Journal articles
Watkins R, Swancutt D, Alexander M, Moghadam S, Perry S, Dean S, Sheaff R, Pinkney J, Tarrant M, Lloyd J, et al (2023). A Qualitative Exploration of Patient and Staff Experiences of the Receipt and Delivery of Specialist Weight Management Services in the UK.
Patient,
16(6), 625-640.
Abstract:
A Qualitative Exploration of Patient and Staff Experiences of the Receipt and Delivery of Specialist Weight Management Services in the UK.
BACKGROUND: Addressing the increasing prevalence of obesity is a global public health priority. Severe obesity (body mass index > 40) reduces life expectancy, due to its association with people developing complications (e.g. diabetes, cancer, cardiovascular disease), and greatly impairs quality of life. The National Health Service (NHS) in the UK provides specialist weight management services (SWMS) for people with severe obesity, but key uncertainties remain around patient access to and engagement with weight management services, as well as pathways beyond the service. METHODS: in this multiple methods study, using online forum data and semi-structured interviews, stakeholders' experiences of delivering and receiving SWMS were explored. Using the web search engine Google with keywords and web address (URL) identifiers, relevant public online platforms were sourced with snowball sampling and search strings used to identify threads related to people's experiences of accessing SWMS (n = 57). Interviews were conducted with 24 participants (nine patients, 15 staff), and data from all sources were analysed thematically using the framework approach. RESULTS: Six themes related to access to and engagement with SWMS emerged during data analysis: (1) making the first move, (2) uncertainty and confusion, (3) resource issues, (4) respect and understanding, (5) mode of delivery, and (6) desire for ongoing support. CONCLUSION: There is a mixed and varied picture of SWMS provision across the UK. The service offered is based on local clinical decision making and available resources, resulting in a range of patient experiences and perspectives. Whilst service capacity issues and patient anxiety were seen as barriers to accessing care, peer support and positive clinical and group interactions (connectedness between individuals) were considered to increase engagement.
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Garrood A, Bjornstad G, Borek A, Gillett A, Lloyd J, Brand S, Tarrant M, Ball S, Hawton A, McDonald A, et al (2023). Healthy Parent Carers: Acceptability and practicability of online delivery and learning through implementation by delivery partner organisations.
Health Expect,
26(5), 2050-2063.
Abstract:
Healthy Parent Carers: Acceptability and practicability of online delivery and learning through implementation by delivery partner organisations.
BACKGROUND: Parent carers of disabled children are at increased risk of physical and mental health problems. The Healthy Parent Carers (HPC) programme is a manualised peer-led group-based programme that aims to promote parent carer health and wellbeing. Previously, the programme had been delivered in person, with recruitment and delivery managed in a research context. This study explored implementation by two delivery partner organisations in the United Kingdom. Facilitator Training and Delivery Manuals were modified for online delivery using Zoom due to COVID-19. METHODS: the study methodology utilised the Replicating Effective Programs framework. A series of stakeholder workshops informed the development of the Implementation Logic Model and an Implementation Package. After delivering the programme, delivery partner organisations and facilitators participated in a workshop to discuss experiences of implementing the programme. A wider group of stakeholders, including commissioners, Parent Carer Forums and charity organisations representatives and researchers subsequently met to consider the sustainability and potential barriers to delivering the programme outside the research context. RESULTS: This study explored implementation by two delivery partner organisations in the United Kingdom that were able to recruit facilitators, who we trained, and they recruited participants and delivered the programme to parent carers in different localities using Zoom. The co-created Implementation Logic Model and Implementation Package were subsequently refined to enable the further roll-out of the programme with other delivery partner organisations. CONCLUSIONS: This study provides insight and understanding of how the HPC programme can be implemented sustainably outside of the research context. Further research will evaluate the effectiveness of the programme and refine the implementation processes. PATIENT AND PUBLIC CONTRIBUTION: Parent carers, delivery partner organisation staff and service commissioners were consulted on the design, delivery and reporting of the research.
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Swancutt D, Tarrant M, Ingram W, Baldrey S, Burns L, Byng R, Calitri R, Creanor S, Dean S, Evans L, et al (2022). A group-based behavioural intervention for weight management (PROGROUP) versus usual care in adults with severe obesity: a feasibility randomised controlled trial protocol.
Pilot and Feasibility Studies,
8(1).
Abstract:
A group-based behavioural intervention for weight management (PROGROUP) versus usual care in adults with severe obesity: a feasibility randomised controlled trial protocol
Abstract
. Background
. Approximately 15 million people in the UK live with obesity, around 5 million of whom have severe obesity (body mass index (BMI) ≥35kg/m2). Having severe obesity markedly compromises health, well-being and quality of life, and substantially reduces life expectancy. These adverse outcomes are prevented or ameliorated by weight loss, for which sustained behavioural change is the cornerstone of treatment. Although NHS specialist ‘Tier 3’ Weight Management Services (T3WMS) support people with severe obesity, using individual and group-based treatment, the current evidence on optimal intervention design and outcomes is limited. Due to heterogeneity of severe obesity, there is a need to tailor treatment to address individual needs. Despite this heterogeneity, there are good reasons to suspect that a structured group-based behavioural intervention may be more effective and cost-effective for the treatment of severe obesity compared to usual care. The aims of this study are to test the feasibility of establishing and delivering a multi-centre randomised controlled clinical trial to compare a group-based behavioural intervention versus usual care in people with severe obesity.
