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08639c2e-864e-4386-adf6-510fcbb59d49 Identifying the knowledge gaps of paramedics managing patients with mental health issues Chief Investigators: Dr Ursula Rolfe. Faculty of Health and Social Sciences. Bournemouth University, Dr Natasha Campling, School of Health Sciences, University of Southampton. Implementation lead: Kirsty Lowery-Richardson, Head of Education, College of Paramedics Partners: Bournemouth University, University of Southampton, College of Paramedics CLASS Professional Publishing, Mental Health Education leads in all 11 ambulance Trusts including West Midlands Ambulance Service. Start: 1 October 2024 End: 31 March 2026 Aim of the research: To identify the knowledge gaps of paramedics when responding to people with mental health issues. Background to the research: Many people experience mental health issues in their lives and about 1 in 6 adults in England have a diagnosed common mental health illness. Mental health issues are rising, but rates are rising most for young people. Amongst 17- to 19-year olds rates of mental health illness rose from 10% in 2017 to 26% in 2022. Rising rates of mental health issues combined with pressure on community services mean that that over 1.2 million people are waiting for support and treatment from NHS community mental health services. The result of such high-level unmet demand has fallen on ambulance services and paramedics. England’s ambulance services received 524,485 mental health related 999 calls in 2018-19, but by 2021-22 this increased to 652,720, a rise of 24%. Across England, ambulance staff spend 1.8 million hours annually (or 75,000 days), responding to people with mental health issues. Paramedics express concerns attending to patients experiencing mental health issues because of a lack of education. However, the specific nature of their knowledge gaps that underpin these concerns are not known. Therefore, this research will identify these gaps and make recommendations to inform the future design of effective educational provision, to better support the paramedic workforce in delivering quality care for the rising population of individuals with mental health needs. Design and methods: The study is designed in two phases. First, university-level education (prior to paramedic qualification) and in-practice training (once qualified) from all England’s ambulance services regarding mental health care provision will be analysed. Second, interviews with up to 20 paramedics regarding their knowledge when managing patients with mental health issues will be undertaken. The interviews will use patient cases, informed by real-life examples, to explore paramedic decision-making. Patient, public and community involvement: We have worked with a dedicated group of individuals with lived experience of mental health issues who have received care from ambulance services and paramedics to design the study. The group have all backed the importance of the study, highlighting the need for “ more caring ” by paramedics when attending those with mental health needs. We will continue to work with this group throughout the study. The group will help co-design study documents, such as the interview guide and patient cases for the paramedic interviews. The group will also be given the opportunity if desired to review and input into data analysis during both study phases. Dissemination: Findings will be shared with healthcare commissioners, ambulance services and Universities. The project’s findings will form the basis of recommendations on educational delivery via both ambulance services and Universities, and further research on how best to provide education solutions to the knowledge gaps identified.

Dr Naomi Klepacz & Professor Jane Ball (School of Health Sciences, University of Southampton) < Back Addressing underlying workforce challenges is essential to meet the nation’s mental health care needs Mental Health Dr Naomi Klepacz & Professor Jane Ball (School of Health Sciences, University of Southampton) What is it like to be part of the mental health nursing workforce? We argue that it is only by understanding the reality of the job – its highs and its lows – that we will be able to grow the mental health workforce and hold on to experienced nurses needed to deliver care well. Demand for mental health services is at an all-time high, yet many people cannot access vital services and face long waits for treatment ( 1) . Nurses comprise one-in-three of the NHS mental health workforce (2) . They are fundamental to providing mental health services and a positive patient experience. However, mental health nursing vacancies represent a third of all nursing vacancies (3) , and while there has been a welcome increase in the number of mental health nurses in recent years, the rate of increase still falls behind that seen in adult and children’s nursing (2) . There are also significant regional differences in mental health nurse staffing that seem disconnected from the level of demand for services (2) . The bottom line is that both now and, in the future, we need more nurses working in mental health – which means expanding supply and ensuring we have the conditions needed to retain the experienced staff we already have. The NHS Long Term workforce plan proposes an investment in expanding training places by 2028/29, with a promised increase of 38% for mental health nursing (4) . A substantial change, but lower than that promised to other fields of nursing. Research has demonstrated the link between nurse wellbeing and patient experience of care, staff and patient