As part of the North Wales Population Needs Assessment, Public Health Wales Evidence Service, at the request of the BCU Public Health Team, produced a map of the evidence available for a list of preventative services commonly used across the region.
Some of the results were surprising. Lots of activities that feel like they should work turned out to have little or no evidence that they do. For some, this was because there isn’t enough good-quality evidence available, so we may need to evaluate them more fully.
Below is a summary of what we found good evidence for and little to no evidence for. There is also a list of topics where organisations like NICE have made detailed recommendations.
The aim of this summary is to quickly highlight the main findings to encourage people to read the full report and investigate further. It does not aim to provide a definitive guide to interventions that we should and should not be delivering.
If you spot something surprising that may affect your work please take a look at the evidence map and the original source where there is much more information about the limitations of the review, the studies and their designs. There is not much evidence available for the unintended harms and consequences of these interventions and some of the reports recommend that more needs to be done in this area. The evidence also needs to be considered along with the context you’re working in and what matters to the people who use your services.
If you need any more information please contact the Research, Innovation and Improvement Coordination Hub.
What works (good evidence)
- Housing First improving housing stability and physical health in the short term.
- Exercise reducing fall-related outcomes.
- Advocacy interventions for abused women that consider both their vulnerabilities and intersectionalities and the trade-offs of abuse-related decisions in the context of individual women’s lives. Decisions should consider the risks to the women’s safety from the abuse.
- Community-led or community collaboration projects which design, deliver and evaluate health interventions are associated with larger behavioural outcomes.
- Breastfeeding support reducing the number of mothers who stop breastfeeding before four to six weeks.
What may work (some evidence)
Older people
- Person-centred care, communication skills and DCM (all with supervision), sensory therapy activities, and structured music therapies reduce agitation in care-home dementia residents.
- Befriending services for older people, people with common mental health problems, people who have had a stroke, children and young people with non‑progressive brain disorders.
- Telecare can promote safety and security to age in place but systems must fit individual needs.
Children and young people
- Providing free breakfasts can improve the dietary quality of breakfast and decrease breakfast skipping and generate long-term economic benefits.
- High-quality early years education increasing literacy-related outcomes.
- When delivered intensively, both NDP‐3 and ReST may effect improvement in word accuracy in 4- to 12‐year‐old children with Childhood Apraxia of Speech, measured by the accuracy of production on treated and non‐treated words, speech production consistency and the accuracy of connected speech.
- Safety promotion interventions with low-income families with toddlers seem to have most impact in households at most risk.
- Psychosocial interventions probably reduce the frequency at which parents use alcohol and drugs. Integrated psychosocial interventions which combine parenting skills interventions with a substance use component may show the most promise. Interventions involving children may not be beneficial but the evidence is low quality.
- Substance misuse in adolescents: motivational interviewing seems to reduce alcohol and substance misuse but not cannabis use days. Family focused therapy may be most effective in reducing low alcohol use.
- The Family Nurse Partnership did not affect maltreatment or maternal outcomes but it does generate advantages in school readiness and attainment at Key Stage 1.
- Group-based parenting programmes to improve the overall emotional and behavioural adjustment of children in the short term.
- Video feedback may improve sensitivity in parents of children who are at risk for poor attachment outcomes due to a range of difficulties but not attachment security, parental stress and anxiety.
Employment
- Supported employment and augmented supported employment were the most effective ways to help people with severe mental illness to get and keep employment.
- There is emerging evidence that employment interventions help improve employment outcomes for autistic people.
Mental health and well-being
- The provision of self-management interventions alongside standard care improves outcomes for people with severe mental illness.
Health improvement
- Health at every size (HAES®)-based interventions improved some cardiovascular outcomes, oxygen consumption, physical activity, quality of life, stress and depression. More evidence is needed about other outcomes such as triglycerides, fasting glucose levels and blood pressure.
- Initiation letters seem to help increase the update of cervical screening but there’s not enough evidence about other interventions to increase uptake.
- WHO Health Promoting Schools approach may help increase physical activity, improve fruit and vegetable consumption, decrease cigarette use, and reduce reports of being bullied. No evidence of effectiveness on fat intake, alcohol and drug use, mental health, violence, and bullying others. Few studies discussed whether the health promotion activities, or the collection of data relating to these, could have caused any harm to the students involved.
Telehealth
- Telehealth consultations seem to be are effective in improving outcomes or providing services, with no difference in outcomes; however, the evidence is stronger for some applications, and less strong or insufficient for others.
What may not work (little or no evidence)
Older people
- Sensory rooms for people with dementia
- Animal-assisted therapy for people with dementia
- Use of doll therapy for people with dementia to manage agitation and aggressive behaviour (but there are no side effects so recommend continuing to use if it brings comfort).
- Video call interventions to reduce loneliness in older adults.
- Mindfulness-based stress reduction may help reduce depressive symptoms and anxiety for family carers of people with dementia, at least in the short-term, but the evidence is low to very low quality.
- A full package of assistive technology and telecare did not increase the length of time that participants with dementia remained in the community, and nor did it decrease caregiver burden, depression or anxiety, relative to a basic package of assistive technology and telecare.
- Vitamin D supplementation to reduce falls showed mixed results and a high dose was associated with higher rates of fall-related outcomes but people with insufficient vitamin D were excluded from the review.
