Search

More people are living for longer following a cancer diagnosis, however long-term survivors are more likely to experience chronic illnesses. Improving their diet and physical activity behaviours may increase survival and reduce the risk of cancer recurrence and other non-communicable diseases. The World Cancer Research Fund and American Institute for Cancer Research recommend that cancer survivors aim to be a healthy weight and physically active; eat a diet rich in wholegrains, vegetables, fruits and beans; limit consumption of ‘fast foods’, red and processed meat, sugar sweetened drinks and alcohol; and meet nutritional needs through diet alone rather than relying on supplements. Evidence suggests that cancer survivors are receptive to receiving advice and making dietary and physical activity changes, but barriers to improving the diet and being physically active need to be explored and addressed. We collaborated with CLAN Cancer Support (an independent charity) to assess the feasibility of a two-day course designed to improve diet and physical activity in cancer survivors in Scotland. Further, it explored the barriers and facilitators that cancer survivors identify in relation to eating a healthy diet and being physically active. The course included presentations, practical activities and group discussions. Initial analysis indicates that factors specific to this population need to be designed into the delivery of the course to enhance recruitment and promote behaviour change. Research then needs to be translated into sustainable support programmes accessible by all cancer survivors. This article describes the rationale behind the study, its design and expected outcomes.

An unpublished pilot study at a charitable youth organisation in the North East of Scotland found that young people (aged 16 to 25) accommodated by the organisation consumed a diet high in sugar and low in levels of foods such as meat, fish, fruit, and vegetables (Perry, 2013). The Foodways and Futures project (2013-2016), combining ethnographic and action research methodology, set out to explore why the diet of young people was sub-optimal, despite the organisation having a number of support services in place that would—it was perceived—encourage better eating habits amongst the young people housed within the organisation. Photovoice (PV) was identified as a participatory research method that was suitable, and that would encourage young people to participate as co-researchers in the investigation. However, despite young people getting involved in other research methods that were employed in the study, PV was generally not taken up as anticipated. This article explores how the method was employed, and argues that what could be deemed the ‘failure’ of PV instead may be interpreted as evidence of young people’s awareness and sensitivity about the potential judgements of others on personal food choices. In this sense, poor uptake of PV actually reveals much more about young people’s lived experiences than the data that it generates. The use of PV as a research method is therefore powerful, in that it allows participants to indicate, through inactivity, their sensitivity to ‘discourses of blame’.

BackgroundSince the introduction of the Child Poverty Act (2017) in Scotland, all health visitors, midwives and family nurses in Scotland are expected to screen and offer a financial advice referral to at-risk pregnant women and parents/carers of families with children under five in Scotland. The so-called ‘Financial Inclusion Pathway’ (FIP) emerged in 2019 as one of a number of strategies intended to tackle child poverty. At this early implementation stage, little is known about parents’ perspectives about the acceptability or impact of this initiative in relation to its aim.MethodsIn 2020, low income parents with young children living in Aberdeen City were invited to take part in a qualitative study that aimed to determine any challenges they might face engaging with the FIP policy in practice, and their perspectives about financial discussions with professionals that could help to increase household incomes through this approach.One-to-one semi-structured telephone interviews lasting between 30–40 minutes took place during July and August 2020. Interviews were fully transcribed and thematically analysed.ResultsTen women, ranging from ages 20–41 years. Each participant had between one and five child(ren), ranging in age from 2 to 18 years and all had one child under school-age. All lived in multiply deprived postcode areas within Aberdeen City. Three main themes emerged: i. difficulties associated with discussing financial concerns;ii. how to talk about the issue;iii. intervention utility. Within each of these three main themes, nine-sub themes were apparent, ranging from those indicating potential unintended negative consequences, as well as intervention benefits.DiscussionMost participants considered health visitors to be a potentially good source of help about financial challenges;they were less clear about midwives’ role here. However, parents’ perceptions of the problems they may face associated with disclosing financial difficulties to health professionals, is a distinct barrier to conversations that could lead to a financial advice referral. Given the levels of unclaimed benefit in the UK, this is important to note. Establishing trust and rapport, careful and sensitive enquiry, and positive framing of financial maximisation were recommended to aid discussion of financial challenges. These findings are important given the current and predicted economic impact of the COVID-19. The study is limited by its sample size and recruitment site, but provides valuable insights to inform a larger scale investigation. The study also indicates the importance of understanding health professionals’ associated views and experiences.

