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dcd0d821-4fe8-4cdb-b80d-1d7503b45f61 Wessex DIET: Determining the Impact of covid-19 on food sEcurity in young families and Testing interventions Joint Lead: Professor Nisreen Alwan and Dr Dianna Smith . Co Applicants : Nida Ziauddeen , Tim Lloyd, Dr Marta Disegna , Ravita Taheem, Sally Shillaker, Fran Richards, Duncan House, Sara Crawford. Partners: Southampton City Council, University of Southampton, Bournemouth University, Solent NHS Trust. starts: 1 November 2021 Ends: 31 March 2024 Publications: Household food insecurity risk indices for English neighbourhoods: Measures to support local policy decisions News: New map shows regions in the UK with a higher risk of food insecurity Lay Summary Aim of the research : We will explore the impact of system shocks on food security, diet quality and health in young families across Wessex, using the covid-19 pandemic and lockdowns as an example of such shocks. We will find out if Council-supported food aid initiatives to counter difficulties around adequate and healthy diet are acceptable, well taken-up and impactful in local populations. This will lead to a toolkit that can be used by Councils to decide which initiatives are best for their populations. Background: The covid-19 pandemic restrictions are likely to have negatively impacted UK families in many ways, including food insecurity (not having enough food because of cost or other barriers, or not having good quality food). Food insecurity has negative health impacts in the short-term including weight gain, malnutrition, poor mental health; these may lead to longer term health outcomes including obesity, diabetes, anxiety, and depression. Local Councils in Wessex have a range of initiatives to help this situation, including food pantries, where eligible families can purchase a range of items at a greatly reduced price, and recipe boxes. Design and methods During this 2-year project we will: Use statistical modelling to explore the effect of the covid-19 pandemic on important aspects of health and wellbeing in Wessex’s families with children under age 12, including their diet quality, food availability, weight status and mental health. Interview families to explore how they coped with the changing social and economic circumstances during the pandemic particularly in relation to their food quality and purchasing behaviours, Work with the local Councils in Southampton and Dorset to evaluate the initiatives to improve diet in disadvantaged families including food pantries. Public Patient Involvement: We involved public contributors in the design of this research through three meetings with 12 contributors overall. We have a public contributor as a co-applicant. Our PPI activities will ensure the interventions reflect the individual needs of young families in the target groups, and that the outreach activities to support the interventions are properly communicated. We already have ongoing public engagement activities involving Sure Start within our existing ARC project which we will continue to utilise. We have and willcontinue to actively involve people on the frontline of food aid systems in shaping this research. Dissemination: We will produce an implementation toolkit for Councils to aid decision-making on food-aid initiatives. Non-academic outputs will be specific to the audience and will include videos, presentations, social media posts and flyers. For public health/councils, short reports on the findings in the form of policy briefs will add to academic content and presentations. We will follow successful models like the oral health posters to Family Hubs delivered by Solent Health. What did we find out? We explored the impact of system shocks on food security, diet quality and health in young families across Wessex, using the covid-19 pandemic and lockdowns as an example of such shocks. We used statistical modelling to explore the effect of the covid-19 pandemic on diet quality, food availability, weight status and mental health in England. We wanted to find out if food aid supported by local councils to counter difficulties around adequate and healthy diet are acceptable, well taken-up and impactful in local populations. We carried a review of the literature on the impact of food aid initiatives in households with children and found that accessing food aid was linked to reducing food insecurity and improving diet quality in some studies. Food aid initiatives that allow users to choose food items and provide other support services are most effective. We also carried out a review of the literature on the impact of the COVID-19 pandemic on food insecurity in households with children and found that most studies showed that the pandemic worsened food security. We assessed the impact of food clubs (a type of food aid initiative that charges a small fee for a set number of items) on food security, diet quality and wellbeing in households accessing these clubs. We did this by recruiting people accessing food clubs to our study and asking them to complete a survey at recruitment and after at least three month of using food clubs in Southampton and Dorset. 97 people took part in the study and 49 people completed a follow-up survey. 11 participants also took part in a semi-structured interview that explore how they coped with the changing circumstances during the pandemic and their views on food clubs. We found that only 12 people (16%) were food secure (had reliable access to sufficient nutritious food) when they first started accessing food club. Among the 49 people who completed a survey after using the food club for at least 3 months, we found that 16 people (42%) were food secure. Diet quality increased in 22 people (45%) and mental wellbeing in 30 people (61%). We found that people’s food security diet and mental wellbeing improved after accessing food clubs. What did we do with this new Knowledge? We have produced a toolkit to aid decision-making on food aid initiatives, to allow them to assess the impact of the interventions and consider how best to implement new interventions. This can be used by local councils to plan new initiatives or by the interventions themselves to monitor impact. We visited the food clubs we recruited participants from and shared the study results with the people accessing the clubs, as well as the staff and volunteers there. What Next? Future research will evaluate the process and impact of food aid interventions using the toolkit. We have applied for further funding to explore how to improve the quality of food provided through aid. Publications The impact of food aid interventions on food insecurity, diet quality and mental health in households with children in high-income countries: a systematic review | Public Health Nutrition | Cambridge Core . The COVID-19 pandemic and food insecurity in households with children: A systematic review | PLOS One A mixed methods study exploring food insecurity and diet quality in households accessing food clubs in England | BMC Public Health

7982ebd7-aab7-4e3f-8493-b1caebcd4bea The Wessex FRIEND Toolbox (Family Risk IdEntificatioN and Decision) Identifying high risk groups early to improve health in young families in Wessex Principal Investigator: Professor Nisreen Alwan and Dr Dianna Smith Team members: Professor Nisreen Alwan (Professor in Public Health, School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton), Dr Dianna Smith (Lecturer in Geographic Information Science, Geography & Environment, University of Southampton), Professor Paul Roderick (Professor of Public Health, School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton), Dr Ivaylo Vassilev (Principal Research Fellow, School of Health Sciences, University of Southampton), Dr Grace Grove (Clinical Research Fellow, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton), Dr Nida Ziauddeen (Research Fellow, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton),Dr Lauren Wilson (Research Fellow, Geography & Environment, University of Southampton) Read report: Food Insecurity Risk Indices for Neighbourhoods 2021 Food Insecurity Brief LSOA Level Estimates Sept2021_online[2] .pdf Download PDF • 363KB Start: 21 October 2019 Ended: 30 September 2022 Project Partners: University of Southampton, Solent NHS Trust, Southampton City Council, Portsmouth City Council, Hampshire County Council, Health Education England, Oxford Brookes University Lay summary We know that prioritising health is complex, particularly for families living in social and economic disadvantage. The