Taster Sessions Research Articles

The impact of physical activity taster sessions on barriers and facilitators to long-term physical activity behaviour

Epidemiological evidence suggests that physical activity (PA) can improve the health, physical function and the quality of life of older adults. Several modes of PA have been highlighted as particularly beneficial for these outcomes, but the challenges of engaging and sustaining participation limit their effectiveness. Therefore, the aim of this study was to determine barriers and opinions to regularly engaging in different types of PA using taster sessions to provide recommendations on how to engage and sustain PA behaviour in older adults. A multi-phase, mixed-method study design on 12 older adults was used to gain insight into older adult's perceptions of five types of PA (two sports, resistance exercise, exergaming, yoga and home-based exercise). Perceptions of these types of PA were collected pre-taster sessions and were re-evaluated after all taster sessions using questionnaires and focus groups. Triangulation of data revealed that in general, all PA types were enjoyed, but yoga was least popular. Pre-taster sessions, home-based exercise and resistance exercise were most popular whereas following the taster sessions, preferences were for exergaming, resistance exercise and sports. Our data highlights the effective utility of taster sessions and combined with other literature; we present several key recommendations to help to improve engagement in long-term PA behaviour in various PA types. These include ensuring adequate social interaction between similarly aged and ability capable older adults during PA. Having appropriate supervisors, and advertising and facilitating PA opportunities, considering the needs of individuals, providing motivational strategies and providing continued accountability.

P036 Missing vital steps: why does my rheumatology team never speak to me about exercise?

Abstract Background/Aims UK Rheumatology services are stretched. Rollout of Patient Initiated Follow Up and pressure on job plans/clinic templates mean people with inflammatory arthritis (IA) may spend less time with their rheumatology team. An important but insufficient aspect of care in people with IA is empowering them to acquire good understanding of their disease and building their ability to deal effectively with the practical, physical and psychological impacts of it. Ability to self-manage in IA represents an essential component of care beyond drug therapy, but barriers to implementation of education in self-management exist. Surveys show that rheumatology Healthcare Practitioners (HCPs) don’t know how best to support patients becoming more physically active. Research demonstrates that people with IA have multiple barriers to undertaking regular physical activity (PA) or exercise, including physical limitations, reduced mobility, fatigue, also lack of confidence and not knowing what to do, fear of embarrassment, injury or making symptoms worse, a lack of professional input, advice and resources, inaccessible facilities and financial costs. Methods To address these issues in those living with IA, the National Rheumatoid Arthritis Society (NRAS) collaborated with experts in PA and exercise to create a module on this topic to include in their e-Learning programme, SMILE-RA. The module included: • science behind the research in lay terms • role of physiotherapists (both specialist rheumatology physios and community-based physios) • barriers and facilitators to exercising • goal setting • types of exercise • stories from people with RA inspired by exercise NRAS wanted to provide free resources for people to use who may struggle with exercise due to loss of mobility/function who may lack confidence to exercise. In addition to the online learning, NRAS approached experts in different exercise and PA fields, some of whom had RA themselves, to provide supplemental 15-minute video sessions to run alongside the module. Results The Module launched end of June 2023 with five 15 minute ‘taster’ videos on different forms of exercise appropriately adapted for a broad spectrum of people with IA. These taster sessions can be done safely, seated or standing, and used as ad hoc routines or as regular daily workout, increasing the repetitions as strength and ability increases. Over 3,500 people are registered to SMILE-RA, and, amongst other beneficial results, a survey has shown that 84% of users would recommend SMILE to another person. An HCP, in recommending this resource to colleagues, stated that this exercise module “will revolutionise your consults on exercise in RA.” Conclusion The “PA and Exercise” module can be used to support busy rheumatology professionals by recommending this free resource to their patients and in educating themselves to gain confidence in how to advise patients in this crucial and often overlooked area. Disclosure A.M. Bosworth: None. W.J. Gregory: Honoraria; W.G. has received honoraria for speakers and advisory board roles from Abbive, Novartis, Pfizer and UCB.

