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1.  Healthy Conversation Skills: increasing competence and confidence in front-line staff 
Public health nutrition  2012;17(3):700-707.
Objectives
1) To assess change in confidence in having conversations that support parents with healthy eating and physical activity post-training. 2) To assess change in staff competence in using ‘open discovery’ questions (those generally beginning with “how” and “what” that help individuals reflect and identify barriers and solutions) post-training. 3) To examine the relationship between confidence and competence post-training.
Design
A pre-post evaluation of ‘Healthy Conversation Skills’, a staff training intervention.
Setting
Sure Start Children’s Centres in Southampton, England.
Participants
A total of 145 staff working in Sure Start Children’s Centres completed the training, including playworkers (45%) and community development or family support workers (31%).
Results
We observed an increase in median confidence rating for having conversations about healthy eating and physical activity (both p<0.001), and in using ‘open discovery’ questions (p<0.001) after staff attended the ‘Healthy Conversation Skills’ training. We also found a positive relationship between use of ‘open discovery’ questions and confidence in having conversations about healthy eating post-training (r=0.21, p=0.01), but a non-significant trend was observed for having conversations about physical activity (r=0.15, p=0.06).
Conclusions
The ‘Healthy Conversation Skills’ training has proved effective at increasing the confidence of staff working at Sure Start Children’s Centres to have more productive conversations with parents about healthy eating. Wider implementation of these skills may be a useful public health nutrition capacity building strategy to help community workers support families with young children to eat more healthy foods.
doi:10.1017/S1368980012004089
PMCID: PMC3776723  PMID: 22989477
2.  The effect of a behaviour change intervention on the diets and physical activity levels of women attending Sure Start Children’s Centres: results from a complex public health intervention 
BMJ Open  2014;4(7):e005290.
Objectives
The UK government's response to the obesity epidemic calls for action in communities to improve people's health behaviour. This study evaluated the effects of a community intervention on dietary quality and levels of physical activity of women from disadvantaged backgrounds.
Design
Non-randomised controlled evaluation of a complex public health intervention.
Participants
527 women attending Sure Start Children's Centres (SSCC) in Southampton (intervention) and 495 women attending SSCCs in Gosport and Havant (control).
Intervention
Training SSCC staff in behaviour change skills that would empower women to change their health behaviours.
Outcomes
Main outcomes dietary quality and physical activity. Intermediate outcomes self-efficacy and sense of control.
Results
1-year post-training, intervention staff used skills to support behaviour change significantly more than control staff. There were statistically significant reductions of 0.1 SD in the dietary quality of all women between baseline and follow-up and reductions in self-efficacy and sense of control. The decline in self-efficacy and control was significantly smaller in women in the intervention group than in women in the control group (adjusted differences in self-efficacy and control, respectively, 0.26 (95% CI 0.001 to 0.50) and 0.35 (0.05 to 0.65)). A lower decline in control was associated with higher levels of exposure in women in the intervention group. There was a statistically significant improvement in physical activity in the intervention group, with 22.9% of women reporting the highest level of physical activity compared with 12.4% at baseline, and a smaller improvement in the control group. The difference in change in physical activity level between the groups was not statistically significant (adjusted difference 1.02 (0.74 to 1.41)).
Conclusions
While the intervention did not improve women's diets and physical activity levels, it had a protective effect on intermediate factors—control and self-efficacy—suggesting that a more prolonged exposure to the intervention might improve health behaviour. Further evaluation in a more controlled setting is justified.
doi:10.1136/bmjopen-2014-005290
PMCID: PMC4120404  PMID: 25031194
complex public health intervention; behavour change; diet ; physical activity; self efficacy; sense of control
5.  Specific psychological variables predict quality of diet in women of lower, but not higher, educational attainment 
Appetite  2010;56(1):46-52.
Our previous work found that perceived control over life was a significant predictor of the quality of diet of women of lower educational attainment. In this paper, we explore the influence on quality of diet of a range of psychological and social factors identified during focus group discussions, and specify the way this differs in women of lower and higher educational attainment. We assessed educational attainment, quality of diet, and psycho-social factors in 378 women attending Sure Start Children’s Centres and baby clinics in Southampton, UK. Multiple-group path analysis showed that in women of lower educational attainment, the effect of general self-efficacy on quality of diet was mediated through perceptions of control and through food involvement, but that there were also direct effects of social support for healthy eating and having positive outcome expectancies. There was no effect of self-efficacy, perceived control or outcome expectancies on the quality of diet of women of higher educational attainment, though having more social support and food involvement were associated with improved quality of diet in these women. Our analysis confirms our hypothesis that control-related factors are more important in determining dietary quality in women of lower educational attainment than in women of higher educational attainment.
doi:10.1016/j.appet.2010.11.003
PMCID: PMC3685814  PMID: 21078352
educational attainment; diet; disadvantage; self-efficacy; perceived control
6.  The Southampton Initiative for Health: a complex intervention to improve the diets and increase the physical activity levels of women and children from disadvantaged communities 
Journal of health psychology  2010;16(1):178-191.
