c7fa8be0-4046-4345-a82a-ce4a38e05e07 Social network facilitated engagement in people who are Homeless to address InEqualities in alcohol related Liver Disease - The SHIELD feasibility study Principle Investigator: Dr Ryan Buchanan, University of Southampton Team: Professor Salim Khakoo, University of Southampton, Dr Mark Wright, University of Southampton, Dr Yun J Kim, University Hospital Southampton NHS Foundation Trust. Starts: 1/4/22 Ends: 1/4/23 Aim: To develop and assess the feasibility of a social network-based intervention to engage people who are homeless and at risk of alcohol-related liver disease with Hepatology services Background: Mortality in people who are homeless (PWAH) is eight times higher than the general population and liver cirrhosis is the third commonest cause of death. PWAH infrequently access hospital based Hepatology services for assessment. Alcohol consumption is a socially perpetuated behaviour that is known to cluster within human social networks. What we did Recruitment continued from February to July 2022 of people who are homeless with high risk of alcohol dependence (AUDIT score) were identified in hostels and at a homeless day centre in Southampton. Those people were then asked to take part in tests and to refer thier drinking partners to the programme. They were given supermarket vouchers as an incentive. Those homeless people who took part, filled in a survey and took part in an interview. They also had a test on their liver and were referred to liver health services. What did we find out? Fifty six peoople took part, all were from homeless hostels. Almost 20% of the group had a new diagnosis of cirrhosis, and there was a link between people who had type 2 diabetes or lived house where alcohol was present. Homeless people with hazardous alcohol consumption are socially connected to others that drink dangerously. This programme of referral can identify undiagnosed disease, however, engagement via trusted staff may be just as effective. The study highlights the importance of working with community organisations supporting underserved populations to overcome inequalities in liver disease and manage multi-morbidity. What's next? Identifying liver disease in people experiencing homelessness is progress but… Sustaining underserved populations with liver health care services after a diagnosis is made is crucial – we have since been awarded a further NIHR research grant in investigate how to approach this problem: To find out more: Follow @liverchampions https://www.southampton.ac.uk/research/projects/nihr-liver-disease-research-partnerships-liver-champions

