Journal articles
Guell C, Ogilvie D, Green J (2023). Changing mobility practices. Can meta-ethnography inform transferable and policy-relevant theory?.
Social Science & MedicineAbstract:
Changing mobility practices. Can meta-ethnography inform transferable and policy-relevant theory?
Social practice theories have attracted attention for their potential insights into how to change transport systems towards “healthier” states. However, most evidence is from small-scale qualitative case studies. We explored whether a synthesis of qualitative evidence on mobility practices in one country, informed by meta-ethnography and a Bourdieusian approach to practice, could produce theory that is of sufficient abstraction to be transferable, yet also capable of informing intervention planning. The synthesis identified three third order constructs: mobility practices result from habitus plus capital in fields; specific configurations of local mobility practices are shaped, but not determined, by material infrastructures and social structures; and changes in practice happen across a number of scales and temporalities. This body of evidence as a whole was then interpreted as an integrative “storyline”: Mobility systems are complex, in that outcomes from interventions are neither unilinear nor necessarily predictable from aggregations of individual practice changes. Infrastructure changes may be a necessary, but not sufficient, condition for change. Moving systems towards “healthier” states requires changing habitus such that “healthier” practices align with fields, and that interventions take sufficient account of the power relations that materially and symbolically constrain or enable attachments to and changes in mobility practices. Meta-ethnography is a useful approach for integrating qualitative evidence for informing policy.
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Barnett-Naghshineh O, Warmington S, Altink H, Govia I, Morrissey K, Smith MJ, Thurstan R, Unwin N, Guell C (2023). Situating commercial determinants of health in their historical context: a qualitative study of sugar-sweetened beverages in Jamaica.
Globalization and Health,
19, 69-69.
Abstract:
Situating commercial determinants of health in their historical context: a qualitative study of sugar-sweetened beverages in Jamaica
Background: Non-communicable diseases (NCDs) are the leading cause of mortality across the Caribbean and similar regions. Structural determinants include a marked increase in the dependency on food imports, and the proliferation of processed foods, including sugar-sweetened beverages (SSBs). We focused on Jamaica as a case study and the health challenge of SSBs, and situated contemporary actions, experiences and policies within their historical context to investigate underlying drivers of commercial determinants of health and attempts to counter them. We asked: how can a historical perspective of the drivers of high level SSB consumption in Jamaica contribute to an enhanced understanding of the context of public health policies aimed at reducing their intake?.
Methods: an ethnographic approach with remote data collection included online semi-structured interviews and workshops with 22 local experts and practitioners of health, agriculture and nutrition in Jamaica and attending relevant regional public webinars on SSBs and NCD action in the Caribbean. Our analysis was situated within a review of historical studies of Caribbean food economies with focus on the twentieth century. Jamaican and UK-based researchers collected and ethnographically analysed the data, and discussed findings with the wider transdisciplinary team.
Results: We emphasise three key areas in which historical events have shaped contextual factors of SSB consumption. Trade privileged sugar as a cash crop over food production during Jamaica’s long colonial history, and trade deregulation since the 1980s through structural adjustment opened markets to transnational companies. These changes increased Jamaican receptiveness to the mass advertisement and marketing of these companies, whilst long-standing power imbalances hampered taxation and regulation in contemporary public health actions. Civil society efforts were important for promoting structural changes to curb overconsumption of SSBs and decentring such entrenched power relations.
Conclusion: the contemporary challenge of SSBs in Jamaica is a poignant case study of commercial determinants of health and the important context of global market-driven economies and the involvement of private sector interests in public health policies and governance. Historically contextualising these determinants is paramount to making sense of the sugar ecology in Jamaica today and can help elucidate entrenched power dynamics and their key actors.
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Alvarado M, Lovell R, Guell C, Taylor T, Fullam J, Garside R, Zandersen M, Wheeler B (2023). Street trees and mental health: developing systems thinking-informed hypotheses using causal loop diagraming. Ecology and Society, 28(2).
Thurstan R, Guell C (2023). The shifting baseline syndrome as a connective concept for more informed and just responses to global environmental change.
People and NatureAbstract:
The shifting baseline syndrome as a connective concept for more informed and just responses to global environmental change
1. The concept of the ‘shifting baseline syndrome’ has assisted researchers in understanding how expectations for the health of the environment deteriorate, despite known, often widespread, and significant impacts from human activities. The concept has been used to demonstrate that more accurate assessment of historical ecosystem decline can be achieved by balancing contemporary perceptions with other sorts of evidence and is now widely referred to in studies assessing environmental change.
2. The potential of this concept as a model for examining and addressing complex and multidimensional social-ecological interactions, however, is underexplored and current approaches have limitations.
3. We perceive the shifting baseline syndrome is a rare working example of a “connective concept” that can work across fields of science, the humanities, and others, and that re-envisioning the concept in this way would assist us to establish more complete, true, and reflective environmental baselines.
4. Through our diverse author team, from a range of disciplines, geographies and cultural backgrounds, we identify gaps in current knowledge and of the shifting baseline syndrome concept, it use, and its effects, and describe several approaches that could be taken to improve investigations and capitalize on the connectivity that it fosters. This re-envisioningg could support a more informed and just way forward in addressing global environmental change.
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Halliday C, Morrissey K, St Ville A, Guell C, Augustus E, Guariguata L, Iese V, Hickey G, Murphy MM, Haynes E, et al (2023). Trends in food supply, diet, and the risk of non-communicable diseases in three Small Island Developing States: implications for policy and research.
FRONTIERS IN SUSTAINABLE FOOD SYSTEMS,
7 Author URL.
Guariguata L, Hickey GM, Murphy MM, Guell C, Iese V, Morrissey K, Duvivier P, Herberg S, Kiran S, Unwin N, et al (2023). Understanding the links between human health, ecosystem health, and food systems in Small Island Developing States using stakeholder-informed causal loop diagrams.
PLOS Glob Public Health,
3(9).
Abstract:
Understanding the links between human health, ecosystem health, and food systems in Small Island Developing States using stakeholder-informed causal loop diagrams.
Globalized food systems are a major driver of climate change, biodiversity loss, environmental degradation, and the increasing prevalence of overweight and obesity in society. Small Island Developing States (SIDS) are particularly sensitive to the negative effects of rapid environmental change, with many also exhibiting a heavy reliance on food imports and high burdens of nutrition-related disease, resulting in calls to (re)localize their food systems. Such a transition represents a complex challenge, with adaptation interventions in one part of the food system contingent on the success of interventions in other parts. To help address this challenge, we used group model-building techniques from the science of system dynamics to engage food system stakeholders in Caribbean and Pacific SIDS. Our aim was to understand the drivers of unhealthy and unsustainable food systems in SIDS, and the potential role that increased local food production could play in transformative adaptation. We present two causal loop diagrams (CLDs) considered helpful in designing resilience-enhancing interventions in local food systems. These CLDs represent 'dynamic hypotheses' and provide starting points that can be adapted to local contexts for identifying food system factors, understanding the interactions between them, and co-creating and implementing adaptation interventions, particularly in SIDS. The results can help guide understanding of complexity, assist in the co-creation of interventions, and reduce the risk of maladaptive consequences.
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Rahtz E, Bell SL, Nurse A, Wheeler BW, Guell C, Elliott LR, Thompson CW, McDougall CW, Lovell R (2023). What is known about what works in community-involved decision-making relating to urban green and blue spaces? a realist review protocol.
Systematic Reviews,
12(1).
Abstract:
What is known about what works in community-involved decision-making relating to urban green and blue spaces? a realist review protocol
Abstract
. Background
. There is now a relatively well-established evidence base suggesting that greener living environments and time spent in urban green and blue spaces (UGBS) can be beneficial for human health and wellbeing. However, benefits are not universal and there remain widespread social inequalities in access to such resources and experiences, particularly along axes of class, race, ethnicity, age and disability, and in relation to efforts to increase the availability and accessibility of such spaces. These injustices often relate to distributive, procedural and recognition-based processes. There is growing interest in how to ensure that efforts to increase access to or use of UGBS (whether through infrastructural or social programmes) result in equitable outcomes whilst minimising potential for exacerbating existing inequalities and injustices. Community engagement is considered an important step towards more inclusive UGBS decision-making, from planning and design to management and maintenance processes. It is thought to contribute to better and more widely trusted decisions, enhanced democracy, community satisfaction, civic interest and feelings of green space ownership, and greater longevity of UGBS projects. However, uneven representation and barriers to participation can create imbalances and undermine these benefits.
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. Methods
. An iterative, multi-stage realist-inspired review will be conducted to ask what works, in what context and in what ways relating to the meaningful involvement of communities in UGBS decision-making, focusing on the skills, capacities and capabilities of different stakeholders and the role of contexts and processes. ‘Effectiveness’ (or what works) will be understood as a multifaceted outcome, encompassing both the processes and results of community engagement efforts.
. Following a scoping stage to identify initial programme theory, inclusion/exclusion criteria and derive search terms, relevant databases and grey literature will be searched to identify interdisciplinary literature in two phases. The first phase will be used to further develop programme theories, which will be articulated as ‘if then’ statements. The second phase searches will be used to identify sources to further explore and evidence the programme and formal theory. We will assess all includable evidence for conceptual richness, prioritising more conceptually rich sources if needed.
