Current research

This is a collaboration with the Public Health Team of the London Triborough Authorities (Hammersmith and Fulham, Kensington and Chelsea and City of Westminster) on the design and delivery of a research evaluation of a new pilot project aimed at preventing obesity in childhood. The project forms part of a wider programme in the three boroughs to halt and reverse levels of childhood obesity and improve associated outcomes for children and their families. ‘Go Golborne: eat happy, move and play’ was launched in May 2015. With many schools, preschools, youth clubs and parks, Golborne - one of London’s most deprived wards – offers potential to reach large numbers of children and young people and explore the environment’s role in supporting healthy behaviours. This pilot takes a ‘whole place’ community approach through a local network of individuals and organisations. Using training opportunities, environmental improvements, consistent messages, community development and a series of social marketing campaigns, Go Golborne encourages children and their families to ‘eat happy, move and play’ by helping to create supportive environments that make healthier choices around eating and physical activity easier.  Their themed campaigns will focus on simple messages such as sugar swaps, snack checks, active travel, and reduced screen time. CHSS is taking a ‘theory of change’ approach to the four-year evaluation, which will study the links between activities, outcomes and contexts of the initiative.  It will incorporate a detailed process evaluation, as well as evaluating outcomes on healthy weight, changes in behaviour, awareness of and attitudes to physical activity and healthy eating, and changes in home, school and community environments. Evidence suggests that healthy lifestyles initiatives work best when targeted at a local level to respond to the unique needs of communities. Learning from other areas also highlights the importance of taking a ‘whole system’ approach where everyone who lives and works in a community plays their part to make it a healthier place for children to grow up.  This pilot, as part of a multi-agency approach to tackling child obesity, will test the feasibility of replicating the intervention in other areas. The research team will: Assess impact and costs of the pilot at child and family, community and local authority level, Identify the least and most effective elements of the project - for who, in what contexts, and how. Inform the progress of the project over the three years to maximize the likelihood of greatest impact. Make recommendations on whether and how the intervention could be rolled out in or adapted for other wards.   Start date: 25/05/2015 End date: 31/03/2019 Funder: Royal Borough of Kensington and Chelsea Funding: £189, 653

Two thirds of people with dementia have problems with sleep and this can negatively affect their health. The hormone Melatonin is released from the brain in dim light, causing sleep. Bright light inhibits melatonin release and helps us stay awake. Without sufficient exposure to light, people may naturally sleep at different times of the day. Those with dementia often find it difficult to get outside and may not be exposed to enough light. Using a bright light box may help people with dementia to stay awake during the day and improve their sleep during the night. Results from previous studies have been mixed, but may be unreliable. Funded by a grant from the University of Kent Faculty of Social Sciences, the researchers will conduct a small pilot of a study to test if a light box used during the day helps people with dementia sleep better at night. Working with Surrey and Borders NHS Foundation Trust, the team will identify participants and run the pilot in spring of 2016. The pilot results will help to establish whether a full trial can be undertaken.

Identifying stroke/TIA survivors' needs and preferences KeMIST This new project puts patients’ long-term needs and preferences at the heart of a new NHS service to improve patient outcomes. Specifically, it aims to reduce the chance of recurrent strokes or cardiovascular events and develop a long term support service for patients beyond stroke rehabilitation. Little is known about how stroke/TIA survivors’ perceive the burden of using long-term medicines, their needs and preferences for medicines support, or how these change over time.  Qualitative interviews with survivors of stroke or TIA (and their hospital and community carers), and community pharmacists. The data gathered around problems encountered and support needed by those prescribed life-long, multiple medicines will inform the design of a toolkit for patients, carers and Health Care Professional (HCPs) to identify the medicine support needed by individuals. The research will inform design of a suitable pharmacy support service making use of relevant available technologies. People affected by stroke/TIA and HCPs will be involved at all stages of the project to ensure the new service is fit for purpose. Start date: 01/02/2016 End date: 31/01/2018 Funder: Stroke Association Funding: £58,198

