Addressing Obesity in Stevenage, Hertfordshire: A Consultation with Young People

Public Health England have identified that almost a quarter of children are overweight when they start primary school, which increases to a third when they leave in year 6 aged 10-11 years. This has implications for young peoples’ physical and mental health and also later in adult life. The newly launched NIHR Applied Research Collaboration (ARC) East of England is focusing on selected areas of health inequality and this includes neighbourhoods in Stevenage, Hertfordshire which have high rates of childhood obesity. In order to find out what young people think about these issues, Hertfordshire County Council and the University of Hertfordshire carried out a collaborative project in 2019. Hertfordshire County Council have adopted a Whole Systems approach to obesity and are keen to engage with young people in order to prioritise issues identified by them. The importance of ‘involving’ young people in shaping services has been widely documented. Two researchers met twice with 56 young people (from a range of schools) aged 16 years who were attending the National Citizen Service (NCS) scheme at a school in Stevenage in the summer holidays. A number of involvement activities were carried out during the sessions. The young people, with help from the researchers, facilitated their own informal discussion groups, using maps, flips charts, post-it notes and an anonymous suggestion box. The first session did not mention obesity but allowed open discussion about what it was like to live in Stevenage and the second session focussed more on the issue of ‘obesity and weight’. The young people were encouraged to find their own solutions and imagine if they “were in charge”. The four main themes that came from the sessions were; affordability, crime and anti-social behaviour, transport and places to go and eat. A number of solutions were suggested by the young people which included; healthy environment (e.g. cycle paths, street lights, regulation of shops), community approach (e.g. more affordable sports activities), schools (e.g. raise awareness, promote sport), focus on young people (e.g. activities for young people and healthy affordable eating outlets) and helping people maintain a healthy weight. The priorities identified by local young people and the wider issues they raised are important to take into consideration when shaping any intervention or public health initiative, especially when considering the wider determinants of health. Listening to the issues and solutions and using the language of young people is vital and young people should be included in co-designing any services that are aimed at them. Involving local young people who know an area and who can identify important issues is vital for any successful public health intervention

Regional Working in the East of England: Using the UK National Standards for Public Involvement

Plain English summary: Involving patients and members of the public to help shape and carry out research is recommended in health research in the United Kingdom (UK). There are a number of regional networks of Patient and Public Involvement (PPI) groups, which support the collaboration between researchers, patients and public members. We are a group of researchers, patients and public members who came together via a PPI regional network in the East of England to collaborate on a research study about the extent of feedback from researchers to PPI contributors.The aim of this paper is to use the recently developed UK National Standards for Public Involvement to structure our thinking about what worked well and what did not, within our recently completed study. We believe this paper is one of the first to use the National Standards to structure a retrospective reflection on PPI within a study.Our findings showed that there are benefits of regional working, including easier access to public members and bringing together researchers, public members and those who run PPI groups for research collaboration. The main challenges included involvement of people before studies are funded and working across organisations with different payment processes.The National Standards for Public Involvement has provided a useful framework to consider how best to involve patients and members of the public in research and could be a helpful structure to reflect on successes and challenges in individual projects and also regional, national or international comparisons of PPI in research. Abstract: Background Regional networks of Patient and Public Involvement (PPI) organisations, including academic institutions, health and social care services, charities, patient and public groups and individuals, can play an important part in carrying out health research. In the UK, recommendations by the National Institute of Health Research (NIHR) encourage the use of regional, collaborative networks with shared resources and training. Methods The newly developed UK National Standards for Public Involvement were used as a framework for a retrospective reflection of PPI within a recently completed research study which focused on feedback from researchers to PPI contributors. PPI contributors, those running PPI groups (PPI leads) and researchers involved in the study have contributed to this reflection by completing evaluation forms throughout the research alongside notes of meetings and co-authors' final reflections. Results Results revealed a number of successes where the regional network was particularly useful in bringing together PPI contributors, those who lead PPI groups and researchers. The regional network helped researchers to get in touch with patients and members of the public. Challenges included involving people before funding and bureaucratic and financial barriers when working across different organisations in the region. The importance of working together in flexible, informal ways was key and on-going support for the PPI contributors was vital for continued involvement, including emotional support not just monetary. The first four National Standards of inclusive opportunities, working together, support and learning and communications were particularly useful as means of structuring our reflections. Conclusions To our knowledge, this is one of the first research studies to use the UK National Standards for Public Involvement as a framework to identify what worked well and the challenges of PPI processes. It is suggested that as more reflective papers are published and the National Standards are more widely used in the UK, many lessons can be learnt and shared on how to improve our Patient and Public Involvement within research studies. Evaluations or reflections such as these can further enhance our understanding of PPI with implications for regional, national and international comparisons.Peer reviewedFinal Published versio

Physical Activity Inclusion in Dementia-Friendly Communities: A Mixed Methods Study

