How to choreograph a dance between policy makers and academic researchers?

Posted by Peter van der Graaf, Associate Professor in Public Health at Northumbria University and AskFuse Research Manager

Dancing is a key move in public health, particularly if you want to make an impact with your research. Knowledge exchange is not just a science or even an art, but very much a dance between researchers and policy makers about the use of research evidence. To complete this dance successfully and get evidence used in decision making, both partners need to follow certain steps. However, learning the steps (science) or performing them perfectly (art) is not sufficient: it requires instinct and feel for where you are in the dance and why you are doing it.

To develop a dance plan for your interactions between policy makers and academic researchers, Fuse hosted a special session (or dance class) at the European Implementation Event in Basel, Switzerland on 8 June. The EIE2023 brought together over 300 implementation scientists, practitioners and funders from across health, social welfare, education and other sectors in Europe. Over two days through fishbowls, science slams, workshops, inspiring keynotes and oral presentations, participants explored how to create a new normal for implementation science in society.

Our session explored dance challenges (e.g. moving too slow, bad timing, outfit malfunctions, and unsynchronised performances) and new routines in response (see: ‘What did we learn?’ below) that we have developed in Fuse over the last 15 years collaboratively with our partners. In the session, we highlighted examples of creative communication (the art of knowledge exchange), research performance both backstage and frontstage (AskFuse), and dancing together (embedded research) to set the scene for a discussion about what makes a successful dance between policy makers, health practitioners and academic researchers. We invited conference participants to share their own reflections of dance routines they have developed to support knowledge exchange and implementation of research evidence in practice and policy making.

What did we learn? 10 dance lessons

Fuse knowledge exchange model

1. Academic researchers need to learn four basic steps for dancing with policy makers (see the Fuse knowledge exchange model):

• Raising awareness, using creative communication.
• Knowledge sharing through joint events.
• Making evidence fit for purpose (localising and tailoring).
• Supporting uptake and implementation (e.g., capacity, co-production, linking activities).

2. A deviant knowledge broker can help to facilitate backstage conversation and protect policy makers and academic researchers from missteps.

3. Go with the music: as the context and process in which evidence is useful changes constantly, it is an important skill for researchers to be able “to go with the music” based on ongoing relationships with policy and practice partners.

4. Emotional engagement between researchers and policy makers is essential to get a better feel for the music. A heart-to-heart or moaning about bad performances helps you to improve dance routines and hide missteps. Don’t forget the power of cookies!

5. Embedded research helps to develop an instinct for the dance, based on a better understanding of each other’s organisational contexts. Embedded research allows you to be part of solutions, developed with the communities affected, not just report on the effect on interventions and their implementations.

6. Public health is political; lobbying and advocacy are a core part of the embedded research roles.

Choreographing your own dance routine

We presented participants with the following questions to help develop their own dance routines: 

In response, conference participants started to develop their own dance metaphors for describing their experiences with collaborative research between academics and policymakers. Someone referred to their routines as a ‘silent disco’, where academics and policymakers were dancing to different pieces of music without knowing what the other where listening too. Other participants emphasised the need to spend time together first before you start picking music, to get a better understanding of each other’s musical tastes (classical meets punk?).

Overall, participants felt inspired to start to think more deeply about their own dance plans. How would you answer the above questions and what would your dance plan look like? 

Full house at the #EIE2023 @fuse_online Special Session! @pvandergraaf75 and Mandy Cheetham choreographing a dance between policymakers and researchers. Creative communication at it’s best! 💃🏽🕺🏼 pic.twitter.com/7ej4Kr29LG

— Leah Bührmann (@LeahBuehrmann) June 8, 2023

Does reaching the ‘hard-to-reach’ mean leaving traditional academia at the door?

Angela Wearn, PhD Researcher, Department of Psychology, Northumbria University

“You tend to find the ones that are protesting and telling you to go and get your smears are the ones that have their cushy little jobs and that lovely flash car that they can just jump in and dive down to the doctors”

From all the conversations I’ve had throughout my research career, this is one of the quotes that has stuck with me the most. For over three years I have been working on my doctoral research, conducted across Newcastle, which explores barriers to cervical screening participation in areas of high relative deprivation. We know that uptake rates tend to be lower in areas of socioeconomic disadvantage, but reviewing existing literature showed very little insight from women who lived within these communities themselves. Incidentally, I am one of these women. I grew up, and still live, within a neighbourhood which, according to the Index of Multiple Deprivation, falls within the 10% most deprived areas in the country. It’s therefore no accident that I ended up with a programme of research which aimed to prioritise the voice of this community.

Graffiti walls can be a simple and effective way of starting conversations

Initially, I had dreams of a wonderfully participatory project, where I formed a steering group and we worked together to find answers and seek solutions. As often happens in research, time ticked on and it didn’t work out the way I had planned. My participatory ideals had to take a backseat for a less time-consuming participant-researcher approach. I suspected my ‘insider’ status might open doors for me and to be fair, it did. I found myself being able to quickly connect and build a rapport with others when I discussed my own background and why I wanted to do this project. However, getting to the point of even having these conversations was by no means easy. I spent days, weeks, months trying to speak to community groups, charities and community members about my research. Some were very open and interested, others were not. I attended community get-togethers handing out cakes alongside research information, making ‘graffiti walls’ with post-its, even chatting about life over freshly made biryani at a cookery club. Actually, these were the most rewarding and enjoyable moments over the past three years, but the more I did this the more I felt I was straying from what academia expected of me. I also began to feel my status as an academic researcher was a hindrance to what I was aiming to do at community level. For a lone PhD researcher, bringing together these two worlds, at times, felt completely impossible.

