Parent-infant relationships have a significant impact on children’s health outcomes. Despite growing evidence that parenting interventions designed to improve parent-infant relationships can be effective, there is less information about what makes parenting interventions meaningful and helpful to parents, and what barriers and facilitators contribute to service accessibility and engagement. To address this knowledge gap, this paper explores the perspectives of both professionals and service users regarding the valued features of, and the barriers and facilitators influencing promotion and participation in, the Nottinghamshire (UK) Healthy Families Parent-Infant Relationship intervention (PIRi). Primary qualitative data were collected employing purposive sampling. We undertook virtual/phone interviews with nine professional staff involved in the PIRi delivery and fourteen parents who had received support. Data were collected between May and July 2023, and analysed thematically using Nvivo 14. Several points in the PIRi process acted as barriers and facilitators to engagement and promotion. Health visitors are the key identification and referral route for the PIRi, but they reported lacking detailed knowledge of the specific support provided, impeding their ability to promote the intervention clearly and consistently. This led to misunderstandings around support for parents and concerns about stigma from their referral. Existing capacity challenges within the health visiting service meant limited family contact time, making it difficult to build rapport and identify those who would benefit from the PIRi. Further, confidence around discussing parent-infant relationship difficulties sensitively was reported as a barrier, with concern about relationship breakdown between professionals and families. Awareness of support options and the tailored nature of support were important in encouraging parents’ engagement. Parents who accepted PIRi support reported extremely positive experiences and outcomes. Support was seen as accessible, tailored and flexible, and perceived as improving bonding, connection and relationships. Our study highlights the importance of effectively promoting and embedding knowledge of services, and supporting key referral routes and pathways of care. A clear understanding of service offerings can facilitate more appropriate referrals and better engagement through clear and consistent messaging about support. Further, ensuring that support is accessible, tailored and flexible is crucial in promoting engagement in parenting programmes.

IntroductionThe school holidays can be a challenging time for many families especially for those reliant on free school meals. The Holiday Activities and Food (HAF) programme aims to provide disadvantaged families across England with healthy meals and enriching activities for children and young people. The clubs are usually in the form of a network of independent clubs and often depends on local partnerships and connections, such as the voluntary, community, social and enterprise sectors. In 2023 Southwark Council, interested in building on the findings of a national evaluation and providing more context specific insights relating to access to and use of their clubs, approached the Public Health Intervention Responsive Studies Teams scheme to collaborate in a service provision evaluation.MethodsAs part of the wider evaluation, a qualitative study was conducted. Semi-structured interviews were conducted with parents/carers of HAF eligible children and semi-structured interviews/focus groups were held with children and young people (CYP) attending a HAF club. Recruitment was through the clubs. The transcripts were coded by two independent researchers and thematic analysis applied.ResultsNine parent/carers and two young people took part in an interview. Six discussion groups with 4–6 young people in each took place. Most participants heard about the club they attended through word of mouth from friends and family, through the child’s school or by seeing a flyer/newsletter advert. Many participants were unaware of the variety and number of different clubs available to families. Finding out about the clubs online was reported to be time-consuming and websites not user-friendly. Parents/carers spoke of the frustration in trying to navigate booking systems. There was also a lack of awareness of the types of other support/signposting available from clubs.DiscussionThe evaluation highlighted the low-level of family awareness of all available HAF activities across the borough. Furthermore, navigating the system was reported as challenging. Southwark Council reviewed and revised its online provision to create a centralised repository accessible to families that aimed to improve awareness and ease the club booking process. Further work is required to improve signposting to support services and provision for parents/carers.