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. Discussion
. The realist synthesis will explore the key context, mechanism and outcome configurations that appear to explain if and how different approaches to community-involved UGBS decision-making are or are not effective. We will consider factors such as different conceptualisations of community, and if and how they have been involved in UGBS decision-making; the types of tools and approaches used; and the socio-cultural and political or governance structures within which decision-making takes place.
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Faccioli M, Law C, Caine C, Berger N, Yan X, Weninger F, Guell C, Day B, Smith R, Bateman I, et al (2022). Combined carbon and health taxes outperform single-purpose information or fiscal measures in designing sustainable food policies.
Nature Food,
3, 331-340.
Abstract:
Combined carbon and health taxes outperform single-purpose information or fiscal measures in designing sustainable food policies
The food system is a major source of both environmental and health challenges. Yet, the extent to which policy-induced changes in the patterns of food demand address these challenges remains poorly understood. Using a randomised-controlled survey of 5,912 respondents from the United Kingdom (UK), we evaluate the potential impact of carbon and/or health taxes, information and combined tax and information strategies on food purchase patterns and their resulting impact on greenhouse gas emissions and dietary health. Our results show that while information on the carbon and/or health characteristics of food is not irrelevant, it is the imposition of taxes which exerts the most substantial effects on food purchasing decisions. Furthermore, while carbon or health taxes are best at separately targeting emissions and health challenges respectively, a combined carbon and health tax policy maximises benefits both in terms of environmental and health outcomes. We show that such a combined policy could contribute to around one third of the residual emission reductions required to achieve the UK’s 2050 net zero commitments, while discouraging the purchase of unhealthy snacks, sugary drinks and alcohol and increasing the purchase of fruit and vegetables.
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Guariguata L, Garcia L, Sobers N, Ferguson TS, Woodcock J, Samuels TA, Guell C, Unwin N (2022). Exploring ways to respond to rising obesity and diabetes in the Caribbean using a system dynamics model. PLOS Global Public Health, 2(5).
Hunter RF, Rodgers SE, Hilton J, Clarke M, Garcia L, Ward Thompson C, Geary R, Green MA, O'Neill C, Longo A, et al (2022). GroundsWell: Community-engaged and data-informed systems transformation of Urban Green and Blue Space for population health – a new initiative.
Wellcome Open Research,
7, 237-237.
Abstract:
GroundsWell: Community-engaged and data-informed systems transformation of Urban Green and Blue Space for population health – a new initiative
Natural environments, such as parks, woodlands and lakes, have positive impacts on health and wellbeing. Urban Green and Blue Spaces (UGBS), and the activities that take place in them, can significantly influence the health outcomes of all communities, and reduce health inequalities. Improving access and quality of UGBS needs understanding of the range of systems (e.g. planning, transport, environment, community) in which UGBS are located. UGBS offers an ideal exemplar for testing systems innovations as it reflects place-based and whole society processes, with potential to reduce non-communicable disease (NCD) risk and associated social inequalities in health. UGBS can impact multiple behavioural and environmental aetiological pathways. However, the systems which desire, design, develop, and deliver UGBS are fragmented and siloed, with ineffective mechanisms for data generation, knowledge exchange and mobilisation. Further, UGBS need to be co-designed with and by those whose health could benefit most from them, so they are appropriate, accessible, valued and used well. This paper describes a major new prevention research programme and partnership, GroundsWell, which aims to transform UGBS-related systems by improving how we plan, design, evaluate and manage UGBS so that it benefits all communities, especially those who are in poorest health. We use a broad definition of health to include physical, mental, social wellbeing and quality of life. Our objectives are to transform systems so that UGBS are planned, developed, implemented, maintained and evaluated with our communities and data systems to enhance health and reduce inequalities. GroundsWell will use interdisciplinary, problem-solving approaches to accelerate and optimise community collaborations among citizens, users, implementers, policymakers and researchers to impact research, policy, practice and active citizenship. GroundsWell will be shaped and developed in three pioneer cities (Belfast, Edinburgh, Liverpool) and their regional contexts, with embedded translational mechanisms to ensure that outputs and impact have UK-wide and international application.
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Haynes E, Augustus E, Brown CR, Guell C, Iese V, Jia L, Morrissey K, Unwin N (2022). Interventions in Small Island Developing States to improve diet, with a focus on the consumption of local, nutritious foods: a systematic review. BMJ Nutrition Prevention & Health, 5(2), 243-253.
Guell C, Brown CR, Navunicagi OW, Iese V, Badrie N, Wairiu M, Saint Ville A, Unwin N, Community Food and Health (CFaH) team (2022). Perspectives on strengthening local food systems in Small Island Developing States.
Food Secur,
14(5), 1227-1240.
Abstract:
Perspectives on strengthening local food systems in Small Island Developing States.
UNLABELLED: Small Island Developing States (SIDS) share high burdens of nutrition-related conditions, including non-communicable diseases, associated with an increasing reliance on imported, processed foods. Improving health through increasing the production and consumption of local, nutritious foods is a policy objective of many SIDS governments. This study aimed to understand contemporary challenges and opportunities to strengthening local food systems in two case study settings, Fiji and St. Vincent and the Grenadines. Fifty-two in-depth, semi-structured interviews were conducted with key stakeholders involved in local food production. Interviews were analysed by both country teams using thematic analysis. Local food production networks in both settings included formal governance bodies as well as more informal connections through civil society and communities. Their main function was the sharing of resources and knowledge, but levels of trust and cooperation between the stakeholders varied in a market open to intense competition from imports. Local food production was hindered by few and slow investments by local governments, dated technology, and lack of knowledge. Stakeholders believed this marginalisation was occurring against a background of rising preferences for imported foods in the population, and increasing disinterest in employment in the sector. Despite the challenges, strong narratives of resilience and opportunity were highlighted such as national pride in local produce for commercialisation and local diets. Efforts to support local food production in SIDS should focus on strengthening governance structures to prioritise local produce over corporate and import markets, assist collaboration and co-learning, and support alternative agro-food practices. SUPPLEMENTARY INFORMATION: the online version contains supplementary material available at 10.1007/s12571-022-01281-0.
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Augustus E, Haynes E, Guell C, Morrissey K, Murphy MM, Halliday C, Jia L, Iese V, Anderson SG, Unwin N, et al (2022). The Impact of Nutrition-Based Interventions on Nutritional Status and Metabolic Health in Small Island Developing States: a Systematic Review and Narrative Synthesis.
Nutrients,
14(17), 3529-3529.
Abstract:
The Impact of Nutrition-Based Interventions on Nutritional Status and Metabolic Health in Small Island Developing States: a Systematic Review and Narrative Synthesis
Small island developing states (SIDS) have a high burden of nutrition-related disease associated with nutrient-poor, energy-dense diets. In response to these issues, we assessed the effectiveness of nutrition-based interventions on nutritional status (under-nutrition) and metabolic health (over-nutrition) among persons in SIDS. We included SIDS-based nutrition studies with change in nutrition status (e.g. markers of anaemia) or metabolic status (e.g. markers of glycaemia) as outcomes. The PRISMA framework was applied and MEDLINE, Embase, CINAHL, OARE library, Web of Science, Scopus, ASSIA, EconLit, AGORA, AGRICOLA, AGRIS, WHO-EMRO, and LILACS were searched (2000–2020). Cochrane risk of bias (ROB) and Cochrane ROBINS-I tools assessed ROB for randomised and non-randomised studies, respectively. PROSPERO registration (CRD42021236396) was undertaken. We included 50 eligible interventions, involving 37,591 participants: 14 trials reported on nutritional status, 36 on metabolic health. Effective interventions, evaluated at the individual level, took a multifaceted approach for metabolic outcomes; while nutrition outcomes utilised supplements. Most intervention types were suitable for issues related to ‘over’ nutrition versus ‘under’ nutrition. Twenty-six studies (nutrition status (six); metabolic health (twenty)) were effective (p < 0.05). With the current rise of nutrition-related public health challenges, there is a need for further development and evaluation of these and related interventions at the population level.
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Guell C, Brown CR, Iese V, Navunicagi O, Wairiu M, Unwin N, Community Food and Health (CFaH) Team (2021). "We used to get food from the garden." Understanding changing practices of local food production and consumption in small island states.
Social Science & Medicine,
284, 114214-114214.
Abstract:
"We used to get food from the garden." Understanding changing practices of local food production and consumption in small island states.