"community get-togethers...were the most rewarding and enjoyable moments over the past three years, but the more I did this the more I felt I was straying from what academia expected of me"

Attending community events was a great way to connect with 

people who were otherwise unfamiliar with research

The quote at the beginning of this blog was when it all clicked into place. Although we were talking about cervical screening, I acknowledged something that I had already known all along - the same issues of accessibility and trust apply to involvement with academic research. If I put my working-class hat on for a minute, academic research feels neither accessible nor promotes interpersonal trust. From the outside, academia appears to be filled with people who think they know better than you, patronising you, sometimes even using you to showcase the poor decisions people make in life. I had to work hard to reassure people that I wasn’t there to pass judgement on their screening status. I’m still not sure many believed me. ‘Eat a healthy diet’, ‘Stop smoking’, ‘Engage in physical activity’, ‘Attend your screening appointments’. These are the messages that come through, focusing on the individual and discounting all the structural and social barriers that exist for people living in communities like mine. If you are trying to figure out how to afford the weekly food shop, the kids have come home with a tear in the coat you only bought a fortnight ago and you’re worried about not getting enough work from your zero hours contract, there is no mental space for ‘living your best life’ (and certainly no space for sitting with a stranger from some university taking part in a research study).

Those living in socioeconomically disadvantaged areas are often described as ‘hard-to-reach’. This often implies that despite best efforts to reach out, these groups are disinterested and disengaged. I tend to believe the reverse is true. Some groups are hard to reach because academic research is too disengaged from the community. I know of many academics who are so obviously committed to tackling the avoidable and unjust disparities in health, and for this reason I do feel positive for the future. However, as someone who is positioned in between the ivory towers of academia and the working-class neighbourhoods at home, I know there is still a lot of work to do. There is a long history of mistrust and marginalisation to put right. If we are serious about tackling inequality and involving so called ‘hard-to-reach’ groups in research, then we need more focus on developing trust and togetherness…and occasionally, this might mean leaving traditional academia at the door.

Is there life beyond the PhD?

Posted by Priyanka Vasantavada, PhD researcher, School of Health and Social Care, Teesside University

Living my Jane Austen fantasy

Don’t ask me if there is? It’s not afterlife. Or is it? But it is a question every PhD student has wondered about during the ups and downs of their PhD journey (unless you have a permanent job and are doing a part-time PhD). So how do you deal with it when this sort of ‘limited existentialism’ strikes? What do you say when the world around you repeatedly asks, “what next?”.

I just curl up in my bed and binge watch screen adaptations of Jane Austen novels or any good costume drama, science fiction series or even fantasy; for what can be better than some good old escapism? Does it answer the question? No! Does it help me forget it? Yes!

So last summer when I received an email from the Graduate Research School of my university regarding a Life Beyond PhD conference being held at Cumberland Lodge, Windsor; I jumped with excitement. I knew I wanted to go for it the moment I saw the pictures of the Lodge. Not unlike Pride and Prejudice protagonist Ms Elizabeth Bennet who started seeing Mr Darcy in a favourable light after visiting Pemberley. Don’t get me, or Ms Bennet, wrong for we both saw the merit in the conference and Mr Darcy respectively, but their residences certainly recommended them.

Cumberland Lodge, Winsor Great Park

Here was an opportunity blending my fantasy and reality - a four night residential conference with hospitality in the actual former residence of a real-life princess…. hello Disney! What more could I have asked for? (*cough*… Cumberland Lodge Scholarship …*cough*). The conference programme was designed to highlight the value of PhDs (both within academia and industry) and it also promised opportunities for sharing research and career aspirations, exploring collaborative and interdisciplinary ways of working, and presenting to a diverse, non-expert audience.


My supervisor considered it to be a good opportunity for me; owing to the nature of my PhD which marginally borders on public engagement in research and public health. She was kind enough to recommend me to the school for sponsorship and I daydreamed my way to the Windsor great park on a balmy summer afternoon.

Conference delegates

All the delegates were welcomed and given a tour of the historical building by the education officer of the lodge. The tour was followed by a session on research culture in the UK topped with a drinks reception. A delicious dinner was served shortly thereafter, and the delegates had fun in the group games session which included a pop quiz, table tennis, and snooker. I don’t think I ever made so many friends in such a short period of time!

The second day centred around PhD researcher development with sessions on self-leadership, speaking and writing techniques, and wellbeing and mental health. Unsurprisingly the session on mental wellbeing: research-based thoughts, issues and toolkit commanded most delegate participation, as the mental health of a PhD researcher is almost always never considered in academia. The conference drew delegates from disciplines across science, art and literature and yet everyone identified with mental health issues in PhD life!

Me and fellow Teesside University
PhD researcher David Oluwadere

On the third day, delegates were divided into four groups and were given the opportunity to present their project to their group mates who were of a different subject background. Every delegate received feedback from their peers on their overall presentation skills and comprehension of content. My colleague David Oluwadere, studying Environmental Sciences at Teesside University, presented on agronomic biofortification technique as a means of increasing zinc concentration and bioavailability in wheat using seaweed. I presented my project on the public perception of community water fluoridation in the UK. The presentations were followed by sessions by PhD graduates on their life after PhD and on public engagement in research.

The fourth day focussed on interdisciplinary research and working in designated groups we were challenged to address a problem by developing interdisciplinary research proposals within the day. These proposals were pitched to a panel of judges in order to seek funding. This was an exercise in developing our collaborative skills and emphasised the importance of interdisciplinary approaches to problem solving. It also demonstrated how a problem is viewed differently by people from various disciplines. Humble brag, but the team I was part of, won the proposal contest and were gifted a box of chocolates.

Winners of the interdisciplinary research proposal contest 

The conference closed with a session on, “Why is a PhD worth it?”. In addition to the conference presentations which were highly informative and relevant, I will always remember the experience for living in a historic aristocratic building, ‘taking a turn’ about the Windsor great park (channelling heroines of Jane Austen and Charlotte Bronte), the late night banter with friends in the sitting rooms of the lodge, playing games and striking the keys of an out of tune piano in the basement in evenings, and being served dinner in a fashion reminiscent of Downton Abbey.