CHSS, as part of a multi-agency collaboration, is evaluating the five year 'Ageless Thanet' project (as part of the Big Lottery's national 'Ageing Better' programme) to reduce social isolation and ensure a better old age for Thanet residents. The evaluation design draws on the RE-AIM framework which explores impact on process and individual outcomes. A mixed methods approach will be used, gathering data from individuals accessing services and the agencies delivering them. The evaluation will be dynamic with continuous assessment and testing of the initiatives to determine which work in having a meaningful impact on social isolation. There is a strong emphasis on stakeholder involvement and empowering the community. The project will equip local community researchers with the requisite skills to take forward the evaluation process beyond 2020. The project, led by SEK (Social Enterprise Kent) will deliver services and activities across five project workstreams: wellbeing - educational, fitness, social and craft activities to enhance health and wellbeing active citizenship - volunteer 'ageing better' champions target and help isolated people in the community planning for later life - advice, support, guidance and life coaching from 'life planners' older entrepreneurs - helping those 50+ to set up or develop small businesses age-friendly businesses - 'Ageless Thanet' kite mark to be developed for display. Start date: 01/04/2015 End date: 31/03/2020 Funder: Big Lottery Fund via Social Enterprise Kent Funding: £199,172

The e-GFR Study. Accuracy of glomerular filtration rate (GFR) estimation using creatinine and cystatin C and albuminuria for monitoring disease progression in patients with stage 3 chronic kidney disease: an observational study in a multiethnic population. The aims of the research are to evaluate glomerular filtration rate (GFR)- estimating equations in assessing and monitoring measured GFR in people with stage 3 chronic kidney disease (CKD) over three years. A focus of the research is the impact of ethnic group, baseline diabetes and proteinuria in the estimation and evaluation of how accurately these equations reflect change in GFR over three years. A further aim of the research is to estimate and model disease progression and compare the effectiveness and costs of monitoring strategies for identifying people that have progressive loss of kidney function utilising different GFR-estimating equations and test schedules, accounting for differences in risk of progression. An accurate knowledge of GFR is required to identify and manage CKD. Measurement of GFR using reference procedures is impractical for large scale application, and GFR-estimating equations are widely used. There is little data addressing the ability of estimated GFR to detect change in true GFR, and no data addressing the accuracy of these equations in British ethnic minority populations. The evidence base on the frequency of monitoring is also very poor for some of the newer estimating equations, and whether the benefits of these new equations are outweighed by the increased costs. This study has been designed to address these questions. A prospective multi-centre longitudinal cohort study to estimate accuracy in eGFR and changes in eGFR. 1300 people will be followed for 3 years with reference (measured) GFR and test (estimated GFR – eGFR) measurements at baseline and 3 years. Test measurements are also undertaken every 6 months. The target population are adults with stage 3 CKD proportionally enriched to include people more likely to have progressive kidney disease (i.e. those with proteinuria and/or diabetes) and including Asians and African-Caribbeans. A sub-study of 300 people (100 each of Caucasian, Asian and African-Caribbean origin; in each case containing subjects at high and low risk of kidney disease progression) will also be undertaken. Reference GFR will be measured yearly in the sub-study population and patterns of disease progression assessed. Start date: 01/08/2013 End date: 31/01/2019 Funder: NIHR via EKHUFT Funding: £25,912 Publication: The eGFR-C study

A major NIHR-funded study of alcohol consumption and associated problems among adolescents. UK adolescents are among the heaviest drinkers in Europe, but there is a gap in the evidence around identifying and intervening with alcohol use among this group. Many adolescents present to hospital emergency departments (EDs) having experienced alcohol-related harm, but effective public health strategies for early interventions to reduce this harm are hampered by this lack of research evidence. The study follows on from the SIPS (Screening and Brief Intervention Pilot Study) research programme examining adults in health and criminal justice settings. A £2 million grant has been awarded to a research consortium led by King's College London, including Universities of Newcastle, Kent, Swansea, Glamorgan, Imperial College, and St Mary's Hospital, the South London and the Maudsley NHS foundation trust, Humber NHS teaching trust, and Newcastle NHS Mental Health Trust. The study, conducted over five years, is examining 5000 young people to develop, implement and evaluate screening and alcohol interventions for 10-18 year olds attending hospital emergency departments (ED). The study will have important implications for the management of adolescent drinkers in ED, and on alcohol-related harm prevention. Results will inform development of strategies and conclude with a pilot study of interventions to reduce use in this population. Start date: 01/06/2011 End date: 14/03/2017 Funder: NIHR (via King's College London) Funding: £56,757 Publication: Linked randomised controlled trials of face-to-face and electronic brief intervention methods to prevent alcohol related harm in young people aged 14–17 years presenting to Emergency Departments (SIPS junior)