Many Small Island Developing States (SIDS) lead global rates in obesity and non-communicable chronic diseases (NCDs). Drivers for this are complex and include lack of food sovereignty, evidenced by an increasing reliance on cheap nutrient-poor food imports and a focus on export orientated cash crop production for much local agriculture. To better inform SIDS' policy goals of improving nutrition through increased local food production, we explored in two SIDS current practices of food production and consumption. Teams of researchers from the two main regional universities conducted 28 focus groups in Fiji in the Pacific and Saint Vincent and the Grenadines in the Caribbean with rural and urban communities of different socio-economic or land-owning status. In both countries home gardens were still common, valued as providing staple foods to households and contributing to health and livelihoods. Yet social changes had been experienced over the life course and across generations, such as increased purchase of foods, consumption of processed and often imported foods, and fast foods. While participants associated local foods with better nutrition and health outcomes than imported foods, some local foods were also acknowledged as unhealthy (e.g. locally produced tinned products, pesticide contaminated fresh produce). Finally, as food and related health advice moves globally, crossing national boundaries, and through formal and informal channels, local experiences can be confusing and contested. We suggest the need to understand temporal and spatial aspects of social practices, as social practices and their meaning change over time, travel globally and are experienced locally. To enhance and support re-localising food to counteract unhealthy consumption of ultra-processed, shop-bought, often imported foods, it is vital to understand these lived experiences of changes and resulting uncertainties, and to explicitly build on the longstanding positive relationships that people continue to express about home gardens and local food.
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Iese V, Wairiu M, Hickey GM, Ugalde D, Hinge Salili D, Walenenea J, Tabe T, Keremama M, Teva C, Navunicagi O, et al (2021). Impacts of COVID-19 on agriculture and food systems in Pacific Island countries (PICs): Evidence from communities in Fiji and Solomon Islands.
Agricultural Systems,
190Abstract:
Impacts of COVID-19 on agriculture and food systems in Pacific Island countries (PICs): Evidence from communities in Fiji and Solomon Islands
CONTEXT: COVID-19 mitigation measures including border lockdowns, social distancing, de-urbanization and restricted movements have been enforced to reduce the risks of COVID-19 arriving and spreading across PICs. To reduce the negative impacts of COVID-19 mitigation measures, governments have put in place a number of interventions to sustain food and income security. Both mitigation measures and interventions have had a number of impacts on agricultural production, food systems and dietary diversity at the national and household levels. OBJECTIVE: Our paper conducted an exploratory analysis of immediate impacts of both COVID-19 mitigation measures and interventions on households and communities in PICs. Our aim is to better understand the implications of COVID-19 for PICs and identify knowledge gaps requiring further research and policy attention. METHODS: to understand the impacts of COVID-19 mitigation measures and interventions on food systems and diets in PICs, 13 communities were studied in Fiji and Solomon Islands in July-August 2020. In these communities, 46 focus group discussions were carried out and 425 households were interviewed. Insights were also derived from a series of online discussion sessions with local experts of Pacific Island food and agricultural systems in August and September 2020. To complement these discussions, an online search was conducted for available literature. RESULTS AND CONCLUSIONS: Identified impacts include: 1) Reduced agricultural production, food availability and incomes due to a decline in local markets and loss of access to international markets; 2) Increased social conflict such as land disputes, theft of high-value crops and livestock, and environmental degradation resulting from urban-rural migration; 3) Reduced availability of seedlings, planting materials, equipment and labour in urban areas; 4) Reinvigoration of traditional food systems and local food production; and 5) Re-emergence of cultural safety networks and values, such as barter systems. Households in rural and urban communities appear to have responded positively to COVID-19 by increasing food production from home gardens, particularly root crops, vegetables and fruits. However, the limited diversity of agricultural production and decreased household incomes are reducing the already low dietary diversity score that existed pre-COVID-19 for households. SIGNIFICANCE: These findings have a number of implications for future policy and practice. Future interventions would benefit from being more inclusive of diverse partners, focusing on strengthening cultural and communal values, and taking a systemic and long-term perspective. COVID-19 has provided an opportunity to strengthen traditional food systems and re-evaluate, re-imagine and re-localize agricultural production strategies and approaches in PICs.
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Le Gouais A, Foley L, Ogilvie D, Panter J, Guell C (2021). Sharing believable stories: a qualitative study exploring the relevance of case studies for influencing the creation of healthy environments.
Health and Place,
71, 102615-102615.
Abstract:
Sharing believable stories: a qualitative study exploring the relevance of case studies for influencing the creation of healthy environments.
Case study examples can inform policy recommendations and action to create healthy environments. This qualitative study, using semi-structured interviews with nine cross-sectoral stakeholders in England, explored the role of context in case study examples. We found that case studies can not only be a 'practical example' but also used as a 'believable story' with the power to influence decision-making. Case studies may be deemed believable if similar and locally relevant, but judgements can be inherently political and politicised. Metrics used to measure case study outcomes can differ in believability. Storytellers who understand different audiences can be used to build support.
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Guariguata L, Unwin N, Garcia L, Woodcock J, Samuels TA, Guell C (2021). Systems science for developing policy to improve physical activity, the Caribbean.
Bull World Health Organ,
99(10), 722-729.
Abstract:
Systems science for developing policy to improve physical activity, the Caribbean.
The World Health Organization (WHO) Global Action Plan on Physical Activity recommends adopting a systems approach to implementing and tailoring actions according to local contexts. We held group model-building workshops with key stakeholders in the Caribbean region to develop a causal loop diagram to describe the system driving the increasing physical inactivity in the region and envision the most effective ways of intervening in that system to encourage and promote physical activity. We used the causal loop diagram to inform how the WHO Global Action Plan on Physical Activity might be adapted to a local context. Although the WHO recommendations aligned well with our causal loop diagram, the diagram also illustrates the importance of local context in determining how interventions should be coordinated and implemented. Some interventions included creating safe physical activity spaces for both sexes, tackling negative attitudes to physical activity in certain contexts, including in schools and workplaces, and improving infrastructure for active transport. The causal loop diagram may also help understand how policies may be undermined or supported by key actors or where policies should be coordinated. We demonstrate how, in a region with a high level of physical inactivity and low resources, applying systems thinking with relevant stakeholders can help the targeted adaptation of global recommendations to local contexts.
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Bartholomew L, Unwin N, Guell C, Bynoe K, Murphy MM (2021). The role of social support in achieving weight loss in adults in the Caribbean aiming to achieve remission of type 2 diabetes: a cross-case analysis.
Abstract:
The role of social support in achieving weight loss in adults in the Caribbean aiming to achieve remission of type 2 diabetes: a cross-case analysis
AbstractBackgroundRemission of type 2 diabetes through weight loss is possible in a high proportion of persons with a recent diagnosis, but a major challenge is achieving sufficient weight loss.ObjectivesIn the first study of this type in the Caribbean, we investigated factors associated with successful weight loss in adults in a diabetes remission intervention. We hypothesized that differences in social support may have influenced differences in weight loss achieved by participants in the Barbados Diabetes Reversal Study (BDRS).MethodsA comparative case study was conducted. Quantitative data for the primary outcome measure of weight reduction (the participants’ baseline and 8-month weights) were assessed to identify the 6 participants with the highest and 6 participants with the lowest weight loss. The 8-week (low-calorie diet phase) and 8-month (weight maintenance phase) interview transcripts for each participant were then analysed via qualitative thematic analysis to explore factors related to social support.ResultsInformal and formal support were identified for both categories of participants. Cases were similar with respect to their sources of support however dissimilarities were found in (1) the depth of support received; (2) access to supportive environments and (3) diversity of social supportive networks. Participants in the top weight loss group reported consistency in the levels of support received over the low-calorie diet and weight maintenance phases of the study while the converse was true for those of the bottom weight loss group.ConclusionStudy findings suggest that individuals aiming at type 2 diabetes remission benefit from strong social support networks. These networks provide tangible assistance and facilitate the sharing and discussion of strategies for weight reduction. Future studies should facilitate in-depth understanding of how formal and informal supportive networks can aid sustained dietary diabetes remission and long-term weight maintenance.
Abstract.
Jong ST, Croxson CHD, Guell C, Lawlor ER, Foubister C, Brown HE, Wells EK, Wilkinson P, Vignoles A, van Sluijs EMF, et al (2020). Adolescents' perspectives on a school-based physical activity intervention: a mixed method study.
J Sport Health Sci,
9(1), 28-40.
Abstract:
Adolescents' perspectives on a school-based physical activity intervention: a mixed method study.
PURPOSE: to examine adolescent experiences and perspectives of the GoActive intervention (ISRCTN31583496) using mixed methods process evaluation to determine satisfaction with intervention components and interpret adolescents' experiences of the intervention process in order to provide insights for future intervention design. METHODS: Participants (n = 1542; 13.2 ±
0.4 years, mean ± SD) provided questionnaire data at baseline (shyness, activity level) and post-intervention (intervention acceptability, satisfaction with components). Between-group differences (boys vs. girls and shy/inactive vs. others) were tested with linear regression models, accounting for school clustering. Data from 16 individual interviews (shy/inactive) and 11 focus groups with 48 participants (mean = 4; range 2-7) were thematically coded. Qualitative and quantitative data were merged in an integrative mixed methods convergence matrix, which denoted convergence and dissonance across datasets. RESULTS: Effect sizes for quantitative results were small and may not represent substantial between-group differences. Boys (vs. girls) preferred class-based sessions (β = 0.2, 95% confidence interval (CI): 0.1-0.3); qualitative data suggested that this was because boys preferred competition, which was supported quantitatively (β = 0.2, 95%CI: 0.1-0.3). Shy/inactive students did not enjoy the competition (β = -0.3, 95%CI: -0.5 to -0.1). Boys enjoyed trying new activities more (β = 0.1, 95%CI: 0.1-0.2); qualitative data indicated a desire to try new activities across all subgroups but identified barriers to choosing unfamiliar activities with self-imposed choice restriction leading to boredom. Qualitative data highlighted critique of mentorship; adolescents liked the idea, but older mentors did not meet expectations. CONCLUSION: We interpreted adolescent perspectives of intervention components and implementation to provide insights into future complex interventions aimed at increasing young people's physical activity in school-based settings. The intervention component mentorship was liked in principle, but implementation issues undesirably impacted satisfaction; competition was disliked by girls and shy/inactive students. The results highlight the importance of considering gender differences in preference of competition and extensive mentorship training.