The earliest relationships between babies and their caregivers can act as a risk factor for social and emotional wellbeing in infancy and impact on later development. Difficulties in parent-infant relationships (PAIR) are characterised by inequalities, with families experiencing adversity at greater risk. In the absence of support, these relationship problems may require later, more expensive services. Interventions exist to address PAIR difficulties but are not widely commissioned, with regional disparities, and infants being under-served. This project qualitatively explored barriers and enablers to commissioning PAIR services. Individuals with commissioning responsibilities relating to PAIR working in Clinical Commissioning Groups or Local Authorities in the North East North Cumbria (NENC) region were invited to participate. Qualitative semi-structured interviews were informed by a topic guide developed through practitioner involvement. Nine interviews were completed online between February and April 2022. Anonymised transcripts were analysed using Framework Analysis. Barriers and enablers to commissioning were general, specific to PAIR services, or related to the pandemic context. General factors included the nature of the commissioning process, the importance of taking a collaborative approach to commissioning and the constraints of funding processes. Commissioners valued being able to demonstrate impact and value for money through service evaluation but faced challenges in doing so. Specific barriers relating to PAIR commissioning included a lack of awareness of the importance of infant mental health although there was an acknowledgement of the importance of maternal and parent-infant services/support during the early years. Factors amenable to change were mapped on to the Behaviour Change Wheel to inform the future co-development of a resource to address barriers and enablers. This paper is the first to report a pragmatic, applied qualitative exploration of barriers and enablers to commissioning parent-infant relationship services. Insights from commissioners with a wide range of portfolios identified key factors operating at the individual level which were amenable to change. In addition, there were barriers beyond the individual level, such as funding. Using a pragmatic approach, we identified best-fit behaviour change initiatives to develop a commissioning support toolkit to increase access to support, improve outcomes, and decrease inequalities, addressing infants as an under-served group.

Despite social prescribing being promoted by the UK government for the last decade, the evidence supporting social prescribing remains weak and has mainly been confined to clinical contexts. Our study aimed to evaluate the impact of a Social Navigator (SN) service in South Tyneside on the health and well-being of users who experience financial hardship with complex health needs and limited access to mental health services.Using a mixed-methods design combining secondary analysis of service data (n=330), qualitative interviews with service users (n=15) conducted by peer researchers, and a social return On investment analysis that matched service data with health economic indicators from the UK Social Value Bank.Our findings demonstrate clear value for money with a £3 return for every £1 invested in the service, with a positive return confirmed in sensitivity analysis. SNs were able to improve the confidence of service users, with statistically significant changes across all eight confidence-related outcomes, and helped them to access other advice and financial services. This resulted in one-off financial gains (average £1237) and annual financial gains (average £1703) for service users. The interviews identified that relieving financial burden and stress improved the quality of life and mental well-being of users as a result of their involvement with the service.SN can break the cycle of multiple visits to crisis teams by building trusting relationships and providing emotional and practical support, while being responsive to the service users’ needs and available when they have needs. They play a key intermediary role in integrated care systems with a unique focus on the wider determinants of health and financial hardship, advocating for service users without time limits and navigating the complexities of the system across local government. Greater integration of local support services could be achieved by mapping all available pathways for support.

Hallucinations are a common feature of psychosis, yet access to effective psychological treatment is limited. The Managing Unusual Sensory Experiences for First-Episode-Psychosis (MUSE-FEP) trial aimed to establish the feasibility and acceptability of a brief, hallucination-specific, digitally provided treatment, delivered by a non-specialist workforce for people with psychosis. MUSE uses psychoeducation about the causal mechanisms of hallucinations and tailored interventions to help a person understand and manage their experiences. We undertook a two-site, single-blind (rater) Randomised Controlled Trial and recruited 82 participants who were allocated 1:1 to MUSE and treatment as usual (TAU) (n=40) or TAU alone (n=42). Participants completed assessments before and after treatment (2 months), and at follow up (3-4 months). Information on recruitment rates, adherence, and completion of outcome assessments was collected. Analyses focussed on feasibility outcomes and initial estimates of intervention effects to inform a future trial. The trial is registered with the ISRCTN registry 16793301. Criteria for the feasibility of trial methodology and intervention delivery were met. The trial exceeded the recruitment target, had high retention rates (87.8%) at end of treatment, and at follow up (86.6%), with good acceptability of treatment. There were 3 serious adverse events in the therapy group, and 5 in the TAU group. Improvements were evident in both groups at the end of treatment and follow up, with a particular benefit in perceived recovery in the MUSE group. We showed it was feasible to increase access to psychological intervention but a definitive trial requires further changes to the trial design or treatment.

