Felicity Jones

Aim: To evaluate the effectiveness of prescribed postnatal exercise on postnatal depression. Prescribed exercise was defined as any physical activity that was carried out in the postnatal period with the objective of reducing postnatal depression, as determined by identified scales. Background: Research has identified that regular physical exercise interventions are beneficial to mental health conditions such as depression and anxiety. Design: A systematic review and narrative analysis of randomised controlled trials (RCTs) reporting on the effectiveness of prescription postnatal exercise on postnatal depression. Data sources: Selection criteria included full text, academic articles written in English comparing exercise retrieved from MEDLINE, CINAHL, PsycINFO, EMBASE and SPORTDiscus. Research focusing on postnatal or postpartum exercise or physical activity; depression or mood swings, published between 2008 and 2016 was included. The search was refined to include females aged eighteen years or more. Review methods: Forty-seven articles were initially identified and full text analysis was performed by two members of the research team. Twelve articles were identified as meeting the inclusion criteria and were distributed for scrutiny and assessment amongst the five members of the research team. Methodological quality was assessed using a Quality Assessment Tool for Quantitative Studies published by the Effective Public Health Practice Project (EPHPP) (1998). Finally the articles were redistributed amongst the team for a second assessment and verification. Discrepancy of ratings for a paper between the reviewers was resolved by a third reviewer through reassessment of the paper and further discussion. Results: Eight studies were included in the final systematic review carried out using the EPHPP assessment tool; the review identified six quality RCTs meeting the inclusion criteria. Conclusions: The findings indicate that a tailored exercise intervention can effectively alleviate postnatal depressive symptoms, benefiting women both physically and psychologically. Social support experienced by participants in relation to the exercise intervention was seen to have a positive impact.

Background: Unintentional injuries are a leading cause of preventable death and a major cause of ill health and disability in children under five years of age. A health promotion mobile phone application, ‘Grow up Safely’, was developed to support parents and carers in reducing unintentional injuries in this population of children. Methods: A prototype of the mobile application was developed to deliver health education on unintentional injury prevention linked to stages of child development. In order to explore the usability of the app and refine its content, three focus groups were conducted with 15 mothers. Data were analysed using thematic analysis. Results: The majority of participants reported previous use of health apps, mainly related to pregnancy, and recommended by health professionals. The app was considered user‐friendly and easy to navigate. Participants in two focus groups found the app informative, offered new information and they would consider using it. Participants in the ‘young mum's’ group considered the advice to be ‘common sense’, but found the language too complex. All participants commented that further development of push‐out notifications and endorsement by a reputable source would increase their engagement with the app. Conclusion: The ‘Grow Up Safely’ mobile phone app, aimed at reducing unintentional injuries in children under five, was supported by mothers as a health promotion app. They would consider downloading it, particularly if recommended by a health professional or endorsed by a reputable organisation. Further development is planned with push‐out notifications and wider feasibility testing to engage targeted groups, such as young mothers, fathers and other carers.

Objectives To test the feasibility of conducting a controlled trial into the effectiveness of a self-management programme integrated into stroke rehabilitation. Design A feasibility cluster-randomised design was utilised with stroke rehabilitation teams as units of randomisation. Setting Community-based stroke rehabilitation teams in London. Participants 78 patients with a diagnosis of stroke requiring community based rehabilitation. Intervention The intervention consisted of an individualised approach to self-management based on self-efficacy. Clinicians were trained to integrate defined self-management principles into scheduled rehabilitation sessions, supported by a patient-held workbook. Main outcomes measures Patient measures of quality of life, mood, self-efficacy and functional capacity, and health and social care utilisation, were carried out by blinded assessors at baseline, 6 weeks and 12 weeks. Fidelity and acceptability of the delivery were evaluated by observation and interviews. Results 4 community stroke rehabilitation teams were recruited, and received a total of 317 stroke referrals over 14 months. Of these, 138 met trial eligibility criteria and 78 participants were finally recruited (56.5%). Demographic and baseline outcome measures were similar between intervention and control arms, with the exception of age. All outcome measures were feasible to use and clinical data at 12 weeks were completed for 66/78 participants (85%; 95% CI 75% to 92%). There was no significant difference in any of the outcomes between the arms of the trial, but measures of functional capacity and self-efficacy showed responsiveness to the intervention. Observation and interview data confirmed acceptability and fidelity of delivery according to predetermined criteria. Costs varied by site. Conclusions It was feasible to integrate a stroke self-management programme into community rehabilitation, using key principles. Some data were lost to follow-up, but overall results support the need for conducting further research in this area and provide data to support the design of a definitive trial.