This is a joint project with the Kyiv Economics Institute at the Kyiv School of Economics www.kse.org.ua  It is a 12-month development study to assess the feasibility of implementing a full-scale evaluation of the Public Health programmes and policies in Ukraine over the period 1990-2014. Ukraine has long faced a significant health crisis exacerbated by growing health inequalities.  It is one of five countries in the World Health Organisation European region with life expectancy 11 years lower than EU average and a 10 year gap between males and females. Since independence in 1992 Ukraine’s health care and public health systems have become inadequate to deal with growing epidemics of non-communicable diseases and TB/HIV/AIDs.  The Ukraine government has stated its commitment to reform and to evidence-based decision-making.  However, the dire state of population health and economic and political difficulties make it likely to opt instead for rapid implementation of ready-made examples from other countries.  This allows for no fundamental analysis of what does/did and does not/did not work in the Ukrainian context. This 12-month development study funded by the Medical Research Council will examine how Ukraine’s national public health programmes and policies evolved from 1990-2014, mapping their implementation across regions and over time.  Professor of Health Economics, Olena Nizalova leads the CHSS team which also includes Prof Stephen Peckham and Dr Erica Gadsby. Project working papers: Public health programmes and policies in Ukraine: development, design and implementation The paper above describes our analysis of the evaluability (in principle) of public health programmes/policies in Ukraine. To do this, we analysed programme and policy documents, and our telephone survey and in-depth interviews, to explore the logic models of programmes/policies and to describe their (intended and actual) implementation. We sought to identify and explain programme aims, objectives, outcomes/targets and mechanisms by which outcomes are expected to be achieved. We also provide some general conclusions resulting from our analysis of a range of programmes/policies, and give explicit examples of specific programmes/policies where relevant. Current population health needs and their regional distribution in Ukraine This paper describes briefly the situation in Ukraine in terms of population health over the past decade, starting from the analysis of the national level data on mortality and comparison of its levels and the last decade’s dynamics to that in the UK, Estonia, and Russia. Further comparison is made between avoidable/non-avoidable mortality as a more appropriate measure of the effectiveness of the Public Health system. To complete the description of the situation with population health, we analyse the available information on morbidity across various conditions linked to high mortality.   Start date: 15/06/2015 End date: 31/12/2016 Funder: Medical Research Council, Wellcome Trust, ESRC, UKAid Funding: £100,590

A two phase, three year development study of an isometric exercise programme to benefit patients who have undergone abdominal and thoracic cancer surgery. Cancer surgery is associated with risk of some loss of physical function and muscle wastage. Isometric exercise has long been established as effective in increasing muscle strength. Phase one will consist of patient focus groups and an online Delphi survey which will develop the exercise intervention and identify suitable functional outcome measures. Phase two will be a mini pilot and evaluation (effectiveness and cost effectiveness) study, based on two groups randomised to either intervention or usual treatment. The programme will be delivered in hospital but the nature of the exercises means that patients can continue at home after discharge.The programme needs little equipment and space, so can be performed when patients are bed-bound in hospital or at home.   Start date: 02/03/2015 End date: 31/03/2018 Funder: NIHR via Maidstone and Tunbridge Wells NHS Trust Funding: £76,130

Start date: 01/11/2015 End date: 31/10/2018 Funder: Kent & Medway NHS Social Care Partership Trust et al Funding: £61,500

