Nigel Lloyd

Background: Drug and alcohol support workers play a vital role in addressing the growing burden of substance-related harm and mortality. The COVID-19 pandemic led to an abrupt and significant shift towards home working for many in this workforce. This study explores these workers’ home working experiences, addressing a research gap and providing valuable insights for staff, organisations delivering public health services, and service users. Design and methods: This qualitative study explores home working experiences of 30 drug and alcohol support workers in northern England during the COVID-19 pandemic. Data collection included innovative digital methods: (1) digital timelines ( n = 16); (2) in-depth interviews ( n = 17); (3) five focus groups ( n = 12). Timeline text was treated as qualitative text data. Interviews and focus groups were recorded, transcribed, and coded. Data were subject to Framework Analysis. Results: Seven themes were identified: (1) Difficulty balancing and separating work and home life; (2) Importance of setup, infrastructure and conducive work environment; (3) The move to remote/home working – a process; (4) Convenience and efficiency benefits; (5) Loss of the social – reductions in social connectedness and feelings of isolation; (6) The importance of the ‘office’ for connection, communication, socialising, and information sharing; (7) Managing remotely – the development and implementation of strategies and ways of coping. Conclusions: While home working offers some benefits for substance use support workers, providers, and service users, it also introduces significant challenges. Understanding these is critical for service optimisation. A hybrid (in-person/remote) delivery model, combining home and co-located, office-based working may be optimal.

Cardiovascular disease (CVD) is the leading cause of death globally; in the UK it contributes to a quarter of all deaths. In 2009, the UK National Health Service launched the NHS Health Check (NHSHC) programme to address CVD by assessing all adults aged between 40 and 74 years for CVD risk factors. Encouraging uptake of NHSHCs has proved challenging and areas for development have been identified nationally, prompting modifications to NHSHC practice in some localities. This protocol article describes a programme of research that will evaluate the impact of NHSHC modifications on attendance and outcomes in a large English local authority area. Modifications to NHSHC delivery (delivery of a modified NHSHC by a healthy lifestyle service rather than via general practice led delivery) and NHSHC invitation processes (implementation of text message prompts and reminders and an additional online booking option) will be evaluated. The research consists of six workstreams within a mixed methods framework: 1) Quantitative analysis of client NHSHCs records; 2) Focus groups with healthy lifestyle staff involved in coordinating and delivering the modified NHSHCs sessions; 3) Interviews with staff from pilot GP practices whose roles involve the coordination or delivery of NHSHCs; 4) Interviews with clients who have attended a healthy lifestyle service NHSHC; 5) Health economic resource and cost evaluation; 6) Data analysis, synthesis, and dissemination. The research programme’s breadth and its novel nature, mean that it will provide valuable findings for those commissioning and delivering NHSHCs nationally, and for the wider public health community.

Today’s challenging times highlight the need for workplaces to support employee wellbeing. Workplaces can offer a means to improve employee wellbeing and promote health initiatives. However, small and medium-sized enterprises (SMEs) are less likely than larger organizations to engage with workplace wellbeing initiatives or offer wellbeing provision. This study, conducted in an urban area in central England, explores SME engagement with local government workplace wellbeing provision, and barriers and facilitators to SME engagement, SME implementation of wellbeing provision, and employee uptake. A mixed-methods design was used. Quantitative data were collected via a survey of 103 SMEs and qualitative data from three focus groups with stakeholders involved in promoting SME engagement with wellbeing support (n = 9) and 16 in-depth interviews with SME representatives (n = 8) and employees (n = 8). Quantitative data were analyzed using the chi-squared, Fisher’s exact and Mann-Whitney U tests, and multivariable logistic regression. Qualitative data were analyzed using framework analysis. Findings highlighted several interrelated factors acting as barriers and facilitators to SME engagement with wellbeing initiatives, SME-provided wellbeing provision, and employee uptake. The study provides valuable insights for policymakers, public health teams, and SME leaders on improving provision of and engagement with wellbeing programs. Trust, awareness, knowledge, and communication are highlighted as important prerequisites of optimal provision and engagement.

