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8dc1e114-6eb5-464b-a8c0-3feeadb70748 ADOPTED: Understanding how and why live-in care packages are arranged and sustained, when dementia is the primary support need: A mixed methods study. Lead: Professor Ruth Bartlett, Health Sciences, University of Southampton. Team: Dr Laura Cole, University of West London. Mr Terry Clark, Southampton City Council. Professor Joanna Thompson-Coon and Mrs Morwenna Rogers from NIHR Applied Research Collaboration South West Peninsula (PenARC). Dr Catherine Henderson, on School of Economics & Political Science. Dr Karen Harrison Dening, Dementia UK. Dr Stefan Brown, Royal Holloway, University of London. Mr George Rook, Public and Patient Contributor, Alzheimer's Society. Ms Aimee Day, Public and Patient Contributor. Ms Linda Hammond, Professor Anne Sophie Darlington and Ms Kathleen Curry, Health Sciences, University of Southampton Start: 01/01/2025 End: 30/06/2027 Summary Our research aims to understand how and why live-in care packages are arranged and sustained in England, when dementia is the primary support need, and to describe the nature of this market (e.g., size and cost). Dementia is a disability affecting hundreds of thousands of people in England. A person with dementia has difficulty with thinking and remembering and this will affect their ability to do everyday tasks such as getting dressed, eating, and going out. A person with dementia will eventually need round-the-clock care. Many people move to a care home when they require help all the time. However, other options are available. One alternative for people with enough living space is to organise a live-in carer; this is when a paid carer moves into (rather than visits) a person’s home to provide support. Searching the internet will bring up lots of home-care providers in England that offer this service. However, it is a relatively ‘hidden market’–there is no information or guidance about this form of homecare on government websites, and all the research about live-in care has been done overseas. Research is needed so people in England know more about this option and can make informed choices about their long-term care. DESIGN & METHODS First we will review previous research to check what is already known and identify the main gaps and issues. Then we will survey all the 42 integrated care boards in England about the live-in care packages they arrange and/or fund for people with dementia. We will also survey all the homecare agencies that provide live-in care listed on the CQC /care regulator website (142) to find out about funding arrangements and other issues like staff training. To learn about the arrangement in detail, we will recruit ten households where a live in carer is employed. In each we will ask the person with dementia and live-in carer to keep a photo diary of their everyday activities for two blocks of seven days. Asking people to keep a photo diary at two separate intervals will provide information about any changes in the arrangement, and we will be able to actually see how it works. We will interview the person with dementia and live-in carer together, before and after each block of diary-keeping. We will conduct separate interviews with a family member and the person’s dementia care coordinator (e.g., a social worker or nurse). These interviews will take place in person, online or by phone. We will create a timeline to show when, how, and why the package was arranged based on these interviews. PATIENT & PUBLIC INVOLVEMENT The research team includes a person with lived experience of dementia (Rook) who will lead the PPI work with support from an independent dementia advocate (Day). It also includes the research lead for a national charity (Harrison Dening/Dementia UK) and a purchaser of care services (Clarke). DISSEMINATION Our findings will be published in an information resource and accompanying video that we will co-create with individuals and families with dementia and make available on the Dementia UK website. We will launch the resource at a Community Conference about live-in care that we will

283829ae-0e8e-40ad-96e6-9c01fa950327 COMPLETED SOCIAL CARE: Local Authority Adult Social Care Recruitment and Retention research project (BCP/Dorset) Lead: Dr Andy Pulman Post Doctoral Researcher and Professor Lee-Ann Fenge Contact: apulman@bournemouth.ac.uk Background Within the Wessex region, we have been working to support the development of social care research over the past few years. In 2022, we completed a year-long study examining social care research enablers and barriers which might prevent or limit a positive research environment for practitioners ( Pulman and Fenge, 2023 ). This built the foundation for four projects across Wessex – funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) Wessex – which aimed to build research partnerships across local authorities (LAs) and universities in the region. As part of these projects, separate funding was available to support research champions embedded within local authorities, to support activities such as lunch time research discussions, journal clubs and the development of practitioner focused research. To encourage buy-in from the LAs we developed research in partnership with them to respond to key priority areas. Aims The aims of our project were: •Explore local recruitment and retention issues in adult social care and adult social work •Helping to inform future workforce development activities undertaken by two local authorities (LAs) •Contributing research data to both the regional and national picture of adult social care recruitment and retention issues How did we do this? Data for our project was collected between February 2023 and October 2023 and explored local recruitment and retention issues in Adult Social Care (ASC) from the perspective of four populations of interest. We collected data from n=131 participants across the four populations of interest: •Social care practitioners - social workers, allied health professionals, unregistered social care practitioners - working in adult social care at two local authorities (LAs) •Social care staff performing exit interviews with staff working in the two local LAs •Social work students (undergraduate and postgraduate programmes) in Wessex •Service users receiving services in either LA and advocates drawn from Wessex LA contracted services es Pos Positive Outcomes • Practitioner demand to participate in this study was very high and we exceeded our initial recruitment targets. • Being able to shine a light on some of the current issues facing advocacy – a