News and events CHSS research CHSS people Featured ... Newsletters/NL_128611... · presentation on behaviour change techniques highlighted practical tools that can be used to promote

NewsletterCentre for Health Services Studies Issue 35 / Spring 2019

Excellence in health research

Congratulations Sally Kendall, MBEOn 31 January Sally, CHSS Professor ofCommunity Nursing and Public Health,received her MBE at BuckinghamPalace. It recognises 30 years’ researchin nursing and health visiting. She isrenowned for practice-based researcharound parenting and maternal and childhealth. Her parenting work isinternationally recognised andimplemented from Kent to Japan.

Sally said: ‘I am delighted and honouredon behalf of the nursing profession toreceive the MBE. It is a particular privilegeto be honoured for research in nursing. Ithas been an important part of my work toraise the profile of nursing and developevidence-based practice.’

CHSS research newsPage 4

CHSS peoplePage 6

Featured PublicationPage 7

News and eventsround upPage 2

www.kent.ac.uk/chss

2 University of Kent | CHSS

News and events round up

CHSS Director Stephen Peckham is leading ateam monitoring Canterbury air quality.

He told Kent Online thatat peak times nitrogendioxide (NO2) levels aresignificantly higher thanthe upper UK averageannual legal limit of 40micrograms per cubicmetre (pcm). Theresearch usessophisticated EarthSenseZephyr monitors. Thereare calls for the Council to invest in sensors like these, which provide NO2 data every 10seconds, as well as data on ozone (O3) and fineparticulate matter (PM2.5). Diffusion tubes sitedin Canterbury give annual averages for NO2 only.

Two monitors have been placed at St Stephen’sRoad and St Dunstan’s level crossings for aproject with Professor Dominic Abrams from theUniversity’s School of Psychology. It is part of anexperiment to assess the impact of signs whichask drivers to switch off engines while waiting atthe crossing. On February 25, between 7am and7pm NO2 readings recorded at St Stephen’sRoad crossing averaged 75.9 micrograms pcm,shot up to 87 during the 8am to 9am rush-hour,119.6 between 6pm and 7pm and peaked at381.

Councils are legally obliged to report monthlyNO2 averages for areas where pollution is abovenational limits. Canterbury City Council has awide network of indicative monitors but only twoare DEFRA approved. Stephen says this doesn’tgo far enough: ‘We are recording levelssubstantially higher than average, because atnight it’s very low, but much higher during the

CHSS air quality work highlighted High levels of daytime air pollution recorded at Canterbury crossings

CHSS Research Fellows on the ball!

Kent FA, the governing body supportingfootball at all levels in the County, recentlycommissioned CHSS Research Fellows DrSarah Hotham and Dr Rowena Merritt todeliver a one day in-house training workshop.

Rowena’s session focused on improvingknowledge and understanding of socialmarketing and how it can promote participationamong hard-to-reach groups. Sarah’spresentation on behaviour change techniqueshighlighted practical tools that can be used topromote and maintain physical activity

day. It’s all very well having an average thatincludes night, when levels are zero. In thedaytime children walking to school along theseroads are nearer to exhausts at ground level.Children breathe faster and take in more air andresearch suggests they can be exposed topollution levels 50% higher than those recordedby monitors normally placed at least 2 metresabove ground’.

Stephen and Dr Ashley Mills will be continuing togather more accurate air quality data across thecity with the Alliance of Canterbury Residents'Associations who, jointly with CHSS, have beenawarded funding towards two additionalmonitors. They are also working with theFaversham Society on a study monitoring thetown’s pollution levels. Campaigners whopetitioned the Department for Transport to forcethe building of a new A2 bypass, highlighteddangerously high levels of pollution, congestionand development in the area.

University of Kent | CHSS 3

Upcoming eventsPint of Science is back!20-22 May 2019Doors 6pm, Event 7-10pmThe Foundry, 77 Stour Street,Canterbury Kent CT1 2NR Tickets (£4) are available forthis year’s Pint of Sciencetaking place on consecutiveevenings. CHSS hascontributed for the past twoyears and we are delighted tobe involved again.

Tue 21 May Dr Rasa Mikelyte – Food for thought: what is a good mealtime for people with dementiaand what can we all learn from it?

