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Workforce & Health Systems publications Causes and solutions to workplace psychological ill-health for nurses, midwives and paramedics: the Care Under Pressure 2 realist review Maben J, Taylor C, Jagosh J, Carrieri D, Briscoe S, Klepacz N, Mattick K Nurses, midwives and paramedics are the largest collective group of clinical staff in the National Health Service and have some of the highest prevalence of psychological ill-health. Existing literature tends to be profession-specific and focused on individual interventions that place responsibility for good psychological health with nurses, midwives and paramedics themselves. The aimof this study is to improve understanding of how, why and in what contexts nurses, midwives and paramedics experience work-related psychological ill-health; and determine which high-quality interventions can be implemented to minimise psychological ill-health in these professions. https://doi.org/10.3310/twdu4109 April 2024 Workforce & Health Systems A protocol for a cross-sectional survey exploring the work lives and wellbeing of the mental health nursing workforce in the UK Klepacz N, Wadey E, Griffiths P, Woodnutt S, Snowden J, Smith C et al Demand for mental health services is high, but so are vacancy levels for registered nurses in mental health. To effectively address the workforce disparity, we need to engage with nurses to understand better the rewards and challenges of being part of the UK's mental health nursing workforce. The aim of the study set out in this protocol will be to identify modifiable workplace factors impacting nurses' work lives and wellbeing. https://doi.org/10.12968/bjmh.2023.0037 February 2024 Workforce & Health Systems Inpatient midwifery staffing levels and postpartum readmissions: a retrospective multicentre longitudinal study Turner LY, Saville C, Ball J, Culliford D, Dall'Ora C, Jones J et al Preventing readmission to hospital after giving birth is a key priority, as rates have been rising along with associated costs. There are many contributing factors to readmission, and some are thought to be preventable. Nurse and midwife understaffing has been linked to deficits in care quality. This study explores the relationship between staffing levels and readmission rates in maternity settings. 10.1136/bmjopen-2023-077710 April 2024 Workforce & Health Systems Critical care pharmacy service provision and workforce in adult extracorporeal membrane oxygenation centres: a multicentre cross-sectional survey Remmington C, Cameron L, Hanks F, Liang YH, Barrow L, Coxhead R et al There is good evidence describing pharmacy workforce and service provision in general critical care units. However, no data exist from adult extracorporeal membrane oxygenation (ECMO) centres. The aim of this study is to describe workforce characteristics, pharmacy service provision, and pharmaceutical care activities in critical care units (CCUs) providing an adult ECMO service in the United Kingdom (UK) and compare to national staffing standards for CCUs. https://doi.org/10.1007/s11096-024-01719-9 April 2024 Workforce & Health Systems The association between midwifery staffing and reported harmful incidents: a cross-sectional analysis of routinely collected data Turner L, Ball J, Meredith P et al. Independent inquiries have identified that appropriate staffing in maternity units is key to enabling quality care and minimising harm, but optimal staffing levels can be difficult to achieve when there is a shortage of midwives. The services provided and how they are staffed (total staffing, skill-mix and deployment) have been changing, and the effects of workforce changes on care quality and outcomes have not been assessed. This study aims to explore the association between daily midwifery staffing levels and the rate of reported harmful incidents affecting mothers and babies. https://doi.org/10.1186/s12913-024-10812-8 March 2024 Workforce & Health Systems Photovoice: An active learning tool with community nursing students Andina-Díaz E, Welch L, Siles-González J, Serrano-Fuentes N, Gutiérrez-García AI, Solano-Ruiz M Objective: To assess nursing students' experiences of using photovoice as a pedagogical approach to active learning in the community. Methods: A descriptive design with a cross-sectional mixed-method questionnaire was used with 108 students following an educational activity, in which their communities were photographed and the impact of the pandemic on vulnerable populations was reflected. Descriptive statistics and thematic analysis were used to analyze the data. https://doi.org/10.1111/phn.13285 February 2024 Workforce & Health Systems What might make nurses stay? A protocol for discrete choice experiments to understand NHS nurses' preferences at early-career and late-career stages Ejebu OZ, Turnbull J, Atherton I, Rafferty AM, Palmer B, Philippou J, Prichard J, Jamieson M, Rolewicz L, Williams M, Ball J Like many countries, England has a national shortage of registered nurses. Employers strive to retain existing staff, to ease supply pressures. Disproportionate numbers of nurses leave the National Health Services (NHS) both early in their careers, and later, as they near retirement age. Research is needed to understand the job preferences of early-career and late-career nurses working in the NHS, so tailored policies can be developed to better retain these two groups. https://doi.org/10.1136/bmjopen-2023-075066 February 2024 Workforce & Health Systems Position Paper on the Reporting of Norepinephrine Formulations in Critical Care from the Society of Critical Care Medicine and European Society of Intensive Care Medicine Joint Task Force Wieruszewski PM, Leone M, Kaas-Hansen BS, Dugar S, Legrand M, McKenzie CA, Bissell Turpin BD, Messina A, Nasa P, Schorr CA, De Waele JJ, Khanna AK Objectives: To provide guidance on the reporting of norepinephrine formulation labeling, reporting in publications, and use in clinical practice. Design: Review and task force position statements with necessary guidance. https://doi.org/10.1097/ccm.0000000000006176 January 2024 Workforce & Health Systems Nursing 12-Hour Shifts and Patient Incidents in Mental Health and Community Hospitals: A Longitudinal Study Using Routinely Collected Data Dall’Ora C, Ejebu OZ, Jones J, Griffiths P Shifts of 12 hours or longer are common in nursing services within general hospital wards. Concerns have been raised about their safety, but previous research has mostly used staff-reported measures of quality and safety and has occurred in general hospital settings only. This study aims to measure the association between the use of 12+ hour shifts in nursing staff (including registered nurses, healthcare support workers or nursing assistants, and nursing associates) and the rate of patient incidents in mental health and community hospitals https://doi.org/10.1155/2023/6626585 January 2024 Workforce & Health Systems Evidence on the use of Birthrate Plus® to guide safe staffing in maternity services - A systematic scoping review Griffiths P, Turner L, Lown J, Sanders J Birthrate Plus® is a widely used tool that informs decisions about the number of midwifery staff needed to provide safe and high quality care in maternity services. Evidence about the effectiveness, validity, reliability, and feasibility of tools such as this is needed. https://doi.org/10.1016/j.wombi.2023.11.003 January 2024 Workforce & Health Systems Ten reasons for the presence of pharmacy professionals in the intensive care unit McKenzie C, Spriet I, Hunfeld N The intensive care unit (ICU) patient requires a plethora of disciplines to optimise care and clinical outcomes. Recently, the European Society of Intensive Care Medicine (ESICM) has given greater attention to ICU pharmacy professionals, i.e., the clinical pharmacist and pharmacy technician, and their integration into the ICU multidisciplinary (MDT) team. In this article, we describe ten reasons why ICU pharmacy professionals are vital for high-quality care in the ICU. 10.1007/s00134-023-07285-4 January 2024 Workforce & Health Systems Evaluation of the nurse-assisted eHealth intervention 'eHealth@Hospital-2-Home' on self-care by patients with heart failure and colorectal cancer post-hospital discharge: protocol for a randomised controlled trial. Storm M, Morken IM, Austin RC, Nordfonn O, Wathne HB, Urstad KH et al Patients with heart failure (HF) and colorectal cancer (CRC) are prone to comorbidity, a high rate of readmission, and complex healthcare needs. Self-care for people with HF and CRC after hospitalisation can be challenging, and patients may leave the hospital unprepared to self-manage their disease at home. eHealth solutions may be a beneficial tool to engage patients in self-care. https://doi.org/10.1186/s12913-023-10508-5 January 2024 Workforce & Health Systems

