Claire Grant, first year PhD student at University College London’s Institute of Epidemiology and Health Care, provides tips for starting doctoral studies in unusual times.  

I found out that I’d been awarded an Economic and Social Research Council (ESRC) studentship to complete a PhD in Epidemiology and Public Health in March 2020. In the following months, the situation in the UK and around the world unfolded into what we now describe as “unprecedented” times, and the world has since changed. Completing a PhD in any time is known to be an overwhelming, challenging and sometimes stressful experience – but there are some unique challenges in the wake of COVID-19.

This blog post offers an insight into my personal experience of starting a PhD at UCL in 2020, with the aim of sharing some tips for navigating the specific challenges of home working and remote learning. It goes without saying that this list is by no means exhaustive, and that each student will face unique challenges and opportunities as they embark on their studies. This is simply a reflection of my past year and a message of hope to new starters.

1) Ask questions

Starting anything new can be daunting. Understanding how things work, making sense of departmental norms and university culture is difficult, especially when you are working from home. My advice is to ask questions from the start.

The reality is, there are many questions you will not know the answer to and a lot of these can be easily answered by friendly and knowledgeable staff/students at the university. Knowing who to ask for what will become clearer the more communication you have. Asking peers, supervisors and departmental staff for ‘best contacts’ to deal with concerns will help orientate you and your position in the university.

2) Create a good home working environment

If you are working from home, you will need the appropriate equipment and environment to do so. Funding bodies and even departmental funds might be able to support you to buy the software, equipment, and resources you need to work. I assumed that being a student meant that I wouldn’t be entitled to support – but this was not the case (see point 1 – ask questions).

From the beginning, try to create a working environment that is separate from your home life. This can be challenging, especially if you’re living in a place with limited space. If possible, try to work in a separate room to where you sleep, and if this is not possible, set-up a separate working station within the ro om. As tempting as it is to sit in bed all day, the environment you create to work in will impact on your motivation more than you might think.

That said, I will admit that in an effort to create my ‘ideal working from home environment’ earlier this year, I purchased a cheap computer desk from Facebook marketplace. The questionable instructions (see pictures) and my lack of craftsmanship mean that the unassembled planks of wood are still lying in my kitchen.

3) Network

A PhD is a solo venture, but nobody can complete it alone. In the absence of happen-chance meetings on campus, it is important to remember to opt-in to networking opportunities. Sign up to mailing lists on topics and methods that interest you. Email peers in your cohort and arrange Zoom coffee breaks. Download Twitter and follow accounts that relate to your work. Attend departmental seminars, and if you’re feeling brave, even ask questions! The more virtual rooms you enter – the more people and opportunities you will be exposed to.

Networking doesn’t just have to be PhD related. The Department of Epidemiology and Public Health did a great job at organising informal catch-up sessions for students over the past year, and the conversations were mainly structured around Netflix recommendations and lockdown recipes. The Students’ Union at UCL also have a wide range of clubs and societies for postgraduate students to get involved with. Building a social network of likeminded people with similar interests will help you find your place.

4) Set boundaries

               Your working day

Structure a day that suits your project and working style. Nobody is productive all day, yet we can feel guilty for taking breaks, particularly when working from home. I’ve learnt that a long lunchtime walk listening to a podcast (usually the Guardian’s Today in Focus) makes me feel brighter and more ready for the afternoon than if I eat lunch slumped over my laptop. If you’re required to do a lot of reading on your computer – make an active effort to schedule time away from your screen throughout the day. Your eyes and mind will thank you for the rest.

Being online makes us more accessible than ever. This is exciting as we can attend more events, seminars, and trainings than ever before. However, be realistic and thoughtful about how much you can do. For example, don’t try to complete other work tasks while attending online seminars or training. You wouldn’t do that in person. Allow yourself the same time and energy you would offline. This is much easier said than done.

Your personal life

Set boundaries with ‘PhD life’ and ‘regular life’ as you would any other job. Your research will be more important to you than it is to most people, and it might feel all consuming. It’s also likely that you’ve chosen a topic of particular interest to you, making it difficult to switch off. There’s always more work to do, more papers to read and more ideas to talk through. It can feel as though you should be doing something all the time. At the beginning, I found this difficult to manage.

