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Artikel ; Online: Do socioeconomic inequities arise during school-based physical activity interventions? An exploratory case study of the GoActive trial

Kirsten Corder / Esther van Sluijs / Paul Wilkinson / Olivia Alliott / Hannah Fairbrother

BMJ Open, Vol 13, Iss

2023 Band 3

Abstract: Objective To investigate socioeconomic inequities in the intervention and evaluation process of the GoActive school-based physical activity intervention and demonstrate a novel approach to evaluating intervention-related inequalities.Design Exploratory ... ...

Abstract	Objective To investigate socioeconomic inequities in the intervention and evaluation process of the GoActive school-based physical activity intervention and demonstrate a novel approach to evaluating intervention-related inequalities.Design Exploratory post-hoc secondary data analysis of trial data.Setting The GoActive trial was run in secondary schools across Cambridgeshire and Essex (UK), between September 2016 and July 2018.Participants 13–14 years old adolescents (n=2838, 16 schools).Methods Socioeconomic inequities across six stages in the intervention and evaluation process were evaluated: (1) provision of and access to resources; (2) intervention uptake; (3) intervention effectiveness (accelerometer-assessed moderate-to-vigorous physical activity (MVPA)); (4) long-term compliance; (5) response in evaluation; and (6) impact on health. Data from self-report and objective measures were analysed by individual-level and school-level socioeconomic position (SEP) using a combination of classical hypothesis tests and multilevel regression modelling.Results Stage: (1) There was no difference in the provision of physical activity resources by school-level SEP (eg, quality of facilities (0–3), low=2.6 (0.5); high=2.5 (0.4). (2) Students of low-SEP engaged significantly less with the intervention (eg, website access: low=37.2%; middle=45.4%; high=47.0%; p=0.001). (3) There was a positive intervention effect on MVPA in adolescents of low-SEP (3.13 min/day, 95% CI −1.27 to 7.54, but not middle/high (−1.49; 95% CI −6.54 to 3.57). (4) At 10 months post-intervention, this difference increased (low SEP: 4.90; 95% CI 0.09 to 9.70; middle/high SEP: −2.76; 95% CI −6.78 to 1.26). (5) There was greater non-compliance to evaluation measures among adolescents of low-SEP (eg, % accelerometer compliance (low vs high): baseline: 88.4 vs 92.5; post-intervention: 61.6 vs 69.2; follow-up: 54.5 vs 70.2. (6) The intervention effect on body mass index (BMI) z-score was more favourable in adolescents of low-SEP (low SEP: −0.10; 95% CI ...
Schlagwörter	Medicine ; R
Thema/Rubrik (Code)	796
Sprache	Englisch
Erscheinungsdatum	2023-03-01T00:00:00Z
Verlag	BMJ Publishing Group
Dokumenttyp	Artikel ; Online
Datenquelle	BASE - Bielefeld Academic Search Engine (Lebenswissenschaftliche Auswahl)

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Artikel ; Online: The impact of the newly developed school-based 'Digital Health Contact'-Evaluating a health and wellbeing screening tool for adolescents in England.

Alice Porter / Katrina d'Apice / Patricia Albers / Nicholas Woodrow / Hannah Fairbrother / Katie Breheny / Clare Mills / Sarah Tebbett / Frank De Vocht

PLoS ONE, Vol 19, Iss 1, p e

2024 Band 0297016

Abstract: Introduction Supporting adolescents with their health and wellbeing is an international public health priority. Schools are well placed to universally detect unmet health needs and support pupils. This study aimed to evaluate the effectiveness of a ... ...

