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Objective: The purpose of this study was to evaluate the healthy weight services in one local authority in England, where obesity levels have been above the national average since 2006. Design: We conducted process and outcome evaluation using a qualitative methodology. Data were generated in focus group discussions and semi-structured interviews with clients, practitioners, healthcare professionals and volunteers. Results: A total of 91 individuals from six services participated in the evaluation. Staff competencies and empowerment outcomes were identified as areas of strength. However, despite examples of excellent practice and enthusiastic recommendations from clients, access and referral processes were areas of weakness. Conclusion: In England, local authorities have an important role to play in tackling obesity. It is crucial that they are provided with the tools to be able to implement healthy weight interventions effectively. A whole-systems approach presents a real opportunity for staff in local authorities and public health to work collaboratively and innovatively towards the same goal of continuous improvement in obesity management.

Background: Previous research has illustrated a drift in the fidelity of behaviour change techniques (BCTs) during the design of the pilot NHS England Low‐Calorie Diet (NHS‐LCD) Programme. This study evaluated a subsequent domain of fidelity, intervention delivery. Two research questions were addressed: (1) To what extent were BCTs delivered with fidelity to providers programme plans? (2) What were the observed barriers and facilitators to delivery? Methods: A mixed‐methods sequential explanatory design was employed. Remote delivery of one‐to‐one and group‐based programmes were observed. A BCT checklist was developed using the BCT Taxonomy v1; BCTs were coded as present, partially delivered, or absent during live sessions. Relational content analysis of field notes identified observed barriers and facilitators to fidelity. Results: Observations of 122 sessions across eight samples and two service providers were completed. Delivery of the complete NHS‐LCD was observed for five samples. Fidelity ranged from 33% to 70% across samples and was higher for group‐based delivery models (64%) compared with one‐to‐one models (46%). Barriers and facilitators included alignment with the programme's target behaviours and outcomes, session content, time availability and management, group‐based remote delivery, and deviation from the session plan. Conclusions: Overall, BCTs were delivered with low‐to‐moderate fidelity. Findings indicate a dilution in fidelity during the delivery of the NHS‐LCD and variation in the fidelity of programmes delivered across England. Staff training could provide opportunities to practice the delivery of BCTs. Programme‐level changes such as structured activities supported by participant materials and with sufficient allocated time, might improve the delivery of BCTs targeting self‐regulation. [ABSTRACT FROM AUTHOR]

This study explored the extent of financial constraints experienced by athletes on the England Talent Pathway, as perceived by talent leads from various sports. Using a mixed-methods approach, 34 participants completed online surveys with 26 follow-up interviews. Findings showed the prevalence of financial constraints on individuals within the system, with three emerging themes: costs; demands on athletes; and potential funding support. "Pinch points", causing the greatest severity of financial constraint, emerged further along the pathway and there were infrequent examples of mechanisms to identify talented athletes experiencing financial hardship. A means-tested system, premised on the demonstration of potential, is suggested by talent leads as a way of providing funding for athletes to ameliorate financial constraints in the future.

Health precautions implemented by the United Kingdom (UK) government to limit the spread of the Coronavirus Disease 2019 (COVID-19) led to the closure of many well-being support services in 2020. This created a need to re-think how impactful recovery support courses can be provided. One such service was that of the five-day Multi Activity Course (MAC) which was redesigned in accordance with national health guidelines to allow continued access for Wounded, Injured and Sick (WIS) military personnel to the service; the positive impacts of which are well established. This study investigated the influence of the newly developed Reduced numbers MAC (R-MAC) on the WIS participants lives during and for 12 months after attending. The R-MAC led to comparable impacts for participants well-being, at a time in which people's mental well-being was often being adversely affected. The positive mental well-being of the 261 participants improved by 33% throughout the course and remained 14% higher for the 37 participants who provided data six months after attending. Key facets of the experience that were most impactful for the participants were (i) shared experience with other veterans, (ii) discussing issues in a safe environment while receiving support from the staff and (iii) developing knowledge around self-help/personal development. Adapting to the challenging circumstances and developing the R-MAC mitigated against the already adverse impact of the COVID-19 pandemic for the WIS participants. [ABSTRACT FROM AUTHOR]

