Publications by year
In Press
Ball S, McAndrew A, Aylward A, Cockcroft E, Gordon E, Kerridge A, Morgan-Trimmer S, Powell R, Price A, Rhodes S, et al (In Press). Detailed statistical analysis plan for a randomised controlled trial of the effects of a modified muscle sparing posterior technique (SPAIRE) in hip hemiarthroplasty for displaced intracapsular fractures on post-operative function compared to a standard. lateral approach: HemiSPAIRE.
TrialsAbstract:
Detailed statistical analysis plan for a randomised controlled trial of the effects of a modified muscle sparing posterior technique (SPAIRE) in hip hemiarthroplasty for displaced intracapsular fractures on post-operative function compared to a standard. lateral approach: HemiSPAIRE
Background: the HemiSPAIRE trial is being conducted to determine whether a modified
muscle sparing technique (SPAIRE - “Save Piriformis and Internus, Repairing Externus”) in
hip hemiarthroplasty brings clinical benefits compared to the standard lateral technique in
adults aged 60 years or older, with a displaced intracapsular hip fracture. This article describes
the detailed statistical analysis plan for the trial.
Methods and design: HemiSPAIRE is a definitive, pragmatic, superiority, multicentre,
randomised controlled trial (with internal pilot) with two parallel groups. Participants, ward
staff and all research staff involved in post-operative assessments are blinded to allocation.
This article describes in detail (1) the primary and secondary outcomes, (2) the statistical
analysis principles, including: a survivor average causal effect (SACE) method chosen
specifically to address the issue of potential bias from differential survival between trial arms,
which was seen from data review by the Trial Steering Committee; the participants that will be
included in each analysis; the covariates that will be included in each analysis, and how the
results will be presented, (3) planned main analysis of the primary outcome; (4) planned
analyses of the secondary outcomes, (5) planned additional analyses of the primary and
secondary outcomes.
Abstract.
Clare L, Kudlicka A, Oyebode JR, Jones RW, Bayer A, Leroi I, Kopelman M, James IA, Culverwell A, Pool J, et al (In Press). Goal-oriented cognitive Rehabilitation in Early-stage Alzheimer’s and related dementias: a multi-centre single-blind randomised controlled Trial (GREAT). Health Technology Assessment
Chestnutt IG, Hutchings S, Playle R, Morgan-Trimmer SA, Fitzsimmons D, Aawar N, Angel L, Derrick S, Drew C, Hoddell C, et al (In Press). Seal or Varnish? a randomised controlled trial to determine the relative cost and effectiveness of pit and fissure sealant and fluoride varnish in preventing dental decay. Health Technology Assessment
Alzehr A, Hulme C, Spencer A, Morgan-Trimmer S (In Press). The Economic Impact of Cancer Diagnosis to Individuals and Their Families: a Systematic Review.
Supportive Care in CancerAbstract:
The Economic Impact of Cancer Diagnosis to Individuals and Their Families: a Systematic Review
Background: the effect of a cancer diagnosis is wide ranging with the potential to affect income, employment and risk of poverty. The aim of this systematic review is to identify the economic impact of a cancer diagnosis for patients and their families/caregivers.
Methods: the search covered peer-reviewed journals using MEDLINE, EMBASE, CINAHL, Cochrane Library, Epistemonikos and PsycINFO databases. Quality appraisal was undertaken using CASP tools. Monetary values were converted to US Dollars/2019 using a purchasing power parities (PPP) conversion factor. The review included articles up to and including January 2020, written in English language, for patients with cancer aged ≥18 years and focused on the costs up to five years following a cancer diagnosis.
Results: the search was run in January 2020 and updated in November 2021. of 7973 articles identified, 18 met the inclusion criteria. Studies were undertaken in the USA, Ireland, Canada, Australia, France, UK, Malaysia, Pakistan, China and Sri Lanka. The majority were cohort studies. Twelve reported out-of-pocket costs (range US$16–US$2,523/month per patient/caregiver) consisting of medical expenses (e.g. surgery, radiotherapy and chemotherapy) and non-medical expenses (e.g. travel, food and childcare). Fourteen studies reported patient/caregiver loss of income and lost productivity (range 14–57.8%).
Conclusions: a high percentage of cancer patients and their families/caregivers experience out-of-pocket expenditure, loss of income and lost productivity. Future research is needed to observe the effects of continuing changes to healthcare policies and social protections on the economic burden among cancer patients and their families/caregivers.
Abstract.
Poltawski L, Van Beurden S, Morgan-Trimmer S, Greaves C (In Press). The dynamics of decision-making in weight loss and maintenance: a qualitative enquiry. BMC Public Health
2023
Raghuraman S, Richards E, Morgan-Trimmer S, Clare L, Anderson R, Goodwin V, Allan L (2023). 1354 USING REALIST PROGRAMME THEORY TO DESIGN a NEW INTERVENTION FOR IMPROVING RECOVERY AFTER DELIRIUM. Age and Ageing, 52(Supplement_1).
2022
Ball S, McAndrew A, Aylward A, Cockcroft E, Gordon E, Kerridge A, Morgan-Trimmer S, Powell R, Rhodes S, Timperley AJ, et al (2022). Detailed statistical analysis plan for a randomised controlled trial of the effects of a modified muscle sparing posterior technique (SPAIRE) in hip hemiarthroplasty for displaced intracapsular fractures on post-operative function compared to a standard lateral approach: HemiSPAIRE.
Griffiths S, Weston L, Morgan-Trimmer S, Wheat H, Gude A, Manger L, Oh TM, Clarkson P, Quinn C, Sheaff R, et al (2022). Engaging Stakeholders in Realist Programme Theory Building: Insights from the Prospective Phase of a Primary Care Dementia Support Study. International Journal of Qualitative Methods, 21
Wyman DL, Butler L, Cooper C, Bright P, Morgan-Trimmer S, Barber J (2022). Process evaluation of the New Interventions for independence in Dementia Study (NIDUS) Family stream randomised controlled trial: protocol.
BMJ Open,
12(6).
Abstract:
Process evaluation of the New Interventions for independence in Dementia Study (NIDUS) Family stream randomised controlled trial: protocol.
INTRODUCTION: New Interventions for independence in Dementia Study (NIDUS)-Family is an Alzheimer's Society funded new manualised, multimodal psychosocial intervention to support people living with dementia (PLWD) to achieve goals that they and their family carers set, towards living as independently and as well as possible at home for longer. This process evaluation will be embedded within the NIDUS-Family Randomised Controlled Trial intervention-arm (n=199), testing how the intervention influences change, as measured by goal attainment. The evaluation will test, refine and develop the NIDUS-Family theoretical model, associated causal assumptions and logic model to identify key mechanisms of impact, implementation and contextual factors influencing the intervention's effectiveness. Findings will inform how the programme is implemented in practice. METHODS AND ANALYSIS: the process evaluation will be theory driven and apply a convergent mixed-methods design. Dyads (PLWD and family carer) will be purposively sampled based on high or low Goal Attainment Scaling scores (trial primary outcome). Qualitative interviews with dyads (approx. n=30) and their respective facilitators post-trial will explore their experiences of receiving and delivering the intervention. Interviews will be iteratively thematically analysed. Matching observational quantitative data will be collected concurrently from videorecordings and/or audiorecordings of NIDUS-Family dyad trial sessions. Further quantitative data will be collected through an acceptability questionnaire for all intervention-arm dyads (n=199). Mixed-method integration will use an interactive analysis strategy, considering qualitative and quantitative findings through mixed-method matrix for dyadic level 'case studies', and a joint display for 'population' level analysis and interpretation. ETHICS AND DISSEMINATION: Ethical approval was received from Camden & Kings Cross Research Ethics Committee (REC). Study reference: 19/LO/1667. IRAS project ID: 271 363. This work is carried out within the UCL Alzheimer's Society Centre of Excellence (grant 300) for Independence at home, NIDUS programme.Findings will be disseminated through publications and conferences, and as recommendations for the implementation study and strategy. TRIAL REGISTRATION NUMBER: ISRCTN11425138.
Abstract.
Author URL.
Poppe M, Duffy L, Marchant N, Barber J, Hunter R, Bass N, Minihane A, Walters K, Higgs P, Rapaport P, et al (2022). The APPLE Tree programme: Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce: Randomised Controlled Trial.
Poppe M, Duffy L, Marchant NL, Barber JA, Hunter R, Bass N, Minihane AM, Walters K, Higgs P, Rapaport P, et al (2022). The APPLE Tree programme: Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce—randomised controlled trial.
