Nourishing our tomorrow needs to start today

Posted by Professor Amelia Lake, Fuse Deputy Director, and Professor of Public Health Nutrition at Teesside University

How do we create a future where every child has access to healthy, affordable food?

That question took centre stage at the British Nutrition Foundation annual conference, which brought together academics, policymakers, and practitioners to tackle one of the most pressing public health challenges of our time: improving the diets of children and young people.

The event was given a special highlight with the attendance of Her Royal Highness The Princess Royal, Patron of the British Nutrition Foundation, who delivered a powerful address on the importance of food in society and education.

Professor Amelia Lake and collegues meeting Her Royal Highness The Princess Royal

Children’s health and children’s diets are hugely important. Yet, rising rates of obesity, food insecurity, and exposure to unhealthy food environments challenge the ability to have affordable and healthy food.

This conference explored both the challenges and solutions, offering evidence-based insights and practical strategies.

I spoke in the morning session alongside my Fuse colleague Professor Greta Defeyter (Northumbria University) and Professor Maria Bryant (University of York). A great representation of Northern University academics!

Profs Maria Bryant, Greta Defeyter, Amelia Lake (L-R) 

Our morning session had a very special guest in the audience, Patron of the British Nutrition Foundation, Her Royal Highness The Princess Royal. Earlier the speakers were invited to meet The Princess Royal and individually talk to her about our work. A good ear for accents, Her Royal Highness. quickly recognised I wasn’t a Teesside native. Those who know me will be aware that I am from Northern Ireland, and I very much sound like I am.

My talk was titled: “Unpacking the Food Environment: Implications for Children and Families” and I discussed Healthy Planning and was able to introduce the audience not just to our academic evidence but also our evidence informed free online training on the topic aimed both at public health and planning teams in local authorities.

I presented our recent ‘Dark Kitchens’ research. The rise of online meal delivery and “dark kitchens” is reshaping how families access food, increasing exposure to calorie-dense options at the click of a button and increasing the availability of accessibility of less-healthy food choices.

While planning allows us to shape our food environment there is much we can do around food retail to create healthier food environments. I discussed some findings from our Fuse Foodscape study funded by the NIHR School for Public Health Research.

We cannot describe the food environment without acknowledging that many households face significant barriers to accessing affordable, healthy food, with direct consequences for children’s health and wellbeing. Food insecurity is real and affects families across the UK. At Teesside, we have worked with communities and organisations using innovative methods to produce healthy food within local social supermarkets such as our healthy ready meal.

Amelia speaking at the event

I called for stronger planning policies and interventions to create healthier food environments, emphasising the importance of collaboration between communities, professionals within local authorities, government and industry.

Improving dietary health isn’t simply about individual choice - it’s about transforming the food environments in which those choices are made.

Her Royal Highness The Princess Royal has been patron of the British Nutrition Foundation since 1988 and delivered a powerful speech at the conference, emphasising the importance of food in society and within education. Her remarks reinforced the British Nutrition Foundation’s mission to ensure every family can access a healthy, sustainable diets.

The conference showcased many impactful speakers and left us with the key message that Nourishing our tomorrow, needs to start today.

The British Nutrition Foundation hosted its annual conference, Nourishing Tomorrow: Equipping Children and Young People for Better Dietary Health in the Future took place on Tuesday 25 November 2025.

This time the hare might win: dark kitchens and the regulatory race

Posted by Helen Moore, Associate Professor (Research) & Fuse Associate, Teesside University 

Do you remember the fable of the tortoise and the hare? The one where the overconfident hare sprints ahead, but takes a nap, and lets the slow but steady tortoise win the race? Well, in today’s digital economy, that story’s getting a reboot, but this time, the hare isn’t napping.

In the world of food delivery and online ordering, the hare (the digital entrepreneurs) is wide awake and developing food purchasing opportunities at an incredible speed. Online delivery outlets, often functioning as dark kitchens, are agile, tech-savvy, and unburdened by the red tape of traditional business models. They’re using popular, well-known apps to reach huge numbers of people, launching new brands overnight, flooding menus with similar, but subtly different options and delivering meals faster than regulators can say “planning permission.” Low overheads, high levels of flexibility and choice have meant that rates of online food ordering are increasing, with the covid-19 pandemic accelerating this phenomenon.

Meanwhile, the tortoise (well-meaning but less agile local and national government) is still trying to understand the race in which it has been entered. Regulators are struggling to keep pace with a food industry that’s evolving in real time while the professionals working in local authorities hit ‘speed bumps’ which include outdated planning laws and limited evidence. For example, there is no clear use classification for dark kitchens, and some councils treat them as “industrial”, others as “sui generis” (unique), and there is inconsistent enforcement between local authorities. While some local authorities have implemented restrictions on takeaways opening close to schools, online food ordering apps mean that food can be delivered from places outside of the restricted areas. In addition, due to limitations with the recording of food outlet data, policymakers also find it hard to track spread or assess impact of dark kitchens which contribute significantly to this industry.

