3a154492-5625-4fba-82b5-37d30dbaccaa Creating Learning Environments for Compassionate Care (CLECC) in mental health settings: an implementation study This project has been completed and had created the CLECC toolkit which you can see here Principal Investigator: Dr Michelle Myall Team members : Dr Michelle Myall (Senior Research and Implementation Fellow, School of Health Sciences, University of Southampton), Dr Sarah Williams (Associate Director for Research and Improvement, Solent NHS Trust) Professor Jackie Bridges (Professor of Older People's Care, School of Health Sciences, University of Southampton), Dr Jane Frankland (Senior Research Fellow, School of Health Sciences, University of Southampton), Cindy Brooks (Research Fellow, ARC Implementation team). Started: 1 October 2020 Ended : 30 September 2022 Project partners : Solent NHS Trust, Southern Health NHS Foundation Trust, NHS Improvement, Wessex AHSN, Centre for Implementation Science, University of Southampton. Co-funded by : NHS Improvement Lay summary Background There is some public concern about NHS hospital nurses’ capacity to provide compassionate care, but very little research about how to improve this situation. We have developed and piloted a programme called Creating Learning Environments for Compassionate Care (CLECC). In CLECC, all registered nurses and health care assistants from participating wards attend a study day, with a focus on team building and understanding patient experiences. A nurse educator (who is not usually part of the ward team) supports the team to try new ways of working on the ward, including regular supportive discussions on improving care. Ward managers attend learning groups to develop their leadership role. Volunteer team members receive training in observations of care and feeding back information to colleagues. In an earlier study, we piloted CLECC on four wards in two NHS hospitals, with two other wards continuing with business as usual. We found that CLECC could be put into practice on NHS hospital wards and that staff felt it improved their capacity to be compassionate. However, we found variations between the four nursing teams and two hospitals, in whether or not, staff felt able to take part in CLECC and to carry on with CLECC after the nurse educator left. We followed up the wards two years later and found that some wards had carried on using CLECC and shared the ideas with other teams. But some wards had stopped using CLECC and we found that this was influenced by amongst other factors: staffing levels, work priorities, staff turnover and managers’ support. The research findings to date suggest that each team differed in the ways they used and responded to the CLECC ideas. If we want programmes like CLECC to make a difference to patient care, we need more research to test it out in other settings. This will help us to better understand the conditions in which CLECC is most likely to make a positive difference and about how these conditions can be developed, supported and maintained. Aims of study This study will follow up to four nursing teams in mental health hospital settings who are using CLECC for the first time. We will use questionnaires, staff interviews and documentary evidence to gather data on the characteristics of organisations and teams, and the factors that influence CLECC’s progress in the first few months. We will look carefully at these data, working out the connections between the characteristics, the influencing factors and what happens when CLECC is used. We will develop a theory about how different organisational conditions affect the journey of programmes like CLECC. We will also use the study to test the best way to measure the impact of CLECC on staff well-being. How will findings be used? This research will help us understand what changes might be needed to get organisations ready for using CLECC. It will also mean we can identify in advance teams who are likely to benefit from CLECC, improving its value for money. We will use the findings to develop a guide for hospital managers to assess and improve their organisations and teams for their receptiveness to quality improvement activities like CLECC. We will share our findings with a wide range of people including patients and families, NHS managers, health and social care staff and other researchers.

a0531f94-b063-4041-908b-5830a10b5f66 ADOPTED: Community pharmacy alcohol-related liver disease risk identification and linkage to care through development of a complex intervention (CIP-LINC) Prinicpal Investigator: Dr Alexander Smith Start Date: 16 February 2023 End Date: 31 March 2025 Background Liver scarring (known as cirrhosis) is a frequent and ever more common reason for dying in the United Kingdom (UK). The most common cause of liver scarring in the UK is alcohol. Death from liver scarring can be prevented if liver disease is found at an early stage. This can be hard because many people with liver scarring do not look or feel unwell until they develop liver failure. At this stage it is too late to prevent complications. Alcohol-related liver disease can be found earlier by assessing for it in people who drink too much alcohol. This is advised in national guidelines. Local pharmacists are one of the most accessible health professionals. There are over 12000 local pharmacies in England. Lots of these pharmacies are in areas where more people have alcohol problems. Local pharmacists are able to identify people who drink too much alcohol and provide them support to drink less. However, it is not known if local pharmacists can get these people assessed for alcohol-related liver disease. This study looks at how this could be done with the aim of creating a Toolkit to make it happen.

