If at first you don’t succeed, try, try, try and try again…

Posted by Suzanne Moffatt, Reader in Social Gerontology, Institute of Health & Society, Newcastle University

Ways to Wellness Link Workers provide support to people with
 long-term health conditions who are referred by their GP

Publishing a study protocol is always gratifying (even though it counts for nothing in the Research Excellence Framework!). Publication of this particular protocol evaluating the impact of social prescribing on health and wellbeing caused me to reflect on the 58 months that had elapsed between that initial invitation to develop an evaluation and getting the study protocol into print. Why on earth had it taken so long and what had we done in those months? Well, we weren’t twiddling our research thumbs, but we did get quite a few knock backs in our efforts to secure “the big grant”, and I thought it worth sharing with the research community as multiple failures before success is often untold.

We started with an outline bid to the National Institute of Health Research (NIHR) Public Health Research Programme in 2015 which was shortlisted, but not successful at the full proposal stage. Fortunately an application to the Cabinet Office was successful that same year, which enabled us to complete a qualitative study exploring the impact of social prescribing for service users and perspectives of ‘link workers’ delivering the intervention (work currently accepted for publication). In 2015 (busy year!) applications to the School for Public Health Research (SPHR) Public Health Practice Evaluation Scheme (PHPES) and School for Primary Care were both unsuccessful. But in 2016 we achieved success with a ‘cut down’ version of our SPHR PHPES application (capitalising on end of year finances, I believe) that allowed us to pilot questionnaire data collection (paper rejected and currently being prepared for re-submission). 2017 also saw us obtain a relatively small grant from Newcastle University’s Institutes for Ageing and Social Renewal, allowing us to follow up 24 out of our original qualitative sample of 30 service users, findings of which have recently been published.

Ukulele group, Throckley Community Centre, Newcastle upon Tyne

Despite our lack of success so far in obtaining the “big” grant, we had contributed a valuable body of work on the impact of social prescribing and into the bargain employed some excellent researchers – Mel Steer, Kirsty Laing and Jo Wildman. Yet, in spite of the apparently unstoppable popularity of social prescribing as a way of addressing long term health problems and tackling inequalities, a systematic review demonstrated that a robust evidence base about impact and cost effectiveness is lacking. When the 2017 NIHR Public Health Programme call for research on Community Groups and Health Promotion[1] (16/122) hit my inbox, it dawned on me that another application (our seventh in case you had lost count) fitted the bill. I felt a mixture of dread and exhilaration. Definitely the last chance saloon.

So, why was this bid successful? In essence, because it was more clearly focused on a specific condition (type 2 diabetes), our substantial body of underpinning research, the mixing of quasi-experimental and ethnographic methods and a really excellent team of researchers. So now all we have to do is deliver. But remember, if at first you don’t succeed, sometimes persistence pays off.

For more information about our evaluation of Ways to Wellness Social Prescribing, visit the project website.

Applications to the SPHR Public Health Practice Evaluation Scheme (PHPES) are now being accepted with funded projects expected to start from January 2020.


After 10 years’ success, as of 18 July 2025, this initial project by Ways to Wellness is closed following a withdrawal in funding. However, the learning from it provided the foundation upon which Ways to Wellness was able to build its varied current prototypes. Find out more about the work it continues to do at www.waystowellness.org.uk/projects



Reference:

1. This work is funded by the National Institute of Health Research, Public Health Research Programme, Community Groups and Health Promotion (grant no. 16/122/33). The research was informed by a NIHR School for Public Health Research (SPHR) funded project (project reference: SPHR-FUS-PES-WTW).

The views expressed are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Mapping collaboration and constructing a compass

Guest post by Lindy Turnbull, Senior Lecturer, Faculty of Health and Life Sciences, Northumbria University

Collaboration is promoted as a key aspect of commissioning and delivery in public health (NHS England, 2016) and health care (NHS England and NHS Improvement, 2016). Joint working and integration of services are seen as the way forward for the future NHS with new integrated models of care at the forefront of service redesign, and collaboration core to managing increased demands with diminishing resources. Although collaboration is a familiar concept and has been the subject of research and discussion it is still an area of practice which is poorly understood. It is striking that existing definitions of collaboration identify professional sharing with the focus on patient care, yet there is little representation of patients in most studies and the role of patients in collaboration seems to be missing from the existing theory.

