‘Improving health and wellbeing through Research’ Preston Football Club 17th October 2014 Improving health and wellbeing through research – October 2014

Developing Clinical Research Jane Beenstock Consultant in Public Health “Making every contact count: emerging public health research” Theme: Developing Clinical Research Improving health and wellbeing through research – October 2014

Making every contact count: emerging public health research

Making every contact count: emerging public health research  Our challenges  Some solutions  Our learning In this presentation will share the highs and lows of our desire to combine research and practice. We want to use research to inform our service work and use our insight into knowledge gaps in service delivery to generate research.

Our public health perspective means we get excited by population level interventions….

Because as explained by Rose in Because as explained by Rose in ???? , for many conditions, we can save more lives by moving the whole population curve than by focusing on those people at the ends of the curve

Making every contact count What it is The evidence base….. Making every contact count is a concept that has been widely adopted in mainly NHS organisations who are taking the opportunity to influence people’s health-related behaviours. It’s a structured way to empower all staff to deliver short health interventions in the context of their daily contact with patients/ clients. Staff are trained to offer brief advice using the model ask, advise and act. Training covers alcohol, diet, physical activity and smoking. There is good evidence to support the focus on these four lifestyle behaviours. In the UK, individuals who did not engage in any of these four behaviours were 3.5 times more likely to die over a 20-year period than those who did.(8) Annual costs to the NHS of cigarette smoking, alcohol-related conditions, physical inactivity and poor diet have been estimated to be £13.3bn.(9) The WHO estimates that if these ‘big four’ behavioural risk factors were eliminated, up to ‘80% of heart diseases, stroke and type 2 diabetes and over a third of cancers could be prevented’(p.5).(23) We also know that interventions for each of these four health-related behaviours is effective. For example, put in evidence for alcohol or smoking BI Should I make this two slides instead of one?

 Our challenges Evidence based policy? The team? Different time frames Different perspectives on ‘good’ However, we can find no research that has evaluated the benefits of combining these interventions into the MECC package…..and that’s not really a surprise given that often health policy is not founded on research evidence. Bambra has referred to this as the ‘primacy of political priorities’ This leaves us with many questions including: How effective is the MECC intervention at changing behaviour (in staff, patients, the public) Does the MECC intervention need to be delivered differently in a mental health setting compared to a general population? So our next challenge was trying to find the right people to help frame the research question and write the bid……this started in February/March Then we realised that all of that took ages…..and we were expected to have test sites up and running by September, which meant devising the training package, training staff, sorting out IT and much more……..so the practice of making this happen from a service perspective meant that thinking carefully about what data we might need as part of the research process and working out who we should involve from a research perspective, what are the outcome measures, don’t contaminate……all severely challenged From a service perspective we had to settle for ‘good enough’ because the measure of success is have we delivered the programme as promised to the executive management team and commissioners. That’s troubling from a research perspective …..

 Some solutions Developing a virtual team Building a network Flexible but……. Public health in LCFT is one consultant post (with two part-time bodies) so we need help from colleagues who are already working at the interface of research and service, experts in specific aspects of this work such as behaviour change We have learnt about the array of research bodies in the north west – CLAHRC, LILAC, AHSN and been to talk to them, present our ideas and try to rewrite our proposals based on all of their feedback This has meant being flexible in terms of how the research questions develop, who we can work with as academic partners and having to compromise on our ambitions

 Our learning Ask for help Keep asking Know the system It can be done! We have learnt that there are research experts who can help…..but it’s hard when we don’t know what we don’t know - so finding the right connections in the research world is challenging – persistence is a virtue in this circumstance! We have now got interest from an academic in Lancaster university to undertake some evaluation of the pilot – we need robust evaluation to support future research bids Thanks to the research experts in the trust and their academic partnerships, someone from Manchester University has submitted a bid to NIHR which would explore the adaptation of the MECC intervention for offenders under community supervision And we hope to shortly submit a bid to CLARC that would investigate the effectiveness of the intervention for people with sever and enduring mental health conditions.

Any questions?