Factors influencing pharmacists' roles in preventing prescription and over-the-counter opioid misuse: a systematic review and narrative synthesis.

BACKGROUND: The prescribing rate of opioids is increasing and is a main contributor to opioid misuse. Community pharmacists can help reduce opioid misuse rates by carrying out prescription and over-the-counter (OTC) opioid misuse prevention services. Understanding the barriers and facilitators to community pharmacists' involvement has the potential to improve these services. OBJECTIVE: To review the literature on the barriers and facilitators of community pharmacists' involvement in prescription and OTC opioid misuse prevention. METHODS: A systematic review of primary research was carried out in MEDLINE, Embase, Scopus, Web of Science, CINAHL, and APA PsycINFO from January 2022 to March 2022. Narrative synthesis underpinned by the COM-B model was used to analyse findings from the included articles. Studies were included if they used qualitative or mixed methods; published in English and focussed on OTC or prescription opioids. RESULTS: Ten studies were included in the review. Barriers and facilitators were grouped into individual, environmental, and system-level factors. Based on the COM-B model, these factors were classified as capabilities (knowledge and skill), opportunities (e.g. relationship with prescribers, time), and motivation (pharmacists' attitude). CONCLUSION: Improving pharmacists' capabilities and opportunities might improve pharmacists' motivation to offer opioid misuse services. This could improve pharmacists' behaviour, that is, their role in preventing prescription and OTC opioid misuse. The findings of this review were based on information obtained from primary evidence from qualitative studies; However. further empirical work is needed to identify how pharmacists can be supported.

Children's nutritional health and wellbeing in food insecure households in Europe: A qualitative meta-ethnography.

Since the 2008 global financial crisis, there has been a rise in the number of people experiencing food insecurity. Particularly vulnerable are households with children. This systematic review and meta-ethnography of qualitative studies focuses on families' perceptions of food insecurity and how it affects children's nutritional health and wellbeing. Six electronic databases (Medline, Scopus, Web of Science, EMBASE, CINAHL and ASSIA), were searched for studies from European high-income countries between January 2008-July 2021, and supplemented by searches of grey literature databases, relevant websites, examination of reference lists and citation searches. We adhered to PRISMA and eMERGe guidelines to improve the completeness and clarity of meta-ethnographic reporting. Methodological quality of the studies were assessed using the Critical Appraisal Skills Programme qualitative checklist. We identified 11,596 records; we included 19 publications involving 813 participants in total. Data were synthesised according to Noblit & Hare's seven phases of meta-ethnography. We identified four key themes-food and eating practices, awareness, fragility, and networks of care-comprising five sub-themes. Our meta-ethnography provides a progressive 'storyline' of the children's experiences of food insecurity from both caregivers and children's perspectives. We found that children are aware of their family's limited resources and are often active in trying to help their families cope, and that food insecurity adversely impacts children's physical, psychological, and social experiences. Our analysis highlights gaps in knowledge about how food insecurity impacts children's nutritional health and wellbeing. It suggests that future research should prioritise minoritised ethnic communities, children living in temporary accommodation and caregivers of very young children.

'What does good look like'-exploring access to healthcare for the homeless population in Gateshead, England.

BACKGROUND: individuals who are homeless encounter extreme health inequalities and as a result often suffer poor health. This study aims to explore ways in which access to healthcare could be improved for individuals who are homeless in Gateshead, UK. METHODS: twelve semi-structured interviews were conducted with people working with the homeless community in a non-clinical setting. Transcripts were analysed using thematic analysis. RESULTS: six themes were identified under the broad category of 'what does good look like', in terms of improving access to healthcare. These were: facilitating GP registration; training to reduce stigma and to provide more holistic care; joined-up working in which existing services communicate rather than work in isolation; utilising the voluntary sector as support workers could actively support access to healthcare and provide advocacy; specialised roles such as specialised clinicians, mental health workers or link workers; and specialised bespoke services for the homeless community. CONCLUSIONS: the study revealed issues locally for the homeless community accessing healthcare. Many of the proposed actions to facilitate access to healthcare involved building upon good practice and enhancing existing services. The feasibility and cost-effectiveness of interventions suggested requires further assessment.

Newspaper media framing of obesity during pregnancy in the UK: A review and framework synthesis.

