Physiotherapy and Physical Activity: A cross-sectional survey exploring physical activity promotion, knowledge of physical activity guidelines and the physical activity habits of UK physiotherapists.

Objective: Physical inactivity is a public health priority and embedding promotion of physical activity (PA) within healthcare systems is an important lever for change. Many factors influence PA promotion in routine healthcare practice, these include the PA habits of healthcare professionals and also their knowledge of the PA guidelines. Little is known about the extent to which PA is currently promoted in physiotherapy practice or the factors that influence it. Methods: Following ethical approval a cross-sectional survey of UK physiotherapists was conducted. Findings were analysed and reported in accordance with STROBE guidelines. Results: There were 522 respondents, 514 of whom were physiotherapists. Seventy seven percent of respondents routinely discussed PA with patients and 68% routinely delivered Brief Interventions. Assessment of PA status was not routine practice neither was signposting to further sources of PA support. Only 16% of respondents correctly answered questions about the content of the PA guidelines. Only 38% of respondents met current PA recommendations. Clinicians' PA levels were not associated with PA promotion activity. Conclusion: Despite the promising finding that some form of PA promotion is integrated into most respondents' practice, we report a poor understanding of Brief Interventions and poor knowledge of the PA guidelines. Additionally, the majority of respondents were not sufficiently active to meet current PA recommendations

Implementing an Integrated Acute Response Service: Professional Perceptions of Intermediate Care

Purpose: The purpose of this study is to examine the implementation, care processes and sustainability of an integrated, intermediate Acute Response Team (ART) service. The primary aims of the service are to enhance the level of health and social care integration across a range of organisations, to ensure a timelier and appropriate service for people in the community at risk of admission to hospital. Design/methodology/approach: A qualitative methodology was employed in order to gain a deep understanding of the experiences of staff members within the ART service and external stakeholders. Twenty-one professionals took part in a focus group or one-to-one interviews. Data were analysed thematically. Findings: The key to successful implementation was that the service was co-created from the “ground-up” with support from local provider organisations. The inclusion of general practitioners (GPs) as part of the team was instrumental in setting up and maintaining the service and seems to be unique in intermediate care settings. Referrals into the ART service were dependent on awareness of the service at the interface with mainstream services. Transitions out were sometimes delayed due lack of availability of social care packages. To ensure sustainability of the ART and other integrated intermediate care services, continued resources, especially skilled staff members, are necessary. Originality/value: This study adds to the intermediate care and acute response service literature by offering insights into “what works” from a professional perspective in terms of service implementation, care processes and sustainability, in an integrated care system

Who is a credible source of preventive advice? An experimental vignette study of general public attitudes towards role expansion in health and social care

© 2020 The Authors. British Journal of Health Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society Objectives: To investigate the general public’s source credibility attitudes towards health and social care professionals when giving advice associated with their ‘traditional role’ versus an ‘expanded health behaviour change’ role, to facilitate the implementation of the health behaviour change agenda. Design: A 3x3 experimental between-subjects vignette questionnaire study with nine scenarios in which a general practitioner (GP), health visitor, or firefighter offered advice on either stopping smoking, preventing cot death, or fire safety. Combinations were either congruent with a traditional role (e.g., health visitor and cot death) or an expanded role (e.g., firefighter and stopping smoking). Methods: Adults were recruited from metropolitan locations in northern England. Participants were randomized to one scenario and complete a validated 18-item source credibility questionnaire. Factor analysis explored source credibility components; ratings for traditional and expanded role scenarios were compared using Mann–Whitney tests. Results: 369 participants completed the questionnaire (49.3% women, 64% White British, age range: 16–83). Factor analysis confirmed three source credibility dimensions: competence, caring, and trustworthiness. Ratings were generally high across professions and scenarios; participants rated professionals as significantly more ‘competent’ where scenarios related to their traditional roles than expanded roles (U 9778.5, p <.001) but equally as caring (U = 14467.5, p<.485) and trustworthy (U 14250.5, p.348). Conclusions: GPs, health visitors, and firefighters were all perceived as credible sources of health behaviour change advice, but may be viewed as ‘less competent’ sources of messages associated with an expanded job role. Effective professional training and public engagement regarding the role expansion agenda are needed to support policy implementation. Statement of Contribution What is already known on this subject? Source credibility surrounds people’s perceptions of the source of advice and includes competence, caring, and trustworthiness dimensions. This may have an important influence on people’s attitudes and behaviour, especially when messages are complex or emotive. A wide range of public sector workers is now expected to routinely offer preventive health and safety advice, as part of role expansion. What does this study add? This experimental survey study compared source credibility perceptions of GPs, health visitors, and firefighters giving advice on topics associated with a traditional or expanded role. Professionals were perceived as less ‘competent’ when giving advice on ‘expanded role’ topics, such as a firefighter discussing smoking, with a small reduction in source credibility. This highlights that source credibility may be specific to professional identities. Policymakers may need to explore this further as part of implementing role expansion for prevention and self-management in health and social care