SLOPE CORE tool estimates the future risk of childhood overweight at the start of primary school. It can be used by health professionals in consultation with the families they are working with to help facilitate various interventions towards the prevention of childhood obesity. We have tested the acceptability and feasibility of this tool in the first phase of the Wessex FRIEND project, as part of a broader programme of work, aiming to improve the health of children and families in Wessex. We have trialled it with health visitors in the first instance, just so that we can get some initial feedback and improve it before combining it with other components of interventions. We have also been refining and tailoring area-based child poverty, food poverty and greenspace access measures to the local and regional context and population, so that our risk tool takes into account the area profile and resources where the family lives. These area-based measures, which represent neighbourhoods, may also be used independently by local governments and civil society/third sector to help in targeting resources to better support people living in areas of higher risk for food and child poverty, or with poorer access to greenspaces. What have we found out? We tested a digital tool called SLOPE CORE which predicts if preschool children are likely to be overweight by the time they start school. Health visitors and parents found the obesity prediction tool quick and easy to use. Using the tool provided the opportunity for health promotion, and may facilitate difficult conversations by giving an objective result and removing the perception of professional judgement. This may encourage conversations on healthy weight and could influence health visitor practice by increasing provision of anticipatory support on feeding. Health visitors felt that, when using the tool, the healthcare professional should have sufficient time to have a sensitive discussion and explain a conceptually difficult concept (risk). Parents felt that the tool provides an opportunity for behaviour change and potential to improve health for the child but can also provide reassurance. They appreciate the provision of additional resources and support with the results. However, before using the tool the healthcare professional should consider whether the tool is appropriate, as it may be unsuitable for some parents. We refined and tailored area-based child poverty, food poverty and greenspace access measures to the regional context and population. These provide improved tools for better planning and targeting of services by the local councils. These area-based measures are combined with the individual childhood obesity estimation provided by the SLOPE CORE Tool on one platform, which can be utilised by frontline professionals dealing with disadvantaged families. We also tested the feasibility of the Generating Engagement in Network Involvement (Genie), a facilitated social network intervention, as a means towards reducing risk of adverse family health outcomes. We tested this with Home-Start in Portsmouth which is a voluntary organisation. Staff found Genie simple to use, really liked the concept and found that familiarity with the system meant the process was much smoother for later entries. Staff felt that being able to fill out Genie on a phone or app would be quite useful. The option of other languages or built-in translation could also make it easier to use. Staff felt that Genie was particularly good for families feeling isolated or new to the area but was unlikely to be relevant for all. However, staff thought it was less realistic for them to use it within the timeframe of visits and other things that need to be done during a visit but they could potentially facilitate the use of Genie by encouraging people to do so themselves. The network mapping was useful as it made people realise what they have and what they need. Staff found it an interesting exercise to start the conversation and find out what was going on in the lives of individuals/families they were supporting. A potential barrier to the use of both tools is lack of wi-fi/internet connectivity. What difference can this make? Using the obesity prediction tool could provide the opportunity for health promotion and facilitate discussions by giving an objective result and removing the perception of professional judgement. This could encourage conversations on healthy weight and potentially influence health visitor practice by increasing provision of anticipatory support on feeding. Using the tool antenatally, or with a younger infant may allow for an easier conversation, allowing the healthcare professional to focus on prevention, as opposed to ‘correcting’ a parent’s current behaviour. Health visitors felt that parents were more likely to be receptive to a preventative approach. The refined area-based measures provide improved tools for better planning and targeting of services by the local councils. Network mapping using Genie made people realise what they have and what they need and help staff start the conversation to find out what was going on in the lives of individuals/families they were supporting. Why in this important? The Childhood Obesity Risk Estimation Tool has the potential to focus targeted intervention for the early prevention of childhood obesity. The updated food insecurity risk index has enabled local government to target available resources to those with greatest need. It has been included in the Joint Strategic Needs Assessment (JSNA) for Hampshire County Council. It has also contributed to food aid planning in Dorset, Hampshire and further resource planning in districts across the country. What’s next? The SLOPE CORE tool combined with the area based measures will require further testing to establish how it can be best used in practice, and any impact it may have on childhood obesity. This could be as part of a new or existing pathway which includes interventions designed to reduce risk of childhood obesity. Healthcare professionals using the tool should be trained in risk commination, be able to advise the parent on next steps, and have time to discuss what can be a sensitive topic. As SLOPE CORE only requires routinely collected data, it may be possible to build the tool into existing systems - such as healthy weight pathways, routine health visiting contacts and relevant GP consultations, which could save time and support existing work rather than further adding to workload for healthcare professionals. If internet access is unreliable, then a paper data collection sheet could be used to capture data required to use the tool at another time. After determining optimum timing and setting for tool use, a longer term evaluation is necessary to explore the impact of the tool on parents and healthcare professionals behaviours in the short term, and childhood obesity in the longer term. Publications: Ziauddeen, N., Roderick, P., Santorelli, G., Wright, J., & Alwan, N.A. (2022). Childhood overweight and obesity at the start of primary school: external validation of pregnancy and early-life prediction models. PLOS Glob Public Health. 2(6): e0000258. Ziauddeen, N., Roderick, P., Santorelli, G., Wright, J., & Alwan, N.A. (2020). OP55 Childhood overweight and obesity at the start of primary school: external validation of pregnancy and early-life prediction models. Journal of Epidemiology & Community Health, 74(Supplement 1), A26. https://doi.org/10.1136/jech-2020-SSMabstracts.54 Smith, D.M., Rixson, L., Grove, G., Ziauddeen, N., Vassilev, I., Taheem, R., Roderick, P., & Alwan, N.A. Household food insecurity risk indices for English neighbourhoods: measures to support local policy decisions. MedRxiv 2022:22273530. https://doi.org/10.1101/2022.04.06.22273530 (preprint and minor revisions requested at PLOS ONE) Smith, D. and Thompson, C. (2022) Food Deserts and Food Insecurity in the UK. Routledge. Further funding because of this research: ARC Wessex - Wessex DIET: Determining the Impact of covid-19 on food sEcurity in young families and Testing interventions MRC Clinical Research Fellowship (Dr Grace Grove) - Investigating the impact of food vouchers on diet composition and the prevention of childhood obesity Other impacts: The food security risk index has been included in the JSNA for Hampshire and has contributed to JSNAs and food aid planning in Dorset, Hampshire and further resource planning in Lancaster, Hull Hertfordshire and Greater Manchester to name a selection of Local Authorities, demonstrating the wider reach beyond Wessex.

