The contribution of qualitative research in designing a complex intervention for secondary prevention of coronary heart disease in two different healthcare systems

Background: Developing complex interventions for testing in randomised controlled trials is of increasing importance in healthcare planning. There is a need for careful design of interventions for secondary prevention of coronary heart disease (CHD). It has been suggested that integrating qualitative research in the development of a complex intervention may contribute to optimising its design but there is limited evidence of this in practice. This study aims to examine the contribution of qualitative research in developing a complex intervention to improve the provision and uptake of secondary prevention of CHD within primary care in two different healthcare systems.

Methods: In four general practices, one rural and one urban, in Northern Ireland and the Republic of Ireland, patients with CHD were purposively selected. Four focus groups with patients (N = 23) and four with staff (N = 29) informed the development of the intervention by exploring how it could be tailored and integrated with current secondary prevention activities for CHD in the two healthcare settings. Following an exploratory trial the acceptability and feasibility of the intervention were discussed in four focus groups (17 patients) and 10 interviews (staff). The data were analysed using thematic analysis.

Results: Integrating qualitative research into the development of the intervention provided depth of information about the varying impact, between the two healthcare systems, of different funding and administrative arrangements, on their provision of secondary prevention and identified similar barriers of time constraints, training needs and poor patient motivation. The findings also highlighted the importance to patients of stress management, the need for which had been underestimated by the researchers. The qualitative evaluation provided depth of detail not found in evaluation questionnaires. It highlighted how the intervention needed to be more practical by minimising administration, integrating role plays into behaviour change training, providing more practical information about stress management and removing self-monitoring of lifestyle change.

Conclusion: Qualitative research is integral to developing the design detail of a complex intervention and tailoring its components to address individuals' needs in different healthcare systems. The findings highlight how qualitative research may be a valuable component of the preparation for complex interventions and their evaluation.

Integrating Land-use Planning and Transportation in Belfast: A New Policy Agenda for Sustainable Development

Much of the interest in promoting sustainable development in planning for the city-region focuses on the apparently inexorable rise in the demand for car travel and the contribution that certain urban forms and land-use relationships can make to reducing energy consumption. Within this context, policy prescription has increasingly favoured a compact city approach with increasing urban residential densities to address the physical separation of daily activities and the resultant dependency on the private car. This paper aims to outline and evaluate recent efforts to integrate land use and transport policy in the Belfast Metropolitan Area in Northern Ireland. Although considerable progress has been made, this paper underlines the extent of existing car dependency in the metropolitan area and prevailing negative attitudes to public transport, and argues that although there is a rhetorical support for the principles of sustainability and the practice of land-use/transportation integration, this is combined with a selective reluctance to embrace local changes in residential environment or in lifestyle preferences which might facilitate such principles.

The 'Belfast' timber roof truss - is it sustainable and relevant today?

In the early 19th century the requirement for clear span industrial buildings brought about the development of a variety of timber truss types. The Belfast truss was introduced circa 1860 to meet the demand for efficient wide span industrial buildings. It has essentially a bow-string configuration with a curved top chord, straight horizontal bottom chord and close-spaced lattice web. Several thousand still exist in Ireland, many in buildings of historic significance. This paper sets out to demonstrate the efficiency of the Belfast truss and to show that, by modern structural design criteria, the concept, member sizes and joint details were well chosen. Trusses in historic buildings can be replicated almost exactly as originally fabricated. Results of a theoretical study are compared with the experimental behaviour of two full-scale trusses: one a replacement truss, tested in the laboratory; the other an 80-year-old truss tested on site. In addition, experimental results from a manufacturers archive material of full-scale truss tests carried out about 100 years ago are compared with theoretical models. As well as considering their significance in building conservation the paper proposes that Belfast trusses are an attractive sustainable alternative to other roof structures. The analysis, design, fabrication and testing of trusses have resulted in a better understanding of their behaviour which is not only of historic interest and fundamental to the repair/restoration of existing trusses, but also relevant to the design of modern timber trusses and the promotion of a sustainable form of roof construction.