and related research evidence highlight the complexity of making and sticking to health-related behaviour changes. These theories make explicit factors that influence behaviour change, such as health beliefs, past behaviour, intention, social influences, perceived control and the context of the behaviour. Nurses can use this information to understand why a particular patient may find making recommended health behaviour changes difficult and to determine factors that may help them. This article outlines five well-established theories of behaviour change: the health belief model, the theory of planned behaviour, the stages of change model, self-determination theory, and temporal self-regulation theory. The evidence for interventions that are informed by these theories is then explored and appraised. The extent and quality of evidence varies depending on the type of behaviour and patients targeted, but evidence from randomised controlled trials indicates that interventions informed by theory can result in behaviour change.

Engaging patients and families in communication across transitions ofcare: an integrative review protocol.

To describe an integrative review protocol to analyse and synthesize peer-reviewed research evidence in relation to engagement of patients and their families in communication during transitions of care to, in and from acute care settings. Communication at transitions of care in acute care settings can be complex and challenging, with important information about patients not always clearly transferred between responsible healthcare providers. Involving patients and their families in communication during transitions of care may improve the transfer of clinical information and patient outcomes and prevent adverse events during hospitalization and following discharge. Recently, optimizing patient and family participation during care transitions has been acknowledged as central to the implementation of patient-centred care. Integrative review with potential for meta-analysis and application of framework synthesis. The review will evaluate and synthesize qualitative and quantitative research evidence identified through a systematic search. Primary studies will be selected according to inclusion criteria. Data collection, quality appraisal and analysis of the evidence will be conducted by at least two authors. Nine electronic databases (including CINAHL and Medline) will be searched. The search will be restricted to 10years up to December 2013. Data analysis will include content and thematic analysis. The review will seek to identify all types of patient engagement activities employed during transitions of care communication. The review will identify enablers for and barriers to engagement for patients, families and health professionals. Key strategies and tools for improving patient engagement, clinical communication and promoting patient-centred care will be recommended based on findings.

Print media coverage of primary healthcare and related research evidence in South Africa.

BackgroundThe news media is located at the nexus of the public and policy agendas and provides a window into issues concerning the public. Therefore, it could be a powerful tool for advocating for citizens’ health and could help promote evidence-based primary health systems responsive to the needs of citizens. However, research on the coverage of primary healthcare and related research evidence in the South African print media is virtually non-existent.MethodsWe examined 2,077 news stories that covered primary healthcare from 25 South African newspapers retrieved from the Lexis-Nexis online archive over a 16-year period (1997–2012). We analysed basic characteristics and conducted a content analysis of the news stories.ResultsOf the 2,077 news stories that mentioned primary healthcare, this was the main focus in 8.3% (n = 173). Of these, 45.7% discussed issues relating to clinics, whereas issues relating to community health workers and nurses were covered by 42.8% and 34.1% of news stories, respectively. The number of news stories discussing infectious diseases (55.5%) was more than twice the number discussing non-communicable diseases (21.4%). HIV/AIDS/TB illness- and service-related issues were covered by 54.3% of news stories and social determinants of health by 22%. Issues relating to how healthcare is organised to deliver services to the people received substantial coverage in the print media, with 72.8% discussing delivery arrangements, 72.3% governance arrangements, and 55% financial arrangements. A small fraction of news stories (7.5%) discussed research studies but none discussed a systematic review.ConclusionOur study underscores the potential role of media analyses in illuminating patterns in print media coverage of health issues. It also shows that an understanding of coverage of health research evidence could help spur efforts to support the climate for evidence-informed health policymaking. Researchers in low- and middle-income countries need to be more proactive in making use of media analyses to help illuminate health related issues that require the attention of health policymakers, stakeholders and reporters, and to identify potential areas of research.Electronic supplementary materialThe online version of this article (doi:10.1186/s12961-015-0051-6) contains supplementary material, which is available to authorized users.