Two thirds of women report experiencing weight stigma during pregnancy. Newspaper media is powerful in framing health issues. This review synthesized UK newspaper media portrayal of maternal obesity. NexisUni was searched to identify newspaper articles, published January 2010 to May 2021, reporting content on obesity during pregnancy. Framework synthesis integrated quantitative and qualitative analysis of the content of articles. There were 442 articles included (59% tabloids and 41% broadsheets). Three overarching themes with interacting sub-themes were as follows: (1) Women were blamed for their weight, risks, and NHS impact. (2) Women were solely responsible for solving obesity, gendered from school age. (3) Women with obesity were a burden on individuals (e.g., themselves, their children, and health professionals), to society, and the NHS. Catastrophizing language framed the "problem," "scale," and "public health concern" of maternal obesity, emphasizing risk, and danger and was alarmist, aggressive, and violent as to elicit fear or devalue women. Articles platformed 'expert' voices rather than women's lived experiences. This review identified that UK newspaper media negatively frames and oversimplifies the topic of maternal obesity. Exposure to blaming and alarmist messaging could increase women's guilt, stigma, and internalized weight bias. The newspaper media should be harnessed to de-stigmatize maternal obesity and promote maternal well-being.

Exploring the impact of elexacaftor-tezacaftor-ivacaftor treatment on opinions regarding airway clearance techniques and nebulisers: TEMPO a qualitative study in children with cystic fibrosis, their families and healthcare professionals.

BACKGROUND: Cystic fibrosis (CF) is a genetic condition caused by variants in the cystic fibrosis transmembrane conductance regulator (CFTR) gene that primarily impacts the lungs. Treatments historically have been symptomatic to improve airway clearance and treat infection. However, CFTR modulator drugs have recently been developed that target the underlying defect. The triple combination of elexacaftor-tezacaftor-ivacaftor (ETI) was approved in 2020 in England for over 80% of people with CF aged over 12 years and in 2022 extended to those over 6 years. ETI treatment is associated with substantial improvements in lung function. The experience of children with CF starting on ETI or their views regarding future treatments have not been well studied. This study aimed to explore the opinions of children with CF, their parents/carers and healthcare professionals (HCPs) on the impact of ETI, airway clearance techniques (ACTs) and nebulised treatments. METHODS: Semistructured qualitative interviews were performed with 10 children with CF, 7 parents/carers and 10 HCPs. Audio recordings were transcribed and analysed using reflexive thematic analysis. RESULTS: Four main themes were identified: 'Kaftrio changed my life', 'Your entire life is dictated by the CF timetable', 'Simplifying treatment-hopes and fears' and 'Kaftrio is a game-changer' along with several subthemes and an overarching theme of 'I still can't get my head around how three tablets can do what Kaftrio done'. CONCLUSIONS: Despite the highly positive impact of ETI on the health of children with CF some concerns remain about the longer-term outcomes of reducing ACTs or nebulised treatments. ETI has prompted a shift in treatment for many and offers an opportunity to personalise approaches.

Experiences and perceptions of nutritional health and wellbeing amongst food insecure women in Europe: A qualitative meta-ethnography.

Since the 2008 global financial crisis, there has been a rise in the number of people experiencing food insecurity. Particularly vulnerable are mothers with young children, pregnant women, and lone parents (the majority of whom are women). This systematic review and meta-ethnography of qualitative studies focused on women's experiences of food insecurity and how it affects their nutritional health and wellbeing. Six electronic databases (Medline, Scopus, Web of Science, EMBASE, CINAHL and ASSIA), were searched from January 1, 2008-July 10, 2021, and supplemented by searches of grey literature databases, relevant websites, examination of reference lists and citation searches. We adhered to PRISMA and eMERGe guidelines to improve the completeness and clarity of meta-ethnographic reporting. Methodological quality of the studies was assessed using the Critical Appraisal Skills Programme qualitative checklist. We identified 11,589 unique records; we included 23 publications reporting data from 22 unique studies involving 647 women. Data were synthesised according to Noblit & Hare's seven phases of meta-ethnography. We identified two key themes - accessing sufficient food and embodying food insecurity - comprising seven sub-themes. Our meta-ethnography provides a progressive 'storyline' of women's experiences of food insecurity. This includes the ways in which women attempt to access sufficient food, are unable to meet their nutritional needs, and the ways in which this is embedded into their everyday lives and embodied in unhealthful physical, social, and mental nutritional health and wellbeing impacts. Our review emphasises that food insecurity directly and tangibly impacts women's nutritional health and wellbeing. It concludes that there needs to be greater recognition of the psychosocial impact of food insecurity on vulnerable women in addition to its impact on their nutritional health and wellbeing.

