Project description

Primary supervisor - Dr Zarnie Khadjesari

Project Overview

Effective behaviour change interventions for smoking cessation, alcohol reduction and weight management are widely available, yet uptake and sustained use in primary care remain limited, particularly among disadvantaged populations. The challenge is no longer identifying evidence-based interventions but understanding how to implement and scale what already works. This PhD will investigate how agricultural extension-inspired health intermediaries can improve uptake of smoking cessation, alcohol brief interventions and weight management within primary care.

Agricultural Extension and Innovation

Agricultural extension refers to systems that support large-scale adoption of innovations by embedding trained intermediaries within local delivery settings. Extension agents translate research into practice, support adaptation, build trust with practitioners and communities and are accountable for implementation outcomes. While health systems include roles such as health coaches, community health workers and peer supporters, these are rarely conceptualised as a coordinated, system-level implementation strategy. This project reframes the intermediary role itself as a strategy for scaling evidence-based practice rather than an ad hoc support function.

PhD project

The PhD will focus on primary care as the implementation setting, using comparative case studies of smoking cessation, alcohol brief interventions and weight management to examine how intermediary activities operate across behaviour change contexts. The student will explore how extension-inspired roles could strengthen implementation processes, reduce barriers to adoption and support sustained delivery in routine care.

Objectives

• Identify extension agent roles and activities that enable equitable, large-scale adoption of innovations from the agricultural literature.

• Examine how similar intermediary practices exist within primary care behaviour change delivery, including clinicians, health coaches and community health workers.

• Co-design a transferable model of extension-inspired health intermediaries to support implementation, engagement and adaptation of behaviour change interventions.

Methods

The student will undertake cross-sector comparative analysis and qualitative case study research within primary care. Methods include document analysis, semi-structured interviews, ethnographic observation of implementation processes and pathway mapping to understand how intermediary activities influence adoption. Co-design workshops with practitioners and system partners will inform development of an enhanced intermediary role for future piloting.

Theoretical Framework

The research will be grounded in implementation science, drawing on the Consolidated Framework for Implementation Research (CFIR), Normalisation Process Theory (NPT) and WHO/ExpandNet principles to explore conditions for scale-up and sustainability. The student will receive training in qualitative and mixed-method implementation research, participatory co-design approaches and systems thinking applied to healthcare challenges.

By translating lessons from agricultural innovation systems into primary care, this project aims to generate new theoretical and practical insights into how health services can scale behaviour change interventions more effectively, equitably and sustainably.

Training

The student will have access to a programme of research training at the University of East Anglia (UEA), including postgraduate modules in research methods and implementation science. The School of Health Sciences offers mentoring, a writing café, Early Career Researcher Club, annual Researcher Summit and regular researcher drop-in sessions. Training will support development of qualitative and mixed-method implementation research skills, co-design approaches and interdisciplinary collaboration.

Person Specification

Applicants should have a background in health sciences or a related field. Interest in implementation science, behaviour change or primary care research is desirable. The successful candidate will demonstrate strong analytical skills, the ability to work independently and collaboratively, and excellent written and spoken English.

Entry requirements

The minimum entry requirement is 2:1. Degree in psychology, public health, epidemiology or other health-related discipline.

Funding

This project is fully funded for 3 years. Funding includes tuition fees, an annual tax-free maintenance allowance and a research training support budget.

References

Brown TJ, Tham NAQ, Naughton F, Goodfellow H, Hull L, Jopling H, Parretti HM, Ramsey AT, Wagner AP, Khadjesari Z. Implementation of electronic signposting to interventions that prevent cancer: a realist review. Under review. https://doi.org/10.20944/preprints202511.1327.v1

ii)

Khadjesari Z, Brown TJ, Ramsey AT, Goodfellow H, El-Toukhy S, Abroms LC, Jopling H, Dierker Viik A, Amato MS. Novel implementation strategy to electronically screen and signpost patients to health behavior apps: mixed methods implementation study (OptiMine study). JMIR Form Res. 2022;6(7):e34271.

iii)

Khadjesari Z, Boufkhed S, Vitoratou S, Schatte L, Ziemann A, Daskalopoulou C, Uglik-Marucha E, Sevdalis N, Hull L. Implementation outcome instruments for use in physical healthcare settings: a systematic review. Implement Sci. 2020 Aug 18;15(1):66.

iv)

Hull L, Goulding L, Khadjesari Z, Davis R, Healey A, Bakolis I, Sevdalis N. Designing high-quality implementation research: development, application, feasibility and preliminary evaluation of the implementation science research development (ImpRes) tool and guide. Implement Sci. 2019;14(1):80.

Reimagining behaviour change at scale: agricultural extension-inspired health intermediaries as a strategy for uptake (KHADJESARIZ_U26FMH)

Welcome to Norwich

Project description

Entry requirements

Funding

References