Ageing & Dementia Publications Barriers and motivators to undertaking physical activity in adults over 70-a systematic review of the quantitative literature Kilgour AHM, Rutherford M, Higson J, Meredith SJ, McNiff J, Mitchell S, Wijayendran A, Lim SER, Shenkin SD Physical activity (PA) has multiple benefits for older adults (≥70 years old). Despite this many older adults do not undertake the World Health Organisation guideline recommended amount of PA. This systematic review examines barriers and motivators to PA in adults aged ≥70 years. We analysed the quantitative literature, including observational studies and baseline data from randomised controlled trials. Studies examining specific diseases (e.g. cognitive impairment), or care home residents were excluded. Database searches of ASSIA, CINAHL, Embase, Medline, PsycINFO and Web of Science were undertaken on 7 March 2023. Quality assessment was performed using the ROBANS tool. We synthesised the results using the socioecological model. The protocol was registered on PROSPERO (CRD42021160503) https://doi.org/10.1093/ageing/afae080 April 2024 Ageing & Dementia Consequences of Anorexia of Aging in Hospital Settings: An Updated Review Cox NJ The anorexia of aging is a widespread problem amongst older people, particularly in the hospital setting with up to 60% affected. Despite its high prevalence anorexia often goes undiagnosed in hospital, due to a lack of standardized assessment and evidence-based management, but also lack of knowledge regarding consequences. This review summarizes current evidence for anorexia of aging specific to the hospital setting, giving an overview of correlates of appetite in hospital and consequences of anorexia. It highlights an overall scarcity of research on this important clinical problem for hospitalized cohorts. The few studies point to the importance of anorexia of aging in major health burdens for older people, namely malnutrition, sarcopenia and reduced physical performance, as well as higher mortality. Further research is needed to assess temporal sequence in pathways of causality and to develop effective interventions to combat anorexia. https://doi.org/10.2147/cia.s431547 March 2024 Ageing & Dementia Healthcare professionals' experiences and views of providing continence support and advice to people living at home with dementia: "That's a carer's job" Bradbury B, Chester H, Santer M, Morrison L, Fader M, Ward J, Manthorpe J, Murphy C People living with dementia at home and their family carers often feel unsupported by healthcare professionals in managing continence problems. In turn, primary and community-based healthcare professionals have reported lacking specific knowledge on dementia-continence. This study aimed to understand more about healthcare professionals' experiences and views of supporting people living with dementia experiencing continence problems, as part of developing acceptable resources. Having a nuanced understanding of unmet need would facilitate the design of engaging resources that enable healthcare professionals to provide more effective continence support to people living with dementia at home. https://doi.org/10.1186/s12877-024-04830-8 March 2024 Ageing & Dementia Towards an improved dementia care experience in clinical radiography practice: A state-of-the-art review Abowari-Sapeh ME, Ackah JA, Murphy JL, Akudjedu TN The increasing global incidence rate of dementia and associated co/multimorbidity has consequently led to a rise in the number of people with dementia (PwD) requiring clinical radiography care services. This review aims to explore and integrate findings from diverse settings with a focus on the experiences of PwD and stakeholders, towards the development of a holistic approach for dementia care and management within the context of radiography services. https://doi.org/10.1016/j.jmir.2024.01.008 February 2024 Ageing & Dementia The anorexia of ageing and risk of mortality: More than a story of malnutrition? Cox NJ, Lim SE Appetite loss or anorexia due to physiological, psychological and socioenvironmental effects of the aging process is termed the anorexia of aging. The link between anorexia of aging and mortality has subsequently been established by a number of longitudinal studies across multiple settings. Despite the association, clear interpretation of the mechanistic relationship between anorexia of aging and mortality, has been limited. https://doi.org/10.1016/j.jnha.2024.100173 February 2024 Ageing & Dementia Perfusion Imaging and Inflammation Biomarkers Provide Complementary Information in Alzheimer's Disease Michopoulou S, Prosser A, Dickson J, Guy M, Teeling JL, Kipps C Single photon emission tomography (SPECT) can detect early changes in brain perfusion to support the diagnosis of dementia. Inflammation is a driver for dementia progression and measures of inflammation may further support dementia diagnosis. In this study, we assessed whether combining imaging with markers of inflammation improves prediction of the likelihood of Alzheimer's disease (AD). https://doi.org/10.3233/jad-230726 January 2024 Ageing & Dementia How can I improve cancer services for people with dementia? Farrington N, Richardson A, Bridges J Tips and guidance on making cancer services People with dementia have poorer cancer outcomes than those without, and are more likely to experience complications and poorer overall survival (McWilliams et al 2017). Few interventions are designed for older people with cancer and complex needs, such as those with dementia (Farrington et al 2022). doi: 10.7748/cnp.21.5.22.s10 October 2023 Ageing & Dementia Artificial intelligence for diagnostic and prognostic neuroimaging in dementia: A systematic review Borchert RJ, Azevedo T, Badhwar A, Bernal J, Betts M, Bruffaerts R, Burkhart MC, Dewachter I, Gellersen HM, Low A, Lourida I, Machado L, Madan CR, Malpetti M, Mejia J, Michopoulou S, Muñoz-Neira C, Pepys J, Peres M, Phillips V, Ramanan S, Tamburin S, Tantiangco HM, Thakur L, Tomassini A, Vipin A, Tang E, Newby D; Deep Dementia Phenotyping (DEMON) Network; Ranson JM, Llewellyn DJ, Veldsman M, Rittman T Introduction: Artificial intelligence (AI) and neuroimaging offer new opportunities for diagnosis and prognosis of dementia. Methods: We systematically reviewed studies reporting AI for neuroimaging in diagnosis and/or prognosis of cognitive neurodegenerative diseases. https://doi.org/10.1002/alz.13412 August 2023 Ageing & Dementia Case management for integrated care of older people with frailty in community settings Sadler E, Khadjesari Z, Ziemann A, Sheehan KJ, Whitney J, Wilson D, Bakolis I, Sevdalis N, Sandall J, Soukup T, Corbett T, Gonçalves-Bradley DC, Walker DM Ageing populations globally have contributed to increasing numbers of people living with frailty, which has significant implications for use of health and care services and costs. The British Geriatrics Society defines frailty as "a distinctive health state related to the ageing process in which multiple body systems gradually lose their inbuilt reserves". This leads to an increased susceptibility to adverse outcomes, such as reduced physical function, poorer quality of life, hospital admissions, and mortality. Case management interventions delivered in community settings are led by a health or social care professional, supported by a multidisciplinary team, and focus on the planning, provision, and co-ordination of care to meet the needs of the individual. Case management is one model of integrated care that has gained traction with policymakers to improve outcomes for populations at high risk of decline in health and well-being. These populations include older people living with frailty, who commonly have complex healthcare and social care needs but can experience poorly co-ordinated care due to fragmented care systems. Objectives: To assess the effects of case management for integrated care of older people living with frailty compared with usual care. https://doi.org/10.1002/14651858.cd013088.pub2 May 2023 Ageing & Dementia Frequency, duration, and type of physiotherapy in the week after hip fracture surgery - analysis of implications for discharge home, readmission, survival, and recovery of mobility Almilaji O, Ayis S, Goubar A, Beaupre L, Cameron ID, Milton-Cole R, Gregson CL, Johansen A, Kristensen MT, Magaziner J, Martin FC, Sackley C, Sadler E, Smith TO, Sobolev B, Sheehan KJ Purpose: To examine the association between physiotherapy access after hip fracture and discharge home, readmission, survival, and mobility recovery. Methods: A 2017 Physiotherapy Hip Fracture Sprint Audit was linked to