Dr Kate Hamilton-West and Tracy Pellatt-Higgins are working with GP Dr Neil Pillai to conduct an evaluation of an 8-week mindfulness course for GPs. The evaluation is funded by the Royal College of General Practitioners - South East Thames Faculty. Analysis will focus on change in measures of wellbeing from baseline (before the course) to follow-up (after the 8 week course). GPs will also be asked to report on their experiences of the course. Start date: 01/04/2016 End date: 29/07/2019 Funder: RCGP Funding: £1,498

The evaluation, funded by the NIHR, will be conducted over 29 months in collaboration with Pilgrims Hospice, CHSS, EKHUFT and the University of Sussex. It will compare outcomes for patients in areas where the new Rapid Response Community End of Life Service has been introduced with those where the service is not yet in operation. This is the first type of trial of its kind in the field of palliative care services provided at home.The primary aim of this project is to evaluate whether the new service enables more patients to die in their preferred place of death, especially for those wishing to die at home. Though death in the preferred place is a key aim in the DH’s End of Life Care Strategy, identifying reliable and useful methods for recording patient preferences is not easy. Improving the recording practices of patient preferences was the subject of a project undertaken in CHSS in preparation for this evaluation. The questionnaire that was developed is currently being used by hospice staff to good effect. The evaluation will also determine the cost of providing the new rapid response service versus the cost of usual services. The needs of carers are also being considered and the impact of the service on them will be evaluated using postal questionnaires and through interviews with bereaved carers. This design is both rigorous in allowing for comparison groups and pragmatic as it gives Pilgrims Hospice time to recruit and train new staff and implement the new service in each area. Star date: 01/12/2009 End date: 30/04/2012 Funder: Department of Health Funding: £178,202 Publications: Evaluation of a hospice rapid response community service: a controlled evaluation Results of a controlled evaluation of a hospice rapid response community service for end of life care Evaluation Of Pilgrims Hospices Rapid Response Hospice At Home Service: Summary of findings March 2015 A quasi-experimental controlled evaluation of the impact of a hospice rapid response community service for end-of-life care on achievement of preferred place of death

Increasingly, national policy makers and professional bodies have become concerned about declining GP numbers with a low uptake of GP training places and problems in maintaining levels of GPs in practice. Reasons are thought to be related to problems with GP morale, pressures on practices, the challenges of changing roles and responsibilities, and reductions in pay. NHS England's 10 point plan published in January 2015 aimed to support GP recruitment, retention and re-engagement. It was developed jointly with Health Education England, the Royal College of General Practitioners and the BMA GPs committee to ensure a skilled, trained and motivated workforce. The plan was designed to take the initial steps in building the workforce for the future and new models of care. As part of ongoing work to support these developments, NHS England and the Department of Health commissioned the Policy Research Unit in Commissioning and the Healthcare System (PRUComm) to undertake an evidence synthesis on GP recruitment, retention and re-employment. An interim report has been provided to NHS England. A final report will be completed. PRUComm website Start date: 01/08/2015 End date: 31/12/2017 Funder: DoH via LSHTM Funding: £114,220

The difference between formulating a policy and making it work in practice, the ‘policy-implementation gap’, has long been recognised as a problem by policy makers and those responsible for putting policy into practice. To date, little attention has been paid to identifying the best ways of improving successful implementation in practice. The Department of Health, together with other central and local government organisations and professional bodies, developed a partnership programme for the Care Act 2014 involving innovative implementation support systems at national and regional levels to ensure local areas were well-placed to deliver the changes required. We will evaluate the extent to which these support arrangements have been successful and identify those elements that supported successful implementation and explore how they can be replicated for other major government policy programmes and initiatives. We will review what has been done previously in other national programmes to assess their respective strengths and weaknesses. We will consider what constitutes good practice across a range of centrally driven national programmes designed to support the introduction of new social care related policy initiatives. We will also undertake research in a number of local authorities to examine the experiences and impact of the Care Act implementation support arrangements. We will examine evidence at four levels – national, regional, local strategic and local frontline, including the views of users and carers – in order to build a comprehensive picture of what works under what circumstances when viewed by policy makers, local service providers and the users of services and their carers. Finally, we will pull all this evidence and learning together to develop guidance for central and local governments for supporting new policy initiatives in social care and health. We are especially keen to establish links between the Care Act support and the early experience of NHS Improvement – the new NHS agency for supporting service improvement in the healthcare sector. We recognise that any framework will have to be adapted to specific contexts and issues, but anticipate that the components will serve as a guide to governments on actions most likely to bring about favourable results. Start date: 01/10/2016 End date: 30/09/2018 Funder: Department of Health Funding: £212,653          

