Publications by category
Journal articles
Le Gouais A, Govia I, Guell C (In Press). Challenges for creating active living infrastructure in a middle-income country: a qualitative case study in Jamaica. Cities & Health
Haynes E, Garside R, Green J, Kelly MP, Thomas J, Guell C (In Press). Semi-automated text analytics for qualitative data synthesis. Research Synthesis Methods
Bartholomew L, Unwin N, Guell C, Bynoe K, Murphy MM (In Press). 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.
Proctor R, Guell C, Wyatt K, Williams AJ (In Press). 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
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.
Abstract.
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.
Abstract.
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.
Abstract.
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.
Abstract.
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 & Place, 71, 102615-102615.
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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Guell C, Brown CR, Iese V, Navunicagi O, Wairiu M, Unwin N (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.
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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Pollard TM, Guell C, Morris S (2020). Communal therapeutic mobility in group walking: a meta-ethnography. Social Science & Medicine, 262, 113241-113241.
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.
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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.
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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.
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Govia I, Guell C, Unwin N, Wadende P (2019). Air travel for global health: flying in the face of sustainable development?.
LANCET,
394(10211), 1786-1788.
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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.
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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.
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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.
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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.
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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.
.
.
. 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.
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.
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.
Chapters
Unwin N, Guell C, Sobers-Grannum N, Nielsen A (2016). System dynamics modelling and finding solutions to the ‘wicked’ Public Health problem of preventing chronic diseases. In Neal ZP (Ed)
Handbook of Applied System Science, Routledge.
Abstract:
System dynamics modelling and finding solutions to the ‘wicked’ Public Health problem of preventing chronic diseases
Abstract.
Conferences
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.
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, Ogilvie D, Guell C (2011). Physical activity and the transition to retirement: a mixed-method systematic review.
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.
Publications by year
In Press
Le Gouais A, Govia I, Guell C (In Press). Challenges for creating active living infrastructure in a middle-income country: a qualitative case study in Jamaica. Cities & Health
Bartholomew L, Unwin N, Guell C, Murphy MM (In Press). Keeping on target during a low-calorie diet: the experiences of participants in a type 2 diabetes reversal pilot.
Abstract:
Keeping on target during a low-calorie diet: the experiences of participants in a type 2 diabetes reversal pilot
AbstractRapid weight loss using a very low-calorie diet (VLCD) for 2 to 3 months followed by weight maintenance has been shown to lead to the restoration of normal glucose and insulin metabolism in people recently diagnosed with type 2 diabetes. We explored the barriers and facilitators of adhering to a VLCD for remission in an Afro-Caribbean population. Twenty-five participants completed an eight-week VLCD followed by a six-month structured weight maintenance phase. Semi-structured interviews and focus groups were thematically analysed. Cravings for ‘usual foods’ consumed by friends and family, stigma of diabetes and resulting lack of disclosure and the participants’ busy schedules were noted as predominant challenges throughout the study. In turn, social support and the participants’ internal drive were considered as key facilitators for success. VLCD is a feasible approach for type 2 diabetes remission. Self-motivation and supportive environments are however crucial in meeting and maintaining the weight loss goals.
Abstract.
Haynes E, Garside R, Green J, Kelly MP, Thomas J, Guell C (In Press). Semi-automated text analytics for qualitative data synthesis. Research Synthesis Methods
Bartholomew L, Unwin N, Guell C, Bynoe K, Murphy MM (In Press). 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.
Proctor R, Guell C, Wyatt K, Williams AJ (In Press). 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
2022
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.
Abstract.
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.
Abstract.
Proctor R (2022). Healthy Green Schools: Investigating how schools can nurture healthier and more environmentally aware young people.
Abstract:
Healthy Green Schools: Investigating how schools can nurture healthier and more environmentally aware young people
Background/Aims -
With complex problems relating to climate change and human health shaping society in the twenty-first century, the ability of schools to foster awareness and proactive behaviours around these issues is of pressing concern to public health practitioners, educators, and policymakers. This exploratory and iterative thesis maps what is known about the extent and range of integrated health and sustainability approaches undertaken in schools globally. It explores why schools have acted around these issues and how.
