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Table 2 Case study projects with impact summaries

From: Mechanisms and pathways to impact in public health research: a preliminary analysis of research funded by the National Institute for Health Research (NIHR)

Project TitleInstitutionNIHR Support StreamPeriod of supportFunding amount (£000 s)Summary of impact
How effective is the Forestry Commission Scotland’s woodland improvement programme - ‘Woods In and Around Towns’ (WIAT) - at improving psychological wellbeing in deprived communities?University of EdinburghPublic Health Research (PHR) Programme2012–16350–1000This study set out to explore links between environmental interventions – in this case, efforts to regenerate and enhance access to local woodland – and local residents’ perceived stress and mental wellbeing. The principal investigator, a professor of landscape architecture, worked collaboratively to generate ideas for the research from an initial concept developed with the Forestry Commission. The multidisciplinary research team included epidemiologists, health geographers, psychologists, and health economists. The team had not yet published findings, but noted a number of practitioner groups, as well as membership of a NICE guideline-writing group on physical activity, as receptive audiences with whom they had developed functional links.
Improving employment outcomes for young people with first episode psychosisSouth London and Maudsley NHS Foundation TrustResearch for Patient Benefit (RfPB) Programme2008–120–350This was the first UK randomised controlled trial exploring how to overcome barriers to helping young people with psychosis return to work via the delivery of individual placement and support (IPS) services – an intervention for which there was already good evidence of patient benefit. It examined the effect of training clinically-based vocational staff in motivational interviewing techniques, to enhance their provision of IPS services. The team partnered with ImROC, a non-profit consultancy with experience of working with NHS Trusts to implement recovery-based models of service delivery. Key factors in the success of the study appeared to be the provision of a dedicated member of the ImROC team working with clinical staff to ensure fidelity to the recovery-based model of care. The team also reflected that clinical teams responded positively to seeing the results of patients’ return to work (i.e. social outcomes), helping to overcome a perceived risk that patients were more likely to relapse. The study showed the benefits of placing and training specialist vocational support staff within the clinical team, with significantly more patients remaining employed following their receipt of the enhanced IPS model. The researchers noted a short-term view of the financial burden placed on NHS trusts from employing these staff as a barrier to achieving impact.
An evaluation of a water fluoridation scheme in CumbriaSt George’s, University of LondonPublic Health Research (PHR) Programme2013–201000+This study was set up in response to a systematic review and MRC working group report calling for improved evidence of the benefits of water fluoridisation. It seeks to evaluate the effects of reintroducing fluoridisation to a population of 5–11 year-olds in Cumbria, following its removal for a period of 5 years while the water system was updated, and the effect of this on children’s dental caries. The team worked with local schools to recruit participants to the study, reflecting that they held back on using social media as an adjunct to recruitment, due to the negative reaction of groups advocating against fluoridisation. They noted the complexity of convening multiple groups – researchers, commissioners, policymakers – as a challenge for public health research, made easier by having Public Health England as a central convening body. They also highlighted a capacity issue arising from limited clinical staff choosing public health as a career, and the need for advocacy from NIHR to make researchers more aware of the different pathways available to them. The team published their study protocol in 2016, and were awaiting results of the study before publishing further information.
Diabetes Prevention ModelUniversity of SheffieldSchool for Public Health Research (SPHR)2014Not availableThe central aim of this project was to develop a new model to evaluate the cost-effectiveness of public health activities to prevent diabetes. The team had early engagement with representatives from NHS England, who in 2015 had expressed an interest in understanding the economic impacts of activities (such as education on healthy eating and lifestyle, help to lose weight and bespoke physical exercise programmes) planned under the national Diabetes Prevention Programme. The team developed the model into an online tool that allowed local NHS commissioners to assess the potential return on investments from prevention activities planned in their local areas, and on different local populations. In parallel they also developed a similar tool for local authorities, following a call from Public Health England. Information from the modelling work informed rollout of the Diabetes Prevention Programme in 2016 and work commissioned by NICE on who to prioritise when planning diabetes prevention programmes.
TOMMY trial: A comparison of TOMosynthesis with digital MammographY in the UK NHS Breast Screening ProgrammeUniversity of CambridgeHealth Technology Assessment (HTA) Programme2010–131000+Breast tomosynthesis is a recently-developed technique that uses a series of low-dose X-rays to build up a 3D picture of the breast tissue. The team’s motivation for trialing this technique was to detect cancers when they were smaller, and reduce the ‘recall’ (false positive) rate of patients called back for further testing. The team worked with INVOLVE and a patient advocacy group – Independent Cancer Patients’ Voice – on the best way to design an initial trial, which recruited to its target of over 7000 women and was published in 2015. Discussions with Public Health England and the National Screening Committee made it clear to the study team that this initial data was insufficient to effect a policy change on national screening for breast cancer. They highlighted both the conservative nature of these organisations, and also the controversy of breast screening with the public. The team are therefore using the data from the initial trial to design a larger trial involving 100,000 patients. They are considering ways to involve policymakers upfront, and also working with a social scientist to explore public perceptions of screening in the context of their research.