Research suggests parental ability to recognise when their child has overweight is limited. It is hypothesised that recognition of child overweight/obesity is fundamental to its prevention, acting as a potential barrier to parental action to improve their child’s health-related behaviours and/or help seeking. The purpose of this study was to investigate the efficacy of an intervention (MapMe) to improve parental ability to correctly categorise their child as having overweight one-month post-intervention, and reduce child body mass index (BMI) z-score 12 months post-intervention. MapMe consists of body image scales of known child BMI and information on the consequences of childhood overweight, associated health-related behaviours and sources of support. We conducted a three-arm (paper-based MapMe, web-based MapMe and control) randomised control trial in fifteen English local authority areas with parents/guardians of 4–5- and 10–11-year-old children. Parental categorisation of child weight status was assessed using the question ‘How would you describe your child’s weight at the moment?’ Response options were: underweight, healthy weight, overweight, and very overweight. Child weight status and BMI z-scores were calculated using objectively measured height and weight data and UK90 clinical thresholds. There was no difference in the percentage of parents correctly categorising their child as having overweight/very overweight (n = 264: 41% control, 48% web-based, and 43% paper-based, p = 0.646). BMI z-scores were significantly reduced for the intervention group at 12 months post-intervention compared to controls (n = 338, mean difference in BMI z-score change −0.11 (95% CI −0.202 to −0.020, p = 0.017). MapMe was associated with a decrease in BMI z-score 12 months post-intervention, although there was no direct evidence of improved parental ability to correctly categorise child overweight status. Further work is needed to replicate these findings in a larger sample of children, investigate mechanisms of action, and determine the use of MapMe as a public health initiative.

IntroductionIndividuals who access at-risk mental state (ARMS) services often have unusual sensory experiences and levels of distress that lead them to seek help. The Managing Unusual Sensory Experiences (MUSE) treatment is a brief symptom targeted intervention that draws on psychological explanations to help account for unusual experiences. Practitioners use formulation and behavioural experiments to support individuals to make sense of their experiences and enhance coping strategies. The primary objective of this feasibility trial is to resolve key uncertainties before a definitive trial and inform parameters of a future fully powered trial.Methods and analysis88 participants aged 14–35 accepted into ARMS services, experiencing hallucinations/unusual sensory experiences which are considered by the patient to be a key target problem will be recruited from UK National Health Service (NHS) sites and randomised using 1:1 allocation (stratified by site, gender, and age) to either 6–8 sessions of MUSE or time-matched treatment as usual. Participants and therapists will be unblinded, research assessors are blinded. Blinded assessment will occur at baseline, 12 weeks and 20 weeks postrandomisation. Data will be reported in line with Consolidated Standards of Reporting Trials. Primary trial outcomes are feasibility outcomes, primary participant outcomes are functioning and hallucinations. Additional analysis will investigate potential psychological mechanisms and secondary mental well-being outcomes. Trial progression criteria follows signal of efficacy and uses an analytical framework with a traffic-light system to determine viability of a future trial. Subsequent analysis of the NHS England Mental Health Services Data Set 3 years postrandomisation will assess long-term transition to psychosis.Ethics and disseminationThis trial has received Research Ethics Committee approval (Newcastle North Tyneside 1 REC; 23/NE/0032). Participants provide written informed consent; young people provide assent with parental consent. Dissemination will be to ARMS Services, participants, public and patient forums, peer-reviewed publications and conferences.Trial registration numberISRCTN58558617.

