Monday, 12 November 2018

Why I left a full-time teaching role to pursue a passion for school food research

Kelly Rose, Graduate Tutor/PhD researcher at Teesside University, writes about her journey to help young people make healthy food choices in a guest post for National School Meals Week.


‘Why?’ was the question I was asked numerous times when I first announced that I would be leaving my role as ‘Head of health education, and food and nutrition’ teacher in a well-respected secondary school. A job everyone around me knew I had loved; it had provided me with job satisfaction and I was able to make a difference everyday (because that’s what teachers do). To add to the incredulity of those around me, not only was I leaving this hard earned role, I was taking a 50% pay cut to embark on a short-term research contract to complete my PhD with no assurance of job security afterwards!

Here is a little background about why I came to - what was for me - a very easy decision.

As an adolescent I found myself in an extremely confused state about healthy food choices, being the ‘right’ weight and having a positive mental health. Then, when I became a mum, the painful realisation that my girls may be feeling that confusion made me want to make a societal change in whatever way I could. Not really knowing where to start, at 32 years old I threw myself into a degree in Food, Nutrition and Health Science. At this stage my only qualifications were four GCSEs and a BTEC diploma in Travel and Tourism. I still don’t know how I believed I could do it!

Three years later I had become so passionate about the power of food that I wanted to teach it to as many young people as possible. With renewed confidence, my First-class honours, and an award winning third-year ‘school lunch’ poster project, off I went to complete a PGCE in design and technology. In that year I spent more time making a wooden stool than learning about nutrition (approximately three hours) because that’s how we still train food teachers – but that’s a story for another time.

I discovered that I loved to teach and, in addition to my teaching, did all I could to help young people make healthy choices. I researched interventions, registered on courses, spoke at various events including ‘Food Matters Live’ in London and was invited to speak at a dietetic student conference at The Hague, Holland. I was thriving and learning so much about the education system: the teaching leads were happy, the GCSE results were superb, and we were improving the healthy choices and the health education in the school. It was a fantastic opportunity to be in a place where the leadership supported the health agenda. Even so, after a while, it became clear that there were barriers that were much larger than the school environment: policy change had become confusing and the support in implementing food standards had disappeared. The external environment of advertising close to schools, proliferation of fast food outlets and shops offering cheap energy drinks. The social norms around eating behaviour in our teenagers had become a turbulent misunderstood tangle of factors, and this with all of the curriculum changes and budget cuts! It was in my last two years (of seven teaching) that I spent time writing PhD proposals, knowing that to make a change I needed to be able to add research to this field, to inform the decision making processes.

That is why I feel extremely lucky to have been given the opportunity to do research at Teesside University and to have access to inspirational researchers and existing work through the Fuse network, and of course to fulfil the dream of having a positive impact on the school food environment.

I am now 8 weeks into my graduate tutor/PhD researcher post and I am sure that I have made the right decision. I used the library every day in my first week, pinching myself, not quite believing I was here with time to research and learn. Every day I am learning and have so far developed a timeline of policy past-to-present, an ecological framework of everything that impacts school food choice from the macro level (government structure and policy, sustainability focus, food supply, food industry and manufacturing, behaviours etc.) to the external and internal physical settings and the individual students. I know from my time in education that consistency and communication are key components of making sustainable healthy change in schools. I hope that I will be able to provide a clear direction on where that focus should be to contribute to the reduction of the ‘obesogenic’ environment for our young people. I have far to go in understanding the myriad of methodologies required to do this work, but I will delve into past research and attend workshops to learn all I can. As I develop questions and embark on a systematic review I have the feeling that I am at the bottom of a huge mountain, ready to make the climb. It is just the beginning and I am aware that significant patience and discipline are going to be needed to get to the top of that mountain.

I look forward to meeting you on my journey.


#schoolmealsshoutout #NSMW18

Find out more about National School Meals Week here: http://thegreatschoollunch.co.uk

Friday, 2 November 2018

Why dramatic enquiry as a form of public engagement gave me my most enjoyable week as an academic

Guest post by Santosh Vijaykumar, Vice Chancellor’s Senior Research Fellow, Northumbria University

“It’s important to eat healthy but we also need sugars, although in moderation.” These are not the words of an expert on BBC’s Food Programme, but a Year 5 student at Chillingham Road Primary School in Newcastle, fidgety and impatient for the next activity to resume. And the caution came about not through a series of in-depth interviews by public health researchers such as myself, but through ‘dramatic enquiry’. Brad McCormick and Katy Vanden from Cap-a-Pie, the theatre company that developed this approach, describe it as one that “places participants in a fictional scenario where they are in-role from start to finish. They are placed in a situation where there is no clear ‘right’ or ‘wrong’ answer and where they have to express their own beliefs and values.”

Brad directing the drama

Over the course of a week, we conducted four such dramatic enquiry workshops with three schools in Newcastle, each session comprising approximately 30 Year 5 pupils (10-11 year olds). Although these workshops were part of the public engagement strategy of my ongoing ESRC funded project* that seeks to understand psychological drivers of confidence in probiotics products, we decided to explore broader themes beyond just probiotics. The aim – suggested by Brad and Katy and gladly welcomed by us – was to avoid a top-down health education approach, and instead utilise this engagement format to get children to think and talk about fundamental issues: why do they eat what they eat? Can food be healthy and unhealthy at the same time? Should the government control what foods we consume? What is the relationship between responsibility and choice in the context of food? We used these themes as a funnel to eventually involve the children in a discussion on probiotics.

Each workshop starts with the children seated in a semi-circle. As soon as they are settled, Brad catches them off guard. He starts shaking hands with one of them and says “I ate at your restaurant last week, superb!”, and then goes to another: “I read your article on raw food diets, so interesting!”, and so on and so forth, setting off a series of giggles or muffled peals of laughter among the children as they make sense of the goings on. Soon after they are informed that they are all members of the Food and Drink Committee of Arcadia (a fictional country) and are asked to take a pledge of allegiance to Arcadia. A series of dramatic games such as DilemmaRama, Shake Hands/High Fives and Stop/Go has now completely warmed them up to Brad and to each other. This lays the foundation for their enthusiastic participation in the ensuing small group activities, each of which is followed by a philosophical discussion or reflection.

The small-group activities include identifying and enacting their favourite dish in a freeze frame, contemplating what it means to be healthy, and explaining the rationale for why they agree or disagree with a certain food policy from different viewpoints (as a journalist, scientist, manufacturer, etc.). In the second half of the session, they are introduced to a fictional probiotics product, to develop a commercial for it, and then asked to make a decision about whether it should be sold after exposing them to news articles reporting conflicting evidence related to the health effects of probiotics products.

As a researcher, observing these sessions live can be tough – it’s so much fun, you want to participate with the kids and leave taking notes for later. And taking notes is not easy either, even after you have committed to it. For, you realise quickly that every activity and philosophical discussion reveals a new strand of thought among children, a sharp, counter-intuitive insight, or a larger ethical perspective. As someone who is newly baptised to this form of public engagement, I realise how uninhibited and enthusiastic kids are in terms of participating in what would seem tricky terrain for adults, and how even seemingly quieter kids volunteer to voice their opinions. I am beginning to understand how this approach lends itself to unearthing perspectives of greater complexity and nuance than a traditional research method, such as a survey or experiment would. Essentially, if one were to invest in dramatic enquiry as a means of formative research for investigating a public health problem, they would reap a rich, and dare I say endless harvest of research questions worth investigating in a format that’s fun, engaging, and revelatory.