Background: As more people are living with one or more chronic health conditions, supporting patients to become activated, self-managers of their conditions has become a key health policy focus both in the UK and internationally. There is also growing evidence in the UK that those with long term health conditions have an increased risk of being food insecure. However, while international evidence outside of the UK indicates that food insecurity adversely affects individual’s health condition management capability, little is known about how those so affected manage their condition(s) in this high-income country context. Methods :A qualitative investigation of lived experience of health condition management was undertaken with food insecure people living in north east Scotland. The study aimed to explore the challenges facing food insecure people in terms of, i. their self-care condition management practices, and ii. disclosing and discussing the experience of managing their condition with a health care professional, and iii. notions of the support they might wish to receive from them. Interview audio recordings were fully transcribed and thematically analysed.Results : Twenty individuals living with a wide range of self-reported health conditions, and being supported by a local poverty alleviation social enterprise took part. Four main themes were identified i.e.: 1. food practices, trade-offs and compromises, that relate to economic constraints and lack of choice; 2. illness experiences and food as they relate to physical and mental ill-health; 3. (in)visibility of participants’ economic vulnerability within health care consultations; and 4. perceptions and expectations of the health care system.Conclusions :This study, the first of its kind in the UK, indicated that participants’ health condition management aspirations were undermined by the experience of food insecurity, and that their health care consultations in were, on the whole, devoid of discussions of those challenges. As such, the study indicated practical and ethical implications for health care policy, practice and research associated with the risk of intervention-generated health inequalities that were suggested by this study. Better understanding is needed about the impact of household food insecurity on existing ill health, wellbeing and health care use across the UK.

I question the notion of food choice and consider how much food choice someone living on low income actually has. In my fieldwork, it became clear that food choices, and hence one’s nutritional and health state, cannot be viewed in separation from the participants’ individual stories and the complexities of their lives. Daily routines, financial situation, and food accessibility have an impact on people’s food choices. In realising this, I found Amartya Sen’s (1979, 1985) capabilities approach useful, which moves beyond food entitlements. More specifically, a health capabilities approach as introduced by Venkatapuram (2007, 2011) and the association made between health and capabilities by others (e.g. Ruger Yale Joural Law Humanities 18 (2): 3, 2003) views health as the combination of the influence of socio-economic structures, as well as personal agency resulting in choices. I present the main learnings from viewing Foodways and Futures through the ‘capabilities lens’ and thus view food choices as the combination of the complex interrelations between socio-economic structures and agency.

This article reflects on ethical limitations and dilemmas encountered during fieldwork of the Foodways and Futures project (2013–2016). Foodways and Futures is a qualitative action research project aimed at exploring the food choices of former homeless young people (aged 16–25) in Aberdeenshire. In Scotland, where over 13,000 young people become homeless every year, Foodways and Futures aims to address social injustices as well as the implications of malnutrition in young people. Four interrelated main themes surrounding ethics became apparent during fieldwork: issues of communication, trust, issues with consent forms and power relations. Reflecting on these themes makes it clear that ethical guidelines are not necessarily beneficial for researchers as well as participants, especially if they are part of so-called vulnerable groups.

BACKGROUND AND OBJECTIVES: Mental illness is increasingly recognized as a global health problem. However, in many countries, including Nepal, it is difficult to talk about mental health problems due to the stigma associated with it. Hence a training programme was developed to train auxiliary nurse midwives, who otherwise are not trained in mental health as part of their pre-registration training in rural Nepal, on issues related to maternal mental health. After the training programme a selection of auxiliary nurse midwives were interviewed to establish their views on the training, its usefulness and ways to improve it. METHODS: This qualitative study reports on the analysis of interviews conducted with auxiliary nurse midwives who participated in the training programme. The interviews addressed issues associated with the training programme as well as perceptions around mental health in rural Nepal. Transcripts were thematically analysed. RESULTS: Three themes emerged from analysis: (1) issues related to training; (2) societal attitudes; and (3) support for women. The 'training' theme describes the benefits and limitations of training sessions. 'Societal attitudes' describes society's attitude towards mental health which is largely negative. 'Support' describes the positive behaviour and attitude towards pregnant women and new mothers. CONCLUSION: The study supports the need for continued training for auxiliary nurse midwives who are based in the community. This gives them the opportunity to reach the whole community group and potentially have influence over reduction of stigma; offer support and diagnosis of mental ill-health. There is still stigma around giving birth to a female child which can lead to mental health problems. It is imperative to increase awareness and educate the general public regarding mental health illnesses especially involving family members of those who are affected.

