• Against all odds—why UK mothers’ breastfeeding beyond infancy are turning to their international peers for emotional and informative support

      Jackson, Jessica; Hallam, Jenny; University of Derby (Informa UK Limited, 2020-04-01)
      The health benefits of breastfeeding are well documented and current recommendations are that women should breastfeed their child for two years and beyond. Despite this the UK has the lowest initiation breastfeeding rates in the world. Additionally, a considerably small percentage of women who do successfully initiate go on to breastfeed past infancy. This could in part be explained by the lack of support women receive when breastfeeding an older child. In this study we provide insight into women’s experiences of healthcare interventions during the transition from breastfeeding an infant to a toddler. We conducted semi-structured interviews with 24 women with experience of breastfeeding at least one child past the age of twelve months. We used a theory driven thematic analysis to identify pertinent themes that ran through the interviews. As mothers progressed through their breastfeeding journey they faced increased social stigma. They also experienced a change in attitudes from healthcare professionals as support was replaced by judgement. This negatively impacted upon trust in healthcare professionals and the advice they offered. In response, the women turned to volunteering organizations and closed social media groups for emotional support and healthcare advice. These women experienced specific issues regarding breastfeeding in toddlerhood as opposed to infancy. They needed specialized interventions tailored for this. Social media was highlighted as a useful platform for supporting women who breastfeed beyond infancy. It allowed these women to feel part of a supportive international community and gain access to practical advice. Healthcare professionals should explore ways to engage in digital platforms to provide support to mothers’ breastfeeding beyond infancy.
    • Digital interventions to promote self-management in people with osteoarthritis: systematic review and meta-analysis - Study protocol

      Safari, Reza; Jackson, Jessica; Dhadda, Buk; Watkins, Merryl; Sheffield, David; Anthony, Denis; Ward, Derek; University of Derby; NHS Southern Derbyshire; Lincolnshire County Council (National Health Service (NHS), 2018-05-11)
      The proposed research is a systematic review and meta-analysis of available randomised controlled trials of digital interventions to promote self-management in people with osteoarthritis. The effects of self-management programs, on patient outcomes such as pain, disability, function and quality of life will be analysed in direct pairwise meta-analysis. The health service outcomes and cost effectiveness data will also be extracted if reported in the papers and will be synthesised narratively.
    • Digital-based self-management interventions for people with osteoarthritis: Systematic review with meta-analysis

      Safari, Reza; Jackson, Jessica; Sheffield, David; University of Derby (JMIR Publications Inc., 2020-06)
      Osteoarthritis (OA) is not curable but the symptoms can be managed through Self-management programmes. Due to the growing burden of arthritis to the health system, and the need to ensure high quality integrated services, delivering Self-management programmes through digital technologies could be an economic and effective community-based model of care. To analyze the effectiveness of digital-based self-management programs on patient outcomes in people with OA. Seven online databases and three grey literature databases were searched for randomized controlled trials (RCT) assessing digital-based structured self-management programs (D-SMP) on self-reported outcomes including pain, function, disability, and health-related quality of life in people with OA. Two reviewers independently screened the search results and reference list of identified papers and related reviews. Data about the intervention components and delivery, and behavioral change techniques were extracted. Meta-analysis, risk of bias sensitivity analysis and subgroup analysis were performed where appropriate. The GRADE approach was used to assess the quality of evidence. Eight studies were eligible including 2687 people with OA. Self-management programs were delivered via telephone plus audio/video, internet or mobile app. D-SMP compared to Treatment As Usual control group resulted in a significant, homogeneous, moderate reduction in pain (SMD -0.28, 95% CI -0.38 to -0.18) and improvement in physical function (-0.26 95% CI -0.35 to -0.16) at post-treatment. The D-SMP effect reduced slightly at 12 months follow-up but remained significant and moderate. Using the GRADE approach, the quality of evidence was rated as ‘moderate’. D-SMPs may result in a moderate improvement in pain symptoms and function in people with OA delivered. Further research is required to confirm the findings of the review and assess the effects of D-SMPs on other health-related outcomes. Clinical Trial: PROSPERO: CRD42018089322
    • Exploring public perspectives of e-professionalism in nursing

