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28e06f68-57c1-47e6-a549-0943eeae5264 COMPLETED: OPTIM Park - Optimization of community resources and systems of support to enhance the process of living with Parkinson’s Disease: a multisectoral intervention COMPLETE: Optimization of community resources and systems of support to enhance the process of living with Parkinson’s Disease: a multisectoral intervention (Linked to PARTNERS) Chief Investigator: Professor Mari Carmen Portillo – University of Southampton Funder : Background: This ongoing project looks at strategies that could help people live with Parkinson’s disease in the community through better use of resources and systems of support. It has worked with other organisations and community groups to test out an intervention to improve the coordination of services and resources for people with Parkinson’s disease, along with their and family carers, in 4 European countries. The overall aim of this project was to establish the feasibility and acceptability of an intervention that will enhance the lives of people with Parkinson’s disease (PD) and their family/carer. It has helped build a multisectoral care pathway. Iin particular it has focussed on how to optimize the use of resources and systems of support in the community, for disadvantaged populations of different European countries. We have looked at personalised assessments of needs and priorities, the role of a Parkinson’s disease coordinator, and navigation of resources in the community. In the UK we are working in collaboration with Hampshire and Isle of Wight Integrated Care System, Solent NHS Trust, and Parkinson’s UK. Who did we work with? Coordinator/chief investigator of the project: United Kingdom : University of Southampton, Professo Mari Carmen Portillo Country leads : Spain: Autonomous University Madrid, Dr Victoria Navarta Sanchez Spain, Fundación La Princesa, Dr Lydia López Denmark: VIA University College, Dr Anita Haahr Norway: University of Oslo, Dr Line Kildal Partners: Parkinson’s disease associations in the four countries What did we learn? During the qualitative phase: 47 people with Parkinson’s disease and 39 family carers were recruited The themes emerged were the following: Personalised care for individual needs Collaboration of different key agents Accessibility of different types of support systems Self-management Intervention 86 participants took part in the intervention (data being analysed) What difference will this make? Based on this project, partnerships between individuals (person living with Parkinson’s disease, family carer, and healthcare professionals) and across sectors in the community were developed. These can optimize the use of resources in the health-care system and personalise the information about disease, treatments, and the use of community resources/professional services in Parkinson’s disease management. A feasible intervention has been developed across countries that could be embedded in care pathways for people with Parkinson’s and carers. What difference can this make to people with Parkinson's disease (PD)? It can promote a change of culture and roles that enables the dialogue between sectors and levels of care It will empower people with PD and families to be at the centre of the decision making process of the multisectoral intervention It can enhance health and create the foundation of a transformative framework of bottom up strategies to create an overarall approach across Europe. This could enhance equity, continuity and transparency, as well as mobilise resources in health and social care. This would have a clear impact on people with Parkinson disease and families’ to make important decisions on their care and improve quality of life What's next? This project has become the basis of a submission for futher funding to test our intervention with people with MLTCs Multiple Long Term Conditions (MLTCs ) and how to implementation it Our partners hope to develop and implement a digital tool, through cross sector collaboration, to improve: - support and self-management for people with Long Term Conditions (LTCs) - communication and quality of cross sector care Publications Management of Parkinson’s in the Community: Interests and Expectations of People Living with Parkinson’s, Family Carers, Healthcare Professionals and Stakeholders in Spain - Azucena Pedraz-Marcos, Ana María Palmar-Santos, Mari Carmen Portillo, María Victoria Navarta-Sánchez, 2025

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Web-based Implementation Toolkit (WIT) Quick links: Project Outputs Buy-in and Engagement Fit with Health and Social Care Systems Alignment with Health and Social Care Priorities Outcomes and Impact Adoption and Spread Checklist, webinar and resources Quick links: Project Outputs This Web-based Implementation Toolkit (WIT) is designed to be easy to use and intended for a variety of users, projects and settings where implementation is planned or being considered. Implementation is the attempt to introduce a new intervention, innovation or policy developed through research and apply it to health and/or social care and the third sector. WIT provides you with an interactive Implementation Wheel, Checklist and bite-size Webinars (average 10 minutes) to support you through your implementation journey. Who is WIT for? WIT recognises the need to provide freely available, accessible and simple to use tools that focus on key considerations at the outset of a project. WIT was through