ObjectiveTo identify shared, generic domains of child health and wellbeing that are important and common across children, and that could be used as generic health indicators and healthcare outcomes across conditions and services. We did this by reviewing existing paediatric, diagnosis-specific, health core outcome sets, and identifying areas of commonality and divergence, as well as gaps.MethodsThe Core Outcome Measures in Effectiveness Trial register was searched for all child health core specific outcome sets published between 2008 and 2022. Outcomes from identified sets were extracted, and the WHO International Classification of Functioning, Disability and Health (WHO ICF) was used to as a framework to categorise the extracted outcomes, and to identify clusters. The involvement of children and their families in developing the core outcome sets was also assessed.ResultsA total of 206 sets were identified, of which 36 were included. These 36 sets related to: gastrointestinal conditions (n=8); neurological conditions (n=7); ear, nose and throat (n=5); orthopaedics (n=4); general paediatrics (n=3); neonatology (n=2); respiratory (n=2); metabolic disease (n=2); and rheumatology, oncology and dentistry specialities (n=1 each). The data extracted from these sets covered 441 unique outcomes, which mapped on to 22 separate outcome clusters. The most common cluster related to medical diagnoses (in 76% of sets) with the next most common being pain, followed by communication and social interaction, mobility, self-care and school. Additionally, three clusters outside the WHO ICF were identified: mortality, dental/oral health, and quality of life. Only 36% of reviewed studies included children and young people’s views in the development of the core outcome sets.ConclusionsThere is considerable overlap in terms of health indicators included in existing child health core outcome sets. Specifically, pain, social communication, mobility, self-care and school participation seem to be universally agreed important outcomes, generic to all children across diagnostic specialities. This suggests that there is potential for a universally relevant, generic set of child health outcomes or indicators spanning traditional diagnostic, discipline and sector boundaries – that is, a minimum set of success criteria that are important for all children, regardless where they are in the healthcare system, what interventions they are receiving, and what conditions they have. Developing and adopting such a generic approach has the potential to facilitate more integrated practice, health care, and research for children and families; as well as to improve co-ordination and resource-use across services.

BackgroundIndicators of child health have the potential to inform societal conversations, decision-making and prioritisation. Paediatric core outcome sets are an increasingly common way of identifying a minimum set of outcomes for trials within clinical groups. Exploring commonality across existing sets may give insight into universally important and inclusive child health indicators.MethodsA search of the Core Outcome Measures in Effectiveness Trial register from 2008 to 2022 was carried out. Eligible articles were those reporting on core outcome sets focused on children and young people aged 0–18 years old. The International Classification of Functioning, Disability and Health (ICF) was used as a framework to categorise extracted outcomes. Information about the involvement of children, young people and their families in the development of sets was also extracted.Results206 articles were identified, of which 36 were included. 441 unique outcomes were extracted, mapping to 22 outcome clusters present across multiple sets. Medical diagnostic outcomes were the biggest cluster, followed by pain, communication and social interaction, mobility, self-care and school. Children and young people’s views were under-represented across core outcome sets, with only 36% of reviewed studies including them at any stage of development.ConclusionsExisting paediatric core outcome sets show overlap in key outcomes, suggesting the potential for generic child health measurement frameworks. It is unclear whether existing sets best reflect health dimensions important to children and young people, and there is a need for better child and young person involvement in health indicator development to address this.

IntroductionHallucinations (hearing or seeing things that others do not) are a common feature of psychosis, causing significant distress and disability. Existing treatments such as cognitive–behavioural therapy for psychosis (CBTp) have modest benefits, and there is a lack of CBTp-trained staff. Shorter, targeted treatments that focus on specific symptoms delivered by a non-specialist workforce could substantially increase access to treatment.Managing Unusual Sensory Experiences (MUSE) explains why people have hallucinations and helps the person to develop and use coping strategies to reduce distress. MUSE focuses only on hallucinations, and treatment is short (four to six, 1-hour sessions per week). It is a digital intervention, run on National Health Service (NHS) laptops, which provides information about hallucinations in an engaging way, using audio, video and animated content. Crucially, it is designed for use by non-specialist staff like community psychiatric nurses.Methods and analysisThe study is a two-arm feasibility randomised controlled trial comparing MUSE and treatment as usual (TAU) (n=40) to TAU alone (n=40), recruiting across two NHS Trusts, using 1:1 allocation and blind assessments before and after treatment (2 months) and at follow-up (3 months). Quantitative information on recruitment rates, adherence and completion of outcome assessments will be collected. Qualitative interviews will capture service users’ experience of therapy and clinicians’ experiences of the training and supervision in MUSE. Clinicians will also be asked about factors affecting uptake, adherence and facilitators/barriers to implementation. Analyses will focus on feasibility outcomes and provide initial estimates of intervention effects. Thematic analysis of the qualitative interviews will assess the acceptability of the training, intervention and trial procedures.Ethics and disseminationThe trial has received NHS Ethical and Health Research Authority approval. Findings will be disseminated directly to participants and services, as well as through peer-reviewed publications and conference presentations.Trial registration numberISRCTN16793301.

