The Healthy Living theme focuses on the prevention of ill health and promotion of positive health and wellbeing.

This theme is important because many of the key health behaviours that contribute to the development of chronic disease follow the social gradient such as smoking, obesity, lack of physical activity and poor nutrition.  Reducing health inequalities therefore requires a focus on these health behaviours and the implementation of evidence-based interventions that relate to the social determinants of health.

The Marmot review (2010) sets out six policy objectives that are required to reduce health inequalities. Included in those objectives is the need to strengthen the role and impact of ill-health prevention. A range of stakeholders, including local and national government departments, workplace, schools and communities all have the potential to help or hinder ill-health prevention and so a partnership approach to research in this area is essential.

CHAD researchers have specific interest and expertise around NHS Health Checks and other primary care-based health and lifestyle promotion programmes for the prevention of chronic disease.

CHAD projects that sit within this theme are:

• Risk COmmunication in NHS Health Check (RICO)
• End of Life Care in Staffordshire: Health Professional Perspective
• HEalth Check TRial (HECTR)
• Evaluation of the Cancer Lifestyle Project
• Evaluation of Thinking Active

Fair Society, Healthy Lives: The Marmot Review (2010).

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RIsk COmmunication in NHS Health Check (RICO)

Qualitative video-stimulated recall study to explore cardiovascular disease risk communication in NHS Health checks using QRISK2 10-year risk and JBS3 lifetime risk calculators: NIHR Health Technology Assessment, 2017-2019.

NHS Health Check is a national cardiovascular disease (CVD) risk assessment programme for 40-74 year olds in England, in which practitioners should assess and communicate CVD risk, supported by appropriate risk-management advice and goal-setting. This requires effective communication, to equip patients with knowledge and intention to act. The RICO study uses novel qualitative methods and quantitative process evaluation to explore practitioner and patient CVD risk perceptions when using two different CVD risk calculators, the associated advice or treatment offered by the practitioner, and patients’ responses.

Find out more information here:

• https://www.journalslibrary.nihr.ac.uk/programmes/hta/1517002#/
• http://www.isrctn.com/ISRCTN10443908

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End of Life Care in Staffordshire: Health Professional Perspective

Background: End-of-life care refers to the final year of a person’s life. End-of-life care in hospital settings has been suggested to be sub-optimal (e.g., Al-Qurainy et al., 2009). The aim of this study was to explore health professionals’ views and experiences of providing end-of-life care in Staffordshire and how this could be improved.

Methods: Sixteen health professionals working in primary care (three general practices) or acute care (one NHS acute hospital trust) participated in a semi-structured interview. Interviews were audio-recorded, transcribed and analysed using thematic analysis.

Results: Three themes emerged from the analysis as follows:

1. Having the conversation earlier – to make the decision that the patient is entering their end-of-life and to initiate the conversation with patient and family at an earlier point.
2. Personalised and holistic journey of care – to build a relationship with patients and allow them and their family the time to make an informed choice about their wishes.
3. Delivering on patients’ wishes – suggestions for how to improve the delivery of end-of-life care locally, including how to share and record patient wishes, and to deliver care that can meet those wishes.

Conclusion: Participants highlighted the complex and challenging nature of end-of-life care. The importance of patient wishes was emphasised and suggestions for how to improve end-of-life care locally, to better deliver on patient wishes, were identified. The development of a local strategy/pathway may help to support this and to provide clarity about expectations and legal implications as well as roles and responsibilities.

Read the final report here.

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HEalth Check TRial (HECTR)
Randomised Controlled Trial of uptake in NHS Health Checks for CVD risk: Public Health England, Stoke-on-Trent city Council, Staffordshire County Council, 2015-2017.

Three-arm randomised controlled trial comparing uptake when patients were invited by generic invitation letters, letters that were personally tailored to individual patients CVD risk, or by telephone. Data from over 4600 patient from 9 general practices in Stoke-on-Trent/Staffordshire showed that the telephone was the most effective and cost-effective method, with the CVD risk-tailored letters offering only modest improvements (vs. generic letters).

Find out more information here: https://doi.org/10.1186/ISRCTN15840751

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Evaluation of the Cancer Lifestyle Project

The North Staffordshire Cancer Lifestyle Project, established by the Beth Johnson Foundation in November 2015, provides support for people living with or after cancer. Its main aim is to increase the levels of physical activity, healthy eating and wellbeing amongst people aged 50+ who are living with or after a diagnosis of cancer. The Project provides 1-to-1 support to help people achieve long term behaviour change in order to improve their wellbeing.

Research suggests that physical activity has a range of benefits for people with cancer, such as improved quality of life, improved physical function and psychosocial benefits (Sabiston and Brunet, 2012). Furthermore, physical activity and healthy eating can reduce the risk of other health conditions such as diabetes, cardio-vascular disease and obesity (Demark-Wahnefried and Jones, 2008).

CHAD are conducting an independent evaluation of the Project. The evaluation is a mixed methods study, combining secondary quantitative data analysis and primary qualitative data collection. We will analyse Project data (baseline and follow up) and conduct interviews with clients to:

• Examine whether participant involvement with the Cancer Lifestyle Project has led to an increase in physical activity and healthy eating since they joined the project
• Examine the delivery and impact of the Project from the clients’ perspective
• Explore the impact of the Project on clients’ well-being and quality of life.

Read the final report here

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Evaluation of Thinking Active

Dementia affects 35 million people worldwide, 850,000 people in the UK and approximately 12,000 people in Staffordshire. Research has shown that regular participation in physical, mental and social activities is associated with a reduction in dementia. Staffordshire County Council has commissioned the delivery of ‘Thinking Active’ – a 14-week pilot programme that combines physical activity with Cognitive Stimulation Therapy (CST) for individuals with a diagnosis of mild to moderate dementia. With the aim to be a sustainable community delivered programme, ‘Thinking Active’ is being piloted in four areas across Staffordshire – Parkwood Community Leisure (Staffordshire Moorlands), Inspiring Healthy Lifestyles (Cannock), COGS for Life (Burntwood) and Age UK South Staffordshire (Penkridge).

CHAD is carred out a mixed methods evaluation of the programme, with the aim of understanding the process of delivering Thinking Active in addition to the impact the programme has had on participants and their caregivers.

Read the final report here.

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Doctoral Research Projects

Victoria Riley – Exploring uptake and risk communication in NHS Health Check. Has developed a practitioner resource that is being used nationally, and a brief training course that is being adopted in several localities. (Victoria.riley@staffs.ac.uk)

Konstantinos Spyropoulos – Multi-morbidity and multiple lifestyle behaviour. Epidemiological, qualitative and intervention studies focused on modifying multiple lifestyle behaviours for the management of multiple chronic conditions. (konstantinos.spyropoulos@research.staffs.ac.uk|)

Sonia Begum – Evaluation of uptake and attendance of National Diabetes Prevention Programme in Southwark. (sonia.begum@research.staffs.ac.uk)

Associated Publication:

Begum, S., Povey, R., Ellis, N., & Gidlow, C. (2020). A systematic review of recruitment strategies and behaviour change techniques in group-based diabetes prevention programmes focusing on uptake and retention. Diabetes Research and Clinical Practice, 108273. https://doi.org/10.1016/j.diabres.2020.108273

Should require any further information about, details of, or access to any of our research, projects, publications or associated publications, please contact us.