Impact case study database

Northumbria’s research extended the validity, reliability, versatility, and positive impact of the LDSQ and CAIDS-Q screening tools, led to policy and practice change across a wide range of services in the UK and internationally, and increased use of the CAIDS-Q and LDSQ. This has had a direct impact on individuals living with intellectual disabilities as diagnosis has enabled them to access support and improve wellbeing and life chances.

4.1 Improved support for people living with intellectual disabilities and their carers

The LDSQ and CAIDS-Q have helped identify vulnerable people who were not previously known to have an intellectual disability, enabling them to receive appropriate support and adjustments. Recent research indicates that over 60% of staff and service users across a variety of settings felt that the CAIDS-Q or LDSQ had helped identify the person’s support needs more quickly, resulted in increased support, and improved the person’s wellbeing and life chances [ E1, p5].

The CAIDS-Q is now available online on the UK-based Learning Disability Matters for Families WebApp [ E2] (a toolkit developed by the NHS North East & Cumbria Learning Disability Network) and provides resources to families and professionals in relation to intellectual disability. Dr Karen Horridge, Consultant Paediatrician (Disability), notes: ‘The inclusion of the CAIDS-Q has allowed…immediate feedback on whether the child/young person is likely to have a learning disability or not. The person is then signposted to sources of support, if required. There is no equivalent evidence-based measure available elsewhere’ [ E3]. Over 500 people used the CAIDS-Q in just the first few weeks after its launch in 2020 [ E3]. Dr Horridge highlights that:

‘The CAIDS-Q helps to ensure that more children receive a timely diagnosis, and that those children who are most likely to have a learning disability received further assessment. As well as being freely available to those accessing the WebApp, the CAIDS-Q is used as part of routine practice by many paediatricians and other professionals’ [ E3].

4.2 Incorporation of the LDSQ and CAIDS-Q into policy and practice

The LDSQ and CAIDS-Q screening tools have been recommended by a range of high-profile bodies in the UK, including the Royal College of Nursing, HM Inspectorate of Probation and HM Inspectorate of Prisons, and the Royal College of Psychiatry [ E1, p4-5]. The screening tools are now embedded in service pathways across the UK. Health Education England [ E4, p7] and at least 130 NHS health boards and council areas in the UK use the tools to support referrals. Internationally, the tools are used in New Zealand, Norway, the USA, and Australia (e.g., the Australian Senate Community Affairs Reference Committee and the Cultural and Indigenous Research Centre Australia report using the CAIDS-Q to facilitate referral to clinical services for assessment) [ E1, p6].

The screening tools have been found to be of particular use in the criminal justice system. Since 2015, at least 22 prisons across the UK have been using the LDSQ to identify prisoners with a possible intellectual disability [ E5], including HMP Brinsford [ E1, p5] and HMP Aylesbury [ E6, p16]. The LDSQ is also used by the police and probation services in Thames Valley, Gloucestershire, and Birmingham [ E5]. Jenny Talbot from the Prison Reform Trust states:

‘The LDSQ is quick, accurate and easy to use (and does not need the person using it to have a professional training), which means that it has been integrated into settings where it would otherwise be difficult to screen for learning disability […identifying learning disabilities at an early stage of the criminal justice system] enables those who might have a learning disability, and who are therefore at increased vulnerability and risk, to be identified in a timely way and receive additional support and assessment as required, for example, identifying the need for an Appropriate Adult, provision of tailored interventions, and accessible information and resources’ [ E5].

Further to this, the LDSQ is routinely used in the service pathways of NHS Trusts and other organisations that provide health and social care to criminal justice services, and those who have been victims of crime, in Yorkshire and Humber, Ashton, Leigh and Wigan Community Healthcare NHS Trust, Cumbria Partnership NHS Foundation Trust, Birmingham Community Healthcare, Wigan Council, Surrey Autism Partnership Board, Manchester University NHS Foundation Trust, and Oxleas NHS Foundation Trust [ E5].

Criminal justice services using the LDSQ report several benefits of this tool over others, including quick, reliable identification of people with an intellectual disability, and more detailed – fewer inappropriate – referrals [ E7, p22]. The scale at which individuals are being assessed and referred using the LDSQ is exemplified by data from Birmingham NHS Healthcare’s Community Forensic Team, who screened 6,683 people using the LDSQ between 2015-2018, of whom 2,963 individuals were referred for further support [ E7, p18].