ARC Wessex Early Career Researchers - Cara Black, Naomi Leonard, Olivia Taylor and Annabelle Prescott < Back Engaging Children and Young People in Research Community of Practice Inaugural Meeting ARC Wessex Early Career Researchers - Cara Black, Naomi Leonard, Olivia Taylor and Annabelle Prescott September 2023, University of York, UK There is a knowledge gap in our understanding about approaches and methods for meaningfully involving and engaging with children and young people in matters and decisions that impact on them. We went to a two-day meeting at the University of York with researchers from the University of York, Bristol, Hertfordshire, Southampton and Auckland, NZ as well as a representative from the International Alliance of Mental Health Research Funders. This group came together to form an international Community of Practice (CoP), with the goal of sharing learning, methods, and experience for effective ways to engage young people. It also highlighted the wide variety of opportunities for putting children and young people at the heart of research, decision making and advocacy for their mental health and well-being. Here are our reflections as early career researchers (ECRs) from the meeting: What did we gain from the meeting? We thoroughly enjoyed being with professionals who have expertise in research for youth health, wellbeing, mental health, and youth advocacy. We gained an understanding of what exactly a community of practice is, listened to the experiences of all members and contributed to the conversations. It was lovely to hear international voices and get to exchange creative ideas for involving young people and encouraging them to share their ideas, as well as learning a great deal about youth engagement in general. What were our highlights? Hearing from the Healthy Mind Apprentices; Chloe, Kenzie, Lauren & Phoebe who are a group of young people passionate about mental health who work across Bradford and Craven to support young people, communities and schools with their health and wellbeing. They reflected on their time working with Y-MHESH and spoke about what their apprenticeship meant to them and what they have learned along the way. They shared with us that the problem is not that young people don’t have a voice; they instead believe that decision makers are not listening. Therefore, it was interesting to hear that we need to take necessary steps to ensure ‘decision makers’ are able and willing to share the decision-making power with young people. Overall being involved in the CoP was positive, as we had the opportunity to be involved in discussions with leaders in the field. Often, we can become ‘stuck’ in our ideas, so having the opportunity to present new ideas and challenge our Community of Practice to think in novel ways which align with the realities for children and young people was a highlight for sure. What could have been improved? It might have been more beneficial for our CoP group if the Healthy Mind Apprentices joined us for longer, as these fabulous young people reminded us that it is about listening and valuing meaningful involvement of children and young people, so it would have been great to have more youth representation in our own decision-making processes. Youth voices should be included throughout our CoP meetings, whether this be the Healthy Mind apprentices or groups of different young people. One of the main challenges in this area is that when coproduction and research is done with young people, they often don’t see the outputs they have created or get to feel the impact of their work before they move. It’s important we consider this when setting out to do co-production work or research with children and young people. What are the advantages of involving early career researchers in research and in the CoP? We provide a fresh perspective on topical issues today and have greater freedom to think beyond our specialty areas. This gives us the ability to consider the broader picture at an international or societal level and bridge the gap between young people and established researchers, as we understand the points of view and needs of young people, while simultaneously understanding research processes. This meeting was a great way to solidify the learning from the CoP and focus us on a clear path forward to best support the goals of children and young people in research. Reflections Reflections on public engagement and engagement in research for young people From the perspective of an ECR, it seems extremely important that “brand image” and visibility are recognised by senior management at universities and funders at research centers. Engaging well with the public, in this case, young people, both heightens visibility and reinforces brand image, which is why Patient and Public Involvement and Engagement (PPIE) work with young people within schools, young people’s PPI groups and other youth groups, including the Healthy Mind Apprenticeship scheme, is so valuable. Although, it can be difficult to get PPIE work funded. The purpose of PPIE work is to get people’s views on what needs to be researched and what is important to them, so to do this after a project has been decided defeats the purpose. Young people form part of our communities, but their inputs have been historically overlooked as unimportant or uninformed. Yet, some of the most valuable insights come from our young people, because at the end of the day this is their reality, and they live it every day. It is therefore crucial to have young people be meaningfully engaged so research, funding and decisions are aligned with what people want and need – and children and young people should be no exception. If we consider and give power to the voices of young people, then perhaps we can work to meaningfully elevate the health and wellbeing of entire future communities. So with that, we leave you with this whakatauki (Māori proverb). Mā whero, mā pango ka oti ai te mahi With red and black the work will be complete https://video.wixstatic.com/video/6fe132_dc59b9a176b94aa791cb13bf6997b1fa/1080p/mp4/file.mp4 Previous Next

