e468f3be-ad28-42e2-8ec5-7270d68258c8 ADOPTED: Treatment burden in people below the age of 65 with multimorbidity in primary care: A mixed methods (SPELL) Principal Investigator: Dr Rachel Johnson, University of Bristol Team: Prof Chris Salisbury, University of Bristol Prof Jose Valderas, University of Exteter Dr Simon Fraser, Univeristy of Southampton Dr Maria Panagioti, University of Manchester Dr Tom Blakeman, Univeristy of Manchester Dr Shoba Dawson, University of Bristol Dr Polly Duncan, University of Bristol Dr Michael Lawton, University of Bristol Start Date: 1 February 2022 End Date: 31 July 2024 Background One in two people over the age of 50 have more than one long term health condition (multimorbidity). The number of people living with multimorbidity is growing. Compared with people without multimorbidity, people with multimorbidity have worse quality of life, take more medicines, and are more likely to die or to be admitted to hospital. More people in deprived areas develop multimorbidity at a younger age. As a group, people with multimorbidity have more contacts with healthcare services than people with one or no long-term conditions. Because of this the NHS and policy-makers want to find ways to manage multimorbidity better. People with multimorbidity put a lot of effort to manage their medicines and healthcare appointments (treatment burden). There is some research that younger people experience more treatment burden. Previous research tells us that sometimes it is the simple things like getting appointments with the GP and finding parking that cause the most burden. Although people with multimorbidity are often grouped together, their experience depends on the health conditions they have, their ethnicity, where they live and their level of income. People with multimorbidity who are working age might have different problems such as getting time off work for appointments, managing their health conditions as work, or juggling childcare. This study will focus on people who are under the age of 65, as not much research has focused on them. A recent report by a charity for people with multimorbidity said that not much research has been done on how it feels for people to live with multimorbidity. Also, we do not know the best way to support and treat people with multimorbidity in GP services. If we understand people’s experiences, we might be able to design better services to meet their needs. There are some questionnaires that could be used to find people who be finding it difficult to cope with their multimorbidity burden, but they need more testing in the UK, particularly in younger people. Some questionnaires are too long, and it would be helpful to have a short version (e.g. just one question). This could be used regularly, as a quick way to identify people who might be ‘overburdened’ and need more support. We want to find out how health care services can support people with multimorbidity and reduce their treatment burden. We will do this in three ways: 1) interviewing people with multimorbidity, 2) ask people to complete questionnaires and 3) hold a meeting with people with multimorbidity, GPs and people who organise GP services, to talk about what we have found and work together to make recommendations to improve care. Throughout the study, we will work with the staff and patients at the GP surgeries involved to increase the number of people who take part. We will make efforts to reach and include people from minority ethnic groups and those who have difficulties in accessing health care. We will work with local community groups to raise awareness about this study and translate study materials into different languages. People with multimorbidity who take part in each part of the study will receive a voucher to thank them for taking part. In the first part of the study, we will ask GPs to find people with multimorbidity at their practice. We will invite some of those people to be interviewed, for up to 1 hour, either by phone, video or face to face. During the interview we will find out about their experience of living with multimorbidity, efforts they have to put into managing their health and treatment burden, and ways in which using health care services help or make it more difficult. We will use what we find in this study to help design the questionnaire that we will use in the second part of the study. In the second part of the study, we will ask GPs to invite randomly selected people from their practice. People who agree to take part will fill in questionnaires and give us permission to look at their medical notes. The questionnaires will ask about their experiences of care, how multimorbidity affects them, including the burden because of their health conditions or from managing them. As part of this we will test how well a short measure, based on a very small number of questions or even a single question, works in identifying overburdened people. In the third part of the study, we will hold a meeting with patients, people who organise healthcare services, and commissioners and healthcare professionals. During this meeting we will make sense of the results from interviews and questionnaires to identify how health services can support people with multimorbidity We will work together with people with multimorbidity or those with experience of caring for people with multimorbidity. The idea for this study came from a PPI group focused on multimorbidity research projects, with which both RJ and SC have been involved in for the past two years. We have set up a patient and public involvement (PPI) group including six people (two from minority ethnic groups). This group will be involved throughout the study from developing study materials to developing materials for sharing study findings.

00ac00f7-6a45-413d-9354-92f1eb973632 Testing the effects of food product placement on customers’ visual attention and intended product purchases: a randomised trial in a virtual supermarket setting (Phase II) Principal Investigators: 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 Muir, Senior Research Fellow, University of Southampton Dr Sarah Crozier, Senior Statistician, MRC Lifecourse Epidemiology Centre, University of Southampton Dr Hayward Godwin, Associate Professor of Psychology, University of Southampton Professor Marcus Munafo and Dr Olivia Maynard, Bristol University Ravita Taheem, Southampton City Council, Sure Start Children’s Centres Started: 1st March 2022 Ends: 30th September 2024 Background Poor diet is linked to an increased risk of obesity, diabetes and heart disease. 