Trials,
23(1).
Abstract:
The APPLE Tree programme: Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce—randomised controlled trial
Abstract
. Background
. Large-scale trials of multidomain interventions show that modifying lifestyle and psychological risk factors can slow cognitive decline. We aim to determine if a lower intensity, personally tailored secondary dementia prevention programme for older people with subjective or mild objective memory decline, informed by behaviour change theory, reduces cognitive decline over 2 years.
.
. Methods
. A multi-site, single-blind randomised controlled trial recruiting 704 older adults at high dementia risk due to mild cognitive impairment (MCI) or subjective cognitive decline (SCD). Participants are randomised using 1:1 allocation ratio to the APPLE Tree intervention versus control arm (dementia prevention information), stratified by site. The intervention explores and implements strategies to promote healthy lifestyle, increase pleasurable activities and social connections and improve long-term condition self-management. Two facilitators trained and supervised by a clinical psychologist deliver ten, 1-h group video call sessions over 6 months (approximately every fortnight), video-call ‘tea breaks’ (less structured, facilitated social sessions) in intervening weeks and individual goal-setting phone calls every 2 weeks. From 6 to 12 months, participants meet monthly for ‘tea breaks’, with those not attending receiving monthly goal-setting phone calls. Participants receive a food delivery, pedometer and website access to cognitive training and information about lifestyle modification. Follow-ups for all outcome measures are at 12 and 24 months. The primary outcome is cognition (Neuropsychological Test Battery (NTB) score) at 24 months. Secondary outcomes are quality of life, cost per quality-adjusted life year (QALY) and wellbeing and lifestyle factors the intervention targets (diet, vascular risk, body weight, activity, sleep, anxiety, depression, social networks and loneliness, alcohol intake and smoking). Participants from purposively selected sites participate in qualitative process evaluation interviews, which will be analysed using thematic analytic methods.
.
. Discussion
. If effective, the intervention design, involving remote delivery and non-clinical facilitators, would facilitate intervention roll-out to older people with memory concerns.
.
. Trial registration
. ISRCTN17325135. Registration date 27 November 2019
.
Abstract.
2021
Luscombe N, Morgan-Trimmer S, Savage S, Allan L (2021). Digital technologies to support people living with dementia in the care home setting to engage in meaningful occupations: protocol for a scoping review.
Syst Rev,
10(1).
Abstract:
Digital technologies to support people living with dementia in the care home setting to engage in meaningful occupations: protocol for a scoping review.
BACKGROUND: People living with all stages of dementia should have the opportunity to participate in meaningful occupations. For those living in care homes, this may not always occur and residents may spend significant parts of the day unengaged, especially those living with more advanced dementia. Digital technologies are increasingly being used in health care and could provide opportunities for people living with dementia (PLWD) in care homes to engage in meaningful occupations and support care staff to provide these activities. With technology advancing at a rapid rate, the objective of this scoping review is to provide an up-to-date systematic map of the research on the diverse range of digital technologies that support engagement in meaningful occupations. In particular, focus will be given to barriers and facilitators to inform future intervention design and implementation strategies, which have not yet been clearly mapped across the full range of these digital technologies. METHOD: a scoping review will be conducted to systematically search for published research using a comprehensive search strategy on thirteen databases. Published, peer-reviewed studies that focused on PLWD in the care home setting and assessed any form of digital technology that supported a meaningful occupation will be included. All methodologies which meet the criteria will be included. Data will be extracted and charted to report the range of digital technologies, underlying mechanisms of action, facilitators and barriers to implementation. DISCUSSION: Mapping the range of technologies to support PLWD to engage in meaningful occupations will identify gaps in research. The systematic search will include a diverse range of technologies such as software to enhance care planning, tablets devices, smartphones, communication robots and social media platforms, rather than focussing on a specific design or interface. This will enable comparison between mechanisms of action, barriers and facilitators to implementation which will be useful for future research and intervention design. TRIAL REGISTRATION: Open Science Framework https://doi.org/10.17605/OSF.IO/7UDM2.
Abstract.
Author URL.
Price A, Ball S, Rhodes S, Wickins R, Gordon E, Aylward A, Cockcroft E, Morgan-Trimmer S, Powell R, Timperley J, et al (2021). Effects of a modified muscle sparing posterior technique in hip hemiarthroplasty for displaced intracapsular fractures on postoperative function compared to a standard lateral approach (HemiSPAIRE): protocol for a randomised controlled trial.
BMJ Open,
11(6), e045652-e045652.
Abstract:
Effects of a modified muscle sparing posterior technique in hip hemiarthroplasty for displaced intracapsular fractures on postoperative function compared to a standard lateral approach (HemiSPAIRE): protocol for a randomised controlled trial
IntroductionCurrently National Institute for Health and Care Excellence clinical guidelines in the UK suggest that surgeons performing partial hip replacements (hemiarthroplasty) should consider using the lateral approach. Alternatively, a newer, modified posterior approach using a muscle sparing technique named ‘Save Piriformis and Internus, Repairing Externus’ (SPAIRE) can be used leaving the major muscles intact. This randomised controlled trial (RCT) aims to compare the SPAIRE approach to the standard lateral approach, to determine if it allows patients to mobilise better and experience improved function after surgery.Methods and analysisHemiSPAIRE is a two-arm, assessor-blinded, definitive pragmatic RCT with nested pilot and qualitative studies. Two hundred and twenty-eight participants with displaced intracapsular fractures requiring hip hemiarthroplasty will be individually randomised 1:1 to either the SPAIRE, or control (standard lateral approach) surgical procedure. Outcomes will be assessed at postoperative day 3 (POD3) and 120 (POD120). The primary outcome measure will be level of function and mobility using the Oxford Hip Score at POD120. Secondary outcomes include: De Morton Mobility Index (DEMMI), Cumulated Ambulatory Score and Numeric Pain Rating Scale (NPRS) at POD3; DEMMI, NPRS and EQ-5D-5L at POD120, complications, acute and total length of hospital stay, and mortality. Primary analysis will be on an intention-to-treat basis. Participant experiences of the impact of surgery and recovery period will be examined via up to 20 semi-structured telephone interviews.Ethics and disseminationThe protocol has been approved by Yorkshire and the Humber—Bradford Leeds Research Ethics Committee. Recruitment commenced in November 2019. Findings will be disseminated via research articles in peer-reviewed journals, presentations at conferences, public involvement events, patient groups and media releases. A summary of the trial findings will be shared with participants at the end of the study.Trial registration numberNCT04095611.
Abstract.
Morgan-Trimmer S, Kudlicka A, Warmoth K, Leroi I, Oyebode JR, Pool J, Woods R, Clare L (2021). Implementation processes in a cognitive rehabilitation intervention for people with dementia: a complexity-informed qualitative analysis.
BMJ Open,
11(10), e051255-e051255.
Abstract:
Implementation processes in a cognitive rehabilitation intervention for people with dementia: a complexity-informed qualitative analysis
ObjectivesHealthcare is often delivered through complex interventions. Understanding how to implement these successfully is important for optimising services. This article demonstrates how the complexity theory concept of ‘self-organisation’ can inform implementation, drawing on a process evaluation within a randomised controlled trial of the GREAT (Goal-oriented cognitive Rehabilitation in Early-stage Alzheimer’s and related dementias: a multi-centre single-blind randomised controlled Trial) intervention which compared a cognitive rehabilitation intervention for people with dementia with usual treatment.DesignA process evaluation examined experiences of GREAT therapists and participants receiving the intervention, through thematic analysis of a focus group with therapists and interviews with participants and their carers. Therapy records of participants receiving the intervention were also analysed using adapted framework analysis. Analysis adopted a critical realist perspective and a deductive-inductive approach to identify patterns in how the intervention operated.SettingThe GREAT intervention was delivered through home visits by therapists, in eight regions in the UK.ParticipantsSix therapists took part in a focus group, interviews were conducted with 25 participants and 26 carers, and therapy logs for 50 participants were analysed.InterventionA 16-week cognitive rehabilitation programme for people with mild-to-moderate dementia.Results‘Self-organisation’ of the intervention occurred through adaptations made by therapists. Adaptations included simplifying the intervention for people with greater cognitive impairment, and extending it to meet additional needs. Relational work by therapists produced an emergent outcome of ‘social support’. Self-organised aspects of the intervention were less visible than formal components, but were important aspects of how it operated during the trial. This understanding can help to inform future implementation.ConclusionsResearchers are increasingly adopting complexity theory to understand interventions. This study extends the application of complexity theory by demonstrating how ‘self-organisation’ was a useful concept for understanding aspects of the intervention that would have been missed by focusing on formal intervention components. Analysis of self-organisation could enhance future process evaluations and implementation studies.Trial registration numberISRCTN21027481.
