Doing Qualitative Research

Peter Craig, MRC Population Health Sciences Research Network Paul Dieppe, Nuffield Department of Orthopaedic Surgery, University of Oxford Sally Macintyre, MRC Social and Public Health Sciences Unit Susan Michie, Centre for Outcomes Research and Effectiveness, University College London Irwin Nazareth, MRC General Practice Research Framework Mark Petticrew, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine

Developing and Evaluating Complex Interventions: New Guidance

Problem: Priority health-risk behaviors contribute to the leading causes of morbidity and mortality among youth and adults. Population-based data on these behaviors at the national, state, and local levels can help monitor the effectiveness of public health interventions designed to protect and promote the health of youth nationwide. Reporting Period Covered: September 2012-December 2013. Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors that contribute to unintended pregnancy and sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. This report summarizes results for 104 health-risk behaviors plus obesity, overweight, and asthma from the 2013 national survey, 42 state surveys, and 21 large urban school district surveys conducted among students in grades 9-12. RESULTS: Results from the 2013 national YRBS indicated that many high school students are engaged in priority health-risk behaviors associated with the leading causes of death among persons aged 10-24 years in the United States. During the 30 days before the survey, 41.4% of high school students nationwide among the 64.7% who drove a car or other vehicle during the 30 days before the survey had texted or e-mailed while driving, 34.9% had drunk alcohol, and 23.4% had used marijuana. During the 12 months before the survey, 14.8% had been electronically bullied, 19.6% had been bullied on school property, and 8.0% had attempted suicide. Many high school students nationwide are engaged in sexual risk behaviors that contribute to unintended pregnancies and STIs, including HIV infection. Nearly half (46.8%) of students had ever had sexual intercourse, 34.0% had had sexual intercourse during the 3 months before the survey (i.e., currently sexually active), and 15.0% had had sexual intercourse with four or more persons during their life. Among currently sexually active students, 59.1% had used a condom during their last sexual intercourse. RESULTS from the 2013 national YRBS also indicate many high school students are engaged in behaviors associated with chronic diseases, such as cardiovascular disease, cancer, and diabetes. During the 30 days before the survey, 15.7% of high school students had smoked cigarettes and 8.8% had used smokeless tobacco. During the 7 days before the survey, 5.0% of high school students had not eaten fruit or drunk 100% fruit juices and 6.6% had not eaten vegetables. More than one-third (41.3%) had played video or computer games or used a computer for something that was not school work for 3 or more hours per day on an average school day. INTERPRETATION: Many high school students engage in behaviors that place them at risk for the leading causes of morbidity and mortality. The prevalence of most health-risk behaviors varies by sex, race/ethnicity, and grade and across states and large urban school districts. Long term temporal changes also have occurred. Since the earliest year of data collection, the prevalence of most health-risk behaviors has decreased (e.g., physical fighting, current cigarette use, and current sexual activity), but the prevalence of other health-risk behaviors has not changed (e.g., suicide attempts treated by a doctor or nurse, having ever used marijuana, and having drunk alcohol or used drugs before last sexual intercourse) or has increased (e.g., having not gone to school because of safety concern and obesity and overweight). Public Health Action: YRBSS data are used widely to compare the prevalence of health-risk behaviors among subpopulations of students; assess trends in health-risk behaviors over time; monitor progress toward achieving 20 national health objectives for Healthy People 2020 and one of the 26 leading health indicators; provide comparable state and large urban school district data; and help develop and evaluate school and community policies, programs, and practices designed to decrease health-risk behaviors and improve health outcomes among youth. Language: en