Background: Significant proportions of school children in the UK do not meet the minimum recommended daily requirements of 60-min moderate-intensity physical activity. Beyond taught classes, playtimes offer the opportunity for children to play and be physically active. Painted markings are one recent addition to school playgrounds that are inexpensive and have been shown to stimulate increased levels of physical activity among children during playtimes. Playground markings and supportive playground assistants can act as cues to increase physical activity. Purpose: While evidence exists to support the impact of playground markings on the levels of physical activity, no attempts have been made to assess the effects of playground markings on important indicators of psychological health such as self-esteem and physical self-concept. The way children view themselves from a physical perspective is likely to impact their future engagement in sport and physical activities. Given that the levels of physical activity have been found to be related to physical self-perceptions and self-esteem, and playground markings appear to facilitate increased physical activity, this study aimed to evaluate the effects of installing playground markings and training playground assistants on children's physical self-perceptions. Participants and setting: Participants were 218 primary school children (117 girls and 101 boys) aged 10 and 11 years. Informed consent was gained from all schools, and parents were given the choice to withdraw their child from the project before commencement of testing. Twelve schools received playground markings, while four further schools acted as controls. Playground assistants were trained to help facilitate use of markings by children. Playground markings consisted of painted lines and boxes. Data collection: The participants completed the Children and Youth Physical Self-Perception Profile under the supervision of trained research assistants. The behaviour of the children was also observed during the morning and lunch playtime periods prior to the installation of playground markings and again 8 months after installation. The System for Observing Children's Activity and Relationships during Play was used to assess playtime behaviour with 242 observations in total undertaken. Every sixth child to enter the playground was randomly observed for 10 min. Data analysis: Mixed-model ANOVAs were used to test for differences in physical self-perceptions of the children on the basis of intervention and over time. Percentage changes in observed physical activity and pro-social behaviours were calculated to determine differences between schools that received markings and those that did not. Findings: No significant differences were found in physical self-perceptions on the basis of intervention or over time. However, boys did report significantly higher perceptions of sport competence, physical conditioning, physical strength and physical self-worth than girls. Observed physical activity was found to increase by 7.5% in schools that received markings as opposed to a 7.7% decline in control schools. In addition, pro-social behaviours were found to increase by 6.7% following the installation of playground markings. Conclusion: These findings indicate that while playground markings can facilitate increased physical activity during playtimes, this does not translate into enhanced self-perceptions in children when evaluated 8 months after intervention.

University inductees may be increasingly vulnerable to stressors during transition into higher education (HE), requiring psychological resilience to achieve academic success. This study aimed to profile inductees' resilience and to investigate links to prospective end of year academic outcomes. Scores for resilience were based on a validated Connor Davison Resilience Scale (CD-RISC) drawn from 1534 inductees in a single UK university. A four-stage analysis revealed that incremental resilience was more facilitative of females' prospective academic attainment, but less functional and more convoluted for males. This large, distinctive study has implications for student support practices and highlights that the relationship between resilience and academic achievement requires further consideration in HE.

The poor outcomes of young people with chronic health conditions indicate that current services and self-care programmes are not meeting the needs of young people. How young people self-manage their condition impacts on long-term health outcomes, but there is little published evidence that details the development of self-care programmes and their most effective components. This article reports on an innovative formative research study, the purpose of which was to develop a self-care intervention prototype. Participants were 87 young people, aged 12-17, and seven young adult facilitators, aged 18-25, with type 1 diabetes or asthma. Each contributed to talking groups exploring themes that young people wanted to be addressed within a self-care programme. Instead of being focused on "illness", young people's main concerns were directed toward "life as an adolescent", while at the same time building sustainable daily routines of self-care. Overall, this article illustrates the process of initiating and implementing a developmental approach focused on young people, while also demonstrating the tailored self-care intervention that the process developed. This approach can be used to involve young people in the design and development of other conditions that rely on self-care interventions.

