Wessex ARC 2020 Applied Research Collaboraঞon - NIHR

Applied Research Collaboraon
         Wessex

         Applied Research Collaboraon
         Wessex

         Applied Research Collaboraon
         Wessex

         Applied Research Collaboraon

          ARC 2020
         Wessex

Setting the agenda for the future of
 health & care research in Wessex

              Stakeholder event

           Tuesday 3rd March 2020

            Novotel, Southampton

        @arc wessex      #letstalkwessex

Welcome
                                 “Thank you for coming today. This is the start
                                 of us thinking about the direction of applied
                                 health and care research of ARC Wessex.
                                 At this crucial point in our programme we
                                 have the opportunity to decide how best to
                                 reflect the needs of Wessex, build on our
                                 strengths and target our research efforts.”
                                 Professor Alison Richardson, Director ARC Wessex

This booklet outlines the main research programme for ARC Wessex from 2019 until
2021 across our four research theme areas

    Ageing & dementia                            Healthy communities

                                                       Workforce &
   Long term conditions
                                                       health systems

You will find the details of the 14 main projects from each theme which will be useful
when we begin to scope our future research programme from 2021-2024

At the back you will find a chart explaining how research ideas will be prioritised in order
to choose the final 3 years of the ARC Wessex research programme

Ageing & dementia

Improving physical activity of older people in the community through trained
volunteers: The ImPACt study

Principal Investigator: Dr Stephen Lim

Team members: Dr Stephen Lim (NIHR Clinical Lecturer in Geriatric Medicine, 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),
Esther Clift (Consultant Practitioner in Frailty, Southern Health NHS Foundation Trust, Lymington New Forest
Hospital), Samantha Agnew (Head of Clubs Services, The Brendoncare Foundation, Winchester)

Start: 1 February 2020 Ends: 31 October 2021

Project Partners: University of Southampton, University Hospital Southampton NHS Foundation Trust,
Southern Health NHS Foundation Trust, Brendoncare.

Lay summary
Physical activity is important for older people. It has many benefits including maintaining older people’s ability
to perform activities of daily living, be independent, and improve their well-being. However, many older adults
living in the community do not engage in regular physical activity.

Aims
We want to know if we can train volunteers to run exercise sessions for older people who attend community
clubs with a focus on social interaction. We are interested in finding out the views and experiences of older
people and volunteers taking part and what factors may promote or hinder the delivery and uptake of the
exercise sessions.

Design and methods used
The study will take place in community social clubs managed by Brendoncare. We will invite older adults
(members) who attend these clubs to join an exercise session during their usual weekly meeting. We will
develop and evaluate a training package for the volunteers who lead these clubs to enable them to run the
exercise sessions. Participants will be encouraged to performed exercises to help improve their muscle
strength and balance, with the use of elastic resistance bands. We will measure how active and physically able
the club members are before we introduce the exercise sessions. After 6 months of these exercise sessions,
we will repeat these measurements to see if this has improved their physical activity levels and physical
abilities. We will also interview volunteers and club members to gain their views and experience of the exercise
sessions.

Findings from this study will help us understand if it is feasible for volunteers to deliver exercises for older
adults in community clubs and how acceptable the intervention is for older adults and volunteers. This study
will begin in February 2020 and is expected to conclude in October 2021.

Ageing & dementia

INVOLVing pEople with cognitive impaiRment in decisions about their hospital
nursing care (INVOLVER): a pilot study

Principal Investigator: Professor Jackie Bridges

Team members: Professor Jackie Bridges (Professor of Older People’s Care, School of Health Sciences,
University of Southampton), Dr Jo Hope (Research Fellow, School of Health Sciences, University of
Southampton), Dr Tula Brannelly (Senior Lecturer, Bournemouth University), Dr Teresa Corbett (Research
Fellow, School of Health Sciences, University of Southampton)

Start: 1 January 2020 Ends: 31 December 2021

Project Partners: University Hospital Southampton NHS Foundation Trust, Solent NHS Trust, Bournemouth
University, Centre for Implementation Science, University of Southampton

Lay summary
We want to help nurses look after their patients in hospital. We want to help them find out how each patient
likes to do things like getting clean, going to the toilet, eating and drinking.

Some people have to go into hospital to get better. Sometimes, when they are in hospital, the nurses don’t ask
them enough about the way they like to do things. For example, if they like a bath or a shower. Or if they need
help going to the toilet. Or if they would like to walk about. Or what food or drink they like.
Not being asked about these things is not helpful. It might mean that people end up getting sicker and staying in
hospital longer. Or they may go home needing more help from their family.
People with dementia, learning disabilities or stroke may not be asked these questions about what they like.
Sometimes the nurses don’t know how to do this well. Sometimes they know how to do it but can’t do it. The
reasons they can’t do it are not well understood.
We are a group of people who want to make this better. Some of us work at a university finding things out.
Some of us are nurses. We want to include people with dementia, learning disabilities or stroke in our group.
This will help us think about how to make things better.
We think we can help nurses by using ideas that have worked in other places. When people like us have an idea
about how something can be made better, we try the idea out and see if it works.
An example of an idea we might try is a training day for nurses. A teacher in a classroom shows the nurses how
to do something new. Then the nurses see if they can do the new thing when they go to work.
We will write down the story of what happens. The story gets printed in a magazine or a book. Or the story
might get shared in meetings with other people or on the internet.