Abstract.
Cooper C, Mansour H, Carter C, Rapaport P, Morgan-Trimmer S, Marchant NL, Poppe M, Higgs P, Brierley J, Solomon N, et al (2021). Social connectedness and dementia prevention: Pilot of the APPLE-Tree video-call intervention during the Covid-19 pandemic.
Dementia (London),
20(8), 2779-2801.
Abstract:
Social connectedness and dementia prevention: Pilot of the APPLE-Tree video-call intervention during the Covid-19 pandemic.
BACKGROUND AND OBJECTIVES: the Covid-19 pandemic reduced access to social activities and routine health care that are central to dementia prevention. We developed a group-based, video-call, cognitive well-being intervention; and investigated its acceptability and feasibility; exploring through participants' accounts how the intervention was experienced and used in the pandemic context. RESEARCH DESIGN AND METHOD: We recruited adults aged 60+ years with memory concerns (without dementia). Participants completed baseline assessments and qualitative interviews/focus groups before and after the 10-week intervention. Qualitative interview data and facilitator notes were integrated in a thematic analysis. RESULTS: 12/17 participants approached completed baseline assessments, attended 100/120 (83.3%) intervention sessions and met 140/170 (82.4%) of goals set. Most had not used video calling before. In the thematic analysis, our overarching theme was social connectedness. Three sub-themes were as follows: Retaining independence and social connectedness: social connectedness could not be at the expense of independence; Adapting social connectedness in the pandemic: participants strived to compensate for previous social connectedness as the pandemic reduced support networks; Managing social connections within and through the intervention: although there were tensions, for example, between sharing of achievements feeling supportive and competitive, participants engaged with various lifestyle changes; social connections supported group attendance and implementation of lifestyle changes. DISCUSSION AND IMPLICATIONS: Our intervention was acceptable and feasible to deliver by group video-call. We argue that dementia prevention is both an individual and societal concern. For more vulnerable populations, messages that lifestyle change can help memory should be communicated alongside supportive, relational approaches to enabling lifestyle changes.
Abstract.
Author URL.
2020
Poppe M, Mansour H, Rapaport P, Palomo M, Burton A, Morgan-Trimmer S, Carter C, Roche M, Higgs P, Walker Z, et al (2020). "Falling through the cracks"; Stakeholders' views around the concept and diagnosis of mild cognitive impairment and their understanding of dementia prevention.
Int J Geriatr Psychiatry,
35(11), 1349-1357.
Abstract:
"Falling through the cracks"; Stakeholders' views around the concept and diagnosis of mild cognitive impairment and their understanding of dementia prevention.
OBJECTIVES: Many people live with an awareness of mild cognitive changes that increase their dementia risk. Previous authors describe the uncertainties of this liminal state, between cognitive health and dementia, where being "at risk" can itself be an illness. We ask how services respond to people with memory concerns currently, and how a future, effective and inclusive dementia prevention intervention might be structured for people with memory concerns. METHODS/DESIGN: We conducted qualitative interviews with 18 people aged 60+ years with subjective or objective memory problems, six family members, 10 health and social care professionals and 11 third sector workers. Interviews were audio-recorded, transcribed and analysed using an inductive thematic approach. RESULTS: Three main themes were identified: (1) acknowledging the liminal state, compounded by current, discordant health service responses: medicalising memory concerns yet situating responsibilities for their management with patients and families; (2) enabling change in challenging contexts of physical and cognitive frailty and social disengagement and (3) building on existing values, cultures and routines. CONCLUSIONS: Effective dementia prevention must empower individuals to make lifestyle changes within challenging contexts. Programmes must be evidence based yet sufficiently flexible to allow new activities to be fitted into people's current lives; and mindful of the risks of pathologising memory concerns. Most current memory services are neither commissioned, financially or clinically resourced to support people with memory concerns without dementia. Effective, large scale dementia prevention will require a broad societal response.
Abstract.
Author URL.
Cooper C, Aguirre E, Barber JA, Bass N, Brodaty H, Burton A, Higgs P, Hunter R, Huntley J, Lang I, et al (2020). APPLE-Tree (Active Prevention in People at risk of dementia: Lifestyle, bEhaviour change and Technology to REducE cognitive and functional decline) programme: Protocol.
Int J Geriatr Psychiatry,
35(8), 811-819.
Abstract:
APPLE-Tree (Active Prevention in People at risk of dementia: Lifestyle, bEhaviour change and Technology to REducE cognitive and functional decline) programme: Protocol.
BACKGROUND: Observational studies indicate that approximately a third of dementia cases are attributable to modifiable cardiometabolic, physical and mental health, and social and lifestyle risk factors. There is evidence that intensive behaviour change interventions targeting these factors can reduce cognitive decline. [Figure: see text] METHODS AND ANALYSIS: We will design and test a low intensity, secondary dementia-prevention programme (Active Prevention in People at risk of dementia: Lifestyle, bEhaviour change and Technology to REducE cognitive and functional decline, "APPLE-Tree") to slow cognitive decline in people with subjective cognitive decline with or without objective cognitive impairment. We will embed our work within social science research to understand how dementia prevention is currently delivered and structured. We will carry out systematic reviews and around 50 qualitative interviews with stakeholders, using findings to coproduce the APPLE-Tree intervention. We plan a 10-session group intervention, involving personalised goal-setting, with individual sessions for those unable or unwilling to attend groups, delivered by psychology assistants who will be trained and supervised by clinical psychologists. The coproduction group (including public and patient involvement [PPI], academic and clinical/third-sector professional representatives) will use the Behaviour Change Wheel theoretical framework to develop it. We will recruit and randomly allocate 704 participants, 1:1 to the intervention: informational control group. This sample size is sufficient to detect a between-group difference at 2 years of 0.15 on the primary outcome (cognition: modified neuropsychological test battery; 90% power, 5% significance, effect size 0.25, SD 0.6). DISSEMINATION: We will work with Public Health England and third-sector partners to produce an effective national implementation approach, so that if our intervention works, it is used in practice.
Abstract.
Author URL.
Bleiker J (2020). An Inquiry into Compassion in Diagnostic Radiography.
Abstract:
An Inquiry into Compassion in Diagnostic Radiography
Compassion is a poorly understood concept in Diagnostic Imaging (DI), but an increase in its focus was recommended in the Francis Report (2013). Much of the healthcare literature including policy and protocol has focussed on benchmarking and individualising compassion. This project aimed to conceptualise compassion in order to understand its meaning and application in DI.
A constructivist approach was taken with appropriate ethical approval. Thirty-four semi-structured interviews with a purposive sample of DI ex-patients, five focus groups with approximately six student radiographers and one group of recently qualified radiographers were conducted. Tweets were also harvested from a Twitter journal club discussion between radiographers of the author’s published literature review. Data were transcribed and analysed thematically.
Compassion in DI is conceptualised according to three themes constructed from the data: 1) Perceptible elements of the procedure; 2) Underlying qualities, skills and abilities of radiographers; 3) Proposed moral and ethical principles. Perceptions of an impersonal ‘production-line’ procedure can be avoided and rapport developed by exercising skills and abilities in asking patient-specific clinical questions and giving explanations. Offering information to patients about their x-ray images may compassionately reduce uncertainty and anxiety. Ethically good practice need not necessarily involve in every interaction expressions of compassion, feelings in a radiographer of caring about their patient or feelings in patients of being valued. Contradictory organisational values were exposed with an over-emphasis on individuals’ responsibility for providing compassionate care.
The original contribution to knowledge is a concept of compassion bespoke to DI, components of which include qualities, skills and values underpinning perceptible acts and behaviours aimed at ameliorating suffering. Radiographers could take a proactive and critically questioning stance to the conflicting demands of efficiency and throughput at the expense of patient care. Clinical and communication skills teaching and reflective learning would promote compassionate professionalism. Compassionate future healthcare policy could be derived from an interpersonal rather than individualist philosophy.
Abstract.
Simpson SA, Matthews L, Pugmire J, McConnachie A, McIntosh E, Coulman E, Hughes K, Kelson M, Morgan-Trimmer S, Murphy S, et al (2020). An app-, web- and social support-based weight loss intervention for adults with obesity: the 'HelpMeDoIt!' feasibility randomised controlled trial.
