Actions bring risks

Posted by Llinos Mary Jehu, Research Associate with AskFuse, and Pat Watson, Research Fellow, Teesside University

We all know that. At a time when many of us are returning from holiday (or conference), we can reflect on the risks we took, like driving to the airport or eating sea-food.

So it’s no surprise that participatory action research brings risks. Co-researchers may be exposed to the risks that academics frequently anticipate, such as risks arising from lone-working or the emotional impact of data collection and reflection. There are also risks associated with research being carried out by people who have not been trained to the level of an academic, such as confidentiality, informed consent or interviewing techniques.

I’ve been involved in participatory action research at two universities, as well as within the NHS and local government. I’ve been through university ethics and NHS ethics, jumping through hoops as we’ve recruited and trained co-researchers, often re-submitting so we can finally start collecting and analysing data. I’ve also spent a fair amount of time getting to grips with systems for paying co-researchers expenses and honoraria. It’s amazing how complicated getting agreement to give out some supermarket vouchers can be, as both the ethical risks and financial risks are apparently enormous.

For all these projects, risk was removed, reduced or managed through our training and support systems. The training sessions allowed potential co-researchers to build their understanding of what the research involved, giving them an opportunity to opt-out should they choose. The sessions also built open, trusting relationships which, very occasionally, allowed us to identify and counsel people away from the project and signpost them to other opportunities. These relationships were vital during data collection periods. We may have drunk gallons of coffee and eaten far too much cake, but frequent, informal meetings with co-researchers ensured we kept a handle on what was happening in terms of ethics, finance and lone-working.

Consequently, I was a bit thrown when AskFuse - the responsive research and evaluation service run by Fuse - received a query from Pat Watson at Teesside University. Pat’s been commissioned by Sunderland City Council to carry out a piece of participatory action research involving pregnant mums in the design, development and implementation of a project looking at how expectant mums make decisions on how to feed their babies. The university Ethics committee had asked about insurance for co-researchers, and we had to admit that no one in the AskFuse team had any examples of formal arrangements. I also had a slight concern that, given the risk-averse nature of many large organisations, such a requirement might pose an insurmountable barrier for the research proposal. Undeterred, Pat went on the hunt, with a meandering email trail that eventually reached the University’s Deputy Director of Finance and the Liability Underwriter for the University’s insurers, UMAL. To my absolute surprise and delight, they confirmed ‘that the Teesside University Employer Liability/Public Liability/Public Indemnity covers apply to all University authorised research activity’. If Ethics approve participatory action research, then the co-researchers are insured.

It’s a huge relief that we now have a tick to put in the required box, and we have an example to cite should another researcher be asked the same question. I am really impressed with the approach of the insurance company: as their website states, they ‘never shy away from difficult risks’. However, managing risk in participatory action research requires far more than ticking boxes, regardless of how important these boxes may be. An equally important tool for identifying and managing risk is the strong relationships that successful co-research depends on. These relationships require time and investment, going to where people are and being prepared to share their space. They require trust and respect; possibly not asking people to show you a receipt before you pay their bus fare and not assuming that they’ll use their supermarket voucher to buy cider.

Research tools, data collection and analysis will be different, and often better, when the research process involves or is led by people who share the same standpoint, or even are, the research subjects. Hopefully universities will continue to recognise the benefits of participatory action research, recognise that the relationships it generates are a valuable asset and tool for managing risk, and not shy away from any ‘difficult risks’ it may present.


Image: 'victorian risk assessment cartoon' by John C Bullas BSc MSc PhD MCIHT MIAT via Flickr.  Attribution-NonCommercial-NoDerivs 2.0 Generic (CC BY-NC-ND 2.0):
https://www.flickr.com/photos/johnbullas/7788230372

Should Nanny be in charge of the tuck-shop (and off-licence)?

Guest post by John Mooney, senior lecturer in Public Health at Sunderland University

Aside from inclement weather and beautiful coastlines, there are a number of more worrying close parallels which the North East of England shares with my native Scotland. Most notable among these are an embedded culture of heavy drinking and an ongoing aversion for substantive proportions of both populations to fresh fruit and vegetables, alongside a fondness for fried and fast food.

The unfortunate consequences of these ‘’lifestyle choices” speak for themselves in the league tables for obesity across the life-course and in the statistics for alcohol related liver disease mortality, where only Scotland has higher rates than the North East. Despite good evidence that parts of Scotland, notably Greater Glasgow and West Central Scotland, have a more significant health burden than comparable areas in England (the widely publicised ‘Glasgow Effect’), there is no room for complacency in the North East, as front-line public health teams know only too well (especially since much of Scotland's culinary delights, including Tunnock's teacakes, are readily available in most major grocery retailers).

Is Scotland ready for a Tunnock’s tea-cake tax?

As an embedded researcher in Sunderland City Council where I work one day a week with the public health team, I have the dubious privilege of being immersed in the reality of what this means for those engaged in efforts to improve population health in the region. Specifically, there is the ever present tension arising from the contrast between the current consensus about what types of intervention might work best, alongside the reality and constraints that can frustrate their implementation. Flipping back to North of the border, Scotland’s best example of that practical tension has to be the ongoing legal machinations of the European Courts, dealing with industry raised legal challenges to alcohol minimum unit pricing.

