Rhiannon Day

Vitamin D deficiency is a serious public health issue in the United Kingdom. Those at increased risk, such as pregnant women, children under 5 years and people from ethnic groups with dark skin, are not all achieving their recommended vitamin D. Effective vitamin D education is warranted. A qualitative study was undertaken to evaluate the acceptability and understanding of a vitamin D infographic, developed using recommendations from previous research. Fifteen parents/carers, recruited through local playgroups and adverts on popular parent websites, participated in focus groups and telephone interviews. The majority were female, White British and educated to degree level. A thematic analysis methodology was applied. The findings indicated that understanding and acceptability of the infographic were satisfactory, but improvements were recommended to aid interpretation and create more accessible information. These included additional content (what vitamin D is; other sources; its health benefits; methods/doses for administration and scientific symbols used) and improved presentation (eye-catching, less text, simpler language, more images and a logo). Once finalized, the infographic could be a useful tool to educate families around vitamin D supplementation guidelines, support the UK Healthy Start vitamins scheme and help improve vitamin D status for pregnant and lactating women and young children.

One in four toddlers are not achieving the recommended vitamin D intake crucial for their healthy development(1, 2). This study explored parents’ acceptability of factors affecting purchasing of foods and drinks fortified with Vitamin D in children aged 0–2 years old. A total of 194 parents completed an online parent questionnaire. Focus groups and interviews were used to explore in depth perceptions of vitamin D fortification. Thirteen participants participated in the 5 focus groups, 5 completed interviews. The majority of participants were female (mothers) and of White-British ethnic background, aged between 25–40 years, with 89 % of the sample with a level 3 qualification (e.g. 2 or more A levels, NVQ level 3). Basic descriptive statistics were calculated from the questionnaire data and a thematic analysis methodology was applied to the qualitative data. The findings indicated low purchasing of vitamin D fortified foods/drinks by parents (21 % of the sample). The foods/drinks most purchased were cereal, yogurts and alternative milks. Willingness to purchase certain products fortified with vitamin D to increase their child's vitamin D was however high. After excluding formula milk, parents would be willing to buy yogurt, yogurt drinks, cereals, milk-based drinks, fruit juice and margarine. The table outlines parents’ views on the facilitators and barriers to purchasing vitamin D fortified foods and drinks. There is a potential for fortified foods to play a role in increasing the intake of vitamin D intake. Parents need quality education explaining the need to prevent vitamin D deficiency, though fortified products. Products also need to be suitable for babies and toddlers; better labelled, lower cost; with healthy options available with lower sugar and salt content, tasty, longer shelf life and better availability in local shops and supermarkets. Future research should determine if consumption of fortified foods/drinks alone rather than supplementation is sufficient to meet children's daily intake of vitamin D(3).

BACKGROUND: Vitamin D deficiency has been highlighted as a serious public health problem in the United Kingdom. One in four toddlers are not achieving the recommended intake for their healthy development. This study uses quantitative and qualitative methods to explore parents' perceptions, awareness and behaviours around vitamin D intake, and the acceptability of and factors affecting purchasing of food and drink fortified with Vitamin D in children aged 0-2 years old. METHODS: One hundred and ninety-four parents completed an online questionnaire, advertised to parents with one child aged up to 2 years on popular social media websites. The majority of participants were mothers, White-British ethnic background, aged 25-44 years. Participants provided an email address if they wanted to be contacted about the focus groups. Recruitment posters advertising the focus groups were placed in community centres. Eighteen participated in 5 focus groups (13 parents), and 5 individual interviews. A thematic analysis methodology was applied. RESULTS: Fifty-seven percent (n = 110) of parents reported receiving information about vitamin D during pregnancy and 52% (n = 100) after the birth of their child. Parents reported a low level of satisfaction with vitamin D information: many thought it was limited and recommendations on supplements were unclear. Parents wanted more information about vitamin D requirements for their child (80%, n = 153 out of 192 respondents, 2 non-response), about vitamin D and breastfeeding (56%, n = 108) and vitamin D and pregnancy (49%, n = 94). The recommendations were for simpler, easier to read, with specific and clearer guidelines; delivered regularly during routine appointments, at timely stages throughout pregnancy and after the birth. 23% (n = 45, out of 194 respondents) of parents did not know why vitamin D is important for health. Only 26% (n = 49, out of 192 respondents) of parents reported giving their youngest child a vitamin D supplement on most days of the week. The majority of parents (interview/focus group) wanted more information about foods/drinks fortified with vitamin D. CONCLUSION: Parents were generally not aware of the importance of vitamin D, dietary requirements including supplementation and the availability of vitamin D fortified foods. Major improvements are required for the effective promotion of vitamin D information to parents.

