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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.

0ff85ad2-7ff5-49d4-b71c-0a912cb8f020 ADOPTED PROJECT: The Gateway Study a randomised controlled trial, economic and qualitative evaluation to examine the effectiveness of an out-of-court community-based Gateway intervention programme aimed at improving health and well-being for young adult offenders; victim satisfaction and reducing recidivism Completed A single-site pragmatic Randomised Control Trial to examine the effectiveness of an OCBI known as ‘Gateway’ on improving health and well-being of offenders aged 18-24, as well as reducing recidivism and improving victim satisfaction Chief Investigator: Professor Julie Parkes – University of Southampton Project Team Members Dr Sara Morgan – University of Southampton, Dr Inna Walker – University of Southampton, Professor Catherine Hewitt – University of York, Professor David Torgerson – University of York, Professor Jenny Fleming – University of Southampton, Professor James Raftery – University of Southampton, Inspector Stu Baker – Hampshire Constabulary Sergeant Caroline Chapman – Hampshire Constabulary, Dr Alison Booth – University of York, Mrs Ann Cochrane – University of York, Mr Alex Mitchell – University of York, Mrs Valerie Wadsworth – University of York, Mrs Megan Barlow-Pay – University of Southampton, Ms Lana Weir – University of Southampton. Organisations Involved: Hampton Trust charity, No Limits charity, Aurora New Dawn, Hampshire and Isle of Wight Constabulary Started: 1/3/2018 Ended: 31/8/2022 Background Young adult offenders commonly have a range of health and social needs, making them vulnerable to mental health problems. If you are aged between 18-24 years old and have committed a crime, you may need to attend court and face convictions or prison. However, many believe that more should be done to prevent young adults from entering the criminal justice system in the first place. The study aims to determine whether a new out of court programme, named Gateway, improves the health and wellbeing of young adult offenders aged 18-24, and influences their chance of offending again, and gives victim satisfaction. The Gateway programme is issued as a conditional caution and has been developed by Hampshire Constabulary (HC), in partnership with local community groups, with an aim to improve the life chances of young adult offenders. In the programme, a mentor assesses the needs of each adult and develops a care pathway with referrals to healthcare. The young adult offenders then participate in two workshops about empathy, and the causes and consequences of their behaviour. Such intervention programmes are believed to improve the health and well-being of young offenders and reduce criminal behaviour. However, there is currently little information about the extent of this improvement. To find out whether the programme works, this research study compares a group of young adult offenders taking part in the Gateway programme as a conditional caution with a group of non- participants who are required to appear in court or given a different conditional caution. Publications An out-of-court community-based programme to improve the health and well-being of young adult offenders: the Gateway RCT | NIHR Journals Library

3a061229-d16f-48eb-aa36-30056ba5bad5 INVOLVing pEople with cognitive impaiRment in decisions about their hospital nursing care (INVOLVER): a pilot study Principal Investigator: Professor Jackie Bridges Team members: Professor Jackie Bridges (Professor of Older People's Care, School of Health Sciences, University of Southampton), Dr Jo Hope (Lecturer, School of Health Sciences, University of Southampton), Dr Tula Brannely (University of Bournemouth). Professor Katie Featherstone (University of West London) Ended: 31 December 2022 Partners: University of Southampton, Solent NHS Trust, University of Bournemouth, University of West London Collaborations developed through project: Alex Iles (grant co-applicant/film contributor) and the Treat Me Well Group (Southampton Mencap) (grant development and film contributors) The Grow Project, Southampton (film contributors) Different Strokes (Southampton) (film contributors) Mayes Bahrani (Hampshire and Isle of Wight Healthcare NHS Foundation Trust Patient Experience Group) (grant co-applicant) Catherine Mead (Portsmouth Hospitals NHS Trust, grant collaborator) Rosalynn Austin (Portsmouth Hospitals NHS Trust, grant collaborator) Francesca Lambert (University of Southampton) (grant co-applicant/film project co-applicant) Sofy Bazzini (Digital Learning Team, University of Southampton) (film project co-applicant) Pippa Collins (University of Southampton) (film project co-applicant) Anthony and Caroline Scott-Gall (film contributors) Lay summary We want to help nurses look after their patients in hospital. We want to help them find out how each patient likes to do things like getting clean, going to the toilet, eating and drinking. Some people have to go into hospital to get better. Sometimes, when they are in hospital, the nurses don’t ask them enough about the way they like to do things. For example, if they like a bath or a shower. Or if they need help going to the toilet. Or if they would like to walk about. Or what food or drink they like. Not being asked about these things is not helpful. It might mean that people end up getting sicker and staying in hospital longer. Or they may go home needing more help from their family. People with dementia, learning disabilities or stroke may not be asked these questions about what they like. Sometimes the nurses don’t know how to do this well. Sometimes they know how to do it but can’t do it. The reasons they can’t do it are not well understood. We are a group of people who want to make this better. Some of us work at a university finding things out. Some of us are nurses. We want to include people with dementia, learning disabilities or stroke in our group. This will help us think about how to make things better. We think we can help nurses by using ideas that have worked in other places. When people like us have an idea about how something can be made better, we try the idea out and see if it works. Summary of findings: We have been looking for good examples of how hospitals have changed what they do to make