This is our plan to make an idea that will help nurses to help patients:
• Find and read the stories of ideas tried in other places that might be useful.
• Talk to patients, nurses and others to make an idea that we think will work.
• Talk to patients, nurses and others to see what they think about the idea.
• When we’ve done this work, we will be ready to try this idea out. If it works, when people go into hospital,
    they will be asked about what they like. And the nurses will be helpful. And the care will be a little more like
    being at home.

Ageing & dementia

PerCent Care - Developing training for person-centred care: A pilot study

Principal Investigator: Professor Jackie Bridges

Team members: Professor Jackie Bridges (Professor of Older People’s Care, School of Health Sciences,
University of Southampton), Dr Teresa Corbett (Research Fellow, School of Health Sciences, University of
Southampton), Professor Alison Richardson (Professor of Cancer Nursing and End of Life Care, University
of Southampton and University Hospital Southampton NHS Foundation Trust), Dr Jane Winter (Macmillan
Consultant Colorectal Nurse, University Hospital Southampton NHS Foundation Trust)

Start: 1 October 2019 Ends: 30 September 2021

Project Partners: University Hospital Southampton NHS Foundation Trust, Southern Health NHS Foundation
Trust, Bournemouth University.

Lay summary
The aim of this research is to find out what type of information we should include in a training package for
health and social care staff. The training will help staff to ask questions about an older adults’ goals and care
needs. Once we have put the training course together, we will test it out to see if care staff can manage it and
find it useful. This study will help us to make a useful training course that we can use to train health and social
care staff in future research.

Background to the research
We have made a tool to help health and social care staff to talk to older adults who have lots of different
conditions. This tool has 8 steps that should be followed in a meeting with people about their needs and
personal goals. In a previous study, when we spoke to health and social care staff they said that they would like
training in how to use the tool.

Design and methods used
We will study similar courses, workshops and training so that we can find out more about how we should plan
our training. We will make a draft of what will be included in the training.
Experts will be consulted to discuss the training draft and we will make changes based on what they say. When
all agree with it, we will try out the training 2-3 times. Up to 10-15 health and social care staff will take part.
They will fill in a survey before and after the training. We will then send them another survey after a month. We
will ask them if they found the training useful and if they have used their new skills. We will also talk to some of
the people who took part to find out more detail about what they liked or did not like about the training.

Patient, public and community involvement
Members of the public have been part of the study so far in many ways. They have helped us to produce the
tool that we will train health and social care staff to use. We also intend to work with group of people from the
community who have agreed to help us to in several ways. These include:

•   Looking over content in the training and letting us know what they think
•   Coming to project meetings
•   Helping us to plan the pilot study
•   Looking over study information that we will send to participants
•   Helping us to make sense of the research findings
•   Dissemination

We intend to present our findings: in papers that will be published in academic journals, at conferences and at
events with audiences who are interested in our study.

Healthy communities

Testing the effects of food product placement changes on customers’ intended
product purchases: an experimental trial in a virtual supermarket setting

Principal Investigators: Professor Janis Baird and Dr Christina Vogel

Team members: Professor Janis Baird (Professor of Public Health and Epidemiology, Medical Research
Council Lifecourse Epidemiology Unit, University of Southampton), Dr Christina Vogel (Principal
Research Fellow in Public Health Nutrition, Medical Research Council Lifecourse Epidemiology Unit,
University of Southampton), Dr Sarah Crozier (Senior Statistician, Medical Research Council Lifecourse
Epidemiology Unit, University of Southampton). Professor Marcus Munafo (Professor of Biological Psychology,
Medical Research Council, University of Bristol), Dr Olivia Maynard (Lecturer in Experimental Psychology,
Medical Research Council, University of Bristol), Ravita Taheem, (Southampton City Council, Sure Start
Children’s Centres)

Start: 1 October 2019 Ends: 30 September 2020

Project Partners: University of Southampton, University of Bristol, Southampton City Council, Sure Start
Children’s Centres

Lay summary
Poor diet is linked to an increased risk of obesity, diabetes and heart disease. Most adults in England consume
too much salt, saturated fat and free sugar, and do not eat the recommended five daily portions of fruit and
vegetables. People with lower education and income levels are more likely to have poor diet and to experience
health problems as a result. Women of childbearing age are primarily responsible for domestic food tasks such
as shopping and cooking, and their diets are closely linked to those of their children. Most families buy their
food from supermarkets and their food choices can be influenced by placement of items in-store and by
promotions.

We want to find out how the placement and packaging of healthy and unhealthy foods influence the foods that
women choose to buy. We will do this by creating a ‘virtual’ supermarket layout that participants will interact
with on a computer screen. We will recruit women attending Sure Start Children’s Centres in Hampshire – a
county with some relatively deprived areas within the Wessex region. We will choose centres located in areas
of higher deprivation. Local data suggests that 70% of families with young children are engaged with these
centres.

Women using the virtual supermarket will be shown images of healthy and unhealthy foods and non-food
items that are placed in noticeable locations in the supermarket like checkouts. We will measure what aspects
of the images women look at using experimental techniques such as eye tracking, which records their gaze
point, and heat-mapping which records where women click on the screen and then creates a graph to show
their areas of interest. The eye tracker is positioned close to the computer screen allowing it to record where
women look. We will then ask women to tell us the products that they saw for sale, the name of the products
they considered purchasing, and aspects of the supermarket that took their interest, and why. Our findings will
tell us how people respond to the placement and packaging of different types of food products. These findings
help us to design ways to layout supermarkets to help families eat more healthy foods.