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Le Gouais A, Govia I, Guell C (2020). Challenges for creating active living infrastructure in a middle-income country: a qualitative case study in Jamaica.
Cities and Health,
7, 81-92.
Abstract:
Challenges for creating active living infrastructure in a middle-income country: a qualitative case study in Jamaica
Walking and cycling infrastructure and quality open spaces (‘active living infrastructure’) can influence levels of physical activity and related risks of non-communicable disease. Understanding the challenges in creating active living infrastructure could help support the creation of more physically active communities. A qualitative study with nine semi-structured interviews was conducted with 10 expert stakeholders purposively sampled across the sectors of urban development, public health and civil society in Jamaica. Thematic analysis found that new active living infrastructure was challenging to provide because it did not fit with widely held views of ‘development’ which focused on road construction, driving and economics, not walking, cycling or nature. Public open spaces were lacking and the few good examples were expensive to maintain, deterring additional investment. Pedestrian infrastructure was poor quality and cycling infrastructure non-existent, making it dangerous for people to walk or cycle which particularly adversely affected people from deprived communities who may lack political voice. Greater collaboration between public health and urban planning, which appeared to be natural allies with shared interests, could help re-frame the multi-sectoral (including economic) benefits of active living infrastructure. Brokers may highlight problems associated with lack of active living infrastructure and also provide contextually relevant examples which go beyond generic international guidance.
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Pollard TM, Guell C, Morris S (2020). Communal therapeutic mobility in group walking: a meta-ethnography.
Social Science & Medicine,
262, 113241-113241.
Abstract:
Communal therapeutic mobility in group walking: a meta-ethnography.
Increased attention to links between walking, health and wellbeing have contributed to a growth in the number of walking groups meeting on a regular basis to offer short, social walks. Walking group interventions are known to increase physical activity and to have wide-ranging health benefits, and there is evidence that drop out is generally low. The aim of this paper is to synthesise qualitative research on experiences and perceptions of group walking in order to develop a new conceptual understanding of the group walking experience. We conducted a systematic search of the literature and identified 22 such studies which we synthesised using meta-ethnography. Included studies were conducted in the UK, USA, Australia and Ireland. Most reported research was undertaken with outdoor walking groups, some of which catered specifically for people who shared a disease experience or a disability. A smaller number of studies examined indoor mall walking groups, while two looked at perceptions of non-participants of group walking as a potential activity. From the original constructs identified in the papers we derived five higher order constructs: seeking and enjoying health and fitness, attachment to walking, providing purpose and confidence, mobile companionship and a peaceful and contemplative shared respite from everyday life. We argue that participating in a walking group provides a set of experiences that together constitute a specific form of shared or communal therapeutic mobility that is not simply the accumulation of the constructs we have outlined. Rather, we suggest that an initial instrumental and disciplinary focus on health and fitness is transformed through the experience of group walking into a shared meaningful and enjoyable practice; an emergent communal therapeutic mobility, which recruits and retains large numbers of group walkers. However, this communal therapeutic mobility is not equally accessible to all.
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Haynes E, Bhagtani D, Iese V, Brown CR, Fesaitu J, Hambleton I, Badrie N, Kroll F, Guell C, Brugulat-Panes A, et al (2020). Food Sources and Dietary Quality in Small Island Developing States: Development of Methods and Policy Relevant Novel Survey Data from the Pacific and Caribbean.
Nutrients,
12(11).
Abstract:
Food Sources and Dietary Quality in Small Island Developing States: Development of Methods and Policy Relevant Novel Survey Data from the Pacific and Caribbean.
Small Island Developing States (SIDS) have high and increasing rates of diet-related diseases. This situation is associated with a loss of food sovereignty and an increasing reliance on nutritionally poor food imports. A policy goal, therefore, is to improve local diets through improved local production of nutritious foods. Our aim in this study was to develop methods and collect preliminary data on the relationships between where people source their food, their socio-demographic characteristics and dietary quality in Fiji and Saint Vincent and the Grenadines (SVG) in order to inform further work towards this policy goal. We developed a toolkit of methods to collect individual-level data, including measures of dietary intake, food sources, socio-demographic and health indicators. Individuals aged ≥15 years were eligible to participate. From purposively sampled urban and rural areas, we recruited 186 individuals from 95 households in Fiji, and 147 individuals from 86 households in SVG. Descriptive statistics and multiple linear regression were used to investigate associations. The mean dietary diversity score, out of 10, was 3.7 (SD1.4) in Fiji and 3.8 (SD1.5) in SVG. In both settings, purchasing was the most common way of sourcing food. However, 68% (Fiji) and 45% (SVG) of participants regularly (>weekly) consumed their own produce, and 5% (Fiji) and 33% (SVG) regularly consumed borrowed/exchanged/bartered food. In regression models, independent positive associations with dietary diversity (DD) were: borrowing/exchanging/bartering food (β = 0.73 (0.21, 1.25)); age (0.01 (0.00, 0.03)); and greater than primary education (0.44 (0.06, 0.82)). DD was negatively associated with small shop purchasing (-0.52 (95% CIs -0.91, -0.12)) and rural residence (-0.46 (-0.92, 0.00)). The findings highlight associations between dietary diversity and food sources and indicate avenues for further research to inform policy actions aimed at improving local food production and diet.
Abstract.
Author URL.
Ogilvie D, Bauman A, Foley L, Guell C, Humphreys D, Panter J (2020). Making sense of the evidence in population health intervention research: Building a dry stone wall.
BMJ Global Health,
5(12).
Abstract:
Making sense of the evidence in population health intervention research: Building a dry stone wall
To effectively tackle population health challenges, we must address the fundamental determinants of behaviour and health. Among other things, this will entail devoting more attention to the evaluation of upstream intervention strategies. However, merely increasing the supply of such studies is not enough. The pivotal link between research and policy or practice should be the cumulation of insight from multiple studies. If conventional evidence synthesis can be thought of as analogous to building a wall, then we can increase the supply of bricks (the number of studies), their similarity (statistical commensurability) or the strength of the mortar (the statistical methods for holding them together). However, many contemporary public health challenges seem akin to herding sheep in mountainous terrain, where ordinary walls are of limited use and a more flexible way of combining dissimilar stones (pieces of evidence) may be required. This would entail shifting towards generalising the functions of interventions, rather than their effects; towards inference to the best explanation, rather than relying on binary hypothesis-testing; and towards embracing divergent findings, to be resolved by testing theories across a cumulated body of work. In this way we might channel a spirit of pragmatic pluralism into making sense of complex sets of evidence, robust enough to support more plausible causal inference to guide action, while accepting and adapting to the reality of the public health landscape rather than wishing it were otherwise. The traditional art of dry stone walling can serve as a metaphor for the more holistic sense-making we propose.
Abstract.
Jong ST, Croxson CHD, Foubister C, Brown HE, Guell C, Lawlor ER, Wells EK, Wilkinson PO, Wilson ECF, van Sluijs EMF, et al (2020). Reach, Recruitment, Dose, and Intervention Fidelity of the GoActive School-Based Physical Activity Intervention in the UK: a Mixed-Methods Process Evaluation.
Children,
7(11), 231-231.
Abstract:
Reach, Recruitment, Dose, and Intervention Fidelity of the GoActive School-Based Physical Activity Intervention in the UK: a Mixed-Methods Process Evaluation
School-based multi-component physical activity (PA) promotion is advocated; however, research has indicated that a multi-component approach may not always be effective at increasing adolescent PA. Evaluation of the GoActive 12-week multi-component school-based intervention showed no effect on adolescent PA. A mixed-methods process evaluation was embedded to facilitate greater understanding of the results, to elicit subgroup perceptions, and to provide insight into contextual factors influencing intervention implementation. This paper presents the reach, recruitment, dose, and fidelity of GoActive, and identifies challenges to implementation. The process evaluation employed questionnaires (1543 Year 9s), individual interviews (16 Year 9s; 7 facilitators; 9 contact teachers), focus groups (48 Year 9s; 58 mentors), alongside GoActive website analytics and researcher observations. GoActive sessions reached 39.4% of Year 9s. Intervention satisfaction was relatively high for mentors (87.3%) and facilitators (85.7%), but lower for Year 9s (59.5%) and teachers (50%). Intervention fidelity was mixed within and between schools. Mentorship was the most implemented component. Factors potentially contributing to low implementation included ambiguity of the roles subgroups played within intervention delivery, Year 9 engagement, institutional support, and further school-level constraints. Multiple challenges and varying contextual considerations hindered the implementation of GoActive in multiple school sites. Methods to overcome contextual challenges to implementation warrant in-depth consideration and innovative approaches.