sure people with dementia, people with learning disabilities and stroke survivors are included in making care decisions in hospitals. We looked at all the research in this area and found only 11 studies that did this! Many more studies said they were making care ‘person-centred’ but did not look at how they could directly include people in decisions about their care. We are currently looking in detail at these studies to see what works well, what can go wrong and which bits work best. We will also check if the people who use or might the service were also involved in the design of the changes and testing them. We will report back soon! Our set of short films, Good Care For Me Is… were co-created with people with learning disabilities, stroke survivors and somebody living with Alzheimer’s. We won funding for this from the University of Southampton’s Public Engagement with Research unit (PERu) PER Development Funding Call 2020/21. These have been used in teaching nursing students at the University of Southampton and we are exploring where else they might be used to teach healthcare staff at the University and other good places. They will also be used in research to help design changes to services with patients and staff. Dr Jo Hope won funding from the NIHR’s RfPB (Research for Public Benefit) grant to follow the care of people with learning disabilities in hospitals, to try to understand why care between wards varies so much ( Improving the care people with learning disabilities receive in hospital: an ethnographic study examining the experiences of people with learning disabilities and the organisation and delivery of their care - NIHR Funding and Awards ). Dr Jo Hope has been developing ideas on how to involve people with profound learning disabilities in research and has published about this with her PhD team. What did we achieve? Good Care For Me Is… films are part of the pre-registration nursing curriculum at the University of Southampton, supporting future nurses to understand how they can improve care for people living with dementia, people with learning disabilities and stroke survivors We have found new collaborators in the health service, and people with lived experience who are co-applicants on our successful Stage 2 NIHR Research for Patient Benefit grant called: Improving the care people with learning disabilities receive in hospital: an ethnographic study examining the experiences of people with learning disabilities and the organisation and delivery of their care. Our papers on the inclusion of people with profound learning disabilities in research are challenging research orthodoxy on who can and cannot be directly involved in research We have shared findings from our previous research in Nursing Times, which explores what makes it difficult for patients to ask for help in hospital and why this is more difficult for people with dementia Publications doi.org/10.1111/1467-9566.13435 doi.org/10.3390/socsci11040159 https://onlinelibrary.wiley.com/doi/10.1111/jan.15637 doi.org/10.3390/socsci13010037 What's next? We will be publishing our systematic review into interventions to engage people living with dementia, people with learning disabilities and stroke survivors in nursing care decisions in hospital settings We will explore how our films about care experiences among people living with dementia, people with learning disabilities and stroke survivors might enable more healthcare students and workers to develop their understanding of supporting these patient groups Dr Jo Hope is developing a research programme to explore how hospital care can be improved for people with learning disabilities We will explore and share practical strategies of how people with more profound communication and understanding difficulties can be involved in research and care decisions

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.

747d2c2b-5ef2-4aa3-91d2-49259acbc2a5 Refinement of an eFalls tool - a multivariable prediction model for the risk of ED attendance or in-hospital fall or fracture in individuals accessing mental health or learning disability services - eFalls Chief Investigators: Dr Luis Marino, South West Yorkshire Partnership NHS Foundation Trust Dr Stephen Lim, University of Southampton Co-investigators: Professor Andrew Clegg, ARC Yorkshire & Humber, University of Leeds Professor Sam Chamberlain, University of Southampton Professor Chris Kipps, University Hospital Southampton Start Date: 1st April 2025 End Date: 31st March 2026 Partners: University Hospital Southampton NHS Trust, South West Yorkshire Partnership NHS Foundation Trust, NIHR ARC Yorkshire & Humber, University of Leeds Our Research Falls have a significant impact on physical health with increased risk of morbidity including, dehydration, pain, chest infection and reduced ability to get on with daily activities of living. This may lead to reduced levels of activity, social isolation, depression and anxiety. Individuals with a mental health or learning disability diagnosis have an increased risk of falls. Although several falls screening tools are available, they usually need a healthcare professional to manually screen electronic health records, which may not always be done. Falls have a big impact on health and social care systems and is a leading reason for admission to hospital. Treatment for fractures also costs the NHS an estimated £4.5billion a year. This study aims to take an electronic tool (eFalls) which automatically predicts the risk of falls in older people (over the age of 65 years) and explore whether it accurately predicts the risk of falls in adults with a mental health or learning disability diagnosis. We will use routinely collected data from two health services covering the regions of West Yorkshire and Hampshire and Isle of Wight for this study. Data for patients aged 18 years and above with a known mental health diagnosis will be included in this study. We want to know whether this tool can be used to predict the falls risk among people living with mental health disorders or learning disability and how effective the tool is in predicting falls. If shown to be successful, we will share our findings with healthcare commissioners and policymakers and the following steps will be to pilot this tool in the healthcare setting to explore its impact on patient outcomes.