I began my research after leading the development of Outpatient Parenteral Antimicrobial Therapy (OPAT) a new model of care which required collaborative working across secondary and primary care to deliver treatment in patient homes. The development of this service was challenging and required strong collaborative relationships to overcome the organisational barriers to integration. Having experienced the challenges of collaborating to develop an integrated service I wondered if these difficulties continue into the delivery of the service in practice, and how collaboration takes place within the challenging environment of the constantly reorganised NHS.

The aim of my research was to develop substantive theory about what collaboration means in the delivery of integrated care, the way it is manifested in day-to-day practice and how it is shaped by the situation in which it takes place. I viewed patients and professionals as participants in collaboration and interviewed three patients and 21 professionals. I have used a social constructionist approach to grounded theory (Charmaz, 2008) and a range of situational mapping techniques (Clarke, 2005)1 to map collaboration within the situation of integrated care delivery. Analysis was a fascinating and absorbing experience as I used mind mapping software to analyse and compare the perspectives of those involved in collaboration and then to combine perspectives to map and analyse the complexity of the situation.

Participants expressed a number of interactive mechanisms (trusting, communicating, co-ordinating and rehearsing) which were influenced by a range of situational co-ordinates (goals, limits, certainty, uncertainty and power) and these were used together to navigate the complexity of the healthcare situation and direct the process and outcomes of collaboration. The capability of individuals to act, or interact was informed by their interpretation of the situation and this directed the capacity for collaboration within the care situation. Positional mapping techniques identified four directions of collaboration: developing, maintaining, limited and disrupted, and I found that limiting factors were significant in changing the direction of collaboration. The communication of some social limitations such as terminal illness, professional roles or work requirements altered an individual’s capability to collaborate and the capacity for collaboration within the situation.

My analysis has constructed a collaboration compass which is used to navigate the situation and direct the collaboration experienced by patients and professionals. I am in the process of writing up and still fighting my enthusiasm to write about everything I found and learned during my study; there simply aren’t enough words!

Reference:

1. Clarke, A. (2005). Situational analysis: Grounded theory after the postmodern turn. Thousand Oaks, CA: Sage.

Health Research Authority summary: The Meaning and Manifestation of Collaboration in Domiciliary Outpatient Parenteral Antibiotic Therapy: A Grounded Theory Situational Analysis.

Too stressed for words? Involving those experiencing stress in research

Post by Fuse members Natalie Forster, Senior Research Assistant, Northumbria University and Sonia Dalkin, Lecturer in Public Health at Northumbria University

On this National stress awareness day, we wanted to take the opportunity to reflect on the ethics of involving those experiencing stress in research.

Fuse researchers are currently undertaking a realist evaluation to understand how, when and for whom, Citizens Advice Bureau (CAB) interventions improve people's health. CAB provide independent, impartial, confidential, and free advice to everyone on their rights and responsibilities. This includes advice on debt, benefits, employment, housing and discrimination.

Changes to physical health take a long time to show, and are therefore difficult to capture in the evaluation timescale. The impact of CAB on stress therefore forms a core focus of the study. As we know already that stress is linked to many mental and physical health outcomes, determining if and how CAB services reduce stress should enable us to project the potential health impact of CAB.

At the point when people approach CAB, they are often under considerable strain. Two in three people accessing CAB services report feeling stressed, depressed or anxious as a result of the problem or problems that they are experiencing, more than one in five people have had to move home or are worried about losing their home, and almost one in five are experiencing difficulties in relationships with other people.

We have had much discussion as a research team, together with CAB staff, around how to design the research in a way that generates sufficient data to assess the impact of the service, but which remains sensitive to what clients are experiencing. Imagine a scenario for example, whereby you approach a service for help already under significant stress, you are anxious to resolve a financial problem, yet before you can start to address the issue you're asked to fill in a lengthy questionnaire about your health. Furthermore, CAB have projects specifically designed to support those diagnosed with cancer. In the case of CAB clients who are currently undergoing treatment for, or supporting a family member with cancer, stress is likely to remain in spite of addressing financial concerns, and to ask if their health has improved would be inappropriate.