currently under-reported research area – as a part of our qualitative data collected from POI 4 was an enlightening and beneficial bonus. • Being able to involve and co-write with both the PPI collaborator and the two research champions from a local authority to produce two separate academic articles from the project was another highlight. • Reaching a national newspaper (both print and online in the Telegraph) with research findings from practitioners regarding hybridization and hotdesking was a very positive development in reaching an external audience. Practioner findings - Data on Staying Reasons for staying with LAs included: • Flexible working – place of work and hours worked • Love of the job and engaging with the service users supported • Supportive management • Supportive team • Training and CPD - via continuing professional development or an apprenticeship. A number of outputs from this project can be viewed below. We have also submitted a number of journal articles describing findings from the project data to the peer review process, which will hopefully be available later this year. Practioner Challenges Challenges to Retention highlighted include: Hybridisation and Hot desking Stress and Burnout Negative Perceptions of Social Care Student Reflections on Social Care • There is always focus on recruitment, but not on retention. • Social care is hugely underfunded but money is not the only answer –a place where people want to be. • Awareness that SW not seen as a fully sustainable career. Some already planning exit strategies before they started work - a perceived shelf life for a social work career. • Worries about excessive caseloads/increased admin burdens and bureaucracy. • Pay level was deemed inadequate for the demands of the job. • On placement students noticed issues with team churn, attrition and a lack of stability – one had 8 different managers over a 12 months. • Staff shortages – some vacancies can’t even be filled by locums. • COVID-19 had been the prompt for a lot of staff to move on. • Agency usage is an issue (for example, out of county managers). This is helping to create a ‘perfect storm’. • Risk of stress and burnout inherent in profession was noted: Ethical Dilemmas / Job related / Questioning of their decision making / Resilience / Coping strategies / Travel issues Students reflected on Cost of Linving Impacts that: • Increased numbers seeking hardship support / more working alongside study • Social work bursaries frozen since 2014 – more earning whilst learning • Some HEI staff do not appreciate hardships experienced or demands faced • Burnout - feeling stressed/lacking in energy after working full-time alongside course. • Longer term, reductions in students entering the profession have major implications for meeting rising level of vacancies in social work. • Cost of living issues an increasingly influential factor for prospective students when choosing route/retraining as mature student. Service User reflections on Social Work Relationships • Changing role - onus now on the carer more to be the lead professional though not through choice. • Biggest issue is lack of money in the system. • Money over empathy – it often feels like carers and SUs cost money. • Inertia - one participant described this feeling as : “It doesn't matter how I am, you're not going to do anything about it”. • Whole structure needs an overhaul. Social work/social care is a societal issue and priority Service User reflections on staff turnover • Previous continuity of same worker no longer exists. Rapid changeover / staffing issues causing upset for carers and SUs. • Churn obliterates previous working relationships • Depersonalisation – team rather than individual; now you don’t usually have a designated social worker. It's a group. • Less frequent contact. • Out-of-hours - service is overstretched and doesn’t cover the whole area effectively for time precious situations. Impact on Advocates · Safeguarding caseloads for advocates have increased. Crisis situations due to lack of early intervention. After discharge there is no pick-up or continuity from the community – loss of advocate, a new LA social worker or unqualified social care practitioner assigned, or the case is closed as it is classified as ‘not in crisis’. · Increased caseloads now have greater complexity. There are more Section 21A challenges – a review under a Deprivation of Liberty Safeguards (DoLS) as SUs unable to care package in the community. · Community advocacy - which prevents crisis in a lot of cases - has been reduced as statutory work always comes first. SUs need be in receipt of an LA commissioned service or NHS secondary care before they can get issues-based advocacy. · Increased complexity causes settled cases to be visited less regularly as advocates now deal with more complex court proceedings and safeguarding issues. Increased caseloads - Social work / NHS overflow · Social work seems to be moving away from relationship-based practice to procedurally driven form-filling with advocates picking up some of this work instead. · “ Hold on, this is not actually my role” - Advocates are doing part of the social worker’s job because, for whatever reason, they are not able to. · There is a greater expectation of monitoring conditions done by the supervising body, when actually it’s not their role as an advocate, but it has become their role. · Less time for IMHA within hospitals as advocates now have little or no time to do it. Further reading – blogs: A blog for World Social Work Day (19/03/24) Further reading – reports: Recruitment and retention in adult social care Executive Summary. Bournemouth: NCCDSW, Bournemouth University. Recruitment and retention in adult social care. Bournemouth: NCCDSW, Bournemouth University. Further viewing: NIHR ARC Wessex Social Care Lunchtime Seminar – Realities of adult social care recruitment and retention in 2023 (18/01/24) Publications Full article: Advocacy in Practice: Who Advocates for the Advocates? Evolving Workplace: The Possible Impacts of Hybrid Working and Hotdesking on Retention of Social Workers | The British Journal of Social Work | Oxford Academic Full article: Impacts of Workplace Stress on the Retention of Social Workers: A Qualitative Study Full article: Struggling with studying and earning – realities of the UK's cost-of-living crisis on students on social work programmes

