Public Health interventions
Welcome to the community e-newsletter for the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) bringing you the latest news and interesting developments from across the thirteen collaborations and the health service research community. The NIHR CLAHRCs are funded by the NIHR and form part of the NIHR infrastructure. This newsletter looks at the work NIHR CLAHRCs are doing around Public Health interventions.
Find out more about the CLAHRC Partnership Programme at www.clahrcpp.co.uk.
NIHR CLARHC Community e-newsletter- Public Health interventions
Public Health Intervention supported by design and technology
Between 2012 and 2014 the NIHR CLAHRC South Yorkshire User-centred Healthcare Design (UCHD) Theme worked with Doncaster Public Health to support and mentor a design led process specifically to increase exercise in the local population through the use of an existing asset, namely a large man-made lake. This project was called Better Services by Design and you can find out more here. The public health programme was called “In good shape: Learning and good practice from the early health and wellbeing peer challenges”.
On Saturday 9 July 2016, the idea was implemented in Doncaster lakeside, with a series of mileposts with QR (Quick Response) codes being installed around the lake. These will allow different walking trails for different groups of people (family treasure trail, heritage guided walks). Evaluation as to the impact and further development of these will take place over the next few months by Doncaster Public Health.
Making Every Contact Count: Development, delivery and evaluation of Sheffield City Council’s ‘Healthy Conversations’ Training Programme. NIHR CLAHRC Yorkshire & Humber
The evaluation of this innovative Healthy Conversations (HC) training programme is funded by Sheffield Hospitals Charity. This co-produced programme is delivered to staff in Sheffield City Council’s Communities Portfolio and aims to increase staff skills and confidence to offer targeted support to vulnerable communities or population groups.
Development was influenced by collaboration at regional level and tailored to account for the diverse range of staff roles. Training began in June 2015 and has been delivered to over 230 staff to date with over 100 participating in the evaluation.
In addition to focusing on the impact of staff health and well-being, interim findings reveal which customer groups may be more responsive to receive this type of intervention and how HC training should be targeted towards those staff teams who have the opportunity to develop relationships with individuals in their daily role, rather than those who have less frequent contact with customers. http://bit.ly/29jgyhK
For more information about this project http://clahrc-yh.nihr.ac.uk/our-themes/public-health-and-inequalities or contact Dr Annette Haywood email@example.com.
Improving care for CKD patients and reducing NHS costs. NIHR CLAHRC Greater Manchester
Using the IMPAKT™ software tool, GP practices are able to identify patients with early stage chronic kidney disease (CKD) and their risk factors for progression. IMPAKT™ grew from clinical interest in how to identify early stages of CKD and was developed into a package to support improved diagnosis and care in primary care. Identifying and managing CKD at its early stages reduces the risk of it progressing and of patients having heart attacks and strokes. Excess cardiovascular disease related to CKD is thought to cost the NHS in England £175 million every year. With end stage CKD growing at an estimated 6% each year, diagnosing and treating CKD effectively as early as possible is hugely important. Early identification of CKD allows for early treatment, which reduces the risk of cardiovascular disease and has the potential to reduce costs. Read more.
Improving outcomes for people with first episode psychosis: cross-CLAHRC working from East of England, West Midlands, and Oxford. NIHR CLAHRC East of England
First episode psychosis affects over 8000 people in England each year; most of them are teenagers and young adults on the cusp of independent lives. The Early Intervention in Psychosis Access and Waiting Time Standard was introduced by NHS England in April 2016: half or more of all patients with first episode psychosis must be assessed and taken on by a specialist early intervention in psychosis service within two weeks of referral. This is the first access and waiting time standard introduced in mental health.
Young people who present with first psychotic symptoms experience long treatment delays due to bottlenecks within specialist mental health services. Even when people with psychosis are seen by mental health services there can be delays during which their psychosis is untreated by antipsychotic medication.
NIHR CLAHRC East of England have developed the online PsyMaptic prediction tool (www.psymaptic.org), derived from epidemiological studies in London, Bristol, Nottingham and East Anglia. PsyMaptic provides psychosis incidence prediction for each locality across England and is the basis of Public Health England’s www.Fingertips.phe.org.uk health indicators gazetteer entry on first episode psychosis.
