Public Health - CLAHRC Community e-newsletter Issue 81

Published Date: 3 May 2019

Welcome to the community e-newsletter for the NIHR CLAHRCs, bringing you news from across the thirteen collaborations and the health services research community. 


East of England: EoE Director Professor Peter Jones on BBC newsbeat “There isn't a childhood and then an adulthood. People are on a pathway” of brain development. Peninsular: New Exeter Medical School research, supported by PenCLAHRC and the Wellcome Trust, has found a link between school absence and anxiety. South London: Plenary speakers announced for our 2nd implementation science research conference: advancing the science of scaling up (18 July 2019). Submit your abstract by 15 April! West: Launch of 'Overcoming Barriers: Autism in the Somali community', a short film about the experiences of Somali families affected by autism, on 3 April. West Midlands: Publication of Systematic Review on the communication of cancer screening results, by Sian Williamson, Phd Student. 

CLAHRC East of England

Detecting, preventing and addressing malnutrition in the community
In the UK over 1 million people aged 65+ are malnourished or at risk of becoming malnourished. Malnutrition is linked with higher rates of hospitalisation, problems with recovery and longer-term co-morbidities. During her CLAHRC EoE Fellowship, Michelle Dewar; a dietitian with Hertfordshire Independent Living Service, analysed data on Meals on Wheels (MoW) clients. The analysis shows that 44% of MoW clients are at medium or high risk of malnutrition. Three quarters of MoW clients are also frail and live alone. Only a minority of MoW clients live in socio-economically deprived neighbourhoods such as Stevenage, which raises questions about access to preventative services.
Michelle’s analysis, supervised by Dr Angela Dickinson and Nigel Smeeton in CRIPACC at the University of Hertfordshire helps fill gaps in knowledge about malnutrition and informs an ongoing programme of prevention and implementation research in the East of England.

Dementia Friendly Communities
DEMCOM is a national evaluation of dementia friendly communities (DFCs) funded by DH Policy Research Programme. The project has benefited from the ongoing support by CLAHRC EoE, with links to universities and PPI groups in the region. The study is looking at what needs to be in place for a community to become dementia friendly; how to measure their impact on people affected by dementia and the wider social benefits of different approaches.
DFCs are perceived as effective approaches by which people affected by dementia can remain active, engaged and valued members of society. The study is expected to inform what the attributes of successful DFCs are, and how the underlying rationale and contextual factors contribute to their success. The goal is to provide an evidence informed evaluation framework to describe potential benefits of supporting people living with dementia and economic benefits of becoming dementia friendly to those involved in DFCs.

CLAHRC East Midlands

Our research is shaping falls prevention strategy nationally
Health bosses across the country will soon have “no excuses” not to roll out programmes to reduce the risk of older people falling after a new resource was developed in Nottingham, according to a leading expert.
The city has been at the forefront of research to help embed strength and balance exercise training to prevent falls, which are the leading cause of unintentional injury in older people. A team of researchers at the University of Nottingham have been working on ways to increase the availability of such programmes.
A toolkit has been developed to enable commissioners and providers to implement the Falls Management Exercise (FaME) programme, which includes balance, endurance and strength exercises. A study in 2014 showed that FaME increased physical activity levels and significantly reduced falls by 26 per cent in the over 65s. 
Read more

Record-breaking recruitment for prison study
A study funded by NIHR CLAHRC East Midlands into the cardiovascular (CVD) health of prisoners has become the largest piece of research to take place in prison in Europe after recruiting 1,200 inmates. Prisoners have high levels of morbidity, with more than 30% of all deaths in custody occurring due to CVD. However, preventative approaches to reduce avoidable mortality in these settings are poorly researched.
Community CVD risk assessment programmes have been rolled out in prisons with limited success and crucially evidence is unavailable on whether high levels of anxiety and depression in prisoners may further challenge uptake of effective health interventions. In response, this research, a non-cohort, prevalence study, has been collecting healthcheck data, including assessments of anxiety and depression.
Read more