Understanding of the active beneficial processes of adventure learning remains elusive. Resilience may provide one foundation for understanding the positive adaptation derived from Outdoor Adventure Education (OAE) and Adventure Therapy (AT) programming. From a neurological perspective, resilience may be explained by the brain's innate capability to adapt its structure (growth of new cells) and function (re-wiring of existing cells) directly in response to environmental exposure. This paper explores the role of known brain responses to experiences analogous to adventure programming based on themes from a key literature review. The fundamental paradigm of "stress and recovery" contends that a balance of neurobiological processes help realign psychosocial equilibrium in the short term and over time. Through progressive, repeated exposure to custom-built outdoor challenges, the concept of brain resilience may provide a scientific platform for understanding the mechanisms of achieving meaningful, authentic and healthy outcomes. It could also help to begin to illuminate a section of the black box of adventure processes.

Objective: To investigate the value of additional days of active commuting for meeting a criterion of 300+ minutes of moderate-to-vigorous physical activity (MVPA; 60+ mins/day x 5) during the school week. Methods: Based on seven-day diaries supported by teachers, binary logistic regression analyses were used to predict achievement of MVPA criteria according to days of active commuting to and from school. MVPA was recorded across five time points: (a) before school, (b) walking/cycling to and from school, (c) during school, (d) in school-based clubs and (e) during leisure time. The study was conducted in Derby, UK, in June 2006. Results: Active commuting was reported by 4218 (78 per cent of 5422) children for an average daily commuting time of 18.4 plus or minus 16.4 minutes. Children who commuted on more days in the week were most likely to achieve the MVPA criterion. Every day of active commuting doubled the chances of meeting the MVPA criterion; in Year 10 girls this effect was stronger (odds ratio 6.45). Conclusion: Results confirm the ubiquity of active commuting among young people. Even one additional day of active commuting helps to meet established criteria. In older girls active commuting is uniquely powerful in contributing to attainment of public health targets of MVPA. (Contains 1 figure and 1 table.)

Objective: With growing concerns to establish the value for returns on public health investment, there is a need to identify cost-effective physical activity interventions. This study measured change in moderate physical activity (MPA) in seven community-based intervention types, costs and cost-effectiveness of the interventions, and possible explanations for cost variation. Design: Between 2004 and 2006, pre- and post-intervention assessments identified demographics and MPA levels, and quarterly interviews with intervention managers identified key implementation costs. Setting: Nine sites across the UK. Method: MPA was collected using self-report measures. MPA categories (sedentary, lightly, moderately, highly active) were assigned at pre- and post-intervention. Differences between pre- and post-intervention scores identified MPA change (median metabolic equivalent (MET)-minutes/week) in completers. Cost, attendance and activity data were combined to estimate the average monthly implementation cost, cost per participant attending interventions, and the cost per completer improving MPA category. An economic model was built to estimate the cost per Quality Adjusted Life Year (QALY) gained and potential savings to the National Health Service (NHS). Results: Demographics (n = 984) show that those who engaged with the interventions were predominantly white, British older females. In completers (N = 1,051), 37.9 per cent improved at least one MPA category. The cost per completer improving MPA category ranged from 260 British Pounds to 2,786 British Pounds (N = 1000). The cost per QALY gained from intervention types ranged from 47 British Pounds to 509 British Pounds, which was below the 20,000 British Pounds threshold implicit in National Institute for Health and Clinical Excellence (NICE) decisions. Future cost savings to the NHS per intervention participant ranged from 769 British Pounds to 4,891 British Pounds. In the case of each of the interventions, this saving per participant exceeds the implementation cost per participant, which ranged from 55 British Pounds to 3,420 British Pounds (N = 6940). Conclusions: MPA interventions are cost-effective. (Contains 3 tables.)