PsyMaptic and Fingertips have been included in the NHS England Access and Waiting Time Standard Implementation Guide which has directly informed commissioning and workforce development plans across England and Health Education England is currently using these predictions in their Workforce Planning Guidance.
This links closely with work completed by CLAHRC West Midlands who showed that treatment delay could be reduced using a youth care pathway within adult services for those up to 25yrs; and CLAHRC Oxford, who in collaboration with Janssen Healthcare Innovation undertook a health economic analysis of cost savings associated with EIP services.
For more information, please visit CLAHRC East of England website.
Asthma and Wellbeing
CLAHRC Northwest London Asthma and Wellbeing project pilots a self-guided treatment resource for patients with asthma and anxiety or low mood. Asthma is the most common long term condition in the UK, and has a high co-morbid prevalence with anxiety. Anxiety and low mood in asthma patients contribute significantly to reduced quality of life and treatment compliance by patients with asthma. The interaction of asthma and anxiety has a negative effect. It is estimated that up to 75% of hospital admissions and up to 90% of deaths are preventable.
The Asthma and Wellbeing project seeks to develop an integrated care pathway between physical and mental health services; and an integrated treatment resource for patients to improve their self-management of asthma and recover from common mental health difficulties.
Read more here: https://clahrcnwlblog.wordpress.com/
CLAHRC Oxford: Preventing obesity in pregnancy study (POPS2)
Pregnancy is a critical period for the development of obesity in women, which can lead to preventable conditions such as gestational diabetes, pre-eclampsia and complications with delivery.
Weight gained during pregnancy which is not lost afterwards could lead to women becoming obese or in an unhealthy weight state following pregnancy. Despite calls for weight management to be part of routine antenatal care, there is little evidence on how best to achieve this.
The POPS2 trial, part of NIHR CLAHRC Oxford’s patient self-management of chronic disease’ theme, is looking at whether regular weighing and feedback by community midwives can prevent excessive weight gain during pregnancy.
This multi-centre trial is recruiting 490 women with low-risk pregnancies who receive community midwife care.
The aim is to develop an evidence base to offer this intervention to every pregnant woman at every contact by a community midwife, without making antenatal appointments significantly longer.
More information on the CLAHRC Oxford website.
CLAHRC Oxford: Optimising the management of blood pressure in pharmacies (OPTIMAP)
High blood pressure (hypertension) affects a third of all adults in the UK. Persistently high blood pressure increases the risk of heart disease and stroke.
With the workload of GPs thought to be nearing saturation point, alternative models of care are needed to ensure appropriate long-term management of hypertension in the community.
Community pharmacies are conveniently located sources of medication advice, and are accessible without appointment. Health economic data suggests that services provided in pharmacies can be delivered at lower costs to the NHS than if conducted by GPs or in secondary care.
The purpose of this research is to determine how pharmacists can provide a blood pressure management service in community pharmacies.
A mixed methods approach will be used to explore current practice during pharmacist-patient hypertension consultations, as well as to determine how pharmacy blood pressure compares with home or GP clinic readings. This work will inform a feasibility study, where a developed blood pressure service will be assessed in community pharmacies in Oxford.
This study could lead to better rates of blood pressure control, which is currently thought to be achieved in only 50% of diagnosed hypertensive patients.
CLAHRC Oxford: The Oxford Food and Activity Behaviours Study (OxFAB)
With more than half the UK population overweight, self-management of weight is the only strategy that can prevent avoidable morbidity and mortality that otherwise might occur. Around 13% of men and 24% of women are trying to lose weight at one time but little is known about the triggers for people to try to lose weight, the variety of methods they use, and how successful they are.
Understanding these would help us develop better public policies to support weight loss, help health professionals to aid weight loss more effectively, and lead to effective self-help programmes.
A group of 5-10,000 weight conscious adults from across the country were enrolled and followed via the internet with the aim of better understanding weight loss behaviour. Participants answered survey questions about their weight management behaviours and strategies using both a website and a mobile phone app.