Professor Lee-Ann Fenge - lfenge@bournemouth.ac.uk Dr Andy Pulman – apulman@bournemouth.ac.uk < Back Realities of adult social care recruitment and retention World Social Work Day 2024 Professor Lee-Ann Fenge - lfenge@bournemouth.ac.uk Dr Andy Pulman – apulman@bournemouth.ac.uk Social Work Week is an opportunity to celebrate the value that social work brings to society as well as acknowledging the challenges the profession faces. The theme of World Social Work Day is ‘Buen Vivir: shared Future for Transformative Change’, calling for social workers to adopt innovative, community-led approaches that are grounded in indigenous wisdom and harmonious coexistence with nature. This is an important focus as we recover in a post-COVID world, where budgets continue to be constrained and social workers increasingly draw on their creativity and innovative practice to provide excellent support for those they work with. To transform practice, it is important that we build an evidence base of what works and why, developing social work and social care research that evidences the value of the approaches taken. To date social work has lacked an established culture of research within social care organisations, resulting in limited high-quality research evidence alongside a limited culture of staff development focused on research opportunities. Practitioners may wish to develop a practitioner-researcher focus to their work, but this is often not supported or developed by their employer. This results in a missed opportunity to develop ground-up inclusive research practice driven by the insights and priorities of practitioners and service users which is essential to underpin high quality care. Within the Wessex region, we have been working to support the development of social care research over the past few years. In 2022, we completed a year-long study examining social care research enablers and barriers which might prevent or limit a positive research environment for practitioners (Pulman and Fenge, 2023). This built the foundation for four projects across Wessex funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) Wessex – which all aimed to build research partnerships across local authorities (LAs) and universities in the region. As part of these projects, separate funding was available to support research champions embedded within local authorities, to support activities such as lunch time research discussions, journal clubs and the development of practitioner focused research. To encourage buy-in from the LAs we developed research in partnership with them to respond to key priority areas. One such project explored local recruitment and retention issues in adult social care (ASC) from the perspective of four populations of interest collecting data from n=131 participants across the four populations of interest: ( POI 1 ) Social care practitioners - social workers, allied health professionals, unregistered and other social care practitioners - currently working in adult social care at two local authorities (LAs) ( POI 2 ) Social care staff with responsibility for performing exit interviews with LA staff currently working at the two LAs ( POI 3 ) Students currently enrolled in social work undergraduate and postgraduate programmes within the Wessex region ( POI 4 ) Service users with lived experience of receiving services in either LA and advocates drawn from Wessex Region LA contracted services Realities of retention So what does our data tell us about the day-to-day realities of people currently working within adult social care? What pressures are they currently experiencing and what might make them question whether they want to stay working within the profession? Within POI 1, n=97 practitioners working in adult social care at two local authorities completed our online survey on recruitment and retention with n=25 subsequently being interviewed. We found: Within next three years, n=17 (17.5%) were planning on leaving social care Career change decisions included changing area of practice, independent working, moving sectors to the NHS/Third Sector and leaving the profession to go to other employment – the biggest response at n=7 (41.2%) The most important reasons for those wanting to leave social care within the next three years were ranked by number of responses and the highest ranked themes were then corroborated within the data collected from all participants as being ongoing issues of concern for LAs. Below we reflect on a number of the challenges, pressures and demands on ASC at the moment. Demands of administrative tasks Participants described support posts being reduced, causing them to spend more time on administerial processes. Additionally, more time-consuming paperwork was required and constantly changing processes created ongoing frustration. Workload demand The increasing demands on roles in terms of a rising number of cases within LAs and subsequent increased caseloads caused immense pressure on being able to process work in a timely manner. Inadequate staffing levels Staffing levels in some teams was not deemed to be adequate. Inadequate pay and benefits Pay was often equated to a lack of value in the profession when compared to other health professionals. Pay was viewed frequently as being less than equivalent to what could be obtained in the retail sector (with a view of that work also being less stressful in comparison). Concerns were also raised about the use of agency staff by LAs and the pay discrepancies between agency and permanent posts, alongside additional impacts on continuity and team stability. Perceived rationing of/limited resources for service users Struggles to provide adequate services to service users was a continual source of frustration in the face of current budgetary pressures. This could also be apposite to the personal ethics of working within the sector. Isolation/too much working from home The effects of hybrid working was viewed positively or negatively, depending upon the individual. Positives included the ability to concentrate more, better productivity with less interruptions and the inherent flexibility