Process to Product and Product to Process - Professor Gareth Stratton

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  • NOTES FOR PRESENTERS: Key points to raise: Bullet 1 NICE recommendations are based on proven best practice. By implementing them, schools are demonstrating to parents and Ofsted that they take pupils’ physical and mental wellbeing seriously. Bullet 2 Our recommendations have been incorporated into the physical activity resources produced by the Department for Children, Schools and Families (DCSF) and the Department of Health (DH) for the Healthy Schools programme. Bullet 3 School governors can use NICE guidance to demonstrate that they are fulfilling their remit on ensuring the health and wellbeing of pupils. (The Education and Inspections Act (Department for Education and Skills 2006) places a duty on governing bodies to promote wellbeing and community cohesion and to take the local area ‘Children and young people's plan’ into consideration. The Act also gives legal force to many of the proposals set out in the schools white paper: ‘Higher standards, better schools for all’.) Additional information: As part of their self-evaluation, schools are expected to indicate the extent to which DCSF standards are being met. Ofsted assesses (among other things) the school’s contribution to wellbeing. ‘Wellbeing’ in this context is defined in terms of the five outcomes in ‘Every child matters’: be healthy stay safe enjoy and achieve make a positive contribution achieve economic wellbeing. The five outcomes are mutually reinforcing. For example, children and young people learn and thrive when they are healthy, safe and engaged; and the evidence shows that educational achievement is the most effective route out of poverty. The NICE work programme is decided by the Department of Health and informed by the Department for Children, Schools and Families.
  • NOTES FOR PRESENTERS: Key points to raise: Bullet 1 NICE recommendations are based on proven best practice. By implementing them, schools are demonstrating to parents and Ofsted that they take pupils’ physical and mental wellbeing seriously. Bullet 2 Our recommendations have been incorporated into the physical activity resources produced by the Department for Children, Schools and Families (DCSF) and the Department of Health (DH) for the Healthy Schools programme. Bullet 3 School governors can use NICE guidance to demonstrate that they are fulfilling their remit on ensuring the health and wellbeing of pupils. (The Education and Inspections Act (Department for Education and Skills 2006) places a duty on governing bodies to promote wellbeing and community cohesion and to take the local area ‘Children and young people's plan’ into consideration. The Act also gives legal force to many of the proposals set out in the schools white paper: ‘Higher standards, better schools for all’.) Additional information: As part of their self-evaluation, schools are expected to indicate the extent to which DCSF standards are being met. Ofsted assesses (among other things) the school’s contribution to wellbeing. ‘Wellbeing’ in this context is defined in terms of the five outcomes in ‘Every child matters’: be healthy stay safe enjoy and achieve make a positive contribution achieve economic wellbeing. The five outcomes are mutually reinforcing. For example, children and young people learn and thrive when they are healthy, safe and engaged; and the evidence shows that educational achievement is the most effective route out of poverty. The NICE work programme is decided by the Department of Health and informed by the Department for Children, Schools and Families.
  • NOTES FOR PRESENTERS: Key points to raise: The estimated costs include both the direct costs of treating major, lifestyle-related diseases and the indirect costs of sickness absence. Definition of physical activity Physical activity is any force exerted by skeletal muscle that results in energy expenditure above resting level: m oderate-intensity activity increases breathing and heart rates to a level where the pulse can be felt and the person feels warmer. It might make someone sweat on a hot or humid day (or when indoors) vigorous-intensity activity results in being out of breath or sweating. Recommended levels of physical activity The Chief Medical Officer recommends that children and young people should do a minimum of 60 minutes moderate to vigorous physical activity daily. At least twice a week, this should include weight-bearing activities to improve bone health, muscle strength and flexibility. This can be achieved in a number of short, 10-minute (minimum) bouts. There is likely to be a link between the amount and intensity of physical activity and its effect on health. Recent evidence suggests that children aged 9 may need 120 minutes per day and young people aged 15 may need 90 minutes per day, to reduce their risk of cardiovascular disease. (Please see the guidance for more information.) Additional information: Opportunities for moderate to vigorous physical activity include everything from competitive sport and formal exercise to active play and other physically demanding activities (such as dancing, swimming or skateboarding). They also include some of the actions involved in daily life (such as walking, cycling or using other modes of travel involving physical activity).