Past research shows that individuals with Williams syndrome (WS) have heightened and prolonged eye contact. Using parent report measures, we examined not only the presence of eye contact but also its qualitative features. Study 1 included individuals with WS (n = 22, ages 6.0-36.3). Study 2 included children with different neurodevelopmental (ND) conditions (WS, autism spectrum condition, fragile X syndrome, attention-deficit/hyperactivity disorder) and children with neurotypical development (NT; n = 262, ages 4.0-17.11). Unusual eye contact features, including staring, were found in approximately half of the WS samples. However, other features such as brief glances were frequently found in WS and in all ND conditions, but not NT. Future research in ND conditions should focus on qualitative as well as quantitative features of eye contact.

Aims: Including parents and other stakeholders in the development of interventions to address the sensitive public health issues such as childhood obesity, through public involvement is critical. However, the Covid-19 pandemic has created a challenge for public involvement and engagement activities (PICE). The aim of this paper is to describe the process and challenges of setting up, maintaining, evaluating, and recording impact of three public and stakeholder groups via remote methods in the context of the MapMe2 study during the Covid-19 pandemic. Parental reaction to result letters received as part of the National Child Measurement Programme (NCMP) informing parents of their child's overweight status is often one of hostility or disbelief. As a result, parents often do not act on these letters to address child overweight. The MapMe2 study is working in collaboration with the NCMP and local authorities, building on previous work (MapMe) and aims to support parents of primary school-aged children to recognise and maintain a healthy weight in their child. The existing MapMe Intervention includes an enhanced NCMP child weight result letter, supplemented with Body Image Scales (BIS), and an intervention website with material to support healthy eating, physical activity, and signposting supporting information. The intervention was to be refined and the evaluation informed with PICE input. Methods: Covid-19 restrictions meant that planned face-to-face PICE methods had to be altered with all recruitment, all correspondence, and activities taking place remotely. A Parent Involvement Panel (PIP), a child panel, and an expert panel were established. Several adaptations were made to accommodate a new way of involving the public in research. Results/Conclusions: Working remotely created many challenges and was a learning experience for all involved. However, an active group was successfully established. Using continuous assessment and evaluation methods, we were able to demonstrate successful involvement and engagement in the refinement of the MapMe2 study. Through the sharing of PICE methods practice, this paper adds to the literature, the value of partnership working.

Background Within the current context of continued austerity and post-pandemic recovery, it remains important that Local Government services address the increasing needs of residents as cost-effectively as possible. Alliancing, whereby services work collaboratively focusing on the 'whole-system', has gained popularity as a tool with the potential to support collaborative whole systems approaches. This synthesis aims to identify how alliancing can be successfully operationalised in the commissioning of public health, wider National Health Service (NHS) and social care-related services. Methods A realist literature synthesis was undertaken in order to identify underlying generative mechanisms associated with alliancing, the contextual conditions surrounding the implementation and operationalisation of the alliancing approach mechanisms, and the outcomes produced as a result. An iterative approach was taken, using a recent systematic review of the effectiveness of Alliancing, online database searches, and grey literature searches. Results Three mechanistic components were identified within the data as being core to the successful implementation of alliances in public health and social care-related services within Local Government: (i) Achieving a system-level approach; (ii) placing local populations at the heart of the system; and (iii) creating a cultural shift. Programme theories were postulated within these components. Conclusions The alliancing approach offers an opportunity to achieve system-level change with the potential to benefit local populations. The realist synthesis approach taken within this study has provided insights into the necessary contextual and mechanistic factors of the Alliancing approach, above and beyond effectiveness outcomes typically collected through more conventional evaluation methodologies.