Supporting physical activity through co-production in people with severe mental ill health (SPACES): protocol for a randomised controlled feasibility trial

BackgroundSevere mental ill health (SMI) includes schizophrenia, bipolar disorder and schizoaffective disorder and is associated with premature deaths when compared to people without SMI. Over 70% of those deaths are attributed to preventable health conditions, which have the potential to be positively affected by the adoption of healthy behaviours, such as physical activity. People with SMI are generally less active than those without and face unique barriers to being physically active. Physical activity interventions for those with SMI demonstrate promise, however, there are important questions remaining about the potential feasibility and acceptability of a physical activity intervention embedded within existing NHS pathways.MethodThis is a two-arm multi-site randomised controlled feasibility trial, assessing the feasibility and acceptability of a co-produced physical activity intervention for a full-scale trial across geographically dispersed NHS mental health trusts in England. Participants will be randomly allocated via block, 1:1 randomisation, into either the intervention arm or the usual care arm. The usual care arm will continue to receive usual care throughout the trial, whilst the intervention arm will receive usual care plus the offer of a weekly, 18-week, physical activity intervention comprising walking and indoor activity sessions and community taster sessions. Another main component of the intervention includes one-to-one support. The primary outcome is to investigate the feasibility and acceptability of the intervention and to scale it up to a full-scale trial, using a short proforma provided to all intervention participants at follow-up, qualitative interviews with approximately 15 intervention participants and 5 interventions delivery staff, and data on intervention uptake, attendance, and attrition. Usual care data will also include recruitment and follow-up retention. Secondary outcome measures include physical activity and sedentary behaviours, body mass index, depression, anxiety, health-related quality of life, healthcare resource use, and adverse events. Outcome measures will be taken at baseline, three, and six-months post randomisation.DiscussionThis study will determine if the physical activity intervention is feasible and acceptable to both participants receiving the intervention and NHS staff who deliver it. Results will inform the design of a larger randomised controlled trial assessing the clinical and cost effectiveness of the intervention.Trial registrationISRCTN: ISRCTN83877229. Registered on 09.09.2022.

"I'm Hooked on e-cycling, I Can Finally Be Active Again": Perceptions of e-cycling as a Physical Activity Intervention during Breast Cancer Treatment.

Electrically-assisted bicycles (e-bikes) are a means through which to increase individual physical activity (PA) and overcome some commonly reported barriers to engaging in conventional cycling. Fatigue is a common side effect to breast cancer treatment, and the rate of PA engagement drops significantly following a breast cancer diagnosis. The aim of this qualitative study was to examine perceptions of e-cycling as a means of increasing PA in this population. Twenty-four participants (mean age = 57.88 (standard deviation 10.8), 100% female) who have had a breast cancer diagnosis, completed two semi-structured interviews via Zoom. One interview was conducted prior to an e-bike taster session and a second, after the session. Taster sessions were conducted by certified cycling instructors in the community. Interviews were conducted between December 2021 and May 2022. Data were transcribed verbatim and analyzed thematically using NVivo 12 software. An inductive and deductive approach to analysis was adopted. Five themes were generated: (1) Perceived role of e-bikes during treatment, (2) The relationship between e-bikes and fatigue, (3) Cancer-specific considerations, (4) Is e-cycling 'enough'?, and (5) Optimizing the intervention. Negative perceptions of e-bikes noted before the taster session were altered following riding an e-bike. The multiple levels of assistance made cycling manageable and less impacted by fatigue, thereby enabling individuals to re-establish previous cycling habits. E-cycling may be a suitable option to increase PA behavior amongst individuals being treated for breast cancer, with the potential to overcome many of the barriers of conventional cycling. Enabling this population to trial an e-bike elicits positive physical and psychological responses that may help to promote future engagement.

The HEADS: UP Development Study: Working with Key Stakeholders to Adapt a Mindfulness-Based Stress Reduction Course for People with Anxiety and Depression after Stroke.

Following stroke, rates of mood disorder are and remain high at five years (anxiety 34.4%; depression 23%). Structured mindfulness-based stress reduction (MBSR) courses are effective in a range of health conditions, but stroke survivors find adherence challenging. We aimed to adapt a standard MBSR course specifically for people affected by stroke. We recruited stroke survivors and family members with symptoms of anxiety and/or depression to take part in a co-development study comprising two rounds of MBSR 'taster' sessions, followed by focus groups in which views were sought on the practices sampled. Data were collected in October 2017 and May 2018 and were analysed using framework analysis, informed adaptations to mindfulness materials and delivery. Twenty-eight stroke survivors and seven family members participated. Nineteen (76%) stroke survivors had anxiety; 15 (60%) had depression. Five (71.4%) family members reported anxiety; n = 4 (57.1%) depression. Thirty participants attended the first round of taster sessions and focus groups; twenty (66%) the second and three (10%) were unable to attend either round. Framework analysis informed adaptations to course delivery, practices, and materials, ultimately resulting in a stroke-specific MBSR course, HEADS: UP (Helping Ease Anxiety and Depression after Stroke). HEADS: UP may provide a feasible, appropriate, and meaningful self-management intervention to help alleviate symptoms of mood disorder.

