No abstract

Background NHS Health Checks is a national cardiovascular risk assessment and management programme in England. To improve equity of uptake in more deprived, and Black, Asian and minority ethnic (BAME) communities, a novel telephone outreach intervention was developed. The outreach call included an invitation to an NHS Health Check appointment, lifestyle questions, and signposting to lifestyle services. We examined the experiences of staff delivering the intervention. Methods Thematic analysis of semi-structured interviews with 10 community Telephone Outreach Workers (TOWs) making outreach calls, and 5 Primary Care Practice (PCP) staff they liaised with. Normalization Process Theory was used to examine intervention implementation. Results Telephone outreach was perceived as effective in engaging patients in NHS Health Checks and could reduce related administration burdens on PCPs. Successful implementation was dependent on support from participating PCPs, and tensions between the intervention and other PCP priorities were identified. Some PCP staff lacked clarity regarding the intervention aim and this could reduce the potential to capitalize on TOWs’ specialist skills. Conclusions To maximize the potential of telephone outreach to impact equity, purposeful recruitment and training of TOWs is vital, along with support and integration of TOWs, and the telephone outreach intervention, in participating PCPs.

Background The NHS Health Checks preventative programme aims to reduce cardiovascular morbidity across England. To improve equity in uptake, telephone outreach was developed in Bristol, involving community workers telephoning patients amongst communities potentially at higher risk of cardiovascular disease and/or less likely to take up a written invitation, to engage them with NHS Health Checks. Where possible, caller cultural background/main language is matched with that of the patient called. The call includes an invitation to book an NHS Health Check appointment, lifestyle questions from the Health Check, and signposting to lifestyle services. Objective To explore the experiences of patients who received an outreach call. Design/Setting/Participants Thematic analysis of semi‐structured interviews with 24 patients (15 female), from seven primary care practices, who had received an outreach call. Results The call increased participants’ understanding of NHS Health Checks and overcame anticipated difficulties with making an appointment. Half reported that they would not have booked if only invited by letter. The cultural identity/language skills of the caller were important in facilitating the interaction for some who might otherwise encounter language or cultural barriers. The inclusion of lifestyle questions and signposting prompted a minority to make lifestyle changes. Conclusions Participants valued easily generalizable aspects of the intervention—a telephone invitation with ability to book during the call—and reported that it prompted acceptance of an NHS Health Check. A caller who shared their main language/cultural background was important for a minority of participants, and improved targeting of this would be beneficial.

Disrespect involves having low regard or low esteem for someone. Disrespect is a universal experience and has the potential to negatively impact relationships and fosters anger and aggression (Hawkins, 2015; Shwalb & Shwalb, 2006). In the current study, younger (ages 19-25) and older adults (ages 50-77) imagined a person they knew had disrespected them in six different hypothetical situations. For each situation, participants rated their emotional reactivity. Participants also indicated their sensitivity to social rejection (i.e. being left out/excluded). The primary research questions for this study included: do reactions to disrespect differ based on age? Also, does one’s relationship status with a disrespect perpetrator matter? In the current study, participants had a stronger emotional reaction to disrespect when imagining the disrespect perpetrator was someone close to them rather than someone not close to them, regardless of age. An age by gender by relationship closeness ANOVA revealed three significant main effects: of age (older are less sensitive), gender (males are less sensitive), and relationship closeness (those more distant to perpetrator are less sensitive) on sensitivity to social rejection. Sensitivity to social rejection mediates the relationship between closeness to a disrespect perpetrator and emotional reaction, even after controlling for age as a covariate, p<.001. The findings of this study highlight the component of rejection that is typically involved within disrespect situations and may help to explain just why disrespect feels so hurtful. These findings also highlight that there may be some protection from disrespect based on age or gender.

In the early months of the COVID-19 pandemic, older age was associated with less anxiety and depression (Bruin de Bruin, 2021). Similar results were found for data collected during the June-July 2020 spike in cases (Smith et al., 2021). Theorists have suggested that benefits of age for well-being may be reduced when stressors are prolonged and unavoidable (Charles, 2010). Here, we investigated whether older age continued to be protective in June-July 2021, when vaccines had become widely available, but the pandemic persisted. Secondary data analysis was conducted from the Understanding America Study, based on n=5,535 (M=52.69 yrs., SD=16.04) participants who responded to online self-report surveys. Participants reported symptoms of anxiety and depression (assessed by the Patient Health Questionnaire, PHQ-4), engagement in protective behaviors (e.g., wearing a mask), and coping strategies (e.g., getting extra exercise). Multiple regression analyses predicted anxiety and depression from age, coping strategies, and protective behaviors, controlling for marital status, gender, and income. Coping through exercise and calling family/friends were significantly associated with less anxiety and depression, whereas coping by using social media and engaging in protective behaviors was significantly associated with more anxiety and depression. The harmful effects of protective behaviors may reflect the people engaging in these strategies most often are also those most worried about COVID-19. Even after accounting for coping strategies and protective behaviors, older age was still associated with fewer symptoms of anxiety and depression. Implications of older adults’ resilience in the face of a prolonged stressor for promoting mental health are discussed.