Welcome to the community e-newsletter for the NIHR CLAHRCs, bringing you news from across the thirteen collaborations and the health services research community. This issue showcases initiatives that the NIHR CLAHRCs are implementing in their regions to develop better health in the community, from projects to improve the lives of disadvantaged groups, campaigns to deliver healthy lifestyle messages, to training programmes to develop the workforce, increase capacity and more.
CLAHRC Director to present at international diabetes summit – What has been your experience of being involved in NIHR research? Take this 15-minute survey to give your opinion! – Check out this new podcast from CLAHRC GM and hear about their projects, concepts and ideas – CLAHRC NT is offering a workshop “Introduction to Evaluation“ aimed at staff who have limited experience of conducting service evaluations – This CLAHRC-supported study informed new NHS plans to trial very low calorie diets for the first time – CLAHRC West has a new Director – Download this brochure from CLAHRC YH, packed with examples of the local, national and international impact of their projects!
CLAHRC East Midlands
Four community events were organised in venues in Leicester city. As a result of these events, the need to carry out more awareness and to offer support targeting predominately African Caribbean men was identified. ‘Play Domino Talk Prostate’ was launched on the 10th March 2018, which attracted over 80 people and was televised by Central News. As a result of the ‘Play Domino Talk Prostate’ campaign, weekly group sessions have been ongoing since the 17th March with approximately 20 men attending every week. In addition, an awareness video has been made.
There is a growing evidence of research that Gypsies and Travellers (G&T) have significantly poorer health status, greater gap in life expectancy and significantly more self-reported symptoms of ill-health than other ethnic minorities. The project aims to enhance the understanding of those needs, identify gaps in primary research, and seek community feedback on the specific interventions that lead to reduction of health inequalities. For more information about the project, contact Barbara Czyznikowska on firstname.lastname@example.org.
The global initiative Cities Changing Diabetes was launched in response to the dramatic rise of diabetes within urban areas. As part of this programme, two exciting pilot schemes have been launched in Leicester involving the Centre for BME Health. Walking Cricket is a partnership project with Leicestershire County Cricket Club who provide coaches for these sessions. The scheme is open to over 50s and has proved very popular. Healthy Goals is the other project launched in September. This programme focuses on both empowering participants with healthy lifestyle education sessions as well as physical activity sessions led by coaches from LCFC.
CLAHRC East of England
Reviewing and developing the evidence-base for community end of life careAs an experienced Community Nurse, Ben Bowers explored the evidence-base during his CLAHRC Fellowship to help understand how effective and acceptable anticipatory prescribing is to all involved. Working with Dr Stephen Barclay, Dr Richella Ryan and Isla Kuhn at the Primary Care Unit of University of Cambridge, Ben systematically reviewed the published evidence.
This review, recently published in Palliative Medicine, shows that anticipatory prescribing is based largely on the beliefs of healthcare professionals that it will reassure patients and their families, effectively control symptoms and prevent hospital admissions. But these beliefs are based on insufficient evidence. The views and experiences of patients and their family carers have not been adequately investigated; neither has the clinical-effectiveness, cost-effectiveness or safety of anticipatory prescribing. Ben’s NIHR School for Primary Care Research PhD Studentship, researching community anticipatory prescribing practice and patient and family carer views, will help address some knowledge gaps and improve patient-centred care in the community.
CLAHRC Greater Manchester
CLAHRC-GM identified that the original Greater Manchester Stroke Assessment Tool (GMSAT) needed further development for those living in care homes. In response, the toolkit was modified through collaboration with a group of professionals experienced in carrying out reviews. A mixed-methods evaluation study then explored the value, acceptability and feasibility of delivery of the modified GM-SAT in a care home setting. The toolkit has been further refined, and the Greater Manchester Stroke Assessment Tool- Version 2 (GM-SAT2) developed.
Developing NMAHPs research capability has the potential to improve patient care. This can be seen in the work of CLAHRC GM interns who are working in clinical practice and their project questions directly relate to current challenges within the NHS. The impact of their work is immediate. They select a topic, review the evidence, conduct a small scale evaluation, and implement the findings. In addition to research skills, staff also get time out to think and reflect on their work, the opportunity to meet colleagues from different fields, and work with research colleagues in their organisations and with researchers at local universities.
Improving Leg Ulcer Management In community Nursing and Podiatry (ILUMIN)The ILUMIN project aims to optimise the assessment and treatment of leg management in NHS community services, improving outcomes for patients through the implementation of as set of quality markers. The ILUMIN team has been working together to implement the plan through a co-design approach, to ensure that the project operates optimally in each location.
The PenCLAHRC team will synthesise and evaluate current evidence and practices for supporting children’s early learning in poverty and find the most effective ways to promote it through interventions, policy and practices. This will allow the team to identify strengths and weaknesses, and priorities for change. Using this information from the evidence review and consolation, PenCLAHRC will work with Save the Children and four Early Learning Communities to co-produce a toolkit for achieving while system change. Read more about the project here.