Aims For many young people with Type 1 diabetes, transition from paediatric to adult care can result in a marked deterioration in glycaemic control. A systematic review assessed the effectiveness of transition models, or components of models, for managing the transition process in young people with long-term conditions, including Type 1 diabetes. This involved identifying (i) the main barriers and facilitators in implementing a successful transition programme, and (ii) the key issues for young people with long-term conditions and professionals involved in the transition process. Methods The following databases were searched from inception to August 2012: MEDLINE, EMBASE, PsychINFO, CINAHL, ASSIA, Social Services Abstracts, Academic Search Complete, Social Science Citation Index, Cochrane and Campbell Libraries. Selected studies included young people aged 11 to 25 diagnosed with long-term conditions who were in transition from paediatric to adult secondary health care services. Results 16 systematic reviews and 13 primary studies were included from 9992 records retrieved. No single transition model was uniquely effective. The most successful transitions centred around: young person-focused; age and developmentally appropriate content and delivery; self-management education; family participation; paediatric and adult collaboration; designated transition clinics; transition co-ordinator; young person’s portfolio; specific professionals training; multidisciplinary approach; structured process embedded in service delivery. There were no distinctive characteristics of condition-specific Type 1 diabetes services. Conclusion This important and timely review summarises the key factors that need to be considered for the development of transition programmes for young people with long-term conditions, including those with Type 1 diabetes.

Aims: For many young people with Type 1 diabetes, transition from paediatric to adult care can result in a marked deterioration in glycaemic control. A systematic review assessed the effectiveness of transition models, or components of models, for managing the transition process in young people with long-term conditions, including Type 1 diabetes. This involved identifying (i) the main barriers and facilitators in implementing a successful transition programme and (ii) the key issues for young people with long-term conditions and professionals involved in the transition process. Methods: The following databases were searched from inception to August 2012: MEDLINE, EMBASE, PsychINFO, CINAHL, ASSIA, Social Services Abstracts, Academic Search Complete, Social Science Citation Index, Cochrane and Campbell Libraries. Selected studies included young people aged 11 25 diagnosed with long-term conditions who were in transition from paediatric to adult secondary healthcare services. Results: Sixteen systematic reviews and 13 primary studies were included from 9,992 records retrieved. No single transition model was uniquely effective. The most successful transitions centred around the following factors: young personfocused; age and developmentally appropriate content and delivery; selfmanagement education; family participation; paediatric and adult collaboration; designated transition clinics; transition coordinator; young person’s portfolio; specific professionals’ training; multidisciplinary approach; structured process embedded in service delivery. There were no distinctive characteristics of condition-specific Type 1 diabetes services. Conclusion: This important and timely review summarises the key factors that need to be considered for the development of transition programmes for young people with long-term conditions, including those with Type 1 diabetes.

Copyright © The Authors 2015 Despite recent attempts to improve the quality of school meals in England through the introduction of school meal standards, uptake remains low. Since the introduction of the universal infant free school meal (UIFSM) scheme in September 2014 all pupils in Reception, Year 1 and Year 2 in English state-funded primary schools are eligible to receive a free lunch. This study aimed to explore the perceptions of pupils, catering managers and head teachers concerning school meal provision in eight primary schools in North England and provides a unique insight into each school’s preparation for implementation of UIFSM. A total of thirty-two focus groups were conducted with sixty-four pupils aged 7–8 years (Year 3) and sixty-four pupils aged 9–10 years (Year 5) in June–July 2014, to explore perceptions of school meals. Interviews were carried out with six catering managers and five head teachers concerning catering and the impending implementation of UIFSM. Increasing acceptance of school meals could lead to improved uptake. Pupils desired increased choice and menu variety, including greater variety of vegetables and fruit. Caterers can influence the quantity and types of foods offered to pupils, and there are opportunities for them to promote healthy eating behaviours in the dining room. The important roles of school meal providers, caterers, pupils and parents need to be recognised to improve delivery and acceptability of school meals and ultimately school meal uptake. There were practical challenges to implementation of UIFSM, with some concerns expressed over its feasibility. Head teachers were mainly positive about the potential beneficial impacts of the scheme.