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. Methods
. This feasibility randomised controlled study is a partially clustered multi-centre trial of PROGROUP (a novel group-based behavioural intervention) versus usual care. Adults ≥18 years of age who have been newly referred to and accepted by NHS T3WMS will be eligible if they have a BMI ≥40, or ≥35 kg/m2 with comorbidity, are suitable for group-based care and are willing to be randomised. Exclusion criteria are participation in another weight management study, planned bariatric surgery during the trial, and unwillingness or inability to attend group sessions. Outcome assessors will be blinded to treatment allocation and success of blinding will be evaluated. Clinical measures will be collected at baseline, 6 and 12 months post-randomisation. Secondary outcome measures will be self-reported and collected remotely. Process and economic evaluations will be conducted.
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. Discussion
. This randomised feasibility study has been designed to test all the required research procedures and additionally explore three key issues; the feasibility of implementing a complex trial at participating NHS T3WMS, training the multidisciplinary healthcare teams in a standard intervention, and the acceptability of a group intervention for these particularly complex patients.
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. Trial registration
. ISRCTN number 22088800.
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Axford N, Berry V, Lloyd J, Wyatt K (2022). How can we optimise learning from trials in child and adolescent mental health?.
Evid Based Ment Health,
25(3), 93-95.
Abstract:
How can we optimise learning from trials in child and adolescent mental health?
Improving child and adolescent mental health requires the careful development and rigorous testing of interventions and delivery methods. This includes universal school-based mindfulness training, evaluated in the My Resilience in Adolescence (MYRIAD) trial reported in this special edition. While discovering effective interventions through randomised controlled trials is our ultimate aim, null or negative results can and should play an important role in progressing our understanding of what works. Unfortunately, alongside publication bias there can be a tendency to ignore, spin or unfairly undermine disappointing findings. This creates research waste that can increase risk and reduce benefits for future service users. We advocate several practices to help optimise learning from all trials, whatever the results: stronger intervention design reduces the likelihood of foreseeable null or negative results; an evidence-informed conceptual map of the subject area assists with understanding how results contribute to the knowledge base; mixed methods trial designs aid explanation of outcome results; various open science practices support the dispassionate analysis of data and transparent reporting of trial findings; and preparation for null or negative results helps to temper stakeholder expectations and increase understanding of why we conduct trials in the first place. To embed these practices, research funders must be willing to pay for pilot studies and 'thicker' trials, and publishers should judge trials according to their conduct and not their outcome. MYRIAD is an exemplar of how to design, conduct and report a trial to optimise learning, with important implications for practice.
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Axford N, Berry V, Lloyd J, Hobbs T, Wyatt K (2022). Promoting Learning from Null or Negative Results in Prevention Science Trials.
Prev Sci,
23(5), 751-763.
Abstract:
Promoting Learning from Null or Negative Results in Prevention Science Trials.
There can be a tendency for investigators to disregard or explain away null or negative results in prevention science trials. Examples include not publicizing findings, conducting spurious subgroup analyses, or attributing the outcome post hoc to real or perceived weaknesses in trial design or intervention implementation. This is unhelpful for several reasons, not least that it skews the evidence base, contributes to research "waste", undermines respect for science, and stifles creativity in intervention development. In this paper, we identify possible policy and practice responses when interventions have null (ineffective) or negative (harmful) results, and argue that these are influenced by: the intervention itself (e.g. stage of gestation, perceived importance); trial design, conduct, and results (e.g. pattern of null/negative effects, internal and external validity); context (e.g. wider evidence base, state of policy); and individual perspectives and interests (e.g. stake in the intervention). We advance several strategies to promote more informative null or negative effect trials and enable learning from such results, focusing on changes to culture, process, intervention design, trial design, and environment.
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McHugh C, Lloyd J, Logan S, Wyatt K (2021). Enablers and barriers English secondary schools face in promoting healthy diet and physical activity behaviours.
Health Promotion International,
37(2).
Abstract:
Enablers and barriers English secondary schools face in promoting healthy diet and physical activity behaviours
Summary
. This study sought to understand the current challenges mainstream secondary schools in England face in creating a health promoting school culture for diet and physical activity behaviours. An in-depth qualitative case study of two purposely selected state-funded schools, including interviews with teachers, observations of school activities including meal breaks and a qualitative survey with parents was done. Inductive thematic analysis was used to explore emerging themes. Additional interviews with the leadership team from four further schools were used to develop and refine emerging themes. Four main themes emerged from the data: competing pressures, school environment, personnel and policy. Results demonstrate that schools recognize they have role to play in promoting healthy lifestyle behaviours to pupils; however, several significant barriers were identified such as lack of government support and regulation, school structures and organization, focus on core subjects, business-run canteens and lack of family and community engagement. Given the importance of maintaining a healthy weight throughout the life course, schools have an important role to play in creating healthy environments in which students can easily make a healthy choice. Future school promotion initiatives need to consider addressing the barriers that schools face by working with them and the communities in which they are embedded.
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Lloyd J, Bjornstad G, Borek A, Cuffe-Fuller B, Fredlund M, McDonald A, Tarrant M, Berry V, Wilkinson K, Mitchell S, et al (2021). Healthy Parent Carers programme: mixed methods process evaluation and refinement of a health promotion intervention.
BMJ Open,
11(8).
Abstract:
Healthy Parent Carers programme: mixed methods process evaluation and refinement of a health promotion intervention.
