Our research aims to understand the determinants of health and well-being, to understand patterns of health service use, and to develop and evaluate interventions to optimise health and well-being.
We have research areas focused on specific health conditions, such as neurodegenerative disorders including dementia, life-changing acute events such as stroke and brain injury, and long-term conditions such as musculoskeletal conditions and chronic lung disease.
We have researchers specialising in methodologies such as development of complex interventions, inclusive research, and implementation science. We also explore primary prevention and promotion of good health, through a focus on particular behaviours or environments that can be modified to protect health.
Explore our current research activity detailed below.
Behavioural and Implementation science
We have developed, refined and piloted a theory-guided smartphone app (Quit Sense, formally known as Q Sense) that provides support to help smokers manage environmental cues to smoke as they arise. The app identifies high-risk situations using a learning tool and location sensing and represents a new type of behavioural intervention called a Just-In-Time Adaptive Intervention (JITAI). Two pilot studies have shown that Quit Sense can provide ‘in the moment’ support to smokers, including lapse prevention strategies, and that this is engaged with and is acceptable. This next phase of its evaluation is to undertake a feasibility randomised controlled trial (RCT) to inform a definitive effectiveness RCT. We will undertake a two arm RCT allocating 160 smokers recruited online to a ‘usual care’ arm (link to NHS SmokeFree website) or a ‘usual care’ plus Quit Sense arm.
Smoking and drinking alcohol at risky levels are associated with cancer later on in life. In England, 15% of adults (17% men and 13% women) smoke cigarettes, and 24% of adults (31% men and 16% women) drink alcohol at risky levels (>14 units per week. There are services to help people quit smoking and reduce their alcohol consumption, but barriers to accessing these include time to travel and sensitivity of disclosing their smoking or alcohol consumption. As an alternative, there are digital programs either online or through mobile phones that support people to quit smoking and reduce their alcohol consumption. But not many people know about these programs and even fewer take advantage of them.
Digital programs are successful in helping people quit smoking or reduce risky alcohol consumption. As these programs are available via websites or smartphone applications, they are available at little to no cost and no travel time. They provide a private form of support for people who would prefer not to speak with their doctor or counselor about these behaviours. Under their ‘One You’ campaign, Public Health England offers several health apps, which include a Smokefree app for quitting smoking and a Drink Free Days app for encouraging days off drinking.
Our approach is to use the electronic health record to reach all patients who may benefit from digital programs without adding any time or workload to healthcare professionals and with limited monetary cost to the healthcare system. We used information in the electronic health record to reach and refer all patients who smoke and/or drink alcohol at risky levels via SMS text-messageto Public Health England’s mobile apps for smoking cessation and alcohol consumption.
Complexity in later life
UCAIRE aims to understand how care home residents, family/friends of residents, and care home staff cope with infection control measures during COVID-19. Their experiences of dealing with infection risk, of any unintended consequences of the measures implemented, or of unmet needs in the pandemic are not yet fully understood. Our mixed-methods study will obtain findings on their lived experiences of infection-control measures and their thinking, morale and behaviours in response to these measures. We hope that findings will produce relevant learnings on the needs of residents, family/friends, and care-home staff in coping with infection-control measures and what works when providing support to care homes in future outbreaks of infectious diseases.
THRIVE aims to understand Nursing and Midwifery Council (NMC)-registered nurses’ experiences of working in care homes for older people during the COVID-19 pandemic, how this impacted on resilience, mental health and wellbeing, and to collaboratively develop theory-informed approaches for ongoing and future support in this professional group.
This mixed-methods PhD project aims to better understand the complex issue of low-intake dehydration amongst older adults, particularly those living with dementia in long term care settings, and to explore ways of promoting and improving drinking for these individuals.
