Dr Emily Kelleher, UCC 2013
The implementation of a family-focused lifestyle programme for managing childhood obesity in the community setting in Ireland
Institution: UCC, 2013 cohort
Supervisors: Dr. Janas Harrington (UCC), Dr. Frances Shiely (UCC), Prof. Ivan J. Perry (UCC), Dr. Sheena McHugh (UCC)
Background and aim: Childhood obesity is a significant public health issue. International guidelines continue to recommend family-focused, multicomponent, childhood weight management programmes despite limited evidence on their effectiveness or implementation in real-world settings. In 2014, the Irish Health Service proposed a national pilot of the W82GO-community programme. The overall aim of this thesis was to investigate the barriers and facilitators to the implementation of W82GO-community and explore the factors influencing family engagement.
Methods: W82GO-community aimed to improve nutrition, increase physical activity and facilitate behaviour change in children aged 5-7 years who measured ≥98th percentile over one year. It was piloted in two community sites by two multidisciplinary teams from April 2015 to April 2016. Firstly, a qualitative study was conducted to explore implementation from the perspective of 29 national and local level stakeholders responsible for implementing the programme including professionals from dietetics, psychology, public health nursing, physiotherapy, health promotion and administration. Framework analysis was used to identify barriers and facilitators which were mapped onto a well-known implementation framework. Secondly, a systematic review of international literature was carried out to investigate what factors influence attendance at similar community-based lifestyle programmes among families of overweight or obese children. This was followed by another qualitative study exploring public health nurses (PHNs) experiences of referring families to, and families’ feelings of being referred to, W82GO-community. It also investigated families’ motivation to participate in and complete treatment. Finally, in light of findings from the aforementioned studies a cross-sectional analysis of data collected as part of the Cork Children’s Lifestyle Survey (CCLaS) was conducted to identify factors influencing parent and child misperception of child weight.
Results: For all stakeholders, barriers to the implementation of W82GO-community arose due to the multidisciplinary nature of the programme, including the lack of role clarity and added complexity of working in different locations. Furthermore, a lack of parental engagement, as evidenced by low enrolment and retention rates, presented a further challenge for programme implementation. Of the 121 children who were eligible for initial assessment, less than half of families accepted the invitation and of those who presented, 19 subsequently started the programme. Just eight families completed the W82GO-community programme. The systematic review on barriers and facilitators to family attendance and retention found that parents are largely driven to enrol because of a concern for their child’s psychological health and wellbeing. However, the stigma surrounding excess weight and the denial of the issue amongst some parents presents significant barriers to enrolment. The systematic review findings also suggest that over the course of a programme, children’s positive social experiences such as having fun and making friends foster the desire to continue participating in treatment. Results from our qualitative study involving PHNs and parents who participated in W82GO-community found that both PHNs and parents were fearful of the referral process. They had concerns about both the practicality of making the referral and the significance of the referral on the health and wellbeing of the child, respectively. Despite these initial fears, parents concern for their child’s future was a major driver behind their participation. Finally, the cross-sectional analysis of CCLaS data highlighted that 45% of parents of overweight/obese children underestimated their child’s weight and this was influenced by child age and child misperception of own weight. 77% of overweight/obese children misclassified their own weight.
Conclusion: This thesis provides critical evidence on the complexities associated with implementing a multidisciplinary childhood weight management programme in real-world settings. It provides practical recommendations to guide future policy makers, programme delivery teams and researchers, in particular, when developing strategies to boost recruitment, minimise attrition and subsequently enhance effectiveness. Findings highlight the profound limitations of family-focused, community-based, weight management programmes and confirm the critical need for broader societal intervention.
Dr. Annette Burns, RCSI 2013
Smoking and Smoking Cessation in those with Mental Health Difficulties in Ireland
Institution: RCSI, 2013 cohort
Supervisors: Dr. Frank Doyle (RCSI), Dr Judith Strawbridge, Professor Luke Clancy (Tobacco Free Research Institute Ireland)
Background: There is a higher prevalence of smoking among individuals with mental health difficulties (MHDs) internationally. This thesis aimed to establish impact of smoking on those with MHDs in Ireland in terms of smoking-related diseases and to evaluate current cessation care in both secondary and community mental health (MH) settings, using three interrelated studies guided by the Medical Research Council framework.