If you are waiting to know what we learned from these workshops, I will share links to a podcast series (on this blog) sometime over the next few weeks. These podcasts will give you a more detailed idea about dramatic enquiry, how the participating children benefited from it, and some perspectives that emerged about how kids perceive scientists, media, and the industry that really surprised us.

When I first arrived into the UK academic environment in February 2017, public engagement seemed a policy or media interfacing, translational exercise for researchers. Being involved in dramatic enquiry has now broadened my personal understanding of public engagement and triggered a cascade of ideas about creative ways to get a conversation going with communities whose lives we seek to positively influence through public health research. And, without a doubt, it has given me my most enjoyable week in eight years as an academic. Brad and Katy deserve some chocolate cake, but in moderation.

*Acknowledgment: This project was funded by the Consumer Data Research Centre, an ESRC Data Investment, under project ID CDRC 085, ES/L011840/1; ES/L011891/1.

Friday, 19 October 2018

What’s a night out without a takeaway?

Ingrained & intertwined risky drinking & eating habits

Posted by Stephanie Scott, Senior Lecturer in Criminology & Sociology, Teesside University

A recent Fuse blog post reflected on the ways in which alcohol and food come together in the lives of young adults (Cassey Muir and Alice Graye ‘the booze, the binge and the bulge’). For example, some young adults may eat a takeaway after a night of drinking and a fry-up the next day, some may choose not to eat prior to drinking and some may drink alcohol alongside a meal. Such reflections are based on findings from the recently completed FOrwaRD project, a study that I have had heavy involvement in as a project applicant and lead researcher.

Yet, whilst the reflections of those on the cusp of adulthood are extremely important, one of the key messages from this project and an abundance of public health research evidence is that behaviours such as risky drinking and associated eating patterns become ingrained and intertwined in our lives long before we turn 18. In other words, health behaviours cluster in adolescence and track to adulthood. Think back. How long have you associated a beer with a curry or white wine with fish or, more bluntly, that going for a takeaway at the end of a night of heavy drinking is the norm? And, are these messages instilled in us during adolescence or perhaps even earlier in childhood? We also know that an unhealthy approach towards food and alcohol is more likely for some young people than others, particularly for alcohol, where we have seen a steady decline in the overall percentages of those who drink alcohol juxtaposed against those who do drink doing so at extremely high levels.

My point here is that, not only do eating and drinking behaviours interact, but the influences on these behaviours, such as parents, peers, marketing, urban space, also overlap, and overlap from an early age. Frankly, we eat and drink certain products for pleasure, for popularity or to socialise. One way in which to tackle a growth in obesogenic and alcohol-related harm is to explore overlapping and distinct influences on these behaviours at the point in which they accelerate i.e. late childhood / early adolescence and use this knowledge in the design of interventions which link rather than separate out such behaviours.

With this in mind, we set out (using Fuse pump prime funding) to identify and synthesise qualitative research evidence into common underlying factors which influence alcohol use and unhealthy eating behaviours amongst young people aged 10–17. This involved bringing together two separate bodies of literature to enable analysis and comparison across two associated fields of study. Thus, our synthesis involves the interpretation of individual studies by identification of second-order constructs (interpretations offered by the original researchers) and third-order constructs (development of new interpretations beyond those offered in individual studies) by way of the development of a ‘model structure’ of shared influences upon both unhealthy eating behaviours and alcohol use amongst young people aged 10–17.

Of the 63 studies included in the review, 27 studies focused on alcohol whereas 36 focused on eating behaviours. Initial analysis of the data identified 16 themes, 14 of which demonstrate shared or overlapping influences on young people’s alcohol use and eating behaviours. For example, we found that both alcohol and food were used by adolescents to overcome personal problems such as to relieve stress, to push away negative feelings or emotions and in some cases to replace human interaction: “…it’s a way like any other to forget or to let off steam, it depends on the person.” (Petrilli et al., 2014).

Whilst these findings are at an exceptionally early stage, one thing is clear – there remains very little research linking young people’s eating behaviours and alcohol use together. Hopefully, emerging publications from this review and the FOrwaRD project will help to lead this change.

With thanks to the core project team Louisa Ells, Emma Giles, Frances Hillier-Brown and Wafa Elamin.


Reference:
  1. Enrico Petrilli, Franca Beccaria, Franco Prina & Sara Rolando (2014) Images of alcohol among Italian adolescents. Understanding their point of view, Drugs: Education, Prevention and Policy, 21:3, 211-220, DOI: 10.3109/09687637.2013.875128

Thursday, 11 October 2018

Safe negotiation of neighbourhoods should be non-negotiable

Posted by Lesley Haley, AskFuse Research Associate, Teesside University

It’s World Sight Day today. This annual event highlights a range of issues surrounding visual impairment, and the day is linked to the World Health Organisation’s Global Action Plan on sight health. Today is also ‘bin collection day’ where I live, when wheelie bins and recycling boxes migrate from their backyards and gardens to clutter our pavements. It’s a weekly event that occurs in every village, town and city. It’s also a weekly hazard to be negotiated and endured by thousands of our neighbours. Especially those with visual impairment.





It’s not an obvious connection - World Sight Day and ‘bin day’. And frankly it was a connection that didn’t occur to me either, until I went to the ‘Negotiating Neighbourhoods’ event earlier this year, run by Fuse, the Royal National Institute for the Blind (RNIB), and the Sight Service. The event examined getting around our neighbourhoods, and gave feedback on Newcastle City Council/RNIB’s Newcastle Street Charter. The Charter describes the barriers faced by people with sight loss or mobility issues, and the actions and commitments needed and agreed to reduce these barriers (Newcastle City Council 2017). At the event, policy makers, researchers and people who are experts by experience shared their opinions and insights into safely getting around the built environment of our streets, local neighbourhoods and public spaces. This included feedback on the proliferation of street furniture such as advertising boards, lamp posts, bollards, street signs, bushes, cars parked on pavements, and wheelie bins (Newcastle City Council 2017).

Sight loss affected more than two million people in the UK in 2015, with one in five people aged over 75 living with some form of sight loss, including macular degeneration (RNIB 2018c). So for a significant number of our neighbours with mobility or sight issues, street ‘clutter’ is an increasingly frustrating and problematic issue.

It’s a public health issue too. Street furniture is impacting the health and wellbeing of people with mobility or sight loss issues. The built environment, and the street furniture cluttering it, “is restricting physical activity participation for people with sight loss” (Phoenix et al, 2015, p.127). Sight loss is associated with reduced physical activity, and the adverse social, economic and psychological effects of sight loss are being more widely recognised, including loneliness and isolation (Sim and Mackie 2015). Even the Design Council (2017) reported that ‘hostile’ public spaces could increase people’s risk of disease as it contributed to sedentary lifestyles and social isolation.

