Determinants of physical activity promotion in primary care from the patient perspective of people at risk of or living with chronic disease: a COM-B analysis.

BACKGROUND: Chronic disease (CD) accounts for more than half of the overall global disease burden and physical activity (PA) is an established evidence-based strategy for the prevention and management of CD. Global policy emphasises the value of embedding PA into primary healthcare, highlighting the positive effects on PA behaviour. However, there is limited implementation of PA protocols in primary care, and research is needed to guide its integration into routine practice. The voice of the patient is underrepresented in the literature, resulting in the absence of critical insights into determinants of PA promotion in primary care. The purpose of the research was to identify the perspectives of people at risk of or living with CD on the determinants of PA promotion in primary care and to map these determinants across the six COM-B constructs. METHODS: Semi-structured interviews (n = 22), guided by the COM-B model were conducted with people aged 35-60 years, at risk of or living with CD and not meeting the PA guidelines. A hybrid analytic approach of thematic inductive and deductive analysis was applied to the participant transcripts guided by a COM-B informed coding framework. RESULTS: In total, 37 determinants across constructs related to capability, opportunity and motivation were prominent, examples include; physical capability constraints, the conflation of exercise with weight management, credibility of the health services in PA advice, communication styles in PA promotion, expectations of tailored support for PA, social support, accessibility, and integration of PA into routine habits. CONCLUSION: Exploring the determinants of PA promotion through the lens of the COM-B model facilitated a systematic approach to understanding the primary care user perspective of the healthcare professional (HCP) broaching the topic of PA. Findings emphasise the value of HCPs being supported to broach the issue of PA in a therapeutic and patient-centred manner using diverse and flexible approaches, while highlighting the importance of tailored, accessible PA opportunities that build self-efficacy and foster social support. The research provides valuable learnings to support PA promotion and the development of strategies in primary care through encompassing the perspective of those living with or at risk of CD.

Understanding shedders: Which socio-demographic, health and wellbeing characteristics best inform appropriate health promotion action in men's sheds and a 'Shed for Life'?

ISSUE ADDRESSED: Men's sheds ('Sheds') have been identified as inherently health promoting and as potential settings to engage 'hard-to-reach' men in more structured health promotion initiatives. However, little is known about the socio-demographic or health and wellbeing characteristics of Shed members ('Shedders') on which such initiatives might be based. This study captures a baseline cross-sectional analysis of Shedders (n = 384) who participated in 'Sheds for Life', a health promotion initiative tailored to Sheds. METHODS: Objective health measures (body composition, blood pressure, blood lipids) captured via health screening as well as socio-demographic and health and wellbeing measures (physical activity, subjective wellbeing, mental health, social capital, cooking and diet) via questionnaires were assessed. Descriptive statistics were generated and differences between groups were determined via parametric and non-parametric testing. Bivariate analysis was used to determine associations and regression analysis then estimated various predictors on mental wellbeing, life satisfaction and loneliness. RESULTS: Participants were mostly over 65 years (77.3%), retired (88.6%) with limited educational attainment (77%). The majority were in the 'at-risk' categories for objective health measures, with most being referred to their GP following health screening (79.6%). Older Shedders were also more likely to meet physical activity guidelines. Mental wellbeing was positively correlated with life satisfaction and increased social capital and these were also positively correlated with physical activity (P < .05). CONCLUSIONS: Findings highlight the potential of Sheds in reaching a 'hard-to-reach' and 'at-risk' cohort of men. Despite a high prevalence of 'at-risk' objective health measures, participants report their health in positive terms. Future health promotion initiatives should capitalise on the inherent health-promoting properties of Sheds. SO WHAT?: Findings raise important implications for prioritising and designing health promotion initiatives in Shed settings.

'Sheds for Life': delivering a gender-transformative approach to health promotion in Men's Sheds.

Research has highlighted the importance of gendered approaches to engage men with health. Sheds for Life (SFL) is a health and wellbeing initiative that utilizes evidence-based and gender-specific approaches to engage hard to reach men with health promotion directly in the Men's Sheds (Sheds) setting. To understand the impact of SFL and how participants (Shedders) experienced SFL in practice, this qualitative study applied a framework of constructivism and aimed to explore how gendered approaches impacted engagement with SFL through Shedder's own accounts of their attitudes, opinions and experiences. Qualitative methods incorporating ethnographical observations, focus groups (n = 8) and short semi-structured interviews (n = 19) were conducted with SFL participants in the Shed setting. Reflexive thematic analysis was used to analyse the data to faithfully capture Shedders' experiences while acknowledging the reflexive influence of the researcher. Findings led to three key themes: Creating the 'right environment'; Normalizing meaningful conversations; a legacy for 'talking health' with subthemes of creating safety and trust and strengthening of bonds; and transforming perceptions of how men 'do health' with subthemes of reaping the benefits of engaging with health and reframing attitudes towards health. This is first study to capture Shedders' experiences of a structured health promotion initiative in the Shed setting. Findings highlight the value in utilizing the Shed setting to engage men with health and the importance of gender-specific strategies which encourage a gender-transformative approach to men's health promotion.