One in four toddlers are not achieving the recommended vitamin D intake crucial for their healthy development(1, 2). This study explored parents’ acceptability of factors affecting purchasing of foods and drinks fortified with Vitamin D in children aged 0-2 years old. A total of 194 parents completed an online parent questionnaire. Focus groups and interviews were used to explore in depth perceptions of vitamin D fortification. Thirteen participants participated in the 5 focus groups, 5 completed interviews. The majority of participants were female (mothers) and of White-British ethnic background, aged between 25-40 years, with 89% of the sample with a level 3 qualification (e.g. 2 or more A levels, NVQ level 3). Basic descriptive statistics were calculated from the questionnaire data and a thematic analysis methodology was applied to the qualitative data. The findings indicated low purchasing of vitamin D fortified foods/drinks by parents (21% of the sample). The foods/drinks most purchased were cereal, yogurts and alternative milks. Willingness to purchase certain products fortified with vitamin D to increase their child’s vitamin D was however high. After excluding formula milk, parents would be willing to buy yogurt, yogurt drinks, cereals, milk-based drinks, fruit juice and margarine. The table outlines parents’ views on the facilitators and barriers to purchasing vitamin D fortified foods and drinks. There is a potential for fortified foods to play a role in increasing the intake of vitamin D intake. Parents need quality education explaining the need to prevent vitamin D deficiency, though fortified products. Products also need to be suitable for babies and toddlers; better labelled, lower cost; with healthy options available with lower sugar and salt content, tasty, longer shelf life and better availability in local shops and supermarkets. Future research should determine if consumption of fortified foods/drinks alone rather than supplementation is sufficient to meet children’s daily intake of vitamin D(3).

© 2019 The Author(s). Background: This study aims to evaluate the feasibility and acceptability of the PhunkyFoods Programme, a primary school-based intervention to promote healthy nutrition and physical activity knowledge and behaviours to assess outcomes to inform a phase 3 trial. Methods: The cluster randomised feasibility trial recruited eight primary schools from the North of England. Elibility criteria included all primary schools in one town, excluding independent and special schools and schools that comprised of only key stage 2 pupils (years 3-6). Eight schools agreed to participate. Randomisation to intervention or control arms was in a 1:1 ratio. Intervention schools received PhunkyFoods over 17 months. Control schools continued with usual curriculum. Assessors were blinded to group assignment. Measures comprised of a Healthy Lifestyle Knowledge Questionnaire and Synchronised Nutrition and Activity Program to assess diet and physical activity, height, weight, and psychological wellbeing. Feasibility outcomes were recruitment, attrition rates, interviews with teaching staff, focus groups with pupils to explore the acceptability of outcome measures, implementation, intervention content, and programme fidelity. Results: Three hundred fifty-eight pupils, aged 6-9 years from eight schools were recruited at baseline (control n = 170, intervention n = 188); 337 (94.1%) at 6 months (control n = 163, intervention n = 181); and 331 (92.5%) at 18 months (control n = 152, intervention n = 179), and 6 pupils opted out. Trends in increased knowledge of healthy lifestyle behaviours, healthier eating, and liking of fruit and vegetables were reported in the intervention compared to the control group. Year 4 intervention pupils had significantly higher healthy balanced diet knowledge scores compared to control pupils, mean difference 5.1 (95% CI 0.1 to 10.1, p=0.05). At 18 months, the mean percentage of vegetables liked was higher (intervention 53.9% vs. 43.0% control). Similarly, percentage of fruits liked was also higher (intervention 76.9% vs. 67.2% control). Qualitative data showed that delivery of the intervention was feasible and acceptable to teachers and pupils. Lessons were learned to inform the phase 3 trial around the dietary assessment measure and timing of recruitment. Conclusions: Whilst the study was not powered to detect a definitive effect, results suggest a potential to increase knowledge of healthy lifestyle behaviours and dietary behaviours, suggesting that with minor changes, a phase 3 trial is likely to be deliverable. Trial registration: ISRCTN, ISRCTN15641330. Registered 8 May 2015 - retrospectively registered, https://doi.org/10.1186/ISRCTN15641330