Can the humble wheelie bin really be classed as ‘hostile’? The experts by experience at the ‘Negotiating Neighbourhoods’ event have bitter experiences to prove it. Research in public health would also back them up. In 2015, 95 per cent of blind and partially sighted people reported that, in the previous three months, they had collided with a street obstacle, and a third said they had injured themselves while walking around their local area (RNIB 2015a). Many participants in the research carried out by Phoenix et al (2015) talked about injuries and also damage to their self-esteem when outdoors, because of a poorly designed built environment. Street ‘clutter’ is literally having a big impact on our neighbours as they try to navigate our streets.

At the ‘Negotiating Neighbourhoods’ event, the audience was asked “What changes could make the situation better?” Well, from a personal perspective, I have tried to stop parking my car on the pavement, have changed where I place my wheelie bin on ‘bin day’, and have tried to write (this) my first ever blog to raise awareness of the issue.

So what are your thoughts? Could you make one small change in your neighbourhood to make everybody’s everyday journeys just a little bit safer?

Surely, on World Sight day in 2018, being able to safely negotiate our neighbourhoods, should not be negotiable?

#WorldSightDay


References:

Design Council (2017) Creating Health Places Available at: https://www.designcouncil.org.uk/what-we-do/built-environment/creating-healthy-places (Accessed: 23.08.2018).

Newcastle City Council (2017) Newcastle Street Charter. Newcastle: Newcastle City Council. Available at: https://www.newcastle.gov.uk/sites/default/files/wwwfileroot/your-council-and-democracy/equality-diversity-and-citizenship/newcastle_street_charter_final.pdf (Accessed on: 23.08.2018)

Phoenix, C. Griffin, M. Smith, B. (2015) ‘Physical activity among older people with sight loss: a qualitative research study to inform policy and practice environment,’ Public Health 129 (2) pp. 124-130

Royal National Institute of Blind People (RNIB) (2015a): Daily assault course of street obstacles and dangerous crossings injuring blind people. Available at: http://www.rnib.org.uk/daily-assault-course-street-obstacles-and-dangerous-crossings-injuring-blind-people. (Accessed 26.04.2018)

Royal National Institute of Blind People (2018c) Key information and statistics on sight loss in the UK. Available at: https://www.rnib.org.uk/professionals/knowledge-and-research-hub/key-information-and-statistics (Accessed: 01.06.2018).

Sim F, and Mackie, P (2015) ‘Sight – the most critical sense for public health?’ Public Health. 129 (2) pp. 89–90. Available at: http://dx.doi.org/10.1016/j.puhe.2015.01.009. (Accessed: 22/08/2018)

World Health Organisation (2009) Global Action Plan for the Prevention of Avoidable Blindness and Visual Impairment 2009-2013. Available at: https://www.iapb.org/resources/who-action-plan-for-the-prevention-of-avoidable-blindness-and-visual-impairment-2009-2013/ (Accessed: 23.8.2018)

Friday, 5 October 2018

Starting out and getting ahead in obesity research

Guest post by Enzo Di Battista, Research Dietitian at Aneurin Bevan University Health Board

In the lead up to the UK Congress of Obesity (#UKCO2018), I attended an Early Career Research Workshop in the beautiful grounds of Newcastle University.

Dr Maria Bryant chaired the event in which we had three talks with some interactive elements.  Here I share a few reflections and tips from the workshop.

Grant application and interview success

Professor Judith Rankin kicked off with ‘Skills to enhance the success of (fellowship) interviews’. The talk was split into three main sections – completing a fellowship application, what to do prior to the interview and what to do during the interview.

On listening to Professor Rankin’s advice on completing a grant application for research, I noted ‘5 tips’:
  1. Start early on the application – you should take about a year to draft, critique, draft, critique, and draft and critique (you get the idea).
  2. Ensure you have a good supervisory team around you for advice and support.
  3. Speak with additional experts in research methods. This might be a statistician or an experienced qualitative/mixed-methods researcher.
  4. Contact senior people in the obesity field. Most are friendly people willing to take a look at draft applications, if given plenty of time to do so.
  5. Liaise with your local clinical trials unit for advice (England), (Scotland), (Wales). 
Getting the application shortlisted is just the first step however, you have to convince funders of your credibility to give you the money. The post-doc fellowship interview is all about YOU, your vision for the research project (not a supervisors) and your commitment to a research career. To ensure you’re ready for interview, Judith stressed the importance of mock interviews. To demonstrate, Dr Bryant stepped up to role play with Judith and we had video interview examples.

To increase the likelihood of success at interview, a panel expects that you have: 
  1. Enthusiasm for your project.
  2. Designed an achievable project.
  3. An understanding of the questions you are trying to address.
  4. An understanding of the experimental approaches you plan to use. 
Influencing health-care policy

Dr Barbara McGowan was next to take to the floor for the second talk titled ‘Conducting research with an aim to influence health-care policy’.  She talked us through her career development, from working in the city as an analyst to becoming a medical doctor and research lead. Her story left the impression that her early work had given her an 'edge', improving her data interpretation skills and had benefited her research career path.

The main take-home for me was the clinical research Barbara was undertaking in pharmacotherapy (therapy using pharmaceutical drugs) for obesity. I summarised it in this tweet at the time:
Semaglutide isn’t licenced in the UK but Barbara feels it will be in the next year or so.

Evaluating public health interventions

Upon returning from a comfort break we settled down to listen to Professor Ashley Adamson, Director of Fuse, talk about‘Evaluating public health interventions’. Ashley highlighted “The value of collaboration” and taking time to develop networks across sectors (industry, public sector, third sector, local government) to establish and maintain public health interventions.

Ashley asked us to form groups and consider how we would implement and evaluate a breakfast club initiative in primary schools. It was a useful exercise to consider what skills (e.g. project management, capacity/network building) and processes (ethics and legalities of working with school children/participant group) were needed for public health interventions and evaluation.

My favourite slide from the talk was entitled ‘An ideal evaluation’ which, as you can see from the picture below has 5 key points, with full references (BRILLIANT!).




























Before closing the workshop, Maria asked for everyone’s opinions on the afternoon and what they would like from future events. On reflection, I felt that maintaining such a high calibre of speakers was key to the quality of the workshop – so that needs to be consistent. Perhaps in future, it would be interesting to hear about emerging subjects within the obesity field and to invite someone who has recently completed a PhD or Post-doc fellowship to share their personal experiences.

If you have any thoughts on what makes for an excellent Early Career Research Workshop please feel free to post a comment below and I can feed it back to the UKCO2019 organising committee. Many thanks!

Friday, 28 September 2018

Cancer and the simple pleasure of a good cuppa

Posted by Duika Burges Watson, Lecturer, Institute of Health and Society, Newcastle University

Thousands of people will today enjoy catching up over cake and a cuppa for the World's Biggest Coffee Morning, Macmillan Cancer Support's biggest fundraising event. But what if after cancer that cuppa and cake don’t taste right?

“When I had been through the treatment and was supposedly ‘cured’, I had hoped a cup of tea would do what it had always done and give me pleasure. But it didn’t, the tea had a textural product in it so I could swallow it. It wasn’t tea anymore, I felt miserable with it”


So said one of the head and neck cancer survivors who participated in our NIHR Research for Patient Benefit (RfPB) funded study, ‘Resources for Living’. Living beyond the life-saving treatment for cancer, all participants in our study had on-going difficulties with food and eating. It’s not the same for everyone, some people return to normal eating, but for those that live long-term with ‘altered eating’ and the unique difficulties they have, it can be miserable.