Abstract.
Proctor R, Guell C, Wyatt K, Williams AJ (2020). What is the evidence base for integrating health and environmental approaches in the school context to nurture healthier and more environmentally aware young people? a systematic scoping review of global evidence.
Health and Place,
64, 102356-102356.
Abstract:
What is the evidence base for integrating health and environmental approaches in the school context to nurture healthier and more environmentally aware young people? a systematic scoping review of global evidence
This scoping review collates empirical and gray literature that examines how schools are acting to nurture healthier and more environmentally aware young people through integrated approaches. Over the last twenty years, integration has been increasing within school contexts. Approaches include teaching and learning, physical environmental adaptations, developing ecologically focused policy, and reorienting wider school culture. We noted a developing discourse around what constitutes evidence in this emerging interdisciplinary field. Developing a better understanding of integrated approaches and an evidence base of what works and how could inform interdisciplinary collaboration and enable a clearer message to be communicated to stakeholders about how the school context can nurture healthier and more environmentally aware young people.
Abstract.
Govia I, Guell C, Unwin N, Wadende P (2019). Air travel for global health: flying in the face of sustainable development?. The Lancet, 394(10211), 1786-1788.
Panter J, Guell C, Humphreys D, Ogilvie D (2019). Can changing the physical environment promote walking and cycling? a systematic review of what works and how. Health and Place, 58
Hanson S, Gilbert D, Landy R, Okoli G, Guell C (2019). Cancer risk in socially marginalised women: an exploratory study.
Social Science and Medicine,
220, 150-158.
Abstract:
Cancer risk in socially marginalised women: an exploratory study
Background: Cancer is a leading cause of premature death in women worldwide, and is associated with socio-economic disadvantage. Yet many interventions designed to reduce risk and improve health fail to reach the most marginalised with the greatest needs. Our study focused on socially marginalised women at two women's centres that provide support and training to women in the judicial system or who have experienced domestic abuse. Methods: This qualitative study was framed within a sociological rather than behavioural perspective involving thirty participants in individual interviews and focus groups. It sought to understand perceptions of, and vulnerability to, cancer; decision making (including screening); cancer symptom awareness and views on health promoting activities within the context of the women's social circumstances. Findings: Women's experiences of social adversity profoundly shaped their practices, aspirations and attitudes towards risk, health and healthcare. We found that behaviours, such as unhealthy eating and smoking need to be understood in the context of inherently risky lives. They were a coping mechanism whilst living in extreme adverse circumstances, navigating complex everyday lives and structural failings. Long term experiences of neglect, harm and violence, often by people they should be able to trust, led to low self-esteem and influenced their perceptions of risk and self-care. This was reinforced by negative experiences of navigating state services and a lack of control and agency over their own lives. Conclusion: Women in this study were at high risk of cancer, but it would be better to understand these risk factors as markers of distress and duress. Without appreciating the wider determinants of health and systemic disadvantage of marginalised groups, and addressing these with a structural rather than an individual response, we risk increasing cancer inequities by failing those who are in the greatest need.
Abstract.
Le Gouais A, Foley L, Ogilvie D, Guell C (2019). Decision-making for active living infrastructure in new communities: a qualitative study in England. Journal of Public Health
Haynes E, Green J, Garside R, Kelly MP, Guell C (2019). Gender and active travel: a qualitative data synthesis informed by machine learning.
Int J Behav Nutr Phys Act,
16(1).
Abstract:
Gender and active travel: a qualitative data synthesis informed by machine learning.
BACKGROUND: Innovative approaches are required to move beyond individual approaches to behaviour change and develop more appropriate insights for the complex challenge of increasing population levels of activity. Recent research has drawn on social practice theory to describe the recursive and relational character of active living but to date most evidence is limited to small-scale qualitative research studies. To 'upscale' insights from individual contexts, we pooled data from five qualitative studies and used machine learning software to explore gendered patterns in the context of active travel. METHODS: We drew on 280 transcripts from five research projects conducted in the UK, including studies of a range of populations, travel modes and settings, to conduct unsupervised 'topic modelling analysis'. Text analytics software, Leximancer, was used in the first phase of the analysis to produce inter-topic distance maps to illustrate inter-related 'concepts'. The outputs from this first phase guided a second researcher-led interpretive analysis of text excerpts to infer meaning from the computer-generated outputs. RESULTS: Guided by social practice theory, we identified 'interrelated' and 'relating' practices across the pooled datasets. For this study we particularly focused on respondents' commutes, travelling to and from work, and on differentiated experiences by gender. Women largely described their commute as multifunctional journeys that included the school run or shopping, whereas men described relatively linear journeys from a to B but highlighted 'relating' practices resulting from or due to their choice of commute mode or journey such as showering or relaxing. Secondly, we identify a difference in discourses about practices across the included datasets. Women spoke more about 'subjective', internal feelings of safety ('I feel unsafe'), whereas men spoke more about external conditions ('it is a dangerous road'). CONCLUSION: This rare application of machine learning to qualitative social science research has helped to identify potentially important differences in co-occurrence of practices and discourses about practice between men's and women's accounts of travel across diverse contexts. These findings can inform future research and policy decisions for promoting travel-related social practices associated with increased physical activity that are appropriate across genders.
Abstract.
Author URL.
Morris S, Guell C, Pollard TM (2019). Group walking as a "lifeline": Understanding the place of outdoor walking groups in women's lives.
Soc Sci Med,
238Abstract:
Group walking as a "lifeline": Understanding the place of outdoor walking groups in women's lives.
Organised walking groups are increasingly widespread in the UK and elsewhere and have been shown to have many benefits for participants. They tend to attract more women than men, but little is known about how and why walking groups 'recruit' women. This is of particular importance given observed inequalities in physical activity participation by gender, in favour of men. To explore women's participation in walking groups, we conducted ethnographic fieldwork (in May-August 2017) with women members of five different walking groups in deprived areas of north-east England. Participant observation and informal 'go along' interviewing were conducted on 25 group walks, and 20 semi-structured interviews were undertaken. Fieldnotes and interview transcripts were analysed thematically. This paper presents five portraits to show how the identified themes played out in women's lives. For many of the women, the act of moving and socialising together in outdoor environments was highly valued. We show how walking groups found a place within the lives of women, becoming spaces of sharing, healing and enjoyment and acting as a positive resource or "lifeline", often around time-spaces of change (biographical disruptions). We contribute new understandings of how walking groups work by showing how women's reasons for participating were intimately intertwined with their life circumstances and relationships, thus furthering the ongoing theoretical shift from investigating health 'behaviours' to health 'practices'. We conclude that walking groups work well for some people at particular times in their lives, especially (but not only) for older women and, more generally, that life transitions offer an opportunity for interventions to enhance health if they work within the lives of prospective participants.
Abstract.
Author URL.
Haynes E, Garside R, Green J, Kelly MP, Thomas J, Guell C (2019). Semi-automated text analytics for qualitative data synthesis.
Research Synthesis Methods,
10, 452-464.
Abstract:
Semi-automated text analytics for qualitative data synthesis
Approaches to synthesizing qualitative data have, to date, largely focused on integrating the findings from published reports. However, developments in text mining software offer the potential for efficient analysis of large pooled primary qualitative datasets. This case study aimed to (a) provide a step-by-step guide to using one software application, Leximancer, and (b) interrogate opportunities and limitations of the software for qualitative data synthesis. We applied Leximancer v4.5 to a pool of five qualitative, UK-based studies on transportation such as walking, cycling, and driving, and displayed the findings of the automated content analysis as intertopic distance maps. Leximancer enabled us to “zoom out” to familiarize ourselves with, and gain a broad perspective of, the pooled data. It indicated which studies clustered around dominant topics such as “people.” the software also enabled us to “zoom in” to narrow the perspective to specific subgroups and lines of enquiry. For example, “people” featured in men's and women's narratives but were talked about differently, with men mentioning “kids” and “old,” whereas women mentioned “things” and “stuff.” the approach provided us with a fresh lens for the initial inductive step in the analysis process and could guide further exploration. The limitations of using Leximancer were the substantial data preparation time involved and the contextual knowledge required from the researcher to turn lines of inquiry into meaningful insights. In summary, Leximancer is a useful tool for contributing to qualitative data synthesis, facilitating comprehensive and transparent data coding but can only inform, not replace, researcher-led interpretive work.
Abstract.