hospital records for 5383 patients. Logistic regression was used to estimate the association between physiotherapy access in the first postoperative week and discharge home, 30-day readmission post-discharge, 30-day survival and 120-days mobility recovery post-admission adjusted for age, sex, American Society of Anesthesiology grade, Hospital Frailty Risk Score and prefracture mobility/residence. https://doi.org/10.1016/j.physio.2023.03.002 September 2023 Ageing & Dementia Physiotherapists' perspectives of barriers and facilitators to effective community provision after hip fracture: a qualitative study in England Adams J, Jones GD, Sadler E, Guerra S, Sobolev B, Sackley C, Sheehan KJ. Purpose: to investigate physiotherapists' perspectives of effective community provision following hip fracture. Methods: qualitative semi-structured interviews were conducted with 17 community physiotherapists across England. Thematic analysis drawing on the Theoretical Domains Framework identified barriers and facilitators to implementation of effective provision. Interviews were complemented by process mapping community provision in one London borough, to identify points of care where suggested interventions are in place and/or could be implemented. https://doi.org/10.1093/ageing/afad130 September 2023 Ageing & Dementia What makes a multidisciplinary medication review and deprescribing intervention for older people work well in primary care? Howard C, Sheikh C, Rutter P, Latter S, Lown M, Brad L, Fraser SDS, Bradbury K, Roberts HC, Saucedo AR, Ibrahim K A third of older people take five or more regular medications (polypharmacy). Conducting medication reviews in primary care is key to identify and reduce/ stop inappropriate medications (deprescribing). Recent recommendations for effective deprescribing include shared-decision making and a multidisciplinary approach. Our aim was to understand when, why, and how interventions for medication review and deprescribing in primary care involving multidisciplinary teams (MDTs) work (or do not work) for older people. https://doi.org/10.1186/s12877-023-04256-8 September 2023 Ageing & Dementia

Healthy Communities Publications Barriers to healthcare access: findings from a co-produced Long Covid case-finding study Clutterbuck D, Ramasawmy M, Pantelic M, Hayer J, Begum F, Faghy M et al Long Covid is often stigmatised, particularly in people who are disadvantaged within society. This may prevent them from seeking help and could lead to widening health inequalities. This coproduced study with a Community Advisory Board (CAB) of people with Long Covid aimed to understand healthcare and wider barriers and stigma experienced by people with probable Long Covid. An active case finding approach was employed to find adults with probable, but not yet clinically diagnosed, Long Covid in two localities in London (Camden and Merton) and Derbyshire, England. Interviews explored the barriers to care and the stigma faced by participants and were analysed thematically. This study forms part of the STIMULATE-ICP Collaboration. https://doi.org/10.1111/hex.14037 April 2024 Healthy Communities Domestic Abuse in the Context of Life-Limiting Illness: A Systematic Scoping Review Michelle Myall, Sophia Taylor, Sally Wheelwright, Susi Lund Domestic abuse is a global public health issue which impacts the health and wellbeing of victim-survivors and their families. While prevalence of domestic abuse is consistent amongst individuals and groups, some experience additional inequalities, vulnerabilities, and risk factors. This includes people living with life-limiting illnesses such as incurable cancer, neurological conditions and progressive heart, pulmonary, and renal conditions, who are at increased risk of domestic abuse because they are vulnerable, frail, isolated, and dependent on others. People with a life-limiting illness are more likely to spend long periods in the home, in close proximity to the perpetrator who may also be their caregiver, and experience multiple barriers to accessing and seeking support and may be less willing or able to escape the abusive situation. Lockdown and social isolation measures implemented to combat COVID-19 exacerbated the risk for those with a life-limiting illness experiencing domestic abuse. Existing patterns of abuse increased in terms of frequency and type. To date, little is known about domestic abuse in the context of life-limiting illness, including the experiences and support needs of those affected; awareness, knowledge, and understanding of domestic abuse and life-limiting illness amongst health and care professionals and third sector organisations or their views and experiences of enquiring about, responding to, and supporting adults living with a life-limiting illness impacted by domestic abuse. This review has been undertaken as part of a wider study (DALLI) to coproduce a toolkit to enable hospice and palliative care practitioners to identify and respond to domestic abuse. The review is needed to inform understanding about the coexistence of domestic abuse and life-limiting illness, address gaps in academics and practitioners’ knowledge, and identify areas for further research. https://doi.org/10.1155/2023/1841944 April 2023 Healthy Communities Silymarin (Milk Thistle) Treatment of Adults With Gambling Disorder: A Double-Blind, Placebo-Controlled Trial Grant JE, Driessens C, Chamberlain SR Data on the pharmacological treatment of gambling disorder are limited. Silymarin (derived from milk thistle) has antioxidant properties. The goal of the current study was to determine the efficacy and tolerability of silymarin in adults with gambling disorder. 10.1097/WNF.0000000000000585 March 2024 Healthy Communities Cognitive function and skeletal size and mineral density at age 6-7 years: Findings from the Southampton women's survey Moon RJ, D'Angelo S, Crozier SR, Fernandes M, Fall C, Gale CR et al Poor cognitive function and osteoporosis commonly co-exist in later life. In women, this is often attributed to post-menopausal estrogen loss. However, a common early life origin for these conditions and the associations between cognitive function and bone mineral density (BMD) in childhood have not previously been explored. We examined these relationships at age 6–7 years in the Southampton Women's Survey (SWS) mother-offspring cohort. https://doi.org/10.1016/j.bone.2024.117067 March 2024 Healthy Communities Blood pressure measurement and adverse pregnancy outcomes: A cohort study testing blood pressure variability and alternatives to 140/90 mmHg Wilson MG, Bone JN, Slade LJ, Mistry HD, Singer J, Crozier SR To examine the association with adverse pregnancy outcomes of: (1) American College of Cardiology/American Heart Association blood pressure (BP) thresholds, and (2) visit-to-visit BP variability (BPV), adjusted for BP level. https://doi.org/10.1111/1471-0528.17724 December 2023 Healthy Communities Causal effects of later-eating rhythm on adiposity in children through the comparison of two cohorts in the UK and China: a cross-cohort study Zou M, Northstone K, Leary S. Later-eating rhythm (LER) refers to a later timing, greater energy intake, and higher meal frequency in the evening. The role of childhood LER in obesity development is emerging, but most evidence is cross-sectional. Cross-context comparison allows the improvement of causal inference in observational studies by comparing cohorts with different confounding structures. This method is applied to assess the causal effects of LER on adiposity, by exploring the likelihood of residual confounding due to socioeconomic status. https://doi.org/10.1016/s0140-6736(23)02142-6 November 2023 Healthy Communities Food insecurity and diet quality in households accessing food membership clubs in Wessex: a mixed-methods study Taylor E, Ziauddeen N, Alwan NA, Smith D Food membership clubs that charge a small fee for a set number of items are in place in Wessex to address food insecurity (inadequate reliable access to sufficient affordable, nutritious food). These clubs incorporate longer-term solutions such as budgeting support, benefit maximisation, and cooking skills. The Wessex DIET project was established to measure acceptability and impact of these clubs. Given the paucity of evidence on the prevalence of food insecurity in those accessing such clubs, we aimed to quantify food insecurity and assess diet quality and wellbeing at recruitment. https://doi.org/10.1016/s0140-6736(23)02131-1 November 2023 Healthy Communities Barriers and facilitators experienced in delivering alcohol screening and brief interventions in community pharmacy: a qualitative evidence synthesis Smith A, Buchanan A, Parkes J, Stone H, Tan QY, Ibrahim K Following