OBJECTIVES: Parent carers of children with special educational needs or disability are at risk of poorer mental and physical health. In response to these needs, we codeveloped the 'Healthy Parent Carers' (HPC) programme. This study examined the views and experiences of participants in the HPC feasibility trial to inform programme refinement. INTERVENTION, SETTING AND PARTICIPANTS: HPC is a peer-led group-based intervention (supported by online materials) for primary carers of disabled children, encouraging behaviours linked with health and well-being. It was delivered by two lead and six assistant peer facilitators in six community sites (one lead and one assistant per group) in South West England over six or 12 sessions. Control participants had online materials only. The trial involved 47 intervention and 45 control parent carers (97% female and 97% white) and eight facilitators (one male). DESIGN: a preplanned mixed methods process evaluation using questionnaires and checklists (during and after the intervention), qualitative interviews with participants after intervention (n=18) and a focus group with facilitators after trial. RESULTS: HPC was highly acceptable to participants and facilitators and experiences were very positive. Participants reported that the programme increased awareness of what parent carers could and could not change and their self-efficacy to engage in health-promoting behaviours. The intended mechanisms of action (social identification and peer support) matched participants' expectations and experiences. Control participants found the online-only programme flexible but isolating, as there were no opportunities to share ideas and problem solve with peers, the key function of the programme. Areas for improvement were identified for programme content, facilitator training and delivery. CONCLUSION: HPC was acceptable, well received and offers considerable potential to improve the health of parent carers. Under the pandemic, the challenge going forward is how best to maintain reach and fidelity to function while delivering a more virtual programme. TRIAL REGISTRATION NUMBER: ISRCTN151144652.
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Bjornstad G, Cuffe-Fuller B, Ukoumunne OC, Fredlund M, McDonald A, Wilkinson K, Lloyd J, Hawton A, Berry V, Tarrant M, et al (2021). Healthy Parent Carers: feasibility randomised controlled trial of a peer-led group-based health promotion intervention for parent carers of disabled children. Pilot and Feasibility Studies, 7
McHugh CA, Lloyd J, Logan S, Wyatt K (2021). Implementing a set of health promoting processes in English secondary schools: a comparative case study. Public Health in Practice, 2, 100214-100214.
McHugh C, Hurst A, Bethel A, Lloyd J, Logan S, Wyatt K (2020). The impact of the World Health Organization Health Promoting Schools framework approach on diet and physical activity behaviours of adolescents in secondary schools: a systematic review.
Public Health,
182, 116-124.
Abstract:
The impact of the World Health Organization Health Promoting Schools framework approach on diet and physical activity behaviours of adolescents in secondary schools: a systematic review.
OBJECTIVE: to examine the effectiveness of interventions using the World Health Organization Health Promoting Schools (HPSs) framework approach in increasing physical activity (PA) and improving the diet of 11-18-year-olds. STUDY DESIGN: a systematic review guided by the National Health Services Centre for Reviews and Dissemination framework and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. METHODS: Nine databases and trial registries were searched from 2013 to 2018 for cluster randomised controlled trials involving adolescents' aged 11-18 years. We also included relevant studies from a 2014 Cochrane Review of HPS approach on health behaviours. Data were extracted from included studies and assessed for quality. RESULTS: Twelve eligible studies were identified from seven countries. The studies varied in outcome measures, sample size, quality and duration of intervention and follow-up. Only four of the included studies were of high to moderate quality. We found some evidence of effectiveness for physical activity only interventions and limited evidence of effectiveness for nutrition only and combined PA and nutrition interventions. CONCLUSIONS: There were no discernible patterns across the studies to suggest effective mechanisms for the HPS approach. The family/community component was poorly developed and superficially reported in all studies. Future research should seek to understand how best to work in partnership with secondary schools, to foster and sustain a healthy eating and physical activity culture, which aligns with their core aims. More attention should be paid to the restriction of unhealthy foods in the school environment.
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Bjornstad G, Wilkinson K, Cuffe-Fuller B, Fitzpatrick K, Borek A, Ukoumunne OC, Hawton A, Tarrant M, Berry V, Lloyd J, et al (2019). Healthy Parent Carers peer-led group-based health promotion intervention for parent carers of disabled children: protocol for a feasibility study using a parallel group randomised controlled trial design.
Pilot and Feasibility Studies,
5(1).
Abstract:
Healthy Parent Carers peer-led group-based health promotion intervention for parent carers of disabled children: protocol for a feasibility study using a parallel group randomised controlled trial design
Abstract
. Background
. Parent carers of disabled children are at increased risk of mental and physical health problems. They often experience challenges to maintaining good health which have implications for their well-being and their ability to care for their children. In response to these needs, researchers and parent carers developed the Healthy Parent Carers (HPC) programme. It is a peer-led, group-based intervention that promotes behaviours associated with health and well-being. The aims of this trial are to assess the acceptability of the HPC programme and the feasibility of its delivery in the community and to assess the feasibility and acceptability of the design of the definitive trial to evaluate the programme’s effectiveness and cost-effectiveness.
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. Methods
. We will establish six research sites and train facilitators to deliver the manualised intervention. Parent carers of children with special educational needs and disabilities will be individually randomised, stratified by group delivery site, to either take part in a group programme and online resources (intervention) or to receive access to the online resources only (control). Measures of mental health; well-being; health-related quality of life; health behaviours; patient activation; protective factors such as resilience, social connections, and practical support; and use of health care, social care, and wider societal resources will be collected before randomisation (baseline), immediately post-intervention, and 6 months later. Recruitment of participants, adherence to the programme, and the dose received will be assessed. Group sessions will be audio-recorded to evaluate the fidelity of delivery and participant engagement. Participants’ and facilitators’ feedback on the programme content and delivery, their experience, and the acceptability of the outcome measures and trial design will be collected through feedback forms, interviews, and focus groups.
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. Discussion
. This trial will assess whether the programme delivery and evaluative trial design are feasible, to inform whether to progress to a definitive randomised controlled trial to test the effectiveness and cost-effectiveness of the Healthy Parent Carers programme.
