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This study aims to evaluate the effect of Alpha-Stim Anxiety, Insomnia and Depression (AID) cranial electrotherapy stimulation (CES) on anxiety, depression and health-related quality of life for primary care social prescribing service patients with anxiety symptoms.

Open-label patient cohort design with no control group. A total of 33 adult patients (average age 42 years) completed six weeks of Alpha-Stim AID use. Pre- and post-intervention assessment with participant self-report measures: Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder (GAD-7) and European Quality of Life Five Dimension (EQ-5D-5L).

Reliable improvement and remission rates, respectively, were 53.39% and 33.3% for GAD-7; 46.7% and 29.5% for PHQ-9. There was a significant improvement in GAD-7 and PHQ-9 with large effect sizes. EQ-5D-5L results showed significant improvements in health-related quality of life. Perceived quality of life increased by 0.17 on the health index score, with the intervention adding 1.68 quality-adjusted life years (QALYs).

Alpha-Stim AID can be delivered through a primary health-care social prescribing service and most patients will use as prescribed and complete treatment course. Alpha-Stim AID CES may be an effective anxiety and depression treatment for people with anxiety symptoms. The widespread roll-out of Alpha-Stim AID in health-care systems should be considered.

To the best of the authors’ knowledge, this is the first study to respond to the UK’s National Institute for Health and Care (NICE) request for the collection of real-world data to understand better Alpha-Stim AID in relation to people’s treatment uptake, response rates and treatment completion rates (NICE, 2021).

Insomnia is highly prevalent in prisoners. The purpose of this paper is a review of research evidence on interventions with sleep as an outcome (2000 to 2020) and rates of insomnia prevalence and associated factors in prisons (2015 to 2020).

An internet-based search used Medline, PubMed, PsycINFO (EBSCOhost), Embase, Web of Science and Scopus. Seven interventions and eight sleep prevalence or sleep-associated factor papers were identified.

Intervention research was very limited and the quality of the research design was generally poor. Interventions such as cognitive behavioural therapy for insomnia (CBT-I), yoga and mindfulness can be beneficial in a prison setting. This review identified a high prevalence of insomnia in prisons across the world, which was supported by recent evidence. Factors associated with insomnia include anxiety, depression, post-traumatic stress disorder, personality disorder and pain.

There is a need for appropriately powered randomised control trials of CBT-I in prisons and a need to use objective measures of sleep quality.

Due to a lack of an up-to-date review, this paper fulfils the need for a review of the evidence on interventions in prison settings with sleep as an outcome, rates of insomnia prevalence and associated factors in prisons.

Depression, physical health, well-being, sleep and physical activity are interlinked. Healthy levels of physical activity and effective night-time sleep can reduce depressive symptoms. In the context of their lives and symptoms of depression, this paper aims to understand participants’ experiences of using a Fitbit, physical activity and sleep and the barriers and facilitators for healthy sleep and physical activity.

Qualitative methods were used to conduct interviews with 19 patients (4 male; 15 female) diagnosed with treatment-resistant depression undergoing transcranial magnetic stimulation (TMS) treatment for depression. Reflexive thematic analysis was used.

Healthy sleep and physical activity levels are interlinked and reduce depressive symptoms as well as improving well-being and physical health. A Fitbit is useful to enhance physical activity, self-awareness, motivation, healthier lifestyles and effective sleep. Barriers to healthy sleep and physical activity levels included depressive symptoms, environmental factors and anxieties. Facilitators for healthy sleep and physical activity levels included knowledge of the benefits, support from family and friends and applying sleep hygiene.

There is a need to provide interventions using wearable activity trackers that build on the links between increased physical activity, improved sleep, enhanced well-being, better physical health and lower depressive symptoms.

To the best of the authors’ knowledge, this is the first time that patients undergoing TMS have had their experiences of sleep, activity and using a Fitbit investigated and reported.

