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

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

55265102-c760-4322-93ed-ed8448f1546f Non-digital support for maintaining physical activity in people with long-term conditions – within Maintenance Of physical acTivity beHaviour (MOTH) programme Start Date 02/10/21 End Date 30/09/23 Researchers: Lead - Professors Mary Barker and Maria Stokes Joint Lead - Professor Suzanne McDonough Co-Applicants - Professor Maria Stokes, Dr Paul Clarkson, Dr Chloe Grimmett, Dr Euan Sadler, Dr Nisreen Alwan, Dr Aoife Stephenson, Dr Katherine Bradbury, Dr James Faulkner, Mr Paul Muckelt, Dr Dorit Kunkel, Mrs Luisa Holt amd Dr James Gavin Summary Being active is important to prevent and help manage long-term conditions (LTC). Previous research shows that being active can help people to do the things that they want to do for longer, reduce pain and improve quality of life. There are many community and NHS programmes that help people with a LTC to start being active, however, these programmes only last for a short period of time. Staying active in the longer-term is more difficult and there is often a decrease in activity over time following the completion of a programme or service. Previous research has shown that programmes or interventions that help people to start being active may not necessarily have the right components to help people to stay active. This project will plan and develop a new intervention that will support people with one or more LTCs to stay active, after taking part in an NHS and/or third sector ERSsphysical activity referral scheme (PARS). Our current research explores factors that help people with LTCs to stay active to allow these to be integrated into plans for the new intervention. The intervention will be non-digital to ensure that it is available to as many people as possible, regardless of access to the internet or a digital device. We know from previous work that it is important that any new intervention fits in with healthcare systems and how people manage their condition. We are therefore currently working with people with LTCs and health and social care professionals to understand how such an intervention could be delivered in practice. In this project we will use previously gathered information to plan the new service. We will recruit people with LTCs from ERSs PARS to take part in interviews to understand their needs and expectations for the intervention. We will also undertake interviews with health and social care professionals and ERSPARS practitioners to develop the intervention’s content. This will allow us to develop the prototype of the intervention and then ask people with LTCs who have taken part in a programme to pilot it and provide feedback through interviews. Once developed, we will plan a larger study to test the intervention’s potential with groups of people who have come to the end of an ERS PARS in the NHS and/or the third sector. This study will help us to gain feedback from people with LTCs using the intervention in real life settings to make further changes. It will also help us to understand whether the approaches to the research, such as how to recruit people to take part, are successful. This information will be used to improve the intervention and to support a larger trial to assess the effectiveness and cost-effectiveness of the intervention. What did we find out? This research included: • Phase 1: We interviewed 15 people living with long-term health conditions (LTCs) and nine NHS healthcare professionals to find out their experiences of being involved in an exercise referral scheme. This included what support they would want in future, as a participant (i.e., people with LTCs) and provider (i.e., healthcare professionals). • Phase 2: Follow-up workshops with LTC patients and multi-sectoral professionals to begin designing a pathway to support physical activity maintenance for people living with LTCs. Professionals shared their experiences from healthcare, leisure and community and voluntary sectors. This research has created a better understanding of the ways in which we might best support people with LTCs to stay physically active, and improve their health and wellbeing following an exercise referral scheme. Two areas of improvement were identified: 1) Better partnership working between people with LTCs, health and social care, leisure and voluntary sectors within Wessex 2) Ensuring people with LTCs have appropriate support with self-management of their lifelong physical activity levels What difference can this new knowledge make? • Better understanding of the factors preventing and enabling participation in exercise referral schemes across Wessex, can help us identify how structured exercise can benefit people with LTCs long-term, especially by highlighting the benefits and future support needs in physical activity. • It gave us understanding of people’s experiences of undertaking a physical activity referral scheme to help manage their LTC(s). This was supported by health professional’s views, having referred, delivered and/or commissioned an activity scheme • In future, this knowledge can inform the development of an integrated care pathway interlinking healthcare, social and community services to support people with LTCs to maintain their health and physical activity long-term, from a view to change physical activity behaviours. What