If you feel that this is something for you (fantasising is optional), visit the the Cumberland Lodge website to find out more.

Getting a job after PhD is subject to availability and visa status, but life beyond PhD is open to endless possibilities. So, I believe that instead of speculating about the future, we should try to live in the moment and savour the #phdlife while it lasts!

Images:

• 1: Hugh Thomson (1860-1920) [Public domain], via Wikimedia Commons: https://commons.wikimedia.org/wiki/File:Thomson-PP14.jpg
• 2 & 4: courtesy of Priyanka Vasantavada
• 3 & 5: courtesy of @CumberlandLodge

Knowledge mobilisation: relationship guidance for ‘stubborn’ practitioners and ‘smug’ scientists

Posted by Peter van der Graaf, AskFuse Research Manager, Teesside University

Last week, I presented at the UK Knowledge Mobilisation Forum in Bristol, which is an annual event for all those with a passion for ensuring that knowledge makes a positive difference to society. The Forum brings together practitioners, researchers, students, administrators and public representatives who are engaged in the art and science of sharing knowledge and ensuring that it can be used.


Getting creative sticking to ‘unconference’ principles

One of the key note speaker, Dez Holmes who is the Director of Research in Practice with 20 years of experience in championing evidence-informed practice in social care, vented her frustration about a question she was often asked by people interested in knowledge mobilisation (KMb): where can I access training in this? Her response: you can’t! Knowledge sharing is personal and therefore a social skill that you can only develop by practising it.

The skills needed to practice KMb are everyday skills, such as listening, emotional intelligence and persuasion. Reciprocity and mutual respect are crucial in relationships and therefore in knowledge mobilisation. Knowledge mobilisers use these skills to make knowledge relatable and therefore relevant to people’s lives. Dez used a Japanese word to sum up these skills: ‘ikigai’ (meaning “reason for being”): if we can’t relate knowledge to people’s sense of self they won’t be inclined to use it.

Acknowledging feelings in knowledge mobilisation is therefore important, not least because implementation barriers for knowledge are often personal. Dez quoted the common misperception between practitioners and academics that are at the heart of the so-called knowledge-to-action gap: “scientist blame the stubbornness of practitioners for insisting on doing it their way, believing they know their patients best, while practitioners lamented the smugness of scientists who believe that if they publish it practitioners will use it”. These misperceptions signify emotions at work in the knowledge gap that need to be addressed before we can start mobilising knowledge.

A great example of on the job knowledge mobilisation learning was captured in a story told by Vicky Ward, Associate Professor in Knowledge Mobilisation at Leeds University and one of the organisers of the Forum, who reflected on her research about knowledge sharing between professionals in social care. The story, titled ‘Dealing with the carousal of knowledge’, illustrates how practitioners continuously added new and different types of knowledge to their team meetings but never really made use of this knowledge until Vicky started asking some ‘constructively clue less’ questions. These questions helped them to recognise the emotions they attached to the client cases that they were discussing and enabled them to discover patterns in their carousel of knowledge. Identifying patterns allowed the professionals to select knowledge that was most useful for each case and made this knowledge transferable.

The conference format itself acknowledged the relational and context-specific work involved in knowledge mobilisation: participants were encouraged to hone their skills in randomised coffee trials, open space discussions, interactive poster sessions, market stalls, short presentations and practical, interactive workshops. The programme was deliberately based on ‘unconference’ principles, which means that it focused on offering opportunities for conversations, creativity and collaborative learning, with much of the direction being driven by the participants instead of the conference organisers. In this sense, the conference was a training ground for knowledge mobilisers to practice and learn new skills.

Is it possible to have a research career without being a workaholic?

Posted by Peter van der Graaf, AskFuse Research Manager, Teesside University

This was one of the burning questions that NIHR trainees put to an esteemed panel of career advisers at their annual meeting in Leeds. Every year the National Institute for Health Research brings together their trainees at a two-day event to network, share experiences, take part in workshops and generally learn more about the largest national clinical research funder in Europe. This year’s theme: Future Training for Future Health.

With all these bright minds in the room and a dedicated session on successful fellowships and grant applications, you would think ‘top tips on surviving an interview’ and ‘what mistakes to avoid in an application’ would be on the top of their list. However, after several inspiring presentations from previous and current award holders who had climbed the academic ladder - including Fuse Director Ashley Adamson a NIHR Research Professor - participants were equally, if not more, concerned about maintaining a healthy life-work balance.


Follow the yellow brick road to academic success

While Brexit questions made a brave entrance (Q: How will Brexit affect future research? A: In the long term, not all all!), they could not knock questions about mental health and wellbeing from the top spot. When Ashley included pictures of her son in a musical-inspired animation of her academic pathway (follow the yellow-brick road!) to explain that she preferred part-time work to spend more time with her family, participants immediately asked “but how do you fit family in with an academic career?”.

New gadget SLI.DO was introduced by the NIHR at the meeting this year: participants could submit questions through a mobile app, which others could vote to be answered by the panel (Bush Tucker Trial for academics). Not having to stand up in front of an audience to say who you are, might have given some participants the confidence to ask uncomfortable questions. The honest and open stories from the presenters about their own struggles and failures in academia (“my new post oscillated between agony and despair”) might also have contributed to this confidence.


Paul McGee emphasises the importance of
 looking after your mental health in academia

Experiences of stress and concerns over mental health in academic careers were acknowledged throughout the conference in various presentations and workshops. This was perhaps most evident in the closing session by Paul McGee (aka The Sumo Guy) who emphasises the importance of looking after your mental health in academia. His four key messages (be kind to yourself; get perspective; hippo time - to wallow - is ok; and keep pushing) resonated with many participants and provoked a strong response on social media.

