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03ec3658-b736-400b-ba5c-c0762b7b0f06 COMPLETED: Understanding, addressing, and meeting the complex needs of people living with long term physical and mental health conditions: a qualitative study Lead applicant: Prof Mari Carmen Portillo and Dr Leire Ambrosio Co-applicants: Prof David Baldwin, Dr Lindsey Cherry, Dr Kate Lippiett, Dr Pritti Aggarwal, Mr William Barnaby Jones, Dr Sara McKelvie What problem will the research address and what evidence do you have this is a major concern for the public and health and care providers of Wessex? People with long term physical conditions are 2-3 times more likely to have mental health problems than the general population: at least 30% of adults with such conditions also have mental health problems (like anxiety and depression). People living with physical and mental long term conditions experience hardships relating to health, and have complex psychosocial, environmental, financial, and spiritual needs. Healthcare professionals find it difficult to provide fully integrated care for these populations, due to systematic barriers and fragmentation of services. The NHS has incorporated an initiative involving Social Prescribing Link Workers (SPLW) in response to these complex needs. SPLWs connect people to community local services to meet needs through a comprehensive person-centred approach. However, the way in which this initiative occurs in different areas and services is variable, and there is unclear guidance for primary care services about how to integrate this novel workforce into wider efforts to address and meet the complex needs of people living with long term physical and mental conditions. Where will the research take place and who will you involve? The project will be undertaken in primary care practices in Hampshire, the Isle of Wight and Oxfordshire, and with a range of local third sector organizations (e.g., Anxiety UK, Mind). Semi-structured interviews will be undertaken with people living with long term physical and mental health conditions. Subsequent focus groups will explore the range of care provider perspectives (e.g., social prescribing link workers, GPs, nurses, practice managers). We expect to interview 20-25 individuals and conduct 4-6 focus groups with 6-8 participants per group. Maximum variation sampling will focus on sociodemographic characteristics (age, sex, ethnicity, socioeconomic background), with a sharp focus on disadvantage and deprivation. Overall aim: To determine the barriers and facilitators to successful implementation of the SPLW role in primary care for individuals living with long term physical and mental conditions. Specific objectives. Identify the range of health and social needs of people living with long term physical and mental conditions. Explore provider perspectives about social prescribing link workers role implementation and effectiveness for people living with long term physical and mental conditions. Explore user perspectives about social prescribing link workers role implementation and effectiveness Explore how, SPLW implementation methods can be adapted to better meet the needs of culturally diverse populations including those living within deprived areas. Explore potential limitations of SPLW model for people living with long term physical and mental conditions. Co-produce recommendations to enable effective implementation of social prescribing link workers to address health and social needs of people living with long term physical and mental conditions. A qualitative design, utilising semi-structured interviews and focus groups will be conducted. Patients and the public will contribute to all aspects of the research process. How will the findings inform improvements in population health and patient care. Following this study, a comprehensive tailored programme will be developed to address the complex needs of people with long term physical and mental conditions including those living in deprived areas. Plans for its implementation will be explored involving key stakeholders from and integrated Care System (ICS), Primary care Networks (PCNs), Local Authorities and any other organizations/sectors that may benefit from the findings. Publications https://doi.org/10.1155/2023/7191247

6e7ee8b2-1a6e-457b-9b3c-d7c31dc9079f ADOPTED: CEDA ‘Making the invisible visible’: identifying and responding to unpaid carers who experience domestic abuse from end-of-life care recipients Chief Investigators: Dr Michelle Myall , School of Health Sciences, University of Southampton and Dr Sandi Dheensa, University of Bristol. Team: Dr Susi Lund, Dr Sophia Taylor and Dr Becky Foster , School of Health Sciences, University of Southampton. Professor Siobhan O'Dwyer, University of Birmingham. Ms Katy Styles, We Care Campaign. Ms Marion Goodchild, Public and Patient Contributor. Summary Globally, home is most people’s preferred place of death. This relies on physical, emotional and practical support from unpaid carers e.g., family members, friends, or neighbours for people at the end-of-life (EOL) who are recognised as the most important factor in delivering at-home end-of-life care (EOLC). In England approximately 500,000 people provide unpaid EOLC. Half of unpaid carers provide up to 19 hours of care per week , increasing to an average of 70 hours at EOL. Unpaid carers make crucial contributions to EOLC, off-setting health service costs and enabling patient choice. Many carers do not identify as ‘carers’ and the caring role is often unplanned. Whether they choose the role or not, the demands of EOLC often exceed carers’ capacity to cope and are associated with poor physical and mental health, social isolation and financial insecurity. For