ScHARR PGR Conference 2019/file/... · 2019-06-03 · Oral Presentations ScHARR PGR Conference 2019 Nicolas Silva –Inequality of opportunity: applications and challenges in the

ScHARR PGR Conference 2019

Pemberton Lecture Theatre

9am – 5pm

Please tweet using #scharrpgr19

Schedule


9:00 – 9:20

9:20 – 9:30

9:30 – 10:45

10:45 – 11:00

11:00 – 12:00

12:00 – 1:00

1:00 – 1:15

1:15 – 2:30

2:30 – 2:45

2:45 – 3:45

3:45 – 3:50

3:50 – 4:50

4:50 – 5:00

Registration

Introduction

Session One

Coffee

Session Two

Lunch/Posters

Gone in 60 Seconds

Session 3

Coffee

Session 4

Comfort Break

Guest Speaker

Prizes and Closing

Oral Presentations


Nicolas Silva – Inequality of opportunity: applications and challenges in the measurement of health inequalities. A literature review

Natalie Bennett – Social connectedness and mental well-being in communities experiencing ethnic change

Thomas Bayley – A conceptual model for describing the role of stigma in driving socioeconomic inequality in obesity and depression

Colette Kearney – A Mixed Methods Review of Grandparental Influence on the diets of their 2-4 year old grandchildren

Session One (9:30 – 10:45)Chair: Sarah Barnes, Director of Public Health

Joseph Kwon – Systematic literature review of economic evaluation of falls prevention intervention for community-dwelling elderly population

Benjamin Kearns – The role of dynamic survival models in technology appraisals: a case-study

Naomi Gibbs – How has a concern for equity been incorporated into economic evaluation of health policy in low- and middle-income countries? A scoping review

Session Two (11:00 – 12:00)Chair: Phil Shackley, Director of HEDS

Oral Presentations


Marit van Buijsen – Current practice in the support of visually impaired adults with a serious mental illness: knowledge and experiences of professionals

Nicola Crook – Evaluating the efficiency and acceptability of methods of delivering evidence based aphasia intervention (intensive language action therapy) to patients in the UK within the NHS: a randomised pilot trial

Latifa Alenezi – Perceptions of Cognitive Behavioural Therapy in Physiotherapy for Chronic Low Back Pain: An Explanatory Grounded Theory

Tourkiah Alessa – Smartphones Apps to Support the Self-Management of Hypertension: identification of the most suitable apps

Session Three (1:15 – 2:30)Chair: Janette Turner, Director of HSR

Nouf Alsulamy – Barriers and Facilitators to Implementing Shared Decision Making: An Umbrella Review of Systematic Reviews

Susan Hampshaw – The craft of Public Health in Local government

Christy Braham – Implementation of health navigation for increasing access to healthcare for vulnerable migrant women: an integrative review

Session Four (2:45 – 3:45)Chair: Steven Julious, Director of DTS

Posters


Liran Li – Integration of urban and rural resident basic medical insurance in China

Sarah Abdi – The potential of emerging technologies to meet the care and support priorities of older people living at home in the UK

Walter-Rodney Nagumo – Factors influencing adverse drug reaction reporting among healthcare professionals in Ghana

Benjamin Kearns – The extrapolation performance of standard and flexible survival models: a simulation study

Madeleine Harrison – Identifying barriers and enablers of adherence to self-directed aphasia computer therapy: a patient and carer perspective

Brenda Maleco – Using robots to reduce anxiety in children

Helen Radford – Dealing with disaster: a qualitative exploration of the experiences of healthcare staff following a mass casualty incident

Postgraduate Research Committee – Transitioning from PGT to PGR

Gone in 60 Seconds


Beshayer AlrumCharlotte Godziewski

Sundus MahdiBruce MooreNicole Nation

Ayodeji OyedejiJanilza SilvaIbby Ullah

Guest Speaker


“Applied health research in the digital era”