As public health researchers, we are familiar with these messages. In our studies, we underline the link between physical and mental health, express our deep concern over the lack of mental health services and highlight the importance of resilience training from an early age in schools. However, it appears that we are not very good at applying this evidence to our own life and work.

This was recently confirmed by a systematic review of published work on researchers' well-being featured in the Times Higher Education. The review, commissioned by the Royal Society and the Wellcome Trust, found that academics face higher mental health risk than many other professions. Lack of job security, limited support from management and weight of work-related demands on time were listed as factors affecting the mental health of those who work in higher education.

Given this evidence, is it possible to have an academic career and stay healthy? Despite the questions raised at the annual event, the NIHR trainees were keen to acknowledge positive mental health messages: you can have a life and family outside academia (no need to be workaholic, although being a data geek is acceptable*); it’s ok to be different and carve your own path to develop your intellectual independence; and most of all: the key to success is self-care and not funding.

* An after-dinner presentation by @StatsJen taught us that there is a perfect correlation between eating cheese and death by entanglement in bedsheets. Will midnight cheese feasts be the next public health scare?

Spice up your research life: match-making in public health

Posted by Peter van der Graaf, AskFuse Research Manager, Teesside University

Three years ago, we had a crazy idea: what if Fuse had its own dating service for academic researchers and health professionals? Instead of innovative research findings gathering dust on lonely bookshelves, we wanted to provide a stage for academics and health professionals to meet and discuss how that evidence could be used in practice. We were keen to facilitate early conversations on how to collaborate on research that is useful, timely, independent, and easily understood.

Instead of health practitioners wandering around University campuses, trying to find the right academic to work with, we envisioned an open door leading to a welcoming friendly-faced guide. Someone who could do the matchmaking and help them to find or create evidence for spicing up their policies or interventions.

After checking our idea with various health practitioners in the region to make sure that it would make their hearts beat faster, we launched AskFuse in June 2013: Fuse’s very own rapid responsive and evaluation service with a dedicated match-maker (research manager) in post – that’s me!

Coming from an applied research background in social sciences, this post was certainly a challenge but also an incredibility exiting opportunity to develop something new with the support of an enthusiastic group of people across Fuse. The job has been a steep learning curve, but also a great way to meet a lot of people working in public health across the region, getting to understand their passions and … what keeps them up at night.

I quickly learned that there were many great public health projects and programmes being developed and delivered locally that deserved more attention and research (e.g. My Sporting Chance, Ways to Wellness, Boilers on Prescription).  I was encouraged by a real appetite among academics to support this work but felt the frustrations of health professionals caused by budget cuts and the need to decommission services rather than to develop them. I also noticed the limited research evidence informing some of these decision-making processes and the lack of knowledge among academics about how to influence these processes and mobilise their research evidence effectively.

AskFuse has supported more than 270 enquiries from a wide range of sectors, organisations and on topics ranging from Laughter Ball Yoga to Whole Systems Approaches to obesity. We have helped to develop new interventions and evaluated existing ones, made research evidence accessible and understandable, organised events to explore new topics, and pioneered new methodologies; all in collaboration with our policy and practice partners. We have also made mistakes, misunderstood procurement procedures, were not able to help in time, could not find relevant expertise or did not always follow-up on conversations.

Despite these challenges - or perhaps because of them - we have been able to build a dating service that (I think/hope) is perceived as useful by our policy and practice partners, that has helped us to build relationships (even in times of considerable system upheaval with public health moving to local authorities), and has informed new research agendas for Fuse going forward over the next five years as a member of the national School for Public Health Research.

As the service is expanding and my role is changing (I recently became a NIHR Knowledge Mobilisation Research Fellow, which I will talk about in another blog), we are looking for a new AskFuse Research Associate to work with me on strengthening the service and taking it in new directions. If you are interested in mobilising knowledge, fancy a challenge and want to work with a fantastic team, why not be part of it?

400 not out

Posted by Mark Welford, Fuse Communications Officer, Teesside University

This is the 400th post on the Fuse blog and in the spirit of using arbitrary milestones as worthy of note, I thought it was time for some (blog) post-match analysis.

Brian Lara who holds the record for the highest individual score in a Test innings
 after scoring 400 not out against England playing for the West Indies in 2004.

Over the last five-and-half-years, we have had 399 posts, written by 116 authors, and more than 395,000 page views. There has also been a lot of #fuseblog twittering, coffee room chats, and (you surely didn’t think it could be any other way?) blog-related committee discussions.

We even won a UK blog award last year (not that we mention it much!) and were shortlisted in two award categories earlier this year. But shortlisted isn’t winning and on the train back from those awards in April, I contemplated what we could do to improve the blog or - dare I say it - if the blog had run its course, done its job, had its time.

In academia, more than any sector that I’ve worked in (and I’ve worked in a few) you are encouraged to STOP, put down your machete, and climb above the canopy to see if the direction that you’re heading in is getting you to where you want to go. Academics will quite happily interrupt you in mid-flow to ask: ‘so what?’, ‘what impact are we making?’, ‘who are we reaching?’.

Since taking the wheel from blog founder Jean Adams I have enjoyed myself. I have learnt a bit about community and herding cats, I have made some real-life and virtual friends. I have written the odd post, although admittedly not as many as Jean, and I have enjoyed the discipline of having to write 500 -700 words for public consumption (usually when I can’t find anyone else to post).

I think the other writers have enjoyed it too, once they’d got past their initial reservations.

From all of this, I surmise that people value both reading and contributing to the blog. But I don’t have a clear view of who you are. You also seem to be discussing it in some forums. But you aren’t leaving comments on the blog itself. We have had a grand total of 480 comments posted, of which 234 were spam. So that’s 246 sensible comments. From 395,000 views.

So, I would now like to invite you to use the comment box below to post your thoughts on the blog so far. What sort of things do you like? What stuff would you rather we skipped? What would you like more of? Who are you? You don’t need to tell everyone your name, but what got you here? Why are you interested in this blog? What would make you more interested?