HeLP – the Healthy Lifestyles Programme
The Healthy Lifestyles Programme seeks to deliver healthy lifestyle messages to encourage children to seek their parents’ support and effect change within the family. Behavioural and weight status outcomes 18 and 24 months from the exploratory trial of the Programme showed consistency in the direction of effects, all in favour of HeLP, demonstrating ‘proof of concept’. Watch the video here, and read more about the project here.
The DE-STRESS project aims to examine how moralising narratives relating to individual responsibility and welfare entitlements influence the medicalisation of mental distress caused by material deprivation and social disadvantage. In particular the project will look at why and how people’s ability to cope with poverty-related issues has become increasingly pathologised, the impact of high level antidepressant prescribing on the health and wellbeing of low-income communities, and also identify good practices and alternative responses to mental distress. Watch the video here, and read more about the project here.
This study seeks to address the public health challenge of supporting members of the public to recognise and respond to possible suicidal intent in an unknown person in a public setting. Research undertaken will underpin the development of an educational campaign, which will include a leaflet (including an online version), and a script for a 90 minute face-to-face training session for staff who are likely to encounter vulnerable individuals. The team also have aspirations to develop the script for television, enabling greater audience reach. Read more about the project here.
The results from a mixed methods feasibility study to assess a paper-based guide for community-based people with Parkinson’s who fall and their caregivers are currently being analysed. The guide, titled ‘Steady Together’, aims to support the effective self-management of falls and was developed with people with Parkinson’s. Through interviews, participants discussed how the guide had increased their understanding of their symptoms, and how the guide acted as a facilitator to implement change. Many participants described how using the guide led to increased confidence in managing falls, and some reported reduced fear of falling arising from enhanced awareness of fall risk or adaptations that they had instigated. Participants suggested ways to further improve the guide. For more details, contact C.L.Owen@soton.ac.uk or look at the website of CLAHRC Wessex.
CLAHRC West Midlands
Research undertaken examining obesity risk in migrants and in minority ethnic groups in Coventry demonstrates the multitude of factors contributing to differences in vulnerability to, and prevalence of obesity in these groups compared with the white British population. The work included evidence synthesis, quantitative analysis of the Coventry National Child Measuring Programme data and qualitative work with the local population. Important factors identified include genetic and epi-genetic predisposition, as well as socio-economic factors, body size preferences and the difficulties of maintaining a healthy traditional diet and physical activity practices within the modern UK context.
To disseminate these findings and give the research a legacy of improving health in Coventry’s diverse local community, CLAHRC WM are planning a Community Café Event in February 2019. This will bring communities, individuals and groups together from a range of backgrounds and age groups to create a Coventry Food Initiative. The aim is to achieve a sense of community ‘belonging’ through cultural exchange of recipes- as well as giving participants the tools to improve the healthiness of the food they make and consume
CLAHRC Yorkshire and Humber
Located at Bradford Teaching Hospitals NHS FT, a new ambulatory care project for children and young people (ACE) has been running since 2017. Over 85% of referrals to ACE have been managed in the community whereas before they would have been seen and managed in hospital. The majority – nearly 60% of referrals – have come from primary care. There have been no adverse events and feedback has all been very positive. ACE has resulted in greater collaboration across community and secondary care services and has been possible because of the development of new clinical roles within nursing and medical teams. It has been the model to trial other innovative shared system wide clinical pathways. It is hoped that the service will be replicated in other areas.
Researchers at CLAHRC YH’s Healthy Children and Healthy Families Theme have been leading a programme of research with Born in Bradford (BiB) to examine the growth and adiposity of children in Bradford. The National Child Measurement Programme (NCMP) provides height and weight data to monitor trends in Body Mass Index (BMI) in English primary schools, but evidence from the BiB cohort suggests that for a given BMI, South Asian children have greater total and central fat than White British children. This may be important to the higher risk of heart disease and diabetes seen in South Asian adults. Therefore, BiB have been working with school nurses to collect additional information such as skinfold thickness in Reception Year and Year 3. They have also been working to develop culturally appropriate interventions to prevent obesity and improve the health of children in Bradford, such as a trial of using standing desks in schools, and by working with Islamic Religious Settings.
Researchers from the Public Health and Inequalities (PHI) theme of NIHR CLAHRC YH have worked with Nat Wight (honorary GP Consultant) in developing a research network establishing pathways into prisons in order to undertake research. This is in recognition of the ingrained health inequalities of this cohort.This culminated in an inaugural network meeting. The findings were then presented at the Prison Health Symposium. have been invited to lead on the offender health theme of the national Contact, Help, Advice and Information Network (CHAIN) network.