safety, sickness absence, job satisfaction and leads to staff leaving the workforce (5) . Physical or mental health, burnout or exhaustion currently follow retirement as the top reason nurses leave the profession (6) . The 2022 NHS Staff Survey reports that 49% of mental health nurses felt unwell because of work-related stress in the last 12 months, 61% came to work despite not feeling well enough to perform their duties, 45% reported often or always finding their work emotionally exhausting, and 28% experienced physical violence from a patient or service user in the last 12 months. In addition, 70% work additional unpaid hours over and above their contracted hours. Therefore, understanding the working lives and wellbeing of the mental health nursing workforce is critical for patient care quality, patient nurses, and the growing nursing workforce. Change is urgently needed to meet the nation’s demand for mental health care, but change requires commitment, investment, and, above all, an understanding of, and sensitivity to, the underlying issues. NHS England made a commitment to the growth and development of mental health nursing (7) , and recommendations from this report together with those from the Nuffield Trust (2) say a more accurate and realistic image of the mental health nursing role is needed, with clarity on career options, work setting and the range of people mental health nurses care for, to challenge false stereotypes. In our research into the working lives and wellbeing of nurses in mental health, we have spoken to some truly inspirational nurses who describe working as a mental health nurse as “the best job in the world”. While both patients and nurses place value on therapeutic relationships (8) , the importance of these relationships appears to be poorly understood by those who have not been touched by this experience (9) . Yet the absence of such relationships in mental health care can impact both patients (who may feel more disconnected, alone or vulnerable) and nurses - who are less likely to feel job satisfaction or take pride in the care provided ( 8 , 10 ). Unlike other fields of nursing, mental health nurses argue that it is this patient familiarity, the knowledge and experience gained through patient interaction, rather than treatment-focused ‘skills’ that make mental health nurses unique and indispensable while also making the role of mental health nurses challenging to define and difficult to evidence. Nurses don’t just deliver the intervention; they are the intervention. This is why we are undertaking a study (with funding from the NIHR ARC Wessex Mental Health Hub ) to provide insight into the work lives, wellbeing and working context of nurses in mental health services so that action can be taken (through local changes and/or national policy) to enable a better experience of work. When nurses feel good about the work they do and are given what they need, the benefits – to staff, organisations, and patients – are many. As part of this work, a national survey of the mental health nursing workforce is currently underway. This survey is open to nurses on the Nursing and Midwifery Council (NMC Register) providing mental healthcare to any patient group, in any setting, and for any health and social care provider. It is completely anonymous and will take 15-20 minutes to complete. This study is supported by the National Institute for Health and Care Research ARC Wessex. The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health and Care Research or the Department of Health and Social Care. Professor Jane Ball Dr Naomi Klepacz References: 1. Care Quality Commission. Rising demand for mental health care [Internet]. 2022. Available from: https://www.cqc.org.uk/publications/major-reports/soc202021_01d_mh-care-demand 2. Palmer W, Dodsworth E, Rolewicz L. In train? Progress on mental health nurse education [Internet]. Nuffield Trust; 2023 May. Available from: https://www.nuffieldtrust.org.uk/sites/default/files/2023-05/Mental%20Health%20nursing%20update_WEB_FINAL.pdf 3. NHS Digital. NHS Vacancy Statistics England, April 2015 - March 2023, Experimental Statistics [Internet]. 2023. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-vacancies-survey/april-2015---march-2023-experimental-statistics 4. NHS England. NHS Long Term Workforce Plan [Internet]. 2023 Jun. Available from: https://www.england.nhs.uk/wp-content/uploads/2023/06/nhs-long-term-workforce-plan-v1.2.pdf 5. Maben J, Adams M, Peccei R, Murrells T, Robert G. Patients’ experiences of care and the influence of staff motivation, affect and well-being. NIHR; 6. Nursing & Midwifery Council. 2023 NMC Registere Leavers Survey (Summary Report) [Internet]. Nursing & Midwivery Council; 2023 May [cited 2023 Jul 10] p. 1–36. Available from: https://www.nmc.org.uk/globalassets/sitedocuments/data-reports/may-2023/annual-data-report-leavers-survey-2023.pdf 7. Health Education England. Commitment and Growth: advancing mental health nursing now and for the future [Internet]. Health Education England; 2022 Apr p. 37. Available from: https://www.hee.nhs.uk/sites/default/files/documents/Commitment%20and%20Growth%20Advancing%20Mental%20Health%20Nursing%20Now%20and%20for%20the%20Future.pdf 8. Simpson A, Hannigan B, Coffey M, Barlow S, Cohen R, Jones A, et al. Recovery-focused care planning and coordination in England and Wales: a cross-national mixed methods comparative case study. BMC Psychiatry. 2016;16(147). 9. Clarke L. The therapeutic relationship and Mental Health Nursing: it is time to articulate what we do! J Psychiatr Ment Health Nurs. 2012;19:839–43. 10. Coffey M, Hannigan B, Barlow S, Cartwright M, Cohen R, Faulkner A, et al. Recovery-focused mental health care planning and co-ordination in acute inpatient mental health settings: a cross national comparative mixed methods study. BMC Psychiatry. 2019;19(115). Previous Next