interactive workshops with health and social care professionals, third sector organisation professionals, academics and members of the public. Anyone looking to understand more about or engage in implementation. Why use WIT? When to use WIT Adoption and Spread Project Outputs Buy-in and Engagement Fit with Health and Social Care Systems Alignment with Health and Social Care Priorities Outcomes and Impact implementation Implementation is the attempt to introduce a new intervention, innovation or policy developed through research and apply it to health and/or social care and the third sector. co-produced Co-production refers to a way of working together, often with service users, to reach a collective output. testing From the beginning – when first considering and designing a project Throughout all stages of your implementation journey and beyond To guide you through implementation considerations for your project There are six wheel domains to help you consider what is required for implementation. Click on a domain segment to find out more. How to use WIT Use the interactive Implementation Wheel, Checklist and bitesize Webinars to support you on your implementation journey and beyond. The six Wheel domains can be used iteratively, and in no particular order. The Checklist is downloadable and consists of the same domains as the Wheel. You can use this to complete with your team and check progress of your implementation journey. The Webinars , approximately 10 minutes duration, provide sessions relating to the six Wheel and Checklist domains and also to an introduction to implementation and implementation theories and frameworks. Hover on keywords to see definitions Other words in bold represent key learning points The Resources section provides suggestions for other resources you may find helpful. Feedback via our short survey If you fulfil the criteria on the attached poster , Researchers from the School of Health Sciences, University of Southampton/NIHR ARC Wessex would like you to test WIT by providing feedback via a short survey . Or alternatively scan the QR code. Thank you. Contact us If you have any questions about WIT, please contact: C.F.Brooks@soton.ac.uk Disclaimer The development of WIT has been supported by the NHS Insight Prioritisation Programme (NIPP). The views expressed are those of the authors and not necessarily those of the NHS. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of this website. How to cite Brooks, C.F., Lund, S., Kryl, D., and Myall M. (2023) Web-based Implementation Toolkit (WIT). University of Southampton. Available at: www.arc-wx.nihr.ac.uk/web-implementation-toolkit Accessibility We are committed to providing a website that is accessible to as many people as possible. We are actively working to increase the accessibility and usability of the website.

b4eba41c-3299-4935-88f1-36d55163f934 MODIFY: The development and iMplementation Of a multidisciplinary medication review and Deprescribing Intervention among Frail older people in primarY care COMPLETED: MODIFY: The development and iMplementation Of a multidisciplinary medication review and Deprescribing Intervention among Frail older people in primarY care Principal Investigator: Dr Kinda Ibrahim Project team : Eloise Radcliffe, Dr Simon Fraser , Clare Howard , Professor Paul Rutter , Professor Susan Latter , Claire Sheikh , Dr Lawrence Brad , Dr Mark Lown , Dr Alejandra Recio-Saucedo , Dr Kat Bradbury , Dr David Culliford , Dr Maria Chorozoglou , Cynthia Russell (PPI lead). Further PPI involvement from:Pam Holloway, Neil Wilson, Rajneesh Kaur Additional support from Renee Servin and Lucy Murphy (Medical students) Partners: University of Portsmouth, Westbourne Medical Centre, Wessex Health Innovation Network, PresQiPP, NIHR CRN Wessex Summary of findings - download plain text summary 1 in 3 people aged 65 and older take 5 or more medicines every day (polypharmacy). Some of these drugs may no longer be appropriate. They could increase the risk of falls, hospital admission, or even death, especially among people who are frail (and less able to recover from injury and illness). Deprescribing (reducing, stopping or switching drugs) is safe for some conditions, medications and in settings such as primary care. But Health Care Professionals (HCPs) may face problems with carrying this out. Problems may include a lack of time for HCPs, and HCPs and patients may be concerned about stopping medication which was first prescribed by a specialist. Previous research highlights that this problem could be addressed by teams of HCPs from different disciplines, including practice pharmacists, working together on the medication review and deprescribing process. The research team reviewed 28 studies on older people in primary care to explore what makes medication review and deprescribing work best in a team of HCPs. Alongside this, the research team carried out in-depth interviews with ten older patients and three of their family carers, and focus groups with 26 health care professionals working in eight different GP practices. This helped the team to understand different experiences of medication reviews and deprescribing, and how this process can work best. Based on the results the team suggested ways to improve deprescribing in primary care. They include: clear roles and responsibilities for HCPs, with good communication between team members, and pharmacists integrated within teams training and education on deprescribing for HCPs routine discussions about deprescribing