• Educating nurses to deliver optimum care to military veterans and their families

      Finnegan, Alan; Di Lemma, Lisa; McGhee, Stephen; University of Miami; University of Chester
      The aim of the project was to help prepare the future nursing workforce to provide optimum care for the Armed Forces Community. Structured evidenced-based educational sessions were designed and then delivered at two Universities in England. This educational model included a flipped approach, didactic classroom teaching, blended learning, and information technology. Educational sessions were provided to 468 first year Bachelor of Nursing undergraduate students in 2017 and 2018. A mixed methods evaluation included a quasi-experiential design with pre and post-test data followed by research interviews conducted by student nurses and analysed using a modified Grounded Theory. Post session evaluation demonstrated a significant improvement in students' knowledge. 93% agreed that the training was useful, 95% felt that nurses should be aware of the healthcare needs of the Armed Forces Community, and 89% indicated that the subject matter should be included in the undergraduate curriculum. A qualitative theoretical model was built from four major clusters: the military community; student's identity, clinical engagement, and future practice. These educational sessions are being introduced into a growing number of United Kingdom Universities to create future nursing leaders with a better insight into the large and diverse Armed Forces Community.
    • Evaluating serious stress in military veterans, their carers and families: a protocol

      Finnegan, Alan; Di Lemma, Lisa; McGhee, Stephen; Watson, Roger; University of Chester; University of Chester; University of Miami; University of Hull
      In 2018, the Armed Forces Covenant Fund Trust (ACFT) allocated approximately £4M to seven UK projects to address serious stress in military veterans, their carers and families. These programmes commenced between May and October 2019 and will conclude in August 2021. This paper outlines the protocol for the evalu- ation of the Serious Stress programme and the novel support provided to grant holders. Entry into the programmes was through multiple routes, including self-referrals with an antic- ipated sample of approximately 2000 partic- ipants. A common outcomes framework was designed to measure outcomes. Grant holders accepted ownership for data collection and quality and were supported through accompa- nying guidance material. Veterans were often reluctant to seek support, and the anonymous and confidential nature of the evaluation plus the study team’s mili- tary background helped address this. Partic- ipants’ voices were a key part in developing the protocol, leading to results to inform policy and highlight success, efficiency and cost effectiveness, and providing markers for future development. The study provided a reservoir of informa- tion. Interim reports indicated compliance with performance indicators and provided timely evidence. Shared learning provided grant holders with an indication of what was helping the beneficiaries and what needed to be improved. The combination of all data sets provided the ACFT with a resource to demonstrate success and insight into projects where improvement was required, and indi- cators of how to redress these problems. The study protocol provided a platform for building lasting partnerships.
    • An evaluation and critical analysis of the impact of the Aged Veterans Fund

      Di Lemma, Lisa; Howe, Sonia; Finnegan, Alan; University of Chester; Armed Forces Covenant Fund Trust.
      There has been research on the numbers and needs of an ageing society yet, relatively little is known about the specific needs of older veterans, and the effectiveness of services specifically developed to meet these needs. In 2016 and 2017, the Armed Forces Covenant Fund Trust funded invested £30 million to the Aged Veterans Fund (AVF) programme. This consisted of 19 portfolio projects to support health, wellbeing, and social care needs for older veterans (born before 1st January 1950) and their families. This report explores the impact of the AVF, with the intent of informing service providers, stakeholders and policy makers, of the lessons learned and the next steps required for the support of older veterans. A retrospective evaluation focused on both the impact of the processes adopted by the programmes, and the outcomes achieved, was commissioned. Qualitative analysis was performed on 78 eligible source documents, from which 10 recurrent themes were identified. Themes focused on the methodology and evaluations adopted by the projects, the number of beneficiaries reached, challenges encountered, associated costs and savings. In addition, the study identified projects outreach and sustainability, including staff, volunteers and clients perceptions of the services. Finally, there are results regarding the related health and wellbeing benefits, behaviour change and influences on the UK National Health Service (NHS) practice. The findings indicated that project promotion, partnership and collaboration was strong, which provides a foundation for the sustainability and outreach of some of the programmes. The AVF programmes were successfully rolled out via referrals, but this was not without challenges such as capacity, uptake, staffing and timelines issues. Two primary approaches were adopted. The first being a person-centred care approach, that takes into consideration the complex needs of the individual. The second was a skill-exchange model consisting of peers passing on their skills to beneficiaries. The results provided compelling evidence that the AVF initiatives were successful and were positively perceived by beneficiaries, staff and volunteers. Evidence was found on the impact of the fund on boosting resilience in the beneficiaries, by reducing social isolation and improving their health and wellbeing. Additionally, awareness was raised in the wider community, via the delivery of specific educational training to staff. In addition, AVF programmes influenced current health-care practice such as re-admission and discharge rates, via effective signposting and cross-referrals. The lessons learnt lead to recommendations and indicators for the next steps required to support older veterans and their families.
    • Event-related and readiness potentials when preparing to approach and avoid alcohol cues following cue avoidance training in heavy drinkers.

