The well now course: a service evaluation of a health gain approach to weight management.

BACKGROUND: The Well Now health and weight course teaches body respect and health gain for all. The course validates peoples' lived experiences and knowledge through group activities and discussion with the aim of helping people to better understand their food and body stories. Well Now explores different ways of knowing, including the use and limits of body signals, like energy levels, hunger, taste and emotions and helps people keep food and behaviours in perspective by drawing attention to other factors that impact on health and wellbeing. This study undertook a service evaluation of the Well Now course to understand its acceptability for participants and its impact on diet quality, food preoccupation, physical activity and mental wellbeing. METHODS: This service evaluation combined quantitative pre- and post-course measures with telephone interviews with previous attendees. Paired t-tests were used to determine if there were statistically significant differences in the intended outcomes. Semi-structured qualitative telephone interviews were undertaken with previous attendees 6-12 months after attendance to understand how participants experienced the Well Now course. RESULTS: Significant improvements were demonstrated in diet quality, food preoccupation, physical activity and mental wellbeing outcomes. Medium effect sizes are demonstrated for mental wellbeing and diet quality, with smaller effect sizes shown for physical activity and food preoccupation. The weight and Body Mass Index (BMI) of attendees remained stable in this timeframe. The qualitative data corroborates and extends elements of the quantitative outcomes and highlights areas of the course that may benefit from further development and improvement. The findings further indicate that the Well Now approach is largely acceptable for attendees. CONCLUSIONS: Well Now's non-judgemental holistic approach facilitates change for those who complete the course, and for those who do not. This health gain approach upholds non-maleficence and beneficence, and this is demonstrated with this service evaluation for both completers and partial completers.

Service contacts prior to death in people dying by suicide in the Scottish Highlands.

INTRODUCTION: Many people who die by suicide have been in contact with health services prior to their death. This study examined service contacts in people in urban and rural areas of the Scottish Highlands. METHODS: Highland residents dying by suicide or undetermined intent in 2001-2004 were identified using routine death records. Health service databases were searched to identify general hospital, mental health and general practice notes. RESULTS: 177 residents died in the time period (136 males). At least one type of record was identified on 175 people, including general practice records (167 people, 94.4%), psychiatric hospital records (n=87, 49.2%) and general hospital records (n=142, 80.2%). Of these, 52.5% had been in contact with at least one health service in the month before their death, including 18.6% with mental health services, and 46.4% with general practice. In total, 68.9% had a previous diagnosis of mental illness, 52.5% of substance misuse problems, and 40.1% of self-harm. The commonest mental illness diagnosis was depression (n=97, 54.8%). There was no difference in rates of GP contact in rural and urban areas. Of those dying in urban areas, 32% had been in contact with mental health services in the previous month, compared with 21% in Accessible Rural/Accessible Small Towns, and 11% in Remote Rural/Remote Small Towns (p<0.01). People in rural areas were less likely to have had contact with mental health services in the year before their death (p<0.01), and to have had lower recorded lifetime rates of mental health service contact (p<0.001), deliberate self-harm (p<0.005) and mental illness (p<0.001). CONCLUSIONS: Overall service contact rates prior to death by suicide were very similar to the results of a previous meta-analysis. Rates of contact with specialist mental health services were significantly lower in rural than urban areas, and this finding increased with greater rurality.

HPV vaccination: vaccine acceptance, side effects and screening intentions.

As part of an evaluation of the introductory campaign of human papilloma virus (HPV) vaccine in a Scottish health board, self-administered questionnaires were offered to all 5007 eligible girls in school following the third dose of HPV to identify side-effects, reasons for non-vaccination and future cervical screening intentions, and 2775 (56.2%) replied. In all, 630 (23.5%) of vaccinated girls reported side effects to the vaccination, about half of which were common injection-site reactions. Main reported reasons for non-vaccination related to perceived inadequate evidence for HPV safety and efficacy, and lack of perceived need or desire to be vaccinated. A total of 2430 (89.2%) of the girls expressed plans to take up cervical screening when older. Reasons for not planning to take up cervical smear were lack of knowledge about cervical screening, anticipated discomfort or embarrassment with the process and no perceived need for a cervical smear. Unvaccinated girls were less likely to report planning to attend for cervical smears in later life (Yates chi-square = 24.30, p < 0.001). The findings emphasise the importance of information on safety and efficacy in future communications about HPV with schoolage girls. The relationship between vaccination and screening intention, and its implications for widening the gap in health inequalities, also requires careful attention in local implementation of the national HPV vaccination programme.