Our research will begin in October 2019 and end in late 2020. We will share the findings from our study with
local families attending Sure Start Children’s Centres. We will inform local and national government employees
about our findings which could help to refine current government policies to address childhood obesity.

Healthy communities

The Wessex FRIEND Toolbox (Family Risk IdEntificatioN and Decision)

Principal Investigator: Dr Nisreen Alwan and Dr Dianna Smith

Team members: Dr Nisreen Alwan (Associate Professor in Public Health, School of Primary Care and
Population Sciences, Faculty of Medicine, University of Southampton), Dr Dianna Smith (Lecturer in
Geographic Information Science, Geography & Environment, University of Southampton),
Professor Paul Roderick (Professor of Public Health, School of Primary Care and Population Sciences,
Faculty of Medicine, University of Southampton), Dr Ivaylo Vassilev (Principal Research Fellow, School of
Health Sciences, University of Southampton)

Start: 21 October 2019 Ends: 20 September 2021

Project Partners: University of Southampton, Solent NHS Trust, Southampton City Council, Portsmouth City
Council, Hampshire County Council, Health Education England, Oxford Brookes University

Lay summary
Nearly a third of all UK children are overweight. Obesity in children is strongly linked to obesity in adulthood,
and hence diabetes, heart disease and stroke. Children living in the most deprived areas in England are twice
as likely to live with obesity compared to children in the least deprived areas. Cost of a healthy and varied diet
is a major barrier against the prevention of childhood obesity and poor health more widely, with an estimated
4 million UK children living in poverty, following a rapid rise within the last 5 years. Food poverty is on the
rise with a record 1.6 million food parcels given to people in the last year. Although we know that poor health
including obesity is shaped early in life, and even before birth, the current system has no means of identifying
families whose children are at risk of obesity in order to focus support efforts early on.

We have created a tool to predict childhood obesity at school age which can be calculated at multiple time
points; pregnancy, birth and during the first two years of life. We have used large-scale Hampshire data from
our SLOPE project (Studying Lifecourse Obesity PrEdictors) to generate those risk scores. This project aims to
produce a user-friendly version of this tool, called the SLOPE CORE (Childhood Obesity Risk Estimation) Tool,
built into a website and a smart-phone app, for the use of health and care professionals interacting with young
families as well as parents/carers.

We will update and derive locally sensitive area-based measures of child poverty, food poverty and access to
green space. These will be available for utilisation by the local council to identify areas and populations where
resources are most needed to reduce existing health inequalities and will aid the SLOPE CORE Tool in targeting
preventive action and support towards disadvantaged families. The intention is to address social inequalities
(food, child poverty and poor access to greenspace) which in turn will positively impact obesity and ill health
risk in disadvantaged households.

We will provide these tools on one platform, the Wessex FRIEND (Family Risk IdEntificatioN and Decision)
Toolbox, along with a social networking intervention, Genie, which will be made relevant to families with young
children and tested to see if it supports more engagement with existing community members, activities and
resources, and develop links with new network members.

We have involved mothers of young children in discussions around the acceptability and delivery mode of the
SLOPE CORE. We will have two public contributors on our steering committee who will help shape the
detailed steps of the project. We will disseminate our findings to regional and national agencies, with the
support of our public contributors, stakeholders and collaborators.

Healthy communities

The feasibility of community pharmacies testing for Hepatitis C in people who inject
performance and image enhancing drugs (PIEDs)

Principal Investigators: Dr Ryan Buchanan

Team members: Dr Ryan Buchanan (Academic Clinical Lecturer Hepatology, Faculty of Medicine, University of
Southampton), Professor Salim Khakoo (Professor of Hepatology, Faculty of Medicine, University of
Southampton), Dr Charlotte Cook (Hepatology Research Fellow, University Hospital Southampton),
Dr Mark Wright (University Hospital Southampton NHS Foundation Trust), Charlotte Matthews
(Southampton City Council), Dr Gemma Ward (Public Health England), Colin McAllister (Southampton City
CCG), Stuart Smith (Hepatitis C Trust), Pamela Campbell (Solent NHS Trust, Homeless Healthcare Team)

Start: 1 October 2019 Ends: 30 September 2021

Project Partners: University of Southampton, University Hospital Southampton NHS Foundation Trust, Solent
NHS Trust, NHS England, Public Health England, Southampton City CCG, Southampton City Council,
Hepatitis C Trust.

Lay summary:
The people at highest risk of Hepatitis C (HCV) in the United Kingdom (UK) are those who are sharing needles,
syringes or injecting equipment. This includes people who inject performance and image enhancing drugs
(PIEDs) such as steroids.

This population are high users of needle and syringe programmes, however, the risks taken by this population
and their access to testing for HCV are poorly understood.

The information that is available is not consistent, with the proportion of people with HCV varying widely but
may be as high as one in seven PIED users. The study has been discussed in detail with body-builders, a gym
owner, pharmacists and people who work at needle and syringe programmes (NSPs). The body-builders were
very keen to be involved in the study as they want to have accurate, scientifically performed studies. They
feel strongly that the information that is out there currently is not representative of their community that use
PIEDs. They also felt that it was important that to have a focus on HCV but they were keen to be involved in a
study that also addresses at other elements of liver health. The methodology for the study were discussed and
adapted after patient and public involvement (PPI) meetings.