Leveraging the London 2012 Paralympic Games to increase sports participation: the role of voluntary sports clubs

ABSTRACT Purpose This study investigates the extent to which English voluntary sports clubs leveraged the London 2012 Paralympic Games, and what impact leveraging had on the sports participation of people with disabilities (PwD) at clubs. Research methods Realist evaluation was used to frame the research. An online questionnaire was administered to English clubs between 27 January 2018 and 8 April 2018. Four hundred and thirty-three clubs were included in the final analysis. Findings Most clubs did not leverage the London 2012 Paralympics. Clubs that leveraged were more likely to have increased their PwD membership. Holding taster sessions was the most effective leveraging activity. Principal components analysis revealed two leveraging constraints: knowledge of disability, and resources to leverage. A one-way MANOVA revealed clubs from inclusively funded national governing bodies were more likely to be constrained by their limited knowledge of disability. Implications This study suggests specific disability provision at clubs was important to the successful leveraging of the 2012 Paralympics for increased sport participation of PwD. The intention and capacity of the club to support leveraging were also important factors. Research contribution This study produces empirical data on the role and effectiveness of clubs as sites for sport participation for PwD following the Paralympic Games.

Self-Care for Family Carers: Can the Alexander Technique help?

Background and purposeCaring for a family member who is living with dementia can be incredibly challenging. Interventions to support family carers are vital and so carers should be supported to care for themselves and to maintain their own sense of self. The aim of this exploratory study was to explore the views of carers on the potential value of developing an Alexander Technique intervention for family carers of people with dementia. Materials and methodsWe delivered a one-off taster session of the Alexander Technique to family carers of people with dementia. Eight carers of people with dementia attended the group session led by two registered Alexander teachers. Post-session questionnaires examined carers’ thoughts on the content, context, and process of learning the Alexander technique. A focus group at the end of the session asked participants to provide feedback on their experience and the perceived benefits for carers. ResultsCarers’ satisfaction with the session was high and they reported benefitting from it. Participants appreciated having time for themselves in which they were able to stop to enjoy a moment of calm. They felt they could use the ideas they gained from the session in everyday life. The use of touch in the sessions was also valued by carers. ConclusionThis study provides preliminary evidence that the Alexander Technique has the potential to increase carers’ ability to self-care and to support them in their caring. In so doing it has the potential to indirectly help those they care for.

Digital frontiers in international psychiatric recruitment: the lessons of the Northwest School of Psychiatry careers event November 2020

AimsA low level of psychiatric recruitment is a global issue[1]. The RCPsych & UK Mental Health Trusts jointly run School Events as part of a recruitment strategy. The North West has been running such events for the past years. After our first virtual event, we compare the quality, effectiveness and experience of a face-to-face (F2F) recruitment programme in 2018 with our first remote recruitment programme in 2020. In a world of fast paced technology, we reflect on what lies in the horizon for international psychiatric recruitment.MethodThe recruitment programme was organised by 4 psychiatric trainees affiliated to each mental health trust. A two-day remote programme on the Zoom platform comprising of 45-minute slots was created. Through their own experiences of inspirational speakers, trainees contacted speakers representing different specialities, teaching styles and philosophical outlooks.Pre and Post Programme questionnaires and certificates of attendance were shared with speakers and attendees. These were compared with Pre and Post Programme questionnaires from the F2F event in 2018.ResultWhen compared to the 2018 F2F programme, the 2020 virtual recruitment programme attracted a higher number and wider variety of applicants, in gender (62% female/38%male), nationality (UK 79%/Non-UK 22%), as well as wider distribution in age, UK deanery and training position. Despite the elimination of cost, the quality of teaching was rated higher than F2F due to the availability of high quality speakers (100% would recommend to a friend; 72% rated excellent). Whilst the programme was effective in changing minds, this did not exceed F2F recruitment rates. F2F recruitment feedback focussed on inclusion of sub-specialities, whereas virtual programme feedback focussed on ways to enhance interaction. Feedback focussed on technological applications such as interactive quizzes, breakout rooms, play-acting, and having the benefit of clinical vignettes or speakers’ personal stories to bring talks to life.ConclusionThe use of remote technology transcended geographical and demographic frontiers. A variety of high-quality speakers, directly appealing to an international cohort were sourced, at no monetary cost. In future, the budget will be used in interactive applications, and time-limited session recordings. As the participants hungered for personal connections, we recommend a blended programme, with links to taster sessions, retaining the advantages of both strategies.

