By Nathan M Davies, on 18 July 2017
In this post Danielle Roberts describes her experience during her four-month academic placement with PCPH’s British Regional Heart Study (BRHS) research team.
I am a foundation year 2 (FY2) doctor; this means I am in my second year of working as a doctor after finishing medical school. Foundation doctors undertake 4-monthly placements, rotating around different hospital departments, general practice or other community posts. The aim is to provide newly-qualified doctors with rich and varied experiences before we apply for speciality training posts.
I was fortunate enough to have secured a place on an academic foundation programme, which meant that one of my 4-month placements was designated to be a research post. With these bespoke academic placements, there is a lot of flexibility with what you can pursue depending on your areas of interest. My future career plans are to become an academic GP, with research interests in public health; and thus it was a great privilege for me to be able to spend my research placement within UCL’s PCPH department. With such a plethora of leading research groups within PCPH, I was spoilt for choice; however considering my main passion for cardiovascular disease and diabetes, I decided to join with the British Regional Heart Study (BRHS) research group.
The BRHS research group are a very friendly, helpful, supportive and fun team to work with. Not only was the placement overwhelmingly productive, but I had an enjoyable four months too. Whoever said research is boring……we had several social trips out for lunch, lots of food and lots of laughs!
The BRHS has a wealth of data from an original cohort of 7735 middle-aged men aged 40-59 years from 24 British towns, initially recruited in 1978-1980. These men have been regularly followed-up for morbidity and mortality since including a physical re-examination in 1998-2000 when aged 60-79 years. My research project investigated the prospective association of individual socioeconomic position and neighbourhood-level socioeconomic deprivation with incident type 2 diabetes mellitus in older British men (60-79 years). We found that diabetes risk was higher in lower social classes and in areas of greater socioeconomic deprivation. For manual social class this was mostly explained by body mass index and triglycerides. For neighbourhood-level socioeconomic deprivation it was largely explained by body mass index and to a lesser extent, other lifestyle factors (smoking, alcohol, physical activity, diet etc.). Our results support the need for public health campaigns specifically targeting obesity as a fundamental means towards preventing type 2 diabetes and reducing socioeconomic inequalities in older adults.
Completing the project during the placement was a big achievement in itself, as I had never used sophisticated statistical software before; yet under the guidance of my supervisors, I was able to write and run my own codes by the end of the project. I also started to write up the first draft of my project as a scientific paper. This was my first experience of writing a research paper. Writing the draft enabled me to develop skills in literature searching and the ability to read and critically appraise evidence. By the end of the four months, I successfully submitted my abstract to an international Public Health conference in Canada, and so I will be presenting our work there in June 2017.
What I really liked about this placement was the flexibility. The BRHS team were very accommodating, so I was able to pursue various interests alongside my primary goal of completing the research project. For example, I wanted to develop my teaching skills, and so I attended a formal “Training to Teach” course and then used the skills I had learnt to teach 4th year UCL medical students together with GP trainees. Additionally, as my future career plans are towards general practice, I was able to arrange some GP taster sessions during my placement, which allowed me to gain further experience.
Believe it or not, this is just a highlight of some the things I was able to achieve during my 4-month placement with the BRHS team! This list could go on, but I want to just take this opportunity to say a massive thank you to all the members of the team who supported me and enabled me to make the most out of the time I had. For any future FY2 doctors, who are searching for a rich and varied academic placement, with a strong research focus, but with the flexibility to allow for the pursuit of other interests too, I cannot think of any group more suitable than PCPH’s British Regional Heart Study group.
By Nathan M Davies, on 22 June 2017
In this post Surinder Singh, Course Director for the iBSc in Primary Health Care gives us na update with some great feedback from past and present students.
We have just just “graduated” the twentieth cohort of students undertaking the Department’s integrated BSc in Primary Health Care (iBSc). After their first two years at UCL all medical students undertake an iBSC year which allows them to pursue an individual subject, of their choice, in considerable depth, with a strong emphasis on undertaking an extended research study. This is a fundamental element of the medical school’s mission to produce “scientifically-literate” clinicians. (http://www.ucl.ac.uk/medicalschool/staff-students/course-information/year-3).
Ever since 1997 one of the iBSc options at UCL has been the iBSc in Primary Health Care. This was the first primary care iBSc in the UK and each year we recruit a small but dynamic cohort of usually 10-14 students.
Over the last twenty years we have produced almost two hundred graduates, most of whom are now practising clinicians throughout the UK and abroad. The original Course Director was Melvyn Jones who subsequently handed over to current lead Surinder Singh.