General Practitioners Views of Implementing a Stratified Treatment Approach for Low Back Pain in Germany: A Qualitative Study.

Background and ObjectiveThe STarT Back stratified primary care approach has demonstrated clinical and cost effectiveness in the UK, and is commonly used by General Practitioners (GPs). However, it remains unknown how this approach could be implemented into the German healthcare system. The aim of this study was therefore to explore the views and perceptions of German GPs in respect to using a stratified primary care for low back pain (LBP).MethodsA 90-minute think-tank workshop was conducted with 14 male and five female GPs, during which the STarT-Back-Screening-Tool (SBST) and related research evidence was presented. This was followed by two focus groups, based on a semi-structured interview guideline to identify potential implementation barriers and opportunities. Discussions were audiotaped, transcribed and coded using a content analysis approach.ResultsFor the three deductively developed main themes, 15 subthemes emerged: (1) application of the SBST, with the following subthemes: which health profession should administer it, patients known to the GP practice, the reason for the GP consultation, scoring the tool, the tool format, and the anticipated impact on GP practice; (2) psychologically informed physiotherapy, with subthemes including: provision by a physiotherapist, anticipated impact, the skills of physiotherapists, management of patients with severe psychosocial problems, referral and remuneration; (3) the management of low-risk patients, with subthemes including: concern about the appropriate advising health professional, information and media, length of consultation, and local exercise venues.ConclusionsThe attitudes of GPs towards stratified primary care for LBP indicated positive support for pilot-testing in Germany. However, there were mixed reactions to the ability of German physiotherapists to manage high-risk patients and handle their complex clinical needs. GPs also mentioned practical difficulties in providing extended advice to low-risk patients, which nevertheless could be addressed by involvement of specifically trained medical assistants.

A24 Genetic Counselling

“Genetic counselling is the process of helping people understand and adapt to the medical, psychological and familial implications of genetic contributions to disease” (NSGC, 2006). In the 20 years since the discovery of the HD gene, guidelines for predictive testing in Huntington’s disease have become a model for genetic counselling across a wide range of inherited conditions. Experience has shown that while many individuals wish to know their genetic status, far fewer actually undergo testing. The predictive testing guidance has been updated in recent years to reflect changes in clinical practice over time and are designed to act as a framework of recommended procedures, rather than regulations, to reflect the uniqueness of each individual wishing to discuss their risk of HD. In this interactive case-based workshop we will consider how genetic counselling for HD can be tailored to meet the needs of the individual and their family. We will look at some of the more challenging genetic counselling situations, such as non-disclosure of genetic information to children at risk of HD, and dealing with the problems of denial of symptom onset where this is causing problems at work or in the home. Research evidence in relation to the provision of genetic counselling services will be highlighted and suggestions made for areas where practice may be enhanced for the benefit of family members.

Acupuncture and women's health: an overview of the role of acupuncture and its clinical management in women's reproductive health

BackgroundAcupuncture and other modalities of Chinese/East Asian medicine have been used to treat women’s health for many centuries. Gynecology specialties focus particularly on menstrual and reproductive disorders. Both the adoption of the use of acupuncture outside Asia, and the incorporation of scientific analysis in Asia have challenged biomedical conceptions of what can be achieved with this treatment method. The scale of research activity in relation to acupuncture and women’s health has increased over the last 20 years.ObjectiveThis review aims to explore the research evidence in relation to acupuncture use for women’s reproductive disorders, focusing on both clinical findings and experimental research on acupuncture’s mechanisms of action in relation to women’s health.MethodsA narrative literature search was undertaken using searches of electronic databases and manual searches of journals and textbooks. The search included all literature published prior to June 2013. The literature was assessed as to the nature of the study it was reporting and findings synthesized into a commentary.ResultsFor acupuncture’s mechanism of action the search resulted in 114 relevant documents; in relation to clinical reports on the use of acupuncture for women’s health 204 documents were found and assessed.ConclusionThere is preliminary data indicating acupuncture may improve menstrual health and coping for women experiencing delays falling pregnant. There is experimental data showing that acupuncture can influence female reproductive functioning, although the actual mechanisms involved are not yet clarified. Further well-conducted clinical research would benefit our understanding of the usefulness of acupuncture to women’s health.

