CaHRU’s research impact has now been captured in a series of stunning infographics created by student intern Beth Warman and accessed via our page ‘How we are making a difference‘. Beth, after studying a number of impact case studies produced by Professor Niro Siriwardena and the team describing the effect of CaHRU’s research on “change or benefit to the economy, society, culture, public policy or services, health, the environment or quality of life, beyond academia”, developed this evidence into the infographics. These capture how CaHRU’s research is making a difference in a visual form, accessible to the general public as well as the scientific community in a number of topics including: sleep and insomnia, prehospital outcome measures, flu vaccination uptake, large-scale healthcare quality improvement programmes, new prehospital ambulance pathways, and reliable, valid and fair licensing exams for doctors.
Beth, a student in psychology recently graduated and is going on to study for her PhD entitled ‘Character strengths, mindfulness and pro-environmental behaviours: how awareness of one’s strengths affects engagement in sustainability’. She will be looking at mindfulness and the positive psychological traits most strongly associated with being eco-friendly.
She is also due to start as a research assistant, working with Dr Roger Bretherton on a project called ‘The character course: design, dissemination and evaluation of a church-based small group programme for character development’. This will involve creating a church-based multimedia course to encourage people’s use of certain personal strengths (in this case, learning, hope, love, forgiveness, gratitude, humour, persistence and curiosity). We wish her the best in her future endeavours and thank her for the work she has done with CaHRU.
By Prof Niro Siriwardena
The latest edition of the CaHRU Newsletter (Spring 2018) was published in July 2018. The newsletter presents the work of the research centre over the previous three months and includes articles from the CaHRU blog covering publications, conferences and funding. The newsletter is written by members of the CaHRU team and produced by Sue Bowler, CaHRU administrator.
[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2018/07/CaHRU-Newsletter-Spring-2018.pdf” width=”660″]Multi-morbidity, goal-oriented care, the community and equity[/su_document]
The latest in the CAHRU/LIH research methods seminars was given by Dr Paul Leighton on 24 October 2017 on the subject of ‘Realist evaluation in health services research’. Paul Leighton is a senior research fellow at the University of Nottingham, deputy director of the NIHR Research Design Service for the East Midlands and an expert in health services research, qualitative methods and process evaluation. The presentation covered the philosophy of critical realism and how this related to realist methods, described a practical example of a realist evaluation and finished with concluding thoughts and comment on the method.
Critical realism was described as a philosophical approach developed by Roy Bhaskar that adopts an ontological position of being in which: the actual world is independent of the human mind and the mind is capable of perceiving the empirical world, but unable to directly perceive unseen forces in the real world. Gravity and social class were cited as examples of unseen forces in the real world.
“Realist” or “realistic evaluation” was described as a form of primary research methodology derived from critical realist philosophy, by Ray Pawson and Nick Tilley, which acknowledges the potential for unseen forces and accepts that interventions will not always work or work in the same way because of local contextual factors will influence how an intervention works and the impact it has. Realistic evaluation was summed up as “What works, for whom, in what circumstances?”
The process of realistic evaluation involves developing a programme theory, which theorises what should happen and how it might happen. This so-called mid-range theory is tested using qualitative and/or quantitative methods to explore the context, mechanisms (often hidden) and outcomes (C+M=O), revised iteratively and tested again, leading to a refined mid-range theory.
This was illustrated using the Falls in Care Homes (FinCH) study and summarised by concluding that interventions will not work all the time in all settings, but will work differently in different contexts.
[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2017/11/lincoln-realist-oct17.pdf” responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]
A. N. Siriwardena
Professor Niro Siriwardena led the recent Lincoln Institute for Health (LIH) research development seminar entitled, ‘Things that go bump in the night’: exploring the problem of tinnitus and sleep.
This seminar brought together researchers at the University of Lincoln with a common interest in sleep research to explore interdisciplinary research into insomnia. Several research centres, groups and experts from a number of disciplines are members of the LIH and each have a record of funded studies investigating sleep and insomnia in a variety of conditions. The work builds on the University of Lincoln’s 4* impact case study on insomnia from REF2014.
The seminar focused on how to combine different research approaches to explore how the team might improve the management of insomnia linked to tinnitus. This began with presentations from each participant on their experience and current work in this field:
- Niro, who is professor of primary and prehospital care, began by describing CaHRU’s translational research focus, seeking to improve health care processes and outcomes. A key area has been in primary care for people with insomnia which includes systematic reviews, qualitative studies and the development and evaluation of psychological interventions for insomnia.
- Prof Alina Rodriguez, professor in psychology, presented her approach combining methodological strategies including psychological, epidemiological, and molecular to understand the development of behavioural, cognitive, emotional or physical problems across the lifespan, seeking to identify factors amenable to change that can be translated into public health policy or interventions.
- Prof Graham Law is professor in medical statistics and has worked extensively in epidemiology and medical statistics, focussing on sleep and the consequences of good and poor sleep on metabolic and cardiovascular health.
- Dr Simon Durrant, senior lecturer in psychology, initially trained as a musician (counter tenor) before developing his expertise in the cognitive neuroscience of sleep. He leads the sleep lab at Lincoln using techniques such as polysomnography, EEG and actigraphy to understand the physiological basis of sleep and its disorders.
The group then discussed, together and with other academics present, the problem of tinnitus (noise generated internally in the body) which affects around 10% of adults and is associated with insomnia in over three-quarters of those with the condition, particularly causing difficulty getting off to sleep (so-called sleep latency). There followed an exploration of potential ways to investigate the problem of insomnia linked to tinnitus (e.g. using evidence synthesis, analysis of large datasets, and qualitative designs) together with the potential for intervention develop (e.g. using CBT for insomnia together with CBT for tinnitus) and evaluation of these.
The seminar ended with suggestions and proposals for how to take this work forward.
[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2017/11/Tinnitus_insomnia_finalrevised.pdf” responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]
A. N. Siriwardena
Professor Graham Law, who recently joined the university and CaHRU as Professor in Medical Statitics, delivered the latest of CaHRU/LIH’s Implementation Science and Research Methods seminar series – on Causal Models and the use of Directed Acyclic Graphs. Professor Law set out the epidemiological context for the seminar. Epidemiology is the study of disease. The scientific methods used within epidemiology aim to discover the determinants of disease. The state of having the disease is the outcome. Causal models seek to examine the factors that contribute to this outcome. Causation is not usually dealt with by statistics. Instead, statistics concerns itself more with associations and relationships between variables.
A Directed Acyclic Graph (DAG) comprises variables (nodes) and arrows between nodes (directed edges) such that the graph is acyclic, i.e., it not being possible to start at any node, follow the directed edges in the arrowhead direction, and end up back at the same node. In seeking to represent causation, DAGs typically display a series of factors, mediators and outcomes. Having explained this, Graham split the audience into two groups and challenged them to create their own DAGs to display all the possible factors involved in whether sunlight causes lymphoma. The interactive nature of the seminar engaged the audience. The fun nature of the concluding task made a potentially complicated subject easier for the audience to understand and apply.
By Viet-Hai Phung