The iBSc consists of six modules encompassing individual patient care, the consultation in primary care as well as health of the population and critical appraisal – now jointly taught with the iBSc in Paediatrics. The single largest module is Research* – led by Richard Meakin. This is a module which students find sometimes challenging, usually fascinating and always rewarding. It is also the component where we are particularly keen to involve PCPH researchers and research students as project supervisors. So please contact Surinder or Richard if you would like to get involved or have a small project in which you think a bright and well-motivated student could contribute in return for your supervision.
A short video about the iBSc and a list of all projects and abstracts/scientific papers are on the iBSc website.
Two recent graduates have kindly sent us the following comments about their experiences of the iBSc in Primary Health Care for this blog:
Student Rajit Randhawa writes:
“As far as I am aware primary healthcare is only amongst a few iBScs to offer patient contact – one day a week throughout the year. Not only does this help tie in the theoretical learning about consultation models and patient-belief systems, it most definitely prepares us for the 4th year clinics and in my opinion, is a truer placement than the 5th year GP placement because we actually see continuity of care over a prolonged period. In my time at my medical practice I clerked and examined many patients, performed basic procedures such as flu jabs, and even had the opportunity to write up an inquest into a patient’s death in addition to doing more routine tasks such as home and hospital visits”
And of the teaching during the year:
“I cannot think of a single session where I thought the teaching was overbearing or too complex. Tutorials can be up to three hours but it’s not as bad as that since the format lends itself to promoting healthy and productive discussion between different groups of students. As someone who was often happy to sit silently I now appreciate being driven out of my comfort zone, and it has helped to develop my confidence speaking to larger groups”
Another graduate of the course, Joht Chanda– now a junior doctor wrote:
“I am currently finishing my Foundation Year 1 in the West Midlands. During medical school at UCL I was fortunate to get onto the iBSc in primary care and population health after my pre-clinical years. I wasn’t sure what to expect before starting the course, however the lessons I went onto learn, were extremely positive in shaping where my career is currently going.
The iBSc was the first opportunity I ever had to try taking part in research. Academia was not something I had ever considered before, as in my head I thought it usually consisted of lab work and being told what to do (two things I can’t stand!).
However, in comparison to the other courses available, this iBSc was one of few to give you an opportunity to run a research project from start to finish, even applying for our own ethics (I can say happily now, but not so much back then!). Although seemingly daunting at the time, the task of designing my own project was possibly one of the most useful I was able to complete during medical school. It meant that in the proceeding clinical years, I had a solid grounding in research methods and was able to start taking on work myself that others in my year group wouldn’t have the knowledge of where to start.
Being self-sufficient meant I was able to strengthen my application for foundation years without having to rely on others for opportunities. Instead this self-sufficiency taught in the iBSc meant I was the person responsible for creating the opportunities. The iBSc supervisory team were extremely supportive and even helped me publish my project and present it at conferences; these were great stepping stones for the future as most career paths usually prefer some level of academic engagement.
I cannot explain quite how useful doing the course was for me and how thankful I am to have got on it, thinking back”.
Joht wrote a paper with Richard Meakin for BMJ Open and Rajit has produced a poster for a conference in 2017.
- J S Chandan & R Meakin: Do special constables in London feel that they are adequately prepared to meet their first aid responsibilities? A qualitative study
- Randhawa, J S Chandan, T Thomas, S Singh. Investigating the attitudes and views of general practitioners on the use of video consultations in primary health care. Poster accepted for conference on Telemedicine (UCL)
PLEASE DO GET IN TOUCH IF YOU WOULD LIKE TO GET INVOLVED
We are currently recruiting projects supervisors for the new cohort of eleven iBSc students starting in September 2017. If you are a PhD student/post doc and would like to get involved please do contact Surinder Singh or Richard Meakin
By Nathan M Davies, on 24 May 2017
This years winner of the Yvonne Carter Award is Nathan Davies.
Each year the RCGP and the Society for Academic Primary Care (SAPC) award the Yvonne Carter Award for Outstanding New Researcher, and each year the competition gets harder. This year panel members from the RCGP Scientific Foundation Board (SFB) and SAPC reviewed several high-quality applications from early career researchers.
Dr Nathan Davies, a Research Fellow at UCL, impressed all the panel members with the number of grants he has secured and projects he has collaborated on in the three years since completing his PhD. Here Nathan outlines his plans for the award, and talks about his career journey.
What is your main area of interest, and how did that develop?
My research currently focuses on end of life care for people with dementia and how we can improve the experience of care not only for patients, but also for families and others affected by dementia. I have a particular interest in making decisions at the end of life and supporting practitioners to make decisions with patients and their families; we know this is an area that practitioners find challenging and I hope that my research will support GPs with this.