2bde6957-3a7b-4fc1-81e9-51f920491c2f Developing a core cohort of community researchers in Wessex: towards a sustainable Wessex Community of Practice for public health research co-production Chief Investigator: Professor Nisreen A Alwan, Professor of Public Health, Centre for Population Health Sciences, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust Team: Dr Donna Clutterbuck, Research Fellow, University of Southampton Megan Barlow-Pay, PPIE Lead, NIHR Research Support Service Professor Julie Parkes, Professor of Public Health, University of Southampton, University Hospital Southampton NHS Foundation Trust and Health Education England Wessex Dr Kath Woods-Townsend, Associate Professor (Research) and Lifelab Project Manager, University of Southampton Mirembe Woodrow, Senior Public Health Practitioner, Southampton City Council and PhD student, University of Southampton Partners: Hampshire and Isle of Wight NHS Foundation Trust, University Hospital Southampton NHS Foundation Trust, Bournemouth University, University of Portsmouth, University of Southampton, Southampton City Council, NIHR Research Support Service Specialist Centre for Public Health, LifeLab, University of Southampton / NIHR Southampton Biomedical Research Centre, Health Determinants Research Collaboration, Southampton, Southampton Centre for Research Engagement & Impact (SCREI), Centre for Seldom Heard Voices, Bournemouth University, HDRC Portsmouth Start: 1 October 2024 End: 31 March 2026 Summary Public health research priorities must stem from the needs of the communities served by such research, particularly those most socially and economically disadvantaged, as well as community groups that are seldom heard. Therefore, community members with lived experience of health conditions and the various factors shaping health and wellbeing have a central role in shaping such research. Co-creating research with the public can lead to research findings that are more relevant to population health and wellbeing, leading to a reduction in heath inequalities. The purpose of this project is to develop a core ‘cohort’ of community public health researchers using an approach that considers the multiple social forces that shape people’s identities to inform research design that is meaningful to Wessex local communities. This cohort will form a Community of Practice (CoP) for research co-design that can help us reach those seldom heard groups in our local communities and understand underrepresented perspectives to inform relevant and meaningful health research priorities, questions and methods. People from such communities are more likely to feel comfortable to inform research that is led or co-led with community researchers. This project will be a Partnership between the NIHR Research Support Service (RSS) National Specialist Centre for Public Health (NSCPH) which aims to support the generation of high-quality research evidence aimed to inform decisions about which interventions have the greatest likelihood to improve population health and reduce health inequalities, and the Healthy Communities Theme of the NIHR ARC Wessex. In the first stage of the project, we will engage with stakeholders, including members of the public, voluntary organisations, Local Councils and health services to shape the project protocol and to co-develop its strategy, key milestones and outcomes. In the second phase of the project, we envisage a group of community researchers being recruited and trained in participatory research (or other research methods of their choice) and be provided with opportunities to link in with health researchers. In the third phase of the project, the community researchers will then choose a pathway (or more) that suits their needs from conducting community-based research, linking with other community members to inform further research projects, co-creating research ideas, or informing research proposals developed by researchers within the ARC or through the RSS. In the fourth phase of the project, we will evaluate the above activities and synthesise and disseminate lessons learnt from the project towards sustainability of our CoP framework. The project’s Research Fellows will also work with public contributors to disseminate findings in ways that are meaningful, alongside preparing publication materials for journals and conferences, and producing infographics. The CoP will help us to co-design health research based on local and regional need; provide stakeholder input into public health research proposals in Wessex; contribute to governance and delivery of NSCPH; and support meaningful and equitable research partnerships with community stakeholders and the public.

9381b390-9efb-4b71-9879-2371689f041c ADOPTED PROJECT: EnablExercise in Crohns: A qualitativE study to uNderstAnd the Barriers and faciLitators to physical activity and Exercise IN children and adolescents with CROHN’S disease ADOPTED PROJECT: EnablExercise in Crohns: A qualitativE study to uNderstAnd the Barriers and faciLitators to physical activity and Exercise IN children and adolescents with CROHN’S disease Principal Investigator: Dr Zoe Saynor Co Applicants : Dr Nadeem Afzal , Dr Christopher Roberts , Professor Kelly Mackintosh , Dr Danielle Lambrick , Professor James Faulkner , Mr William Freer (PPI Contributor) Partners: University of Portsmouth, University Hospital Southampton NHS Foundation Trust, Swansea University, University of Winchester, For Crohns (charity), Guts UK (Charity) Duration : 12 Months Background: We know that people with inflammatory bowel disease (IBD), of which one of the main forms is Crohns, are at a high-risk of not meeting the physical activity recommendations for health, due to a combination of bowel and general physical symptoms (e.g. abdominal pain, diarrhoea and fatigue). Additionally, there are currently no physical activity and exercise guidelines for young people with IBD – making it difficult to advise what people should be doing. Researchers within our team have been monitoring the effects of COVID-19 and associated lockdowns on physical activity and mental health on a global scale, and saw negative impacts in both people with long-term conditions and in the wider population. However, there is currently no data to tell us how young people with e.g. Crohns have been impacted during this time. in our centre, we are seeing an increasing number of people with Crohns transitioning from paediatric to adult care with metabolic syndrome and we anticipate this will rise in response to the COVID-19 pandemic. Objectives: Assess the barriers to, and facilitators of, physical activity and exercise participation in young people with Crohns disease. Additionally, comparing their views to their parents/guardians and clinicians. Design and Methods: The proposed research will be a qualitative cross-sectional