This presentation will examine the connections between the various (and varied) research topics that have shaped my career in applied health research

to date. This work - from its roots in the sociology of protest, to current explorations of the disposal of limbs after amputation - spans a wide variety of

topics, but at it core, shares many similarities, not least the values and motivations for conducting such research. Understanding aspects of social life

which are often hidden, presents challenges for researchers, but contemporary innovations in technology and the methods to then utilise such platforms for research offer useful solutions for enabling research to capture the voices of those who are otherwise hidden. Through exploring a number of different

topics of research, this paper will examine the value that internet mediated research offers for applied health research and the challenges and

opportunities it may afford. Creating a strong ‘thread’ to tie together a disparate CV can feel daunting at the early stages of an academic career, but as this paper will examine - often the ties that bind are themselves stronger than

the perceived differences.

Dr Esmée Hanna

Inequality of opportunity: applications and challenges in the measurement of health inequalities. A literature review

Abstracts Session One

Responsibility-sensitive egalitarianism or 'equality of opportunityethics' is a normative theory that has received increasing attention inthe analysis of income and health inequalities. The implementation ofthis ideas in empirical analyses consist on applying measures ofinequality that can isolate the variability due to characteristics forwhich individuals should be hold responsible (called 'effort'), fromthose for which they do not (called 'circumstances'). A literaturereview of articles that have applied this framework to assess healthinequalities using econometric methods was conducted in Embase,MEDLINE and EconLit. The analysis focused on the following aspects:health outcome assessed in each study, how the partition betweencircumstances and effort was defined, which research questions wereexplored, and the empirical strategy to answer these questions. Selfassessed health was the outcome most frequently used. Most studiescoincide in the classification of effort and circumstances, howeversome variables such as adult socioeconomic position, age and sex arehave received different normative interpretations. The researchquestions focused mainly on providing measures inequality ofopportunity and decomposing explained inequality due to effort andcircumstances. Methodological and normative challenges amongthese and other aspects are explored in the review.

Nicolas Silva

Social connectedness and mental well-being in communities experiencing ethnic change


It is now well established that minority ethnic groups suffer fromhigher rates of common mental disorders. In part, this negativeassociation is thought to be a result of social relationships which areoften approached from an ethnic density perspective. There has beena growing body of research surrounding the so-called ˜effect of ethnicdensity” on mental health. However, despite a proliferation ofresearch and systematic reviews surrounding ethnic density andmental well-being, the mechanisms and pathways are seldom morethan briefly stated and almost never tested. During this project, asystematic search of the literature will be performed in order toproduce a hypothesised causal framework between density andmental health, illustrating those pathways which have beenhypothesised in theoretical and qualitative literature and those whichhave currently been tested by the quantitative literature. This researchaims to collate key sociological and geographical concepts on socialnetworks and communities in order to provide a useful schematic toolin an accessible format which can be used to aid public healthresearchers investigate the relationship between ethnic density andmental health.

Natalie Bennett

A conceptual model for describing the role of stigma in driving socioeconomic inequality in obesity and depression


Obesity and depression are common afflictions and individuals with theseconditions are frequently subjected to stigmatisation. Individuals of lowsocioeconomic position (SEP) are also stigmatised and research hassuggested that stigma may be a fundamental cause of inequalities inhealth. However, whether and how stigmatisation of obesity, depressionand SEP generates and/or perpetuates socioeconomic inequalities inobesity and depression remains relatively unexplored.

Here we describe a conceptual model based on the fundamental notion ofstigma, that explains why we should expect obesity and depression to berelated, and reveals insights as to why socioeconomic patterning isgenerated and sustained. We describe our conceptual model in threestages. Firstly, we present a brief overview of conceptualisations of stigmafor the purpose of outlining a framework within which our model will bedescribed. Secondly, we present a model which describes how therelationships between obesity, depression and SEP might be driven bytheir associated stigmas. Lastly, we locate our model within the context ofthe current literature on the consequences of stigmatisation of obesity,depression, and low SEP.

Having outlined our conceptual model, thought is then given to how thismodel will be tested using Agent-based simulation.