How do you know what you want? Service user views on decision aids for the arts therapies

Service user preferences should be integrated into mental healthcare wherever possible, and providing information about the treatments on offer is essential for informed choice. Methods of presenting information about the arts therapies require consideration. This study sought to obtain service user opinions on three decision aids designed for the arts therapies.Five focus group workshops totalling 20 participants were conducted with service users in community mental health services. They were shown three decision aids for the arts therapies: leaflets, videos and taster sessions. Discussions were recorded, transcribed and analysed using framework analysis.Four themes were developed: Previous experiences of the arts shaped discussions; Aims of treatment are essential information; There were different expectations of each decision aid; The decision aids offered an evolving understanding of the art form in the workshops.These results imply that service users’ previous experiences and expectations of the arts must be understood by clinicians when engaging in decision-making about treatment. Service users wanted to know explicit aims and goals of the arts therapies in all three decision aids. All decision aids were useful in different ways, therefore timing in the decision making process and physical location of the aids are worth considering.

Formative research to develop a school-based, community-linked physical activity role model programme for girls: CHoosing Active Role Models to INspire Girls (CHARMING)

BackgroundPhysical inactivity is a persistent challenge among girls. School-based physical activity (PA) interventions have shown mixed effects on girl’s activity levels, with multi-component approaches involving both school and community links appearing more effective for sustainable change. The purpose of the current research was to gather views from preadolescent girls, parents, teachers and stakeholders in order to co-produce a multi-component school-based, community linked PA intervention programme.MethodsFocus groups were conducted in two primary schools with 34 girls aged 9–11 years and 11 parents (10 female, 1 male). In-depth interviews were conducted with four female teachers (including two head teachers). Focus groups and interviews focused on programme design (structure, content and delivery) and potential factors affecting intervention uptake and continued PA participation. A series of stakeholder engagement events occurred throughout the study period. All data were transcribed verbatim and thematically analysed in NVivo 11.ResultsGirls reported that fun taster sessions delivered by role models would encourage them to participate in a school-based role model programme, with tailored taster sessions each week to enhance continued PA participation. Parents and teachers identified a number of barriers to uptake and continued PA participation, and active involvement of stakeholders facilitated the development of intervention strategies. Strategies included; single-sex after-school sessions, use of female role models, low-cost activity options and mapping community provision. Analyses revealed the importance of tailoring the programme to align with local needs, demands and provision.ConclusionsData show numerous barriers to intervention uptake and continued PA participation when designing a school-based, community-linked intervention. Adopting a co-production approach, this formative work highlights a number of potential strategies for overcoming these barriers. Findings from the research directed the development and implementation of the CHARMING role model intervention and informed the creation of an intervention logic model.

223. A Quality Improvement Project Aimed At Integrating An Adapted Mindfulness Based Stress Reduction (MBSR-AH) Programme Into A Paediatric Psychology Service