Support groups are a common feature of the mental health support engaged by carers and consumers. The purpose of this paper is to update and consolidate the knowledge and the evidence for the effectiveness of mental health support groups.

This paper is based on a systematic literature review of relevant databases around support groups for mental health. Support groups are defined as meetings of people with similar experiences, such as those defined as carers of a person living with a mental illness or a person living with a mental illness. These meetings aim to provide support and companionship to one another.

The results show that there is a consistent pattern of evidence, over a long period of time, which confirms the effectiveness of mental health support groups for carers and people living with mental illness. There is strong, scientifically rigorous evidence which shows the effectiveness of professionally facilitated, family-led support groups, psychoeducation carers support groups, and professionally facilitated, program-based support groups for people living with mental illness.

This research implies the use of support groups is an important adjunct to the support of carers and people with mental illness, including severe mental illness.

This research brings together a range of studies indicating the usefulness of support groups as an adjunct to mental health therapy.

The learning outcomes are as follows: to demonstrate the phenomenon of strategic inertia in organizations and the impact this has on the type of renewal process that is undertaken; to differentiate between environmental and organizational adaptation strategies and synergies; to apply practical steps of renewal by outlining the influential forces and distinct stages of the process; and to create a practical framework that organizations can use as a guideline for sensing and reacting to changes in the business environment.

The case study examines the strategic renewal processes of Anglo American Platinum (Amplats) for the period 2012–2019. Amplats is the world’s largest producer of platinum group metals (PGMs). Despite the adversarial business environment of the South African PGM mining industry, six years into its new strategy, the organization had emerged debt-free and was poised to be sustainable. This posed a unique dilemma in strategic decision-making, namely, how to maintain a strategic renewal process. Chris Griffith, CEO of Amplats, was about to retire, but realized that the organization had yet to fulfil its potential. The ambition of the organization was to redefine the industry benchmark for performance across multiple pillars of value for different stakeholders, and to become the most valued mining company by 2023. Set in 2019, the case invites students to look back at the symptoms of strategic inertia at the time of Griffith’s appointment as CEO, and to define the nature and stages of the renewal that the organization underwent. This will provide insights that will enable an examination of the application of a framework for continual strategic renewal.

Postgraduate business students

Teaching Notes are available for educators only.

CSS 11: Strategy

Hospital cleaning and healthcare associated infections (HCAIs) continue to attract adverse media attention and consumer concern. Parallels exist with similar publicity relating to cleaning and food safety in the food industry almost 13 years earlier. This paper examines some of the management solutions developed in the food industry, and discusses their application to healthcare delivery.

The food industry is managing food safety by adopting a dual approach based on pre‐requisite programmes and Hazard Analysis Critical Control Points (HACCP). How these differ is described and how the approaches and terminology can be adapted for use in healthcare is discussed.

The food industry is moving towards external certification of safety using national and international standards. The HACCP approach, a management tool and a central requirement of these standards, is evolving and there is interest worldwide from the healthcare community. Its application to the decontamination of endoscopes, using conventional HACCP, is presented, as well as suggestions for a simplified format for managing patient‐related procedures. Taking this type of approach to the management of HCAIs could provide greater transparency, reduce infection rates and increase consumer confidence.

Potential problems in adopting HACCP, including cost and human resource, are discussed.

The HACCP method/approach has previously been mentioned in the medical literature but this paper is one of the few to examine, from basic principles, its infection control application within a broader approach to quality assurance.

The purpose of this research is to aim to use observation, linked to quantitative risk‐based scoring, to evaluate the effectiveness of a small‐scale consumer food safety initiative based on the social marketing approach. Evaluation of intervention effectiveness is considered to be an important component of any health education initiative. The ultimate goal for social marketing initiatives is sustained behavioural change. Thus, when determining the effectiveness of community‐based social marketing interventions, direct measurement of behaviour is advocated.