This qualitative study explored frontline service providers’ perceptions of the nature of food insecurity in Scotland in 2015 to inform national policy and the provision of locally-based support for ‘at risk’ groups. A country-wide in-depth interview study was undertaken with informants from 25 health, social care, and third sector organisations. The study investigated informants’ perspectives associated with how food insecurity was manifesting itself locally, and what was happening at the local level in response to the existence of food insecurity. Data analysis revealed three key themes. First, the multiple faces and factors of food insecurity involving not only increased concern for previously recognised ‘at risk of food insecurity’ groups, but also similar concern held about newly food insecure groups including working families, young people and women. Secondly, respondents witnessed stoicism and struggle, but also resistance amongst some food insecure individuals to external offers of help. The final theme identified community participation yet pessimism associated with addressing current and future needs of food insecure groups. These findings have important implications for the design and delivery of health and social policy in Scotland and other countries facing similar challenges.

Summary Understanding the drivers for improving Scotland's dietary health is one of the key objectives within the ‘Food, Land and People’ component of the Scottish Government's Strategic Research Programme (SRP). Food producer, processor, retailer and consumer behaviour relative to diet and health are investigated through the programme's ‘Healthy Safe Diets’ theme. The research recognizes both the importance of food to Scotland's economy, health and wellbeing, as well as the challenges faced by the burden of obesity and dietary-related illness. The Healthy Safe Diets theme's analysis of diet and behaviour has a focus on the interplay of the social, biological, behavioural and environmental determinants of nutritional health and aims to develop and test prototype policy interventions relevant to improving the health of Scotland's population. Here, we argue the necessity for concerted and coordinated multidisciplinary approaches to understand and influence dietary behaviour within the changing technological, economic, social and cultural context of individuals within society. The SRP's structure encourages and is developing such interdisciplinary links. Inherent to this is the combining of qualitative and quantitative approaches; using the insights gained from in depth study of small numbers of people, both to provide a better understanding of the results of quantitative analysis and to inform new research questions. Placed in context with the SRP's wider research objectives (such as on physical activity, the role of ‘urban green space’, enhancing the health-beneficial properties of foods and the environmental sustainability of food production and supply), SRP interconnection offers significant opportunity to develop synergies and reconcile conflicts between research areas to create cohesive policy advice and enhance health and wellbeing outcomes.

There is growing recognition that poor adolescent mental well-being is a serious global health issue. Research exploring adult mental well-being issues has shown positive and negative associations with environmental factors such as quality of the neighbourhoods and social support. However, little is known about young people's notions of mental well-being, or factors they associate with generating, sustaining or eroding it. A qualitative community-based participatory research study was conducted using photovoice (PV), with young people attending a youth project based in a deprived inner-city neighbourhood in Scotland. The research enabled participants to identify and explore aspects of their neighbourhood they experienced as having a direct impact on their mental well-being. The following themes emerged as those most important to participants' mental well-being: (1) perceived levels of local neighbourhood investment and care; (2) access to various forms of capital (including social, economic and natural ca...

ObjectiveTo develop a timeline for evaluating public health nutrition policy interventions.DesignConcept mapping, a stakeholder-driven approach for developing an evaluation framework to estimate the ‘time to impact’ for policy interventions. The Schools (Health Promotion and Nutrition) (Scotland) Act 2007 was used as the model to develop the evaluation timeline as it had typical characteristics of government policy. Concept mapping requires stakeholders to generate a list of the potential outcomes, sort and rate the outcomes. Multidimensional scaling and hierarchical cluster data analysis were used to develop an anticipated timeline to impact for the policy.SettingUnited Kingdom.SubjectsOne hundred and eleven stakeholders representing nutrition, public health, medicine, education and catering in a range of sectors: research, policy, local government, National Health Service and schools.ResultsEighty-five possible outcomes were identified and grouped into thirteen clusters describing higher-level themes (e.g. long-term health, food literacy, economics, behaviour, diet, education). Negative and unintended consequences were anticipated relatively soon after implementation of the policy, whereas positive outcomes (e.g. dietary changes, health benefits) were thought likely to take longer to emerge. Stakeholders responsible for implementing the legislation anticipated that it would take longer to observe changes than those from policy or research.ConclusionsDeveloping an anticipated timeline provides a realistic framework upon which to base an outcome evaluation for policy interventions and identifies positive and negative outcomes as well as considering possible unintended consequences. It offers benefit to both policy makers and researchers in mapping the progress expected towards long-term health goals and outcomes.