Pilot Feasibility Stud,
6Abstract:
An app-, web- and social support-based weight loss intervention for adults with obesity: the 'HelpMeDoIt!' feasibility randomised controlled trial.
BACKGROUND: Social support has an important role in successful weight loss. The aim of this study was to assess the feasibility and acceptability of an app-, web- and social support-based intervention in supporting adults with obesity to achieve weight loss. METHODS: the intervention and evaluation methods were tested in a feasibility randomised controlled trial. Adults in the Greater Glasgow and Clyde Health Board area of Scotland with a body mass index ≥ 30 kg/m2 were recruited and randomised 2:1 (intervention to control). The feasibility and acceptability of the intervention and trial methods were assessed against pre-specified progression criteria, via process, economic and outcome evaluation. Three primary outcomes were explored: BMI, diet and physical activity, as well as a number of secondary outcomes. The intervention group had access to the HelpMeDoIt! intervention for 12 months. This encouraged them to (i) set goals, (ii) monitor progress and (iii) harness social support by inviting 'helpers' from their existing social network. The control group received a healthy lifestyle leaflet. RESULTS: One hundred and nine participants were recruited, with 84 participants (77%) followed-up at 12 months. The intervention and trial methods were feasible and acceptable. Participants and helpers were generally positive. of the 54 (74%) participants who downloaded the app, 48 (89%) used it. Interview data indicated that HelpMeDoIt! promoted social support from existing social networks to support weight loss. This support was often given outside of the app.Outcomes were compared using linear regression models, with randomised group, the baseline measurement of the outcome, age and gender as predictor variables. These analyses were exploratory and underpowered to detect effects. However, all pre-specified primary outcome effects (BMI, diet and physical activity) had wide confidence intervals and were therefore consistent with clinically relevant benefits. Objective physical activity measures perhaps showed most potential (daily step count (p = 0.098; 1187 steps [- 180, 2555])) and sedentary time (p = 0.022; - 60.8 min [- 110.5, - 11.0]). However, these outcomes were poorly completed. CONCLUSIONS: the study demonstrated that a novel social support intervention involving support from participants' close social networks, delivered via app and website, has potential to promote weight loss and is feasible and acceptable. TRIAL REGISTRATION: ISRCTN, ISRCTN85615983. Registered 25 September 2014.
Abstract.
Author URL.
Simpson SA, Matthews L, Pugmire J, McConnachie A, McIntosh E, Coulman E, Hughes K, Kelson M, Morgan-Trimmer S, Murphy S, et al (2020). An app-, web- and social support-based weight loss intervention for adults with obesity: the HelpMeDoIt! feasibility RCT.
Public Health Research,
8(3), 1-270.
Abstract:
An app-, web- and social support-based weight loss intervention for adults with obesity: the HelpMeDoIt! feasibility RCT
. Background
. Finding solutions to rising levels of obesity continues to be a major public health focus. Social support has an important role in successful weight loss, and digital interventions can reach a large proportion of the population at low cost.
.
.
. Objective
. To develop and assess the feasibility and acceptability of an application (app), web- and social support-based intervention in supporting adults with obesity to achieve weight loss goals.
.
.
. Design
. Stage 1 – intervention development phase involved three focus groups (n = 10) with users, and think-aloud interviews and field testing with another group (n = 28). Stage 2 – the intervention and evaluation methods were explored in a feasibility randomised controlled trial with economic and process evaluation.
.
.
. Setting
. Greater Glasgow and Clyde, UK.
.
.
. Participants
. Adults with a body mass index of ≥ 30kg/m2 who owned a smartphone and were interested in losing weight were randomised 2 : 1 (intervention : control) and followed up at 12 months. Recruitment took place in April–October 2016.
.
.
. Interventions
. The intervention group had access to HelpMeDoIt! for 12 months. This encouraged them to (1) set goals, (2) monitor progress and (3) harness social support by inviting ‘helpers’ from their existing social network. The control group received a healthy lifestyle leaflet.
.
.
. Main outcome measures
. Data from stage 1 informed the intervention design. Key measures in stage 2 assessed the feasibility and acceptability of the intervention and trial methods against prespecified progression criteria. Three primary outcomes were explored: body mass index, diet and physical activity. Secondary outcomes included weight, waist and hip circumference, social support, self-efficacy, motivation, mental health, health-related quality of life, NHS resource use, participant-borne costs and intervention costs. Qualitative interviews with participants (n = 26) and helpers (n = 9) explored the feasibility and acceptability of the trial methods and intervention.
.
.
. Results
. Stage 1 produced (1) a website that provided evidence-based information for lifestyle change and harnessing social support, and (2) an app that facilitated goal-setting, self-monitoring and supportive interaction between participants and their helper(s). Progression criteria were met, demonstrating that the intervention and trial methods were feasible and acceptable. A total of 109 participants (intervention, n = 73; control, n = 36) were recruited, with 84 participants (77%: intervention, 71%; control, 89%) followed up at 12 months. Data were successfully collected for most outcome measures (≥ 82% completion). Participants and helpers were generally positive, although helper engagement with the app was low. of the 54 (74%) participants who downloaded the app, 48 (89%) used it twice or more, 28 helpers enrolled via the app, and 19 (36%) participants interacted with their helper(s) via the app. Interview data indicated that HelpMeDoIt! prompted support from helpers that often occurred without the helpers using the app.
.
.
. Limitations
. Early technical problems meant that some participants and helpers had difficulty accessing the app. Ethical constraints meant that we were unable to contact helpers directly for interview.
.
.
. Conclusions
. The HelpMeDoIt! study demonstrated that a weight loss intervention delivered via an app and a website is feasible and acceptable. Progression criteria were met, supporting further evaluation of the intervention.
.
.
. Future work
. To further explore (1) the motivation and engagement of helpers, (2) the programme theory and (3) the effectiveness and cost-effectiveness of the intervention.
.
.
. Trial registration
. Current Controlled Trials ISRCTN85615983.
.
.
. Funding
. This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 3. See the NIHR Journals Library website for further project information.
.
Abstract.
Mansour H, Whitty E, Aguirre E, Palomo M, Charlesworth G, Ramjee S, Poppe M, Brodaty H, Kales HC, Morgan‐Trimmer S, et al (2020). Effectiveness of lifestyle and psychosocial interventions in reducing cognitive decline in older people: Systematic review. Alzheimer's & Dementia, 16(S7).
Whitty E, Mansour H, Aguirre E, Palomo M, Charlesworth G, Ramjee S, Poppe M, Brodaty H, Kales HC, Morgan-Trimmer S, et al (2020). Efficacy of lifestyle and psychosocial interventions in reducing cognitive decline in older people: Systematic review.
Ageing Res Rev,
62Abstract:
Efficacy of lifestyle and psychosocial interventions in reducing cognitive decline in older people: Systematic review.
It is unclear what non-pharmacological interventions to prevent cognitive decline should comprise. We systematically reviewed lifestyle and psychosocial interventions that aimed to reduce cognitive decline in healthy people aged 50+, and people of any age with Subjective Cognitive Decline or Mild Cognitive Impairment. We narratively synthesised evidence, prioritising results from studies rated as at lower Risk of Bias (ROB) and assigning Centre for Evidence Based Medicine grades. We included 64 papers, describing: psychosocial (n = 12), multi-domain (n = 10), exercise (n = 36), and dietary (n = 6) interventions. We found Grade a evidence that over 4+ months: aerobic exercise twice weekly had a moderate effect on global cognition in people with/ without MCI; and interventions that integrate cognitive and motor challenges (e.g. dance, dumb bell training) had small to moderate effects on memory or global cognition in people with MCI. We found Grade B evidence that 4+ months of creative art or story-telling groups in people with MCI; 6 months of resistance training in people with MCI and a two-year, dietary, exercise, cognitive training and social intervention in people with or without MCI had small, positive effects on global cognition. Effects for some intervention remained up to a year beyond facilitated sessions.
Abstract.
Author URL.
O’Rourke G, Parker D, Anderson R, Morgan-Trimmer S, Allan L (2020). Interventions to support recovery following an episode of delirium: a realist synthesis. Aging & Mental Health, 25(10), 1769-1785.
Warmoth K, Morgan-Trimmer S, Kudlicka A, Toms G, James IA, Woods B (2020). Reflections on a personalized cognitive rehabilitation intervention: Experiences of people living with dementia and their carers participating in the GREAT trial. Neuropsychological Rehabilitation, 32(2), 268-286.