      Jackson, Jessica; University of Derby (RCN Publishing Ltd., 2019-12-02)
      Background E-professionalism is a term used to describe the behaviours of healthcare professionals, including nurses, in the online environment. While a range of professional guidance on the use of online social media platforms is available, there has been little research into the perspectives of patients and the public more generally on nurses’ e-professionalism. Aim To explain what, how and why the public make decisions about the acceptability of nurses’ online behaviours and e-professionalism, and to make recommendations for nurses on managing the information they share online. Method This was a mixed-method critical realist study. Participants in a survey (n=53) and two focus groups (n=8) discussed and rated the acceptability of five vignettes related to nurses’ online behaviours based on real-life examples. Findings The participants generally thought that nurses are entitled to have a personal life and freedom of speech and to promote causes they believe to be important, even if these were not aligned with their own beliefs. Participants unanimously considered the use of profane language against any individuals or groups to be unacceptable. Conclusion The public make decisions on the acceptability of nurses’ online behaviours based on a range of complex factors, including social and individual values, attitudes and beliefs, as well as their intent and consequences. Recommendations for nurses on how to manage the information they share online include: using separate platforms for personal, educational and professional purposes; using functions that control who can ‘tag’ and share their posts; and ensuring any information they share that relates to healthcare or nursing practice is up to date and evidence based.
    • Exploring the long-term influence of the family nurse partnership on the lives of young mothers

      Woodward, Amelia; Ward, Derek; Jackson, Jessica; University of Derby (Oxford University Press, 2017-10-20)
      Background The Family Nurse Partnership (FNP) is an intensive nurse led home-visiting programme for first-time mothers under 19 years old and their babies, run by the English Government. This small qualitative study is part of a larger study which examined the key outcomes of the programme in one UK location. Few studies have explored the experiences of young mothers after graduating from the FNP. The aim of this study was to explore mother’s own experiences of the programme and particularly how the FNP programme has had an impact upon parents and their children post-graduation from the programme. Methods Data was collected using face to face, semi-structured interviews with a purposeful sample of 12 mothers who had graduated from the FNP programme. Mothers were asked about their experience of the programme and their subsequent life-course. The interviews were recorded and then transcribed verbatim. Analysis of the data was conducted using a constant comparative approach. Results The mothers who had participated in the FNP program were very positive about their experiences and talked about the continued impact the programme has had on their lives. Themes emerging from the data included the importance of the supportive nature of the relationship with the family nurse and how participating in the FNP had increased their self-confidence and has empowered them to make positive changes in their lives. Conclusions The interviews found that mothers valued the intervention and it had a long-term impact on the mothers. In addition ways in which the FNP intervention has influenced the lives of clients and their families, that are not routinely measured by the programme were identified. Researchers are now working with the programme providers to support its development of a more flexible intervention model of parenting support so that the beneficial effects of the programme can reach more vulnerable parents. Key messages: •Mothers value the FNP intervention and continue to benefit from the programme after it has finished •Further development and evolution of the model is being undertaken which aims to reach more parents and should be researched.
    • 'I felt like I was doing something wrong': A qualitative exploration of mothers' experiences of breastfeeding

      Jackson, Jessica; Hallam, Jenny; University of Derby (MAG, 2019-04-18)
      Despite its multiple health benefits, rates of breastfeeding to 2 years and beyond remain low in the UK. This qualitative study explored the experiences of support provided by health professionals to mothers breastfeeding beyond infancy. A key finding of the study was that health services are effective at supporting breastfeeding in the postnatal period, but that beyond the 1-year review the focus shifts to rapid weaning. A new approach to support breastfeeding continuation alongside the introduction of complementary foods is needed in line with professional guidance and recommendations. As critical reflective practitioners, health visitors are ideally placed to support and educate women about the wider social complexities of breastfeeding. However, health service commissioners need to recognise the importance of investment in the profession to enable health visitors to use their skills fully.
    • ‘It’s quite a taboo subject’: an investigation of mother’s experiences of breastfeeding beyond infancy and the challenges they face