c5ca53e9-5f1d-4394-8679-3abfad5e1fe1 WHELD: Training care home staff to improve well-being and mental health of dementia residents led by NIHR ARC Peninsula and working with NIHR ARC South London, NIHR ARC East Midlands, NIHR ARC East of England, NIHR ARC North East North Cumbria, NIHR ARC North West Coast and NIHR ARC Yorkshire and Humber Implementation of evidence-based cost-effective training for care home staff to improve Wellbeing and mental HEaLth for care home residents with Dementia and reduce unnecessary sedative medications (WHELD into Practice) Principle Investigator: Professor Clive Ballard Team members: Joanne McDermid, Jane Fossey, Barbara Woodward Carlton, John-Paul Taylor, Louise Robinson, Martin Orrell, Clare Hulme, Sube Banerjee, Esme Moniz-Cook, Dag Aarsland, Annette Boaz, Clarissa Giebel, Caroline Watkins, Jo Day Partners: NIHR ARC South West Peninsula ARC, University of Exeter, NIHR ARC Yorkshire and Humber, NIHR ARC East Midlands, NIHR ARC East of England, NIHR ACR South London, NIHR ARC North West Coast , NIHR ARC North East and North Cumbria, University of Plymouth, University of Newcastle, University of Hull, King’s College London, University of Nottingham, South West AHSN, Pendennis Care Home, Devon Partnership NHS trust, Alzheimer’s Society. Research sites: University of Exeter, University of Newcastle, University of Hull, King’s College London, University of Nottingham, University of Liverpool Starts: 1/09/2021 Ends: 31/03/2023 Lay Summary WHELD is an evidence-based person-centred training programme which, in 4 clinical trials involving 2349 care home residents with dementia, demonstrated benefits in well-being and mental health and a reduction in sedative medications across London and Buckinghamshire. No similar programme has been successfully implemented in the UK or elsewhere. Nationwide implementation would have a major impact on well-being among the most vulnerable people with dementia. Lead ARC South West Peninsula with implementation sites also in East Midlands, East of England, North East and North Cumbria, North West, and Yorkshire and Humber ARCs WHELD intervention resources have been optimized for implementation, based on the results of our recent COVID WHELD programme. WHELD will now be implemented in 75 care homes in ARC regions where WHELD has not previously been delivered. Implementation evaluation will identify implementation enablers and barriers, fidelity, reach and buy-in, and provide illustrative case studies. Engagement of PPI representatives and stakeholders to Develop Real World Implementation Plan will be integrated throughout the programme. Key stakeholder groups for this work will include commissioners, senior representatives from Integrated care system organizations, representatives from the AHSNs in the different ARC regions and care home owners/senior managers. A series of dissemination activities, including stakeholder workshops, will enable the development of a plan for scaling up the implementation to national level and any required adaptations to WHELD resources. Progress by October 2022: The digital materials for the programme have been optimized. The programme has IRAS approval and CRN adoption. We currently have 19 participating care homes, with a goal of completing recruitment by the end of March 2023. The first PPI and stakeholder workshops have been completed, with further workshops through the autumn and in the New Year.

78e6cc7b-5ff9-411b-b288-1d82a03f0414 Testing the effects of food product placement on customers’ visual attention and intended product purchases: a randomised trial in a virtual supermarket setting (Phase I) Does supermarket placement affect intention to buy healthy and unhealthy foods? Principal Investigator: Janis Baird and Christina Vogel, Professor of Public Health and Epidemiology and Principal Research Fellow in Public Health Nutrition respectively, MRC Lifecourse Epidemiology Centre, University of Southampton Team: Dr Sarah Crozier, Senior Statistician, MRC Lifecourse Epidemiology Centre, University of Southampton Sarah Jenner, Senior Research Assistant at University of Southampton Dr Sarah Muir, Senior Research Fellow, University of Southampton Professor Marcus Munafo and Dr Olivia Maynard, Bristol University Ravita Taheem, Southampton City Council, Sure Start Children’s Centres Megan Brook, Public Contributor Tiana Chadwick, Public Contributo Start date: 1 October 2019 End date: 28 February 2022 Background Poor diet has been recognised as a major contributor to the burden of non- communicable diseases in the UK and costs the NHS approximately £6 Billion annually. Most adults in England consume too much salt, saturated fat and free sugar, and do not eat the recommended five daily portions of fruit and vegetables. Among low-income groups these trends are more extreme. Almost 90% of UK grocery sales occur within supermarkets4 and their subtle use of marketing techniques influences the food choices of an almost captive market. Women of childbearing age are an important target group to study because they remain primarily responsible for domestic food tasks such as shopping and cooking and their nutrition status influences the short and long-term health of their children. Our prior work in Hampshire showed that the diets of women with low educational attainment were more affected by less healthy supermarket environments than women with higher attainment. Shopping at less healthy discount and small supermarkets, with poorer availability, pricing and placement of healthy foods, was associated with poor dietary quality among women who left school aged 16 years but not among those with degree qualifications. UK government policy recognises that more effort is needed to develop interventions to improve health equitably and is introducing legislation on product placement initiatives to support families to make healthier food choices in supermarkets. Research using adequately powered clustered randomised controlled trials in supermarkets is limited, largely due to the complexity and large number of stores required. Evaluating changes in supermarket layout is notoriously challenging due to differing health and business agendas and randomisation