Thomas Bayley

A Mixed Methods Review of Grandparental Influence on the diets of their 2-4 year old grandchildren


The early years are a crucial time for the formation of dietary habitsand preferences. These first few years of life are also whenGrandparents frequently assume child care-giving responsibilities.Grandparents may therefore play an influential role in young children’sdiets. The aim of this review is to determine the influence ofgrandparents on the diets of their grandchildren aged two to fouryears old, synthesising the evidence based upon grandparents’ dietaryprovision, feeding practices and the feeding styles they adopt.Medline, PsycInfo & Web of Science were searched in November 2018for articles that reported on grandparents’ involvement in youngchildren’s diets. Seventeen studies were identified in the review; 8studies described grandparents feeding styles, 11 studies reported ongrandparents’ feeding practices and 14 studies captured grandparentsdietary provision. Predominantly, Grandparents adopt an indulgentfeeding styles and use feeding practices which may negatively affectthe dietary intake of their preschool-aged grandchildren. No study hasrigorously assessed grandparents’ dietary provision and further workis required to explore this. Nevertheless, Grandparents may be animportant group to target to improve dietary related health outcomesin young children.

Colette Kearney

Systematic literature review of economic evaluation of falls prevention intervention for community-dwelling elderly population

Abstracts Session Two

Background: Falls are leading causes of disability and death in the elderly. Fallsprevention interventions have consistently been found to be clinically and costeffective.

Aim: To systematically review the literature to identify economic evaluations of fallsprevention for community-dwelling elderly persons in OECD-member countries andnarratively review strengths and limitations of decision-analytic models.

Method: Systematic review followed PRISMA protocol and covered 12 academicdatabases. Two data extraction forms specific to falls prevention were designed, one fordecision-analytic models and the other for non-model economic evaluations. Includedstudies were categorised by setting, intervention and other characteristics. Strengthsand limitations of decision-analytic models were organised by themes with suggestionson improvement.

Result: Sixty-nine studies were included, 26 of which were decision-analytic models.Limitations included: contextless setting without defined decision-maker or targetpopulation; short model horizon without history of falls; poor characterisation of age-related progression of risk factors in lifetime models; poor consideration of recurrentfalls; cohort models without individual-level risk heterogeneity; mismatch betweenmodel and trial population characteristics; application of homogeneous effectivenessevidence; and no or crude consideration of targeted intervention approach.

Conclusion: Understanding the strengths and limitations of previous decision-analyticmodels offers foundation for improved modelling of falls prevention interventions.

Joseph Kwon

The role of dynamic survival models in technology appraisals: a case-study


Estimating lifetime mean survival by extrapolating the hazard functionis often a key task in technology appraisals. For extrapolations, thereare often two key issues. The first is the choice between either usingall of the available evidence or only using the more recent (butpotentially more relevant) evidence. The second is that commonlyused survival models may not be sufficiently flexible to provide anadequate description of the hazard function. Dynamic survival modelscombine time-series and survival methods, and have the potential toovercome both of these issues. We demonstrate the usefulness ofdynamic survival models via a re-analysis of an existing technologyappraisal: Nivolumab for previously treated squamous non-small-celllung cancer (TA483). For this appraisal the extrapolation of survivaldata was identified as a key source of uncertainty, and the choicebetween using all or a subset of the data for extrapolation had apronounced impact on estimates of cost-effectiveness. We show howthe use of dynamic survival models allows for greater insight into howthe hazard function evolves over time, and also provides a morerealistic characterisation of uncertainty.

Benjamin Kearns

How has a concern for equity been incorporated into economic evaluation of health policy in low- and middle-income countries? A scoping review


Aim: To explore the scope of health economic evaluation of health policiesapplied in LMIC/s with an explicit focus on equity.

Research question: How has a concern for equity been incorporated intoeconomic evaluation of health policy in LMICs?