Objective:To provide information on baseline knowledge, skills and attitudes (KSA) of paediatric staff to formulate a plan for improving infant feeding support in hospitals.Design:Semistructured interviews assessed baseline infant feeding KSA and experiences in 14 paediatric health professionals of various grades (medical students, healthcare assistants, ward nurses and specialist nurses). Audio recordings were transcribed verbatim and underwent thematic analysis. An online questionnaire gathered descriptive statistics about participants.Setting:A single large hospital trust, North East England.Results:Seven major themes were identified in KSA: culture and trends, roles and working practice, training and resources, the health professional, understanding the parent, effective communication and the challenges of feeding the ill child.Staff discussed various organisational and personal barriers to acquiring infant feeding support training and experience, and to delivering feeding support. Staff were keen to support families with feeding but often felt constrained by a belief that this required specialist knowledge and skills. Although staff believed they actively promoted breastfeeding-friendly messages, it was evident that marketing communications and personal experiences inadvertently influenced their approach to families.Conclusions:The development of clear, evidence-based infant feeding education and training for paediatric staff delivered by experienced mentors is warranted. Training should cover background theory, delivering practical support, communication skills and creating a baby-friendly hospital environment. UNICEF Baby Friendly Standards would be suitable to inform content. Training is likely to be received positively by staff and benefit women and babies in this setting.

Rationale The present scoping review seeks to gain insight into what is known regarding the transition of treatment responsibility, specifically for individuals with haemophilia. A focus will be placed on the barriers and facilitators experienced towards the treatment transition process for families and young people engaged in prophylaxis therapy. A scoping review affords an opportunity to map out and provide an overview of the emerging literature given the newly emerging enquiry into treatment transition in haemophilia.Objective The current scoping review will aim to address the following research question: “What barriers and facilitators are experienced by young people, caregivers and healthcare professionals towards treatment transition in haemophilia?”The subsequent objectives were identified to address the research question: • To provide a detailed representation of the range of available literature for barriers and facilitators experienced by the array of actors involved, towards treatment transition and successful self-management in haemophilia. • To visually map the existing evidence (in diagrammatic form) in alignment with the objective of the review.• To consider clear recommendations for future directions of research based on the identified knowledge gaps. Recommendations will ultimately seek to support optimal transition from family-orientated to self-management, and paediatric to adult services. Method: Articles published in peer-reviewed journals are eligible for inclusion. Both primary research studies and secondary data analysis will be accepted. No restrictions are placed upon study design. Articles which explored treatment transition independently or alongside other related concepts such as quality of life, self-care and treatment adherence will be eligible. The current review aims to include articles sampling children and/or adults with haemophilia, their caregivers and/or healthcare professionals involved in haemophilia care. Articles sampling individuals living with haemophilia can have a diagnosis of haemophilia A or B. Articles can define “treatment” as regular prophylaxis therapy or on-demand administration following a bleeding episode. Information Sources The following four databases will be searched: •Medline•Scopus•PsycINFO •CINAHLAt this stage, no date or language restrictions have been implemented in the electronic searches for studies to allow an accurate estimate of the variety of literature available. Additionally, no exclusions regarding the publication status have been applied. Data charting aims to include: • Study aim•Healthcare professional group •Barriers to treatment transition•Facilitators to treatment transition•Future actions for supporting treatment transition

Background: International societies have recommended that levothyroxine should not routinely be prescribed in older individuals for the management of mild subclinical hypothyroidism (SCH). However, it is unknown whether clinicians managing people with SCH are either aware of or adhere to these guidelines. Methods: A web-based survey of members of several international thyroid associations and general practitioners in North-East England was conducted. Respondents were presented with a vignette of an 80-year-old gentleman with mild persistent SCH experiencing tiredness. Multivariable logistic regression analyses were performed to evaluate predictors of awareness of guidelines and responses to treatment. Results: The survey response rate was 21.9% (565/2,583). Only 7.6% of clinicians were unaware of guidelines regarding management of SCH in older people. Twenty percent of clinicians stated that they would treat the older patient with mild SCH, whereas 13% were unsure. Clinicians from North America were more likely to treat the older person with mild SCH than clinicians from elsewhere (OR 2.24 [1.25–3.98]). Likewise, non-endocrinologists were also more likely than endocrinologists to treat the older person with mild SCH (OR 3.26 [1.45–6.47]). Conclusion: The majority of clinicians are aware of guidelines regarding management of SCH in older individuals. However, a considerable proportion of clinicians would still treat an older person with non-specific symptoms and mild SCH. These guidelines need to be disseminated more widely and more research is required to understand barriers to adherence to international recommendations.