increases in deaths due to alcohol during the COVID-19 pandemic, there have been renewed calls to increase resources in alcohol screening and brief intervention (SBI). Research has shown that community pharmacy could be a promising setting for SBI. This review aimed to investigate the barriers and facilitators to SBI delivery in community pharmacy to inform its further development. https://doi.org/10.1093/ijpp/riad071 November 2023 Healthy Communities The Palestinian primary ciliary dyskinesia population: first results of the diagnostic and genetic spectrum Rumman N, Fassad MR, Driessens C, Goggin P, Abdelrahman N, Adwan A, Albakri M, Chopra J, Doherty R, Fashho B, Freke GM, Hasaballah A, Jackson CL, Mohamed MA, Abu Nema R, Patel MP, Pengelly RJ, Qaaqour A, Rubbo B, Thomas NS, Thompson J, Walker WT, Wheway G, Mitchison HM, Lucas JS. Diagnostic testing for primary ciliary dyskinesia (PCD) started in 2013 in Palestine. We aimed to describe the diagnostic, genetic and clinical spectrum of the Palestinian PCD population. doi: 10.1183/23120541.00714-2022. April 2023 Healthy Communities The role of parity in the relationship between endometriosis and pregnancy outcomes: a systematic review and meta-analysis Sri Ranjan Y, Ziauddeen N, Stuart B, Alwan NA, Cheong Y Endometriosis is a chronic and debilitating condition which can affect the entire reproductive life course of women with a potentially detrimental effect on pregnancy. Pregnancy (and increasing parity) can affect endometriosis by modulating disease severity and suppressing symptoms. Multiparous women could be less likely to suffer from endometriosis-related pregnancy complications than primiparous women. We aimed to systematically review the evidence examining the role of parity in the relationship between pregnancy outcomes and endometriosis. doi: 10.1530/RAF-22-0070 March 2023 Healthy Communities Ethnic differences in kidney function in childhood: the Born in Bradford Cohort Renal Study Ziauddeen N, Jeffrey RF, Waiblinger D, Fraser SDS, Alwan NA, Yuen HM, Azad R, Mason D, Wright J, Coward RJM, Roderick PJ Endstage kidney failure rates are higher in South Asians than in White Europeans. Low birth weight is associated with adult chronic kidney disease and is more common in South Asians. Foetal kidney size was smaller in South Asians in the Born in Bradford (BiB) birth cohort. As part of BiB follow up, we aimed to investigate if there were ethnic differences in kidney function and blood pressure in early childhood and whether this was different by foetal kidney size. 10.12688/wellcomeopenres.17796.1 August 2023 Healthy Communities EXPERTS II - How are patient and caregiver participation in health and social care shaped by experienced burden of treatment and social inequalities? Protocol for a qualitative synthesis. May CR, Chew-Graham CA, Gallacher KI, Gravenhorst KC, Mair FS, Nolte E, Richardson A Background: The workload health and social care service users and caregivers take on, and their capacity to do this work is important. It may play a key part in shaping the implementation of innovations in health service delivery and organisation; the utilisation and satisfaction with services; and the outcomes of care. Previous research has often focused on experiences of a narrow range of long-term conditions, and on factors that shape adherence to self-care regimes. Aims: With the aim of deriving policy and practice implications for service redesign, this evidence synthesis will extend our understanding of service user and caregiver workload and capacity by comparing how they are revealed in qualitative studies of lived experience of three kinds of illness trajectories: long-term conditions associated with significant disability (Parkinson's disease, schizophrenia); serious relapsing remitting disease (Inflammatory Bowel Disease, bipolar disorder); and rapidly progressing acute disease (brain cancer, early onset dementia). doi: 10.7748/cnp.21.5.22.s10 October 2023 Healthy Communities

PPI/E Strategy 2021-2024 full report Below you will find the full report of the Patient and Public Involvement and Engagement (PPI/E) Strategy 2021-2024. ​ NIHR Applied Research Collaboration Wessex Authored by Caroline Barker (Lead for PPI/E). Supported by our Public Champions and Katherine Baker (PPI Officer). ​ Document overview: Background information Our vision Our aims Programme of activities Resources, partners and collaborators Reporting and monitoring The purpose of this strategy Patients and the public are at the heart of our vision to improve the health and well-being of people across Wessex . We need and value the voices of the communities our research serves. The knowledge, experiences and support of patients and the public are essential to ensure that our research goals and solutions are relevant, prevent waste, and bring the greatest possible benefits to society. This document outlines our strategy for Patient and Public Involvement and Engagement (termed PPI/E) in the work of ARC Wessex . Definitions We recognise there are different definitions to describe involvement and engagement activities within health and social care. For the purposes of this document we will adopt the following definitions: Patient and public involvement: research being carried out ‘with’ or ‘by’ members of the public rather than ‘to’, ‘about’ or ‘for’ them. (NIHR INVOLVE 2017). Engagement: where information and knowledge about research is provided and shared. PPI/E: an abbreviation/acronym. Used to describe patient and public involvement or engagement work and projects, or activities that connect or encompass both. Public: in this strategy we use the term ‘public’ to describe people affected by our research who do not have a professional role in health and social care services. This may include patients, service users, survivors, carers, family members or members of the general population. We also use the acronym WISeRD, which stands for Wessex Inclusion in Service Research and Design Group. This is our strategic PPI/E group. It is composed of PPI Champions (public), the PPI/E team and staff links for each research theme. As you read this document, you may come across other terms, abbreviations and acronyms that are unfamiliar to you. We have provided brief descriptions in the footnotes. There is also a glossary of terms at the end of the document. Context and opportunities ARC Wessex launched in October 2019. As part of our application to become an ARC, we had to develop an outline PPI/E strategy. CLAHRC Wessex (preceded ARC Wessex) shared our commitment to PPI/E and the work done by the CLAHRC laid good foundations for ARC Wessex to build on and progress. We are proud of the work we have done to embed PPI/E in our projects and programmes over the first 18 months. ​ This strategy, developed in wide consultation with our partners and public communities, builds on the outline PPI/E strategy from our application. It covers activities from April 2021-Oct 2024. ​ Our locality, Wessex, has strengths in involvement and engagement. We have the Wessex Public Involvement Network (PIN) that ARC Wessex plays a leading role in. This is a network of staff and public working with NIHR and committed to improving public involvement in research. We do this by sharing our knowledge, supporting and developing each other. We also work together on projects that would not be possible if we did not share the workload between us. These include developing PPI/E training and trialling approaches to improve diversity and inclusion in PPI/E. ​ Our partners in NHS providers , charities and higher education institutions (e.g. Universities) have their own expertise and strengths. We are willing and committed to working together on areas of shared priority. Our Vision We aim to deliver high quality public involvement and engagement for health and social care. Our activities will meet the values and principles of good public involvement as outlined in the UK Standards for Public Involvement . Our activities will occur across, and add value to, each aspect of Wessex ARC: At project-specific level (e.g. an ARC-funded or ARC-supported research project). Across each of our four research themes and the wider ARC programme. With our partners and collaborators organisations. Our overarching aims Aligned to the UK Standards for Public Involvement, are aims are to: Listen to voices relevant to our research priorities that reflect the diversity of our local population – ensuring the underserved have a voice (UK Standard Inclusive Opportunities). Build a culture that respects different perspectives, values contributions and supports mutually respectful and productive relationships (UK Standard Working Together). Provide health research communities