The aim of this study is to see if widening access to testing of HCV based in community pharmacies with a
pathway into specialist care is able to provide improved and acceptable access to testing and treatment
compared with standard care. We also want to gain a better understanding of the burden of HCV in this group
of people who are using PIEDs, and an understanding of risk behaviours. We will also investigate knowledge of
liver disease caused by other factors (e.g. alcohol and obesity). This will be done via interviews with
body-builders to understand more about their behaviour and the risks they take. This will be followed by a
survey with an associated HCV test and measurement of liver scarring.

The information gained from the interviews, surveys and tests will give a far greater understanding of this
population and their risk of HCV. This information can then be used to target at-risk groups and to adapt
current approaches with the aim of elimination. The results will be disseminated in medical journals and
presented at medical conferences.

Healthy communities

A public health approach to crime: secondary and tertiary prevention schemes for
females victims 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
(Restorative Justice Lead, Hampshire Constabulary) , Debbie Willis (Domestic Abuse Service Manager,
Hampton Trust charity), Vicky Atkinson (Domestic Abuse Project Coordinator, Hart District Council), Patricia
Durr (One Small Thing), Mona Samiy (Project Manager, Stop Domestic Abuse charity)

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 managers, 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).

Long term conditions

Using the Wessex Activation and Self-Management (WASP) Tool to design and
implement system wide improvements in self-management support for people with long
term conditions

Principal Investigator: Professor Mari-Carmen Portillo

Team members: Professor Mari-Carmen Portillo (Professor of Long Term Conditions, School of Health
Sciences, University of Southampton), Dr Hayden Kirk (Consultant Physiotherapist and Clinical Director
Adults Southampton, Solent NHS Trust), Dr Chris Allen (Lecturer, School of Health Sciences, University of
Southampton), Stephanie Heath (WASP Clinical Lead, Royal Bournemouth and Christchurch Hospitals NHS
Foundation Trust), Dr David Culliford (Senior Medical Statistician, School of Health Sciences, University
of Southampton), Dr Louise Johnson (WASP Project Manager, Royal Bournemouth and Christchurch
Hospitals NHS Foundation Trust), Dr David Kryl (Director, Centre for Implementation Science, University of
Southampton), Professor Alison Richardson (Professor of Cancer Nursing and End of Life Care, University
of Southampton and University Hospital Southampton NHS Foundation Trust), Anya de Iong (Senior Self-
Management Coach and Primary Care Development Lead, Patient Editor for the BMJ)
Start: 1 October 2019 Ends: 31 December 2020
Project Partners: Solent NHS Trust, Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust,
University Hospital Southampton NHS Foundation Trust, University of Southampton
Lay summary
The NHS wants to achieve better health outcomes, improved experience for patients, and more effective use
of services and resources for people living with a long-term health condition. Helping people to self-manage
their condition helps improve people’s health and their experience of managing the condition in everyday
life. Increasing people’s knowledge, skills and confidence may help them to be more actively involved in self-
management of their condition. This is sometimes referred to as ‘patient activation’.
The Wessex Activation Self-Management Programme (WASP) Self-Assessment Tool has been developed
to help health teams understand where their service could do more to help people be more active in the
management of their condition. The tool can be used by people who use services and people who plan, manage
and deliver care and services. It asks about behaviour: WHAT people actually do, and WHY they do (or don’t
do) certain things. The answers can help health teams decide how to improve their service. We have already
tested the tool in several different services. Early findings show differences across health services, e.g.
managers reported ways in which their services helped people to be more active in the management of their
condition, but front-line staff (such as nurses and doctors) and patients often had different experiences of this.
The next stage is to use the tool to help teams identify aspects of support in their service that require
improvement and help services to make these improvements. We will do this by: Assessing the services current
practice in relation to self-management support, using the Wessex Self-Assessment Tool. Providing bespoke
coaching and support (over a 10-month period) to enable teams (consisting of those who fund the service,
managers, front-line staff (such as doctors, nurses and physiotherapists those who deal directly with patient)
and patients themselves) to identify areas for improvement and support them to make improvements that
benefit patients.
We will re-assess self-management support by repeating the WASP Self-Assessment Tool. Several ways will be
used together to decide if this works, how it works and how it can be improved. These will help us understand
if this coaching and support can benefit other health services. Firstly, members of healthcare team (including
those who provide funding for the service, the services managers, front line staff and patients themselves)
will complete a questionnaire. At the end of the study, following the teams coaching and support, this
questionnaire will be completed again by all members of the team and the answers will be compared with those
provided at the beginning to see if improvements have been made. We expect 8 teams to take part in this. In
addition, a small number of teams will be observed during the coaching and support sessions and will be given
the opportunity to share their experiences of the service in an interview at the start of the project, as well as of
the coaching and support that they have received during an interview at the end of the project. This will help us
understand how the coaching and support works and how it can be improved. We expect to work with 3 of the
8 teams in this part of the project.