d7cea2fb-fab3-4e8d-86f6-e2d2952f0404 ADOPTED: Nurture-U (Southampton): A longitudinal survey for student metal health and wellbeing Principal Investigator: Lucy Dorey Start Date: 1 July 2021 End Date: 1 July 2025 Background: Promoting good mental health within university students is a priority. Anxiety, depression and self-harm are rapidly increasing. University mental health services report demand beyond their capacity. Effective ways to prevent student mental difficulties are urgently needed. Further, university should be a positive life experience and promote students' emotional fitness and ability to thrive. Research and student feedback recommend changing university culture, environment and teaching to promote wellbeing. Stepped care in which students move through different steps based on need is also suggested to improve student wellbeing and service capacity. This starts with wellbeing promotion and prevention for all students, steps up to self-help for those with mild symptoms and to professional support for those with elevated symptoms. However, these approaches have not been rigorously tested in universities. We don't know which elements best promote good student mental health. We don't know what approaches work best for the diverse student body across gender, ethnicity, sexuality, sociodemographic background. We will test initiatives within the university environment and at each of the steps, see which initiatives students use, how well they work, and identify which work best for which students across diverse groups. Students will be active partners in shaping, delivering and evaluating all research. We will use repeated twice-yearly online surveys across 6 universities (110k undergraduates) to assess student wellbeing and mental health and understand what helps or hinders students seeking and getting help. A digital self-monitoring tool allows students to track their wellbeing, stress, and what support they use over time so we can map how they move through stepped care and how different steps interact with each other. To test whether changing university environment promotes wellbeing, first we will evaluate embedding compassion into education: teaching about diversity and mental health, practising kindness and understanding for self and others, and making assessment more flexible and responsive to students. Focus groups will explore how students experience this approach. Second, we will introduce a voluntary online mental health literacy course for first year undergraduates that teaches what influences mental health, how to promote wellbeing and how to seek help. Surveys before and after the course will test if it increases students' knowledge, healthy behaviours, helps-seeking and wellbeing. To better understand how to make self-help work for students, randomised trials will test book-based guided self-help to build personal strengths, unguided digital self-help to prevent depression in high-worrying students and digital self-help for depression and anxiety. We will compare supported versus unsupported digital cognitive-behavioural therapy, meditation and peer support apps to find out which app(s) students find most acceptable and explore which students most benefit from. We will test self-help with and without support because unsupported self-help can reach vastly more people and there is uncertainty about whether and for whom supported self-help is more effective. To improve the efficiency of student mental health services, we will test if adding a digital self-monitoring tool shared between student and clinician improves student experience and time to recovery by enabling care to be more proactive and responsive (e.g., more frequent meetings if symptoms rise). From this research, we will develop an evidence-based integrated model of inclusive and acceptable student wellbeing and mental health support. In partnership with students and university leaders, this model will inform policy recommendations. We will develop guidance, courses and tools to promote student wellbeing that are easily added to existing systems or that use tried-and-tested low-cost technology to ease their adoption and ongoing use.