some carers, suicide and homicide-suicide can seem like the only way out. There is clear evidence that EOL carers experience worse outcomes compared with those who care for someone who is not at EOL, and these outcomes increase in line with number of care hours provided and severity of the person’s illness . These negative consequences are compounded for EOL carers who are female, older, disabled, migrants, black, or minority ethnic. While the general toll of caring is well documented, little attention has been paid to the impact of caring or a person at EOL who is, or has previously been, abusive. Research that understands carers survivors’ experiences, and informs policy and practice for improved support is imperative. This research is a 24-month qualitative study comprising three linked phases. A qualitative approach will enable a sensitive and nuanced exploration of complex experiences and the relational aspects of domestic abuse (DA) in EOL caring relationships . We will work in partnership with people with lived experience, HSCPs, specialist DA organisations and key public service representatives through a Community of Practice (CoP) to co-produce knowledge and guidance to help HSCPs identify and respond to carer-survivors and generate recommendations to inform policy and practice. This study will generate important new insights into carer-survivor experiences. This is essential to ensure improved outcomes and to address gaps in support for carer-survivors during the EOL period and through to bereavement. The study will also produce resources for (Health and Social Care Professionals)HSCPs to identify and respond to DA, with the goal of improving carer experience, wellbeing, and safety. The study is part of a programme of research focused on domestic abuse where it co-exists with long-term/life-limiting illness and end of life. In 2024, we co-developed the DALLI toolkit, a resource for health and social care professionals working with people at end-of-life who are at risk of domestic abuse. The DALLI toolkit is hosted by Marie Curie and has been adopted in hospices, local authorities, integrated care boards and domestic abuse services in the UK and has attracted international interest. If you would like to find out more please click here: COMPLETED: Domestic Abuse and Life-Limiting Illness: identifying and supporting adults at risk (DALLI Study)

e468f3be-ad28-42e2-8ec5-7270d68258c8 ADOPTED: Treatment burden in people below the age of 65 with multimorbidity in primary care: A mixed methods (SPELL) Principal Investigator: Dr Rachel Johnson, University of Bristol Team: Prof Chris Salisbury, University of Bristol Prof Jose Valderas, University of Exteter Dr Simon Fraser, Univeristy of Southampton Dr Maria Panagioti, University of Manchester Dr Tom Blakeman, Univeristy of Manchester Dr Shoba Dawson, University of Bristol Dr Polly Duncan, University of Bristol Dr Michael Lawton, University of Bristol Start Date: 1 February 2022 End Date: 31 July 2024 Background One in two people over the age of 50 have more than one long term health condition (multimorbidity). The number of people living with multimorbidity is growing. Compared with people without multimorbidity, people with multimorbidity have worse quality of life, take more medicines, and are more likely to die or to be admitted to hospital. More people in deprived areas develop multimorbidity at a younger age. As a group, people with multimorbidity have more contacts with healthcare services than people with one or no long-term conditions. Because of this the NHS and policy-makers want to find ways to manage multimorbidity better. People with multimorbidity put a lot of effort to manage their medicines and healthcare appointments (treatment burden). There is some research that younger people experience more treatment burden. Previous research tells us that sometimes it is the simple things like getting appointments with the GP and finding parking that cause the most burden. Although people with multimorbidity are often grouped together, their experience depends on the health conditions they have, their ethnicity, where they live and their level of income. People with multimorbidity who are working age might have different problems such as getting time off work for appointments, managing their health conditions as work, or juggling childcare. This study will focus on people who are under the age of 65, as not much research has focused on them. A recent report by a charity for people with multimorbidity said that not much research has been done on how it feels for people to live with multimorbidity. Also, we do not know the best way to support and treat people with multimorbidity in GP services. If we understand people’s experiences, we might be able to design better services to meet their needs. There are some questionnaires that could be used to find people who be finding it difficult to cope with their multimorbidity burden, but they need more testing in the UK, particularly in younger people. Some questionnaires are too long, and it would be helpful to have a short version (e.g. just one question). This could be used regularly, as a quick way to identify people who might be ‘overburdened’ and need more support. We want to find out how health care services can support people with multimorbidity and reduce their treatment burden. We will do this in three ways: 1) interviewing people with multimorbidity, 2) ask people to complete questionnaires and 3) hold a meeting with people with multimorbidity, GPs and people who organise GP services, to talk about what we have found and work together to make recommendations to improve care. Throughout the study, we will work with the staff and patients at the GP surgeries