Since we formed the Altered Eating Research Network at Newcastle University following the end of the study, we’ve come to appreciate just how widespread the problem is of altered eating. Far from limited to cancer survivorship, we have a long list (and one that grows with each successive public engagement event) of conditions and experiences that may result in altered eating. We define ‘altered eating’ as a changed state of any combination of physical, emotional and social interactions with food and eating that has a negative impact on health and wellbeing. It’s a deliberately broad definition that we’ve found useful in charting a new approach to addressing it.

And on public engagement. We are very lucky to have Sam Storey, BBC Food and Farming ‘cook of the year’ finalist, 2018, as one of our team members. His passion for food notwithstanding, Sam has a unique empathy for those that have lost enjoyment in food and a remarkable skill at finding ways to bring that pleasure back. If there was a headline for our research and events it would be that ‘pleasure matters’. With increasing evidence[1] from the neurological sciences, and the advent of a research focus on ‘hedonia’(pleasure) and eudaimonia (satisfaction) in human wellbeing (e.g. the Journal of Happiness Studies) it appears there is a very real reason for the importance of pleasure to wellbeing. Combined with the feedback we get from events and research, we are ploughing ahead with a whole range of ideas of how we can help those that experience a loss of pleasure and find eating a burden.

Over the summer we ran two very successful events in collaboration with the Whitley Bay Film Festival. Two chocolate themed events - a ‘smell-along’ experience of the Spanish movie Like Water for Chocolate, and an ‘eat-along’ experience of Chocolat. They were for general audiences, but at each we introduced the films with information about the research we are doing with Altered Eating. Both events were sell-outs and great successes. You can read a blog about one person’s experience of the first event here. But as with the other events we’ve held in the last year or so (flavour masterclasses for example) we invariably discover something new, meet someone who is affected and distressed by altered eating difficulties.
Cook Sam Storey and Dr Duika Burges Watson: raining chocolate for the film festival

Our first serving during Chocolat was the most delicious hot chocolate timed perfectly to coincide with the moment Vianne Rocher (Juliette Binoche), an expert chocolatier, opens her shop in a conservative and austere rural French village. At 24 minutes in she serves hot chocolate, prepared with a ‘special kind of chilli pepper’, to the disbelieving Armande (Judi Dench), her elderly, eccentric landlady. With the first sniff and taste, Armande is emotionally transformed from bitterness to joy. For most of the movie-goers, the hot chocolate Sam had prepared was indeed a joyful experience. However, in presenting it to one person they told me “no thank you, I don’t like chocolate”. At first, I was perplexed, why pay for a chocolate eat along film if you don’t like chocolate? But then, in our research we’ve experienced this before, participants who didn’t want to participate in ‘eating’ at food play events (or not at first anyway). A reminder that food is more than about eating and that the commensal experience of being together with others matters too.

But chocolate is a little unique in terms of eating pleasures. As Professor Barry Smith, a member of the AE Network and expert in the sensory and hedonic elements of food notes, chocolate is for most, a hugely pleasurable experience that is both about flavour and texture, “the pleasure of anticipation and the reward in eating it match up. The aroma and the taste are the same. And that matters because there are two sorts of pleasure ivolved. When you start eating it, turn it around in your mouth to get the melting quality which strokes the tongue. Receptors in the tongue then respond to this stroking and it's a different feeling from touch. That's why we love a velvety wine or double cream - it's the feeling on our tongues”.

Ah yes, no wonder the tea didn’t ‘taste’ right.


Reference:
  1. Kringelbach, M.L., 2015. The pleasure of food: underlying brain mechanisms of eating and other pleasures. Flavour, 4(1), p.20.

Friday, 21 September 2018

Collaborating, meandering and consolidating to identify research priorities on welfare advice and health

Posted by Natalie Forster, Senior Research Assistant and Monique Lhussier, Associate Professor in Public Health and Wellbeing, Northumbria University and Fuse

As the judges of the Man Booker prize for fiction whittle down their long list and decide on the shortlist of books in the running for best novel of the year, we’ve been making a few (more research focused) lists of our own.

Setting aside our individual research plans and ambitions to focus on welfare and health
Funded by the NIHR School for Public Health Research, we are currently working collaboratively (from across Fuse, University College London, The University of Sheffield, and London School of Hygiene and Tropical Medicine) to set the future research agenda in the area of welfare advice and health. Working across this number of institutions, we have managed to set aside our individual research plans and ambitions and combine our expertise in a series of workshops to focus on the issues of welfare and health. Colleagues from the welfare advice sector have agreed to join us and are keeping the discussions grounded in the realities of practice, over the course of four workshops (this blog marks our half way point).

The first workshop saw us (tentatively at first) present our research to each other; with both our detailed topics and methodologies varying significantly, as one might expect. Deciding which research questions to pursue is a daunting task. Shortlisting questions was a delicate juggling act of managing our respective interests and expertise, while keeping practice perspective up front and centre, to ensure the usefulness of our future findings. This process also opened up fundamental discussions about the role of welfare advice in society, and how this should be studied.

One key area of debate concerns whether we should study the health impact of welfare advice, welfare itself, and/or systems of welfare provision in their broadest sense. At present, the UK boasts a welfare system that, in its complexity and inaccessibility, needs the intervention of advice services for users to access their entitlements. As researchers, should we therefore focus our attention on this hostile welfare environment, thought to perpetuate or deepen health inequalities, as opposed to advice services themselves? For example, a research emphasis on the health outcomes of advice might have been interesting but could play into wider failings to make benefits accessible if the advice-health relationship is proved any less than definitive. The group also considered whether advice services should be studied as an intervention or in terms of their function within society.

Further discussions centred around which outcomes, and particular user groups to focus on, and whether to study universal or means tested benefits, continuously swerving between the pragmatic and the theoretical, the national and the local. These fruitful meanderings were captured in a long list of possible research questions which we then worked to weigh up against agreed criteria. The result? A consolidated and (slightly!) shortened list of research questions, focused on five priority areas:
  1. Are there inequalities in the impact and reach of advice services across social groups? How/ does advice delivery mode matter?
  2. What are the individual and system level impacts of the de-implementation of advice services?
  3. What are the impacts of changes to welfare provision on children, inter-generationally and throughout the life course? 
  4. How do experiences of social welfare vary by social group, geographically and across generations? How do different identities combine to influence how social welfare is understood? 
  5. What is the impact of the rise in precarious employment and low wages on advice seeking and provision?
So quite a research agenda to fulfil! Throughout the remainder of the project, we’ll be engaging with advice sector representatives and recipients of advice to hear their views on the directions research in the area should take before developing concrete plans for how we could actually carry out this research. After that it’s time to commit pen to paper and draft those grant applications!

Friday, 7 September 2018

What has social media got to do with your mental health?

Niamh McDade, Senior Policy and Communications Executive at the Royal Society for Public Health

There is no denying that social media has revolutionised the way we communicate and share information. Social media has become a space in which we form and build relationships, shape self-identity, express ourselves, and learn about the world around us – so it’s really no surprise that social media is intrinsically linked to mental health!