This project used quality improvement methods to pilot the introduction of mindfulness-based stress reduction (MBSR) groups to a clinical psychology service for young people aged between 15 and 19. Quality improvement methods were used and three "Plan, Do, Study, Act” (PDSA) cycles were deployed, utilising both data on uptake and adherence together with qualitative feedback at each cycle to plan the next stage. Step 1: Taster sessions, designed to include didactic information about mindfulness, provide the opportunity for participants to experience some short meditations and also experience being in a group situation. Step 2: MBSR groups of 4 weeks in duration were rolled out into the service. A priori targets for uptake and adherence were set at 50% (i.e. at least 50% of people approached would take up the offer of joining the group and at least 50% should complete at least 75% of the sessions). Step 3: The development of MBSR-AH, an adapted MBSR programme specifically for adolescents. This was modelled on the traditional MBSR programme with adaptations to the session format, meditations used and an adolescent friendly manual was also developed. Step 1: Uptake was good and 18/25 (72%) of people referred attended the sessions. Qualitative feedback indicated that this was indeed an approach that could be acceptable to young people. Step 2: Uptake and treatment adherence were 65% (17/26) and 82% (14/17) respectively. This compared well against our a priori targets of 50% for both. Qualitative feedback indicated that these four week courses were too short and therefore we aimed to introduce a group programme of 8 weeks in duration, in line with the standard MBSR format, adapted for adolescents. Step 3: For practical reasons it was not possible to run 8 weeks courses and therefore courses of lasting 7 weeks took place. Uptake of the extended groups fell short of target at 35 % (8/22), although treatment adherence remained high with the majority of participants (6/8) completing at least 75% of the course. A mindfulness based stress reduction programme does appear to be faesible and acceptable to young people with chronic health problems. In this pilot the traditional MBSR programme has been adapted to be more adolescent friendly and these adaptations are described. The traditional 8 week course format posed some recruitment challenges and methods to address this are discussed.

Mentoring for urologists

Trainee and established urologists are familiar with ‘generic mentoring’ as a potpourri of helping aids that include supervision, coaching, buddying, career advice, counselling and patronage to enable mentees to develop professionally. However, most are unfamiliar with ‘developmental mentoring’ as a highly specific learnt technique through which mentors help mentees, by interactive dialogue, to choose their own agendas and arrive at their own solutions to career/professional/personal opportunities or difficulties as distinct from the paternalistic mentor approach typified by the downward flow of information generated by ‘generic mentoring’. This paper is a systematic review of developmental mentoring as pertains to urologists in the UK, and reports outcomes of 1-hour taster sessions between Egan-trained mentors and urologists offered at British Association of Urological Surgeons (BAUS) annual general meetings since 2013. Both the General Medical Council and the Royal College of Surgeons of England imply that ‘mentoring’ is mandatory for both trainees and trained urologists, but fail to clarify what they mean by a ‘mentor’, which potentially creates a void in providing ‘developmental mentoring’ since the later requires specific training and is costly to provide. Currently, most ‘developmental mentoring’ is performed by trained staff in Local Education and Training Boards or National Health Service Trusts. BAUS has an opportunity to offer ‘developmental mentoring’ through a portal on its website to manage opportunities and difficulties experienced by its members. Level of evidence: This paper is a systematic review as pertains to the place of mentoring in current urological practice. By its nature, it has reviewed previous narrative reviews and its highest level of evidence is a contemporary paper from 2016, which was a comparative cross-sectional study; other case series were reviewed. Overall, this amounts to level 4 with a recommendation of C as per the Oxford Centre for Evidence-based Medicine Levels of Evidence.

Acceptability of mindfulness from the perspective of stroke survivors and caregivers: a qualitative study

BackgroundDepression is very common among stroke survivors with estimated prevalence rates of approximately 33% among stroke survivors, but treatment options are limited. Mindfulness-Based Stress Reduction (MBSR) is an effective treatment for depression generally, but benefits in stroke patients are unclear. The aim of this study was to determine the feasibility of delivering MBSR to stroke survivors and their caregivers in the community. We conducted a study to gain views of MBSR as a potential treatment option among stroke survivors and their caregivers in the community.MethodsParticipants were recruited from an urban community in Scotland (UK) using newspaper adverts, social media and support groups run by health charities. A 2-h MBSR taster session was delivered by two experienced mindfulness instructors, followed by focus group sessions with all participants on their user experience and suggestions for MBSR modifications for stroke survivors. The focus group sessions were audio recorded and transcribed verbatim. Transcript data were analysed thematically using the framework approach.ResultsThe study sample consisted of 28 participants (16 females); there were 21 stroke survivors (11 females) and 7 caregivers (5 females). The median age for participants was 60 years.Most participants described the MBSR taster session as a positive experience. The main challenge reported was trying to maintain focus and concentration throughout the MBSR session. Some participants expressed reservations about the duration of standard mindfulness course sessions, suggesting a preference for shorter sessions. The potential for achieving better control over negative thoughts and emotions was viewed as a potential facilitator for future MBSR participation. Participants suggested having an orientation session prior to starting an 8-week course as a means of developing familiarity with the MBSR instructor and other participants.ConclusionIt was feasible to recruit 21 stroke survivors and 7 caregivers for MBSR taster sessions in the community. A shorter MBSR session and an orientation session prior to the full course are suggestions for potential MBSR modifications for stroke survivors, which needs further research and evaluation.