did we do with our new Knowledge • We presented the results at the Health Enhancing Physical Activity (HEPA) Europe 2024 Conference in Dublin (August 2024) • We submitted a research paper for journal publication • Dr James Gavin ran a series of ‘Active Living’ community cafés across Southampton to share the research with the public living with LTCs and their carers. • This has led to additional grant funding and partnerships with Energise Me, Saints Foundation, Communicare, and Southampton City Council, to begin co-designing a multi-sectoral pathway within the city for the wider LTC population, not just those having undertaken an exercise referral scheme. • On January 8th 2025, we will run workshops with professional stakeholders including the HIOW Integrated Care Board, to find agreement on a ‘prototype’ pathway. Where next? •We have submitted the findings to the journal, Int J Behav Nutr Phys Activ December 2024. •Move Consulting Ltd. are supporting us with our professional stakeholder workshops (Jan 2025). •The co-lead, James Gavin, has secured £14,900 Wessex Health Partners funding to continue the community cafes and develop a pathway plan. •We will build upon our community-based partnerships with Saints Foundation, Communicare, Thornhill Baptist Church, and Energise Me as the HIOW Living Well Partnership. •Follow-on funding will be sought from the NIHR Research for Patient Benefit programme (tiers 2/3) in Spring 2025. Testimonials for Active Living Cafes "it's really good that you don't want to reinvent the wheel. My slight critique of the community cafes that have been set up is that you don't have to reinvent them .” “There are already community groups doing very similar things around…I know it's been brilliant that you have been partnering with people like Thornhill Baptist Church. They do wonderful things, some wonderful community events… My recommendation is to join and work with them , and that's what you're doing.” “It's a better strategy than trying to set up something new and try and hope that people come to it with a long-term condition. I think it's much better to go to people rather than expect people to come to you ."

6dc4c269-ddb7-41c3-afd8-8173c69a4651 ADOPTED ActMed-VW - Healthcare professional's experiences of Access to Medication for people on Virtual Wards who are in their last year of life Virtual wards provide acute, hospital-level care in an individual’s own home, rather than in a hospital or hospice. They are also known as Hospital at Home services. We know that virtual wards can care for people who are in their last year of life. For individuals approaching the end of life, control of symptoms requires prompt access to medication. We know access to palliative care medication can be challenging in the community. There have also been reports of difficulty accessing medication on virtual wards; however, it is not known if there are specific issues accessing palliative care medications on virtual wards. This study aims to investigate access to medication for adults on virtual wards who are in their last year of life. We aim to understand the experiences of healthcare professionals so that we can make recommendations on how to improve access to medication in the future. We will ask healthcare professionals working in virtual wards to answer questions in an online survey. We will ask doctors, nurses, pharmacists, and allied health professionals such as physiotherapists to complete the survey. We will ask them about what works well and what does not. We will ask them about the challenges they have faced, and what would help them to minimise or eradicate these. We will also interview 20 healthcare staff. This will include both professionals who completed the survey and individuals who oversee the management of virtual ward services. We will explore in more detail examples of good practice and the processes that need to be in place to ensure straightforward, fast access to medication. We will consult with clinical and policy experts on potential solutions to the challenges identified in the study findings. We will also work with these experts to develop recommendations for policy and practice. Project team includes: Co-PI - Dr Nicola Andrews Co-PI - Prof Sue Latter Co-I Dr Natasha Campling Co-I Dr Sara McKelvie Research Fellow Dr Dan Aze

016c507b-e112-4be0-a796-8f4c4a8cdbe0 DIALOR: DIgitAL cOaching for fRailty (DIALOR) Principle Investigator: Professor Jane Murphy Team members : Dr Euan Sadler , Dr Michele Board , Dr Kat Bradbury , Professor Mike Vassallo , Dr Simone Yule , Dr Dawn-Marie Walker , Crystal Dennis, Matt Sait, Jim McMahon (Patient and Public Involvement Lead) Partners: Bournemouth University, University of Southampton, University Hospitals Dorset NHS Foundation Trust, The Adam Practice, Dorset CCG, Wessex AHSN, Southern Health NHS Foundation Trust Start Date: 1/4/2022 End Date: 30/9/2024 Bournemouth University web page Lay Summary Frailty is a condition that affects one in ten people over the age of 65. It means people are at higher risk of falls, disability and poorer quality of life. Some may struggle with decreased energy levels, poor appetite, lower strength and having difficulty with household tasks such as shopping and cooking. As the population ages, frailty also impacts on health and social care services because of more GP appointments and increased hospital and care homes admissions. More