at the store level requires commitment that is problematic in this highly competitive, commercial setting. Virtual supermarkets offer a viable alternative to investigate the likely impact of supermarket-based, healthy eating policy options using robust trial designs. Additionally, neuroscience techniques, such as eye-tracking, offer objective evidence that complements self-report behaviours, and facilitate a deeper understanding of the cognitive mechanisms underlying health-related behaviours. Such techniques have been used to examine how product placement facilitates customers’ visual attention, however there is a gap in understanding of how visual attention differs according to the healthfulness of products, particularly while placed in prominent in-store locations and whether visual attention differs according to customer’s socioeconomic position. This study aims to use experimental randomised trials and a virtual supermarket setting to determine differences in visual attention and intended purchase of healthy, unhealthy and non-food products placed in prominent in-store locations such as checkouts. It will also assess effect modification by educational attainment on these relationships to explore potential effects on inequalities. This is the first of two phases of research assessing visual responses to product placement. In this phase, heat mapping technology using Qualtrics software determined whether interest in and intended purchase of products in prominent in-store locations differed if the products were healthy, unhealthy or non-food items. We assessed effect modification by educational attainment to explore potential effects on inequalities. Women with young children (n=230), recruited through Sure Start Children’s Centres, early years setting and other community groups in Hampshire, undertook shopping trips in a virtual supermarket to assess whether their purchasing intentions differ if unhealthy foods, healthy foods or non-food items are placed in prominent positions (store entrances, checkouts and end of aisle). Preliminary findings indicated differences in women’s intention to buy certain types of products according to their educational attainment. Women with no educational qualifications beyond aged 16 years were intent on purchasing fewer healthy products when they were placed in prominent locations whereas those with higher educational attainment were intent on buying significantly more healthy products. A total of 230 women participated in phase I, exceeding our target sample size of 52. The study Women were shown a series of pictures representing six journeys through a supermarket. Pictures focused on the areas in a store where most shoppers usually pass through including the store entrance, end-of-aisles and checkouts. In the first three journeys, women needed to click all items they were interested in. In the last three journeys they needed to click all the items they would intend to buy if this was a real shop. Each set of journeys included a healthy journey, unhealthy journey and a non-food journey. What were the results? 201 women took part in a virtual supermarket survey. Overall, women in the study showed more interest in unhealthy products than healthy or non-food items. At checkouts, however, they did show more interest in non-food items. Women intended to buy more healthy and non-food items than unhealthy food items. On average they wanted to buy 12.9 healthy products per shop compared to 11.5 unhealthy products. What difference will this make? Unhealthy products can be interesting to women who shop at supermarkets but they have higher intentions to buy healthy and non-food items in noticeable places in stores. Supermarkets usually place unhealthy foods in noticeable places to make profits. Replacing these unhealthy foods with healthy or non-food items will just as likely, if not more successfully, lead to purchases. This can help families lead healthier lives. Why is this important for patients, health and care providers and policy makers ? Placing unhealthy foods in noticeable places can lead to impulse purchases of foods that can lead to obesity. Our study shows that women do not intend to buy these foods but may show interest in them. Since 2022, UK policy has banned the placement of some unhealthy foods at noticeable places in supermarkets. This research provides evidence that customers likely support this policy as they would like to buy healthy and non-food items from these locations. What we are going to be doing next? We wanted to further understand how attention to healthy, unhealthy and non-food items differ in noticeable places in supermarkets. We therefore ran eye-tracking experiments with 70 women in Hampshire. Data are being analysed. We plan to report the results of our survey and eye-tracking studies to policymakers (e.g. Department of Health and Social Care and Public Health England) via a policy brief. We also aim to share our results with families via Sure Start Children’s Centres, Facebook and Local Schools. We have plans to share our findings at public health conferences and in an academic journal.

9786dc43-811c-409a-95aa-666af8766d3d ADOPTED PROJECT: Developing and testing a Patient Report Experience Measure for patients accessing Acute OnCology services: The PREMAC study Principal Investigator : Dr Richard Wagland, Senior Research Fellow, University of Southampton, School of Health Sciences Co-Investigators : Professor Alison Richardson, Professor of Cancer Nursing & End of Life Care and Director of NIHR ARC Wessex, University of Southampton & University Hospital Southampton John Defty, Advanced Clinical Practitioner in Cancer Care, University Hospital Southampton Dr Emma Brown, Medical Oncologist, Acute Oncology Lead. University Hospital Southampton Start date : January 2023 End Date: May 2024 Funder : University Hospitals Southampton (UHS) NHS Foundation Trust R&D Small Grants Award Summary People with cancer often need to access acute oncology services for serious problems caused by their disease or treatment. It is good practice for services to collect information about patients’ experiences of care to understand how they could be improved. The aim of the