Poppe M, Mansour H, Rapaport P, Palomo M, Burton A, Morgan‐Trimmer S, Carter C, Roche M, Higgs P, Walker Z, et al (2020). Stakeholders’ views around the concept and diagnosis of mild cognitive impairment and their understanding of dementia prevention: a qualitative study. Alzheimer's & Dementia, 16(S7).
Bleiker J, Knapp K, Morgan-Trimmer S, Hopkins S (2020). What Medical Imaging Professionals Talk About When They Talk About Compassion. Journal of Medical Imaging and Radiation Sciences, 51(4), S44-S52.
2019
Borek AJ, Smith JR, Greaves CJ, Gillison F, Tarrant M, Morgan-Trimmer SA, McCabe R, Abraham SCS (2019). Developing and applying a framework to understand mechanisms of action in group-based, behaviour change interventions: the MAGI mixed-methods study.
Efficacy and Mechanism Evaluation,
6(3), 1-162.
Abstract:
Developing and applying a framework to understand mechanisms of action in group-based, behaviour change interventions: the MAGI mixed-methods study
Background
Theories and meta-analyses have elucidated individual-level mechanisms of action in behaviour change interventions. Although group-based interventions are commonly used to support health-related behaviour change, such interventions rarely consider theory and research (e.g. from social psychology) on how group-level mechanisms can also influence personal change.
Objectives
The aim was to enhance understanding of mechanisms of action in group-based behaviour change interventions. The objectives were to (1) develop a potentially generalisable framework of change processes in groups, (2) test the framework by analysing group session recordings to identify examples illustrating group processes and facilitation techniques and (3) explore links between group-level mechanisms and outcomes.
Data sources
In this mixed-methods study, the research team reviewed literature, conducted consultations and analysed secondary data (i.e. delivery materials and 46 audio-recordings of group sessions) from three group-based weight loss interventions targeting diet and physical activity: ‘Living Well Taking Control’ (LWTC), ‘Skills for weight loss Maintenance’ and ‘Waste the Waist’. Quantitative LWTC programme data on participant characteristics, attendance and outcomes (primarily weight loss) were also used.
Methods
Objectives were addressed in three stages. In stage 1, a framework of change processes in groups was developed by reviewing literature on groups (including theories, taxonomies of types of change techniques, qualitative studies and measures of group processes), analysing transcripts of 10 diverse group sessions and consulting with four group participants, four facilitators and 31 researchers. In stage 2, the framework was applied in analysing 28 further group sessions. In stage 3, group-level descriptive analyses of available quantitative data from 67 groups and in-depth qualitative analyses of two groups for which comprehensive quantitative and qualitative data were available were conducted to illustrate mixed-methods approaches for exploring links between group processes and outcomes.
Results
Stage 1 resulted in development of the ‘Mechanisms of Action in Group-based Interventions’ (MAGI) framework and definitions, encompassing group intervention design features, facilitation techniques, group dynamic and development processes, interpersonal change processes, selective intrapersonal change processes operating in groups, and contextual factors. In stage 2, a coding schema was developed, refined and applied to identify examples of framework components in group sessions, confirming the content validity of the framework for weight loss interventions. Stage 3 demonstrated considerable variability in group characteristics and outcomes and illustrated how the framework could be applied in integrating group-level qualitative and quantitative data to generate and test hypotheses about links between group mechanisms and outcomes (e.g. to identify features of more or less successful groups).
Limitations
The framework and examples were primarily derived from research on weight loss interventions, and may require adaptations/additions to ensure applicability to other types of groups. The mixed-methods analyses were limited by the availability and quality of the secondary data.
Conclusions
This study identified, defined, categorised into a framework and provided examples of group-level mechanisms that may influence behaviour change.
Future work
The framework and mixed-methods approaches developed provide a resource for designers, facilitators and evaluators to underpin future research on, and delivery of, group-based interventions.
Funding
This project was funded by the Efficacy and Mechanism Evaluation programme, a Medical Research Council and National Institute for Health Research partnership.
Abstract.
Denford S, Abraham C, Van Beurden S, Smith JR, Morgan-Trimmer S (2019). Health behaviour change interventions. In (Ed) Cambridge Handbook of Psychology, Health and Medicine: Third Edition, 270-273.
Smith JR, Noble MJ, Winder R, Poltawski L, Ashford PA, Musgrave S, Stirling S, Morgan-Trimmer S, Caress AL, Wilson AM, et al (2019). INITIAL PROCESS EVALUATION FINDINGS FROM THE AT-RISK REGISTERS INTEGRATED INTO PRIMARY CARE TO STOP ASTHMA CRISES IN THE UK (ARRISA-UK) TRIAL: PRACTICE CHARACTERISTICS, ENGAGEMENT AND EARLY EXPERIENCES OF THE INTERVENTION.
Author URL.
Borek AJ, Abraham SCS, Greaves CJ, Gillison F, Tarrant M, Morgan-Trimmer SA, McCabe R, Smith JR (2019). Identifying change processes in group-based health behaviour-change interventions: development of the mechanisms of action in group-based interventions (MAGI) framework.
Health Psychology ReviewAbstract:
Identifying change processes in group-based health behaviour-change interventions: development of the mechanisms of action in group-based interventions (MAGI) framework
Group-based interventions are widely used to promote health-related behaviour change. While processes operating in groups have been extensively described, it remains unclear how behaviour change is generated in group-based health-related behaviour-change interventions. Understanding how such interventions facilitate change is important to guide intervention design and process evaluations. We employed a mixed-methods approach to identify, map and define change processes operating in group-based behaviour-change interventions. We reviewed multidisciplinary literature on group dynamics, taxonomies of change technique categories, and measures of group processes. Using weight-loss groups as an exemplar, we also reviewed qualitative studies of participants’ experiences and coded transcripts of 38 group sessions from three weight-loss interventions. Finally, we consulted group participants, facilitators and researchers about our developing synthesis of findings. The resulting ‘Mechanisms of Action in Group-based Interventions’ (MAGI) framework comprises six overarching categories: (1) group intervention design features, (2) facilitation techniques, (3) group dynamic and development processes, (4) inter-personal change processes, (5) selective intra-personal change processes operating in groups, and (6) contextual influences. The framework provides theoretical explanations of how change occurs in group-based behaviour-change interventions and can be applied to optimise their design and delivery, and to guide evaluation, facilitator training and further research.
Abstract.
Bleiker J, Morgan-Trimmer S, Knapp K, Hopkins S (2019). Navigating the maze: Qualitative research methodologies and their philosophical foundations.
Radiography,
25, S4-S8.
Abstract:
Navigating the maze: Qualitative research methodologies and their philosophical foundations
Objectives: One of the three objectives of the Society and College of Radiographers is the promotion and dissemination of research in radiography and radiotherapy. This article aims to assist in the production of high standard research by explaining how transparency in reporting the underpinning philosophical basis of a qualitative study can be achieved in addition to the more customary descriptions of how data were collected and analysed. Key findings: Unlike their quantitative equivalent, qualitative research methodologies are less well understood and reported in radiography research, in particular the philosophical and epistemological assumptions which underpin the methods used. Conclusion: Demonstrating consistency between the philosophical position taken and the methods used within a study is an important aspect of research quality. Implications for practice: Qualitative research can offer valuable insights into the social, organisational, behavioural and interpersonal aspects of medical imaging practice. These may include wellbeing, attitudes, perceptions and beliefs, leadership, management practices, education, professionalism and a wide range of issues around patients' experiences during medical imaging. Patient care and outcomes can be positively impacted as a result of acquiring these insights.
Abstract.
Morgan-Trimmer S (2019). Participatory governing at the margins of the state. In (Ed) Governance Analysis, 173-190.
Morgan-Trimmer S, Chadwick BL, Hutchings S, Scoble C, Lisles C, Drew CJ, Murphy S, Pickles T, Hood K, Chestnutt IG, et al (2019). The acceptability of fluoride varnish and fissure sealant treatments in children aged 6-9 delivered in a school setting.
Community Dent Health,
36(1), 33-38.
Abstract:
The acceptability of fluoride varnish and fissure sealant treatments in children aged 6-9 delivered in a school setting.