These are just some of the issues we've been grappling with and which have informed our decisions about which client groups we invite to participate, when we contact potential participants, and what they can reasonably be asked to take part in. A decision was made for instance, not to include a project for patients and families with cancer among those being evaluated. Baseline questionnaires will not be delivered before, but rather during or just after clients’ initial appointments. The number of questionnaires clients will be asked to complete has been carefully considered and where possible, shorter versions of questionnaires have been used in order to avoid over-burdening participants.

That said, we're also conscious of the risk of excluding people from taking part by making too many presumptions about participant preferences. We have often reflected during involvement with previous research on how generously people have shared their time and experiences even when undergoing difficult circumstances. We therefore continue to consider the balance between participant protection and autonomy when recruiting potentially stressed participants. In research with people experiencing difficult circumstances, involving potential participants and organisations working with them in designing data collection strategies is key to ensuring their appropriateness.

Photo attribution: Photograph ‘Anxious 1’ (File ID #1431663) by Joana Croft via freeimages.com, copyright © 2007: http://www.freeimages.com/photo/anxious-1-1431663

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Animation designers…'the day in the life of a researcher'

Guest post by Megan and Glen (TeamAlpha)

TeamAlpha (The alcohol team at Teesside University: Professor Dorothy Newbury-Birch, Dr Emma Giles, Dr Grant McGeechan, Dr Victoria McGowan, Gillian Waller, Lisa Anderson, Robert Sayer) were joined by two young people from local schools - Megan and Glen – who helped the team to develop the groundwork for an animation video. This video is part of the SIPS JR-HIGH trial, a multi-centre individual-randomised controlled trial of the effectiveness of brief alcohol intervention for 14-15 year olds in a school setting. This animation video is currently being developed to show to young people in the school setting, and will be used to provide advice on how to complete the questionnaire component of the trial. This animation replaces the need for individual researchers to enter all the schools in the trial to inform the young people about the study process.

In order to develop the animation Megan and Glen spent two days drawing storyboards, drafting scripts, searching for background music, and even thinking of examples of voices for the characters. This blog was drafted by Megan and Glen to highlight their thoughts on being a researcher and graphic designer for two days.

Day one

Brainstorming and initial storyboards were created as we worked hard all morning. We had a jolly start to the day and thought it was quite interesting and fast going, however more tiring than anticipated!

Individual tasks were completed as we both researched ideas for the animation, even though we had to overcome difficulties associated with having to think of our own ideas for the initial designs for the animation. We definitely thought it was more hands on than we thought it would be, given the number of tasks planned throughout the day. We developed character images and screen shots for the video and really liked the process of doing this.

Storyboards

We felt that we worked hard during the first day at the University but we really enjoyed ourselves. This is partly due to the fact that we’d both like graphic design careers, and so a ‘taster’ of the process was really helpful. We were busy most of the time throughout the day; this was tiring, but also stopped the boredom setting in. This project showcased our skills in graphic design and our use of technology that we have learnt from school. Our experience of drawing, researching pictures and mood board designs really impressed TeamAlpha. As the day went by we described our visit to TeamAlpha as interesting but “full on” given that we did a 9-4 job!

TeamAlpha was very welcoming and Dot (the Professor!) helped us with our ideas and team work. Emma also mentored us throughout the two days, helped guide our ideas, and helped us to showcase our skills as designers. Initially it was hard to build a rapport with each other, since we came from different schools, but by the end of the first day we worked as a duo much better.

Day two

The second day was more relaxing since we knew who we were working with in terms of TeamAlpha, and we were also getting used to each other. Additionally, the environment felt more relaxing since we had been there before; this helped us to interact better with each other and helped us to work on our tasks much more quickly. The day was very interesting, particularly when we found out what the animation script was – basically what each character says during each scene. We enjoyed editing this script to make it relevant for the target audience, which will be Year 10 students. It was good to see all of the different components coming together to become the animation.

