Papers by Christina Victor
International Journal of Behavioral Nutrition and Physical Activity, 2019
Background: Few trials have compared estimates of change in physical activity (PA) levels using s... more Background: Few trials have compared estimates of change in physical activity (PA) levels using self-reported and objective PA measures when evaluating trial outcomes. The PACE-UP trial offered the opportunity to assess this, using the self-administered International Physical Activity Questionnaire (IPAQ) and waist-worn accelerometry. Methods: The PACE-UP trial (N = 1023) compared usual care (n = 338) with two pedometer-based walking interventions, by post (n = 339) or with nurse support (n = 346). Participants wore an accelerometer at baseline and 12 months and completed IPAQ for the same 7-day periods. Main outcomes were weekly minutes, all in ≥10 min bouts as per UK PA guidelines of: i) accelerometer moderate-to-vigorous PA (Acc-MVPA) ii) IPAQ moderate+vigorous PA (IPAQ-MVPA) and iii) IPAQ walking (IPAQ-Walk). For each outcome, 12 month values were regressed on baseline to estimate change. Results: Analyses were restricted to 655 (64%) participants who provided data on all outcomes at baseline and 12 months. Both intervention groups significantly increased their accelerometry MVPA minutes/week compared with control: postal group 42 (95% CI 22, 61), nurse group 43 (95% CI 24, 63). IPAQ-Walk minutes/week also increased: postal 57 (95% CI 2, 112), nurse 43 (95% CI-11, 97) but IPAQ-MVPA minutes/week showed non-significant decreases: postal-11 (95% CI-65, 42), nurse-34 (95% CI-87, 19). Conclusions: Our results demonstrate the necessity of using a questionnaire focussing on the activities being altered, as with IPAQ-Walk questions. Even then, the change in PA was estimated with far less precision than with accelerometry. Accelerometry is preferred to self-report measurement, minimising bias and improving precision when assessing effects of a walking intervention. Trial registration: ISRCTN, ISRCTN98538934. Registered 2 March 2012.
Journal of Health Organization and Management, 2017
article-type="researcharticle" dtd-version="1.1d1" xml:lang="en"><front id="meta-hdr"><journal-me... more article-type="researcharticle" dtd-version="1.1d1" xml:lang="en"><front id="meta-hdr"><journal-meta><journal-id journal-id-type="publisher">JHOM</journal-id><journal-id journalid-type="doi">10.1108/JHOM</journal-id><journal-title-group><journal-title>Journal of Health Organization and Management</journal-title><abbrev-journal-title abbrev-type="publisher">JHOM</abbrev-journal-title></journal-title-group><issn publication-format="print">1477-7266</issn><publisher><publisher-name>Emerald Publishing Limited</publisher-name></publisher></journal-meta><article-meta id="art-meta"><article-id pub-id-type="publisher-id">591278</article-id><article-id pub-id-type="
Researching Later Life and Ageing, 2012
In this chapter we reflect upon our experiences of undertaking qualitative fieldwork with older P... more In this chapter we reflect upon our experiences of undertaking qualitative fieldwork with older Pakistani Muslim women and men living in the United Kingdom (UK). The significant increase that is expected within the next 20 years in the proportion of older people living in minority black and ethnic communities within the UK (Merrell et al., 2006) — particularly those living within the Bangladeshi and Pakistani communities (see Katbamna et al., 2002; Phillipson et al., 2003; Burholt & Wenger, 2003) — suggests a growing need for conducting research on this hitherto under-researched group of Bangladeshi and Pakistani older people (see Vincent et al., 2006; Victor et al., 2012). This is especially because of the particularly high levels of inequality and disadvantage experienced by members of these communities in the UK (Qureshi, 1998; Harding & Balarajan, 2001; Nazroo et al., 2004; Nazroo, 2006), and their higher levels of morbidity rates (Katbamna et al., 2002), which are likely to have important implications for how old age is experienced by members of these minority groups. However, as it is common with many other under-researched minority and migrant groups, doing qualitative research with older Bangladeshis and Pakistanis presents researchers with key challenges. These challenges stem not merely from the cultural and linguistic differences that may often exist between researchers (and also between the wider academic world) and these ethnic minority groups (see Boneham, 2002; Feldman et al., 2008; Hanna et al., 2008; Lloyd et al., 2008), but also relate to the particular social and cultural identities of the researchers vis-a-vis those they research.
International Journal of Integrated Care, 2010
Introduction: Within the UK health and social care policy is placing an increasing emphasis on im... more Introduction: Within the UK health and social care policy is placing an increasing emphasis on improving the quality of care for older people in care homes through integrated working between health and social care services. This study aims to clarify the research available on integrated working and evaluate its impact on older people in order to devise a typology for informing future service development. Theory: Kodner and Spreeuwenberg [1] argue that patient/person centred integrated working between health and social care should include methods and models which involve the different levels of organisation, management, funding and clinical care within and between them. Methods: Phase one included a systematic review to evaluate interventions utilising integrated working between care home staff and health care practitioners, and a survey to describe care homes' experiences of integrated working. Phase one will inform phase two; a case study evaluating six different approaches to integrated working currently in use in three different areas of England. Results and conclusions: The review found evidence of integrated working between health care and care homes at the patient level of care, but minimal evidence of models that extended beyond this level. Findings from the survey, currently in progress, will also be presented. Discussion: The discussion will provide an overview of the challenges and issues surrounding integrated working.