A 1-year follow-on study from a randomised, head-to-head, multicentre, open-label study of two pandemic influenza vaccines in childrenUniversity of OxfordHealth Technology Assessment (HTA) Programme2010–11350–1000This study responded to the UK Government’s purchase in 2009 of two pandemic influenza (H1N1, or ‘swine flu’) vaccines, Celvapan and Pandemrix, and an urgent need to test their safety and efficacy in children. Public Health England had contacted the Oxford group given their ‘track record in delivering trials’, though the study team involved three other centres with established clinical trials groups. The team fed emerging results through to Public Health England and the Joint Committee on Vaccination and Immunisation, as data was gathered. They reflected that the UK was unusual in using unpublished data in this fashion to inform policy decisions, and noted that the UK regulatory environment and exiting relationships with the Department of Health helped ensure that the research was able to move swiftly, given the emergency nature of the pandemic. Impacts of the trial included the children who were vaccinated and the Department of Health, who benefitted from guidance on how to conduct trials in pandemic situations. One negative impact was an association with children developing narcolepsy, which was noted as a rare side effect of the Pandemrix vaccine.
Evaluation of a National Surveillance System for mortality alertsImperial College LondonHealth Services & Delivery Research (HS&DR) Programme2014–16350–1000Following their work on the Shipman Inquiry, the Dr. Foster unit at Imperial College London developed a national system to generate monthly alerts from routinely collected hospital administrative data on 122 diagnoses and procedures. Their evaluation was designed to address concerns of bias and establish the extent to which variations in quality of care was a factor in triggering alerts. The team had already been sending mortality data freely to NHS trusts, copying the Care Quality Commission (CQC) if it exceeded a certain threshold. They ran a workshop with CQC to help with recommendations based on their research, in particular the service and mode of delivery of the alerts. The team were taking a mixed-methods approach to understand institutional responses to mortality alerts. While they noted that the research was at an early stage, and that death is a crude indicator of underlying issues, the team hoped that their approach was supporting best practice in CQC investigations, and how hospitals can respond well. They flagged that social media engagement around their findings had ‘turned nasty’ due to its timings coinciding with the junior doctors’ strike.
Comprehensive Longitudinal Assessment of Salford Integrated Care (CLASSIC): a study of the implementation and effectiveness of a new model of care for long-term conditionsSalford Royal NHS Foundation TrustHealth Services & Delivery Research (HS&DR) Programme2014–20161000+The aim of this project was to evaluate the changes that had been made in Salford to the provision of care for long-term conditions reflecting a move towards integrated care. The study found that integrated care did not have a significant impact in terms of reducing hospital admissions as intended. The challenge in disseminating these findings since they are in contradiction to the current direction of travel in terms of the organisation of care within the NHS and the wider policy landscape. Significant investment has been made in integrated care in some locations and as such this is a challenging message to share that will not necessarily be openly received by policy makers and practitioners.
Prenatal screening and treatment strategies to prevent group B streptococcal (GBS) and other bacterial infections in early infancy: cost effectiveness and expected value of information analysesUniversity College LondonHealth Technology Assessment (HTA) Programme2005–60–350,000HTA commissioned this study in the context of wider decision-making processes around levels of evidence required to adopt screening strategies for common infections in early infancy. A larger randomised controlled trial costing £12million had been planned, involving 600,000 women, to evaluate the effect of screening for group B streptococcal (GBS) infections. The 2005 study brought together methods experts in techniques to model the economic value of generating further evidence – in this case, applied to existing treatment and screening options for GBS infections. The main impact was that the study team concluded that running the larger controlled trial would not be cost-effective: the trial was therefore called off. Instead, resources would be better spent on treating patients at a higher risk of infection, and investing in developing a vaccine. The team noted that their involvement in fora that brought together different groups throughout the research – their case, a patient advocacy group, members of the larger planned trial team, and the UK National Screening Committee – provided the means to allow them to apply relevant evidence from their study. They noted a barrier to further impacts in this area as the challenge of making routinely captured infection surveillance (i.e. audit) data available for research purposes, and that trials funding might usefully be redirected into ways of improving access to and use of these data.