Financing equitable access to antiretroviral treatment in South Africa

<p>Abstract</p> <p>Background</p> <p>While South Africa spends approximately 7.4% of GDP on healthcare, only 43% of these funds are spent in the public system, which is tasked with the provision of care to the majority of the population including a large proportion of those in need of antiretroviral treatment (ART). South Africa is currently debating the introduction of a National Health Insurance (NHI) system. Because such a universal health system could mean increased public healthcare funding and improved access to human resources, it could improve the sustainability of ART provision. This paper considers the minimum resources that would be required to achieve the proposed universal health system and contrasts these with the costs of scaled up access to ART between 2010 and 2020.</p> <p>Methods</p> <p>The costs of ART and universal coverage (UC) are assessed through multiplying unit costs, utilization and estimates of the population in need during each year of the planning cycle. Costs are from the provider’s perspective reflected in real 2007 prices.</p> <p>Results</p> <p>The annual costs of providing ART increase from US$1 billion in 2010 to US$3.6 billion in 2020. If increases in funding to public healthcare only keep pace with projected real GDP growth, then close to 30% of these resources would be required for ART by 2020. However, an increase in the public healthcare resource envelope from 3.2% to 5%-6% of GDP would be sufficient to finance both ART and other services under a universal system (if based on a largely public sector model) and the annual costs of ART would not exceed 15% of the universal health system budget.</p> <p>Conclusions</p> <p>Responding to the HIV-epidemic is one of the many challenges currently facing South Africa. Whether this response becomes a “resource for democracy” or whether it undermines social cohesiveness within poor communities and between rich and poor communities will be partially determined by the steps that are taken during the next ten years. While the introduction of a universal system will be complex, it could generate a health system responsive to the needs of all South Africans.</p

Rural connectivity in Africa: motorcycle track construction

Motorcycle transportation has burgeoned in war-affected West Africa over the past decade. The penetration ofmotorcycle taxis deep into isolated rural communities has spread spontaneously and created direct and indirectemployment opportunities for low-skilled youth, a category most susceptible to militia recruitment. Equallyimportant, it has significantly contributed to lifting smallholder farmers out of poverty by reducing the costs ofmoving produce to markets, with motorcycles able to visit villages connected to feeder roads solely by footpaths.Nevertheless, state actors and international donors remain reluctant to allocate funds to rural track building/upgrading, preferring to stick to more conventional, but expensive, construction/rehabilitation of rural roadsaccessible to four-wheeled vehicles. Through a case study of Liberia – still recovering from two civil wars and an Ebolahealth crisis – this paper argues that the impact of bringing community access through track construction/footpathupgrading is significant, particularly because track construction lends itself par excellence to the involvement of therural communities themselves

Neoliberalism and the revival of agricultural cooperatives: The case of the coffee sector in Uganda

Agricultural cooperatives have seen a comeback in sub‐Saharan Africa. After the collapse of many weakly performing monopolist organizations during the 1980s and 1990s, strengthened cooperatives have emerged since the 2000s. Scholarly knowledge about the state–cooperative relations in which this “revival” takes place remains poor. Based on new evidence from Uganda's coffee sector, this paper discusses the political economy of Africa's cooperative revival. The authors argue that donors' and African governments' renewed support is framed in largely apolitical terms, which obscures the contested political and economic nature of the revival. In the context of neoliberal restructuring processes, state and non‐state institutional support to democratic economic organizations with substantial redistributional agendas remains insufficient. The political–economic context in Uganda—and potentially elsewhere in Africa—contributes to poor terms of trade for agricultural cooperatives while maintaining significant state control over some cooperative activities to protect the status quo interests of big capital and state elites. These conditions are unlikely to produce a conflict‐free, substantial, and sustained revival of cooperatives, which the new promoters of cooperatives suggest is under way