My own previous experience during a career development fellowship at the Scottish Collaboration for Public Health Research and Policy (SCPHRP), gave me a small taste of comparable “practicality constraints” when our review of the international evidence around obesity prevention highlighted that a sugared-drinks tax would be the most promising and cost effective intervention at a national level. The commonly used slang for all fizzy drinks in Scotland (due to the popularity of a certain rustic coloured tipple) of ‘bottles of ginger’ led the Scottish Daily Mail to pronounce on its front page: “Nanny State Researchers propose a Ginger Tax!”. It’s only fair to say that SCPHRP Director, Prof John Frank’s subsequent telephone conversation with the then Treasury Secretary, Danny Alexander was particularly tense!

The all pervasiveness of the term “nanny state” in relation to public health interventions was recently brought home with a colleague’s recollection of her eight year old daughter’s reaction to school tuck shop restrictions: “I don’t want to be living in a <>~^+*!! nanny state”. It was very much in evidence also with the Chief Medical Officer’s festive cheer about there being no safe minimum level of alcohol consumption in relation to cancer risk. No surprises for guessing how that particular advice was received by New Year revellers in Scotland.

While public health “nudge” messages are often ridiculed as nanny state interventions, what is often forgotten in relation to dietary or behavioural advice is that these “nudge messages”, whether around availability, affordability, or portion (glass size/ strength of beverages), have all been incrementally (and imperceptibly) ratcheted up in the other direction over preceding decades. This could equally apply to the added sugar content of processed food and drink or the cultural normalisation of everyday drinking.

This should not however be a council of despair for public health practitioners and policy makers across the board. Smoking was once thoroughly normalised behaviour in all public and workplace environments. The legal challenges to alcohol minimum unit pricing, the most effective intervention at reducing excessive consumption based on solid international evidence, are steadily being chipped away in my native Scotland and perhaps “a ginger tax” for the whole of the UK might not be far away. Especially now Jamie Oliver has taken up the mantle of the sugared drinks tax debate and NHS Chief (Simon Stevens) seems, as of last week, to be fully on board – for NHS premises at least. Although I dread the reaction of my colleague’s politically savvy eight year old when she finds out!

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John Mooney FFPH is senior lecturer in Public Health at The University of Sunderland and spends one day per week with the public health team at Sunderland City Council.

He will be presenting at Teesside University’s Health and Social Care Institute lunchtime meeting in a talk entitled: Is Scotland Ready for a Tunnock’s Tea-cake Tax and other public health conundrums? On Wednesday 27 January 12.30 – 2pm in C2.22, Constantine Building, Middlesbrough.

"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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How to improve your productivity: don’t read this blog

Posted by Jonathan Ling

One of my first office mates was Roger.

He was an older academic who had just been recruited by my department. As I helped him carry boxes of books into our room, I noticed that at the top of one of them was a book with his name on the cover. I was impressed – I was sharing my office with an author! I told him how great it must be when someone said to him: “I’ve read your book”. He agreed that it was a nice feeling, but what felt even better was when, having written a couple more books, he was able to say: “Which one?”

I’d never really thought about writing a book myself, until I was asked a couple of years ago to co-author a short textbook. It was on a topic I knew a bit about, but I’d never met the co-author who came from a university at the other end of the country. The editor suggested that the process would be reasonably straightforward and fairly speedy. As he had written several books himself I thought he obviously knew what he was talking about.

With hindsight I now realise he must be significantly more methodical in his approach to writing than I am.

I eventually finished my part of the book and it was published last year. Mostly by trial and error, I learnt a few things as I went along:

1. Have a writing routine. Take time out of every day to write. If you don’t block out a specific time each day to write (and stick to it), you won’t get anything written. It doesn’t matter when it is (I work better in the afternoons), just hang a “Do not disturb” sign on your door, or around your neck, and get going.

2. Don’t get side-tracked. See point 1. Your writing time is for writing – it’s not time for admin, catching up with emails, fitting in meetings or reading engaging and erudite blogs.

3. Seek feedback from your target audience. Unless it’s your diary, everything you write is for an audience. Think about who the audience is, and make sure they get a look at it. For a textbook, this was undergraduate students and other lecturers. For a journal article, most likely it would be fellow academics, as well as practitioners or policy makers.

Egg timer, by Martin Lopatka

4. When all else fails, get an egg timer. There were some parts of the book where I really struggled – topics I was unfamiliar with, that required lots of reading and which I wasn’t particularly interested in. But I just had to grind these sections out. In one of my more (possibly only) fruitful side-tracks, (see point 2), I came across the Pomodoro technique. In essence, this is just working on your chosen task for 20 minutes (no email, no looking out of the window – just work!) and then having a 5 minute break before another 20 minute session. Try it sometime – it did the trick for me.

Eventually, with the help and support of my co-author, editor and publishers, the book was finished, proofread and published. It is nice to have a book on the shelf with my name down the spine. But it was a huge amount of work, on something that’s not REF-able. So it’s not something I can see myself doing again.
Although, in my weaker moments I can’t help but think that one day it might be quite nice to say “Which one?” when someone tells me that they’ve read my book….