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.

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.

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.

© 2018 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.

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.

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.

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.

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.

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.