5a0c9214-8a00-419e-80b5-dd5d80c94fdf ADOPTED PROJECT: Magnet4Europe: Improving mental health and wellbeing in the health care workplace Joint Lead: Professor Peter Griffiths and Professor Jane Ball Partners: University of Southampton, Katholieke Universiteit Leuven (KUL), Belgium Start date – Jan 2020 End date – Dec 2023 Lay Summary The pervasiveness and growing levels with which mental health morbidity is reported by healthcare professionals is a matter of concern. Underlying causes are frequently rooted within the work environment. In the United States, implementing the Magnet© model of organizational work re-design for nurses in hospitals has been associated with improved mental health, reduced burnout and turnover and improved patient outcomes, yet the model has not been implemented at scale in Europe. The aim of the EU-funded Magnet4Europe study is to transfer, modify, scale up, and evaluate the Magnet© model in 60 European hospitals in 6 countries (Belgium, England, Germany, Ireland, Norway, Sweden) between 2020 and 2023. The intervention involves the following: implementing hospital-wide change via a bundle of organizational measures as stipulated in the Magnet© manual, facilitated by one-to-one twinning with 60 Magnet© recognized U.S. hospitals with experience in implementing the Magnet© model, a European learning collaborative for hospital managers, and a critical mass of hospitals promoting innovation to attract public interest and foster replication. Magnet4Europe uses a usual-practice wait-list cluster randomized trial (RCT) to determine the effect and costs of Magnet© hospital organizational redesign on nurse and physician health outcomes and wellbeing, with burnout as the primary outcome, using validated instruments. Secondary outcome variables include staff well-being and turnover. In addition, the implementation of the intervention is evaluated using a nested mixed-methods process evaluation, based on focus groups and individual interviews with a selection of hospitals in the participating countries. Analyses will be based on quantitative (RCT) and qualitative methods (process evaluation) and a triangulation of the findings. Dissemination of the results are planned for different audiences, including clinicians, hospital managers, policymakers and the wider public. NB: The term ‘Physician’ is used for consistency across the EU countries in the study Consortium. In the UK context the staff group referred to equates to Medical Staff -Medics Intervention Hospital Magnet® is a trademark of ANCC registered in the United States of America and other jurisdictions and is being used under license from ANCC. All rights are reserved by ANCC. ANCC’s consent to the use of the Intervention Hospital Magnet® mark shall not be construed as ANCC sponsoring, participating, or endorsing the Magnet4Europe intervention. ©American Nurses Credentialing Center. Reproduced under license from the American Nurses Credentialing Center. All rights reserved. Publications Laying the foundations for implementing Magnet principles in hospitals in Europe: A qualitative analysis - ScienceDirect

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.

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

be5aaf78-5349-4834-a57a-fcddffbfb962 GOODNIGHT Covid-19 to care-home-based vulnerable individuals Novel corona virus (COVID-19) is a virus that has spread quickly around the world. Elderly people with other health problems have a high death rate from the infection. There are no treatments for COVID-19 so prevention of infection is very important. COVID-19 is thought to infect people via the nose and mouth. Current best practise to prevent infection focuses on good hand hygiene, the wearing of masks and by limiting social contact. However, elderly people in care homes have to come into contact with staff members who are looking after them. Hypertonic saline nasal irrigation and gargling (HSNIG) has been shown to reduce the viral load of coronaviruses and has potential to reduce Covid-19 transmission in a community setting. The objective of this trial is to assess the feasibility and acceptability of care home staff adopting this technique. This research has now been submitted for publication. If you would like to know more about this study please contact Dr Ryan Buchanan Co-Chief investigators Dr Thomas Daniels, Consultant Respiratory Physician, Honorary Senior Clinical Lecturer, University of Southampton Dr Ryan Buchanan, Academic Clinical Lecturer, Primary Care, Population Science and Medical Education, University of Southampton Partners: University Hospital Southampton NHS Foundation Trust, Southampton CTU & NIHR ARC Wessex Co-applicants Professor Julie Parkes, Professor of Public Health, University of Southampton Professor Helen Roberts, Professor of Medicine for Older People, University of Southampton Emeritus Professor Jeremy Wyatt – University of Southampton Dr Beth Stuart – Medical Statistician, Southampton Clinical Trials Unit Dr Kinda Ibrahim - Senior Research Fellow, Faculty of Medicine, University Hospital Southampton NHS Foundation Trust Dr Andrew Cook – Public Health Consultant, Fellow of Health Technology Assessment, University of Southampton See the training video for Care Home staff: https://www.youtube.com/watch?v=__-QSLlGWps Publications http://dx.doi.org/10.14283/jnhrs.2021.3

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.

