Sparking curiosity with Twinkle, Twinkle Arti

Posted by Nicola Aldridge, Research Associate, and Cassey Muir, Research Associate / Co-lead of the Fuse Early Life and Adolescence Research Cluster, both from Newcastle University

We were recently given the exciting opportunity to showcase the Twinkle, Twinkle Arti project at Discover Festival, a free, one-day festival organised by Newcastle University that brings together families, communities, and researchers through interactive activities and inspiring ideas.

Nicola and Cassey

Discover Festival is designed to spark curiosity, build connections, and encourage people of all ages to explore new ideas. Each year, the university creates a packed programme of family-friendly events, and this year, we were delighted to be part of it as members of the Twinkle, Twinkle Arti research team.

Bringing Arti's story to life

Throughout the day, we invited families to step into Arti’s world through the Twinkle, Twinkle Arti storybook. Developed by Fuse researchers at Newcastle University, with funding from the NIHR School for Public Health Research, the book was created and co-produced with families to support the wellbeing of children experiencing challenging family circumstances, such as drug and alcohol use. While these experiences inspired the story, its themes of feelings, belonging, resilience, and hope resonate with all children.

Visitors to our stall in the Great North Museum had the chance to watch a CBeebies Bedtime Stories style video of it being read aloud by the author. They could also explore puppets and original illustrations from the book, and view artwork created by primary school-aged children who had participated in a pilot study of classroom lessons based on the story.

Families were also able to take home a free copy of the storybook, along with a link to the online read-aloud video and a set of simple conversation prompts designed to encourage creativity, emotional expression, and meaningful family time at home. We handed out nearly 80 copies on the day!

Conversations that matter

Beyond engaging with families, it was equally exciting to see the conversations that the project sparked among professionals attending the festival. We spoke with people from a range of sectors, including teaching, school governance, clinical psychology, and general practice with social prescribing links. Their curiosity about the project and enthusiasm for its potential applications highlighted the broad relevance of Twinkle, Twinkle Arti and the importance of creating accessible resources that support children's emotional and social wellbeing.

One particularly rewarding conversation was with a family who shared their personal experience of the impact of alcohol on family life and how they might be able to use the book. Hearing their reflections was both moving and affirming. It served as a powerful reminder of why the project began in the first place and reinforced the continued need for resources that help children navigate difficult experiences. Moments like these bring the research to life, reminding us that behind every study, storybook, and activity are real families whose experiences matter and whose voices continue to shape our work.

Creating a community star mural

Another highlight of the day was our evolving community star mural. We invited children to create their own star by drawing, colouring, or writing ideas about what they or Arti could do when they felt sad or worried, with 114 stars being created on the day. It was wonderful to see children enthusiastically embracing the activity, and even more special to watch parents, carers and grandparents join in too, talking to their children about the messages in the book. The excitement on their faces as they added their stars to the mural was a lovely reminder of the power of creativity to bring people together.

A colourful celebration of hope and resilience

By the end of the day, the mural had grown into a colourful display of hope, kindness, and imagination. It was a privilege to share the Twinkle, Twinkle Arti project with so many families and to see first-hand how children connected with Arti’s story and messages of hope, resilience and belonging. Events like Discover Festival provide a fantastic opportunity to bring research into the community, and we were grateful to be part of such an inspiring day.

Find out more about Twinkle, Twinkle Arti

• Read this Fuse blog about the development of Twinkle, Twinkle Arti
• Read about Twinkle, Twinkle Arti as a NIHR School for Public Health Research (SPHR) case study
• Read about piloting Twinkle, Twinkle Arti in primary schools
• Listen to this Fuse podcast to hear Cassey discussing her research on social and emotional resilience in children and young people affected by parental substance use.
• Download the book for free.
• Watch a video of the book being read aloud.

How our ‘test & learn’ prototypes are strengthening Social Prescribing

Posted by Ang Broadbridge, Head of Implementation at Ways to Wellness, on #SocialPrescribingDay

Evaluation is often something that happens at the end of a project, but what if we built learning into the process from the very start?