After a pilot study at a charitable youth organisation in the North East of Scotland found no considerable improvements in the food choices of former homeless young people accommodated by the organisation (Perry, 2013), the Foodways and Futures project (2013-2016) set out to explore why. Both members of staff at the same organisation as well as young people were invited to voice their views and opinions on the factors influencing young people’s food choices. Whilst everyone’s contribution was considered equally informative for our findings, I was attentive to where the information originated from. In this, I found that three conflicting discourses of blame pervade the participants’ expressions of the rationales underlying young people’s food choices. Trying to make sense of these, I employ Strauss’ Social Worlds Theory (1978). I find that the different discourses of blame make sense in the context of the complex organisational structures. In objecting to a tendency in the literature to assign standardised discourse of blame primarily to youth workers’ practice, these discourses showcase mutual understanding instead.

Background: Partnership working has been a key tenet of health policy in Scotland since 1997. Much has been written about the benefits of partnership working, but it has been difficult to prove its effectiveness. This paper describes the reality of working in partnership when undertaking an evaluation of a complex intervention aimed at engaging with hard-to-reach men to improve their health. Methods: A collaborative model of working was used to develop an evaluation tool to assess the effectiveness of the intervention. Six phases were used in the developmental process each involving a different group of stakeholders. The progress through these phases was not linear; it involved numerous iterative feedback loops. A number of challenges were faced at each phase and steps were taken to overcome them. Results: Four lessons emerged which are more generally applicable. Collaborative working is a slow process, a fact which key advocates in the field have failed to recognise. Study participants need to b...

Reducing meat consumption is central to many of the scientific debates on healthy, sustainable diets because of the high environmental impact of meat production. Missing from these debates are the public perspectives about eating less meat and consideration of cultural and social values associated with meat. The aim of this study was to explore public awareness of the environmental impact of food and their willingness to reduce meat consumption. Twelve focus groups and four individual interviews were conducted with adults from a range of socio-economic groups living in both rural and urban settings in Scotland. Public understanding of the link between food, environment and climate change was explored, with a focus on meat and attitudes towards reducing meat consumption. Data were transcribed and analysed thematically. Three dominant themes emerged: a lack of awareness of the association between meat consumption and climate change, perceptions of personal meat consumption playing a minimal role in the global context of climate change, and resistance to the idea of reducing personal meat consumption. People associated eating meat with pleasure, and described social, personal and cultural values around eating meat. Some people felt they did not need to eat less meat because they had already reduced their consumption or that they only ate small quantities. Scepticism of scientific evidence linking meat and climate change was common. Changing non-food related behaviours was viewed as more acceptable and a greater priority for climate change mitigation. The study highlights the role meat plays in the diet for many people, beyond nutritional needs. If healthy, sustainable dietary habits are to be achieved, cultural, social and personal values around eating meat must be integrated into the development of future dietary recommendations.

Background: Systematic reviews often investigate the effectiveness of interventions for one sex. However, identifying interventions with data presented according to the sex of study participants can be challenging due to suboptimal indexing in bibliographic databases and poor reporting in titles and abstracts. The purposes of this study were to develop a highly sensitive search filter to identify literature relevant to men's health and to assess the performance of a range of sex-specific search terms used individually and in various combinations. Methods: Comprehensive electronic searches were undertaken across a range of databases to inform a series of systematic reviews investigating obesity management for men. The included studies formed a reference standard set. A set of sex-specific search terms, identified from database-specific controlled vocabularies and from natural language used in the titles and abstracts of relevant papers, was investigated in MEDLINE and Embase. Sensitivity, precision, number needed to read (NNR) and percent reduction in results compared to searching without sex-specific terms were calculated. Results: The reference standard set comprised 57 papers in MEDLINE and 63 in Embase. Seven sex-specific search terms were identified. Searching without sex-specific terms returned 31,897 results in MEDLINE and 37,351 in Embase and identified 84% (MEDLINE) and 83% (Embase) of the reference standard sets. The best performing individual sex-specific term achieved 100%/98% sensitivity (MEDLINE/Embase), NNR 544/609 (MEDLINE/Embase) and reduced the number of results by 18%/17% (MEDLINE/Embase), relative to searching without sex-specific terms. The best performing filter, compromising different combinations of controlled vocabulary terms and natural language, achieved higher sensitivity (MEDLINE and Embase 100%), greater reduction in number of results (MEDLINE/Embase 24%/20%) and greater reduction in NNR (MEDLINE/Embase 506/578) than the best performing individual sex-specific term. Conclusions: The proposed MEDLINE and Embase filters achieved high sensitivity and a reduction in the number of search results and NNR, indicating that they are useful tools for efficient, comprehensive literature searching but their performance is partially dependent on the appropriate use of database controlled vocabularies and index terms.