of Wessex (including public) adequate PPI/E training, support and learning opportunities at the right time for their project/programme and/or their own development needs (UK Standard Support and Learning). Involve the public at strategic and operational levels, ensuring best practice and supporting research transparency (UK Standard Governance). Use innovative approaches and good communication to expand the reach of our activities, maximising impact by stimulating knowledge-of, and interest-in, our research (UK Standard Communications). Capture, monitor and share learnings to feedback to those involved, avoid duplication, contribute to the evidence base and build our academic PPI/E (UK Standard Impact). We will build on our local strengths and focus on areas where we believe we can have the greatest impact. [1] [2] [3] [4] [5] [6] [7] [8] [9] Aim 1: Listen to voices relevant to our research priorities that reflect the diversity of our local population – ensuring the underserved have a voice (UK Standard Inclusive Opportunities ). Aim 2: Build a culture that respects different perspectives, values contributions and supports mutually respectful and productive relationships (UK Standard Working Together ) Aim 3: Provide health research communities of Wessex (including public) adequate PPI/E training, support and learning opportunities at the right time for their project/programme and/or their own development needs (UK Standard Support and Learning ). Aim 4: Involve the public at strategic and operational levels, ensuring best practice and supporting research transparency (UK Standard Governance ). Aim 5: Use innovative approaches and good communication to expand the reach of our activities, maximising impact by stimulating knowledge-of, and interest-in, our research (UK Standard Communications ). Aim 6: Capture, monitor and share learnings to feedback to those involved, avoid duplication, contribute to the evidence base and build our academic PPI/E (UK Standard Impact ). Resources Our PPI/E team, in partnership with our research community (including public and researchers), will deliver the programme. A Lead for PPI/E will oversee delivery. A Communications & Partnerships Manager, Administrative Officer and a PPI Officer support them. A dedicated PPI/E budget will support: expense and time reimbursement for public contributing to our work; training costs required to support public in their role; consumable and facilities costs relating to PPI/E events, including training events; development and testing of new initiatives. This is in addition to PPI/E budgets set out within each research project, and academic career development awards. ​ Partners and collaborators We will work closely with involvement, engagement and communications teams in our partner charities, health and care providers and higher education institutions. This will enable us to maximise opportunities, minimise duplication and create economies-of-scale. Our public engagement activities wil l benefit from University of Southampton’s experienced Public Engagement in Research Unit, Public Policy Unit (connects with policy advisors and central government) and LifeLab (working with young people to engage them with research). Consolidated funding for our Lead for PPI/E facilitates strong cross-organisational working. This Lead person manages a PPI/E team working across University Hospital Southampton, including the Wessex PIN and other NIHR infrastructure (Southampton BRC and CRF ). ​ Reporting and monitoring An annual plan is written each year that covers progress to date and plans for the next year (see footnote for full detail ). The plan is developed by the Lead, with input from WISeRD, and approved by the ARC Director. Progress against our milestones are reported to: WISeRD at our meetings (every two months). The Executive Leadership Group (every two months). Rolling theme updates (including PPI/E) are a standing item. The Lead for PPI/E provides a formal update annually and given additional time on the agenda to discuss items as required. The ARC Director at meetings with the PPI/E team (twice a year). The ARC Partnership Board (twice a year) as part of the progress reports submitted to board members. CCF vi a the formal annual reporting structures (once a year). [17] [18] [19] [20] [1] Wessex includes Dorset, Hampshire, the Isle of Wight and South Wiltshire. [2] ARC stands for Applied Research Collaboration. They support applied health and care research that responds to, and meets, the needs of local populations and local health and care systems. [3] INVOLVE was a national coordinating centre for public involvement in health and care (until March 2020). A new Centre for Engagement and Dissemination aims to build on the work of INVOLVE. [4] Collaborations for Leadership in Applied Health Research and Care [5] National Institute for Health Research [6] Any organisation that provides NHS services [7] The standards are a framework for what good public involvement in research looks like. [8] ARC Wessex has four research themes: Ageing & Dementia; Long Term Conditions; Healthy Communities and Workforce and Health Systems. Found out more on our website. [9] Underserved is the term we have chosen to use to describe people who are less well included in research. It is important to recognise that underserved groups are context-specific. There is no single, simple definition to describe all underserved groups. [10] The Microsoft Accessibility Checker is a free tool available in Office 365. It finds most accessibility issues and explains why each might be a potential problem for someone with a disability. It also offers suggestions on how to resolve each issue. [11] The equality impact assessment is a systematic and evidence-based tool, which enables us to consider the likely impact of work on different groups of people. [12] Operational leadership group. [13] This project aims to test how feasible and acceptable a childhood obesity prediction tool is. [14] The Academic Career Development Group in ARC Wessex is focused on building capacity and capability within the health and care system. [15] The ARC Partnership Board is a decision-making body for ARC Wessex. [16] A theory of change is a description of why a particular way of working will be effective, showing how change happens in the short, medium and long term to achieve its intended impact. Logic models are a way to graphically represent this theory. [17] Biomedical Research Centre [18] Clinical Research Facility [19] PPI/E annual plan covers: progress against last year’s objectives and the wider strategy; objectives, plans and milestones (with timescales) for the next year; plans for engaging our stakeholders; plans for dissemination and monitoring impact; cross ARC collaborations; plans for research and capacity building; leadership and management; finances [20] CCF = NIHR Clinical Commissioning Facility. They manage and administer the ARC funding scheme [ii] Public involvement activities describe activities where research is carried out ‘with’ or ‘by’ members of the public rather than ‘to’, ‘about’ or ‘for’ them. [iii] Engagement activities describe activities where information and knowledge about research is provided to and shared with the public. [iv] Underserved is the term we have chosen to use to describe people who are less well included in research. It is important to recognise that underserved groups are context-specific. There is no single, simple definition to describe all underserved groups. Want to know more? You can read our full strategy Have questions or comments? Email PublicInvolvement@uhs.nhs.uk