0962122f-1175-4112-bec9-7327da6e0e5a Work lives and Wellbeing of Mental Health Nursing Workforce Lead applicant: Prof Jane Ball Co-applicants: Dr Gemma Simons, Prof David Baldwin, Prof Peter Griffiths, Dr Catherine Smith, Dr Emma Wadey Project Summary: Read a long project summary Read a short project summary We have a growing demand for mental health care and nurses are key to meting this demand. Each year roughly 10,000 NHS staff in England leave mental health services. 22% of nursing posts in mental health are vacant. Across the NHS it is recognised that work pressures impact on staff wellbeing, their ability to deliver care well, and likelihood of staff staying in the NHS. Despite being a priority area, most research related to nurses’ work engagement, retention and positive staff outcomes focuses on staff in general acute hospitals. Very little attention has been paid to mental health nurses’ work lives and wellbeing. Where will the research take place and who will it in involve This study focusses on mental health nurses. It will take place in Wessex but also includes desk research to collate workforce data, and a national survey of nurses in a range of mental health settings (community, hospitals, specialist units). The project will be led by the mental health workforce team at Southampton, in collaboration with the Hampshire & Isle of Wight Staff Support Hub, and the national lead for mental health nursing. An advisory group and patient public group will support the research. Aim & Design The aim is to examine the work lives and wellbeing of mental health nurses, in order to improve wellbeing and retention of these staff. This study will map what is known about the mental health nursing workforce, identify modifiable workplace factors that impact on staff experience, wellbeing and outcomes, and work collaboratively to identify solutions. The companion project will identify metrics that we can use to assess the wellbeing of the mental health workforce. Methods Labour market and workforce review - analyse data on the mental health nursing workforce, to create an overview. Survey nurses working in mental health (in Wessex NHS Trusts and a national sample). The questionnaire includes measures of: burnout, job satisfaction, intention to leave, workloads and practice environment. We will include open-ended questions so staff can give their views of work-life challenges, how they impact on their health, and what helps. The RCN Mental Health Forum will be main gateway for the national survey. Interview and focus groups with mental health nurses in Wessex NHS Trusts to explore experiences and views of working in mental health and issues related to wellbeing. These will be both before and after the survey (to help with survey design, and afterwards, to enrich interpretation). Coproduction workshop . Preliminary findings will be shared with a wide range of people with vested interest in, or responsibility for, the mental health workforce (e.g. nurses, managers, workforce leads) at a Wessex based co-production workshop, to identify actions and next steps. How will the findings inform improvements in population health and patient care? Services will run better and care quality will be improved if the workforce is healthy, happy and there are enough staff to provide care to the expected standards. Publications doi:10.12968/bjmh.2023.0037

Justin Strain < Back Thinker, sailor, author, physio Justin's journey so far.. Justin Strain Justin Strain I began my healthcare career a little later than most. At the age of thirty, after a short career in the Royal Navy, I took my first steps into the University of Southampton’s School of Health Professions. I was interested in research from day one. The importance of evidenced-based practice was drummed into us throughout our time at university. From the moment we first wielded a tendon hammer or a stethoscope we were encouraged to ask ourselves those all-important questions: What is the best treatment? Does it work? Why am I doing this? Starting out as a musculoskeletal physiotherapist, I threw myself into clinical practice, desperate to learn every treatment technique and test I could get my hands on. I believed that being a great clinician was about perfecting those tricky manual techniques and learning everything there was to know about anatomy. Or so I thought. Thinking differently Later, as I developed in confidence, I began to think differently about my practice. It seemed to me that what made most difference to my patients was the therapeutic relationship. Understanding the patient’s experience and learning to listen more and communicate better (and sometimes talk less!) started to seem more important than having the biggest toolbox of treatment techniques. Specialising in pain management helped me to appreciate how peoples’ experiences of health-conditions and healthcare were shaped by a complex web of social and personal interactions, making each person’s experience unique to them.The need to understand these unique experiences drew me to qualitative research. I wanted to go further than comparing different interventions. I wanted to understand the stories of the people at the heart of those interventions – our patients. The importance of narrative was not new to me. In my non-clinical life, I write children’s novels – I’ve written two so far and I’m working on a third. In my novel writing, I enjoy the magic of exploring fictional worlds from other peoples’ perspectives. I’ve always found that what brings a novel to life is the personal connection between the reader and the characters. I wanted to apply a similar approach to understanding patients’ stories - listening to, understanding and recording other peoples’ perspectives, and acknowledging the role of the researcher and the reader in interpreting those perspectives. While I was taking my first tentative steps towards qualitative research, the world of healthcare research was changing. The n=1 campaign was gathering momentum, and recognition of qualitative research was increasing. I wanted to get more involved, and found myself looking for the right opportunity. Then, at the beginning of 2020, the world turned upside down with the advent of the COVID 19 pandemic. Along with many other things, the COVID 19 situation has highlighted the need for research – to explore the impact of immediate responses to the crisis, and also to understand how the pandemic will influence longer term changes in how healthcare is delivered. One of those long-term changes is likely to be the proliferation of online healthcare. The plethora of online health interventions now on offer enables people to access consultations and courses that might previously not have been available to them, in a safe, socially distant way. I felt this area was worthy of more exploration, and I wanted to listen to the stories of service users, to understand how these changes had impacted on their experiences. I resolved to start a research project looking at patients’ experiences of online pain management in our own service, but I was struggling to find the time - alongside a busy job in clinical practice, dealing with redeployment and the current challenges of COVID 19, and being dad for our two wonderful children. The NIHR ARC Wessex Clinical Academic Internship has given me that time. It has enabled me to build and apply my skills in research as part of my clinical job, making a difference to how I can support patients within my service. So where am I now? I am in the early stages of my project – a systematic review of qualitative literature about patients’ experiences of online pain management, combined with semi-structured interviews with patients who have completed the online pain management programme within our own service.As well as time, the Clinical Academic Internship has provided a network of similarly minded people, interested in research and qualitative exploration of issues. The excellent events run by NIHR ARC Wessex have introduced me to new research concepts and skills. My supervisors, Dr Euan Sadler and Dr Lindsay Welch , have been extremely supportive and with their help my skills and confidence are growing. I am planning to complete my project in Autumn this year and I am hopeful that this will lead on to a pre-doctoral, and eventually a doctoral fellowship with NIHR ARC Wessex in the future. Dr Euan Sadler is an Associate Clinical Professor of Older People and Frailty within Health Sciences at the University of Southampton. Dr Lindsay Welch is a Lecturer in Adult Nursing and a Researcher in long term conditions. Previous Next