PREMAC study was to develop a questionnaire for patients who have used acute oncology services to feedback their experiences. The study progressed in three stages. First, a literature review to identify previous research that described elements of care important to people with cancer whilst experiencing a cancer emergency. This was followed by interviews with eight patients who had cancer and eight doctors and nurses from the acute oncology team at Southampton General Hospital to hear their thoughts about the most important elements of care. From these two activities we identified what the questionnaire should aim to measure. In the second stage, a group of patients who had a diagnosis of cancer and used acute oncology services helped the research team draft questions and response options. These questions were then tested with a further four people with cancer, to make sure the questions were easy to understand. Then we made some changes to the questionnaire. The final questionnaire had 37 questions about the quality of care and nine questions about a patients’ background and condition. Questions included aspects such as: quality of information and care they received; the quality of the care environment (whether it was clean and safe, and provided privacy; whether patients’ family and friends were supported and kept informed by staff; whether patients had long waits for care; and the ease of discharge. In the third stage, the questionnaire was sent to patients with cancer to complete one to two weeks after they had used the acute oncology service at Southampton General Hospital. Patients were sent a text to their mobile phone with a link to the questionnaire. 171 patients completed the questionnaire, the majority of whom were female (56.5%). Most participants rated their overall care experience positively, with 82.4% selecting “Very good” and 9.7% selecting “Good.” Only 4.2% of participants rated their care as “Poor” or “Very poor”. Responses to the questionnaire allowed us to test how well each of the questions worked both by themselves and in combination with others in the questionnaire. Responses provided the Trust with important information to help identify areas where care was very good and areas in need of improvement. The next study will test the questionnaire in other Trusts whose acute oncology services might be organised in different ways to the services at Southampton. Background Hospitals have established structured pathways for managing patients with oncological emergencies through acute oncology (AO) services. Whilst some Trusts have developed local questionnaires specific to that service there is no survey available to measure and compare patient experience across NHS trusts. This study will co-design a patient-reported experience measure (PREM), intended to be adaptable for use across different AO service models. Advisory Group Members : Andrew Dossett, Lead Clinical Advanced Clinical Practitioner for Acute Oncology Service, University Hospital Southampton Jane Winter, Macmillan Lead Nurse, Wessex Cancer Alliance Laura White, Head of Involvement & Participation, University Hospital Southampton Katie Hudson, Lead Advanced Clinical Practitioner for Cancer Care Wards, University Hospital Southampton Mrs Susan Restorick-Banks (PPI Representative) Mrs Anne Ongley (PPI Representative) Alison Keen, Head of Cancer Nursing, University Hospital Southampton Philippa Jones, Acute Oncology Nurse Advisor, Board Member of UK Acute Oncology Society. Prof. Ernie Marshall, Medical Oncologist, Wirral University Teaching Hospital (Clatterbridge) NHS England national lead for Acute Oncology

ARC qualitative network Aim The aim of the group is to encourage debate and discussion about the place of qualitative research in health research, its core concepts and methods in a dynamic and supportive atmosphere. The group is multidisciplinary with over 140 participants drawn mainly from di fferent faculties (Health Science, Medicine, Psychology, Sociology) and universities across Wessex, and some national and international participants. The group aims to be helpful and facilitate the use and development of qualitative research in health, illness and care. Participants The group is primarily concerned with providing a peer support network and the development of knowledge and skills of early and mid-career researchers who are conducting or interested in qualitative research. Frequency of meetings The group meets every 2-3 months to discuss a specific topic related to qualitative research, with selection of topic normally driven by the members and their interests and needs. Webinar 1 May 2020 - Qualitative Longitu dinal Research (QLR) - hosted by Dr Eloise Radcliffe, from the MacMillan Survivorship Research Group & Dr Meredith Tavener, University of Newcastle, Australia Webinar 8 July 2020 - Phone and online qualitative interviews - hosted by Dr Sofia Strommer and Dr Kinda Ibrahim Webinar 2 October 2020 - Teaching and Qualitative Research Webinar 11 February 2021 - Realist synthesis - Webinar by Dr Ivaylo Vassilev, Dr Alejandra Recio Saucedo & Dr Ksenia Kurbatskaya as part of ARC Qualitative Network Webinar 12 February 2021 - Realist Synthesis Exercise for Context, Mechanism and Outcome (CMO) configuration - with Dr Ivaylo Vassilev, Dr Alejandra Recio Saucedo & Dr Ksenia Kurbatskaya as part of the ARC Qualitative Research Network Webinar 19 March 2021 - Innovative ideas for Patient and Public Involvement (PPI) in qualitative research - March 19 2021 - Presented by Dr Caroline Barker (ARC PPI lead) and Carmel McGrath - Chaired by Dr Kinda Ibrahim (download copy of presentation) Webinar Friday 18 June, 2021 11.00am-12.30pm - How to conduct a systematic review and synthesis of qualitative studies - Speakers and researchers, Dr Teresa Corbett and Dr Kate Lippiett, who will share their recent experiences in conducting systematic reviews of qualitative studies, top tips and issues to avoid. (Download copy of presentation) Webinar December 8, 2021 - 1.00pm-2.30pm - Dr Kat Bradbury explain the value of using Qualitative Research in designing interventions - A Person Based Approach (Download a copy of presentation) Webinar March 29, 2022 - 