My background is in Psychology. I worked in memory clinics and I noticed a pattern whereby we would see patients with mild to moderate stages of dementia, but they then fell off our radar. This got me thinking about what was happening in the wider context. There was also little support for those with later stages of dementia, which surprised me. Through my early work, I realised that most guidelines and research for example was very practitioner oriented with little input from family carers, who we know provide most support day to day and are experts through experience.
What does your research involve?
My PhD was a large piece of qualitative research; I carried out in depth interviews with 47 family carers. I wanted to find out what their experience of end of life care was, what do they see and what are their experiences? I realised that their priorities aren’t always the medical but usually centre around the psychosocial importance of end of life care – being treated with respect and dignity.
My post-doctoral work has focussed on two areas: 1) supporting practitioners make decision through the development of rules-of-thumb. These have been implemented in NHS sites and the Alzheimer’s Society have incorporated them into their end of life training programme; 2) supporting family carers at home with the development of an online support tool.
How will you use this award?
This award will allow me to expand my networks with lower income countries, and I’m specifically interested in working with Sri Lanka.
Sri Lanka has an increasing ageing population with the highest proportion of older adults in South Asia. This award will allow me to travel to Sri Lanka to carry out workshops with GPs and the Ministry of Health to provide education, awareness and an understanding of dementia and how they can support family carers. I will also hold workshops with family carers to not only provide them with support, but also to learn more about their approach to caring for people with dementia.
Based on your experience, what advice do you have for people who are interested in working in the research field?
You can’t underestimate the importance of networking in research. This means ensuring you are talking to people that do similar work, but also networking with those who have different research interests not necessarily in a directly related field. There is so much we can learn from each other.
Academia is changing and social media is becoming a huge part of what it means to be involved with research. I use Twitter to keep up to date with new research and key topics in the field of healthcare, but also to talk about the work that I’m doing. It’s also useful to blog about new research or publications to disseminate findings. You can’t rely on people reading academic papers anymore!
Make sure to get involved in lots of different events and networks across not just your research group or department, but also the wider institute and organisations such as the SAPC or RCGP.
Lastly, I would say to not be afraid to keep trying when you’re not successful – whether it’s a grant application or an unsuccessful publication, don’t get disheartened and go for it again!
By Nathan M Davies, on 12 May 2017
In this post Manuj Sharma talks about the mid-year meeting for the International Society of Pharmacoepidemioogy (ISPE) he recently attended at the Royal College of Physicians in London.
Pharmacoepidemiology itself comes across as quite a mouthful, but it simply refers to the study of the use and effects of medications in large numbers of people – focusing on both how effective and safe medications are. As such, research including both trials and observational studies focused on medication all come under the pharmacepidemiological heading.
A big point for discussion at this years conference was the impact of ever growing volumes of “real world” patient data and what it means for the field of pharmacoepidemiology going forward. “Real world” is any data collected outside of the constraints of conventional randomised trials. When it comes to medications, there are many who traditionally have looked at randomised controlled trials as the only means of getting to a clear unbiased answer but given so much data is now becoming accessible, can we really afford to ignore other study designs and methods?
The thoughts on what all this new patient data meant for the future of research into medication were sought from representatives from 3 key stakeholders, regulators, industry, and the NHS. The discussion was extensive but here are some of the major points that grasped my attention and gave, I felt, most food for thought…
The regulators were up first and their perspective was delivered by Dr Enrica Alteri, Head of Research and Development at the European Medicines Agency (EMA). She was quick to emphasise how the EMA have been advocating increasing use of “real world” data for some time.
The most interesting example provided of this was regarding an extension of licensing granted to a medication called Soliris® (eculizumab), used for paroxysomal nocturnal haemoglobinuria, a life threatening condition where red blood cells break apart prematurely. The original trials approved the medicine for use in particular patient group with history of blood transfusions while a registry based study using “real world data” was subsequently used to successfully extend the license of the medication for use in patients with other levels of disease severity. The path that any new treatment takes from development to decisions on approval and reimbursement can take over 20 years. So with new medicines being developed at a faster pace, there is a need to make this process more efficient to allow patients to safely access treatments sooner. The EMA is accepting of this type of licensing extension using “real world” data, provided of course, like with any trial, the study is conducted in a rigorous, robust manner!
The industry perspective came from Andrew Roddan, Vice President & Global Head of Epidemiology at GlaxoSmithKline who highlighted another important role for this data in drug development through identifying disease patterns and targets. He also emphasised that use of “real world” data and undertaking randomised trials did not have to be mutually exclusive. Andrew Roddan used The Salford Lung Study as an exciting example where professionals from eight organisations across Greater Manchester involving over 2,800 patients, 80 GP practices and 130 pharmacies collaborated to investigate effectiveness of a new inhaler, Relvar Ellipta® for COPD. The study was securely hosted within the NHS network, which integrated the electronic medical records of consenting patients across all of their everyday interactions with their GPs, pharmacists and hospitals. This linked database system allowed monitoring of patients’ safety in close to real-time with minimal intrusion into their daily lives. This also meant recruitment of a large group of patients was possible – including types often excluded in traditional respiratory trials. Not everywhere has the technological integration that is in place in Salford, but this was an exciting vision for where medicines development can go!