involved to increase the number of people who take part. We will make efforts to reach and include people from minority ethnic groups and those who have difficulties in accessing health care. We will work with local community groups to raise awareness about this study and translate study materials into different languages. People with multimorbidity who take part in each part of the study will receive a voucher to thank them for taking part. In the first part of the study, we will ask GPs to find people with multimorbidity at their practice. We will invite some of those people to be interviewed, for up to 1 hour, either by phone, video or face to face. During the interview we will find out about their experience of living with multimorbidity, efforts they have to put into managing their health and treatment burden, and ways in which using health care services help or make it more difficult. We will use what we find in this study to help design the questionnaire that we will use in the second part of the study. In the second part of the study, we will ask GPs to invite randomly selected people from their practice. People who agree to take part will fill in questionnaires and give us permission to look at their medical notes. The questionnaires will ask about their experiences of care, how multimorbidity affects them, including the burden because of their health conditions or from managing them. As part of this we will test how well a short measure, based on a very small number of questions or even a single question, works in identifying overburdened people. In the third part of the study, we will hold a meeting with patients, people who organise healthcare services, and commissioners and healthcare professionals. During this meeting we will make sense of the results from interviews and questionnaires to identify how health services can support people with multimorbidity We will work together with people with multimorbidity or those with experience of caring for people with multimorbidity. The idea for this study came from a PPI group focused on multimorbidity research projects, with which both RJ and SC have been involved in for the past two years. We have set up a patient and public involvement (PPI) group including six people (two from minority ethnic groups). This group will be involved throughout the study from developing study materials to developing materials for sharing study findings.

c8454e17-14f6-4e3b-b8ba-8a5db14fcdcd Gambling and Alcohol Use Addiction in Military Veterans Chief Investigator: Professor Sam Chamberlain , Department of Psychiatry, Faculty of Medicine, University of Southampton; Sam.chamberlain@soton.ac.uk Co-Investigator: Dr Konstantinos Ioannidis , Department of Psychiatry, Faculty of Medicine, University of Southampton and Hampshire and Isle of Wight Healthcare NHS Foundation Trust [NHS]; k.ioannidis@soton.ac.uk Partners: Dorset Integrated Care Board, Hampshire and Isle of Wight Integrated Care Board, Hampshire and Isle of Wight NHS Foundation Trust, University Hospital Southampton NHS Foundation Trust, Southampton City Council, Health Innovation Wessex, CNWL NHS Trust, National NHS Gambling Clinic London, Avon and Wiltshire Partnership NHS Foundation Trust, South West NHS Gambling Service, Swansea University, Gambling in Armed Forces research group, Royal Navy, Southampton City Council, Stronger Communities, Southampton Armed Forces Covenant, Eling Royal British Legion branch, Southampton Voluntary Services, HIOWH NHS Armed Forces Network, The Society of St James, Parent Support Link. Start: 1 December 2024 End: 31 March 2026 Background to the research Military veterans face a number of challenges including being at elevated risk of Alcohol Use Disorder and Gambling Disorder, in comparison to the general population. In the Wessex region there are over 100,000 serving/retired military personnel, yet, our regional addiction services report levels of veteran personnel referrals below the expected numbers. Aims of the research Informed by extensive stakeholder consultation with regional addiction services, a need has emerged to carry out explorative research and community partnership building on understanding the extent of engagement in accessing treatment and formal support for gambling and/or alcohol problems for military veterans and learn how this knowledge can enable improvement . Design and methods used This research will consist of one-to-one interviews with military veterans and multiple stakeholder workshops with key multidisciplinary partners and collaborators. Both work packages (WPs) will utilise robust methodological approaches and will build on findings from interviews, PPIE input and views of wider stakeholders. Patient, public and community involvement Public and service user representation is an embodied element throughout this study that will guide decision making and will support multidisciplinary partnership building in the wider community. The PPIE group will consist of members with experience in gambling and/or alcohol use disorders to ensure that research activities and recommendations for the improvement in support pathways reflect the needs of those affected in local communities. Dissemination By identifying common thematic experiences of military veterans affected by gambling and/or alcohol use, and conducting a series of collaborative stakeholder workshops, a consensus set of recommendations will be constructed. This new knowledge will be mobilised amongst key Wessex region stakeholders (e.g. VCSE, military NHS pathways, regional NHS treatment services for gambling disorder) that will enable knowledge identification and exchange, both of which are necessary for informing the planning of further work in this area.