study consisting of individual semi-structured interviews with the three participant groups (in clinic for young people; videoconference for parents/guardians and clinicians). The interview schedule will be co-developed with people living with Crohns. Information from the interview will be digitally recorded, transcribed verbatim and thematically analysed. For the young people with Crohns involved in the study, we are interested in documenting their disease activity and nutritional/growth status at the time of interview so will use the Paediatric Crohns Disease Activity Index (PCDAI) to determine remission, mild activity, or moderate-to-severe activity and growth ‘weight height and BMI’ Z-scores for this. Clinical and Scientific Impact: Physical activity is important for both mental and physical health and is particularly important in people with a long-term condition. This work will provide important understanding of the views and experiences of young people with Crohns, their parents/guardians and clinicians surrounding physical activity and exercise. The findings from this qualitative study will provide insight as to why young people with Crohns may not undertake physical activity and exercise and will help inform the design and delivery of future appropriate physical activity and exercise programmes for this population. This information would complement our ongoing research (The ACTIVE-IBD Study), and will inform future funding applications to develop, evaluate and implement educational and interventional resources to increase the physical activity and exercise undertaken by young people living with Crohns. This funding award will help expedite our journey to the end goal of improving this provision and, ultimately, the quality of lives of people with Crohns

Web-based Implementation Toolkit Home Alignment with Health and Social Care Priorities Fit with Health and Social Care Systems Project Outputs This Web-based Implementation Toolkit (WIT) is designed to be easy to use and intended for a variety of users, projects and settings where implementation is planned or being considered. Implementation is the attempt to introduce a new intervention, innovation or policy developed through research and apply it to health and/or social care and the third sector. WIT provides you with an interactive Implementation Wheel, Checklist and bite-size Webinars (average 10 minutes) to support you through your implementation journey. Alignment with Health and Social Care Priorities - Will implementation of your project outputs be a priority for those involved in health and social care? Who is WIT for? WIT recognises the need to provide freely available, accessible and simple to use tools that focus on key considerations at the outset of a project. WIT was through interactive workshops with health and social care professionals, third sector organisation professionals, academics and members of the public. Anyone looking to understand more about or engage in implementation. Why use WIT? implementation Implementation is the attempt to introduce a new intervention, innovation or policy developed through research and apply it to health and/or social care and the third sector. co-produced Co-production refers to a way of working together, often with service users, to reach a collective output. When to use WIT Adoption and Spread Adoption and Spread - How will implementation be adopted and spread beyond the original site where implementation takes place. Project Outputs Project Outputs - What is to be produced as a result of your project? For example, this could be a policy contribution, innovation or a tool. Buy-in and Engagement Buy-in and Engagement - Who needs to be engaged in supporting implementation? For example, patients, service users, health and social care professionals. Fit with Health and Social Care Systems Fit with Health and Social Care Systems - How will implementation of your project outputs fit with the changing needs of the health and social care systems. From the beginning – when first considering and designing a project Throughout all stages of your implementation journey and beyond To guide you through implementation considerations for your project There are six wheel domains to help you consider what is required for implementation. Click on a domain segment to find out more. Alignment with Health and Social Care Priorities Alignment with Health and Social Care Priorities - Will implementation of your project outputs be a priority for those involved in health and social care? Outcomes and Impact Outcomes and Impact - Outcome(s) refers to what you wish to achieve as a result of implementation (e.g. increased patient usage of an innovation). Impact refers to the effects of those outcomes for different stakeholder groups (e.g. patients) and the wider health and social care system. How to use WIT Use the interactive Implementation Wheel, Checklist and bitesize Webinars to support you on your implementation journey and beyond. The six Wheel domains can be used iteratively, and in no particular order. The Checklist is downloadable and consists of the same domains as the Wheel. You can use this to complete with your team and check progress of your implementation journey. The Webinars , approximately 10 minutes duration, provide sessions relating to the six Wheel and Checklist domains and also to an introduction to implementation and implementation theories and frameworks. Hover on keywords to see definitions Other words in bold represent key learning points The Resources section provides suggestions for other resources you may find helpful. Feedback via our short survey If you fulfil the criteria on the attached poster , Researchers from the School of Health Sciences, University of Southampton/NIHR ARC Wessex would like you to test WIT by providing feedback via a short survey . Or alternatively scan the QR code. Thank you. Contact us If you have any questions about WIT, please contact: C.F.Brooks@soton.ac.uk Disclaimer The development of WIT has been supported by the NHS Insight Prioritisation Programme (NIPP). The views expressed are those of the authors and not necessarily those of the NHS. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of this website. How to cite Brooks, C.F., Lund, S., Kryl, D., and Myall M. (2023) Web-based Implementation Toolkit (WIT). University of Southampton. Available at: www.arc-wx.nihr.ac.uk/web-implementation-toolkit Accessibility We are committed to providing a website that is accessible to as many people as possible. We are actively working to increase the accessibility and usability of the website.