CLAHRC North Thames

Investigating the impact of London’s Ultra Low Emission Zone (ULEZ) on children’s physical activity and weight
new CLAHRC North Thames study will measure how London’s new Ultra Low Emission Zone (ULEZ) affects primary school children's physical activity and health. Inactivity and obesity among young people has risen sharply in recent decades - both are distributed unevenly across the socioeconomic spectrum, creating a powerful lever to widen further health inequalities in later life.
Interventions to increase activity and address obesity have focused on parental support and education, changes to school’s curricula and micro-environment for physical activity and nutrition.  Little work has been done to investigate the impact of a system-wide change to the physical environment, such as ULEZ, on children’s activity and obesity.
A collaboration between four CLAHRCs and a number of research bodies will address the impact of this environmental improvement.
Contact Professor Chris Griffiths

Welfare advice co-located with primary care
Following a CLAHRC North Thames Welfare Hubs Study investigating the impact of co-locating welfare advice with primary care we have disseminated and built on the findings. 
A NIHR School for Public Health Research/CLAHRC funded studentship investigated the integration of socio-legal advice and health services, informing the implementation of such services in different healthcare settings.
We fed into the Ministry of Justice strategy in response to the Post Implementation Review of changes made to controlling civil litigation costs under LASPO Part 2. This identified a need for evidence on the benefits of co-locating legal advice services in GP settings. We shared findings with Ministry of Justice Parliamentary Under Secretary of State Lucy Frazer MP during her visit to the UCL Integrated Legal Advice Clinic. We responded to the Healthy London Partnership social prescribing consultation on the incorporation of socio-legal advice.
Contact Dr Charlotte Woodhead

CLAHRC North West Coast

Key global document features CLAHRC NWC community work 
“Health 2020 priority area four: creating supportive environments and resilient communities A compendium of inspirational examples”, compiled by the World Health Organization (Regional Office for Europe), features the CLAHRC NWC Neighbourhood Resilience Programme. The resilience programme is based on a network of 10 relatively disadvantaged neighbourhoods for learning and it aims to enhance resilience in these neighbourhoods by using evidence from research alongside the experiential knowledge of the people who live and work there to address upstream social, economic and/or environmental drivers of health inequalities.  
The compendium provides inspirational examples of building resilience at individual, community and system levels. “Supporting local systems to tackle the social determinants of health inequalities”, from CLAHRC NWC, features on Page 123 of the document.

Community research project shines a spotlight on social isolation 
A booklet has been published as part of a CLAHRC NWC community research project to highlight the issue of social isolation. During 2018 a number of residents in Haslingden, Rising Bridge and Acre (Lancashire) came together with university researchers and community organisations to investigate how friends and neighbours connect with each other, as part of the CLAHRC NWCs Neighbourhood Resilience Programme (Public Health Theme).
The findings of this work have been published in a 24-page graphic art booklet called “What’s Your Story” - illustrated by artist Len Grant. The booklet contains interviews with residents who give their experiences of loneliness and directs people to community groups and organisations that can help alleviate the problem. Those participating, known as ‘Resident Advisors’, were questioned about their experiences of living in Haslingden and nearby.

CLAHRC North West London

Building future leaders: Integrating Quality Improvement in a Public Health Masters Programme
The 2018/2019 ‘Quality Improvement in Healthcare’ module led by Dr Tom Woodcock and Dr Mable Nakubulwa forms part of the Health Services and Systems stream on the Master of Public Health at Imperial College London. This 10-week long module has been developed by the CLAHRC NWL team, whose work involves facilitating the translation research evidence into practice to benefit patients within the NHS.
Introduced in 2017, under the leadership of Dr Catherine French and Dr Julie Reed, the module introduces students to the complexities of improving healthcare, supporting them to develop an understanding of Quality Improvement (QI) and how academic research can impact on the reality of healthcare. CLAHRC NWL has supported and supervised research projects, with many students going-on to work in QI practice. They take with them the skills and knowledge from the MPH as they contribute to efforts to improve healthcare for populations across the globe.
Read more


