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3163bb6a-69ec-4161-8433-72a5810416ad POST DOCTORAL PROJECT: Understanding, addressing, and meeting the complex needs of people living with long term physical and mental health conditions: a qualitative study POST DOCTORAL PROJECT: Understanding, addressing, and meeting the complex needs of people living with long term physical and mental health conditions: a qualitative study Chief Investigator: Dr Leire Ambrosio – University of Southampton Project Team Members: Professor David Baldwin – University of Southampton. Professor Mari Carmen Portillo – University of Southampton, Dr Kate Lippiett – University of Southampton, Dr Lindsey Cherry – University of Southampton, Dr Pritti Aggarwal – Living well partnership – NHS Southampton CCG, Mr Barney Williams Jones – University Hospital Southampton NHS Foundation Trust, Dr Sara Mckelvie – University of Southampton, Ms Linda Lamond – PPI co-applicant Organisations Involved: University of Southampton, Hampshire and Isle of Wight Integrated Care System, Living well Partnership – Southampton CCG. Oxfordshire Primary Care System, Anxiety UK, Mind, Oxfordshire. Background: People with long term physical conditions are 2-3 times more likely to experience mental health problems than the general population, particularly depression and anxiety. At least 30% of all adults with long term physical conditions also have mental health problems. People living with long term physical and mental conditions not only experience hardships relating to health but also have complex psychosocial, environmental, economic, and spiritual needs. Healthcare professionals find it difficult to deliver fully integrated care for these populations, partly due to systematic barriers and the fragmentation of health and social services. The advent of social prescribing link workers as a priority for the NHS provides an opportunity to address some of these hardships and needs. Social prescribing link workers aim to connect people to community local services to address their complex needs through a person- centred approach. However, approaches to social prescribing link worker implementation are variable, with potential pathway gaps, and there is unclear guidance for primary care networks about how to integrate this novel workforce into efforts to address and meet the complex needs of people living with long term physical and mental conditions.

c07181de-349f-421b-8259-3fdae15d93ab COMPLETED: Development of a structured deprescribing intervention for people with dementia or mild cognitive impairment in primary care (STOP-DEM) Project partners Memory Assessment and Research Centre ( Hampshire and Isle of Wight NHS Foundation Trust was a Participant Identification Centre (PIC) Portsmouth Older Person’s Mental Health (OPMH) Service (Hampshire and Isle of Wight NHS Foundation Trust) was a Participant Identification Centre (PIC) Full team Dr Kinda Ibrahim (CI), Dr Nicola Andrews, Cindy Brooks, Dr Jay Amin, Prof Sue Latter, Prof Simon Fraser (University of Southampton), Dr Rosemary Lim (University of Reading), Dr Michele Board (Bournemouth University) Assisted with the systematic review: Dr Eloise Radcliffe, Paula Sands (University of Southampton), Dr Kirsty Aplin, Dr Beth McCausland (NHS OPMH), Dr Ellen van Leeuwen (Ghent University) PPI: members of Friends of MARC group and members of Dementia Support – Hampshire and Isle of Wight’s Eastleigh support group Started: October 2022 Ended : September 2024 Jump to publications The team produced a video about their work: Team video about experiences of people living with dementia and their family carers 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. Summary of findings We reviewed existing evidence on interventions to reduce or stop (deprescribe) medications for people with dementia or mild cognitive impairment (MCI). We found that most studies focused on medications that affect behaviour, mood, or perceptions and people in residential care. Many interventions reduced numbers of medications and improved appropriateness of medications. However, there was limited evidence on outcomes relating to safety and outcomes such as falls, quality of life and cognition. There was limited involvement of patients and informal carers in the interventions. We interviewed people with dementia or MCI, informal carers, primary care professionals and professionals working in memory clinics. We found that patients, carers and healthcare staff need to be involved in the deprescribing process. This process needs to consider patient cognitive abilities and independence. It also needs to consider carer experiences. Flexible medication management processes are needed to support successful deprescribing. These should be adapted to each person. These should involve joint working across the healthcare system. Deprescribing discussions need to be held in-person and in a safe setting. There needs to be enough time. Discussions should be led by a professional who knows the patient and can answer their questions. The possible impact of deprescribing decisions should be carefully considered. This includes impact on how medication is managed day-to-day and allso, carer burden. See the summary report Summary report for participants .pdf Download PDF • 559KB See the Key Practical Implications What we did with the new knowledge Sharing with frontline health and care professionals We shared our findings at a Hampshire and Isle of Wight Integrated Care Board (ICB) Medicines Optimisation webinar, engaging with an audience of 110 professionals, mostly pharmacists. We were invited to present the work at the RCGP Wessex Faculty Conference in March 2025 with around 100 attendees We shared our findings at a Wessex Older People’s Mental Health Academic meeting involving more than 50 professionals working in this area, primarily doctors. Meeting