016c507b-e112-4be0-a796-8f4c4a8cdbe0 DIALOR: DIgitAL cOaching for fRailty (DIALOR) Principle Investigator: Professor Jane Murphy Team members : Dr Euan Sadler , Dr Michele Board , Dr Kat Bradbury , Professor Mike Vassallo , Dr Simone Yule , Dr Dawn-Marie Walker , Crystal Dennis, Matt Sait, Jim McMahon (Patient and Public Involvement Lead) Partners: Bournemouth University, University of Southampton, University Hospitals Dorset NHS Foundation Trust, The Adam Practice, Dorset CCG, Wessex AHSN, Southern Health NHS Foundation Trust Start Date: 1/4/2022 End Date: 30/9/2024 Bournemouth University web page Lay Summary Frailty is a condition that affects one in ten people over the age of 65. It means people are at higher risk of falls, disability and poorer quality of life. Some may struggle with decreased energy levels, poor appetite, lower strength and having difficulty with household tasks such as shopping and cooking. As the population ages, frailty also impacts on health and social care services because of more GP appointments and increased hospital and care homes admissions. More people own a smartphone with applications (apps) and have access to the internet. This technology can help people to live well by enabling access to person-centred advice and care. It can help share in decision making to meet well-being and health needs and reduce the burden on health and social care systems. However little research has been done, particularly for people with frailty, living at home. Aims This study aims to explore whether a digital approach could be used alongside support from health coaches to help the lifestyle management of frailty (in its early stages). The approach has been used across the NHS in people with long term conditions which we think will transfer to people with frailty. We will work together with people living with frailty, their carers, health coaches and health care professionals (key stakeholders). Design and methods We will do this through two work-packages (WPs) with people from 2 areas in Wessex (Dorset and Hampshire). WP1 will develop and test a new digital approach. It will include interviews with 10 people with frailty and family carers, 20 health care professionals and health coaches. In WP2, we will train health coaches to use the digital approach and measure how well it works in people with frailty. We will collect data including physical activity, eating and drinking, social engagement, quality of life, frailty status, costs of the approach. We will also ask people about their experiences of using it. We aim to recruit 20 people with frailty and their carers, 20 health coaches, 20 health care professionals and commissioners of care services from both areas to do this. This information will help us plan for carrying out a larger study to implement the approach wider across Wessex. We will regularly seek advice from doctors, nurses, commissioners of services during the project. Patient and public involvement (PPI) A group of family carers and health coaches will support the project by membership of a group to support project design, delivery, analysis and reporting and advise on how we share the findings. NOTE: DIALOR was previously known as DONOR and the name changed in consultation with Public contributors Dissemination We aim to share the findings in academic and professional publications, social media, a website, conferences as well as deliver an end of project stakeholder event. What did we find out? As the population ages frailty is increasing, affecting one in ten people over 65 in the UK. Frailty increases the risk of disabilities, falls, and hospital stays, leading to a greater need for long-term care. Early actions like improving physical activity, nutrition, mental health, and social interaction can help reduce or reverse frailty and lower healthcare costs. NIHR Applied Research Collaboration Wessex funded a study to test a new digital health coaching programme called 'DIALOR' for people with frailty. This programme, developed with input from healthcare professionals and patients, provides a digital app and a health coach to help users with exercises, nutrition, and wellbeing plans. Older people using the digital health coaching programme saw improvements in frailty, physical activity, diet, quality of life, social engagement, and mental wellbeing. Most found the experience positive and helpful in meeting their health goals, although some found the digital component difficult and did not like the term frail. Healthcare professionals said this approach could help older people manage their health better and reduce pressure on primary care services. DIALOR helps older people with frailty manage their health independently, reducing frailty progression and easing the burden on NHS healthcare by drawing on existing allied services such as health coaching. What Next? A meeting was held on 25th June 2025 with attendees from the healthcare professions, academia, digital healthcare and healthcare charities to learn about the outcomes from DIALOR and discuss the way forward. They concluded that DIALOR has a strong alignment with NHS health priorities as it supports preventative care goals and a shift into more community-based care. There is potential to scale up and roll out regionally and nationally, with support from organisations like Health Innovation Wessex, Help & Care and alignment with the NHS 10-year plan. Report from DIALOR Showcase held on 25th June 2025 .pdf Download PDF • 8.24MB More research needs to be done to discover how DIALOR can work across different regional systems, technology platforms, and wider social contexts to discover how it can be effective and cost-efficient for a wider range of people, especially those from ethnic and socially deprived communities. This will support its broader use across the UK. Publications DIALOR (DIgitAL cOaching for fRailty): protocol for a single-arm mixed-methods feasibility study of a digital health coaching intervention for older people with frailty in primary care https://doi.org/10.1136/bmjopen-2023-080480 Digital empowerment in long-term condition management: A systematic review and narrative synthesis of the experiences and perceptions of home-based digital health coaching interventions https://doi.org/10.1177/20552076241302230