It isn’t that tricky:

1. Depending on how you got to this page, you either start typing straight in the white box, or you need to click the orange link “No comments” at the bottom of the post to get the white box to appear.
2. After writing your thoughts, click on the “Comment as” pull-down. If you know what any of the branded options mean, select one. If not, just chose “Name/URL” or “Anonymous”. Then do the ‘prove you’re not a robot’ thing and you’re done.

I’ll get an email. If you’re not flogging Viagra or using a barrage of abuse, I’ll approve your comment and you’ll be published.

And, just before you get to work: thanks. Thanks to the writers, the readers, the reviewers, the commenters, the retweeters, and the lurkers. See you all again at the next arbitrary milestone.

How I overcame my scholionophobia... a clinical pharmacist in an academic world

By Rachel Berry, Specialist Antibiotic Pharmacist, County Durham and Darlington NHS Foundation Trust, and Health Education England (HEE) and National Institute for Health Research (NIHR) Intern 2016/17

“Scholionophobia* – A fear of school, college or university”

So, I want you to picture the day ….. It was a sunny September morning and there I was, a clinical pharmacist currently working in hospital, standing by the River Tees at Queen’s Campus Stockton about to enter Durham University. And I was terrified. Honestly, the last time I was this scared walking into a university building was in 2004 and I was about to sit my Registration Assessment to become a qualified pharmacist. I was obviously suffering from scholionophobia.

Courtesy of mothmediatech & the creators of The adventures of Worrisome Wilf books

“But why were you so scared?” I hear you ask. Well, the answer is that I was just about to start my Health Education England (HEE) and National Institute for Health Research (NIHR) Integrated Clinical Academic Internship programme.

The HEE/NIHR funded internship is a programme to enable Healthcare Professionals working in clinical practice to gain research experience and skills by working alongside a university academic. I had ahead of me, 30 days away from my clinical commitments that I could use to gain an introduction into clinical academic research.

My fear was based on the fact that I didn't know anything about research or universities. Not one bit. And I definitely wouldn't be able to do it myself. In my mind, research was only done by brilliantly clever people who know everything. I was only a lowly hospital pharmacist. I was pretty sure that I would be the most stupid person there!

Fortunately for me, I was about to meet my amazing academic mentor, and go on an adventure into the unknown world of research. I have gained experience and skills in literature searches and critical appraisal, project design and data collection, statistics, statistical analysis software (SPSS) and writing for publication. I have met so many talented, lovely people who have been interested and willing to help me, even when I probably was the most stupid one there (try explaining Poisson regression and statistics to a person who doesn’t have A-level maths!). It really has opened my eyes to the world of research, and the possibilities for clinical practitioners. My mentor has helped me realise that the skills and experience I have from clinical practice are just as important in clinical research as the skills of doing the research.

I am now coming to the end of my time. I have completed my project, which will be disseminated to local Clinical Commissioning Groups (CCGs) to enable them to focus on key target areas to improve patient safety within antibiotic prescribing. I am also planning on publishing it, and hopefully this will allow the work to have wider impact. I have been able to take what I have learnt about research and its impact on patients back to my clinical work too. This has meant that I am more reflective and research-aware when doing my job. I have also shared this with the colleagues in my department, and hopefully encouraged them to be more research aware and active, to enable us to provide better care to our patients.

In the future I would love to do more research in conjunction with the School of Pharmacy as I have realised that blending our skills and experiences, whether they are clinical or research based, can lead to more relevant patient-focussed clinical research being undertaken. I am also trying to get other members of my department to apply for the Internship next year.

The 30 days spent at Durham University were some of the most challenging, interesting, frustrating and rewarding I have ever spent at work. My scholionophobia has been cured, with no medicines required. If you are a sufferer in clinical practice, I would recommend talking to academics in your clinical speciality and applying for the Internship; there is no need to be scared. And if you are an academic in health research there is a wealth of experience that you could utilise within the clinical teams; they would probably love to be involved, they just might be too scared to ask.


My thanks go to the team at North West Research and Development who ran the 2016/17 Internship Programme on behalf of HEE/NIHR. Also thanks to my managers at County Durham and Darlington Foundation Trust, and especially to Professor Cate Whittlesea and the School of Medicine, Pharmacy and Health at Durham University.

*Also known as Didaskaleinophobian or Scolionophobia.

Image credit: Thank you to mothmediatech and Séan Baldwin & Martin Gordon the creators of The adventures of Worrisome Wilf books.

"What should I wear?!" - My first conference as a PhD student

Guest post by Roxanne Armstrong, PhD student at Sunderland University

First of all, let me introduce myself. My name is Roxanne and I am currently doing a PhD at the University of Sunderland and I am part of the Fuse partnership. On the 18 – 20 November I attended my first ever conference, the UKCRC public health conference that took place in Edinburgh. I am going to use this blog to guide you through my experience, not to include the academic research that was presented. Hopefully providing an insight into what the “First Conference” feels like for a PhD student.

I am writing this blog, because despite being surrounded by a really supportive supervisory team, there are some things you just wouldn’t ask. A few examples; “do you think a four inch wedge is too formal for the day events? How about with jeans? Do I wear a dress for the conference dinner? Are flat shoes okay?”. This list goes on… This “fashion anxiety” led me to take a suitcase that could clothe a small town, four pairs of shoes and an array of eye shadow shades that a stylist from London fashion week would be proud of.

I started my journey on the train. A busy, smelly, full train. I had reserved a seat, sure, but due to me being (possibly overly) kind, I let someone take it. I glanced around and saw some other Fuse members that I recognised; I braved going over and introducing myself and ended up having a really nice, chatty trip to Edinburgh. Hurdle one – accomplished!