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. People with lower education and income levels are more likely to have poor diet and to experience health problems as a result. Women of childbearing age are primarily responsible for domestic food tasks such as shopping and cooking, and their diets are closely linked to those of their children. Most families buy their food from supermarkets and their food choices can be influenced by placement of items in-store and by promotions. Our research This project follows on from COMPLETED: 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) We want to find out how the placement and packaging of healthy and unhealthy foods influence the foods that women choose to buy. We will do this by creating a ‘virtual’ supermarket layout that participants will interact with on a computer screen. We will recruit women attending Sure Start Children’s Centres in Hampshire and those whose children attend early years settings. Hampshire is a county within the Wessex region with some relatively deprived areas. We will choose centres and early years settings located in areas of higher deprivation. Local data suggests that 70% of families with young children are engaged with the centres. Women using the virtual supermarket will be shown images of healthy and unhealthy foods and non-food items that are placed in noticeable locations in the supermarket like checkouts. We will measure the specific aspects of the images women look at using experimental techniques such as eye tracking, which records their gaze point and gaze duration. The eye tracker is positioned close to the computer screen allowing it to record where women look. We will then ask women to tell us the products that they saw for sale, the name of the products they considered purchasing, and aspects of the supermarket that took their interest, and why. Our findings will tell us how people respond to the placement and packaging of different types of food products and whether these reponses differ if families are poorer or more wealthy. These findings help us to design ways to layout supermarkets to help all families eat more healthy foods. Our research will begin in March 2022 and end in late 2022. We will share the findings from our study with local families attending Sure Start Children’s Centres and early years settings. We will inform local and national government employees about our findings which could help to refine current government policies to address childhood obesity. The Study • 68 mothers took part in an eye-tracking study at the University of Southampton. •The women viewed scenes from a virtual supermarket which showed healthy, unhealthy and non-food products. •Scenes focused on the areas in a store where most shoppers usually pass through including the store entrance, end-of-aisles and checkouts. •Eye tracking software captured their eye movements to measure their attention. Participants were also asked to click on items on the screen that they wanted to purchase. •Twelve women also took part in interviews. mothers took part in an eye-tracking study at the University of Southampton. What did we learn? •We compared women’s attention to healthy, unhealthy and non-food items by showing them images of products side by side. Women showed higher levels of attention to healthy products over unhealthy and non-food items. Healthy products were viewed for 0.10 more seconds than unhealthy products and 0.15 more seconds than non-food items. The eye-tracking study also showed that the women had higher intention to purchase healthy foods over unhealthy and non-food items. Interviews with the women showed they used strategies like shopping lists and avoiding aisle ends to avoid unhealthy purchases. They wanted more healthy snacks or products they might have forgotten (such as paracetamol or batteries) at checkouts. What difference can this new Knowledge make? 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 locations can lead to impulse purchases of foods that can lead to obesity. Our study shows that women do not intend to buy these foods and would prefer healthier alternatives. Since 2022, UK policy has banned the placement of some unhealthy foods at noticeable locations in supermarkets. This research provides evidence that customers are likely to support this policy as they would like to buy healthy and non-food items from these locations. What Next? We are creating an infographic to share our findings with families via Sure Start Children’s Centres, Facebook and local schools. These results support our ongoing evaluation of the Food (Promotion and Placement) Regulations. Data will be shared in ongoing conversations with local authorities and via an academic publication. We have received funding to expand our study from mothers to young people. Adolescence is a time when young people may start to make independent food purchases. We aim to further understand what environmental factors influence young people’s purchases on their journey to and from school.

f5788d42-1d65-4ac1-a9d5-00a8fcb316fd Improving support for self-management (WASP) Using the Wessex Activation and Self-Management and Personalisation (WASP) Tool to design and implement system wide improvements in self-management support for people with long-term conditions See the WASP website https://www.wasp.soton.ac.uk/ Principal Investigator: Professor Mari-Carmen Portillo Team members: Professor Mari-Carmen Portillo (Professor of Long-Term Conditions, School of Health Sciences, University of Southampton), Dr Hayden Kirk (Consultant Physiotherapist & Clinical Director Adults Southampton, Solent NHS Trust), Dr Chris Allen (Lecturer, School of Health Sciences, University of Southampton), Stephanie Heath (WASP Clinical Lead, Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust), Dr David Culliford (Senior Medical Statistician, School of Health Sciences, University of Southampton), Dr Louise Johnson (WASP Project Manager, Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust), Dr David Kryl (Director, Centre for Implementation Science, University of Southampton), Professor Alison Richardson (Professor of Cancer Nursing and End of Life Care, University of Southampton) Start: 1 October 2019 Ends: 30 September 2024 Project Partners: Solent NHS Trust, Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust, University Hospital Southampton NHS Foundation Trust, Hampshire and Isle of Wight ICS Summary Good health and health care are key to a flourishing society. Focussing on what matters most to patients is essential for accessible, equitable and efficient care. In an NHS that is facing many challenges - including an increasing prevalence of multimorbidity and high levels of workforce burnout - this is easier said than done. The Wessex Academy for Skills in Personalised Care (WASP) has developed a programme to facilitate adoption of personalised care in practice. Led by the University of Southampton in partnership with NHS organisations across the Southeast, this programme supports health and social care services to embed personalised care practices – through rigorous evaluation, training, and bespoke improvement initiatives. Research is underway to evaluate the impact of the programme, and to understand how it could be spread and scaled. If adopted nationally, this programme has potential to be the catalyst for changing how we deliver and sustain services across the NHS. Impact People with multiple long-term conditions (MLTC) represent a significant proportion of the primary care population; with an estimated 14 million in England living with two or more chronic conditions. Many experience high treatment burden, fragmented care and reduced quality of life. While national policy promotes personalised care, implementation at scale has proved challenging. Services often lack the tools, skills and system support needed to embed personalised approaches into everyday practice. Difficulties in defining and