Factors associated with non-participation in a physical activity promotion trial.

BACKGROUND: Non-participation can bias outcome in intervention studies of physical activity. OBJECTIVES: To compare characteristics, knowledge and attitudes to physical activity in participants and non-participants of a physical activity intervention trial in primary care. STUDY DESIGN: Cross-sectional survey. METHODS: Patients aged 40-64 years were recruited opportunistically during surgery visits in an inner city general practice in Newcastle upon Tyne, UK. Attitudes to physical activity, views of its health benefits, and barriers to participation were elicited in interviews with participants, and by postal questionnaire from non-participants. Data held by general practitioners were used to compare anthropometry and lifestyle between groups. RESULTS: Of 842 eligible patients, 276 (33%) refused outright (non-volunteers) and 566 volunteered for the intervention study, of which 353 (42%) attended a baseline assessment and 213 (25%) subsequently defaulted. The initial refusal rate was higher amongst men, smokers and those with addresses in more deprived areas. The response rate to the postal survey of non-volunteers was 45%. Compared with participants, the non-volunteers were more likely to be an adult carer and to report poorer health, and were less likely to have had higher education or to have children living at home. Far more non-volunteers considered that they already did enough exercise to maintain health. Non-volunteers had slightly less knowledge of the benefits of physical activity; attached far less importance to it in maintaining health; were more likely to cite 'fear of leaving their home unattended', 'do not enjoy exercise' and 'poor health' as barriers to exercise; and were less likely to cite 'no one to exercise with' as a barrier to exercise. CONCLUSION: Recruitment of 'hard to engage' individuals requires careful phrasing of the message to focus on their personal goals and to address gaps in their knowledge about physical activity and the principal barriers they perceive. Differential uptake across population subgroups could lead to a widening of health inequalities.

The family study: a model for integrating the individual and community perspective in medical education.

The principles of and experience with a family study and survey undertaken by first-year medical students are reported. The family study is based on the observations made by pairs of students on a selected family, which includes a pregnant mother, in the Newcastle upon Tyne area. These observations include the family context, the pregnancy, the early development of the new-born baby, and the use of health and other services. The family survey records and analyses relevant data on the collective group of selected families. The family study acts as a preparation for clinical understanding by emphasizing the individual or family view. In addition, students learn that the collective epidemiological approach provided by the survey can guide the clinical impression gained from the observational study, yet each individual and family remains unique. An early opportunity is therefore provided for students to explore and integrate these two approaches.

Mothers' appreciation of their children's symptoms.

A prospective study of mothers' reactions to their babies' symptoms was carried out in Newcastle upon Tyne. Forty-four mothers kept a health diary about their first infant, recording symptoms that occurred and action taken. Symptoms, most of which were minor, were present on three out of four days. Mothers were therefore making almost daily decisions about their babies' health, usually without medical advice. No evidence was found of mothers failing to appreciate the severity of symptoms or failing to seek medical help. Our findings reinforce those of other studies that parents are able to recognize their babies' illnesses, even in their first children.

Cure or care in everyday practice.

Two cases of carcinoma of the stomach presenting during the same month and dying within four weeks of one another less than one year later are presented. One was treated symptomatically and the other received radical surgery. The care they received depended on decisions about diagnosis and treatment; the outcomes of these and the difficulties involved in evaluating monetary costs and quality of care are discussed in the light of recent interest in medical audit.

Vocational training for general practice: a comparison of the views of trainees and teachers.

The views of 89 vocational trainees were compared with those of 45 doctors concerned in schemes of vocational training for general practice. Both groups agreed over most points, except on the desirability of compulsory vocational training: 42 of the trainees thought this to be desirable compared with 35 of the teachers.The composite scheme favoured by both trainees and teachers offered an initial period in general practice together with an organized course of seminars throughout the training period. The subjects in which most considered hospital experience essential were paediatrics, general medicine, and obstetrics and gynaecology.