with the national lead for NHS prescribing to present the study. Academic Publications We have published two papers, one reporting the systematic review in Drugs and Aging and the other reporting the qualitative study in Dementia. The Importance of a Relationship-Centred Approach to Deprescribing for People with Dementia or Mild Cognitive Impairment in Primary Care: A Qualitative Study (November 20, 2025) Medicine Optimisation and Deprescribing Intervention Outcomes for Older People with Dementia or Mild Cognitive Impairment: A Systematic Review (March 2025) Oral and poster presentations at the European Geriatric Medicine Society Conference in Reykjavik, 24-26 September 2025 Presentation about using “photo elicitation” as a creative qualitative methodology at the ARC Qualitative Network Sharing with policy makers We have presented the study findings to MPs and representatives from royal colleges (RCGP, RPS, BGS) in a policy roundtable discussions in Westminster Nov 2025 We have produced a policy brief and shared it with relevant parties Nov 2025 We have presented the findings in an ARC Wessex stakeholder event Feb 2026 Sharing with the wider community including patient and public Summary findings and infographics from the qualitative study have been shared on social media, with a post on the ARC Twitter/X, LinkedIn and Facebook pages, and the ARC website. University of Southampton website link - Deprescribing for Dementia MSN News - Why good healthcare can mean stopping medications Daily Expresss coverage - Link Radio coverage - Greatest Hits Radio Video featuring members of our PPI group and other members of the dementia support group sharing the findings of the qualitative study. The video is being used in undergraduate and postgraduate teaching in Faculty of Medicine at the University of Southampton. Where Next? Grants : Dr Kinda Ibrahim (University of Southampton) and Dr Rosemary Lim (University of Reading) submitted Research for Patient Benefit grant application to develop and test and deprescribing intervention for people with dementia or mild cognitive impairment in primary care. Academic conferences: The Society of Academic Primary Care conference attended mainly by GPs and academics.

c585330f-e35f-4618-bc81-287d81f85239 The PD Life Study: Exploring the treatment burden and capacity of people with Parkinson’s and their caregivers Principal Investigator: Professor Helen Roberts Research team: Dr Qian Yue Tan (Research Fellow, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton), Professor Helen Roberts (Professor of Medicine for Older People, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton), Dr Kinda Ibrahim (Senior Research Fellow, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton), Dr Simon Fraser (Associate Professor of Public Health. School of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital), Dr Khaled Amar (Consultant Geriatrician and Honorary Senior Lecturer at Bournemouth University, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust) Start: October 2020 Ends: October 2022 Project Partners: University of Southampton, Bournemouth University, University Hospital Southampton NHS Foundation Trust, Royal Bournemouth and Christchurch Hospitals NHS Foundation . Lay Summary People with Parkinson’s (PwP) have many symptoms including tremor, stiffness, slow movements, constipation, urinary incontinence and mental health issues. They are often older and have other long-term health conditions. PwP need to do many things to look after their health including manage multiple medications, attend healthcare appointments and lifestyle changes such as improving diet and exercise. The effort of looking after their health and its impact on them is termed ‘treatment burden’. Some PwP need help from their family or friends (caregiver) to complete these tasks. Caregivers may also experience treatment burden themselves when caring for someone with Parkinson’s. People’s ability to manage treatment burden is termed ‘capacity’ and is influenced by physical, mental, social and economic factors. People are overburdened when the workload of looking after their health exceeds their capacity. This can lead to poor adherence with treatment, poor quality of life and worse health outcomes. Aim We aim to understand the factors that influence treatment burden and capacity in PwP and their caregivers. Methods Interviews with 15 PwP and 15 caregivers will identify factors that influence treatment burden and capacity. These factors will be explored further in a national survey for PwP and caregivers with support from Parkinson’s UK. We will then form focus groups with PwP, caregivers, voluntary sector representatives, healthcare professionals, policymakers and managers through Parkinson’s Excellence Networks to discuss the findings and prioritise recommendations for change. This study will enable to us develop recommendations of ways to reduce treatment burden and improve future experiences of PwP and their caregivers. This research is also supported by a legacy in memory of Carolyn and Tore-Jan Myhre