Social media has huge potential to support good mental health and wellbeing and indeed, in many ways it does. Our Status of Mind report published in May 2017, examined the positive and negative effects of social media on young people’s health and after surveying 1,479 14-24 year olds, we revealed many benefits of social networking. It can provide young people who may be suffering from mental health issues an opportunity to read, watch or listen to, and understand, the health experiences of others – relating them back to their own reality.

We also found nearly seven in 10 teens reported receiving support on social media during tough or challenging times via ‘groups’ or ‘pages’ which allow users to surround themselves with like-minded people and share their thoughts or concerns. Adding to this, social media can act as an effective platform for accurate and positive self-expression, and a place to share creative content and express interests and passions with others.

All in all, it seems great, right? And you are probably asking why a public health organisation would be running a campaign asking users to go Scroll Free this September!

Whilst there are a range of benefits, for many of us, our relationship with social media has become a little complicated. This is understandable in an online world where we are faced with a constant influx of images and videos, unrealistic beauty standards and an endless stream of apparently blissful, happy relationships. Our research has shown social media to contribute to anxiety and depression, poor sleep, negative body image, cyberbulling and FoMO (fear of missing out) – characterised by the need to be constantly connected with what other people are doing, so as not to miss out.

Scroll Free September offers a unique opportunity to take a break from all personal social media accounts for 30 days during September. A good relationship is one of balance, and Scroll Free September is here to help you gain that with social media both on and offline. By going Scroll Free for a month, you’ll have a chance to reflect on your social media use – what you missed, what you didn’t, and what you got to do and enjoy instead!

The idea is that by taking notice of and learning which elements of social media make you feel good and which make you feel bad, participating in Scroll Free September could help you build a healthier, more balanced relationship with social media in the future – a relationship where your use is conscious and mindful, and where you are the one in control.

We know that going cold turkey on social media may seem a bit much of an ask for some, so before you start tweeting your excuses, there are a range of different options to make your participation that bit easier including:

1. The Cold Turkey

Give up all personal social media for 30 days. Looking for #inspo? Emma Stone, Jenifer Lawrence, Elton John and Simon Cowell are all scroll free.

2. The Night Owl

If going cold turkey sounds a bit much, you can choose to take a break from social media at evenings after 6pm.


 
 
3. The Social Butterfly

Why not try taking a break from social media at all social events - talk to your friends, listen to the music, eat your burger without worrying about the insta post – #connect.

4. The Sleeping Dog

Find yourself going to bed at a reasonable time with the best intentions, then spending hours scrolling through your social media accounts? Is the first thing you do in the morning check your newsfeed? Give up social media in the bedroom and improve your sleep.

5. The Busy Bee

Secretly scrolling your way through the working day? Give up social media in school, work or university and maximise your productivity.


Whichever plan you choose is up to you, but the more you disconnect with social media, the more you might get from it. You can still use it for work and of course, still use your device for other purposes. Our hope is that by the end of the month you will be able to reflect back on what you missed, what you didn’t, and use that knowledge to build a healthier relationship with social media which will last into the future.

Why not join almost 5,000 others across the world who have already signed-up. Who knows what you could get up to with all that free time spent Scroll Free!

Take the plunge and sign-up at www.scrollfreeseptember.org

Wishing you the best of luck!

Friday, 10 August 2018

Blogiday

The blog is on holiday over August but we still need your 500-700 word blog posts so that we can start September in style.

Please email them to Mark Welford (m.welford@tees.ac.uk).

Here's how to take part and why you should blog.




Image: "'Gone fishing'" by Stephen McCowage via Flickr.com, copyright © 2015: https://www.flickr.com/photos/130768092@N05/16139476647

Friday, 3 August 2018

The booze, the binge and the bulge

Guest post by Cassey Muir, Research Assistant, and Alice Graye, MRes Student, Newcastle University.

Drinking behaviours and eating behaviours in young adults have been widely studied separately, but our research - FOrwaRD; exploring FOod and Risky Drinking behaviours in young adults aged 18-25 - takes a novel perspective to try and understand how drinking and eating behaviours interact and the implications for interventions.

We hope that intervening in early adulthood, when these linked unhealthy patterns emerge and are prominent, may prove beneficial in reducing the risks associated with obesity and heavy drinking. From our formative research, there seems to be an unquestioned norm that drinking alcohol and eating unhealthy food link together in the lives of young adults. There are a number of ways in which drinking and eating behaviours may interact, for example, some young adults may eat a takeaway after a night of drinking and a fry-up the next day, some may choose not to eat prior to drinking and some may drink alcohol alongside a meal (look out for research on this soon to be published by Dr Stephanie Scott and colleagues). 

While the answer to how these behaviours link together may vary, it is clear that young adults are provided with a social benefit from their linked eating and drinking patterns. A benefit that seems to be the biggest barrier for intervening with these linked behaviours.

Alice and I recently organised a Fuse Quarterly Research Meeting. The event kicked off with three inspiring talks. Firstly, Sharon Hodgson the Shadow Minister for Public Health, gave her thoughts on young adult alcohol use and eating patterns from a policy perspective. This was followed by Fuse Associate Director Dr Amelia Lake, a Reader in Public Health Nutrition who delved into the obesogenic environments that today’s young people live in, with particular emphasis on the high rates of energy drink consumption in the UK. The current research findings of the FOrwaRD project were presented by Dr Stephanie Scott and the team. These findings led into the workshop activities for the day, with attendees giving their views on young adult associated eating and drinking habits and intervention strategies. The meeting was attended by over 50 delegates responsible for policy or service delivery for young adults; this included people from Local Authorities, voluntary sector organisations and Higher Education Institutions from across the North East, as well as three young adults involved in patient and public involvement. 
Sharon Hodgson, Shadow Minister for Public Health, at the
Fuse Quarterly Research Meeting
For the workshop activities, attendees visited ‘FOrwaRD’s Food and Alcohol Big Market’ in which there were tables representing ‘venues’ and everyone had time to socialise in two venues, one bar and one takeaway shop. At each venue there was a topic to be discussed, which were:
  1. Young adult eating and drinking patterns
  2. Current support for young adults
  3. Developing an intervention
  4. Recruiting young adults at risk
There was lots of energy and positive discussions throughout the workshop activities and a clear opinion voiced that young adults should be better supported when it comes to safer drinking and healthier eating and the link between the two. Ideas to support this focused on both individual and population based approaches. Firstly, young adults may benefit from a change in policy around the food and alcohol environment. This could include; reducing the amount of alcohol and food promotional offers, restricting development of fast food and alcohol venues (for example, on and around student campuses), or setting up activities that do not revolve around food or alcohol. While these discussions mainly focused on the environment in and around Higher Education campuses, this approach may be beneficial more widely.
“We need to have a shift in the way that we approach planning and licensing around universities or colleges. Obviously, it’s harder to do because there are a lot of people who don’t go to university and college who you wouldn’t reach with that.” Group 1
Indeed, in earlier interviews with young adults, it was also found that linked food and alcohol pricing, and the night-time environment could be target areas for change.