The final perspective, fittingly came from Dr Indra Joshi who gave her viewpoint from the NHS frontline, as a practising acute medicine physician. Dr Indra Joshi was excited by the increasing volumes of patient data emerging and believed it could greatly contribute to various aspects of pharmacoepidemiology while also improving patient care. She was, however, keen to remind everyone that patients must be involved each step of the way to ensure this data continues to become available. She also believes that despite advances there was still some way to go before we achieve the healthcare record integration needed to conduct studies to the quality of the Salford Lung Study throughout the UK.
The lively discussion and presentations from the stakeholders gave interesting perspectives on the future of growing volumes of patient data and what it meant for research into medication. Despite some differences there was overall agreement on a few points. While trials remain central to medication licensing decisions and establishing efficacy of treatments early on, there are multiple opportunities for “real world” data to add to this evidence base to support the process. A clear understanding of the strengths and limitations of the available “real world” data was key to realising where they can add most value. And finally, how important it is to ensure early and frequent engagement between all stakeholders for success. Next time, it would be great to hear the patient perspective as well!
By Nathan M Davies, on 9 May 2017
In this post Nathan Davies talks about his recent oversees visit and the importance of developing international collaborations.
Working as a researcher in academia, one of the great benefits we have is the ability to work with others from across the globe and travel to visit them; sharing our ideas, results and enthusiasm for the work that we do. And this is exactly what I have done recently in Hong Kong and Australia. But importantly it is not just a benefit but I think a vital part of academia, learning from other leading academics and health care systems.
In 2011 I started working on a European Commission funded study whic
h had a whole host of leading academics in both dementia and palliative care not just from Europe but even from Australia. It was at this point I met Prof Wendy Moyle from Griffith University, Brisbane, Australia who invited me to visit her and the team at Griffith. I did so back in 2015 and have just returned from my second visit.
On the way to Australia I made a quick but exciting pit-stop at Hong Kong Polytechnic University, where I was hosted by Prof Wai Tong Chien at the School of Nursing. In addition to presenting the work I have been doing as part of my NIHR School of Primary Care Research Fellowship, I met with members of the team to understand how cultural variations affect the provision of end of life care, for example a hot topic was the use of feeding tubes in people with dementia. But, it was also fantastic to see how Hong Kong uses the latest technology to train their new generation of aged care nurses, with specifically designed teaching labs.
Following Hong Kong I was in Australia for just over four weeks – although, I must admit it wasn’t all work and I did take a bit of time to have a holiday out there too. For the first part of the trip I was in Sydney and I met with various academics from three different universities; University of New South Wales, University of Sydney, and University of Technology Sydney. I presented some of the exciting work that we have been doing here in the UK, including my work on developing an online support tool for family carers of people with dementia, as part of my SPCR Fellowship. In Sydney I was particularly keen to hear about the digital interventions and trials which are currently underway which focus on supporting families and people with dementia. At UNSW I met with Prof Henry Brodaty and Dr Megan Heffernan who went through their Maintain Your Brain project which is about developing a website for use by teaching people how to manage modifiable risk factors for dementia. We were able to have a lengthy discussion regarding the design of websites but also the challenges of eHealth interventions in academic research, learning some valuable lessons for my own eHealth research. I was also able to meet with Associate Prof Lee-Fay Low who discussed her trial of CareToons which is an online program on management of behaviour changes for carers of people with dementia. These were great learning opportunities to bring back to my own work here in the UK.
Moving up the coast to Brisbane, I spent a week with Prof Moyle and her team meeting and learning a lot from different academics and clinical staff, including Prof Elizabeth Beattie, the Director for the Dementia Collaborative Research Centre: Carers and Consumers. I also visited a long term care facility Jeta Gardens. This was a great opportunity to learn not just about aged care in Australia but also to learn about the architectural design of aged care facilities.
Prof Moyle has a large group of PhD students from across Australia and the rest of the world. I was asked to provide a qualitative methods workshop to get the students thinking about what qualitative research is and how it can work with and alongside quantitative research. This was a great chance to learn about the PhD students’ work and to understand how they could see qualitative methods working within their work, much of which was clinical trials.