Journal of the American Medical Directors Association, 2015
Creative Commons Legal Code AttributionNonCommercialNoDerivatives 4.0 International Official tran... more Creative Commons Legal Code AttributionNonCommercialNoDerivatives 4.0 International Official translations of this license are available in other languages. Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer client or other relationship. Creative Commons makes its licenses and related information available on an "asis" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible. Using Creative Commons Public Licenses Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.
BMC Health Services Research, 2014
Sociological Research Online, 2012
In recent years, there has been an increasing interest in researching people growing older in the... more In recent years, there has been an increasing interest in researching people growing older in the South Asian ethnic minority communities in the UK. However, these populations have received comparatively little attention in wide-ranging discussions on culturally and socially appropriate research methodologies. In this paper, we draw on the experiences of a young female Pakistani Muslim researcher researching older Pakistani Muslim women and men, to explore the significance of gender, age and ethnicity to fieldwork processes and ‘field’ relationships. In particular, we highlight the significance of dress and specific presentations of the embodied self within the research process. We do so by focusing upon three key issues: (1) Insider/Outsider boundaries and how these boundaries are continuously and actively negotiated in the field through the use of dress and specific presentations of the embodied ‘self’; (2) The links between gender, age and space - more specifically, how the resea...
Systematic reviews, Jan 24, 2014
Care homes in the UK rely on general practice for access to specialist medical and nursing care a... more Care homes in the UK rely on general practice for access to specialist medical and nursing care as well as referral to therapists and secondary care. Service delivery to care homes is highly variable in both quantity and quality. This variability is also evident in the commissioning and organisation of care home-specific services that range from the payment of incentives to general practitioners (GPs) to visit care homes, to the creation of care home specialist teams and outreach services run by geriatricians. No primary studies or systematic reviews have robustly evaluated the impact of these different approaches on organisation and resident-level outcomes. Our aim is to identify factors which may explain the perceived or demonstrated effectiveness of programmes to improve health-related outcomes in older people living in care homes. A realist review approach will be used to develop a theoretical understanding of what works when, why and in what circumstances. Elements of service m...
Journal of the American Medical Directors Association, 2014
Long-term institutional care in the United Kingdom is provided by care homes. Residents have prev... more Long-term institutional care in the United Kingdom is provided by care homes. Residents have prevalent cognitive impairment and disability, have multiple diagnoses, and are subject to polypharmacy. Prevailing models of health care provision (ad hoc, reactive, and coordinated by general practitioners) result in unacceptable variability of care. A number of innovative responses to improve health care for care homes have been commissioned. The organization of health and social care in the United Kingdom is such that it is unlikely that a single solution to the problem of providing quality health care for care homes will be identified that can be used nationwide. Realist evaluation is a methodology that uses both qualitative and quantitative data to establish an in-depth understanding of what works, for whom, and in what settings. In this article we describe a protocol for using realist evaluation to understand the context, mechanisms, and outcomes that shape effective health care deliv...
evaluation- UP) – a pedometer-based walking intervention with and without practice nurse support ... more evaluation- UP) – a pedometer-based walking intervention with and without practice nurse support in primary care patients aged 45–75 years: study protocol for a randomised controlled trial
Full list of author information is available at the end of the articleParticipants: Less active 4... more Full list of author information is available at the end of the articleParticipants: Less active 45–75 year olds (n = 993) will be recruited by post from six South West London general practices, maximum of two per household and households randomised into three groups. Step-count and time spent at different PA intensities will be assessed for 7 days at baseline, 3 and 12 months by accelerometer. Questionnaires and anthropometric assessments will be completed. Intervention: The pedometer-alone group will be posted a pedometer (Yamax Digi-Walker SW-200), handbook and diary detailing a 12-week pedometer-based walking programme, using targets from their baseline assessment. The pedometer-plus-support group will additionally receive three practice nurse PA consultations. The handbook, diary and consultations include behaviour change techniques (e.g., self-monitoring, goal-setting, relapse prevention planning). The control group will receive usual care. Outcomes: Changes in average daily st...
Frontiers in Psychology, 2020
Loneliness has been reframed from a ‘social problem of old age’ into a major public health proble... more Loneliness has been reframed from a ‘social problem of old age’ into a major public health problem. This transformation has been generated by findings from observational studies of a relationship between loneliness and a range of negative health outcomes including dementia. From a public health perspective, key to evaluating the relationship between loneliness and dementia is examining how studies define and measure loneliness, the exposure variable, and dementia the outcome. If we are not consistently measuring these then building a body of evidence for the negative health outcomes of loneliness is problematic. Three key criteria had to meet for studies to be included in our analysis. To test the proposition that loneliness is a cause of dementia we only included longitudinal studies. For inclusion studies had to measure loneliness at baseline, have samples free of dementia and assess dementia at follow up (specified as a minimum of 12 months). We identified 11 papers published bet...