The LDSQ screening tool is also used to support victims of crime – most notably within Saint Mary’s Sexual Assault Referral Centre (SARC), a service in Manchester, UK, for victims of rape or sexual assault. The SARC routinely uses the LDSQ to assess victims for likely intellectual disability and consequently ensure they receive appropriate support to meet their needs. This is a particularly important tool for this service as pilot studies using the LDSQ revealed that on average 1 in 12 individuals using the service have an intellectual disability and require specialist support [ E8, p2]. A press release from SARC in 2020 highlights that the data gained from the LDSQ is making the organisation ‘start to think about how services should be tailored for people with learning difficulties. For instance, the LDSQ score can be routinely shared with the police who can arrange additional support…such as representatives who can advocate on their behalf’ [ E8, p2] .

This impact is not limited to the UK. The SARC’s work with the LDSQ is being replicated by counterpart organisations in Australia [ E8, p3]. Further, youth justice programmes in the state of New South Wales (NSW) in Australia are using the CAIDS-Q screening tool to assess all those who participate in Youth on Track (YoT) – an early intervention programme aimed at reducing offending rates among young people, funded by the Department of Communities and Justice – totalling around 350 individuals a year [ E9]. Mandy Loundar, manager at Youth Justice NSW, states that the benefits of using the CAIDS-Q are that it is ‘accessible and easy to use with the young people with complex needs by YoT caseworkers’ [ E9]. Loundar is also clear that CAIDS-Q leads to more constructive relationships with service users as it reminds caseworkers that young people ‘may have a disability instead of their behaviour being simply seen as “bad” behaviour’ [ E9]. The CAIDS-Q is also being used in other areas of Australia, such as Victoria [ E9]. The tool has been recommended by the Victorian Auditor-General’s Office [ E1, p4-5] and was incorporated into Victoria’s Youth Justice Strategic Plan 2020-2030 [ E10, p38].

McKenzie’s research on the factors affecting the diagnosis of ASD has led to impact in relation to 1) policy, strategy, and planning, 2) practice, and 3) outcomes regarding waiting times.

4.1 Informed national policy, strategy, and planning

As a result of McKenzie’s research expertise, she was part of the 2016 Scottish Intercollegiate Guidelines Network (SIGN) guidance development group, to update the existing national clinical guidelines and checklist for the ‘Assessment, diagnosis and interventions for ASD’ [ E1]. SIGN guidelines facilitate the implementation of effective measures to improve the standards of healthcare in ASD services across Scotland. The resulting SIGN 145 guidance document, published in 2016, now incorporates guidance that applies to adults and older people as there was a ‘need for a guideline which reflects the whole age range’ [ E1, p1]. It now recommends, in line with the research, the need to include ‘all relevant information regarding any concerns, the individual’s current situation and details of any professionals involved’ and the development of protocols to ‘ gather as much relevant information preassessment as possible, in order to reduce assessment duration’ [ E1, p44].

McKenzie’s research also informed the development of NHS Education for Scotland Autism Training Framework: Optimising Outcomes Training Plan [ E2], which sets the standards for all autism-related clinical training in Scotland’s health services – as part of professional training or as CPD – and provides a framework to enable service leads and individual practitioners to establish the training needs of their staff. The plan recognises that acquiring more information for a person prior to their diagnostic assessment can be key to reducing the wait for diagnosis, as highlighted in the research [ R2], and highlights the need for training clinical staff to facilitate better identification, screening, assessment, and diagnosis of ASD, particularly within adult services [ E2, p33].

4.2 Improved understanding of, and practices involved in, ASD referral and assessment

McKenzie’s research (and subsequent clinical recommendations listed above) informed the action plans of health and social care partnerships (HSCPs) in Scotland, including: The Autism Strategy in Fife (2014-2024) [ E3], the East Lothian Strategy (2015) [ E4], and the Perth and Kinross Autism Strategy (2016-2021) [ E5]; areas serving a combined population of approximately 632,000. Collaboration between these HSCPs and the AAA: ‘worked to upskill the workforce and improve processes to reduce waits and evidence best practice’ for adult services in Fife [ E3, p9], led to quicker referral to diagnosis times in East Lothian child services [ E4, p6], and in Perth and Kinross ‘all diagnostic teams have been made aware of…up to date research on reducing waiting times’ [ E5, p8].