While innovation races ahead, regulation is not keeping pace, raising questions about public health, urban planning, and fairness. This isn’t just a story of speed, it’s also a story of systems, and unless the tortoise finds ways to modernise the traditional policy cycles to become proactive rather than reactive, and to reduce potential loopholes, the hare might just win this one, particularly as consumers like convenience and variety, which online ordering offers in abundance.

So, what can be done?

National and local authorities need to rethink how they engage with fast-moving digital industries - not to stifle innovation, but to ensure it serves the public good. We need clear national guidance on planning classifications, and health-focused planning laws that include digital-only food outlets. It isn’t all bad news though, there are some signs of progress with local authorities beginning to enforce planning permission requirements and with funded research projects examining various aspects of dark kitchens.

Free online training

To support local authorities and communities in using the planning system to promote healthier diets and reduce obesity, we have launched a new, free e-learning course called Planning for a Healthier Food Environment. The course was developed through a collaborative effort between Fuse (the Centre for Translational Research in Public Health), academic experts from Teesside University and Newcastle University, and the Office for Health Improvement and Disparities (OHID).

This one-hour online Fuse Research Event, held on 23 September, introduced the wider policy and planning context for the course, provided insights into its cross-disciplinary development, and outlined how the resource can be applied in practice to support healthier, more equitable environments.

Photo by Roman on Unsplash

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

Bringing dietetics into Public Health

Posted by Alex O'Connor-Sherlock, MSc Dietetic student, Teesside University.

Introduction by Steph Sloan, Senior Lecturer in Dietetics and Course Leader MSc Dietetics at Teesside University.

Practice-based learning (PBL) is a key part of dietetic training, with students required to complete 1,000 hours of hands-on experience in a practice setting. Traditionally, this has mostly taken place in NHS settings, with students working one-on-one with supervisors. However, as healthcare demands grow, diversifying placement opportunities is becoming increasingly important - not just to support student learning, but also to strengthen public health initiatives.

Suited and booted to present to a factory workforce

The Allied Health Professions (AHP) Strategy for England highlights the role of AHPs in disease prevention and health promotion, helping to reduce the burden on already stretched health and social care services. Diet-related diseases remain a major public health challenge, yet dietetic care is still largely focused on treatment rather than prevention. If the profession is to play a greater role in supporting population health, then equipping students with strong public health knowledge and skills is crucial.

To support this, Teesside University’s MSc Dietetics programme now includes public health placements alongside traditional NHS clinical placements. Here, Alex shares her experience of working in a Public Health practice-based learning setting. A must read in National Careers Week for anyone considering a future career as a dietitian!

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What I worked on

During my placement, I was involved in three projects focused on health improvement and disease prevention. My work involved meeting with stakeholders, conducting research, presenting findings, and engaging with the public. The projects covered a wide range of population groups, including expectant mothers, school-age children, local workforces, and food bank users.

1. Supporting parents with child nutrition

A key part of my placement involved reviewing the nutrition education available to parents of children aged six months to four years.

What I did:

• Conducted a literature and policy review
• Spoke to parents, NHS staff, and school representatives
• Attended a breastfeeding class to hear directly from parents
• Presented my findings to several teams, including the Director of Public Health

Why it matters:

The insights from this work will help shape future research and improve nutrition support for families in the local area.

2. Linking oral health and nutrition

There is a strong connection between what we eat and oral health, but not everyone has access to clear, easy-to-understand information about this link.

What I created:

• Infographics and presentations to educate local workforces
• Materials designed in an easy-read format, avoiding jargon

Why it matters: 

My presentation was really well received, and I was even asked to record it for wider distribution, so it could be shared with professionals working with children and people with additional needs.

 

Infographics to educate local workforces

3. Reducing food waste in a local food pantry

Many food pantry users rely on short-dated products, and without clear guidance, a lot of good food can go to waste.

What I did:

• Designed simple, visual signs with food storage and cooking tips (e.g. "Chop me then freeze me")
• Introduced a ‘Freeze me’ sign for bread and monitored its impact

What happened?

Twice as much bread was sold the day after the sign was put up compared to the previous two weeks combined!

Signs made to reduce food waste

What I learned

• Public health plays a key role in patient care - I saw first-hand how wider social factors impact people’s ability to manage their health and access services.
• Being proactive is crucial - I reached out to stakeholders independently, which helped me build confidence and leadership skills.
• Flexibility is a great learning experience - managing my own projects and working in a less structured environment improved my time management and adaptability.
• Self-care matters - the flexibility of this placement meant I could work in different settings, including from the park on sunny days!