In addition, attendees also discussed the importance of targeting a young adult’s social network, tailoring the motivational hook and goals to the individual, whether that be to lose weight, save money, to improve their appearance or mental health awareness, and that we offer healthier - and just as social - alternative behaviours.
“Perhaps finding more avenues for socialising as well that don’t involve eating and drinking. There are plenty of other things to be doing.” Group 5
“The important thing is your hook and what motivates them, because if you don’t get that then you’re not going to.” Group 3
While student eating and drinking behaviours were seen as problematic, there was a view throughout discussions that these behaviours may change or improve upon graduating, and that going into employment may act as a buffer against these behaviours escalating. Whereas, young adults who do not go to university may benefit from an intervention in the long-term. One way of accessing young adults may be to start within the community setting and approach services that support them.

At the event we made fantastic connections to discuss our findings with other young adults within community settings such as the YMCA, Balance North East, Matrix, and the Young Health Commissioners.

Do you know of any organisations who work with and support young adults and who would like to find out more information or get involved with our research project? If so, then please contact me, Cassey Muir (cassey.muir@newcastle.ac.uk). We are aiming to run workshops over the summer with young adults to get their views on how we can support them to drink safe, eat well and be social.

#DrinkSafeEatWellBeSocial

Cassey and Alice are part of a multidisciplinary research team working on the FOrwaRD project. Cassey is an early career researcher running the day-to-day activities of the project and Alice is an MRes student working on the project, exploring students’ experiences.

Friday, 27 July 2018

Do councils have what they need to help tackle obesity?

Guest post by Michael Chang, Project and Policy Manager, Town & Country Planning Association

The new revised National Planning Policy Framework (NPPF) is published by the Ministry for Housing, Communities and Local Government this week (24 July). It now provides the policy basis for planning healthy communities (Section 8 Paragraphs 91 and 92). In this context, here I want to explore whether there are enough planning powers to successfully tackle fast food outlets. At a Fuse event earlier this year on ‘Planning for Healthier diets: restricting hot food takeaway proliferation’, I also highlighted interesting results of recent planning policy developments and planning appeal decisions.
 

Back to the future… again?

Firstly it should be stated that concerns about the physical built environment and food environment in relation to people’s health and wellbeing are not a new trend. There has long been an understanding (with increasing supporting academic evidence) of the negative implications of food deserts and extant planning policies to tackle the negative environmental impacts from food outlets such as smells, noise, opening hours, litter and traffic generation.

The Foresight Tackling Obesities report was published in 2007 which, in the context of addressing the issue through a whole system approach, suggested two actions in which urban planners can effect change in the living environment, one of which refers to food and drink access and availability[1]. But a year earlier, the Royal Commission on Environmental Pollution, an independent standing body established in 1970 to advise the Queen, the Government, Parliament and the public on environmental issues, had already highlighted availability and cost of healthy food as an environmental determinant to cardiovascular risk in its seminal 26th report on The Urban Environment[2].

Is there an enabling policy environment to tackle obesity?

Given the weight of evidence, research and high-level recommendations in the last decade, in 2018, do planning practitioners working in local authorities have the right policy tools to do something about it? The main indicator is whether local plans, which each local authority across England have created, have the right policies? Local plans are powerful because in addition to setting out the council’s long-term vision and pathway for creating sustainable local communities, they are the basis with which decisions on planning applications are made from extensions to your house, to opening new shops on the high street to the creation of a complete new neighbourhood.

CEDAR (Centre for Diet and Activity Research) will publish more extensive results on local plans and fast food outlet policies so I will focus on the wider issue of tackling obesity. As part of the Planning Healthy Weight Environment work in 2014[3], the Town & Country Planning Association (TCPA) undertook an extensive policy review of local plans in England. Forty-one percent (41%) did reference obesity but generally only in the introductory paragraphs where they identified that obesity was a problem in the area. Only 17% followed through to the policy sections, but always in the supporting text rather than in the policy text. In statutory Joint Health and Wellbeing Strategies, only 31% make specific links to the built environment as one of the wider determinants of obesity. 

There is no reason, if supported by evidence and needs assessment, for councils not to have relevant policies such as on active travel, open space and food environment with a specific objective to help reduce local obesity rates. Recent planning inspector reports on draft local plans, before they are approved by councils, indicate a growing positive picture of a more welcoming stance on restricting fast food outlet policies including greater acceptance of the exclusion zone approach.

Have planning appeal decisions been favourable?

How are councils actually faring when they apply these policies in defending their decisions to refuse planning permission for new fast food outlets? The picture is more mixed with some councils successfully defending their decisions while many others have their decisions overturned by planning inspectors. The justifications by planning inspectors are not as you might expect.

"...this is politics, it's not medicine..." - 24 TV series
To illustrate the way planning appeals have been decided for and against planning applications for new fast food takeaways, take for example a scene from the hit American drama ‘24’. President Palmer’s advisor Wayne Palmer said to the President’s doctor Anne Packard: “It’s he said, she said, you see this is politics, it’s not medicine, so do me a favour and stay out of it”. 

Most, if not all the recent judgements I have seen (but there would need to be a more systematic review), do reference national guidance and support the obesity crisis as a valid planning reason. The health and medical arguments appear to have been won, but other wider considerations including local ‘political’ issues come into play and only evidence presented on the day are valid. This scene underlies the tension in planning decisions, which is why in its three reports into the government’s Childhood Obesity Plan in the last three years, the Health and Social Care Select Committee[4] has consistently called for health to be a material planning consideration in an arena of competing considerations from economic to employment.

What does this all means?

There needs to be more research done in the area to better understand the implications of proliferation of fast food outlets on population health from the health inequalities lens. There also needs to be more applied research to understand why practitioners could not effectively implement policies and what the real barriers are. Evidence and aspiration can only go so far. It is time we all take a breather from pursuing perfect evidence to properly supporting practitioners at the coal-face.


Michael Chang is a Chartered Town Planner at the Town and Country Planning Association (TCPA), leads on TCPA’s Reuniting Health with Planning Initiative and currently undertaking a part time Master by Research at Leeds Beckett University on using planning powers to promote healthy weight environments.


References:
  1. Foresight, 2007, Tackling Obesities: Future Choices: https://www.gov.uk/government/publications/reducing-obesity-future-choices  
  2. Royal Commission on Environmental Pollution (RCEP), 2006, The Urban Environment: http://webarchive.nationalarchives.gov.uk/20110322144101/http://www.rcep.org.uk/reports/26-urban/documents/urban-environment.pdf
  3. Town & Country Planning Association (TCPA), 2014, Planning Healthy-weight environments: https://www.tcpa.org.uk/Handlers/Download.ashx?IDMF=7166d749-288a-4306-bb74-10b6c4ffd460
  4. Health and Social Care Select Committee, Childhood obesity inquiries reports 2015, 2017 and 2018: 

Images:
  1. "318-365 Year3 On Our Way Home" by John Garghan via Flickr.com, copyright © 2011: https://www.flickr.com/photos/johngarghan/6351566649
  2. By The original uploader was Tuxo at German Wikipedia. [Public domain], via Wikimedia Commons: https://commons.wikimedia.org/wiki/File:24-Logo.svg

Friday, 20 July 2018

How can governments reduce health inequalities in high-income countries?