78e6cc7b-5ff9-411b-b288-1d82a03f0414 Testing the effects of food product placement on customers’ visual attention and intended product purchases: a randomised trial in a virtual supermarket setting (Phase I) Does supermarket placement affect intention to buy healthy and unhealthy foods? Principal Investigator: Janis Baird and Christina Vogel, Professor of Public Health and Epidemiology and Principal Research Fellow in Public Health Nutrition respectively, MRC Lifecourse Epidemiology Centre, University of Southampton Team: Dr Sarah Crozier, Senior Statistician, MRC Lifecourse Epidemiology Centre, University of Southampton Sarah Jenner, Senior Research Assistant at University of Southampton Dr Sarah Muir, Senior Research Fellow, University of Southampton Professor Marcus Munafo and Dr Olivia Maynard, Bristol University Ravita Taheem, Southampton City Council, Sure Start Children’s Centres Megan Brook, Public Contributor Tiana Chadwick, Public Contributo Start date: 1 October 2019 End date: 28 February 2022 Background Poor diet has been recognised as a major contributor to the burden of non- communicable diseases in the UK and costs the NHS approximately £6 Billion annually. Most adults in England consume too much salt, saturated fat and free sugar, and do not eat the recommended five daily portions of fruit and vegetables. Among low-income groups these trends are more extreme. Almost 90% of UK grocery sales occur within supermarkets4 and their subtle use of marketing techniques influences the food choices of an almost captive market. Women of childbearing age are an important target group to study because they remain primarily responsible for domestic food tasks such as shopping and cooking and their nutrition status influences the short and long-term health of their children. Our prior work in Hampshire showed that the diets of women with low educational attainment were more affected by less healthy supermarket environments than women with higher attainment. Shopping at less healthy discount and small supermarkets, with poorer availability, pricing and placement of healthy foods, was associated with poor dietary quality among women who left school aged 16 years but not among those with degree qualifications. UK government policy recognises that more effort is needed to develop interventions to improve health equitably and is introducing legislation on product placement initiatives to support families to make healthier food choices in supermarkets. Research using adequately powered clustered randomised controlled trials in supermarkets is limited, largely due to the complexity and large number of stores required. Evaluating changes in supermarket layout is notoriously challenging due to differing health and business agendas and randomisation at the store level requires commitment that is problematic in this highly competitive, commercial setting. Virtual supermarkets offer a viable alternative to investigate the likely impact of supermarket-based, healthy eating policy options using robust trial designs. Additionally, neuroscience techniques, such as eye-tracking, offer objective evidence that complements self-report behaviours, and facilitate a deeper understanding of the cognitive mechanisms underlying health-related behaviours. Such techniques have been used to examine how product placement facilitates customers’ visual attention, however there is a gap in understanding of how visual attention differs according to the healthfulness of products, particularly while placed in prominent in-store locations and whether visual attention differs according to customer’s socioeconomic position. This study aims to use experimental randomised trials and a virtual supermarket setting to determine differences in visual attention and intended purchase of healthy, unhealthy and non-food products placed in prominent in-store locations such as checkouts. It will also assess effect modification by educational attainment on these relationships to explore potential effects on inequalities. This is the first of two phases of research assessing visual responses to product placement. In this phase, heat mapping technology using Qualtrics software determined whether interest in and intended purchase of products in prominent in-store locations differed if the products were healthy, unhealthy or non-food items. We assessed effect modification by educational attainment to explore potential effects on inequalities. Women with young children (n=230), recruited through Sure Start Children’s Centres, early years setting and other community groups in Hampshire, undertook shopping trips in a virtual supermarket to assess whether their purchasing intentions differ if unhealthy foods, healthy foods or non-food items are placed in prominent positions (store entrances, checkouts and end of aisle). Preliminary findings indicated differences in women’s intention to buy certain types of products according to their educational attainment. Women with no educational qualifications beyond aged 16 years were intent on purchasing fewer healthy products when they were placed in prominent locations whereas those with higher educational attainment were intent on buying significantly more healthy products. A total of 230 women participated in phase I, exceeding our target sample size of 52. The study Women were shown a series of pictures representing six journeys through a supermarket. Pictures focused on the areas in a store where most shoppers usually pass through including the store entrance, end-of-aisles and checkouts. In the first three journeys, women needed to click all items they were interested in. In the last three journeys they needed to click all the items they would intend to buy if this was a real shop. Each set of journeys included a healthy journey, unhealthy journey and a non-food journey. What were the results? 201 women took part in a virtual supermarket survey. Overall, women in the study showed more interest in unhealthy products than healthy or non-food items. At checkouts, however, they did show more interest in non-food items. Women intended to buy more healthy and non-food items than unhealthy food items. On average they wanted to buy 12.9 healthy products per shop compared to 11.5 unhealthy products. What difference will this make? Unhealthy products can be interesting to women who shop at supermarkets but they have higher intentions to buy healthy and non-food items in noticeable places in stores. Supermarkets usually place unhealthy foods in noticeable places to make profits. Replacing these unhealthy foods with healthy or non-food items will just as likely, if not more successfully, lead to purchases. This can help families lead healthier lives. Why is this important for patients, health and care providers and policy makers ? Placing unhealthy foods in noticeable places can lead to impulse purchases of foods that can lead to obesity. Our study shows that women do not intend to buy these foods but may show interest in them. Since 2022, UK policy has banned the placement of some unhealthy foods at noticeable places in supermarkets. This research provides evidence that customers likely support this policy as they would like to buy healthy and non-food items from these locations. What we are going to be doing next? We wanted to further understand how attention to healthy, unhealthy and non-food items differ in noticeable places in supermarkets. We therefore ran eye-tracking experiments with 70 women in Hampshire. Data are being analysed. We plan to report the results of our survey and eye-tracking studies to policymakers (e.g. Department of Health and Social Care and Public Health England) via a policy brief. We also aim to share our results with families via Sure Start Children’s Centres, Facebook and Local Schools. We have plans to share our findings at public health conferences and in an academic journal.

