Research Design Service: East Midlands
National Institute for Health Research

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Help at Home: themed review of NIHR research into assistive technology for older people

  Created on Monday, 14 Jan 2019. Posted in Ageing

More people are living longer with complex conditions and needs. Technology can help people to stay living well and safely at home as they get older. But technology is changing rapidly and it can be challenging to get the right technology for the right person with the right support. There has been considerable investment recently in developing and evaluating assistive technologies for older people. But this is a relatively new field and there are important gaps in what we know.

Help at Home brings together recent NIHR and other government-funded research with focus on the use of technology in the home and designing better environments. In this review the focus is on research around the use of technology in the home, remote monitoring systems and designing better environments for older people.


MHRA Guidance on the Regulation of Medicines, Medical Devices and Clinical Trials in 'No-Deal Brexit' Scenario

  Created on Tuesday, 08 Jan 2019. Posted in News Items

MHRA Guidance on the Regulation of Medicines, Medical Devices and Clinical Trials in 'No-Deal Brexit' Scenario


Learning for involvement website

  Created on Thursday, 20 Dec 2018. Posted in Public Involvement

The pages sit within the involve website and are full of tools, resources and systems to support public involvement in research. There is a great section featuring top tips on various topics from what makes good public involvement to reviewing research applications. Training programmes and providers are due to be added early next year.


Social care: investing in better research

  Created on Thursday, 20 Dec 2018. Posted in Social Care

New NIHR blog from Professor Martin Knapp, Director of NIHR School for Social Care Research

Most readers of this blog will know someone who uses adult social care services. You may actually be that ‘someone’. Or you may be a carer. Many of the rest of you - if survey findings are accurate – will be seriously underestimating the likelihood that you will have social care needs yourself at some point.

Adult social care is the provision of personal and practical care and support that people may need due to ageing, illness, or disability, provided in a number of settings ranging from help in their own homes, to nursing homes, or in community settings such as day centres. Support is also provided to family and other carers. The likelihood that you might need these services is growing over time.

If only out of self-interest, therefore – although I hope that wouldn’t be the sole motivation – we will all want an adult social care system that is fit for purpose.

The system should be good at identifying social care needs in timely fashion, and responding to changes over time, and make sure it understands the preferences of individuals about how their needs are met and the personal strengths they bring to the care setting. It should recognise and support family and other unpaid carers. It should recognise people as individuals, engaging with them with respect and dignity. It should recruit, train and retain a skilled workforce. It should support that workforce with appropriate technology and other resources. It should recognise the enormous contributions that communities do and can make.

A high-performing social care system goes further. It ensures that every individual with social care needs - whatever their financial or family circumstances – has access to good quality support, and has a choice about what that support will be. A good social care system will also be funded fairly, and in a way that is sustainable over the long term.

And, importantly, it will be built on solid research evidence. That is why last week’s announcement by NIHR that it will fund a third phase of the School for Social Care Research (NIHR SSCR) is so welcome. Just under £20 million has been committed over 5 years to continue the work of the School. This includes £1.8 million specifically targeted on building research capacity: this is the exciting new NIHR Social Care Incubator.

Research helps

Research helps. Note the careful choice of verb: not research ‘solves’ or ‘has all the answers’. Research is only one ingredient into decision-making. It offers evidence to be considered alongside other things. It helps decision-makers make difficult decisions.

Good research can address questions suggested by individual experience or prompted by wider contextual changes. Those latter might include population ageing, shifting societal priorities, cuts or boosts to public expenditure, technological innovation, breakthroughs in healthcare, changes in welfare benefit eligibility or housing policy, and even (whisper it quietly) possible workforce implications of Brexit.

So what does ‘good’ look like? Good research will include at least the following ingredients:

  •       the views and opinions of people who use services and provide unpaid care, and also of service practitioners;
  •       measures that show how progress is (or is not) being made in pursuit of personal and system-wide objectives; and
  •       measures too of the resources required to achieve that progress.
  •       Good research will likely draw on more than one academic discipline to find the best framework for interpreting data, whether qualitative or quantitative – ideally both.
  •       It will endeavour to collect these data in a way that makes it possible to generalise from the findings to a wider context.
  •       And it will, of course, be ethically sound and have the informed consent of participants.

NIHR School for Social Care Research

These are among the principles that have underpinned the work of the School since it was established. Since 2009, NIHR SSCR has funded 128 studies, published methods and scoping reviews, held a series of very successful annual conferences, and organised numerous other events.