when prescribing, with medication reviews tailored to patients’ needs and preferences, and addressing any questions or concerns involvement of patients and informal carers, and trusted relationships with professionals allowing continuity of care. Based on the results the research team developed an intervention to improve medication review and deprescribing for older people with frailty and taking 10 or more medicines, to target those who would benefit most. The intervention has five phases: 1) Identification on practice databases of older patients aged 75 and over living with frailty, prescribed 10 or more medications, to be invited for a medication review 2) Preparation for HCPs, through using deprescribing tip sheets and a digital tool to help prioritise medication for deprescribing (with training provided) 3) Written information leaflet sent to patients and carers about the purpose of medication review and the reasons for potentially stopping or changing medications 4) The HCP (mainly a practice pharmacist) will conduct a person-centred medication review taking into account patient and carer needs and preferences. They will involve other HCPs members based on their expertise, and document and share any agreed changes with patients and other staff members if needed; 5) Tailored written follow-up plans to be given to patients and carer, and further contact arranged if needed. See NIHR Alert - How to deprescribe in Primary Care which features this research How we shared these findings Conferences and dissemination to Health Care Professionals •European Clinical Pharmacy Society conference, October 2022, Prague, Czech Republic 2022 (oral and poster) •Faculty of Medicine Conference, University of Southampton, June 2023 (oral and poster) •Health Services Research and Pharmacy Practice conference, Cork, Ireland 2023 (oral and poster) •ARC Wessex collaborating for impact showcase event, June 2023 •Society for Academic Primary Care conference, Brighton, July 2023 •South West Society for Academic Primary Care conference, Cardiff Wales, March 2024 •International Conference on Deprescribing, Nantes, France September 2024 Other presentations and talks •Invited to present MODIFY at the Society for Academic other presentations Primary Care Medicines Optimisation Special Interest Group, 12th March 2024 •Invited to present on deprescribing at the CRN national event on Multimorbidity in May 2023. •Invited to present MODIFY at the CRN coordination Wessex Pharmacy Research Network meeting, 28th February 2024 •Presented MODIFY during a meeting with Prof. Tony Avery, the National Clinical Director for Prescribing, 1st March 2024 •Shared learning on MODIFY with Prof David Alldred and his team at Leeds, Jan 2022 •Introduced MODIFY at the Health Innovation Network Polypharmacy Community of Practice meeting, July 2022 Publications: We published our findings from our realist review in BMC Geriatrics: What makes a multidisciplinary medication review and deprescribing intervention for older people work well in primary care? A realist review and synthesis Plos One publication (April 2025): Development of a complex multidisciplinary medication review and deprescribing intervention in primary care for older people living with frailty and polypharmacy Our publication was selected as an NIHR evidence alert, and promoted more widely on social media to health care professionals and policymakers: How to deprescribe inprimary care - NIHR Evidence Education of undergraduate an postgraduate students •Plenary talk on polypharmacy and deprescribing to year 1 medical students in May 2024 •Invited talk by University Hospital Southampton at a General Internal Medicine Training day 16th September 2024, MODIFY presented to over 100 trainees Public and patient engagement Presentation and discussion of MODIFY at a Community medical science engagement session with 12 older people (via Communicare, a local social service organisation on 4th September 2024) The project has prompted Bob Heath to write a song about deprescribing - which was played at the ARC Event 2025 Bob and Peter Heath wrote this song about deprescribing Lay Summary or research protocol Background: A third of older people take five or more regular medications (polypharmacy) potentially increasing the risk of side-effects, hospital admission and death. These effects are higher among people living with frailty who lose their in-built reserves and become vulnerable to changes triggered by small events such as a change in medication. National recommendations suggest that medications taken by frail older people should be reviewed annually by their GPs to identify and reduce/stop inappropriate medications (deprescribing).Yet this does not happen routinely due to GPs’ lack of time, increased workloads and worries about stopping medicines. Recent recommendations suggest involving other non-medical prescribers such as practice pharmacists and advanced nurse practitioners (ANPs) in reviewing medications. However, it is unknown how staff could work together most effectively and whether they have any training needs. Aim: This research will investigate how practice-pharmacists, ANPs and GPs could best work together with patients living with frailty to perform regular medication review. Methods The study involves four work packages (WPs). We will review previous literature to identify what makes a successful medication review and how to safely reduce/ stop inappropriate medications (WP1). Interviews with GPs, practice-pharmacists, ANPs, frail