I also found it strange not having the same sense of completing a task as I did when I submitted course work in previous taught courses. At undergraduate level, I remember the feeling of relief after sitting exams, knowing I’d be enjoying some well-deserved time off before being informed of a definitive result – ‘pass’ or ‘fail’. From my experience, this is not the case in a PhD. Feedback from supervisors usually leads to more work. Good project management will account for the much-needed breaks in this academic marathon. When you do take time off, try to detach completely. Let your supervisors know you won’t be available, turn off email notifications on your phone and wait until you return to reply to messages.

Importantly, life continues as you study. Make sure to carve out room for friends and family. Make time for hobbies and interests. A PhD is only one part of your identity.

5) Trust your abilities

You are probably already doing better than you’re giving yourself credit for. It takes time to get used to this new way of working and the beginning of such a mammoth task can feel daunting. Remember that every project is different, so try not to spend time comparing your progress to your peers. Your supervisors will help guide you and there are various UCL check-ins along the way to make sure you’re on track (such as Thesis Committee reviews).

One of the most common anxieties among new doctoral students is ‘imposter syndrome’ – the overwhelming feeling that you’re a fraud. Take note: you have started on a training programme and that is merited on the basis that you have the abilities required to succeed. Trust the process and know that everyone else is probably thinking the same about themselves.

6) Be flexible with your project

Due to COVID-19 restrictions, your project might have to be adapted or changed completely. You are not alone if this is the case. Over the past year many students have faced dilemmas with methodologies and research topics that are not easily modifiable to the world of online learning. Be open to potential alternatives and listen to the experiences of others in your field. There are many learnings from the past year which will be useful to consider when thinking of alternative approaches to your research.

7) Be kind

To yourself, to your peers, and to staff.

Students and staff at UCL have worked tirelessly to adapt to new ways of learning over the past 18-months. It has been a tough time for everyone, and we have all been impacted in some way. Try to acknowledge this and be compassionate to yourself and others. Remember that staff are also facing some of the same challenges as students and will appreciate your understanding.

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Enjoy the journey & best of luck with your studies!

In this months post Dr Sadie Lawes-Wickwar, a Health Psychologist and Lecturer in the department teamed up with other health researchers, health psychologists, public health practitioners, and public contributors across the UK during the COVID-19 pandemic to find out what we can learn about getting the message right to support the public to prevent the  spread of Covid-19.

In the event of an outbreak of an infectious disease, the population is required to make often rapid changes to their behaviour to reduce the spread. Public health campaigns can support population-level behaviour change, but it is crucial that the public receives consistent, clear information, so they understand what it is they need to do new (e.g. when using fa

ce coverings). However, public information during a pandemic can be conflicting, change frequently, or use language that the general population may find it hard to understand. We need to think

carefully about the messages that are used to instruct the public to perform behaviours that are key to reducing the spread of a virus.

After the outbreak of Covid-19 in the UK last year, a collaborative group of health psychologists, behavioural scientists, public health practitioners, and members of the public formed the Health Psychology Exchange to support the public health response to the pandemic. A group of Health Psychology Exchange members set about reviewing existing evidence to inform recommendations for local and national public health teams in developing health campaigns. Our aim was to identify what characterises effective public health messages for managing risk and preventing infectious disease, and what influences people’s responses to such messages.

Our first review of public health messaging found that, to influence behaviour effectively at the population level, messages need to be acceptable to the populations they are targeting, be delivered by credible and trustworthy sources, and in language target populations can understand, to increase understanding and threat perceptions [1]. Specifically, in the context of encouraging vaccine uptake, evidence tells us that providing information about virus risks, vaccination safety, vaccine clinics, and addressing misunderstandings about vaccines, can support uptake at hospitals (e.g. among hospital staff) or within local communities. We can also support understanding and beliefs about vaccines by framing messages in a particular way, such as emphasising the reduction of risks and the benefits to society from being vaccinated [2].