© 2024 The Authors. Published by Human Kinetics, Inc. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0International License, CC BY 4.0. See: http://creativecommons.org/licenses/by/4.0.Dementia-friendly communities (DFCs) are a policy-endorsed approach to community engagement in England that promotes social inclusion to enable people affected by dementia to live well. Research suggests that physical activity is beneficial in encouraging social connection and improving health. A mixed method sequential study design in England involving a national survey (n = 31) and semi structured interviews (n = 65) in three DFCs was carried out. The aim was to understand how DFC senable people affected by dementia to participate in physical activities. An evaluation framework for DFCs was used to organize and interpret the data, and analysis was informed by the inclusive (social) citizen lens. Findings showed that DFCs offered a range of adapted dementia-inclusive and dementia-specific activities; however, people were not routinely offered information at time of diagnosis. Local authorities (councils) were key to enable access to information and infrastructure change to support sustainable inclusion within their local community.Peer reviewe

BeeZee Bodies Evaluation: Summary Report

© 2023 University of Hertfordshire. This is an open access article distributed under the Creative Commons Attribution License, to view a copy of the license, see: https://creativecommons.org/licenses/by/4.0

BeeZee Bodies Embedded Ethnography Evaluation Project

The Centre for Research in Public Health and Community Care, University of Hertfordshire (UH) were commissioned by BeeZee Bodies (BZB) to bring academic insights and support BZB’s development of future services. This work aimed to explore: - How can BZB best engage diverse communities? - How can evidence and insights be considered from a range of professional perspectives and utilised to shape and influence service development? - If and how can BZB co-produce their services? The project used an ‘embedded ethnography’ approach, a qualitative methodology which enables collaboration and interaction between researchers and those responsible for planning and delivering services, as a way of developing more effective service delivery. This involved four main elements: participation in strategic oversight group (SOG) meetings, qualitative research training for BZB staff, observation of BZB meetings, and primary data collection (focus groups and interviews)

Exploring English policymakers' attitudes towards dementia risk reduction: A qualitative study

© 2023 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Aim: A growing evidence‐base indicates that dementia occurrence can be changed. This has been linked to potentially modifiable risk factors. Risk reduction and primary prevention strategies are increasingly recognized as needing to include population‐level policies to tackle the social and commercial determinants of health. How this knowledge can influence policymaking on dementia prevention is unknown. Understanding attitudes of policymakers is an important step in translating evidence into practice, helping to gauge system readiness for implementation, and potential barriers and enablers for influencing policy. The aim of this qualitative study is to explore the understanding of, and attitudes to, dementia risk reduction and population‐level prevention strategies amongst English policymakers at national, regional, and local level. Methods: Semi‐structured interviews were undertaken with a range of dementia and prevention policymakers, with purposive sampling of national and local policymakers, including politicians, government officials, health system leaders, academics, and dementia charity directors. Analysis of interview transcripts was undertaken by thematic analysis. Results: 14 policymakers were interviewed between November 2021 and February 2022. Three main themes were identified (1) Preventability of dementia, (2) Prevention approach, (3) Barriers and facilitators to improving the approach. Discussion: Policymakers generally held dementia to be partially preventable. Policymakers recognised that both individual‐ and population‐level approaches to primary prevention of dementia are required – with some policymakers perceiving that population‐level approaches are under‐utilised. Key barriers to implementing more population‐level approaches were identified as the complexity and co‐ordination required to effectively tackle upstream determinants of health.Peer reviewe

Commissioning and co‐production in health and care services in the United Kingdom and Ireland: An exploratory literature review

© 2024 The Authors. Health Expectations published by John Wiley & Sons Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Introduction: This exploratory literature review seeks to examine the literature around commissioning processes in the co‐production of health and care services, focusing on two questions: How do health and care commissioning processes facilitate and/or pose barriers to co‐production in service design and delivery? What are the contextual factors that influence these processes? Method: A systematic search of three databases (Medline, Public Health and Social Policy and Practice) and a search platform (Web of Science) was conducted for the period 2008–2023. A total of 2675 records were retrieved. After deduplication, 1925 were screened at title and abstract level. Forty‐seven reports from 42 United Kingdom and Ireland studies were included in the review. A thematic synthesis of included studies was conducted in relation to the research questions. Results: The review identified one overarching theme across the synthesised literature: the complexity of the commissioning landscape. Three interconnected subthemes illuminate the contextual factors that influence this landscape: commissioners as leaders of co‐production; navigating relationships and the collective voice. Conclusion: Commissioning processes were commonly a barrier to the co‐production of health and care services. Though co‐production was an aspiration for many commissioners, the political and economic environment and service pressures meant that it was often not fully realised. More flexible funding models, longer‐term pilot projects, an increased emphasis in social value across the health and care system and building capacity for strong leadership in commissioning is needed. Patient and Public Contribution: Patients and the public did not contribute to this review as it was a small piece of work following on from a completed project, with no budget for public involvement.Peer reviewe

The impact of covid-19 and the resulting mitigation measures on food and eating in the East of England: Interim report