Abstract	Introduction Supporting adolescents with their health and wellbeing is an international public health priority. Schools are well placed to universally detect unmet health needs and support pupils. This study aimed to evaluate the effectiveness of a digital health and wellbeing screening tool, called the 'Digital Health Contact' (DHC) implemented in schools in the East Midlands of England. The DHC, delivered by Public Health Nurses (School Nurses) (PHN(SN)), aims to identify pupils with unmet health needs (via a 'red flag' system) and provide appropriate support. Materials and methods Using data from 22 schools which took part in the DHC and 14 schools which did not take part, across three academic years (2018-2020), we conducted a controlled interrupted timeseries analysis with negative binomial regression to explore the effect of the DHC on the number of annual referrals to PHN(SN). Using DHC data from 164 pupils, we further conducted a Difference-in-Difference analysis to explore the impact of 'red flag' and referral via the DHC in Year 9 (age 13-14) on the number of red flags in Year 11 (age 15-16). Results Across all schools, the mean annual number of referrals increased over the three year follow-up period. In the adjusted model, the number of referrals was comparable between schools taking part in the DHC and non-participating schools (0.15 referrals [95% CI -0.21, 0.50]). Red flag score was not significantly different among Year 11 pupils, after being referred via the DHC in Year 9 (-0.36 red flags [95% CI -0.97, 0.24]). Discussion The DHC, and similar screening tools, have the potential to raise awareness of the health and wellbeing support in schools and provide an additional pathway of referral to this support for pupils with unmet health needs, without replacing the traditional pathway where pupils refer themselves or are referred by teachers.
Schlagwörter	Medicine ; R ; Science ; Q
Thema/Rubrik (Code)	360
Sprache	Englisch
Erscheinungsdatum	2024-01-01T00:00:00Z
Verlag	Public Library of Science (PLoS)
Dokumenttyp	Artikel ; Online
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Artikel ; Online: Privileges of Power

Grace Spencer / Hannah Fairbrother / Jill Thompson

International Journal of Qualitative Methods, Vol

Authenticity, Representation and the “Problem” of Children’s Voices in Qualitative Health Research

2020 Band 19

Abstract: The widespread privileging of children’s voices in recent times has triggered expansion of differing forms of qualitative enquiry that aim to “give children a voice.” Engaging children in research and eliciting their voices on matters that affect them is ...

Abstract	The widespread privileging of children’s voices in recent times has triggered expansion of differing forms of qualitative enquiry that aim to “give children a voice.” Engaging children in research and eliciting their voices on matters that affect them is often showcased as being a more “authentic” way to capture children’s lived realities and afford their agency. Yet, the uptake of voice in qualitative enquiry, and how it may contribute to the privileging of particular ways of knowing (some) children’s lives, is rarely interrogated. Drawing on examples from our own research, in this paper we critically reflect on the frequent invoking of the term voice in qualitative health research with children. In doing so, we challenge claims of authenticity by exposing the tricky epistemological tensions and relations of power that are embedded within the production and legitimation of particular voices as being “correct” ways of knowing about health—including the ways our research intentions and methods contribute to these processes. We reflect on the methodological and epistemological value of silences, dissenting voices and other modes of expression to highlight forms of resistance to adult-led health agendas. We conclude by illustrating how dominant relations of power are (re)produced within and across research spaces, and through the mobilizing or pathologizing of particular young voices through research. Possibilities for advancing ways to harness children’s preferred modes of expression in qualitative research are also considered.
Schlagwörter	Social sciences (General) ; H1-99
Thema/Rubrik (Code)	410 ; 360
Sprache	Englisch
Erscheinungsdatum	2020-09-01T00:00:00Z
Verlag	SAGE Publishing
Dokumenttyp	Artikel ; Online
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Artikel ; Online: An analysis of English national policy approaches to health inequalities

Naomi Griffin / Jonathan Wistow / Hannah Fairbrother / Eleanor Holding / Mihirini Sirisena / Katie Powell / Carolyn Summerbell

BMC Public Health, Vol 22, Iss 1, Pp 1-

‘transforming children and young people’s mental health provision’ and its consultation process

2022 Band 11

Abstract: Abstract Background A national policy for England, published in 2017, entitled ‘Transforming Children and Young People’s Mental Health Provision’ aimed to address the increasing prevalence mental health problems in children and tackle inequalities. In ... ...