Anxiety Disorders in Children With Learning Disabilities (LD) and Autism (ASD)

Purpose: Children and young people with learning disabilities (LD) and autism are more prone to experience mental health problems compared to people with LD but without autism. Children and young people with LD and autism may experience symptoms of anxiety at a greater level than the general population; howe ver, this is not supported with research evidence in relation to the prevalence of anxiety in people with ID and autism. The increasing number of individuals with Learning Disabilities (LD) and psychiatric disorders presents a key challenge to their assessment and treatment in mental health services. Children and young people with LD are more likely to experience mental health than the general population (FPLD, 2002; Emerson, 2003; Allington - Smith, 2006). Epidemiological studies suggest that autism is more frequent in people with LD, nearly 40% of people with LD also have autism (Bouras et al., 1999; Kraijer, 1997) on the other hand, nearly 70% of people with autism also have LD (La Mafa, 2004) The strong association between autism and LD (Bradley et al, 2004) also associates an increased risk of mental health problems (Morgan et al., 2003). Method: This article provides an overview of the clinical implications of anxiety disorders within the context of learning disability and autismFindings: It is suggested that children and young people with LD and autism spectrum disorder may experience symptoms of anxiety at a greater level than the general population; however, this requires more conclusive evidence in relation to the prevalence of anxiety disorders in people with LD and autism. There is a close relationship between autism spectrum disorder and learning disability. The presence of anxiety in individuals with LD and autism has rarely been studied and is the focus of this study.

Differential Correlations of Digit Ratio (2D:4D) with Aggressive Dominance and Sociable Dominance Are Not Demonstrated: Commentary on van der Meij, Almela, Buunk, Dubbs, and Salvador (2012, Aggressive Behavior, 38(3), 208–212)

Van der Meij, Almela, Buunk, Dubbs, and Salvador reported that, among young men (N = 84), a putative biomarker for prenatal androgen exposure (second-to-fourth digit ratio; 2D:4D) correlated negatively to self-reported aggressive dominance, but not to sociable dominance. A critical examination of this allegedly differential effect shows it to be unsupported and unlikely to be replicable. Statistical power of the sample was so low that the nominally significant correlation coefficient with aggressive dominance and the nominally not significant one with sociable dominance actually did not differ significantly from each other. Apart from these data-analytic and statistical power issues, a number of further substantive comments are raised, including conceptual and study design issues, 2D:4D measurement and reliability issues, and biased presentation (i.e. selective citation) of prior related research evidence. More generally, it is suggested that 2D:4D research would benefit from adopting publishing standards requiring discovery and replication samples (i.e. successful replication of novel findings by the initial researchers themselves), as is now increasingly required for publishing in various fields of inconsistent, hard-to-replicate evidence.

Comparison of Task Performance, Hand Power, and Dexterity with and without a Cock-up Splint

[Purpose] The purpose of this study was to investigate the difference in task performance, grip and pinch strength, and dexterity with and without cock-up splints, which are widely used in occupational therapy practice. [Methods] Twenty-three participants performed Jebsen-Taylor hand function test and grooved pegboard for task performance and dexterity. The power grip and pinch strength was measured using Jamar hydraulic hand dynamometer and pinch gauge. [Results] In the result of the Jebsen-Taylor hand function test, task performance with the cock-up splint was slower compared to without the splint for all items. Men’s grip power with the cock-up splint was found to be significantly decreased compared to without the splint. Women’s grip and palmar pinch strength with the splint decreased significantly compared to without the splint. In the grooved pegboard test, the dexterity of both men and women with the cock-up splint decreased significantly compared to without the splint. [Conclusion] To assist patients to make wise decisions regarding the use of splints, occupational therapists must have empirical knowledge of the topic as well as an understanding of the theoretical, technical, and related research evidence. The results of this study will be useful in the analysis and understanding of changes in hand function in splint applications for people with hand dysfunction.