Cost-effectiveness of personal tailored risk information and taster sessions to increase the uptake of the NHS stop smoking services: the Start2quit randomized controlled trial.

AimsTo assess the cost‐effectiveness of a two‐component intervention designed to increase attendance at the NHS Stop Smoking Services (SSSs) in England.DesignCost‐effectiveness analysis alongside a randomized controlled trial (Start2quit).SettingNHS SSS and general practices in England.ParticipantsThe study comprised 4384 smokers aged 16 years or more identified from medical records in 99 participating practices, who were motivated to quit and had not attended the SSS in the previous 12 months.Intervention and comparatorIntervention was a personalized and tailored letter sent from the general practitioner (GP) and a personal invitation and appointment to attend a taster session providing information about SSS. Control was a standard generic letter from the GP advertising SSS and asking smokers to contact the service to make an appointment.MeasurementsCosts measured from an NHS/personal social services perspective, estimated health gains in quality‐adjusted life‐years (QALYs) measured with EQ‐5D and incremental cost per QALY gained during both 6 months and a life‐time horizon.FindingsDuring the trial period, the adjusted mean difference in costs was £92 [95% confidence interval (CI) = –£32 to –£216) and the adjusted mean difference in QALY gains was 0.002 (95% CI = –0.001 to 0.004). This generates an incremental cost per QALY gained of £59 401. The probability that the tailored letter and taster session is more cost‐effective than the generic letter at 6 months is never above 50%. In contrast, the discounted life‐time health‐care cost was lower in the intervention group, while the life‐time QALY gains were significantly higher. The probability that the intervention is more cost‐effective is more than 83% using a £20 000–30 000 per QALY‐gained decision‐making threshold.ConclusionsAn intervention designed to increase attendance at the NHS Stop Smoking Services (tailored letter and taster session in the services) appears less likely to be cost‐effective than a generic letter in the short term, but is likely to become more cost‐effective than the generic letter during the long term.

The Barriers to Uptake of Diabetes Education study

BackgroundStructured therapeutic education courses transfer clinical knowledge to empower people to self-manage long-term conditions. Type 1 diabetes requires multiple daily decisions about self-management to maintain glycaemic control and avoid complications. Despite national recommendations, attendance at high-quality courses run by the National Health Service (NHS) is poor. We aimed to understand reasons for poor attendance by examining the pathway from commissioner to service-user in an adult population in south London, UK, in the Barriers to Uptake of Diabetes Education study. MethodsThere were three parts to this mixed-methods study using exploratory sequential design with quantitative dominance. Adults with, or providing care for people with, type 1 diabetes, in two London boroughs were included. In part 1, we compared attenders with non-attenders of courses as recorded in an NHS service-use database. In part 2, a survey of adults with type 1 diabetes and semi-structured interviews were done, and a provider survey was conducted. Focus groups were conducted in part 3. Analysis included exploratory regression models, thematic analysis of interviews, and quantisising data using a mixed methods matrix. FindingsIn part 1, 303 (27%) of 1121 adults were attenders. In univariate analysis, non-attendance was significantly associated with social determinants of health. In part 2 (n=496, 33% response rate), there were 233 non-attenders (47%), 59 (31%) of whom had not heard of the course. Univariate analysis corroborated part 1 findings, with significant differences (all p<0·05) in attendance according to employment status, ethnic origin, and other socioeconomic factors. Exploratory regression analysis identified four key variables associated with attendance: a positive health-care professional message (odds ratio for positive vs negative message 2·77, 95% CI 1·54–5·01; p=0·001), female sex (0·56, 0·36–0·86; p=0·009), educational attainment (university vs secondary school attainment 0·49, 0·3–0·81; p=0·005), and glycaemic control (glycated haemoglobin <7·5% vs 7·5–8·9%; 1·83 1·06–3·14; p=0·03). Four typologies were identified according to individuals' coping strategies: go-getters (high educational attainment, high thirst for knowledge, and internal locus of control leading to self-education and perceived low benefit from the course); not yetters (long-standing diagnosis, previous or current judgmental relationships, unable to prioritise attendance); trodden downers (low numeracy, low self-worth, nervousness of taking control); and diabetes downers (denial of diabetes or avoidant behaviour making it difficult to self-manage). These typologies were integrated with the patient survey to quantify barriers. In part 3 (five focus groups) potential solutions were proposed, such as modular or blended learning options and taster sessions for both health-care professionals and patients. InterpretationSocial determinants of health such as educational attainment, employment status, and gender influence attendance at structured education, but health-care professional attitude to courses is key. Identifying and quantifying typologies on the basis of psychological constructs supports recommendations for service redesign—eg, patient champions, motivational interviewing, and clear clinical pathways integrating education courses. The results are generalisable to other long-term conditions, although our study is limited by response bias. FundingNational Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, South London.