71793130-6407-4a7a-8ebf-2af1daf96dd5 COMPLETED: Understanding the psychosocial needs and trajectories of older adults (>64 years) with alcohol use disorder (AUD) from hospital back into community Lead applicant : Professor Julia Sinclair Co-applicants : Dr Rebecca Band, Professor Jackie Bridges Team Dr Steph Hughes – Research Fellow Zara Linssen – Medical Student Sophie Crouzet – Medical Student Stephen Lim – Implementation Champion Melinda King – PPI advisor Start: 01/01/2023 End: 01/07/2024 Partner organisations: University Hospital Southampton NHS Foundation Trust University of Southampton Background Over 200 physical and mental health conditions are caused by alcohol. In England, more people are being admitted to hospital with, and dying from, alcohol-related disease than ever before. In 2018/19, 44.7% of all alcohol related admissions were for people over the age of 65 compared with 14% in 2010/11. In 2021,1563 patients were assessed by the Alcohol Care Team (ACT) at University Hospital Southampton, 43% of whom were over the age of 60. We know that older adults can often feel more shame and stigma related to their alcohol use compared with younger people. This can create barriers to accessing help with existing community addiction services. Beyond this, very little is known about the reasons why older adults drink alcohol and how this may interact with other social factors like loneliness and social isolation. Further research is needed to understand the ways in which to best support older adults to seek help, and what interventions may best promote positive outcomes. Study Design This study will recruit older people with alcohol use disorder (AUD) admitted to hospital in Wessex. A longitudinal observational design will be used, meaning that people in the study will be asked by the research team to complete questionnaires over time following admission into hospital. This will help to understand the needs of the population. There will be four main research aims: What are the personal characteristics of older adults with AUD? How do participants make sense of themselves in relation to their alcohol use? What happens to participants in the six months following a hospital admission? What factors what might prevent or encourage people from seeking help for their alcohol use? Study Methods The study will identify potential participants through the ACT in Southampton in the first instance. Around 40% of people seen over the age of 65 years. Clinicians working in ACTs have the skills and experience to sensitively identify and assess patients with comorbid alcohol use disorders Discussion about the study and consent processes will be undertaken by the UHS clinical trials officer. Participants who are willing to be part of the study will complete a set of questionnaires in hospital. Well-established measures of alcohol use, quality of life, loneliness, collective efficacy and health service use will be collected. Participants will be asked to complete similar questionnaires again at 3 and 6 months. This will probably take place over the phone. Health service use data will be collected for the 6 months after discharge to explore resource use. Plain English summary of findings Recruitment to the study was difficult. Many patients who were identified as drinking at increasing or possibly dependent levels did not have mental capacity to take part. Of those who were eligible, a large percentage declined to participate. This resulted in a small sample size of 30, 16 of which completed their follow-up questionnaire, and 7 interviews. 20% of the sample died during the study window. Results indicated: Over 50% participants showed some level of cognitive impairment Participants had an average of 4 people in their social network; usually family members Interviews revealed links between social isolation, loneliness and drinking alcohol Those who were housebound reported drinking alcohol all day long Participants stated alcohol is not, and never has been a problem for them 50% participants met the threshold for depression Participants often provided conflicting information for the follow-up questions and in the interviews Participants had poor diets; of 32 nutrients measured 22 were not consumed in-line with the government recommendations 93% participants were taking 5 medications or more What's next? As a small preliminary study the new knowledge has been used to inform future research. Impact on patient care and population health will come from the future research. Recruitment was harder than expected. This learning point has informed recruitment and retention procedures in future research applications. Other findings, for example, the link described qualitatively between social isolation and increased alcohol consumption, has shaped ideas for intervention development. We are preparing an application to undertake the planning and developmental work for an intervention aimed at reducing alcohol consumption in a general population of adults aged 65 and over. We plan to test the feasibility of this intervention in a feasibility study.

a95fe10a-8d2a-464a-8d99-2e3067bb89e8 ADOPTED PROJECT: ExACT-CF: Exercise as an Airway Clearance Technique in people with Cystic Fibrosis – A randomised pilot trial ADOPTED PROJECT: ExACT-CF: Exercise as an Airway Clearance Technique in people with Cystic Fibrosis – A randomised pilot trial Principal Investigators: Dr Don Urquhart , Dr Zoe Saynor Co Applicants : Mrs Lorna Allen (Cystic Fibrosis Trust), Professor Steve Cunningham, Professor Ioannis Vogiatzis , Professor Steff Lewis, Ms Aileen Neilson Partners: University of Portsmouth, University Hospital Southampton NHS Foundation Trust, University of Edinburgh, University of Northumbria at Newcastle, Cystic Fibrosis Trust, CF Warriors (Charity) Starts: May 2022 Ends: 31 October 2023 Background: Cystic fibrosis (CF) is the UK’s most common inherited genetic condition and affects more than 10,500 people. The disease causes problems with the movement of salt and water in the body, resulting in sticky mucus building up, mostly in the lungs and gut. Thick mucus in the airways leads to repeated infections which, over time, damage the lungs. Chest physiotherapy is prescribed to loosen and clear sticky thick mucus from the airways and so to help to reduce lung infection. Chest physiotherapy is a routine treatment to keep people with CF healthy. However, many say it is time consuming and a burden. People with CF have asked if doing exercise could have the same effect as chest physiotherapy sessions for helping clear mucus. Exercise could be more enjoyable and less burdensome. Through a recognised priority setting partnership, the CF community recently ranked research to ‘reduce the burden of their care’ and answer ‘whether exercise can replace chest physiotherapy’, as their number 1 and 7 priorities. Surveys show that many people with CF have occasionally chosen to replace chest physiotherapy with exercise for airway clearance, and we recently confirmed this through a UK-wide survey. We now need to know if they would be willing to take part in research that asks some to stop chest physiotherapy and to exercise (with coughs and huffs) instead. New medicine (modulators) have recently become available for many people with CF, bringing dramatic improvements in their health. Some people who have started modulators are considering whether they can reduce or stop treatments – including chest physiotherapy. So, we need to know the effects of stopping chest physiotherapy and determine if exercise can be used instead - our study aims to understand this. Our recent survey in people with CF, their families, physiotherapists and doctors, showed us that many consider hard exercise with coughs and huffs to be able to clear mucus from the airways. We will study 50 people with CF (>12 years old) for 28-days. We will ask half of them to continue their usual care, and half to stop chest physiotherapy and do exercise that gets them breathing deeply (with coughs and huffs) instead. We will see if people are willing to start and continue with such a study and what they think of the study processes. We will also see how stopping chest physiotherapy and replacing it with exercise affects measurements of their lung function. Within the study we will talk with people with CF and members of their CF team to understand their experiences. This information will tell us whether a larger study can answer Publications Safety, feasibility and efficacy of exercise as an airway clearance technique in cystic fibrosis: a randomised pilot feasibility trial | Thorax

