A qualitative study of active travel amongst commuters and older adults living in market towns.

BACKGROUND: Being physically active is associated with better health, but rates of physical inactivity are high amongst adults in England. Active travel, defined as making routine journeys in physically active ways, has been identified as a potential solution. There is a lack of research into how modal shift towards active travel can be encouraged in market towns. The aims of the current study are to understand how new cycling and walking infrastructure and community activation projects might support modal shift to active travel amongst commuters and older adults in market towns. METHODS: This was a qualitative study using focus groups, 'go-along' interviews, and in-depth interviews as the main methods of data collection. Thirty-three participants (12 commuters and 21 older adults) took part across six focus groups. Eight of these also completed a go-along interview (4 walking, 4 cycling). Data were analysed using the Framework method of thematic analysis. RESULTS: Market towns have existing advantages for active travel, being relatively compact with most routine destinations within easy reach. The barriers to active travel faced by older adults and commuters in market towns are similar to those in cities; poor infrastructure remains the key barrier. Poorly maintained paths are hazardous for older pedestrians, and low-or-no lighting and lack of well-connected, delineated cycle routes deter both commuters and older adults. One factor which does appear qualitatively different to cities is participants' perception that the social norms of cycling differ in market towns. CONCLUSIONS: Policies to promote active travel in market towns are most likely to be effective when they include measures targeted at both individual behaviour change and population level measures like large-scale infrastructure improvements. Initiatives to change the social norms around cycling may be required to increase active travel rates.

A Mixed Methods, Quasi-Experimental Evaluation Exploring the Impact of a Secondary School Universal Free School Meals Intervention Pilot.

Food insecurity amongst households with children is a growing concern globally. The impacts in children include poor mental health and reduced educational attainment. Providing universal free school meals is one potential way of addressing these impacts. This paper reports findings on the impact of a universal free school meals pilot in two English secondary schools. We adopted a mixed-methods, quasi-experimental design. The intervention schools were one mainstream school (n = 414) and one school for students with special educational needs (n = 105). Two other schools were used as comparators (n = 619; n = 117). The data collection comprised a cross sectional student survey during the pilot (n = 404); qualitative interviews with students (n = 28), parents (n = 20) and school staff (n = 12); and student observations of lunchtimes (n = 57). Qualitative data were analysed using thematic analysis, and descriptive analyses and logistic regressions were conducted on the quantitative data. Self-reports of food insecurity were high at both intervention (26.6%) and comparator schools (25.8%). No effects of the intervention were seen in the quantitative findings on either hunger or food insecurity. Qualitative findings indicated that students, families and staff perceived positive impact on a range of outcomes including food insecurity, hunger, school performance, family stress and a reduction in stigma associated with means-tested free school meals. Our research provides promising evidence in support of universal free school meals in secondary schools as a strategy for addressing growing food insecurity. Future research should robustly test the impact of universal free school meals in a larger sample of secondary schools, using before and after measures as well as a comparator group.

A qualitative process evaluation of universal free school meal provision in two London secondary schools.

BACKGROUND: In the UK, one in five households with children experienced food insecurity in 2022, defined as a household-level economic and social condition of limited or uncertain access to adequate food. Free school meals are a public health intervention aimed at reducing food insecurity amongst children. The provision of universal free school meals (UFSM) to secondary school-aged children is a novel and untested intervention in the UK. This study is a process evaluation of a pilot of UFSM in two secondary schools in England. The aim was to understand the feasibility, acceptability, cost implications and lessons for the implementation of UFSM. METHODS: 20 parents, 28 students and 8 school staff from two intervention schools participated in online qualitative interviews, as well as 4 staff from non-intervention schools. The Framework Method of thematic analysis was applied. These data were supplemented with student-led observations of school meal times, and school lunch uptake-data and cost information provided by the local authority delivering the pilot. RESULTS: UFSM in secondary schools is a feasible and acceptable intervention, with coherent goals of increased access to a healthy meal, reduced food insecurity and better nutrition. All participants perceived these goals were met. Acceptability was further enhanced by the perception that UFSM were supporting a greater proportion of low-income families than the national, targeted Free School Meal scheme, as well as being easier to implement. Potential barriers to implementation include limited school kitchen and dining infrastructure, meal quality and choice, and increased queuing times. Participants' concerns that UFSM may benefit middle- and high- income families not in need were not as prevalent as the perception that UFSM was an effective way to support all families with secondary-aged children experiencing food insecurity. CONCLUSION: This small-scale pilot study suggests that UFSM in secondary schools is feasible and acceptable, but more evidence is required from larger studies on the impact on long-term health, psychosocial and educational outcomes. Future, larger studies should also include detailed economic evaluations so this approach can be compared with other possible interventions.

