Monthly Archives: January 2013

All surgeries signed up

Today we confirmed all the local surgeries have agreed to participate in the project.  This includes two INPS, and two SystmOne surgeries (live or converting) and seven Emis Practices who are all transferring to EMisWEB in the next few months.

Next step to sort out individual timelines for each practice to ensure the E4H lifestyle trainers are used effectively.

Library Search for Attitudinal Questionnaires

One aspect of the process I struggled with was how we could assess the characteristics of the attendees of the intervention course.  I asked our local Medical Library at Prospect Park, Reading and got a fantastic list of potential references listed below.  As we refine the process I’ll create a shortlist and put them into the reference and resource sections.

(I’m particularly taken by WLRT and PHCS)


Walker SN, Sechrist KR, Pender NJ. The health-promoting lifestyle profile II. Omaha: University of Nebraska Medical Center, College Of Nursing; 1995; [Unpublished]
Includes links to the abstract, permisisons, the actual scale, scoring and usage.

An example in a thesis:Appendix C p 105-106

Predictors of success to weight-loss intervention program in individuals at high risk for type 2 diabetes. Diabetes Research & Clinical Practice, 01 November 2010, vol./is. 90/2(147-153), Kong W; Langlois MF; Kamga-Ngandé C; Gagnon C; Brown C; Baillargeon JP
Uses the 16-item weight-loss readiness tool (WLRT) – no reference
DAS3 (Diabetes attitude scale)

Attitudes towards gestational diabetes among a multiethnic cohort in Australia, Journal of Clinical Nursing Sep 1 2010 Mary Carolan, Cheryl Steele and Heather Margetts

“The instrument used to measure attitudes was the DAS3, which has been shown to be a valid and reliable measure of diabetes-related attitudes (Anderson et al. 1998).”
Anderson RM, Fitzgerald JT, Funnell MM & Gruppen LD (1998)
The third version of the diabetes attitude scale. Diabetes Care 21(9) , 1403–1407.
The full DAS can be obtained from RM Anderson.
Health Value Scale and Generalized Self-Efficacy Scale

Predictors of Health-Promoting Behaviors Among Freshman Dental Students at Istanbul University. Kadriye Peker, Ph.D. and Gülçin Bermek, Ph.D. Journal of Dental Education March 1, 2011 vol. 75 no. 3 413-420

“HPLP II was used to measure students’ health-promoting behaviors.26 The scale was comprised of fifty-two items in six subscales: spiritual growth, health responsibility, physical activity, nutrition, interpersonal relations, and stress management.”

“The four-item Health Value Scale was used to assess the value participants place on their health.28 Response categories ranged from 1 (strongly disagree) to 7 (strongly agree).”
28. Lau R, Hartman K, Ware J. Health as a value: methodological and theoretical considerations. Health Psychol 1986; 5(1):25–43.

“the Generalized Self-Efficacy Scale is designed to assess optimistic self-beliefs to cope with a variety of difficult demands in life29 “
29. Schwarzer, R., & Jerusalem, M. (1995). Generalized Self-Efficacy scale. In J. Weinman, S. Wright, & M. Johnston, Measures in health psychology: A user’s portfolio. Causal and control beliefs (pp. 35-37). Windsor, UK: NFER-NELSON.
Perceived Health Competence Scale

Smith, M. S., Wallston, K. A., & Smith, C. A. (1995). The development and validation
of the perceived health competence scale. Health Education Research. 10(1), 51-
Example in a thesis:Appendix D p 108
Health Beliefs Model

I have found several articles on the Health Belief model and questionnaires related to it but they mainly seem to be developed for the specific research rather than being a standard questionnaire. For example:

O’Connell JK, Price JH, Roberts SM, Jurs SG, McKinley R (1985) Utilizing the health belief model to predict dieting and exercising behavior of obese and nonobese adolescents.Health Education Quarterly, vol./is. 12/4(343-51), 0195-8402;0195-8402 (1985)
This study was undertaken to explain dieting and exercising behavior of obese and nonobese adolescents as measured by the elements of the Health Belief Model (HBM). An elicitation questionnaire was used to determine salient beliefs about dieting, exercising, and obesity for each of the major components of the HBM. The Health Belief Model questionnaire, developed from the elicited salient beliefs, contained items employed to measure attitudes towards obesity and exercise, knowledge of obesity and exercise, weight locus of control, and beliefs and evaluations about obesity and exercise. Discriminant analysis and stepwise discriminant analysis were employed in the data analysis of the 69 obese and 100 nonobese HBM respondents to determine the relative importance of the investigated factors in predicting obesity. It was found that benefits of dieting was the most powerful predictor of dieting behavior for the obese adolescents, whereas susceptibility to the causes of obesity best explained present dieting behavior of nonobese adolescents. Exercising behavior of obese teenagers was best explained by cues to exercising. No HBM variables were significant in predicting exercising behavior of nonobese adolescents.




