Parents' perceptions of reasons for excess weight loss in obese children: a peer researcher approach.

BACKGROUND: This study reports on the process of conducting participatory research by training peer researchers to conduct interviews and analyse data collected with parents of overweight children. The methodology was chosen as a means of (a) encouraging participation among a hard-to-engage group (i.e., parents of overweight children), and (b) generating novel insights and challenging academic/health professional assumptions through the involvement of parents in the interpretation of findings. METHODS: Four parents (all female) were recruited as peer researchers and trained in research processes, ethics, and interview skills over three half-day workshops. The intended interviewees were parents of children identified as obese through the National Child Measurement Programme (NCMP) at the start of primary school (age 4-5) but who had lost their excess weight by age 10-11; little is currently known about how this excess weight loss is achieved. Interviews were conducted by peer researchers, transcribed verbatim and analysed thematically by both peer- and university-based investigators. RESULTS: The peer researchers felt confident to conduct interviews after three training sessions. Recruitment of interviewees was challenging, resulting in only four volunteers (all mothers) over a 5-month period; thus peer researchers were only able to conduct one interview each. All interviews were considered good quality in comparison to those conducted by Masters-level research assistants. The process of co-analysis resulted in a change in emphasis from that initially generated by the university research team; the role of health professionals in weight management was de-emphasised, and the importance of 'not singling out' overweight children accentuated. Given the limited number of interviews, the results of the study are only provisional but resulted in three themes: Whole Family Action, Support (and lack of support), and Protecting Childhood. CONCLUSIONS: Training peer researchers to conduct and analyse interviews was feasible within a short period of training. Peer researchers found the experience interesting, informative and worthwhile. Two of the four volunteered to be involved in a related study 12 months later. The different perspective brought through co-analysis suggests that this approach to conducting participatory research may be a useful means of working with the public to generate new ideas to tackle intransigent issues.

A randomised controlled trial of the effect of automated interactive calling combined with a health risk forecast on frequency and severity of exacerbations of COPD assessed clinically and using EXACT PRO.

BACKGROUND: We have developed a winter forecasting service to predict when patients with COPD are at higher risk of an exacerbation and alert them via an automated telephone call. AIMS: To assess the effect of the service and its ability to predict periods of increased risk. METHODS: A 4-month prospective randomised controlled trial using clinical criteria and the EXACT PRO questionnaire to identify exacerbations. Patients were randomly allocated to receive alert calls. All patients completed a diary including the EXACT PRO questionnaire on a BlackBerry Smartphone each day. They were contacted and assessed if they appeared to be exacerbating. RESULTS: 79 patients participated, 40 received alert calls. The exacerbation frequency per patient per week was significantly greater during periods of predicted high risk (0.086 ± 0.010 v 0.055 ± 0.010). The exacerbation frequency (± standard error of the mean, SEM) in patients receiving alert calls was lower (0.95 ± 0.27 v 1.17 ± 0.29) but this was not statistically significant. Fewer patients receiving alert calls had one or more EXACT event compared to the controls (34% v 53%, p=0.11), their duration was shorter (8.2 ± 2.0 v10.1 ± 1.9 days, p=0.481) and they were less severe (AUC 65 ± 21 v 115 ± 22, p=0.118). There were no significant differences in the mean change (± SEM) in SGRQ scores between the groups. CONCLUSIONS: The ability of the forecast to predict high risk periods was confirmed unequivocally. Alert calls appeared to reduce the frequency and severity of exacerbations but these effects did not reach statistical significance, perhaps because of the number of participants, lower than expected exacerbation rates, and the fact that there was contact with patients in both groups whenever they appeared to be exacerbating.

An investigation into the awareness and understanding of the ultraviolet index forecasts in the South West of England.

Despite large sun protection behaviour intervention campaigns there has not been a marked reduction in the incidence of skin cancer. This study explored the awareness and understanding of global solar UV index (UVI) information presented to the public in weather forecasts and whether individuals changed their sun exposure/protection behaviour as a result of receiving such information. A cross-sectional, face-to-face survey was undertaken in Devon and Cornwall in the South West of England between 20 August and 7 September 2008. 466 interviews were completed; 53% at beach locations and 38% in town centres. The specified targets for the interviews were achieved: males (n = 232), females (n = 234); resident (n = 251), tourist (n = 215); aged 16-34 (n = 156), 35-54 (n = 158), and 55 years plus (n = 152). Sixty-seven percent of participants had heard of the UVI (the predominant source being television broadcasts). Only 40% were able to state correctly that a value of 7 would be considered to be 'high'. Sixty percent indicated that knowing the UVI value did not influence their sun protection behaviour. Awareness of UVI in the UK appears to have altered little in the past decade and although some improvements in understanding have been observed, it is concerning that this information is not influencing most individual's sun protection behaviour.

Can a health forecasting service offer COPD patients a novel way to manage their condition?

OBJECTIVES: The UK Meteorological Office (Met Office) has developed a health forecasting service for chronic obstructive pulmonary disease (COPD) patients, combining a rule-based model predicting risk based on environmental conditions with an anticipatory care intervention providing information on self-management and warnings via an interactive telephone call. Our aim was to explore the acceptability and utility of such a service to patients with COPD and its perceived impact on their behaviour and disease management. METHODS: A cross-sectional questionnaire survey of service users drawn from 189 general practices in England, Scotland and Wales at the end of the winter of 2007/8. RESULTS: Completed questionnaires were received from 3288 COPD patients, representing a response rate of 40%. Eighty-five percent of those returning a questionnaire reported at least one exacerbation during the study period and 8% had been admitted to hospital on one occasion or more. The majority of respondents deemed the information pack (comprising a booklet and thermometers) useful while the automated calls were generally said to be convenient, easy to understand and reassuring. Those less satisfied with the service felt they were already sufficiently aware of the prevailing weather conditions or felt more detailed information was needed. Most benefit was reported by those patients who were willing to be pro-active in the management of their condition, with the service encouraging 36% of respondents to seek a repeat prescription, 28% to re-read their information pack and 12% to consult their GP for worsening of symptoms. CONCLUSIONS: Patients found the automated interactive calling, combined with a health risk forecast, both viable and useful, welcoming the information and tools it offered. In many cases, it added to patients' understanding of their illness and promoted better self-management. Future research should focus on the potential impact of the service in terms of health outcomes and cost-effectiveness.