Roadworks can be particularly challenging for people who are D/deaf or disabled to navigate. The existing roadworks ramps have been identified as being problematic for this section of the community. Melba Swintex co-designed a new ramp (The Right Ramp) with a panel of disabled people that addressed most of the concerns about the traditional ramp. This project worked with panel of people with disability to ensure this new ramp was accessible to people with a range of disabilities.
Since 2015 we have set-up self-help groups for caregivers of children with disabilities in Kenya. Caregivers come together in shared enterprises of economic empowerment, peer support, and shared problem-solving. We have established proof of concept and developed a set of practical guidelines that are being trialled by our partners in the CBR Africa network. The follow up study started in 2018.
The research questions are:
- What impacts are associated with self-help groups for caregivers of children with disabilities?
- What is the uptake of the self-help group guidelines in other regions of Africa and how are they being used?
There is increasing evidence that involving patients and the public can improve research in several ways, such as in recruiting people to take part in research, in making research procedures pre-ethically sensitive, and in making research more useful to a wider variety of people. However, for PPI to happen, different groups of people need to work together. The aim of IMPRESS is to find out how Patient and Public Involvement is being used within projects that are part of the CLAHRC East of England research programme.
The treatment of hand swelling is a constant challenge for therapists where the objective is to reduce the swelling quickly and effectively in order to focus therapy on more functionally related goals, such as return to work and usual activity. There is no consensus on what is the most effective method of treating hand swelling after trauma or surgery. With the introduction of novel therapeutic techniques and modalities to treat swelling there is a need to assess the efficacy of these when compared to standard treatment.
Trauma and compression to the nerves of the hand results in paralysis and a loss of sensory feedback. Given the importance of good hand function for everyday functions nerve disorders can have a devastating impact on a person’s quality of life. Patient reported outcome measures or PROMs, provide a means for evaluating this impact. They aim to capture how a person functions or feels in relation to a health condition, coming directly from the patient without any interpretation from another person. The assessment of patient reported outcomes is now advocated for many health conditions and there is a consensus that they play an important role in clinical practice and research. There are currently no PROMs available specifically for people with a range of hand nerve conditions. To address this need the Impact of HaND Nerve Disorders Scale or I-HaND Scale, was developed.
The I-HaND study addresses the following questions:
- What is the lived experience of a person with a hand nerve disorder?
- What should be the content of a new patient-reported outcome measure for hand nerve disorders?
- How relevant and acceptable to patients is the newly developed I-HaND?
- How reliable, valid and responsive is the I-HaND?
Our team have undertaken a series of studies investigating firstly the degree of physical activity after hip or knee replacement and secondly what factors may influence why someone is (or is not) physically active following a hip or knee replacement. This is important as physical activity can have a significant beneficial effect on an individual’s health and well-being as well as on society as whole.
Physiotherapy is a common point of referral for many people with musculoskeletal shoulder pain. Although effective for many, not all people will benefit. This study identified which patient characteristics and baseline measures, commonly assessed at the first physiotherapy appointment, are associated with outcome six months later.
1,030 people attending physiotherapy for the treatment of musculoskeletal shoulder pain across the East of England were included in the study. We collected information on 71 patient characteristics and clinical examination findings.
A number of factors were associated with outcome. The most important predictor of outcome was the person’s pain and disability at the first appointment - higher levels were associated with higher levels six months later. However, high pain self-efficacy and a high expectation of recovery could change this to a better outcome. Pain self-efficacy is a person’s confidence in their ability to do things despite their pain.
In many countries, family members are essential in caring for people with dementia and establishing effective evidence-based psychological support that can help them manage challenging situations is critically important. This study aims to test the feasibility of Acceptance and Commitment Therapy (ACT) with dementia carers. ACT helps carers to explore what is truly important and meaningful to them in their life and engage in activities that serve their valued ends. ACT also helps individuals to use mindfulness skills as an effective way to deal with psychological barriers they encounter as they attempt to pursue their personal life goals.