OBJECTIVE: to assess the acceptability of fluoride varnish and fissure sealant treatments for children. To investigate the acceptability of delivering this treatment in a school setting for children, parents, clinicians and school staff. BASIC RESEARCH DESIGN: Semi-structured interviews (with children, parents, clinicians and school staff) and a questionnaire (for school staff) as part of a two-arm, randomised clinical trial. PARTICIPANTS: Children aged 6-9, their parents, clinical staff and school staff. INTERVENTIONS: Fluoride varnish or fissure sealant was delivered to children from the ages of 6 to 9 years for 36 months, by a community dental service in a school setting. Fluoride varnish was re-applied every 6 months; fissure sealant was applied once to first permanent molars and re-applied as required. RESULTS: Interviews with children a few days after treatment indicated little difference in preference; acceptability at this point was driven by factors such as finding it fun to visit 'the van' (i.e. mobile dental unit) and receiving a "sticker" rather than specific treatment received. Interviews with parents, clinicians and school staff indicated high acceptability of delivering this type of intervention in a school setting; this may have been partly due to the service being delivered by a well-established, child-oriented community dental service which delivered the clinical trial. CONCLUSIONS: Preventive fluoride varnish and fissure sealant treatments in a school setting has high overall acceptability.
Abstract.
Author URL.
2018
Bleiker J, Knapp KM, Morgan-Trimmer S, Hopkins SJ (2018). “It's what's behind the mask”: Psychological diversity in compassionate patient care.
Radiography,
24, S28-S32.
Abstract:
“It's what's behind the mask”: Psychological diversity in compassionate patient care
Introduction: the Francis Report recommended an increased focus on compassion in healthcare, and recognition and non-judgmental acceptance of diversity is fundamental in compassionate patient care. The aim of this study was to achieve a wider understanding of diversity that includes individual patient needs, expectations, perceptions and feelings during diagnostic imaging. Methods: Using thirty-four semi-structured interviews with individual patients, this qualitative study explored their experiences of undergoing diagnostic radiography examinations and asked what compassionate care meant to them and how it is perceived and manifested in the brief, task-focussed and highly technical diagnostic projection imaging encounter. Data were analysed using Thematic Analysis. Results: Four key themes were identified from the analysis; these were: feelings and vulnerability; hidden emotions; professionalism and valued qualities and communication. Conclusion: Diversity is defined not only in terms of socio-cultural differences but also psychological ones, i.e. individual emotional and attitudinal characteristics, some of which may be consciously or unconsciously concealed. In order that patients are treated equitably and all of their care needs met, recommendations include a broader focus in education and training to include adapting communication skills and techniques in perception and expression of non-verbal cues. Further research into the pressures specific to the time-pressured, task-focussed, highly technical and rapid turnover environment of projection imaging radiography and how this impacts upon compassionate patient care would make a useful contribution to the field.
Abstract.
2017
Segrott J, Murphy S, Rothwell H, Scourfield J, Foxcroft D, Gillespie D, Holliday J, Hood K, Hurlow C, Morgan-Trimmer S, et al (2017). An application of Extended Normalisation Process Theory in a randomised controlled trial of a complex social intervention: Process evaluation of the Strengthening Families Programme (10–14) in Wales, UK. SSM - Population Health, 3, 255-265.
Tsekleves E, Cooper R, Denford S, Abraham C, Van Beurden S, Smith JR, Morgan-Trimmer S (2017). Behaviours. In (Ed) Design for Health, 58-71.
Denford S, Abraham C, Van Beurden S, Smith JR, Morgan-Trimmer S (2017). Behaviours: Behaviour-change interventions for public health. In (Ed)
Design for Health, 58-71.
Abstract:
Behaviours: Behaviour-change interventions for public health
Abstract.
Chestnutt IG, Playle R, Hutchings S, Morgan-Trimmer S, Fitzsimmons D, Aawar N, Angel L, Derrick S, Drew C, Hoddell C, et al (2017). Fissure Seal or Fluoride Varnish? a Randomized Trial of Relative Effectiveness.
J Dent Res,
96(7), 754-761.
Abstract:
Fissure Seal or Fluoride Varnish? a Randomized Trial of Relative Effectiveness.
Fissure sealant (FS) and fluoride varnish (FV) are effective in preventing dental caries when compared with a no-treatment control. However, the relative clinical effectiveness of these interventions is uncertain. The objective of the study was to compare the clinical effectiveness of FS and FV in preventing dental caries in first permanent molars (FPMs) in 6- to 7-y-olds. The study design was a randomized clinical trial, with 2 parallel arms. The setting was a targeted-population program that used mobile dental clinics in schools located within areas of high social and economic deprivation in South Wales. A total of 1,016 children were randomized 1:1 to receive either FS or FV. Resin-based FS was applied to caries-free FPMs and maintained at 6-mo intervals. FV was applied at baseline and at 6-mo intervals for 3 y. The main outcome measures were the proportion of children developing caries into dentine (D4-6MFT) on any 1 of up to 4 treated FPMs after 36 mo. At 36 mo, 835 (82%) children remained: 417 in the FS arm and 418 in the FV arm. A smaller proportion of children who received FV ( n = 73, 17.5%) versus FS ( n = 82, 19.6%) developed caries into dentine on at least 1 FPM (odds ratio [OR] = 0.84; 95% CI, 0.59 to 1.21; P = 0.35), a nonstatistically significant difference between FS and FV treatments. The results were similar when the number of newly decayed teeth (OR = 0.86; 95% CI, 0.60 to 1.22) and tooth surfaces (OR = 0.85; 95% CI, 0.59 to 1.21) were examined. In a community oral health program, semiannual application of FV resulted in caries prevention that was not significantly different from that obtained by applying and maintaining FS after 36 mo (EudraCT: 2010-023476-23; ISRCTN: ISRCTN17029222).
Abstract.
Author URL.
Borek AJ, Smith JR, Abraham C, Greaves CJ, Morgan-Trimmer S, Gillison F, Jones M, Tarrant M, McCabe R (2017). MECHANISMS OF ACTION IN GROUP-BASED INTERVENTIONS (MAGI) STUDY: a FRAMEWORK OF CHANGE PROCESSES IN GROUP-BASED HEALTH INTERVENTIONS.
Author URL.
Chestnutt IG, Hutchings S, Playle R, Morgan-Trimmer S, Fitzsimmons D, Aawar N, Angel L, Derrick S, Drew C, Hoddell C, et al (2017). Seal or Varnish? a randomised controlled trial to determine the relative cost and effectiveness of pit and fissure sealant and fluoride varnish in preventing dental decay.
Health Technol Assess,
21(21), 1-256.
Abstract:
Seal or Varnish? a randomised controlled trial to determine the relative cost and effectiveness of pit and fissure sealant and fluoride varnish in preventing dental decay.
BACKGROUND: Fissure sealant (FS) and fluoride varnish (FV) have been shown to be effective in preventing dental caries when tested against a no-treatment control. However, the relative clinical effectiveness and cost-effectiveness of these interventions is unknown. OBJECTIVE: to compare the clinical effectiveness and cost-effectiveness of FS and FV in preventing dental caries in first permanent molars (FPMs) in 6- and 7-year-olds and to determine their acceptability. DESIGN: a randomised controlled allocation-blinded clinical trial with two parallel arms. SETTING: a targeted population programme using mobile dental clinics (MDCs) in schools located in areas of high social and economic deprivation in South Wales. PARTICIPANTS: in total, 1016 children were randomised, but one parent subsequently withdrew permission and so the analysis was based on 1015 children. The randomisation of participants was stratified by school and balanced for sex and primary dentition baseline caries levels using minimisation in a 1 : 1 ratio for treatments. A random component was added to the minimisation algorithm, such that it was not completely deterministic. of the participants, 514 were randomised to receive FS and 502 were randomised to receive FV. INTERVENTIONS: Resin-based FS was applied to caries-free FPMs and maintained at 6-monthly intervals. FV was applied at baseline and at 6-month intervals over the course of 3 years. MAIN OUTCOME MEASURES: the proportion of children developing caries into dentine (decayed, missing, filled teeth in permanent dentition, i.e. D4-6MFT) on any one of up to four treated FPMs after 36 months. The assessors were blinded to treatment allocation; however, the presence or absence of FS at assessment would obviously indicate the probable treatment received. Economic measures established the costs and budget impact of FS and FV and the relative cost-effectiveness of these technologies. Qualitative interviews determined the acceptability of the interventions. RESULTS: at 36 months, 835 (82%) children remained in the trial: 417 in the FS arm and 418 in the FV arm. The proportion of children who developed caries into dentine on a least one FPM was lower in the FV arm (73; 17.5%) than in the FS arm (82, 19.6%) [odds ratio (OR) 0.84, 95% confidence interval (CI) 0.59 to 1.21; p = 0.35] but the difference was not statistically significant. The results were similar when the numbers of newly decayed teeth (OR 0.86, 95% CI 0.60 to 1.22) and tooth surfaces (OR 0.85, 95% CI 0.59 to 1.21) were examined. Trial fidelity was high: 95% of participants received five or six of the six scheduled treatments. Between 74% and 93% of sealants (upper and lower teeth) were intact at 36 months. The costs of the two technologies showed a small but statistically significant difference; the mean cost to the NHS (including intervention costs) per child was £500 for FS, compared with £432 for FV, a difference of £68.13 (95% CI £5.63 to £130.63; p = 0.033) in favour of FV. The budget impact analysis suggests that there is a cost saving of £68.13 (95% CI £5.63 to £130.63; p = 0.033) per child treated if using FV compared with the application of FS over this time period. An acceptability score completed by the children immediately after treatment and subsequent interviews demonstrated that both interventions were acceptable to the children. No adverse effects were reported. LIMITATIONS: There are no important limitations to this study. CONCLUSIONS: in a community oral health programme utilising MDCs and targeted at children with high caries risk, the twice-yearly application of FV resulted in caries prevention that is not significantly different from that obtained by applying and maintaining FSs after 36 months. FV proved less expensive. FUTURE WORK: the clinical effectiveness and cost-effectiveness of FS and FV following the cessation of active intervention merits investigation. TRIAL REGISTRATION: EudraCT number 2010-023476-23, Current Controlled Trials ISRCTN17029222 and UKCRN reference 9273. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 21. See the NIHR Journals Library website for further project information.