What are the features of Hospice at Home models that work, for whom, and under what circumstances? Offering a choice about where people receive care at the end of life is central to UK policy and the numbers of people wishing to die at home is increasing. There are a range of “Hospice at Home” (HAH) services and most operate within non NHS settings, but are funded to provide NHS specialist care. Gaps exist in the evidence around what works best in terms of outcomes. This three year project, funded by the NIHR Health Services and Delivery Research Programme is a collaboration between CHSS, Pilgrims Hospices East Kent, and the Universities of Cambridge and Surrey. The team will conduct a realist evaluation of a range of UK ‘Hospice at Home’ service models to understand their impact on patients and carers, and identify which features work for whom, under what circumstances. A project PPI (patient and public involvement) advisory group will advise on sensitive approaches to working with bereaved people. The project team includes two lay members. The project incorporates three phases. Phase 1: A national telephone survey of all HAH services in the UK on funding, staffing levels and roles, extent of service and care, local demographics etc. Data will inform the design of a typology of services, patterns and models using a CMOc framework (Context-Mechanism-Outcome configuration). 1-2 case studies per service model will receive in-depth investigation. Phase 2: An economic evaluation to compare the costs of delivering services in the different models and assess which models are likely to lead to the best outcomes and represent best value for money. Phase 3: Stakeholder validation Two national workshops will gather feedback on the implications of data findings from HAH providers, local health service planners and service user representatives. Guidelines will be developed to help plan HAH services in the future. Dissemination strategy includes a project report, conference presentations and peer reviewed journal articles aimed at professional audiences. Start date: 01/02/17 End date: 31/01/20 Funder: NIHR Health Services and Delivery Research programme. 14/197/44 HS&DR Researcher-led Funding: £760,162 Project team: CI: Dr Claire Butler Contractor: University of Kent Co-investigators: CHSS, Uni of Kent: Prof Tricia Wilson, Dr Ferhana Hasham, University of Cambridge: Dr Stephen Barclay University of Surrey: Prof Heather Gage, Dr Peter Williams Pilgrims Hospices East Kent: Ms Charlotte Brigden NHS England: Prof Bee Wee, (Nat Clin Dir. End of Life Care/Assoc Prof Uni of Oxford) Nat Assn for Hospice at Home (NAHH): Ms Kay Greene, Chair & Trustee PPI/Service users: Ms Nicola Enright, Mr Graham Silsbury

Dr Kate Hamilton-West and Annette King are working together with collaborators at Canterbury Christ Church University (CCCU) and East Kent Hospitals University NHS Foundation Trust (EKHUFT) to conduct research into a postural care education programme for parents and teachers who are responsible for the postural care needs of disabled children at home and school. The collaborators will deliver a number of ‘train the trainer’ workshops using materials developed from their previous NIHR-funded study. Feedback from the workshops will enable further refinement of the materials and data collected will be used as part of the programme’s ongoing evaluation.​   Start date: 04/04/2016 End date:30/06/2016 Funder: EKHUFT Funding: £4,271

Adolescence is a critical developmental stage when young people make behavioural and lifestyle choices that have the potential to impact on their health and wellbeing into adulthood. While risk-taking is important for healthy psychological development, for many, inappropriate risk-taking is significantly associated with health and social harm during adolescence and these harms persist well into adulthood. Young people involved in the criminal justice system are a particularly vulnerable group with a greater propensity to take risks that are likely to have long term impact on their future health and wellbeing. The RISKIT-CJS programme is a multi-component intervention encompassing both individual and group work and includes elements of motivational enhancement, psycho-education, psychosocial approaches, cognitive behavioural therapy and mindfulness. The study is a major multi-centre evaluation of RISKIT-CJS. The methodological approach is a mixed method, prospective, pragmatic randomized controlled trial with individual allocation, combining both quantitative and qualitative evidence. The study will be conducted across three geographical areas; South East England, South London, North East England, covering a diverse socio-economic and ethnic population. Start date: 01/09/2016 End date: 31/08/2019 Funder: NIHR Public Health Research Funding £892,675    