b0d87773-4d77-4612-90fe-50bd8c01a4e7 COMPLETED: Development of policy recommendations to reduce the impact of COVID-19 on physical activity and mental health in individuals with multimorbidity: a mixed method study. Principle Investigator – Professor Mari-Carmen Portillo (University of Southampton) Team: Dr Danielle Lambrick (University of Southampton) Dr James Faulkner (University of Winchester) Dr Leire Ambrosio Gutierrez (University of Southampton) Associate Professor Beth Stuart (University of Southampton), Professor Suzanne McDonough (Royal College of Surgeons in Ireland) Professor Melitta McNarry (Swansea University) Dr Jacqui Morris (University of Dundee) Dr James Steele (Solent University) Mr Eric Compton (PPI Representative) Ms Katherine Baker (University Hospital Southampton) Mr Jack Shakespeare (UK Active) Dr Matthew Wade (UK Active) Start: January 2021 End: June 2022 Aim of the research: To understand the impact of COVID-19 and government restrictions on physical activity and mental health of people with long-term conditions, and propose recommendations to support and sustain their physical activity during and after COVID-19 or other pandemics. The findings of our study will inform stakeholder events across the UK including participants and policy-makers to draw action plans together. Background to the research: People, including those with long-term conditions, were told to use physical distancing, self-isolation and/or shielding during COVID-19 to protect themselves and others. Government guidance on physical activity may or may not have explained to people how to be physically active and take part in exercise during COVID-19. Physical activity has a positive effect on physical and mental health, so understanding the impact of COVID-19 on physical activity behaviours (amount, type and intensity of physical activity, resources) of people with or without long-term conditions is important. What did we find out? General physical activity (PA) guidelines are not suitable for people with long term conditions (LTCs). Existing generic PA guidelines by the World Health Organization are not suitable for everyone because differences in age, gender, physical abilities, PA preferences, and LTC severity may affect why people choose not to exercise Online resources are not accessible for all populations. During COVID-19 pandemic, provision of PA information was most commonly available online. Hence, PA programmes designed for the general population may not be appropriate for clinical groups from a safety perspective People living with one LTC engaged in more moderate and high intensity PA compared to those with multiple LTCs People living with one LTC present better overall quality of life and lower anxiety and depression than those living with multiple LTCs Physical activity guidelines should be specific. Local and national government guidelines were identified as unclear for those living with LTCs and should be more specific regarding what people who were shielding could and could not do What difference could this make? Developing health and social care strategies to sustain PA, optimise online/offline resources and communication to promote individuals with LTCs can remain physically active Helping policy and guidelines development, particularly for those living with multiple LTCs Why is this important? Understanding the impact of COVID-19 on physical activity and mental health is beneficial to informing LTC policy development, to better support people living with LTCs to be physically active during future periods of mobility restriction and/or pandemics Findings emerged in this project, will support The development of more tailored and person-centred physical activity (PA) guidelines. in the case of individuals who are advised to shield, guidance should be provided on how they can be physically active within and around their homes. For example, tailor their PA according to how they manage and cope with their LTC and its changeability is recommended Prioritising vulnerable groups is recommended. Therefore, people with LTCs are an important and specific group to consider when designing and delivering PA guidelines during shielding or social-distancing periods How we are sharing our findings Policy recommendations have been developed that capture strategies to sustain Physical Activity and optimise online/offline resources and communication to promote individuals with Long Term Conditions can remain physically active. Policy Brief .pdf Download PDF • 3.53MB Findings from the quantitative and qualitative phase of the project informed stakeholder engagement activities across all counties of the UK. Representatives from macro, meso and micro levels were approached as well as Patients and Public contributors. Publication: Full article: Accessibility and applicability of physical activity guidelines and recommendations for adults living with long term conditions during COVID-19 (tandfonline.com) https://doi.org/10.1371/journal.pone.0285785 Conference: Presented mixed methods results of the project in an international congress - 7th World conference on qualitative research (25-27 January 2023) Development of recommendations co-developed at event January 2023 Podcast planned for 2023

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.