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. Trial registration
. ISRCTN, ISRCTN151144652, registered on 25 October 2018; ClinicalTrials.gov, NCT03705221, registered on 15 October 2018.
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Abstract.
McHugh CA, Anderson L, Lloyd J, Wyatt K, Logan S (2019). Influences on diet and physical activity choices of 11–13-year-olds in a school setting. Health Education Journal
Price L, Wyatt K, Lloyd J, Abraham C, Creanor S, Dean S, Hillsdon M (2018). Are We Overestimating Physical Activity Prevalence in Children?.
J Phys Act Health,
15(12), 941-945.
Abstract:
Are We Overestimating Physical Activity Prevalence in Children?
BACKGROUND: Physical activity guidelines state that children should achieve at least 60 minutes of moderate to vigorous physical activity (MVPA) on each day of the week. Accurate assessment of adherence to these guidelines should, ideally, include measurement over 7 days. When less than 7 days of data are available, researchers often report the average minutes of MVPA per day as a proxy for 7-day measurement. The aim of this study was to compare prevalence estimates generated by average MVPA per day versus MVPA assessed over 7 days. METHODS: Data were collected as part of the Healthy Lifestyles Programme. One class from each school was randomized to wear a GENEActiv accelerometer for 8 days. The percentages of children achieving an average of ≥60 minutes of MVPA per day and those achieving ≥60 minutes of MVPA on each of 7 days were calculated. RESULTS: a total of 807 children provided 7 days of data. When the average MVPA per day was calculated, 30.6% (n = 247) of children accumulated ≥60 minutes of MVPA per day. Only 3.2% (n = 26) accumulated ≥60 minutes of MVPA on every day of the week. CONCLUSION: Previous studies utilizing average MVPA per day are likely to have overestimated the percentage of children meeting recommendations.
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Price L, Wyatt K, Lloyd J, Abraham C, Creanor S, Dean S, Hillsdon M (2018). Children’s Compliance with Wrist-Worn Accelerometry Within a Cluster-Randomized Controlled Trial: Findings from the Healthy Lifestyles Programme.
Pediatric Exercise Science,
30(2), 281-287.
Abstract:
Children’s Compliance with Wrist-Worn Accelerometry Within a Cluster-Randomized Controlled Trial: Findings from the Healthy Lifestyles Programme
Purpose: the purpose of this study was to assess children’s compliance with wrist-worn accelerometry during a randomized controlled trial and to examine whether compliance differed by allocated condition or gender. Methods: a total of 886 children within the Healthy Lifestyles Programme trial were randomly allocated to wear a GENEActiv accelerometer at baseline and 18-month follow-up. Compliance with minimum wear-time criteria (≥10 h for 3 weekdays and 1 weekend day) was obtained for both time points. Chi-square tests were used to determine associations between compliance, group allocation, and gender. Results: at baseline, 851 children had usable data, 830 (97.5%) met the minimum wear-time criteria, and 631 (74.1%) had data for 7 days at 24 hours per day. At follow-up, 789 children had usable data, 745 (94.4%) met the minimum wear-time criteria, and 528 (67%) had complete data. Compliance did not differ by gender (baseline: χ2 = 1.66, P = .2; follow-up: χ2 = 0.76, P = .4) or by group at follow-up (χ2 = 2.35, P = .13). Conclusion: the use of wrist-worn accelerometers and robust trial procedures resulted in high compliance at 2 time points regardless of group allocation, demonstrating the feasibility of using precise physical activity monitors to measure intervention effectiveness.
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Wyatt K, Lloyd J, Creanor S, Green C, Dean SG, Hillsdon M, Abraham C, Tomlinson R, Pearson V, Taylor RS, et al (2018). Cluster randomised controlled trial and economic and process evaluation to determine the effectiveness and cost-effectiveness of a novel intervention [Healthy Lifestyles Programme (HeLP)] to prevent obesity in school children.
Public Health Research,
6(1), 1-204.
Abstract:
Cluster randomised controlled trial and economic and process evaluation to determine the effectiveness and cost-effectiveness of a novel intervention [Healthy Lifestyles Programme (HeLP)] to prevent obesity in school children
BackgroundApproximately one-third of children in England leave primary school overweight or obese. There is little evidence of effective obesity prevention programmes for children in this age group.ObjectiveTo determine the effectiveness and cost-effectiveness of a school-based healthy lifestyles programme in preventing obesity in children aged 9–10 years.DesignA cluster randomised controlled trial with an economic and process evaluation.SettingThirty-two primary schools in south-west England.ParticipantsChildren in Year 5 (aged 9–10 years) at recruitment and in Year 7 (aged 11–12 years) at 24 months’ post-baseline follow-up.InterventionThe Healthy Lifestyles Programme (HeLP) ran during the spring and summer terms of Year 5 into the autumn term of Year 6 and included four phases: (1) building a receptive environment, (2) a drama-based healthy lifestyles week, (3) one-to-one goal setting and (4) reinforcement activities.Main outcome measuresThe primary outcome measure was body mass index (BMI) standard deviation score (SDS) at 24 months post baseline measures (12 months post intervention). The secondary outcomes comprised waist circumference SDS, percentage body fat SDS, proportion of children overweight and obese at 18 and 24 months, accelerometer-assessed physical activity and food intake at 18 months, and cost-effectiveness.ResultsWe recruited 32 schools and 1324 children. We had a rate of 94% follow-up for the primary outcome. No difference in BMI SDS was found at 24 months [mean difference –0.02, 95% confidence interval (CI) –0.09 to 0.05] or at 18 months (mean difference –0.02, 95% CI –0.08 to 0.05) between children in the intervention schools and children in the control schools. No difference was found between the intervention and control groups in waist circumference SDS, percentage body fat SDS or physical activity levels. Self-reported dietary behaviours showed that, at 18 months, children in the intervention schools consumed fewer energy-dense snacks and had fewer negative food markers than children in the control schools. The intervention effect on negative food markers was fully mediated by ‘knowledge’ and three composite variables: ‘confidence and motivation’, ‘family approval/behaviours and child attitudes’ and ‘behaviours and strategies’. The intervention effect on energy-dense snacks was partially mediated by ‘knowledge’ and the same composite variables apart from ‘behaviours and strategies’. The cost of implementing the intervention was approximately £210 per child. The intervention was not cost-effective compared with control. The programme was delivered with high fidelity, and it engaged children, schools and families across the socioeconomic spectrum.LimitationsThe rate of response to the parent questionnaire in the process evaluation was low. Although the schools in the HeLP study included a range of levels of socioeconomic deprivation, class sizes and rural and urban settings, the number of children for whom English was an additional language was considerably lower than the national average.ConclusionsHeLP is not effective or cost-effective in preventing overweight or obesity in children aged 9–10 years.Future workOur very high levels of follow-up and fidelity of intervention delivery lead us to conclude that it is unlikely that school-based programmes targeting a single age group can ever be sufficiently intense to affect weight status. New approaches are needed that affect the school, the family and the wider environment to prevent childhood obesity.Trial registrationCurrent Controlled Trials ISRCTN15811706.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 6, No. 1. See the NIHR Journals Library website for further project information.
