Evaluation of the Heart of Birmingham teaching Primary Care Trust (HoBtPCT): My Choice Weight Management Programme:report commissioned by Heart of Birmingham teaching Primary Care Trust

This report details an evaluation of the My Choice Weight Management Programme undertaken by a research team from the School of Pharmacy at Aston University. The My Choice Weight Management Programme is delivered through community pharmacies and general practitioners (GPs) contracted to provide services by the Heart of Birmingham teaching Primary Care Trust. It is designed to support individuals who are ‘ready to change’ by enabling the individual to work with a trained healthcare worker (for example, a healthcare assistant, practice nurse or pharmacy assistant) to develop a care plan designed to enable the individual to lose 5-10% of their current weight. The Programme aims to reduce adult obesity levels; improve access to overweight and obesity management services in primary care; improve diet and nutrition; promote healthy weight and increased levels of physical activity in overweight or obese patients; and support patients to make lifestyle changes to enable them to lose weight. The Programme is available for obese patients over 18 years old who have a Body Mass Index (BMI) greater than 30 kg/m2 (greater than 25 kg/m2 in Asian patients) or greater than 28 kg/m2 (greater than 23.5 kg/m2 in Asian patients) in patients with co-morbidities (diabetes, high blood pressure, cardiovascular disease). Each participant attends weekly consultations over a twelve session period (the final iteration of these weekly sessions is referred to as ‘session twelve’ in this report). They are then offered up to three follow up appointments for up to six months at two monthly intervals (the final of these follow ups, taking place at approximately nine months post recruitment, is referred to as ‘session fifteen’ in this report). A review of the literature highlights the dearth of published research on the effectiveness of primary care- or community-based weight management interventions. This report may help to address this knowledge deficit. A total of 451 individuals were recruited on to the My Choice Weight Management Programme. More participants were recruited at GP surgeries (n=268) than at community pharmacies (n=183). In total, 204 participants (GP n=102; pharmacy n=102) attended session twelve and 82 participants (GP n=22; pharmacy 60) attended session fifteen. The unique demographic characteristics of My Choice Weight Management Programme participants – participants were recruited from areas with high levels of socioeconomic deprivation and over four-fifths of participants were from Black and Minority Ethnic groups; populations which are traditionally underserved by healthcare interventions – make the achievements of the Programme particularly notable. The mean weight loss at session 12 was 3.8 kg (equivalent to a reduction of 4.0% of initial weight) among GP surgery participants and 2.4 kg (2.8%) among pharmacy participants. At session 15 mean weight loss was 2.3 kg (2.2%) among GP surgery participants and 3.4 kg (4.0%) among pharmacy participants. The My Choice Weight Management Programme improved the general health status of participants between recruitment and session twelve as measured by the validated SF-12 questionnaire. While cost data is presented in this report, it is unclear which provider type delivered the Programme more cost-effectively. Attendance rates on the Programme were consistently better among pharmacy participants than among GP participants. The opinions of programme participants (both those who attended regularly and those who failed to attend as expected) and programme providers were explored via semi-structured interviews and, in the case of the participants, a selfcompletion postal questionnaire. These data suggest that the Programme was almost uniformly popular with both the deliverers of the Programme and participants on the Programme with 83% of questionnaire respondents indicating that they would be happy to recommend the Programme to other people looking to lose weight. Our recommendations, based on the evidence provided in this report, include: a. Any consideration of an extension to the study also giving comparable consideration to an extension of the Programme evaluation. The feasibility of assigning participants to a pharmacy provider or a GP provider via a central allocation system should also be examined. This would address imbalances in participant recruitment levels between provider type and allow for more accurate comparison of the effectiveness in the delivery of the Programme between GP surgeries and community pharmacies by increasing the homogeneity of participants at each type of site and increasing the number of Programme participants overall. b. Widespread dissemination of the findings from this review of the My Choice Weight Management Project should be undertaken through a variety of channels. c. Consideration of the inclusion of the following key aspects of the My Choice Weight Management Project in any extension to the Programme: i. The provision of training to staff in GP surgeries and community pharmacies responsible for delivery of the Programme prior to patient recruitment. ii. Maintaining the level of healthcare staff input to the Programme. iii. The regular schedule of appointments with Programme participants. iv. The provision of an increased variety of printed material. d. A simplification of the data collection method used by the Programme commissioners at the individual Programme delivery sites.

The role of trust in the transition from traditional to electronic B2B relationships in agri-food chains

E-business adoption rates in the agri-food sector are rather low, despite the fact that technical barriers have been mostly overcome during the last years and a large number of sophisticated offers are available. However, concerns about trust seem to impede the development of electronic relationships in the agri-food chains as trust is of particular importance in any exchange of agri-food products along the value chain. Drawing on existing research, characteristics and dimensions of trust are initially identified both in traditional and in electronic B2B relationships and a typology of trust is proposed. The aim of the paper is to provide an overview of the implementation and use of trust elements that e-commerce offers dedicated to agri-food sector. This assessment will show the current situation and discuss gaps for further improvement with the objective to facilitate the uptake of e-commerce in agri-food chains. © 2009 Elsevier B.V. All rights reserved.