945aa457-32c2-485e-a4e6-687eee387f97 COMPLETED ADOPTED PROJECT: Optimising Outpatients: Effective service transformation through face-to-face, remote and digital care delivery. Principal Investigator: Professor Chris Kipps, Consultant Neurologist at University Hospital Southampton NHS Foundation Trust Team: Dr Sarah Fearn, Senior Research Fellow, University of Southampton Starts: 1/2/2022 Ends: 31/07/24 Background The number of people living with a neurological condition is increasing, placing ever greater demand on existing services. The NHS Long Term Plan outlines a need for new service models to optimise care. Remote and digital technologies, aimed at improving efficiency and service delivery, can promote a more personalised approach to outpatient care, with a key outcome being a reduction of unnecessary appointments. ‘Remote care’ provides synchronous communication between the patient and the healthcare professional (HCP) across different locations. The COVID-19 pandemic accelerated the uptake of remote care with a rapid shift in appointments performed via phone or video-call. ‘Digital care’ provides technology-enabled asynchronous communication between the patient and their care team (e.g. messaging) where contact with an HCP is not required in real time. UHS has been a leader in developing digital care through the My Medical Record care platform that provides a unique digital tool connecting patients to their care team. Both remote and digital care provide cost effective, implementable opportunities to transform outpatient services in neurology and for other long-term conditions. Yet little is known about the most effective ways to combine the standard face-to-face appointment with remote and digital technologies to provide effective, efficient, high quality outpatient care. There has been some research into the advantages, disadvantages, barriers and enablers of remote care during the pandemic for people with neurological conditions (Nakornchai et al. 2021), with a growing body of work into digital healthcare and the moderating factors of its use and success within this population (Moccia et al. 2018). However, in a post-pandemic environment, we need to shift the focus from separate analyses of remote and digital care onto how best to combine face-to-face, remote and digital care to better serve patient needs and realise the ambitions of the Long Term Plan. Why this research matters During the COVID-19 pandemic, many outpatient neurology appointments were moved online or over the phone to keep people safe. Five years on, remote care is still widely used—but are we doing it well? We wanted to find out what works, what doesn’t, and how we can make remote neurology care better for both patients and healthcare professionals. What we did We analysed large national surveys about remote appointments from over 2,400 neurology patients and carers (via The Neurological Alliance’s national survey) and nearly 600 neurologists (via two surveys collected by the Association of British Neurologists). We also ran local focus groups and co-production workshops with patients, carers and healthcare professionals to understand what really matters in a neurology appointment. Together, we co-designed a set of practical, evidence-based recommendations to help services deliver better, more person-centred, and efficient remote neurology care. What people told us Remote care can be hugely beneficial when done well. Patients appreciated the convenience – avoiding travel, hospital parking and long waits - especially if they had mobility issues or lived far from the hospital. It also made it easier for carers or family members to join the appointment. But there were challenges. Patients worried they might not get the same quality of care without being seen in person. They were concerned about symptoms being missed, not being taken seriously, or struggling to explain themselves over the phone. Some felt remote appointments could feel rushed or impersonal. Patients were also concerned about maintaining their own privacy during the consultation and wanted to feel certain that their healthcare professional was also in a private space. Not all patients felt confident with video technology and weren’t sure what to do if things went wrong. Healthcare professionals also found remote working challenging at times — IT systems and technology weren’t always reliable and were clunky to use, finding a private room could be difficult, and it wasn’t always easy to ensure timely in-person follow up if a concern had been identified remotely. What we recommend Together with patients, carers, and professionals, we developed key recommendations to improve remote care: • Let patients choose the type of appointment that suits them—face-to-face, phone, or video—where it’s safe to do so. • Co-design clear, accessible tools and information with patients to improve trust in remote care and help all patients get the most out of their remote appointments. • Protect clinical staff time to keep digital platforms and patient resources up-to-date. • Implement fair and robust triage systems to reduce variation in care. • Provide regular training and support so staff can deliver the quality of patient care they aspire to. • Ensure there are enough private spaces for healthcare professionals to deliver confidential remote consultations. • Maintain enough