people own a smartphone with applications (apps) and have access to the internet. This technology can help people to live well by enabling access to person-centred advice and care. It can help share in decision making to meet well-being and health needs and reduce the burden on health and social care systems. However little research has been done, particularly for people with frailty, living at home. Aims This study aims to explore whether a digital approach could be used alongside support from health coaches to help the lifestyle management of frailty (in its early stages). The approach has been used across the NHS in people with long term conditions which we think will transfer to people with frailty. We will work together with people living with frailty, their carers, health coaches and health care professionals (key stakeholders). Design and methods We will do this through two work-packages (WPs) with people from 2 areas in Wessex (Dorset and Hampshire). WP1 will develop and test a new digital approach. It will include interviews with 10 people with frailty and family carers, 20 health care professionals and health coaches. In WP2, we will train health coaches to use the digital approach and measure how well it works in people with frailty. We will collect data including physical activity, eating and drinking, social engagement, quality of life, frailty status, costs of the approach. We will also ask people about their experiences of using it. We aim to recruit 20 people with frailty and their carers, 20 health coaches, 20 health care professionals and commissioners of care services from both areas to do this. This information will help us plan for carrying out a larger study to implement the approach wider across Wessex. We will regularly seek advice from doctors, nurses, commissioners of services during the project. Patient and public involvement (PPI) A group of family carers and health coaches will support the project by membership of a group to support project design, delivery, analysis and reporting and advise on how we share the findings. NOTE: DIALOR was previously known as DONOR and the name changed in consultation with Public contributors Dissemination We aim to share the findings in academic and professional publications, social media, a website, conferences as well as deliver an end of project stakeholder event. What did we find out? As the population ages frailty is increasing, affecting one in ten people over 65 in the UK. Frailty increases the risk of disabilities, falls, and hospital stays, leading to a greater need for long-term care. Early actions like improving physical activity, nutrition, mental health, and social interaction can help reduce or reverse frailty and lower healthcare costs. NIHR Applied Research Collaboration Wessex funded a study to test a new digital health coaching programme called 'DIALOR' for people with frailty. This programme, developed with input from healthcare professionals and patients, provides a digital app and a health coach to help users with exercises, nutrition, and wellbeing plans. Older people using the digital health coaching programme saw improvements in frailty, physical activity, diet, quality of life, social engagement, and mental wellbeing. Most found the experience positive and helpful in meeting their health goals, although some found the digital component difficult and did not like the term frail. Healthcare professionals said this approach could help older people manage their health better and reduce pressure on primary care services. DIALOR helps older people with frailty manage their health independently, reducing frailty progression and easing the burden on NHS healthcare by drawing on existing allied services such as health coaching. What Next? A meeting was held on 25th June 2025 with attendees from the healthcare professions, academia, digital healthcare and healthcare charities to learn about the outcomes from DIALOR and discuss the way forward. They concluded that DIALOR has a strong alignment with NHS health priorities as it supports preventative care goals and a shift into more community-based care. There is potential to scale up and roll out regionally and nationally, with support from organisations like Health Innovation Wessex, Help & Care and alignment with the NHS 10-year plan. Report from DIALOR Showcase held on 25th June 2025 .pdf Download PDF • 8.24MB More research needs to be done to discover how DIALOR can work across different regional systems, technology platforms, and wider social contexts to discover how it can be effective and cost-efficient for a wider range of people, especially those from ethnic and socially deprived communities. This will support its broader use across the UK. Publications DIALOR (DIgitAL cOaching for fRailty): protocol for a single-arm mixed-methods feasibility study of a digital health coaching intervention for older people with frailty in primary care https://doi.org/10.1136/bmjopen-2023-080480 Digital empowerment in long-term condition management: A systematic review and narrative synthesis of the experiences and perceptions of home-based digital health coaching interventions https://doi.org/10.1177/20552076241302230