Sheds for life: health and wellbeing outcomes of a tailored community-based health promotion initiative for men's sheds in Ireland.

BACKGROUND: Gender is increasingly recognised as a critical factor in designing community-based health promotion programmes. Men's Sheds ('Sheds') are community-based informal environments that represent a safe space in which to engage cohorts of hard-to-reach (HTR) men in health promotion. Sheds for Life (SFL), the first structured health promotion initiative evaluated globally in Sheds, is a 10-week initiative co-designed with Shed Members (Shedders) and delivered directly in the Shed setting in Ireland. This research describes the health and wellbeing outcomes experienced by SFL participants. METHODS: Purposive sampling was used to recruit a diverse representation of Shedders (n = 421) participating in SFL alongside a wait list control (n = 86). Questionnaires assessing constructs of health and wellbeing were administered one-to-one in Sheds at baseline, 3, 6 and 12 months. Descriptive data for health outcomes were generated for each time point and assessed for significant changes using inferential testing, while considering COVID-19 impact. RESULTS: Outcomes related to subjective wellbeing, mental wellbeing, physical activity, social capital and healthy eating significantly increased post SFL (p < 0.05). Mental wellbeing scores (SWEMWBS) post SFL remained significantly higher than baseline despite COVID-19 impact (p < 0.05). Binary logistic regression indicated that the odds of a meaningful SWEMWBS change was significantly higher for shedders that had lower SWEMWBS (OR 0.804), less loneliness (OR 0.638) and lived alone (OR 0.456) at baseline. Shedders with lower SWEMBWS had higher odds of experiencing positive changes in life satisfaction (OR 0.911) and trust (OR 0.928), while Shedders who lived alone had also higher odds of experience positive changes in healthy eating (OR 0.481). Finally, inactive Shedders at baseline had higher odds of experiencing increased levels of physical activity (OR 0.582). CONCLUSIONS: Findings suggest that the inclusive, community-based SFL model is effective in engaging Shedders and facilitating positive and sustained changes in health and wellbeing outcomes. Using gender-specific approaches in the informal and safe environment of the Shed are effective in engaging men in structured health and wellbeing initiatives, particularly those who may be more vulnerable, isolated or lonely. TRIAL REGISTRATION: This study has been retrospectively registered with the 'International Standard Randomised Controlled Trial Number' registry (ISRCTN79921361) as of 05/03/2021.

An Economic Evaluation of 'Sheds for Life': A Community-Based Men's Health Initiative for Men's Sheds in Ireland.

Men's Sheds ('Sheds') attract a diverse cohort of men and, as such, have been identified as spaces with the potential to engage marginalized subpopulations with more structured health promotion. 'Sheds for Life' is a 10-week men's health initiative for Sheds in Ireland and the first structured health promotion initiative formally evaluated in Sheds. Cost is an important implementation outcome in the evaluation of Sheds for Life when operating in an environment where budgets are limited. Therefore, an economic evaluation is critical to highlight cost-effectiveness for decision makers who determine sustainability. This is the first study to evaluate the cost-effectiveness of health endeavors in Sheds. All costs from pre-implementation to maintenance phases were gathered, and questionnaires incorporating the SF-6D were administered to participants (n = 421) at baseline, 3, 6, and 12 months. Then, utility scores were generated to determine quality-adjusted life years (QALYS). Results demonstrate that the intervention group experienced an average 3.3% gain in QALYS from baseline to 3 months and a further 2% gain from 3 months to 6 months at an estimated cost per QALY of €15,724. These findings highlight that Sheds for Life is a cost-effective initiative that effectively engages and enhances the well-being of Shed members.

Strategies for effective implementation and scale-up of a multi-level co-designed men's health initiative "Sheds for Life" in Irish Men's Sheds.

Sheds for Life is a gender-specific tailored men's health initiative engaging "hard-to-reach" men in the Men's Shed setting in Ireland. It is implemented by multiple stakeholders at individual, provider, organization and systems level and thus multiple contextual factors influence its scalability. This research used established implementation science frameworks to guide participatory research approaches that captured the process and identified facilitators of and barriers to implementation and scale-up. Active recruitment, co-design processes, leadership and stakeholder engagement emerged as key facilitators of implementation. Prominent barriers were institutional capacity and funding. Acceptability, adoption and appropriateness of the initiative were high among stakeholders with sustainability largely contingent on funding and staff resources. Findings make a valuable contribution to knowledge by capturing the process involved in the implementation of a complex multi-level men's health intervention. It provides a "how to" guide of strategies to engage hard-to-reach men with health promotion, the operationalization and application of implementation frameworks in community-based health promotion, and the implementation of health promotion in Men's Sheds. Documented barriers and facilitators that impact implementation of a community-based men's health program are rare and provide a valuable blueprint for practitioners, researchers and policy makers in the field.