older patients and carers will be conducted (WP2). These will discover views about where medication review should take place, the role of each of the involved parties in the process, type of medications that could be deprescribed, staff development and training needs, barriers and facilitators for implementation, and strategies to address these barriers. Information gathered from WP1&2 will be used to develop the intervention: a structured medication review process using pharmacists, ANPs and GPs most effectively and involving frail patients and their families in decisions about medications (WP3). The intervention will be refined further through a series of workshops with service users, clinicians and commissioners. A training programme to implement the intervention and increase staff confidence in reducing/ stopping medications safely will be developed and delivered to GPs, practice-pharmacists and ANPs based on the Polypharmacy Action Learning Sets approach adopted by the Wessex Academic Health Science Network (AHSN) . Finally, we will assess whether itis feasible and acceptable for staff in four GP practices to be trained and to implement the intervention with their patients (WP4). Public Patient Involvement: Three PPI members have been involved in protocol development and refinement and will continue to contribute to the research study by for example being involved in developing research instruments and monitoring recruitment. Dissemination and Impact: Working with colleagues in the Wessex AHSN and local clinical commissioners, we will be able to share our findings and training programme to the wider research and clinical community in Wessex and potentially influence practices and policies both locally and nationally. Ibrahim, K., Cox, N.J., Stevenson, J.M. et al. A systematic review of the evidence for deprescribing interventions among older people living with frailty. BMC Geriatr 21, 258 (2021). https://doi.org/10.1186/s12877-021-02208-8 Pazan, F., Petrovic, M., Cherubini, A. et al. Current evidence on the impact of medication optimization or pharmacological interventions on frailty or aspects of frailty: a systematic review of randomized controlled trials. Eur J Clin Pharmacol 77, 1–12 (2021). https://doi.org/10.1007/s00228-020-02951-8 Radcliffe E, Servin R, Cox N, Lim S, Tan QY, Howard C, Sheikh C, Rutter P, Latter S, Lown M, Brad L, Fraser SDS, Bradbury K, Roberts HC, Saucedo AR, Ibrahim K. What makes a multidisciplinary medication review and deprescribing intervention for older people work well in primary care? A realist review and synthesis. BMC Geriatr. 2023 Sep 25;23(1):591 (2023). https://doi.org/10.1186/s12877-023-04256-8

f06fb2ad-c8c9-436f-982c-c278b7185585 ENRICHER – involvEment iN the cRiminal justice system & the ImpaCt on women’s Health dorsEt & hampshiRe Chief Investigator Professor Julie Parkes Professor in Public Health Head of School of Primary Care, Population Sciences and Medical Education Faculty of Medicine University of Southampton, South Academic Block, Southampton General Hospital, Tremona Road, Dr Emma Plugge Associate Professor in Public Health School of Primary Care, Population Sciences and Medical Education Faculty of Medicine University of Southampton, Co-Investigators Dr Donna Arrondelle , Research Fellow, University of Southampton Dr Naomi Gadian, Public Health Specialist Registrar, University of Southampton Donna Gipson, Director EP:IC Consultants Ltd, West Malling, Kent Dr James Hall , Associate Professor of Educational Psychology, University of Southampton Paula Harriott , Head of Prison Engagement, Prison Reform Trust Professor Kathleen Kendall , Professorial Fellow of Sociology as Applied to Medicine, University of Southampton Dr Sara Morgan , Associate Professor in Public Health, Faculty of Medicine, University of Southampton Professor James Raftery , Faculty of Medicine, University of Southampton, Dr Lucy Wainwright , Director of Research, EP:IC Consultants Ltd, West Malling, Kent Starts: 1st April 2023 Ends: 30th September 2024 Summary This study will look at what happens to women’s health and wellbeing when they are imprisoned. The imprisoned women will be women from Dorset and we will compare any changes to changes in women from Hampshire who go to Hope Street instead of going to prison. Hope Street is a charity-funded alternative to prison, available only to women from Hampshire; 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 who go to prison are often from the poorest communities and they often 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 new and 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 who are imprisoned. Researchers will collect information on the health and social care needs of the two groups of women at the same time intervals over a one-year period and in the same way. We will then compare this information to look for differences. We will interview the women so that we understand what their experiences are like in prison or Hope Street, and why there might be differences. We will also look at the cost of their care. The information from our 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 imprisonment are part of the eight-person study team. They have helped design the project and will be working with Hope Street women to train them in research. They 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 or presenting at research conferences, but also people with lived experience of 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.