Methods: Study 1, a cross-sectional retrospective secondary analysis (n=8,175), established the prevalence of smoking and smoking-related disease in a nationally representative sample of community living adults aged 50 and over. Individuals with evidence of MHDs were compared to their general population counterparts through adjusted regression analyses, including mediation and moderation assessments. In study 2 cessation care in MH settings was explored. A survey of inpatients (n=246) with 3-month follow-up established current levels of care and quit rates in a private inpatient setting. Finally, study 3 involved a qualitative process evaluation of the recent implementation of a community-based smoking cessation service in public adult MH centres, involving interviews with 20 service users and 4 focus groups with 17 facilitators.
Results: Older adults with MHDs had increased prevalence of smoking ((25-39%) RRRs 1.84 [1.50 to 2.26] to 4.31 [2.47 to 7.53]) and of smoking-related disease ((53-60%) ORs 1.24 [1.01 to 1.51] to 1.62 [1.00 to 2.62]). Very few psychiatric inpatients report cessation advice from any HCP in the past year (13%), but numbers wanting to quit (75%) and 3-month quit rates (17%) are similar to non-psychiatric inpatient samples. Key enablers and barriers emerged at facilitator and participant levels in community MH centres, which also have implications for other settings.
Conclusions: Individuals with MHDs are disproportionately impacted by smoking yet remain undertreated. While cessation care is improving in community settings, a joined-up approach across all sectors of the health service is needed.
Dr. David O’ Riordan, UCC 2013
The role of the pharmacist in optimising prescribing in community-dwelling older adults
Institution: UCC, 2013 cohort
Supervisors: Prof. Stephen Byrne (UCC), Prof. Patricia Kearney (UCC), Dr. Carol Sinnott (THIS Institute), Dr. Rose Galvin (UL)
Background: Providing optimal care for older adults creates many challenges for healthcare providers especially general practitioners. The overarching aim of this thesis was to understand the potential role of the pharmacist in optimising prescribing for older people in primary care.
Methods: A cross-sectional study was carried out to highlight the prevalence of prescribing issues in older adults across three European countries. The published literature was then systematically reviewed to evaluate studies of pharmacist-led interventions on potentially inappropriate prescribing (PIP) among community-dwelling older adults. A qualitative study was carried out to reveal the determinants of GP prescribing behaviour for older adults in primary care and to elicit GPs’ views on the potential role for broad intervention strategies involving pharmacists and/or information technology systems in general practice. These findings then informed the pharmacist-led academic detailing intervention with GPs on the topic of urinary incontinence in older people.
Results: The cross-sectional study highlighted that PIP and potential prescribing omissions (PPOs) were prevalent in this cohort of European participants. The systematic review demonstrated that pharmacist-led interventions may improve prescribing appropriateness in community-dwelling older adults. The qualitative study highlighted the complexities of behavioural determinants of prescribing for older people in primary care and the need for additional supports to optimise prescribing for this growing cohort of patients. One approach that GP participants agreed could lead to a meaningful and sustained improvement in prescribing is interactive educational outreach or academic detailing. Therefore, an intervention was developed incorporating pharmacist-led academic detailing. The results of the research indicate that the intervention was well received and highly valued by GPs.
Conclusion: This study has made an important contribution to the topic of prescribing for older adults in primary care by highlighting that educational interventions such as academic detailing are welcomed in the context of general practice in Ireland.
Dr. Padraic Fleming, MU 2013
An evaluation of the development and implementation of individualised funding for people with a disability
Institution: Maynooth University, 2012 cohort
Supervisors: Professor Sinéad McGilloway (MU) and Dr. Sarah Barry (TCD).
Dr. Áine Ryan
Levels of Physical Activity and Function and Multimorbidity Risk
Institution: RCSI, 2013 cohort
Supervisors: Prof. Susan Smith (RCSI), Dr. Rose Galvin (UL), Dr. Caitriona Murphy (DCU)
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