Prevalence of anxiety disorder in children and young people with intellectual disabilities and autism

Purpose – Children and young people with co‐morbid intellectual disabilities and autism are more prone to experience mental health problems compared to people with intellectual disabilities but without autism. Children and young people with intellectual disabilities and autism may experience symptoms of anxiety at a greater level than the general population; however, this is not supported with research evidence in relation to the prevalence of anxiety in people with intellectual disabilities and autism. The aim of this study is to identify the prevalence of anxiety disorders in children and young people with intellectual disabilities and autism.Design/methodology/approach – In total, 150 children and young people (age range of 5‐18 years) from a metropolitan district in the North of England were screened for anxiety using the Reiss Scales for Children's Dual Diagnosis and the Glasgow Anxiety Scale.Findings – The results indicate that the prevalence of anxiety was 32.6 per cent for children and young peopl...

SUPPORT Tools for evidence-informed health Policymaking (STP)

This article is the Introduction to a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers.Knowing how to find and use research evidence can help policymakers and those who support them to do their jobs better and more efficiently. Each article in this series presents a proposed tool that can be used by those involved in finding and using research evidence to support evidence-informed health policymaking. The series addresses four broad areas: 1. Supporting evidence-informed policymaking 2. Identifying needs for research evidence in relation to three steps in policymaking processes, namely problem clarification, options framing, and implementation planning 3. Finding and assessing both systematic reviews and other types of evidence to inform these steps, and 4. Going from research evidence to decisions. Each article begins with between one and three typical scenarios relating to the topic. These scenarios are designed to help readers decide on the level of detail relevant to them when applying the tools described. Most articles in this series are structured using a set of questions that guide readers through the proposed tools and show how to undertake activities to support evidence-informed policymaking efficiently and effectively. These activities include, for example, using research evidence to clarify problems, assessing the applicability of the findings of a systematic review about the effects of options selected to address problems, organising and using policy dialogues to support evidence-informed policymaking, and planning policy monitoring and evaluation. In several articles, the set of questions presented offers more general guidance on how to support evidence-informed policymaking. Additional information resources are listed and described in every article. The evaluation of ways to support evidence-informed health policymaking is a developing field and feedback about how to improve the series is welcome.

Accounting for Liabilities: Conceptual Issues, Standard Setting, and Evidence from Academic Research

In this paper, we summarize conceptual issues that arise in the definition, recognition, derecognition, classification, and measurement of liabilities. We also highlight problems in existing accounting standards for liabilities and identify opportunities to refine those standards. Where relevant, we describe evidence from empirical accounting research involving liabilities and identify opportunities for future research. Our objective is to highlight the inconsistencies and controversies surrounding existing accounting standards for liabilities, and to describe the research evidence that provides insights into accounting for liabilities. A better understanding of the current problems in accounting for liabilities and the related research evidence should help standard setters and their constituents in their attempts to improve GAAP, and should stimulate future academic research to shed new light on accounting for liabilities.

Promoting environmentally sustainable attitudes and behaviour through free‐choice learning experiences: what is the state of the game?

Environmental education, both in and outside of the classroom, aims to facilitate adoption of sustainable practice by both school students and the general public. This paper explores the role of free‐choice learning experiences in this regard. An overview of theoretical approaches underpinning free‐choice learning research is provided, examples are presented of the ways in which informal educational settings can promote environmentally sustainable attitudes and behaviour, and the factors contributing to the effectiveness of these endeavours are discussed. By reviewing research evidence in relation to these issues, the paper identifies the current ‘state of the game’ and areas where new research is needed.