About NIHR The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by: Funding high quality, timely research that benefits the NHS, public health and social care; Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services; Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research; Attracting, training and supporting the best researchers to tackle complex health and social care challenges; Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system; Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries. NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK Aid from the UK government.

Web-based Implementation Toolkit (WIT) Quick links: Project Outputs Buy-in and Engagement Fit with Health and Social Care Systems Alignment with Health and Social Care Priorities Outcomes and Impact Adoption and Spread Checklist, webinar and resources Quick links: Project Outputs This Web-based Implementation Toolkit (WIT) is designed to be easy to use and intended for a variety of users, projects and settings where implementation is planned or being considered. Implementation is the attempt to introduce a new intervention, innovation or policy developed through research and apply it to health and/or social care and the third sector. WIT provides you with an interactive Implementation Wheel, Checklist and bite-size Webinars (average 10 minutes) to support you through your implementation journey. Who is WIT for? WIT recognises the need to provide freely available, accessible and simple to use tools that focus on key implementation considerations at the outset of a project. WIT was co-produced through interactive workshops with health and social care professionals, third sector organisation professionals, academics and members of the public. Anyone looking to understand more about or engage in implementation. Why use WIT? When to use WIT From the beginning – when first considering and designing a project Throughout all stages of your implementation journey and beyond To guide you through implementation considerations for your project There are six wheel domains to help you consider what is required for implementation. Click on a domain segment to find out more. Adoption and Spread Project Outputs Buy-in and Engagement Fit with Health and Social Care Systems Alignment with Health and Social Care Priorities Outcomes and Impact How to use WIT Use the interactive Implementation Wheel, Checklist and bitesize Webinars to support you on your implementation journey and beyond. The six Wheel domains can be used iteratively, and in no particular order. The Checklist is downloadable and consists of the same domains as the Wheel. You can use this to complete with your team and check progress of your implementation journey. The Webinars , approximately 10 minutes duration, provide sessions relating to the six Wheel and Checklist domains and also to an introduction to implementation and implementation theories and frameworks. Hover on keywords to see definitions Other words in bold represent key learning points The Resources section provides suggestions for other resources you may find helpful. Feedback via our short survey If you fulfil the criteria on the attached poster , Researchers from the School of Health Sciences, University of Southampton/NIHR ARC Wessex would like you to test WIT by providing feedback via a short survey . Or alternatively scan the QR code. Thank you. Contact us If you have any questions about WIT, please contact: C.F.Brooks@soton.ac.uk Disclaimer The development of WIT has been supported by the NHS Insight Prioritisation Programme (NIPP). The views expressed are those of the authors and not necessarily those of the NHS. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of this website. How to cite Brooks, C.F., Lund, S., Kryl, D., and Myall M. (2023) Web-based Implementation Toolkit (WIT). University of Southampton. Available at: www.arc-wx.nihr.ac.uk/web-implementation-toolkit Accessibility We are committed to providing a website that is accessible to as many people as possible. We are actively working to increase the accessibility and usability of the website.