The data collection phase of the study has now completed. Early results were shared with participants via an infographic, which also received an ‘Honourable mention’ at the University of Oxford’s OxTALENT awards.
The aim of the project is to use the findings to develop new interventions to test in future randomised trials to aid self-management of weight loss and to understand how health professionals might best support it.
More information here.
Review supports use of ‘precautionary principle’ in new alcohol in pregnancy guidelines
A review of existing studies on the effects of low-to-moderate alcohol consumption during pregnancy has found there is a lack of evidence to inform the new guidelines for expectant mothers about the effects of light drinking in pregnancy. The review, carried out by NIHR CLAHRC West and the MRC Integrative Epidemiology Unit, found that what little evidence does exist is poor quality.
This important public health question, of how much alcohol is actually ‘safe’ to consume during pregnancy, has been reviewed as part of the revised UK alcohol guidelines, published in January. Light drinking was defined in the previous guidance from 2012 as four UK units of alcohol a week or less. The guidelines development group, commissioned by the UK Chief Medical Officer, have adopted the ‘precautionary principle’, which means that, in the light of a lack of evidence either way, people should exercise caution and avoid alcohol during pregnancy.
Find out more on the CLAHRC West website
Evaluation of an SMS-based weight maintenance programme ‘Lighten Up PLUS’
A randomised controlled trial to evaluate the effectiveness of a text-based weight management programme was recently completed by Professor Kate Jolly at University of Birmingham (supported by pilot CLAHRC and CLAHRC West Midlands). Previous evidence produced by the same research group demonstrated that commercial sliming clubs, such as Weight Watchers and Slimming World, were more effective than ‘own grown’ programmes developed by General Practices and recommended that local practices disinvest in ‘own grown’ services in favour of commercially provided services . The Lighten Up PLUS study  recruited 380 participants, randomly assigned to receive a brief telephone call and leaflet of weight loss maintenance strategies (usual care); or usual care plus text intervention that encourage regular self-weighing. The results showed no significant difference in weight change between the intervention and usual care groups: participants in both study groups maintained weight loss in the short term, but regained weight over the longer term. The authors recommended further research is needed into how tele-health can support behaviour change, and future research should focus on providing personalised information about diet and/or physical activity, and setting weekly weight-related goals.
Visit www.clahrc-wm.nihr.ac.uk for more information.
1. Jolly,K., Lewis,A. and Beach, J. et al. (2011) Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity: Lighten Up randomised controlled trial. British Medical Journal. 3;343:d6500
2. Sidhu MS, Daley A, Jolly K. Evaluation of a text supported weight maintenance programme ‘ Lighten Up Plus’ following a weight reduction programme: randomised controlled trial. Int J Behav Nutr Phys Act. 2016. 13:19
Worcestershire County Council public health projects supported by CLAHRC WM research
Dr Gavin Rudge of the Research Methods theme is leading on a programme of work developed in partnership with Worcestershire County Council (WCC), in response to the specific health priorities of their local population. Projects include: Embedding public health in planning: Jenny Shepherd (a collaborator on this programme of work) drove the adoption of the Health Impact Assessment (HIA) process by facilitating workshops for WCC staff. Health and wellbeing is now considered in all policies at WCC to consider whether an HIA is required; Providing evidence for public health interventions: Researchers created a ‘Census Atlas’ to help target public health interventions and contribute to improved health and wellbeing outcomes in Worcestershire. The findings were presented to key groups at the local authority via two ‘health geography’ seminars; Domestic abuse needs assessment: researchers worked on a review, evaluation and assessment of domestic abuse services, systems and processes in WCC. This includes analysis of the extent of the problem in Worcestershire, impact on certain groups and the current service response. This evidence will help to inform the recommendations for future Worcestershire domestic abuse services.
Visit www.clahrc-wm.nihr.ac.uk for more information.