of choosing where and when an individual worked. Negatives included feelings of isolation and lack of support - a particular risk for new entrants. A lack of a team culture was also described in some cases. Additionally, management seemingly became more distant in some instances. Poor support and induction for newly qualified staff The induction process was viewed as being inconsistent across LAs. Providing initial support for new staff can be complicated by the effects of hybrid working, limiting support and team building opportunities for new entrants. Suggestions for improving consistency included mentoring, shadowing and standardising the structural induction process. Stress and COVID-19 burnout Stresses caused by working in the sector and lowered resilience over a prolonged period of time could contribute to burnout. Stress caused by the nature of the job was mentioned by a number of participants. COVID-19 and post pandemic effects contributing to stress were noted. This also impacted on staff working from home during and after this period. Stress was also caused by the ethical challenges of working within the constraints of the current social care system. Office environment/hot-desking issues As with hybrid working, both the pros and cons of attending the office were discussed by participants – with travel and parking costs described as factors which might influence office attendance. There was an acknowledgement that hub office space had been lost since the pandemic, which some thought had been detrimental. Both home and work environments had their supporters, depending on working preferences. For some, the office was preferred for providing deeper and broader opportunities for networking and helping to build a positive team culture. Open plan offices could be a problem due to their nature – be it issues of noise, a lack of privacy and storage space in some cases. Also a lack of locations to debrief or chat in private. Hot-desking could also prevent a team culture from developing. Next Steps Social Work England’s State of the Nation report (2023) suggested that high demand for health and care services, a rising complexity of needs and increases in vacancies continues to put pressure on a system that is already stretched. Workforce challenges around the recruitment and retention of staff alongside increased reliance on agency social workers constantly proves challenging for employers. Although social workers are adaptable and innovative in the ways they deliver social work, ultimately pressure in the system can undermine the stability of relationships which can have a direct bearing on people’s care (Social Work England, 2023). Similarly, Skills for Care (2021) concluded that a well-led, supported and developed ASC workforce were more likely to stay in post and deliver consistent, high quality, personalised care. Conversely, a workforce that was under-funded, under-developed, suffering from poor wellbeing and not supported to advocate for themselves and the people they cared for was likely to result in poor care or worse. Our research highlights that unless employers, and the government, recognise the current concerns of front-line practitioners, recruitment and retention will continue to be a challenge. Addressing these concerns, alongside wider consideration of career paths that may include the opportunity for research engagement for practitioners, is essential to stem the tide. Thanks to: The authors wish to thank all participants who took part in the online survey and gave up their time to be interviewed. This work was supported by the NIHR Applied Research Collaboration (ARC) Wessex More information on our project: Professor Lee-Ann Fenge - lfenge@bournemouth.ac.uk Dr Andy Pulman – apulman@bournemouth.ac.uk https://nccdsw.co.uk/clusters/research/building-research-capacity-in-social-care https://www.arc-wx.nihr.ac.uk/research-areas-list/social-care%3A-local-authority-adult-social-care-recruitment-and-retention-research-project Further viewing: Pulman, A. 2024. NIHR ARC Wessex Social Care Lunchtime Seminar – Realities of adult social care recruitment and retention in 2023 https://vimeo.com/920484647 References: Pulman, A. and Fenge, L. A. (2023) Building Capacity for Social Care Research - Individual-Level and Organisational Barriers Facing Practitioners. The British Journal of Social Work. bcad117). Skills for Care. (2021). Evidence review and sector consultation to inform Skills for Care strategy: Final sector report. Available from: https://www.skillsforcare.org.uk/resources/documents/Adult-social-care-workforce-data/Evidence-review-and-consultation-analysis.pdf (accessed February 22, 2024). Social Work England (2023) Social work in England: State of the nation 2023. Available from: https://www.socialworkengland.org.uk/about/publications/social-work-in-england-state-of-the-nation/ (accessed February 29, 2024). Previous Next

27d064e4-2601-492e-b882-a0ef85373d44 ADOPTED: (SIFT) Sensors in Fatigue Tracking in Parkinson’s. Exploring the relationship between perception of Fatigue and the performance of physical activities in people with Parkinson's with fatigue using wearable sensors Fatigue is one of the three most debilitating symptoms in Parkinson’s. Fatigue is difficult to diagnose, it often goes unrecognised, and is challenging to treat. The SIFT-PD study is exploring how fatigue impacts physical activity in people with and without Parkinson’s over a 3-day period. It asks participants to fill in fatigue diaries and uses wearable sensors to monitor the how people move over a period of three days. The sensors are small and light and worn on a belt. The sensors track activity (the amount, type and quality of movement). This research looks at whether the sensors can reveal how people’s movements change over the course of three days when they are fatigued. Furthermore, information from sensors might help understand what makes people fatigued and allow it to be measured. Knowing more about fatigue will help to recognise its impact and help develop ways of managing it better.

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.