Guest post by Dr Katie Thomson, Institute of Health and Society, Newcastle University

In recent months, there have been high profile stories of how governments can influence public health. The Scottish minimum unit price for alcohol introduced on the 1 May 2018, and more recently the publication of Chapter 2 of the Government’s Childhood Obesity Plan. This update proposed measures to address children’s exposure to junk food advertising on television and online, and called for a ban of price promotions on products that are high in fat, salt or sugar.

20mph zones were shown to increase inequalities in cycle accidents and
 rates of death between more and less deprived neighbourhoods

Such policies have great potential to improve public health, by shifting the distribution of health risk and addressing the underlying social, economic and environmental conditions (Hawe and Potvin, 2009)1. However, it is imperative to understand the impact of these policies on health across the entire social gradient. Thereby ensuring the most marginalised, are not adversely effected by policies which aim to improve health overall.

I have been part of a group of academics which recently completed an umbrella systematic review (‘review of reviews’) which aimed to understand the effects of public health policies in high-income countries. You can read about the research in a handy two-page Fuse research brief. As part of the Health inequalities in European welfare states (HiNews) project, we found evidence of 29 reviews (comprising 150 unique primary studies) which detailed the evidence of how fiscal (government revenue), regulatory, education, preventative treatment and screening approaches can be used by governments to influence health inequalities across eight key domains.

Conceptual framework of population-level preventative public health policies to reduce health inequalities
Our review highlighted 13 key interventions which were demonstrated to reduce health inequalities. These include taxes on unhealthy food and drinks; food subsidy programmes for low-income families; incentive schemes linked to immunisation status; proof of immunisation for school admission; tobacco advertising control measures; traffic calming measures; oral health (water fluoridation and tooth brushing campaigns); some nutritional and cancer education programmes; universal and targeted vaccinations for indigenous populations; and targeted and population screening interventions.

Worryingly, we also found evidence of interventions that were shown to increase health inequalities – potentially leading to so-called 'intervention generated inequalities’ (Lorenc et al., 2013)2. For instance, lowering alcohol tax by 33% was shown to increase inequalities in rates of death amongst disadvantaged groups in Finland. Environmental interventions, including 20mph and low emission zones, were also shown to increase inequalities in cycle accidents and rates of death between more and less deprived neighbourhoods.

Our research also demonstrates that for some potentially important interventions, such as for policies to control alcohol, there is a lack of robust evaluations highlighting the effects on different groups of people.

Given the volume of literature we found on the effects of government-led policies on health overall, it was disappointing that we could only identify 29 reviews that reported data on health inequalities. Going forward, those tasked with evaluating such policies must report how health outcomes differ for specific interventions by subgroup as standard. Furthermore, reviews should incorporate sufficient information on how the intervention was implemented and enforced to be useful for policy makers thinking of adopting such approaches. We also found many of the reviews and their primary studies were US-based, which could potentially limit the transferability of interventions from one country to another.

Undertaking a systematic review is not without its challenges. When published, the article reads like a definitive narrative when in reality it comprises a multitude of subjectivities – which reviews to include? Which primary studies are relevant? Which outcomes are most appropriate? And how to summarise the state of evidence in a particular field given multiple studies/reviews? The methodology is designed to be systematic, but as it uses human interpretation there is always an element of judgement. Umbrella reviews assess the state of the evidence across a wide area of interest, and are therefore worth the blood, sweat and tears which goes into producing them.

Upstream public health interventions involving state or institutional control offer great hope to improve health for all. However, a comprehensive understanding on the effects of different interventions is a necessary first step to ensure policies have an equitable benefit for all members of society and therefore are worthy tools at the disposal of governments tasked with improving health.


The Health inequalities in European welfare states (HiNews) project is a collaboration between the universities of Newcastle, York, Trondheim, Siegen and Harvard and funded by the New Opportunities for Research Funding Agency Cooperation in Europe (NORFACE).

References:
  1. Hawe, P., Potvin, L., 2009. What is population health intervention research? 100, I8-I14.
  2. Lorenc, T., Petticrew, M., Welch, V., Tugwell, P., 2013. What types of interventions generate inequalities? Evidence from systematic reviews. Journal of Epidemiology and Community Health 67, 190-193.
Photo: © Albert Bridge (cc-by-sa/2.0)

Friday, 13 July 2018

Putting the 'occupation' in Occupational Therapy and debating its role in Public Health

Guest post by Andrew Graham, Registered Occupational Therapist and PhD Candidate, Teesside University

Having recently made the move from NHS clinician into academia (I started my PhD at Teesside University in December 2017), I arrived in Belfast for the Royal College of Occupational Therapy Annual Conference with an appetite to hear new and interesting research in the profession.


In my welcome pack, I received a copy of the RCOT’s Strategic Intentions which represent the leadership response to the challenges of the changing landscape of health and social care. The principle that stood out for me was to ‘position the Profession, and our members, for the 21st century’.

With my background in amputee rehabilitation I have seen first-hand the impact of socio-economic inequalities and lifestyle trends on amputation rate in North East England. For example, the amount of amputations due to diabetes, and more shockingly intra-venous drug use, has spiked in the past 10 years or so. As an Occupational Therapist (OT), I view the person holistically and always try to take into account the social and psychological not just physical barriers they will need to overcome post amputation. My focus will always be on what the person needs and wants to do. The person’s meaningful activities (occupations).

The pledge tree

During the conference, we were asked to make a pledge about how we would do our part to ensure the new strategic intentions are met. The pledge tree seemed to have a recurring theme of ‘ensuring occupation is central to my work’.

My own pledge was to better explain ‘occupation’ and its meaning within occupational therapy to a range of audiences.

So, my attempt at articulating ‘occupation’? I’ll go with ‘doing things that we need to do and want to do (meaningful activities), which enable a sense of self-meaning and improved health and well-being.

I feel as a profession we are experts in using occupation as a goal (top down approach) and/or a means (bottom up approach) to ensure provision of high-quality, client centred services. Utilising the OT process from information gathering to evaluation we strive to enable growth, confidence and self-meaning.

Despite OTs generally being able to better define what they do and what the outcomes can be, it was a bit of a shock to see that the debate at the conference highlighted that the profession is still unsure about its stakeholders. The topic up for discussion was ‘This house believes that Occupational Therapy needs to be predominately based in public health, not in secondary or tertiary services’.

From my experience, this issue had been debated and answered years ago. My pre-registration training saw me working in the NHS, community mental health teams, a special needs school and a charity. The OTs all had a prominent and effective role in these sectors, so as intrigued as I was to hear the debate, I knew which way I would be voting!

For the purpose of this blog I’d like to highlight the case for OTs working in Public Health. A starting point would be the statement by the professional body, which points out that the Public Health Agenda has been of increasing importance and relevance for occupational therapists, who facilitate health promotion through working with people of all ages to enable their participation in meaningful occupations (RCOT 2004).

The evidence base is also pretty strong. A systematic review of Allied Health Professions and Health Promotion (Needle et al 2011) reviewed 28 studies related to occupational therapy and Public Health, and found related interventions in the areas of mental health, arthritis, pain and fatigue, pulmonary rehabilitation, stroke, drug and alcohol problems, and falls prevention.