bd39e9d4-a228-4123-b44c-d499a7f27a45 Prevention schemes for female vicitms and offenders in Hampshire and Dorset Principal Investigators: Dr Sara Morgan Team members: Dr Sara Morgan ( Lecturer in Public Health School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton), Fiona Maxwell (Public Health Registrar School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton), Sergeant Ali Attwood (Hampshire Constabulary, Restorative Justice Lead) , Debbie Willis ( Hampton Trust charity, Domestic Abuse Service Manager), Vicky Atkinson (Hart District Council, Domestic Abuse Project Coordinator), Patricia Durr ( One Small Thing ), Mona Samiy ( Stop Domestic Abuse charity , Project Manager) Start: 11 November 2019 Ends: 11 November 2021 Project Partners : University of Southampton, University Hospital Southampton NHS Foundation Trust, Hampshire Constabulary, Hampton Trust, Hart District Council, One Small Thing, Stop Domestic Abuse. Lay summary: Background and study aims Compared to the previous year, in 2018 there was an overall 8% increase in theft in England and Wales and a 6% increase in crimes involving sharp instruments or knives. In order to tackle this increase in crime, many believe that more needs to be done to address the reasons why people commit crime in the first place, as well as the damage it causes to peoples’ lives. This means working together in the community to offer solutions to those affected by crime, including victims and offenders. When we discussed possible solutions with local service providers, it was felt that a tailored approach is needed for women, as their needs are unique. Women in prison are very likely to be both victims and offenders whilst, in the general population, one in four women are also victims of abuse within the home and more than half the women in prison have experienced domestic abuse themselves. In response, three projects are being piloted in Hampshire and Dorset to address the needs of women affected by crime. What does the study involve? To understand how these projects are working, we plan to carry out group interviews with those delivering the pilot intervention projects in the community. This will primarily be to understand how the projects are working. We will also use information gathered from the project staff about the women using the service to understand whether women go on to seek further assistance in the community, what sort of women engage with the project, and what changes for them as a result of using the service. This study proposal was developed in collaboration with public representatives; including offenders, victims, social care workers, domestic abuse service manager, and police officers. They have all shaped the design of the study; by informing us what types of research questions we should be asking. Going forward, we will continue to involve similar representatives throughout the research study; for example, to co-produce the materials used in the study, such as information sheets, and to gain feedback on the write up of the study. What will we do with the study findings? It is important that the information gained from the study reaches the widest number of people. We will therefore consider who to engage, and how to reach them, from the very start of the study. The main findings will be developed into a short summary report, which will be accessible to the general public through our public representatives and collaborators. They might include charitable organisations in the community (e.g. Stop Domestic Abuse, Hampton Trust) or services that work directly with women affected by crime (e.g. NHS, probation services).

09039be4-7f54-4e52-b415-7d6e49acfe67 Predicting nurse staffing requirements -validation and scoping extension study (PREDICT-NURSE validation and extension) Chief Investigator: Paul Meredith, Senior Research Fellow, University of Southampton Team: Christina Saville, Senior Research Fellow, University of Southampton Chiara Dall’Ora, Associate Professor in Health Workforce, University of Southampton Zlatko Zlatev, Senior Enterprise Fellow, University of Southampton Peter Griffiths, Chair in Health Sciences Research, University of Southampton Ian Dickerson, PPI Representative Tom Weeks - E Systems Implementation Manager Tom.Weeks@porthosp.nhs.uk Sue Wierzbicki - Lead Nurse - Workforce Sue.Wierzbicki@porthosp.nhs.uk Partners: Hampshire and Isle of Wight Integrated Care Board, Hampshire Hospitals NHS Foundation Trust, Portsmouth Hospitals University NHS Trust, Salisbury NHS Foundation Trust. Start: 1 October 2024 End: 30 September 2025 Our aim We aim to show that a computer algorithm we have developed which uses information that is already collected about patients can provide good estimates of the number of nurses needed on hospital wards to provide safe care for the patients. Background information It is important to have enough nurses to care for patients on hospital wards. If there are too few nurses, patients may take longer to recover, suffer complications, or die, and the capacity of the hospital to cope with new admissions is reduced. Also staff well-being is affected by high workloads and there is more staff sickness. Many hospitals use the Safer Nursing Care Tool (SNCT) to help them manage staffing levels. This involves surveying all the patients in a ward perhaps three times a day. Assessing each patient in this way is an extra nursing task and in itself adds to the workload. We have developed a computer algorithm using data from one hospital which can provide similar estimates of nursing staff requirements to SNCT but we need to check that these estimates would keep patients safe if they were followed. What we will do We shall use data collected for a previous study as input to the algorithm to produce estimates of nurse staffing requirements for each ward shift using information which could be known at the time. We will compare actual staffing with the algorithm’s estimate to see if there is a deficit or surplus of staff. For each admission we will examine how these deficits and surpluses relate to patient outcomes. We will compare using the algorithm to set a threshold for safe staffing with using the SNCT estimates as a threshold. Our comparisons will include looking at how good the methods are for wards with higher numbers of under-served groups such as the over 75s, those with learning disabilities and those with mental health conditions. We will measure the effect of staff shortfalls on the number of staff sickness absences. The performance of the algorithm will be checked using data from a second hospital in the database. We shall work with our partners to find out what tools are used to determine nurse and other staffing requirements on a day-to-day basis in community and mental health settings and what data on care requirements and outcomes is electronically recorded. We will discuss with partners what opportunities, potential benefits and practical considerations there are to implementing a predictive tool of staffing requirements. Communicating results We will write an academic paper, produce an article for the Nursing Times, create a poster for display at conferences, and publicise the results on social media. Involving the public We will involve local PPIE group members in evaluating and commenting on the possible uses of a predictive tool to support decisions in the day-to-day management of nurse staffing levels on wards.