At Newcastle-based charity Ways to Wellness, we believe that embedding a culture of learning from the outset helps social prescribing link workers share real-time insights, refine approaches, and ultimately improve support for the communities we serve.

One area where this model has been used is in maternal mental health

Co-designing for impact

A core part of our work is connecting with local communities to shape and refine prototypes that align with our mission:

• Improving health and wellbeing
• Tackling health inequalities
• Reducing demand on NHS services

To ensure our link workers could share learning, develop key messages, and highlight gaps in services, we adopted the Learning Communities model. As described in the Learning Communities Handbook, these are:

"A group of peers who come together in a safe space to reflect and share their judgements and uncertainties about their practice and to share ideas or experiences to collectively improve."

To embed this approach into recruitment and training, we:

• Included an expectation for link workers to actively engage in Learning Communities
• Encouraged participation in ‘test and learn’ approaches
• Provided ongoing support and facilitation to foster a sense of ownership and belonging.

This approach helped link workers collaborate across different host organisations, spanning locations across the North East and North Cumbria.

Extending learning into maternal mental health

One area where this model has been used is in maternal mental health. After eight months of Learning Community meetings, we expanded this approach through a series of external learning events. These events:

• Shared early insights from our maternal mental health prototypes
• Brought in new partners to co-develop next steps
• Strengthened cross-sector collaboration

A key learning was that while social prescribing is well known in GP practices, it was midwives and health visitors who played a crucial role in referring parents to our prototypes - roles that hadn’t previously collaborated with link workers.

By opening up new referral pathways, we helped develop best practices for integrating link workers into maternal healthcare settings.

Turning insights into action

Our Learning Communities aren’t just discussion spaces - they drive change. Link workers use them to:

• Identify barriers in accessing social prescribing
• Test new ways to connect people with support
• Share insights at external events and policy discussions

The impact has been tangible. For example, after testing different approaches, some link workers are now based in health appointment clinics - an innovation that has improved system-wide connectivity and access to services.

Why this approach matters

By embedding a culture of continuous learning, we are:

• Strengthening partnerships across health and care sectors
• Ensuring services are designed with communities, not just for them
• Maximising the impact of social prescribing

At Ways to Wellness, we believe that the voluntary sector, healthcare services, and community organisations must work together to tackle health inequalities.

That’s why we’re committed to testing, learning, and adapting - so that social prescribing continues to evolve, improve, and reach the people who need it most.

Find out more at: waystowellness.org.uk

Image credits: Ways to Wellness Limited company number: 08798423

Beyond stats and diseases: my summer internship in Public Health

Posted by Bethany Henshaw, NIHR School for Public Health Research (SPHR) Intern in Fuse, undergraduate at Newcastle University

The NIHR School for Public Health Research (SPHR) recently asked its members (including Fuse) if we would like to host an internship this summer. The summer internships are aimed at undergraduate students with an interest in a career in public health research. The internships offer support for 6-8-week projects supervised by SPHR Early Career Researcher (ECRs), Fellows and PhD students. 

In this post, Beth (pictured right) tells us about her internship experience last year at Gateshead Council. 

When you think of the term ‘public health’ what comes to mind? According to the World Health Organization, it is:

“the art and science of preventing disease, prolonging life and promoting health through the organised efforts of society.” 

If you had asked me this question in early 2023, I would probably have given a very general, slightly muddled answer which was focused on the disease aspect of the field. What my answer would have highlighted was that I had very little understanding of just how broad and wide ranging the field of public health is.

Last year I undertook a NIHR School for Public Health Research (SPHR) summer internship in Fuse, looking at the perspectives of social prescriber link workers (who connect people to community-based support) on the promotion of active travel. Active travel refers to modes of travel that involve a level of physical activity such as walking and cycling. I was interested in understanding how social prescriber link workers felt the prescription of this to their patients would impact them.

The findings will be used to inform the development of an active travel pilot in Gateshead. The internship was a fantastic experience in many ways: it enabled me to develop my qualitative research skills, for example, I developed a topic guide for the social prescriber link worker focus group, and gave me valuable insight into professional working life. However, my biggest take-away was the insight it gave me into career options within public health.