I can definitely say this was a fantastic opportunity to have early on in my research career and I left having developed some fantastic connections and learnt a lot not only about research methods and topics, but also about how aged care works in different countries. As part of this trip I am also now supervising a new PhD student studying at Griffith University, conducting a qualitative study exploring end of life care for older adults in Ghana. I will remain in contact with Prof Moyle who is now also a mentor in my future work and new fellowship.
I 100% encourage everyone especially early career researchers to think about who they want to work with outside of the department, not just nationally but also internationally, and don’t be afraid to go for it!
On the 21st July Dr Lee-Fay Low will be visiting us from Sydney giving a talk for our seminar series about her work on CareToons and several other projects she has been involved in, please do come along.
By Nathan M Davies, on 24 April 2017
This month Jane Wilcock explains the North London Research Design Service.
Here at PCPH we are a Hub covering the North London region of the London Research Design Service (RDS). Several members of the department are involved as RDS advisors along with colleagues from across UCL.
We offer support to any researcher or health and social care professional who are preparing a grant application to a national peer reviewed funding stream, e.g. NIHR, MRC, Wellcome Trust, charity or even educational grants from industry.
As skilled NIHR RDS advisors we will provide a review which considers all aspects of your application from identifying a suitable funding stream, developing your research question, importance and rationale for the research, the research team composition, as well as the study design.
Using a case managed approach we then facilitate input from specialist RDS advisors in health economics, statistics, qualitative research and health psychology. These specialists can work with you to further develop aspects of your research project.
We even provide mock panel interviews for shortlisted candidates.
“It was very helpful to have an initial general discussion with the RDS team about the overall focus for the call”.
Patient and Public Involvement (PPI) is an integral component of the advice given to those approaching RDS London. Support is given on an individual level, we want to ensure that researchers adopt good PPI practice. NIHR RDS London has an Enabling Involvement Fund to facilitate involvement of patients and the public in designing and developing a research proposal. This fund, has the potential to be very meaningful for researchers and patients and the public and the feedback and success rate in achieving funding so far been excellent.
“We have found RDS feedback to be very useful after the rejection of this application first time round. We are particularly grateful for their suggestions on the ‘Health Economic’ and ‘Patient and Public Involvement’ aspects of our application. Overall the patient centred approach suggested by the RDS has certainly aided the development of our project and strengthened our final proposal”.
A new addition to our PPI support is our fast track lay-summary review service: researchers are benefiting from access to our dedicated network of public advisers, providing detailed input and advice on the lay summaries of their research proposals.
It is satisfying working for the NIHR RDS, feedback is extremely positive. Of the people who have come to RDS London for advice, 45% have submitted an application, and 50% of full submissions were funded.
“RDS London provided useful experience that helped us navigate our way through the application process. We found the service to be a very useful resource to help us challenge and improve many aspects of our study and grant application –and we are very grateful to them for the support”.
We always suggest approaching us as early as possible before submission – ideally three to six months (minimum four weeks) – so we can provide meaningful input into the research proposal: You can formally request individual support using our support request form
Or come to one of our drop in sessions on the first Tuesday of every month 11-13:00, see locations here
We look forward to working with you to support your funding applications.
Check out RDS website for more information and resources.
By Nathan M Davies, on 5 April 2017
In this post Tom Hartney, a PhD student at PCPH, talks about the Health Protection Research Unit and its recent Academy day.
The Health Protection Research Unit (HPRU) is a collaboration between universities, including University College London and Imperial College London, and Public Health England (PHE). This is part-funded by the National Institute of Health Research (NIHR) in order to promote high quality multi-disciplinary health research. It was set up in 2012, and supports the funding of PhD students to work on projects related to the HPRU’s research objectives.
These students make up the HPRU Academy – this isn’t a university in itself, but instead represents PhD students based across several universities, working in 10 research units each of which focuses on a different health issue (such as emerging infections or environmental hazards) or methodology (such as modelling or evaluation of interventions). This January saw the first HPRU Academy Retreat, which brought together students from across the country to present results from their work and hear about future plans and priorities for the Academy.
Myself and Josina Calliste from PCPH attended, both representing the HPRU in Blood Borne and Sexually Transmitted Infections. With 19 students giving oral presentations, as well as talks from academics and PHE staff, over two days, we knew this would be a packed schedule, but it gave us a chance to meet other students working on public health topics, to talk about our projects and find opportunities to work with them in future.
The format was divided into two types of talks, with those from students talking about their work making up the majority of the programme, and each day introduced and ending with talks from HPRU academics on the public health research landscape and aspects of methodology. The student presentations covered a huge breadth of healthcare topics, from the effects of traffic pollution to the risks from ticks in urban areas, with the research opportunities provided by genomic sequencing being a common theme. Given there was so much to cover, students somehow still managed to convey their enthusiasm for their chosen topic and explain their key results while sticking to time.