This paper discusses the use of diary‐keeping as part of an evaluation of a complex, community‐based health promotion initiative, using the Mobile Information Bus (MIB) as an example. The MIB was designed to provide health and related information for living adolescents in rural areas of Northeast Scotland. The general strengths and limitations of diary‐keeping as a research method are discussed alongside an account of the evaluators' experiences of using this method within the MIB context, as well as suggestions for improving the efficacy of diary‐keeping as a research method. In addition, the results of an extensive literature search on the topic of diaries as a research method are reported. As part of the MIB evaluation, the diary provided a contemporaneous, in‐depth account of the intervention in operation. Those engaged in evaluation of similar types of projects (particularly related to process evaluation) may find the use of a project diary a useful adjunct to other research methods.

The interdisciplinary Foodways and Futures project (2013-2016) is based on a pilot study which found noimprovement in the nutritional state of formerly homeless young people (16-25), now in supported accommodationat a charitable youth organization. Because a healthy food intake during adolescence is important, and because youngpeople with socioeconomic lower backgrounds face difficulties in maintaining a healthy diet (Beasley at al., 2005), Iinvestigated how the young people themselves experience their relationship to food. In this paper I explore linksbetween the lived experience before and during their stay with the organization of this vulnerable group, and theirfood choices and practices. The study illustrates the ways in which those choices and practices may appearnutritionally undesirable, but are nevertheless linked to the young people’s search for ontological security and socialconnectedness, in their new living environment. In this, I draw on and extend Schlossberg’s (1981) transition theoryin order to better understand the rationales underlying an individual’s subjective food choices.

While there is evidence that weight-loss interventions reduce morbidity, indications of their acceptability are limited. Understanding preferences for lifestyle interventions will help policymakers design interventions. We used a discrete choice experiment to investigate preferences for lifestyle interventions to reduce adult obesity. Attributes focused on: the components of the programme; weight change; short-term and longer-term health gains; time spent on the intervention and financial costs incurred. Data were collected through a web-based questionnaire, with 504 UK adults responding. Despite evidence that dietary interventions are the most effective way to lose weight, respondents preferred lifestyle interventions involving physical activity. While the evidence suggests that behaviour change support improves effectiveness of interventions, its value to participants was limited. A general preference to maintain current lifestyles, together with the sensitivity of take up to financial costs, suggests financial incentives could be used to help maximise uptake of healthy lifestyle interventions. An important target group for change, men, required more compensation to take up healthier lifestyles. Those of normal weight, who will increase in weight over time if they do not change their lifestyle, required the highest compensation. Policymakers face challenges in inducing people to change their behaviour and adopt healthy lifestyles.

Background: The high prevalence of childhood obesity is a concern for policy makers and health professionals, leading to a focus on early prevention. The beliefs and perspectives of parents about early childhood obesity, and their views and opinions about the need for weight management interventions for this age group are poorly understood. Methods: A formative qualitative focus group study with parents of pre-school children took place in eight community-based locations throughout North-East Scotland to explore their ideas about the causes of early childhood obesity, personal experiences of effective weight management strategies, and views about the format and content of a possible child-orientated weight management programme. Study participants were recruited via pre-school nurseries. Results: Thirty-four mothers (median age 37 years) took part in the study, but only two believed their child had a weight problem. Participants (who focussed primarily on dietary issues) expressed a strong sense of personal responsibility to ‘get the balance right’ regarding their child’s weight, and were generally resistant to the idea of attending a weight management programme aimed at very young children. At the same time, they described a range of challenges to their weight management intentions. These included dealing with intrinsic uncertainties such as knowing when to stop ‘demand feeding’ for weight gain, and judging appropriate portion sizes - for themselves and their children. In addition they faced a range of extrinsic challenges associated with complex family life, i.e. catering to differing family members dietary needs, food preferences, practices and values, and keeping their ‘family food rules’ (associated with weight management) when tired or pressed for time. Conclusions: The findings have important implications for health professionals and policy makers wishing to engage with parents on this issue, or who are currently developing ‘family-centred’ early childhood weight management interventions. The challenge lies in the fact that mothers believe themselves to be the primary (and capable) agents of obesity prevention in the early years – but, who are at the same time, attempting to deal with many mixed and conflicting messages and pressures emanating from their social and cultural environments that may be undermining their weight management intentions.