measuring personalised care, add further challenge. The Wessex Academy for Skills in Personalised Care (WASP) was established to address this gap. Funded and commissioned by Hampshire and Isle of Wight and Dorset Integrated Care Boards (>£710K), WASP has developed an evaluation and training approach, focused on cultural and system-level change rather than isolated interventions. Led by the University of Southampton and working in close partnership with NHS organisations, WASP supports health and social care services to embed personalised care in a sustainable way. Training is accredited by the Personalised Care Institute and WASP is a partner with the Coalition for Personalised Care. Being hosted within NIHR ARC Wessex has enabled WASP to bring together research expertise, service improvement skills and frontline clinical experience. This collaboration underpins a structured programme built around three core elements: evaluating current practice, building skills through accredited training, and supporting services to make sustained improvements. A co-produced service evaluation tool enables teams to reflect on how personalised care is experienced by staff, service users and the wider system; enabling understanding of not just what happens in practice, but why. Training builds staff confidence and capability, while improvement support helps translate learning into measurable change. This work has had broad impact. To date, 45 clinical services across Hampshire, the Isle of Wight, Dorset and Sussex have completed the WASP programme. Over 1,400 healthcare staff have taken part in training, and more than 2,000 people, including clinicians, managers, commissioners and service users, have engaged with the service evaluation. Teams report shifts in mindset, with greater focus on “what matters” to individuals and increased confidence in delivering flexible, responsive care. People using services benefit from care that better reflects their priorities and circumstances, while staff gain shared language, clearer frameworks and practical tools. Commissioners and system leaders benefit from robust evidence to guide investment and improvement. WASP has also influenced practice beyond participating services, contributing to NHS England South East guidance; providing regional leadership on Patient Activation Measure use for NHS England; and contributing to ICB values-based care steering boards. NIHR ARC Wessex has been critical in enabling this impact by supporting programme development, evaluation and dissemination. ARC infrastructure has provided methodological and statistical expertise, mentorship, impact capture guidance and communications support, enhancing credibility and enabling scale-up. Through ARC Wessex, WASP accessed expertise across the University of Southampton, including business intelligence and the Business School, securing two development grants in 2023: the Southampton Enterprise Development Fund (£8,550) and Higher Education Innovation Fund (£10,000). Engagement has also taken place through WASP conferences in 2023 and 2024, with over 100 delegates including clinicians, commissioners and national policy stakeholders. The team is now collaborating with colleagues from UCL, Bristol, Leeds and Exeter to develop a programme grant focused on a scalable and sustainable personalised care intervention. This partnership demonstrates how NIHR investment can translate evidence into meaningful improvements for people living with long-term conditions. “It was good that we were able to focus on how shared decision making can work for continuing healthcare joint working on assessing challenges and positives- in a structured way. The idea of the need was there, and it helped to provide the framework to address the need ” [Programme Participant] https://www.wasp.soton.ac.uk/ We have now held 3 regional conferences, with attendance from 100+ delegates and a range of regional and national speakers – photos can be found on the conference page of our website. https://www.linkedin.com/company/wessex-academy-for-skills-in-personalised-care A scoping review followed this project to provide the rationale for the WASP assessment tool of personalised care practices – this has now been published: Johnson et al (2025) Next? WASP II is now evaluating and collecting evidence of the impact of the Wessex Academy for Personalised Care programme. We are conducting a secondary data analysis on existing WASP survey data, to better understand the behavioral factors impacting personalised care practices. We are seeking for further NHS teams to complete the training beyond Wessex. We are planning an NIHR PGfAR Submission in April 2026 – focussing on sustainable and scalable development and national evaluation of the programme. We are collaborating with UCL, Bristol, Leeds and Exeter, as well as the Personalised Care Institute. Now there's a series of FREE webinars to develop skills supporting personalised care, for health and care professionals in the Isle of Wight, Hampshire. More here

1ab7e5e6-86e2-4f8e-a9c6-1bc46e56207d ADOPTED: Personalised social and self-management support for better living with multiple long-term conditions in the community (CO-ACTION) Chief Investigators : Dr Dorit Kunkell, School of Health Sciences, University of Southampton and Professor Mari Carmen Portillo, School of Health Sciences, University of Southampton. Team: Dr Hannah Wheat, Professor Victoria Allgar and Professor Richard Byng from the University of Plymouth. Miss Francesca White, Hampshire and Isle of Wight Integrated Care Board (ICB). Dr Tom Blakeman and Professor Peter Bower from the University of Manchester. Professor Daniel Prieto-Alhambra, Associate Professor Rafael Pinedo-Villanueva, Dr Annika Jödicke and Miss Maria T Sanchez-Santos from the University of Oxford. Dr Lindsey Cherry and Dr Kate Lippiett from the University of Southampton. Mr Eric Compton, Patient and Public Contributor, Southampton. Start: 1 June 2024 End: 30 November 2028 The CO-ACTION programme aims to improve wellbeing for people with multiple health problems. Living with Multiple Long-Term Conditions often called ‘Multimorbidity’ (MLTC-M) involves multiple appointments and care plans. Patient priorities are often overlooked. Common issues include pain, mobility problems and fewer interactions with friends and family. This can lead to loneliness and poorer mental health. The research team will work with fellow researchers, health, social care and VCSE sector workers to co-design and test a health and wellbeing intervention with and for people living with MLTC-M . To evaluate the CO-ACTION intervention: We will run a trial involving 500 people living with MLTC-M and carers. Half will receive the intervention. The other half will continue with usual care. We will recruit participants (with Patient and Public Involvement support) in health and community settings in Manchester, Leeds, Plymouth, and Southampton. Wellbeing, quality of life, unplanned hospital admissions, and costs will be assessed at the beginning, 6 and 12 months later. Researchers will test how this intervention can be adopted in the NHS in six case study sites. Public and patient (PPIE) contributors will help us design materials, consider challenges and provide feedback on findings.