Diet replacements for weight loss
CLAHRC Oxford supported work shows that replacing meals with a diet of soups, shakes and bars starting at 810 calories per day and, importantly, alongside regular sessions with a counsellor is a safe and clinically effective way to treat obesity in primary care.
The randomised controlled trial involved 278 adults in Oxfordshire who were substantially overweight and interested in losing weight. Participants were either offered a referral to a low energy total diet replacement (TDR) programme for 24 weeks or were enrolled into their GP practice’s weight management programme, including advice and support to lose weight from a practice nurse.
 After 12 months, participants on the TDR programme had lost on average 10.7kg (1 stone, 9lb) which was 7.2kg (1 stone, 1 lb) more than those enrolled into the GP practice programme. They also showed greater reductions in their risk of developing heart disease, stroke and diabetes.
Read more

Personalised feedback on your supermarket food shop’s nutrition. 
The foods we eat can have strong effect on our health, not just weight but also your risk for things like heart attacks and strokes. Making simple changes to your diet could help reduce this risk, without having to drastically impact your lifestyle. Most supermarkets collect information on people's purchasing behaviours using loyalty cards, allowing purchases to be tracked, and the nutritional content of the food people buy to be analysed.
CLAHRC Oxford is working with a major UK supermarket to use this data to deliver personalised nutrition advice and feedback and, importantly, suggest appropriate healthier alternatives to the foods people enjoy. This project focuses on helping people with high cholesterol levels – putting the at a higher risk of some cardiovascular diseases – to make healthier food purchasing choices.
Read more


HSMA Programme projects increases Operational Research in health services - a video
PenCLAHRC’s Operational Research team, PenCHORD, have released a video detailing projects the Health Service Modelling Associates (HSMA) Programme have undertaken this year. It features simulation modelling to improve the outcomes for patients with glaucoma at Torbay Hospital and to tackle a high rate of surgical cancellations at Derriford Hospital.The is a joint initiative between PenCHORD and the South West Academic Health Science Network. Working directly with staff from NHS organisations in Devon, Cornwall and Somerset, it aims to support the increased use of Operational Research within health service development and decision making. Each year the Associates, released for one day a week from their substantive roles, are given training, a mentor and day release to undertake advanced modelling, simulation and analysis work on a research project. Dr Daniel Chalk, who leads the scheme, considers the HSMA to ‘represent the future of operational research and decision making in the NHS.’
Read more and watch the film

Delivering and evaluating new social prescription schemes in Plymouth and Cornwall
PenCLAHRC team have worked in collaboration with Volunteer Cornwall, the AHSNCornwall Public Health and the Wolseley Trust, to develop successful bids for funding to deliver new social prescription schemes in Plymouth and Cornwall. Grants have been awarded by the Department of Health and Social Care to include an allocation for evaluation work, conducted by a Researcher-in-Residence, alongside the schemes’ delivery. Evaluation work will help services refine delivery throughout the programme across the two sites for 2 years from early 2019 and will generate reports and events to discuss and champion social prescribing in the South West.
Two further projects will run concurrently; ‘Effective mechanisms for Social prescribing’ - a realist review to unpack uncertainties relating to methods of social prescription referral, and ‘Nature on Prescription’, a nature-based intervention being developed for people with, or at risk of, common mental health conditions.
Read more

CLAHRC South London

Addressing resistance to vaccination in Europe: a case study in state–society relations
Following recent outbreaks of diseases such as measles in Europe, policymakers and public health practitioners are seeking new strategies to address parental resistance to vaccines and to increase immunisation rates. However, identifying effective strategies that will not further alienate vaccination sceptics raises challenges that go to the heart of relations between the state and society. Political scientist Dr Katharina Kieslich, who until recently was based within the public health theme at CLAHRC South London, has examined how the problem can be explained from a political science perspective. Dr Kieslich argues that policymakers need to pay closer attention to individual reasons why parents are hesitant about vaccinating their children to design more effective policies.
Read more