1ab7e5e6-86e2-4f8e-a9c6-1bc46e56207d ADOPTED: Personalised social and self-management support for better living with multiple long-term conditions in the community (CO-ACTION) Chief Investigators : Dr Dorit Kunkell, School of Health Sciences, University of Southampton and Professor Mari Carmen Portillo, School of Health Sciences, University of Southampton. Team: Dr Hannah Wheat, Professor Victoria Allgar and Professor Richard Byng from the University of Plymouth. Miss Francesca White, Hampshire and Isle of Wight Integrated Care Board (ICB). Dr Tom Blakeman and Professor Peter Bower from the University of Manchester. Professor Daniel Prieto-Alhambra, Associate Professor Rafael Pinedo-Villanueva, Dr Annika Jödicke and Miss Maria T Sanchez-Santos from the University of Oxford. Dr Lindsey Cherry and Dr Kate Lippiett from the University of Southampton. Mr Eric Compton, Patient and Public Contributor, Southampton. Start: 1 June 2024 End: 30 November 2028 The CO-ACTION programme aims to improve wellbeing for people with multiple health problems. Living with Multiple Long-Term Conditions often called ‘Multimorbidity’ (MLTC-M) involves multiple appointments and care plans. Patient priorities are often overlooked. Common issues include pain, mobility problems and fewer interactions with friends and family. This can lead to loneliness and poorer mental health. The research team will work with fellow researchers, health, social care and VCSE sector workers to co-design and test a health and wellbeing intervention with and for people living with MLTC-M . To evaluate the CO-ACTION intervention: We will run a trial involving 500 people living with MLTC-M and carers. Half will receive the intervention. The other half will continue with usual care. We will recruit participants (with Patient and Public Involvement support) in health and community settings in Manchester, Leeds, Plymouth, and Southampton. Wellbeing, quality of life, unplanned hospital admissions, and costs will be assessed at the beginning, 6 and 12 months later. Researchers will test how this intervention can be adopted in the NHS in six case study sites. Public and patient (PPIE) contributors will help us design materials, consider challenges and provide feedback on findings.

f6a3bc9c-cb06-4577-8723-be7beaceddc2 Development, evaluation and provision of an intervention for primary and community NHS staff to help carers and homecare workers supporting people living at home with dementia with their continence. Principal Investigator: Dr Catherine Murphy, Senior Research Fellow, School of Health Sciences, University of Southampton. c.murphy@soton.ac.uk Team: Jane Ward: former carer, Alzheimer’s Society Research Network Member, co-founder of Dementia Friendly Hampshire, Patient Research Ambassador: Prof Miriam Santer: Professor of Primary Care Research, Faculty of Medicine, University of Southampton: Prof Jill Manthorpe: Professor of Social Work, Director of NIHR Policy Research Unit in Health & Social Care Workforce, King’s College London – Associate Director of NIHR School for Social Care Research: Prof Mandy Fader: Professor of Continence Technology, School of Health Sciences, University of Southampton: Dr Leanne Morrison: Lecturer in Health Psychology, School of Psychology & Primary Care Research Centre, University of Southampton. Partners: Health Innovation Wessex, Alzheimer’s Society, Homecare Association, Carers UK, Queen’s Nursing Institute, Dementia UK, King's College London. Start: 1/06/2022 End: 1/4/2024 Plain English Summary of Findings We found that Healthcare professionals wanted an easy and quick to use intervention to sign-post carers to continence care guidance. Homecare workers would welcome resources aimed at having difficult continence conversations The findings led us to develop the first evidence-based website to support healthcare professionals to provide continence advice to the carers of people living with dementia. The intervention also provides carers with detailed, practical self-management guidance. The website is www.demcon.org.uk A summary of the work can be found in this article: C Murphy, B Bradbury, M Fader, L Morrison, M Santer, J Ward, H Chester. Supporting continence care for people living at home with dementia. 22 APRIL, 2024. Nursing Times What Next? The project has provided foundational findings for the next phase of work which includes developing a new intervention to support homecare workers to initiate continence conversations with people living at home with dementia. This work (DemCon2) is being funded by NIHR Three School’s Dementia Research Programme and will start Autumn 2024. Initial Summary (2022) Most of the 850,000 people living with dementia in the UK live in their own homes with support from family or friend carers. Dementia puts people at much greater risk of developing continence problems (with urine/wee or faeces/poo) than people without dementia of the same age. Continence and toilet-use difficulties cause many problems for both people living with dementia and carers, for example, sore skin, infections, embarrassment, anxiety, fear of going out, relationship breakdown, and expenses such as cleaning carpets or laundry. Dementia can mean that using pads or reminders do not work well for people as time goes by. Many carers find dealing with incontinence hugely distressing. They describe feeling poorly prepared and alone. Many find it difficult to talk about and want better support from health and care professionals. Recently we asked people living with dementia, carers and nurses to tell us what information and support they would find useful. From that, we developed a detailed, practical handbook specifically for carers, covering: · understanding why someone with dementia might become incontinent · helping people keep ‘dry’ · managing incontinence · talking about incontinence · continuing with daily activities and socialising. The handbook contains many ‘real-world’ quotes from carers and will be made freely available on www.continenceproductadvisor.org (an NHS endorsed website). This is a good start but requires carers to find and use the handbook by themselves. Most carers want proactive support from the professionals they see (either healthcare or homecare workers), but healthcare professionals often feel ill-equipped to help carers or advise homecare workers. Therefore, in this study, we will develop a new resource that will build on the handbook and equip healthcare professionals to: · start conversations with carers and homecare workers · discuss continence problems and help people choose goals · deliver practical advice to carers and homecare workers. To do this, first we will review research on similar resources and speak to up to 45 primary and community healthcare professionals and homecare workers to fully understand their needs and how a new resource could be used and useful. We know that many people living with dementia and carers have regular contact with homecare workers who often help with washing and going to the toilet. Then, we will work with carers, people living with dementia, healthcare professionals, homecare workers, care commissioners or funders, voluntary groups and professional bodies to develop the resource. We will ask up to 60 people living with dementia, carers, homecare workers and healthcare professionals to use the resource and tell us what they think. We will then make changes to improve the resource. We want this resource to be used by as many primary and community healthcare professionals as possible so that they can support homecare workers and family carers. So, throughout this project, we will ask people about the best way to make it both useful and accessible. It will be freely available via www.continenceproductadvisor.org and we expect adopted and recommended by a range of organisations such as the Alzheimer’s Society, Skills for Care, Homecare Association and professional groups.

