Reducing Health Inequalities - CLAHRC Community Newsletter Jan 2019

Published Date: 31 Jan 2019

Welcome to our CLAHRC Community newsletter, showcasing the breadth of CLAHRC research in Reducing Health Inequalities 


CLAHRC EM: Don’t miss out on our latest funding calls! Gold postdoctoral fellowship for research active clinicians, PhD studentship in applied health research and applied health economicsCLAHRC NWC: New survey identifies the social influences in people attending A&E. CLAHRC NWL: invite you to their Winter Collaborative Learning Event on 6/02/19 - Register to join for sessions on Creating Learning Environments in Quality Improvement. PenCLAHRC: EST dementia project 'Caring about Care' Improving the Experience of Care for People with Dementia in Hospital on BBC Spotlight  CLAHRC SLKing's Improvement Science - a team of researchers and quality improvement experts have produced a free glossary of terms used in improvement and implementation science

CLAHRC East Midlands

Reducing ethnic health inequalities

The Centre for BME Health, which is funded by CLAHRC East Midlands and the University of Leicester, has one clear vision: to reduce ethnic health inequalities. We do this by working with patients, the public, community and voluntary sectors, researchers, health and social care organisations, to:

  • Inspire community-led research
  • Develop and promote culturally sensitive resources
  • Raise awareness of community engagement
  • Encourage active research participation
  • Collaborate with researchers to widen participation

Recent projects include raising awareness of prostate cancer, wellbeing project with the Gypsy and Travellers community and Leicester’s campaign to prevent type 2 diabetes. 
We are currently planning for the next Healthy Goals programme to be delivered to women only to encourage and promote lifestyle education and physical activity. These women are inactive because of cultural traditions that prevent access to provide in a typical sports facility.  
Read more here and follow Twitter

Implementing ‘A Safer Ramadan’ education programme
20% of the South Asians community has type 2 diabetes in contrast to 3% of the general population.  This means that South Asian people are 3 times more likely to develop type 2 diabetes than the white Europeans in the UK.  From the 2011 census the Muslim population within England and Wales is approximately 2.71 million (4.8%).  The estimated number of UK Muslims with diabetes is 320,000.  
There are risks associated with fasting in people with type 2 diabetes as a result fasting during Ramadan: low or high blood sugars, dehydration and thrombosis and hospitalisation, as a result fasting  has been uniformly discouraged by the medical profession. 
Safer Ramadan aims to overcome these barriers between HCPs, patients and religion to provide education and awareness of how people with type 2 diabetes can safely fast during Ramadan with help from their health care provider. 

CLAHRC East of England

Supporting LGBTQ Young People In Care: co-devising research-led training materials for multi-professional practice.
LGBTQ young people in care are often a particularly vulnerable and mobile group. Researchers at UEA worked with a group of 6 ‘young researchers’ to improve support and services. 
They first collaborated in the national ESRC funded ‘Speak Out Study’, which explored LGBTQ young people’s experiences in the social care system in England. Funded by CLAHRC EoE they then went on to co-produce training materials, for example the Speakout film which premiered in July 2018 at Norwich Pride. In the film young people speak about coming out in care. It is now available online and reaches both young people in care and professionals working with them. 
The researchers and the young people continue to develop materials together with major national partner organisations such as Coram BAAF and research findings continue to be disseminated nationally and internationally.

CLAHRC Greater Manchester

The implementation of a pledge scheme to promote behaviour change in people who are overweight or obese
Nia Coupe, a researcher from the University of Manchester, is currently doing a PhD with CLAHRC GM. The aim of her PhD was to develop an intervention tailored to this population in order to improve weight and behavioural outcomes. The intervention is a goal setting and commitment booklet, and its development was informed by qualitative work and public and stakeholder involvement. The booklet has been used within a local authority run weight loss service as part of a research study, and preliminary results suggest that it is acceptable to both deliverers and users, and is considered to be both useful and effective.  Possible future work from this PhD may look at determining the effectiveness of the intervention in relation to weight loss and behavioural outcomes.
Read more here.

CLAHRC North Thames

The impact of comorbidities on access to hip and knee replacement surgery
New CLAHRC North Thames research looks at how comorbidities – multiple conditions experienced by patients – influence referrals to, and outcomes of hip and knee replacement surgery. Taking a 360-degree view of the referral and treatment process our researchers investigated current evidence in this area for patients with comorbidities undergoing surgery. We also interviewed health professionals and therapists for their take on referring and selecting patients with comorbidities for joint replacement surgery. We found comorbidities predominantly impact the safety of hip and knee replacement surgery but have little impact on its effectiveness. We found some disagreement among professionals – ranging from GPs to surgeons – on roles and responsibilities in the management of these patients. Read an interview study with healthcare professionals in the NHS and a review of the current evidence.  
Contact Bélène Podmore 

CLAHRC North West Coast

New survey identifies the social influences in people attending A&E
A survey of 20 disadvantaged neighbourhoods across the North West has revealed the social influences on why people attend their local Accident & Emergency department. Researchers from CLAHRC NWC conducted a household health survey including over 3,500 face-to-face interviews with households randomly selected in communities across Lancashire, Cheshire and Merseyside.  
31% of survey respondents had attended A&E in the previous 12 months with individual attendance rates ranging between 1 and 95 visits. 18-26 year olds three times more likely to attend A&E compared to those above 64 years of age.  
Other outputs from the research, published in the online journal BMJ Open, suggested a lack of a job increased the likelihood of A&E attendance by 38% and poor housing conditions increased attendance by 34%. Results will be used by CLAHRC NWC Partners to reduce health inequalities.  