Pender N (1996). Health promotion in nursing practice (3rd ed.). Stanford, CT: Appleton and Lange. 2010 6th edition too.

Health-Promoting Lifestyle Profile Simple Scale (HPLP-S)
Used in: The predictors of adopting a health-promoting lifestyle among work
site adults with prediabetes , Journal of Clinical Nursing Oct 1st 2010
No Reference though.

Teng HL, Yen M, Fetzer S. Health promotion lifestyle profile-II: Chinese version short form. Journal of Clinical Nursing. 2010;66:1864–1873

Wierenga ME(1994) Life-style modification for weight control to improve diabetes health status. Patient education and counselling 23(1) p. 33-40
The purpose of this study was to describe the relationship among variables which are associated with life-style modification, knowledge of diabetes, social support, health practices, and body mass index, to examine their effect on health status, and to test the effectiveness of a community based life-style modification program for weight control. Adults (n = 66) with non-insulin-dependent diabetes mellitus participated in either a treatment or control group. The treatment consisted of 5 weekly 90-min sessions on modifying eating and exercise patterns. All participants completed a personal resource questionnaire (PRQ), health practices survey (HPS), and diabetes health status questionnaire (DHS) at intake, 5 weeks, and 4 months. Knowledge of diabetes was assessed only at intake. Knowledge of diabetes, social support, and health practices explained 27% of the variance in health status, but health practices explained the largest (18%) proportion of the variance and was the only study variable significantly affected by the life-style modification program
PM: PUBMED 7971538


Pathology Cost estimate

Pathology Costs

  • Glucose 1.29
  • HbA1c 3.44
  • ALT 1.29
  • Creatinine 1.29
  • Full Lipid Profile 2.58

This would equate to 9.89 per pt per test profile and estimates to 400 per surgery and 5k for the project anticipating one pre and one post intervention.

This is based on 50 letters sent per practice, 50% response initially, and 33% completing the course and having a second profile

Initial Costing Estimate

This is our initial “fag packet” calculation.

Eat4Health Course (10 * 1.5 hr Sessions plus taster) 400 * 15 courses

Hosting (10 * Accommodation plus surgery staff) 400 * 15 courses

Mailing costs 500

Blood tests for those participating 10 pounds * 250 patients (initial costs plus repeat at completion)

Misc Admin Costs 3000

Public Health and CCG costs are assumed to be covered within budget

Total estimate 18000


First meeting

Today we held the inaugral meeting (2hrs) between the Clinical Lead (TW), CCG Lead (AT), and Public Health Lead (BR).

We discussed the overall plan, and outlined costing.  We aim to mail out to practices shortly, gaining their general permission to enrol them into the study, identify their situation with respect to clinical system, and whether they are able to host the intervention planned.

As previously agreed we have chosen QDiabetes as the tool to identify and stratify Diabetic Risk and Eat4Health as our intervention.

We discussed blood tests required.  We aim to collect HbA1c, ALT, Fasting lipid profile, fasting blood glucose for each patient entering the intervention.  We need to discuss with the lab to cost out the blood test bundle and how to facilitate blood requests to reduce impact for practices.  We use SunQuest ICE online pathology requesting and this doesn’t currently have the facility to “bulk request” lab tests.

In order to understand the pre-intervention position of the sample, we need to assess both objective values (blood tests and body morphology) and also subjective attitudes, to exercise, food and lifestyle etc.  BR charged to identify validated lifestyle questionnaires.

We agreed that when the target group is identified they will be invited to a “taster” session where the concept will be discussed and patients invited to sign up for the full intervention.

We felt that surgeries may have different facilities and needs for hosting Eat4Health sessions, so a mixture of surgery based and non-surgery based sessions will be offered.  Include in initial Questionnaire to practices.

We need to formulate a full detailed business case for the CCG to sign off the budget that has been agreed

Outcomes of First Meeting

TW – Generate information, consent and signup forms for practices

TW – Collate timescales from practices

AT – Liaise with Path Lab

BR – Identify lifestyle questionnaires

BR – Identify cost of Eat4Health courses and taster sessions

BR/TW – To liaise regarding Detailed Business Case