Barriers and facilitators to implementing community-based physical activity interventions: a qualitative systematic review.

BACKGROUND: Over the past decade several physical activity (PA) interventions have been shown to be efficacious in a controlled research setting, however there is a continued lack of evidence for how to successfully implement these PA interventions in real-world settings such as the community. This review aims to explore the barriers and facilitators that affect the implementation of community-based PA interventions and make recommendations to improve implementation from the included studies. METHODS: A systematic literature search of EBSCOhost, Scopus, PUBMED and Web of Science was conducted to identify articles that reported qualitative data on the implementation factors of community-based interventions where PA was a primary outcome. Data were extracted using the Consolidated Framework for Implementation Research (CFIR) as a guide. Implementation factors and recommendations were then mapped onto the 5 domains of the CFIR and synthesised thematically. RESULTS: From 495 articles, a total of 13 eligible studies were identified, with 6 studies using a mixed methods approach, and 7 reporting qualitative methods only. There were 82 implementation factors identified, including 37 barriers and 45 facilitators, and a further 26 recommendations from the papers across all 5 domains of the CFIR. More barriers than facilitators were identified within the CFIR domain inner setting, in contrast to all other domains where facilitator numbers outweighed barriers. CONCLUSIONS: This review identified many facilitators and barriers of implementing physical activity interventions in the community. A key finding of this review was the impact of implementation strategies on successful implementation of community PA interventions. From the evidence, it was clear that many barriers to implementation could have been negated or reduced by an implementation plan in which several strategies are embedded. The findings of this review also suggest more attention to individual' skills and involvement is needed to improve self-efficacy and knowledge. The role of individuals across all organisational levels, from providers to leaders, can impact on the implementation of an intervention and its success. TRIAL REGISTRATION: PROSPERO - CRD42020153821 .

Study protocol: evaluation of sheds for life (SFL): a community-based men's health initiative designed "for shedders by shedders" in Irish Men's sheds using a hybrid effectiveness-implementation design.

BACKGROUND: Men's Sheds ("Sheds") offer a unique opportunity to reach a captive audience of "hard-to-reach" men. However, attempts to engage Sheds in structured health promotion programmes must respect the ethos of Sheds as highly variable, autonomous, non-structured spaces. This paper captures the key methodologies used in "Sheds for Life' (SFL), a men's health initiative tailored to the Shed setting. METHODS: A hybrid effectiveness-implementation study design is used to test effectiveness and implementation outcomes across multiple levels (participant, provider, organisational and systems levels). A dynamic, iterative and collaborative process seeks to address barriers and translation into the real world context. Using a community-based participatory research approach and guided by established implementation frameworks, Shed members ('Shedders') assume the role of key decision makers throughout the evaluation process to promote the systematic uptake of SFL across Shed settings. The protocols pertaining to the development, design and implementation of SFL and the evaluation of impact on participants' health and wellbeing outcomes up to 12 months are outlined. CONCLUSIONS: There is a dynamic interplay between the intervention characteristics of SFL and the need to assess and understand the diverse contexts of Sheds and the wider implementation environment. A pragmatic and context-specific design is therefore favoured over a tightly controlled efficacy trial. Documenting the protocols used to evaluate and implement a complex multi-level co-developed intervention such as SFL helps to inform gender-specific, community-based men's health promotion and translational research more broadly. TRIAL REGISTRATION: This study has been retrospectively registered with the 'International Standard Randomised Controlled Trial Number' registry ( ISRCTN79921361 ) as of the 5th of March 2021.

The impact of the COVID-19 pandemic on the wellbeing of Irish Men's Shed members.