Methods: A scoping review method was chosen as it stipulates a systematic,transparent and replicable search strategy whilst not requiring the formalprocess of quality assessment commonly found in systematic reviews (Grantand Booth, 2009). It facilitates the inclusion and analysis of papers which arewide ranging in both topic and methods. The databases Web of Science,Scopus, Medline and Embase were chosen to cover literature from both healthand social sciences. This resulted in 5748 papers.

Results: A final group of 35 papers were selected. They covered 28 countries, ofwhich seven papers covered Ethiopia, seven India and four China. Healthproblems covered both infectious and noncommunicable disease. Amongstthem seven papers covered rotavirus, five tobacco related mortality and fourinfant malnutrition. The three most populous categories of policies evaluatedincluded: vaccination programmes, healthcare provision and pricing policies.Equity was incorporated into the evaluations using extended cost-effectivenessanalysis, distributional cost-effectiveness analysis, simple stratification ofresults and the use of concentration indices.

Naomi Gibbs

Current practice in the support of visually impaired adults with a serious mental illness: knowledge and experiences of professionals

Abstracts Session Three

Background: Adults with a visual impairment (VI) and serious mental illness(SMI) experience challenges in finding appropriate support. Knowledge abouthow to best support this group is implicitly held by expert professionals. Thisstudy aims to transfer the implicit knowledge of professionals to an explicitlevel by analysing current practice.

Methods: Implicit knowledge was made explicit using a Participatory ActionResearch approach, in which daily practice was discussed in individualinterviews and group meetings with professionals from three Dutchorganisations for people with VI.

Results: A systematic description of clientsâ€™ characteristics and carepathways were elucidated, resulting in consensus about a stepped model ofcare. Other explicit forms of knowledge, including basic requirements forsupport, such as building safety and trust and establishing a detailedunderstanding of each clientâ€™s problems and needs were revealed. Thesebasic requirements ask for specialist knowledge about comorbid VI and SMI.

Significance: The stepped model of care for adults with VI and SMI provides apreliminary framework for conceptualising the specific types of support andcare this group requires. This framework will be further tested, providing inputfor a logic model of the support and a realist evaluation of a more systematicand explicit approach.

Marit van Buijsen

Evaluating the efficiency and acceptability of methods of delivering evidence based aphasia intervention (intensive language action therapy) to patients in the UK within the NHS: a randomised pilot trial


Design: This study is a pragmatic, parallel group randomised controlled pilot trialcomparing Intensive Language Action Therapy (ILAT) facilitated byassistants/volunteers with usual care.

Methods: Participants aged 18 or over with chronic aphasia following stroke wererecruited from two district general hospitals within the National Health Service.This study aimed to examine the feasibility of undertaking a randomised controltrial to compare the clinical effectiveness of ILAT facilitated by trainedassistants/laypersons with usual treatment. ILAT was delivered in groups of 2-4participants for 30 hours over 10 consecutive working days. The primary outcomeswere recruitment and retention, feasibility of randomisation and group allocationand acceptability of the intervention, clinical outcomes and trial procedures. Theprimary clinical outcome measure was rated conversational ability through videorecorded conversations using Therapy Outcome Measures. A process evaluationinvestigated potential sources of failure in the intervention and trial procedures.

Results: 29 participants were randomised, 16 to ILAT and 13 to usual care. Datawas analysed for 15 participants in the ILAT arm and 11 in the usual care arm. 14people completed interviews reporting intervention and trial procedures wereacceptable.

Discussion: Trial and intervention procedures were found to be acceptable andfeasible with minor modifications.