Murphy M, Unwin N, Samuels AT, Hassell TA, Bishop L, Guell C (2018). Evaluating policy responses to noncommunicable diseases in seven Caribbean countries: challenges to addressing unhealthy diets and physical inactivity. Pan American Journal of Public Health, 42
Haynes E, Brown CR, Guell C, Wou C, Vogliano C, Unwin N (2018). Health and other impacts of community food production in Small Island Developing States: a systematic scoping review. Pan American Journal of Public Health, 42
Guell C, Whittle F, Ong KK, Lakshman R (2018). Towards Understanding How Social Factors Shaped a Behavioral Intervention on Healthier Infant Formula-Feeding.
Qualitative Health ResearchAbstract:
Towards Understanding How Social Factors Shaped a Behavioral Intervention on Healthier Infant Formula-Feeding
As part of a process evaluation, we explored in semi-structured interviews the experiences of nineteen mothers who had taken part in a trial to reduce infant formula-milk intake and promote healthy weight gain, and reflections of three facilitators who delivered the intervention and control group protocols. Mothers appreciated the non-judgmental support provided during the trial, after experiencing stigma and receiving limited advice on how, how much and how often formula-milk should be given. The information mothers had previously found, printed on formula-milk tins, or provided by family, friends and health professionals, was often perceived as contradictory; the trial guidance also conflicted with social norms relating infant health positively with weight gain. For those recruited into the trial with older infants, who had already exceeded the recommendations, reducing formula-milk amounts was difficult. The findings highlight the difficulties of addressing a highly stigmatized, complex social practice with an individual, behavioral intervention approach.
Abstract.
Guell C, Panter J, Griffin S, Ogilvie D (2018). Towards co‐designing active ageing strategies: a qualitative study to develop a meaningful physical activity typology for later life. Health Expectations
Guell C, Mackett R, Ogilvie D (2017). Negotiating multisectoral evidence: a qualitative study of knowledge exchange at the intersection of transport and public health. BMC Public Health, 17(1).
Panter J, Guell C, Prins R, Ogilvie D (2017). Physical activity and the environment: conceptual review and framework for intervention research. International Journal of Behavioral Nutrition and Physical Activity, 14, 156-156.
Panter J, Guell C, Prins R, Ogilvie D (2016). Concepts and mechanisms linking environmental change with changes in physical activity: a systematic review. , 388(Special Issue), S85-S85.
Ogilvie D, Panter J, Guell C, Jones A, Mackett R, Griffin S (2016). Health impacts of the Cambridgeshire Guided Busway: a natural experimental study. Public Health Research, 4(1), 1-154.
Panter J, Guell C, Prins R, Ogilvie D (2016). OP22 Synthesising theoretical evidence on causal pathways by which changes to the environment may act to promote physical activity. Journal of Epidemiology & Community Health, 70(Suppl 1).
Ogilvie D, Panter J, Guell C, Jones A, Mackett R, Griffin S (2016). OP40 Health impacts of the Cambridgeshire Guided Busway: a natural experimental study. Journal of Epidemiology & Community Health, 70(Suppl 1).
Guell C, Mackett R, Ogilvie D (2016). P93 Negotiating evidence in uncertain times: a qualitative study of knowledge exchange in transport and health. Journal of Epidemiology & Community Health, 70(Suppl 1).
Panter J, Guell C, Ogilvie D (2016). Qualitative research can inform clinical practice. BMJ (Online), 352
Guariguata L, Guell C, Samuels TA, Rouwette EAJA, Woodcock J, Hambleton IR, Unwin N (2016). Systems Science for Caribbean Health: the development and piloting of a model for guiding policy on diabetes in the Caribbean. Health Research Policy and Systems, 14(1).
Unwin N, Samuels TA, Hassell T, Brownson RC, Guell C (2016). The Development of Public Policies to Address Non-communicable Diseases in the Caribbean Country of Barbados: the Importance of Problem Framing and Policy Entrepreneurs. International Journal of Health Policy and Management, 6(2), 71-82.
Hanson S, Guell C, Jones A (2016). Walking groups in socioeconomically deprived communities: a qualitative study using photo elicitation. Health & Place, 39, 26-33.
Guell C, Shefer G, Griffin S, Ogilvie D (2016). ‘Keeping your body and mind active’: an ethnographic study of aspirations for healthy ageing: Table 1. BMJ Open, 6(1), e009973-e009973.
Alvarado M, Murphy MM, Guell C (2015). Barriers and facilitators to physical activity amongst overweight and obese women in an Afro-Caribbean population: a qualitative study. International Journal of Behavioral Nutrition and Physical Activity, 12(1).
Guell C, Unwin N (2015). Barriers to diabetic foot care in a developing country with a high incidence of diabetes related amputations: an exploratory qualitative interview study. BMC Health Services Research, 15(1).
Sobers-Grannum N, Murphy MM, Nielsen A, Guell C, Samuels TA, Bishop L, Unwin N (2015). Female Gender is a Social Determinant of Diabetes in the Caribbean: a Systematic Review and Meta-Analysis. PLOS ONE, 10(5), e0126799-e0126799.
Kesten JM, Guell C, Cohn S, Ogilvie D (2015). From the concrete to the intangible: understanding the diverse experiences and impacts of new transport infrastructure. International Journal of Behavioral Nutrition and Physical Activity, 12(1).
Christian T, Guell C (2015). Knowledge and Attitudes of Cervical Cancer Screening Among Caribbean Women: a Qualitative Interview Study from Barbados. Women & Health, 55(5), 566-579.
Keizer Beache S, Guell C (2015). Non-urgent accident and emergency department use as a socially shared custom: a qualitative study. Emergency Medicine Journal, 33(1), 47-51.
Granado MN, Guell C, Hambleton IR, Hennis AJM, Rose AMC (2013). Exploring breast cancer screening barriers among Barbadian women: a focus group study of mammography in a resource-constrained setting. Critical Public Health, 24(4), 429-444.
Barnett I, Guell C, Ogilvie D (2013). How do couples influence each other’s physical activity behaviours in retirement? an exploratory qualitative study.
BMC Public Health,
13(1).
Abstract:
How do couples influence each other’s physical activity behaviours in retirement? an exploratory qualitative study
Abstract
.
. Background
. Physical activity patterns have been shown to change significantly across the transition to retirement. As most older adults approach retirement as part of a couple, a better understanding of how spousal pairs influence each other’s physical activity behaviour in retirement may help inform more effective interventions to promote physical activity in older age. This qualitative study aimed to explore and describe how couples influence each other’s physical activity behaviour in retirement.
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.
. Methods
. A qualitative descriptive study that used purposive sampling to recruit seven spousal pairs with at least one partner of each pair recruited from the existing EPIC-Norfolk study cohort in the east of England, aged between 63 and 70 years and recently retired (within 2-6 years). Semi-structured interviews with couples were performed, audio-recorded, transcribed verbatim and analysed using data-driven content analysis.
.
.
. Results
. Three themes emerged: spousal attitude towards physical activity, spouses’ physical activity behaviour and spousal support. While spouses’ attitudes towards an active retirement were concordant, attitudes towards regular exercise diverged, were acquired across the life course and were not altered in the transition to retirement. Shared participation in physical activity was rare and regular exercise was largely an individual and independent habit. Spousal support was perceived as important for initiation and maintenance of regular exercise.
.
.
. Conclusions
. Interventions should aim to create supportive spousal environments for physical activity in which spouses encourage each other to pursue their preferred forms of physical activity; should address gender-specific needs and preferences, such as chances for socialising and relaxation for women and opportunities for personal challenges for men; and rather than solely focusing on promoting structured exercise, should also encourage everyday physical activity such as walking for transport.
.
Abstract.
Guell C, Ogilvie D (2013). Picturing commuting: photovoice and seeking well-being in everyday travel.
Qualitative Research,
15(2), 201-218.
Abstract:
Picturing commuting: photovoice and seeking well-being in everyday travel
We used participant-produced photography to investigate everyday commuting practices in Cambridge, UK. Photovoice served as an observational method for producing ethnographically rich data. A total of 19 participants produced over 500 photos about their journeys to and from work and took part in photo-elicitation interviews. Three themes emerged. First, many images depicted ‘well-being’ in commuting, for example, beautiful landscapes. Second, during elicitation interviews, participants described positive images that they intended but failed to capture in photos. Third, those participants who did not depict well-being described a lack of choice in their commuting, while those who acknowledged well-being seemed to do so in order to make practices of commuting meaningful and habitable. While our interpretations of photos of well-being could be subject to a methodological fallacy relating to a preference for positive over negative images in lay photography, we nonetheless suggest that the rich visual and oral narratives indicate a ‘real’ experience, albeit elicited through the photovoice.
Abstract.
Guell C, Panter J, Ogilvie D (2013). Walking and cycling to work despite reporting an unsupportive environment: insights from a mixed-method exploration of counterintuitive findings. BMC Public Health, 13(1).
Pollard TM, Guell C (2012). Assessing Physical Activity in Muslim Women of South Asian Origin.
Journal of Physical Activity and Health,
9(7), 970-976.
