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Effectiveness and implementation of interventions for health promotion in urgent and emergency care settings: an umbrella review

Adams, Emma J.; Morris, Lucy; Marshall, Goolnora; Coffey, Frank; Miller, Philip D.; Blake, Holly

Effectiveness and implementation of interventions for health promotion in urgent and emergency care settings: an umbrella review Thumbnail


Authors

Lucy Morris

Goolnora Marshall

FRANK COFFEY frank.coffey@nottingham.ac.uk
Clinical Consultant To The Postgraduate Clinical Skills Prog

Philip D. Miller

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HOLLY BLAKE holly.blake@nottingham.ac.uk
Professor of Behavioural Medicine



Abstract

Background: Urgent and emergency care (UEC) settings provide an opportunity to prevent ill-health and promote healthy lifestyles with potential to screen and deliver interventions to under-served, at-risk populations. The aim of this study was to synthesise and summarise the evidence on the effectiveness and implementation of interventions for health promotion in UEC settings. Methods: PubMed and Embase (OVID) databases were used to search for studies published in English between January 2010 and January 2023. Systematic reviews and meta-analyses of studies that examined the effectiveness or implementation of face-to-face health promotion interventions for lifestyle behaviours delivered in UEC settings were eligible. Extracted data were synthesised and qualitatively summarised by lifestyle behaviour. Reviews were quality assessed using AMSTAR 2. Results: Eighteen reviews met the inclusion criteria; all included studies were conducted in emergency departments or trauma units. We identified 15 reviews on alcohol interventions (13 on effectiveness; 2 on implementation) and 3 on smoking interventions (effectiveness). There were no reviews of intervention studies targeting physical activity or diet and nutrition. There was heterogeneity across studies for study design, target populations, intervention design and content, comparator/control groups and outcomes assessed. The effectiveness of alcohol and smoking interventions in UEC settings varied but some reviews provided evidence of a significant decrease in alcohol consumption, alcohol-related outcomes and smoking in intervention groups, particularly in the short-term and in specific population groups. Research has focused on ‘brief’ interventions as part of screening, brief intervention and referral to treatment (SBIRT) approaches. Interventions are delivered by a wide range of staff with substantial variation in design. Alcohol brief interventions appear to be acceptable to UEC patients but clinicians face barriers in delivering them. Conclusions: UEC settings have been under-researched and appear to be under-utilised for delivering health promotion activities, except for alcohol prevention. Review level evidence suggests alcohol and smoking interventions are warranted in some population groups. However, further research is needed to determine the optimal intervention design, content and delivery mode for lifestyle behaviours which are suitable for implementation in UEC settings and promote long-term intervention effectiveness. Changes in clinical practice may be needed, including increased training, integration into service delivery and supportive policy, to facilitate the implementation of SBIRT for lifestyle behaviours. Interventions may need to be delivered in the wider UEC system such as urgent care centres, minor injury units and walk-in centres, in addition to emergency departments and trauma units, to support and increase health promotion activities in UEC settings.

Journal Article Type Article
Acceptance Date Feb 24, 2023
Online Publication Date Apr 6, 2023
Publication Date Apr 6, 2023
Deposit Date Feb 27, 2023
Publicly Available Date Apr 6, 2023
Journal BMC Emergency Medicine
Electronic ISSN 1471-227X
Publisher Springer Science and Business Media LLC
Peer Reviewed Peer Reviewed
Volume 23
Article Number 41
DOI https://doi.org/10.1186/s12873-023-00798-7
Keywords emergency medicine; urgent care; health promotion; intervention; lifestyle; review
Public URL https://nottingham-repository.worktribe.com/output/17896378
Publisher URL https://bmcemergmed.biomedcentral.com/articles/10.1186/s12873-023-00798-7
Additional Information Received: 28 July 2022; Accepted: 24 February 2023; First Online: 6 April 2023; : ; : Not applicable.; : Not applicable.; : The authors declare they have no competing interests.

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