Professor Bernie Hannigan gave the PHE perspective on the Academy, emphasising its focus on applied research – identifying gaps in the evidence and addressing them with research outputs – as well as the need for researchers to think about how evidence influences public health policy & practice. Dr Satnam Sagoo, PHE’s Head of Education and Training, discussed routes to develop a career in public health, setting out the options available and ways to enhance transferable skills during the PhD process.
Karen Wilding from the University of Liverpool presented on research ethics and governance, a fundamental aspect of every research project. She described the variety of clinical research governance systems and frameworks, as well as the key considerations for ethics, and resources available for help and advice. Finally, Professor Jackie Cassell from Brighton and Sussex Medical School talked about getting patients and the public involved in research. She described ways to implement this at every stage of the lifespan of the doctorate, some of the challenges involved in healthcare research in general, and on transient and stigmatised conditions in particular. Imaginative approaches to public engagement were illustrated these using the example of an exhibition on scabies at the Eastbridge Hospital in Canterbury – originally a medieval hospital for pilgrims – set up in collaboration with the Textile Department of the University of Brighton.
To break things up the Retreat included interactive elements – firstly, in the form of an outbreak response exercise led by Dr Ruth Ruggles, Head of Public Health Training at PHE. Dr Ruggles used data from a real outbreak to put students in the role of public health response teams with crucial decisions to make as the outbreak developed. This culminated in a role played press conference, with volunteers fielding tricky questions from the audience on the media and public reaction to the outbreak. Also, students were able to vote online on their favourite talks and poster presentations, with prizes awarded by Professor Tom Solomon from the University of Liverpool on the final day.
Despite the challenge of packing so much into a two day schedule, the inaugural HPRU Academy retreat provided plenty of food for thought on how to use the expertise available within the Academy – here’s looking forward to next year’s event.
What’s new at PCPH about reproductive health: the women-health professional communication and risk awareness of combined hormonal contraceptives project
By Nathan M Davies, on 28 February 2017
In this post Paula Gomes Alves who has recently joined PCPH as a research associate working with Fiona Stevenson, discusses their European Medicines Agency funded project which is looking into how women and health professionals communicate about the risks of oral contraceptives.
In this international project, we will have the opportunity to gain a greater insight into what women know about the health risks of combined hormonal contraceptives and which information sources they use to learn about these risks. We will also study this topic from the perspective of health professionals, so that we can learn about how these two groups communicate regarding the use of oral contraceptives and their risks to health.
Our project will follow a mixed-methods approach, including semi-structured interviews and a web-survey. The interviews and the survey will be conducted with women and health professionals, to gain both perspectives. We will also recruit in several European countries simultaneously, which will allow us to explore this topic in a multicultural context.
What attracted me to this project?
As a woman in her mid-thirties, I have already been involved in many informal discussions with friends and family members about contraceptives, in particular, birth control pills. Some say that “all women put on a lot of weight when they take it”, whilst others advise that “no women should ever read the pill information leaflet, or they might withdraw from taking it for being so dangerous”.
Although these are examples drawn from my personal experience, I wonder whether they reflect the beliefs, attitudes and perceptions that most women have about oral contraceptives?? From the perspective of a researcher, it is also interesting to investigate where and how do woman form their knowledge about the birth control pill and to what extent that knowledge influences their contraceptive choices. For instance, a few years ago, and in another different population, I was part of a research project in which we found that the false beliefs that people hold about opioid substitution treatment (for instance, methadone) are likely to affect the outcome of that treatment. This means that medications may not work as expected if patients are misinformed about how they work and the benefits/risk that they involve.
Where are we now and what will be our next steps?
Our project is evolving at a fast pace. After being launched in October 2016, and following the approval of its final protocol by the European Medicines Agency, our empirical work began in January 2017 with my research appointment. We submitted our application for the UCL Research Ethics Committee in late January and we are now waiting for its outcome. We were fortunate to have informal discussions with Ana Gubijev and Julia Bailey throughout this process – so yes, I can confirm that in case of doubt, discussing your thoughts and learning from your colleagues’ previous experiences is definitely the way to go if you want to be successful.
In the meantime, we are starting a narrative review to explore the existing literature about our topic. Contacts with potential participating research sites, for recruitment purposes, will also be made shortly.
How does our project contribute to (a better) reproductive health?
I recently read on the United Nations Population Fund’s website that “to maintain one’s sexual and reproductive health, people need access to accurate information and the safe, effective, affordable and acceptable contraception method of their choice”. However, as a researcher and, most importantly, as a woman, I do not know to what extent this health recommendation is translated into practice. But hopefully, our project will be a step forward in this direction.