Background: Obesity is a global epidemic affecting all age groups, populations, and income levels across continents, though is known to disproportionately affect socioeconomically disadvantaged populations. The causes of obesity are complex, informed by diet and weight practices, but shaped by social, commercial, and environmental factors and government policy. Consequently, a Whole System Approach (WSA)–which considers the many causes of obesity and shifts the focus away from individuals as points of intervention and puts an emphasis on understanding and improving the system in which people live–is required. This scoping review of reviews aims to: determine how WSAs to diet and healthy weight have been implemented and evaluated nationally and internationally; to determine what models or theories have been used to implement WSAs; describe how WSAs have been evaluated; determine if WSAs are effective; and to identify the contribution of the public and/or service users in the development of WSAs. Method: Systematic searches were carried out using CINAHL, Scopus, PsycINFO (ProQuest), the Cochrane Library, and MEDLINE. Included review papers were those that focused on the application of a whole system approach to diet and/or healthy weight, and/or reported the theory/model used to implement or simulate this approach. Databases were searched from 1995 to March 2022 using a combination of text and Medical Subject Headings (MeSH terms). In addition, reference sections of identified articles were examined for additional relevant articles. Covidence software was used to screen titles and abstracts from the electronic databases and resolve conflicts. Results: A total of 20,308 articles were initially retrieved; after duplicate removal 7,690 unique title and abstracts were reviewed, and 110 articles were selected for full text review. On completion of full text review, 8 review articles were included for data extraction. These included: one umbrella review, four systematic reviews, a rapid review, and two literature reviews (one of which was on strategic reports written for government and public health policy). Evaluations of WSA were mainly process evaluations although health outcomes were assessed in some studies. Several conceptual frameworks or mathematical modelling approaches have been applied to WSAs for diet, healthy weight, and obesity to inform their planning or delivery, and to understand/map the associated systems. Common mathematical approaches include agent based or System Dynamic Modelling. Underlying both conceptual and mathematical models is an understanding how the elements of the complex systems impact each other to affect diet, healthy weight, and obesity. WSA implementations have reported some success in positively impacting health outcomes including reducing Body Mass Index, reducing sugary food intake, and increasing physical activity. Public and user involvement in WSA was not widely reported. Conclusion: The application of WSA to diet and healthy weight shows promise, yet the research is lagging behind their implementation. Further robust evidence for using WSA to address diet and healthy weight are required, including incorporating process and outcome evaluations (perhaps using established approaches such as Systems Dynamic Modelling). Furthermore, the analysis of epidemiological data alongside longitudinal process and outcome evaluation regarding the implementation of a WSA is required.

Background: Substance misuse is a significant global health concern. In the UK, the prevalence of substance misuse has increased over the past decade and the number of alcohol and drug related deaths are increasing. Individuals with substance dependency issues are entitled to access treatment services. However, the COVID-19 pandemic created significant challenges for public services, including drug and alcohol treatment, and resulted in significant service reconfiguration and a shift from in-person to remote delivery. This study aims to evaluate the delivery of drug and alcohol services in a large metropolitan area in Northern England during the COVID-19 pandemic. It aims to understand the impact of service reconfiguration for services, staff and service users, and to use this understanding to inform the future optimised design of services. Design and methods: The study has five workstreams within a mixed methods framework: (1) Systematic review of literature; (2) Qualitative process evaluation with service providers (digital timelines, focus groups and interviews); (3) Qualitative process evaluation with service users (interviews, focus groups, text based conversations and case studies); (4) Quantitative outcomes and health economic analysis; and (5) Data synthesis and dissemination. Expected Impact of the study for Public Health: The breadth of the study, its novel nature, and the importance of substance misuse as a public health issue, mean that this study will provide valuable findings for those who commission, deliver and use drug and alcohol treatment services nationally and internationally. There will also be important learning for the effective remote delivery of services in sectors beyond drug and alcohol treatment.

Electronic patient records offer unique opportunities to undertake population-based research. The Health Research Support Service (HRSS) pilot project sought to extract electronic records on a national basis from across health and social care and transfer them together with identifiers to a designated ‘safe haven’. To determine the feasibility and acceptability of the HRSS pilot in primary care. Interviews and focus groups with patients and practice staff. There was general support from both patients and staff for the principle of the HRSS. The ‘opt-out’ basis for participation in the HRSS drew mixed responses from patients and staff, with an appreciation of the advantages in relation to participation by default, but concerns about the extent to which this constituted true consent. Concerns were expressed about confidentiality and the safety and security of the extracted data. The patient information pack was roundly criticized by both patients and staff. Trust in individual GPs, practices and the National Health Service (NHS) was a crucial factor in patients’ decisions about participation. Although patients and staff were generally supportive of the HRSS, they require clear information about the proposed use of medical records for research purposes. The question of ‘opt out’ versus ‘opt in’ remains controversial and further consideration will be needed if research using routine medical records is to achieve its full potential as a ‘core’ activity in the NHS.

This article uses the example of Sure Start, a national initiative introduced by the UK Government in the late 1990s, as a case study to explore the reasons why large-scale, complex, national initiatives often fail to adequately evidence the impact of their work. The authors explore a range of structural, cultural, methodological and practical factors that have acted to inhibit effective evaluation of the impacts of Sure Start. They argue that the potential exists for more effective and efficient evaluation of the outcomes of complex community initiatives such as Sure Start, if factors such as those outlined within the article are adequately addressed. This article provides important learning for those funding, commissioning and delivering complex community initiatives.