Children and young people
- No randomised trials identified into the effectiveness of speech and language therapy interventions to improve the speech of children with early acquired dysarthria.
- Verbally based and Augmentative Communication (ACC) interventions may improve spoken and non‐verbal communication in minimally verbal children with ASD but the overall evidence is very low quality.
- A relationship between diet, physical activity and zBMI in 2 to 4 year olds. Children with a higher zBMI were more physical active. A low proportion of children met the dietary or physical activity standards.
- Insufficient evidence to conclude that mindful parenting programmes can improve parents’ and children’s wellbeing.
- Negligible to small effects of universal, school-based interventions in the UK that aim to promote emotional or mental well-being or the prevention of mental health difficulties.
- Transition interventions for young people leaving care can foster improved independent living outcomes when they provide long-term, consistent and integrated coordinated support tailored to and individual’s needs but are less successful at improving health outcomes.
- Transition interventions from children’s to adults’ health services may improve some outcomes but there isn’t enough evidence to be sure.
Mental health and well-being
- No good evidence to suggest life skills programmes are effective for people with chronic mental illnesses.
- Little evidence about the benefits of psychosocial therapy interventions for self‑harm in children, adolescents and adults and more trials needed for these and other interventions.
- There is a link between volunteering and well-being but it’s difficult to tell whether this is due to volunteering or because higher well-being makes people more likely to volunteer. Some volunteering can lead to anxiety, stress or burnout and there is a gap in the evidence on the negative effects.
Health improvement
- Little evidence to support the use of social networking sites to promote the uptake and adherence to contraception in reproductive-age women.
- School‐based physical activity interventions probably result in little to no increase in time engaged in moderate to vigorous physical activity and may lead to little to no decrease in sedentary behaviour (low‐certainty evidence). School‐based physical activity interventions may improve physical fitness reported as maximal oxygen uptake (low‐certainty evidence). School‐based physical activity interventions may result in a very small decrease in BMI z‐scores (low‐certainty evidence) and may not impact BMI expressed as kg/m² (low‐certainty evidence).
- The cooking skills courses evaluated were engaging and enjoyable for those who took part but no evidence that they lead to more families eating a healthy balanced diet in the longer term.
- There’s little evidence of quantitative positive or negative health and well-being benefits from taking part in environmental enhancement and conservation activities but participants said they found them beneficial.
Recommendations
These are the topics listed in the evidence map where recommendations are available about how best to deliver services.
- Advocacy: due to be published 26 July 2022 (NICE)
- Supporting low-income renters post-pandemic (Joseph Rowntree Foundation)
- Increasing affordable housing supply (Wales Centre for Public Policy)
- Supporting older people’s independence, health and well-being (NICE)
- Mid-life approaches to prevent the onset of dementia, disability and frailty in alter life (NICE)
- Diagnosing and managing dementia and interventions to promote cognition, independence and well-being (NICE)
- Dementia prevention, intervention and care (Lancet Commission)
- Understanding loneliness in later life (Age UK)
- Community engagement: improving health and well-being and reducing inequalities (NICE)
- Lessons from befriending in the time of Covid-19 (The Mercer’s Company and Independent Age)
- Supporting adult carers (NICE)
- What works to improve participation in good work (Public Health Wales)
- A systematic mapping summary of interventions that may help get people into work and keep people in work (Public Health Wales)
- What works to support 15 to 24 year olds at risk of becoming NEET (Learning and Work Institute)
- Installation of home safety equipment to reduce the risk of unintentional injuries in under 15 year olds (NICE)
- Falls prevention (Royal College of Occupational Therapists and NICE)
- Stop smoking interventions and services (NICE)
- Smoking: harm reduction (NICE)
- Smoking: stopping in pregnancy and after childbirth (NICE)
- Smoking prevention in schools (NICE)
- Smoking preventing update in children and young people (NICE)
- Smoking workplace interventions (NICE)
- Preventing excess weight gain (NICE)
- Weight management before, during and after pregnancy (NICE)
- Weight management lifestyle services for overweight or obese children and young people (NICE)
- Weight management lifestyle services for overweight or obese adults (NICE)
- Obesity working with local communities (NICE)
- Physical activity: exercise referral schemes (NICE)
- Physical activity for children and young people (NICE)
- Physical activity brief advice for adults in primary care (NICE)
- Physical activity walking and cycling (NICE)
- Physical activity and the environment (NICE)
- Physical activity in the workplace (NICE)
- Mental well-being in over 65s: occupational therapy and physical activity interventions (NICE)
- Drug misuse prevention: targeted interventions (NICE)
- Alcohol interventions in secondary and further education (NICE)
- Alcohol use disorders prevention (NICE)
- Sexually transmitted infections and under 18s conceptions prevention (NICE)
- Contraceptive services for under 25s (NICE)
- Sexually transmitted infections: condom distribution schemes (NICE)
- Transition from children’s to adults’ services for young people using health or social care services (NICE)
- Educational interventions for looked after children and young people (CASCADE)
- Domestic violence and abuse: multi-agency working (NICE)
- A whole-system multi-agency approach to serious violence prevention (Public Health England)
- Social and emotional wellbeing: early years (NICE)
- Social and emotional wellbeing: primary education (NICE)
- Social and emotional wellbeing: secondary education (NICE)
- Older people: independence and mental wellbeing (NICE)
- Self harm in over 8s (NICE)
- Older people independence and mental wellbeing (NICE)