Effectiveness of personalised risk information and taster sessions to increase the uptake of smoking cessation services (Start2quit): a randomised controlled trial

SummaryBackgroundNational Health Service Stop Smoking Services (SSSs) offer help to smokers motivated to quit; however, attendance rates are low and recent figures show a downward trend. We aimed to assess the effectiveness of a two-component personalised intervention on attendance at SSSs.MethodsWe did this randomised controlled trial in 18 SSSs in England. Current smokers (aged ≥16 years) were identified from medical records in 99 general practices and invited to participate by their general practitioner. Individuals who gave consent, were motivated to quit, and had not attended the SSS within the past 12 months, were randomly assigned (3:2), via computer-generated randomisation with permuted blocks (block size of five), to receive either an individually tailored risk letter and invitation to attend a no-commitment introductory session run by the local SSS (intervention group) or a standard generic letter advertising the local SSS (control group). Randomisation was stratified by sex. Masking of participants to receipt of a personal letter and invitation to a taster session was not possible. The personal letter was generated by a research assistant, but the remainder of the research team were masked to group allocation. General practitioners, practice staff, and SSS advisers were unaware of their patients' allocation. The primary outcome was attendance at the first session of an SSS course within 6 months from randomisation. We did analysis by intention to treat. This trial is registered with Current Controlled Trials, number ISRCTN 76561916.FindingsRecruitment, collection of baseline data, delivery of the intervention, and follow up of participants took place between Jan 31, 2011, and July 12, 2014. We randomly assigned 4384 smokers to the intervention group (n=2636) or the control group (n=1748); 4383 participants comprised the intention-to-treat population. Attendance at the first session of an SSS course was significantly higher in the intervention group than in the control group (458 [17·4%] vs 158 [9·0%] participants; unadjusted odds ratio 2·12 [95% CI 1·75–2·57]; p<0·0001).InterpretationDelivery of personalised risk information alongside an invitation to an introductory session more than doubled the odds of attending the SSS compared with a standard generic invitation to contact the service. This result suggests that a more proactive approach, combined with an opportunity to experience local services, can reduce patient barriers to receiving treatment and has high potential to increase uptake.FundingNational Institutes of Health Research Health Technology Assessment.

Personalised “stop smoking” tasters double sign-up and increase quit rate

Giving smokers personalised information on their risk and inviting them to a “stop smoking” taster session more than doubled the likelihood that they would go on to attend NHS stop smoking services and increased their quit rate compared with giving standard information, a randomised trial has shown.1 Government funded smoking cessation services were established in England in 2000 to help smokers quit. But under 5% of smokers attend these services each year, and numbers have been decreasing since 2012. Previous research suggests that proactive, personalised invitations can increase attendance. Researchers randomly allocated 4384 smokers to personalised information on quitting smoking or …

Start2quit: a randomised clinical controlled trial to evaluate the effectiveness and cost-effectiveness of using personal tailored risk information and taster sessions to increase the uptake of the NHS Stop Smoking Services.