When should palliative care be introduced for people with progressive fibrotic interstitial lung disease? A meta-ethnography of the experiences of people with end-stage interstitial lung disease and their family carers.

BACKGROUND: Little is currently known about the perspectives of people with interstitial lung disease and their carers in relation to the timing of palliative care conversations. AIM: To establish patients' and carers' views on palliative care in interstitial lung disease and identify an optimum time to introduce the concept of palliative care. DESIGN: Meta-ethnography of qualitative evidence. The review protocol was prospectively registered with PROSPERO (CRD42021243179). DATA SOURCES: Five electronic healthcare databases were searched (Medline, Embase, CINAHL, Scopus and Web of Science) from 1st January 1996 to 31st March 2022. Studies were included that used qualitative methodology and included patients' or carers' perspectives on living with end-stage disease or palliative care. Quality was assessed using the Critical Appraisal Skills Programme checklist. RESULTS: About 1779 articles were identified by initial searches. Twelve met the inclusion criteria, providing evidence from 266 individuals across five countries. Three stages were identified in the illness journey of a person with interstitial lung disease: (1) Information seeking, (2) Grief and adjustment, (3) Fear of the future. Palliative care involvement was believed to be most appropriate in the latter two stages and should be prompted by changes in patients' health such as respiratory infections, onset of new symptoms, hospital admission, decline in physical function and initiation of oxygen. CONCLUSIONS: Patients and carers prefer referral to palliative care services to be prompted by changes in health status. Future research should focus on supporting timely recognition of changes in patients' health status and how to respond in a community setting.

Barriers and facilitators of childhood flu vaccination: the views of parents in North East England.

Aim: The aim of this study was to complete a descriptive qualitative investigation of parents' perceptions of the barriers and facilitators to flu vaccination for pre-school children. Subject and method: Participants were recruited through various communication channels to maximize sample variation. Invitations to participate in the study were sent to members of the Newcastle University Parent Network and to parents who had participated in previous research conducted at Newcastle University. Twelve participants (six with vaccinated children, six whose children were not vaccinated) took part in a semi-structured interview via Zoom. Transcripts were coded using Nvivo 12 and data were thematically analyzed using the COM-B model of health behavior change. Results: Participants whose children were not vaccinated against flu nonetheless generally held favourable views of vaccination and reported low concern about side-effects. Barriers involved a combination of internal and external factors, mainly a lack of convenient access to vaccination opportunities and flu vaccination being a low priority for busy parents. Conclusion: Our findings suggest that socioeconomic status, which is known to influence other vaccination behaviors, may influence uptake of the flu vaccine in this population. Inconvenient vaccination opportunities and a lack of awareness of the need to vaccinate are major barriers to uptake for some parents. The finding that belief that flu vaccination is a civic responsibility is a new contribution to the literature. Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-022-01695-2.

Which factors influence the quality of end-of-life care in interstitial lung disease? A systematic review with narrative synthesis.

BACKGROUND: People dying from interstitial lung disease experience considerable symptoms and commonly die in an acute healthcare environment. However, there is limited understanding about the quality of their end-of-life care. AIM: To synthesise evidence about end-of-life care in interstitial lung disease and identify factors that influence quality of care. DESIGN: Systematic literature review and narrative synthesis. The review protocol was prospectively registered with PROSPERO (CRD42020203197). DATA SOURCES: Five electronic healthcare databases were searched (Medline, Embase, PubMed, Scopus and Web of Science) from January 1996 to February 2021. Studies were included if they focussed on the end-of-life care or death of patients with interstitial lung disease. Quality was assessed using the Critical Appraisal Skills Programme checklist for the relevant study design. RESULTS: A total of 4088 articles were identified by initial searches. Twenty-four met the inclusion criteria, providing evidence from 300,736 individuals across eight countries. Most patients with interstitial lung disease died in hospital, with some subjected to a high burden of investigations or life-prolonging treatments. Low levels of involvement with palliative care services and advance care planning contributed to the trend of patients dying in acute environments. This review identified a paucity of research that addressed symptom management in the last few days or weeks of life. CONCLUSIONS: There is inadequate knowledge regarding the most appropriate location for end-of-life care for people with interstitial lung disease. Early palliative care involvement can improve accordance with end-of-life care wishes. Future research should consider symptom management at the end-of-life and association with location of death.