/pdf/youth-risk-behavior-surveillance-united-states-2013-36byboxh0c.pdf

Youth risk behavior surveillance - United States, 2013

Accumulating evidence suggests that, independent of physical activity levels, sedentary behaviours are associated with increased risk of cardio-metabolic disease, all-cause mortality, and a variety of physiological and psychological problems. Therefore, the purpose of this systematic review is to determine the relationship between sedentary behaviour and health indicators in school-aged children and youth aged 5-17 years. Online databases (MEDLINE, EMBASE and PsycINFO), personal libraries and government documents were searched for relevant studies examining time spent engaging in sedentary behaviours and six specific health indicators (body composition, fitness, metabolic syndrome and cardiovascular disease, self-esteem, pro-social behaviour and academic achievement). 232 studies including 983,840 participants met inclusion criteria and were included in the review. Television (TV) watching was the most common measure of sedentary behaviour and body composition was the most common outcome measure. Qualitative analysis of all studies revealed a dose-response relation between increased sedentary behaviour and unfavourable health outcomes. Watching TV for more than 2 hours per day was associated with unfavourable body composition, decreased fitness, lowered scores for self-esteem and pro-social behaviour and decreased academic achievement. Meta-analysis was completed for randomized controlled studies that aimed to reduce sedentary time and reported change in body mass index (BMI) as their primary outcome. In this regard, a metaanalysis revealed an overall significant effect of -0.81 (95% CI of -1.44 to -0.17, p = 0.01) indicating an overall decrease in mean BMI associated with the interventions. There is a large body of evidence from all study designs which suggests that decreasing any type of sedentary time is associated with lower health risk in youth aged 5-17 years. In particular, the evidence suggests that daily TV viewing in excess of 2 hours is associated with reduced physical and psychosocial health, and that lowering sedentary time leads to reductions in BMI.

http://activeworking.com/pdfs/research/71.pdf

Systematic review of sedentary behaviour and health indicators in school-aged children and youth: an update.

The widespread use of digital technologies by young people has spurred speculation that their regular use negatively impacts psychological well-being. Current empirical evidence supporting this idea is largely based on secondary analyses of large-scale social datasets. Though these datasets provide a valuable resource for highly powered investigations, their many variables and observations are often explored with an analytical flexibility that marks small effects as statistically significant, thereby leading to potential false positives and conflicting results. Here we address these methodological challenges by applying specification curve analysis (SCA) across three large-scale social datasets (total n = 355,358) to rigorously examine correlational evidence for the effects of digital technology on adolescents. The association we find between digital technology use and adolescent well-being is negative but small, explaining at most 0.4% of the variation in well-being. Taking the broader context of the data into account suggests that these effects are too small to warrant policy change.

The association between adolescent well-being and digital technology use

A logistic regression model of individual neighbourhood dissatisfaction was developed using data from the 1997/98 Survey of English Housing. Housing satisfaction and the general appearance of the neighbourhood were closely associated with neighbourhood dissatisfaction, although perceptions of noise, friendliness, community spirit, schools and crime were also important. Although sociodemographic factors were much less important than residential perceptions in helping to predict dissatisfaction, the type of neighbourhood remained a significant independent predictor of dissatisfaction even when residents' views were taken into account. Some factors were more important in different areas: in particular, residents in less affluent areas were more sensitive to unfriendliness and crime. There were also indications that owner-occupiers were less satisfied in areas where they had a lower tenure share. The paper concludes that neighbourhood policies with a broad spectrum of goals are required, that pay careful atte...

What Makes People Dissatisfied with their Neighbourhoods

Improving the reproductive health of young women in developing countries requires access to safe and effective methods of fertility control, but most rely on traditional rather than modern contraceptives such as condoms or oral/injectable hormonal methods. We conducted a systematic review of qualitative research to examine the limits to modern contraceptive use identified by young women in developing countries. Focusing on qualitative research allows the assessment of complex processes often missed in quantitative analyses. Literature searches of 23 databases, including Medline, Embase and POPLINE®, were conducted. Literature from 1970–2006 concerning the 11–24 years age group was included. Studies were critically appraised and meta-ethnography was used to synthesise the data. Of the 12 studies which met the inclusion criteria, seven met the quality criteria and are included in the synthesis (six from sub-Saharan Africa; one from South-East Asia). Sample sizes ranged from 16 to 149 young women (age range 13–19 years). Four of the studies were urban based, one was rural, one semi-rural, and one mixed (predominantly rural). Use of hormonal methods was limited by lack of knowledge, obstacles to access and concern over side effects, especially fear of infertility. Although often more accessible, and sometimes more attractive than hormonal methods, condom use was limited by association with disease and promiscuity, together with greater male control. As a result young women often relied on traditional methods or abortion. Although the review was limited to five countries and conditions are not homogenous for all young women in all developing countries, the overarching themes were common across different settings and contexts, supporting the potential transferability of interventions to improve reproductive health. Increasing modern contraceptive method use requires community-wide, multifaceted interventions and the combined provision of information, life skills, support and access to youth-friendly services. Interventions should aim to counter negative perceptions of modern contraceptive methods and the dual role of condoms for contraception and STI prevention should be exploited, despite the challenges involved.