a2f4485f-e939-4775-b10a-095900320a55 FinCH Implementation study: Falls prevention in care homes led by NIHR ARC East Midlands working with NIHR ARC North East North Cumbria, NIHR ARC West Midlands and NIHR ARC South London. Project: Falls in Care Homes (FinCH Imp2 study) Principle Investigator: Professor Pip Logan Team members: Dr Jane Horne , Dr Fran Allen, Maureen Godfrey , Professor Adam Gordon , Professor John Gladman , Dr Katie Robinson , Dr Paul Leighton , Dr Janet Darby , Michael Fletcher, Professor Gillian Manthorpe , Professor Barbara Hanratty , Professor Dan Lasserson , Professor Elizabeth Orton . Partners: Nottingham University Hospitals (NHS) Trust; Leicestershire County Council (Local Government); University of Newcastle, Kings College London; NHS Bromley CCG; Northumbria-Healthcare NHS Trust. Research sites: East Midlands , North East (North Cumbria), West Midlands and South London. Starts: 1/10/2021 Ends: 30/9/2023 Lay Summary People who live in care homes are at great risk of falling. Falls are common, harmful, costly, and difficult to prevent. The Guide to Action for Falls Prevention Care Homes (GtACH) programme trains and supports care home staff to identify the reasons why residents fall and then guides them to complete actions to reduce falls. In a large multicentre randomised controlled trial called the FinCH trial (1), the GtACH programme was cost-effective and reduced falls by 43%. We now need to research how to deliver the GtACH programme in ‘real life’ outside a research trial. We will work with three regions – East Midlands, South London and the North-East - to develop and research ideas about taking up the GtACH training programme which can be used nationwide. Using an approach to talking to people in care homes called Normalisation Process Theory (NPT) we will consider the work that people do in managing falls to assess whether GtACH becomes routine practice. NPT will help us to think about those things which help and those which hinder the adoption of GtACH. We have three work packages: WP1. Quality Improvement Collaboratives (QIC) will bring care home and healthcare staff together to develop and research ways to implement the GtACH. WP2. The QIC site teams will implement GtACH in 25 care homes per region (60 in total). Data from all homes and residents (about 2000 residents) will tell us the extent to which GtACH has been taken up in the homes. WP3. We will develop ‘toolkits’ of materials for care homes; containing the GtACH, a ‘return on investment’ calculator, the implementation package, and a ‘how to’ guide for establishing Communities of Practice to deliver and sustain the GtACH across regions. This study has been developed in collaboration with care home managers, care home staff, NHS clinicians and our active Patient, Public, Involvement (PPI) group who are co applicants. Going forward we have identified new PPI partners from Ashington and Bromley. We will talk by videoconferencing if needed. The study will be completed by July 2023 and we will disseminate our findings on the ARC-EM website, producing a short trailer video for YouTube, and through articles in journals and MyHomeLife Magazine. We will link our website on the national forums of the National Care Forum, Skills for Care, and Care England, Age UK, and the Alzheimer’s Society, and hold webinars for funders and managers Method Using monthly stakeholder meetings, consensus groups, interviews and literature searching we re-designed the GtACH into a suite of resources that care homes were happy to use and renamed it, on their request, to the Action Falls programme. Using an implementation theory called Normalisation Programme Theory we designed a research study to test how the Action Falls programme worked in 60 real world care homes. Care homes are being recruited across four ARC locations. All care home staff included in the 60 homes are being invited to complete the Action Falls training and complete a questionnaire (called the NoMAD) to assess how ready they are to use the programme. Interviews with care home staff and the trainers are being completed to get a first-hand view of how well the Action Falls is getting embedded into routine care. Care home staff are coming together in supportive collaborations, called Action falls Collaborations (AFC) to share knowledge, with researchers collecting data at these events. Results Ethical approval for the study has been granted by HRA East Midlands and Derby Research Ethics Committee Ref: 22\EM\0035. The study is adopted by the NIHR portfolio and the NIHR Clinical Research Network are helping to deliver the study in all locations, which are listed below in brackets. 36 care homes (60%) have been recruited, 13 in ARC North East (NE), 9 ARC London South (SE), 14 ARC East Midlands (EM). ARC West Midlands (WM) will start recruitment soon. In the ARC EM location we have four separate NHS Trusts/ Local authority areas involved. 7 NHS/ Local Authority/HEI Falls Leads have been trained in ARC’s NE, LS and EM and have begun training of the care home staff across the locations. One AFC has taken place in NE with the East Midlands AFC and South London due to take place later this month. The NoMAD questionnaires have been delivered to care homes. No interviews have yet been completed as these are due to start in November. In addition to the four locations the team have interacted with 83 individual care homes and 47 stakeholder groups sending them the Action Falls resources and talking over how they might be used, but no training has been offered. The images below show the spread of these enquiries Conclusion The study is progressing well, and care homes are very keen to take part and recruitment for the study is currently at 60%. The sites are set up and staff are in posts. We are approximately three months behind target on the activities due to care homes being reluctant to engage early in 2022 due to COVID. We consider that we may need a no cost 6-month extension to complete all the activities and to also get the Action Falls programme ready for wider spread. All our study meetings are well attended, and we have good participation from our PPI members with information being communicated from out Study Steering Group to the Stakeholders and vice versa sharing knowledge and experience. The study has gathered a lot of interest from outside of the study areas, from care homes and a range of other stakeholders. The research team have been sending out study materials and meeting with these groups over MS Teams meetings sharing resources and information about the study.A PhD student will be working with the care homes outside of our study locations from October 2022.