Our work has highlighted gaps in research and the development of previous public health messages, including the valuable input of the public in the design, delivery, dissemination and evaluation of health messages [2]. One of our key recommendations has been the involvement of local communities in all aspects of the messaging process, which is also in line with recommendations from the World Health Organisation (WHO)[3]. We also need more high-quality research to demonstrate the effects of messaging interventions on the uptake of recommended behaviours. Surprisingly few studies to date have evaluated messages adequately to be able to conclude the definitive impact of campaigns on population-level behaviour, such as vaccine uptake.

Our recommendations have informed two British Psychological Society (BPS) Behavioural Science Disease Prevention Taskforce guidance documents to date, one to support public health teams to deliver effective public health campaigns, and another to optimise vaccination uptake during Covid-19. Using behavioural science can boost public health campaigns during the Covid-19 pandemic, and I hope to see more collaborations between health psychologists and public health teams in the coming months as we look to a brighter future.

1. Ghio, D., et al., What Influences People’s Responses To Public Health Messages For Managing Risks And Preventing Disease During Public Health Crises? A Rapid Review Of The Evidence And Recommendations. PsyArXiv Preprints, 2020.
2. Lawes-Wickwar, S., et al., A rapid systematic review of public responses to health messages encouraging vaccination against infectious diseases in a pandemic or epidemic. Vaccines, 2021. 9(2): p. 72.
3. WHO, Communicating risk in public health emergencies: a WHO guideline for emergency risk communication (ERC) policy and practice. 2017: World Health Organization.

Authors: Chantal Edge, Al Story, Andrew Hayward

As the UK continues to wage war against COVID-19 the news is awash with stories speculating when vaccines and diagnostics will become available, and when life can return to ‘normal’ for the general population. Yet amongst these reports we hear very little about society’s most marginalised groups. What has the UK been doing to protect and support the most vulnerable – homeless, prisoners, drug users, and what problems do they foresee for these groups in the near future? We asked the UCL Collaborative Centre for Inclusion Health (CCIH) what they’ve been up to in support of pandemic response.

What is the UCL Collaborative Centre for Inclusion Health?

The UCL Collaborative Centre for Inclusion Health (CCIH) was set up by a multidisciplinary team of researchers, experts with lived experience and frontline professionals who are dedicated to reducing health inequity amongst socially excluded groups. Inclusion Health is a service, research, and policy agenda that aims to prevent and redress health and social inequities among the most vulnerable and excluded populations such as homeless, prisoners and drug users. The Centre is co-directed by UCL’s Professor Andrew Hayward and Dr Alistair Story, Clinical lead of the London Find&Treat Service.

COVID-19 and socially excluded groups

Homeless accommodation

At CCIH we were very aware early on in the outbreak that excluded groups would be highly vulnerable. There was a well-timed conference – 2020: A Decade for Inclusion – on homeless and inclusion health justbefore the UK went into lockdown, which we used to raise awareness across the homeless sector about what needed to be done to prevent outbreaks, particularly within overcrowded hostels, night shelters and day centres. We were able to secure a lot of support from different agencies, for example, the Ministry of Housing, Communities and Local Government set up an initiative to place those living on the streets in hotels and to close down the large hostels in which people share dormitory-style accommodation. This was achieved incredibly rapidly, over the course of about a week. We’ve also done a lot of work to raise awareness in settings which remain vulnerable to outbreaks, including improving social distancing by encouraging closure of communal areas, and strict rules about social distancing measures. We’ve been able to bring in drug treatment services and addiction services for people with very challenging addiction issues. A pan-London methadone-prescribing service has been established so that homeless people can get access to substitution treatment for addictions much more easily than they would have done on the streets. This video tells the story about one such homeless hotel in Shrewsbury.

We’ve also established what we’re calling a COVID-CARE hotel in East London for homeless people who are diagnosed as having the disease. They are referred from the streets, hotels, hostels, Secondary Care and A&E departments across the capital to be clinically monitored in a safe infection control environment. The accommodation is provided by GLA, while the medical staff are provided by the UCLH Find&Treat team working with Médicins Sans Frontières (MSF) – this is the first time MSF have deployed in the UK, a video about this work can be found here.