Rasa’s session focuseson research which aimedto improve mealtimeexperiences in twodementia care wards.Rasa invites you toimagine yourself in theposition of a person withdementia who hasmealtime difficulties, and she shows that herfindings bear relevance to us all – not justpeople with dementia.

For more details seehttps://pintofscience.co.uk/events/kent

#PintofScience

Darzi project film launchedto promote breastfeeding A film to promote breastfeeding among Kent’sSlovakian Roma community was formallylaunched on Thursday 25 April at the TurnerContemporary Gallery, Margate.

CHSS Visiting Darzi Fellow Philippa Burden co-produced the video which documents women’sown views and experiences.

The event attracted over 70 people whoparticipated in a workshop about next stepssupporting breastfeeding within the Romacommunity. The celebratory launch – red carpetand all – was followed by a traditional Slovakianlunch.

NIHR Research Design Service South EastNeed help applying for health research funding?

RDS SE – FREE advice and support on all aspects of research designSince 2008 CHSS has hosted the RDS SE at the University Kent. The service also operates fromBrighton and Surrey Universities. Funded by the National Institute for Health Research (NIHR) the RDSsupports teams and individuals preparing applications for health and social care research funding.

See more at: www.rds-se.nihr.ac.uk

Philippa said ‘CHSS has been a welcoming,supportive place to be a Darzi Fellow – thank youall – and I’m ending my Darzi year on a verypositive note. Do watch our film!’

You can view the film along with other CHSSvideos here: www.youtube.com/channel/UC0LrhBamXnSy4uoGKljnXbw

4 University of Kent | CHSS

1 Tracy (centre) and the CHSS WHYSPERresearch team

2 Whysper class teacher Nina Dhiman

CHSS research news

Research Fellow Tracy Pellatt-Higgins leads theinnovative WHYSPER yoga research study, withfellow CHSS team members Katie Saxby andKate Hamilton-West, and Nina Dhiman a yogaand mindfulness teacher.

The study explores the feasibility of a six-weekHatha Yoga course designed by Tracy and Nina,who are both yoga teachers and mental healthprofessionals, using recommended yogapractices for stress, burnout and anxiety. Existingdata suggest that over a third of University ofKent staff report ‘often’ or ‘always’ experiencinglevels of stress that are unacceptable.

Yoga is known to improve well-being but thereare no published trials which address theeffective ‘dosage’ of yoga for stress andburnout, ways of maintaining yoga practice inthe longer term and the impact of practisingyoga at home. These are all important factorswhich could contribute to the effectiveness ofyoga, and which the researchers want to explorein this feasibility study.

The WHYSPER yoga course includes therepetition of posture sequences which can bepractised at home and course materials andworkbooks to help home practice. The projectexplores the feasibility of running the workplaceyoga course for members of staff experiencingstress and anxiety, the potential impact of theprogramme on stress and burnout measures,and the uptake and impact of home yogapractice.

Thirty-nine members of staff from the Universityof Kent, including two CHSS staff members,participated in the WHYSPER yoga coursesbetween January and March 2019. The researchteam are now collecting data on outcomesfollowing completion of the classes.

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WHYSPER: Workplace Hatha Yoga for Stress Prevention, Exercise and Relaxation

University of Kent | CHSS 5

New projects

It is widely recognised that researchundertaken by the NHS staff who will use theresults can improve clinical practice.

A Royal College of Physicians’ report ‘Building aResearch-Active Medical Workforce’ found thatdoctors want to engage more in research.However, the evidence suggests that there is alack of time, funding and support to enablethem – along with other professionals such asnurses and allied health professionals – toengage in research.

Professor Stephen Peckham leads a CHSS teamin a new Cancer Research UK-funded, mixed-methods study to discover the scale of theproblem. What action can be undertaken bypractitioners, the organisations they work for,research funders and the NHS more widely toaddress the research capacity problem?Professor Sally Kendall, Dr Ferhana Hashem, Dr Catherine Marchand and Sarah Spencer areworking with Stephen, alongside Kent Surreyand Sussex Clinical Research Network. Theteam are exploring questions such as why NHSstaff lack capacity to conduct research and whatbarriers and facilitators exist that hinder or helpthem. What differences are there betweendifferent health care practitioners’ ability toincorporate research into their clinical career?What training and development support isneeded?