55265102-c760-4322-93ed-ed8448f1546f COMPLETED: Non-digital support for maintaining physical activity in people with long-term conditions – within Maintenance Of physical acTivity beHaviour (MOTH) programme Start Date 02/10/21 End Date 30/09/23 Researchers: Lead - Professors Mary Barker and Maria Stokes Joint Lead - Professor Suzanne McDonough Co-Applicants - Professor Maria Stokes, Dr Paul Clarkson, Dr Chloe Grimmett, Dr Euan Sadler, Dr Nisreen Alwan, Dr Aoife Stephenson, Dr Katherine Bradbury, Dr James Faulkner, Mr Paul Muckelt, Dr Dorit Kunkel, Mrs Luisa Holt amd Dr James Gavin Summary Being active is important to prevent and help manage long-term conditions (LTC). Previous research shows that being active can help people to do the things that they want to do for longer, reduce pain and improve quality of life. There are many community and NHS programmes that help people with a LTC to start being active, however, these programmes only last for a short period of time. Staying active in the longer-term is more difficult and there is often a decrease in activity over time following the completion of a programme or service. Previous research has shown that programmes or interventions that help people to start being active may not necessarily have the right components to help people to stay active. This project will plan and develop a new intervention that will support people with one or more LTCs to stay active, after taking part in an NHS and/or third sector ERSsphysical activity referral scheme (PARS). Our current research explores factors that help people with LTCs to stay active to allow these to be integrated into plans for the new intervention. The intervention will be non-digital to ensure that it is available to as many people as possible, regardless of access to the internet or a digital device. We know from previous work that it is important that any new intervention fits in with healthcare systems and how people manage their condition. We are therefore currently working with people with LTCs and health and social care professionals to understand how such an intervention could be delivered in practice. In this project we will use previously gathered information to plan the new service. We will recruit people with LTCs from ERSs PARS to take part in interviews to understand their needs and expectations for the intervention. We will also undertake interviews with health and social care professionals and ERSPARS practitioners to develop the intervention’s content. This will allow us to develop the prototype of the intervention and then ask people with LTCs who have taken part in a programme to pilot it and provide feedback through interviews. Once developed, we will plan a larger study to test the intervention’s potential with groups of people who have come to the end of an ERS PARS in the NHS and/or the third sector. This study will help us to gain feedback from people with LTCs using the intervention in real life settings to make further changes. It will also help us to understand whether the approaches to the research, such as how to recruit people to take part, are successful. This information will be used to improve the intervention and to support a larger trial to assess the effectiveness and cost-effectiveness of the intervention. What did we find out? This research included: • Phase 1: We interviewed 15 people living with long-term health conditions (LTCs) and nine NHS healthcare professionals to find out their experiences of being involved in an exercise referral scheme. This included what support they would want in future, as a participant (i.e., people with LTCs) and provider (i.e., healthcare professionals). • Phase 2: Follow-up workshops with LTC patients and multi-sectoral professionals to begin designing a pathway to support physical activity maintenance for people living with LTCs. Professionals shared their experiences from healthcare, leisure and community and voluntary sectors. This research has created a better understanding of the ways in which we might best support people with LTCs to stay physically active, and improve their health and wellbeing following an exercise referral scheme. Two areas of improvement were identified: 1) Better partnership working between people with LTCs, health and social care, leisure and voluntary sectors within Wessex 2) Ensuring people with LTCs have appropriate support with self-management of their lifelong physical activity levels What difference can this new knowledge make? • Better understanding of the factors preventing and enabling participation in exercise referral schemes across Wessex, can help us identify how structured exercise can benefit people with LTCs long-term, especially by highlighting the benefits and future support