A project to develop an understanding of the anxiety that is experienced by many people with Parkinson’s Disease (PwP), including an initial survey of the character of anxiety in Parkinson's, followed up by another survey to identify the range and preferences for therapies used to manage anxiety. This will allow us to develop an informed conceptualisation of anxiety in Parkinson’s, which will in turn inform the development of a Parkinson's-specific form of psychotherapy for anxiety.
Motor neurone disease (MND) is now recognised as a systemic condition, affecting not only limbs, bulbar and respiratory systems, but also leading to deficits in cognitive and behavioural functioning. Despite recognition of behavioural symptoms, no standardised approaches in managing these symptoms have been developed.
MiNDToolkit, a novel psychoeducational hybrid intervention for carers, is currently being tested in a randomised feasibility trial in the UK.
People with dementia develop high needs for assistance with their personal care and in the later stages can be reluctant to receive support with these daily tasks. Refusals of care can leave carers in a difficult position, since they are difficult to manage and can lead to serious consequences. The Pro-CARE study aims to:
- Determine the factors influencing refusals of care in care home and family settings
- Explore how family carers and care-home staff provide assistance with personal care to people in the later stages of dementia
- Create a training intervention to add to informal and formal carer skills
Primary supervisor: Prof Eneida Moishi
Secondary supervisor: Naoko Kishita
Supervisory team: Tamara Backhouse and Mizan Khonkoder (MED)
PhD student: Polly Trucco
Family carers of people living with Motor Neurone Disease are at a higher risk of grieving in a more intense than usual manner during and after the trajectory of the disease of the person living with MND.
They experience multiple losses during the disease trajectory, which start before the death of the person living with MND leading to the phenomenon of anticipatory grief and continue during bereavement.
Previous studies on grief in non-MND carer populations revealed that unsuccessful adjustment of grieving processes in the early stage can lead to prolonged and complicated grief. However, there are few studies investigating anticipatory grief in MND carers to date. This study, therefore, aims to explore and understand factors associated with anticipatory grief in family carers of people living with MND. Findings from this study might better inform future non-pharmacological interventions and enable tailored information for families, services, as well as training for association visitors and healthcare professionals to better support this cares’ population with emotional wellbeing.
Key research actions
- Aim 1: To synthesize the findings from previous studies to identify the factors related to grieving processes in family carers of people living with MND.
- Aim 2: To investigate the predictive effects of patient-related factors and cares-related factors on carers’ anticipatory grief.
- Aim 3: To explore current MND family carers’ emotional experiences of anticipatory grief with people living with MND through qualitative interviews.
A systematic review of factors related to different grieving processes on informal carers of people living with Motor Neurone Disease during and after the progression of the disease was conducted to answer the research question of Aim 1. Aim 2 uses a quantitative design to investigate the predictive effects of psychological flexibility, familism, relationship closeness, patient behavioural changes and disease severity on carers’ anticipatory grief. Current family carers are invited to complete an online survey with 8 self-reported standardized questionnaires at https://uea.onlinesurveys.ac.uk/factor-mnd to collect data and answer this question. In order to answer the research question in aim 3, exploratory individual interviews with current MND family carers are being conducted to contribute to overcome the limitations of previous research and fill the gap of carers’ experiences of losses when caring for their loved one. Through them, deeper and valuable information of MND carers’ own emotions, feelings and perceptions will be captured, providing rich information to better support them.
The project is funded by MND Scotland
Contact us: email@example.com
Sleep and brain health
We spend nearly one-third of our life asleep, which has a profound effect on our bodily functions ranging from the way our genes become expressed, through various physiological processes including cardiovascular function, metabolism and immunity to the way our brain works.
Sleep affects our body and brain ranging from the very core of our biological existence, the way our genes work through multiple physiological processes involving immunity, cardio-metabolic and neural functions to ultimately modulating our emotional well-being and cognition including attention, memory and behaviour control.