/pdf/limits-to-modern-contraceptive-use-among-young-women-in-452zag321v.pdf

Limits to modern contraceptive use among young women in developing countries: a systematic review of qualitative research

Current neighbourhood renewal and urban policies in the UK seek to improve neighbourhood conditions in poor areas and achieve greater residential stability. Using one of the few longitudinal housing datasets available in the UK, this paper analyses the influence of residential perceptions on house moving behaviour in poor and other areas. It is found that residential dissatisfaction is notably higher among residents of poor areas, and they respond to poor neighbourhood conditions in the same way as the general population. Dissatisfaction with the home itself, and unhappiness with disorder in the immediate surroundings both significantly increased the odds that someone would move home. Perceived neighbourhood decline was also found to increase the odds that someone wished to move home but to reduce the likelihood that they would actually do so. Residential mobility was found to be a particular problem for owner occupiers in declining neighbourhoods and for residents in deprived parts of inner London.

Living in and leaving poor neighbourhood conditions in England

Background Screen entertainment for young children has been associated with several aspects of psychosocial adjustment. Most research is from North America and focuses on television. Few longitudinal studies have compared the effects of TV and electronic games, or have investigated gender differences. Purpose To explore how time watching TV and playing electronic games at age 5 years each predicts change in psychosocial adjustment in a representative sample of 7 year-olds from the UK. Methods Typical daily hours viewing television and playing electronic games at age 5 years were reported by mothers of 11 014 children from the UK Millennium Cohort Study. Conduct problems, emotional symptoms, peer relationship problems, hyperactivity/inattention and prosocial behaviour were reported by mothers using the Strengths and Difficulties Questionnaire. Change in adjustment from age 5 years to 7 years was regressed on screen exposures; adjusting for family characteristics and functioning, and child characteristics. Results Watching TV for 3 h or more at 5 years predicted a 0.13 point increase (95% CI 0.03 to 0.24) in conduct problems by 7 years, compared with watching for under an hour, but playing electronic games was not associated with conduct problems. No associations were found between either type of screen time and emotional symptoms, hyperactivity/inattention, peer relationship problems or prosocial behaviour. There was no evidence of gender differences in the effect of screen time. Conclusions TV but not electronic games predicted a small increase in conduct problems. Screen time did not predict other aspects of psychosocial adjustment. Further work is required to establish causal mechanisms.

https://adc.bmj.com/content/archdischild/98/5/341.full.pdf

Do television and electronic games predict children's psychosocial adjustment? Longitudinal research using the UK Millennium Cohort Study

Objective To assess the impact of a theoretically based sex education programme (SHARE) delivered by teachers compared with conventional education in terms of conceptions and terminations registered by the NHS.
 Design Follow-up of cluster randomised trial 4.5 years after intervention. Setting NHS records of women who had attended 25 secondary schools in east Scotland.
 Participants 4196 women (99.5% of those eligible).
 Intervention SHARE programme (intervention group) v existing sex education (control group).
 Main outcome measure NHS recorded conceptions and terminations for the achieved sample linked at age 20.
 Results In an “intention to treat” analysis there were no significant differences between the groups in registered conceptions per 1000 pupils (300 SHARE v 274 control; difference 26, 95% confidence interval −33 to 86) and terminations per 1000 pupils (127 v 112; difference 15, −13 to 42) between ages 16 and 20.
 Conclusions This specially designed sex education programme did not reduce conceptions or terminations by age 20 compared with conventional provision. The lack of effect was not due to quality of delivery. Enhancing teacher led school sex education beyond conventional provision in eastern Scotland is unlikely to reduce terminations in teenagers.
 Trial registration ISRCTN48719575.

https://www.bmj.com/content/bmj/334/7585/133.full.pdf

Impact of a theoretically based sex education programme (SHARE) delivered by teachers on NHS registered conceptions and terminations: final results of cluster randomised trial

Alison Parkes

Papers

What Makes People Dissatisfied with their Neighbourhoods

Limits to modern contraceptive use among young women in developing countries: a systematic review of qualitative research

Living in and leaving poor neighbourhood conditions in England

Do television and electronic games predict children's psychosocial adjustment? Longitudinal research using the UK Millennium Cohort Study

Impact of a theoretically based sex education programme (SHARE) delivered by teachers on NHS registered conceptions and terminations: final results of cluster randomised trial