The NHS Stop Smoking Services (SSSs) offer help to smokers who want to quit. However, the proportion of smokers attending the SSSs is low and current figures show a continuing downward trend. This research addressed the problem of how to motivate more smokers to accept help to quit. To assess the relative effectiveness, and cost-effectiveness, of an intervention consisting of proactive recruitment by a brief computer-tailored personal risk letter and an invitation to a 'Come and Try it' taster session to provide information about the SSSs, compared with a standard generic letter advertising the service, in terms of attendance at the SSSs of at least one session and validated 7-day point prevalent abstinence at the 6-month follow-up. Randomised controlled trial of a complex intervention with follow-up 6 months after the date of randomisation. SSSs and general practices in England. All smokers aged ≥ 16 years identified from medical records in participating practices who were motivated to quit and who had not attended the SSS in the previous 12 months. Participants were randomised in the ratio 3 : 2 (intervention to control) by a computer program. Intervention - brief personalised and tailored letter sent from the general practitioner using information obtained from the screening questionnaire and from medical records, and an invitation to attend a taster session, run by the local SSS. Control - standard generic letter from the general practice advertising the local SSS and the therapies available, and asking the smoker to contact the service to make an appointment. (1) Proportion of people attending the first session of a 6-week course over a period of 6 months from the receipt of the invitation letter, measured by records of attendance at the SSSs; (2) 7-day point prevalent abstinence at the 6-month follow-up, validated by salivary cotinine analysis; and (3) cost-effectiveness of the intervention. Eighteen SSSs and 99 practices within the SSS areas participated; 4384 participants were randomised to the intervention (n = 2636) or control (n = 1748). One participant withdrew and 4383 were analysed. The proportion of people attending the first session of a SSS course was significantly higher in the intervention group than in the control group [17.4% vs. 9.0%; unadjusted odds ratio (OR) 2.12, 95% confidence interval (CI) 1.75 to 2.57; p < 0.001]. The validated 7-day point prevalent abstinence at the 6-month follow-up was significantly higher in the intervention group than in the control group (9.0% vs. 5.6%; unadjusted OR 1.68, 95% CI 1.32 to 2.15; p < 0.001), as was the validated 3-month prolonged abstinence and all other periods of abstinence measured by self-report. Using the National Institute for Health and Care Excellence decision-making threshold range of £20,000-30,000 per quality-adjusted life-year gained, the probability that the intervention was more cost-effective than the control was up to 27% at 6 months and > 86% over a lifetime horizon. Participating SSSs may not be representative of all SSSs in England. Recruitment was low, at 4%. The Start2quit trial added to evidence that a proactive approach with an intensive intervention to deliver personalised risk information and offer a no-commitment introductory session can be successful in reaching more smokers and increasing the uptake of the SSS and quit rates. The intervention appears less likely to be cost-effective in the short term, but is highly likely to be cost-effective over a lifetime horizon. Further research could assess the separate effects of these components. Current Controlled Trials ISRCTN76561916. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 3. See the NIHR Journals Library website for further project information.

Assessing the fidelity of delivery of an intervention to increase attendance at the English Stop Smoking Services.

BackgroundImplementation fidelity refers to the extent to which a proposed intervention is enacted as designed and is necessary to determine how much the intervention in question is the primary mechanism in any changes observed. Start2quit was a randomised controlled trial that aimed to improve attendance at the English Stop Smoking Service (SSS). The complex intervention combining computer-tailored personal risk letters and no-commitment (“taster”) sessions aimed at encouraging attendance at the SSS doubled attendance at the SSS and significantly increased abstinence rates, although attendance and abstinence varied between participating SSSs. Assessment of the fidelity of the delivery of the taster sessions to the protocol was embedded into the trial and is the focus of this study.MethodsEighteen SSSs participated in the study. Taster sessions were delivered by SSS advisors in the area. Of the 131 sessions delivered, 93 (71 %) were recorded and 41 (31.3 %) were selected for transcription and analysis. The taster session protocol contained 73 specified behaviours, which were independently classified into component behaviour change techniques (BCTs) using an established taxonomy for smoking cessation. All transcripts were coded by two authors with 25 % additionally coded by a third. The fidelity of each taster session was expressed as the percentage of overall protocol-specified behaviours that were delivered. Adherence to each BCT was measured as the number of behaviours applied by the advisors within each BCT divided by the total number classified within each.ResultsAdherence of protocol-specified behaviours was relatively high (median 71.23 %), though there was considerable variation (28.76 to 95.89 %) in individual sessions. Median fidelity to specific BCTs across sessions also varied from 50 to 100 %. Shorter sessions, sessions run jointly by two advisors, by female advisors, or by advisors aged 45 to 54 were associated with higher levels of adherence. There was no association between adherence and subsequent attendance at the SSS.ConclusionsThese results suggest that the delivery of the intervention of this study is not likely to have been impacted by issues of fidelity. As such, we can have greater confidence that variability in the main outcome is not due to variability in SSS advisor adherence to the protocol of the taster sessions.Trial registrationCurrent Controlled Trials ISRCTN76561916

Education: build it and they still don't come

Education: build it and they still don't come