At the end of our project, we expect to have a better understanding of health communication, by revealing the perspectives and voices of health professionals and women about the use of combined hormonal contraceptives. Most importantly, we will listen to women/health professional’s personal and professional experiences, which hopefully will provide a more realistic account on what people know about pills and which type of information they are provided with before making any decision about their reproductive health.
In a nutshell, by sharing my experience so far and what we are going to do in this project, we trust that other people may become as excited and curious about this topic as we. And don’t worry – we will keep you posted on further developments!
By Nathan M Davies, on 23 February 2017
In this post Anasztazia Gubijev a research associate working on the Contraception Choices project with Dr Julia Bailey and Professor Judith Stephenson talks about her experiences on the contraception choices project which is split between PCPH and The Institute for Women’s Health.
The Contraception Choices project involves designing a digital intervention (a website) to help women choose a method of contraception that suits their needs. Many women are not aware of the wide range of contraceptive methods that are available to them and there are various misconceptions that deter women from using contraception. We are aiming to design a website that addresses some of the common misconceptions (such as thinking that hormones are harmful, that contraception causes infertility or that your body needs a break from contraception), and suggests contraceptive methods that may suit a woman’s preferences and lifestyle.
There are two phases in our project. Phase 1 involves doing a qualitative evaluation of women’s contraceptive knowledge and common misconceptions. Phase 2 is a pilot randomised controlled trial to evaluate effectiveness of our website. We are currently finishing up phase 1 and hoping to start phase 2 soon.
After a year and a half of working on this project there are a lot of things that I have learned, often by trial and error. We have made good progress on this project, but there have also been a few setbacks on the way. As an early careers researcher I wish I had known a few things before I started, so I will share these with you:
NHS ethics and R&D applications always take longer than you think they will.
Our project is a multi-site project because we recruit women from 5 different sites, so it made getting approval for recruitment quite tricky. It took us nearly 6 months to be given full approval to go ahead with recruitment at one of our project sites, which we definitely didn’t expect.
Make sure the sites you recruit from have the right population sample.
Our study population sample is women from the age of 15-30. One of our recruitment sites for phase 1 was the maternity unit at UCLH. After going through a lengthy and tedious process of getting NHS ethics and R&D approval we discovered that most women at UCLH were having babies in their late thirties or well into their forties! This meant that it was essential for us to change this maternity site so that we could recruit the population sample we needed for phase 2. Ideally you want to make sure the sites you recruit from have the right population sample from the start.
Food, drinks and incentives go a long way if you are struggling with recruitment.
We have been very lucky to have had a budget for offering the women we recruit incentives in the form of shopping vouchers. However, I still struggled with recruitment at some of our project sites, so we decided to also offer women drinks and pizza for taking part in our focus groups. Not only did this make recruitment a lot easier, offering women food before we started our focus groups was a nice ice breaker to get conversation flowing. If you don’t have the budget or ethics approval for offering incentives in the form of payment, then offering food and drinks is a budget friendly way of being able to offer something small in return for your participants giving up their time to help with your research.
And now onto what I enjoy most about being a research associate on this project:
I can honestly say that I have really enjoyed being a researcher on this project. Yes, there have been a few setbacks on the way, but the work that I have been involved in has been really interesting. One of the tasks that I really enjoyed was doing a literature review on women’s views of contraception on social media. I watched and analysed videos and comments posted on YouTube to gain a better understanding of contraceptive misconceptions. Social media is an underused resource for research, however we live in an increasingly digital world and it would be a shame to ignore all the voices and views we can learn from through social media.
I have also really enjoyed the qualitative field work, such as running focus groups and conducting individual interviews with women we have recruited. We have been actively seeking women’s views throughout this project, and their views have shaped the design and content of our website. I may have been dreaming of focus groups and interviews at some point because we have conducted so many, but we wouldn’t have been able to create our website without the valuable feedback we have received.
The Lancet: Offering a ‘stop smoking’ taster session and personalised disease risk doubles likelihood smokers will seek help to quit
By Nathan M Davies, on 25 January 2017
Dr Hazel Gilbert and her team have today had their start2quit trial findings published in The Lancet. Read the official press release from The Lancet below.
Smokers underestimate their personal risk of illness, and a key aim of the study was to try and persuade them that these risks are personally relevant.
Offering smokers a taster session at an NHS Stop Smoking Service and explaining their personal risk of developing smoking-related diseases doubles their likelihood of attending a stop smoking course, according to a study in The Lancet.
Smoking is the leading cause of preventable ill health worldwide. Although smoking rates in England have halved since 1974, this decrease has slowed since 2007, and the total cost for the National Health Service to treat smoking-related disease was estimated at £5.2 billion in 2005-06.