Abstract:
Assessing Physical Activity in Muslim Women of South Asian Origin
Background:We assessed the quality of data on physical activity obtained by recall from Muslim women of South Asian origin, and the feasibility of using accelerometer-based physical activity monitors to provide more objective measures of physical activity in this group.Methods:In this largely qualitative study, 22 British Pakistani women were asked to wear accelerometers (the GT1M Actigraph and/or the Sensewear Armband) for 4 days, provided 2 24-hour recalls of activities, and were interviewed about their experiences with the monitors.Results:Women reported spending most of their time in housework and childcare, activities which generated the majority of recorded bouts of moderate to vigorous physical activity. However, women had difficulty in recalling the timing, and assessing the intensity, of these usually unstructured activities. A significant minority of accelerometer datasets were incomplete and some women reported either forgetting to wear the acceler-ometer or finding it intrusive.Conclusions:Questionnaires are unlikely to provide an accurate assessment of physical activity in this group of women. This suggests that accelerometer data will be preferable. However, collecting sufficient data for large-scale studies using activity monitors in this population will be challenging.
Abstract.
Goodman A, Guell C, Panter J, Jones NR, Ogilvie D (2012). Healthy travel and the socio-economic structure of car commuting in Cambridge, UK: a mixed-methods analysis. Social Science & Medicine, 74(12), 1929-1938.
Samuels TA, Guell C, Legetic B, Unwin N (2012). Policy initiatives, culture and the prevention and control of chronic non-communicable diseases (NCDs) in the Caribbean. Ethnicity & Health, 17(6), 631-649.
Guell C (2012). Self‐Care at the Margins: Meals and Meters in Migrants’ Diabetes Tactics.
Medical Anthropology Quarterly,
26(4), 518-533.
Abstract:
Self‐Care at the Margins: Meals and Meters in Migrants’ Diabetes Tactics
Drawing on ethnographic fieldwork in 2006 and 2007, this article examines Turkish migrants’ everyday practices of diabetes self‐management in Berlin, Germany. To avoid diabetes complications, Turkish Berliners became self‐carers who altered food choices, cooking and eating practices, and made their self‐care practices visible with the help of blood sugar self‐testing. Rather than representing the common image of the disadvantaged migrant patient they assumed the role of “expert patients” and their self‐care was a deliberate practice to make their chronic illness experience manageable and tangible where formal support by the German healthcare system was inadequate. This article thus aims to interrogate both “self” and “care” in the context of “self‐care at the margins” and draw on de Certeau's tactics of the ordinary person that make everyday life habitable.
Abstract.
Barnett I, Guell C, Ogilvie D (2012). The experience of physical activity and the transition to retirement: a systematic review and integrative synthesis of qualitative and quantitative evidence.
International Journal of Behavioral Nutrition and Physical Activity,
9(1).
Abstract:
The experience of physical activity and the transition to retirement: a systematic review and integrative synthesis of qualitative and quantitative evidence
Abstract
.
. Background
. The transition to retirement has been recognised as a critical turning point for physical activity (PA). In an earlier systematic review of quantitative studies, retirement was found to be associated with an increase in recreational PA but with a decrease in PA among retirees from lower occupational groups. To gain a deeper understanding of the quantitative review findings, qualitative evidence on experiences of and views on PA around the transition to retirement was systematically reviewed and integrated with the quantitative review findings.
.
.
. Method
. 19 electronic databases were searched and reference lists were checked, citations tracked and journals hand-searched to identify qualitative studies on PA around the transition to retirement, published between January 1980 and August 2010 in any country or language. Independent quality appraisal, data extraction and evidence synthesis were carried out by two reviewers using a stepwise thematic approach. The qualitative findings were integrated with those of the existing quantitative systematic review using a parallel synthesis approach.
.
.
. Results
. Five qualitative studies met the inclusion criteria. Three overarching themes emerged from the synthesis of these studies: these related to retirees’ broad concepts of PA, the motives for and the challenges to PA in retirement. Integrative synthesis of the qualitative findings with the quantitative evidence offered several potential explanations for why adults might engage in more recreational PA after the transition to retirement. These included expected health benefits, lifelong PA patterns, opportunities for socialising and personal challenges, and the desire for a new routine. A decrease in PA among retirees from lower occupational groups might be explained by a lack of time and a perceived low personal value of recreational PA.
.
.
. Conclusions
. To encourage adoption and maintenance of PA after retirement, interventions should promote health-related and broader benefits of PA. Interventions for retirees from lower occupational groups should take account of busy post-retirement lifestyles and the low personal value that might be attributed to recreational PA. Future research should address predictors of maintenance of recreational PA after the transition to retirement, the broader benefits of PA, and barriers to PA among retirees from lower occupational groups.
.
Abstract.
Guell C, Panter J, Jones NR, Ogilvie D (2012). Towards a differentiated understanding of active travel behaviour: Using social theory to explore everyday commuting. Social Science & Medicine, 75(1), 233-239.
Guell C (2011). Candi(e)d Action: Biosocialities of Turkish Berliners Living with Diabetes.
Medical Anthropology Quarterly,
25(3), 377-394.
Abstract:
Candi(e)d Action: Biosocialities of Turkish Berliners Living with Diabetes
In this article, I explore Turkish migrants’ responses to diabetes in Germany. Anthropological studies on health inequalities tend to theorize “social suffering” as passive experiences; those that analyze active social engagement by patient groups as “biosociality” do so solely in the realm of biotechnologies and suggest that social disadvantage prevent active engagement. This article draws on 12 months of ethnographic fieldwork in Berlin from 2006 to 2007. Although Turkish Berliners seem burdened by diabetes, informal diabetes care, for example through a self‐help group, is nonetheless collectively negotiated. Increasing incidence and awareness of diabetes in Berlin's Turkish population and their growing political organization and economic entrepreneurship, against the backdrop of experiences of marginality, gives rise to biosociality unanticipated in previous accounts. Addressing the limitations of previous uses of biosociality, this ethnography suggests that social interaction and belonging that formed around altered biologies, here diabetes, are complex and fragmented.[biosociality, diabetes, migrant communities, Turkish Berliners]
Abstract.
Guell C (2011). Diabetes management as a Turkish family affair: Chronic illness as a social experience. Annals of Human Biology, 38(4), 438-444.
Goodman A, Guell C, Panter J, Ogilvie D (2011). How and why do people commute by car? a mixed-methods investigation.
,
65(Suppl 2), A9-A9.
Abstract:
How and why do people commute by car? a mixed-methods investigation
Background Reducing car use and promoting physically active travel would be expected to decrease air pollution, traffic crashes and diseases associated with sedentary lifestyles.
Objective to investigate how and why people commute by car.
Design Mixed-methods cross-sectional study, integrating qualitative data from in-depth interviews with quantitative data from questionnaires.
Setting Cambridge, UK.
Participants Commuters to Cambridge. 47 participants (23−68 years, 26 female) completed interviews, 1142 (17−71 years, 782 female) completed questionnaires.
Outcome measures Regular car commuting, defined as always/usually commuting by car in the past four weeks. We also examined whether regular car commuters drove all the way (unimodal) or used cars plus another mode (multimodal – eg, park and ride).
Analysis Initial qualitative analyses generated hypotheses and conceptual models which we tested in the quantitative data. Key quantitative findings formed the starting point for further thematic analyses of the qualitative data.
Results Regular car commuting was independently associated with female gender, longer commuting distance, having a driving licence, more household cars and availability of workplace parking. There was no independent effect of age, presence of children, long-term illness or difficulty walking. Socio-economic characteristics (education, housing tenure and area deprivation) showed strong univariable effects which appeared entirely mediated by commuting distance. Qualitative analysis suggested that this reflected high house prices in central Cambridge, meaning less wealthy households moved further out to achieve goals such as home ownership. Nevertheless, cars were generally affordable in this relatively affluent population, reducing the barrier which distance posed to labour-force participation. Car access was also valued by many non-regular car commuters in letting them overcome short-term challenges such as illness. Yet car commuting also introduced constraints, for example pushing drivers with flexible working hours to travel earlier (40% of drivers started work by 8:30 vs 20% of walkers and cyclists). Finally, only workplace parking availability strongly predicted unimodal versus multimodal car commuting (90% unimodal if free workplace parking, 65% if charged parking, 20% if no parking). 84% of multimodal car journeys involved walking or cycling.
Conclusion in car-centred environments, car access enables individuals to reconcile life goals such as home ownership and employment, and to meet unexpected challenges. Nevertheless, car dependence also imposes constraints, particularly on those who are less affluent or who have less control over their working hours. Car commuters were much more likely to incorporate some walking or cycling into their journey if their workplace restricted parking or charged for it, suggesting potential health benefits.
Abstract.
Ogilvie D, Griffin S, Jones A, Mackett R, Guell C, Panter J, Jones N, Cohn S, Yang L, Chapman C, et al (2010). Commuting and health in Cambridge: a study of a 'natural experiment' in the provision of new transport infrastructure. BMC Public Health, 10(1).
Guell C (2007). Painful Childhood: Children Living with Juvenile Arthritis. Qualitative Health Research, 17(7), 884-892.
Conferences
Augustus E, Murphy M, Guell C, Howitt C, Ramdath D, Anderson S, Unwin N (2023). OP51 Changes in food security and diet indicators following an intervention to support the recovery of backyard garden food production post a major volcanic eruption. SSM Annual Scientific Meeting.