      Jackson, Jessica; Hallam, Jenny; University of Derby (Taylor and Francis, 2021-06-10)
      Current recommendations state that women should breastfeed their child up to 2 years and beyond. However, the UK has one of the lowest breastfeeding rates in the world. This could in part be explained by the stigma mothers face when breastfeeding an older child. This research aims to provide a detailed understanding of what motivates women to continue breastfeeding beyond infancy and the barriers they face to (i) add to existing research literature which has examined this area and (ii) support and normalize this practice. Semi-structured interviews were conducted between April and June 2018 with 24 women who had breastfed at least one child past 12 months. A theory-driven thematic analysis identified themes that ran through the interviews centering on the benefits of continued breastfeeding, the stigma mothers faced when breastfeeding past infancy and the challenges of returning to work. The women felt that continued breastfeeding enabled them to play a central role in their child’s health and develop an attachment led parental style but faced social and cultural stigma due to a lack of public awareness of current breastfeeding recommendations. Interventions which raise awareness of breastfeeding beyond infancy are needed to normalize this practice in the UK.
    • Physical activity: understanding and addressing inequalities

      Jackson, Jessica; Roscoe, Clare M. P.; Mourton, Niamh; University of Derby (Public Health England, 2021-02-22)
      This guidance can be used by local level practitioners and commissioners to begin tackling inequalities in physical activity across and within protected characteristic groups. It presents the findings of a review, analysis and research aimed at understanding the enablers, barriers and opportunities for increasing physical activity across inequality groups. Three major themes are identified as considerations for action by practitioners and commissioners: enablers, barriers, and identifying opportunity community consultation, engagement, and partnership adopting a holistic approach for protected characteristics and intersectionality The document concludes with a full set of recommendations for commissioners and practitioners to consider when designing services and interventions locally.
    • Social media: blurred lines between personal and professional behaviour

      Jackson, Jessica; University of Derby (Medical Education Solutions, 2019-04-17)
      It is now over twenty years since the birth of social media and, according to Statista, the number of people engaged in these types of online networking platforms has reached over 39 million in the UK alone. These users include a generation who have grown up with such fast social interactions in a virtual world of posts for ‘likes’, ‘friends’ and ‘followers’. These young adults’ desire to engage in social media is often intertwined with their everyday lives.
    • Using behavioural insights to improve the healthiness of children’s packed lunches.

      Jackson, Jessica; Ward, Derek; Giles, David; Bunten, Amanda; Howell-Jones, Rebecca; Burgess-Allen, Jilla; University of Derby; Public Health England (Oxford University Press, 2017-10-20)
      Background Childhood obesity continues to rise in the UK from 9.3% in children aged 4-5 years to 19.8% by age 10-11. Only 1 in 100 school packed lunches meet national recommendations for school meals in England with 82% containing unhealthy snacks and 61% sugar sweetened drinks. Encouraging parents to identify healthier choices could reduce added sugar content and improve the healthiness of school lunches. Methods A cluster randomised controlled trial was implemented in 17 primary schools (8 intervention, 9 control) in England. The intervention comprised of 3 packs of materials delivered to parents who make children lunches (7-11 years). Materials were designed using behavioural-insights to raise awareness of added sugar and offer healthier options. The materials were delivered over a 4-week period in intervention schools. Photographs of the contents of the packed lunches were taken at 3 time points; 1719 pre-intervention, 1745 post-intervention & 1725 at 3 month follow-up. Visible items in each photograph were coded for nutritional content. A parental survey was conducted at post follow up to explore parental knowledge, attitudes and beliefs about healthier packed lunches. Results The coding and analysis is underway and findings will be presented in November. Presented data will describe group differences pre-intervention, post-intervention and follow up from the >5000 lunch boxes for 1) the number lunch boxes that contain surgery food; 2) the average number of sugary food items; 3) the average grams of sugar in lunch boxes; and 4) the proportion of lunch boxes that contain fruit or vegetables. Conclusions This study was funded by Public Health England to explore whether low cost, low intensive interventions can have a significant impact on changing health behaviours. There is a lack of evidence on improving the nutritional quality of packed lunches and if improvements are identified there are potential implications for child health, nutrition and obesity rates. Key messages: •The study aims to ascertain the effectiveness of a behavioural-insight informed intervention in changing the healthiness of packed lunches provided by parents of primary school aged children. •This low cost, low intensity intervention has the potential to improve the healthiness of primary school age children’s diets.
    • Using behavioural insights to reduce sugar in primary school children's packed lunches in derby; A cluster randomised controlled trial