The team will conduct a staff survey, carry outcase studies of specific groups of staff andspecialities and conduct data analysis onexisting research activity and supportprogrammes. The focus is on finding ways ofworking which support research at individual,

Identifying and improving the capacity ofhealth service staff to conduct research

Do Multidisciplinary Meetings (MDMs) contribute towards improving patientoutcomes and prevent the need for health and social care support?

organisational and system levels. The study willseek practical solutions to support policy-making in the NHS, research funders and UKDepartments of Health to improve andoptimise the health service researchenvironment.

CHSS Research Fellow Dr Sarah Hotham iscarrying out an evaluation of MultidisciplinaryIntegrated Care Management meetings(MDMs) in the London Borough of Bexley, on behalf of Oxleas Mental Health NHSFoundation Trust, the Borough’s mentalhealth provider. MDMs unite relevant healthprofessionals across health and social care,to discuss patients with complex multiplehealth and social care needs.

This evaluation uses mixed methods todiscover the impact and effectiveness of theMDMs in improving patient outcomes andreducing need for health and social care

support. Sarah said: ‘Integrated care requiresprofessionals and practitioners from differentsectors to work together around the needs of

people, families and communities. Thisevaluation takes an implementation scienceapproach. By talking to multidisciplinaryteam members, stakeholders and GPs, wewant to find out what works and what doesn’tabout these meetings and the way they areput in place. Do they achieve more joined-upcare for those with complex social andmental health problems?

‘We want to understand what works, forwhom and in what circumstances, to enablemaximum impact on patient outcomes andservice use’.

6 University of Kent | CHSS

CHSS people

Where were you born/grewup?I was born near Glasgow inScotland, the second oldestof four sisters. Dad owned abusy ladies’ hairdressingsalon attached to our house.Me and my sisters andfriends used to play in thesalon and style our hair. Mumwas a housewife, but sometimes worked in thesalon.

When I was 13 we moved to the Yorkshire markettown, Pocklington. Everything was very differentthere, even the way people dressed, and nobodycould understand what I was saying because ofmy strong Scottish accent! It took a while to getover the culture shock and I missed my friends,but I settled and grew to love the area. As ateenager, I listened to Bob Dylan and LeonardCohen a lot and was given my first acousticguitar at 18, which I still play occasionally.

Were you always into maths at school?I was good with numbers from a very young age.I liked school and in fact was once told off fordoing too much maths homework! I was a bit ofa geek and was thrilled to receive a scientificcalculator for Christmas once. I also loved art,writing and needlework, and designed andmade clothes for myself and my younger sisters.

Where was your first job?My Dad’s hair salon; sweeping up, shampooing,blow-drying and getting the hairdressers’lunches from the local bakery. During my A levelsin the summer holidays, I worked in a local fruitpacking company. It was fun because I workedwith school friends, but I’d have hated it long-term!

How and where was University?I studied Applied Statistics at the University ofSheffield. I didn’t really know what I wanted todo, so stuck to what I was good at. I did aplacement year at the University of York workingon data analysis of the Rowntree longitudinalstudy. When I graduated I lived in Harrogate andgot a job in pharma as an Assistant Statistician.

What are your passions/hobbies? I am passionate about yoga and I love walkingmy two Scottie dogs. I enjoy creative writing andhave been on retreats at the Isle of Iona and acouple of Arvon poetry courses. I don’t havemuch time for writing these days with two youngchildren though!

I enjoy spending time with my kids, and havingdays out and holidays with them and the dogs,it’s great to rent a cottage and enjoy lovelyscenery in Cornwall or the Yorkshire Wolds,where I can also visit my family.

What would be your dream job if not this one?Being a Yoga therapist practitioner researcher,with enough time off to travel and write poetry.

What unusual fact can you tell us aboutyourself?On our honeymoon we walked the whole 500mile Camino de Santiago pilgrimage. It took fiveweeks. On the first day we walked up thePyrenees and back down again -– I’ve never feltsuch physical exhaustion! It was a real adventureand we met lots of interesting characters.