COVID-19 disproportionately affects males especially those who are older and more socio-economically disadvantaged. This study assessed wellbeing outcomes among men's shed members (Shedders) in Ireland at baseline (T1), 3 (T2), 6 (T3) and 12 months (T4) in response to a 10-week health promotion program 'Sheds for Life' (SFL). Two cohorts participated in SFL commencing in March and September 2019. This study compares the T3 findings from one cohort carried out during the COVID-19 pandemic [COVID cohort (n = 185)] with T3 findings from a comparator cohort [pre-COVID cohort (n = 195)], completed pre-COVID-19. Questionnaires assessing wellbeing [life satisfaction, mental health, loneliness, physical activity (PA), self-rated health and other lifestyle measures] were analyzed in both cohorts T1, T2 and T3. Self-rated Health and life satisfaction decreased in the COVID cohort at T3 (p < 0.001), while loneliness scores increased (p < 0.0005). Higher loneliness scores were correlated with lower health ratings, life satisfaction and PA during COVID-19 (p < 0.001). Days PA decreased in the COVID cluster at T3 from T2 (p < 0.01) with those in urban areas reporting lower activity levels than rural areas (p < 0.05). Those sufficiently active at baseline managed to maintain PA during COVID-19 while those not meeting guidelines were more likely to report decreases (p < 0.001). Shedders experiencing COVID-19 restrictions are at an increased risk of poorer wellbeing and increased levels of loneliness. Support and guidance are needed to safely encourage this cohort back into men's sheds, settings that protect against loneliness and positively promote health and wellbeing. Lay summary The COVID-19 pandemic will have wide-reaching implications on wellbeing, particularly on those who are older and more vulnerable. Evidence also suggests that COVID-19 disproportionately affects males. This study aimed to understand the impact that COVID-19 has had on men in the setting of Men's Sheds in Ireland. Two cohorts of men who were participating in a 10-week health and wellbeing program (Sheds for Life) at different stages were followed over time. At 6 months follow-up the first Cohort had not experienced COVID-19 whereas the second cohort was actively experiencing the COVID-19 pandemic. We measured wellbeing using questionnaires, comparing both groups of men for differences. We found that the men who were experiencing COVID-19 had lower self-rated health, physical activity and life satisfaction as well as higher rates of loneliness, with those who were more lonely reporting lower wellbeing scores. We also found that men in rural areas were more physically active during COVID-19 and that those were not active were more likely to become more inactive during COVID-19. This study suggests that support and guidance is needed to safely encourage this cohort back into Men's Sheds, settings that protect against loneliness and positively promote health and wellbeing.

Abnormal level of arousal as a predictor of delirium and inattention: an exploratory study.

OBJECTIVE: Abnormal level of arousal (LoA) and inattention are key features of delirium. However, the extent to which abnormal LoA alone might predict delirium and inattention is unclear. Here we tested the hypotheses that (1) patients with abnormal LoA have delirium, and (2) abnormal LoA is associated with worse performance on tests of attention. METHODS: Thirty acute hip fracture patients aged 64-97 years underwent assessments of LoA, delirium status, and attentional functioning in the 24 hours before surgery and at 2-4 and 7-10 days after surgery. The Observational Scale of Level of Arousal (OSLA) and the Richmond Agitation-Sedation Scale (RASS) were used to assess LoA. Sustained attention was measured with the Edinburgh Delirium Test Box. Delirium was assessed with the Confusion Assessment Method and the Delirium Rating Scale-Revised-98. RESULTS: Ten patients (33%) were diagnosed with delirium. Abnormal LoA as measured by the OSLA was strongly associated with the presence of delirium. The area under the receiver operating characteristic curve was 0.89 (95% confidence interval: 0.81-0.97), with a sensitivity of 0.87 and a specificity of 0.81. Area under the curve, sensitivity, and specificity for the RASS were 0.81 (95% confidence interval: 0.68-0.94), 0.80, and 0.79, respectively. Abnormal LoA was associated with worse attentional deficits preoperatively and at postoperative days 2-4 (p <0.01). CONCLUSION: These exploratory findings suggest that abnormal LoA is a strong indicator of delirium. Also, abnormal LoA is strongly associated with inattention as measured by an objective cognitive test. These findings suggest that acute-onset abnormal LoA could be used as a trigger for delirium assessment in routine clinical practice. Future work will help to clarify further the interrelationships among abnormal LoA, inattention, and delirium.

Hybridisation between two cyprinid fishes in a novel habitat: genetics, morphology and life-history traits.

BACKGROUND: The potential role hybridisation in adaptive radiation and the evolution of new lineages has received much recent attention. Hybridisation between roach (Rutilus rutilus L.) and bream (Abramis brama L.) is well documented throughout Europe, however hybrids in Ireland occur at an unprecedented frequency, often exceeding that of both parental species. Utilising an integrated approach, which incorporates geometric morphometrics, life history and molecular genetic analyses we identify the levels and processes of hybridisation present, while also determining the direction of hybridisation, through the analysis of mitochondrial DNA. RESULTS: The presence of F2 hybrids was found to be unlikely from the studied populations, although significant levels of backcrossing, involving both parental taxa was observed in some lakes. Hybridisation represents a viable conduit for introgression of genes between roach and bream. The vast majority of hybrids in all populations studied exhibited bream mitochondrial DNA, indicating that bream are maternal in the majority of crosses. CONCLUSIONS: The success of roach x bream hybrids in Ireland is not due to a successful self reproducing lineage. The potential causes of widespread hybridisation between both species, along with the considerations regarding the role of hybridisation in evolution and conservation, are also discussed.