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Lloyd J, Creanor S, Logan S, Green C, Dean SG, Hillsdon M, Abraham C, Tomlinson R, Pearson V, Taylor RS, et al (2017). Effectiveness of the Healthy Lifestyles Programme (HeLP) to prevent obesity in UK primary-school children: a cluster randomised controlled trial. The Lancet Child & Adolescent Health, 2(1), 35-45.
Lloyd J, Dean S, Creanor S, Abraham C, Hillsdon M, Ryan E, Wyatt KM (2017). Intervention fidelity in the definitive cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP) trial: findings from the process evaluation. International Journal of Behavioral Nutrition and Physical Activity, 14(1).
Lloyd J, McHugh C, Minton J, Eke H, Wyatt K (2017). The impact of active stakeholder involvement on recruitment, retention and engagement of schools, children and their families in the cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP): a school-based intervention to prevent obesity. Trials, 18(1).
Lloyd J, Creanor S, Price L, Abraham C, Dean S, Green C, Hillsdon M, Pearson V, Taylor RS, Tomlinson R, et al (2017). Trial baseline characteristics of a cluster randomised controlled trial of a school-located obesity prevention programme; the Healthy Lifestyles Programme (HeLP) trial. BMC Public Health, 17(1).
Creanor S, Lloyd J, Hillsdon M, Dean S, Green C, Taylor RS, Ryan E, Wyatt K (2016). Detailed statistical analysis plan for a cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP), a novel school-based intervention to prevent obesity in school children. Trials, 17(1).
Lloyd J, Wyatt K (2015). The Healthy Lifestyles Programme (HeLP)--an overview of and recommendations arising from the conceptualisation and development of an innovative approach to promoting healthy lifestyles for children and their families.
Int J Environ Res Public Health,
12(1), 1003-1019.
Abstract:
The Healthy Lifestyles Programme (HeLP)--an overview of and recommendations arising from the conceptualisation and development of an innovative approach to promoting healthy lifestyles for children and their families.
Despite the rise in childhood obesity, there remains a paucity of evidence for effective interventions that engage children and parents sufficiently to make and sustain lifestyle behaviour change. The Healthy Lifestyles Programme (HeLP) is a school-located obesity prevention programme, which has been developed with teachers, families and healthcare professionals. The underpinning assumption in the development of HeLP was to take a relational approach to changing behaviour, building relationships with the schools, children and their families to create supportive environments for healthy lifestyle choices. Thus, HeLP was conceptualised as a complex intervention within a complex system and developed as a dynamic, evolving set of processes to support and motivate children towards healthy behaviours. The delivery methods used are highly interactive and encourage identification with and ownership of the healthy lifestyle messages so that the children are motivated to take them home to their parents and effect change within the family. We have good evidence that HeLP engages schools and children such that they want to participate in the Programme. Results from an exploratory trial showed that the Programme is feasible and acceptable and has the potential to change behaviours and affect weight status. This paper presents an overview of and recommendations arising from the conceptualization; development and evaluation of the Healthy Lifestyles Programme as part of a special issue focusing on novel approaches to the global problem of childhood obesity.
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Lloyd J, Wyatt K (2015). Uptake, retention and engagement of children participating in the cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP). Education and Health, 33(4), 88-95.
Lloyd JJ, Wyatt KM (2014). Qualitative findings from an exploratory trial of the Healthy Lifestyles Programme (HeLP) and their implications for the process evaluation in the definitive trial.
BMC Public Health,
14Abstract:
Qualitative findings from an exploratory trial of the Healthy Lifestyles Programme (HeLP) and their implications for the process evaluation in the definitive trial.
