Background Physical Activity Referral Schemes (PARS), including exercise referral schemes, are a popular approach to health improvement, but understanding of effectiveness is limited by considerable heterogeneity in reporting and evaluation. We aimed to gain consensus for a PARS taxonomy as a comprehensive method for reporting and recording of such schemes. Methods We invited 62 experts from PARS policy, research and practice to complete a modified Delphi study. In round one, participants rated the need for a PARS taxonomy, the suitability of three proposed classification levels and commented on proposed elements. In round two, participants rated proposed taxonomy elements on an 11-point Likert scale. Elements scoring a median of ≥7, indicating high agreement, were included in the final taxonomy. Results Of those invited, 47 (75.8%) participated in round one, with high retention in round two (n = 43; 91.5%). 42 were UK-based, meaning the resultant taxonomy has been scrutinised for fit to the UK context only. The study gained consensus for a three-level taxonomy: Level 1: PARS classification (primary classification, provider, setting, conditions accepted [have or at risk of], activity type and funding). Level 2: scheme characteristics (staff structure, staff qualifications, behaviour change theories, behaviour change techniques, referral source, referrers, referral process, scheme duration, session frequency, session length, session times, session type, exit routes, action in case of non-attendance, baseline assessment, exit assessment, feedback to referrer and exclusion criteria) and Level 3: participant measures (demographics, monitoring and evaluation, and measures of change). Conclusion Using a modified Delphi method, this study developed UK-based consensus on a PARS classification taxonomy. We encourage PARS practitioners and public health colleagues, especially those working with similar service models internationally, to test, refine and use this taxonomy to inform policy and practice.
Increased exposure to green space has many health benefits. Scottish Green Health Partnerships (GHPs) have established green health referral pathways to enable community-based interventions to contribute to primary prevention and the maintenance of health for those with established disease. This qualitative study included focus groups and semi-structured telephone interviews with a range of professionals involved in strategic planning for and the development and provision of green health interventions (n = 55). We explored views about establishing GHPs. GHPs worked well, and green health was a good strategic fit with public health priorities. Interventions required embedding into core planning for health, local authority, social care and the third sector to ensure integration into non-medical prescribing models. There were concerns about sustainability and speed of change required for integration due to limited funding. Referral pathways were in the early development stages and intervention provision varied. Participants recognised challenges in addressing equity, developing green health messaging, volunteering capacity and providing evidence of success. Green health interventions have potential to integrate successfully with social prescribing and physical activity referral. Participants recommended GHPs engage political and health champions, embed green health in strategic planning, target mental health, develop simple, positively framed messaging, provide volunteer support and implement robust routine data collection to allow future examination of success.
Atrial fibrillation (AF) affects over 1.4 million people in the UK, resulting in a five-fold increased stroke risk and a three to four times greater risk of severe, disabling stroke. Atrial fibrillation, a chronic disease, requires monitoring, medication, and lifestyle measures. A self-management approach supported by mobile health (mHealth) may empower AF self-care. To assess the need to develop new mHealth self-management interventions for those with AF this review aimed to identify commercially available AF self-management apps, analyse, and synthesize (i) characteristics, (ii) functions, (iii) privacy/security, (iv) incorporated behaviour change techniques (BCTs), and (v) quality and usability. We searched app stores for ‘atrial fibrillation’ and ‘anticoagulation’, and included apps focused on AF self-management in the review. We examined app functions, privacy statements against best practice recommendations, the inclusion of BCTs using the App Behaviour Change Scale, and app quality/usability using the Mobile App Rating Scale. From an initial search of 555 apps, five apps were included in the review. Common functions were educational content, medication trackers, and communication with healthcare professionals. Apps contained limited BCTs, lacked intuitive functions and were difficult to use. Privacy policies were difficult to read. App quality rated from poor to acceptable and no app had been evaluated in a clinical trial. The review reports a lack of commercially available AF self-management apps of sufficient standard for use in healthcare settings. This highlights the need for clinically validated mHealth interventions incorporating evidence-based BCTs to support AF self-management.
Atrial fibrillation (AF), the most common cardiac arrhythmia, is associated with a five-fold increased risk of stroke (Menke et al, 2010). AF-related stroke is more likely to be fatal or severely disabling compared to other types of stroke, because clots that form in the heart are large and can obstruct large vessels in the brain. This November, the Atrial Fibrillation Association's Global AF Aware Week will draw national attention to: ■ Detecting AF ■ Protecting those with AF from stroke using anticoagulation therapy ■ Correcting irregular rhythms using appropriate treatments ■ Perfecting the patient care pathway (Atrial Fibrillation Association, 2020). Increased clinical understanding and knowledge of recent guidelines among healthcare professionals are necessary to ensure integrated care for those diagnosed with, or suspected of having, AF. The prevalence of AF is increasing and is predicted to double by 2050 (Schnabel et al, 2015), leading to costly and complex hospital admissions and reduced quality of life for patients. Estimates suggest around 1.2 million people in the UK have a diagnosis of AF (Stroke Association, 2017), with a further half a million people currently undiagnosed. The risk of developing AF increases with age and those aged ≥85 years are seven times more likely to have AF than those aged under 55 years (Lane et al, 2017). Other risk factors include diabetes, ethnicity, hypertension, obesity, obstructive sleep apnoea and congestive heart failure. Although it is possible to develop AF without other health conditions, the incidence is higher among complex comorbid populations. Public Health England (2016) have declared that stroke prevention in AF is a national priority. Anticoagulation is a preventative treatment that reduces AF-related stroke risk by two-thirds. In fact, if AF were adequately identified and treated, around 7000 strokes could be prevented every year in England alone, saving approximately 2000 lives (Stroke Association, 2017). AF is greatly associated with heart failure, in part because both conditions have shared mechanisms, leading to neurohormonal and proinflammatory activation, which can induce myocardial inflammation and fibrosis (Staerk et al, 2017). Equally, AF has been shown to be an independent risk factor for cognitive decline and dementia. Symptoms such as palpitations, breathlessness and fatigue affect up to 80% of individuals with AF (Go et al, 2001) and psychological distress is reported in 35%, potentially because of the unpredictable nature of symptoms, or fear of a future thromboembolic event (Walters et al, 2018). Management is complex and attention must be given to the complete patient experience.
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