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

A three year study to develop and pilot a physiotherapy intervention for boys with haemophilia, an inherited condition (mainly in boys) affecting the blood's clotting ability. It causes bleeding into muscles and joints resulting in weakness and pain. One of the things which affects this group is being able to participate in games and activities with friends. Patients and physiotherapists are working together to design a programme of exercises to help strengthen muscles and help boys with haemophilia with their movement potential.   Funder: NIHR Research for Patient Benefit via East Kent Hospitals University Foundation Trust   £247,816

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. Start date: 01/09/2015 End date: 31/12/17 Funder: NIHR (via Newcastle University)

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

Evaluating and analysing integrated service development Local Clinical Commissioning Groups (CCGs), in collaboration with providers, are currently developing programmes of transformational change, with a particular focus on strengthening integrated health and social care initiatives. These programmes aim to be evidence-based and include research and evaluation workstreams. These workstreams, led by Professor Billings, Director of the Integrated Care Research Unit (ICRU), demonstrate a commitment to ensuring an evidence-based approach, alongside the generation of local evidence of the effectiveness of the integrated care initiatives. Such evidence has the potential to provide a body of transferable knowledge to support the programmes as they roll out across the CCGs and influence developments in the rest of Kent. Researchers are applying the Evidence Integration Triangle, which is based on the methodological approach of “implementation science” (Glasgow et al 2012). This approach is centred on involving a multi-agency stakeholder group from the onset to support the design and evaluation of a specific service through the use of best-practice evidence supplied by the researchers. A key part of this approach is to determine what works for whom, in what circumstances, and with what effects. The overall aim of this methodology is to: Develop realistic person-centred and service-level outcomes Create and source a menu of appropriate indicators for the evaluation and monitoring of interventions Use a participatory approach that focuses on speedy results of processes and outcomes As part of this methodology, the researchers have developed and validated an evaluation framework (the Kent Evaluation Framework) that is relevant to integrated care initiatives being developed and implemented across Kent. ICRU has been supporting the development and evaluation of the following integrated health and social care services: Integrated Intermediate Care (IIC) pathway A bespoke IIC KPI and monitoring framework has been developed which consists of indicators from the Kent Evaluation Framework and local KPIs.  This framework is being used by providers to feed the relevant data to the CCG who are compiling the information in order to address any issues within the pathway. Focus groups with staff and managers have been conducted  to investigate staff perceptions of the pathway and to highlight areas for improvement. Multidisciplinary Teamwork In Deal, researchers have worked with GP practices, the CCG and other stakeholders to develop an evaluation framework for an integrated multidisciplinary team (MDT) initiative to improve the care of frail, older people who are high users of health and social care services. This initiative involves referrals to a Town GP who leads an MDT involving health, social and voluntary care organisations. A bespoke evaluation frameworkhas been developed based on the Kent Evaluation Framework and the availability of local data. A patient survey has also been developed to determine the extent to which care is perceived to be integrated and person-centred. End of Life Care (EOLC) Pathway Two literature reviews were carried out to inform the development of the pathway and researchers worked with stakeholders to develop the KPI and monitoring framework to support the evaluation of the pathway. This framework has been agreed by the steering group and is now in use for providers to collect the data, which will be analysed by the CCG. This will enable the CCG and the providers to identify areas of EOLC, which require further development within the pathway. The Acute Response Team (ART) This clinical team operates from the Emergency Department at QEQM Hospital in Margate and Westbrook House. The service focuses on older people with long term conditions, preventing hospital admissions and keeping people in their homes for as long as possible. Researchers at ICRU are working with ART and other stakeholders to co-design and deliver an evaluation strategy, which measures the patient experience with respect to person-centred, co-ordinated care, and the experiences of a wide range of professionals and managers associated with the service.   Start date: 01/11/2015 End date: 31/10/2018 Funder: Kent & Medway NHS Social Care Partership Trust et al Funding: £61,500 Funder: All Seasons Amount: £9,000