Final thoughts

Introducing dietetic placements into public health settings is a win-win. It helps students gain a broader skillset, supports NHS capacity, and brings dietetic expertise into community settings.

Of course, doing things differently comes with challenges. Expanding placements into public health settings has required commitment from everyone involved - academics, placement providers, and students. But we’re constantly learning and improving, and we’re proud to be making a real impact on the health of our local communities.

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/

My passion for research comes from always asking "why?"

Posted by Pascal Landindome Navelle, FRSPH, Public Health Research Operations Officer and Doctor of Public Health Student at Teesside University.

In today's Fuse blog, Pascal gives his top tips for anyone starting out in research, and shares his own experience which began working with Fuse and Teesside University.

His advice? A passion for the "why?" question and accessing the right mentorship.

As part of the NIHR ‘Your Path In Research’ campaign.

 

After working as a clinician for several years, I felt that my impact on service users was limited. So, upon a thorough reflection, I was inspired to progress into public health research, where I felt I would have a broader impact on society.

Research work is fascinating as it provides a clear pathway to contributing to advancing the knowledge of the disciplinary sector to which I am dedicated. The importance of research should go beyond conceiving theoretical works that would only find a physical location in a library. Research should be "living", circulating, interacting, multidisciplinary, and impacting the environment.

What I enjoy about research is that it allows me to pursue my interests, learn something new, hone my problem-solving skills and challenge myself in several unique ways. Working on a faculty-initiated research project enables me to work closely with a mentor–a faculty member, and other experienced researchers. With a self-initiated public health research project, I can leave the community with a service that represents the distillation of my interests and studies and, possibly, a real contribution to knowledge.

There are many training and support systems that I have found valuable during my career. Researchers usually embark on increasingly diverse careers, where collaboration, networking and interdisciplinarity have become more important. Critical reading, academic writing and critical analysis are valuable training and support required of a researcher. Transferable skills, such as effective communication and problem-solving abilities, have helped me operate more effectively in different work environments.

Starting a research career can be daunting but exciting! The challenge of getting the support needed to achieve my dream came true when I enrolled at Teesside University for a research degree. This began by getting involved with AskFuse (Fuse’s responsive research and evaluation service) and with Associate Professor Dr Peter van der Graaf, working on an enquiry to evaluate Northumbria NHS Foundation Trust’s staff health and wellbeing resources during the pandemic, as part of my PhD research. This then led to working on the South Tees Arts Project (STAR) with Peter, a pilot study to co-produce wellbeing measures with primary school children, their parents, teachers, and artists for a school-based dance intervention. I supported the data collection, analysis and report writing for the STAR project as a Research Assistant and even wrote a song for the engagement activities with children in the research!

I had the opportunity of getting mentorship and some academic resources to enhance my knowledge. I connected and contacted very experienced researchers in the field of public health who supported my interest in growing as a research professional. Through the people I’ve met, I have had the opportunity to work on exciting but substantial research projects that have had a massive impact on the public health community.

My top three tips for somebody starting out in research are:

1. First and foremost, you should be motivated, passionate, and curious about your research topic – do it for science, not tenure! No one ever became a successful scientist with the sole premise of being awarded the Nobel Prize. And remember that plans rarely work out the way you thought they would.
2. Be prepared for a challenging career. Research is ever-changing. Be prepared for the change that research comes with strengthening your problem-solving skills to enhance the fun aspect of research. Problem-solving skills refer to handling difficult situations and overcoming complex challenges. They involve breaking a problem down into its parts, thinking critically about each element, analysing the information you find and using that information to form an effective solution. Having strong problem-solving skills will help make you an asset in your research practice and help you advance your research career.
3. Finally, be proactive, network and connect more with like-minded professionals. Sometimes, the key to getting to places is not what you know but who you know. We can learn a lot from talking to peers and senior colleagues. Attending symposiums, seminars and conferences is a great way to meet people who share common interests with you but have different experiences.

The NIHR has supported my career development through the provision of training, access to leadership development opportunities, networking events, mentoring and guidance on research funding.

The NIHR launched the Your Path In Research campaign this week. Better research leads to better services for the public. That’s why the NIHR want to encourage organisations and social care and public health professionals to play an active role in research, as a way to deliver even better services.

The Your Path in Research campaign highlights how people can make research part of their careers. Some amazing researchers have shared their experiences, how they started in research and what advice they can give to researchers that are considering adding research to their careers.

Take your first step in research today.