Evaluation & Exploration of Multi-Agency Stalking Partnership Interventions Have you been a victim-survivor of stalking? Do you live in Hampshire & Isle of Wight? Hide this page in an emergency Jump to tips on safe web browsing A team of researchers from the Faculty of Medicine at the University of Southampton are doing a research study to learn more about how to best support people who are victim-survivors of stalking. ​ We want to learn more about the experiences of people who have been supported by the Multi-Agency Stalking Partnership’s Stalking Advocacy & Support Service, in Hampshire & Isle of Wight. The goal is to help the Stalking Advocacy & Support Service improve the support they offer. ​ You can help us improve this service by taking part in an anonymous online survey, and/or an ‘interview’ – a telephone discussion with a researcher. These are optional – you will receive the same service from the Stalking Advocacy & Support Service whether you participate or not. The online survey can be accessed here (INSERT SURVEY LINK HERE). This is an anonymous survey which will ask you some brief questions about your experiences since being referred to (or contacted by) the Stalking Advocacy & Support Service. The survey should take you approximately 15 minutes. If you decide to participate in an interview, this would be completely confidential and would take about an hour, at a time and date of your choosing. We would ask you questions about your experiences since being referred to (or contacted by) the Stalking Advocacy & Support Service. For example, were you satisfied with the support you received? Has the support had any impact on your life? Has the stalking stopped? We can offer you a £25 shopping voucher to thank you for your time. ​ Would you like to share your experience? We would be very interested to hear from you. Please watch this video to learn more. If you decide to participate in an interview, the researcher will ask you to provide your informed consent – to ensure that you understand why we are asking you questions, and how we will use and store the answers you give to those questions. Click here to see a copy of the Consent Form that will be used. (EMBED LINK TO PDF DOCUMENT HERE) If you have any questions, or if you would like to take part in this evaluation, please contact: SASSresearch@soton.ac.uk SAFE BROWSING TIPS Domestic abuse is not just violence and often includes controlling behaviour. If you are scared your partner will find out you’ve been here, here’s how you cover your tracks. How do I turn on private browsing on Google Chrome (incognito window)? Start Chrome and click the three dot icon in the top right corner of the screen. Click New Incognito Window and start browsing. You can press Ctrl + Shift + N to bring up a new incognito window without entering the Chrome settings menu. Before opening the browser, you can right click the Chrome icon, then select New Incognito window How do I enable InPrivate browsing in Microsoft Edge? Open Microsoft Edge, and click on the three Dots at the top right corner of the browser Window. Now click on New InPrivate window. You can press Ctrl + Shift + P to bring up a new InPrivate window without entering the settings menu. Before opening the browser, you can right click the Edge icon, then select New InPrivate window How do I enable InPrivate browsing in Internet Explorer? Open Internet Explorer, and click on the Tools icon at the top right corner of the browser Window. Now click on Safety then InPrivate Browsing. You can press Ctrl + Shift + P to bring up a new InPrivate window without entering the settings menu. Before opening the browser, you can right click the Edge icon, then select New InPrivate window How do I turn on private browsing in Mozilla Firefox? Click or tap the Open menu button in the top right side of the browser window. It has the shape of three parallel lines. Then, choose New Private Window. You can press Ctrl + Shift + P to bring up a New Private Window without entering the settings menu. How do I turn on private browsing in Safari on an iPhone? Tap to open Safari, then tap the 2 overlaid squares in the bottom right corner, then tap Private to enable Private Browsing Mode and finally tap Done and start browsing. When finished be sure to tap the 2 overlaid squares again and then tap x on each page to clear the pages before finally tapping Private to go back to normal. How do I turn on private browsing on an Android phone? Tap to open Internet, then tap tabs in the bottom right corner, then tap Turn On Secret Mode and start browsing. When finished be sure to tap x on each page to clear the pages before finally tapping Turn Off Secret Mode to go back to normal. ​ Information from STOP DOMESTIC ABUSE - https://stopdomesticabuse.uk/cover-your-tracks ​

Guidance for publications As an NIHR researcher you are required to acknowledge NIHR ARC Wessex and inform ARC Wessex when you have submitted a publication. Notification should be sent to arcwessex@soton.ac.uk . ​ When acknowledging the NIHR, please use the relevant statement below ​ ARC Wessex funded projects This study is funded 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. ​ ARC Wessex adopted projects 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. ​ Academic Career Development Awards (Name) received(s) support from the NIHR Applied Research Collaboration ARC Wessex and funded through an {insert name of award e.g. NIHR ARC Wessex Internship/PhD fellowship, Post Doctoral Fellowship). The views expressed are those of the authors and not necessarily those of the NIHR, NHS or Department of Health and Social Care. ​ For individuals listed as co-funded ARC investigators and where the research output is linked to the ARC Wessex portfolio please use the following ​ 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. Download the Funded by NIHR logo Download

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SOCIAL CARE: Building capacity in social care through co-produced research and a research learning partnership between University of Portsmouth and Portsmouth City Council Background Social care is facing many challenges and, in a time where staff are stretched and resources are low, research can feel like a luxury rather than part of daily activities. Yet research is crucial for improving practice and finding innovative ways to overcome challenges. To increase capacity in social care research, academia and social care need to work together to understand each other and co-produce a programme that will fit with the workplace demands of social care and focuses on issues that hold meaning and value to those we are seeking to engage. The work that we co-produce will therefore lead to tangible practice change and/or a strengthening of the evidence for existing practice. The University of Portsmouth (UoP) and Portsmouth City Council (PCC) do not currently have a research learning partnership established, however our civic partnership agreement provides a strong impetus to build a learning partnership that will inspire, engage, and provide professional development for social care professionals in research, whilst providing academics with direct experience of co-producing research in complex public service contexts. Through this project we aim to develop such a research learning partnership. Contributors: Amy Drahota, Reader in Health & Social Care Evidence & Evaluation, University of Portsmouth Carole Fogg, Senior Research Fellow, University of Southampton Patricia Gilbert, Lecturer (Sociology), University of Portsmouth Patryk Jadzinski, Senior Lecturer (Paramedics), University of Portsmouth Gail Mann, Research Development Lead, Portsmouth City Council Nils Niederstrasser, Senior Lecturer (Psychology), University of Portsmouth Lucy Porteous, Senior Lecturer (Social Work), University of Portsmouth Clare Rachwal, Deputy Head of Service, Adult Social Care, Portsmouth City Council Jenny Roddis, Associate Head (Research & Innovation), University of Portsmouth Sharon Smith, Principal Social Worker, Adult Social Care, Portsmouth City Council Annabel Tremlett, Senior Lecturer (Social Work), University of Portsmouth Aims and Objectives Our overall aim is to build research capacity in social care through establishing a research learning partnership between the University of Portsmouth (UoP) and Portsmouth City Council (PCC) adult social care team, the public and other key partners, and develop co-produced research relevant to PCC social care practice and national issues. We will achieve this via the following four objectives: A. To establish a research learning partnership for social care between UoP and PCC which will provide learning opportunities for both partners and their associated stakeholders around the development, design, and delivery of research. B. To identify and prioritise research topics for development for further grant funding opportunities, within social care and also in collaboration with other health and care delivery partners. C. To undertake preliminary research activities (e.g. a systematic review, public involvement activities, and potential data gathering) on a prioritised topic in adult social care, which will underpin a funding application for further primary research. D. To develop guidance on increasing capacity in social care research via co-production in collaboration with wider ARC Wessex social care research partnerships. Research Plan / Methods We will begin this project with a three-month exploratory process with social care teams, that will be about relationship-building and working together to devise a programme of activities that will meet the needs of social care, establish what a learning partnership would look like, and how this will fit with the expertise of academics. We envisage that we will co-develop some activities that centre