What is the impact of structural and cultural factors and interventions within educational settings on promoting positive mental health and preventing poor mental health: a systematic review.

Mental health (MH) difficulties are on the increase among children and young people (CYP). Evidence has shown that educational settings contain both risk and protective factors for MH. This review investigated which structural and cultural factors and interventions within educational settings promote positive MH and prevent poor MH in 4-18 year olds. Searches were conducted in PsychINFO, Embase, ERIC, ASSIA and British Education Index, and reference lists from key studies and relevant systematic reviews were hand-searched. Intervention, cohort, and qualitative studies were included. Of the 62 included papers, 36 examined cultural factors (30 social/relational and six value-related) while 12 studies examined structural factors (eight organisational and four physical) and 14 studies examined multiple factors. There was strong evidence for the impact of positive classroom management techniques, access to physical activity, and peer mentoring on student MH. Studies examining the impact of positive school culture, teacher training in MH and parent involvement in school MH activities also found predominantly positive results for student MH, albeit the evidence was of lower quality or from a low number of studies. Few studies explicitly examined the impact of interventions on MH inequalities; those that did indicated limited if any reduction to inequalities. A very small number of studies suggested that interventions targeting those at risk of poor MH due to socioeconomic factors could successfully improve wellbeing and reduce depression, anxiety and behavioural problems. Studies exploring the effect of management and leadership strategies within schools, policies, and aspects of the physical environment other than green space were scarce or absent in the literature. This review highlights the need to consider the ways in which educational settings are organised, the culture that is created and the physical space in order to improve the MH of CYP.

A systems map of the determinants of child health inequalities in England at the local level.

Children and young people in the UK have worse health outcomes than in many similar western countries and child health inequalities are persistent and increasing. Systems thinking has emerged as a promising approach to addressing complex public health issues. We report on a systems approach to mapping the determinants of child health inequalities at the local level in England for young people aged 0-25, and describe the resulting map. Qualitative group concept mapping workshops were held in two contrasting English local authorities with a range of stakeholders: professionals (N = 35); children and young people (N = 33) and carers (N = 5). Initial area maps were developed, and augmented using data from qualitative interviews with professionals (N = 16). The resulting local maps were reviewed and validated by expert stakeholders in each area (N = 9; N = 35). Commonalities between two area-specific system maps (and removal of locality-specific factors) were used to develop a map that could be applied in any English local area. Two rounds of online survey (N = 21; N = 8) experts in public health, local governance and systems science refined the final system map displaying the determinants of child health inequalities. The process created a map of over 150 factors influencing inequalities in health outcomes for children aged 0-25 years at the local area level. The system map has six domains; physical environment, governance, economic, social, service, and personal. To our knowledge this is the first study taking a systems approach to addressing inequalities across all aspects of child health. The study shows how group concept mapping can support systems thinking at the local level. The resulting system map illustrates the complexity of factors influencing child health inequalities, and it may be a useful tool in demonstrating to stakeholders the importance of policies that tackle the systemic drivers of child health inequalities beyond those traditionally associated with public health.

A qualitative study of health promotion in academy schools in England.

BACKGROUND: Schools are an important setting for health promotion. In England, around one third of publicly funded schools have become independent of local authorities since 2000 and are now academies, run by an academy trust. The aim of this research was to examine attitudes towards health promotion held by academy trust leaders and senior staff. The research questions were: 1. How do academy trusts in England perceive their role in health promotion amongst students? 2. How are decisions around health promotion made in academy trusts? 3. What factors inhibit and encourage health promotion in academy schools? 4. How might public health academics and practitioners best engage with academy schools to facilitate health promotion activity and research? METHODS: Qualitative study utilising semi-structured interviews. Twenty five academy and school leaders were purposively sampled to achieve variation in trust size and type. In addition, five respondents were recruited from public and third-sector agencies seeking to work with or influence academy trusts around health promotion. Framework analysis was used to determine emergent themes and identify relationships between themes and respondent type. Early findings were triangulated at a stakeholder event with 40 delegates from academia, local authority public health teams, and third sector organisations. RESULTS: There is wide variation amongst senior academy and trust leaders in how they perceive the role of academies in promoting health and wellbeing amongst students. There is also variability in whether academy trusts responsible for more than one school adopt a centralised strategy to health promotion or allow individual schools autonomy. This was dependent on the trust leaders' attitude and interest in health promotion rather than any perceived external accountability. Identified barriers to health promotion include financial constraints, a narrow focus on educational outcomes and school performance, and limited understanding about effective health interventions. CONCLUSION: In the current absence of national policy or guidance around health promotion in schools, health has variable status in academies in England. There is a need to better engage all academy trusts in health promotion and support them to implement a strategic approach to health promotion.