bd39e9d4-a228-4123-b44c-d499a7f27a45 Prevention schemes for female vicitms and offenders in Hampshire and Dorset Principal Investigators: Dr Sara Morgan Team members: Dr Sara Morgan ( Lecturer in Public Health School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton), Fiona Maxwell (Public Health Registrar School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton), Sergeant Ali Attwood (Hampshire Constabulary, Restorative Justice Lead) , Debbie Willis ( Hampton Trust charity, Domestic Abuse Service Manager), Vicky Atkinson (Hart District Council, Domestic Abuse Project Coordinator), Patricia Durr ( One Small Thing ), Mona Samiy ( Stop Domestic Abuse charity , Project Manager) Start: 11 November 2019 Ends: 11 November 2021 Project Partners : University of Southampton, University Hospital Southampton NHS Foundation Trust, Hampshire Constabulary, Hampton Trust, Hart District Council, One Small Thing, Stop Domestic Abuse. Lay summary: Background and study aims Compared to the previous year, in 2018 there was an overall 8% increase in theft in England and Wales and a 6% increase in crimes involving sharp instruments or knives. In order to tackle this increase in crime, many believe that more needs to be done to address the reasons why people commit crime in the first place, as well as the damage it causes to peoples’ lives. This means working together in the community to offer solutions to those affected by crime, including victims and offenders. When we discussed possible solutions with local service providers, it was felt that a tailored approach is needed for women, as their needs are unique. Women in prison are very likely to be both victims and offenders whilst, in the general population, one in four women are also victims of abuse within the home and more than half the women in prison have experienced domestic abuse themselves. In response, three projects are being piloted in Hampshire and Dorset to address the needs of women affected by crime. What does the study involve? To understand how these projects are working, we plan to carry out group interviews with those delivering the pilot intervention projects in the community. This will primarily be to understand how the projects are working. We will also use information gathered from the project staff about the women using the service to understand whether women go on to seek further assistance in the community, what sort of women engage with the project, and what changes for them as a result of using the service. This study proposal was developed in collaboration with public representatives; including offenders, victims, social care workers, domestic abuse service manager, and police officers. They have all shaped the design of the study; by informing us what types of research questions we should be asking. Going forward, we will continue to involve similar representatives throughout the research study; for example, to co-produce the materials used in the study, such as information sheets, and to gain feedback on the write up of the study. What will we do with the study findings? It is important that the information gained from the study reaches the widest number of people. We will therefore consider who to engage, and how to reach them, from the very start of the study. The main findings will be developed into a short summary report, which will be accessible to the general public through our public representatives and collaborators. They might include charitable organisations in the community (e.g. Stop Domestic Abuse, Hampton Trust) or services that work directly with women affected by crime (e.g. NHS, probation services).

3ace18ec-d7ab-47b5-898a-8030d0eb53f7 POST DOCTORAL PROJECT: Early detection of chronic liver disease in community settings Chief Investigator: Dr Kate Glyn-Owen – University of Southampton Project Team Members: Julie Parkes – University of Southampton, Dr Richard Aspinall – Portsmouth University Hospitals NHS Trust Organisations Involved: British Liver Trust, Portsmouth Football Club (Pompey In The Community), Portsmouth City Council public health team Background: Liver disease is the third biggest cause of early death in the UK. Two of the main causes of liver disease are drinking too much alcohol, which directly damages the liver, and being overweight, which can lead to fat building up in the liver and causing damage. If liver disease is detected early, it is possible to prevent disease progression, and in some cases to reverse damage done. This benefits patients and reduces impact on the healthcare system. The best way to detect liver disease early is not known. Tests and risk scores are available which use a simple blood test and information about the patient. These were developed in hospital settings, for people with known liver disease. They have not been used sufficiently in general population settings and we do not know how good they are at detecting liver disease in these settings. This project is investigating how these tests and scores perform in general population settings, using data from the UK Biobank, a big dataset from general population volunteers. We are exploring whether combining tests/scores with information about people’s risk factors, may improve detection of disease.We are going out to community settings, performing a risk assessment and simple scan for liver disease in populations at high risk. We are working with Portsmouth Football Club, the British Liver Trust and Portsmouth City Council public health team, to target populations at risk and to find out how effective we can be at early detection of disease in these settings.