Abstract.
Author URL.
Matthews L, Pugmire J, Moore L, Kelson M, McConnachie A, McIntosh E, Morgan-Trimmer S, Murphy S, Hughes K, Coulman E, et al (2017). Study protocol for the 'HelpMeDoIt!' randomised controlled feasibility trial: an app, web and social support-based weight loss intervention for adults with obesity.
BMJ Open,
7(10).
Abstract:
Study protocol for the 'HelpMeDoIt!' randomised controlled feasibility trial: an app, web and social support-based weight loss intervention for adults with obesity.
INTRODUCTION: HelpMeDoIt! will test the feasibility of an innovative weight loss intervention using a smartphone app and website. Goal setting, self-monitoring and social support are three key facilitators of behaviour change. HelpMeDoIt! incorporates these features and encourages participants to invite 'helpers' from their social circle to help them achieve their goal(s). AIM: to test the feasibility of the intervention in supporting adults with obesity to achieve weight loss goals. METHODS AND ANALYSIS: 12-month feasibility randomised controlled trial and accompanying process evaluation. Participants (n=120) will be adults interested in losing weight, body mass index (BMI)> 30 kg/m2 and smartphone users. The intervention group will use the app/website for 12 months. Participants will nominate one or more helpers to support them. Helpers have access to the app/website. The control group will receive a leaflet on healthy lifestyle and will have access to HelpMeDoIt! after follow-up. The key outcome of the study is whether prespecified progression criteria have been met in order to progress to a larger randomised controlled effectiveness trial. Data will be collected at baseline, 6 and 12 months. Outcomes focus on exploring the feasibility of delivering the intervention and include: (i) assessing three primary outcomes (BMI, physical activity and diet); (ii) secondary outcomes of waist/hip circumference, health-related quality of life, social support, self-efficacy, motivation and mental health; (iii) recruitment and retention; (iv) National Health Service (NHS) resource use and participant borne costs; (v) usability and acceptability of the app/website; and (vi) qualitative interviews with up to 50 participants and 20 helpers on their experiences of the intervention. Statistical analyses will focus on feasibility outcomes and provide initial estimates of intervention effects. Thematic analysis of qualitative interviews will assess implementation, acceptability, mechanisms of effect and contextual factors influencing the intervention. ETHICS AND DISSEMINATION: the protocol has been approved by the West of Scotland NHS Research Ethics Committee (Ref: 15/WS/0288) and the University of Glasgow MVLS College Ethics Committee (Ref: 200140108). Findings will be disseminated widely through peer-reviewed publication and conference presentations. TRIAL REGISTRATION NUMBER: ISRCTN85615983.
Abstract.
Author URL.
Morgan-Trimmer S, Gregory J, Townson J, Channon S, Chestnutt I, Chadwick B, Murphy S, Hutchings S (2017). Understanding intervention acceptability: changing participant views over time and the importance of context. Society for Social Medicine Annual Scientific Meeting 2017. 5th - 8th Sep 2017.
Abstract:
Understanding intervention acceptability: changing participant views over time and the importance of context
Abstract.
2016
Morgan-Trimmer S, Wood F (2016). Ethnographic methods for process evaluations of complex health behaviour interventions.
Trials,
17(1).
Abstract:
Ethnographic methods for process evaluations of complex health behaviour interventions.
This article outlines the contribution that ethnography could make to process evaluations for trials of complex health-behaviour interventions. Process evaluations are increasingly used to examine how health-behaviour interventions operate to produce outcomes and often employ qualitative methods to do this. Ethnography shares commonalities with the qualitative methods currently used in health-behaviour evaluations but has a distinctive approach over and above these methods. It is an overlooked methodology in trials of complex health-behaviour interventions that has much to contribute to the understanding of how interventions work. These benefits are discussed here with respect to three strengths of ethnographic methodology: (1) producing valid data, (2) understanding data within social contexts, and (3) building theory productively. The limitations of ethnography within the context of process evaluations are also discussed.
Abstract.
Author URL.
Morgan-Trimmer S, Channon S, Gregory JW, Townson J, Lowes L (2016). Family preferences for home or hospital care at diagnosis for children with diabetes in the DECIDE study.
Diabet Med,
33(1), 119-124.
Abstract:
Family preferences for home or hospital care at diagnosis for children with diabetes in the DECIDE study.
AIMS: a diagnosis of Type 1 diabetes in childhood can be a difficult life event for children and families. For children who are not severely ill, initial home rather than hospital-based care at diagnosis is an option although there is little research on which is preferable. Practice varies widely, with long hospital stays in some countries and predominantly home-based care in others. This article reports on the comparative acceptability and experience of children with Type 1 diabetes and their parents taking part in the DECIDE study evaluating outcomes of home or hospital-based treatment from diagnosis in the UK. METHODS: Semi-structured interviews with 11 (pairs of) parents and seven children were conducted between 15 and 20 months post diagnosis. Interviewees were asked about adaptation to, management and impact of the diabetes diagnosis, and their experience of initial post-diagnosis treatment. RESULTS: There were no differences between trial arms in adaptation to, management of or impact of diabetes. Most interviewees wanted to be randomized to the 'home' arm initially but expressed a retrospective preference for whichever trial arm they had been in, and cited benefits relating to learning about diabetes management. CONCLUSIONS: the setting for early treatment did not appear to have a differential impact on families in the long term. However, the data presented here describe different experiences of early treatment settings from the perspective of children and their families, and factors that influenced how families felt initially about treatment setting. Further research could investigate the short-term benefits of both settings.
Abstract.
Author URL.
Denford S, Abraham C, Smith JR, Morgan-Trimmer S, Lloyd J, Wyatt K (2016). Intervention design and evaluation: behaviour change imperatives. In (Ed) Beyond Behaviour Change, 49-70.
Denford S, Abraham C, Smith J, Morgan-Trimmer S, Lloyd J, Wyatt K (2016). Intervention design and evaluation: behaviour change imperatives. In Spotswood F (Ed)
Beyond behaviour change Key issues, interdisciplinary approaches and future directions, Bristol: Policy Press, 49-70.
Abstract:
Intervention design and evaluation: behaviour change imperatives
Abstract.
Denford S, Abraham C, Smith JR, Morgan-Trimmer S, Lloyd J, Wyatt K (2016). Intervention design and evaluation: behaviour change imperatives. In (Ed) Beyond Behaviour Change, 49-70.
Smith JR, Borek A, Abraham C, Greaves C, Morgan-Trimmer S, Gillison F, Jones M, Keable J, Tarrant M, McCabe R, et al (2016). MECHANISMS OF ACTION IN GROUP INTERVENTIONS (MAGI) STUDY: INITIAL FINDINGS AND a CONCEPTUAL FRAMEWORK.
Author URL.
Simpson SA, Matthews L, Pugmire J, Moore L, Kelson M, McIntosh E, McConnachie A, John E, Morgan-Trimmers S, Murphy S, et al (2016). MOBILISING SOCIAL SUPPORT: INSIGHTS FOR THE DEVELOPMENT OF a WEB AND APP BASED INTERVENTION FOR WEIGHT LOSS.