Back home we had a big wedding party where aformer Pfizer colleague’s band played theProclaimers song ‘I’m gonna be 500 miles’ forus! It almost made the blisters worth it!

After five years I became Manager of theStatistics Department overseeing more than 20staff, and after eight years my role was verymanagement-focused. In 1997-9 I studied for apart time MSc in Medical Statistics at Leicester, toget back to more hands-on statistics.

What brought you to Kent?In 2002 I was headhunted by Pfizer for aPharmacometrician job in Sandwich. Much of thework involved using pharmacokinetic andpharmacodynamic modelling and simulation todesign trials. I made great friends and enjoyedthe work and travelling in the US and Europe. Itwas a good time to make a move and I felt athome in Canterbury very quickly.

Not long after, I began volunteering for theSamaritans. That led to me training as aCounsellor and a yoga teacher, and I becamemore interested in preventative healthcare.

How did you come to CHSS?I had an interview with CHSS in February 2010and joined the Research Design Service (RDS)as Statistician Research Adviser. I graduallybecame more directly involved with CHSS andRDS research through being a co-applicant onsome projects.

What do you enjoy most about working here?I like the variety of work, and finding out aboutnew areas. There is always something new tolearn. Being able to develop and carry out myown research is a big plus, it’s a nice place towork with good people and the campus is lovely.

I have learnt a lot about the NHS and health andsocial care research, I am also able to contributefrom my experience in statistics and trials. I’velearnt a lot from being trial statistician on the SIPSjunior, RISKIT-CJS and eGFR-C trials.

I was very excited to recently receive facultyfunding to run my first yoga therapy feasibilitystudy which will hopefully lead to more yogaresearch. It has been a new experience beinginvolved in every stage of running a trial.

And she would walk 500 miles!Tracy Pellatt-Higgins, Research Fellow, Senior Statisticianand NIHR RDS SE Research Adviser

University of Kent | CHSS 7

1 Professor Chris Farmer2 Dr James Hadlow

Featured CHSS publications

Around 3,000 renal transplants are carried outeach year in the UK. They offer the best treatmentfor patients whose kidneys have failed. Acuterejection, a common complication in the first yearafter transplant, occurs when the body’s immunesystem begins to attack the donated organ.Currently, acute rejection can only be confirmedby biopsy of the transplanted organ. It can betreated, but only once damage occurs.

Once validated further, this new technique haspotential to offer clinicians use of a simple bloodtest to predict rejection. Ability to intervenebefore the event will help prevent damage andextend the life of the transplanted organ.

Development of a multivariable gene-expression signature targeting T-cell-mediatedrejection in peripheral blood of kidneytransplant recipients validated in crosssectional and longitudinal samples.EBioMedicine ISSN 2352-3964

Predicting kidney transplantrejection

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CHSS visiting Darzi FellowDr James Hadlow andProfessor Chris Farmerhave written a timely articlehighlighting ethicalquestions and dilemmasaround ‘AI’ and digitalhealthcare. Publishedrecently in New StatesmanTech, it stresses the vitalneed for meaningful patient engagement in the ‘digital future’:

‘Proper engagement of our patients to ensurefully informed consent is imperative. It is notgood enough to innovate without engaging thepublic or properly considering the moral and

ethical dilemmas which might arise as the resultof their design and implementation’.

The article was very well received and has led to plenty of social media discussion.

How do we ensure digital healthcare doesn’tleave some patients behind? New StatesmanTech: CHSS Visiting Darzi Fellow Dr JamesHadlow and Professor Chris Farmerhttps://tech.newstatesman.com/emerging-technologies/digital-ready-citizen-health

Digital healthcare – let’s not leavepatients behind!

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Christakoudi S, Runglall M, Mobillo P, Tsui T, DuffC, Domingo-Vila C, Kamra Y, Delaney F, MonteroR, Spiridou A, Kassimatis T, Phin-Kon S, Tucker B,Farmer C K, Strom, T B, Lord G M, Rebollo-MesaI, Stahl D, Sacks S, Hernandez-Fuentes M andChowdhury P (2019).