Behind the stats are real people with their own unique story

As a biomedical science undergraduate, I spent two years studying topics like physiology, pharmacology, and immunology largely at the molecular level. I understand how many different diseases invade the body and make a patient ill. However, for a while now I have been interested in understanding disease at a population level. Rather than the cellular mechanisms of disease, I have grown more interested in why some people are more susceptible, and how we can reduce this disparity and prevent further people from becoming ill in the future. Before my internship, I mainly considered public health from a disease related perspective and thought that health protection covered the vast majority of the field. However, by speaking to both researchers and members of the Public Health team at Gateshead Council, it became clear to me that it covers significantly more than this! Issues such as environmental health, health services and health improvement are all things I previously wouldn’t have thought about when trying to define what I considered public health to be.

Something that surprised me during my internship was just how central recognising the individuality of each patient’s situation is in public health. I came to the realisation that when I had read research papers on disease outbreaks or rates of chronic disease as part of my degree, I had been overlooking this important detail: that behind the stats are real people with their own unique story. Talking to members of the active travel social prescribing team at the Council, made me realise just how individual and unique the journey is for each patient. Summarising, for example, how many patients continued to regularly use active travel for the time period they were prescribed it as a percentage does not reflect the reality of what these patients go through, something that will only be understood by talking to the patients to understand their experience. I found this outlook on viewing patients as people and not just statistics to be incredibly refreshing, and it has provided me with a new perspective to take into my final year of university and beyond.

My internship offered me a view of what life could be like working within public health research and the broader field. My understanding of what public health is, has been challenged and has been significantly changed from the disease focused perspective I had before. However, one of the main things I will take away is that behind all the statistics we see in the news and read in research papers regarding rates of disease, it is vital to remember that each statistic is a patient whose own unique experience should not be undermined.

Image:

2. Photo by cottonbro studio: https://www.pexels.com/photo/woman-with-red-light-on-face-5473950/

Is Exercise Referral fit for a new decade?

Posted by Coral Hanson, Emily Oliver, Caroline Dodd-Reynolds and Paul Kelly

“Exercise referral doesn’t work”. We have heard this said time and time again, particularly by those who are peripherally aware of the field, but perhaps most worryingly by commissioners and those involved in public health policy. We’ve argued that this is simply not true. A different interpretation is that the exercise referral evidence-base, and the way it is used, hasn’t been working.

The term ‘exercise’ conjures images of Mr Motivator-style aerobics in eye-searing 1990’s lycra

Exercise referral is a decades-old process where professionals in primary care (GP/practice nurse) or secondary care (specialist doctor/physiotherapist) refer patients to a community-based physical activity scheme - often delivered by a leisure provider. National policy guidance (NICE, 2014) recommends that referrals are made where a patient is otherwise inactive or sedentary (both different parameters and not simple to classify in a primary care setting such as a GP surgery) and additionally has an existing health condition, or is at risk of having one.

Traditional evidence-generation for exercise referral has tended to be single-site studies that are then condensed using systematic-review-based methods. Given the considerable variation in how schemes are designed, delivered and evaluated at local level, this is problematic. Vague policy guidance and limited evaluation funding means that most scheme iterations are unsuitable for inclusion and interpretation in this outcome-driven way (Oliver et al., 2016). Collectively, the findings of such overviews are rather underwhelming.

Consequently, during times of tightened public health spending and commissioning, many UK exercise referral schemes have been de-commissioned. This seems misguided, given evidence that some schemes work, for some individuals, in some contexts. Understanding these nuances is at odds with the ‘best practice’ and ‘scaling-up’ that is so often seen as desirable within physical activity policy. Evidence must (and thankfully is starting to) account for consideration of local tailoring and best fit for a given community. Incorporating such evidence into policy is a different matter, of course.

To assist with collating evidence that can meaningfully inform policy and commissioning decisions in this area, our recent editorial in the British Journal of Sports Medicine proposes a sea change in how exercise referral is considered, categorised and reported. The term ‘exercise referral’ is outdated in 2020. ‘Physical activity referral schemes’ more appropriately describes the innovative and extensive range of programmes being delivered, and allows for other types of referral including self-referral, social prescribing and group-based needs assessments, to potentially contribute to the evidence base.