a3233a2e-82c9-4634-a984-44c5ddb93cad ADOPTED PROJECT: MELD Developing a Multidisciplinary Ecosystem to study Lifecourse Determinants of Complex Mid-life Multimorbidity using Artificial Intelligence (MELD) Chief Investigator: Dr Simon Fraser – University of Southampton Project Team Members: Dr Nisreen Alwan – Associate Professor in Public Health, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Professor Michael Boniface – Director of the University of Southampton IT Innovation Centre and Web Science Institute, Professor Ben MacArthur – Mathematical Sciences University of Southampton, Professor Rebecca Hoyle – Mathematical Sciences University of Southampton, Dr Sarah Crozier – Associate Professor of Statistical Epidemiology, MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Mr William Ware – Patient and Public Involvement Contributor, Mr James McMahon – Patient and Public Involvement Contributor, Dr Emilia Holland – Public Health Specialty Registrar, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Dr Zlatko Zlatev – Senior Enterprise Fellow, Electronics & Computer Science, University of Southampton Background: As with many countries we are facing challenges related to the growing number of people living with multiple long-term health conditions like diabetes, heart disease or dementia. All the way through peoples’ lives many things influence the chances of developing such conditions. This includes some things that are hard to research - broader issues throughout life such as the environment people grew up in, their education, work, and so on. Sadly, people from more socially and economically disadvantaged backgrounds are more likely to develop multiple conditions at an earlier age. There is also evidence that the order of developing conditions varies considerably and influences what then happens to people. This makes understanding these broader issues and how they affect that order vital to inform when and how we should intervene to prevent conditions developing. To achieve this, we need to study large numbers of people over their whole lifetime, but such datasets do not exist. Very large health datasets collected from NHS GPs are helpful but haven’t been running long enough to track from birth to later life. They include lots of information on long term conditions but not much about broader issues. In our Development Award (called ‘MELD’) we had access to one such dataset of about 700,000 people, which we used to identify health conditions. We also accessed data from the ‘1970 British Cohort Study’ – a long-running research study called a ‘birth cohort’ Publication: Early-onset burdensome multimorbidity: an exploratory analysis of sentinel conditions, condition accrual sequence and duration of three long-term conditions using the 1970 British Cohort Study https://bmjopen.bmj.com/content/12/10/e059587.full

db1daab2-c480-4960-beba-7955afeebc20 Wessex Frail2Fit – A feasibility and acceptability study of a virtual multi-modal intervention delivered by volunteers to improve functional outcomes of older adults with COVID-19 discharged from hospital Lay project title: Can we train volunteers to deliver exercise and nutrition support to older adults with frailty after a hospital stay? Project Partners: University of Southampton; University Hospital Southampton NHS Foundation Trust; Bournemouth University; Swansea University Principal Investigator: Dr Stephen Lim Team members: Dr Stephen Lim ( NIHR Clinical Lecturer in Geriatric Medicine, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton), Dr Samantha Meredith ( Research Fellow, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton ), Professor Mike Grocott ( Professor of Anaesthesia & Critical Care, Clinical and Experimental Science, University of Southampton), Professor Sandy Jack (Consultant Clinical Scientist in Anaesthesia and Critical Care, University Hospital Southampton NHS FT), Professor Jane Murphy (Professor of Nutrition, Ageing and Dementia Research Centre, Bournemouth University), Dr Judit Varkonyi-Sepp (Chartered Psychologist, Manager Behavioural Science Theme, NIHR Biomedical Research Centre, University of Southampton), Andrew Bates (Clinical Academic Intensive Care Nurse and Critical Care, Clinical and Experimental Science, University of Southampton), Luisa Holt (Physiotherapist, Research Fellow, University of Southampton), Professor Kelly Mackintosh (Professor in Sport and Exercise Sciences, Swansea University), Professor Melitta McNarry (Professor in Sport and Exercise Sciences, Swansea University), Cynthia Russell (patient representative), Steph Keith (Volunteer services - Patient Support Hub Coordinator), Kieran Fifield (Volunteer services - Project Support Officer) Start: 31/10/2022 Ended: 10/01/2024 Lay Summary Around half of older people over the age of 65 in hospital are affected by frailty. Frailty is a long-term health condition where your body loses its natural reserves. People with frailty take longer to bounce back from simple things, like a common cold, they tire easily, and need a bit more help to do things. Exercise and good nutrition are important to build strength in older people with frailty and can help them to perform their normal daily activities, like dressing, or cooking a meal. However, the motivation to eat well and to move more after a hospital stay can be hard for many older adults living with frailty. We found that we could train volunteers to encourage older people with frailty to eat well and exercise after a hospital stay. Hospital volunteers were trained by a health professional to deliver 3-month support to older people online through Zoom, or over the telephone. Five hospital volunteers completed the training. The volunteers were college students (3 female) with an average age of 16 years and were interested in gaining experiences working in a health setting. The exercises were seated strength movements using resistance bands. Volunteers were also taught to use the ‘nutrition wheel’ which is a tool to help start conversations with older people about their eating and whether they had lost any weight. Older people who were identified as at risk of undernutrition (not getting enough nutrients to support their health) were given booklets containing suitable nutrition advice. Twenty-seven older people with frailty signed up to receive support from the volunteers, and seventeen completed the 3-month programme. Eight older people completed the intervention online, and 9 opted for telephone support. The volunteers delivered 45 online sessions and 90 telephone calls from January 2023 to October 2023. After the programme we found that older peoples’ physical activity levels, quality of life, and appetite improved, and they maintained these improvements at 3-month follow-up. Only 1 minor incident happened during exercise where an older person strained their shoulder muscle using the resistance band. We interviewed volunteers, older adults, and their carers to find out more about what they thought of the exercise and nutrition support. Participants completing the online sessions enjoyed the group interactions and described the sessions like ‘a virtual cuddle’. They appreciated the support of the younger volunteers, who helped motivate and guide their exercise and nutrition behaviours. Participants receiving support through weekly telephone calls felt the volunteers were very encouraging and provided non-judgmental support. Overall, participants thought the online sessions helped build a better exercise routine, but the one-to-one telephone calls allowed more in-depth, personal conversations around nutrition. The young volunteers found listening to some of the illness stories of older people leaving hospital quite emotionally difficult. But they found the experience changed their perceptions on ageing. The volunteers had support from the trainer to help with any challenging conversations. Some older people found a key barrier to participating in the programme was their unmet care needs. Older people with better social care had resources to focus on their health, whereas older people who were alone and unsupported were more focussed on meeting their basic care needs rather than participating in the support programme. Overall, it was safe and feasible for volunteers to deliver exercise and nutrition support to older people living with frailty after a hospital stay. What we did with the new knowledge Our findings