needs in physical activity. • It gave us understanding of people’s experiences of undertaking a physical activity referral scheme to help manage their LTC(s). This was supported by health professional’s views, having referred, delivered and/or commissioned an activity scheme • In future, this knowledge can inform the development of an integrated care pathway interlinking healthcare, social and community services to support people with LTCs to maintain their health and physical activity long-term, from a view to change physical activity behaviours. What did we do with our new Knowledge • We presented the results at the Health Enhancing Physical Activity (HEPA) Europe 2024 Conference in Dublin (August 2024) • We submitted a research paper for journal publication • Dr James Gavin ran a series of ‘Active Living’ community cafés across Southampton to share the research with the public living with LTCs and their carers. • This has led to additional grant funding and partnerships with Energise Me, Saints Foundation, Communicare, and Southampton City Council, to begin co-designing a multi-sectoral pathway within the city for the wider LTC population, not just those having undertaken an exercise referral scheme. • On January 8th 2025, we will run workshops with professional stakeholders including the HIOW Integrated Care Board, to find agreement on a ‘prototype’ pathway. Where next? •We have submitted the findings to the journal, Int J Behav Nutr Phys Activ December 2024. •Move Consulting Ltd. are supporting us with our professional stakeholder workshops (Jan 2025). •The co-lead, James Gavin, has secured £14,900 Wessex Health Partners funding to continue the community cafes and develop a pathway plan. •We will build upon our community-based partnerships with Saints Foundation, Communicare, Thornhill Baptist Church, and Energise Me as the HIOW Living Well Partnership. •Follow-on funding will be sought from the NIHR Research for Patient Benefit programme (tiers 2/3) in Spring 2025. Testimonials for Active Living Cafes "it's really good that you don't want to reinvent the wheel. My slight critique of the community cafes that have been set up is that you don't have to reinvent them .” “There are already community groups doing very similar things around…I know it's been brilliant that you have been partnering with people like Thornhill Baptist Church. They do wonderful things, some wonderful community events… My recommendation is to join and work with them , and that's what you're doing.” “It's a better strategy than trying to set up something new and try and hope that people come to it with a long-term condition. I think it's much better to go to people rather than expect people to come to you ."

6b068013-6ee6-484b-88bf-12a053cec877 Wessex SNSDE Study (SETT Centre) Project lead: Professor Chris Kipps, University Hospital Southampton NHS Foundation Trust Development and Testing of Collaborative Data Science Approaches with the Southampton Emerging Therapies and Technologies Centre and the Wessex Secure Data Environment The Southampton Emerging Therapies and Technologies (SETT) Centre, in partnership with NIHR ARC Wessex, has awarded support to four early-stage data science projects. This is a collaborative initiative to develop and test data science approaches addressing compound pressures across health and care systems. The project aims to build analytic capacity by bringing together clinical, academic, and data science expertise from University Hospital Southampton (UHS), the University of Southampton, and other regional partners with a focus on 4 use cases. Central to this work is the Wessex Secure Data Environment (SDE), part of a national programme to provide safe, secure access to clinical data. The SETT data team curates and onboards health data into the SDE, enabling secure and effective data analysis. Substance Use Disorder: Analysing electronic health records to understand how substance use impacts hospital services and to inform more effective interventions. Neurocritical Blood Pressure Control: Comparing the effectiveness of two drugs (labetalol and nicardipine) in managing blood pressure in very unwell patients, with a focus on clinical outcomes and resource efficiency. Liver Monitoring in IBD: Assessing liver function test monitoring in patients with inflammatory bowel disease (IBD) to improve early detection of liver disease and clinical pathways. Digital Tools for Rare Liver Disease: Evaluating how digital tools can improve care and screening for primary sclerosing cholangitis (PSC), a rare and progressive liver disease. This initiative has a focus on improvements in patient care and resource efficiency, while also building data science capacity to enable innovation in health and care delivery.