Across Kent 28.1% of adults are classed as physically inactive. KCC Public Health department wants to commission a programme to reduce inactivity in high risk individuals, especially those with, or at high risk of acquiring, diseases caused or exacerbated by physical inactivity. CHSS has been commissioned to conduct an evaluation of KCC’s pilot programme targeting physical inactivity through selected GP surgeries. The evaluation, led by Dr Sarah Hotham, Chartered Psychologist and Research Fellow at CHSS will inform the design of a county-wide programme due to be rolled out in primary care in 2015/2016. The first pilot is designed to successfully deliver a programme based on ‘Let’s Get Moving’ (LGM) a Department of Health intervention based on motivational interviewing (MI) and long term support for behaviour change around inactivity. Recruitment will be in selected GP surgeries in catchment areas with high deprivation and high levels of inactivity. The focus is on high risk physically inactive individuals with conditions caused or exacerbated by their low activity levels. UK active, a not-for-profit health body for the physical activity sector, will  screen and invite participants to receive 12 weeks of MI and support (with follow up at 6 and 12 months), delivered by a network of specially recruited practitioners. The programme aims to: increase and sustain regular physical activity levels county wide. reduce reliance on costly medication for conditions which could be affected by adopting an active, healthy lifestyle. ensure maximum return on existing public health Investment by linking to wider primary care services build on successes to embed scalable, replicable physical activity interventions in partner services and networks and as a preventative in disease pathways The evaluation team will gather qualitative and quantitative data, including semi structured interviews with primary care staff involved in the screening and recruitment process. A framework analysis will be undertaken to identify emerging themes from the interviews. As well as identifying characteristics in patients who changed behaviours (in order to predict future success), the evaluation will address questions around feasibility, scalability, effectiveness and cost effectiveness of patient screening, and the recruitment of practitioners to deliver the interventions. A final report will be provided when 12-month follow-up monitoring is complete. It will provide details of the findings and recommendations for future commissioning of a county-wide physical inactivity service. Start date: 03/03/2015 End date: 31/03/2017 Funder: Kent County Council Funding £4,000 Evaluation of KCC physical inactivity pilot final report here

CHSS is working with the University of Kent’s Centre for Professional Practice on the use of enhanced technology in education.  A course in telesupervision is to be piloted with experienced GP supervisors and other educators in primary care. The course aims to develop their supervision, mentoring and coaching skills to work through the medium of online technologies such as Skype.  CHSS will evaluate the course against its learning objectives. Start date: 01/01/2016 End date: 31/03/2017 Funder: HEKSS (Health Education Kent Surrey Sussex) Funding: £9,000          

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. The CHSS team is working with Newcastle University partners Professor David Hunter and Samantha Redgate on this project, along with CHSS Visiting Professor Bob Hudson.   Start date: 01/10/2016 End date: 30/09/2018 Funder: Department of Health Funding: £212,653          

Professor Jenny Billings will be working with lead investigator Professor Peter Lloyd-Sherlock at the University of East Anglia (School of International Development) on this timely and valuable research project. Brazil’s large public healthcare system aims to provide good care to all, but in common with the UK is facing mounting financial pressures due to the needs of a rapidly ageing population. This MRC-funded project aims to support policy and practice to reduce unneeded admissions of older Brazilians to hospital and care homes, and reduce unnecessarily long stays. This will improve efficiency of service provision and optimise the health of the older population. Unnecessary hospital stays expose older people to new risks such as acquired infections. Drawing on studies and experiences in other countries, such as the UK, and talking to Brazil’s policymakers and practitioners, the study will develop a clear strategy to identify whether admissions could have been averted or length of stay reduced. A new national survey (ELSI) will produce data showing which older people are most likely to experience these problems and identify which situations trigger unnecessary admissions/lengthy stays. As well as analysing the data, the research team, working closely with social care practitioners, will develop detailed case studies of two Brazilian cities in different regions, talking to selected ELSI survey participants and their families about their experiences to gather a clear picture of the problem and focus on solutions. They will carry out a review of a pilot project offering temporary homecare services for frail people and carefully assess this, considering how well it has worked (in the eyes of practitioners, as well as older people and families) and any impact on unneeded admissions/long stays. The project represents an excellent opportunity for CHSS to apply extensive research expertise gained in the UK and elsewhere, to a Brazilian context. Specifically, the aspects of our work relating to the development of new models for integrated health and care provision for older people are highly relevant to similar challenges now facing Brazil’s health system. Funder: The Newton Fund, Medical Research Council (MRC) £32,000  

Project information to follow.   Start date: 25/9/2017 End date: 24/12/2018 Funder: Health Foundation (via East Kent Hospitals University Foundation Trust) Funding: £37,017

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

Against a background of increasing youth labour market insecurities during the recent economic crisis, this interdisciplinary and internationally comparative project aims to provide a comprehensive understanding of the consequences of youth labour market vulnerability for risks of social exclusion in Europe. The research team will adopt a dynamic perspective on objective and subjective dimensions of social exclusion to identify the complex interrelationships and potential risks of cumulative disadvantages, while examining possible mechanisms to address them. The project will examine the implications of labour market insecurities for young people in the following areas: risk of poverty material deprivation subjective well-being health status ability to gain independence from the parental home. Mixed methods will be used throughout the project. Qualitative interviews with youths from nine selected European countries including Ukraine will help to understand how disadvantaged youths perceive their social situation and try to cope in different economic, institutional and cultural environments. The quantitative element will use EU-28 and national micro-data to identify causal interrelationships and dynamic processes of youth social exclusion in different national contexts. A central objective is to assess the reach and effectiveness of EU and national policies in addressing issues around youth social exclusion, drawing on best practice examples to suggest reforms and policies designed to improve this group’s social situation. Different stakeholder groups will be involved at all stages to enable young people to be given a voice. This will also assist in the dissemination of project findings. Start date: 01/05/2015 End date: 30/04/2018 Funder: European Union Horizon 2020 Funding: €243,562 Publications: Except Working Papers Except Website

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.