are helping to develop a volunteer toolkit, including recruitment packages, and training and support materials for future volunteer-led projects in hospital and in the community. Where next? We are working with various Universities and community organisations to develop a volunteer-led intervention to improve health and wellbeing of older people in different regions and for older people from diverse ethnic backgrounds. What did people say about the work? Volunteer: “It (training) was very thorough, and I knew what I had to do when I first started. Especially at the beginning, when I was invited to join one of the zoom sessions, to see the volunteer delivering the exercises. And also, the nutrition support; that was really helpful to understand how everything worked. Not only how it was meant to, but how someone delivered it. I thought the training was amazing, and I felt comfortable with what I was doing when I first started.” Participant receiving telephone support: “ What was very good was they (volunteers) didn’t push it too much. When I said I exercise 3 times a week, they didn’t push that and say, ‘oh, you should be doing this; you should be doing that’ - they didn’t push anything… They just encouraged you, which was good…. They were polite, finding out what I’d been doing, and what I hadn’t been doing I s’pose but not criticising me for not doing it… They’re concerned about you, getting people back to normal, aint they?” Participant receiving online support: “ I enjoyed doing the one online. It was interesting talking to people to see what other people were feeling and how they were all doing…. You sort of get that feeling that you’re part of something… it was fun. Strangely enough, I would find myself looking forward to the next one…” Participant receiving online support: “ Full of enthusiasm.. They (volunteers) weren’t just telling you what to do, they were rooting for you too, ‘come on, we can do this!” Publications Frail2Fit study protocol: a feasibility and acceptability study of a virtual multimodal intervention delivered by volunteers to improve functional outcomes in older adults with frailty after discharge from hospital | BMJ Open

0962122f-1175-4112-bec9-7327da6e0e5a Work lives and Wellbeing of Mental Health Nursing Workforce Lead applicant: Prof Jane Ball Co-applicants: Dr Gemma Simons, Prof David Baldwin, Prof Peter Griffiths, Dr Catherine Smith, Dr Emma Wadey Project Summary: Read a long project summary Read a short project summary We have a growing demand for mental health care and nurses are key to meting this demand. Each year roughly 10,000 NHS staff in England leave mental health services. 22% of nursing posts in mental health are vacant. Across the NHS it is recognised that work pressures impact on staff wellbeing, their ability to deliver care well, and likelihood of staff staying in the NHS. Despite being a priority area, most research related to nurses’ work engagement, retention and positive staff outcomes focuses on staff in general acute hospitals. Very little attention has been paid to mental health nurses’ work lives and wellbeing. Where will the research take place and who will it in involve This study focusses on mental health nurses. It will take place in Wessex but also includes desk research to collate workforce data, and a national survey of nurses in a range of mental health settings (community, hospitals, specialist units). The project will be led by the mental health workforce team at Southampton, in collaboration with the Hampshire & Isle of Wight Staff Support Hub, and the national lead for mental health nursing. An advisory group and patient public group will support the research. Aim & Design The aim is to examine the work lives and wellbeing of mental health nurses, in order to improve wellbeing and retention of these staff. This study will map what is known about the mental health nursing workforce, identify modifiable workplace factors that impact on staff experience, wellbeing and outcomes, and work collaboratively to identify solutions. The companion project will identify metrics that we can use to assess the wellbeing of the mental health workforce. Methods Labour market and workforce review - analyse data on the mental health nursing workforce, to create an overview. Survey nurses working in mental health (in Wessex NHS Trusts and a national sample). The questionnaire includes measures of: burnout, job satisfaction, intention to leave, workloads and practice environment. We will include open-ended questions so staff can give their views of work-life challenges, how they impact on their health, and what helps. The RCN Mental Health Forum will be main gateway for the national survey. Interview and focus groups with mental health nurses in Wessex NHS Trusts to explore experiences and views of working in mental health and issues related to wellbeing. These will be both before and after the survey (to help with survey design, and afterwards, to enrich interpretation). Coproduction workshop . Preliminary findings will be shared with a wide range of people with vested interest in, or responsibility for, the mental health workforce (e.g. nurses, managers, workforce leads) at a Wessex based co-production workshop, to identify actions and next steps. How will the findings inform improvements in population health and patient care? Services will run better and care quality will be improved if the workforce is healthy, happy and there are enough staff to provide care to the expected standards. Publications doi:10.12968/bjmh.2023.0037

22c6bc93-4002-4a39-ba1e-6b7c981fbe5f A qualitative case study to understand Young people’s food purchasing patterns in CONvenience stores in the school neighbourhood environment (Y-CON) Chief Investigators: Janis Baird and Christina Vogel, Professor of Public Health and Epidemiology and Adjunct Professor of Food Policy, MRC Lifecourse Epidemiology Centre, University of Southampton Team: Dr Sarah Muir, Senior Research Fellow, MRC Lifecourse Epidemiology Centre, University of Southampton Dr Kath Woods-Townsend, Principal Research Fellow, School of Healthcare, Enterprise and Innovation Dr Sarah Crozier, Senior Statistician, MRC Lifecourse Epidemiology Centre, University of Southampton Dr Hayward Godwin, Associate Professor of Psychology, University of Southampton Professor Marcus Munafo and Dr Olivia Maynard, Bristol University Ravita Taheem, Southampton City Council, lead on childhood obesity Partners: Bristol University, University of Southampton, Southampton City Council Start: 1 October 2024 End: 31 March 2026 Background A poor diet significantly contributes to illnesses including heart disease, diabetes and stroke. One in three children who leave primary school have obesity or overweight, raising concerns about their future health. The teenage years are crucial because this is when young people start making their own food choices, setting the stage for their lifelong eating habits. The Problem The journey to and from school often involves passing by convenience stores which rely on shoppers, such as young people, to impulse-buy products that are high in fat, salt and sugar. The presence of these stores in school neighbourhoods may be linked to the high rates of childhood obesity. Our Research Focus We used a qualitative approach to understand convenience stores near schools influence the buying patterns of young people making their own dietary decisions. Study Design Our research ran between October 2024 and March 2026. Forty-three students from two secondary schools in Hampshire took part in focus groups about how they used convenience stores near their school. Young people from the LifeLab NxtGen programme were also employed as citizen scientists: they took part in a ‘mystery shopper’ task to purchase a healthy product near the stores and reported on their experience. NxtGen researchers also worked with the team to support the analysis of findings and development of dissemination materials. Engagement and Dissemination The team, including members of the NxtGen research group, have developed an infographic detailing core recommendations for independent stores in the UK to help improve young people’s access to healthier food. Plans are underway to share this infographic with our young participants, as well as policy makers and retail groups. Internationally, our research will also be presented in scientific journals and at conferences.