Nicola Crook

Perceptions of Cognitive Behavioural Therapy in Physiotherapy for Chronic Low Back Pain: An Explanatory Grounded Theory


Chronic Low Back Pain (CLBP) is one of the most common and recurrentmusculoskeletal problems that causes patients to frequently access healthcareservices. The Bio-psychosocial model emphasises that psychological, behavioural andsocial factors contribute to the development and persistence of CLBP. Cognitivebehavioural therapy (CBT) is a psychological pain management strategy that can beused by physiotherapists treating chronic low back pain. However, evidence of theeffectiveness of CBT for CLBP varies between different studies. The proposed studywas preceded by a mixed methods systematic review that found that CBT has abeneficial effect for CLBP patients when compared to waiting list or othertreatments; however, there is variation in effectiveness across different settings.Little is known about how CBT is applied by physiotherapists in physiotherapysettings. The interest of this research is directed towards generating an explanationand understanding of why, when, and how some physiotherapists make decisionsand choose to apply CBT for CLBP patients, whereas others do not. Also, how and forwhat type of CLBP patients does CBT work, and for whom might CBT not work?Therefore, the study took a qualitative approach to explore CLBP patients’,physiotherapists’ and managers’ perceptions of CBT and how it is used inphysiotherapy to enable a deeper understanding and richer explanation of CBTeffectiveness and help to inform research and practice. The study used groundedtheory approach to generate an explanatory theory of the clinical application of CBTfor CLBP in physiotherapy settings. Physiotherapists, patients and mangers ofphysiotherapy services were interviewed. Grounded theory techniques was used toanalyse the data. This PhD thesis will describe findings form the interviews and theemerging theory. This research will help to further inform RCTs about theeffectiveness of CBT for CLBP in physiotherapy.

Latifa Alenezi

Smartphones Apps to Support the Self-Management of Hypertension: identification of the most suitable apps


Background: Hypertension is a common chronic disease in adults that requires effectivepatients’ self-management. Smartphone apps provide considerable potential to play arole in self-management. However, the increasing number of blood pressure (BP) appsavailable on the market creates the need to be made aware of their effectiveness, andthe levels of security and privacy that they offer. This will help to identify apps that areuseful and safe.

Method: Two studies were conducted to evaluate apps for supporting the self-management of hypertension. Firstly, a published systematic review was conducted,including articles that assessed effectiveness of hypertension apps. Secondly, a contentanalysis study was undertaken, scanning the most popular UK app stores and describingall available apps supporting hypertension self-management. A privacy and securityassessment of potentially effective apps was also performed.

Results: The systematic review included a total of 21 articles, evaluating 14 appsbetween them. This review indicated that apps have a positive effect on controlling BP.Due to inconsistencies in the design and quality of the articles, there is inconclusiveevidence about which of the functionality combinations are most effective. However, itis clear that apps are likely to be more effective when they have more comprehensivefunctionalities. Most apps in this review were study-specific, that is, they weredeveloped solely for the purpose of the study. This is in contrast to the scores ofcommercial available apps on app stores. Indeed, the content analysis study identified186 such apps. Most of them lack a sound theoretical basis, little is known about theireffectiveness and usability, and many do not meet security and privacy standards. Onlya few can be assumed to be effective and safe.

Tourkiah Alessa

Barriers and Facilitators to Implementing Shared Decision Making: An Umbrella Review of Systematic Reviews

Abstracts Session Four

Background: Number of studies on barriers and facilitators to shared decision making hasincreased over time, making it challenging to collect evidence from multiple health caresettings without doing a systematic review in each setting.

Objective: To provide an overview of factors that may either facilitate or inhibit theimplementation of shared decision Making.

Methods: I performed an umbrella review of systematic literature reviews reporting barriersand facilitators to shared decision making. The databases searched were MEDLINE via Ovid,PsycINFO via Ovid, CINAHL, Scopus, and Cochrane Library. Reference lists of included articleswere screened, articles citing the included reviews were tracked, and grey literature sourceswere searched. The reviews were included if they performed a systematic review of barriersand facilitators to shared decision making. After quality assessment of all included reviews,data were extracted on type of review, number of studies included in each review, country oforigin, aim or objective of the review, participants, settings, barriers, and facilitators.

Results: The total number of records were 414, and of that number 388 references wereexcluded and 26 full text articles retrieved, 7 eligible reviews were identified. Most of theincluded reviews performed well on the CASP checklist. Themes and subthemes wereidentified from the findings. The six themes that emerged were: patient factors, professionalfactors, environmental factors, decision factors, relationship factors, and factors related toinformation provision.

