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1.  Nurses’ self-efficacy and practices relating to weight management of adult patients: a path analysis 
Health professionals play a key role in the prevention and treatment of excess weight and obesity, but many have expressed a lack of confidence in their ability to manage obese patients with their delivery of weight-management care remaining limited. The specific mechanism underlying inadequate practices in professional weight management remains unclear. The primary purpose of this study was to examine a self-efficacy theory-based model in understanding Registered Nurses’ (RNs) professional performance relating to weight management.
A self-report questionnaire was developed based upon the hypothesized model and administered to a convenience sample of 588 RNs. Data were collected regarding socio-demographic variables, psychosocial variables (attitudes towards obese people, professional role identity, teamwork beliefs, perceived skills, perceived barriers and self-efficacy) and professional weight management practices. Structural equation modeling was conducted to identify correlations between the above variables and to test the goodness of fit of the proposed model.
The survey response rate was 71.4% (n = 420). The respondents reported a moderate level of weight management practices. Self-efficacy directly and positively predicted the weight management practices of the RNs (β = 0.36, p < 0.01), and fully or partially mediated the relationships between perceived skills, perceived barriers, professional role identity and teamwork beliefs and weight management practices. The final model constructed in this study demonstrated a good fit to the data [χ2 (14) =13.90, p = 0.46; GFI = 0.99; AGFI = 0.98; NNFI = 1.00; CFI = 1.00; RMSEA = 0.00; AIC = 57.90], accounting for 38.4% and 43.2% of the variance in weight management practices and self-efficacy, respectively.
Self-efficacy theory appears to be useful in understanding the weight management practices of RNs. Interventions targeting the enhancement of self-efficacy may be effective in promoting RNs’ professional performance in managing overweight and obese patients.
PMCID: PMC4235199  PMID: 24304903
Nurses; Self-efficacy; Weight management practices; Model testing
2.  Physical activity in older people: a systematic review 
BMC Public Health  2013;13:449.
Physical activity (PA) in older people is critically important in the prevention of disease, maintenance of independence and improvement of quality of life. Little is known about the physical activity of the older adults or their compliance with current physical activity guidelines.
A systematic literature search of the published literature was conducted. Included were published reports of original research that independently reported: the PA level of non-institutional older adults (aged 60 years and over); and the proportion of older adults in the different samples who met PA recommendations or guidelines. The review was restricted to studies published since 2000 to provide a current picture of older adults’ PA levels.
Fifty three papers were included in the review. The percentage of older adults meeting recommended physical activity ranged from 2.4 – 83.0% across the studies. Definitions of “recommended” physical activity in older adults varied across the studies as did approaches to measurement which posed methodological challenges to data analysis. Older age groups were less likely than the reference group to be regularly active, and women were less likely than men to achieve regular physical activity, especially leisure time physical activity, when measured by both subjective and objective criteria.
The review highlights the need for studies which recruit representative random samples of community based older people and employ validated measurement methods consistently to enable comparison of PA levels over time and between countries.
PMCID: PMC3651278  PMID: 23648225
Physical activity; Exercise; Older people; Older adults
3.  The E Sibling Project – exploratory randomised controlled trial of an online multi-component psychoeducational intervention for siblings of individuals with first episode psychosis 
BMC Psychiatry  2013;13:123.
Siblings of individuals with first episode psychosis are natural partners to promote service users’ recovery and are themselves vulnerable to mental ill health due to the negative impact of psychosis within the family. This study aims to develop and undertake a preliminary evaluation of the efficacy of an online multi-component psychoeducational intervention for siblings of individuals with first episode psychosis. The impetus for the intervention arose from siblings' expressed needs for peer support and information on psychosis, coping and management strategies for common symptoms and ways to promote recovery.
The project design draws on the Medical Research Council framework for the design and evaluation of complex interventions. Mixed methods comprising collection of qualitative focus group data, systematic review and expert advisory group consultation are used to develop the theoretical basis for and design of the intervention. This protocol focuses on the modelling and piloting phase which uses a randomised controlled trial with factorial design to test the efficacy of the intervention. Outcome data on participants’ mental wellbeing, knowledge, perceived self-efficacy and experiences of caregiving will be assessed at baseline, at end of the intervention (10 weeks later) and at 10 week follow-up. In addition, a post-intervention semi-structured interview with 20% of the participants will explore their experiences and acceptability of the intervention.
This multi-component online psychoeducational intervention aims to enhance siblings' knowledge about psychosis and their coping capacity, thus potentially improving their own mental wellbeing and promoting their contribution to service users’ recovery. The factorial design randomised controlled trial with a supplementary process evaluation using semi-structured interviews and usage-monitoring will collect preliminary evidence of efficacy, feasibility and acceptability, as well as feedback about the barriers and strategies to using such an innovative resource. The RCT will provide data for estimating the likely effect size of the intervention on outcomes for siblings and inform the development of a definitive future trial.
Trial registration
Trial registration: ISRCTN01416694
PMCID: PMC3644258  PMID: 23622123
Siblings; Brothers; Sisters; First-episode early onset psychosis; Family; Randomised controlled trial; Psychoeducation; Peer support; Health education
4.  Effectiveness of alcohol brief intervention delivered by community pharmacists: study protocol of a two-arm randomised controlled trial 
BMC Public Health  2013;13:152.