The Sleep and Brain Research Unit (SBRU) aims to host state of the art research in order to improve our understanding of the significance of sleep in brain health throughout the life-span and drive changes in evidence based practice targeting the prevention, treatment and care of patients with brain health conditions.
Supportive, palliative and end of life care
Families and friends play a crucial role supporting people they care for as their unpaid carers. However, they are not always well prepared for this, and it can damage their own health and wellbeing. Carers need support to (1) look after their own health and wellbeing and (2) boost their skills and confidence to care. Healthcare policy says this should happen, but healthcare professionals can find this difficult to achieve alongside supporting the patient. To address this, we have worked with carers and professionals from health, social care and the voluntary sector to develop a new Carer Support Nurse role. It is designed to help carers who have their own needs, or who need extra support for their caring role, that cannot be met by their usual healthcare team. The nurse will also work with other healthcare providers to raise their awareness of carer needs and how to support them. This project is evaluating the pilot role.
Lead investigator: Prof Morag Farquhar
Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality. Informal carers (family members/friends) play a key role in supporting patients, but with considerable impact on their well-being. The Carer Support Needs Assessment Tool (CSNAT) is an evidence-based validated tool for identifying carer support needs in clinical practice, underpinning a person-centred approach to carer support (the CSNAT Intervention: CSNAT-I). However, the tool was developed in end-of-life hospice care, predominantly in cancer rather than non-malignant long-term conditions such as COPD. This project adapted CSNAT for COPD carers using evidence from a systematic review of COPD carer support needs and carer focus groups, informing the development of CSNAT v3.0.
Breathlessness is a distressing, disabling and common symptom of advanced disease. For informal carers (family members/friends who help and support patients) it causes anxiety, isolation, and helplessness. Informal carers lack knowledge and confidence in supporting patients with breathlessness.
The Learning about Breathlessness Study programme (LaB) aims to develop and test an intervention to help carers learn about breathlessness in life-limiting disease: to increase their knowledge and confidence. LaB1 identified topics carers wanted to learn about and how. Building on LaB1, LaB2 worked with carers, patients, healthcare professionals to develop the web-based intervention which is now publicly available.
Health care should be driven by patients’ needs. This is known as “person-centred care.” The NHS recommends it, but there is little guidance on how to provide it. We have developed a way to do this called Support Needs Approach for Patients (SNAP). SNAP uses a tool (a booklet called the “How are you?” Booklet, containing a set of questions to help patients think about areas where they need more support) and a focused conversation between the patient and healthcare professional to help address those needs. SNAP was first developed for patients with chronic lung disease and is now being used to enable person-centred conversations for patients with a range of chronic physical conditions. This project is exploring the usefulness of SNAP for patients with acute mental health conditions where it has not yet been explored. To do this we are working with service users with experience of being an inpatient in an acute mental health hospital, and healthcare professionals from the setting, in a series of focus groups and workshops to adapt the ”How are you?” Booklet and SNAP’s person-centred process for acute mental health. The study is funded by the NIHR Applied Research Collaboration.
Lead investigators: Prof Morag Farquhar & Dr Carole Gardener
NHS ambulance service personnel are at risk of poor physical and mental wellbeing, and may have a greater risk of occupational suicide than the general population. The factors which influence this are poorly understood, as are interventions aimed at modifying these risks. It is important to recognise where occupation-specific risks can be modified in personal, cultural and job-specific areas (for example trauma), and within an individual organisation. This national project will map how Trusts are currently supporting staff and identify areas for priority action.
The changing pace of pre-hospital emergency care means there is very little down time between jobs and missed shift breaks and late finishes are the new normal. Fatigue on the job and poor sleep quality increases the risk for a range of adverse patient, staff, and organisational outcomes, including patient care quality and safety, and staff mental health and burnout. We are conducting the first UK research study to estimate the magnitude of sleep problems and fatigue at work in ambulance staff, the association with patient safety outcomes, and explore what staff and ambulance services are currently doing to support healthy sleep.