4d75ba35-779f-4c29-9dd6-a4bbffb8ad71 Determining the effectiveness and outcomes of innovative interventions for people who have used stalking behaviours: An extension of the exploration of the Hampshire & Isle of Wight Multi-Agency Stalking Partnership (MASP) Chief Investigator: Dr Sara Afshar Morgan, Associate Professor of Public Health, Faculty of Medicine, University of Southampton Team: Mrs Katerina Porter, Senior Research Assistant, Faculty of Medicine, University of Southampton, Lisa Allam, Commissioning Manager, Hampshire & Isle of Wight Office of the Police & Crime Commissioner Dr Kirsty Butcher, Principal Clinical Psychologist & Clinical Lead, Multi-Agency Stalking Partnership, Hampshire and Isle of Wight NHS Foundation Trust Detective Chief Inspector Abigail Leeson, Hampshire & Isle of Wight Constabulary Dr Andrew Bates, Regional Forensic Psychologist, National Probation Service Rachel Windebank, Operations Director, STOP Domestic Abuse Partners: Hampshire and Isle of Wight NHS Foundation Trust, University of Southampton, Hampshire & Isle of Wight Office of the Police & Crime Commissioner, Hampshire & Isle of Wight Constabulary, National Probation Service, STOP Domestic Abuse. Start: 1 October 2024 End: 31 March 2026 Summary People often use the word ‘stalking’ to describe using social media to learn details about someone of interest. However, in law enforcement, the word ‘stalking’ is used to describe something much more serious: ‘fixated, obsessive, unwanted and repeated behaviour that makes [the survivor] feel pestered and harassed’, alarmed, distressed, or afraid. [1] In fact, the use of stalking behaviours can lead to serious violence; in a recent review of female deaths over 3 years, stalking behaviours were found to be present in 94% of cases [2] . People who use stalking behaviours often suffer from psychological inflexibility which causes them to fixate on particular individuals. Recently, psychologists have been using various psychological therapies to attempt to treat the obsessiveness that people who stalk suffer from. The use of these therapies has been evaluated in the short-term, with small groups. Results have been positive, but there is a need for longer-term follow-up of people who have used stalking behaviours, to determine whether psychological therapies are useful in helping people to stop stalking. This research study aims to explore the experiences of individuals who have used stalking behaviours, and who have completed a psychologist-led stalking intervention (PLSI), to learn whether participating in psychological therapies is useful in preventing further stalking. We will gather information by doing interviews with people who have completed a programme of psychological therapy to stop stalking. We will do up to 6 interviews with each person, over the course of one year, to understand their experiences. We will also obtain information from the Police to learn whether any of the individuals have been reported as using stalking behaviours, after having completed the psychological therapy. We will use this information to build a picture of the reasons why the psychological therapy might or might not work, in various cases, to prevent future stalking. We will compare the experiences of the people who have used stalking behaviours, with information from victim-survivors and professionals. There is already an evaluation and research study ongoing, to learn more about the use of these psychological therapies for stalking prevention. This study will be an extension of the existing study, to follow up existing research participants over a longer period of time. Longer-term follow-up of people who have used stalking behaviours is scarce. This original research will provide an important look into the experiences of people who have used stalking behaviours and completed psychological therapies to try to treat the underlying fixation. The ultimate goal of the psychological therapy is to prevent future violence. The results of the research will be fed back to all research partners directly (Hampshire & Isle of Wight Constabulary, Hampshire & Isle of Wight Office of the Police & Crime Commissioner, Southern Health NHS Foundation Trust, National Probation Service), as well as being submitted for publication. Results will also be presented in an easy-to-read format, for use by research partners to share with their potential clients (including people who have used stalking behaviours, and their victim-survivors).