There is strong evidence to support the effectiveness of Brief Intervention (BI) in reducing alcohol consumption in primary healthcare.
Methods and design
This study is a two-arm randomised controlled trial to determine the effectiveness of BI delivered by community pharmacists in their pharmacies. Eligible and consenting participants (aged 18 years or older) will be randomised in equal numbers to either a BI delivered by 17 community pharmacists or a non-intervention control condition. The intervention will be a brief motivational discussion to support a reduction in alcohol consumption and will take approximately 10 minutes to deliver. Participants randomised to the control arm will be given an alcohol information leaflet with no opportunity for discussion. Study pharmacists will be volunteers who respond to an invitation to participate, sent to all community pharmacists in the London borough of Hammersmith and Fulham. Participating pharmacists will receive 7 hours training on trial procedures and the delivery of BI. Pharmacy support staff will also receive training (4 hours) on how to approach and inform pharmacy customers about the study, with formal trial recruitment undertaken by the pharmacist in a consultation room. At three month follow up, alcohol consumption and related problems will be assessed with the Alcohol Use Disorders Identification Test (AUDIT) administered by telephone.
The UK Department of Health’s stated aim is to involve community pharmacists in the delivery of BI to reduce alcohol harms. This will be the first RCT study to assess the effectiveness of BI delivered by community pharmacists. Given this policy context, it is pragmatic in design.
Trial registration
Current Controlled Trials ISRCTN95216873
PMCID: PMC3583737  PMID: 23419053
Alcohol; Brief intervention; Community pharmacist; Community pharmacy; Hazardous and harmful drinking
9.  A comparison of the clinical effectiveness and costs of mental health nurse supplementary prescribing and independent medical prescribing: a post-test control group study 
Supplementary prescribing for mental health nurses was first introduced in the UK in 2003. Since then, a number of studies have reported stakeholders' perceptions of the success of the initiative. However, there has been little experimental research conducted into its effectiveness. This paper reports findings from the first known study to compare the cost and clinical impact of mental health nurse supplementary prescribing to independent medical prescribing.
A post-test control group experimental design was used to compare the treatment costs, clinical outcomes and satisfaction of patients in receipt of mental health nurse supplementary prescribing with a matched group of patients in receipt of independent prescribing from consultant psychiatrists. The sample comprised 45 patients in receipt of mental health nurse supplementary prescribing for a minimum of six months and a matched group (by age, gender, diagnosis, and chronicity) of patients prescribed for by psychiatrists.
There were no significant differences between patients in the nurse supplementary prescribers' group and the independent prescribers' group in terms of medication adherence, health status, side effects, and satisfaction with overall care. Total costs per patient for service use were £803 higher for the nurse prescribers' group but this difference was not significant (95% confidence interval -£1341 to £3020).
No significant differences were found between the health and social outcomes of patients in the mental health nurse supplementary prescribers' group, and those prescribed for by the independent medical prescribers. The cost appraisal also showed that there was no significant difference in the costs of the two types of prescribing, although the pattern of resources used differed between patients in the two prescriber groups. The results suggest that mental health nurse supplementary prescribers can deliver similar health benefits to patients as consultant psychiatrists without any significant difference in patients' service utilisation costs.
PMCID: PMC2820038  PMID: 20051131
10.  Exposing the key functions of a complex intervention for shared care in mental health: case study of a process evaluation 
Complex interventions have components which can vary in different contexts. Using the Realistic Evaluation framework, this study investigates how a complex health services intervention led to developments in shared care for people with long-term mental illness.
A retrospective qualitative interview study was carried out alongside a randomised controlled trial. The multi-faceted intervention supported by facilitators aimed to develop systems for shared care. The study was set in London. Participants included 46 practitioners and managers from 12 participating primary health care teams and their associated community mental health teams. Interviews focussed on how and why out comes were achieved, and were analysed using a framework incorporating context and intervening mechanisms.
Thirty-one interviews were completed to create 12 case studies. The enquiry highlighted the importance of the catalysing, doing and reviewing functions of the facilitation process. Other facets of the intervention were less dominant.
The intervention catalysed the allocation of link workers and liaison arrangements in nearly all practices. Case discussions between link workers and GPs improved individual care as well as helping link workers become part of the primary care team; but sustained integration into the team depended both on flexibility and experience of the link worker, and upon selection of relevant patients for the case discussions. The doing function of facilitators included advice and, at times, manpower, to help introduce successful systems for reviewing care, however time spent developing IT systems was rarely productive. The reviewing function of the intervention was weak and sometimes failed to solve problems in the development of liaison or recall.
Case discussions and improved liaison at times of crisis, rather than for proactive recall, were the key functions of shared care contributing to the success of Mental Health Link. This multifaceted intervention had most impact through catalysing and doing, whereas the reviewing function of the facilitation was weak, and other components were seen as less important.
Realistic Evaluation provided a useful theoretical framework for this process evaluation, by allowing a specific focus on context. Although complex interventions might appear 'out of control', due to their varied manifestation in different situations, context sensitive process evaluations can help identify the intervention's key functions.
PMCID: PMC2627847  PMID: 19105823

Results 1-10 (10)