Professor Ruth Bartlett - National lead for DEM-COMM, post-doctoral training scheme for applied dementia researchers across the ARCs < Back Alzheimer's Europe Conference DEM-COMM researchers in Geneva Professor Ruth Bartlett - National lead for DEM-COMM, post-doctoral training scheme for applied dementia researchers across the ARCs DEM-COMM was out in force at the 34th Alzheimer’s Europe conference in Geneva. We weren’t all wearing DEM-COMM emblazoned bobble hats (next time, maybe?) but there were twenty of us, all presenting work, supporting each other, and generally making the most of being at this important annual event. Our headline act was Dr Esther Loseto-Gerritzen from the University of Nottingham, ARC East Midlands. Esther gave her first plenary talk: ‘Online peer support for people with young onset dementia’ in the largest auditorium I’ve ever been in; it was like the United Nations (see photo below). So very well done to Esther. We’re all proud of you and look forward to supporting you in your new role as Junior Board member and representative of the INTERDEM Academy . Other DEM-COMM fellows shared their work in a parallel session or one of the quick oral presentations (5 minutes), or like me, presented a poster. Some people gave two or three presentations - extra brownie points to you guys. Here’s a list of all works in the order they were presented at the conference, followed by a collage of photos of each person giving their talk. Oral presentations Hannah Wheat ‘Findings of the realist mixed methods, longitudinal evaluation of the D-PACT (dementia personalised care team), primary care based, post-diagnostic, dementia care model’. Amirah Akhtar ‘Depression and dementia risk: exploring the impact of cognitive dysfunction during recurrent depression in middle-aged British South Asians: A qualitative study. Orri McDermott ‘Co-working with local Caribbean communities to raise awareness and normalise talking about dementia’. Neil Chadborn ‘Yaad participatory project: exploring memories with South Asian Communities to understand the context of family of care for people with dementia’. Marie Poole ‘Understanding post-diagnostic dementia support through football organisations to provide person-centred, culturally appropriate support for underserved communities’. James Faraday ‘Better mealtimes for people living with dementia: working with care homes to share good practice’. Rasa Mikelyte ‘Inclusion from the start: co-development and application of a priority setting method for dementia care research’. Emma Elliot ‘Physical activity interventions for hospitalised patients with dementia: systematic review’. Orri McDermott ‘Lived experience of advance care planning and shared decision making’. Rasa Mikelyte ‘Co-designing an easy-read measure of care-related quality of life: reflections on involving people living with dementia and their supporters’. Megan Rose Readman ‘Understanding the experience of hearing loss for people living with lewy body or parkinson’s disease dementia. Emmanuel S. Nwofe ‘DEM-SAFE: co-designing information campaigns to promote brain health and reduce dementia risk in south Asian and African Caribbean communities in the UK’. Amirah Akhtar ‘DEM-SAFE: Living well with dementia for south Asian and African Caribbean communities in the UK’. Posters Jiamin Du ‘Prevalence and correlates of neuro-psychiatric symptoms in individuals referred to a memory clinic, and the distress experienced by their caregivers’. Hannah Wheat ‘Triadic communication during dementia care: a conversation analytical study. Megan Polden ‘Music Make Us! The impact of singing and dancing interventions on people living with dementia’. Tamara Backhouse ‘How can we improve personal care assistance for people living with dementia to reduce refusals of care? A realist synthesis Juanita Hoe ‘Risk Assessment in people living with dementia: a systematic review’. Esther Loseto-Gerritzen ‘Online peer support for people living with dementia: a scoping review’. Hannah Wheat ‘Supporting dementia support workers to adapt to their role within a primary care setting: what works, for whom and in what circumstances’. Ruth Bartlett ‘Building capacity in applied dementia research’. Chris Poyner ‘Personalising domiciliary dementia care via co-designed computational matching: a study protocol’. Ilianna Lourida ‘Data-driven discovery of associations between prescribed medication and dementia risk: a systematic review’. Emmanuel S. Nwofe ‘Dementia risk factors and brain health: a scoping review of interventions to reduce social isolation and loneliness among minority ethnic populations in OECD countries’. Thanks to Sarah Smith for darting around the venue to take these shots, great job! Previous Next

9651ede0-0793-4179-aed8-009aca83e877 Developing Pathways for older adults who are also drinking at increased-risk levels: Hampshire Older adults Alcohol Pathway (HOAAP) Chief Investigator: Julia Sinclair , Professor of Addiction Psychiatry, Faculty of Medicine, University of Southampton. Co-Investigators: Skaiste Linceviciute, Research Fellow, NIHR ARC Wessex, University of Southampton Gabrielle A Palermo, Senior Research Assistant, NIHR ARC Wessex, University of Southampton Stephanie Hughes, Research Fellow, NIHR ARC Wessex, University of Southampton Becky Band, Associate Professor, University of Swansea Melinda King, Lived Experience Consultant Stephen Lim, Consultant Geriatrician, NIHR ARC Wessex Ageing and Dementia Theme Lead, University Hospital Southampton Partners: Hampshire and Isle of Wight Integrated Care Board, Hampshire and Isle of Wight NHS Foundation Trust, Hampshire Hospitals NHS Foundation Trust, University Hospital Southampton NHS Foundation Trust, University of Southampton, Hampshire County Council, Southampton City Council, Wessex Health Partners, Inclusion (community treatment provider of addiction services), CGL, ‘With you’ Community Addiction Services Bournemouth and Poole, NIHR School of Primary care Start: 1 October 2024 End: 31 March 2026 Summary Alcohol once swallowed is absorbed into every organ of the body as well as affecting the mind. Although approximately 80% of people in Wessex drink alcohol, many people remain unaware of the harm it causes even at relatively low levels. As people age, they are more likely to develop long term health conditions, which alcohol can adversely affect as well as putting them at increased risk of medication interactions, memory problems, and falls. We know that older adults may feel more uncomfortable talking about their alcohol use compared with younger people. This can