Michael Ravey

Purpose Over 200,000 young people in the UK embark on a smoking career annually, thus continued effort is required to understand the types of interventions that are most effective in changing perceptions about smoking amongst teenagers. Several authors have proposed the use of social norms programmes, where correcting misconceptions of what is considered normal behaviour lead to improved behaviours. There are a limited number of studies showing the effectiveness of such programmes for changing teenagers’ perception of smoking habits, and hence this paper reports on the results from one of the largest social norms programmes that used a variety of interventions aimed at improving teenagers’ perceptions of smoking. The paper aims to discuss this issue. Design/methodology/approach A range of interventions were adopted for 57 programmes in year nine students, ranging from passive interventions such as posters and banners to active interventions such as student apps and enterprise days. Each programme consisted of a baseline survey followed by interventions and a repeat survey to calculate the change in perception. A clustering algorithm was also used to reveal the impact of combinations of interventions. Findings The study reveals three main findings: the use of social norms is an effective means of changing perceptions, the level of interventions and change in perceptions are positively correlated, and that the most effective combinations of interventions include the use of interactive feedback assemblies, enterprise days, parent and student apps and newsletters to parents. Originality/value The paper presents results from one of the largest social norm programmes aimed at improving young people’s perceptions and the first to use clustering methods to reveal the impact of combinations of intervention.

Background: Therapeutic footwear is recommended for those people with severe foot problems associated with rheumatoid arthritis (RA). However, it is known that many do not wear them. Although previous European studies have recommended service and footwear design improvements, it is not known if services have improved or if this footwear meets the personal needs of people with RA. As an earlier study found that this footwear has more impact on women than males, this study explores women's experiences of the process of being provided with it and wearing it. No previous work has compared women's experiences of this footwear in different countries, therefore this study aimed to explore the potential differences between the UK, the Netherlands and Spain.Method: Women with RA and experience of wearing therapeutic footwear were purposively recruited. Ten women with RA were interviewed in each of the three countries. An interpretive phenomenological approach (IPA) was adopted during data collection and analysis. Conversational style interviews were used to collect the data.Results: Six themes were identified: feet being visibly different because of RA; the referring practitioners’ approach to the patient; the dispensing practitioners’ approach to the patient; the footwear being visible as different to others; footwear influencing social participation; and the women's wishes for improved footwear services. Despite their nationality, these women revealed that therapeutic footwear invokes emotions of sadness, shame and anger and that it is often the final and symbolic marker of the effects of RA on self perception and their changed lives. This results in severe restriction of important activities, particularly those involving social participation. However, where a patient focussed approach was used, particularly by the practitioners in Spain and the Netherlands, the acceptance of this footwear was much more evident and there was less wastage as a result of the footwear being prescribed and then not worn. In the UK, the women were more likely to passively accept the footwear with the only choice being to reject it once it had been provided. All the women were vocal about what would improve their experiences and this centred on the consultation with both the referring practitioner and the practitioner that provides the footwear.Conclusion: This unique study, carried out in three countries has revealed emotive and personal accounts of what it is like to have an item of clothing replaced with an ‘intervention’. The participant's experience of their consultations with practitioners has revealed the tension between the practitioners’ requirements and the women's ‘social’ needs. Practitioners need greater understanding of the social and emotional consequences of using therapeutic footwear as an intervention.

Background: The foot is often the first area of the body to be systematically affected by rheumatoid arthritis. The multidimensional consequences of foot problems for patients can be subjectively evaluated using patient‐reported outcome measures (PROMs). However, there is currently no systematic review which has focused specifically upon the PROMs available for the foot with rheumatoid arthritis. The aim of this systematic review was to appraise the foot‐specific PROMs available for the assessment and/or evaluation of the foot affected with rheumatoid arthritis.Methods: A systematic search of databases was conducted according to pre‐defined inclusion/exclusion criteria. PROMs identified were reviewed in terms of: conceptual bases, quality of construction, measurement aims and evidence to support their measurement properties.Results: A total of 11 PROMs were identified and 5 papers that provided evidence for the measurement properties of some of the PROMs. Only one of the PROMs was found to be RA disease‐specific. The quality of construction, pretesting and presence of evidence for their measurement properties was found to be highly variable. Conceptual bases of many of the PROMs was either restricted or based on reductionist biomedical models. All of the PROMs were found to consist of fixed scales.Conclusions: There is a need to develop an RA‐disease and foot‐specific PROM with a greater emphasis on a biopsychosocial conceptual basis, cognitive pre‐testing methods, patient preference‐based qualities and evidence to support the full complement of measurement properties.

Specialist 'therapeutic' footwear is recommended for patients with diseases such as rheumatoid arthritis (RA) as a beneficial intervention for reducing foot pain, improving foot health, and increasing general mobility. However, many patients choose not to wear this footwear. Recommendations from previous studies have been implemented but have had little impact in improving this situation. The aim of this study was to explore RA patients' experiences of this footwear to ascertain the factors which influence their choice to wear it or not.