rapid-access face-to-face slots to allow timely and safe in-person follow up when needed. • Improve digital systems and streamline admin to reduce stress, avoid unnecessary delays and boost satisfaction for both staff and patients. • Regularly review how remote services are working to make sure they’re fair and effective for all, especially those with less digital access or confidence. What’s next Remote care is here to stay. But for it to work well, it needs to be flexible, inclusive and built around patient and staff needs. We have shown that with the right systems, tools and support, remote neurology can deliver safe, high-quality and accessible services. These recommendations will not only optimise remote care in neurology but would also be adaptable to other clinical specialities across the NHS. What did we do with this new Knowledge? • Shared findings with patients and carers and healthcare professionals. • Informed content of the UHS outpatient webpages. • Provided national and local feedback to the UHS outpatient transformation team to inform strategy for remote care in neurology and more generally. • Used the positive feedback from our workshop participants to inform future approaches to Increase engagement and inclusion in research. • Drafted an article about optimising remote appointments in neurology for publication. What's next We will discuss the recommendations with the Association of British Neurology Quality Committee with regards to endorsement of the recommendations for a neurology clinical practice guideline. Once endorsed and put into practice, the next step would be to audit practice and measure change.

d94081d4-7fee-46f1-acf1-61bd1a5364fc Understanding barriers and enablers of using the Living with Long Term Conditions scale as part of routine care for people from under-served groups living with type 2 diabetes Chief investigator: Dr Leire Ambrosio, Lecturer, School of Health Sciences, University of Southampton. Team: Professor Mari Carmen Portillo, School of Health Sciences, University of Southampton Dr Lindsey Cherry, School of Health Sciences, University of Southampton Dr Kinda lbrahim, Associate Professor, Faculty of Medicine. University of Southampton Dr Michelle Myall, Principle Researcher, School of Health Sciences, University of Southampton Ms Rashmi Kumar, PPI representative Partners: Ha mpshire and Isle of Wight Integrated Care Board, Hampshire and Isle of Wight NHS Foundation Trust, University of Southampton, Diabetes UK, SO:Linked (Southampton Voluntary Services). Start: 1 October 2024 End: 31 March 2026 Why is this research important? In the England over 15 million people are living with at least one long-term conditions (LTC). People from under-served groups, are at greater risk of having one or more than one LTCs. This not only affects a person’s physical health, but other aspects of their lives, such as emotional, cultural, and socio-economic wellbeing. It is key for healthcare professionals, to understand and assess how a person is living with an LTC to provide person-centred care. We recently developed the Living with Long Term Conditions (LwLTCs) scale for English-speaking populations. This is a person-centred questionnaire to evaluate how well a person lives with a long-term condition, to inform care for people based on their individual needs. What is our aim? To better understand the barriers, enablers as well as contextual factors to successfully use the LwLTCs scale within primary care for underserved groups living with LTCs and liaise with healthcare professionals to support and deliver the future implementation study. What do we plan to do? We will explore potential barriers and enablers to using of the LwLTCs scale in routine primary care. We will interview (n=20) people with LTCs from under-served groups and (n=15) healthcare professionals including General Practitioners (GPs), Specialist Nurses, or Podiatrists who support LTCs patients, across Hampshire. We will also identify and engage with key healthcare professionals to guarantee their support through the later implementation process. All this will help us on developing an implementation strategy to test how feasible it is to use the scale in primary care. How have we involved patients and the public? This study has been developed with public and patient involvement (PPI). Our PPI co-applicant is from a Mixed Asian background from Africa with a family history of type 2 diabetes and living in an area of high socio-economic and health care diversity where high numbers of the population have diverse LTCs. He has been living with an LTC, particularly type 2 diabetes for 20 years. He will chair the PPI group (n=4), help to develop patient information, review data collection materials, and validate and disseminate findings. The PPI group will also assist with reaching out to communities engaged less frequently in research. Three meetings will be scheduled with the PPI group. How will we share our findings? We will publish in academic journals, with public contributor involvement and co-authorship. A lay summary of findings will be provided to participants who wish to receive them. Findings will be shared with clinical teams at primary care practices and healthcare decision makers. How long will it take? 18-months, starting the 1st of October 2024. How will we share our findings? We will publish in academic journals, with public contributor involvement and co-authorship. A lay summary of findings will be provided to participants who wish to receive them. Findings will be shared with clinical teams at primary care practices and healthcare decision makers.

