In-person and online mixed method non-randomised studies exploring feasibility and acceptability of HEADS: UP, an adapted Mindfulness Based Stress Reduction programme for stroke survivors experiencing symptoms of anxiety and depression (preprint)

Background Depression and anxiety are prevalent after stroke and associated with poor outcomes. We previously co-developed a stroke-specific self-management intervention, HEADS: UP (Helping Ease Anxiety and Depression after Stroke). The two studies reported here aimed to test the feasibility and acceptability of the HEADS: UP course and supporting materials, and research processes ahead of a definitive trial. Methods We recruited community-dwelling stroke survivors (SS) ≥3 months post-stroke, with symptoms of mood disorder (Hospital Anxiety and Depression Scale ≥8). Participants could ‘enrol’ a family member/‘other’ to take part with them, if desired. Study 1 tested HEADS: UP delivered in-person, and informed optimisation of research processes and intervention delivery and materials. In response to Covid-related socialising restrictions HEADS: UP was then adapted for online delivery; tested in Study 2. The primary outcome (both studies) was feasibility (acceptability, fidelity) of the intervention and of research processes. Quantitative data (including patient reported outcomes measures (PROMs) assessing mood and quality of life), and qualitative data were collected pre-/post-intervention. Descriptive statistics were used to analyse quantitative data; a thematic framework approach was used to analyse qualitative data. Both studies received ethical approval prior to commencement. Results Study 1: Feasibility: 13 (59.1%) of 22 potentially eligible stroke survivors consented; aged 66 (median, IQR 14); male (n=9; 69%); 28 (IQR 34; 13.5-48) months poststroke. Of these n=10 (76.9%) completed PROMS pre-intervention; n=6 (46.2%) post-intervention. Acceptability: Six (85.7%) stroke survivors attended ≥4 core intervention sessions. Aspects of screening and data collection were found to be burdensome. Study 2: Feasibility: SS n=9 (41%) of 22 potentially eligible stroke survivors consented; aged 58 years (median; IR 12); male (n=4; 44.4%); 23 (IQR 34; 10-38) months poststroke. Of these n=5 (55.6%) completed PROMS pre-intervention; n=5 (55.6%) post-intervention. Acceptability: Five (55.6%) stroke survivors attended ≥ 4 core sessions. They found online screening and data collection processes straightforward. Conclusions Stroke survivors found in-person and online HEADS: UP intervention and research processes feasible and acceptable. A pilot RCT is warranted, after making the adaptations to intervention delivery and research processes identified in this feasibility and acceptability research. Trial registration Study 1 (in-person delivery): ClinicalTrials.gov: NCT03956693, registered 20 May 2019, https://www.clinicaltrials.gov/study/NCT03956693 Study 2 (online delivery): ClinicalTrials.gov: NCT04567472, registered 23, September 2020, https://clinicaltrials.gov/study/NCT04567472?tab=results

Sharing positive changes made during COVID-19 national lockdown: a multi-method co-production study (preprint)

Objectives: A multi-method co-production study was designed to share psychosocial insights into the adoption of positive changes made during COVID-19 national lockdown in Scotland. We examined: i) the psychosocial patterning of positive changes, ii) the psychosocial processes by which positive change was realised, and worked with partner organizations to share our insights. Method: A sequential multi-method design included an online survey (n=2445) assessing positive changes in sleep and physical activity patterns, socio-demographics, mood, social support, coping, and resilience, with multivariate logistic regression analysis. We also employed interviews with a purposive diverse sub-sample of people self-reporting high levels of positive change (n=48) and used thematic analysis. Finally, partnership work translated insights into positive change-sharing targeted resources. Results: The survey identified positive change was significantly patterned by age, gender and vulnerability to COVID-19. Higher positive reframing and higher active coping were associated with higher levels of cross-domain positive change. Higher symptoms of depression, planning, and self-distraction were associated with less cross-domain positive change. Thematic analysis showed the centrality of perceptions of time, opportunities to self-reflect and engage with the natural world, access support in diverse ways, actively build routine and purposefully build self-efficacy and a sense of control were key to initiating positive change. Our partner organizations focused on the rapid co-production of a series of online resources that shared study insights. Conclusions: Our study, based around a salutogenic ethos and the constraints of COVID-19, sought to identify and share insights into achieving positive changes at a time of international crisis.

Changes in physical activity, sitting and sleep across the COVID-19 national lockdown period in Scotland. (preprint)

We examine the impact of the COVID-19 outbreak and concomitant restrictions (i.e. lockdown) on 24-hour movement behaviors (i.e. physical activity, sitting, sleep) in a purposive sample of people (n=3230) reporting change recruited on-line. Participants self-reported time spent in moderate-to-vigorous physical activity (MVPA), walking, sitting and sleep prior to lockdown (T1), during the first national lockdown (T2) and as restrictions initially started to ease (T3). For each 24-hour movement behavior, category-shifts are reported (positive, negative or did not change), as well as the percentage of participants recording positive/negative changes across clusters of behaviors and the percentage of participants recording improvement or maintenance of change across time. From T1 to T2 walking decreased, whereas MVPA, sitting and sleep increased, from T2 to T3 levels returned to pre-lockdown for all but MVPA. Participants who changed one behavior positively were more likely to report a positive change in another and 50% of those who reported positive changes from T1 to T2 maintained or improved further when restrictions started to ease. The current study showed that a large proportion of the sample reported positive changes, most notably those displaying initially poor levels of each behavior. These findings will inform salutogenic intervention development.

What have we learned about positive changes experienced during COVID-19 lockdown? Evidence of the social patterning of change (preprint)

BackgroundMultiple studies have highlighted the negative impact of COVID-19 and its particular effects on vulnerable sub-populations. Complementing this work, here, we report on the social patterning of self-reported positive changes experienced during COVID-19 national lockdown in Scotland. MethodsThe CATALYST study collected data from 3342 adults in Scotland during weeks 9-12 of a national lockdown. Participants completed an online questionnaire providing data on key sociodemographic and health variables, and completed a measure of positive change. The positive change measure spanned diverse domains (e.g., more quality time with family, developing new hobbies, more physical activity, and better quality of sleep). We used univariate analysis and stepwise regression to examine the contribution of a range of sociodemographic factors (e.g., age, gender, ethnicity, educational attainment, and employment status) in explaining positive change. ResultsThere were clear sociodemographic differences across positive change scores. Those reporting higher levels of positive change were female, from younger age groups, married or living with their partner, employed, and in better health. ConclusionOverall our results highlight the social patterning of positive changes during lockdown in Scotland. These findings begin to illuminate the complexity of the unanticipated effects of national lockdown and will be used to support future intervention development work sharing lessons learned from lockdown to increase positive health change amongst those who may benefit.