  • ABOUT THIS PRESENTATION: This presentation has been written to help you raise awareness of the NICE public health guidance on promoting physical activity for children and young people. The guidance is for all those who have a direct or indirect role in – and responsibility for – promoting physical activity for children and young people. This includes those working in the NHS, education, local authorities and the wider public, private, voluntary and community sectors. It will also be of interest to parents, grandparents and other carers (including professional carers), children and young people and other members of the public. It includes recommendations for schools, but does not make recommendations for the national curriculum. The guidance and a quick reference guide are available from NICE. You may want to hand out copies of the quick reference guide at your presentation so that your audience can refer to it. See the end of the presentation for ordering details. You can add your own organisation’s logo alongside the NICE logo. We have included notes for presenters, broken down into ‘key points to raise’, which you can highlight in your presentation, and ‘additional information’ that you may want to draw on, such as a rationale or an explanation of the evidence for a recommendation. DISCLAIMER This slide set is an implementation tool and should be used alongside the published guidance. This information does not supersede or replace the guidance itself. PROMOTING EQUALITY Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance, in their local context, in light of their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity. Nothing in this guidance should be interpreted in a way which would be inconsistent with compliance with those duties.
  • NOTES FOR PRESENTERS: Key points to raise: The recommendations cover all children and young people up to 18, including those with a medical condition or disability. They do not apply to children and young people who require clinical assessment or monitoring prior to and/or during physical activity. They do not cover specialised services for children and young people with a disability. Rationale for the target age groups: Girls aged 11 to 18 There is evidence of a reduction in children’s physical activity after the age of 11. This is more marked in girls than boys, which may result in health inequalities. Children aged 11 and under There is evidence that early development of core physical skills would lead to greater enjoyment of physical activities. In addition, being physically active from an early age would become an ingrained habit.
  • How much? One RCT? 20 RCTS? 30 cohort studies? In clinical settings, maybe that 1 well-conducted, large RCT in the relevant population is enough to make recommendations (clear evidence of effect, and no evidence of harms). In PH, this becomes a lot more difficult to answer, as likely to be limited RCT evidence, evaluating complex interventions, in populations that may not be relevant. In addition, outcomes may be more difficult to define and measure How good? Does a well-conducted observational study outweigh a flawed RCT? Again, accepted clinical evidential hierarchy is that interventions should be based on RCT evidence as some attempt has been made to limit potential biases…but this may not be case in PH interventions… What type of evidence? In obesity, even where RCT evidence was identified, lower levels (cohorts) were used to provide corroborative evidence to support the results of the RCTs…how do you integrate policy and expert opinion? How important is the context or perspective of the population?
  • Diversity – for PH is much bigger question than in Clinical, but even in the clinical arena, debate is ongoing about the broader meaning of evidence. I would like to talk you through an example from the clinical Obesity guidelines where we looked at the evidence for changing the diet of children who were overweight or obese.
  • The success of targeting older girls may be due to two factors. First, younger girls are likely to be reasonably active and thus an intervention may find it difficult to change an already positive behaviour. Moreover, older girls are likely to show lower levels of activity and be more amenable to change. Second, the older girls may be better placed to understand certain types of interventions, such as educational materials and mediated approaches.

Transcript

  • 1. Professor Gareth Stratton Chair, NICE Physical activity and Children PDG Research Institute for Sports and Exercise Sciences Liverpool John Moores University Producing Public Health Guidance the “NICE” Way Process to Product and Product to Process
  • 2. How can NICE help?
    • NICE is an independent organisation responsible for standards to promote good health and prevent or treat ill health, based on best value for money
    • NICE recommendations can help organisations
    • meet public health targets (NIs, PSAs etc)
    • NICE offers advice to organisations who have a role in promoting health and wellbeing
  • 3. How can NICE help? Public Health Problem Low Physical Activity Where is the problem? Young People Can PA be changed? Evidence Effectiveness:Cost Use Evidence Recommendations Use Recommendations Policy, Strategy, Practice Monitor Evaluate Product
  • 4. The issues
    • Physical inactivity in England is estimated to cost £8.2 billion a year and is predicted to rise
    • Physical activity is important for children’s healthy growth and development
    • Physical activity contributes to general health and wellbeing and can reduce the risk of several chronic conditions
  • 5. Assessing Cost Effectiveness Probability of rejection Cost per QALY (£K) x XX XX 10 20 30 40 50 0 1
  • 6. Promoting physical activity for children and young people Schools and colleges Implementing NICE guidance 2009 NICE public health guidance 17
  • 7. Decrease in Physical Activity in School Age Children Physical activity Overestimated
  • 8. EYHS Physical Activity and Metabolic Risk Increased risk SD>1 Andersen LB , Lancet. 2006 Jul 22;368(9532):299-304 >2000 cpm 116 min 9y olds 88 min 15y olds
  • 9. Mapping the obesity epidemic in Liverpool 9-10 year olds Taylor, Stratton, and Hackett, Health Educ Res (2004). Dummer, Hackett, Stratton, Taylor PHN (2004). Stratton, Hackett, Boddy, Taylor, Buchan and Canoy IJO (2007) 30000 children 1998-2004 Fitness, fatness, parents activity, diet, sports preference .