Another aspect of our work has been to establish a surveillance system with UCLH Find & Treat and led by Miriam Bullock, through which we survey hostels for COVID-19 control and social distancing measures, suspected COVID-19 cases and related hospitalisations or deaths. This surveillance system triggers telephone triage and advice from the Find&Treat team who are outreaching same day testing to homeless people across the city with three outreach teams.

Prisons

Public Health England and the prison service have published guidance on their management strategies for COVID-19 in prisons and have as yet managed to avoid the ‘explosive outbreaks’ predicted at the start of the pandemic. Yet healthcare delivery in prisons remains challenging now that inmates are confined to their cells for up to 23 hours a day and many staff are off sick or isolating with COVID-19 symptoms.

One of the CCIH PhD fellows, Chantal Edge, has paused her work on local prison telemedicine implementation in Surrey, to go to the central NHS England Health and Justice team to lead on the rapid deployment of prison telemedicine nationally. Telemedicine will be scaled up across 135 secure sites in England including prisons, immigration removal centres and secure children’s homes. Approvals have also been secured from the prison service to deploy NHS 4G enabled tablets in prisons to support the telemedicine work, a ground-breaking change seeing as mobile devices are traditionally strictly prohibited in prison settings.  Telemedicine will remain in prisons after the pandemic and support improved access and quality of healthcare services for prisoners, so in this way the pandemic has driven forward innovation.

Migrant health

Ines Campos Matos, who has a joint appointment between PHE and CCIH has led PHE’s investigation of the high levels of COVID in BAME groups showing how poverty is compounding this inequality.

Advocacy in the media

We have also been working closely with the press to advocate for inclusion health groups including articles on prisons, and homeless hotels and GP surgeries.

Looking to the future

As COVID-19 decreases in the general population following lockdown, we’re moving to a stage of continued vigilance. This is going to be really important because there are likely to be more transmissions when the lockdown is eased. So far, we have avoided large outbreaks of COVID-19 in the homeless community and in prisons. In other countries such as the USA up to half of people in big, night-shelter-type hostels are being infected, our screening finds only about 3 or 4% of homeless people have been infected. Prisons in countries such as Italy and the USA have also seen huge outbreaks, whereas cases in England remain controlled.

There is a concern that people will begin to think the outbreak is over and will start to relax both the social distancing across society but also in the homeless hostels. As the numbers decrease, there will be pressure to close down the COVID-CARE facility and the hotels. Prisons will likely need to keep measures in place to isolate the vulnerable and enforce social distancing for many months, the mental health consequences of this enforced isolation remain as yet unknown.

We’re planning to launch a major health needs assessment (HNA) led by Dr Binta Sultan, to systematically identify the health needs of people within the hotels. We’ll have 38 clinicians doing telephone interviews, and have established referral pathways into mental health, sexual health and drug and alcohol services. We’ll be screening everybody for hepatitis C, then starting people on treatment with the aim of completion while they’re at the hotel. This could have a major impact on the transmission of hepatitis C in the homeless population. We’re hoping to do the same thing for latent TB infection. The HNA will also identify people who need shielding, therefore requiring their own self-contained accommodation. This will move people up the priority list for permanent housing and will help with advocating for their needs.

During this pandemic, many of us are having to change what we do and prioritise everything towards this response. It’s too serious and awful to feel any excitement about the research: it feels more like a war. We’re trying to use every resource and opportunity that we have – and every waking hour – to work out what we can do to help in the fight against COVID-19. It is rewarding to feel that you’re able to make a difference, but it’s heart-breaking to see how terrible it has become.

Chantal Edge is an NIHR Clinical Doctoral Research Fellow and Specialty Registrar in Public Health, researching the use of telemedicine for hospital appointments in prison. Dr Al Story leads the Find&Treat Outreach Service based at UCLH and is Co-Director of the UCL Collaborative Centre for Inclusion Health. Professor Andrew Hayward is the Director of the UCL Institute of Epidemiology and Health Care and Co-Director of the UCL Collaborative Centre for Inclusion Health.