A new CLAHRC publication offers valuable insight into the types of evidence used by decision-makers working in public health. In 2013, responsibility for public health services and planning shifted from the “health” boundary to local authority control. These services can range from health checks to open access sexual health.
CLAHRC researchers examined English local public health decision-making in a new review of what evidence is used and how by those planning, designing and commissioning services.
The review, published in a new paper in the Journal Implementation Science identifies three clear trends in evidence use
- the primacy of local evidence
- the important role of local experts in providing evidence and knowledge, and
- the high value placed on local evaluation evidence despite the varying methodological rigour.
Barriers to the use of research evidence included issues around access and availability of applicable research evidence, and indications that the use of evidence could be perceived as a bureaucratic process.
This is part of a wider project entitled Exploring decision-making processes and knowledge requirements in public health
Read the full paper
Kneale et al. Implementation Science (2017) 12:53
The use of evidence in English local public health decision-making: a systematic scoping review
A project under our mental health theme focuses on improving the care of Black African and Caribbean people with memory problems, which can be an early warning sign for dementia. We know that Black African and Caribbean elders develop dementia earlier, and seek help later than their white peers.
This delay can greatly impact access to care and support, and reduce the independence of dementia patients prematurely.
We have carried out extensive engagement work within this community – running focus groups and conducting interviews to find out the perceptions and beliefs that prevent people visiting their GP when memory problems first arise.
As well as disseminating our findings we have concentrated all the learning from the project into a new leaflet “Getting help for forgetfulness“.
We co-designed this leaflet with patients and the public and it aims to encourage health-seeking behaviour among elders encountering memory problems.
It answers questions about symptoms, sets out what help is available and why you should visit your GP, and provides useful information and contacts.
We trialled the leaflet in patients without a diagnosis of dementia in several GP practices and they liked it.
We can provide printed copies to the NHS, community and voluntary groups and charities – just contact us with your needs.
Email Moïse Roche to order copies of the leaflet – firstname.lastname@example.org
School-based interventions to increase health and wellbeing
The health and wellbeing of school children is a pressing concern in England, with a growing prevalence of obesity and diabetes in childhood. It is also widely recognised that a child’s emotional health and wellbeing influences their cognitive development and learning, as well as their physical and social health and mental wellbeing in adulthood.
These increased concerns, aligned with a better recognition of the emotional and mental health needs of children, led the Greater London Authority (GLA) to develop and co-ordinate a school based health programme to improve health and wellbeing for all pupils in London.
The result was the development of the GLA’s Healthy Schools London programme (HSL) launched in April 2013 and co-ordinated by the Greater London Authority (GLA). The programme encourages schools to adopt a whole school approach to combat the specific health and wellbeing needs of their pupils by developing their policies and procedures. HSL recognises and rewards the schools’ endeavours through a system of awards: Bronze, Silver, and Gold.
A CLAHRC North Thames project recently completed a two-year evaluation of the programme. The aim of the evaluation was to assess the contribution of the programme to improving educational attainment, and health and well-being, among schoolchildren in London. It was funded jointly by the GLA and the CLAHRC, and was conducted between 2014 and 2016 by Dr Harry Rutter and Dr Andrew Barnfield from the London School of Hygiene and Tropical Medicine (LSHTM).
We conducted literature reviews, focus groups in 20 schools, interviews with 6 directors of public health and directors of children’s services, focus groups with borough leads, interviews with the GLA core team and borough leads, and two assessment visits to special schools. We also conducted an online survey across all participating schools, with a total of over 450 responses.
Was HSL effective in its aims?
- Assessed the potential for the HSL programme to influence educational achievement, promote healthy lifestyle behaviours, and reduce health inequalities in London
- Investigated the extent to which becoming a Healthy School is associated with changes in school-level policies, and activities.
- Assessed the nature and level of engagement with the HSL programme by schools, including any differential uptake by socio-economic factors, and to understand the drivers and barriers to becoming a Healthy School
- Provided recommendations to inform the ongoing development of the HSL programme
The evaluation concluded that HSL provides a valuable mechanism to encourage change at school level. Among a suite of recommendations, the evaluation suggested that:
- HSL would be strengthened by encouraging schools to work more closely together.
- A mentoring programme could help to spread best practice between schools,
- There is scope for stronger links between school sand local communities.
- The implementation of a programme to enhance health and wellbeing provision in early year’s settings could provide an additional mechanism for health improvement, and promote school preparedness among the capital’s children.
The London Evening Standard features CLAHRC research in a story on the impact of air pollution on the capital’s younger asthma sufferers.
Our newly published research highlights poor asthma control and knowledge among London secondary school pupils and is referenced in the piece, which also includes contributions from CLAHRC researchers Professor Jonathan Grigg and Kate Harris.
The paper has campaigned extensively on the quality of London’s air, and the health impact on young and developing lungs. Poor asthma control, as highlighted in our work, can make things worse for those already living with respiratory conditions.
Professor Jonathan Grigg, CLAHRC child health theme and Principal Investigator on the study runs a severe asthma clinic at the Royal London hospital, said: “If you have asthma and it is not well-controlled, you are going to be more likely to suffer from these days of high pollution.If you have poor control, you run a risk of having a severe episode. The number of children who die is very small, but we are not really treating asthma as seriously as we should. In other countries, they say, ‘If you have got asthma, make sure you take your medication on the next few days’. That is what I would do. I would say, ‘There is an air pollution event. Make sure you take it.’ ”
Another researcher on the project Katherine Harris was quoted in the ES story, saying it was the first childhood asthma study carried out in schools: “We know from previous work about asthma in children that there were high levels of hospitalisation and asthma-related deaths were higher than Europe.One reason could be due to poor levels of asthma control in children. What we concluded is that there is a prevalence of poor control in children. There are also low levels of knowledge. A lot of children don’t understand what their medication does or how it was helping them.”