Project Outputs Project Outputs This domain helps you consider the deliverables or what is to be produced as a result of your project. These are the project outputs . Outputs can be singular or multiple and include any of the following: policy guideline(s), innovation, intervention, website or a tool. No FAQs yet This category doesn't have any FAQs at the moment. Check back later or explore other categories. What should I consider for my project? Adoption and Spread Project Outputs Buy-in and Engagement Fit with Health and Social Care Systems Alignment with Health and Social Care Priorities Outcomes and Impact Project Outputs Buy-in and Engagement Fit with Health and Social Care Systems Alignment with Health and Social Care Priorities Outcomes and Impact Adoption and Spread Checklist, webinar and resources Quick links: Case study “ As we had early discussions t o identify our project outputs within our team, we were able to plan resources required to support this. For example, we knew that one of our key outputs would be a website to be made freely available to all. However, as we engaged with our wider networks of stakeholders across d ifferent care homes, we realised that some also expressed interest in having a printed training resource which they could share with colleagues when hosting in-person workshops . This presented a challenge initially as we had not costed for the development of these printed materials. However, as we were still at an early stage of the project, we were able to apply for a small grant which helped accommodate these costs. Stakeholder involvement was invaluable to ensuring that our project outputs matched their needs . We will take this learning forward in future projects and consult with a range of stakeholders initially. This will help to support our project outputs to be available and accessible in formats which best fit the needs of those using them.” Person-centred care training resource for care homes project (PCCP) Take away tips Early engagement with stakeholders about what project outputs are helpful for them can enhance their longer-term value and utility Early engagement also ensures that resources can be prioritised and financially supported

Case studies: Anna Badley It doesn't matter where you start. Find your research journey - there’s more than one path I love research and I always have done, but my journey to being awarded an ARC Wessex PhD Scholarship has been far from traditional. I have always been passionate about the nursing profession and in particular nurses and others who provide care in a person’s home. As a very busy District Nurse and Community Matron I had always assumed that research would be something I did later in my career. An incident at work left me severely unwell. This incident not only changed my life, it made me want to help others and learn about work pressure and how this impacts well-being and mental health. I moved into a Research Nurse position which was invaluable, it opened my eyes in seeing how research works in the NHS from research design to recruitment and data collection. It also gave me a great understanding of research governance and ethics. At the same time, I began work on my Master’s dissertation. I was fortunate enough to work with Professor Jane Ball, a globally renowned nursing researcher who became my supervisor. The MSc Dissertation allowed me to experience conducting my own research whilst developing skills in academic research. For anyone thinking of getting into research I would say go for it! Research is rich, rewarding and exciting. It doesn’t matter where you are starting from, there are so many opportunities available. It is easy to think that research or doing a PhD is an individual activity, I have learnt from my journey that it is only possible as a team - without the generosity of time, knowledge and leadership from Professor Jane Bal l, University of Southampton and Dr Sarah Williams , Solent NHS Trust this research would not be possible and I hope that together we can learn how to prevent nurses and others from getting harmed by doing a job that they love. Top tips Get in touch with your Research and Development team - they are a great source of knowledge about opportunities and how to start your research journey If you can, I would really encourage people to get experience in NHS Research Delivery, Internships are a good way of getting this experience Connect with people - research is only achieved in a team Find your research journey - there’s more than one path

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)

Healthy Communities Theme leads Professor Nisreen Alwan Theme lead Professor Dianna Smith Deputy theme lead Healthy Communities Theme The health of people across our communities faces a number of challenges from the start of someone’s life until the end – our research teams are addressing inequalities, diet, domestic violence and a wide range of issues that touch on everyone’s lives in particular those in more vulnerable and underserved populations. Next theme meeting: see events page or or contact: H.Down@soton.ac.uk for details Research projects ARC Wessex programme of research on Medicines Optimisation (MODIFY SPiDeR STOP-DEM) Read more ADOPTED PROJECT: Exploratory research to examine the health impact of scams and fraud and the current knowledge and systems in the police and partner agencies for targeting and delivering victim support services Read more ADOPTED: DASA - Domestic abuse and housing: local authorities' provision of safe accommodation for adults living with disabilities and/or long-term/life-limiting illness: a mixed-methods study Read more ADOPTED: CEDA ‘Making the invisible visible’: identifying and responding to unpaid carers who experience