144 research outputs found
The Impact of Health Qigong and Tai Chi Exercises on Quality of Life and Physical Functioning in Patients with Atrial Fibrillation: A Multi-Method Feasibility Study
No full textThe effectiveness and efficiency of a primary care based osteopathy clinic for spinal pain
No full textSpinal pain is common, disabling, costly to society, and a frequent reason for consulting a general practitioner (GP). Usual GP care involves the prescription of analgesia, advice about rest, activity and work, and orthopaedic or physiotherapy referral. Spinal manipulation is recommended by low back pain clinical guidelines, but recent Cochrane reviews found that manipulation has limited effectiveness compared with other treatments, although few trials comparing spinal manipulation with usual GP care were identified. A primary care osteopathy clinic was established in Llanfairfechan health centre by the author. The overall aims of this thesis were to determine whether this was more effective than usual GP care, and an efficient use of health service resources. Preparatory studies comprised an audit of the clinic to describe the treatment package, development of a set of condition-specific outcome measures for the whole spine, the Extended Aberdeen Spinal Pain Scales (EASPS), and their psychometric testing, as well as piloting other secondary outcome measures. The Randomised Osteopathic MANipulation Study (ROMANS) recruited 199 patients randomised to usual GP care, or an additional three sessions of osteopathic spinal manipulation. After two months all outcome measures had improved in both groups the osteopathic treatment group by more than the usual care group. This improvement was significantly greater in the primary outcome measure the EASPS (effect size 0.4) and the SF-12 mental score (effect size 0.6). At six months most outcome measures had continued to improve in both groups, and the improvement in the osteopathy group remained significantly greater for the mental score of the SF-12 (effect size 0.5) but not for the EASPS. The point estimate of the cost per improvement in QALY gain was less than £4,000. When these results were combined in a meta-analysis with similar trials, manipulation was significantly more effective. Compared to usual GP care spinal manipulation is an effective and efficient use of health service resources
Socioeconomic diversity and physical activity: Using the Model of Human Occupation to explore physical activity behaviour
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Barriers to and Facilitators of Physical Activity Promotion and Participation for People Living With and Beyond Head and Neck Cancer: A Mixed Methods Study Using Behaviour Change Theory
No full textA comparative case study process evaluation of a Community Health and Wellbeing Worker pilot in three settings in England
No full textBackground
In 2021, three localities in England implemented Community Health and Wellbeing Worker (CHWW) pilot programmes aimed at enhancing preventive public health within primary care. Modelled on the Brazilian Family Health Strategy, the initiative was founded on four key principles: 1) recruiting, training, and paying local laypeople to deliver the intervention; 2) implementing proportionate universal outreach based on geographical area, with each CHWW assigned approximately 150 households to visit monthly, regardless of demand or need; 3) providing support to the entire household, without differentiation by age or health condition; and 4) integrating the workers into primary and community care services. A process evaluation was essential to understand this innovative and complex healthcare intervention. The evaluation examined the pilots' planning, delivery, and uptake, identified causal pathways, and documented contextual factors influencing implementation and outcomes.
Methodology
From February 2021 to September 2024, I conducted a mixed-methods comparative case study process evaluation to investigate the determinants of implementation and to generate practical programme theories for the CHWW model. Data collection methods included participant observation, interviews, focus groups, and the analysis of secondary qualitative and quantitative reports. The Consolidated Framework for Implementation Research (CFIR) guided the identification and interpretation of contextual factors, while programme theory was developed using context-mechanism-outcome configurations derived from case comparisons. Additionally, a systematic review of barriers to and facilitators of CHW programmes in high-income countries was conducted.
Results
The process evaluation provided comprehensive evidence of contextual determinants influencing each programme across the CFIR's five domains. These included: 1) Innovation: Programmes were commissioned and hosted heterogeneously—by the local authority and a GP surgery in Westminster, through the Community Mental Health Transformation framework and a mental health charity in Calderdale, and by a Community Healthcare NHS Foundation Trust in Warrington. 2) Outer Setting: National partnerships promoted fidelity to the CHWW model and facilitated cross-pilot collaboration. 3) Inner Setting: Host organisation culture, resources, training opportunities, and mission alignment were crucial for CHWW confidence, workflow integration, and community outreach. 4) Individuals: A GP service champion and proactive supervisors were critical for workforce integration, resilience, and self-efficacy. Service users valued the support offered and the workers’ relatability, accessibility, and continued support. 5) Implementation: Productivity data indicated limited uptake, and programme impact data were generally low quality. CHWW case reports illustrated their varied, challenging, and effective work. Eight overarching programme theories were developed, describing key implementation mechanisms and the contextual factors that shape them.
Conclusions
This study provides comprehensive and contextualised evidence regarding the commissioning and delivery of the innovative CHWW model, along with practical recommendations for its implementation, scaling, and further evaluation. These findings will be highly valuable to the growing number of implementation sites, which, as of 2025, includes 26 localities
Community Health and Wellbeing Worker Process Evaluation Dataset
No full textThese quantitative and qualitative data were gathered to conduct a mixed methods process evaluation of three Community Health and Wellbeing Worker pilot programmes in three settings in England. The dataset comprises transcripts from interviews and focus groups, steering group meeting minutes, and documents produced during the course of the pilots, including quarterly reports, business cases, training and recruitment materials, and productivity outputs
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