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

18fd758f-b147-4294-acb1-07c88dc1baa9 PUNDIT – Predicting hospital Usage Numbers via a DIgital Twin Principal Investigator: Dr Carlos Lamas-Fernandez , Associate Professor in Business Analytics/ Management Science in Southampton Business School / Faculty of Social Sciences, University of Southampton. Team : Professor Christine Currie , School of Mathematics, Faculty of Social Sciences, University of Southampton. Dr Dan Burns , Innovation Centre, Electronics & Computer Science, University of Southampton. Dr Chris Duckworth , Innovation Centre, Electronics & Computer Science, University of Southampton. Professor Michael Boniface , I nnovation Centre, Electronics & Computer Science, University of Southampton. Professor Peter Griffiths , School of Health Sciences, University of Southampton. Dr Mark Wright , University Hospital Southampton NHS Foundation Trust. Starts: 1 April, 2024 Ends : 30 September 2024 Summary Hospitals in the UK are in crisis with high levels of occupancy. The percentage of occupancy in England during July-September was 88%, and in UHS it reached 92.2% . These levels exceed the safety threshold for hospital occupancy, which sits at around 85%. Together with difficulties to ensure a smooth patient flow across the hospital, this results in adverse effects for patients: elongated hospital stays, increasing the backlog of elective procedures, increasing delays in ambulance handovers and increased mortality. In practice, hospitals try and control high occupancy levels by certain interventions, such as dedicated discharge teams, re-scheduling or cancelling elective procedures or repurposing hospital wards. These measures, however, are reactive, i.e. when the occupancy is already reaching unsafe levels, rather than proactive, that is, when anticipating a high occupancy in the near future. Further, it is not clear whether occupancy levels have an effect on treatment and discharge times, but from frontline clinicians at UHS, there is the hypothesis that higher occupancy could make them longer (as clinicians are busier prioritising the sick over the well patients who could go home), compounding the occupancy issues. Higher occupancy also decreases likelihood of patients being in the optimal location. A related research project (PROCED) has shown early evidence that frequent ward/team changes increase delays in patient discharge. The aim of this project is to investigate the feasibility and build the foundations of a simulation model that can predict accurately future, short-term, hospital bed occupancy to inform interventions. The project will have a special focus on investigating the feasibility of a model to be tailored to use in practice as a “Digital Twin” (DT), which can anticipate hospital occupancy under different scenarios, some of which can reflect proposed interventions.