Reducing Health Inequalities
CLAHRC NWC strives to tackle health inequalities and the socio-economic drivers of these inequalities by enabling critical conversations and collaborations between a range of local and national organisations. An example is the CLAHRC NWC Improving Public Health Theme Neighbourhood Resilience Programme (NRP), which brings together partners in several local authorities to focus on health improvement barriers in 10 relatively disadvantaged neighbourhoods. 
Local actions and local partnerships involving anyone working or living in those neighbourhoods (including residents, schools, healthcare providers, businesses, public transport and council services) have an important contribution to make and their impact should not be underestimated.  
A case study of the initiative has been published in “Health 2020 priority area four: creating supportive environments and resilient communities A compendium of inspirational examples”, compiled by the World Health Organization Regional Office for Europe. “Supporting local systems to tackle the social determinants of health inequalities” Page 123.

CLAHRC North West London

Could birdsongs help boost engagement with hearing tests?
Novel idea to raise awareness of hearing loss and increase screening uptake wins funding from innovation workshop. 
Around 1 in every 6 of us in the UK is estimated to be affected by hearing loss, amounting to 11 millionpeople. Yet it’s thought that hearing loss goes unaddressed in as many as four million of these individuals, and those seeking help take an average a decade to do so. With hearing loss becoming more common as we get older, living in in ageing population means that the issue will only become more widespread. 
This growing problem has far-reaching implications for people’s health and quality of life. Not only can hearing loss contribute to social isolation and depression, it’s also linked with a number of other health conditions including dementia and stroke. Additionally, hearing loss could negatively impact patient safety if communication about a person’s health or care isn’t clear.


Health inequalities in Psychosis
A new joint CLAHRC Oxford and Oxford BRC project is examining the barriers between mental health and good physical health for patients with psychosis, starting at the earliest stages of the Early Intervention in Psychosis pathway, to prevent weight gain.
Patients with psychosis have a reduced life expectancy of about 14.5 years. Excess weight in patients with serious mental health problems is a major health, social, and economic problem, as reflected in  
the high prevalence of obesity, cardiovascular disease and diabetes in patients with psychosis.
This ongoing project aims to improve our theoretical understanding of the causes of weight gain and barriers to weight loss in patients with psychosis in order to devise an effective intervention and will also gauge the preferences for weight loss interventions of people with psychosis.
Read more here 


‘Early Learning Communities’
Save the Children is developing a UK network of ‘Early Learning Communities’ to work with partners to co-design effective local early learning systems. An early years toolkit, drawing on evidence and consultation with practitioners, system leaders and families will be used by Save the Children staff and their partners as a tool to guide strategy and activity in these communities.
PenCLAHRC Associate Professor Dr Nick Axford is working with Save the Children to synthesise the best international evidence on how best to support the early learning of children in poverty and protect against the impact on development of significant family stress or adverse childhood experiences. 

Adapting the Chance UK mentoring programme
The Chance UK mentoring programme is for children in London aged 5-11 years who are reported to be displaying challenging behaviour and emotional problems at school and at home. PenCLAHRC Associate Professor Dr Nick Axford is leading research in collaboration with Chance UK to co-design evidence-informed adaptations to the mentoring programme in order to address identified concerns and aspects for improvement. A review of the evidence on the effectiveness of youth mentoring and factors associated with success will be carried out to better understand the children served by the mentoring programme and contribute to its redesign.
Read more here

CLAHRC South London

Improving the physical health of people with mental illness to improve their life expectancy
People who have a serious mental illness live shorter lives compared with the national average – one study in south London showed that women with schizoaffective disorder lived 17.5 years less than the national average, and that the lives of men with schizophrenia were 14.6 years shorter than the national average. Premature death is mostly caused by preventable diseases such as diabetes, coronary heart disease and respiratory problems such as COPD (chronic obstructive pulmonary disease).
Researchers in CLAHRC South London’s psychosis theme are part of a Lancet Commission to address the issue of poor physical health, inequalities in care and ultimately premature mortality in people with mental illness. Their work will involve an international collaboration of multiple stakeholders to set out the future priorities, actions in clinical practice and identify policy implications.
Read more here