Objective To evaluate the frequency, validity, and relevance of statistically significant (P

Participating parents and children were generally positive about the programmes, but also identified a range of modifications that they felt would improve effectiveness and encourage more families to engage. The personal characteristics and attributes of staff delivering the programme emerged as crucial factors regarding engagement and satisfaction with the programme. The main barrier to engagement identified by parents and health professionals was associated with notions of parents failing to acknowledge or accept that their children had been assessed as overweight. This view was particularly evident amongst parents whose child’s BMI was just above the cut-off point for overweight. There was also some evident confusion amongst parents about children’s BMI classification. Some parents also believed there was a general lack of knowledge about the programmes within their school community. Both issues might explain the lack of engagement amongst some families with overweight children. Some staff were anxious about raising the issue with parents, while other more experienced staff, who believed they had good existing relationships with the families concerned, were less anxious about it. It was not possible to ascertain whether dietary or physical activity changes claimed by parents or children, as a result of the programmes, had actually occurred. Moreover, many staff members expressed doubt that families would be able to sustain any changes in the longer term without further support from a professional. Given current concern over childhood weight trends, this research provides insights into the experiences and views of parents, children and health professionals involved with child healthy weight programmes, and identified possible improvements for existing programmes in Grampian. However, it also suggests that the problem of childhood obesity is not perceived by many parents in the same way as policy makers or health professionals, and further research is required to understand their perspectives in more depth.

Literature about same-sex love and sexuality in Nepal is rare. However, limited anecdotal evidence on these issues signals that the health and social care needs of lesbians in Nepal are high. This qualitative study explores the challenges faced by lesbians in Nepal in accessing health and social services. In-depth interviews carried out with fifteen lesbians found that Nepalese lesbians face many challenges from families and society which result in a stressful life, homelessness and forced and unwanted relationships and marriage, including self-harming behaviours. They often face discrimination and harassment when coming out at public administration and social institutions. Hence, most lesbians of Nepal prefer not to disclose their sexual identity due to the fear of becoming isolated and not getting quality health care services.

Background Since the Helsinki Declaration was introduced in 1964 as a code of practice for clinical research, it has generally been agreed that research governance is also needed in the field of public health and health promotion research. Recently, a range of factors led to the development of more stringent bureaucratic procedures, governing the conduct of low-risk population-based health research in the United Kingdom. Methods Our paper highlights a case study of the application process to medical research ethics committees in the United Kingdom for a study of the promotion of physical activity by health care providers. The case study presented here is an illustration of the challenges in conducting low-risk population-based health research. Results Our mixed-methods approach involved a questionnaire survey of and semi-structured interviews with health professionals (who were all healthy volunteers). Since our study does not involve the participation of either patients or the general population, one would expect the application to the relevant research ethics committees to be a formality. This proved not to be the case! Conclusion Research ethics committees could be counter-productive, rather than protecting the vulnerable in the research process, they can stifle low-risk population-based health research. Research ethics in health services research is first and foremost the responsibility of the researcher(s), and we need to learn to trust health service researchers again. The burden of current research governance regulation to address the perceived ethical problems is neither appropriate nor adequate. Senior researchers/academics need to educate and train students and junior researchers in the area of research ethics, whilst at the same time reducing pressures on them that lead to unethical research, such as commercial funding, inappropriate government interference and the pressure to publish. We propose that non-invasive low-risk population-based health studies such as face-to-face interviews with health and social care professionals or postal questionnaire studies with patients on non-sensitive topics are given a waiver or a light touch review. We suggest that this can be achieved through a two-staged ethics application process. The first stage starts with a one or two-page outline application which ethics committees can use as the basis to grant a waiver or request a full application.