Long term conditions

Validation of the living with chronic illness scale in an English-speaking population
with long term conditions

Principal Investigator: Professor Mari-Carmen Portillo

Team members: Professor Mari-Carmen Portillo (Professor of Long Term Conditions, School of Health
Sciences, University of Southampton), Dr Kelly Hislop-Lennie (Lecturer, School of Health Sciences. University
of Southampton), Dr Emily Arden-Close (Department of Psychology, Bournemouth University), Dr Jo Hope
(Research Fellow, School of Health Sciences, University of Southampton), Dr David Culliford (Senior Medical
Statistician, School of Health Sciences, University of Southampton), Dr James Bennett (Primary Care Research
Locality Lead, Clinical Research Network Wessex), Dr Simon Fraser (Associate Professor of Public Health,
Faculty of Medicine, University of Southampton), Dr Leire Ambrosio (Lecturer, Faculty of Nursing, University
of Navarra, Spain)

Start: 1 October 2019 Ends: 30 September 2021

Project Partners: Clinical Research Network (CRN) Wessex, Primary Care Dorset, Bournemouth University,
University Hospital Southampton NHS Foundation Trust, University of Southampton, University of Navarra,
Spain

Lay summary
Long term conditions (LTCs) are a worldwide challenge because of their complications, increasing numbers,
costs and impact on people’s lives. In order to develop interventions that improve the adaptation to illness and
quality of life, we need appropriate, reliable and valid tools, which reflect cultural and language diversities and
individual needs. This would benefit both patients and health/social care professionals in the management
of LTCs, by allowing the patients a way to express their needs and therefore, allow the health/social care
professional to direct the patient to specific, relevant resources.

The present study aims to produce an English version of the Living with Chronic Illness Scale and establish if it
can be useful and applicable to English speaking people with LTCs in the UK.

The Living with Chronic Illness Scale is the only available tool, which comprehensively evaluates the experience
of living with a long term condition, focusing on the person and not on the disease. This scale was created after
previous research, and successfully used with people with Parkinson’s Disease from Spain and South America.

In this study we will first translate the Spanish version of the scale into English, making any necessary cultural
changes. After this, we will test the understanding of the approved English version with 15 people with LTCs.
Then, we will use the final English version of the scale with at least 1,650 people with different LTCs in Wessex
community settings. Apart from the Living with Chronic Illness Scale, we will ask participants about perceived
social support, life satisfaction, quality of life, and the perceived severity of their LTC(s), using tools for English
speakers.

Finally, 2 discussion groups will take place with people with LTCs, 2 with family-carers and 2 with health
professionals to explore and compare their views about the usefulness of this scale in the daily management of
LTCs.

People with long term conditions and associations have contributed to the choice of topic, research and
dissemination plan.

Long term conditions

Medicines optimisation: improving safety and reducing treatment burden among people
taking non-steroidal anti-inflammatory drugs or disease modifying anti-rheumatic drugs

Principal Investigator: Dr Simon Fraser
Team members: Dr Simon Fraser (Associate Professor of Public Health, Faculty of Medicine, University
of Southampton), Professor Chris Edwards (Professor of Rheumatology, University of Southampton and
Associate Director of the NIHR Clinical Research Facility), Dr Chris Holroyd (Consultant Rheumatologist,
University Hospital Southampton NHS Foundation Trust), Dr Kinda Ibrahim (Senior Research Fellow, Faculty
of Medicine, University Hospital Southampton NHS Foundation Trust), Dr Ravina Barrett (Pharmacist,
University of Portsmouth), Dr Clare Howard (Chief Pharmacist, Medicines Optimisation, Wessex AHSN),
Dr Mary O’Brien (NHS England, NHS Rightcare), Dr David Culliford (Senior Medical Statistician, School of
Health Sciences, University of Southampton), Professor Paul Roderick (Professor of Public Health, Faculty
of Medicine, University of Southampton), Prof James Batchelor (Director Clinical Informatics Research Unit,
Faculty of Medicine, University of Southampton), Dr Matthew Stammers, (Senior Endoscopy Fellow, University
Hospital Southampton NHS Foundation Trust and Clinical Informatics Research Fellow at Clinical Informatics
Research Unit)
Start: 1 October 2019 Ends: 30 September 2021
Project Partners: University Hospital Southampton NHS Foundation Trust, NHS England (NHS Rightcare),
University of Portsmouth, University of Southampton, Academic Health Sciences Network (AHSN) Wessex.
Lay summary
Painful conditions associated with age (such as arthritis) are common in the UK and safe pain relief options
for older people are limited. Anti-inflammatory drugs such as ibuprofen are widely used – both bought from
the pharmacy and prescribed by doctors, but they have significant risks, such as bleeding from the stomach
and kidney damage. Older people and those with certain long term medical conditions are at higher risk of
experiencing bad effects from these drugs.
Another issue concerns people who are taking one of a group of medications call ‘disease-modifying anti-
rheumatic drugs’ (DMARDs). These drugs are often used for rheumatoid arthritis and work by slowing its
progression, reducing the likelihood of severe joint damage and other related health problems. They are
also used for inflammatory bowel diseases, like Crohn’s disease. Methotrexate is one of the most commonly
used DMARD in arthritis and Azathioprine is one of the most commonly used in inflammatory bowel disease.
Anti-TNF drugs are an important group of so called ‘biological agents’ – another type of DMARD. DMARDs
are powerful drugs that require regular blood tests to check for adverse effects, such as liver problems, and
guidelines advise how often these tests should be done. However, for most people, these blood tests are
almost never abnormal, and could potentially be safely done less frequently. In addition, some people with
inflammatory arthritis have an excellent response to DMARDs. Stopping DMARDs can lead to flare ups of
disease, but the amount of therapy used may be tapered successfully to reduce dose-dependent adverse
events and costs.
In one part of this research we will use an anonymous database of about half a million people from GP practices
in Hampshire to identify how many people are prescribed anti-inflammatory drugs, particularly those who
may be at high risk of complications by being older or having other conditions. The aim is to help doctors
transfer high risk patients to other pain relief options. In another part, we will use the same dataset and also
data from people who have attended University Hospital Southampton NHS Foundation Trust who take
Methotrexate, Azathioprine and anti-TNF drugs. We will look at their blood results to see if some people might
not need blood tests so frequently. Patients may be understandably nervous that problems could be missed
if the blood check is not done so often, so we plan future research asking patients and doctors whether such
reduction in checks would be acceptable. We will also investigate the possibility of successful dose reduction
strategies for anti-TNF drugs. Specifically, we will identify which kinds of patients tend to succeed in being able
to reduce the dose. This research has potential to reduce the burden on patients and on the NHS by reducing
the frequency of blood tests and/or medication burden for some people and avoiding hospital admissions for
anti-inflammatory drug complications. Through connections our team has already, the results of this research
will be shared with relevant doctors, nurses and patient groups across Wessex so it makes a difference locally.
It will also be published in academic journals and presented at conferences.