f5c7ef05-9a58-48a5-9c06-02ebd55d89cd Medicines optimisation Principal Investigator: Dr Simon Fraser Team members: Dr Simon Fraser (Associate Professor of Public Health. School of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital), Professor Chris Edwards (Professor of Rheumatology, Southampton and Associate Director of the NIHR Clinical Research Facility) Dr Chris Holroyd (Consultant Rheumatologist, University Hospital Southampton NHS Foundation Trust), Dr Kinda Ibrahim (Senior Research Fellow, Faculty of Medicine, University Hospital Southampton NHS Foundation Trust), Dr Ravina Barrett (Pharmacist, University of Portsmouth), Dr Clare Howard (Chief Pharmacist, Medicines Optimisation, Wessex AHSN), Dr Mary O’Brien (NHS England, NHS Rightcare), Dr David Culliford (Senior Medical Statistician, Health Sciences, University of Southampton), Professor Paul Roderick (Professor of Public Health, Primary Care and Population Sciences, University of Southampton), Professor James Batchelor (Director Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton), Dr Matthew Stammers (Senior Endoscopy Fellow, University Hospital Southampton and Clinical Informatics Research Fellow at Clinical Informatics Research Unit) Start: 1 October 2019 Ends: 30 September 2024 Project Partners: University Hospital Southampton NHS Foundation Trust, NHS England (NHS Rightcare), University of Portsmouth, University of Southampton, Academic Health Sciences Network (AHSN) Wessex. Lay summary Painful conditions associated with age (such as arthritis) are common in the UK and safe pain relief options for older people are limited. Anti-inflammatory drugs such as ibuprofen are widely used – both bought from the pharmacy and prescribed by doctors, but they have significant risks, such as bleeding from the stomach and kidney damage. Older people and those with certain long-term medical conditions are at higher risk of experiencing bad effects from these drugs. Another issue concerns people who are taking one of a group of medications call ‘disease-modifying anti-rheumatic drugs’ (DMARDs). These drugs are often used for rheumatoid arthritis and work by slowing its progression, reducing the likelihood of severe joint damage and other related health problems. They are also used for inflammatory bowel diseases, such as Crohn’s disease. Methotrexate is one of the most commonly used DMARD in arthritis and azathioprine is one of the most commonly used in inflammatory bowel disease. Anti-TNF drugs are an important group of so called ‘biological agents’ – another type of DMARD. DMARDs are powerful drugs that require regular blood tests to check for adverse effects, such as liver problems, and guidelines advise how often these tests should be done. However, for most people, these blood tests are almost never abnormal, and could potentially be safely done less frequently. In addition, some people with inflammatory arthritis have an excellent response to DMARDs. Stopping DMARDs can lead to flare ups of disease, but the amount of therapy used may be tapered successfully to reduce dose-dependent adverse events and costs. This project involved two studies The first study showed that non-steroidal anti-inflammatory drugs (NSAIDs) are still sometimes prescribed for high-risk patients, such as older adults and those with chronic kidney disease. NSAIDs can cause acute kidney injury (AKI), leading to serious complications. This study developed a risk tool for practices to identify those who should not be prescribed NSAIDs. The second explored the frequency of blood testing for patients on Disease-Modifying Anti-Rheumatic Drugs (DMARDs) like methotrexate, commonly used for rheumatoid arthritis. Guidelines recommend 3-monthly blood tests due to potential liver issues. The research found that many tests were seldom abnormal, suggesting that low-risk patients might safely have less frequent tests if further research is done on the safety of risk-stratifying people. What did we learn? In the two different parts of the project we found that: About half of people taking the ‘disease modifying’ drugs (‘ DMARDs ’) methotrexate for rheumatoid arthritis or azathioprine for inflammatory bowel disease experienced no blood test abnormality over two years despite having to have blood tests every three months. Reducing testing frequency may therefore be safe for younger people and those without other long-term conditions. Among people taking non-steroidal anti-inflammatory drugs (‘ NSAIDs ’ like ibuprofen) the risk of kidney damage was highest among older people with combinations of long-term conditions including chronic kidney disease, diabetes, heart disease and heart failure, and high blood pressure. These people should avoid taking NSAIDs and we provided a way for GPs to identify them in their databases. What difference will this new knowledge make? DMARDs: Further investigation is needed on the safety and acceptability of reduced blood testing frequency testing for some people taking DMARDs but this could potentially result in reduced unnecessary patient anxiety and burden, fewer referrals to hospital and reduce resource use for the NHS. If testing could be reduced this would mean reduced treatment burden for patients and reduced cost and admin work for the NHS NSAIDs: GP practices can be provided with a search tool that helps identify those at highest risk of kidney damage from NSAIDs. Using this information they can review and stop NSAIDs to reduce the risk. If prescribing was stopped for some people at risk, this would reduce risk of acute kidney injury which can have lasting consequences or even be fatal What was the impact? Non-steroidal anti-inflammatory drugs (NSAIDs) As part of the medicines optimisation project we explored the risks of acute kidney injury (AKI) associated with taking non-steroidal anti-inflammatory drugs like ibuprofen and naproxen. There was a news article here about it: https://www.arc-wx.nihr.ac.uk/post/southampton-led-study-shows-need-for-painkiller-caution-to-prevent-kidney-damage and a publication here: https://bjgpopen.org/content/6/1/BJGPO.2021.0208 We developed a risk score that can help GP practices identify those patients at highest risk of NSAID-associated kidney injury. We have run this risk tool in the Dorset Intelligence and Insight Service (a database covering over 70 Dorset GP practices - more than 800,000 people) and along with colleagues from the AHSN we are running a masterclass with many of the GP practices involved to present the findings and to promote best practice in NSAID prescribing. The aim is to reduce NSAID prescribing in those at high risk of adverse outcomes like AKI. Rheumatoid arthritis (RA) and inflammatory bowel disease (IBD) are prevalent inflammatory conditions, affecting 0.8% and 0.7% of the population, respectively. Disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate for RA and azathioprine for IBD, are commonly used to control disease activity. These drugs require regular safety blood-test monitoring for liver function abnormalities, kidney function, and bone marrow toxicity. Monitoring is frequent at initiation and less frequent once a maintenance dose is established. In the UK, initiation usually occurs in secondary care, with ongoing monitoring in primary care as recommended by NICE. Regular blood-test monitoring has been linked with anxiety and depression for some patients, incurs substantial costs for healthcare providers, and increases the workload for clinicians and laboratory staff. Despite guidelines, the optimal monitoring frequency has not been established, and the extent to which patients experience prolonged periods with no abnormal tests is unclear. This study aimed to assess the extent of persistently normal blood-test results among people with RA and IBD, and to describe the frequency of blood testing to indicate health-service and patient workload. Targeted monitoring of higher-risk individuals and reduced monitoring for lower-risk patients may improve efficiency and reduce patient workload. Our large, 2-year retrospective cohort study (over 700,000 people) assessed persistently normal blood tests among people with rheumatoid arthritis (RA) taking methotrexate and those with inflammatory bowel disease (IBD) taking azathioprine. Approximately half of the patients experienced no blood-test abnormalities using NICE-recommended tests. In the RA/methotrexate cohort, abnormalities were more common in older people with reduced renal function. For the IBD/azathioprine cohort, abnormalities were less common and mainly involved reduced renal function in older people with comorbidities. The absolute risk of persistently normal blood tests was lowest among older people and those with comorbidities. Since the study, a piece of work led by Nottingham cited our work ( https://www.bmj.com/content/381/bmj-2022-074678 ) and created a model to risk stratify patients taking methotrexate. This is quite likely to change clinical practice when NICE reviews its guidance on DMARDs in due course. This work was supported by representatives of the ‘Getting It Right First Time’ programme, who also linked this issue to sustainability: ‘Saving the planet with reduced routine DMARD blood monitoring frequency BMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p1645’ https://www.youtube.com/watch?v=uSriKPqdbvA&t=6s

860cb5e1-0b96-40d2-ae12-634f4a925c64 ADOPTED PROJECT: Exploratory research to examine the health impact of scams and fraud and the current knowledge and systems in the police and partner agencies for targeting and delivering victim support services Team: Ruth Halkon Dr Michael Skidmore Dr Felicity O'Connell Dr Amy Meenaghan Professor Mark Button Start Date: 1st May 2024 End Date: 30th November 2024 Project Partners: Police Foundation and University of Portsmouth This research explores how being a victim of fraud affects people’s health and wellbeing and what help they need to recover. We used surveys and interviews to reach fraud victims and spoke to the professionals who support them. How fraud affects health Most fraud victims have emotional or mental health problems. In the study, 92% had at least one symptom. Common issues included worry (58%), stress (56%), fear of becoming a victim again (52%), and feelings of anger (46%), weakness (46%), or distress (45%). Victims also had more serious symptoms like depression (18%), hopelessness (16%), panic attacks (8%) and feeling out of control (14%). Physical health was also affected. Over half (58%) of victims had symptoms such as trouble sleeping (45%), headaches (27%), or tiredness (24%). Changes in behaviour were common too. Victims often became distrustful (44%) or stopped going out (19%). We found that symptoms often happened together. Victims with emotional symptoms often also had physical ones. We found six separate patterns or “clusters” of symptoms, such as a “worry and distrust” group, and a more severe “hopelessness and self-harming” group. The impact varied widely. Some felt only mild, short-term symptoms. Others felt long-term effects that lasted for years. These were worse among the old or those in poor health. Nearly 19% said their daily lives were seriously affected. Some stopped using technology or thought of taking their own lives. Why some victims are more affected than others We found many things can impact how much a victim is affected including: the tactics used by fraudsters (e.g. building fake relationships or using threats), the amount of money lost, any pre-existing health issues, feelings of shame or self-blame, and lack of a support network. Victims who had a mix of these factors often suffered more. What support do victims want or need ? Many victims wanted practical help – such as advice on avoiding further fraud or help getting their money back. Others wanted help to come to terms with what had happened. But only those the police deemed "vulnerable" received further support. The report highlights a mismatch between what victims want, what they need, and what is available. Some people who could benefit from support don’t qualify or don't think they need or deserve it. The concept of "vulnerability" is also vague and needs to be better defined. How services should improve Many victims felt blamed, ignored or treated with suspicion by the police, banks and tech companies. This often made their health worse. Those who got the right help from family and friends, case workers or peers were best able to recover from the fraud. Recommendations include: •Keep support options open beyond the initial police report. •Define vulnerability more clearly in policy. •Adopt trauma-informed approaches across all service •Launch public campaigns to challenge victim-blaming attitudes and explain how fraud happens. In short, we need better understanding and better support to help fraud victims recover and reduce long-term harm. What did we do with this new knowledge This study has been completed but has not yet been published. It has been submitted to an academic journal and will also be published by the Police Foundation in the autumn. The research study was presented at Portsmouth University’s 2025 Counter Fraud, Cybercrime and Forensic Accounting Conference in June, where it was the keynote speech. Through this conference we shared our findings with public health experts, academics, police leaders and representatives from the private sector. We also hope to present the work at the Australasian and the Pacific Conference on Law Enforcement and Public Health, having been invited to present because of the global impact this research could have. Where next? This project was an exploratory study which we are planning to use as the basis of a much larger study. This is particularly important as while the impact of fraud is beginning to be known amongst specialist circles, it is a struggle to get this issue noticed in general policing/policy circles who do not realise there is a problem let alone understand the impact that our poor responses to fraud is having on millions of victims. •We are currently in the purpose of drawing up a proposal for a follow up study. This study will explore a) the sheer scale of fraud, its impact on health, evidence gaps in relation to both; b) what is known about the policy response/interventions (e.g. what exists, what's known about the effectiveness of responses) Methodology: •Phase 1: Review of: a) the evidence and theory to explain and account for the impact of fraud on victim health; b): of policy responses/interventions •Phase 2: Empirical research: (not just the health impact of fraud but also policy responses/interventions) •Phase 3: Develop a risk assessment tool and health toolkit to guide frontline support staff •Phase 4: Preliminary evaluation of the toolkit The project team for the new research proposal would include the Police Foundation and Portsmouth University along with Professor Mike Levi of Cardiff University and Thara Raj, Director of Public Health for Warrington.

27d064e4-2601-492e-b882-a0ef85373d44 ADOPTED: (SIFT) Sensors in Fatigue Tracking in Parkinson’s. Exploring the relationship between perception of Fatigue and the performance of physical activities in people with Parkinson's with fatigue using wearable sensors Fatigue is one of the three most debilitating symptoms in Parkinson’s. Fatigue is difficult to diagnose, it often goes unrecognised, and is challenging to treat. The SIFT-PD study is exploring how fatigue impacts physical activity in people with and without Parkinson’s over a 3-day period. It asks participants to fill in fatigue diaries and uses wearable sensors to monitor the how people move over a period of three days. The sensors are small and light and worn on a belt. The sensors track activity (the amount, type and quality of movement). This research looks at whether the sensors can reveal how people’s movements change over the course of three days when they are fatigued. Furthermore, information from sensors might help understand what makes people fatigued and allow it to be measured. Knowing more about fatigue will help to recognise its impact and help develop ways of managing it better.