f06fb2ad-c8c9-436f-982c-c278b7185585 ENRICHER – involvEment iN the cRiminal justice system & the ImpaCt on women’s Health dorsEt & hampshiRe Chief Investigator Professor Julie Parkes Professor in Public Health Head of School of Primary Care, Population Sciences and Medical Education Faculty of Medicine University of Southampton, South Academic Block, Southampton General Hospital, Tremona Road, Dr Emma Plugge Associate Professor in Public Health School of Primary Care, Population Sciences and Medical Education Faculty of Medicine University of Southampton, Co-Investigators Dr Donna Arrondelle , Research Fellow, University of Southampton Dr Naomi Gadian, Public Health Specialist Registrar, University of Southampton Donna Gipson, Director EP:IC Consultants Ltd, West Malling, Kent Dr James Hall , Associate Professor of Educational Psychology, University of Southampton Paula Harriott , Head of Prison Engagement, Prison Reform Trust Professor Kathleen Kendall , Professorial Fellow of Sociology as Applied to Medicine, University of Southampton Dr Sara Morgan , Associate Professor in Public Health, Faculty of Medicine, University of Southampton Professor James Raftery , Faculty of Medicine, University of Southampton, Dr Lucy Wainwright , Director of Research, EP:IC Consultants Ltd, West Malling, Kent Starts: 1st April 2023 Ends: 30th September 2024 Summary This study will look at what happens to women’s health and wellbeing when they are imprisoned. The imprisoned women will be women from Dorset and we will compare any changes to changes in women from Hampshire who go to Hope Street instead of going to prison. Hope Street is a charity-funded alternative to prison, available only to women from Hampshire; women live in special accommodation in the community where they are secure and where they are able to access a range of health and social care services. Women who go to prison are often from the poorest communities and they often have many different health problems, particularly relating to their mental health. These health problems are often related to their crimes and so by making sure they get the services they need, this will help their health improve and benefit wider society by helping tackle crime. This study will ensure that this new and unique information is available to those who plan and deliver health services locally. The Southampton research team on this project are carrying out a 5-year evaluation of Hope Street. This means they can use the data that they are collecting as part of this evaluation on the health of women at Hope Street to compare to women from Dorset who are imprisoned. Researchers will collect information on the health and social care needs of the two groups of women at the same time intervals over a one-year period and in the same way. We will then compare this information to look for differences. We will interview the women so that we understand what their experiences are like in prison or Hope Street, and why there might be differences. We will also look at the cost of their care. The information from our study will help the professionals who plan health and social care services and also those who work in criminal justice settings such as prison or probation. Women with experience of imprisonment are part of the eight-person study team. They have helped design the project and will be working with Hope Street women to train them in research. They will also be important in spreading the word about the study. This will enable us to reach not just academic audiences and policy makers through publishing in journals or presenting at research conferences, but also people with lived experience of imprisonment and charities that work in this area. Informing a wide range of people will be important in ensuring that the findings from this study are acted on.