Relative age effects (RAEs; R. H. Barnsley, A. H. Thompson, & P. E. Barnsley, 1985) convey school attainment (dis)advantages depending on whether one is relatively older or younger within annually age-grouped cohorts. In the present study, the authors examined the pervasiveness of RAEs by examining (a) attainment in 4 secondary school subjects, (b) attainment consistency across subjects, (c) pupils enrolled in gifted and talented programs, (d) pupils referred for learning support or identified as having special educational needs, and (e) whether RAEs were related to pupil attendance. For 2004-2005, attainment, program participation, and attendance data for 657 pupils (aged 11-14) at a secondary school in North England were analyzed. Relatively older pupils (i.e., September-November born) attained significantly higher in subjects (except for English), were more likely to attain consistently high scores across subject areas, and be enrolled in gifted and talented programs. In contrast, relatively younger pupils (i.e., January-August born) were overrepresented in learning support referrals and identified as having special educational needs, and were more likely to be among the lowest 20% of attainment and attendees, attending on average school 6 days less. RAEs are pervasive and systematic across the curriculum, implicating maturational and psychological mechanisms. (Contains 3 tables and 3 figures.)

Objective: Identifying community physical activity interventions that facilitate increases in moderate physical activity (MPA) is important in meeting targets set in government health policy. This study evaluated community interventions that aimed to increase levels of MPA. Intervention themes included exercise referral, classes and groups, peer mentoring, motivational interviewing, campaigns and directories, outdoor activity and training physical activity leaders. Design: Longitudinal, pre-intervention and intervention assessments occurred between 2004 and 2006. Setting: Recruitment of 10,433 people from ten sites located in areas of high health need across England. Method: Demographic data were collected by questionnaire, with seven-day, population-specific self-reports assessing pre-intervention and intervention MPA. Using guidelines for young people and adults, MPA MET-minutes/week were used to assign participants to four MPA categories (sedentary, lightly, moderately and highly active) at pre-intervention and intervention phases. Cross-tabulation established movement between three change categories (reversal, stability and progression). Results: From nine sites, 5324 people engaged in the evaluation, and a sub-sample of 998 provided demographic and 1022 self-report baseline and intervention data (i.e. completers) for a typical week's physical activity participation. Of completers who were sedentary or lightly active at pre-intervention, 58.5 per cent achieved recommended physical activity guidelines. 80.9 per cent who were sedentary at pre-intervention reported as lightly, moderately or highly active at intervention. Conclusions: Completers increased overall activity levels, including those sedentary and lightly active at pre-intervention who increased levels to recommended guidelines. (Contains 2 tables.)

Subjective well-being has increasingly been used as a key indicator of quality of life in older people. Existing evidence shows that it is likely that eastern cultures carry different life values and so the Chinese Aging Well Profile was devised for measuring subjective well-being in Chinese adults (50+). Data was collected from 1,906 community-dwelling Chinese (50+) in Taiwan in six sequential stages, involving qualitative interviews and psychometric testing. Seven key dimensions of subjective well-being identified in the interviews provided an item bank for instrument construction. The 31-item Chinese Aging Well Profile comprised seven subscales-"physical", "psychological", "independence", "learning & growth", "material", "environmental", and "social" well-being. The study indicated that elements of subjective well-being are common across western and eastern cultures but are interpreted and weighted differently. This new instrument has demonstrated preliminary evidence for reliability and validity and that it is suitable for use in the Chinese speaking older population.

Garth Armstrong (pseudonym) agreed to participate based on a pre-existing "career-guidance-and-support" relationship with the researcher, to explore the realities of career transition. An account-making approach was used over the last eight months of his professional rugby-playing career (termination) and for a further ten months into his next career (transition). For Garth, retirement was premature, contested and unjust--he felt the moral outrage of being kicked out and of becoming excluded from his own athletic past. Garth regarded himself as embodying the values of a (proper) "rugby man", which were unmatched by those central to making him retire. Being central to the club and modelling idealized behaviours contrasted with still not being offered a replacement contract, meaning that his retirement represented a strong sense of betrayal. This was compounded by then being offered a contract extension, but only with reduced terms. Even after 18 months, support is continuing with retirement still being discussed.