Feeling like an imposter? Learn to get comfortable with ambiguity

Peter van der Graaf, Fuse Knowledge Exchange Broker, Teesside University and Travis Sztainert, Knowledge Mobilization Specialist, Frayme

Do you ever feel like your lack of ability or knowledge is going to be exposed? In that case, you might suffer from Imposter Syndrome! Knowledge Mobilisers work across boundaries and are asked to perform tasks that they don’t feel “qualified” for, triggering feelings of anxiety and failure. What causes these feelings and how can we overcome them? In an attempt to answer these questions, we compared experiences across the pond by reflecting on our roles as Knowledge Mobilisers in Canada and in the UK. We argue that these feelings should not be avoided but harnessed by turning imposter syndrome into a useful repertoire for the role.

"Piled Higher and Deeper" by Jorge Cham www.phdcomics.com

In March the annual UK Knowledge Mobilisation Forum took place, which 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. This year, the Forum was held online for the first time, and one of the sessions was dedicated to interactive posters. Participants could preview posters in GoogleDocs and leave comments and questions for the presenters, who were later interviewed to respond to the feedback left on their posters.

In our poster, we explored why Knowledge Mobilisers are particularly prone to feelings of being an imposter. They work in a competitive specialist profession; everyone strives to be a guru, but at the same time their work occurs in the background. It often goes unrecognised if done well (and shows up particularly bad if it fails!) but is time-intensive with work often being unclear, making it feel like you’re not moving forward.

Our poster - see the full version here

Developing trusting relationships between knowledge producers and users often requires complex and lengthy conversations, which only increase the risk of being exposed as an imposter. At the same, there are limits to collaboration (not everybody wants to work together or share their knowledge), which can add to feelings of failing at your job as a knowledge broker.

Moreover, the role requires you to be a neo-generalist with varied expertise and, therefore, there is always more to learn. Organisational change and consequently personal change (the one certainty of working in the health and care sector) are always on the horizon, meaning that you have to continuously adapt your role. In addition, system changes often change the knowledge and evidence that is required by users and this increases transaction costs (time and resources spent on adapting knowledge) for boundary workers.

However, there is a lack of ‘professionalisation’ of the field and training is scattered: this can make you feel like you’re missing essential skills and knowledge. During the poster session we conducted a quick poll to ask how many participants had received formal training in knowledge mobilisation: 83% had not. Or as one of the participants summarised: Knowledge Mobilisation is a Cinderella service. Being undervalued by funders, universities and professional organisations means you are often faced with a lack of resources and unable to do your job. In fact, it is often expected that Knowledge Mobilisation can be done “off the side of the desk” or in addition to work as a researcher or policy maker. Thus, a paucity of time and space is set aside to adequately tackle complex issues.

To overcome these challenges, the first rule of Knowledge Mobilisation is that you need to be comfortable with ambiguity. Feeling like an imposter is not (in itself) bad, is a normal part of the learning process, and can be harnessed. Skills are most often developed on-the-job, and feelings of imposter syndrome can help drive you to learn more, do better, and be open to new concepts and experiences. Overconfidence can lead to a lack of insight into your weaknesses, which in turn can lead to actually becoming an imposter. Accept that you have shortcomings and areas for improvement. It’s okay not to know what you’re doing, or not to have all the answers. Think of yourself as an enthusiastic learner who is gaining experience and expertise - imposter syndrome will help you to stay humble.

Being open and honest about not having all the answers can actually be seen as a strength. As one participant pointed out in response to the poster: it helps to level power differences between partners by showing that you don't hold all the power (and are human like everyone else) and therefore empowers those working with you. It's ok for them not to know it all too and therefore may prompt questions that people may otherwise have been afraid to ask, leading to more open conversations, and strengthening relationships and trust. It can also mean that, when you are sure of answers, others know that they can trust you because you have previously shown that you would not say you knew something when you did not.

What skills do you need to be a good knowledge mobiliser? @AnnetteBoaz reckons connectivity, charm, inclusivity, empathy, creativity, integrity, curiosity, diplomacy and humility. Sounds very familar! #KMb2021 #ukkmbf2021

— Vicky Ward (@VLWard) March 22, 2021

Participants described this as a cyclical process, where feelings of imposter syndrome drive new learning, which increases your confidence to go into new situations that lead to fresh experiences of imposter syndrome, starting the cycle again. Forum members also emphasised the importance of operating as a team: the vast amount of skills required as a Knowledge Mobiliser (keynote speaker Annette Boaz mentioned connectivity, charm, inclusivity, empathy, creativity, integrity, curiosity, diplomacy and humility for starters), means it is almost impossible to develop these skills as an individual. Teams of Knowledge Mobilisers can bring these skills together and use different skills at the same time.