The ‘Southampton Initiative for Health’ (SIH) is a training intervention with Sure Start Children’s Centre staff designed to improve the diets and physical activity levels of women of child-bearing age. Training aims to help staff to support women in making changes to their lifestyles by improving three skills: reflection on current practice; asking ‘open discovery’ questions; and goal setting. The impact of the training on staff practice is being assessed. A before and after non-randomised controlled trial is being used to evaluate the effectiveness and cost-effectiveness of the intervention in improving women’s diets and increasing their physical activity levels.
doi:10.1177/1359105310371397
PMCID: PMC3685267  PMID: 20709878
diet; physical activity; reflexive practice; goal setting; self-efficacy; intervention, disadvantage
8.  Implementation of new skills to support lifestyle changes - what helps and what hinders? 
Effective communication is necessary for good relationships between healthcare practitioners and clients. This study examined barriers and facilitators to implementing new communication skills.
One hundred and one Sure Start Children’s Centre staff attended one of 13 follow-up workshops to reflect on the use of new skills following a training course in communication, reflection and problem-solving. Barriers and facilitators were assessed with an adapted Problematic Experiences of Therapy scale (PETS). Staff reported frequency of skill use, and described what made it more difficult or easier to use the skills.
The PETS indicated that staff had confidence in using the skills, but felt there were practical barriers to using them, such as lack of time. Skills were used less often when staff perceived parents not to be engaging with them (rs=−0.42, p<.001), when staff felt less confident to use the skills (rs =−0.37, p<.001), and when there were more practical barriers (rs =−0.37, p<.001). In support of findings from the PETS, content analysis of free text responses suggested that the main barrier was a perceived lack of time to implement new skills. Facilitators included seeing the benefits of using the skills, finding opportunities and having good relationships with parents.
Understanding the range of barriers and facilitators to implementation is essential when developing training to facilitate on-going support and sustain skill use. Special attention should be given to exploring trainees’ perceptions of time, in order to be able to address this significant barrier to skill implementation. Staff training requires a multifaceted approach to address the range of perceived barriers.
doi:10.1111/j.1365-2524.2012.01063.x
PMCID: PMC3679516  PMID: 22452549
barriers; communication; epidemiology; Sure Start; training
9.  Does living in a food insecure household impact on the diets and body composition of young children? Findings from the Southampton Women’s Survey 
Background
Little is known about food insecurity in the UK. The aims of this study were to assess the prevalence and factors associated with food insecurity in a UK cohort, and to examine whether the diets, reported health and anthropometry of young food insecure children differed from those of other children.
Methods
The Southampton Women’s Survey is a prospective cohort study in which detailed information about the diet, lifestyle and body composition of 3000 women was collected before and during pregnancy. Between 2002-2006, 1618 families were followed up when the child was 3 years old. Food insecurity was determined using the Household Food Security scale. The child’s height and weight were measured; diet was assessed by food frequency questionnaire.
Results
4.6% of the households were food insecure. Food insecurity was more common in families where the mothers were younger, smokers, of lower social class, in receipt of financial benefits, and who had a higher deprivation score (all p<0.05). In comparison with other 3-year-old children, those living in food insecure households were likely to have worse parent-reported health and to have a diet of poorer quality, characterised by greater consumption of white bread, processed meat and chips, and by a lower consumption of vegetables (all p<0.05). They did not differ in height or body mass index.
Conclusions
Our data suggest that there are significant numbers of food insecure families in the UK. The poorer reported health and diets of young food insecure children have important implications for their development and lifelong health.
doi:10.1136/jech.2010.125476
PMCID: PMC3679518  PMID: 21652519
food insecurity; body composition; dietary quality; children
10.  Effectiveness of community- and workplace-based interventions to manage musculoskeletal-related sickness absence and job loss – a systematic review 
Rheumatology (Oxford, England)  2011;51(2):230-242.