domestic abuse from end-of-life care recipients Read more COMPLETED ADOPTED PROJECT: Evaluating the Operation Encompass Scheme: A Qualitative Scoping Study Read more 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 Read more Determining the effectiveness and outcomes of innovative interventions for people who have used stalking behaviours: An extension of the exploration of the Hampshire & Isle of Wight Multi-Agency Stalking Partnership (MASP) Read more A qualitative case study to understand Young people’s food purchasing patterns in CONvenience stores in the school neighbourhood environment (Y-CON) Read more ENRICHER-C: Involvement in the criminal justice system & the impact on women's health in Dorset & Hampshire – Community comparison Read more Developing a core cohort of community researchers in Wessex: towards a sustainable Wessex Community of Practice for public health research co-production Read more COMPLETED: WADE. Women and Desistence Engagement : An evaluation of a community-based, conditional caution pilot programme for women in the criminal justice system Read more COMPLETED: Motivating and sustaining engagement of young people in improving their health and that of their communities Read more COMPLETED SOCIAL CARE: Building Bridges: Elevating Research Culture in Social Care through Collaboration, Qualitative Insight and Relationship-Driven Impact Read more ADOPTED: Investigating the impact of food vouchers on diet composition and the prevention of childhood obesity Read more ADOPTED: Community pharmacy alcohol-related liver disease risk identification and linkage to care through development of a complex intervention (CIP-LINC) Read more ADOPTED: Evaluation & Exploration of Multi-Agency Stalking Partnership Interventions Read more Qualitative Data Preservation and Sharing (Q-DaPS) Read more SOCIAL CARE: Evaluation of Southampton City Council’s Male Engagement Worker (MEW) Project Read more ADOPTED: Exploratory research to examine the health impact of scams and fraud and the current knowledge and systems in the police and partner agencies for targeting and delivering victim support services Read more COMPLETED: Co-POWeR - Consortium on Practices of Wellbeing and Resilience in BAME Families and Communities Read more COMPLETED: Testing the effects of food product placement on customers’ visual attention and intended product purchases: a randomised trial in a virtual supermarket setting (Phase II) Read more COMPLETED: Symptoms, Trajectory, Inequalities and Management: Understanding Long-COVID to Address and Transform Existing Integrated Care Pathways (STIMULATE) Read more ADOPTED: Mapping pathways of response for adult and child victim-survivors of domestic abuse in Southampton City Read more ENRICHER – involvEment iN the cRiminal justice system & the ImpaCt on women’s Health dorsEt & hampshiRe Read more CHAMPION: Children whose mothers are involved in the criminal justice system in Dorset & Hampshire: developing health and social care outcome indicators Read more COMPLETED: How to Support children with cancer, or another serious condition, and their parents during the COVID-19 outbreak Read more COMPLETED: Developing a web resource to support families bereaved during COVID-19 Read more COMPLETED SOCIAL CARE: Local Authority Adult Social Care Recruitment and Retention research project (BCP/Dorset) Read more COMPLETED: Mental health Burden of Increased Living costs: Local Support (My BILLS) Read more COMPLETED ADOPTED PROJECT: Young people’s barriers to mental health services Read more POST DOCTORAL PROJECT: Early detection of chronic liver disease in community settings Read more COMPLETED ADOPTED PROJECT: Comparing pharmacological and non-pharmacological interventions for adults with Attention-Deficit/Hyperactivity Disorder (ADHD): systematic review and network meta-analysis Read more COMPLETED ADOPTED PROJECT: ADAPT: The cross-sector implementation of NICE-recommended CBT-based interventions for young people in care: Framework Read more ADOPTED PROJECT: DIGNIFIE Gender-seNsitive evaluatIon oF a prIson alternativE Read more ADOPTED PROJECT: High Harm Domestic Violence Perpetrator Pilot Evaluation Read more COMPLETED 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 Read more COMPLETED: Social network facilitated engagement in people who are Homeless to address InEqualities in alcohol related Liver Disease - The SHIELD feasibility study Read more A national evaluation of Project Cautioning And Relationship Abuse (‘CARA’) awareness raising workshops for first time offenders of domestic violence and abuse Read more COMPLETED: Wessex DIET: Determining the Impact of covid-19 on food sEcurity in young families and Testing interventions Read more COMPLETED: Domestic Abuse and Life-Limiting Illness: identifying and supporting adults at risk (DALLI Study) Read more Prevention schemes for female vicitms and offenders in Hampshire and Dorset Read more COMPLETED: GOODNIGHT Covid-19 to care-home-based vulnerable individuals Read more The feasibility of community pharmacies testing for Hepatitis C in people who inject image and performance enhancing drugs Read more COMPLETED: Testing the effects of food product placement on customers’ visual attention and intended product purchases: a randomised trial in a virtual supermarket setting (Phase I) Read more COMPLETED: The Wessex FRIEND Toolbox (Family Risk IdEntificatioN and Decision) Read more Mental health hub projects Adolescent Resilience to OVercome Adversity: EmpoweRment and intervention development – the ROVER study Read more Pharmacological And Non-Pharmacological treatment of ADHD in Pre-schoolers: a systematic review and network meta-analysis: the PANPAP study Read more Read our publications here Read more Publications