Long Term Conditions Theme leads Professor Mari-Carmen Portillo Theme lead Long Term Conditions Theme To promote better living with and management of long-term conditions we need care plans that make sense to people and respond to individual needs. We aim to listen to and learn from people's experiences, explore resources in the community and work in teams that represent different lay people, sectors and professionals. Research projects ARC Wessex programme of research on Medicines Optimisation (MODIFY SPiDeR STOP-DEM) Read more ADOPTED: Personalised social and self-management support for better living with multiple long-term conditions in the community (CO-ACTION) Read more Social Prescribing Link Workers framework: supporting complex needs of adults living with physical and mental health long term conditions Read more Evaluating impact of personalised care at service at service and system levels: Learning from the Wessex Academy for Skills in Personalised Care (WASP) programme. Read more Understanding barriers and enablers of using the Living with Long Term Conditions scale as part of routine care for people from under-served groups living with type 2 diabetes Read more PARTNERS II: Testing implementation and evaluation of a digital tool for multisectoral support and management of people living with Parkinson’s disease and/or arthritis. Read more Avoiding care escalations through targeted care coordination for people with multiple long-term conditions – a knowledge mobilisation project Read more Deprescribing and Optimisation of Medicines IN Older people with Heart Failure and Frailty (DOMINO-HFF) Read more COMPLETED: Change in treatment burden among people with multimorbidity: Protocol of a follow up survey and development of efficient measurement tools for primary care Read more ADOPTED: Treatment burden in people below the age of 65 with multimorbidity in primary care: A mixed methods (SPELL) Read more ADOPTED: (SIFT) Sensors in Fatigue Tracking in Parkinson’s. Exploring the relationship between perception of Fatigue and the performance of physical activities in people with Parkinson's with fatigue using wearable sensors Read more Reframing responsibility through public empowerment: proposing the ‘FoodEnviroScan’ app to unmask unfair environmental cues influencing poor diets Read more COMPLETED: Non-digital support for maintaining physical activity in people with long-term conditions – within Maintenance Of physical acTivity beHaviour (MOTH) programme Read more COMPLETED: Digital support for maintaining physical activity in people with long-term conditions Read more COMPLETED: Development of policy recommendations to reduce the impact of COVID-19 on physical activity and mental health in individuals with multimorbidity: a mixed method study. Read more ADOPTED PROJECT: Understanding risk stratification of patients with chronic kidney disease (CKD) in primary care Read more ADOPTED PROJECT: Development of a decision aid for offloading device selection for people with diabetic foot ulceration Read more ADOPTED PROJECT: Breast Cancer Choices: Evaluation and implementation of a digital patient-centred decision aid to support genetic testing in mainstream care. Read more ADOPTED PROJECT: Multidisciplinary Ecosystem to study Lifecourse Determinants and Prevention of Early-onset Burdensome Multimorbidity (MELD-B) Read more ADOPTED PROJECT: MELD Read more POST DOCTORAL PROJECT: Understanding, addressing, and meeting the complex needs of people living with long term physical and mental health conditions: a qualitative study Read more COMPLETED: Testing the living with chronic illness scale Read more COMPLETED: Medicines optimisation Read more Interventions to support physical activity for adults (MOTH) Read more MODIFY: The development and iMplementation Of a multidisciplinary medication review and Deprescribing Intervention among Frail older people in primarY care Read more COMPLETED: PARTNERS Project: Development and implementation of a digital tool for multisectoral support and management of long-term condition Read more ADOPTED PROJECT: EnablExercise in Crohns: A qualitativE study to uNderstAnd the Barriers and faciLitators to physical activity and Exercise IN children and adolescents with CROHN’S disease Read more ADOPTED PROJECT: ExACT-CF: Exercise as an Airway Clearance Technique in people with Cystic Fibrosis – A randomised pilot trial Read more ADOPTED PROJECT: Happier Feet Read more COMPLETED: OPTIM Park - Optimization of community resources and systems of support to enhance the process of living with Parkinson’s Disease: a multisectoral intervention Read more Improving support for self-management (WASP) Read more Mental health hub projects Understanding, addressing, and meeting the complex needs of people living with long term physical and mental health conditions: a qualitative study Read more Role of patient-assessed functioning as a predictor of health service use in patients with long term mental health conditions Read more Read our publications here Read more Publications Collaborative project: Improving review appointments for people with long-term conditions