A small‐scale food safety strategy using targeted interventions was piloted in a geographical test community in South Wales, UK. Targeted consumers from the community prepared a set meal in a model domestic kitchen before, immediately after, and 4‐6 weeks after implementation of the strategy. Observations of meal preparations were made using CCTV and food‐handling behaviours were recorded and assessed using a risk‐based scoring system. A quantitative evaluation of overall and specific food safety behaviours was made, and an effect size analysis provided a measure of potential intervention effectiveness.

This pilot study suggested that “one‐off” food safety interventions developed and implemented using a social marketing approach may result in a short‐term improvement of consumer food safety behaviours. Interventions targeting specific food safety behaviours may produce a “halo effect” upon other food safety behaviours that are known, yet not consistently implemented during domestic food preparation. Intervention effect was greater immediately after implementation of the strategy than 4‐6 weeks later. Use of the risk‐based scoring system and observation techniques were effective for assessing food hygiene behaviours and evaluating the effectiveness of interventions.

The use of an observational risk‐based approach to assess consumer food safety behaviours can provide a valuable tool for evaluation of the estimated immediate and long‐term effectiveness of food safety interventions on a small scale prior to launch of a larger initiative.

The purpose of this research is to show the evaluation of food hygiene knowledge and self‐reported behaviours of school children, assessment of children's attitudes towards food hygiene and evaluation of barriers to the adoption of appropriate food hygiene behaviours.

The food hygiene knowledge and self‐reported behaviours of pupils (4 and 14 years; Key Stages 1‐3 in the English system – or Scottish equivalent) were determined using age‐appropriate knowledge quizzes completed by 2,259 pupils across England, Scotland, Northern Ireland and Wales. Attitudes towards food hygiene and barriers to performing desirable hygiene‐related behaviours were established through semi‐structured interviews with 82 pupils who completed knowledge tasks in South East England.

Children generally had good knowledge of food hygiene. However, there were misconceptions about the nature of micro‐organisms and how they affect food. In addition, a lack of reminders and practical food activities, especially at Key Stage 2 (7‐11 years), coupled with poor hand‐washing facilities, meant that children did not always adopt desirable behaviours. Children gave suggestions for ways to help others to remember good practice.

The study identified areas of weakness in pupils' hygiene knowledge and understanding and has determined barriers to adoption of desirable behaviours at all times. It has also suggested ways in which food hygiene education could be made more engaging for pupils, and other methods to encourage good practice.

The purpose of this paper is to examine the extent, sources, diversity, costs, formats and content of food safety educational interventions for consumers provided by UK Local Authorities (LAs). Inadequate implementation of food safety practices in the home is known to contribute to the incidence of foodborne disease and therefore effective food safety education concerning risks and correct domestic food‐handling behaviours is essential.

A postal questionnaire was administered to all Environmental Health and Health Promotion departments in LAs in 2004 (n=436). The questionnaire assessed the extent of LA provision of consumer food safety advice, types, formats and content of interventions, rationale for information provision, methods used for design and delivery of information and participation in national initiatives.

A considerable quantity of food safety advice is provided to UK consumers; in general this is variable between regions, variable in quality, infrequently evaluated and relatively uncoordinated. Overall, 95 per cent of UK LAs who responded to the questionnaire reported current provision of consumer food safety advice. The most common intervention used for provision of consumer hygiene information was leaflets (93 per cent of LAs) and data indicated that this is likely to continue. Hand‐washing (87 per cent), cross‐contamination (85 per cent) and cooking (77 per cent) were the most common issues reportedly addressed in hygiene initiatives. Less than a third of LAs reported evaluating the effectiveness of food hygiene advice.

This study has provided evidence of a large quantity of unique and diverse intervention materials across the UK, and suggests the need for the sharing of information materials and areas of innovation between LAs. Provision of generic, managed and co‐ordinated general and targeted food safety education resources in the UK may not only decrease important time and financial costs within LAs, but also increase consumer confidence in the accuracy of information provided and alleviate the risk for potential confusion of information from differing sources.