Food insecurity and the nutritional health and well-being of women and children in high-income countries: protocol for a qualitative systematic review.

INTRODUCTION: Since the global financial crises of 2008, there has been a rise in the number of people experiencing food insecurity. The COVID-19 pandemic has exacerbated this. Many more are unable to afford or access food of sufficient quality and quantity to enable good health and well-being. Particularly vulnerable are mothers with young children, pregnant women and lone parents (the majority of whom are women). This review aims to understand experiences of food insecurity and how it affects women and children's nutritional health and well-being, focusing on experiences explicitly related to nutrition. Findings will help guide health policy and practice to support food-insecure women and children from high-income countries. METHODS AND ANALYSIS: A systematic review and meta-ethnography exploring (1) food-insecure women's own accounts of their nutritional health and (2) food-insecure household's accounts of their children's nutritional health. Six major databases (MEDLINE, Scopus, Web of Science, EMBASE, CINAHL and ASSIA), grey literature databases and relevant stakeholder websites will be searched from 1 January 2008 to 30 March 2021. Reference list and citation searches will supplement electronic database searches. Outcomes of interest are accounts of nutrition and nutritional health, including diet, food practices, infant feeding practices and physical and mental health. The review will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol guidelines, but as this is a meta-ethnography it will adhere to eMERGe Reporting Guidance for synthesis and writing findings of the final report. Critical Appraisal Skills Programme qualitative checklist will assess the quality of studies. A meta-ethnographic analysis will be conducted for all included studies. ETHICS AND DISSEMINATION: As a qualitative systematic review, without primary data collection, ethical approval will not be required. Findings will be submitted for peer-reviewed publication. PROSPERO REGISTRATION NUMBER: CRD42020214159.

'I'm Gonna Tell You about How Mrs Rona Has Affected Me'. Exploring Young People's Experiences of the COVID-19 Pandemic in North East England: A Qualitative Diary-Based Study.

Children and young people risk being 'disproportionately harmed' by the COVID-19 pandemic. Whilst an evolving body of literature focuses on the impact of the pandemic on the mental health and wellbeing of children and young people, less attention has been paid to the collection of qualitative, exploratory data. The aim of this study was to examine young people in North East England's experiences of COVID-19 and associated control measures. Flexible, qualitative diaries were collected with 31 young people aged 13-17 for six weeks between July and October 2020. Diary extracts were curated using Instagram Direct Messaging (DM), email and text messaging. At the end of this study, participants took part in a follow-up interview (conducted by telephone or Zoom), asking them to reflect on their diary entries. Thematic analysis of diaries and interviews yielded three central themes: (1) impacts upon mental health and emotional wellbeing; (2) disruptions and changes to education and school life; and (3) frustration, burden and responsibility. These findings highlight acute mental health impacts (loneliness, isolation, anxiety) as well as longer-term repercussions from disrupted education (missed parts of curriculum, home schooling, cancelled exams, periods of isolation) on young people aged 13-17 as a result of the COVID-19 pandemic.

Assessing the value for money of an integrated health and wellbeing service in the UK.

Lay health workers have been utilized to deliver health promotion programmes in a variety of settings. However, few studies have sought to determine whether these programmes represent value for money, particularly in a UK context. The present study involved an economic evaluation of Wellbeing for Life, an integrated health and wellbeing service in northern England. The service combined one-to-one interventions delivered by lay health workers (known as health trainers), group wellbeing interventions, volunteering opportunities and other community development activities. Value for money was assessed using an established economic model developed with input from a panel of commissioners and providers, and the main data source was the national health trainer data collection and reporting system. Between June 2015 and January 2017, behaviour change outcomes (i.e. whether client goals in relation to diet, physical activity, smoking or other behaviours, had been achieved) were recorded for 2433 of the 3179 individuals who accessed one-to-one interventions. The level of achievement observed gave an estimated total health gain of 287.7 quality-adjusted life years (QALYs). In addition, there were 4669 health-promoting events, five asset mapping projects and 1595 occurrences of signposting to other services. Combining the value of individual behaviour change with the value of these additional activities gave an overall net cost per QALY gained of £3900 and a total estimated societal value of at least £3.45 for every £1 spent on the service. These results suggest that the Wellbeing for Life service offered good value for money. Further research is needed to systematically and comprehensively determine the societal value of similar holistic, asset-based and lay-led approaches.