Not only are OTs already working with people on aspects of Public Health and health promotion activity, but there is an expectation that this focus will form part of the delivery of all occupational therapy interventions in the future. For example, I remember reading about the ‘make every contact count’ campaign when working on an acute stroke ward and making sure I asked about smoking and drinking habits as part of my OT assessment.

So, it was with no surprise that the result swung against the motion at the conference. A particularly convincing rebuttal speech was given by Professor Diane Cox and Dr Jenny Preston, clearly showing the professions ability to address Public Health matters but also reach a wider audience through demonstrating outcomes in secondary and tertiary services.

Overall, I left the conference with a sense that the profession has strategically positioned itself to demonstrate that it is making a difference and will continue to make a difference to the health and well-being of people in the 21st century. It is time for OTs working in Public Health and other services to be proud. In my favourite quote of the conference….‘we are not the jack of all trades, rather we are the masters of human occupation’.


Andrew Graham is investigating ‘Sensory Discriminating Training for Phantom Limb Pain’, as a PhD candidate in the School of Health and Social Care at Teesside University.

Friday, 6 July 2018

Game of Thrones: King in the NoRTH… Workshop is coming… but has anyone actually read the books?

Dr Sonia Dalkin, Senior Lecturer in Public Health and Wellbeing, Northumbria University

Unless you’ve been living in a box since 2011, it’s likely that you will have heard of the series Game of Thrones. For those of you still in your boxes – Game of Thrones is fantasy drama television series created by David Benioff and D. B. Weiss. It is an adaptation of A Song of Ice and Fire, George R. R. Martin's series of fantasy novels, the first of which is called A Game of Thrones. The series has been acclaimed for many things including its acting, complex characters, story, scope, and production values. Notably, it has also received praise from both The Guardian and The Times for what is perceived as a sort of medieval realism. Here, I want to talk about a different type of Realism, that of Scientific Realism, or more specifically Realist Approaches to Research.


What is realist research?

Just as Martin’s novels rely on believable characterisation and relatable motivation to create enough suspension of disbelief to enter a world of dragons and sorcery, realist research focuses on social interventions to explain not only whether an intervention works or not, but for whom and under which circumstances. The focus therefore embraces and explains the complexity of social interventions. It aims to understand the responses people have to programme resources, therefore understanding the reasoning and motivations behind their actions. In order to do this, we focus on programme theory and utilise context, mechanism and outcome configurations. It provides rich findings, explaining why interventions work in some contexts, but not in others. For example – why is Daenerys impervious to fire when others are burnt? Because she’s a decedent of House Targaryen. Context is important, people! Alongside context is its trusty friend mechanism – similar to Ghost (an albino dire wolf) and Jon Snow – they go hand in paw. Mechanisms can be referred to as a combination of intervention resources and participant reasoning. More information is available on mechanisms here.

Altogether, the analytical tools of realist evaluation described above are used in the following way: Intervention resources are introduced in a context, in a way that enhances a change in reasoning. This alters the behaviour of participants, which leads to outcomes.

The methodology is not without its difficulties. Often realist researchers describe feeling that they are in a ‘realist swamp’; going down different alleyways, trying to understand and explain how a programme works, for whom and in which circumstances, but not getting too far. Often in this phase, realist researchers are similar to the White Walkers (an ancient race of humanoid ice creatures who really aren’t too friendly), in both looks and temperament. This phase can be frustrating, but like Arya against The Waif (acolyte of the Faceless Men), in most projects there is a sudden moment of clarity, where the dark alley becomes your friend, it all comes together, and you come out fighting.

Here at Northumbria University we have engaged in many projects using realist methods and want to help other realist researchers beat The Waif as quickly as possible, where possible. In order to do this, we’ve engaged a three-pronged approach as sharp as Arya’s sword, ‘Needle’:

1. Realist research Team Hub (NoRTH)

We felt it was time to highlight ourselves as key players in the realist game and to create a hub of realist research. What does every hub need? An acronym! We are now the Northern Realist research Team Hub (NoRTH).

NoRTH’s priorities will be to: advance the implementation of the methodology; collaborate with others focusing on realist research; contribute to and host realist education platforms; support PhD students in realist research; and continue to offer methodological expertise to those who seek it.

One thing of importance to note here is that we don’t feel we are the only big players in the North in terms of realist research – The Starks (University of Leeds) are obviously the long term true Kings of the North, with Professor Ray Pawson at the helm (our Jon Snow) for many years, and Nick Emmel, Joanne Greenhalgh, and Ana Manzano (Bran, Sansa and Arya) now fighting strong. But being ‘Northumbria University’, the acronym NoRTH seemed too good to resist… please take this blog as a token of our affection and don’t give us a fate like that of the Red Wedding!

2. Winter’s coming… along with a workshop in realist approaches

Winter is coming and soon we’ll have dark nights and frosty mornings, but never fear; alongside winter we have a brilliant offer of a Realist Approaches Workshop. Like Daenerys, mother of dragons, we wanted to educate others and decided one way to do this would be to provide a workshop. Whilst we can’t promise dragons, rebirths in blood and fire, or steamy scenes with Jon Snow, we can offer a fantastic line up of realist researchers, ready to take you on an exciting methodological journey.

Day 1 of the workshop will focus on Basic Principles of Realist Research, whilst day two will focus on contemporary developments such as realist ethnography and realist economic evaluation. To find out more and to book, check out the website.

3. ‘Doing Realist Research’ – a new book

As much as a lot of people claim to be Game of Thrones fans, how many of them have actually read the original books? TV series and films can bring whole worlds to life before our eyes, make characters into living people, but books take you into the detail, the nooks and crannies of the story. For example, the maps in Martin’s book displaying the geography of the mythical Kingdom aren’t as well portrayed in the TV series, despite efforts in the opening titles. Books provide the details that are often overlooked yet important in really understanding the overall story or the characters. Thus, if interested in realist research, I would like to suggest you read the new book ‘Doing Realist Research’, available to pre-order now), which provides much more detail on realist approaches, covering topics such as: realist review problem-solving, literature searching for realist reviews and mechanisms at higher levels of abstraction.

Edited by Nick Emmel, Joanne Greenhalgh, Ana Manzano (The Starks), Mark Monaghan and myself, this book celebrates the possible ways in which realism can contribute to researching complex social puzzles, providing practical advice on the ‘how to’ of realist methods.

Similar to Game of Thrones, so far, it’s received rave reviews, like that from Professor Kieran Walshe, (University of Manchester): “I wish all social science researchers would read this book”. Best of all, it has absolutely no Game of Thrones references – and that’s a promise (similar to that of Ned Starks to Lynna Stark in the infamous Tower of Joy Scene)…



Acknowledgements

Many thanks to Dr Phil Hodgson (Northumbria University) for helping me in identifying so many obvious Game of Thrones parallels with realist research…


Image: "Game of Thrones. Xbox One. 1080.P. 😁 Gameplay Part.04.-06. On my YouTube Channel 😁 https://youtube.com/playlist?list=PLwsjII0MclEGZnmdii3LZb9FZLby_iP4Q 😁 by Rob Obsidian via Flickr.com, copyright © 2015: https://www.flickr.com/photos/65092514@N08/18679295525