9f2dd724-7738-441f-b1ed-16eef04ecccd ENRICHER-C: Involvement in the criminal justice system & the impact on women's health in Dorset & Hampshire – Community comparison Chief Investigator: Emma Plugge, Associate Professor of Public Health, Faculty of Medicine , University of Southampton Team: University of Southampton - Donna Arrondelle, Research Fellow - Kathleen Kendall, Professor of Sociology as Applied to Medicine - Sara Morgan, Lecturer in Public Health - Julie Parkes, Professor Public Health - James Raftery, Professor of Health Technology Assessment EP:IC -Donna Gipson, Director -Lucy Wainwright, Director Prison Reform Trust -Paula Harriott, Head of Involvement Partners : University of Southampton, Dorset Council, Southampton City Council, HM Probation Services, South West, One Small Thing, Prison Reform Trust. Start: 1 October 2024 End: 31 March 2026 Summary This study will look at what happens to women’s health and wellbeing when they are being followed up by probation in the community, serving a ‘community sentence’. We will follow up these women in Dorset and we will compare any changes in wellbeing to changes in women from Hampshire who go to Hope Street on a community sentence. Hope Street is charity-funded residential care for women from Hampshire in contact with the criminal justice system; women live in special accommodation in the community where they are secure and where they are able to access a range of health and social care services. Women in contact with the criminal justice system are often from the poorest communities and they have many different health problems, particularly relating to their mental health. These health problems are often related to their crimes and so by making sure they get the services they need, this will help their health improve and benefit wider society by helping tackle crime. This study will ensure that this unique information is available to those who plan and deliver health services locally. The Southampton research team on this project are carrying out a 5-year evaluation of Hope Street. This means they can use the data that they are collecting as part of this evaluation on the health of women at Hope Street to compare to women from Dorset on community sentences. Researchers will collect information on the health and social care needs of the two groups of women at similar time intervals over a one-year period. They will then compare this information to look for differences. They will interview the women to understand their experiences. They will also look at the cost of their care. The information from the study will help the professionals who plan health and social care services and also those who work in criminal justice settings such as prison or probation. Women with experience of the criminal justice system are part of the nine-person study team. They have helped design the project and will also be important in spreading the word about the study. This will enable us to reach not just academic audiences and policy makers through publishing in journals and presenting at research conferences, but also people with lived experience of probation and imprisonment, and charities that work in this area. Informing a wide range of people will be important in ensuring that the findings from this study are acted on.

8549d888-5b96-445e-9088-9a757edd9282 ADOPTED: IneQUIty in end of life care for children: Investigating experiences and families’ Needs after sudden and unexpecTEd deaTh in children and young people – the QUINTET study Chief Investigators: Professor Anne-Sophie Darlington, School of Health Sciences, University of Southampton and Dr Katherine Hunt, Senior Research Fellow, School of Health Sciences, University of Southampton Team: Dr Vicky Payne, School of Health Sciences, University of Southampton, Miss Sarah Hodkinson, Associate Professor, Department of Music, University of Southampton, Professor Heather Gage, Professor of Health Economics, School of Biosciences and Medicine, University of Surrey, Dr Emily Cooper, Law and Policing, University of Central Lancashire, Dr Jamal Hossain, Lecturer in Applied Statistics, School of Health Sciences, University of Southampton, Dr Joanna Garstang, Consultant Community Paediatrician, University of Birmingham, Dr Nicola Speed, SUDC (UK), Miss Emma Kneebone, 2wish, Miss Stacey John, Forget Me Not Children's Hospice. From: 01/12/2024 to: 30/11/2027 BACKGROUND Around 3000 children die each year in England and Wales, and 30% of deaths represent infants and children who die unexpectedly or suddenly from accidents, suicide or unexplained deaths. Clear guidance and palliative care services exist for children who die of a life-limiting condition, including emotional and psychological support for their families, which extends into bereavement. However, clear guidance and care are not available for sudden and unexpected infant and child deaths, even though these are often the most tragic, brutal and shocking deaths. We do not know very much about what it is like for families, what care they need, what care is available, how they manage and cope in the longer term after their child’s death, and how professionals need to be supported after often traumatic experiences. PLAN We recently brought together organisations and professionals who care for families when a child has died suddenly (e.g., health professionals, fire department, police, hospices, charities, schools) to commit to working together to improve care for these families, and improve training and support for professionals. This network helped develop this project. We want to investigate these aspects (organised in Work Packages -WPs), focusing on different questions: WP1: What care is available for these families – around the time of the death and into bereavement, and where do children die. We will investigate this through 1) past research, and 2) existing database with information on child deaths. WP2: Which services are available to families and who provides that care, and what are the experiences and needs of the professionals providing that care? We will 1) interview professionals who carry out the Child Death Review and 2) interview professionals who provide care in different settings. WP3: What are the experiences of families, what care helped and what do they need? And what are the long-term consequences for parents, such as grief and depression and physical health? - we will investigate this by 1) interviewing bereaved parents about their experiences, and 2) asking bereaved parents to complete a questionnaire about grief, depression and quality of care. WP4: What recommendations around care and support should we make? We will use the information from the previous work packages to develop recommendations on how to improve care around the time of the death and in bereavement. We will agree what the needs are for training and supporting professionals. INVOLVING FAMILIES We will involve bereaved parents though the organisations included in our network. We have two parent and two other lay members as co-applicants on the study. A formal parent advisory group will be set up to help us with research questions, materials, design of the study, recruiting parents, content, social media presence and study branding, and dissemination. We will also work with a team of parent investigators who will provide guidance to the researcher and support participants during interviews. DISSEMINATION We will produce scientific papers, develop recommendations for care and maintain a network of parents and professionals to support the project. We will create national awareness of the needs of these families and work with a policy engagement organisation to influence policy and change practice. We will produce newsletters, social media posts, and result postcards to update families and the wider network.