Long term conditions

Digital and non-digital behaviour change interventions to support the maintenance of
physical activity for adults with long term conditions: mixed methods studies

Principal Investigator: Professor Maria Stokes

Team members: Professor Maria Stokes (Professor of Musculoskeletal Rehabilitation, School of Health
Sciences, University of Southampton, UK Head of Active Living Research Group), Dr Paul Clarkson (Research
Fellow, School of Health Sciences, University of Southampton), Dr David Culliford (Senior Medical Statistician,
School of Health Sciences, University of Southampton), Mr Paul Muckelt (Research Fellow, School of Health
Sciences, University of Southampton, Centre for Sport, Exercise and Osteoarthritis Research Versus
Arthritis), Mr Jem Lawson (Patient and Public Involvement (PPI) Representative,) Mr Ranj Parmar (Patient
and Public Involvement (PPI) Representative), Carol Clark (Associate Professor and Head of Department,
Human Sciences and Public Health, Bournemouth University), Dr Katherine Cook (Senior Physiotherapy
Lecturer, University of Winchester), Dr Hazel Everitt (Associate Professor, Faculty of Medicine, University
of Southampton), Dr Zoe Saynor (Senior Lecturer in Physical Activity, Exercise and Health, University of
Portsmouth), Professor Mari-Carmen Portillo (Professor of Long Term Conditions, School of Health Sciences,
University of Southampton), Dr Simon Fraser (Associate Professor of Public Health, School of Primary Care
and Population Sciences, Faculty of Medicine, University of Southampton), Professor Suzanne McDonough
(Professor of Health and Rehabilitation, Royal College of Surgeons, Ireland)
Start: 1 October 2019 Ends: 30 September 2020
Project Partners: University of Southampton, Bournemouth University, University of Winchester, Portsmouth
University, University Hospital Southampton NHS Foundation Trust, Salisbury NHS Foundation Trust,
Portsmouth Hospitals NHS Trust, Royal College of Surgeons, Ireland

Lay summary
For people living with a long-term condition (LTC) research has shown that physical activity can be beneficial
for managing symptoms and preventing future problems. However, many people with a LTC are not active
enough to achieve these benefits. The reasons for this may be symptoms that restrict activity such as fatigue or
pain, or fear of activity making things worse.

Supporting people with LTCs to undertake physical activity is therefore important. While programmes do
exist to help, they are not always effective at improving the physical activity levels. Additionally, results are
often measured in the short-term and it is less clear whether the benefits can be maintained over an extended
period.

Digital interventions defined as “devices and programs using digital technology to foster or support behaviour
change” have become increasingly accessible for health-related information, to help support people to manage
their own conditions. There is some evidence that web-based programmes for promoting physical activity can
be effective. We are interested in finding out how effective digital interventions are at helping people with
LTCs to maintain physical activity beyond three months.
We will review studies published over the past 10 years that test digital interventions using statistics and
those that report people’s experiences of undergoing the interventions to find out if these interventions have
been effective in the longer term and if so, what has made them effective. Our searches will be conducted in
a systematic manner and we will include the most widespread LTCs. This review will only include studies that
have been conducted with adults. Our team is made up with people who have expertise in living with a LTC
and clinicians and academics with expertise across a range of LTCs. We will review the quality of each study,
explore the results to find out if they are truthful and robust and then report on the findings.
We will publish the review to facilitate the design of more effective interventions. With PPI representatives,
we will co-develop key messages from the findings and activities to reach different populations. We will
present the results of this review at both research conferences and public events to highlight the potential
benefits of digital interventions to maintain physical activity. This may ultimately help to reduce the burden
and improve the quality of life of people living with LTCs, while also providing resources for NHS services.