Methods -
A mixed-methods research approach makes use of current evidence to inform effective and responsive further inquiries. The thesis consists of three empirical research studies that were designed and undertaken sequentially, as follows:
1. Systematic scoping review of global evidence (Chapter 3)
2. Thematic synthesis of global evidence (Chapter 4)
3. In-depth qualitative case study of New Zealand Enviroschools
(Chapters 5 and 6)
Findings -
The systematic scoping review of global evidence collated 87 sources. The four main areas in which integrated approaches were implemented were: teaching and learning (n= 27), physical environment adaptations (n= 23), ecologically focused policy development (n= 13) and whole-school holistic approaches (n= 12). Evidence has increased in the last two decades and is heterogeneous in nature, with few sustained attempts to explain the potential role of theory in design, implementation, and evaluation of healthy green approaches.
The thematic synthesis generated four key drivers of integrated approaches: an awareness of the urgency of issues related to the environment and human health; a need for systemic solutions to wicked problems; increased levels of reflective curiosity; and a focus on transformative actions. Across the evidence, integrated approaches were thought to foster connected systems (between upstream and downstream school influences) and connected thinking (through action-oriented, place-based experiences). The evidence suggests that holistic approaches that seek to reorient whole-school culture through action and policy are deemed most likely to reflect the urgency and systemic nature of the climate emergency. Across disciplines, three theories resonate with integrated school-based action and policy: (eco)sociological theories (education), transformation theories (social science), and salutogenesis (public health).
The in-depth qualitative case study of New Zealand ‘Enviroschools’ reveals the importance of quality relationships with others, environments, and oneself in the design, implementation, and sustainability of an approach that aims to foster healthier and more environmentally aware young people within the mainstream school context. Implementation strategies such as planning using a sustainability lens, co-ordination between regional and national networks, and providing those involved with feedback in context, were associated with building and nurturing quality relationships across the school community by encouraging connections and a shift in mindset around change.
Implications -
The findings generated in this thesis outline why a mainstream movement towards an integrated conceptual ‘third space’ may be necessary at the intersection between health, environment, and education. This ‘third space’ refers to an integration of health (first space) and environment (second space) into a socioecological (third space) that is united in its complexity rather than divided into separate complex problems. A movement towards an integrated conceptual ‘third space’ may connect previously disaggregated systems and thinking to reveal transformative and pragmatic ways in which schools can develop, implement, and sustain action and policy which nurtures healthier and more environmentally aware young people.
Abstract.
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.
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.
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.
Abstract.
Author URL.
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.
Abstract.
2021
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.
Abstract.
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.
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 & Place, 71, 102615-102615.
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.
Abstract.
Author URL.
Guell C, Brown CR, Iese V, Navunicagi O, Wairiu M, Unwin N (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.
2020
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.
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.
Abstract.
Author URL.
Pollard TM, Guell C, Morris S (2020). Communal therapeutic mobility in group walking: a meta-ethnography. Social Science & Medicine, 262, 113241-113241.
Haynes E, Green J, Garside R, Kelly MP, Guell C (2020). EXPLORING GENDERED ACTIVE TRAVEL BY POOLING AND SYNTHESISING QUALITATIVE STUDIES.
Author URL.
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.
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.
2019
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.
Govia I, Guell C, Unwin N, Wadende P (2019). Air travel for global health: flying in the face of sustainable development?.
LANCET,
394(10211), 1786-1788.
Author URL.
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.
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.
2018
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.
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
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, 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
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.
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
Pollard T, Morris S, Guell C (2018). Understanding women's participation in walking groups in deprived areas: an ethnographic approach.
Author URL.
2017
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.
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).
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.
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.
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.
2016
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.
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.
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
Unwin N, Guell C, Sobers-Grannum N, Nielsen A (2016). System dynamics modelling and finding solutions to the ‘wicked’ Public Health problem of preventing chronic diseases. In Neal ZP (Ed)
Handbook of Applied System Science, Routledge.
Abstract:
System dynamics modelling and finding solutions to the ‘wicked’ Public Health problem of preventing chronic diseases
Abstract.
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.
2015
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).
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.
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.
2013
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.
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. 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.
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. 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.
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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).
2012
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.
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.
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. 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.
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. 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.
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. 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.
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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.
2011
Guell C (2011). Candi(e)d Action: Biosocialities of Turkish Berliners Living with Diabetes. Medical Anthropology Quarterly, 25(3), 377-394.
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.
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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.
Barnett I, Ogilvie D, Guell C (2011). Physical activity and the transition to retirement: a mixed-method systematic review.
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.
2010
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).
2007
Guell C (2007). Painful Childhood: Children Living with Juvenile Arthritis. Qualitative Health Research, 17(7), 884-892.
