out and about across

the North West

Coast promoting our

work, including a

joint initi-

ative with

Lancaster

University

called

“Campus

in the

City”,

providing

public lectures on

health inequalities

and offering the pub-

lic an opportunity to

feedback on issues

about their commu-

nities.

Please get in touch

with us if you have

any feedback, ideas

or general queries.

Mark Gabbay

Director of

CLAHRC NWC

Welcome to the

Summer 2016 edition

of our Newsletter,

keeping you up to

date with activities in

CLAHRC NWC,

I’m delighted to re-

port in this edition

about two key pro-

jects with acute hos-

pitals in Merseyside,

one of which will see

research results pub-

lished shortly. Ensur-

ing we have some of

the top doctors and

surgeons in the re-

gion involved in cut-

ting edge research,

collaborating with

academics is what we

are all about, and I

would urge you to

also read the blog by

Deb Roberts, Clinical

Nurse Specialist from

the Royal Liverpool

Hospital and Broad-

green University

Hospitals NHS Trust,

to show how partner

staff can

gain new

research

skills that

enhances

both their

personal

develop-

ment and

potential for use in

frontline service im-

provement

An update on the

Partner Priority Pro-

gramme and other

research projects is

included in addition

to some of our

Stroke Research

work at the Universi-

ty of Central Lanca-

shire.

We have also been

Research partnerships heat up

Summer 2016 Issue 2

CLAHRC NWC Quarterly

News for Partners and Public across the North West

The mission of the

NIHR CLAHRC NWC is

to work collaboratively

with Partner organisa-

tions and other stake-

holders, including mem-

bers of the public, to co-

produce and conduct

high quality, leadership

enhancing, applied re-

search designed to de-

crease health inequali-

ties and improve the

health of the population

of the North West

Coast.

Inside this issue:

Link-up with RLUBHT on

Cancer Screening Research 2

Researching Oral Cancer at

Aintree Hospital 3

PeARS Research Project

shapes up 5

Stroke Survivors cycle for

Research 6

CLAHRC NWC hits the

High Street 7

Out and About promoting

Research across NWC 7

Developing Neighbourhood

Resilience 8

Caption describing picture or graphic.

Collaboration for Leadership in

Applied Health Research and Care North West

Coast (CLAHRC NWC)

Partnership delivers findings on cancer screening uptake in South Asian women

A piece of research that has involved collecting and critically analysing hundreds of studies from around

the world has been completed, thanks to academic and healthcare partners working together.

The systematic review of social,

cultural and individual influences

on the beliefs, attitudes and be-

haviours of South Asian women regarding asymptomatic screen-

ing for female cancers, is cur-

rently being prepared for publi-

cation in peer reviewed journals

after a year of exhaustive analy-

sis and in-depth study.

The Project Team: Photo (L-R): Mr Mysore Chandrashekar, Consultant Oncoplastic Breast Surgeon (RLBUHT), Dr

Pooja Saini, Knowledge Exchange Theme Manager (University of Liverpool/CLAHRC NWC), Gillian Naylor, Senior

Nurse for Research Development & Innovation (RLBUHT), Deb Roberts, Clinical Nurse Specialist (RLUBHT), Dr

Steve Brown, Senior Lecturer in Clinical Psychology (University of Liverpool/CLAHRC NWC), Dr Mike Beadsworth,

Consultant in Infectious Diseases (RLBUHT).

South Asian women diagnosed with female cancers have poorer relative survival rates than the national

average. Full reasons for this are unclear, but poorer survival is partly attributable to South Asian wom-

en’s lower uptake of screening opportunities, which may be attributable to cultural factors within South

Asian populations.

Co-Principal Investigator on the project, Dr Pooja Saini, of the University of Liverpool’s Department of

Health Services Research, said; “This work will inform interventions directed toward early detection of

female cancers in South Asian women from hard to reach communities. Such interventions could im-

prove cancer mortality and morbidity outcomes in these groups and help to reduce health inequalities.

“Until now there has been no systematic collation of this body of research with the intention of devel-

oping recommendations for health promotion practice in a UK context. It is a positive step forward.”

The University of Liverpool, Royal Liverpool and Broadgreen University Hospitals NHS Trust

(RLBUHT) and University of Central Lancashire were amongst the Partners involved in the latest piece

of innovative work which has focused on female cancer screening uptake in Bangladeshi, Pakistani, Indian

and Sri Lankan populations.