Workforce & health systems

Improving community health care logistics using Operational Research

Principal Investigator: Dr Carlos Lamas-Fernandez

Team members: Dr Carlos Lamas-Fernandez, (Research Fellow in Operational Research, University of
Southampton), Professor Peter Griffiths (Chair of Health Services Research, School of Health Sciences,
University of Southampton), Dr Antonio Martinez-Sykora (Associate Professor of Business Analytics.
Southampton Business School, University of Southampton)

Start: 1 October 2019 Ends: 30 September 2021

Partners: University of Southampton, Solent NHS Trust

Lay summary
Operational Research (OR) is the application of computer and mathematical modelling to support decision
making. In health services research, OR aims to improve patient outcomes, increase efficiency and enhance
health professionals’ and public understanding of how an NHS service achieves good performance. In this
study, we will use OR to improve the quality of patient care by supporting community nursing teams organise
how they visit people in their own home.

Community nursing teams in England are part of an NHS Community Trust. Everyday each trust sends nurses
out to visit hundreds of people at home to provide care. The process of planning home visits is largely manual
(paper and pencil) and planned a day in advance. Nurses of different bands and even within the same band
have different skills, for example some nurses are able to deliver wound care and some nurses are not. Home
visits are allocated to nurses in a way that makes sure that patients care needs are met (e.g, an insulin injection
must be administered between 9am and 11am ), that the cost of delivering care is minimised (e.g, by clustering
patients by geographic location) and that nurses and patient preferences are met (e.g, variation in care activity
for nurses, and continuity of care for patients).

Much of community nursing work is planned, however, it is common for teams to receive urgent referrals
during the day. This type of planning problem is well known to OR. It is very difficult for manual planning of
home visits to achieve all its aims. To make this problem simpler in practice large regions are broken down into
smaller regions and planning takes place only for the next day. Such an approach works but is likely to miss
benefits for patients and any efficiency savings for the NHS offered by looking at the problem as a whole.
To address this gap, academic OR recently developed algorithms to automate the solution of what it has called
the ‘Home Health Care Routing and Scheduling Problem’. In 2018, Dr Carlos Lamas-Fernandez worked with
Solent NHS Trust to learn from both academic research and the practice of community nursing to develop a
novel decision support tool (DST) to help community teams to improve patient care and efficiency.

This study aims to scale up this work in the following ways: the decision support tool will be tested with nursing
teams in Portsmouth, Southampton and Dorset, to evaluate the feasibility of comparing a sample of historical
patient home visit schedules to those generated by the DST. Evaluate the acceptability of schedules generated
by the tool to clinical practitioners. Identify the adaptations needed to model urgent referrals. Identify, by
modelling, the benefits for NHS trust to centralise their planning across larger regions and to plan further
ahead than a single day.

We will achieve these aims by: collecting primary data to quantify the benefits (and/or disadvantages) of an OR
approach over manual planning, making use of a Turing Test* framework to explore nurse planners’ views on
automated home visit plan, using OR mathematical and computational approaches to adapt the DST for new
setting and developing novel approaches for planners to handle urgent (unplanned) daily referrals

* The Turing Test - a test set by the computer pioneer Alan Turing which challenged programmers to design a
computer program that could fool a human being into thinking they were interacting with another human.

Workforce & health systems

Nursing shift patterns in acute, community and mental health hospital wards:
A feasibility study and survey

Principal Investigator: Dr Chiara Dall’Ora

Team members: Dr Chiara Dall’Ora (Senior Research Fellow in Nursing Workforce, School of Health Sciences,
University Of Southampton), Professor Peter Griffiths (Chair of Health Services Research, School of Health
Sciences, University of Southampton), Ms Nicky Sinden (Head of Nursing Workforce at Portsmouth Hospitals
NHS Trust), Dr Sarah Williams (Associate Director of Research and Improvement, and Academy Lead at
Solent NHS Trust), Ms Catherine Smith (Associate Director, Workforce Research and Innovation, Southern
Health NHS Foundation Trust), Professor Jane Ball (Deputy Head of School (Research & Enterprise), School of
Health Sciences, University of Southampton), Dr David Culliford (Senior Medical Statistician, School of Health
Sciences, University of Southampton)

Start: 1 October 2020 Ends: 30 September 2022

Partners: University of Southampton, Portsmouth Hospitals NHS Trust, Solent NHS Trust, Southern Health
NHS Foundation Trust.

Lay summary
Nurses and care assistants form the largest group of NHS staff. Most work in services that provide care
across 24 hours of the day. Research indicates that the organisation of nursing shift patterns might affect the
productivity of health services. The introduction of long shifts in nursing was offered as a strategy to maintain
service levels while eliminating overlaps. However, research has found that long shifts are associated with
higher rates of sickness and poorer patient care. So far, there has been little research exploring individual
factors influencing shift work experiences among nurses, and research has been largely confined to acute
hospitals.

Aims of the research
The aim of this research is to provide evidence to support decision making about deployment of nursing shift
patterns on acute, mental health and community hospital wards in England. To do this we will:

•   Understand how shift work may impact on the experience of work and productivity from the nurses’
    perspective, including an assessment of preferences and constraints through a survey
•   Determine the availability and quality of nurse and patient routinely collected data
•   If data are of good quality, measure associations between shift patterns, workforce characteristics and
    outcomes including nurses’ sickness

Design and methods
This research will consist of three parts:

•   A survey
•   Routinely collected data extraction from trusts
•   Data analysis

We will work with our partner trusts to access routine data. We will assess feasibility and data quality of such
data.

Patient, public and community involvement
We will work with one acute and two community providers, who both participated in the development of this
project. Patient and public representatives were involved in preparing this research, by offering their views.
They will continue to be involved throughout the project, and nurses will help inform the survey design.