Abstract	Abstract Background A national policy for England, published in 2017, entitled ‘Transforming Children and Young People’s Mental Health Provision’ aimed to address the increasing prevalence mental health problems in children and tackle inequalities. In the context of this policy’s implementation as ongoing and the effects of the Covid-19 pandemic, the need for appropriate, timely and ongoing national government commitment is vital. Methods A narrative review using a problem representation evaluation [1], we critiqued the policy and related consultation documents using a social determinants of health perspective. We also reviewed wider policy discourses through engaging with stakeholder responses, providing an innovative methodological contribution to scholarship on public health policy and health inequalities. Results We found absences and oversights in relation to inequalities (most notably the lack of acknowledgement that mental health can cause inequalities), access, workforce capacity, and the impacts of cuts and austerity on service provision. We suggest these inadequacies may have been avoided if stakeholder responses to the consultation process had been more meaningfully addressed. We illustrate how ‘problems’ are discursively created through the process of policy development, justified using specific types of evidence, and that this process is politically motivated. Local policy makers have a critical role in translating and adapting national policy for their communities but are constrained by absences and oversights in relation to health inequalities. Conclusions This narrative review illustrates how policy discourse frames and produces ‘problems’, and how the evidence used is selected and justified politically. This review contributes to the existing transdisciplinary field of knowledge about how using methods from political and social science disciplines can reveal new insights when critiquing and influencing policy approaches to health inequalities.
Schlagwörter	Health inequalities ; Children ; Mental health ; National Policy ; Narrative review ; Public aspects of medicine ; RA1-1270
Thema/Rubrik (Code)	360
Sprache	Englisch
Erscheinungsdatum	2022-05-01T00:00:00Z
Verlag	BMC
Dokumenttyp	Artikel ; Online
Datenquelle	BASE - Bielefeld Academic Search Engine (Lebenswissenschaftliche Auswahl)

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Artikel ; Online: Clustering of health-related behaviours within children aged 11–16

Victoria Whitaker / Melissa Oldham / Jennifer Boyd / Hannah Fairbrother / Penny Curtis / Petra Meier / John Holmes

BMC Public Health, Vol 21, Iss 1, Pp 1-

a systematic review

2021 Band 12

Abstract: Abstract Objective We aimed to systematically review and synthesise evidence on the clustering of a broad range of health-related behaviours amongst 11–16 year olds. Method A literature search was conducted in September 2019. Studies were included if ... ...

Abstract	Abstract Objective We aimed to systematically review and synthesise evidence on the clustering of a broad range of health-related behaviours amongst 11–16 year olds. Method A literature search was conducted in September 2019. Studies were included if they used cluster analysis, latent class analysis, prevalence odds ratios, principal component analysis or factor analysis, and considered at least three health-related behaviours of interest among 11–16 year olds in high-income countries. Health-related behaviours of interest were substance use (alcohol, cigarettes and other drug use) and other behavioural risk indicators (diet, physical activity, gambling and sexual activity). Results The review identified 41 studies, which reported 198 clusters of health-related behaviours of interest. The behaviours of interest reported within clusters were used to define eight behavioural archetypes. Some included studies only explored substance use, while others considered substance use and/or other health-related behaviours. Consequently, three archetypes were comprised by clusters reporting substance use behaviours alone. The archetypes were: (1) Poly-Substance Users, (2) Single Substance Users, (3) Substance Abstainers, (4) Substance Users with No/Low Behavioural Risk Indicators, (5) Substance Abstainers with Behavioural Risk Indicators, (6) Complex Configurations, (7) Overall Unhealthy and (8) Overall Healthy. Conclusion Studies of youth health behavioural clustering typically find both a ‘healthy’ cluster and an ‘unhealthy’ cluster. Unhealthy clusters are often characterised by poly-substance use. Our approach to synthesising cluster analyses may offer a means of navigating the heterogeneity of method, measures and behaviours of interest in this literature.
Schlagwörter	Cluster analysis ; Health behaviours ; Youth ; Multiple risk factors ; Systematic review ; Children ; Public aspects of medicine ; RA1-1270
Sprache	Englisch
Erscheinungsdatum	2021-01-01T00:00:00Z
Verlag	BMC
Dokumenttyp	Artikel ; Online
Datenquelle	BASE - Bielefeld Academic Search Engine (Lebenswissenschaftliche Auswahl)

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Artikel ; Online: Exploring the local policy context for reducing health inequalities in children and young people

Eleanor Holding / Hannah Fairbrother / Naomi Griffin / Jonathan Wistow / Katie Powell / Carolyn Summerbell

BMC Public Health, Vol 21, Iss 1, Pp 1-

an in depth qualitative case study of one local authority in the North of England, UK

2021 Band 14

Abstract: Abstract Background Improving children and young people’s (CYP) health and addressing health inequalities are international priorities. Reducing inequalities is particularly pertinent in light of the Covid-19 outbreak which has exacerbated already ... ...