A multilevel investigation of the mediating role of trust in the relationships between leadership and follower outcomes

The following research project investigated the mediating effects of individual trust in the relationships between eight leadership dimensions and follower motivation and efficacy. The research comprised of a total of three studies of which two are individual level analyses investigating the above relationship for individual followers, while the final study established the relationship between the eight dimensions and collective efficacy and group cohesion. A new measure of trust — collective vertical trust — was developed and tested and formed the mediator for the final study. The findings showed that leadership is indeed mediated through trust on both individual and collective level in the majority of relationships. In addition it was shown that individual and collective vertical trust are significantly related. Finally, the final study showed an absence of a significant relationship between trust on both the individual and collective level and organizational performance. The findings contributed to existing research in various ways: 1) the mediating effect of individual trust was established for eight separate leadership dimensions; 2) the studies established that while the indirect effects of leadership on follower motivation are similar amongst all age groups and levels of work experience, more work experienced individuals draw their beliefs in their abilities (i.e., self-efficacy) from alternative sources than leadership or trust in the leader; 3) a new measure of collective trust —collective vertical trust was established; 4) the mediating effect of collective trust was shown to be crucial in leadership effects on collective efficacy and group cohesion; and finally 5) a leadership measure initially designed for executive leaders was refined and tested for non-executive leaders.

An exploratory study of the role of trust in medication management within mental health services

Objective - To develop understandings of the nature and influence of trust in the safe management of medication within mental health services. Setting - Mental health services in the UK. Method - Qualitative methods were applied through focus groups across three different categories of service user—older adult, adults living in the community and forensic services. An inductive thematic analysis was carried out, using the method of constant comparison derived from grounded theory. Main Outcome - Measure Participants’ views on the key factors influencing trust and the role of trust in safe medication management. Results - The salient factors impacting trust were: the therapeutic relationship; uncertainty and vulnerability; and social control. Users of mental health services may be particularly vulnerable to adverse events and these can damage trust. Conclusion - Safe management of medication is facilitated by trust. However, this trust may be difficult to develop and maintain, exposing service users to adverse events and worsening adherence. Practice and policy should be oriented towards developing trust.

A probabilistic model for trust and reputation

This paper concerns the problem of agent trust in an electronic market place. We maintain that agent trust involves making decisions under uncertainty and therefore the phenomenon should be modelled probabilistically. We therefore propose a probabilistic framework that models agent interactions as a Hidden Markov Model (HMM). The observations of the HMM are the interaction outcomes and the hidden state is the underlying probability of a good outcome. The task of deciding whether to interact with another agent reduces to probabilistic inference of the current state of that agent given all previous interaction outcomes. The model is extended to include a probabilistic reputation system which involves agents gathering opinions about other agents and fusing them with their own beliefs. Our system is fully probabilistic and hence delivers the following improvements with respect to previous work: (a) the model assumptions are faithfully translated into algorithms; our system is optimal under those assumptions, (b) It can account for agents whose behaviour is not static with time (c) it can estimate the rate with which an agent's behaviour changes. The system is shown to significantly outperform previous state-of-the-art methods in several numerical experiments. Copyright © 2010, International Foundation for Autonomous Agents and Multiagent Systems (www.ifaamas.org). All rights reserved.

Triggering trust : to what extent does the question influence the answer when evaluating the perceived importance of trust triggers?

Trust is a critical component of business to consumer (B2C) e-Commerce success. In the absence of typical environmental cues that consumers use to assess vendor trustworthiness in the offline retail context, online consumers often rely on trust triggers embedded within e-Commerce websites to contribute to the establishment of sufficient trust to make an online purchase. This paper presents and discusses the results of a study which took an initial look at the extent to which the context or manner in which trust triggers are evaluated may exert influence on the importance attributed to individual triggers.

Justice and trust as antecedents of careerist orientation

Purpose – This paper aims to explore the antecedents of careerist orientations to work. Hypotheses are drawn from referent cognitions theory. First, it is proposed that trust mediates the relationship between an individual's perceptions of procedural justice and their careerist orientations to work. Second, perceptions of distributive justice, regarding the allocation of career development opportunities, will moderate the relationship between trust and careerist orientations to work. Design/methodology/approach – A total of 325 employees of a large UK financial institution completed a structured questionnaire. Regression analysis (using SPSS version 11) was used to test the presented hypotheses. Findings – All hypotheses were confirmed. However, the interaction effect observed was different from that hypothesised. It appears that trust only matters, in terms of the development of careerist orientations to work, when individuals feel that they are receiving equitable career development opportunities. Research limitations/implications – Much more research is required in different organisational contexts if one is to fully confirm and understand these relationships. However, these findings suggest that employers will only reduce the development of careerist attitudes in their workforce if they ensure the fair distribution of career development opportunities and engender trusting relations through the implementation of fair decision-making procedures. Originality/value – This paper adds much needed empirical research to the literature on new career realities and careerist orientations to work. Moreover, referent cognitions theory is presented as a new theoretical framework for understanding the cognitive processes involved in an individual's development of careerist attitudes.

Career development and careerist orientation to work:it's a question of trust, isn't it?

Presentation

Bent v Central Manchester University Hospitals NHS Trust 2012

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North Bristol NHS Trust v Harrold 2012

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Smith v Trafford Housing Trust

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