In the new phase, there will be seven member universities: Birmingham, Bristol, Kent, Kings College London, Manchester, York, and the London School of Economics and Political Science, which will lead on coordination and management. I have the privilege of continuing as Director of the School.

What exactly gets researched by the School depends in part on our consultation: we listen to people who use services, carers, practitioners, managers, local authorities, organisations that provide services, third sector bodies and even other researchers!

Research themes might include:

  •       Met and unmet needs; prevention
  •       New approaches to care and social work practice, particularly user-led, carer-led and other innovations, including new technologies
  •       Workforce development and retention, new ways of working
  •       Issues for people who self-fund their care; supporting carers
  •       Working with communities, such as through asset-based working, social prescribing, personalisation
  •       Care market management, especially of quality
  •       Diversity, inequality and marginalised communities, including how to tackle differences in access to care
  •       Interfaces with other systems, especially housing, hospitals, primary care, employment.

None of this is set in stone. Indeed, the programme should evolve over time as new ideas and challenges emerge.

More than just NIHR SSCR

NIHR’s continuing commitment to SSCR is just part of a wider push to encourage and support research on adult social care. (NIHR does not fund research on child social care: this is the responsibility of the Department for Education.)

This is not a case of just adding the words ‘and social care’ every time an NIHR call or initiative mentions health research. The NIHR ‘push’ includes investing in research skills and researchers so that social care questions get suitably framed and answered. It is about making sure that commissioning panels and reviewers include people with expertise in social care. It is about working with local authorities and social care providers (the vast majority of which are in the private sector) to be ‘research-ready’ – indeed to be ‘research-hungry’. As the leading funder of social care research, NIHR has an enormous amount to contribute.

Objectives

There are huge pressures on adult social care today. Needs and demands are rising, while public funding has been falling. There are growing numbers of self-funders, most of whom find it hard to understand the system. Many thousands of family and other unpaid carers face enormous challenges every day. Service providers often struggle to stay afloat.

The Government is expected to publish a Green Paper soon that will stimulate widespread debate about how social care should be funded, organised and accessed. NIHR-supported research can contribute enormously to this debate and to the future shaping of adult social care.


James Lind Alliance recruiting advisers

  Created on Wednesday, 12 Dec 2018. Posted in Priorities

The James Lind Alliance would like to recruit advisers to join the team. JLA are looking for independent consultants who will contract with the University of Southampton to support and facilitate Priority Stetting Partnerships. 

A solid background in facilitation, project management and chairing is essential, with excellent communication skills and an understanding of the health research landscape. You’ll need to demonstrate a commitment to, and understanding of, the principles of the JLA. Of course, you will need to be passionate about bringing patients, carers and clinicians together to jointly agree on the questions that are most important to the future of health research.

If you are interested one of the senior advisers, Katherine Cowan, has described a typical week for a JLA adviser. Read more at JLA website.

Applications go live from 9 January www.jla.nihr.ac.uk 


Partnership Fellowships

  Created on Wednesday, 12 Dec 2018. Posted in Funding

The NIHR Academy is partnering with seven of the UK's leading medical charities for the first time, offering jointly funded Partnership Fellowships, at both Doctoral and Advanced (post-doctoral) level.

  • Diabetes UK
  • Kidney Research UK
  • Moorfields Eye Charity
  • MS Society
  • Muscular Dystrophy UK
  • Pancreatic Cancer UK
  • Parkinson's UK.

The Partnership Fellowships are now open.


Recent research design publications December 2018

  Created on Wednesday, 12 Dec 2018. Posted in Literature


New NIHR Themed Review: Help at Home

  Created on Tuesday, 04 Dec 2018. Posted in Dissemination

Help at Home brings together recent NIHR and other government funded research with focus on the use of technology in the home and designing better environments for older people. It features:

  • 40 published studies
  • Questions to ask about how technology can support older people living with complex conditions and what designs could help create an ageing friendly environment.

Mental Health of Children and Young People in England

  Created on Monday, 03 Dec 2018. Posted in Mental Health

Major surveys of the mental health of children and young people in England were carried out in 1999, 2004, and 2017. While many surveys use brief tools to screen for nonspecific psychiatric distress or dissatisfaction, this series applied rigorous, detailed and consistent methods to assess for a range of different types of disorder according to International Classification of Disease (ICD-10) diagnostic criteria. All cases were reviewed by clinically-trained raters.