© 2019 The Author(s). Background: Primary schools are valuable settings to implement healthy lifestyle (healthy eating and physical activity) interventions, aimed at targeting childhood obesity. This study explored school staff perceptions of factors that hinder and enable successful implementation and sustainability of healthy lifestyle interventions in primary schools. Qualitative data was pooled and analysed from two evaluations carried out in primary schools in North England: a feasibility study of a nutrition and physical activity educational programme (PhunkyFoods Feasibility Study), and an evaluation of a healthy eating programme (The Food Dudes Evaluation). Methods: Sixty-five qualitative semi-structured interviews were conducted with head teachers, teachers, catering managers, designated school-based programme coordinators and programme staff supporting schools with programme delivery, at 14 schools involved in both evaluations. Thematic analysis was undertaken and emergent themes categorised using a framework for successful implementation by Durlak and Dupre (2008). Results: Overall, all schools were delivering a range of healthy lifestyle programmes, often with overlapping content. Perceived challenges to implementation of individual programmes included: limited time, timing of implementation, limited training and support, insufficient resources, capacity and facilities, staff perceptions of intervention and perceived skill-proficiency (for cooking and physical activities). Short-term funding, lack of external and internal support were perceived to hinder sustainability. Staff recommendations for successful implementation of future programmes included: extended training and planning time, sufficient capacity, external support for delivery, good resources (interactive, practical and adaptable), and facilities for cooking, healthy eating, gardening and physical activities. Head teachers need to prioritise delivery of a few key healthy lifestyle programmes, in an overcrowded curriculum. Schools need to employ strategies to engage participation of staff, pupils and parents long term. Conclusions: Effective implementation of school-based healthy lifestyle programmes was thought to be aided by flexible and adaptable programmes, enabling good contextual fit, well-resourced programmes and effective leadership at multiple levels, pupil (pupils support delivery) and parent involvement. To facilitate sustainability, it was perceived that programmes need to be integrated within the curriculum and school policies long term, with sustained support from head teachers and staff. These findings are relevant to programme developers, policy makers and those involved in delivering interventions.

Purpose: This paper presents findings from an evaluation of a mental health resilience intervention for unemployed men aged 45-60. The paper examines the place of facilitated peer support within a men’s mental health programme, and explores implications for resilience building approaches for men. Design: The paper draws on before and after survey data and qualitative interviews, to report results concerning effectiveness in changing men’s perceived resilience, to consider project processes concerning peer support, and to situate these within wider environments. Findings: The programme significantly raised the perceived resilience of participants. Project activities promoted trusting informal social connections, gains in social capital arose through trusting relations and skill-sharing, and peer-peer action-focused talk enhanced resilience. Practical and social implications: The paper discusses gender-sensitive approaches to engage men and build resilience by focusing on doing and talking and peer support, and highlights the need to consolidate gains with a focus on individual and community resilience. Originality/value: The paper adds fresh evidence of gendered intervention approaches with a specific focus on facilitated peer support, including effects on male resilience.

Background Childhood obesity is a pertinent public health problem in the UK. Consumption of free sugars has been associated with the development of obesity. In 2018, the Change 4Life (C4L) 100 cal snack campaign was launched with the slogan ‘100 calorie snacks, two a day max’, aiming to encourage parents to choose lower sugar, fat and calorie snacks for their children. This study aimed to examine how the campaign has been perceived by parents. Methods An online survey was developed to explore parent awareness, perceptions and understanding of the C4L 100 cal snack campaign. Respondents were recruited via Leeds City Council, posters displayed at primary schools and children’s centres across Leeds and via social media. Paper surveys were also shared with voluntarily led playgroups. Survey data was analysed using descriptive statistics. Thematic analysis was performed on open text responses. Results Three hundred forty-two 342 respondents completed the survey. Just over half of the respondents had come across the campaign, most seeing the leaflet or a television advert. Over two-thirds of respondents ‘agreed’ or ‘strongly agreed’ that the campaign caught their attention. A similar proportion ‘agreed’ or ‘strongly agreed’ that the campaign informed them about 100 cal snacks and just over a half thought it was memorable. Most respondents used positive language to describe the campaign, but there was no clear consensus of a perceived positive impact on healthier snack purchasing, nor preparing more 100 cal snacks at home. Respondents provided examples of how the campaign could be improved to positively impact eating behaviours: better publicity and information delivery; healthier snack examples made more visible; improved nutritional labelling and access to healthier products in supermarkets (availability, promotion, display, choice). Conclusions The C4L 100 cal snack campaign was perceived positively by parents and carers, with many agreeing that the campaign was informative and memorable. However, there was no agreement in terms of the parents reporting an impact of the campaign on behaviour change and healthier snack habits. Future social marketing campaigns could be improved through more formal pilot testing to assess the understanding and acceptance of the campaign amongst the target audience.

