Capacity development

SPCR has a number of Capacity development awards available every year. This includes an annual PhD place funded by NIHR, Wellcome funded Doctoral Training Programme places for Primary Care clinicians,  a fellowship for up to two years for academics and an SPCR Primary Care Clinicians Career Progression Fellowship for one year. This is part time so clinicians can still work within their clinical setting. The Seedcorn Bridging awards also are offered annually (monthly duration is flexible); these may be a stop gap for those in between projects who are seeking to upskill with training or expand upon work already undertaken. There is an internship once a year in the summer months.  Staff can also apply for consideration for an NIHR Professorships. 

PhD project - Iona Hindes

The Impact of COVID-19 Lockdowns on Maternal and Neonatal Health: a Mixed-Methods Study.

One of the main objectives of the study is to explore how lockdowns impacted individuals from different deprivation and ethnicity groups - hence the exploration of the unequal impact of lockdowns on maternal and neonatal morbidity is an integral aspect of this project. The topic is explored through a number of different methodological approaches. 

• Systematic Review and Meta-analysis: a systematic review of all the literature which explores the impact of lockdowns on birth outcomes in high income countries and are now in the midst of conducting a meta-analysis. A meta-analysis of each key outcome including preterm birth, postpartum depression, readmission rates for mothers and Newborns, etc. Then we will conduct a meta-analysis specifically looking at studies which have data stratified according to deprivation level and ethnicity group. In this stratified meta-analysis, an exploration of how rates of key outcomes changed per group and if inequalities increased or increased in high income countries.  
• NHS Hospital data analysis:  approved access to a large amount of Hospital Episode Statistics Data from the NHS, ranging from the present to 2018 with data on all information related to pregnancy and birth admissions. The plan of analysis is to explore which key birth outcomes changed significantly over lockdowns - by conducting an interrupted time series regression. Followed by a stratified analysis to explore which socio-economic and ethnic groups experienced which changes. Finally, to pinpoint key regions in which outcomes worsened and where outcomes improved. This will inform which social and demographic groups experienced adverse outcomes due to lockdowns and whether or not inequalities were substantially affected. 
• Finally, - between 15-30 interviews with women who were pregnant over lockdown will be conducted. A key aspect of questions in the interviews relate to inequality directly - for example asking about experiences of discrimination or racial abuse, as well as the housing environment, financial insecurity, and employment insecurity. Through these interviews it is hoped to elucidate the lived experiences of lockdown for a variety of individuals and explore how lockdown impacted different groups of people very in various and inconsistent ways. 

Targets to reduce inequality, mortality and morbidity

• This project investigates how key perinatal outcomes were impacted by the COVID-19 lockdowns. We will explore key maternal and neonatal morbidity and mortality outcomes, such as stillbirth, preterm birth, neonatal mortality, maternal length of stay & readmission, perineal tears, Caesarean section, and maternal mental health. 
•  Analyze the inequalities in the outcomes between ethnic groups and deprivation levels, and how lockdowns may have exacerbated or alleviated these inequalities.
• To gain understand of how lifestyle changes that occurred during lockdowns could have impacted perinatal health, through qualitative research on mothers who were pregnant in lockdowns. 

 

Meredith Hawking - Fellowship award 

 

Fellowship project - Everyday ethics in a pandemic: exploring (re)negotiated practices within households that include children with obesity 

 

Summary

The study of households with children with obesity will help to understand how people’s beliefs and actions about being ‘good’ and doing the ‘right’ thing affect their conversations, decisions and routines in the home.

Concerned with ordinary ethics, the research will consider the different ways, or practices, of ‘doing’ health and happiness.  This will include a focus on weight, but will also include all the other ways of ‘doing good’ and ‘being good’ that families care about.   The research will take into account the external pressures households have faced during the pandemic that influence decisions and actions about health.

Meredith will spend a year with twelve diverse families and households in East London. She will use a variety of methods to understand the daily practices and priorities of parents/carers and children:

• online interviews and a focus group with parents/carers
• ‘walk through’ videos of the household
• voice notes for parents/carers to record their reflections and thoughts about the decisions they have to make throughout a normal day
• children’s drawings of their household and their favourite activities

The approach will pay attention to practices, moments of decision, conversation and compromise, and descriptions of daily activities in people’s accounts. The research will identify new ways for helping households with children in their journey towards a healthier weight for the future. This in turn will inform local childhood obesity strategies in East London.

Sarah Spencer - Career progression fellowship award

Summary

Background Informal carers find their role in medication management is challenging. This can affect adherence and may negatively impact relationships between carer, cared-for and clinicians. Medicines are prescribed (and sometimes stopped) within clinical consultations. Carers’ experiences of these consultations, and the extent to which their priorities are considered is an important aspect of managing caregiver burden.  

The COVID-19 pandemic has dramatically changed consulting practices with more consultations conducted remotely. There is concern that patients have difficulty accessing face-to-face consultations to discuss ‘non urgent’ chronic disease management. It is unclear whether, how, and to what extent these changes have impacted carers’ partnerships with their healthcare providers.  

Objectives 

1. To explore carers’ experience of consultations where medications are prescribed and stopped. 
2. To consider how carers’ relationships with healthcare providers may have changed with the shift to remote consulting during the COVID-19 pandemic. 
3. To engage carers in a process of co-design to inform processes of medication management that better meet the needs of patients with complex health conditions. 

Methods 

This qualitative study will begin with in-depth narrative interviews with 12 carers recruited from carers support groups. Analysis of this data will inform the development of two ‘trigger’ films of ‘triadic’ doctor-patient-carer consultations that involve prescribing. These films will be used to stimulate a process of co-production, in which carers recount real-life stories of experience in the process of creating fictive stories about the carers’ journey through this process to improve service design. 

Analysis will be informed by the Burden of Treatment theory. This model describes a framework through which medical, social and emotional factors, combine to form the carer’s workload of demands. If the burden exceeds the carer’s capacity to cope, then the result may be poor carer engagement, non-adherence and poor mental and physical wellbeing for both carer and cared-for.   Discourse analysis and narrative techniques will be used to analyse the data.