55265102-c760-4322-93ed-ed8448f1546f Non-digital support for maintaining physical activity in people with long-term conditions – within Maintenance Of physical acTivity beHaviour (MOTH) programme Start Date 02/10/21 End Date 30/09/23 Researchers: Lead - Professors Mary Barker and Maria Stokes Joint Lead - Professor Suzanne McDonough Co-Applicants - Professor Maria Stokes, Dr Paul Clarkson, Dr Chloe Grimmett, Dr Euan Sadler, Dr Nisreen Alwan, Dr Aoife Stephenson, Dr Katherine Bradbury, Dr James Faulkner, Mr Paul Muckelt, Dr Dorit Kunkel, Mrs Luisa Holt amd Dr James Gavin Summary Being active is important to prevent and help manage long-term conditions (LTC). Previous research shows that being active can help people to do the things that they want to do for longer, reduce pain and improve quality of life. There are many community and NHS programmes that help people with a LTC to start being active, however, these programmes only last for a short period of time. Staying active in the longer-term is more difficult and there is often a decrease in activity over time following the completion of a programme or service. Previous research has shown that programmes or interventions that help people to start being active may not necessarily have the right components to help people to stay active. This project will plan and develop a new intervention that will support people with one or more LTCs to stay active, after taking part in an NHS and/or third sector ERSsphysical activity referral scheme (PARS). Our current research explores factors that help people with LTCs to stay active to allow these to be integrated into plans for the new intervention. The intervention will be non-digital to ensure that it is available to as many people as possible, regardless of access to the internet or a digital device. We know from previous work that it is important that any new intervention fits in with healthcare systems and how people manage their condition. We are therefore currently working with people with LTCs and health and social care professionals to understand how such an intervention could be delivered in practice. In this project we will use previously gathered information to plan the new service. We will recruit people with LTCs from ERSs PARS to take part in interviews to understand their needs and expectations for the intervention. We will also undertake interviews with health and social care professionals and ERSPARS practitioners to develop the intervention’s content. This will allow us to develop the prototype of the intervention and then ask people with LTCs who have taken part in a programme to pilot it and provide feedback through interviews. Once developed, we will plan a larger study to test the intervention’s potential with groups of people who have come to the end of an ERS PARS in the NHS and/or the third sector. This study will help us to gain feedback from people with LTCs using the intervention in real life settings to make further changes. It will also help us to understand whether the approaches to the research, such as how to recruit people to take part, are successful. This information will be used to improve the intervention and to support a larger trial to assess the effectiveness and cost-effectiveness of the intervention. What did we find out? This research included: • Phase 1: We interviewed 15 people living with long-term health conditions (LTCs) and nine NHS healthcare professionals to find out their experiences of being involved in an exercise referral scheme. This included what support they would want in future, as a participant (i.e., people with LTCs) and provider (i.e., healthcare professionals). • Phase 2: Follow-up workshops with LTC patients and multi-sectoral professionals to begin designing a pathway to support physical activity maintenance for people living with LTCs. Professionals shared their experiences from healthcare, leisure and community and voluntary sectors. This research has created a better understanding of the ways in which we might best support people with LTCs to stay physically active, and improve their health and wellbeing following an exercise referral scheme. Two areas of improvement were identified: 1) Better partnership working between people with LTCs, health and social care, leisure and voluntary sectors within Wessex 2) Ensuring people with LTCs have appropriate support with self-management of their lifelong physical activity levels What difference can this new knowledge make? • Better understanding of the factors preventing and enabling participation in exercise referral schemes across Wessex, can help us identify how structured exercise can benefit people with LTCs long-term, especially by highlighting the benefits and future support needs in physical activity. • It gave us understanding of people’s experiences of undertaking a physical activity referral scheme to help manage their LTC(s). This was supported by health professional’s views, having referred, delivered and/or commissioned an activity scheme • In future, this knowledge can inform the development of an integrated care pathway interlinking healthcare, social and community services to support people with LTCs to maintain their health and physical activity long-term, from a view to change physical activity behaviours. What did we do with our new Knowledge • We presented the results at the Health Enhancing Physical Activity (HEPA) Europe 2024 Conference in Dublin (August 2024) • We submitted a research paper for journal publication • Dr James Gavin ran a series of ‘Active Living’ community cafés across Southampton to share the research with the public living with LTCs and their carers. • This has led to additional grant funding and partnerships with Energise Me, Saints Foundation, Communicare, and Southampton City Council, to begin co-designing a multi-sectoral pathway within the city for the wider LTC population, not just those having undertaken an exercise referral scheme. • On January 8th 2025, we will run workshops with professional stakeholders including the HIOW Integrated Care Board, to find agreement on a ‘prototype’ pathway. Where next? •We have submitted the findings to the journal, Int J Behav Nutr Phys Activ December 2024. •Move Consulting Ltd. are supporting us with our professional stakeholder workshops (Jan 2025). •The co-lead, James Gavin, has secured £14,900 Wessex Health Partners funding to continue the community cafes and develop a pathway plan. •We will build upon our community-based partnerships with Saints Foundation, Communicare, Thornhill Baptist Church, and Energise Me as the HIOW Living Well Partnership. •Follow-on funding will be sought from the NIHR Research for Patient Benefit programme (tiers 2/3) in Spring 2025. Testimonials for Active Living Cafes "it's really good that you don't want to reinvent the wheel. My slight critique of the community cafes that have been set up is that you don't have to reinvent them .” “There are already community groups doing very similar things around…I know it's been brilliant that you have been partnering with people like Thornhill Baptist Church. They do wonderful things, some wonderful community events… My recommendation is to join and work with them , and that's what you're doing.” “It's a better strategy than trying to set up something new and try and hope that people come to it with a long-term condition. I think it's much better to go to people rather than expect people to come to you ."