15c54097-9d85-4170-b90f-d0f5767a45d4 Predicting Patient Deterioration Risks in COMMunities https://vimeo.com/689303375 Team: Principle Investigator – Professor Michael Boniface, University of Southampton Co-Investigator - Dr Francis Chmiel and Dr Dan Burns, University of Southampton Clinical Lead – Dr Matt Inada-Kim, Hampshire Hospitals NHS Foundation Trust Completed What did we learn? We found evidence for policies and practices supporting safe COVID-19 integrated care pathways in community settings for early identification of deterioration and timely escalation to hospital. Research validating home oxygen saturations as a marker of clinical deterioration in patients with suspected COVID-19 informed national policies and was critical and rapid evidence necessary to support the COVIDoximetry@home ( https://doi.org/10.1101/2020.11.06.20225938 under peer review at BMJ Open) What difference did it make? £ 500K NHSx RECOxCARE (Remote COVID oximetry care) project for COVID Virtual Wards in collaboration with HHFT, North Hants Primary Care Network, Mid Hants Primary Care Network, South Central Ambulance Service NHS Foundation Trust, WAHSN and University of Southampton IT Innovation Centre. Scaling nationally as the COVID oximetry@home programme, the guidance for people at home to purchase a pulse oximeter published on the BBC News Website https://www.bbc.co.uk/news/health-55733527 and broadcast on BBC News at 10 on Thursday 21st January 2021 (citing the ARC publication) Clinical model was adopted by the World Health Organisation Digital and data analytics approach for remote monitoring of patients in communities was presented by Inada-Kim and Boniface as part of the NHSx@home innovators engagement event 16th Sept 2021. COVID oximetry@home received the overall winner of the prestigious for HSJ Patient Safety Award 2021 Service evaluation demonstrated improved patient outcomes Boniface, M., Burns, D., Duckworth, C., Ahmed, M., Duruiheoma, F., Armitage, H., Ratcliffe, N., Duffy, J., O’Keeffe, C. and Inada-Kim, M., 2022. COVID-19 Oximetry@ home: evaluation of patient outcomes. BMJ Open Quality, 11(1), p.e001584. What impact has it had on patient and the health system? Remote monitoring of patients in communities is important for improved patient outcomes, hospital attendance/admissions avoidance and resource planning. Remote monitoring is a key NHS transformation within the NHS@Home programme Remote monitoring is being extended from COVID to all Acute Respiratory Infections, and is likely to be extended to other conditions in the future What's next? We are working with Hampshire Hospitals and NHS England to transfer the learning from COVID to more general approaches. This research is being conducted in: HDRUK rapid insight project (Jan22-Sep23) called PHILOSARIP “ Predicting Hospital Length of Stay in Acute Respiratory Infections Patients” Wessex ARC PARIEDA project which is tacking “ Prediction of Acute Respiratory Infection outcomes prior to Emergency Department Attendance” Resources Covid Oximetry at Home Toolkit - via AHSN Wessex Publications https://doi.org/10.1101/2020.11.06.20225938 https://doi.org/10.1136/bmjopen-2022-067378 Original Project outline ARC Wessex is supporting research to explore COVID patient risks (deterioration, admission and readmission) in community settings working with Hampshire Hospitals NHS Foundation (HHFT) Trust who are co-leading the development of national pathways linking community, primary and secondary care. According to leading acute care clinicians (Dr. Inada-Kim - HHFT) working at the forefront of UK’s COVID-19 emergency response and policymaking, two of most pronounced COVID-19 Unmet Medical Care Needs (UMCN) include: UMCN-1) Risk prediction tools on triage and admission to emergency care: Evidence shows that early identification of physiological deterioration risks improves patient outcomes through timely and appropriate interventions, including escalations to higher levels of acute care through hospital admissions and intensive care [1] . UMCN-2) Rapid follow up of patients post discharge: There is little evidence to predict the occurrence of COVID19-related complications following discharge, particularly for vulnerable patients with multiple long term conditions at high risk of adverse complication events, and therefore rapid follow up and continuous monitoring