NHS Stop Smoking Services combine specialist support with prescribed medication, and are an effective way of helping people to stop smoking. However, attendance is low and only around one in 20 (less than 5%) smokers use the service each year.
In the trial, 4384 smokers from 18 service areas across England were either given a routine referral letter (1748 people) or a new personalised letter explaining their individual risk of smoking-related diseases and offering them a stop smoking taster session (2636 people).
The personalised letter included the person’s individual risk of serious illness if they continued to smoke, rating them as being at high, very high or extremely high risk compared to people who used to or never smoked. It also included information about how much their risk would reduce if they quit smoking immediately. The calculations were based on information from the person’s medical records. For example:
“Based on your smoking habits and your personal health, your current risk of developing a serious illness and suffering an early death is very high compared to a non-smoker or ex-smoker of your age… Even by smoking 12 cigarettes per day you are seriously increasing your risk of developing one of these major diseases and dying sooner than you need to… The good news is that if you quit now, at 45, you can halve your additional risk of contracting these diseases, or of suffering any other conditions such as a stroke and osteoporosis…”
The trial found that 17% (458) of those who received the personalised letter attended the first session of a Stop Smoking Service course within six months of receiving the letter, compared with 9% (158) of those who had the routine referral letter – meaning the personalised letter doubled the likelihood that a person would attend. It also doubled the likelihood of people completing the full six-week course (15% (382) vs 7% (123)).
Six months after receiving the letter, those who had the personalised letter were more than 1.5 times more likely to have gone without a cigarette for a week (9% compared with 5.5% ). Those who didn’t attend the Stop Smoking Service were least likely to have quit for a week (4.4% of those who received the personalised letter and 4.9% of those who had the routine letter).
Of those who took up the offer and attended the taster session, and also subsequently attended the Stop Smoking Service, 28.7% achieved 7-day abstinence.
“Smokers underestimate their own personal risk of illness, so a key aim in motivating them to try to quit is to persuade them that these risks are personally relevant. Individual risk information can also arouse fear or concern, which might prompt them to quit, particularly when combined with a reassuring message that doing so would be effective and that help is available,” said lead author Dr Hazel Gilbert, University College Medical School, UK. “The combination of hard-hitting “why quit” messages about the consequences of tobacco use, and supportive and positive “how to quit” messages, emphasising quitting resources, has been shown to be effective in some mass media campaigns. In our study, we found that this combination of personalised risk and easy access to a session doubled smokers’ likelihood of attending and increased their chances of quitting.” 
Overall smokers found the taster sessions helpful and interesting. Two-thirds of participants (66%) found the letter useful and very few found it antagonistic, depressing or anxiety-inducing, suggesting that using risk information while offering support was an appropriate way to target smokers.
The researchers estimate that the intervention would be a cost-effective use of NHS resources. While the intervention is more costly than the usual treatment in the short term, the authors say that it is likely to be cost-effective in the longer-term because of health-care cost savings and health benefits attributable to the reduced risk of smoking-related diseases.
Limitations of the study are that only 18 of 151 Stop Smoking Services in England participated, and that the proportion of potentially eligible smokers recruited was low. The average age of smokers involved in the trial was 49 years-old meaning the results may not be representative of a younger age group. More research is needed to confirm how this intervention would apply in practice.
Writing in a linked Comment, Dr K Michael Cummings, Medical University of South Carolina, USA, said: “Most people who have smoked for any significant length of time would like to stop smoking. Findings from prospective studies examining the natural history of efforts to stop smoking show that smokers often make frequent efforts to stop smoking or reduce their consumption, with little long-term success… Low attendance at Stop Smoking Services is a concern because evidence shows that these services are not only a highly cost-effective medical intervention producing higher quit rates than other approaches, but are also effective in reaching smokers from disadvantaged communities… Government authorities should resist any cost-cutting suggestions to decrease support for the Stop Smoking Services on the basis of the obvious and well documented benefits achieved when smokers are enrolled in these services.”
NOTES TO EDITORS
The study was funded by the National Institutes of Health Research Health Technology Assessment. It was conducted by scientists from UCL, the University of Cambridge, Smokefree Camden, and the University of York.
 Quote direct from author and cannot be found in the text of the Article.
 9% of all people who received the personalised letter and invitation to a taster session (236 of 2636 people; ie. Including people who did not attend the services) and 5.5% (97 of 1748 people) of all people who received the routine referral letter.
For interviews with author, Dr Hazel Gilbert, University College Medical School, Royal Free Campus, UK, please contact: E) email@example.com T) +44 (0) 1635 203484 / +44 (0) 788 4121630