Preventing childhood obesity: updating the Cochrane Review 
The CLAHRC West evidence team are working with the University of Durham on an update to the Cochrane systematic review of interventions for preventing obesity in children. Obesity prevention is an international public health priority. More children are becoming overweight and obese worldwide, which can lead to health problems, as well as potentially affecting them psychologically and socially. Overweight children are likely to remain overweight as adults and continue to experience poor physical and mental health.
There are many studies aimed at preventing obesity in children. The authors of the current Cochrane systematic review, which was up to date in 2011, screened more than 27,000 titles and abstracts and included 55 studies. Up to 4,000 papers are published every year on this topic, so reviewing this vast amount of literature is a significant piece of work.
Read more

How Do You Move? Improving the communication of the national physical activity guidelines
The UK Chief Medical Officers (CMO) are due to publish new guidelines on physical activity in 2019. Based on a comprehensive review of the latest research, they will recommend how much physical activity we should do and what types most benefit our health.
In the past, physical activity guidelines have been tricky to understand and difficult to follow. A new CLAHRC West project alongside collaborators Knowle West Media Centre (KWMC) will show how professionals can make them more meaningful and useful for members of the public.
Read more

CLAHRC West Midlands

POSTBOX study will look for important patterns in breast screening data from over 10million women
We have been screening women for breast cancer in England since 1988. This involves offering women mammograms (x-rays) which NHS experts examine to spot signs of cancer. A review of breast screening in the UK in 2012 led by Sir Michael Marmot concluded that breast cancer screening saves lives, but also causes harm through overdiagnosis and false positive results.
The POSTBOX study, led by Sian Taylor-Phillips, brings together data for over 10 million women screened in the English NHS Breast Screening Programme, with records about whether they developed breast cancer, and what happened to them. They will look at differences in how the women were screened, and see if there are any patterns suggesting that some ways of doing screening are better than others. The study is funded by the NIHR, and has ethical approvals from the NHS and approvals from the Office for data release.
Read more

Public engagement project on childhood obesity working with ethnic groups in Coventry
Marie Murphy undertook a public engagement project to disseminate the findings of her PhD research into childhood obesity across ethnic groups in Coventry.  The funding allowed Marie to host a community engagement session at Arabian Bites, a social enterprise café in Coventry staffed by refugees from Syria and Iraq. The session aimed to bring local food researchers and community food practitioners together.
Attendees were given a set of quotes taken directly from Marie’s qualitative research with families, to prompt discussion around three themes: what influences the food families eat; how can food help families to lead healthier and happier lives; and how does food connect us to others? This provided an opportunity to gain alternative perspectives on what the quotes mean (as a way of sense-checking Marie’s interpretations), and enabled the group to begin a conversation on how we can collectively support families to lead healthier lives through food.

CLAHRC Yorkshire and Humber

Reporting the key aspects of our Health inequalities activity.
The NIHR CLAHRC YH, through the work of Professor Kate Pickett has had three goals, namely to: 

  • identify key evidence gaps that can be bridged using regional expertise
  • support a programme of research to generate evidence for ‘what works, for whom and how’, and to identify groups at higher risk of health problems
  • on this basis, develop interventions designed to change the way people behave, to increase the uptake of support, and to reduce the risk of chronic disease, both regionally and nationally.

As we move towards the end of the CLAHRC we have produced a summary report of the key aspects of our Health inequalities activity.

New public health partnerships in research
The University of Huddersfield has begun a new partnership within NIHR CLAHRC Yorkshire and Humber with the University of Sheffield Public Health group.  
The team will work together to analyse health and lifestyle information from over seventy-three thousand people across the Yorkshire and Humber region. This information was collected and is held as part of a regional, longitudinal health study known as the Yorkshire Health Study.
The team is planning to involve members of the public, service users and health and social care professionals to explore how this information can be used to design future health and social care services. 
Contact Annette Haywood