08639c2e-864e-4386-adf6-510fcbb59d49 Identifying the knowledge gaps of paramedics managing patients with mental health issues Chief Investigators: Dr Ursula Rolfe. Faculty of Health and Social Sciences. Bournemouth University, Dr Natasha Campling, School of Health Sciences, University of Southampton. Implementation lead: Kirsty Lowery-Richardson, Head of Education, College of Paramedics Partners: Bournemouth University, University of Southampton, College of Paramedics CLASS Professional Publishing, Mental Health Education leads in all 11 ambulance Trusts including West Midlands Ambulance Service. Start: 1 October 2024 End: 31 March 2026 Aim of the research: To identify the knowledge gaps of paramedics when responding to people with mental health issues. Background to the research: Many people experience mental health issues in their lives and about 1 in 6 adults in England have a diagnosed common mental health illness. Mental health issues are rising, but rates are rising most for young people. Amongst 17- to 19-year olds rates of mental health illness rose from 10% in 2017 to 26% in 2022. Rising rates of mental health issues combined with pressure on community services mean that that over 1.2 million people are waiting for support and treatment from NHS community mental health services. The result of such high-level unmet demand has fallen on ambulance services and paramedics. England’s ambulance services received 524,485 mental health related 999 calls in 2018-19, but by 2021-22 this increased to 652,720, a rise of 24%. Across England, ambulance staff spend 1.8 million hours annually (or 75,000 days), responding to people with mental health issues. Paramedics express concerns attending to patients experiencing mental health issues because of a lack of education. However, the specific nature of their knowledge gaps that underpin these concerns are not known. Therefore, this research will identify these gaps and make recommendations to inform the future design of effective educational provision, to better support the paramedic workforce in delivering quality care for the rising population of individuals with mental health needs. Design and methods: The study is designed in two phases. First, university-level education (prior to paramedic qualification) and in-practice training (once qualified) from all England’s ambulance services regarding mental health care provision will be analysed. Second, interviews with up to 20 paramedics regarding their knowledge when managing patients with mental health issues will be undertaken. The interviews will use patient cases, informed by real-life examples, to explore paramedic decision-making. Patient, public and community involvement: We have worked with a dedicated group of individuals with lived experience of mental health issues who have received care from ambulance services and paramedics to design the study. The group have all backed the importance of the study, highlighting the need for “ more caring ” by paramedics when attending those with mental health needs. We will continue to work with this group throughout the study. The group will help co-design study documents, such as the interview guide and patient cases for the paramedic interviews. The group will also be given the opportunity if desired to review and input into data analysis during both study phases. Dissemination: Findings will be shared with healthcare commissioners, ambulance services and Universities. The project’s findings will form the basis of recommendations on educational delivery via both ambulance services and Universities, and further research on how best to provide education solutions to the knowledge gaps identified.

27d064e4-2601-492e-b882-a0ef85373d44 ADOPTED: (SIFT) Sensors in Fatigue Tracking in Parkinson’s. Exploring the relationship between perception of Fatigue and the performance of physical activities in people with Parkinson's with fatigue using wearable sensors Fatigue is one of the three most debilitating symptoms in Parkinson’s. Fatigue is difficult to diagnose, it often goes unrecognised, and is challenging to treat. The SIFT-PD study is exploring how fatigue impacts physical activity in people with and without Parkinson’s over a 3-day period. It asks participants to fill in fatigue diaries and uses wearable sensors to monitor the how people move over a period of three days. The sensors are small and light and worn on a belt. The sensors track activity (the amount, type and quality of movement). This research looks at whether the sensors can reveal how people’s movements change over the course of three days when they are fatigued. Furthermore, information from sensors might help understand what makes people fatigued and allow it to be measured. Knowing more about fatigue will help to recognise its impact and help develop ways of managing it better.

fa252260-9b08-4bee-8ac4-2e68a124d401 Qualitative Data Preservation and Sharing (Q-DaPS) Principal Investigators: Prof. Fiona Stevenson ,, Professor of Medical Sociology, University College London, Head of the Research Department of Primary Care and Population Health; Prof. Geraldine Leydon-Hudson , , Professor of Primary Care Research, University of Southampton . Co-applicants: Dr Barbara Caddick Senior Research Associate in Primary Care and Honorary Senior Research Associate Department of History, University of Bristol; Dr Rebecca Barnes , Senior Qualitative Researcher, University of Oxford; Prof Carolyn Chew-Graham , Professor of General Practice Research, Keele University; Prof Sue Latter , Professor of Health Services Research, University of Southampton; Dr Emma Pitchforth , Senior Lecturer & Senior Research Fellow in Primary Care, University of Exeter. Prof. Catherine Pope , Professor of Medical Sociology, University of Oxford; Dr. Benjamin Saunders , Lecturer in Applied Health Research, Medical Sociology, University of Keele; Prof. Katrina Turner , Professor of Primary Care Research, University of Bristol; Prof Sue Ziebland Professor of Medical Sociology and Co-Director of the