Effects of local authority expenditure on childhood obesity.

BACKGROUND: Under the 2013 reforms introduced by the Health and Social Care Act (2012), public health responsibilities in England were transferred from the National Health Service to local authorities (LAs). Ring-fenced grants were introduced to support the new responsibilities. The aim of our study was to test whether the level of expenditure in 2013/14 affected the prevalence of childhood obesity in 2016/17. METHODS: We used National Child Measurement Programme definitions of childhood obesity and datasets. We used LA revenue returns data to derive three measures of per capita expenditure: childhood obesity (<19); physical activity (<19) and the Children's 5-19 Public Health Programme. We ran separate negative binomial models for two age groups of children (4-5 year olds; 10-11 year olds) and conducted sensitivity analyses. RESULTS: With few exceptions, the level of spend in 2013/14 was not significantly associated with the level of childhood obesity in 2016/17. We identified some positive associations between spend on physical activity and the Children's Public Health Programme at baseline (2013/14) and the level of childhood obesity in children aged 4-5 in 2016/17, but the effect was not evident in children aged 10-11. In both age groups, LA levels of childhood obesity in 2016/17 were significantly and positively associated with obesity levels in 2013/14. As these four cohorts comprise entirely different pupils, this underlines the importance of local drivers of childhood obesity. CONCLUSIONS: Higher levels of local expenditure are unlikely to be effective in reducing childhood obesity in the short term.

Local authority commissioning of NHS Health Checks: A regression analysis of the first three years.

In April 2013, the public health function was transferred from the NHS to local government, making local authorities (LAs) responsible for commissioning the NHS Health Check programme. The programme aims to reduce preventable mortality and morbidity in people aged 40-74. The national five-year ambition is to invite all eligible individuals and to achieve an uptake of 75%. This study evaluates the effects of LA expenditure on the programme's invitation rates (the proportion of the eligible population invited to a health check), coverage rates (the proportion of the eligible population who received a health check) and uptake rates (attendance by those who received a formal invitation letter) in the first three years of the reforms. We ran negative binomial panel models and controlled for a range of confounders. Over 2013/14-2015/16, the invitation rate, coverage rate and uptake rate averaged 57% 28% and 49% respectively. Higher per capita spend on the programme was associated with increases in both the invitation rate and coverage rate, but had no effect on the uptake rate. When we controlled for the LA invitation rate, the association between spend and coverage rate was smaller but remained statistically significant. This suggests that alternatives to formal invitation, such as opportunistic approaches in work places or sports centres, may be effective in influencing attendance.

Directors of public health as 'a protected species': qualitative study of the changing role of public health professionals in England following the 2013 reforms.

Background: The Health and Social Care Act 2012 gave councils in England responsibility for improving the health of their populations. Public health teams were transferred from the National Health Service (NHS), accompanied by a ring-fenced public health grant. This study examines the changing role of these teams within local government. Methods: In-depth case study research was conducted within 10 heterogeneous councils. Initial interviews (n = 90) were carried out between October 2015 and March 2016, with follow-up interviews (n = 21) 12 months later. Interviewees included elected members, directors of public health (DsPH) and other local authority officers, plus representatives from NHS commissioners, the voluntary sector and Healthwatch. Results: Councils welcomed the contribution of public health professionals, but this was balanced against competing demands for financial resources and democratic leverage. DsPH-seen by some as a 'protected species'-were relying increasingly on negotiating and networking skills to fulfil their role. Both the development of the existing specialist public health workforce and recruitment to, and development of, the future workforce were uncertain. This poses both threats and opportunities. Conclusions: Currently the need for staff to retain specialist skills and maintain UKPH registration is respected. However, action is needed to address how future public health professionals operating within local government will be recruited and developed.

Children and young people's perceptions of energy drinks: A qualitative study.

