Improving health and wellbeing

Our intervention research draws on methodological expertise in prognosis research, pragmatic clinical trials, intervention development and process evaluation, with applications across community, primary care, and secondary settings to improve health and the efficiency of healthcare.

Our models of risk-based stratified care and vocational interventions for common musculoskeletal disorders are recognized in Public Health England’s Return on Investment tool, and are now underpinning efforts to transfer supported self-management interventions from NHS to community settings for low-risk patients and the wider public.

Following from our lifecourse epidemiologic research that identified trajectories and risk factors for pain in childhood and adolescence, our research in now exploring the feasibility and effects of intervening earlier in the lifecourse.

Developing and evaluating interventions to reduce low-value care in the NHS features in our research tackling over-prescribing of opioids and gabapentinoids for adults with persistent pain.

Reducing repeat self-harm in young people in primary care

The COPING study will work in partnership with young people aged 16-25 with lived experience of self-harm and GPs to develop a treatment guide (called COPING) for GPs to use with young people to reduce repeat self-harm.

Links: COPING study
People: Dr Faraz Mughal

Integrating vocational advice into primary care

Building on observational and qualitative research on the needs of adults with long-term conditions for early and effective employment support, we developed a vocational advice service in general practices for adults consulting for musculoskeletal pain and either struggling at work or with recent absence from work. In a cluster randomised trial, compared with best current care, adults in practices offering the new service had fewer days off work and an estimated return on investment from a societal/productivity perspective of £11.14 for every £1 spent on the intervention.

We have extended this work through:

  • An implementation project with First Contact Practitioners (I-SWAP)
  • A new multi-centre trial expanding the remit of the vocational advice service to other health conditions (WAVE)
  • International collaborations with researchers looking to adapt and evaluate this approach in their national settings

Links: SWAP, iSWAP, WAVECentre for Musculoskeletal Health & Work 
People: Gwenllian Wynne-Jones, Nicola Evans
Key references:

  • Effectiveness and costs of a vocational advice service to improve work outcomes in patients with musculoskeletal pain in primary care: a cluster randomised trial. Pain 2018.
  • Acceptability of a vocational advice service for patients consulting in primary care with musculoskeletal pain: A qualitative exploration of the experiences of general practitioners, vocational advisers and patients. Scand J Public Health. 2019.
  • Public Health England. Return on Investment of Interventions for the Prevention and Treatment of Musculoskeletal Conditions. Final Report. 2017.
  • Managing work participation for people with rheumatic and musculoskeletal diseases. Best Pract Res Clin Rheumatol. 2020.
Non-traditional support workers delivering a brief psychosocial intervention for older people with anxiety and depression

Support workers working within third-sector (voluntary) organisations are a valuable source of expertise within the community but are under-used by primary care practitioners in the management of older people with anxiety and depression. This project:

  • Developed and refined a behavioural activation psychosocial intervention based on synthesising existing guidelines, an updated systematic review, and results from new empirical qualitative research
  • Assessed the feasibility of recruiting and training support workers to deliver the intervention
  • Conducted a feasibility study in local general practices to inform a possible future randomised trial

Links: NOTEPADMental health research 
Key references:

  • Non-traditional support workers delivering a brief psychosocial intervention for older people with anxiety and depression: the NOTEPAD feasibility study. Southampton (UK): NIHR Journals Library; 2019.
  • Can support workers from AgeUK deliver an intervention to support older people with anxiety and depression? A qualitative evaluation. BMC Fam Pract. 2019.
  • Developing a community-based psycho-social intervention with older people and third sector workers for anxiety and depression: a qualitative study. BMC Fam Pract. 2017.
health literacy couple
Increasing the activity of older people with long-term pain

Long-term pain is a common and important predictor of physical inactivity, particularly in older people. This project is intended to find out if a walking programme, delivered and supported by trained healthcare assistants, can encourage people over the age of 65 with joint pain to become more active.

Links: iPOPP
People: Clare JinksEmma Healey
Key references:

  • The feasibility and acceptability of a physical activity intervention for older people with chronic musculoskeletal pain: The iPOPP pilot trial protocol. Musculoskeletal Care. 2018.
Managing sub-threshold depression in community pharmacy settings

The Community Pharmacies Mood Intervention Study (CHEMIST) seeks to adapt ‘what works’ for people with sub-threshold depression in primary care and examine if this can be translated to the important public health setting of community pharmacy

People: Carolyn Chew-Graham
Key references:

  • Community Pharmacies Mood Intervention Study (CHEMIST): feasibility and external pilot randomised controlled trial protocol. Pilot and Feasibility Studies, 2019.
Pain in children

Adult prevalence levels for low back pain appear to be reached by around the age of 18 years, and the patterns and trajectories of musculoskeletal pain in childhood and adolescence differ from those in adulthood, with evidence to suggest greater variability and change. Childhood and adolescence may be a critical period to investigate the development of long-term pain trajectories and our research on this topic seeks to identify risk factors and approaches to earlier recognition and effective management.