Background Mood and weight problems are common in young people, yet few treatments address both conditions concurrently. Behavioural activation (BA) has shown promise as a treatment for adults with comorbid obesity and depression. This study aimed to examine the feasibility and acceptability of a manualised BA treatment targeting weight and mood problems in young people. Methods Young people with low mood and weight difficulties were identified via a school-based screening process. Following a diagnostic interview, young people with clinically significant mood problems and concurrent overweight/obesity were invited to participate. A total of 8–12 sessions of BA were delivered by a graduate therapist to eight adolescents (four male) aged 12–15 years. Weight, mood and functioning were assessed before, during and after treatment, and a semistructured qualitative interview was conducted, along with selected outcome measures at 4 months’ follow-up. Results Low attrition and positive qualitative feedback suggested the intervention was acceptable. Trends towards a reduction in reported depression symptoms and improved functioning scores were observed at follow-up, with more mixed results for change in body mass index. Of those attending the 4-month follow-up, 57% (4/7) no longer met the screening threshold for major depressive disorder. However, low screening and baseline recruitment rates would pose challenges to executing a larger trial. Conclusions BA delivered by a graduate therapist in a British community setting is an acceptable, feasible treatment for comorbid mood and weight problems in adolescence, and its effectiveness should be evaluated in an adequately powered randomised controlled trial.

Background: Active travel to school (ATS) can increase children's levels of physical activity but so far there is limited evidence that ATS interventions are effective. The RIGHT TRACKS pilot study aimed to test the feasibility of an incentivescheme to increase ATS in Year 5 children. Data collection included weekly child and parental reports of ATS (daily, when by text message), and accelerometers worn by children, in both control and intervention schools, over nine weeks (one week baseline + eight weeks intervention). Objective: The objective of this process evaluation was to obtain additional data on the feasibility and acceptability of the intervention and trial procedures of the RIGHT TRACKS study. Methods: Qualitative semi-structured interviews were conducted at the end of the pilot study in January and February 2015 (and during the pilot study, in November 2014, in the case of one dropout participant). Participants were from both intervention and control schools and included children, parents, school staff, and other stakeholders. Interviews were voice-recorded, transcribed and theme-analysed. Results: A total of 29 participants were interviewed including children (n = 9), parents (n = 9), Year 5 teachers (n = 6), head teachers (n = 2), school receptionists (n = 3) and wider stakeholders (n = 2). In general, data suggested that participants enjoyed taking part in the RIGHT TRACKS study and engaged with it. However, a number of issues were raised pertaining to recruitment, data collection, and use of incentives. Key recommendations included close collaboration with organisations already working in schools, considering a different range of incentives, and the possibility of running the scheme as a lunchtime activity. Conclusions: Findings support the feasibility and acceptability of an incentive scheme to increase ATS. Additional feasibility work should be carried out prior to a definitive evaluation trial, taking into account the findings and recommendations of this study.

Active school travel (AST) is an important source of physical activity for children and a conceptual understanding of AST is necessary to inform promotion efforts. The aim of this article is to provide a conceptual analysis of AST. All currently identified AST formulations include intra-individual variables which are often recommended as intervention targets. However, existing literature lacks clarity on precisely how these intra-individual variables might shape specific AST interventions. Moreover, evaluative studies of AST interventions typically fail to specify an underpinning theory or model. To address this limitation, the Behavioural Ecological Model (BEM), not previously addressed in AST, is presented to guide this area of research. Based on specific examples, we draw attention to the role of potential antecedents and potential reinforcers of AST, as well as potential reinforcers of motorised travel. Antecedents and reinforcers may help to explain choices of school travel mode, and to inform and increase intervention options to promote AST. Consistent with the BEM, the provision of more immediate consequences, such as fun and material prizes, is an evidence-based strategy for increasing AST which is likely to be low-cost and easier to deliver than alternative interventions. This approach to the study of AST is expected to contribute to similar analyses in this and other areas of behaviour change research, and to a more useful discussion and treatment of theoretical and conceptual behavioural models.