1.00pm-2.00pm - Dr Sarah Fearn and Mrs Veena Agarwal Content analysis of interviews and surveys: Methodology and application (Download a copy of the presentation) Webinar April 28, 2022 - 11.00am-12.30pm -Dr Amanda Blatch-Jones and Dr Katie Meadmore share their experience of using netnography to explore funding committee practice allocation of research funding. (Download a copy of the presentation) Webinar June 9, 2022 - Professor Carl May presents “qualitative studies of innovations in treatment, organisations, and delivery of healthcare services: how the normalisation process theory coding manual can help?" Webinar October 6, 2022 -Dr Kate Lyle and Dr Susie Weller : Exploring the complexity of patient journeys: analysing, representing and communicating experiences through visual methods Webinar March 29, 2023 - download slides : WATCH: Video Reflexive Ethnography as a research and healthcare improvement tool – methodology and application. Webinar September 15, 2023: Watch:Decolonising qualitative research: Employing a critical cultural safety lens to address inequity and social justice Dr Elissa Elvidge Slides Webinar December 1, 2023: Watch: ARC Qualitative Research Network: Understanding Narratives Through Timeline Drawings. Webinar March 12, 2024: Watch: ARC Qualitative Network: Co-Production Webinar May 15, 2024: Watch: ARC Qualitative Network: Photo Elicitation Webinar September 2024: Watch: ARC Qualitative Network: Think Aloud Slides set 1 and Slide set 2 Webinar December 5 2024 - Using I-Poems for Deeper Insights in Qualitative Data Analysis Slides Using i-poems for deeper insights in qualitative data analysis - Lisa Ballard UoS Using I-Poems to extract the essence of a participant's experience - Chloe Langford Uos Webinar June 3 2025 - Qualitative Research Network - Digital Stories for enabling the voices of autistic children and young people to contribute to transitions in education, health and social care settings. Resources The group has developed a “MUST READ LIST” for qualitative researchers that include articles and books that discuss different areas including: challenges of conducting qualitative research; ensuring quality in qualitative research; the place of different methods of data collection; teaching qua litative research. We built this dedicated resource to help and advise people and we are constantly updating the list to include any further useful resources. If you would like to update the Must Read list email Jamie.stevenson@soton.ac.uk The group has also started building a resource of people with their expertise so members can identify at a glance the most suitable person(s) within the group to help, advise, and support on a particular topic. If you would like to add your details, please click here Group Convenor If you would like to know more about the group or interested in joining in please email Dr Kinda Ibrahim K.ibrahim@soton.ac.uk

9f2dd724-7738-441f-b1ed-16eef04ecccd ENRICHER-C: Involvement in the criminal justice system & the impact on women's health in Dorset & Hampshire – Community comparison Chief Investigator: Emma Plugge, Associate Professor of Public Health, Faculty of Medicine , University of Southampton Team: University of Southampton - Donna Arrondelle, Research Fellow - Kathleen Kendall, Professor of Sociology as Applied to Medicine - Sara Morgan, Lecturer in Public Health - Julie Parkes, Professor Public Health - James Raftery, Professor of Health Technology Assessment EP:IC -Donna Gipson, Director -Lucy Wainwright, Director Prison Reform Trust -Paula Harriott, Head of Involvement Partners : University of Southampton, Dorset Council, Southampton City Council, HM Probation Services, South West, One Small Thing, Prison Reform Trust. Start: 1 October 2024 End: 31 March 2026 Summary This study will look at what happens to women’s health and wellbeing when they are being followed up by probation in the community, serving a ‘community sentence’. We will follow up these women in Dorset and we will compare any changes in wellbeing to changes in women from Hampshire who go to Hope Street on a community sentence. Hope Street is charity-funded residential care for women from Hampshire in contact with the criminal justice system; women live in special accommodation in the community where they are secure and where they are able to access a range of health and social care services. Women in contact with the criminal justice system are often from the poorest communities and they have many different health problems, particularly relating to their mental health. These health problems are often related to their crimes and so by making sure they get the services they need, this will help their health improve and benefit wider society by helping tackle crime. This study will ensure that this unique information is available to those who plan and deliver health services locally. The Southampton research team on this project are carrying out a 5-year evaluation of Hope Street. This means they can use the data that they are collecting as part of this evaluation on the health of women at Hope Street to compare to women from Dorset on community sentences. Researchers will collect information on the health and social care needs of the two groups of women at similar time intervals over a one-year period. They will then compare this information to look for differences. They will interview the women to understand their experiences. They will also look at the cost of their care. The information from the study will help the professionals who plan health and social care services and also those who work in criminal justice settings such as prison or probation. Women with experience of the criminal justice system are part of the nine-person study team. They have helped design the project and will also be important in spreading the word about the study. This will enable us to reach not just academic audiences and policy makers through publishing in journals and presenting at research conferences, but also people with lived experience of probation and imprisonment, and charities that work in this area. Informing a wide range of people will be important in ensuring that the findings from this study are acted on.