Author URL.
2015
Morgan-Trimmer SA, Spooner S, Audrey S (2015). Health, health behaviours and health promoting services for care leavers: perspectives of young people and LAC nurses, CASCADE Paper 03.
Abstract:
Health, health behaviours and health promoting services for care leavers: perspectives of young people and LAC nurses, CASCADE Paper 03
This working paper reports findings from a qualitative study of care leavers’ and looked after children’s (LAC) nurses’ perspectives on the health, health behaviours and health promoting services for care leavers. Looked after children and adults with a prior history of being looked after tend to have poorer health and social outcomes, even when compared to populations with similar socio-economic backgrounds (Viner and Taylor 2010; Dregan et al. 2011). Additionally, very little is known about how looked after children and care leavers view their own health and lifestyles. This study explored care leaver and LAC nurse perspectives on health and health behaviours of young people leaving care, and what effective health promoting services for care leavers might look like. Sixteen young people leaving care in the south Wales area were interviewed, and a focus group with 14 looked after children’s nurses from mid, south and west Wales was also conducted.
The first main finding was that the care leavers tended to identify their overall health in terms of psychological health, and most experienced difficulties in mental health and emotional well-being. Most care leavers reported at least one mental health problem such as depression. LAC nurses also identified mental health and inadequate access to mental health services as a concern. Emotional well-being was discussed by young people in terms of loneliness, self-harm and stress, and LAC nurses mentioned care leavers’ low self-esteem. The second main finding was the interaction between physical health, psychological health and social issues in care leavers’ lives. Physical and psychological health were regarded by the young people interviewed as being closely related to each other, for example smoking and alcohol were used by some care leavers as a coping mechanism for stress. Psychological and physical health also interacted with social factors in various ways. For example, poor emotional well-being reduced the amount and quality of sleep and increased sedentary behaviour, which then affected social participation. Wider social factors such as employment and housing also affected the health of this group, for example some interviewees valued employment for reducing financial-related stress and social isolation. Half of the young people interviewed mentioned financial problems being a significant source of stress, and most thought that lack of money had a negative impact on their physical health. Overall, the period of transition to independent living created challenges which made a healthy lifestyle difficult to achieve.
Care leavers saw their health as primarily their own responsibility, though some lacked skills in accessing health and other services due to lack of confidence, organisational skills, and money to travel to services. Interviewees had mixed experience of public sector social and medical services, while eleven commented on positive experiences of voluntary sector support service. Care leavers identified several factors which they thought characterised good services:. consistent and long-term staff; staff they could develop relationships with, who were caring and had good listening skills; services that could be contacted in flexible ways (e.g. by telephone, internet or face-to-face) and which had long opening hours; holistic services which could address multiple needs were also valued.
Findings presented here on the multiple, interrelated factors that affect care leavers’ health suggest that holistic, accessible and consistent services could go some way towards improving health for this group. Given pressures on public services and the immediacy of care leavers’ other needs, health promotion is not often a priority for care leaver services. Nonetheless, health promotion to improve psychological and physical health would reduce short and long-term disadvantage for this group.
Abstract.
Morgan-Trimmer SA, Spooner S, Audrey S (2015). Health, health behaviours health promoting services for care leavers: Perspectives of young people and LAC nurses, Research Briefing 04.
Morgan-Trimmer S (2015). Improving Process Evaluations of Health Behavior Interventions: Learning from the Social Sciences.
Eval Health Prof,
38(3), 295-314.
Abstract:
Improving Process Evaluations of Health Behavior Interventions: Learning from the Social Sciences.
This article reflects on the current state of process evaluations of health behavior interventions and argues that evaluation practice in this area could be improved by drawing on the social science literature to a greater degree. While process evaluations of health behavior interventions have increasingly engaged with the social world and sociological aspects of interventions, there has been a lag in applying relevant and potentially useful approaches from the social sciences. This has limited the scope for health behavior process evaluations to address pertinent contextual issues and methodological challenges. Three aspects of process evaluations are discussed: the incorporation of contexts of interventions; engagement with the concept of "process" in process evaluation; and working with theory to understand interventions. Following on from this, the article also comments on the need for new methodologies and on the implications for addressing health inequalities.
Abstract.
Author URL.
Morgan-Trimmer S (2015). People-centred Public Health.
SOCIOLOGY OF HEALTH & ILLNESS,
37(5), 799-800.
Author URL.
2014
Segrott J, Rothwell H, Murphy S, Morgan-Trimmer S, Scourfield J, Holliday J, Thomas C, Gillespie D, Roberts Z, Foxcroft D, et al (2014). Fidelity of implementation of the Strengthening Families Programme 10-14 UK in Wales UK: a mixed-method process evaluation within a randomised controlled trialLaurence Moore. European Journal of Public Health, 24(suppl_2).
Morgan-Trimmer S (2014). Policy is political; our ideas about knowledge translation must be too.
J Epidemiol Community Health,
68(11), 1010-1011.
Author URL.
2013
Morgan-Trimmer S (2013). 'It's who you know': community empowerment through network brokers. Community Development Journal, 49(3), 458-472.
2012
Morgan-Trimmer S (2012). Participation outcomes in governance networks: the role of network ties. In Enjolras B, Bozzini B (Eds.)
Governing Ambiguities New Forms of Local Governance and Civil Society, Nomos Verlagsgesellschaft Mbh & Company.
Abstract:
Participation outcomes in governance networks: the role of network ties
Abstract.
Chestnutt IG, Chadwick BL, Hutchings S, Playle R, Pickles T, Lisles C, Kirkby N, Morgan MZ, Hunter L, Hodell C, et al (2012). Protocol for "Seal or Varnish?" (SoV) trial: a randomised controlled trial to measure the relative cost and effectiveness of pit and fissure sealants and fluoride varnish in preventing dental decay.
BMC Oral Health,
12Abstract:
Protocol for "Seal or Varnish?" (SoV) trial: a randomised controlled trial to measure the relative cost and effectiveness of pit and fissure sealants and fluoride varnish in preventing dental decay.
BACKGROUND: Dental caries remains a significant public health problem, prevalence being linked to social and economic deprivation. Occlusal surfaces of first permanent molars are the most susceptible site in the developing permanent dentition. Cochrane reviews have shown pit and fissure sealants (PFS) and fluoride varnish (FV) to be effective over no intervention in preventing caries. However, the comparative cost and effectiveness of these treatments is uncertain. The primary aim of the trial described in this protocol is to compare the clinical effectiveness of PFS and FV in preventing dental caries in first permanent molars in 6-7 year-olds. Secondary aims include: establishing the costs and the relative cost-effectiveness of PFS and FV delivered in a community/school setting; examining the impact of PFS and FV on children and their parents/carers in terms of quality of life/treatment acceptability measures; and examining the implementation of treatment in a community setting. METHODS/DESIGN: the trial design comprises a randomised, assessor-blinded, two-arm, parallel group trial in 6-7 year old schoolchildren. Clinical procedures and assessments will be performed at 66 primary schools, in deprived areas in South Wales. Treatments will be delivered via a mobile dental clinic. In total, 920 children will be recruited (460 per trial arm). At baseline and annually for 36 months dental caries will be recorded using the International Caries Detection and Assessment System (ICDAS) by trained and calibrated dentists. PFS and FV will be applied by trained dental hygienists. The FV will be applied at baseline, 6, 12, 18, 24 and 30 months. The PFS will be applied at baseline and re-examined at 6, 12, 18, 24, and 30 months, and will be re-applied if the existing sealant has become detached/is insufficient. The economic analysis will estimate the costs of providing the PFS versus FV. The process evaluation will assess implementation and acceptability through acceptability scales, a schools questionnaire and interviews with children, parents, dentists, dental nurses and school staff. The primary outcome measure will be the proportion of children developing new caries on any one of up to four treated first permanent molars. DISCUSSION: the objectives of this study have been identified by the National Institute for Health Research as one of importance to the National Health Service in the UK. The results of this trial will provide guidance on which of these technologies should be adopted for the prevention of dental decay in the most susceptible tooth-surface in the most at risk children. TRIAL REGISTRATIONS: ISRCTN ref: ISRCTN17029222 EudraCT: 2010-023476-23 UKCRN ref: 9273.
Abstract.
Author URL.
2007
Morgan-Trimmer SA (2007). An Experiment in Visual Ethnography.