From Community resilience to Neighbourhood resilience – a systems approach to addressing the social determinants of health inequalities
The Public Health (PH) theme of CLAHRC North West Coast (NWC) is delivering a programme of action research that aims to develop greater resilience in 10 relatively disadvantaged areas and evaluate its impact on the social determinants of health and on health inequalities. This Neighbourhood Resilience programme is underpinned by a systems approach which sees resilience as emerging from the interactions between people who live in an area and the organisations that operate there – private, public or voluntary. Working with local authority partners the CLAHRC NWC PH theme has developed a resilience framework comprising four components – social cohesion, economic security, the quality of the living environment and community involvement in governance.
In each ‘Neighbourhood for Learning’, which range from Cumbria to Cheshire West and Chester, a local multi-sectoral group is working with residents to identify and implement evidence based initiatives to improve one or more of these aspects of resilience. In one Neighbourhood, for example, the focus is on improving the quality of privately rented accommodation; in another the focus is on improving social cohesion. A range of resources is being provided to support the work in the Neighbourhoods including a series of rapid evidence reviews (focused for example, on approaches to reduce debt/increase economic security and on selective licensing of private landlords).
A Community Research and Engagement Network (COREN) is being established to support residents in the 10 Neighbourhoods to get involved in the programme. An early COREN engagement initiative has involved running a Digital Photography competition in seven of the Neighbourhoods, encouraging residents to capture images of events, sites, people, places or things they like (and dislike) in their community. Winning photographs will be published in a Community Calendar specific to each Neighbourhood which can be used to record key local events including events linked to the Neighbourhood Resilience programme. The photographs are also contributing visual data to the process evaluation. http://www.clahrc-nwc.nihr.ac.uk/about-us/photocom.php
Evaluating rapid HIV testing in General Practice
A CLAHRC North Thames project evaluating HIV care in East London GP surgeries has found increased HIV testing and diagnosis in boroughs actively promoting sexual health screening. Researchers working across Hackney, Newham and Tower Hamlets are comparing different approaches to diagnosis and treatment of the disease, affecting 100,000 people in the UK and costing the NHS £750m in 2013.
A recent randomised trial demonstrated rapid HIV testing routinely offered as part of the New Patient Health Check led to increases in HIV testing and diagnosis in Hackney practices offering the rapid test, versus control practices. This also identified more people living with HIV during earlier stages of their infection, versus control practices. Investigation of whether other aspects of specialist HIV care could be integrated into GP services will follow.
Contact Dr Werner Leber firstname.lastname@example.org
Improving the healthcare response to domestic violence and abuse
Domestic Violence and Abuse (DVA) continues to be the biggest health risk to women under 45, presenting a major public health issue, as well as causing individual harm. An NIHR CLAHRC North Thames project evaluating IRIS (Identification and Referral to Improve Safety) – a programme of domestic violence training and education for general practice staff – has shown promising early results.
Working across practices in five North East London boroughs IRIS sees staff training delivered by clinicians alongside DVA “advocate-educators” to improve identification of women affected by abuse and provide a competent as well as compassionate healthcare response.
Initial results from three boroughs (Enfield, Camden and Islington – where IRIS has been implemented for between 1-2 years) show a significant and sustained increase in referrals from IRIS trained practices to the major DVA service provider in each area.
Exploring public health decision-making processes
The 2013 shift in responsibility for public health from the NHS to Local Authorities has implications for researchers as generators and synthesisers of evidence. A CLAHRC North Thames project is investigating how to better support the evidence needs of public health decision-makers, and whether standard research outputs (particularly systematic reviews) are fit for purpose in this new climate.
The researchers conducted a systematic review of literature to investigate evidence-use practice and drivers in public health decision-making. The review identified a high value placed on evidence that is reflective of local experiences, and the frequent deployment of “expert opinion” as a source of evidence in public health decision-making. The researchers are now seeking to further understand points in the decision-making process where research evidence (particularly systematic review evidence) is currently underutilised but could be tailored to better meet the needs of decision-makers.
Contact Dr Dylan Kneale D.Kneale@ioe.ac.uk
Project links housing and health expertise
A NIHR CLAHRC South West – supported project by the University of Exeter Medical School is investigating the effectiveness of a local organisation, Bay 6, in its work to bridge the gap between hospital discharges and housing for homeless people.