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

COVID-19 projects We have been responding to the call from the National Institute for Health Research and the Department of Health and Social Care to rapidly respond to the demand for evidence and support for the NHS and care settings during the Covid-19 pandemic. The ARC Wessex Central team has been called in to support the NHS Nightingale Hospital and we are working with other ARCs and specialists. Professor Peter Griffiths is leading a team on Workforce and Staffing. This page lists the ARC Wessex Covid-19 research projects underway, and is updated when new projects come online. #staysafe Our research projects COMPLETED: Symptoms, Trajectory, Inequalities and Management: Understanding Long-COVID to Address and Transform Existing Integrated Care Pathways (STIMULATE) Read more ADOPTED PROJECT: Supported remote rehabilitation post Covid-19 Read more COMPLETED: Development of policy recommendations to reduce the impact of COVID-19 on physical activity and mental health in individuals with multimorbidity: a mixed method study. Read more COMPLETED: Predicting Patient Deterioration Risks in COMMunities 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: GOODNIGHT Covid-19 to care-home-based vulnerable individuals Read more COMPLETED: COVID-19 Emergency Department Project Read more

22c6bc93-4002-4a39-ba1e-6b7c981fbe5f A qualitative case study to understand Young people’s food purchasing patterns in CONvenience stores in the school neighbourhood environment (Y-CON) Chief Investigators: Janis Baird and Christina Vogel, Professor of Public Health and Epidemiology and Adjunct Professor of Food Policy, MRC Lifecourse Epidemiology Centre, University of Southampton Team: Dr Sarah Muir, Senior Research Fellow, MRC Lifecourse Epidemiology Centre, University of Southampton Dr Kath Woods-Townsend, Principal Research Fellow, School of Healthcare, Enterprise and Innovation Dr Sarah Crozier, Senior Statistician, MRC Lifecourse Epidemiology Centre, University of Southampton Dr Hayward Godwin, Associate Professor of Psychology, University of Southampton Professor Marcus Munafo and Dr Olivia Maynard, Bristol University Ravita Taheem, Southampton City Council, lead on childhood obesity Partners: Bristol University, University of Southampton, Southampton City Council Start: 1 October 2024 End: 31 March 2026 Background A poor diet significantly contributes to illnesses including heart disease, diabetes and stroke. One in three children are leaving primary school have obesity or overweight, raising concerns about their future health. The teenage years are crucial because this is when young people start making their own food choices, setting the stage for their lifelong eating habits. The Problem The journey to and from school often involves passing by convenience stores which rely on shoppers, such as young people, to impulse-buy products that are high in fat, salt and sugar. The presence of these stores in school neighbourhoods may be linked to the high rates of childhood obesity. Our Research Focus Our recent research, funded by NIHR ARC Wessex, looked at how supermarket product placement affects the shopping habits of mothers. Now, we aim to study how the placement of items in smaller convenience stores near schools influences the buying patterns of young people making their own dietary decisions. Study Design Our research is planned to run between October 2024 and March 2026. We will use one area in Chandler’s Ford, Hampshire, to understand what influences what young people's buy from convenience stores near their schools. We will invite around 40 students aged 11-16 years to participate in small focus groups. These groups will discuss their experiences and perceptions of using local convenience stores, including factors like convenience, travel, social influences, product placement, product choice, and promotions. Some students will also be employed as citizen scientists and will be trained to collect data from local stores and will be involved in analysis of findings and development of dissemination materials. Expected Outcomes Our findings will provide critical insights for shaping policies. They may help refine existing regulations on food placement and promotions, which currently exempt small businesses, potentially worsening health inequalities among young people. Engagement and Dissemination Results will be shared with the young participants in our study and the PPI panel through various media including infographics and we will involve them in wide dissemination to other groups of young people. Nationally, we will present our findings to the Department of Health and Social Care, Chartered Institute of Trading Standards, Impact for Urban Health, and the Association of Convenience Stores. Internationally, our research will be presented in scientific journals and at conferences.