around relevant topic(s) of importance to social care, and that the academics can support based on their expertise. Our focus will be adult social care, to tie in with the School of Health & Care Professions’ thematic strength in older adults, PCC’s adult social care team, and the ‘ageing and dementia’ research area of ARC Wessex. The project will involve a researcher-in-residence, employed by UoP but embedded within PCC, to work alongside adult social workers and build a culture of joint research across the organisations. We will be seeking to integrate research into current processes, for example through senior social worker team meetings and practice support forums that would be happening anyway. Throughout the project we will be seeking to establish a legacy of ongoing work and practice, through the development of funding applications for future projects and the development of a community of practice that will outlive the duration of the funding, nurture an affinity for research, and help demonstrate the value of research to social care. Work packages: Our objectives will be met via the following four work packages: Developing research culture and collaborative working (objectives A and B). This work package will be about developing mechanisms for the organisations to learn from each other, and adding value to each party of working collaboratively. There are a number of tools and mechanisms through which we could promote this learning partnership, which we will explore and develop over the course of the project. Initially, this will comprise: Establishing visiting researchers from PCC to UoP, to provide colleagues in PCC with access to library resources, online resources, and internal seminars. Provide academic mentorship to support an internship application from PCC and an application to the research champion role, with ongoing mentorship for any successful applicants in these posts. This will involve working alongside PCC’s Research Development Lead (Dr. Gail Mann) and service leads to help identify and encourage suitable individuals, and connecting with wider support mechanisms (e.g. the Research Design Service) as appropriate. Develop a community of practice for wider stakeholder engagement. The shape of this will be developed during the initial engagement phase to determine how the group will interact and the process of engagement. It may involve for example: relationship building between researchers and practitioners, finding points of commonality/solidarity/shared purpose; sharing of research summaries to support practice-based issues; sharing how research has informed practice; sharing challenges faced in social work to develop new project ideas for future research; supporting our objective to identify and prioritise research topics that matter to practitioners for development for further grant funding opportunities, within social care and also in collaboration with other health and care delivery partners; identifying and tackling barriers to engagement in research. Utilising practice-based issues arising in adult social work to inform question development for students on the BSc Social Work programme, where they undertake a module on ‘Using Evidence and Research in Social Work’. This will help in the development of research-mindedness of social workers of the future, and provide feedback loops between academia and practice as part of a learning partnership. Students will need to identify and appraise evidence based on a research question as part of their assessment. At this stage in their studies, students will not have been on placement, and it presents a real opportunity to have pertinent questions exchanged with them, which could support the practice of colleagues at PCC. 2. Co-produced social care project (objective C) Our plan is to work with adult social workers to develop some research activities that they can hold a sense of ownership of, and appreciate the relevance of, to their practice. An example of the sort of topic this team could support could be around the delivery of social care packages and strength-based approaches to decision-making. This ties in with a national priority area that the James Lind Alliance identified in 2018: “ How are eligibility criteria applied to people with different types of needs and are the thresholds appropriate? What impact does this have on the care and support offered and/or early prevention? ”, and also work that the UoP team members have been involved in, demonstrating that older adults with social care packages are less likely to be transferred to hospital. The partnership would aim to assess evidence, and explore innovative solutions, for issues of national significance currently impacting both health and social care, such as those highlighted in the recent Age UK report “Why can’t I get care? Older people’s experience of care and support”. A research learning partnership could utilise expertise from both social care and academia, to generate shared learning, future collaborations on funding proposals, and impactful research. To make this project work, it is paramount that we first engage with our social care colleagues to design a project that will suit their needs. We will develop our research topic focus with consideration of what the other ARC Wessex capacity building partnerships are working on, to ensure our work is complementary to activities in the wider region. We anticipate our direction with be to: Undertake a systematic review to underpin a research proposal (future funding application) that is developed alongside practitioners over the course of the project. This project will be led by the embedded researcher who will work alongside PCC staff, who will have opportunities to contribute to, shape, and guide the project. Exploration of what data PCC currently hold on the chosen topic of focus and if/how this could be used to support a funding application and future research. 3. Collaborative research learning programme (objective A) This work package will link in with wider learning opportunities across the ARC Wessex (i.e. as is being proposed by Bournemouth University). We also propose to run our own series of social care seminars, which will be integrated into our current Health & Care Research Group online seminar series to provide opportunities for wider networking between the organisations. We aim to: Deliver a programme of seminars on putting evidence into practice to cover the topics of: (1) question formulation, (2) searching for evidence, (3) appraising evidence, (4) synthesising evidence, and (5) assessing the quality of cumulative evidence. These seminars will utilise the systematic review in progress (work package 2) as a worked example, and provide an opportunity for two-way exchange to further help shape the review as it develops, as well as train attendees in the process of the research. The seminar series will culminate in a seminar covering (6) the final review findings and discussion around implications for practice. Contribute to a series of workshops being delivered across the Wessex region (led by Bournemouth University) to share examples of social care research and encourage discussion around different research methods. We will contribute three workshops on the suggested topics of: A mixed methods evaluation of a service delivered by Age UK Portsmouth to reduce loneliness in older adults Using routine data to evaluate the influence of social care packages on hospital transfers - the interplay between health and social care. Using art and imagery to understand the lived experiences of marginalised groups (moving beyond research interviews) 4. Reflective practice and evaluation of process (objective D) This work package will be centred around drawing learning from our experiences of addressing our aims and objectives, to appraise the cultural ‘feel’ around the project and reflecting the experiences of the embedded researcher and practitioners who have participated in the project. Our activities will include: The embedded researcher will maintain a reflective journal of their journey (to include a log of how co-production has informed the shape of the project); We will incorporate feedback mechanisms throughout the project (e.g. via Padlet boards for online events), as well as tracking engagement with the various opportunities for interaction throughout the project; We will aim to track impacts arising (e.g. funding applications submitted, funding awards, examples of how research-informed practice); Working collaboratively with projects within the ARC Wessex to source and evaluate models for developing research capacity in social care to reflect on lessons learnt, and create guidance for co-producing research within social care.