This systematic review assesses the effectiveness of interventions in community and workplace settings to reduce sickness absence and job loss in workers with musculoskeletal disorders (MSDs). Relevant studies (randomised controlled trials (RCTs) and cohort studies published since 1990) were identified by screening citations in 35 earlier systematic reviews and from searches of Medline and Embase to April 2010. Among 42 studies (54 reports) including 34 RCTs, 27 assessed return to work, 21 duration of sickness absence, and five job loss. Interventions included exercise therapy, behavioural change techniques, workplace adaptations and provision of additional services. Studies were typically small (median sample size 107 (inter-quartile range (IQR) 77 to 148) and limited in quality. Most interventions were reported as beneficial: the median relative risk (RR) for return to work was 1.21 (IQR 1.00 – 1.60) and that for avoiding MSD-related job loss, 1.25 (IQR 1.06-1.71); the median reduction in sickness absence was 1.11 (IQR 0.32 to 3.20) days/month. However, effects were smaller in the larger and better quality studies, suggesting publication bias. No intervention was clearly superior to others, although effort-intensive interventions were less effective than simple ones. No cost-benefit analyses established statistically significant net economic benefits. Given that benefits are small and of doubtful cost-effectiveness, employers’ practice should be guided by their value judgements about the uncertainties. Expensive interventions should be implemented only with rigorous cost-benefit evaluation planned from the outset. Future research should focus on the cost-effectiveness of simple low cost interventions, and further explore impacts on job retention.
doi:10.1093/rheumatology/ker086
PMCID: PMC3276837  PMID: 21415023
Occupational Disease; Epidemiology; Rehabilitation; Systematic review; Psychological techniques; Physiotherapy
11.  Development of a 20-item food frequency questionnaire to assess a ‘prudent’ dietary pattern amongst young women in Southampton 
Objective
To develop a short food frequency questionnaire (FFQ) that can be used amongst young women in Southampton to assess compliance with a prudent dietary pattern characterised by high consumption of wholemeal bread, fruit and vegetables, and low consumption of sugar, white bread, and red and processed meat.
Methods
Diet was assessed using a 100-item interviewer-administered FFQ in 6,129 non-pregnant women aged 20-34 years. 94 of these women were re-interviewed two years later using the same FFQ. Subsequently diet was assessed in 378 women attending SureStart Children’s Centres in the Nutrition and Well-being Study using a 20-item FFQ. The 20 foods included were those that characterised the prudent dietary pattern.
Results
The 20-item prudent diet score was highly correlated with the full 100-item score (r=0.94) in the Southampton Women’s Survey. Both scores were correlated with red blood cell folate (r=0.28 for the 100-item score and r=0.25 for the 20-item score). Amongst the women re-interviewed after two years, the change in prudent diet score was correlated with change in red cell folate for both the 20-item (rS=0.31) and 100-item scores (rS=0.32). In the Nutrition and Well-being Study a strong association between the 20-item prudent diet score and educational attainment (r=0.41) was observed, similar to that seen in the Southampton Women’s Survey (r=0.47).
Conclusions
The prudent diet pattern describes a robust axis of variation in diet. A 20-item FFQ based on the foods that characterise the prudent diet pattern has clear advantages in terms of time and resources, and is a helpful tool to characterise the diets of young women in Southampton.
doi:10.1038/ejcn.2009.114
PMCID: PMC3091018  PMID: 19756032
Food frequency questionnaire; Principal component analysis
12.  Socio-economic factors, lifestyle and gender differences in body mass index in rural India 
The Journal of nutrition  2006;136(12):3062-3068.
A survey of the nutritional status of women in six villages in the Pune district of Maharashtra, India found young women to have significantly lower body mass index (BMI) than their male peers. The purpose of this study was to identify social and economic factors associated with this difference in thinness, and to explore the behaviour in men and women that might underlie these associations. We compared men and women in 90 families in this part of Maharashtra, recording social and economic details, fasting practices and oil consumption, and took measurements of the height and weight of a married couple of child-bearing age in each family. In this agricultural community, women were thinner in joint, land-owning families where the main occupation was farming, than they did in non-farming families. This was not true of men in this type of family. Men in ‘cash-rich’ families had higher BMIs than men in families without this characteristic. There was no corresponding difference in women’s body mass index. We then examined the lifestyles of men and women in a sub-set of 45 of these families. Women were more likely to work full-time in farming than men, to carry the burden of all household chores, to have less sleep and to eat less food away from home than men. Women fasted more frequently and more strictly than men. Despite identifying significant differences in behaviour between men and women in the same household, we could find no direct link between behaviour and body mass index. We conclude that being married into a farming family is an important factor in determining the thinness of a woman in rural Maharashtra.
PMCID: PMC1975810  PMID: 17116720
socio-economic status; maternal nutrition; body mass index; India; gender

Results 1-12 (12)