Integrated care (IC) is defined as those initiatives that proactively seek to structure and coordinate care in home environments and improve health outcomes while constraining health care expenditures. ‘Older people’ are defined as European citizens aged 65+ with multiple health and social care needs. The focus on this group reflects the general increase in complexity of care with age. SUSTAIN’s overall aims are to improve established IC initiatives for older people living at home with multiple health and social care needs and to ensure that these improvements can be adapted and applied to other health systems and regions in Europe. Core elements are: a well-coordinated and proactive approach to health and social care needs; patient-centredness involving older people in decision-making and taking their individual needs into account delivery of multiple interventions at the same time involvement of professionals from multiple disciplines. The project will Identify established integrated care initiatives and conduct baseline assessments to examine their patient-centredness, prevention orientation, efficiency, resilience to crises, safety and sustainability; Improve established integrated care initiatives based on the outcomes of the baseline assessments in co-creation with local key stakeholders and implement these improvements; Evaluate the implementation process and identify how the established integrated care initiatives have improved; Assess the applicability and adaptability of improved integrated care initiatives; design and implement dissemination strategies. Start date: 01/04/2015 End date: 30/03/2019 Funder: EC Horizon 2020 Funding: €584,119

Public Health Collaboration. CHSS has been commissioned to conduct an external evaluation of Medway Public Health Department’s weight management projects. This collaborative project will assess how Medway’s initiatives and programmes could be built on and improved. In 2014 Medway Council hosted an Obesity Summit attended by private, public and voluntary sector partners, to help develop a framework for tackling obesity. Medway Council’s dedicated ‘Supporting Healthy Weight’ team (SHW) works with adults, families, children and young people to help them in achieving healthy weight. Within the National Child Measurement Programme (NCMP) classification, 23.3% of 4-5 year olds and 32.7% of 10-11 year olds in Medway are overweight or obese. The SHW team provide and commission a diverse range of interventions across Medway to help prevent and manage overweight.  These include four MEND programmes (2-4, 5-7, 7-13 and Graduates) and Fit Fix, a programme for 13 – 17 year olds. The team work across the Council to maximise opportunities to support obesity prevention in all aspects of the Council’s work, and in the revised Medway Local Plan. The evaluation will also focus on raising awareness of the SHW portfolio and developing its media profile to get the message out to a wide audience about obesity and public health initiatives in Medway.  Start date: 15/01/2015 End date: 14/01/2017 Funder: Medway Council Funding: £67,187 Poster presentation: Evaluability assessments as part of a ‘whole systems approach’ to evaluating Medway Council’s interventions to tackle obesity.

ESRC: Ageing populations pose serious challenges for the health and long-term care systems (LTC) in rural China. This research seeks to address key questions concerning inequities in health and LTC among rural elderly in China, bridging the research gap in this area, and offering policy suggestions.  Objectives of the research: To first examine whether the socioeconomic status of the rural elderly is associated with their health status. To then assess the impact of a non-communicable disease prevention and control programme on rural elderly with different socioeconomic backgrounds, To examine whether the needs of this population can be sufficiently addressed with home-based care support. The study will simulate the population structure of the rural Chinese in the next few decades, and predict whether the New Cooperative Medical Scheme (NCMS) (the only financial support available to the rural elderly to finance their long-term care) will be sustainable in the long term. It will draw lessons on LTC financing from other developed countries, and propose potential policy recommendations for decision makers. The study will reveal how the current health status and patterns of health care and LTC use among the rural elderly differ across different socioeconomic groups. The intention is to inform the policy-making process and encourage policymakers to re-examine existing health and LTC policies. Start date: 01/01/2016 End date: 31/12/2018 Funder: ESRC Funding: £269,148 Publication: Ageing China institutional long-term care long-term care financing