dc3e8b34-4159-44f6-a95e-c9d11121781c ADOPTED: Mapping pathways of response for adult and child victim-survivors of domestic abuse in Southampton City Team: Dr Sara Morgan, Associate Professor School of Primary Care, Population Sciences, and Medical Education Faculty of Medicine, University of Southampton Mrs Katerina Porter, Senior Research Assistant, Faculty of Medicine, University of Southampton Dr Eunice Aroyewun, Senior Research Assistant at the School of primary care, population science and medical education, University of Southampton Supervisor: Professor Julie Parkes, School of Primary Care, Population Sciences, and Medical Education Faculty of Medicine, University of Southampton The aim of the evaluation is to map the pathways by which victim-survivors are referred for, and receive, support for domestic abuse situations, from the Council and its partners. There are several processes to which victim-survivors can be referred in Southampton City: PIPPA and HRDA. PIPPA stands for the Prevention, Intervention, & Public Protection Alliance, and is the referral and support process for domestic abuse cases that have been assessed as standard- or medium-risk. PIPPA is a group of services working together to end domestic and sexual violence in Southampton, and comprises the following agencies: STOP Domestic Abuse Yellow Door Southampton City Council’s Independent Domestic Violence Advisor (IDVA) Service Hampton Trust South Hampshire Women’s Refuge No Limits HRDA stands for the High-Risk Domestic Abuse (process), and is the referral and support process for domestic abuse cases that have been assessed as high-risk. The process begins when someone makes the decision to refer a victim-survivor of domestic abuse to Southampton City Council, for support. The referrer could be from the Police, or Council team member from Adult Safeguarding, Children’s Services, Substance Abuse, Housing, or a member of the public, including the victim-survivor themselves. At this point, the referrer must use the DASH (Domestic Abuse, Stalking, & Honour-based violence) checklist tool to assess the risk of the domestic violence situation ( https://www.dashriskchecklist.co.uk/ , accessed 26/02/23). This tool was developed by the Association of Chief Police Officers (ACPO) and Laura Richards, in conjunction with SafeLives (formerly Coordinated Action Against Domestic Abuse (CAADA). Southampton City Council currently use a 24-question DASH checklist. The number of risk indicators (0-24) which are identified on the completed DASH suggest at which risk level the case should be assessed. The levels of risk are based on the Offender Assessment System (OASys), developed by the Prison and Probation Services definitions of what constitutes standard, medium, and high risk. For futher information email the team

af50ff28-5b02-41fa-bc1f-f9689464860e EnTech (Enabling Technology): Investigating the enabling and inhibiting factors to the use of internet-based support tools for caregivers of people with dementia, and how to promote engagement. Chief investigator: Prof Chris Kipps Neurologist, Clinical Director R&D University Hospital Southampton Dr Sarah Fearn Senior Research Fellow NIHR ARC Wessex (Ageing & Dementia) University of Southampton Team: Prof Cathy Murphy, Professorial Fellow Research, School of Health Sciences University of Southampton Prof Eneida Mioshi Professor in Dementia Care Research University of East Anglia NIHR ARC East of England Jane Ward Dementia Friendly Hampshire Amanda Wollam Public contributor with personal and professional (social care) experience of caregiving to people with dementia Start: 1 October 2024 End: 31 March 2026 Partners: Do rset HealthCare University NHS Foundation Trust, University Hospital Southampton NHS Foundation Trust, University of Southampton, University of East Anglia / NIHR ARC East of England, Dementia Friendly Hampshire, My Dementia Support. Our research This research aims to identify the factors that help or hinder caregivers of people with dementia to use online support tools. It also aims to create strategies to support caregivers to use them. We will use two internet-based resources as examples in our work: the DemCon website, which provides advice on dementia and continence, and FTDToolkit, which will be a psychoeducational intervention to support management of behavioural symptoms in people with frontotemporal dementia (FTD) and FTD with Motor Neurone Disease (FTDMND). Whilst some previous research in this area exists, it has been based mostly on surveys and has not included caregivers who do not go online. We will use interviews and focus groups so that caregivers can discuss all of the factors that affect their use of online support tools. This could include their personal situation and attitude towards online support tools, as well as thoughts about the tool itself. We will ensure that caregivers who are less confident or less able to use online websites are also included. We will also investigate the factors that help or hinder caregivers of people with a specific type of dementia – young onset dementia or frontotemporal lobar degeneration, which includes, but is not limited to, FTD. These sub-types of dementia often affect