Moreover, acting like an imposter can be a valuable role: by communicating out of character a knowledge broker can help to make sense of differences in knowledge use. Adapting to the audience and stage required helps knowledge brokers to translate differences in performances between policymakers, practitioners and academics. Knowledge Mobilisers should not fear being an imposter but instead learn to embrace imposter syndrome!

If you are interested in learning more about imposter syndrome in knowledge mobilisation, take a look at:

• Travis’s PowerPoint presentation at the Canadian Knowledge Mobilization Forum sharing experiences, reflections and potential antecedents and consequences of imposter syndrome, as well as exploring ways to address this feeling (https://www.dropbox.com/s/x73adly7m3c1bid/Feeling%20Like%20and%20Imposter%2C%20and%20How%20to%20Overcome%20it.pptx?dl=0)
• Peter’s upcoming book chapter in Palgrave Handbook of ‘Imposter Syndrome’ in Higher Education (in print), reflecting on challenges in knowledge brokering through AskFuse, a rapid response and evaluation service run by Fuse, the Centre for Translational Research in Public Health, which caused feelings of being an imposter.
• Their joint poster can be accessed here: https://www.linkedin.com/posts/travis-szt_imposter-syndrome-in-knowledge-mobilisation-activity-6782473994651217920-XUud

Summer school at home: Learning online and adapting research to reach the ‘hard to reach’

Posted by Emma Adams, Newcastle University, and Jo Dawes, University College London, NIHR School for Public Health Research (SPHR) Pre-Doctoral Fellows

Starting a new post in a new institution just as a global pandemic and lockdown sweeps the UK is not how we envisaged beginning our NIHR School for Public Health Research (SPHR) fellowships. When our training and development allowance letters came through initial thoughts were to delay booking any training until it was possible to attend in person. However, as time passed, it became clear we may be waiting some time. This realisation coincided with hearing about the “Applied Research Methods with hidden, marginal and excluded populations” course run by Nuffield College, University of Oxford. The course is usually a weeklong residential summer school, but this year it was offered online. The idea of spending five full days sitting at home doing online learning seemed a disappointing second best to a week in Oxford and somewhat limited our enthusiasm. However, these concerns were misplaced. We could not believe how engaging the course was, with tutor Andrea Rossi doing an excellent job of varying the activities, keeping us captivated and packing the course with relevant, interesting, and interactive tasks. 

For this ‘participatory research method’ we were given 5 minutes to create a map of our childhood community, using items we could easily reach. The task was designed as an ‘icebreaker’ activity to start a conversation about our childhoods. Using available objects, rather than drawing, takes away any pressure interviewees might feel about their aptitude for drawing. This activity could be adapted in rural communities using found items outside. Once my map was created, I talked about the map and why I had highlighted specific aspects of my community - this is the point at which ‘data collection’ might start.

Beginning with what makes a population ‘hard to reach’, we were armed with the linguistic tools to define whether our population was hidden, marginal, elusive, rare, excluded, or blurred (see Table 1 for breakdown). By breaking down populations into these different categories, we were better able to understand approaches for reaching and involving them in research. People experiencing homelessness may be perceived as ‘hard to reach’, when in fact they might just be elusive (purposely hiding or not reporting). If we, as researchers, recognise individuals may be making a conscious decision not to report, then perhaps we need to build a foundation of trust. The responsibility a researcher has to find ways to reach the ‘hard to reach’ was one of the most important things that we learned. 

With optimism that the virtual learning might not be as onerous as we had feared, we jumped into three days of research methods (both qualitative and quantitative). Challenging us to approach every technique from both the researcher and participant perspective, we were pulled out of our comfort zones and into creatively mixing research techniques. Opportunities to transform recruitment strategies (such as respondent driven sampling into a data collection tool for analysing social networks were explored. Learning to make the interview experience more interactive challenged our preconceptions of data collection - ever thought about asking a participant to reconstruct an important/memorable place with only items in their kitchen? Having experienced this first-hand, we both agree it was a great facilitation tool as a participant and researcher. The breadth of material in the course left us feeling that it was a week well spent, despite the initial apprehension and sitting at a computer in the blistering summer heat.

As a result of attending this course, we have already adapted how we approach our research activities. Jo was struggling to define a ‘hard to reach’ population in a patient and public involvement (PPI) paper. The course provided real clarity about this topic and helped her confidently address this definition in her writing. Emma was trying to find a way to approach recruitment and the re-shaping and framing of populations has provided me with optimism about my future recruitment strategy.