FRESH AIR international lung health research programme
Researchers from Plymouth University Peninsula Schools of Medicine and Dentistry, supported by NIHR PenCLAHRC, are instrumental in an international collaboration addressing the problem of non-communicable chronic lung disease in countries which are resource-poor. Public health initiatives are supported by rigorous research. More here.
HeLP – the Healthy Lifestyles Programme
NIHR PenCLAHRC has supported research teams from the University of Exeter Medical School and Plymouth University Peninsula Schools of Medicine and Dentistry to develop the Healthy Lifestyles (HeLP) programme. HeLP is an innovative school-based programme which uses drama-based activities to deliver healthy lifestyle messages to children in Year 5. Working with schools, parents and pupils, this intervention combines a variety of methods including drama sessions, sport and food-tasting to create a positive impact on children’s eating habits, activity levels and weight. More information here.
Let’s Prevent Diabetes
CLAHRC East Midlands wants to help primary care deliver a prevention pathway that will reduce the risk of developing diabetes. The pathway will identify people who are at high risk of type 2 diabetes and invite them to attend a lifestyle education programme based on helping people to eat a healthy diet and do more exercise. We will also ensure the programme is suitable for BME populations.
We believe our study will lead to a best practice approach for reducing the risk of type 2 diabetes. The East Midlands has some areas with very high prevalence of diabetes and it is predicted the prevalence will continue to increase. Improving people’s knowledge of diabetes risk and reducing prevalence will have substantial impacts on an individual’s health and quality of life as well as reducing NHS costs. This study will ensure that the programme is suitable for multi-ethnic communities and will develop a resource pack to aid implementation of the programme.
Find out more about the Let’s Prevent Diabetes study on pages 22-23
’Move to teach, move to learn’
The CLASS PAL (Physically Active Learning) project is working with schools in the East Midlands (CLAHRC East Midlands) to develop, implement and evaluate a programme that provides opportunities to break up sedentary time and, in turn, increase physical activity for year 5 students (aged 9-10 years). We are supporting teachers to use flexible adaptive components of the intervention within different contexts and settings rather than prescribing a standard ‘one size fits all’ approach.
Reducing sedentary time and increasing physical activity during the school day will hopefully produce positive changes in the health and wellbeing of students and lead to behaviour change that will be sustained into adulthood. In addition, this work will hopefully engage and mobilise a range of stakeholders to create feasible and sustainable changes to policy and practice which will lead to a decrease in the time pupils spend sitting in UK schools.
Reducing the risk of developing cardiovascular disease (3R Study)
Despite heart disease being a major cause of death in England many people do not know what the risk factors are and how to manage them. The team in CLAHRC East Midlands have developed a pragmatic structured education programme for people at high risk of heart disease. The Ready to Reduce Risk Programme is designed to support a healthy lifestyle and improve taking prescribed medicines. The effectiveness of the programme is being assessed in a randomised controlled trial in Northamptonshire.
The East Midlands experiences high rates of cardiovascular disease (CVD) and the large Black and Minority Ethnic communities in the region have higher than average rates. Developing and implementing an educational programme for people who are already at risk of CVD, will reduce the existing and future risks of CVD, improve patients’ health and reduce NHS costs.
Find out more about the 3R study on pages 8-9
Study finds low dead space syringes are acceptable to users
The NIHR CLAHRC West project examining whether new ‘low dead space’ syringes are acceptable to people who inject drugs as an alternative to traditional syringes, has found that users support use of the new syringe. Low dead space syringes could reduce the chance of spreading infections, if syringes are re-used.
Needle and syringe programmes supply sterile equipment to people who inject drugs to reduce the transmission of blood-borne viruses and other infections caused by sharing injecting equipment. However, sometimes needles and syringes still get re-used or shared. This increases the chance of spreading infections such as HIV and hepatitis C. The likelihood of spreading these infections is influenced by the type of equipment used to inject drugs.
This project was a collaboration with the NIHR Health Protection Research Unit in Evaluation of Interventions.