The Medical Research Council Centre forTransplantation and the NIHR Guy’s and StThomas’ Biomedical Research Centre havefound a novel way to predict rejection of atransplanted kidney before it happens, bymonitoring transplant patients’ immunesystems. Research published in journalEbioMedicine showed that a signaturecombination of seven immune genes in bloodsamples can predict rejection earlier thancurrent techniques. Monitoring these markerscould help doctors intervene before organdamage occurs.

Chris Farmer, Consultant in renal medicine atEast Kent Hospitals University NHS FoundationTrust (EKHUFT), who is also a CHSS ClinicalProfessor, co-authored the article. He said: ‘thislarge multi-centre study was seeking ways toimprove transplant outcome through bettersurveillance. The results are very exciting andmay pave the way to reducing the need forkidney biopsies in transplant recipients andimproving tailored use of anti-rejectiontreatments’.

8 University of Kent | CHSS

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Canterbury, Kent, CT2 7NF, United KingdomT: +44 (0)1227 824057 E: [email protected]

www.kent.ac.uk/chss

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About CHSSCHSS is a centre of research excellence which undertakes high quality research into a widerange of health systems and health services issues at local, national and international levels.CHSS also supports and advises health care staff to develop and undertake research projects.CHSS collaborates with a wide range of partners in Kent, the UK and in other countries toimprove the links between research, policy and practice.

Please see the CHSS website for details of current and previous research and publications.

Details of current CHSS vacancies and studentships can be found at:www.kent.ac.uk/chss/vacancies.html

CHSS staff newsInformation about all CHSS staff is available on our website: www.kent.ac.uk/chss/staffDetails of our current vacancies and studentships: www.kent.ac.uk/chss/vacancies.html

Welcome to:

Esther Mugweni,Honorary ResearchFellowEsther is Research Lead at the Institute of HealthVisiting. She has led andpublished several studieswith Professor Sally Kendall,and will be working with herin the area of maternal and child health.

Ann-Marie TowersAnn-Marie recently joined us from the University’sPersonal Social ServicesResearch Unit (PSSRU).She brings with her a wealthof experience and expertisein social care research andin qualitative methods.

Congratulations

Dr Lindsay Forbes,Senior ClinicalResearch FellowLindsay has been appointedPublic Health Lead for theNIHR Clinical ResearchNetwork, Kent Surrey andSussex (CRN KSS).

CHSS promotions(all effective from 1 October 2019)

Nadine Hendrie, ResearchAssistant has been promotedto Research Associate.

Dr Rasa Mikelyte, ResearchAssistant has been promotedto Research Associate.

Dr Eirini Saloniki, ResearchAssociate has been promotedto Research Fellow.

Recent CHSSpublicationsAbrahamson V & Wilson P M (2019)Positioning the six-month review in therecovery process post-stroke: The ideologyof personal responsibility. Health & SocialCare in the Community 27 (1) pp249-259ISSN 0966-0410

Saddi F C, Peckham S & dos SantosMundim, P (2018) Pay for Performance,Formulation, Implementation and PolicySuccess: in Low, Middle and High IncomeCountries. Sociedade e Cultura 21 ISSN1415-8566. E-ISSN 1980-8194

Kendall S, Nash A & Braun A et al (2019)Acceptability and understanding of the Ages& Stages Questionnaires®, Third Edition, aspart of the Healthy Child Programme 2-yearhealth and development review in England:Parent and professional perspectives Child:Care, Health and Development 45 (2) pp251-256 ISSN 0305-1862

Hudson B, Hunter D & Peckham S (2019)Policy failure and the policy-implementationgap: can policy support programs help?Policy Design and Practice

Hamilton-West K E, Gadsby E W & Hotham S (2019) Re: Helen Salisbury: Socialprescribing and the No 17 bus. BMJ 364ISSN 0959-8138

Early F, Wilson P M, Deaton C, Wellwood I &Dickerson T et al (2019) Developing anintervention to increase REferral and uptakeTO pulmonary REhabilitation in primary carein patients with chronic obstructivepulmonary disease (the REsTORE study):mixed methods study protocol BMJ OpenISSN 2044-6055

Details of all CHSS current and pastresearch is available on our website:www.kent.ac.uk/chss/research/current.html