BACKGROUND: Approximately one third of 10-11 year olds in England are now overweight or obese suggesting that population approaches are urgently required. However, despite the increasing number of school-based interventions to prevent obesity, results continue to be inconsistent and it is still unclear what the necessary conditions are that lead to the sustained behaviour change required to affect weight status. The Healthy Lifestyles Programme is a theoretically informed four phase multi-component intervention which seeks to create supportive school and home environments for healthy behaviours. METHODS: a process evaluation has run alongside the exploratory trial of the Healthy Lifestyles Programme to ascertain the feasibility and acceptability of; the trial design (including the trial outcomes) and the HeLP Programme and whether it is able to engage schools, children and their families. Data was collected using interviews with teachers (n = 12) and parents (n = 17) and six focus groups with children (n = 47) and a questionnaire for parents of children in the intervention schools. Interview and focus group data relating to the intervention was analysed using framework analysis. RESULTS: Four schools and 201 children participated in the exploratory trial. The data showed that the trial design was feasible and acceptable for schools and children. Three themes emerged for the data in relation to the acceptability and feasibility of the HeLP Programme (value, compatibility with the curriculum and enjoyment) and two themes emerged in relation to engagement ('knowledge and awareness' and 'taking messages on board'). The latter could be broken down into 4 subthemes ('initiating discussion with family and friends', 'acceptance of family rules', 'increased responsibility' and 'the importance of the mode and agent of delivery'). The use of highly inclusive and interactive delivery methods where the children were encouraged to identify with and take ownership of the healthy lifestyle messages were identified as important factors in motivating the children to take the messages home, seek parental support and initiate family lifestyle behaviour change. CONCLUSION: the process evaluation of the exploratory trial has not only provided evidence of the feasibility and acceptability of the Programme, it has also allowed an understanding of how HeLP engages schools, children and their families. These findings have informed the process evaluation for the definitive trial.
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Wyatt K, Lloyd J (2013). Development of a novel, school located, obesity prevention programme, the healthy lifestyles programme (HeLP). Education and Health, 31(2), 89-95.
Wyatt KM, Lloyd JJ, Abraham C, Creanor S, Dean S, Densham E, Daurge W, Green C, Hillsdon M, Pearson V, et al (2013). The Healthy Lifestyles Programme (HeLP), a novel school-based intervention to prevent obesity in school children: study protocol for a randomised controlled trial.
Trials,
14Abstract:
The Healthy Lifestyles Programme (HeLP), a novel school-based intervention to prevent obesity in school children: study protocol for a randomised controlled trial.
Over the last three decades there has been a substantial increase in the proportion of children who are overweight or obese. The Healthy Lifestyles Programme (HeLP) is a novel school-based intervention, using highly interactive and creative delivery methods to prevent obesity in children.
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Lloyd JJ, Wyatt KM, Creanor S (2012). Behavioural and weight status outcomes from an exploratory trial of the Healthy Lifestyles Programme (HeLP): a novel school-based obesity prevention programme.
BMJ Open,
2(3).
Abstract:
Behavioural and weight status outcomes from an exploratory trial of the Healthy Lifestyles Programme (HeLP): a novel school-based obesity prevention programme.
To assess the behavioural and weight status outcomes in English children in a feasibility study of a novel primary school-based obesity prevention programme.
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Abraham C, Britten N, Dean S, Greaves C, Lloyd JJ, Poltawski L, Wyatt K (2012). Creating Change that Counts: Evidence-led Co-creation as a Pathway to Impact. European Health Psychologist, 14(3).
Green C, Auguste P, Lloyd JJ, Wyatt K (2012). Modelling future outcomes to estimate the cost effectiveness of interventions related to child and adolescent overweight and obesity. The Lancet
Lloyd JJ, Logan S, Greaves CJ, Wyatt KM (2011). Evidence, theory and context--using intervention mapping to develop a school-based intervention to prevent obesity in children.
Int J Behav Nutr Phys Act,
8Abstract:
Evidence, theory and context--using intervention mapping to develop a school-based intervention to prevent obesity in children.
BACKGROUND: Only limited data are available on the development and feasibility piloting of school-based interventions to prevent and reduce obesity in children. Clear documentation of the rationale, process of development and content of such interventions is essential to enable other researchers to understand why interventions succeed or fail. METHODS: This paper describes the development of the Healthy Lifestyles Programme (HeLP), a school-based intervention to prevent obesity in children, through the first 4 steps of the Intervention Mapping protocol (IM). The intervention focuses on the following health behaviours, i) reduction of the consumption of sweetened fizzy drinks, ii) increase in the proportion of healthy snacks consumed and iii) reduction of TV viewing and other screen-based activities, within the context of a wider attempt to improve diet and increase physical activity. RESULTS: Two phases of pilot work demonstrated that the intervention was acceptable and feasible for schools, children and their families and suggested areas for further refinement. Feedback from the first pilot phase suggested that the 9-10 year olds were both receptive to the messages and more able and willing to translate them into possible behaviour changes than older or younger children and engaged their families to the greatest extent. Performance objectives were mapped onto 3 three broad domains of behaviour change objectives--establish motivation, take action and stay motivated--in order to create an intervention that supports and enables behaviour change. Activities include whole school assemblies, parents evenings, sport/dance workshops, classroom based education lessons, interactive drama workshops and goal setting and runs over three school terms. CONCLUSION: the Intervention Mapping protocol was a useful tool in developing a feasible, theory based intervention aimed at motivating children and their families to make small sustainable changes to their eating and activity behaviours. Although the process was time consuming, this systematic approach ensures that the behaviour change techniques and delivery methods link directly to the Programme's performance objectives and their associated determinants. This in turn provides a clear framework for process analysis and increases the potential of the intervention to realise the desired outcome of preventing and reducing obesity in children.
Abstract.
Author URL.
Bond M, Wyatt K, Lloyd J, Taylor R (2011). Systematic review of the effectiveness of weight management schemes for the under fives.
Obes Rev,
12(4), 242-253.
Abstract:
Systematic review of the effectiveness of weight management schemes for the under fives.
