BackgroundA major healthcare reform agenda in Ireland is underway which underpins the establishment of a series of National Clinical Programmes (NCPs), which aim to take an evidence based approach to improve quality, access and value. The current study aimed to determine the enablers and barriers to implementation of the NCPs.MethodsA qualitative methodology advocated by the Medical Research Council (MRC) framework on conducting process evaluations of complex interventions guided this research. Purposive sampling techniques were used to recruit participants from seven NCPs across both acute and chronic healthcare domains, comprised of orthopaedics, rheumatology, elective surgery, emergency medicine, paediatrics, diabetes and chronic obstructive pulmonary disease. A total of 33 participants were interviewed using a semi-structured interview guide. Participants included current and previous Clinical Leads, Programme Managers, Health Service Executive management, hospital Chief Executive Officers, representatives of General Practice, and a Nursing and a Patient representative. Thematic analyses was conducted.ResultsA range of factors of different combinations and co-occurrence were highlighted across a total of six themes, including (i) positive leadership, governance and clinical networks of the NCPs, (ii) the political and social context in which the NCPs operate, (iii) constraints on resources, (iv) a passive attitudinal resistance to change borne from poor consultation and communication, (v) lack of data and information technology, (vi) forces outside of the NCPs such as the general practitioner contract thwarting change of the model of care.ConclusionsThe MRC framework proved a useful tool to conduct this process evaluation. Results from this research provide real world experiences and insight from the people charged with implementing large-scale health system improvement initiatives. The findings highlight the need for measured responses that acknowledge both direct and non-direct challenges and opportunities for successful change. Combined, it is recommended that these elements be considered in the planning and implementation of large-scale initiatives across healthcare delivery systems, both in Ireland and internationally.

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Background Sedentary behaviour (SB) has been linked with detrimental effects on morbidity and mortality. This study aims to identify the individual, social and environmental correlates of total sedentary behaviour and the contexts in which sitting time accumulates in an Irish adult cohort. Methods Cross-sectional analysis of data from 7328 adults of the nationally representative Healthy Ireland Survey. Ordinal regression analyses were used to examine participants’ socio-demographic characteristics, lifestyle factors, physical and mental health status, perceived neighbourhood environmental factors, and their association with total daily sitting times and sitting times across the domains of occupation, leisure screen-time and transportation/leisure. Results Overall median of sitting time per day was 450 min (7.5 h). Male gender, and living in an urban location were associated with increased total-, occupational, and screen-time sitting ( p < 0.001). Younger age was associated with increased total and occupational sitting times ( p < 0.001), while being older was associated with increased screen-time and transportation/leisure sitting ( p < 0.001). Insufficient physical activity levels were associated with increased sitting across all domains ( p < 0.001). Higher socio-economic classification and education levels were associated with increased total, occupational, and transportation/leisure SB ( p < 0.001), while lower socio-economic classification and education levels were associated with increased screen-time sitting (p < 0.001). Alcohol consumption was associated with screen-time and transportation/leisure sitting ( p < 0.01), while smoking was associated with increased screen-time sitting ( p < 0.001). Being married was associated with less screen-time (p < 0.001) and transportation/leisure sitting ( p = 0.02), while those with a caring role had less total ( p = 0.04) and screen-time sitting ( p = 0.01). A significant negative association between neighbourhood attributes and total (p = 0.04), and transportation/leisure sitting times ( p < 0.001) was found. Conclusion The results of this study provide a starting position for development of targeted interventions aimed at the most sedentary, such as males with sedentary occupations in higher socio-economic groups and education levels, those with insufficient levels of physical activity and who live in an urban location.

Background Prolonged sitting, a significant risk factor for increased morbidity and mortality, is accumulated mostly in the workplace. There is limited research targeting specific at-risk populations to reduce occupational sedentary behaviour. A recent study found that professional males have the longest workplace sitting times. Current evidence supports the use of multi-level interventions developed using participative approaches. This study’s primary aims are to test the viability of a future definitive intervention trial using a randomised pilot study, with secondary aims to explore the acceptability and feasibility of a multicomponent intervention to reduce workplace sitting. Methods Two professional companies in Dublin, Ireland, will take part in a cluster randomised crossover pilot study. Office-based males will be recruited and randomised to the control or the intervention arms. The components of the intervention target multiple levels of influence including individual determinants (via mHealth technology to support behaviour change techniques), the physical work environment (via provision of an under-desk pedal machine), and the organisational structures and culture (via management consultation and recruitment to the study). The outcomes measured are recruitment and retention, minutes spent sedentary, and physical activity behaviours, work engagement, and acceptability and feasibility of the workplace intervention. Discussion This study will establish the acceptability and feasibility of a workplace intervention which aims to reduce workplace SB and increase PA. It will identify key methodological and implementation issues that need to be addressed prior to assessing the effectiveness of this intervention in a definitive cluster randomised controlled trial.