Adolescent Resilience to OVercome Adversity: EmpoweRment and intervention development – the ROVER study Lead applicant: Anne-Sophie Darlington Co-applicants : Professor Graham Roberts , Professor Mary Barker , Dr Ivo Vassilev University of Southampton, Dr Catherine Hill Associate Professor in Child Health at the University of Southampton, Dr Jana Kreppner Associate Professor in Developmental Psychopathology within Psychology at the University of Southampton , Dr Luise Marino ​, Abigail Oakley ​ Project Summary: Mental health conditions and symptoms in children and young people are increasing. Children and young people (CYP) with a chronic physical health condition often report having mental health problems such as feelings of anxiety and depression. A lot of research has focused on risk – circumstances that make it more likely for young people to experience mental health problems. In this project we want to focus on resilience - the young person’s ability to use their strengths and support from family and friends to overcome challenges in their life. ​ Resilience has not often been a focus of support programmes for CYP with a physical condition. We would like to find out what experiences are common for young people living with physical health conditions, so that we can develop a support programme that applies across Child Health. We will use knowledge from these shared experiences to co-create the support programme with young people – called ‘tools for life’ (suggestion by CYP). We will also partner with national charities (partnerships have already been developed) who have worked with us before and who are very interested in supporting CYP around their mental health. The charity partners could help us to develop support components that are very specific to the condition (for example, fear of cancer coming back), which can be included in the overall support programme. Finally, work with young people has taught us that flexibility is very important: flexibility in when they access support, the way they access it and how it is offered to them. We will work together with young to shape this flexibility in support. The project will have four parts: ​ Part 1 – Finding out what might work: List successful support components from 15 existing summaries of the evidence (reviews of the literature) to date and a report from Wellcome (an independent global charitable foundation which focuses on research), and identify the support elements (e.g., building confidence) which work well, and are acceptable to young people. ​ Part 2 – Developing partnerships: Develop a partnership with local stakeholders (e.g., Paul Hughes and Laura Renishaw-Villier – Hub stakeholders; SolentMind, No Limits) and national charities (e.g., Children’s Cancer and Leukaemia Group, Kidney Care UK, Asthma UK). who can support the development of the support programme, both the general as disease-specific elements. We will hold several workshops with stakeholders to develop the partnership and agree on the goals of the partnership and ways to work together. ​ Part 3 – Developing the support programme: We will co-create (develop together with young people) the support programme– ‘tools for life’ - to increase resilience. We will focus on flexibility in the way the programme is offered to young people, and when young people access the programme, to suit their needs. This flexibility will make young people more likely to use the programme. ​ Part 4: Testing the support programme: We will test the support programme with 30 young people, to find out how many young people use the programme, if the programme is acceptable, how they use the programme, and how much they use the programme. We will also find out what the most important indicators of success are for the programme, such as young people experiencing less symptoms of anxiety and depression, and a better quality of life. Read all Mental Health Hub projects

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

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Role of patient-assessed functioning as a predictor of health service use in patients with long term mental health conditions Lead applicants: Prof David Baldwin, Prof Mari Carmen Portillo Co-applicants: Dr Leire Ambrosio, Dr Bethan Impey ​ Read project summary document (short summary) Read project summary document (long summary) ​ Project Summary: Treatments for patients with long term medical conditions are often disappointing in their effectiveness and acceptability in clinical practice. This is perhaps because they tend to be targeted at reducing troublesome symptoms rather than directed at improving everyday functioning. ​ We have previously shown that self-assessed functioning (using a self-report scale known as the PARADISE-24) was a better predictor of health service use than is anxiety and depressive symptom severity, among a group of patients attending a Mood Disorders Service in Southampton. That research was undertaken with patients with a primary diagnosis of an anxiety or depressive disorder, and we are now interested in conducting a similar study of functioning in patients with other long-term health conditions in which anxiety and depressive symptoms are common, to understand if functioning will also be a useful predictor of health service use in these conditions. ​ Hearing function is not one of the measures included within PARADISE-24, however, hearing loss is associated with increased likelihood of anxiety and depression and increased use of health services and our PPIE representatives highlighted sensory function as an important measure. We will therefore also include a self-report measure of hearing difficulties as well as some further questions about hearing function to see whether they also are useful in predicting use of health services in our cohorts. ​ The long-term conditions we are going to study are gambling disorder, alcohol use disorder, ‘long-covid’ and hearing loss (those attending the University of Southampton Auditory Implant Service, USAIS). We have chosen these populations since anxiety and depression are common in all of them, and because these populations are available to us (large convenience samples). These groups would have a variety of functional symptoms: for example, memory problems might be more likely in those with alcohol use disorder, attention deficit might be common in those with gambling disorder, sleep and energy problems common in those rehabilitating after Covid-19, and independence might be relevant for those with hearing loss in later life (in addition to the hearing loss itself). ​ Participation in the research should not be too onerous for patients. Clinical diagnoses will be identified from the medical records, and participants will report the severity of anxiety and depressive symptoms and other symptoms associated with the condition and whether they have hearing difficulties and will report on their everyday functioning using the PARADISE-24 scale at Baseline. They will be followed-up twice (at three and six months after the Baseline assessment), with further queries relating to symptom severity and functioning. The use of health services will be ascertained by self-report and through inspection of electronic health records. ​ The findings from this study could influence clinical practice. It should help to better understand the burden of illness and could ascertain the relative importance of symptom severity and degree of functioning in predicting health service use by groups of patients with a range of long-term conditions. It could therefore result in more targeted delivery of health and social care interventions, to both improve the patient’s quality of life and reduce their need for health service use. It would also contribute to addressing the objectives of the National Institute of Health Research Applied Research Collaborative Mental Health Infrastructure programme. Read all Mental Health Hub projects