Concern persists in health-related literature about men’s reduced life expectancy and higher premature death rates; this is often linked to difficulties in engaging with men as a client group. However, some innovative projects and programmes, often led by health visitors or other community based nurses, have developed successful health promotion work with men. This article collates existing tacit knowledge (previous learning) about men’s health interventions by integrating interview data from nine practitioners who have established such initiatives with data from 35 men’s health project reports to consider ‘what works’. Five themes stood out as being significant across the data reviewed: using the right setting (often outside statutory services); ensuring the right approach (drawing on malespecific interests and language); actively listening to what local men say; appropriate training (initial and ongoing) for those involved in such work; and partnership working with local community groups, businesses and statutory service providers. While not a panacea for working with any and all men, these themes form a good basis for successful engagement with men and align well with what a recent review of health visitor interventions suggest works in helping bridge service provision-uptake gaps.

Purpose This paper presents findings from an evaluation of a mental health resilience intervention for unemployed men aged 45-60. The focus is on examining the place of activities within a multi-dimensional men’s mental health programme, and exploring interactions between social context factors and models of change. Design The paper draws on before and after survey data and qualitative interviews, to report results concerning effectiveness in changing men’s perceived resilience, to consider project processes concerning activities, social support and coping strategies, and to situate these within wider environments. Findings The programme significantly raised the perceived resilience of participants. Activities were engaging for men, while the complex intersection between activities, social networking, and coping strategies course provided opportunities for men to develop resilience in contexts resonant with their male identities. Practical implications The paper discusses emerging considerations for resilience building, focusing on gender-sensitive approaches which can engage and retain men by focusing on doing and talking, in the contexts of men’s life-course, highlighting embodied (male) identities not disembodied ‘mental states’, and facilitating social support. There are challenges to recruit men despite stigma, support men to speak of feelings, and facilitate progression. Social implications Potential exists for gender-aware programmes to sustain salutogenic change, co-producing social assets of peer support, male-friendly activities, and context sensitive course provision. Originality/value The paper adds fresh evidence of gendered intervention approaches, including effects on male resilience. Application of a context-sensitive change model leads to multi-component findings for transferring and sustaining programme gains.

Health Champions are a growing component within the British public health workforce and their roles are now emphasised within the coalition’s Government’s public health strategy. However, there is the need for further exploration of the way in which Health Champions use interpersonal communication within their roles. This paper reports on the findings from a mixed method evaluation of one Health Champion programme in North East England. A key finding was the way in which Health Champions used circles of influence to communicate health knowledge and to try to achieve behaviour change, starting with themselves in the centre of their circle and then moving outwards to influence others such as family, friends and colleagues through their social networks. The paper argues that health champions act as healthy role models within their own circles of influence to successfully communicate health knowledge to those around them.

In 2012, I project managed a team of researchers who were commissioned to undertake an evaluation of the Sunderland Health Champions Programme. Evaluation is an activity that remains central to health promotion practice because it is concerned with assessing whether interventions are effective (Green and South 2006). Health Champions are a growing component within the British public health workforce and their roles are emphasised within the coalition’s Government’s public health strategy. However, there is the need for further exploration of the way in which Health Champions work and the effectiveness of programmes that use Health Champions as a mechanism to try to achieve positive health changes. Therefore Sunderland tPCT commissioned independent researchers, staff from the Centre for Health Promotion Research at Leeds Metropolitan University to evaluate their Health Champion Programme.

Summary This umbrella review assessed the association between excess weight and COVID‐19 outcomes. MEDLINE, PsycINFO, and CINAHL were systematically searched for reviews that assessed the association between excess weight and COVID‐19 outcomes. A second‐order meta‐analysis was conducted on the available data for intensive care unit admission, invasive mechanical ventilation administration, disease severity, hospitalization, and mortality. The quality of included reviews was assessed using the AMSTAR‐2 appraisal tool. In total, 52 systematic reviews were included, 49 of which included meta‐analyses. The risk of severe outcomes (OR = 1.86; 95% CI: 1.70 to 2.05), intensive care unit admission (OR = 1.58; 95% CI: 1.45 to 1.72), invasive mechanical ventilation administration (OR = 1.70; 95% CI: 1.57 to 1.83), hospitalization (OR = 1.82; 95% CI: 1.61 to 2.05), and mortality (OR = 1.35; 95% CI: 1.24 to 1.48) following COVID‐19 infection was significantly higher in individuals living with excess weight compared with those with a healthy weight. There was limited evidence available in the included reviews regarding the influence of moderating factors such as ethnicity, and the majority of included reviews were of poor quality. Obesity appears to represent an important modifiable pre‐infection risk factor for severe COVID‐19 outcomes, including death.