BACKGROUND: Consumption of soft drinks is declining in many countries, yet energy drink sales continue to increase, particularly amongst young consumers. Little is currently known about the drivers behind these trends. Energy drinks are high in sugar and caffeine, and evidence indicates that regular or heavy use by under 18s is likely to be detrimental to health. This study aimed to explore children and young people's attitudes and perceptions in relation to energy drinks in a UK context. METHODS: Eight focus groups were conducted with pupils aged 10-11 years (n = 20) and 13-14 years (n = 17) from four schools in northern England. A sub-sample also took part in a mapping exercise to generate further insights. Data were analysed using the constant comparative approach. RESULTS: Energy drinks were reportedly consumed in a variety of public and private places, generally linked to social activities, sports and computer gaming (particularly amongst boys). Participants demonstrated strong brand awareness and preferences that were linked to taste and perceived value for money. The relatively low price of energy drinks and their widespread availability were identified as key factors, along with gendered branding and marketing. Some participants demonstrated a critical approach to manufacturers' claims and many were keen to become better informed, often through school- or peer-based interventions. Other potential interventions included age restrictions, voluntary schemes involving retailers and improved labelling. CONCLUSIONS: The lack of a single dominant factor in participants' consumption choices suggests that there is unlikely to be a 'silver bullet' in attempting to address this issue. However, the findings provide support for policy-level interventions that seek to change the behaviours of manufacturers and retailers as well as consumers, and actively involve children and young people where possible.

Designing equitable workplace dietary interventions: perceptions of intervention deliverers.

BACKGROUND: Workplaces are a good setting for interventions that aim to support workers in achieving a healthier diet and body weight. However, little is known about the factors that impact on the feasibility and implementation of these interventions, and how these might vary by type of workplace and type of worker. The aim of this study was to explore the views of those involved in commissioning and delivering the Better Health at Work Award, an established and evidence-based workplace health improvement programme. METHODS: One-to-one semi-structured interviews were conducted with 11 individuals in North East England who had some level of responsibility for delivering workplace dietary interventions. Interviews were transcribed verbatim and analysed using thematic framework analysis. RESULTS: A number of factors were felt to promote the feasibility and implementation of interventions. These included interventions that were cost-neutral (to employee and employer), unstructured, involved colleagues for support, took place at lunchtimes, and were well-advertised and communicated via a variety of media. Offering incentives, not necessarily monetary, was perceived to increase recruitment rates. Factors that militate against feasibility and implementation of interventions included worksites that were large in size and remote, working patterns including shifts and working outside of normal working hours that were not conducive to workers being able to access intervention sessions, workplaces without appropriate provision for healthy food on site, and a lack of support from management. CONCLUSIONS: Intervention deliverers perceived that workplace dietary interventions should be equally and easily accessible (in terms of cost and timing of sessions) for all staff, regardless of their job role. Additional effort should be taken to ensure those staff working outside normal working hours, and those working off-site, can easily engage with any intervention, to avoid the risk of intervention-generated inequalities (IGIs).

Impact and acceptability of lay health trainer-led lifestyle interventions delivered in primary care: a mixed method study.

Aim To evaluate the impact and acceptability of offering one-to-one lifestyle interventions delivered by lay health trainers in the primary care setting. BACKGROUND: Chronic conditions represent major causes of ill-health, avoidable disability, pain and anxiety, and tend to be more prevalent in less affluent groups. This is due, in part, to the link between unhealthy lifestyles and lower socio-economic status, although factors such as poverty, worklessness and social exclusion play a larger role. Lay health trainers were introduced in England with the aim of providing personalised lifestyle advice, support and access to services for people living in disadvantaged areas. There is a body of literature on the effectiveness of lay or community health workers in the management of chronic conditions. However, little is known about their potential to promote lifestyle changes in newly diagnosed patients. An innovative health trainer service was piloted in the primary care setting, to work with people diagnosed with a chronic condition or identified as potentially benefitting from one-to-one support. METHODS: A mixed method study design was utilised. Semi-structured interviews and focus groups were conducted with practice staff (n=11) and patients (n=15) from one primary care practice in North East England, United Kingdom. Discussions were audio-recorded and analysed using a thematic content approach. Routinely collected pre-/post-intervention data (n=246 patients at baseline; sample sizes varied at end line) were analysed and appropriate descriptive and summary statistics produced. Findings The discussions highlighted a high level of satisfaction with the health trainer model in terms of supporting positive lifestyle changes. Locating the intervention within the practice removed access barriers, particularly for those with long-term conditions. Anecdotal evidence of health improvement was supported by the quantitative analyses, which revealed statistically significant improvements in body mass index, blood pressure, dietary habits, exercise levels, alcohol intake, self-rated health and self-efficacy amongst those who completed the intervention.