create barriers to accessing help. Beyond this, very little is known about the reasons why older adults drink alcohol and how this may interact with other aspects of their lives. The aim of this project was to build on our first study funded by the ARC Wessex, Older Adults, Loneliness and Alcohol (OLA), which recruited individuals over 65 years admitted to University Hospital Southampton (UHS) whose alcohol consumption was at increased risk levels. In collaboration with local clinicians and researchers, the study generated evidence that informed a follow-on project focused on alcohol use among community-dwelling older adults. To date we have undertaken the following studies: “Modelling the Impact of People with Alcohol Use Disorder on Clinical Outcomes and Healthcare Use” - in collaboration with Southampton Emerging Therapies and Technologies (SETT) Centre, and the Wessex Secure Data Environment (SDE). We have accessed and begun the analysis of retrospective, routinely collected data from all patients admitted to UHS between January 2017 - June 2025. There are over 95,000 inpatient discharges during this time. This work is supporting the investigation of associations between alcohol use disorder, clinical outcomes and healthcare use, as well as helping to refine the processes required to analyse data in the SDE. “Understanding lifestyle and alcohol consumption in older adults: a qualitative study” - We interviewed a community sample of individuals across Wessex over the age of 65 years, who consume alcohol and experience other potentially challenging contributing factors, to learn about their lifestyle choices, daily routines and demands with a scope for exploring alcohol consumption and related experiences. This study identified a range of alcohol consumers with diverse life factors, demonstrating the need for tailored health messaging/ advice and wellbeing support. Brought together an engaged and active stakeholder group of experts by experience and training in this field; including patients, carers, clinicians, social care workers, community support providers, commissioners and academics to inform our research planning and undertaking, to exchange and disseminate the learning and to build a network of collaborations to apply for further funding to take this work forward. These three strands of work have supported necessary evidence and partnership infrastructure building that will now require to be taken forward.

a0531f94-b063-4041-908b-5830a10b5f66 ADOPTED: Community pharmacy alcohol-related liver disease risk identification and linkage to care through development of a complex intervention (CIP-LINC) Prinicpal Investigator: Dr Alexander Smith Start Date: 16 February 2023 End Date: 31 March 2025 Background Liver scarring (known as cirrhosis) is a frequent and ever more common reason for dying in the United Kingdom (UK). The most common cause of liver scarring in the UK is alcohol. Death from liver scarring can be prevented if liver disease is found at an early stage. This can be hard because many people with liver scarring do not look or feel unwell until they develop liver failure. At this stage it is too late to prevent complications. Alcohol-related liver disease can be found earlier by assessing for it in people who drink too much alcohol. This is advised in national guidelines. Local pharmacists are one of the most accessible health professionals. There are over 12000 local pharmacies in England. Lots of these pharmacies are in areas where more people have alcohol problems. Local pharmacists are able to identify people who drink too much alcohol and provide them support to drink less. However, it is not known if local pharmacists can get these people assessed for alcohol-related liver disease. This study looks at how this could be done with the aim of creating a Toolkit to make it happen.

0f5a7259-3857-4aa4-8b2c-0c628421e76a Interventions to support physical activity for adults (MOTH) Maintenance Of physical aTivity beHaviour (MOTH) programme Also see Digital support for maintaining physical activity in people with long-term conditions and Non-digital support for maintaining physical activity in people with long-term conditions – within Maintenance Of physical acTivity beHaviour (MOTH) programme Principal Investigator: Professor Mary Barker Deputy Lead: Professor Mary Barker ( Professor of Psychology and Behavioural Science) Professor Maria Stokes (Professor of Musculoskeletal Rehabilitation, School of Health Sciences, University of Southampton, UK Head of Active Living Research Group) Team members: Dr James Gavin, Luisa Holt, Professor Jo Adams , Dr David Culliford , Professor Suzanne McDonough (Royal College of Surgeons in Ireland; Visiting Prof at UoS), Dr Aoife Stephenson (Royal College of Surgeons in Ireland), Dr James Faulkner (University of Winchester), Mr Ranj Parmar , Mr Jem Lawson (Public contributors), Dr Euan Sadler , Dr Dorit Kunkel , Dr Simon Fraser , Professor Sandy Jack , Professor James Bilzon (University of Bath), Dr Simon Jones (University of Bath), Dr Enhad Chowdhury (University of Bath), Mr Jem Lawson and Mr Ranj Parmer (public contributors) Start: October 2019 Ends: 31 December 2023 Project Partners: Royal College of Surgeons in Ireland, University of Winchester, Bournemouth University, University of Portsmouth, Wessex Clinical Research Network, University of Bath, NHS, AHSN Lay summary Physical activity is an important part of managing and preventing long-term conditions (LTC), through supporting people to remain active, improve symptoms and reduce future problems. A variety of digital and non-digital programmes and tools exist, such as exercise referral schemes and websites or mobile applications, to support people to start being active. However, these programmes/tools are often less effective at helping people to stay active in the longer term. The MOTH programme aims to identify existing digital tools and their components that help people with LTCs to stay active and understand the factors that support or inhibit their use in the NHS. The programme is also working with exercise referral schemes to evaluate and understand the needs of participants to support physical activity after the scheme has ended. Ultimately, the MOTH programme aims to develop digital and non-digital support that is usable, accessible and relevant to help people with LTCs to stay active. In doing so, the programme is aligned to many of the NHS long-term plan priorities, such as ‘responding to population needs’, ‘supporting people to age well’ and ‘increasing equitable provision of resources’