Professor John Frank, Director of  SCPHRP, got into the Scottish spirit at the conference dinner

Second hurdle, accommodation. Would I have a bed? Would I be sharing with a stranger that was prone to sleepwalking? How about free toiletries? I had no idea what to expect and have heard some fairly scathing reviews about conference accommodation. When I walked into my room I practically had to call someone to pick my jaw up off the floor. My accommodation was bigger than my own house! Bed? Check. Free toiletries? Check. Oh and two double beds, two plasma TVs and a kitchen area. I felt like Kate Middleton; surely this means I have made it in the world….

The third hurdle I faced was being in a sociable environment with people I’d only ever seen in a professional light. This was the most rewarding aspect for me; making connections, talking about normal things with lovely, like minded people. We shared mealtime and a couple of drinks and I finished the first evening with people I now class as friends.

Making connections with lovely like minded people

The conference itself was another challenge; I was full of nerves thinking about all of the other academics that would be there and how I’d act around them, but in truth it was so easy going. I was engaging with lots of approachable individuals with a lot of knowledge to share and exchange. I left the conference sessions feeling excited for my own future and how I was so grateful that I have such a diverse and welcoming community around me for at least the next three years and hopefully many more after that.

If I had to give some advice to someone who had never been to a conference before it would be the following: be open minded – every conference is different and you will find yourself being a social chameleon, adapting to whoever you meet, this is a great skill to develop. Secondly, enjoy it! I enjoyed every minute and really made the most of it. Finally, take as many free pens as your pocket will allow… That’s what they’re there for!

Oh, and I couldn’t end this blog without telling you – I opted for three inch wedge boots, jeans and a neutral shade of eye shadow. You’re welcome.

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Would you accept money to be healthier?

Guest post by Emma Giles, Senior Research Lecturer in Public Health, Teesside University

As newspaper headlines have shown, the issue of encouraging individuals to adopt healthier lifestyle behaviours by paying them is controversial. Whilst many of us know that we should do a bit more physical activity, eat our five-a-day fruit and vegetables and even attend our vaccination and screening appointments, we don’t always do this. Many barriers prevent us from fully engaging with these healthy behaviours, and these barriers are often complex, individual, and are not always easily surmountable. These barriers range from living away from green spaces which would allow outdoor exercising, to deep-seated social norms that stop individuals from engaging in healthy behaviours because they are not well accepted by family, friends or the wider community.

In recent years there has been a growing body of research looking at paying people to be healthier. This essentially means providing individuals or groups with cash, shopping vouchers or gifts in return for the adoption of healthier behaviours. Such schemes include the Pound for Pound weight loss incentive scheme, the Give it Up for Baby scheme, and offering incentives for breastfeeding.

In order to hear recent research evidence, and to provide a forum for friendly debate, I organised the recent Fuse Quarterly Research Meeting, which focused on payment for health behaviours. Last Wednesday (22 July), policymakers, practitioners, and academics came together to hear presentations from four academics and practitioners working in the broad field of incentives. As Claire Sullivan, a Consultant in Public Health from Public Health England mentioned in her opening address as Chair of the meeting, often incentives can take various forms – including paper pants for Chlamydia screening!

In terms of specific incentives, Professor Pat Hoddinott, Chair in Primary Care, Nursing Midwifery and Allied Health Professions Research Unit at the University of Stirling, presented research which focused on incentives for breastfeeding and to quit smoking in pregnancy – the BIBS study. Key findings suggest that tailoring of incentives is important to meet local needs, but that they show promise to encourage these behaviours.

Professor David Tappin, Professor for Clinical Trials in Children within the School of Medicine at the University of Glasgow, followed Pat by showcasing data from the CPIT trial – a smoking cessation in pregnancy trial in its second phase. Results showed that there was a 14% increase in quit rate and further analysis showed that there was a 150g increase in birth weight of babies born to mothers who quit smoking. Findings suggest that financial incentives were found to be acceptable by the women involved, and may double the quit rate when used with existing smoking cessation services.

A practitioner perspective was provided by Mr Andrew Radley, Consultant in Public Health Pharmacy, NHS Tayside, who talked about operationalising the use of financial incentives in a stop smoking programme within a community pharmacy setting. In particular, 393 women in Tayside engaged with the smoking cessation services, and incentives were found to be effective. Of note was the finding that mothers preferred receiving their incentives on a weekly basis.

I spoke last and presented qualitative data exploring the acceptability of incentives. The findings suggest that incentives are more likely to be accepted if they are provided to certain population groups including pregnant women and those on a low income, but not for those who may have alcohol or drug problems. The ‘perfect’ incentive has yet to be identified, but it will need to be shown to be cost-effective for it to be accepted on a wider scale.

The presenters were then joined by Peter Kelly, Director of Public Health Stockton Borough Council, Jim Beall, Health and Wellbeing Board Chairman, and Dr Jean Adams NIHR Research Fellow at CEDAR for a panel discussion. The audience raised many questions and comments around the use of incentives, with particular concerns around incentives increasing health inequalities, aggressively placing the blame of poor health on individuals, and that incentives may result in moral implications when individuals are rewarded for their behaviour. The debate suggested that more research evidence is needed to discover what type of incentive works for whom, and in what setting, and to better explore group (rather than individual) incentives.

What is obvious is that paying people to be healthier is an emotive topic, a highly contested intervention approach, but at the same time, it also shows promise to encourage individuals to adopt healthier lifestyle behaviours. It certainly provides food for thought…how many of us would accept money to be healthier?

Follow this link to find out more about the Fuse Quarterly Research Meeting ‘Payment for health behaviours: the case of health promoting financial incentives’ on the Fuse website.

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Who needs nudging, shoving, and shaming? Individuals or government?

Guest post by Victoria McGowan, Post-Doctoral Research Associate at Teesside Uni, Alcohol & Public Health Research Team

I recently attended International Society for Behavioural Nutrition and Physical Activity (ISBNPA) conference in Edinburgh (see #ISBNPA2015 on twitter). The conference was a great event and I’m very grateful to Teesside University for supporting my attendance.