people at a younger age and can have different symptoms to other, more common types of dementia. This specific group of caregivers has not previously been discussed in existing research on this topic. We will use our findings on the factors that help or hinder caregivers of people with dementia to use online support tools to create strategies to support them. We will do this in workshops with caregivers so that we create them together. Managing continence issues and behavioural changes can be difficult topics for caregivers to discuss. This project will provide insight into how online support tools can help support conversations about challenging topics. Public involvement We are working with caregivers of people with dementia and local dementia charities in this project. On our team, we have two public contributors who both have lived experience of caring for someone with dementia. They will help us to design and carry out the research, to make sure it is relevant to caregivers and benefits them. 60 caregivers will participate in the research in interviews, focus groups or workshops. Outcomes This research will inform the roll-out of DemCon and development of FTDToolKit, to promote their successful adoption by caregivers. Our findings will also be relevant to the development and roll-out of other online support tools for caregivers of people with dementia. We will share our findings with caregivers, academics, support tool developers and others involved in the care of people with dementia. We will produce reports, write scientific articles, present at conferences, and work with national and local dementia organisations to share our findings. Email lead researcher

1810d0c8-e9bb-4a7c-9947-bbac48f4dd69 Mental Health, Workforce and Well-being Research Framework - ARC Collaboration More details on ARC Greater Manchester website What are we trying to do? The purpose of the document is to propose a pan National Insititue of Health Research (NIHR) Applied Research Collaboration (ARC) workforce focused mental health and well-being research framework. The aim is for the research framework to serve as a reference point to: Create coherence and comparability across the research carried out by NIHR ARCs Reduce duplication of work to reduce workforce burden. Adopting a coherent approach with an agreed purpose and broad aims will maximise the potential for cross-ARC collaboration, synergy and impact. While the focus of this research has a COVID-19 focus, the ambition is that this framework should facilitate research beyond the current pandemic, ensuring programme sustainability and longevity across the lifetime of this 5-year NIHR ARC funding cycle. This framework is not intended to be prescriptive, rather, it is a call to colleagues doing research under the NIHR ARC umbrella to use the framework as a point of reference in the development of research projects and programmes. It is a modular approach which allows flexibility to fit the scientific questions and data collection to the needs of the specific workforce and context being studied. Why is it important? The NIHR has invested £135 million to support 15 collaboratives covering every region within England. The NIHR ARC collaborative provides a framework within which key stakeholders are brought together locally and nationally with a mandate to tackle difficult issues facing our health and care system including: patient outcomes, effectiveness of our health and care system, system sustainability, and carrying out research with an applied focus to facilitate the rapid translation of research into practice. Moreover, the designation of ARC South London and ARC East of England as national leads for mental health and the establishment of a National Mental Health Priorities Network provides a further opportunity for effective collaboration. The NIHR ARC network presents a unique opportunity to develop a coherent and consistent approach to workforce mental health and well-being research which embodies these principles. What will we do? The framework is available for any NIHR ARC to review and align with, to guide the development of work that aligns to the fundamental principles of the NIHR ARC programme. Who are we working with? The NIHR ARCs and their research themes are set out in a table included in the document. In line with the framework, colleagues are encouraged to work collaboratively to maximise synergy, impact, and reduce duplication and burden. The origins of this framework arose out of conversation with colleagues from across NIHR ARC sites between April 2020-June 2020. The framework has been developed by: Kirsten Windfuhr (ARC Greater Manchester), Jane Ball (ARC Wessex), Karina Lovell (ARC Greater Manchester) Penny Bee (ARC Greater Manchester). Additional contributions and comments were gratefully received from ARC colleagues, and in particular Kristy Sanderson (ARC East of England). More information For further information about this work, please contact Alison Littlewood (Programme Manager). (ARC GM) Download - Mental Health, Workforce and Well-being Research Framework