Abstract	Abstract Background Improving children and young people’s (CYP) health and addressing health inequalities are international priorities. Reducing inequalities is particularly pertinent in light of the Covid-19 outbreak which has exacerbated already widening inequalities in health. This study aimed to explore understandings of inequality, the anticipated pathways for reducing inequalities among CYP and key factors affecting the development and implementation of policy to reduce inequalities among CYP at a local level. Methods We carried out a qualitative case study of one local government region in the North of England (UK), comprising semi structured interviews (n = 16) with service providers with a responsibility for child health, non-participant observations of key meetings (n = 6 with 43 participants) where decisions around child health are made, and a local policy documentation review (n = 11). We employed a novel theoretical framework, drawing together different approaches to understanding policy, to guide our design and analysis. Results Participants in our study understood inequalities in CYP health almost exclusively as socioeconomically patterned inequalities in health practices and outcomes. Strategies which participants perceived to reduce inequalities included: preventive support and early intervention, an early years/whole family focus, targeted working in local areas of high deprivation, organisational integration and whole system/place-based approaches. Despite demonstrating a commitment to a social determinants of health approach, efforts to reduce inequalities were described as thwarted by the prevalence of poverty and budget cuts which hindered the ability of local organisations to work together. Participants critiqued national policy which aimed to reduce inequalities in CYP health for failing to recognise local economic disparities and the interrelated nature of the determinants of health. Conclusions Despite increased calls for a ‘whole systems’ approach to reducing inequalities in health, ...
Schlagwörter	Children and young people ; Health policy ; Health inequalities ; Social determinants of health ; Systems approaches ; Public aspects of medicine ; RA1-1270
Thema/Rubrik (Code)	360 ; 300
Sprache	Englisch
Erscheinungsdatum	2021-05-01T00:00:00Z
Verlag	BMC
Dokumenttyp	Artikel ; Online
Datenquelle	BASE - Bielefeld Academic Search Engine (Lebenswissenschaftliche Auswahl)

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Artikel ; Online: Exploring the Potential of a School-Based Online Health and Wellbeing Screening Tool

Nicholas Woodrow / Hannah Fairbrother / Katrina D’Apice / Katie Breheny / Patricia Albers / Clare Mills / Sarah Tebbett / Rona Campbell / Frank De Vocht

International Journal of Environmental Research and Public Health, Vol 19, Iss 4062, p

Young People’s Perspectives

2022 Band 4062

Abstract: Despite high levels of need, many young people who experience health issues do not seek, access or receive support. Between May and November 2021, using semi-structured interviews, we explored the perspectives of 51 young people (aged 13–14) from two ... ...

Abstract	Despite high levels of need, many young people who experience health issues do not seek, access or receive support. Between May and November 2021, using semi-structured interviews, we explored the perspectives of 51 young people (aged 13–14) from two schools who had taken part in a novel online health and wellbeing screening programme, the Digital Health Contact (DHC). One school delivered the DHC during home-learning due to COVID-19 restrictions, whilst the other delivered it in school when restrictions were lifted. The DHC was seen as a useful approach for identifying health need and providing support, and had high levels of acceptability. Young people appreciated the online format of the DHC screening questionnaire and thought this facilitated more honest responses than a face-to-face approach might generate. Completion at home, compared to school-based completion, was perceived as more private and less time-pressured, which young people thought facilitated more honest and detailed responses. Young people’s understanding of the screening process (including professional service involvement and confidentiality) influenced engagement and responses. Overall, our findings afford important insights around young people’s perspectives of participating in screening programmes, and highlight key considerations for the development and delivery of health screening approaches in (and out of) school.
Schlagwörter	schools ; screening ; child ; adolescent ; health ; mental health ; Medicine ; R
Thema/Rubrik (Code)	360
Sprache	Englisch
Erscheinungsdatum	2022-03-01T00:00:00Z
Verlag	MDPI AG
Dokumenttyp	Artikel ; Online
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Artikel ; Online: Implementing a regional School Health Research Network in England to improve adolescent health and well-being, a qualitative process evaluation