Conferences have a tendency to be sedentary affairs and can often have limited opportunities for physical activity or even just standing during sessions. However, I was delighted to see that the conference organisers had marked out significant space for standing during sessions. Not only that, but there was the opportunity for yoga and health walks early every morning as well as lessons in ceilidh dancing at lunch time and a walk to Arthur’s Seat as part of the social programme. It was quite a physically active, physical activity conference.

Lunch time ceilidh dancing

However, there were some interesting discussions about whether us delegates were being socially shamed or nudged into partaking in physical activity during the conference. The conference opened with Professor Nanette Mutrie describing how she’d spotted one of her own researchers using the escalator as opposed to the stairs and encouraged delegates to give standing ovations to all speakers in an attempt to get us on our feet more. Although I found the level of physical activity on offer a refreshing change from being largely sedentary, I was slightly unnerved about the underlying social shaming.

I’m a strong advocate for informed choice, I love posters on stairs telling me how many calories I’ll burn by walking up them but I also love having the option of taking the escalator. There were stories of academics taking photos of people using the escalator to shame them for not using the stairs. It was interesting to watch the Mexican wave of delegates standing to applaud, a few individuals would stand and then row after row behind them followed suit… until it came to me and I would sit in defiance. Why did I stay seated? Because I have a choice and honestly, I don’t like being socially shamed into doing something. Yes, I agree obesity, nutrition, and physical activity researchers should not be hypocritical and practice what they preach. However, we also need to be mindful that we’re working with people who are more concerned about paying their rent, whether their children need new school shoes, zero hours contracts, whether they can get an appointment with their GP, the list goes on. Yes, taking the stairs may improve our health if we use them regularly but we have to understand that some individuals choose the unhealthier option due to a whole host of external pressures. Lecturing these individuals about taking the stairs may fall on deaf ears or, as in my case, may lead to defiance. I used the escalator on occasion because it was quicker for me to walk up/down the escalator to dash between sessions and avoid the crammed stairs.

There are other reasons why individuals choose the less healthy option and we need to understand these external pressures rather than shaming people into taking the stairs. As Professor Alan Batterham rightly pointed out in his debate with Professor Stuart Biddle we’re evolutionary predisposed to conserve energy whenever possible so sometimes we may choose the escalator. However, we may choose the stairs if we’re provided with information on why it’s good for our health, or if we alter the environment to make healthy choices easier. But please don’t shame us into choosing one option or the other as this could lead to unintentional detrimental consequences of purposeful rebellion. Yes, I’m aware of the obesity ‘epidemic’, but I’m also aware this is caused by factors which are outside of individual control. Professors Ted Schrecker and Clare Bambra’s book How Politics Makes Us Sick shows how the rise in neoliberal policies in the UK and US are associated with rises in obesity and health inequalities.

Inequalities are having the greatest impact on health

Kylie Ball highlighted this point at the end of her keynote speech, yes we need to help improve nutrition and physical activity BUT we also need to help reduce inequalities in nutrition and physical activity. Inequalities are having the greatest impact on the nation’s health, not occasionally taking the escalator.

It’s time to nudge, shove, and shame our government, not individuals, into reducing health inequalities and improving overall public health.

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Collaborative research: agreeing to disagree?

Posted by Peter van der Graaf

Fuse sponsored a parallel session at the Faculty of Public Health conference last week in Gateshead, chaired by Professor John Ashton CBE, President, UK Faculty of Public Health. The session focused on the challenges and opportunities of collaborative research between academics, health practitioners and decision makers.

The four papers presented in the session outlined different challenges in collaborative research: Alyson Learmonth, reviewing Health and Wellbeing Strategies in the North East, highlighted the diversity in priorities between different areas, making it difficult to focus and combine resources across local authorities.

Silvia Scalabrini showed that, in spite of dedicated health economic support from academics to local public health teams in prioritising their investment and resources, the use of these formal tools was met with resistance by elected members who put a higher value on other sources of information, such as stories from residents.

I highlighted limits to collaborative working through a mismatch in timescales, funding and interests. For example, academics showing limited enthusiasm for applied research due to a lack of incentives within their institution, which put a higher value on high quality publications and research council funding.

Fuse Director Professor Ashley Adamson talked about the challenges in setting up data sharing agreements with different local authorities to access National Child Measurement Programme (NCMP) data, in spite of positive support and demand for the research from local government.

Listening to these presentations one might wonder whether collaborative working is really possible. At the same time, each presentation offered examples of where it was achieved and made a difference. For instance, Alyson Learmonth's appreciative enquiry demonstrated common interests between Health and Wellbeing Boards (HWBs) in giving each child the best start in life and in the social determinants of health, particularly interventions around education and housing.

Silvia Scalabrini highlighted the usefulness of the Portsmouth Scoring Card, developed by Austin, Edmundson-Jones, and Sidhu (2007)* for local authorities to prioritise their spending. I reflected on the value of responsive research services, such as AskFuse, to provide backstage negotiation spaces for what constitutes useful evidence. Professor Adamson discussed the benefits of matching data from the NCMP with local intelligence to increase the effectiveness of child obesity interventions and their evaluations.

I’m wondering where this leaves us? In spite of problems in setting priorities, even agreeing on the tool to do this, limits to willingness and capacity among academics and public health practitioners to collaborate on research projects, and barriers in data sharing once a project has been agreed, the different examples made it clear that not collaborating was simply not an option.

Public health practitioners have limited resources and lack the capacity to analyse and interpret data, while academics are increasingly required to demonstrate the impact of their research and lack an understanding of the context and processes in which evidence is used in practice. Working together is a must to ensure that public health can provide an answer to the questions it is currently being asked.

Moreover, the number of participants from academia and practice at the conference session, demonstrates that there is a clear appetite to work together on these issues as long as we are able to provide the conversation spaces for this.