74810517-8b1b-4b38-87c8-8743533a5bbb COMPLETED: Developing a web resource to support families bereaved during COVID-19 Principal Investigators : Dr Natasha Campling and Dr Michelle Myall Team Members : Dr Natasha Campling (Lecturer & Senior Research Fellow, School of Health Sciences, University of Southampton; Dr Michelle Myall (Senior Research & Implementation Fellow, School of Health Sciences, University of Southampton); Dr Susi Lund (Visiting Research Fellow, School of Health Sciences, University of Southampton); Dr Alison Allam (Patient and Public Representative) Start: 1 January 2021 Finish: 31 December 2022 Project Partners: Winchester Bereavement Support; The Bereavement Centre (Southern CO-OP) Plain English Summary Why is the study needed? The current coronavirus (COVID-19) pandemic has led to increasing numbers of people who have experienced, or are facing, bereavement both in the UK and worldwide. We know that bereavement can seriously affect people’s health. Bereaved people are more likely to experience serious physical and psychological health consequences, such as heart disease and anxiety and depression, particularly in the first year of losing someone close to them. There are some things that can help prevent the health effects caused by grief. For example, being able to see a person receive good end of life care, being prepared for the death of a person, attending the funeral and having the support of family members and friends. During COVID-19 many families and others important to a dying person have not been present during end of life care and death has occurred suddenly. Social distancing restrictions have prevented the support often provided through families and friends coming together. Restrictions applied to funerals have prevented some families being able to attend the funeral of a relative. All of this can make it difficult for people to make sense of what has happened and to look for support to help them with their loss and grief. However, traditional ways of providing bereavement support (face-to-face or by telephone or video) may not be possible because of an increase in demand for support. A family focused online support resource, which considers grief in the context of the family, offers a way of helping people to deal with their bereavement in these unusual times. What did we do and what did we find out? Families, friends and support networks are key to managing bereavement. COVID-19 social restrictions prevented families and friends from being with the dying and participating in usual rituals to honour the dead. This resulted in social disconnection, feelings of guilt, and difficulty in making sense of the death and reconstructing relationships. In response to this context a theoretically informed, co-produced web-resource to facilitate meaning-making, which situates bereavement in the context of family and friends, was developed. We conducted a survey of bereaved people and bereavement professionals to understand how the pandemic had influenced their bereavement experiences and for their views on the key elements of a web-resource. Findings from the survey along with those from a literature review were shared at an online workshop with bereavement professionals to generate agreement on the content and format of the resource. We worked with them and bereaved people to co-produce the resource which was theoretically informed by the Dual Process Model and Family Sense of Coherence. The resource was piloted to gain user feedback which was used to further refine the website. Following these refinements, the website was evaluated via interviews and focus groups with bereaved people and bereavement professionals. Survey respondents reported the pandemic negatively affected bereavement (guilt, isolation, inability to bear witness) but also presented new opportunities to celebrate the deceased and support the bereaved (new funeral rituals, technology, remote contact, social acknowledgement of grief). Sense-making and managing bereavement were helped through information-giving, support networks, and relocating the person within the family context. A web-resource to facilitate collective grief was viewed positively and endorsed. Key content including family activities to stimulate support, information regarding the range of grief experience and dealing with the practicalities, along with other sources of support was agreed by workshop participants to form the basis of the resource. The Families and Friends in Bereavement website is a novel resource which encourages consideration of bereavement in the context of close social networks. It enables grief to be understood and managed within a shared experience by promoting communication and meaning-making.ur