The Gerontologist
Background and Objectives Loneliness is proposed to be linked with increased service use. This re... more Background and Objectives Loneliness is proposed to be linked with increased service use. This review examined the association of loneliness and health and social care utilisation (HSCU) in older adults from the general population. Research Design and Methods Four databases were screened for studies that examined the association of loneliness (predictor) with HSCU (outcome) in older adults (defined as majority of sample 60 or older). Study quality was assessed with the NIH scale for observational cohorts and cross-sectional studies. Results We identified 32 studies, of which 9 prospective studies were evaluated as being good or good-fair quality. Two good-fair quality studies found loneliness at baseline was associated with subsequent admission to a residential care home. There was emerging evidence that loneliness was associated with emergency department use (n=1), and CVD-specific hospitalisation (n=1). Once adjusted for confounders the highest quality studies found no association...
Innovation in Aging
The IDEAL research programme is national nine-year (2014-2022) ESRC/NIHR/Alzheimer’s Society UK f... more The IDEAL research programme is national nine-year (2014-2022) ESRC/NIHR/Alzheimer’s Society UK funded longitudinal cohort study of 1547 people with mild to moderate dementia and 1283 family members or friends who provide support and aims to identify what promotes (or inhibits) people living well with dementia and their carers and how these change longitudinally. Loneliness and/or isolation are key indicators of quality of life and living well is posited as a factor which compromises wellbeing. Loneliness was measured using both the six-item de Jong Gierveld (DJG) scale (range 0-6) and isolation by the six-item Lubben social network scale (range 0 to 30). The three presentations in this symposium use data from the baseline assessment. Clare focuses upon the 18.5% of our participants who live alone and compares them with those living with others and suggests that there are few systematic differences in terms of cognition, psychological factors and well-being between these groups. Usi...
Developmental Medicine & Child Neurology
Standardized mortality ratio AIM To compare mortality rates for cardiovascular disease, cancer, a... more Standardized mortality ratio AIM To compare mortality rates for cardiovascular disease, cancer, and respiratory disease between adults with cerebral palsy (CP) and the general population. METHOD A cohort study was conducted using data from adults with CP in England, identified through a primary care data set (the Clinical Practice Research Datalink), with linked data on death registrations from the Office for National Statistics. Cause of death was categorized according to International Classification of Diseases codes. Standardized mortality ratios (SMRs) were calculated to compare mortality rates between adults with CP and the general population, adjusted for age, sex, and calendar year. RESULTS Nine hundred and fifty-eight adults with CP were identified (52.5% males, 47.5% females; median age at start of follow-up 31y [interquartile range 22-43y]) and followed for a total of 7693 person-years. One hundred and forty-two patients (15%) died during follow-up. Adults with CP had an increased risk of death due to cardiovascular disease (SMR: 3.19, 95% confidence interval [CI] 2.20-4.62) and respiratory disease (SMR: 13.59, 95% CI 9.89-18.67), but not from malignant neoplasms (SMR: 1.42, 95% CI 0.83-2.45). INTERPRETATION We found that adults with CP in England have increased risk of death due to diseases of the circulatory and respiratory systems, supporting findings from two studies that compared cause-specific mortality rates between adults with CP in the USA and the general population. Further research is required into primary and secondary prevention of cardiovascular and respiratory disease in people with CP worldwide.
GeroPsych, 2016
Doebler and Ethnic Focus for the contributions made to the research project. We acknowledge that ... more Doebler and Ethnic Focus for the contributions made to the research project. We acknowledge that the article could not be written without the contribution of the older people from ethnic groups in England and Wales who took the time to respond to our survey.
Archives of Gerontology and Geriatrics, 2016
Background: Physical Activity (PA) has significant health benefits for older adults, but nearly a... more Background: Physical Activity (PA) has significant health benefits for older adults, but nearly all UK over 60 0 s are not achieving recommended levels. The PACE-Lift primary care-based walking intervention for 60-75 year-olds used a structured, theoretically grounded intervention with pedometers, accelerometers, handbooks and support from practice nurses trained in behaviour change techniques. It demonstrated an objective increase in walking at 3 and 12 months. We investigated the experiences of intervention participants who did (and did not) increase their walking, in order to explore facilitators to increased walking. Methods: Semi-structured telephone interviews used an interview schedule with a purposive sample of 30 intervention participants, 19 who had objectively increased their walking over the previous year and 11 who had not. Interviews were audio-recorded, transcribed and coded independently by researchers to generate a thematic coding framework. Results: Both groups confirmed that walking was an appropriate PA for people of 'their age'. The majority of those with increased walking participated in the trial as a couple, were positive about individualised goal-setting, developed strategies for maintaining their walking, and had someone to walk with. Nonimprovers reported their attempts to increase walking were difficult because of lack of social support and were less positive about the intervention's behaviour change components. Discussion: Walking is an acceptable and appropriate PA intervention for older people. The intervention's goal-setting components were important for those who increased their walking. Mutual support between partners participating as a couple and having someone to walk with also facilitated increased walking.
BMC Family Practice, 2015
The Futures of Old Age, 2006
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Papers by Christina Victor