BackgroundPreventative medicine has become increasingly important in efforts to reduce the burden of chronic disease in industrialised countries. However, interventions that fail to recruit socio-economically representative samples may widen existing health inequalities. This paper explores the barriers and facilitators to engaging a socio-economically disadvantaged (SED) population in primary prevention for coronary heart disease (CHD).MethodsThe primary prevention element of Have a Heart Paisley (HaHP) offered risk screening to all eligible individuals. The programme employed two approaches to engaging with the community: a) a social marketing campaign and b) a community development project adopting primarily face-to-face canvassing. Individuals living in areas of SED were under-recruited via the social marketing approach, but successfully recruited via face-to-face canvassing. This paper reports on focus group discussions with participants, exploring their perceptions about and experiences of both approaches.ResultsVarious reasons were identified for low uptake of risk screening amongst individuals living in areas of high SED in response to the social marketing campaign and a number of ways in which the face-to-face canvassing approach overcame these barriers were identified. These have been categorised into four main themes: (1) processes of engagement; (2) issues of understanding; (3) design of the screening service and (4) the priority accorded to screening. The most immediate barriers to recruitment were the invitation letter, which often failed to reach its target, and the general distrust of postal correspondence. In contrast, participants were positive about the face-to-face canvassing approach. Participants expressed a lack of knowledge and understanding about CHD and their risk of developing it and felt there was a lack of clarity in the information provided in the mailing in terms of the process and value of screening. In contrast, direct face-to-face contact meant that outreach workers could explain what to expect. Participants felt that the procedure for uptake of screening was demanding and inflexible, but that the drop-in sessions employed by the community development project had a major impact on recruitment and retention.ConclusionSocio-economically disadvantaged individuals can be hard-to-reach; engagement requires strategies tailored to the needs of the target population rather than a population-wide approach.

Secondary prevention programmes can be effective in reducing morbidity and mortality from coronary heart disease (CHD). In particular, UK guidelines, including those from the Department of Health, emphasize physical activity. However, the effects of secondary prevention programmes with an exercise component are moderate and uptake is highly variable. In order to explore patients' experiences of a pre-exercise screening and health coaching programme (involving one-to-one consultations to support exercise behaviour change), semi-structured telephone interviews were undertaken with 84 CHD patients recruited from primary care. The interviews focused on patients' experiences of the intervention including referral and any recommendations for improvement. A thematic analysis of transcribed interviews showed that the majority of patients were positive about referral. However, patients also identified a number of barriers to attending and completing the programme, including a belief they were sufficiently active already, the existence of other health problems, feeling unsupported in community-based exercise classes and competing demands. Our findings highlight important issues around the choice of an appropriate point of intervention for programmes of this kind as well as the importance of appropriate patient selection, suggesting that the effectiveness of health coaching may be under-reported as a result of including patients who are not yet ready to change their behaviours.

This paper reports on a systematic literature review to examine the association between children and young people's participation in arts activities and their academic achievement. The 24 studies that met our criteria for inclusion and weight of evidence (2004-16) had mixed findings. Whilst many of the research designs employed would not meet positivist criteria for rigoursuch as sample size, statistical significance and causalitytypically required by public bodies to justify expenditure, there are examples throughout the literature reviewed of academically-related benefits to participants, such as increased confidence, creativity or more positive attitude towards their studies. Overall, there appears to be some justification from the literature for public investment in high-quality, long-term arts education programmes for children and young people in schools and community settings, on the basis of its potential to enhance academic achievement. However, there may be more intrinsic benefits to arts participation than the instrumental, essentially economic justification of improved academic standards.

Purpose-Previous research emphasises the need for preventative interventions to reduce mental health problems among disadvantaged children and adolescents. There is however little consensus concerning the delivery and impacts of such interventions particularly non-clinical, arts-based models delivered within community settings. The purpose of this paper is to begin to address this deficit through a qualitative assessment of the short-to medium-term impacts to participants' mental and emotional wellbeing within Sistema Scotland's Big Noise orchestral programme. Design/methodology/approach-Semi-structured interviews, observation, participant drawing exercise, participatory filmmaking, focus group and analysis of programme engagement were undertaken to examine the mental and emotional wellbeing impacts of the programme which are observable at this early stage of programme delivery and participants' lives. Findings-The qualitative findings indicate that participation in the Big Noise programme enhances participant mental and emotional wellbeing in three ways; first, the happiness and enjoyment of taking part in the programme and orchestra, particularly from music making; second, the security, belonging and relationships fostered through participation; the quality of musician/participant relationship is important here as is programme design which enables support, routine and structure; and third, increased pride, confidence and self-esteem, as a result of acquiring difficult musical skills, receiving regular praise and having frequent opportunities to demonstrate these acquired skills through regular orchestral performances. Originality/value-There is little evidence or understanding of community-based, preventative, arts interventions like Big Noise: their delivery, their life-course impacts and their potential contribution to mental health and to addressing social and health inequalities. The causal pathways in the field are under-theorised. These early findings are important as they serve as an important basis from which to consider the programme's wider and longer term impacts, which will be assessed through an ongoing longitudinal, mixed method summative evaluation.

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