Understanding the psychosocial needs and trajectories of older adults (>64 years) with alcohol use disorder (AUD) from hospital back into community Team: Kinda Ibrahim is a lecturer and a pharmacist at the Faculty of Medicine and the Deputy Lead for the Ageing and Dementia Theme within the NIHR ARC Wessex Jay Amin is Associate Professor in Psychiatry of Older Age at the University of Southampton and an honorary consultant in Old Age Psychiatry at Southern Health NHS Foundation Trust. Sue Latter is a Professor of Health Services Research and a nurse by background and an expert in medicines optimisation research. Simon Fraser is an Associate Professor in Public Health at the University of Southampton. Ruth Bartlett is a Professor at the University of Southampton and Director of the University of Southampton's Doctoral Training Centre in Dementia Care, and a lead coordinator for the ARC Wessex Faculty. Rosemary Lim is an Associate Professor at school of pharmacy, University of Reading. Michelle Board is an Associate Professor in Nursing Older People at the Faculty of Health and Social Science at Bournemouth University. Starts: October 2022 Ends: September 2024 Lay Summary Most people with dementia or mild cognitive impairment (MCI) have multiple chronic conditions and take five or more regular medications (polypharmacy). Polypharmacy in people with dementia/MCI can lead to increased risk of drug interactions, side effects such as falls and cognitive decline, and sometimes hospitalisation and death. Some types of medications (such as strong anticholinergic drugs) can increase risk of developing dementia and cognitive impairment. It is estimated that over £400 million is spent annually in the UK in hospital admissions related to harm from medications. Identifying harmful medications and stopping or switching to safer alternative (deprescribing) has the potential to reduce the risk of developing dementia and improve outcomes for people already living with dementia. However, to date, deprescribing interventions for people with dementia/MCI have focused on specific drug classes (e.g., anti-psychotics) or have been limited to inpatient or nursing home setting. In the UK, it is estimated that 61% of people with dementia live at home where medication is a part of daily living. Most studies also focused on medication-related outcomes (e.g. discontinuation of high-risk medications) rather than patient-centred outcomes, and did not involve the person with dementia and their carer. Therefor it is essential to understand how primary care staff could involve people with dementia/MCI and their caregivers in shared-decision making about stopping medications safely. The aim of this study is to develop a primary care–based deprescribing intervention focusing on increasing shared-decision making targeting people with dementia/MCI and their caregivers. The proposed research will include two phases: First, a search of published literature to understand how effective deprescribing interventions among people with dementia/MCI, with a focus on what works or does not work for this population. Secondly, we will conduct interviews with people with dementia/MCI and their caregivers as well as healthcare professional. We want to understand how deprescribing can be initiated and monitored among people with dementia or MCI in primary care setting and how patients and their caregivers could be involved in decisions about medication taking. Then we will use the information we gather to identify the key elements/factors that make deprescribing and shared-decision making possible in primary care. We will develop an intervention which will then be refined in a future study, subject to funding, through a series of workshops and rapid iterations with key stakeholders to discuss its content, format, style and delivery. Read all Mental Health Hub projects

Justin Strain < Back Thinker, sailor, author, physio Justin's journey so far.. Justin Strain Justin Strain I began my healthcare career a little later than most. At the age of thirty, after a short career in the Royal Navy, I took my first steps into the University of Southampton’s School of Health Professions. I was interested in research from day one. The importance of evidenced-based practice was drummed into us throughout our time at university. From the moment we first wielded a tendon hammer or a stethoscope we were encouraged to ask ourselves those all-important questions: What is the best treatment? Does it work? Why am I doing this? Starting out as a musculoskeletal physiotherapist, I threw myself into clinical practice, desperate to learn every treatment technique and test I could get my hands on. I believed that being a great clinician was about perfecting those tricky manual techniques and learning everything there was to know about anatomy. Or so I thought. Thinking differently Later, as I developed in confidence, I began to think differently about my practice. It seemed to me that what made most difference to my patients was the therapeutic relationship. Understanding the patient’s experience and learning to listen more and communicate better (and sometimes talk less!) started to seem more important than having the biggest toolbox of treatment techniques. Specialising in pain management helped me to appreciate how peoples’ experiences of health-conditions and healthcare were shaped by a complex web of social and personal interactions, making each person’s experience unique to them.The need to understand these unique experiences drew me to qualitative research. I wanted to go further than comparing different interventions. I wanted to understand the stories of the people at the heart of those interventions – our patients. The importance of narrative was not new to me. In my non-clinical life, I write children’s novels – I’ve written two so far and I’m working on a third. In my novel writing, I enjoy the magic of exploring fictional worlds from other peoples’ perspectives. I’ve always found that what brings a novel to life is the personal connection between the reader and the characters. I wanted to apply a similar approach to understanding patients’ stories - listening to, understanding and recording other peoples’ perspectives, and acknowledging the role of the researcher and the reader in interpreting those perspectives. While I was taking my first tentative steps towards qualitative research, the world of healthcare research was changing. The n=1 campaign was gathering momentum, and recognition of qualitative research was increasing. I wanted to get more involved, and found myself looking for the right opportunity. Then, at the beginning of 2020, the world turned upside down with the advent of the COVID 19 pandemic. Along with many other things, the COVID 19 situation has highlighted the need for research – to explore the impact of immediate responses to the crisis, and also to understand how the pandemic will influence longer term changes in how healthcare is delivered. One of those long-term changes is likely to be the proliferation of online healthcare. The plethora of online health interventions now on offer enables people to access consultations and courses that might previously not have been available to them, in a safe, socially distant way. I felt this area was worthy of more exploration, and I wanted to listen to the stories of service users, to understand how these changes had impacted on their experiences. I resolved to start a research project looking at patients’ experiences of online pain management in our own service, but I was struggling to find the time - alongside a busy job in clinical practice, dealing with redeployment and the current challenges of COVID 19, and being dad for our two wonderful children. The NIHR ARC Wessex Clinical Academic Internship has given me that time. It has enabled me to build and apply my skills in research as part of my clinical job, making a difference to how I can support patients within my service. So where am I now? I am in the early stages of my project – a systematic review of qualitative literature about patients’ experiences of online pain management, combined with semi-structured interviews with patients who have completed the online pain management programme within our own service.As well as time, the Clinical Academic Internship has provided a network of similarly minded people, interested in research and qualitative exploration of issues. The excellent events run by NIHR ARC Wessex have introduced me to new research concepts and skills. My supervisors, Dr Euan Sadler and Dr Lindsay Welch , have been extremely supportive and with their help my skills and confidence are growing. I am planning to complete my project in Autumn this year and I am hopeful that this will lead on to a pre-doctoral, and eventually a doctoral fellowship with NIHR ARC Wessex in the future. Dr Euan Sadler is an Associate Clinical Professor of Older People and Frailty within Health Sciences at the University of Southampton. Dr Lindsay Welch is a Lecturer in Adult Nursing and a Researcher in long term conditions. Previous Next