4eb65901-c241-410c-86cb-3a42cbe62229 The feasibility and acceptability of a collaborative deprescribing intervention to reduce anticholinergic burden among hospitalised older patients. Digital Anticholinergic Reduction Tool (DART) Chief Investigator: Dr Kinda Ibrahim Associate Professor, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton Team: Dr Stephen Lim, Principal Clinical Research Fellow, Honorary Consultant Geriatrician, Academic Geriatric Medicine, University Hospital Southampton. Dr Eloise Radcliffe, Senior Research Fellow, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton Dr Emily Smith, Research Fellow, Pharmacy, University Hospital Southampton Dr Cathrine McKenzie, Pharmacy and Critical Care, University Hospital Southampton Mr Andrew Bates, Critical Care Nurse, Research Manager and NIHR Clinical Doctoral Research Fellow, University Hospital Southampton. Dr Andy Fox, Consultant Pharmacist Medicines Safety, University Hospital Southampton, Southampton General Hospital Dr Sara Mckelvie, Clinical lecturer, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton. Mr Edward Hewertson, Geriatric consultant, Medicine for Older People, University Hospital Southampton, Southampton, General Hospital Prof Tracey Sach, Professor in Health Economics, Faculty of Medicine, University of Southampton Mrs Sarah Bennett, Medicine for Older People Lead Pharmacist, Pharmacy Department, University Hospital Southampton, Southampton General Hospital Mr Kenny Fraser, co-founder of TRISCRIBE. Mrs Pam Holloway and Mr Neil Wilson (Patient representatives) Start: 1 October 2024 Duration: 31 March 2026 Partners: University Hospital Southampton NHS Foundation Trust, Triscribe Limited, Health Innovation Wessex. Why this research is important? It is estimated that over one third of all older adults are prescribed medication which are known to have “anticholinergic” side effects. These anticholinergic side effects can include an increased risk of falls, delirium, and memory problems. People who have a high number of anticholinergic medications have an increased risk of these side effects. This can be measured as their anticholinergic burden (ACB). Several tools have been developed to assess the ACB score, by checking a person’s medication list, with the aim of reducing these medications where possible (deprescribing). The study aim The project team worked with a company to design an online tool which can calculate the total ACB score for patients using their electronic medication list. It can also list the individual anticholinergic medications contributing to that score. Patients with high ACB score will be highlighted to healthcare staff including pharmacists, nurses, and doctors. In this project, we plan to understand how this tool can be used by clinicians in older persons wards to reduce the number of anticholinergic medications prescribed where appropriate. Our approach Working with doctors and pharmacists in one large hospital, we agreed how the tool should be used. First, pharmacists with check weekly using the digital tool how many patients have high ACB scores. Then they would highlight in patients’ medical notes the list of medications with high anticholinergic effects using a sticker note. The doctor looking after the patient then sees the note which would prompt him/her to either stop the drug, reduce the dose or switch to a safer drug. We will test this intervention among 50 patients admitted to older people wards. We will collect information before and after receiving the intervention including number and type of medications prescribed, quality of life, and cognition. We will also talk to staff and patients to understand their views about the intervention, any challenges, and how to improve the process. Involving patients and public Two patient and public contributors have been actively involved in developing this research proposal. They represent an older person with comorbidity and polypharmacy and a carer, and both have lived experience of managing polypharmacy following hospital admission. They will continue to provide input on study procedures and materials and contribute to plans for sharing the findings. What did we find? We found that there is very little research on prescribing for older people with heart failure, especially those aged over 75. No studies looked at frailty, which is important for understanding how well treatments work in this group. Very few studies reported on ethnicity, and none considered people’s socio-economic background. Only a small number included information about quality of life, and none were carried out in primary care settings. • Overall, this means there is not enough good evidence to clearly understand the benefits of heart failure treatments for older people. • Some medications may help, particularly a group called SGLT-2 inhibitors (also known as “gliflozins,” such as dapagliflozin), but it is difficult to say how much benefit they provide. In addition, side effects may make these treatments harder to tolerate and could increase the risk of harm for some patients. We found that for research on stopping or reducing (deprescribing) heart failure medications for older people is also limited. Stopping medicines during a sudden worsening of symptoms may be harmful. However, the available evidence is limited and varies in quality, and it does not properly consider people living with frailty. This highlights an important gap in research and a need for better evidence to guide safe treatment decisions. What did we do with this new knowledge We have presented findings at the South West Society for Academic Primary Care conference in Oxford, and later in the year at the European Geriatric Medicine Society in France, and are publishing the results of the two systematic reviews in two peer-review widely read journals. We also plan to share the findings with We will share findings with the National Clinical Director for Prescribing in England, Prof. Tony Avery, and the British Geriatric Society (BGS) and present the findings to the South West BGS group. This will ensure the findings reach decision-makers who design and fund future clinical trials. The impact of this research is in contributing to the evidence base and identifying critical gaps in knowledge about how heart failure medications are used in frail older populations. It highlights the underrepresentation of these groups in clinical trials and the limited evidence available to guide deprescribing. This will inform priorities for future research, while also supporting greater awareness among clinicians of the need for personalised, context-specific prescribing and shared decision-making. In the long-term this will contribute to safer prescribing, reduced medication-related harm, improved quality of life, and fewer avoidable hospital admissions. What Next? •This is a complex and challenging area of research. Our work has highlighted variation in approaches to prescribing, as well as differences in the challenges faced by healthcare professionals across disciplines and care settings. •It is clear that further high-quality clinical trials are needed to address the important gaps we have identified—particularly the lack of robust evidence on prescribing and deprescribing for older people with heart failure who are living with frailty and multiple long-term conditions. •We will share findings with the National Clinical Director for Prescribing in England, Prof. Tony Avery, and the British Geriatric Society (BGS) and present the findings to the South West BGS group. •We hope our findings will contribute to the recent ongoing public debate on medicines optimisation in frail older people, and will shape and inform future research, supporting the development of clearer, more relevant evidence to guide care for this population.