of a patients recovery is needed to reduce risk of readmission to hospital. In addition, consideration of population infection risks resulting from contact and transmission from infected individuals has demanded alternative care delivery models. During the initial phase of the pandemic patients freely made their way to GPs and hospitals increasing infection rates within the general population and the healthcare workforce, leading to policies aimed at reducing contact between infected patients and health care workers (HCWs) [2] . This has driven then need to reimagine care pathways that minimise physical interaction using virtual care (video conferencing, mobile symptom reporting/scores, real-time remote sensing, and surveillance) delivered through telemedicine solutions. Virtual care not only protects the population and HCWs during highly infectious periods of a pandemic but importantly offers significant benefits to patients who can now be treated longer in community settings reducing the number of admissions to hospital, the length of stay and mortality. PPDRCOMM proposes to undertake research to develop predictive models for early warning detection arising from a COVID-19 infection, capable of running in residential settings such as care homes. Models will use near-patient observation data (e.g., temperature, respiration rate, and blood oxygen levels), patient demographics, and comorbidities from patients in the community who are in the early stages of a COVID-19 infection. The measurements will be collected with high frequency such that machine-learning algorithms will be able to report real-time risk scores of imminent deteriorations. Overall, this models will allow for real-time detection of deterioration earlier than currently possible with conventional techniques. This will help address the clinical need for pre-emptively stopping the severe deterioration of those with a seemingly mild case of COVID-19. Read the Evaluation Pre-Print evaluation paper

Research Fellow < Back Laila Khawaja Research Fellow Long Term Conditions Dr. Laila Khawaja holds a PhD in Social Sciences from the University of Southampton and is an experienced qualitative researcher with a strong background in public health, well-being, and social engagement. She has worked extensively on projects that explore the intersection of mental health, agency, and lifestyle behaviors, particularly among young people. Laila was involved in a National Institute for Health and Care Research (NIHR) project that focused on empowering young individuals to enhance their sense of agency and well-being. This work aimed to positively influence their mental health, dietary choices, and physical activity habits through participatory engagement strategies. Currently, Laila is contributing to the Applied Research Collaboration (ARC) Wessex Long-Term Conditions theme, where she is actively engaged in two key projects: the SCALE project, which examines enablers and barriers of using a long term conditions-scale tool and a study on Social Prescribing for Link Workers , which investigates how healthcare professionals can better connect individuals to community-based resources to improve well-being and health outcomes. Her research interests include health inequalities, patient and public involvement in healthcare, and the role of social interventions in managing long-term conditions. Previous Next

Mental Health Hub We focused on addressing areas of mental ill health linked to our deprived rural and coastal communities: neurodevelopmental conditions (e.g. attention-deficit hyperactivity disorder), treatment resistant anxiety-depression, addiction (alcohol and gambling); as well as supporting front line workers (addressing knowledge gaps in paramedics, social prescribing framework for link workers). Building on our prior work we have: Increased involvement of public and people affected by mental health issues in mental health research. For example, we now have in excess of 300 public contributors per year who have joined our gambling research database via our digital tool and have established a gambling Lived Experience Advisory Group (LEAG) that has already contributed substantially to grant applications and informing service improvements. Increased our joint working with our Mental Health Public Advisor, into multiple extension research projects