fa252260-9b08-4bee-8ac4-2e68a124d401 Qualitative Data Preservation and Sharing (Q-DaPS) Principal Investigators: Prof. Fiona Stevenson ,, Professor of Medical Sociology, University College London, Head of the Research Department of Primary Care and Population Health; Prof. Geraldine Leydon-Hudson , , Professor of Primary Care Research, University of Southampton . Co-applicants: Dr Barbara Caddick Senior Research Associate in Primary Care and Honorary Senior Research Associate Department of History, University of Bristol; Dr Rebecca Barnes , Senior Qualitative Researcher, University of Oxford; Prof Carolyn Chew-Graham , Professor of General Practice Research, Keele University; Prof Sue Latter , Professor of Health Services Research, University of Southampton; Dr Emma Pitchforth , Senior Lecturer & Senior Research Fellow in Primary Care, University of Exeter. Prof. Catherine Pope , Professor of Medical Sociology, University of Oxford; Dr. Benjamin Saunders , Lecturer in Applied Health Research, Medical Sociology, University of Keele; Prof. Katrina Turner , Professor of Primary Care Research, University of Bristol; Prof Sue Ziebland Professor of Medical Sociology and Co-Director of the Medical Sociology and Health Experiences Research Group (MS & HERG) in the Nuffield Department of Primary Care Health Sciences, University of Oxford. Colaborators: Dr Ian Maidment , Reader in Clinical Pharmacy at Aston; Lynn Laidlaw is an experienced public contributor involved in UK wide and international research projects; Ali Percy, public co-applicant. Start: 1 June 2022 End: 31 May 2024 Background: Researchers may use different types of data to increase understanding of issues in relation to health and social care. Data may include audio or video recordings of interviews, focus groups (group discussions), and consultations between professionals and patients / service users, as well as written data, such as notes about research. These types of data are referred to as qualitative data. Funders of research increasingly encourage researchers to make their data available to be reused by other research teams. This is in part because qualitative data collection takes a lot of time and costs a great deal of public money. It is also considered ethical to make maximum use of data. Importantly, many people who participate in research tell us it is important to them that their contribution to research is used as much as possible. The project: Despite the increasing need and wish to safely store and share qualitative data, there is no central place to store and provide access to qualitative research data collected about health and social care. We will work with a company that specialises in keeping data secure and has a track record of working with university and health care organisations to develop secure digital storage (a repository) for qualitative data about health and social care. Part of the work will involve taking account of the views of members of the public about consent and use of data as well as data security. This will make sure the guidelines we put in place for people putting data into the repository or using data from the repository are acceptable to both researchers and participants in research. We will publicise the repository to encourage researchers to store their study data and allow access for researchers to answer their research questions. We will also provide a description of what is in the repository on a website so researchers can plan if they could use data from the repository rather than collecting new data. We will charge for use of data so the repository can be self-funding and sustainable in the long term. Expected impact : Increasing access to existing qualitative data from research projects in health and social care will make better use of what we already know about health and social care, saving time and money that would otherwise be spent on collecting new data. It will also satisfy the expectations of funders of research that data should be reused where possible. This project is particularly important as the COVID 19 pandemic has made data collection even more challenging in health and social care sites meaning we need to make the best use of the data we already have.