Dr Preeti Dhuria (University of Southampton) and Professor Christina Vogel (The Centre for Food Policy, City St George’s, University of London) discuss how weak enforcement lets retailers bypass UK obesity regulations < Back Chocolate at the checkout Weak enforcement of obesity regulations is undermining public health Dr Preeti Dhuria (University of Southampton) and Professor Christina Vogel (The Centre for Food Policy, City St George’s, University of London) discuss how weak enforcement lets retailers bypass UK obesity regulations It’s far too easy to choose unhealthy options in retail stores in the UK. This isn’t just a personal challenge for citizens, it’s a public health crisis. The places we shop shape our food choices and quite frankly, the odds are stacked against us in selecting healthy food. There is a growing momentum for strong policies to rein in the aggressive promotion of unhealthy foods, and that’s a positive step. In fact, the UK government introduced a ban on placing unhealthy foods at checkouts, aisle-ends and store entrances in 2022. But you wouldn’t necessarily know it as a shopper. Our research shows there is a significant lack of resources for adequate enforcement. This situation means we still see chocolate at checkouts in some stores and alcohol at the aisle-ends in others because stores are either breaking the rules or using loopholes to continue making money at the expense of the country’s health. Regulating the food retail environment is an important part of the solution to lower levels of obesity but weak enforcement can undermine health goals. The Food (Promotion and Placement) Regulations 2021 are designed to limit the promotion of unhealthy foods in most retail stores and online equivalents in England. When 22 local government officers were asked about their approach to enforcement before the regulations came into effect, the clear narrative was that these regulations would not be robustly enforced because of a lack of staff and training. Our research showed the key obstacles to enforcing these regulations include: Staffing Constraints : There is limited capacity within local authority enforcement teams to enforce these regulations. Their scarce resources are used for immediate threats to life like knife crime rather than assessing breaches, issuing notices and processing fines for these anti-obesity regulations. Inadequate financial support: Funding constraints further hinder enforcement because only £281k in funding has been allocated across the 317 local authorities in England to support these enforcement tasks, leading to inconsistencies across regions. Minimal training: Enforcement officers are likely to rely on personal judgment and experience due to limited training and guidance on how to interpret the definitions in the regulations, leading to significant variations in the interpretation and enforcement of the rules across regions. Despite the regulations’ long-term health goals, it is clear that they are ranked as a low priority and the process of issuing infringement notices is cumbersome. This situation is leading to patchy enforcement, and businesses not being held accountable uniformly. The processes for reporting breaches are also unclear meaning even action by the public is usually difficult. A freedom of information request covering a three-month period showed that no improvement notices had been issued despite instances of non-compliance being observed. A Call for Stronger Enforcement Our research outlines actions at the national and local levels that could help to improve the level of enforcement being undertaken. National-level actions Provide adequate and dedicated funding to local authorities to recruit and allocate staff specifically for compliance assessment of these regulations. Provide centralised training and detailed guidelines for enforcement officers to ensure consistency and build confidence among enforcement teams. Streamline compliance assessments by requiring manufacturers to disclose nutrient profile scores for their products and retailers to provide key details, such as store square footage and employee count, to their local authorities. Local-level actions Instigate linkages within local authorities by supporting cross departmental activity between trading standards, environmental health and public health officers to make enforcement efficient. Raise regulations’ priority by incorporating into joint strategic needs assessment within local authorities to increase buy-ins from councillors and Directors of Public Health. Lack of enforcement compromises impact Investing in enforcement is essential to securing regulation compliance and achieving the level playing field that food businesses and public health advocates called for. Early enforcement ensures that businesses fully understand their obligations, comply with the rules, and help build a precedent for healthier retail environments. Proactive enforcement sends a clear message- the regulations are here to stay, and compliance is non-negotiable. But local authorities cannot achieve strong compliance without adequate funding and the right tools. A lack of enforcement risks being misinterpreted as a sign of regulatory failure and withdrawal of the regulations. This outcome would be detrimental to the health of British children and families. Here are a few instances recently where our research team have spotted non-compliance but do not know how to effectively report the instances, and even approaching the store manager has not led to an immediate removal of products from restricted areas. To truly make an impact, future food policies must incorporate robust enforcement strategies and dedicated funding from the outset to maximise the regulations’ impact and safeguard public health. Previous Next