      Stancak, Andrej; Soto, Vicente; Fallon, Nick; Di Lemma, Lisa; University of Chester; University of Liverpool; Universidad Adolfo Ibáñez; University of Sheffield.
      Rationale Cue avoidance training (CAT) reduces alcohol consumption in the laboratory. However, the neural mechanisms that underlie the effects of this intervention are poorly understood. Objectives The present study investigated the effects of a single session of CAT on event-related and readiness potentials during preparation of approach and avoidance movements to alcohol cues. Methods Heavy drinking young adults (N = 60) were randomly assigned to complete either CAT or control training. After training, we recorded participants’ event-related and motor readiness potentials as they were preparing to respond. Results In the CAT group, N200 amplitude was higher when preparing to approach rather than avoid alcohol pictures. In the control group, N200 amplitudes did not differ for approach and avoidance to alcohol pictures. Regarding the late positive potential (LPP), in the CAT group, the negativity of this was blunted when preparing to avoid alcohol pictures relative to when preparing to avoid control pictures. In the control group, the negativity of the LPP was blunted when preparing to approach alcohol pictures relative to when preparing to approach control pictures. There were no effects on motor readiness potentials. Behavioural effects indicated short-lived effects of training on reaction times during the training block that did not persist when participants were given time to prepare their motor response before executing it during the EEG testing block. Conclusions After a single session of CAT, the enhanced N200 when approaching alcohol cues may indicate the engagement of executive control to overcome the associations learned during training. These findings clarify the neural mechanisms that may underlie the effects of CAT on drinking behaviour.
    • Public acceptability of public health policy to improve population health: A population‐based survey

      Bellis, Mark A.; Hughes, Karen; Di Lemma, Lisa; Public Health Collaborating Unit, School of Health Sciences, Bangor University, Wrexham; Public Health Wales; University of Chester
      Background: For public health policies to be effective, it is critical that they are acceptable to the public as acceptance levels impact success rate. Objective: To explore public acceptance of public health statements and examine differences in acceptability across socio-demographics, health behaviours (physical activity, diet, binge drinking and smoking), health status and well-being. Method: A cross-sectional survey was conducted with a nationally representative sample (N = 1001) using a random stratified sampling method. Face-to-face interviews were conducted at homes of residents in Wales aged 16+ years. Individuals reported whether they agreed, had no opinion, or disagreed with 12 public health statements. Results: More than half of the sample were supportive of 10 out of 12 statements. The three statements with the greatest support (>80% agreement) reflected the importance of: a safe and loving childhood to becoming a healthy adult, schools teaching about health, and healthier foods costing less. Individuals who engaged in unhealthy behaviours were less likely to agree with some of the statements (eg 39.8% of binge drinkers agreed alcohol adverts should be banned compared to 57.6% of those who never binge drink; P < .001). Conclusions: Findings show an appetite for public health policies among the majority of the public. The relationship between supporting policies and engaging in healthy behaviours suggests a feedback loop that is potentially capable of shifting both public opinion and the opportunities for policy intervention. If a nation becomes healthier, this could illicit greater support for stronger policies which could encourage more people to move in a healthier direction.
    • Responding to Adverse Childhood Experiences: An evidence review of interventions to prevent and address adversity across the life course.

      Ford, Kat; Di Lemma, Lisa; Gray, Benjamin; Hughes, Karen; University of Chester; Public Health Collaborating Unit Bangor University; Public Health Wales.
      Adverse childhood experiences (ACEs) are stressful events during childhood that can have a profound impact on an individual’s present and future health (Section 1.3). Growing up in the face of such adversities is recognised as an important public health concern in Wales and internationally (Welsh Government, 2017a; World Health Organization [WHO], 2014). Actions to prevent and mitigate ACEs and their associated harms are essential to improve population health for present and future generations (Bethell et al., 2017; Pachter et al., 2017). In Wales, many sectors are working to identify and respond to adversity in order to improve outcomes for those who have experienced ACEs. Whilst a number of evidence-based interventions target specific types of adversity (e.g. domestic violence), we know that ACEs are strongly correlated (e.g. individuals exposed to adversity are often exposed to more than one type; Hughes et al., 2017). Thus, complex adversity requires a response which extends across sectors including health, social care, policing, education, community and others, and across the life course from early childhood through to adulthood. To support innovation in addressing ACEs we have undertaken a review of evidence on common approaches to prevent ACEs and/or mitigate their negative impacts. Over 100 interventions were identified and collated across four common approaches: supporting parenting; building relationships and resilience; early identification of adversity; and, responding to trauma and specific ACEs (Chapter 3). Whilst the interventions vary in type, the review identified cross-cutting themes, which could be used to inform a whole system approach (spanning individual, family and community levels) to tackle ACEs across the life course, supporting the development of an ACE-informed approach (Chapter 4). The report concludes by highlighting current gaps in the evidence and suggests key areas for further work to tackle ACEs for our future generations (Chapter 5). The report is not an exhaustive systematic evidence review of the interventions for specific ACE types, nor does it advocate any specific intervention, rather it seeks to present a summary of the research evidence and information on common approaches across the prevention of ACEs and mitigation of their impact. We hope the report will be a useful resource for service planners, practitioners and commissioners to support innovation and development towards an ACE-free future.
    • Stay Well in Wales Super Profiles: Who thinks what about the nation's health

      Sharp, Catherine A.; Hughes, Karen; Bellis, Mark; Di Lemma, Lisa; Public Health Collaborating Unit Bangor University; Public Health Wales; University of Chester
      Using a household and online survey, the views of 3,310 individuals in Wales (aged 16+ years) on 19 public health statements were gathered. Eight demographic and five health-related behaviour super profiles were created to explore differences in opinions across population groups.