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Implementation of brief opportunistic health promotion services (smoking cessation, weight management and alcohol intervention) in an NHS urgent care walk in treatment centre for minor injury and illness: a feasibility study using mixed methods

Student thesis: Doctoral Thesis

Background: NHS walk in centres were opened in 2000 to modernize the NHS and to increase accessibility to health care. They are successfully used by the public. However, little is known about the clients presenting and even less about the role of health promotion more so, as there is a global epidemic of long-term conditions and non-accidental premature deaths. In Portsmouth, over 23% of adults are regular smokers, 33% overuse alcohol, 58% are overweight and obese. Avoidable unhealthy behaviours lead to early onset of longterm conditions and are major causes of premature non-accidental deaths. The purpose of this mixed methods feasibility study is to explore the feasibility, efficacy and acceptability of brief health promotion interventions on smoking, alcohol overuse, overweight and obesity in an NHS urgent care walk in treatment centre for minor injury and illness by producing a profile, conducting a randomized controlled trial, client survey and nurse practitioner interviews.

Study methods and results: A profile was developed by screening 16-75 year old clients for unhealthy behaviour on a mandatory booking in form. Of 4029 clients in four weeks, 80% were aged 16-75years. Over 76% had unhealthy behaviours from smoking 13%, obesity 47%, alcohol overuse 10% and 15% had a combination of these behaviours. A randomised controlled trial with 204 participants (102 participants in two arms) was conducted to compare the efficacy of healthy conversation, offer of referral to a Wellbeing service and a written leaflet at initial or delayed consultation. The primary outcome was the number of referrals made. A total of 22 referrals (11%) equal in each arm were made. Brief health promotion interventions took an average of 3 minutes.
Self-administered questionnaires were completed by 204 client participants to explore the acceptability of a brief health promotion intervention.
Over 80% were positive about the intervention when they had presented for an injury or illness and 1% expressed negative views. Over 60% reported that they would utilise the service in future and over 80% stated that they would inform friends, family and colleagues.
One-on-one semi-structured interviews were conducted with 14 nurse practitioners. The majority of nurse practitioners were positive about brief health promotion. Training and knowledge of health promotion were brought up as barriers by 80% while time was viewed as a barrier by 14%.

Conclusion: It is feasible, effective and acceptable to offer brief health promotion intervention on smoking, alcohol, overweight and obesity in walk in urgent care centres for minor injury and illness. It is recommended that brief health promotion forms part of a routine consultation with training to support nurse practitioners to engage in brief health promotion.
Original languageEnglish
Awarding Institution
Supervisors/Advisors
Award dateJan 2019

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