Brugulat-Panés A, Martin-Pintado C, Augustus E, Iese V, Guell C, Foley L (2022). OP08 the value of adding ‘grey literature’ in evidence syntheses for global health: a contribution to equity-driven research. SSM Annual Scientific Meeting.
Guell C, Barnett-Naghshineh O, Warmington S, Altink H, Morrissey K, Smith MJ, Thurstan R, Unwin N, Govia I (2022). OP15 How can history be harnessed for understanding commercial determinants of health in Jamaica? a qualitative study of sugar-sweetened beverages. SSM Annual Scientific Meeting.
Augustus E, Murphy M, Guell C, Anderson S, Unwin N (2022). OP32 the impact of COVID-19 on local food production and food security in a small island developing state: a mixed method study. SSM Annual Scientific Meeting.
Augustus E, Whiteman S, Haynes E, Guell C, Ash C, Jia L, Morrissey K, Iese V, Murphy M, Anderson S, et al (2022). OP42 the impact of interventions aimed at improving nutritional status and metabolic health in small island developing states: a systematic review. SSM Annual Scientific Meeting.
Haynes E, Augustus E, Brown C, Guell C, Iese V, Jia L, Morrissey K, Unwin N (2022). OP77 the impact of interventions that adopt a local approach on diet in small island developing states: a systematic review. SSM Annual Scientific Meeting.
Rahtz E, Szaboova L, Guell C, Bell S (2022). P38 Nurturing and negotiating health and wellbeing in small businesses during Covid-19: a qualitative study. SSM Annual Scientific Meeting.
Ogilvie D, Bauman A, Foley L, Guell C, Humphreys D, Panter J (2021). P38 Making sense of the evidence in population health intervention research: building a dry stone wall. SSM Annual Scientific Meeting.
Haynes E, Bhagtani D, Guell C, Hambleton IR, Iese V, Fesaitu J, Benjamin-Neelon SE, Forouhi NG, Unwin N (2020). AN INVESTIGATION INTO THE ASSOCIATIONS BETWEEN SOCIO-DEMOGRAPHIC FACTORS, FOOD SOURCES AND DIETARY QUALITY IN SMALL ISLAND DEVELOPING STATES.
Author URL.
Haynes E, Green J, Garside R, Kelly MP, Guell C (2020). EXPLORING GENDERED ACTIVE TRAVEL BY POOLING AND SYNTHESISING QUALITATIVE STUDIES.
Author URL.
Guell C, Brown C, Iese V, Navunicagi O, Wairiu M, Unwin N (2020). UNDERSTANDING PRACTICES AND CHALLENGES OF (RE-)LOCALISING FOOD PRODUCTION AND CONSUMPTION IN SMALL ISLAND DEVELOPING STATES FOR BETTER NUTRITION: a QUALITATIVE MULTI-SITE STUDY.
Author URL.
Guell C, Altink H, Moore M, McMorris M, Morrissey K, Smith M, Unwin N, Williams A, Govia I (2019). AN INTERDISCIPLINARY STUDY OF HISTORICAL AND EPIDEMIOLOGICAL TRANSITIONS IN URBAN CARIBBEAN FOODSCAPES: UNDERSTANDING THE PAST TO ENHANCE FUTURE NUTRITION STRATEGIES.
Author URL.
Proctor R, Guell C, Wyatt K, Williams AJ (2019). WHAT IS THE EVIDENCE BASE FOR INTEGRATING HEALTH AND ENVIRONMENTAL AGENDAS IN THE SCHOOL CONTEXT TO IMPROVE HEALTHY AND ENVIRONMENTALLY AWARE BEHAVIOURS? a SYSTEMATIC SCOPING REVIEW OF GLOBAL EVIDENCE.
Author URL.
Haynes E, Garside R, Green J, Kelly MP, Thomas J, Guell C (2018). APPLYING MACHINE LEARNING TO POOLED QUALITATIVE STUDIES ON ACTIVE TRAVEL: a METHOD TO UNCOVER UNANTICIPATED PATTERNS TO INFORM BEHAVIOUR CHANGE?.
Author URL.
Hanson S, Gilbert D, Landy R, Okoli G, Guell C (2018). CANCER PREVENTION IN VULNERABLE WOMEN: AN EXPLORATORY QUALITATIVE STUDY WITH WOMEN WHO HAVE EXPERIENCED DOMESTIC VIOLENCE AND OFFENDING BEHAVIOURS.
Author URL.
Haynes E, Brown C, Wou C, Vogliano C, Guell C, Unwin N (2018). COMMUNITY FOOD PRODUCTION IN SMALL ISLAND DEVELOPING STATES: a SYSTEMATIC SCOPING REVIEW OF HEALTH, SOCIAL, ECONOMIC AND ENVIRONMENTAL IMPACTS.
Author URL.
Hanson S, Gilbert D, Landy R, Okoli G, Guell C (2018). Cancer, risk and decision making in vulnerable women: an exploratory study.
Author URL.
Panter J, Guell C, Humphreys D, Ogilvie D (2018). Effectiveness and mechanisms of environmental interventions to promote walking and cycling: what works and how?.
Author URL.
Le Gouais A, Guell C, Foley L, Ogilvie D (2018). Evidence and active urban environment: a qualitative study of how stakeholders in three English local authority areas use evidence in decision making for 'active living' infrastructure.
Author URL.
Haynes E, Garside R, Green J, Kelly MP, Ogilvie D, Thomas J, Guell C (2018). Pooling and synthesising qualitative datasets to develop a new social science approach to promote active living.
Author URL.
Pollard T, Morris S, Guell C (2018). Understanding women's participation in walking groups in deprived areas: an ethnographic approach.
Author URL.
Guell C, Unwin N, Samuels TA, Bishop L, Murphy MM (2017). DEVELOPING ROBUST METHODS FOR a LARGE SCALE, MULTI-SITE QUALITATIVE POLICY EVALUATION.
Author URL.
Murphy MM, Guell C, Samuels TA, Bishop L, Unwin N (2017). EVALUATING POLICY RESPONSES TO UPSTREAM DETERMINANTS OF CHRONIC, NON-COMMUNICABLE DISEASES: SUPPORTING HEALTHY DIETS AND ACTIVE LIVING IN SEVEN CARIBBEAN COUNTRIES.
Author URL.
Guariguata L, Guell C, Samuels TA, Rouwette EAJA, Woodcock J, Hambleton IR, Unwin N (2017). OP73 Systems science for caribbean health: the development of a system dynamics model for guiding policy on diabetes in a resource limited setting.
Guell C, Murphy MM, Samuels TA, Bishop L, Unwin N (2017). OP74 Understanding the process of developing and implementing chronic disease policies in the caribbean region: a qualitative policy analysis.
Guell C, Unwin N, Samuels TA, Bishop L, Murphy MM (2017). P88 Developing robust methods for a large scale, multi-site qualitative policy evaluation.
Guariguata L, Guell C, Samuels TA, Rouwette EAJA, Woodcock J, Hambleton IR, Unwin N (2017). SYSTEMS SCIENCE FOR CARIBBEAN HEALTH: THE DEVELOPMENT OF a SYSTEM DYNAMICS MODEL FOR GUIDING POLICY ON DIABETES IN a RESOURCE LIMITED SETTING.
Author URL.
Guell C, Murphy MM, Samuels TA, Bishop L, Unwin N (2017). UNDERSTANDING THE PROCESS OF DEVELOPING AND IMPLEMENTING CHRONIC DISEASE POLICIES IN THE CARIBBEAN REGION: a QUALITATIVE POLICY ANALYSIS.
Author URL.
Guell C, Griffin S, Ogilvie D (2016). Ideal types of activeness in later life and implication for promoting physical activity: an ethnographic study. Society for Social Medicine, 60th Annual Scientific Meeting. 14th - 16th Sep 2016.
Abstract:
Ideal types of activeness in later life and implication for promoting physical activity: an ethnographic study
Abstract.
Guell C, Mackett R, Ogilvie D (2016). Negotiating multisectoral evidence: a qualitative study of knowledge exchange in transport and public health. Public Health Science.
Abstract:
Negotiating multisectoral evidence: a qualitative study of knowledge exchange in transport and public health
Abstract.
Sobers Grannum NP, Murphy M, Nielsen A, Guell C, Samuels TA, Bishop L, Unwin N (2015). Health inequities in diabetes, its risk factors, and adverse outcomes in populations living in the Caribbean: a systematic review. Caribbean Public Health Agency: 60th Annual Scientific Meeting.
Abstract:
Health inequities in diabetes, its risk factors, and adverse outcomes in populations living in the Caribbean: a systematic review
Abstract.
Barnett I, Guell C, Ogilvie D (2011). Physical activity and the transition to retirement: a mixed-method systematic review. Society for Social Medicine 55th Annual Scientific Meeting. 14th - 16th Sep 2011.
Abstract:
Physical activity and the transition to retirement: a mixed-method systematic review
Abstract.
Barnett I, Ogilvie D, Guell C (2011). Physical activity and the transition to retirement: a mixed-method systematic review.