Implementation Our dedicated focus on implementation planning has enhanced the uptake and impact of ARC projects. Through a joint leadership role with Health Innovation Wessex, and close working with our partners, including Wessex Health Partners, our ICSs, health and care providers and our higher education partners, researchers have been supported to foster connections and networking critical to implementation success. Stakeholders (such as clinicians and commissioners) have been engaged early in the research cycle to understand the factors that will support the adoption of research. Our implementation team provided an implementation advice, co-developed implementation plans and advised on grant applications. An implementation checklist was developed to assist researchers in planning for implementation at the outset of their projects Other resources | NIHR ARC Wessex. Our partnership with Health Innovation Wessex has benefitted understanding of how to optimise the impact of ARC innovations and research findings , and has led to several joint programmes of work including research in optimising the use of medicines , the Wessex NHS Insights Prioritisation Programme (NIPP) , a review of the evidence for community based falls prevention , and development of a Workforce Evaluation Toolkit. Our medicines optimisation programme was founded on a deep understanding of system priorities, resulting in research questions that addressed system priorities and successful implementation of the findings and new resources. Our evaluations of digital remote monitoring for people with frailty in Wessex, and our joint evidence review of community based falls prevention in England with ARC South West Peninsula, provided insights into the implementation of innovation in practice and have been widely disseminated. Our policy brief on falls prevention , published in 2025, describes lessons for implementation from several ARC implementation studies of falls prevention programmes to benefit commissioners, providers and the public. Ageing, dementia & frailty priority | NIHR ARC Wessex . And in response to an expressed need from our system partners for help with evaluating change in the workplace, we produced an evaluation framework and toolkit to guide what to evaluate, how to ask evaluation questions and ways to measure change (In development). In October 2024, we launched our knowledge mobilisation programme and recruited a team of four knowledge mobilisation fellows, enabling us to develop expertise in this area and amplify awareness of the importance of knowledge mobilisation for research impact.

0b30aba5-25eb-4a0f-ba09-0cc56d28cb07 PROCED-DST: PROactive, Collaborative and Efficient complex Discharge – Decision Support Tool Chief Investigator: Dr Chris Duckworth, Senior Research Engineer, University of Southampton Email: C.J.Duckworth@soton.ac.uk Team: Professor Michael Boniface, Director of the IT Innovation Centre, University of Southampton, (HEI) Dr Carlos Lamas-Fernandez, Associate Professor, Southampton Business School Dr Dan Burns, Senior Research Engineer, University of Southampton Dr Mark Wright, Patient Flow Lead, University Hospital Southampton NHS Foundation Trust (NHS) Rachel Leyland, Complex Discharge Team Manager, Hospital Southampton NHS Foundation Trust (NHS) Ian Dickerson (PPIE) Partners: Hampshire and Isle of Wight NHS Foundation Trust, Hampshire Hospitals NHS Foundation Trust, Isle of Wight NHS Trust, Portsmouth Hospitals University NHS Trust, University Hospital Southampton NHS Foundation Trust, University of Southampton, Health Innovation Wessex. Start: 1/10/24 End: 31/3/26 Summary As of January 2023, 14,436 patients a day (14% of total capacity) remained in hospital despite being well enough to leave. This is due to delays in arrangements for onward care. Discharge delay occupies beds putting pressure on a wide-range of NHS services. There are currently 7.6 million patients waiting for treatment and an average waiting time of 15 weeks. Leaving hospital at the right time is also better for patients for many reasons. It reduces physical and mental deconditioning and chance of hospital infections. Part of the problem is organising further care required after a hospital stay. For patients in hospitals for seven days or more, 65% are delayed because they are waiting for after-care including care at home, short-term reablement and permanent care or a nursing home. Discharge planning involves lots of people and organisations from patients through to clinical teams in hospitals, community care, and local authorities. Organising care takes time considering the availability of social care services and mediation with patients and their families. It is therefore important that patients are assessed, and needs identified as early as possible within a hospital stay to give time for planning and conversations. An initial discharge assessment is supposed to be made with the first 24 hours of hospital admission. In practice this planning is provided for less than 50% of patients. Staff workload and inability to identify care requirements can delay assessments. Aims: In a previous project called PROCED, we developed a machine learning model to predict onward care needs when someone is admitted to hospital. Machine learning is a computer programme that can learn from information about patients and the services they use to make predictions. We have compared the model against predictions made by clinicians, and the results have shown it works well. In PROCED-DST we aim to investigate how a machine learning prediction can support better discharge planning. By planning care earlier during hospital stays gives more time for patients and families to discuss care needs with care workers. Ultimately we aim to improve the chance that patients can leave hospital on time. Approach: We will consider how a computer algorithm can help clinicians organise onward care by predicting admitted patient’s potential onward care needs. We will organise collaborative sessions with clinicians, patients, and computer programmers to understand how it could be used in the hospital and consider how it may benefit or impact patients. Patient and Public Involvement: Patients and Public will be directly involved in designing, testing and evaluating a decision support tool and help decide how it should be used by care providers to help plan onward care. PPI will influence data usage, patient journey, algorithms and how this should be communicated. The public will participate in a steering committee who will organise a series of workshops to engage patients and public in the research. Dissemination : Communication materials will engage the public and decision makers. We will work with PPIE support networks to develop accessible communication and ensure distribution to diverse communities. Evidence of effectiveness, safety and acceptance will be published. A decision support tool with computer-based decision support will be demonstrated. The outcomes will be championed with institutional, regional, and national implementation teams.