Overweight and obesity in pre-school children are an increasing problem, with poor diet and exercise habits laying the foundation for serious health risks in later life. Yet most research into childhood obesity has focused on school-age children. Two previous systematic reviews of pre-school children have included uncontrolled designs and self-report outcomes potentially biasing the results in favour of the interventions. We have conducted a systematic review of the effectiveness and cost-effectiveness of weight management schemes for the under fives restricting the inclusion criteria to controlled trials with objective measures. We found four effectiveness randomized controlled trials of prevention. No treatment or cost-effectiveness studies were found. Only one study in a Latino community showed a statistically significant advantage from the intervention in a slower rate of increase in body mass index. However, trends in decrease in body mass index and weight loss favoured the intervention groups in other studies. From the studies characteristics we hypothesize that important features to include in future interventions may be; cultural sensitivity, sustained moderate to vigorous exercise, active engagement of the parents in the programme and as role models of healthy living and active engagement of the children in nutrition education. Further randomized controlled trials are needed in this population.
Abstract.
Author URL.
Wyatt KM, Lloyd, Creanor S, Logan GS (2011). The development, feasibility and acceptability of a school-based obesity prevention programme: results from three phases of piloting. British Medical Journal
Bond M, Wyatt K, Lloyd J, Welch K, Taylor R (2009). Systematic review of the effectiveness and cost-effectiveness of weight management schemes for the under fives: a short report.
Health Technol Assess,
13(61), 1-iii.
Abstract:
Systematic review of the effectiveness and cost-effectiveness of weight management schemes for the under fives: a short report.
OBJECTIVE: to search for, review and synthesise studies of the effectiveness and cost-effectiveness of weight management schemes for the under fives. DATA SOURCES: MEDLINE [Ovid], MEDLINE In-Process [Ovid], EMBASE [Ovid], CAB [Ovid], Health Management Information Consortium [Ovid], the Cochrane Database of Systematic Reviews, Cochrane Register of Controlled Trials, Science Citation Index Expanded [Web of Science], Conference Proceedings Citation Index [The Web of Science], Database of Abstract Reviews [CRD; Centre for Reviews and Dissemination], HTA [CRD], PsycINFO [Ebsco], NHS CRD. These databases were searched from 1990 to February 2009. Supplementary internet searches were additionally conducted. REVIEW METHODS: Relevant clinical effectiveness studies were identified in two stages. Titles and abstracts returned by the search strategy were examined independently by three researchers and screened for possible inclusion. Disagreements were resolved by discussion. Full texts of the identified studies were obtained. Three researchers examined these independently for inclusion or exclusion, and disagreements were again resolved by discussion. RESULTS: One of the randomised controlled trials (RCTs) was from the UK. It measured the effects of a physical activity intervention for children in nurseries combined with home-based health education for their parents; this was compared to usual care. The main outcome measure was body mass index (BMI); secondary measures were weight and physical activity. At the 12-month follow-up, no statistically significant differences were found between the groups on any measure. However, a trend, favouring the intervention, was found for BMI and weight. The other two RCTs were from the USA. The larger trial investigated the effects of a combined preschool and home intervention in African American and Latino communities. Nutrition education and physical activity programmes were aimed at under fives in preschool. The home component consisted of related health education and homework for the parents, who received a small financial reward on completion. The 1- and 2-year results for the African American sites showed a significantly slower rate of increase in BMI than for results at baseline, for the intervention group than for the control group. However, in the Latino communities no such differences were found. The second US trial was a much smaller home-based parental education programme in Native American communities in the USA and Canada. The intervention consisted of a parental skills course for parents to improve their children's diet and physical activity. This was compared with a course providing skills to improve child behaviour. Follow-up was at 16 weeks and showed no significant differences between groups in BMI. CONCLUSIONS: No controlled trials addressing the issue of treating obesity or evidence of cost-effectiveness studies in the under fives' population were found. From the three prevention studies, apart from the larger US trial, the interventions showed no statistically significant differences in BMI and weight between the intervention and control groups (although there was some evidence of positive trends for BMI and weight). It should also be noted that these conclusions are based on only three dissimilar studies, thereby making the drawing of firm conclusions difficult. Research is urgently needed in further well-designed UK-based RCTs of weight management schemes aimed at the prevention of obesity, that combine with cost-effectiveness studies targeted at preschool children with long-term follow-up.
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Author URL.
Fox KR, Sparkes A, Goudas M, Lloyd JJ, McNally J (1994). Commitment to intensive participation in sport in adolescent females. Journal of Sport Sciences, 12, 192-193.
Lloyd JJ, Fox KR (1992). Achievement goals and motivation to exercise in adolescent girls: a preliminary intervention study. British Journal of Physical Education Research Supplement, 11, 12-16.
Conferences
Lloyd J, Creanor S, Logan G, Green C, Dean S, Hillsdon M, Abraham C, Tomlinson R, Pearson V, Taylor R, et al (2018). Effectiveness of the Healthy Lifestyles Programme (HeLP) to prevent obesity in UK primary school children: a cluster randomised controlled trial. South West Public Health (SWPH) Scientific Conference.
Wyatt K, Lloyd J (2018). Embracing complexity; methodological and practical considerations for the development and evaluation of programmes which seek to create the conditions for health and reduce health inequalities. European Society for Prevention Research (EUSPR).
Axford N, Berry V, Lloyd J, Wyatt K, Hobbs T (2018). Embracing ‘failure’ in prevention science: how can we promote a more open and honest response to trial results showing that interventions ‘don’t work’ or cause harm?. European Society for Prevention Research (EUSPR). 23rd - 25th Oct 2018.
McHugh C, Anderson L, Lloyd J, Wyatt K (2018). The barriers to and facilitators of healthy lifestyle choices of adolescents transitioning to secondary school. South West Public Health Scientific Conference 2018. 13th - 13th Mar 2018.