Emily Widnall / Lorna Hatch / Patricia N Albers / Georgina Hopkins / Judi Kidger / Frank de Vocht / Eileen Kaner / Esther MF van Sluijs / Hannah Fairbrother / Russell Jago / Rona Campbell

BMC Public Health, Vol 23, Iss 1, Pp 1-

2023 Band 13

Abstract: Abstract Background There is an increased need for prevention and early intervention surrounding young people’s health and well-being. Schools offer a pivotal setting for this with evidence suggesting that focusing on health within schools improves ... ...

Abstract	Abstract Background There is an increased need for prevention and early intervention surrounding young people’s health and well-being. Schools offer a pivotal setting for this with evidence suggesting that focusing on health within schools improves educational attainment. One promising approach is the creation of School Health Research Networks which exist in Wales and Scotland, but are yet to be developed and evaluated in England. Methods This qualitative process evaluation aimed to identify the main barriers and facilitators to implementing a pilot School Health Research Network in the South West of England (SW-SHRN). Semi-structured interviews were conducted with school staff, local authority members, and other key stakeholders. Interview data were analysed using the 7-stage framework analysis approach. Results Four main themes were identified from the data: (1) ‘Key barriers to SW-SHRN’ (competing priorities of academic attainment and well-being, schools feeling overwhelmed with surveys and lack of school time and resource); (2) ‘Key facilitators to SW-SHRN: providing evidence-based support to schools’ (improved knowledge to facilitate change, feedback reports and benchmarking and data to inform interventions); (3) ‘Effective dissemination of findings’ (interpretation and implementation, embedding findings with existing evidence and policy, preferences for an online platform as well personalised communication and the importance of involving young people and families); and (4) ‘Longer-term facilitators: ensuring sustainability’ (keeping schools engaged, the use of repeat surveys to evaluate impact, informing school inspection frameworks and expanding reach of the network). Conclusion This study identifies several barriers to be addressed and facilitators to be enhanced in order to achieve successful implementation of School Health Research Networks in England which include providing a unique offering to schools that is not too burdensome, supporting schools to take meaningful action with their data and to ...
Schlagwörter	Mental health ; Well-being ; Adolescents ; Schools ; School Health Research Network ; Public aspects of medicine ; RA1-1270
Thema/Rubrik (Code)	360
Sprache	Englisch
Erscheinungsdatum	2023-04-01T00:00:00Z
Verlag	BMC
Dokumenttyp	Artikel ; Online
Datenquelle	BASE - Bielefeld Academic Search Engine (Lebenswissenschaftliche Auswahl)

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Artikel ; Online: A systems map of the determinants of child health inequalities in England at the local level.

Patricia E Jessiman / Katie Powell / Philippa Williams / Hannah Fairbrother / Mary Crowder / Joanna G Williams / Ruth Kipping

PLoS ONE, Vol 16, Iss 2, p e

2021 Band 0245577

Abstract: Children and young people in the UK have worse health outcomes than in many similar western countries and child health inequalities are persistent and increasing. Systems thinking has emerged as a promising approach to addressing complex public health ... ...