0ff85ad2-7ff5-49d4-b71c-0a912cb8f020 ADOPTED PROJECT: The Gateway Study a randomised controlled trial, economic and qualitative evaluation to examine the effectiveness of an out-of-court community-based Gateway intervention programme aimed at improving health and well-being for young adult offenders; victim satisfaction and reducing recidivism Completed A single-site pragmatic Randomised Control Trial to examine the effectiveness of an OCBI known as ‘Gateway’ on improving health and well-being of offenders aged 18-24, as well as reducing recidivism and improving victim satisfaction Chief Investigator: Professor Julie Parkes – University of Southampton Project Team Members Dr Sara Morgan – University of Southampton, Dr Inna Walker – University of Southampton, Professor Catherine Hewitt – University of York, Professor David Torgerson – University of York, Professor Jenny Fleming – University of Southampton, Professor James Raftery – University of Southampton, Inspector Stu Baker – Hampshire Constabulary Sergeant Caroline Chapman – Hampshire Constabulary, Dr Alison Booth – University of York, Mrs Ann Cochrane – University of York, Mr Alex Mitchell – University of York, Mrs Valerie Wadsworth – University of York, Mrs Megan Barlow-Pay – University of Southampton, Ms Lana Weir – University of Southampton. Organisations Involved: Hampton Trust charity, No Limits charity, Aurora New Dawn, Hampshire and Isle of Wight Constabulary Started: 1/3/2018 Ended: 31/8/2022 Background Young adult offenders commonly have a range of health and social needs, making them vulnerable to mental health problems. If you are aged between 18-24 years old and have committed a crime, you may need to attend court and face convictions or prison. However, many believe that more should be done to prevent young adults from entering the criminal justice system in the first place. The study aims to determine whether a new out of court programme, named Gateway, improves the health and wellbeing of young adult offenders aged 18-24, and influences their chance of offending again, and gives victim satisfaction. The Gateway programme is issued as a conditional caution and has been developed by Hampshire Constabulary (HC), in partnership with local community groups, with an aim to improve the life chances of young adult offenders. In the programme, a mentor assesses the needs of each adult and develops a care pathway with referrals to healthcare. The young adult offenders then participate in two workshops about empathy, and the causes and consequences of their behaviour. Such intervention programmes are believed to improve the health and well-being of young offenders and reduce criminal behaviour. However, there is currently little information about the extent of this improvement. To find out whether the programme works, this research study compares a group of young adult offenders taking part in the Gateway programme as a conditional caution with a group of non- participants who are required to appear in court or given a different conditional caution. Publications An out-of-court community-based programme to improve the health and well-being of young adult offenders: the Gateway RCT | NIHR Journals Library

f6f0f7ec-ab98-4c5c-9b52-2674a93b8c90 ADOPTED: A Study to Evaluate the Introduction of new Staffing Models in Intensive Care: a Realist evaluation (SEISMIC-R) Prinicipal Investigator: Professor Natalie Pattison, University Of Hertfordshire Team: Professor Peter Griffiths, Dr Chiara Dall'Ora, Dr Christina Saville, Dr Lisa Whiting, Dr Melanie Handley, Dr Susie Pearce, Dr Marion Penn, Dr Paul Mouncey, Professor Thomas Monks, Mrs Clare Leon-Villapalos, Professor Suzanne Bench, Professor Ruth Endacott, Mr Jeremy Dearling, Mrs Jennifer Gordon. University of Southampton, University of Hertforshire, University of Plymouth, Intensive Care National Audit & Research Centre, University of Exeter, Imperial College Healthcare NHS Trust, Guys & St Thomas' NHS Foundation Trust/London South Bank University, NIHR Clinical Research Network. Start Date: 01 May 2023 End Date: 31 August 2024 Background Staffing in intensive care units (ICU) has been in the spotlight since the pandemic. Having enough nurses to deliver safe, quality care in ICU is important. There is national guidance, re-issued in April 2021, on how many nurses should care for ICU patients. However, what the skill mix should be (how many should be qualified nurses or have an ICU qualification) is unclear. Very little research has been done to look at which nursing staff combinations and mix of skills works best in ICU to support patients (described as ‘staffing models’). Across ICUs in UK, various ratios of qualified and unqualified nursing staff are being tried (staff ratios refer to the number of nurses caring for a set number of patients). Hospitals vary; some use a high proportion of non-registered nurses and others a low proportion of ICU qualified nurses. Research shows that there is a link between the quality of nurse staffing and poor patient outcomes, including deaths. Aim : Our research plans to look at different staffing models across the UK. We aim to examine new staffing models in ICU across six very different Trusts. We will use a research technique called Realist Evaluation that examines what works best in different situations and helps us to understand why some things work for some people and not others. The design of this approach will help us to better understand the use of different staff ratios across different ICU settings. We will examine what combinations of staff numbers and skills result in better patient care and improved survival rates. Our aim is to produce a template that every ICU unit can use. To do this, we will compare staffing levels with how well patients recover, and seek to understand the decisions behind staffing combinations. Publications Nurse staffing configurations and sickness absence in English intensive care units: A longitudinal observational study - ScienceDirect ICU staffing and patient outcomes in English hospital Trusts: A longitudinal observational study examining ICU length of stay, re-admission and infection rates - ScienceDirect