Consultant Oncoplastic Breast Surgeon Mysore Chandrashekar of RLBUHT, a Partner in CLAHRC

NWC, said: “It’s been a pleasure to be part of such a unique collaboration, providing clinical guidance on

this important topic. We want the findings to contribute towards cancer screening policy

in primary care communities and take the findings to as wide an audience as possible.” Page 2

The incidence of some female

cancers in South Asian women,

such as breast cancer, is equal

to and exceeding national rates

in the UK.

Partnership delivers findings on cancer screening uptake in South Asian women (cont’d)

Page 3

Public involvement has been critical to the success of the project with two Public Advisers being an

integral part of the Steering Group, overseeing the progress of the research. It has also proved to

be an invaluable exercise for some of the partner’s frontline staff. “The public advisers and partner

staff have been offered capacity building opportunities including training in conducting research, sys-

tematic reviews and critical appraisal of existing scientific research. These skills have empowered

partner staff to write their own research proposals for service improvements with real world evi-

dence based knowledge and empowered public advisors to become involved in the wider CLAHRC

NWC work,” said Pooja.

Professor Mark Gabbay, Director of CLAHRC NWC, said: “We are grateful to RLBUHT for fund-

ing and supporting the secondment of Deb and time of their staff working on the project, as part of

their commitment to the NIHR CLAHRC NWC collaboration, which has now generated this very

valuable piece of research.”

Findings from the research will also be presented at several key local and national conferences in the Autumn of 2016 with formal submission to peer reviewed journals by October.

A personal insight into the research by RLUBHT’s Deb

Roberts, (pictured) who undertook a secondment as a Re-

search Nurse on the project, is available to view on the

CLAHRC NWC website.

Aintree teams up with CLAHRC NWC to research oral cancer

CLAHRC NWC PhD student Sarah Allen is exploring socioeconomic differences in doctor-patient

communication with head and neck cancer patients to understand whether these differences can be

reduced using the Patient Concerns Inventory (PCI).

Oral cancer has a higher incidence in the lower social strata,

and these patients are less likely to engage in supportive in-

terventions and report a poorer quality of life (QoL).

Working with the Oral and Maxillofacial Surgery team, based at University Hospital Aintree and

colleagues at University of Liverpool, Sarah’s research, published in July, is titled Is social inequality

related to different patient concerns in routine oral cancer follow-up clinics? It was featured in the Euro-

pean Archives of Oto-Rhino-Laryngology.

The CLAHRC NWC’s Partners’ Priority Programme, focusing on the question ‘Which models of out

of hospital treatment and care are most (cost) effective in reducing health inequalities, improving population

health and wellbeing and reducing emergency admissions?, has completed the scoping review and re-

trieved over 100 potentially relevant local initiatives which were presented to the Partner’s Forum.

The discussions around the next steps included refining the initiatives list, adding any missing initia-

tives which were added by Partners which have now been completed. There are now 63 initiatives

included for the next stage.

Our CLAHRC NWC team is now in the process of contacting the project leads for each included

initiative to confirm which initiatives are active, to gauge who is interested in gaining CLAHRC-

linked evaluation support, and to clarify any uncertainties about fact and focus with initiative and/or

partner leads. Following this CLAHRC NWC will survey the Partners to select which initiatives may

come forward to take part in the Priority Programme. In early autumn we will bring together teams

to co-develop work packages within the Priority programme and link partner teams to the different

capacity building pathways including Internships; Evidence Synthesis Support and The Evaluating Im-

plementation College.

Update on our Partners’ Priority Programme

Page 4

Jen spreads research message at LSTM

CLAHRC NWC PhD student Jen Walker (pictured) presented details of

her CLAHRC NWC funded research (and potential benefits) to the Liver-

pool Tuberculosis Research Group at the Liverpool School of Tropical

Medicine. The audience contained representation from partners including

clinicians, nursing staff, lab staff, AHPs, etc. The talk title was: Patient’s expe-

riences of TB treatment in the North West and the real challenges they face.

Jenny’s PhD is titled A qualitative study to review reasons for non­completion of TB treatment and patient

groups who have the highest complex needs.

PhD Student Leanne Male, based at CLAHRC NWC Partner

Aintree University Hospitals NHS Foundation Trust, present-

ed her work “How well do we measure Patient Experience in

Emergency Departments: A Systematic Review” at the University

of Liverpool’s Faculty of Health & Life Sciences Poster Day in

June.

Leanne presents A&E research

The Perinatal Access to

Resources and Support

(PeARS) Study, which

includes Partners’ Liver-

pool City Council and

Liverpool Women’s

Hospital, amongst oth-ers, has been progress-

ing well.