3a7ef7ca-de0e-49f1-be5c-8349df40131c ADOPTED: Community Alternatives to aCute Hospitalisation for Older People who have Fallen (CAtCH-Falls) Principal Investigator: Dr Sara McKelvie, GP & NIHR Clinical Lecturer at the Primary Care Research Centre, University of Southampton. Team members: Lois Woods, Southampton Health Technology Asessments Centre, University of Southampton. Dr Rachel Dewar-Haggart, Primary Care Research Centre, University of Southampton. Professor Peter Griffiths, Health Sciences, University of Southampton Associate Clinical Professor Jacqui Prieto, Health Sciences, University of Southampton Dr Dan Baylis, Chief Medical Officer, NHS Solent Foundation Trust Dr Syed Hasan, Clinical Lead for Virtual Wards, NHS England Dr Elizabeth Angier, PhD student Main funding: NIHR School For Primary Care Research Starts: 1 April 2024 Ends: 31 March 2026 Summary Each year 30% of older people living in the community fall and are often taken to hospital for assessment. National guidelines recommend that after a fall, older people have a thorough check up and help to prevent further falls. We currently don’t know what the best assessment is for older people who fall and are assessed at home. There are several health services which can assess people in the community without a hospital visit. These can be described as “Community Alternatives to aCute Hospitalisation” (CAtCH) services. In different areas in the country these services have different team members, resources and ways of working. Research is needed who and what is needed to work in CAtCH services, particularly to support older people who have fallen. This study plans to look at previous work in this area by looking at published articles, service reports, government documents and internet resources to find out what is essential for these services. We also plan to survey and interview people who work in CAtCH services in the UK to understand what is available for older people who have fallen. The research findings will be used to develop resources for patients, the public and healthcare workers to showcase CAtCH services. The team also plan to produce a report for healthcare commissioners and support policy-makers. It will also allow the team to apply for further research funding in this area including further projects to look at public awareness of CAtCH.

c585330f-e35f-4618-bc81-287d81f85239 The PD Life Study: Exploring the treatment burden and capacity of people with Parkinson’s and their caregivers Principal Investigator: Professor Helen Roberts Research team: Dr Qian Yue Tan (Research Fellow, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton), Professor Helen Roberts (Professor of Medicine for Older People, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton), Dr Kinda Ibrahim (Senior Research Fellow, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton), Dr Simon Fraser (Associate Professor of Public Health. School of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital), Dr Khaled Amar (Consultant Geriatrician and Honorary Senior Lecturer at Bournemouth University, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust) Start: October 2020 Ends: October 2022 Project Partners: University of Southampton, Bournemouth University, University Hospital Southampton NHS Foundation Trust, Royal Bournemouth and Christchurch Hospitals NHS Foundation . Lay Summary People with Parkinson’s (PwP) have many symptoms including tremor, stiffness, slow movements, constipation, urinary incontinence and mental health issues. They are often older and have other long-term health conditions. PwP need to do many things to look after their health including manage multiple medications, attend healthcare appointments and lifestyle changes such as improving diet and exercise. The effort of looking after their health and its impact on them is termed ‘treatment burden’. Some PwP need help from their family or friends (caregiver) to complete these tasks. Caregivers may also experience treatment burden themselves when caring for someone with Parkinson’s. People’s ability to manage treatment burden is termed ‘capacity’ and is influenced by physical, mental, social and economic factors. People are overburdened when the workload of looking after their health exceeds their capacity. This can lead to poor adherence with treatment, poor quality of life and worse health outcomes. Aim We aim to understand the factors that influence treatment burden and capacity in PwP and their caregivers. Methods Interviews with 15 PwP and 15 caregivers will identify factors that influence treatment burden and capacity. These factors will be explored further in a national survey for PwP and caregivers with support from Parkinson’s UK. We will then form focus groups with PwP, caregivers, voluntary sector representatives, healthcare professionals, policymakers and managers through Parkinson’s Excellence Networks to discuss the findings and prioritise recommendations for change. This study will enable to us develop recommendations of ways to reduce treatment burden and improve future experiences of PwP and their caregivers. This research is also supported by a legacy in memory of Carolyn and Tore-Jan Myhre