  • 10. Data from G Stratton, Liverpool Sportlinx Rise in BMI and fall in cardio-respiratory endurance of Liverpool 10 year olds from 1998 to 2004
  • 11. Scope
    • The recommendations are for:
    • all children and young people up to 18
    • specifically: - children aged 11 and under - girls aged 11 to 18
  • 12. What is evidence?
    • How much evidence do you need to make recommendations?
    • How good does the evidence need to be?
    • What type of evidence should you use?
  • 13. Searching for Evidence for Programme Effectiveness
    • Review 1 : Descriptive epidemiology
    • Review 2: Correlates of physical activity in children: a review of quantitative systematic reviews
    • Review 3: The views of children on the barriers and facilitators to participation in physical activity: a review of qualitative studies
    • Review 4: Intervention review: under eights
    • Review 5: Intervention review: children and active travel
    • Review 6 : Intervention review: adolescent girls
    • Review 7 : Intervention review: family and community
    • Review 8: Review of learning from practice: children and active play
    • Review of economic evaluations :
    • Cost effectiveness analysis :
    • Fieldwork
  • 14. What does evidence tell you?
    • Quantity
    • Quality
      • Different question
      • Different population group
      • Different comparator
      • Different outcome
      • Different context
      • Different intervention…
    • Diversity
    Lay Members Professionals Practitioners Academics Chair NICE PACC Reading Understanding SHOKK®
  • 15. Product Children’s Physical Activity Guidelines (draft) Positive + Marks et al. (2006) RNCT No change Positive No change Positive - - - - Baxter et al. (1997) Metzker (1999) Moon et al. (1999) Winett et al. (1999) CNRT Positive Positive No change Positive No change + + + + + Simon et al. (2004) Schofield et al. (2005) Haerens et al. (2006) Murphy et al. (2006) Robbins et al. (2006) CRCT No change No change ++ ++ Prochaska & Sallis (2004) Patrick et al. (2006) RCT Physical activity change? Study Quality Authors Study Type
  • 16. Adolescent Girls Review .
    • There is evidence from one controlled non-randomised trial in the USA [-], that a counselling intervention can lead to an increase in physical activity in adolescent girls. A characteristic of this intervention is that it is was short (8 weeks) and included older girls (>14 y) only.
  • 17.
    • Who is the target population? Focus, related to the scope
    • Who should take action? Be as specific as possible
    • What action should they take? Be precise and realistic
    Targeted and Specific
  • 18. Recommendation 14
    • Who is the target population?
    • Girls and young women aged 11–18.
    • Who should take action?
    • Practitioners who lead physical activities, including youth leaders, teachers, coaches and volunteers.
    • What action should they take?
    • Ensure all physical activity opportunities emphasise participation, enjoyment and personal development. Support participants of all abilities in a non-judgemental way which is sensitive to cultural and religious issues. Encourage those who initially choose not to participate in physical activity to observe. Help them move gradually from observation to full participation.
  • 19. Key Principles
    • Y oung people at the centre
    • Involving staff and parents
    • Effective community links
    • Space, facilities and equipment
    • Developing a physical activity policy
    • Providing structured and unstructured opportunities
    • Monitoring and evaluation
    • Cost:Benefit
  • 20. Recommendations : Audience
    • NHS – hospital,community
    • Local authority
    • Education
    • Third Sector
    • Individual
    • Public
    • Government
    • Private/Commercial
  • 21. Product Children’s Physical Activity Guidelines (draft) Sections
    • Key priorities
    • Public health need and practice
    • Children and young people’s activity levels
    • National policy
    • Non-government initiatives
    • Considerations
    • Value of physical activity
    • Children and young people’s needs
    • Factors that encourage or hinder physical activity
    • Limitations
    • Recommendations
  • 22. How the Recommendations Fit Together Local Practitioners Delivery Local Organisations Planning, Delivery, Training Local Strategic Planning High Level Policy And Strategy National Policy
  • 23. Ordering of Recommendations
  • 24. “ Between the thought and the action lies the shadow” (Mark Twain) www.nice.org.uk/PH17 Using NICE Public Health Guidance