*Reference. Austin, D., Edmundson-Jones, P. and Sidhu, K. (2007) Priority setting and the Portsmouth scorecard: prioritising public health services: threats and opportunities. Available at: http://www.publichealthconferences.org.uk/health_services_2007/presentations.php

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Complexity in health organisations: setting ourselves up for chaos or enjoying the simple things in life?

Posted by Peter van der Graaf

Can applying a complexity lens to health organisations be more than an academic exercise with practical applications for service delivery? This question was central to a two-day meeting last week in London at the Health Foundation between researchers, policy makers and health practitioners. The event was organised by The Knowledge to Action Group (KTAG), an international team of senior academics and coordinated by two leading members of Fuse’s Complex Systems research programme, Prof David Hunter and Dr Emily Henderson. The group brought together the crème de la crème of health research and knowledge mobilisation, with about 40 handpicked participants from across the UK to debate a green paper on the topic (which is a tentative government report and consultation document of policy proposals for debate and discussion).

The essence of this meeting was about getting to grips with the consequences of doing research and developing interventions in a world that is inherently complex (which is not to be confused with just being complicated!). The green paper (Knowledge-to-Action: Addressing Complex Problems in Health Systems, May 28/29 2015) described complex systems as non-linear; dynamic; and having no single point of control.  Because of these characteristics, outcomes in a complex system are unpredictable and resistant to interventions. So are health systems really complex? Anyone trying to get research evidence into practice will quickly discover that knowledge mobilisation is prone to all the characteristics outlined above for complex systems.

In one of the breakout sessions during the event the difference between complicated and complex was illustrated with the example of building a rocket versus raising a child.  Building a rocket is complicated but will lead to a predictable outcome (successful launch) if all the different pieces are correctly assembled according to the guidebook. However, raising a child is complex (as many parents will testify) and often leads to chaos in many academic households. This is bad news for academic parents and health service managers: you cannot steer the thing (but you are still accountable for it) and even if you find the solution to a problem in the system it is likely not to work when you try it again. The dynamic nature of systems means that what works in one context or at one point in time may not work the same as the system changes.

How do you work within such a system? Fortunately, the event provided four case studies of research projects where the academics had managed to work within a complex health system to produce change across different areas, often in co-production with policy makers and health practitioners. The authors of the green paper distilled four themes from these case studies to inform future research and interventions:

1. the balance of central and distributed authority in organisations and systems; 
2. the importance of emergence (continuous learning and adaptation); 
3. the need for co-produced knowledge; and 
4. a range of leadership positions and styles.

These four themes were discussed in more detail in various breakout sessions over the two days.

Participants embraced the spirit of the event and discussed a wide range of topics (from the need for a critical discourse department to finding positive deviants), whose relationships with the four themes were sometimes unclear and mostly unpredictable. Nevertheless, some key messages emerged from the event that will soothe the nerves of academics and service managers. By visualising complex organisations as “patterns of conversations between interdependent individuals” (as quoted in a presentation from Allan Best on the first day), working in complex systems becomes conversation management and engagement. According to the researchers involved in the successful case studies, this works all the better outside the normal context of everyday work by taking commissioners to the pub or baking a cake for a meeting with service managers to get the conversation really going. Isn’t it ironic that to work inside complex systems, one needs to go back to basics in a more simple system?

52 weeks in public health research – the (very) rough guide

Guest post by Avril Rhodes

Remember the natty idea to take photographs representing a year of working in public health research? Well, how about a quick analysis of what we saw, snapped and submitted? Here are the exciting and indeed revealing results.

After looking at 198, or was it 200, images a portrait of researchers concerns emerges – not exactly Maslow’s hierarchy of needs, so much as the Rhodes' hierarchy of academic obsessions.

Bottom or is it top of the pile comes food. It’s official – no less than 42 pictures, close up and distance shots, ranging from individual snacks, drinks and meals to full size conference spreads and displays. I felt slightly queasy after looking at them all. Feed those academics!

The next most important thing is to feed the mind. Any passing course, lecture, symposium and the like weighing in with 20 pictures. But there’s lots more that get close to the mind-feeding category although making more cameo-esque appearances, such as degree ceremonies, IT, stands and posters, books, theses, work in progress and journal covers. Publication definitely counts. Completing work even more.

The office – no not the TV series, comes next, with 16 images, inflated perhaps with opportunities created by moving office and the delights of standing desks and desks tied to exercise apparatus. I would not have dreamed that taking a picture of the immediate work environment was so important. 

Travel ranks highly but possible to count in different ways. Railway stations are significant at 11 pictures, especially Newcastle Central – of world significance as stations go, but that’s just me. Car travel featured just slightly with a nod to cycling. Active travel (good and bad) is clearly a source both of delight, when stairs get favoured, and frustration, when lifts are promoted. Exercise equipment got a decent look in too. 

Signs and marketing really played on the collective academic mind. Labelling, the impact of shop placements and advertising, spelling mistakes, unintended humour, public health messaging, came in with around 12 images. Some of this felt a bit judgemental, when it came to cheap unhealthy food signs. Not too many wider determinants of health, it has to be said.

 

Field work related images scored a fairly respectable 9.

 

Culture kept creeping in. Museum visits, architecture, music, sculpture were all there. Nature played a relatively small part, but researchers did appreciate the cute, the beautiful, office plants and the changing seasons.

 

Then a whole rag bag of one-offs. Some were clearly novelty items or personal reminiscences, and some seemed like stream of consciousness, or pet concerns.

Curiously, the academic world was quite short of pictures of people, except in crowd shots doing serious lecture type stuff. It looked a camera shy world. So what do we have? A hard working, semi-office bound, nomadic community that likes writing, learning, unable to switch off form public health even when undertaking a leisure activity or just walking around the town, that enjoys high art and longs to sniff a flower. Is this what we are? The camera apparently doesn’t lie.