Abstract:
The barriers to and facilitators of healthy lifestyle choices of adolescents transitioning to secondary school
Abstract.
Wyatt K, Lloyd J, Durie R (2018). Whose problem is it anyway? Co-identifying local issues to create the conditions for health. South West Public Health Conference.
Price L, Lloyd J, Wyatt K, Hillsdon M (2017). Children’s compliance with wrist worn accelerometry over multiple time points: Results from the Healthy Lifestyles Programme. South West Public Health Scientific Conference (SWPH).
Lloyd J, Creanor S, Streeter A, Green C, Dean S, Abraham C, Hillsdon M, Taylor R, Logan G, Tomlinson R, et al (2017). Effectiveness and cost effectiveness of the ‘Healthy Lifestyles Programme’ (HeLP) cluster randomised controlled trial: a school-based obesity prevention intervention for 9-10 year olds. ISBNPA.
Lloyd J (2017). Engaging schools, children and families across the socio-economic spectrum. South West Whole Systems Obesity Network: Prioritising investment in obesity prevention.
Lloyd J, Dean S, Abraham C, Creanor S, Green C, Hillsdon M, Taylor R, Logan G, Tomlinson R, Pearson V, et al (2017). Findings from the process evaluation of ‘Healthy Lifestyles Programme’ (HeLP) cluster randomised controlled trial: a school-based obesity prevention intervention for 9-10 year olds. International Society for Behavioural Nutrition and Physical. Activity (ISBNPA).
Lloyd J, Price LRS, Wyatt K, Hillsdon M (2017). Is there a relationship between how children accumulate moderate to vigorous physical activity and their BMI sds? Findings from the Healthy Lifestyles Programme (HeLP). International Soceity for Behavioural nutrition and physical activity. 7th - 10th Jun 2017.
Abstract:
Is there a relationship between how children accumulate moderate to vigorous physical activity and their BMI sds? Findings from the Healthy Lifestyles Programme (HeLP)
Abstract.
Lloyd J, Price LRS, Wyatt K, Hillsdon M (2017). Physical activity prevalence in children depends on our methodology:. Findings from the Healthy Lifestyles programme (HeLP). International society of behavioural nutrition and physical activity. 7th Jun - 10th Mar 2017.
Abstract:
Physical activity prevalence in children depends on our methodology:. Findings from the Healthy Lifestyles programme (HeLP)
Abstract.
Price L, Lloyd J, Wyatt K, Hillsdon M (2016). Accumulation of Physical activity in primary school children: the Healthy Lifestyles Programme (HeLP). SWPH.
Lloyd J, Creanor S, Dean S, Abraham C, Green C, Hillsdon M, Taylor R, Logan G, Tomlinson R, Pearson V, et al (2016). Engagement and retention of schools and their families in the cluster RCT of the healthy Lifestyles programme (HeLP). UK Society for Behaviour Medicine (UKSBM).
Lloyd J, Creanor S, Dean S, Abraham C, Green C, Hillsdon M, Taylor R, Logan G, Tomlinson R, Pearson V, et al (2016). Engagement and retention of schools, children and their families in a cluster RCT of a novel obesity prevention intervention: the Healthy Lifestyles programme (HeLP). ISBNPA.
Wyatt K, Lloyd J (2016). Using complex system principles to develop and trial a novel obesity prevention intervention: the Healthy Lifestyles Programme (HeLP). ISBNPA.
Lloyd J, Wyatt K (2015). A relational approach to the design and development of a complex intervention to prevent childhood obesity: Impact on recruitment and retention in a cluster RCT of the Healthy Lifestyles Programme (HeLP). SWPH.
Lloyd J, Logan G, Wyatt K (2015). The Healthy Lifestyles Programme (HeLP); Evidence of Feasibility, Acceptability and Proof of Concept in Affecting Children’s Weight Status. SWPH.
Lloyd J, Wyatt K (2014). Capturing fidelity and engagement within the process evaluation of the Healthy Lifestyles Programme (HeLP) trial. Process evaluation for complex behaviour change interventions symposium, UKSBM.
Wyatt K, Lloyd J (2014). The Healthy Lifestyles Programme; Development of a novel school located obesity prevention programme. British Science Festival.
Lloyd J, Wyatt K, Dean S, Abraham C (2014). The healthy Lifestyles programme (HeLP): creating the conditions for change and identifying change processes. Emerging Science in the design, evaluation and implementation of behaviour change intervention symposium, International Congress of Applied Psychology (ICAP).
Lloyd J, Logan G, Wyatt K (2013). The Healthy Lifestyles Programme (HeLP); Evidence of feasibility, acceptability and proof of concept in affecting children’s weight status. ISBNPA.
Wyatt K, Lloyd J, Dean S (2012). The Healthy Lifestyles Programme (HeLP); Creating the conditions for changing obesity related behaviours. UKSBM.
Lloyd J, Logan G, Wyatt K (2012). The Healthy Lifestyles Programme (HeLP); Evidence of feasibility, acceptability and proof of concept in affecting children’s weight status. UKSBM.
Lloyd J, Creanor S, Wyatt K (2011). Behavioural and weight status outcomes from an exploratory trial of the Healthy Lifestyles Programme (HeLP); a novel school-based obesity prevention programme. ISBM.
Lloyd J, Logan G, Wyatt K (2011). HeLP: a school-based programme to prevent and reduce obesity in children. ISBNPA.
Lloyd J, Logan G, Wyatt K (2009). The development and evaluation of a novel obesity prevention programme. International Society for Behavioural Medicine (ISBM).