Measures to control the spread of Covid-19 are impacting food systems, household food practices, and organisations supporting vulnerable people in the UK. We report here on the interim findings of an ongoing qualitative study which aims to understand how Covid-19 is affecting local food systems, household food practices and efforts to mitigate dietary health inequalities in the East of England. The findings presented are from the first 35 interviews carried out with households (n=24) and those involved in community and local authority schemes (n=11) providing assistance in relation to food. Our findings so far suggest that Covid-19 and the mitigation measures put in place from March 2020 (e.g. ‘lockdown’ and social distancing) are serving to amplify existing dietary health inequalities. Those who are relatively more secure financially have been able to spend time addressing and improving their dietary health, whereas those struggling financially or in economic hardship have experienced their diets worsening. Older people living alone and/or on low incomes have had to contend with difficulties in accessing food and a lack of opportunities to eat socially. Those with physical impairments and limited mobility sometimes find busy supermarkets potentially hostile and stressful environments and this has been amplified by the instore changes related to Covid-19. Online food shopping has been a particular challenge reported by participants. For some, the Covid-19 mitigation measures meant they were shopping online for the first time. Participants expressed frustration at the difficulty in securing a delivery slot and deliveries arriving with missing products and/or unsuitable substitutions. There was a general perception that food prices have risen since Covid-19 mitigation measures, especially in supermarkets. Participants suggested this was due to a reduction in the availability of food products and special offers. Across the East of England, locally organised efforts to support and feed people included setting up community funds to supplement the income of organisations working with vulnerable people and with local businesses and partners to organise food supplies. While the Government food parcel scheme focused on feeding those in the shielding category, local authorities worked on supplementing the scheme, where required, by helping to feed and support other vulnerable groups in the community. Food banks have seen a rapid increase in need for their services and have also had to change their operating practices. Some have had to close or change venue and operating hours to accommodate changes to their volunteer base. While media coverage during the pandemic has reported a reduction in donations to foodbanks, some of our participants reported that donations to food banks have increased. This has created the need for increased storage capacity and processing facilities. Despite ongoing difficulties, local groups across the region have devised, adapted and operated a range of schemes to support and feed vulnerable people, tailored to the needs of local residents. Some of the feedback and recommendations provided by households and organisations thus far are summarised at the end of this interim report. The Covid-19 pandemic has impacted on food and eating practices across the East of England in a range of ways. While some groups have been merely inconvenienced, others have had to manage with less healthy food and less money to buy food. The potential of the pandemic to amplify existing dietary health inequalities is a theme that we will continue to explore and report on as our research progresses into 2021

Changes to household food shopping practices during the COVID-19 restrictions: Evidence from the East of England

© 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license. https://creativecommons.org/licenses/by/4.0/Measures to control the spread of COVID-19 have changed the way we shop for food and interact with food environments. This qualitative study explored food shopping practices in the East of England, a large diverse region including coastal, urban and rural settings. In 2020/2021 we interviewed 38 people living in the region and 27 professionals and volunteers providing local support around dietary health. Participants reported disruption to supermarket shopping routines; moving to online shopping; and increased reliance on local stores. COVID-19 has impacted disproportionately upon lower-income households and neighbourhoods. The longer-term implications for dietary health inequalities must be investigated.Peer reviewe

Reporting on patient and public involvement (PPI) in research publications: Using the GRIPP2 checklists with lay co-researchers

© The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License. https://creativecommons.org/licenses/by/4.0/Background: Patient and public involvement (PPI) in health and social care research is considered important internationally, with increasing evidence that PPI improves the quality, relevance and outcomes of research. There has been a growth in research publications that describe PPI in the research process, but the frequency and detail of PPI reporting varies considerably. This paper reports on a collaborative study that aimed to describe the extent of PPI in publications from research funded by the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) in the East of England (EoE), part of the National Institute of Health Research (NIHR) in England (2014-2019). Methods: A descriptive study of all research publications (1st January 2014 to 31st October 2017) funded by the NIHR CLAHRC EoE. Members of the Public Involvement in Research group (PIRg), at the University of Hertfordshire, were actively involved, with four PIRg co-researchers. We used an internationally recognised reporting checklist for PPI called the GRIPP2 (Guidance for Reporting Involvement of Patients and the Public, Version 2) to guide the reviewing process. Results: Out of 148 research papers identified, 16 (14%) reported some aspect of PPI activity and were included for review. Ten of the publications (63%) acknowledged the contributions of PPI individuals and/or groups and five had PPI co-authors. There was considerable variation in the PPI reported in the publications, with some ‘missed opportunities’ to provide detail of PPI undertaken. The perspectives of the co-researchers shaped the reporting of the results from this study. The co-researchers found the GRIPP2-SF (short form) to be useful, but the GRIPP2-LF (long form) was considered over complicated and not user-friendly. Conclusions: This is one of the first studies to involve lay co-researchers in the review of PPI reporting using the GRIPP2 reporting checklists (GRIPP2-SF and GRIPP2-LF). We make recommendations for a revised version of the GRIPP2-SF, with clearer instructions and three additional sections to record whether PPI is reported in the abstract or key words, in the acknowledgements section, and whether there are PPI co-authors. We also recommend the provision of training and support for patient and public peer reviewers.Peer reviewe