Update:

- Recruitment for the

PeARS Study finished in

April 2016 with a total

of 126 participants.

- Each participant is re-

ceiving a PeARS con-

gratulations card and

bib once their baby ar-

rives (pictured).

More than 20 cards and

bibs have already been delivered.

- The study is now in the middle of its second

phase. From March 2016 until November 2016

participants are being followed up at 34-37

weeks pregnant. To date 24 of our participants

have completed this antenatal follow up.

- The first postnatal peer facilitation meetings

have been scheduled. These meetings take

place between participants who were randomly

allocated to the intervention group at recruit-

ment and a peer facilitator.

- These participants have already met with a

peer facilitator antenatally to identify any sup-

port that might be useful and to make a plan of

how to get that support. Participants will now

meet with a peer facilitator postnatally with the

same aim.

PeARS project shapes up

CLAHRC NWC published research during Summer 2016

Page 5

Is social inequality related to different patient concerns in routine oral cancer follow-up clinics?

(European Archives of Oto-Rhino-Laryngology) (Sarah Allen et al)

Listening visits by health visitors as an intervention for mild-to-moderate postnatal depression or

anxiety (Journal of Health Visiting). (Emma Cummings, Karen Whittaker)

Change in diagnosis on fit notes within an episode of certified sickness absence (Family Practice)

(Mark Gabbay et al)

PhD Student Sarah Allen’s research, based at Aintree University Hospitals NHS Trust Maxillofacial

dept, was featured in Newsletter of British Psychosocial Oncology Society

The effects of patient suicide on general practitioners - (Family Practice online blog) (Pooja Saini)

CLAHRC NWC is hosting a half-day event outlining how public involvement has been embedded in

its research work and benefited key health programmes in Liverpool including Bowel Cancer

Screening, the Healthy Lung Project and Breast and Cervical Cancer Screening (across population

groups where uptake is low.) The day will include presentations, posters and stands outlining the

specific research projects Partner organisations have in partnership with CLAHRC NWC.

Wednesday 19th October 9am-12.30pm at Blackburne House, Liverpool, L8 7PE.

Members of the Public and staff from CLAHRC NWC Partners are welcome to attend. Presenters

will include RLUBHT, Liverpool Council, Liverpool CCG (Healthy Lung), Public advisors, CLAHRC

NWC. To attend please email psaini@liverpool.ac.uk

Public Involvement in research and pathways to impact

Accelerating delivery of psychological therapies after Stroke

Stroke survivors cycle for research

trically assisted bicycles.

The idea to explore cy-

cling for people after

stroke resulted from an

experience shared by a

stroke survivor who is

actively involved in

stroke research at

UCLan. He had recently

started cycling using a

recumbent bicycle but

found that due to fatigue he was unable to travel

as far as he would like. It was thought that the

use of adapted electrically as-

sisted bicycles could potential-

ly provide a unique way of

overcoming some of the tradi-

tional barriers to cycling for

people after stroke.

The purpose of the event was

to explore if adapted electric

bicycles could be feasibly used

to support people to return to

cycling after a stroke. At-

tendees were very positive

about the range of options that are available and

now future work will involve examining in great-

er detail the adaptations that would need to be

made to electrically assisted bicycles to make

them suitable for stroke survivors with a range

of physical impairments.

This work presents independent research fund-

ing by National Institute for Health Research

(NIHR) through CLAHRC NWC.

The University of Cen-

tral Lancashire (UCLan)

Stroke Re-

search Team,

led by

CLAHRC

NWC's Profes-

sor Caroline

Watkins, deliv-

ered an

‘electric bikes

after stroke’

event at the

UCLAN Sports

Arena. Attendees were

supported to try out a

range of adapted cycles

including three wheel-

ers, four wheelers, re-

cumbents, hand cycles,

wheelchair transporters

and two wheeled elec-

Page 6

This study, involving four sites across North West Coast com-

mitted to improving psychological support, is exploring the feasi-

bility of implementing and researching integrated pathways; hos-

pital and community collaborative psychological care pathways.

In Phase One, staff at all hospitals (41 staff in total) have been in-

terviewed to gain an understanding of the barriers and facilitators

to them providing, and for patients accessing, psychological sup-

port. Focus groups (3 in total) with community Improving Ac-

cess to Psychological Therapy teams have explored their con-

cerns and perceived training needs to enable them to work with

patients following a stroke. Patients and carers have told us about their journeys, and their experience

of, and views on, current psychological support, including barriers and facilitators to accessing ser-

vices.