People: Kate Dunn
Key references:

  • Pain and learning in primary school: a population-based study - PubMed
  • Low back pain across the life course - PubMed
Reducing inappropriate opioid use and improving the quality of life for people with persistent pain

Prescriptions for opioid medicines in England and Wales have risen dramatically from more than 14 million in 2008 to 23 million in 2018. But although opioids can be effective painkillers for short-term pain, for many people they do not help in the long-term and can cause other problems, including dependence.

This five-year research programme called PROMPPT, seeks to develop and evaluate a clinical pharmacist review service that is relevant, useful and appealing to the people who will use it.

People: Christian Mallen, Julie Ashworth
Key references:

  • The effectiveness of national guidance in changing analgesic prescribing in primary care from 2002 to 2009: an observational database study. Eur J Pain 2013.

Gabapentin and pregabalin (‘gabapentinoids’) prescriptions have increased considerably in the past decade with growing concern over widespread ‘off-label’ prescribing for other pain conditions in which there is little clear evidence of their effectiveness. This study investigates patterns and trends in gabapentinoid prescribing in the UK, including prescribing indications and the risks and risk factors for fracture, drug misuse and overdose.

People: Julie Ashworth

Supported self-management for all with musculoskeletal pain: an inclusive approach to intervention development (EASIER)

Evidence for supported self-management in musculoskeletal health is mixed, and growing evidence suggests current interventions do not work for patients with lower health literacy. This project, funded through a Versus Arthritis award, aims to develop a model for new, inclusive intervention(s) for supported self-management for musculoskeletal health that takes account of patient health literacy.

People: Joanne Protheroe, Emma Healey, Danielle van der Windt, Noureen Shivji, Nadia Corps, Gill Rowlands, Martyn Lewis
Key references:

  • The Impact of Inadequate Health Literacy in a Population with Musculoskeletal Pain. HLRP: Health Literacy Research and Practice. 2018.
  • Self-management of a musculoskeletal condition for people from harder to reach groups: a qualitative patient interview study. Disability and Rehabilitation, 2018.
  • The health information gap: the mismatch between population health literacy and the complexity of health information; an observational study. Br J Gen Pract. 2015.
family silhouette
Childhood risk factors for low health literacy in young adults

A key challenge is the prevention of low health literacy, and the WHO has recognised that intervention in early life course offers the optimum opportunity to influence the “life chances of children” and confer health benefits into adulthood. To address this, there is a clear need to understand what childhood factors predict adult health literacy. This project, funded in part by the Sir Halley Stewart Trust, uses a longitudinal study of childhood (ALSPAC) to investigate which factors in childhood are associated with health literacy in adulthood.

Links: Sir Halley Stewart trustAvon Longitudinal Study of Parents and Children (ALSPAC)
People: Joanne ProtheroeKate DunnIvonne Solis-Trapalas, Paul Campbell, Gill Rowlands

Key references:

  • The evidence-based development of an intervention to improve clinical health literacy practice. Int J Environ Res Public Health. 2020.
  • Can patients with low health literacy be identified from routine primary care health records? A cross-sectional and prospective analysis. BMC Fam Pract. 2019.
  • Celebrating the health literacy skills of parents: A photovoice study. J Health Psychol. 2020.
  • Effective partnership in community-based health promotion: lessons from the Health Literacy Partnership. Int J Environ Res Public Health. 2017.
  • The digital divide: examining socio-demographic factors associated with health literacy, access and use of internet to seek health information. J Health Psychol. 2019.
  • Lay health trainers supporting self-management amongst those with low health literacy and diabetes: lessons from a mixed-methods pilot, feasibility study. J Diabetes Res. 2016.
  • The feasibility of health trainer improved patient self-management in patients with low health literacy and poorly controlled diabetes: a pilot randomised controlled trial. J Diabetes Res. 2016.
  • Do web-based mental health literacy interventions improve the mental health literacy of adult consumers? Results from a systematic review. J Med Internet Res. 2016.
  • Health literacy, associated lifestyle and demographic factors in adult population of an English city: a cross-sectional survey. Health Expect. 2017.