evaluation data demonstrates that the Families and Friends in Bereavement website: •Normalises the range of grief experiences ( about grief page) •Gives permission not to have to grieve all the time ( space to pause page, Dual Process Model theoretical underpinning) •Sits well with the nature of grief – can be accessed in small ‘chunks’ (when concentration is limited), dipped into and out over time (as there is no timeline to grief) •Is therapeutic in itself – calming colours / images and supportive, gentle text, encourages reflection What difference will this Knowledge make? •Contribution to understanding experiences and support needs of bereaved people during COVID-19 and beyond •Using theory to explain these experiences and develop a resource to meet the needs of bereaved people. •The resource makes an important difference to the health and wellbeing of bereaved people within the local population and beyond, regionally and nationally. Addresses the gap in existing support for those experiencing non-complex grief. •The website is a useful resource for professionals to signpost people to (something for their toolbox). It offers a useful addition for the current context of tightened / restricted professional resources and bereavement service cuts. Next Steps •Pursue impact funding . •Harness the interest of a charity to host the resource in the longer term. •Continue to develop partnership with the national funeral director trade associations. •Develop collaborative funding proposal for submission to NIHR palliative and end of life care call (Public Health stream) to build on this work. https://familiesandfriendsinbereavement.org.uk/ Publications https://doi.org/10.12688/f1000research.134193.2

f6f0f7ec-ab98-4c5c-9b52-2674a93b8c90 ADOPTED: A Study to Evaluate the Introduction of new Staffing Models in Intensive Care: a Realist evaluation (SEISMIC-R) Prinicipal Investigator: Professor Natalie Pattison, University Of Hertfordshire Team: Professor Peter Griffiths, Dr Chiara Dall'Ora, Dr Christina Saville, Dr Lisa Whiting, Dr Melanie Handley, Dr Susie Pearce, Dr Marion Penn, Dr Paul Mouncey, Professor Thomas Monks, Mrs Clare Leon-Villapalos, Professor Suzanne Bench, Professor Ruth Endacott, Mr Jeremy Dearling, Mrs Jennifer Gordon. University of Southampton, University of Hertforshire, University of Plymouth, Intensive Care National Audit & Research Centre, University of Exeter, Imperial College Healthcare NHS Trust, Guys & St Thomas' NHS Foundation Trust/London South Bank University, NIHR Clinical Research Network. Start Date: 01 May 2023 End Date: 31 August 2024 Background Staffing in intensive care units (ICU) has been in the spotlight since the pandemic. Having enough nurses to deliver safe, quality care in ICU is important. There is national guidance, re-issued in April 2021, on how many nurses should care for ICU patients. However, what the skill mix should be (how many should be qualified nurses or have an ICU qualification) is unclear. Very little research has been done to look at which nursing staff combinations and mix of skills works best in ICU to support patients (described as ‘staffing models’). Across ICUs in UK, various ratios of qualified and unqualified nursing staff are being tried (staff ratios refer to the number of nurses caring for a set number of patients). Hospitals vary; some use a high proportion of non-registered nurses and others a low proportion of ICU qualified nurses. Research shows that there is a link between the quality of nurse staffing and poor patient outcomes, including deaths. Aim : Our research plans to look at different staffing models across the UK. We aim to examine new staffing models in ICU across six very different Trusts. We will use a research technique called Realist Evaluation that examines what works best in different situations and helps us to understand why some things work for some people and not others. The design of this approach will help us to better understand the use of different staff ratios across different ICU settings. We will examine what combinations of staff numbers and skills result in better patient care and improved survival rates. Our aim is to produce a template that every ICU unit can use. To do this, we will compare staffing levels with how well patients recover, and seek to understand the decisions behind staffing combinations. Publications Nurse staffing configurations and sickness absence in English intensive care units: A longitudinal observational study - ScienceDirect ICU staffing and patient outcomes in English hospital Trusts: A longitudinal observational study examining ICU length of stay, re-admission and infection rates - ScienceDirect

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