Conclusions: The number of reviews being published have increased over time, indicating thatthe level of awareness and interest in shared decision making has been increasing. Thereviews highlighted different factors that influence the implementation of shared decisionmaking and strategies to overcome these factors.

Nouf Alsulamy

The craft of Public Health in Local government


This presentation focuses on insights from a PhD study examining howNICE guidance aimed at local government was received, viewed and usedby local government officers. The study was a realist inquiry (undertakenby an embedded researcher); and identified, tested and refined theories toexplain how NICE guidance was received following its release, and why thisreception occurs.

Three hypotheses were targeted; two on the nature of decision-makingand one on the uniqueness of individual authorities. These hypotheseswere tested by methodically reviewing the literature using theory-guidedsearches, data extraction and synthesis, and by primary data collectionduring fieldwork in 3 councils.

The focus of realist inquiry is explanation. The study findings offer insighton how and when decisionmaking processes are navigated, by whom andidentify mechanisms that support or hinder the use of evidence. Theseexplanations have implications in terms of the public health practice inlocal government and the paper will highlight these. We will make thecase, that Public Health in local government is a craft practice of art andscience to influence local government policy making. The presentation willsurface the dilemmas within this craft practice.

Susan Hampshaw

Implementation of health navigation for increasing access to healthcare for vulnerable migrant women: an integrative review


Health navigation has the potential to improve access to healthcare forunderserved groups, however its functioning and impacts on access tohealthcare for vulnerable migrant women have not been systematicallyevaluated. Studies reporting the effect of health navigation on uptake ofhealth services by migrant women in vulnerable circumstances, healthbehaviours, health outcomes, or perceptions of navigation were identifiedthrough searching electronic databases, grey literature and relevantjournals. Of 3225 studies, 129 full-texts were assessed, of which 16quantitative and qualitative studies met the eligibility and quality criteria.Studies showed wide variation in the roles, practices and terminologiesassociated with navigation interventions for vulnerable migrant women.Although navigation facilitates access to preventative, diagnostic andtreatment services, evidence on the effect of navigation on women’shealth knowledge and awareness was inconclusive. Shared identities andexperiences between navigators and women may influence navigationalprocesses and foster trust, however there was limited evidence. Furtherdata on the characteristics, mechanisms and effectiveness of navigation forvulnerable migrant women is needed in maternity care and non-NorthAmerican contexts. Future research is also needed on perceptions ofnavigation, and on the potential impacts of shared identity and experienceon navigation for this particular population.

Christy Braham

Special Thanks


Prize Judges

Stephen Potter (HSR)

Louise Preston (HEDS)

Tracey Young (HEDS)

Luc de Witte (HSR)

Simon Dixon (HEDS)

Elizabeth Such (PH)

Rebecca Simpson (DTS)

Jill Carlton (HEDS)

Session Chairs

Sarah Barnes (PH)

Phil Shackley (HEDS)

Janette Turner (HSR)

Stephen Julious (DTS)

Opening and Closing the Day

John Brazier

PGR Committee


Tracey Young - Director of PGR Studies

John Holmes - Deputy Director of PGR Studies

Kirsty Tolmay - PGR Administrator

Emma Cordell - Learning and Teaching Manager

Philip Powell - Student Experience Officer

Maxine Kuczawski - Quality and Progression Officer

Lindsay Blank - Admissions Officer

Jill Carlton - Fellowships Officer

Jessica Wright - Studentships Officer

Nick Fox - Staff Development Officer

Kate Ren - Research Training Officer

Nicola Crook - Student Representative (Full Time)

Zakia Abdul-haq - Student Representative (International)

Steven Markham - Student Representative (Part Time)

Johanna Lister - Student Representative (Distance Learning)

Documents

ScHARR PGR Conference 2019/file/... · 2019-06-03 · Oral Presentations ScHARR PGR Conference 2019 Nicolas Silva –Inequality of opportunity: applications and challenges in the