There is no doubt that by learning online instead of face-to-face, we really missed out on networking opportunities with our course peers - nothing could really replace a good natter over coffee. Conversely, the online nature of the course really opened up the cohort - we were learning with people sitting in their homes in England, Wales, Switzerland, France and Germany, while our tutor taught us from his apartment in Bangkok. Perhaps without being online, we would have been a far less international cohort. After undertaking this excellent course, we certainly feel more positive about online learning, how engaging it can be and how - in these uncertain times - it is important to not simply wait for face-to-face learning to return as the norm. The variety of learning and research activities we used online challenged us to translate so much of what we usually do face-to-face to our ‘virtual classroom’. As a result, we developed skills in how to adapt our current methods of communication in our research.

Our take home messages from the course:

1. Online research and learning can work well if you are creative and willing to be flexible.
2. Researchers must consider reasons some populations are ‘hard to reach' (are they rare, hidden, elusive, marginal, excluded or blurred?).
3. When you recognise WHY a group of people are ‘hard to reach’, you must adapt your research methods to better reach them.
4. Through mixing methods/data sources you can strengthen your understanding of ‘hard to reach’ groups.

The long and winding (and emotional) road to impact

Posted by Mandy Cheetham, Research Associate, Teesside University

Having submitted written evidence to the Work and Pensions Select Committee inquiry on the impact of the 5 week wait for Universal Credit (details here), I had not anticipated being invited to give evidence by Zoom to a panel of MPs in the midst of lockdown. The evidence submitted (available here) drew on qualitative research into the experiences of claimants in North East England (Cheetham et al 2019) and quantitative research showing the mental health impact of Universal Credit, undertaken by colleagues from Liverpool University (Wickham et al 2019). Dr Sophie Wickham and I were both invited to be part of a panel for the second evidence session. I had watched the first evidence session to see the lines of inquiry pursued, realising (with dismay) it was available live on parliament tv.

As witnesses, we had been given a broad indication of the areas on which MPs would focus their questions. These included the effects of the 5 week wait, its impact on mental health, and our thoughts on what could be done to mitigate the adverse effects. I had read and re-read our research paper, digested more recent reports and published literature and carefully prepared my responses to the anticipated questions. I had emailed colleagues in local advice organisations to see if the issues identified in the research were still relevant. I had a chat with a university colleague who had given evidence to a different committee drawing on our research on energy drinks 2 years previously. A final check that the technology worked in a test call the afternoon before and all was set.

Following advice from the friendly and efficient clerk of the committee, I had moved my laptop away from the background distractions of grandchildren’s Batman costumes and toys. I woke up early on the morning of 17 June feeling nervous with anticipation. ‘Trust you know enough’ were the calm words of advice offered by one committee official.’ ‘Stick to the evidence; be focused and don your cloak of authority’ came texted advice from a senior academic colleague with a good luck message. I have a tendency to talk too much when I’m nervous, and knew I needed to avoid waffling, so this was a helpful reminder. But I wasn’t sure I had a suitable cloak of authority handy.

In the event, the preparation paid off. I stuck to my bullet points and weaved in quotes from participants when I could. It wasn’t perfect and there’s always more to say. I’m not sure it’s possible to do justice to the harrowing experiences which had been shared by research participants, but I tried. There is a big focus in academia on impact, and I sometimes feel limited recognition of the time and multi-layered approaches needed to achieve it. Immediately after the evidence session, which lasted an hour, I was contacted by a journalist from the Independent asking about a paper I had mentioned in my evidence. Within an hour the Sun online quoted our evidence in an article supporting their campaign to make Universal Credit work.

Evidence is clearly not the only, or the most important deciding factor in the messy world of policy making. I believe we need to use a combination of political levers of influence at our disposal to affect changes when opportunities present themselves. This felt like a huge moment. The priorities and timeframes of academia and policy making do not always align. The study I was reporting grew out of embedded research with community members in Gateshead who talked about their fears about Universal Credit being rolled out in 2017, fieldwork was undertaken April – October 2018, written up and paper submitted in November 2018 and published in 2019. Following the select committee, a colleague posted links to the evidence session on the Facebook pages of organisations who had supported the research for community members to see. It felt right to let participants know what had happened.

Since 2018, we have shared the research findings at numerous conferences and with Department for Work and Pensions staff, but with limited effect. COVID-19 has prompted temporary changes to be made to Universal Credit, which will help. My experience in the shielding hub demonstrates how many families claiming Universal Credit, particularly those with children, continue to struggle with the additional costs of lockdown. Last month, Therese Coffey announced the re-instatement of conditionality requirements and sanctions, which will add to Universal Credit claimants’ stress at a time of economic insecurity, rising unemployment, unprecedented job losses, and anxiety about the future. Even a global pandemic can’t halt political will it seems.

In my view, public health is political. Lobbying and advocacy are a core part of our role, particularly when government policy has such a crucial role to play in addressing inequalities. We need to continue to highlight the harmful impacts of policy on particular groups and be part of the process of informing solutions. Researchers need to seek out these opportunities for ‘academic activism’ (Askins 2009) to help shape policy. We need to provide training and support to academics at all levels, and accept the emotional investment these efforts require. After all, the drive to impact is fuelled by emotional as well as scientific engagement with our subject matter.