Objectives To investigate what weight management interventions work for men, with which men, and under what circumstances.Design Realist synthesis of qualitative studies.Data sources Sensitive searches of 11 electronic databases from 1990 to 2012 supplemented by grey literature searches.Study selection Studies published between 1990 and 2012 reporting qualitative research with obese men, or obese men in contrast to obese women and lifestyle or drug weight management were included. The studies included men aged 16 years or over, with no upper age limit, with a mean or median body mass index of 30 kg/m2 in all settings.Results 22 studies were identified, including 5 qualitative studies linked to randomised controlled trials of weight maintenance interventions and 8 qualitative studies linked to non-randomised intervention studies, and 9 relevant UK-based qualitative studies not linked to any intervention. Health concerns and the perception that certain programmes had ‘worked’ for other men were the key factors that motivated men to engage with weight management programmes. Barriers to engagement and adherence with programmes included: men not problematising their weight until labelled ‘obese’; a lack of support for new food choices by friends and family, and reluctance to undertake extreme dieting. Retaining some autonomy over what is eaten; flexibility about treats and alcohol, and a focus on physical activity were attractive features of programmes. Group interventions, humour and social support facilitated attendance and adherence. Men were motivated to attend programmes in settings that were convenient, non-threatening and congruent with their masculine identities, but men were seldom involved in programme design.Conclusions Men's perspectives and preferences within the wider context of family, work and pleasure should be sought when designing weight management services. Qualitative research is needed with men to inform all aspects of intervention design, including the setting, optimal recruitment processes and strategies to minimise attrition.

Summary Background Increasing obesity related health conditions have a substantial burden on population health and healthcare spending. Obesity may have a sex-specific impact on disease development, men and women may respond differently to interventions, and there may be sex-specific differences to the cost-effectiveness of interventions to address obesity. There is no clear indication of cost-effective treatments for men. Methods This systematic review summarises the literature reporting the cost-effectiveness of non-surgical weight-management interventions for men. Studies were quality assessed against a checklist for appraising decision modelling studies. Results Although none of the included studies explicitly set out to determine the cost-effectiveness of treatment for men, seven studies reported results for subgroups of men. Interventions were grouped into lifestyle interventions (five studies) and Orlistat (two studies). The retrieved studies showed promising evidence of cost-effectiveness, especially when interventions were targeted at high-risk groups, such as those with impaired glucose tolerance. There appears to be some sex-specific elements to cost-effectiveness, however, there were no clear trends or indications of what may be contributing to this. Conclusion The economic evidence was highly uncertain, and limited by variable methodological quality of the included studies. It was therefore not possible to draw strong conclusions on cost-effectiveness. Future studies are required to demonstrate the cost-effectiveness of interventions specifically targeted towards weight loss for men.

Background: It is accepted that young people in the UK are familiar with, and are high-level users of a wide range of information technologies. In addition, the health of students in higher education (HE) is causing concern as there is growing evidence that they experience higher levels of psychological ill- health than non-students. At the same time, little attention is focused on young people's health once they leave school. Therefore, the Health Education Board for Scotland (now known as NHS Health Scotland) developed a computer desktop-based health promotion intervention aimed at HE students. The intervention took the form of seven media pieces—specially designed animations or adaptations of existing HEBS multimedia campaign material—presented to students on PC desktops. Some of the media pieces provided a ‘click through’ link to the HEBS website (HEBSWEB). This paper describes the formative evaluation of this initiative. Methods: The evaluation used a mixed-methods approach, which included a...

The Grampian Mobile Information Bus (MIB) is a community-based intervention that provides health and related information for young people aged 1218 years living in rural areas in the north-east of Scotland. The MIB is a partnership project involving health and local authorities and voluntary organisations, and operates as a mobile outreach service for this group of young people.This paper provides an overview of the early implementation and evaluation of the MIB initiative. The strengths and limitations of the project and its evaluation are discussed. Findings suggest that this initiative proved very popular with the intended target group, with users reporting high levels of satisfaction. In addition, it suggests that an initiative of this nature has the potential to mobilise local agencies in addressing their health and local needs. However, at this early stage in the project's lifetime, it is impossible to determine if changes made to the provision of services with local communities, attributed ...