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Process to Product and Product to Process - Professor Gareth Stratton


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Process to Product and Product to Process - Professor Gareth Stratton

  1. 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. 2. How can NICE help? <ul><li>NICE is an independent organisation responsible for standards to promote good health and prevent or treat ill health, based on best value for money </li></ul><ul><li>NICE recommendations can help organisations </li></ul><ul><li>meet public health targets (NIs, PSAs etc) </li></ul><ul><li>NICE offers advice to organisations who have a role in promoting health and wellbeing </li></ul>
  3. 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. 4. The issues <ul><li>Physical inactivity in England is estimated to cost £8.2 billion a year and is predicted to rise </li></ul><ul><li>Physical activity is important for children’s healthy growth and development </li></ul><ul><li>Physical activity contributes to general health and wellbeing and can reduce the risk of several chronic conditions </li></ul>
  5. 5. Assessing Cost Effectiveness Probability of rejection Cost per QALY (£K) x XX XX 10 20 30 40 50 0 1
  6. 6. Promoting physical activity for children and young people Schools and colleges Implementing NICE guidance 2009 NICE public health guidance 17
  7. 7. Decrease in Physical Activity in School Age Children Physical activity Overestimated
  8. 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. 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. 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. 11. Scope <ul><li>The recommendations are for: </li></ul><ul><li>all children and young people up to 18 </li></ul><ul><li>specifically: - children aged 11 and under - girls aged 11 to 18 </li></ul>
  12. 12. What is evidence? <ul><li>How much evidence do you need to make recommendations? </li></ul><ul><li>How good does the evidence need to be? </li></ul><ul><li>What type of evidence should you use? </li></ul>
  13. 13. Searching for Evidence for Programme Effectiveness <ul><li>Review 1 : Descriptive epidemiology </li></ul><ul><li>Review 2: Correlates of physical activity in children: a review of quantitative systematic reviews </li></ul><ul><li>Review 3: The views of children on the barriers and facilitators to participation in physical activity: a review of qualitative studies </li></ul><ul><li>Review 4: Intervention review: under eights </li></ul><ul><li>Review 5: Intervention review: children and active travel </li></ul><ul><li>Review 6 : Intervention review: adolescent girls </li></ul><ul><li>Review 7 : Intervention review: family and community </li></ul><ul><li>Review 8: Review of learning from practice: children and active play </li></ul><ul><li>Review of economic evaluations : </li></ul><ul><li>Cost effectiveness analysis : </li></ul><ul><li>Fieldwork </li></ul>
  14. 14. What does evidence tell you? <ul><li>Quantity </li></ul><ul><li>Quality </li></ul><ul><ul><li>Different question </li></ul></ul><ul><ul><li>Different population group </li></ul></ul><ul><ul><li>Different comparator </li></ul></ul><ul><ul><li>Different outcome </li></ul></ul><ul><ul><li>Different context </li></ul></ul><ul><ul><li>Different intervention… </li></ul></ul><ul><li>Diversity </li></ul>Lay Members Professionals Practitioners Academics Chair NICE PACC Reading Understanding SHOKK®
  15. 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. 16. Adolescent Girls Review . <ul><li>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. </li></ul>
  17. 17. <ul><li>Who is the target population? Focus, related to the scope </li></ul><ul><li>Who should take action? Be as specific as possible </li></ul><ul><li>What action should they take? Be precise and realistic </li></ul>Targeted and Specific
  18. 18. Recommendation 14 <ul><li>Who is the target population? </li></ul><ul><li>Girls and young women aged 11–18. </li></ul><ul><li>Who should take action? </li></ul><ul><li>Practitioners who lead physical activities, including youth leaders, teachers, coaches and volunteers. </li></ul><ul><li>What action should they take? </li></ul><ul><li>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. </li></ul>
  19. 19. Key Principles <ul><li>Y oung people at the centre </li></ul><ul><li>Involving staff and parents </li></ul><ul><li>Effective community links </li></ul><ul><li>Space, facilities and equipment </li></ul><ul><li>Developing a physical activity policy </li></ul><ul><li>Providing structured and unstructured opportunities </li></ul><ul><li>Monitoring and evaluation </li></ul><ul><li>Cost:Benefit </li></ul>
  20. 20. Recommendations : Audience <ul><li>NHS – hospital,community </li></ul><ul><li>Local authority </li></ul><ul><li>Education </li></ul><ul><li>Third Sector </li></ul><ul><li>Individual </li></ul><ul><li>Public </li></ul><ul><li>Government </li></ul><ul><li>Private/Commercial </li></ul>
  21. 21. Product Children’s Physical Activity Guidelines (draft) Sections <ul><li>Key priorities </li></ul><ul><li>Public health need and practice </li></ul><ul><li>Children and young people’s activity levels </li></ul><ul><li>National policy </li></ul><ul><li>Non-government initiatives </li></ul><ul><li>Considerations </li></ul><ul><li>Value of physical activity </li></ul><ul><li>Children and young people’s needs </li></ul><ul><li>Factors that encourage or hinder physical activity </li></ul><ul><li>Limitations </li></ul><ul><li>Recommendations </li></ul>
  22. 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. 23. Ordering of Recommendations
  24. 24. “ Between the thought and the action lies the shadow” (Mark Twain) Using NICE Public Health Guidance