Overall reflections

The two days were interesting for us both and I think our experience with TeamAlpha was brilliant. We thought the team were really cooperative and they communicated very well with each other – particularly during our ‘picnic’ lunches. We feel that the work that we created and produced on these two days will enhance our CVs and help inform the work that we will be doing in school and college next year. We were really surprised by the range of tasks that researchers undertake, and the amount of thought and research that has to go into making such a short (2 minute!) animation. We really feel that we have learnt the basics of research, working independently and as part of a team, and overall we really enjoyed being in such a creative environment. We’re really excited to see the finished animation later in the year, to see how our thoughts and work have helped shape the final video.

TeamAlpha

Energy drinks: Don't believe the hype

Guest post by Shelina Visram, Lecturer in the Centre for Public Policy and Health, Durham University

When asked where the idea for our study on energy drinks came from, I usually say it was through discussions with colleagues as part of another project I’m leading on in County Durham. But that's not strictly true. The original spark came from my experience a few years ago of lecturing at Northumbria University in the dreaded Tuesday 9am slot (student night in Newcastle is on a Monday), where I noticed some students regularly downing a couple of energy drinks throughout the lecture. This was my first encounter with these drinks being consumed during daylight hours and I was fascinated by the idea that some people might have them for breakfast. So this got me wondering - why would young, seemingly healthy students feel the need to use an artificial source of energy to get them through the day? Or was it just my lectures sending them back to sleep? (That is if they had even been to sleep).

Over the years I noticed more and more of these drinks appearing in shops, on TV shows, in adverts and as litter on the streets, and assumed that they were used primarily by adults to stay awake. Most cans and bottles state that these products are not recommended for children, given that they contain high levels of caffeine which children are advised to consume in ‘moderation’ [1]. But then I overheard a couple of external partners discussing energy drinks in the context of them being seen as a growing 'problem' in primary and secondary schools in County Durham. They were looking for support in scoping the evidence base and exploring what types of interventions or educational materials could be developed locally. Around the same time, a call was circulated via Fuse for research proposals to The Children’s Foundation [2]. Colleagues from Fuse and the Wolfson Research Institute for Health and Wellbeing at Durham University [3] were keen to collaborate on an application. We developed our proposal, were awarded funding, and the HYPER! (Hearing Young People’s views on Energy drinks: Research) study was born [4]. 

Since June 2014, the HYPER! study team has been busy: reviewing the published literature on children and young people’s use of energy drinks; conducting a series of focus groups and interviews with students, parents and staff from four local schools; and involving young people in a mapping exercise, drawing on their knowledge of the area around their school to identify local energy drink vendors. Here are some of the things we’ve learned:

• If you come across a paper that says ‘energy drinks are good for you’, check to see if the work has been funded by Red Bull or conducted by someone with shares in PepsiCo.
• Most papers that say ‘energy drinks are bad for you’ are based on expert opinion, rather than robust research.
• Young people in the UK drink more energy drinks than those in other European countries, yet there are no published studies from the UK.
• Sales restrictions might seem like a sensible option; they would help to send a clear message but our study participants had concerns that they would be difficult to enforce.
• The strong influence of the marketing activities of energy drink companies should not be underestimated.
• Any interventions should ideally involve children and young people, as well as parents, schools, retailers and the industry.
• There is a lot of confusion around whether energy drinks are safe for children, and parents, teachers and young people need help to make more informed choices.  At least one young person in all but one of our focus groups thought that energy drinks contained bull or horse sperm [5]. They don’t.

There are still lots of unanswered questions. For example, if the government requires energy drinks to carry warnings stating that they are not recommended for children, why are manufacturers allowed to market them so obviously towards young people? What are the long-term health and other effects? Is there a link to health inequalities? And why would anyone knowingly drink something that they thought contained bull sperm? We’re hoping to answer some of these questions by conducting further research so please get in touch if you’d like to collaborate with us or if you’re already involved in work on energy drinks. We would love to hear from you.

You can find out more about this study by reading the new Fuse Brief here.

Shelina spoke about the HYPER! study at the CPPH/Wolfson Seminar - Sweetness, social norms and schools: factors influencing children and young people’s food and drink practices (9 September)

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