Personally, we’re not keen on the term ‘exercise’; it conjures images of Mr Motivator-style aerobics in eye-searing 1990’s Lycra. It sounds so imposed and constrained

You may have noticed we have replaced ‘exercise’ with ‘physical activity’ – surely a more inclusive term for what is ultimately a behaviour – and one which we are trying to change. Traditionally exercise referral schemes were mainly gym-based and we think that this image probably persists when we think of exercise referral today. Personally, we’re not keen on the term ‘exercise’; it conjures images of Mr Motivator-style aerobics in eye-searing 1990’s lycra. It sounds so imposed and constrained. Even a simple phrasing change can have far-reaching implications, and hopefully for the better in this case.

In the editorial, we propose a simple way of identifying, classifying, and recording key information about physical activity referral schemes that will enable better understanding of what exists and what is working. Our new reporting checklist (or taxonomy) encompasses all physical activity schemes that:

1. have the primary aim of increasing physical activity,
2. have a formalised referral process, 
3. are provided for individuals who are inactive/sedentary, and/or have or are at risk of a health condition. 

The classification framework can be seen in figure 1 (below). The full reporting checklist can be found in the editorial. We propose that this be used by commissioners, practitioners and researchers alike: for auditing and monitoring, to capture service delivery and in generation of evidence reviews.

Figure 1

We are very keen to hear from anyone working in exercise/physical activity referral of any kind as we move forward with refining this idea. The model was proposed to policy-makers, practitioners and academics at a consensus event in late 2019, and we are currently refining it by undertaking a Delphi Survey. We are inviting further comment, critique and engagement to make the final version as accessible and ‘fit for purpose’ as it possibly can be, so please get in touch with Coral, Caroline, Paul, or Emily via twitter or email - details below.

Coral Hanson, Research Fellow, Edinburgh Napier University @HansonCoral / C.Hanson@napier.ac.uk

Emily Oliver, Associate Professor, Director of Research in the Department of Sport and Exercise Sciences, Durham University @_EJOliver

Caroline Dodd-Reynolds, Associate Professor, Department of Sport and Exercise Sciences, Durham University @carolinedod / caroline.dodd-reynolds@durham.ac.uk  

Paul Kelly, Lecturer in Physical Activity for Health, The University of Edinburgh @narrowboat_paul 

References:

• Hanson, CL, Oliver, EJ, Dodd-Reynolds, CJ & Kelly, P (2019). We are failing to improve the evidence base for “Exercise Referral” How a Physical Activity Referral Scheme Taxonomy can help. [CR14] British Journal of Sports Medicine Published Online First: 17 December 2019. doi: 10.1136/bjsports-2019-101485
• National Institute for Health and Care Excellence. Physical activity: exercise referral schemes. National Institute for Health and Care Excellence, 2014. https://www.nice.org.uk/guidance/ph54/resources/physical-activity-exercisereferral-schemes-pdf-1996418406085 (Accessed 06 Jan 2020).
• Oliver EJ, Hanson CL, Lindsey IA, Dodd-Reynolds CJ. Exercise on referral: evidence and complexity at the nexus of public health and sport policy. International Journal of Sport Policy and Politics 2016;8:731–6.

Images: 

1. ‘Mr Motivator 2’ by Dave Tett via Flickr. Attribution-NonCommercial-NoDerivs 2.0 Generic (CC BY-NC-ND 2.0): https://www.flickr.com/photos/66551670@N00/388434590 © 2007.
2. 'Figure 1' reproduced from Hanson, CL, Oliver, EJ, Dodd-Reynolds, CJ & Kelly, P (2019). We are failing to improve the evidence base for “Exercise Referral” How a PhysicalActivity Referral Scheme Taxonomy can help. British Journal of Sports Medicine Published Online First: 17 December 2019. doi: 10.1136/bjsports-2019-101485 with permission from BMJ Publishing Group Ltd.

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.