Medical Sociology and Health Experiences Research Group (MS & HERG) in the Nuffield Department of Primary Care Health Sciences, University of Oxford. Colaborators: Dr Ian Maidment , Reader in Clinical Pharmacy at Aston; Lynn Laidlaw is an experienced public contributor involved in UK wide and international research projects; Ali Percy, public co-applicant. Start: 1 June 2022 End: 31 May 2024 Background: Researchers may use different types of data to increase understanding of issues in relation to health and social care. Data may include audio or video recordings of interviews, focus groups (group discussions), and consultations between professionals and patients / service users, as well as written data, such as notes about research. These types of data are referred to as qualitative data. Funders of research increasingly encourage researchers to make their data available to be reused by other research teams. This is in part because qualitative data collection takes a lot of time and costs a great deal of public money. It is also considered ethical to make maximum use of data. Importantly, many people who participate in research tell us it is important to them that their contribution to research is used as much as possible. The project: Despite the increasing need and wish to safely store and share qualitative data, there is no central place to store and provide access to qualitative research data collected about health and social care. We will work with a company that specialises in keeping data secure and has a track record of working with university and health care organisations to develop secure digital storage (a repository) for qualitative data about health and social care. Part of the work will involve taking account of the views of members of the public about consent and use of data as well as data security. This will make sure the guidelines we put in place for people putting data into the repository or using data from the repository are acceptable to both researchers and participants in research. We will publicise the repository to encourage researchers to store their study data and allow access for researchers to answer their research questions. We will also provide a description of what is in the repository on a website so researchers can plan if they could use data from the repository rather than collecting new data. We will charge for use of data so the repository can be self-funding and sustainable in the long term. Expected impact : Increasing access to existing qualitative data from research projects in health and social care will make better use of what we already know about health and social care, saving time and money that would otherwise be spent on collecting new data. It will also satisfy the expectations of funders of research that data should be reused where possible. This project is particularly important as the COVID 19 pandemic has made data collection even more challenging in health and social care sites meaning we need to make the best use of the data we already have.

f6f0f7ec-ab98-4c5c-9b52-2674a93b8c90 ADOPTED: A Study to Evaluate the Introduction of new Staffing Models in Intensive Care: a Realist evaluation (SEISMIC-R) Prinicipal Investigator: Professor Natalie Pattison, University Of Hertfordshire Team: Professor Peter Griffiths, Dr Chiara Dall'Ora, Dr Christina Saville, Dr Lisa Whiting, Dr Melanie Handley, Dr Susie Pearce, Dr Marion Penn, Dr Paul Mouncey, Professor Thomas Monks, Mrs Clare Leon-Villapalos, Professor Suzanne Bench, Professor Ruth Endacott, Mr Jeremy Dearling, Mrs Jennifer Gordon. University of Southampton, University of Hertforshire, University of Plymouth, Intensive Care National Audit & Research Centre, University of Exeter, Imperial College Healthcare NHS Trust, Guys & St Thomas' NHS Foundation Trust/London South Bank University, NIHR Clinical Research Network. Start Date: 01 May 2023 End Date: 31 August 2024 Background Staffing in intensive care units (ICU) has been in the spotlight since the pandemic. Having enough nurses to deliver safe, quality care in ICU is important. There is national guidance, re-issued in April 2021, on how many nurses should care for ICU patients. However, what the skill mix should be (how many should be qualified nurses or have an ICU qualification) is unclear. Very little research has been done to look at which nursing staff combinations and mix of skills works best in ICU to support patients (described as ‘staffing models’). Across ICUs in UK, various ratios of qualified and unqualified nursing staff are being tried (staff ratios refer to the number of nurses caring for a set number of patients). Hospitals vary; some use a high proportion of non-registered nurses and others a low proportion of ICU qualified nurses. Research shows that there is a link between the quality of nurse staffing and poor patient outcomes, including deaths. Aim : Our research plans to look at different staffing models across the UK. We aim to examine new staffing models in ICU across six very different Trusts. We will use a research technique called Realist Evaluation that examines what works best in different situations and helps us to understand why some things work for some people and not others. The design of this approach will help us to better understand the use of different staff ratios across different ICU settings. We will examine what combinations of staff numbers and skills result in better patient care and improved survival rates. Our aim is to produce a template that every ICU unit can use. To do this, we will compare staffing levels with how well patients recover, and seek to understand the decisions behind staffing combinations. Publications Nurse staffing configurations and sickness absence in English intensive care units: A longitudinal observational study - ScienceDirect ICU staffing and patient outcomes in English hospital Trusts: A longitudinal observational study examining ICU length of stay, re-admission and infection rates - ScienceDirect

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