Reference:

• Askins K. (2009) ‘That’s just what I do’: Placing emotion in academic activism Emotion, Space and Society doi 10.1016/j.emospa.2009.03.005

Images:

1. Screenshot taken from parliamentlive.tv: https://parliamentlive.tv/event/index/5d5e46b8-c323-4a64-8bca-53e2ed17cb4f 16/07/2020
2. Screenshot taken from The Sun website: https://www.thesun.co.uk/news/11883566/universal-credit-wait-12-weeks-severe-hardship 16/07/2020

Policy, procedure, practice and plate-spinning - how to achieve a work-life balance

Posted by Susanne Nichol, Better Health at Work Award Programme Coordinator, Northern TUC

I regularly wish for an extra hour in the day, or a day in the week and I even more regularly feel like my frenetic movement from place to place whilst grabbing various coats, bags, children, laptops, papers and other extraneous articles is accompanied by the Benny Hill theme tune. And I know that I am absolutely not alone in this daily plate-spinning, multi-tasking blur that is reality for the vast majority of parents, carers – and well, everyone else!

However, I am fortunate to work for an employer that has a raft of measures in place to help me restore some balance. For example, having flexi-time means I can get a much needed hit of endorphins by going to the gym or out for a power-walk on my lunch hour, or before I have to sprint through the school gates lest my youngest child becomes an accidental boarder.

The Better Health At Work Award (BHAWA) is a regional flagship public health programme that is the result of a long-standing (currently celebrating a decade of making workplaces healthier), progressive partnership between 11 of the regional local authorities. This was evaluated in 2012 by Durham University, received a RAND Europe award in 2018 for its impact on health and wellbeing, and due to cross-organisational working between Local Authority specialist public health practitioners, academics and Fuse, was a featured element in the Prevention stream of the recently awarded regional NIHR Applied Research Collaboration (ARC) funding.

As BHAWA Coordinator I have contact with literally hundreds (currently over 400) workplaces across North East England and Cumbria, who cumulatively employ nearly a quarter of a million workers. One of the mandates of the BHAWA is that participants survey their staff biennially (at a minimum) and ask them what topics/ issues they’d like to see addressed or get more information/ support on and more often than not, work-life balance is ubiquitous in the top 5.

To me, this presents more of a challenge for both employer and employee than some of the other regular top 5 entries such as healthy eating, physical activity and mental health. Work-life balance encompasses all of those things and more, and whilst the application of all health topics is subjective, this even more so, as we all have our fulcrum in a different place – with a large measure of economics thrown in. Most of us would like to work less time for the same pay, but currently business demands and finances often make this unviable; conversely, whilst going to 3 days instead of 5 might give you perfect work-life balance, most of us wouldn’t be able to sustain a 40% reduction in salary.

Unfortunately, there is no quick fix or magic wand. However, there are multiple ways and means to mitigate work-life imbalance and to actively facilitate a redress in the right direction. The BHAWA takes a holistic approach to workplace health that emphasises making positive changes to all aspects of the workplace, from the infrastructure and logistics, to the pervading culture of staff and management engagement and interaction – and everything in between.

So, how do they do it and what does ‘good’ look like? Well, based on my six years of experience I can safely say that the best employers take a wholesale approach and embed health and wellbeing into the holy workplace triumvirate of policy, procedure and practice.

It all starts with having fit for purpose policies in place, specifically such as Flexible Working; one of our workplaces operates a best practice ‘Adult Working’ policy, which is uber-flexible, employee-led and based around a mutually trusting relationship, so if Costa is a conducive place for them to deliver their work in between school-runs or meetings, then so be it. More and more participants are also introducing ‘stuck not sick’ policies that allocate a bank of ‘reserve’ hours that people can use to deal with unexpected issues, such as an ill child or a flooded kitchen.

Then there are underpinning procedures like regular and supportive line management, meetings/1-2-1s that start with the question ‘How are you?’ which allows for an open dialogue and an easier conversation around any issues and hopefully a subsequent resolution. But, what is of paramount importance is the active implementation of policy and procedure. If an employer has the best policy in the world, yet nobody actually knows about it, then it’s not worth the paper it’s written on. Awareness, buy-in, good communication/training and a practical approach is imperative here.

Having managers who are properly supported to understand and apply the policy in practice is fundamental. They can do this in various ways; by advertising jobs as flexible from day one, supporting a range of flexible working options such as home-working, flexi-time, or compressed hours; reminding colleagues that they can (and should) take their lunch break/leave and can attend medical appointments or workplace campaigns or activities like on-site flu jabs, or a lunch-time yoga class, without it being detrimental to pay.