Phase Two of the study is currently ongoing, which involves using this information to inform imple-

mentation, to help us identify targets for improvement, and to select strategies to change practice.

The first two sites (Preston and East Lancashire) have now held stakeholder events, priorities agreed,

and teams are currently working hard on implementing an improved patient pathway.

Representatives from

CLAHRC NWC met

frontline staff from its

Partners at the North

West Allied Health

Professionals Network

Summer Conference ,

in Bolton, where the

theme was Doing things

differently: transforming

health and care.

The Partners Priority

Programme was dis-

cussed by many at-

tendees, with Dr

Pooja Saini, who was

also signposting visi-

tors to our Building a

Research Career - a

Guide for Aspiring Clini-

cal Academics event at University of Central Lan-

cashire. Information regarding internships, sup-

port materials and advice on following a

research career were also disseminated.

CLAHRC NWC was also at the 2016 Lan-

cashire Science Festival promoting health

inequalities and its work to reduce them.

Visitors discovered health inequalities in-

formation using the CLAHRC NWC

Snakes & Ladders board. The Evidence for

Change Team were at the International

Festival of Public Health, in Manchester, which

included presenting the Team’s work on the Bow-

el Cancer Screening Programme in Liverpool.

CLAHRC NWC gets out and about to promote its work

CLAHRC NWC hits the High Street

Page 7

Over 300 shoppers visited a “Pop-up Neighbourhood”, organised by CLAHRC NWC, to find out the

factors impacting on their health and communities in the North West.

For one day only, shoppers in the centre of Lancaster had a chance to find out about good health and

the health inequalities that affect the North West region as a whole, including what could be contrib-

uting to them. The day was part of Lancaster University’s Campus in the City annual spring event in

which the University takes over a former shop in St Nicholas Arcades in the heart of Lancaster to

showcase its research and activities.

Public Engagement Facilitator at CLAHRC NWC, Jenny Irvine, said: “There are pockets in the North

West where people’s health compares poorly to other pockets in the same region. We have seen

hundreds of people visit us today, finding out about the work we are doing to tackle these inequalities

and improve health. We have held speed talks on health inequalities and people have been able to ask

questions about our research. People have also been involved by letting us know what changes to their

local community might improve their health. We will be feeding this back to our Partners which in-

cludes local authorities. It has also been great to see people taking part in health inequality quizzes,

games to learn about good health and children enjoying their colouring wall”

A walk-on snakes and ladders game (pictured) took centre stage,

co-created with a young person’s group in Morecambe.

This was funded by the Research Council UK and has been made

available for partner schools across the region to use in classes

and summer schools to teach children about health inequalities

and what causes them.

Contact:

Darren Charles

CLAHRC NWC

Communications

Manager

charlesd@liverpool.ac.uk

0151 794 5342

Website

@clahrc_nwc

The Public Health (PH) theme of CLAHRC NWC is delivering a programme

of action research that aims to develop greater resilience in 10 relatively dis-

advantaged areas and evaluate its impact on the social determinants of health

and on health inequalities. The Neighbourhood Resilience programme is un-

derpinned by a systems approach which sees resilience as emerging from the

interactions between people who live in an area and the organisations that op-

erate there – private, public or voluntary. Working with local authority part-

ners the CLAHRC NWC PH theme has developed a resilience framework

comprising four components - social cohesion, economic security, the quality

of the living environment and community involvement in governance. In each

‘Neighbourhood for Learning’, which range from Cumbria to Cheshire West

and Chester, a local multi-sectoral group is working with residents to identify

and implement evidence based initiatives to improve one or more of these as-

pects of resilience. In one Neighbourhood, for example, the focus is on im-

proving the quality of privately rented accommodation; in another the focus is

on improving social cohesion. A range of resources is being provided to sup-

port the work in the Neighbourhoods including a series of rapid evidence re-

views (focused for example, on approaches to reduce debt/increase economic

security and on selective licensing of private landlords).

A Community Research and Engagement Network (COREN) is being estab-

lished to support residents in the 10 Neighbourhoods to get involved in the

programme. An early COREN engagement initiative has involved running a

Digital Photography competition in seven of the Neighbourhoods, encouraging

residents to capture images of events, sites, people, places or things they like

(and dislike) in their community. Winning photographs will be published in a

Community Calendar specific to each Neighbourhood which can be used to

record key local events including events linked to the Neighbourhood Resili-

ence programme. The photographs are also contributing visual data to the

process evaluation. (pictured, examples of photos and Southport’s calendar).

Got a Story?

Engagement From Community Resilience to Neighbourhood Resilience

Page 8