Research areas Key research themes Ageing and Dementia Read More Long Term Conditions Read More Healthy Communities Read More Workforce & Health Systems Read More Cross-cutting research projects Mental Health Hub Read More Social Care Read More

40fed7f8-d8d0-46f4-80c3-660e33675330 PIVOT: Promoting Increased physical actiVity in hospitalised Older adults with Trained volunteers NIHR Advanced Fellowship Award: Dr Stephen Lim, Honorary Consultant Geriatrician University Hospital Southampton NHS Foundation Trust and Principal Clinical Research Fellow, University of Southampton Team : Dr Samantha Meredith Research Fellow, University of Southampton, Professor Beth Stuart Clinical Trials Co-director of the Pragmatic Trials Unit, Queen Mary University of London, Professor Carl Thompson Applied Health Research, University of Leeds Aim(s) of the research To determine whether hospital volunteers can be trained to engage older people in hospital to be more active. We want to know if this intervention will work in different hospitals and explore factors that will support or prevent it from being delivered successfully. Background to the research Between 30 and 60% of older people in hospital are at risk of losing muscle strength and function, known as deconditioning. This reduces their ability to look after themselves independently. Low physical activity level contributes to deconditioning but dedicated physical activity sessions can benefit older inpatients. In most studies, physical activity is led by paid staff. New ideas are needed to ensure additional physical activity sessions are costeffective and sustainable. The Southampton Mobility Volunteer study showed that trained volunteers can safely engage older inpatients to be more active. However, more information is needed on how to make this approach accessible to more people in more hospitals. Design and methods used Hospital inpatients aged 65 years and older will be invited to participate in the study. We will conduct the study in four hospitals. The hospitals will be different in size and from a wider region to include a range of population groups from different settings and context. This is so that different social groups are represented, and the research will be more representative of the wider population. We will use one hospital as a ‘control site’ – where patients will not get volunteer input – to compare our findings against. Volunteers will encourage participants who can walk independently to walk twice daily. Patients who need help with walking will do bedside exercises. They will be encouraged to walk once they can do so independently. We want to know whether trained volunteer delivered exercise sessions are feasible and acceptable to hospitals. We will determine this by collecting data on volunteer recruitment and training, patient recruitment and the walking/ exercises intervention. We will interview patients, staff, and volunteers as the intervention is delivered to establish what worked well and what could be improved. Other outcomes will include physical abilities, muscle strength, length of stay and readmission rates. We will analyse how much money it costs the NHS to deliver the intervention. Patient/service user, carer and public involvement The James Lind Alliance Priority Setting Partnership has highlighted promoting of independence, and physical and emotional well-being as 2 of the top 3 key research priorities for older adults. More specifically, our PPI research with 92 older people showed that 45% of them had experience with hospital volunteers and all spoke highly of their contribution. Most respondents thought volunteers could be trained to help with mobility. My feasibility study (SoMoVe study) confirmed the volunteer-led intervention was acceptable to patients, volunteers, and staff in one hospital. Patients were grateful that the volunteers encouraged them to be more active. Staff members valued the work of the volunteers. This proposal was developed with the support of 2 public researchers, the volunteer services manager and a hospital therapy lead. The study protocol and study documents will be developed with PPI collaboration. 2 public researchers will be invited to join the study steering group. PPI input will be paid at INVOLVE rates. Dissemination Findings from this study will be shared through conferences, academic papers/reports, and media/social media. In collaboration with the Academic Health Science Network, we will share our findings with commissioners, providers of care and voluntary organisations. Study findings will be of interest to voluntary services, healthcare professionals, and directorate managers. A collection of resources will be produced to encourage the adoption of this intervention in other settings.