      Bunten, Amanda; Porter, Lucy; Burgess-Allen, Jilla; Howell-Jones, Rebecca; Jackson, Jessica; Ward, Derek; Staples, Vicki; Staples, Paul; Rowthorn, Harriet; Saei, Ayoub; et al. (Elsevier BV, 2020-10-08)
      Children's packed lunches contain more sugar than school-provided meals. Interventions to improve the provision of healthier packed lunches have modest effects on lunch contents. This cluster randomised controlled trial tested an intervention to encourage healthier provision of packed lunches by parents of primary school children in Derby. Schools were randomised to intervention (n = 8) or control (n = 9) using blocked random allocation. In the intervention group, parents of children who brought packed lunches to school in years 3–6 (age 7–11 years) received three bundles of materials (including packed lunch planner, shopping list, information on sugar content of popular lunchbox items and suggestions for healthier swap alternatives) in bookbags/lunchboxes over a 4-week period. Control parents received no materials. Photos of lunchbox contents were taken at baseline, immediately post-intervention and at three-month follow-up. A parental survey aimed to assess capability, opportunity and motivation for packing a healthier lunchbox. No intervention effects were observed for primary outcomes (presence and number of sugary snacks or chilled sugary desserts). The intervention had a significant impact on one secondary outcome (increased number of healthier “swap” items suggested in intervention materials) immediately post-intervention, but this effect had disappeared at three-month follow-up. No intervention effects were found on survey variables. Parent comments revealed that materials were either received positively (as they reinforced existing behaviours) or negatively (as they were not perceived to be helpful or appropriate). The results of this study suggest that providing educational materials and resources to parents of primary school children in Derby was not sufficient to increase provision of healthier packed lunches. Future research should investigate how behavioural science can support families to improve the nutritional content of primary school children's lunchboxes.
    • Using figured worlds to explore parents' attitudes and influences for choosing the content of primary school packed lunches

      Jackson, Jessica; Giles, David; Gerrard, Clarabelle; University of Derby (MAG Online Library, 2019-09-30)
      This study aimed to explore parents' attitudes toward the content of their child's packed lunch, school healthy eating policies, and their child's wishes. Furthermore, in this context, it also aimed to explore perceptions of health promotional materials and how these interventions interplayed with issues parents felt were important. The ideology of ‘figured worlds’ was used as a stance to consider the relationship between bounding structures within society and the individual positional identity. Focus groups interviews obtained qualitative data of parents' multiple viewpoints. Iterative categorisation was employed as a method of analysis to observed findings in the data in relation to the individuals as intersubjective beings and their behaviour influenced by environmental conditions. A cross selection of local schools and parenting network were approached. Snowballing techniques were implemented highlighting the inclusion criteria. Participants were required to have a child attending primary school who they provided a packed lunch for on a regular basis. Three umbrella themes were identified: ‘The parents ideal’, ‘The child's desires’, and ‘Inconsistencies of the governing school’. A fourth theme, ‘The health promotional intrusion’ provides insight into the parents' reality when being presented with health promotional materials. This study has highlighted the complex, conflicting interplay between parents' ideal for their child's diet, their child's desires and the governing approaches to encouraging healthier choices. This understanding is vital when designing specific interventions to meet the needs of individuals, which prevent, protect and promote a healthy lifestyle for children and their families.