Workforce & health systems

Identifying wards for which the Safer Nursing Care Tool is appropriate for assessing
nurse staffing requirements

Principal Investigator: Dr Christina Saville

Team members: Dr Christina Saville (Research Fellow, School of Health Sciences, University of Southampton)
Professor Peter Griffiths (Chair of Health Services Research, School of Health Sciences, University of
Southampton), Rosemary Chable RN (Deputy Director of Nursing, Education & Workforce, University Hospital
Southampton NHS Foundation Trust) Ms Nicky Sinden (Head of Nursing Workforce at Portsmouth Hospitals
NHS Trust), Tracy Moran (Lead Nurse for Nursing Workforce, Education & Practice, Poole Hospital NHS
Foundation Trust)

Start: 1 December 2020 Ends: 1 August 2021

Partners: University of Southampton, Portsmouth Hospitals NHS Trust, Poole Hospital NHS Foundation Trust,
University Hospital Southampton NHS Foundation Trust

Lay summary
It is important to have enough qualified (registered) nurses looking after patients staying on hospital wards,
because having too few is associated with worse patient care and more patient deaths. On the other hand,
there are extreme shortages of nurses, so having “too many” on a ward could be considered a waste. The Safer
Nursing Care Tool is used in many hospital wards in England to work out the number of nursing staff (including
nursing assistants) needed. However, a recent study showed that it is more suitable on some wards than on
others. For example, we found that factors not accounted for in the tool, e.g. whether a ward is surgical or
medical, and the proportion of single rooms, also affected professional judgement of whether staffing was
adequate.

Aim
This study aims to understand which ward characteristics mean that the Safer Nursing Care Tool gives a good
estimate of the nursing staff required, and which ward characteristics mean that the number might need to be
adjusted or further considered by taking into account the expertise of ward leaders. It also aims, if possible, to
provide some general rules or an add-on tool to help nursing managers with setting staffing levels.

Methods
We will analyse the data that were collected for a previous study in a different way. This time we will focus
on differences between wards rather than hospitals. We will use analytical techniques for finding patterns
in data to identify similar wards. In our team we have experienced leaders in nursing who will provide expert
professional insights into ward characteristics.

Patient, public and community involvement and sharing results
We will involve nursing managers in the study because they are the potential users of any rules or tools we
develop. We plan to develop a resource (rules or a tool) for nursing ward managers and to run a workshop to
test use of this resource. We plan to write one academic paper about what we find out. We will also share the
plans for this with lay members from the PPI group as appropriate. We are developing a smaller user group
across Workforce and Frailty and Older People teams.

NIHR ARC Wessex

                 Research prioritisation process for years 3-5 (2021-2024)

                                    Stakeholder engagement event
  March 2020       • Theme focused workshops to discuss topics or problems
                     needing solutions
                   • Results of workshops posted on arc-wx@nihr.ac.uk and shared

                                      ARC ‘Pitch a Proposal’ events
  By July 31        Ageing &         Long term       Healthy             Workforce &
    2020            dementia         conditions      communities         health systems

By September 30                  Call for submission of outline applications
     2020

                                           Stage 1 Assessement
By December 1
    2020           • Degree of fit with ARC programme & ICS/STP priorities
                   • Research impact

By February 14                    Research teams submit full application
     2021

  By May 30                            Stage 2 Expert panel review
    2021

  By June 30                     ARC Wessex Partnership Board consider
    2021                               panel recommendations

                               If successful research begins October 1, 2021

Applied Research Collaboraon
                          Wessex
Our mission is to improve health & well-being of people of Wessex across the life course
targeting quality, safety, effectiveness & efficiency of health & care services. Through
conduct, application & dissemination of applied health research for patient, community
& population benefit.

We will bring together the public & expert researchers from a wide range of
disciplines, clinical leaders of health & care systems & other stakeholders. We will
work across the Wessex health & care system to ensure local reach & national impact.

Thanks to our Partners:
Commissioners
Dorset Integrated Care System (ICS), Bournemouth, Christchurch & Poole Council,
Dorset Clinical Commissioning Group, Dorset Council, Hampshire & Isle of Wight
Sustainability and Transformation Partnership, Hampshire County Council, Isle of
Wight Council, Portsmouth City Council, Southampton City Council, West Hampshire
CCG, Southampton City CCG, Portsmouth CCG, Fareham & Gosport CCG, North East
Hampshire & Farnham CCG, North Hampshire CCG, South Eastern Hampshire CCG,
Isle of Wight CCG

NHS Trusts
Dorset County Hospital NHS Foundation Trust, Dorset HealthCare University NHS
Foundation Trust, Hampshire Hospitals NHS Foundation Trust, Isle of Wight NHS
Trust, Portsmouth Hospitals NHS Trust, The Royal Bournemouth & Christchurch
Hospitals NHS Foundation Trust, Poole Hospital NHS Foundation Trust, Salisbury
NHS Foundation Trust, Solent NHS Trust, Southern Health NHS Foundation Trust,
University Hospital Southampton NHS Foundation Trust

Universities
Bournemouth University, University of Portsmouth, University of Southampton,
University of Winchester

                          www.arc-wx@nihr.ac.uk
                             @arc_Wessex

                      Email: arcwessex@soton.ac.uk
                       Telephone: 02380 597983