Abstract	Children and young people in the UK have worse health outcomes than in many similar western countries and child health inequalities are persistent and increasing. Systems thinking has emerged as a promising approach to addressing complex public health issues. We report on a systems approach to mapping the determinants of child health inequalities at the local level in England for young people aged 0-25, and describe the resulting map. Qualitative group concept mapping workshops were held in two contrasting English local authorities with a range of stakeholders: professionals (N = 35); children and young people (N = 33) and carers (N = 5). Initial area maps were developed, and augmented using data from qualitative interviews with professionals (N = 16). The resulting local maps were reviewed and validated by expert stakeholders in each area (N = 9; N = 35). Commonalities between two area-specific system maps (and removal of locality-specific factors) were used to develop a map that could be applied in any English local area. Two rounds of online survey (N = 21; N = 8) experts in public health, local governance and systems science refined the final system map displaying the determinants of child health inequalities. The process created a map of over 150 factors influencing inequalities in health outcomes for children aged 0-25 years at the local area level. The system map has six domains; physical environment, governance, economic, social, service, and personal. To our knowledge this is the first study taking a systems approach to addressing inequalities across all aspects of child health. The study shows how group concept mapping can support systems thinking at the local level. The resulting system map illustrates the complexity of factors influencing child health inequalities, and it may be a useful tool in demonstrating to stakeholders the importance of policies that tackle the systemic drivers of child health inequalities beyond those traditionally associated with public health.
Schlagwörter	Medicine ; R ; Science ; Q
Thema/Rubrik (Code)	360
Sprache	Englisch
Erscheinungsdatum	2021-01-01T00:00:00Z
Verlag	Public Library of Science (PLoS)
Dokumenttyp	Artikel ; Online
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Artikel ; Online: A critique of the English national policy from a social determinants of health perspective using a realist and problem representation approach

Naomi Griffin / Sophie M. Phillips / Frances Hillier-Brown / Jonathan Wistow / Hannah Fairbrother / Eleanor Holding / Katie Powell / Carolyn Summerbell

BMC Public Health, Vol 21, Iss 1, Pp 1-

the ‘Childhood Obesity: a plan for action’ (2016, 2018, 2019)

2021 Band 10

Abstract: Abstract Background The UK government released Chapter 1 of the ‘Childhood Obesity: a plan for action’ (2016), followed by Chapter 2 (2018) and preliminary Chapter 3 was published for consultation in 2019 (hereon collectively ‘The Policy’). The stated ... ...

Abstract	Abstract Background The UK government released Chapter 1 of the ‘Childhood Obesity: a plan for action’ (2016), followed by Chapter 2 (2018) and preliminary Chapter 3 was published for consultation in 2019 (hereon collectively ‘The Policy’). The stated policy aims were to reduce the prevalence of childhood obesity in England, addressing disparities in health by reducing the gap (approximately two-fold) in childhood obesity between those from the most and least deprived areas. Methods Combining a realist approach with an analysis of policy discourses, we analysed the policies using a social determinants of health (SDH) perspective (focusing on socio-economic inequalities). This novel approach reveals how the framing of policy ‘problems’ leads to particular approaches and interventions. Results While recognising a social gradient in relation to obesity measures, we critique obesity problem narratives. The Policy included some upstream, structural approaches (e.g. restrictions in food advertising and the soft-drinks industry levy). However, the focus on downstream individual-level behavioural approaches to reduce calorie intake and increase physical activity does not account for the SDH and the complexity and contestedness of ‘obesity’ and pays insufficient attention to how proposals will help to reduce inequalities. Our findings illustrate that individualising of responsibility to respond to what wider evidence shows is structural inequalities, can perpetuate damaging narratives and lead to ineffective interventions, providing caution to academics, practitioners and policy makers (local and national), of the power of problem representation. Our findings also show that the problem framing in The Policy risks reducing important public health aims to encourage healthy diets and increase opportunities for physical activity (and the physical and mental health benefits of both) for children to weight management with a focus on particular children. Conclusions We propose an alternative conceptualisation of the policy ...
Schlagwörter	Childhood Obesity ; Health inequalities ; Social Determinants of Health ; Health Policy ; Public aspects of medicine ; RA1-1270
Thema/Rubrik (Code)	360
Sprache	Englisch
Erscheinungsdatum	2021-12-01T00:00:00Z
Verlag	BMC
Dokumenttyp	Artikel ; Online
Datenquelle	BASE - Bielefeld Academic Search Engine (Lebenswissenschaftliche Auswahl)

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