4f21e11e-3fe7-460c-9bc0-113a56eec7a5 The ImPACt study - Improving physical activity of older people in the community Club members at Brendoncare joining in group exercise Principal Investigator: Dr Stephen Lim Team members: Dr Stephen Lim (NIHR Clinical Lecturer in Geriatric Medicine, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton), Professor Helen Roberts (Professor of Medicine for Older People, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton), Dr Samantha Meredith (Research Fellow, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton) , Dr Kinda Ibrahim (Senior Research Fellow, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton), Esther Clift (Consultant Practitioner in Frailty, Hampshire and Isle of Wight Healthcare NHS Foundation Trust, Lymington New Forest Hospital), Samantha Agnew (Head of Clubs Services, The Brendoncare Foundation , Winchester), Pam Holloway (Patient representative) Start: 1 February 2020 Ended: 31 October 2021 Project Partners: University of Southampton, University Hospital Southampton NHS Foundation Trust, Hampshire and Isle of Wight Healthcare NHS Foundation Trust, Brendoncare. Lay summary Physical activity is important for older people. It has many benefits including maintaining older people’s ability to perform activities of daily living, be independent, and improve their well-being. However, many older adults living in the community do not engage in regular physical activity. Findings We found that we could train volunteers to support older people during the COVID-19 pandemic to stay active by performing exercises that help strengthen their muscles. Trained volunteers from Brendoncare led the online group exercises for older people who attended online community clubs during the COVID-19 pandemic. This was a challenging time when social distancing and lockdown rules were in place, which limited opportunities for older people to stay active. We recruited 19 volunteers, and 15 volunteers completed the training. The volunteers were mainly female (78%), with an average age of 68 years. The exercises were seated exercises and older adults were given exercise bands to increase the exercise intensity. Halfway through the study, lockdown restrictions were lifted, and some groups continued the group exercise in a face-to-face setting. The volunteers led 184 group weekly exercise sessions (127 online and 57 in-person). Thirty older adults participated in the group exercises. We interviewed volunteers, older adults and Brendoncare staff to find out more about what they thought of the online group exercise. The older adults enjoyed the intervention and understood the benefits of exercising. Additionally, they felt that they could exercise in a relaxed way with their peers without fear of being judged. The group exercises helped reduce social isolation and motivated older adults to engage with the exercises. Volunteers were enthusiastic to support the exercise groups. They appreciated the training and opportunity to lead the group exercises. One volunteer reported that the role gave her a sense of purpose by playing an active role the community club. Brendoncare staff members were a great help to the older adults and supported them with any issues, in particular those who were less familiar with the internet. At six months, we found that older adults who participated in the group exercise had an improved physical activity level. The time spent in light physical activity per week improved from an average of 1530 minutes per week to 1620 minutes per week. Only two minor incidents happened during the group exercises. Two participants experienced worsening of old injuries while performing the exercises. The programme trainer ensured the participants were safe and adapted the exercise for them. Overall, we found that volunteers can be trained to lead online group seated exercises. The exercises were safe and older adults enjoyed the exercises as well as the social interaction in the group setting. What we did with the new knowledge We supported Brendoncare in continuing the exercise groups after the study had ended. We presented our study findings to the board of trustees and demonstrated the exercises. Brendoncare has since employed an activity coordinator to continue to role of training volunteers and supporting volunteer-led exercise groups within Brendoncare. We trained the activity coordinator and shared our exercise sheets and other study materials to help Brendoncare develop their own training package. They are now actively recruiting more volunteers to lead group exercises in their community clubs. https://www.brendoncare.org.uk/get-involved/support-us/volunteering/#:~:text=Chair%20Based%20Exercise%20Volunteer,improving%20their%20health%20and%20wellbeing . We have developed a volunteer toolkit which is available to share with other volunteer organisations. The toolkit has recently been shared with Valley Leisure Ltd, a charitable leisure organisation, who have developed their offer of volunteer-based community clubs in Test Valley. Where next? Having explored how we can train volunteers to engage with healthy community-dwelling older adults to stay active through online group exercises, we collaborated with researchers from the Southampton Biomedical Research Centre and Bournemouth University to further develop this volunteer-led online intervention. We successfully secured research funding (£51,000) from University Hospital Southampton NHS FT to conduct a study to explore a multimodal intervention consisting of exercise, nutrition and behaviour change support, to engage with older people living with frailty who have been discharged from hospital, to stay active and eat well. This research has now been completed (10/01/2024) and we showed that it was feasible to translate the programme to support older people living with frailty ( COMPLETED: Wessex Frail2Fit – A feasibility and acceptability study of a virtual multi-modal intervention delivered by volunteers to improve functional outcomes of older adults with COVID-19 discharged from hospital ). What did people say about the work? Volunteer : “We do it because we want to help others…. we enjoy it. I'm gonna go back to belonging again, I feel that I'm benefiting from the group. Because again, I feel like I belong to that group….. I get so much out of it.” Club member: ‘We are not self-conscious when they (volunteers) are around. We have a laugh as well.’ Club member: ‘I’ve really enjoyed it because it keeps you in touch with people, especially during this COVID….. I still feel as if I’m part of a group.’ NEWS: ImPACT volunteers recognised for their wor k ImPACt exercise video IMPACT Exercise with Steve and Esther from NIHR ARC Wessex on Vimeo . Impact Exercise video using Resistance bands - Dr Sam Meredith watch the video on Vimeo Publications doi.org Volunteer-led physical activity interventions to improve health outcomes for community-dwelling older people: a systematic review - Aging Clinical and Experimental Research Background Physical activity (PA) is important for older people to maintain functional independence and healthy ageing. There is strong evidence to support the benefits of physical activity interventions on the health outcomes of older adults. Nonetheless, innovative approaches are needed to ensure that these interventions are practical and sustainable. Aim This systematic review explores the effectiveness of volunteer-led PA interventions in improving health outcomes for community-dwelling older people. Methods Five databases (MEDLINE, Embase, CINAHL, PEDro, Cochrane library) were systematically searched for studies using trained volunteers to deliver PA interventions for community-dwelling older people aged ≥ 65 years. Meta-analysis was not conducted due to included study heterogeneity. Results Twelve papers describing eight studies (five papers reported different outcomes from the same study) were included in the review. All eight studies included strength and balance exercises and frequency of PA ranged from weekly to three times a week. Volunteer-led exercises led to improvements in functional status measured using the short physical performance battery, timed up and go test, Barthel Index, single leg stand, step touch test, chair stand test, and functional reach. Frailty status identified by grip strength measurement or the use of long-term care insurance improved with volunteer-led exercises. Interventions led to improvement in fear of falls and maintained or improved the quality of life. The impact on PA levels were mixed. Conclusion Limited evidence suggests that volunteer-led PA interventions that include resistance exercise training, can improve outcomes of community-dwelling older adults including functional status, frailty status, and reduction in fear of falls. More high-quality RCTs are needed to investigate the effects of volunteer-led PA interventions among older people. https://doi.org/10.1007/s12603-020-1442-0 https://doi.org/10.7861/clinmed.2022-0283 doi.org Detecting low-intake dehydration using bioelectrical impedance analysis in older adults in acute care settings: a systematic review - BMC Geriatrics Background Dehydration is a frequent cause of excess morbidity and poor health outcomes, particularly in older adults who have an increased risk of fluid loss due to renal senescence, comorbidities, and polypharmacy. Detecting dehydration is key to instigating treatment to resolve the problem and prevent further adverse consequences; however, current approaches to diagnosis are unreliable and, as a result, under-detection remains a widespread problem. This systematic review sought to explore the value of bioelectrical impedance in detecting low-intake dehydration among older adults admitted to acute care settings. Methods A literature search using MEDLINE, EMBASE, CINAHL, Web of Science, and the Cochrane Library was undertaken from inception till May 2022 and led to the eventual evaluation of four studies. Risk of bias was assessed using the Cochrane tool for observational studies; three studies had a high risk of bias, and one had a low risk. Data were extracted using systematic proofs. Due to insufficient reporting, the data were analysed using narrative synthesis. Results One study showed that the sensitivity and specificity of bioelectrical impedance in detecting low-intake dehydration varied considerably depending on the total body water percentage threshold used to ascertain dehydration status. Other included studies supported the technique's utility when compared to conventional measures of hydration status. Conclusions Given the scarcity of literature and inconsistency between findings, it is not possible to ascertain the value of bioelectrical impedance for detecting low-intake dehydration in older inpatients. https://bmjopen.bmj.com/content/13/3/e069533 https://www.sciencedirect.com/science/article/pii/S2260134125000854[SM1] doi.org Evaluating the feasibility and acceptability of virtual group exercise for older adults delivered by trained volunteers: the ImPACt study protocol Introduction Physical activity is important for healthy ageing. Despite strong evidence on the benefits of physical activity for health and well-being, physical inactivity remains a significant problem among older adults. This study aims to determine the feasibility and acceptability of implementing an online volunteer-led group exercise for older adults. Methods A quasi-experimental mixed-methods approach will be used in this study. A training programme will be developed to train volunteers to deliver online group exercises to older adults aged >65 years (n=30). The primary outcome is the feasibility of implementing the intervention. This will be assessed by the number of volunteers recruited, trained, and retained at the end of the study, and the number of exercise sessions delivered and completed by participants. Secondary outcomes include physical activity levels measured using the Community Health Model Activities Programme for Seniors questionnaire, Barthel Index, EQ-5D-5L as a measure of health-related quality of life, SARC-F to determine sarcopenia status, and PRIMSA-7 to determine frailty status. Outcomes will be measured at baseline and at 6 months. Qualitative interviews will be conducted with volunteers(n=5), older adults (n=10) and family members (n=5) to explore their views on the intervention. Analysis Simple descriptive statistics will be used to describe participant characteristics, the feasibility of the study and the impact of the intervention on health outcomes. Parametric(t-test) or non-parametric(Mann-Whitney U test) statistics will be used to analyse continuous variables. χ2 test will be used for categorical variables. Qualitative data will be analysed using an inductive thematic analysis approach. Ethics and dissemination This study received ethical approval from the University of Southampton Faculty of Medicine Ethics Committee and Research Integrity and Governance committee (ID: 52 967 .A1). Study findings will be made available to service users, voluntary organisations and other researchers who may be interested in implementing the intervention. Trial registration number [NCT04672200][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04672200&atom=%2Fbmjopen%2F12%2F2%2Fe052631.atom · 40 Faces of Brendoncare - Sharon Green · 40 Faces of Brendoncare - Dr Sam Meredith · 2022 Winners | Pride of Andover Awards · https://www.linkedin.com/posts/karen-lewis-6b009665_ahpsday-activity-7385000352397385728-8v1K?utm_source=share&utm_medium=member_android&rcm=ACoAAGAmYqMBCL-wtu3ZnECr4UsylRfjAyKeGFY · https://youtu.be/nMSQR7kp9ec · https://youtu.be/6vxyL4OenmQ?si=RiOBz-yU7tO09fwX