Working with BME faith communities to improve mental healthcare
Researchers at King’s College London’s Centre for Implementation Science are working on a project with clinicians at South London and Maudsley NHS Foundation Trust (SLaM) to address the stark healthcare inequalities for the Black community related to mental health care in Southwark and Lambeth. The incidence of psychosis among black and minority ethnic (BME) groups is up to 14 times higher than for white people, while the prevalence rate is 2.7 times higher in inner London (Quassem et al, 2015). 
This project aims to create a mental health awareness training package for local Black majority or led churches which is accredited by King’s College London. The researchers also hope to train local mental health staff to become more aware of different local faith communities and the importance of working alongside them to help people on their journey to recovery.
Read more here


Study finds telephone outreach for NHS Health Checks positively received by patients from deprived communities
A Bristol-based telephone outreach initiative to increase uptake of NHS Health Checks among people from more deprived communities and minority ethnic groups has been positively received by patients, a CLAHRC West study has shown.
Telephone outreach involves community workers telephoning patients in communities potentially at higher risk of cardiovascular disease, and who may be less likely to take up a written invitation, to engage them with NHS Health Checks. Where possible, the caller’s cultural background and main language is matched to the patient. 
The call increased participants’ understanding of NHS Health Checks and overcame difficulties that the patients thought they might have in making an appointment. Half of the patients reported that they would not have booked if only invited by letter.

CLAHRC West receives funding to explore online information about end of life care
The Elizabeth Blackwell Institute at the University of Bristol has awarded researchers at NIHR CLAHRC West £1,600 to carry out a survey of online resources for people looking for support for end of life issues.
There is a potential inequality in the support people receive at this important time of their lives. Research suggests that online health information tends to focus on younger people, those with jobs, the educated, students, people living in urban areas and those with ongoing illnesses. This leaves out a lot of people. Older people, people who have had fewer years of education and those who are relatively inactive tend to access information online less, as do those dealing with mental illness and poverty.

CLAHRC West Midlands

‘Better Births’ – Survey of Midwives

The 2016 National Maternity Review, ‘Better Births’, recommended that women have a named midwife, based in the community, who can provide continuity of care throughout pregnancy, birth and postnatal periods. To explore midwives’ ability to provide this, we conducted an online survey of across 27 providers in October 2017. 

Only a third of the 798 participating midwives were willing and able to work in ‘continuity-based models of care’. We recommended that implementation of continuity is targeted for women most able to benefit, including disadvantaged populations.  

Trusts around the country are using our survey tool to support their own plans. The NHS Long Term Plan has refreshed continuity plans, adding a commitment to targeting continuity implementation for women in BAME and disadvantaged communities.  We welcome this focus aiming to address inequalities in outcomes and experience in maternity care.

Contact Beck Taylor   @BeckTaylorBham.

Survey findings summary:

Yoga for Bump -  A new approach to public involvement/engagement in research
Researchers in CLAHRC WM’s Maternity and Child Health team, together with CLAHRC WM’s Patient and Public Involvement Lead, have been trialling a new approach to public involvement and engagement in research.  ‘Yoga for Bump’ was set up with the aim of engaging and involving women from a range of backgrounds in research that is relevant to them. Funds were secured from the Wellcome Trust to support this activity.

‘Yoga for Bump’ sessions had the following structure:

  • Engagement/Involvement with maternity-related research;
  • Informal Q&A with a midwife;
  • Free Pregnancy Yoga Session.

Sessions took place in two different locations in Birmingham (Hall Green and Perry Barr) in communities with populations traditionally under-represented in research.  There was no cost for attending sessions.
Researchers in CLAHRC WM are evaluating this activity using mixed-methods.
Contact Magdalena Skrybant

CLAHRC Yorkshire and Humber

Modern slavery and public health
Our Public Health and Inequalities Theme have contributed to a briefing on Modern Slavery and Public Health. Modern slavery is a human rights violation and has severe consequences for the health and wellbeing of survivors. It is an exploitative crime that impacts on physical and mental health and has public health implications. The role of public health in addressing modern slavery has not been fully articulated in the UK. This project addressed this gap by asking the following questions:

  1. What is the case for public health engagement in addressing modern slavery?
  2. What are the components of a ‘public health approach’ to modern slavery?
  3. What are the gaps in understanding, approach and practical action in public health on the issue of modern slavery?


Primary care platform will support 'equity of access' for new migrants
An online information tool for everyone working in primary healthcare, aims to ensure new migrants receive the same access to healthcare as everyone else.  is the result of a collaboration involving Doctors of the World (DOTW) UK, the University of Sheffield and Yoomee. It offers practical support and information to help primary care professionals care for migrants, particularly those in vulnerable circumstances.
Migrant health has factsheets covering areas such as healthcare entitlement, how to guides, the facility to share ‘bright ideas’, links to national resources and a community platform to ask and respond to colleagues. Dr Elizabeth Such from our Public Health and Inequalities theme “ shows the strength of research and practice working together to co-create a tool that we hope will ultimately improve people’s health."