One thing is for certain - work-life balance is for life and not just for a week



Image:

1.  'plate spinning' by Clancy Mason via Flickr. Attribution-NonCommercial 2.0 Generic (CC BY-NC 2.0): https://www.flickr.com/photos/clancy123/1805082629
2. 'I'm working through my lunch hour. Work - life balance survey' by David Austin via University of Kent, British Cartoon Archive (Reference number: 84983, Published by: The Guardian, with thanks to Copyright holder: Janet Slee): https://archive.cartoons.ac.uk/Record.aspx?src=CalmView.Catalog&id=84983

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

Managing difficult conversations at work; ambulances, snow ploughs and submarines

Posted by Peter van der Graaf, AskFuse Research Manager / Fuse Knowledge Exchange Broker, Teesside University

We all face difficult conversations in our work; whether as a PhD student trying to tell a supervisor that they are not very helpful, or as post-doctoral researcher, explaining to your line manager that you really don’t want to take up any more teaching responsibilities. Or even as a practitioner having to point out to an esteemed researcher that their pet project is not relevant at all for your practice.

Like most people, I try to avoid these conversations as much as I can and prefer ‘flight’ rather than ‘fight’. Best to give in and avoid confrontation than have an uncomfortable row that will keep me up at night.

But could confrontations also be useful, and if so, how could you manage them in a way that they benefit you? This was the aim of the Courageous and Compelling Conversations Masterclass I attended in London as part of the NIHR Leadership Development Programme. Before starting the masterclass, I had to complete a self-assessment of my preferred response mode to confrontational conversations, which neatly confirmed my ‘flight’ status and gave me new labels for it: 60% Give In; 20% Run Away; and 20% Compromise.

What the masterclass taught me was that confrontation is not about preparing well for the other’s potential responses; for instance, by endlessly scripting clever and rational dialogues to counteract every accusation that a person could throw at me.

Instead, the course focused on better understanding my own response style in relation to other people. My light bulb moment was the realisation that you can’t control the response of the person you are talking to, but that you can manage yourself on how to respond, and take time to formulate this response during the conversation. Therefore, my nights (more preferably work hours) would be better spent understanding what I want to get out of the confrontation (outcome) and plan my conversations accordingly, instead of worrying what the other person will say and need.

During the course we were split into three groups, according to our preferred Motivation Value Style, with each group given its own emblem in the shape of a transport vehicle. Apparently, I am an ambulance, which is the symbol of the ‘carer’ group, who are motivated by the protection, growth and welfare of others. We prefer to ensure that everyone is happy, relationships are good and don’t want to be a burden to others. As an ambulance, I am responsive to other people’s needs and therefore go into conversations where I am needed (with blue lights if possible!).

In contrast, the ‘driver’ group (snow ploughs) - motivated by task accomplishment and achieving results - prefer to exercise persuasion. The third group, technicians (submarines) are different again in that they are motivated by meaningful order and thinking things through; they want to be practical and fair.

Although, these three styles feel quite stereotypical, I was surprised to see how much each of us on the course was conforming to these styles when explaining their behaviour in difficult conversations. We discovered that we incorporate elements of each style into our conversations but have a natural gravitas to a particular style. Realising your preferred style and working out the preferred style of your conversation partner, proved really helpful.

For example, someone who prefers to be a submarine (technician style), does not respond well to pressure to make an on the spot decision. Forcing them to agree to a solution at the end of the conversation will only escalate the confrontation. Instead, agreeing to give them time to mull the problem over and come back with a response later, will likely result in a much more favourable response and implementable solution.

Under stress, people tend to respond in either of two ways: they become more extreme in their preferred style (dig their heels in) or switch to a different style. What we were encouraged to do during the training course, was to play with different styles and practice switching during a confrontational conversation to a different style that would be more attuned to the person we were speaking to. In that sense, we are better able to manage ourselves and the responses we get from the person we are confronting.

A key part of this switching of styles was being assertive; not shouting over the other or ignoring what they say, but quite the opposite: taking more time to listen to the other and trying to understand what they say and where they are coming from. Are we really hearing what the other person is telling us or are we too busy trying to contain our emotions and constructing our next argument in our heads? Armed with this understanding, you will be better prepared to say what you think and feel, and, most importantly, what you want to happen.

As an ambulance, I need to be patient with submarines and focus on the practical, while being more competitive and assertive with snow ploughs, or team up with submarines to create new opportunities in joint conversation with snow ploughs.


Image:

1. 'Arguments' by Jeff Eaton via Flickr. Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0): https://www.flickr.com/photos/jeffeaton/7436909698