and regional grant submissions, contributing to a successful application for NIHR Advanced Fellowship and application to ARC competition. Expanded PPIE activities via our partnership with Raising Voices in Research (RViR). For example, an innovative scheme has matched voluntary and charity organisations with researchers, covering marginalised groups such as older adults, military veterans, men with mental health conditions, and young neurodiverse people. Discovered new important findings for treatment of ADHD; notably the finding (paper submitted) that ADHD with co-morbid autism responds preferentially to a particular type of medication (atomoxetine). Secured additional funding to sustain research in areas of focus. For example, the AUD in Older Adults project has led to a Leverhulme/British Academy research grant (“Alcohol Research? No thanks”), a University of Southampton seed award (“Our Voice Matters: Older People, Stigma & Alcohol”), and Accelerated Knowledge Transfer (AKT-4) grant (“Evaluation of VCia’s Capital Card Scheme”). In addition, secured three UKRI rapid evidence review grants, and a Partnership grant, for research into gambling-related harms. Our research projects Developing Pathways for older adults who are also drinking at increased-risk levels: Hampshire Older adults Alcohol Pathway (HOAAP) Read more Gambling and Alcohol Use Addiction in Military Veterans Read more Comparative Effectiveness of Methylphenidate vs. Second‑ and Third‑Line Medications for Children with Attention- Deficit/Hyperactivity Disorder and Autism Read more Social Prescribing Link Workers framework: supporting complex needs of adults living with physical and mental health long term conditions Read more Identifying the knowledge gaps of paramedics managing patients with mental health issues Read more ADOPTED: Gambling in the UK: An analysis of data from individuals seeking treatment at the NHS Southern Gambling Service Read more Understanding psychosocial determinants of alcohol use disorder (AUD) in older adults: exploring the role of social networks and loneliness in living with AUD (OLA study 2). Read more Development of a core outcome set for nurse wellbeing: a Delphi study Read more Work lives and Wellbeing of Mental Health Nursing Workforce Read more Understanding, addressing, and meeting the complex needs of people living with long term physical and mental health conditions: a qualitative 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 Adolescent Resilience to OVercome Adversity: EmpoweRment and intervention development – the ROVER study Read more Mental health Burden of Increased Living costs: Local Support (My BILLS) Read more Understanding the psychosocial needs and trajectories of older adults (>64 years) with alcohol use disorder (AUD) from hospital back into community Read more Mental health projects

c3f60ada-92b2-427a-992e-e9d18e00b011 ADOPTED: Mobility assessments in hospitalised older adults: study protocol for an e-survey of UK healthcare professionals PhD Candidate: Catherine Wharfe University of Portsmouth; Team: Maria Perissiou University of Portsmouth; Zoe Saynor University of Portsmouth; Jim Briggs University of Portsmouth; Carolina Gonçalves University of Portsmouth & University Hospitals Sussex NHS Foundation Trust Start : 1/11/2023 Ends: 1/05/2025 Abstract Hospitalisation in acute care poses a significant risk of adverse outcomes in older adults, including loss of functional independence, disability, and death. Research carried out in hospitalised older adults suggests functional mobility tools or scales can predict adverse events and care needs in this population, which facilitates prompt escalation of care and discharge planning procedures. As such, a need to develop a standardised methodology for assessing or measuring mobility has been recognised. However, the degree to which standardised mobility tools are routinely used, how data is collected, and/or which clinical assessment processes are utilised in hospitals across the UK is currently lacking. The aim of this national survey is to identify the current practice of mobility assessment in older adults admitted to NHS Trusts and Private Health Organisations, with a view to informing further research on a standardised approach or best practice guidelines to assessing or measuring mobility in hospitalised older adults.