Comparable data is available for 5 to 15 year olds living in England in 1999, 2004, and 2017. The 2017 survey for the first time provides findings on the prevalence of mental disorder in 2 to 4 year olds, and spans the transition into adulthood by covering 17 to 19 year olds.

The latest survey was funded by the Department of Health and Social Care, commissioned by NHS Digital, and carried out by the National Centre for Social Research, the Office for National Statistics and Youthinmind.


Public Health Research: You can’t ignore the latest trends

  Created on Monday, 26 Nov 2018. Posted in Public Health

NIHR blog from Professor Frank Kee on Public Health Research

 As Einstein said: “We can't solve problems by using the same kind of thinking we used when we created them”.  We need new ways to tackle issues affecting public health as many fall into the category of life’s wicked problems.

I have been associated with the NIHR PHR Funding Committee since its inception, as a committee member and for the last three years, as its chair. Over that time, the programme has matured and evolved, forging relationships with other funders and sustaining NIHR’s reputation for supporting high quality research focussed on real world challenges. Over the last decade we have also witnessed trends in public health science, so we have adapted and harnessed the best of these to ensure that scientific excellence continues. I highlight a few of these trends here, to acknowledge that funders need to be visionary, nimble and occasionally take risks.

Addressing the real world problems

Our research questions must not be borne from disciplinary traditions but rather must be problem based. Thus our Prioritisation Committee, made up of practitioners and policy makers, use their knowledge and experience of real world public health practice to ensure prioritised proposals will result in usable evidence.

Importance of having multi-disciplinary teams

We place great importance on applicants having a broad disciplinary mix in their team, who can bring appropriate methods and insights to answer their research questions. I am encouraged to see evidence that universities increasingly value institutional collaborations to attract research funding and to build transdisciplinary capacity. 

Innovative research designs

There is a growing recognition that the “gold standard” randomised controlled trial (RCT) design is ill suited to the evaluation of the rather messier real world issues that we face.  Thus we have witnessed a growing number of applications that use alternative approaches such as natural experiments, realist evaluations, stepped wedge designs and difference in difference methods, to name but a few. Applicants to our programme need not be shy in making a case for their chosen approach when a conventional RCT can be justified as unfeasible or unethical.

The need for a population based approach

The PHR programme is not receiving enough applications that aim to test interventions that harness a population or systems perspective - this is one of our highest priorities. We have funded some excellent applications in this category - such as the evaluation of minimum unit pricing for alcohol and a study of the effects of reduced street lighting – but we want more! For decades, prevention science has been dominated by a focus on individual level research which arguably has diverted public policy away from the upstream determinants of population health. Leading scientists in our field have called for a more nuanced complex systems perspective.

Galtons Quincunx

Francis Galton’s ‘Quincunx’ provides an example of how emergent phenomena can arise as a result of such complex systems. What organises the distribution of the beads, is not the innate qualities of the “elements” (a metaphor for the people we are trying to help with our interventions), but the shape and placement of both the funnel and the pegs of the Quincunx. Together, these features (a metaphor of the way society is structured) determine which beads can pass through the pegs and their possible pathways (and health outcomes). Interventions based solely on individuals place too much emphasis on the elements (people) cascading through the Quincunx, rather than the system generating the distribution itself. Although individual level interventions and evaluations are still valuable, combining structural, population-wide interventions with individual based approaches could help maximise both effectiveness and health equity.  

Intervention development and adaptation

Since the release of the MRC Complex Intervention Guidance we have learned a lot about how important it is to adopt a careful and staged approach to intervention development and testing.  If we are to have scalable translatable public health interventions that can have traction in different settings, we must understand the elements from which they are built and how they are put together. It is a cliché to say that science never stands still and while new methods are emerging, all the i’s have yet to be dotted and t’s crossed with respect to intervention development. This is why in 2013 the MRC instigated the Public Health Intervention Development (PHIND) funding scheme. 

To conclude, if you are planning to apply to PHR please consider the above. We want to see more upstream, population-focused approaches to tackling public health problems. Make sure you engage with your public health community, develop a multi-disciplinary team, and don’t be afraid to use innovative research designs where the gold standard RCT doesn’t fit.

To aid you in the development of an application to PHR the Funding Committee have produced this short video of key elements to be aware of when applying. Good luck!

View our latest funding opportunities and submit your applications.

To find out more about the PHR Programme, read the blog from Professor Martin White (Programme Director).