d6d7fb08-5eb7-4cab-afcf-359d64b8fe12 ADOPTED PROJECT: Young people’s barriers to mental health services Lead: Dr. Corine Driessens Co-Investigator: Professor Peter W F Smith Kim Markham Jones & Fiona Lacey – YoungMinds Nicole Davenport, Mahdi Hassan, Shahrbano Iqbal, Friday Skelton – young researchers recruited by and in employ of YoungMinds Starting date: October 2022 Ended: July 2025 Published in journal of psychiatric research online: Use or no use? Young People's engagement with mental health services https://doi.org/10.1016/j.jpsychires.2026.01.034 Many young people in the UK experience anxiety or depression, but most can’t get mental health support when they need it. From the very beginning of this project, young people, both as young researchers and as participants in four co-production workshops, played a central role in shaping our questions, interpreting the findings, and explaining what the results mean in real life. Their insight guided every stage of the work. This study looked at what affects whether young people use mental health services and what happens to those who don’t. The biggest factor in getting help was whether health care professionals recognized the young person’s distress was a mental health disorder. Other things like, severity of symptoms, being a female, having fewer supportive people around, or having unemployed parents played a smaller role. Young people who didn’t use services were less likely to be female, come from single-parent families, have caring responsibilities, or have been bullied. They were also more likely to have good relationships with their parents. Those who did use services had poorer outcomes later in adulthood, suggesting they faced greater difficulties overall. Because specialist mental health services are overstretched, responsibility has shifted to GPs and teachers, who often feel under-resourced and not fully trained to meet these needs. The GPs we spoke to faced strict referral rules, long waiting lists, short appointments, and limited mental health training. The teachers we spoke to also felt pressure to support students without the resources or guidance they need. After hearing these findings, a group of young people from the “missing middle” (those struggling but not qualifying for specialist care) recommended: Training all school and college staff in mental health. Better support for apprentices at work. Peer support groups in schools, colleges, and universities. Safe spaces and housing support for LGBTQIA+ students. More help for young carers and fairer benefits. Better training for all health workers to support diverse communities. Looser referral rules so young people don’t have to be “ill enough” to get help. Youth hubs offering safe spaces, activities, and mental health support. Overall, the findings show the need for more inclusive, preventative, and joined-up mental health support for young people. Reflections on Young People involvement with shaping analysis framework for mental health .docx Download DOCX • 2.37MB What did we find out? Presented the findings at national and international conferences (e.g. MQ/DATAMIND, ADRUK, NIHR Statistics Group, EPA Epidemiology & Social Statistics, International Congress of the European Society for Child and Adolescent Psychiatry) Presented the findings at ARC Wessex webinar Presented findings on ARC Wessex website Where next? The young people who took part in our workshops were very clear about one thing: we need to start much earlier. They told us that helping children learn emotional skills, like understanding their feelings, managing stress, and asking for help, before stigma takes hold could make a big difference in preventing mental health problems later on. Taking this guidance seriously, our team has now grown to include experts who know how to design effective mental health programmes for primary schools, as well as researchers who can identify exactly which elements such a programme should include. Our next step is to develop a primary school–based intervention shaped by what young people told us matters most. Because this type of work sits outside ARC Wessex’s remit, we are now seeking external funding to take the project forward and bring this early-intervention programme to life. https://video.wixstatic.com/video/6fe132_c8aa61002b864940a8aac2b8d7754c07/480p/mp4/file.mp4 https://video.wixstatic.com/video/6fe132_ee6a84e1cd6a4745a6de0f05e2034688/480p/mp4/file.mp4 https://video.wixstatic.com/video/6fe132_fc53aac3539f4f839ea71adcfb34b517/720p/mp4/file.mp4 Olly Parker, Head of External Affairs and Research at YoungMinds , said: “This research from YoungMinds and the University of Southampton shines a vital light on the record numbers of young people needing mental health support. Growing up today is incredibly tough. Many young people are experiencing multiple pressures which impact their mental health, including poverty, inequality, intense academic pressure and the online world, so it’s no wonder so many are struggling. One of the clearest recommendations from the young people involved is the urgent need for early support hubs in every community. We know many young people face long waits for mental health support and become more unwell while waiting, which can lead to needing more urgent care. We need major reforms to address the root causes of poor mental health and for the Government to focus on reducing waiting lists so young people can get the support they need. The recent 10 Year Health Plan showed promising commitments with Young Futures Hubs and Mental Health Support Teams. These initiatives are vital to reducing pressures on the system, improving support and reducing waiting times - their rollout must be a political priority. But more is needed to tackle the scale of need - we need radical solutions that will address the reasons why so many young people are struggling in the first place.” Corine Driessens, one of the researchers based in Southampton, said: “It has been a truly wonderful and positive experience working with these groups of young people. Their innovative and fresh ideas across a wide range of ways to help others get the mental health support they need have been inspiring.”