The AAA Autism Knowledge Hub was created to enable Scottish autism diagnostic services and clinicians (e.g. from Lothian, Fife, Ayrshire and Arran, Borders, Highland, and Glasgow) to share best practice and collate documentation, protocols, action plans and recommendations from the research, and subsequent practice, in one place. The Scottish Government identified the Knowledge Hub as a key resource to ‘facilitate improvement for autism assessment and diagnosis for all age groups and genders’ [ E6, p10].

4.3 Reduced wait for ASD assessment

The research clarified the causes and extent of delays in ASD diagnosis in Scotland and developed a strategy to improve the ASD diagnostic pathway. Once implemented, these strategies introduced more efficient working and communication into services, improving the effectiveness of care pathways in both child and adult services [ E7]. Mentoring and support were also made available to clinicians involved in diagnosing ASD [ E8]. Results from the implementation of this strategy in 11 adult diagnostic services across Scotland concluded that waiting times reduced by an average of 29.9 days (4.3 weeks) [ E8; E9, p16].

Andy Fleming, Autism Spectrum Disorder Nurse Practitioner, NHS Lanarkshire (population of 650,000), acknowledged the benefits of the research and intervention in this area of Scotland, noting an average reduction in wait times of 36 days. He stated that this strategy led Lanarkshire’s ASD diagnostic pathway to become ‘ more focused, effective, and efficient for both staff and patients’ by: 1) introducing a clear assessment pathway focused on information gathering and reporting back to patients (to adhere to good practice guidance specified by SIGN and NICE), 2) timely provision of information to potential referrers to ensure the appropriateness of referrals, 3) introducing systems to pre-empt, and ultimately prevent, non-attendance at appointments (e.g. sending reminders), and 4) working to improve information sharing between team members [ E10]. Fleming identified key benefits of improved post-diagnostic support and the opportunity to share good practice with, and learn from, the experiences of other services throughout Scotland:

‘The timely diagnosis of autism and reduced waiting times for assessment and diagnosis…allow those who are diagnosed to receive additional support and resources that they may require and they can be signposted to organisations and support networks that may be of benefit to them, which will help to improve the outcomes for them. The sooner that diagnosis takes place the sooner that such support can be arranged. This might include specialist input from staff to provide interventions to help with social interaction, managing anxiety, and behaviours that challenge, such as aggression. As long waiting times can lead to dissatisfaction with and loss of confidence in services, reduced waits can counter this’ [ E10, p2].

This research has influenced UK and European organisations, enabling them to improve approaches to cybersecurity through innovative training initiatives, policies, and practice.

4.1 Reducing vulnerability to cyberattacks through improved training

Following a presentation of Northumbria research to the national Research Institute in the Science of Cybersecurity (RISCS) in 2018, Professor Pam Briggs was approached by digital training company ThinkCyber to share research findings, particularly around how PMT can be used to design prompts for appropriate behaviour [ R1- R3]. This work influenced the company’s approach to training: ‘little and often, easy to access, simple and actionable, context driven/real-time’ [ E1, p2]. The company blogged the influence of this work on its thinking [ E1, p5] and incorporated Northumbria’s findings into its digital cyber awareness training product Redflags [ E1, p2]. Redflags won ‘Best Professional Training or Certification Programme’ at the 2020 SC Awards Europe (cybersecurity magazine) [ E1, p7] and the company has since been added to the CyberTech100 list of the best global cybersecurity companies . ThinkCyber also asked Briggs to collaborate in developing other new products, submitting a joint InnovateUK grant ‘Reimagining Cyber Security Awareness Training’, which was awarded in November 2018. This enabled Northumbria’s team to work with ThinkCyber’s clients Camden Council, Deloitte, and Axelos, running workshops to identify problems and suggest design solutions, integrating the ‘value-sensitive design’ approach [ R5] from earlier research [ E1, p2]. Tim Ward, CEO of ThinkCyber, confirmed that ‘Two particular ideas from this [work with Northumbria] – Security Bulletins and Real-time tips have evolved into key parts of our product. [text removed for publication] ’ [ E1, p2].

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The team has also worked directly with older people in the North East of England, through peer-to-peer training to improve e-safety. This work was undertaken in collaboration with the University of the Third Age and the Old Low Light Heritage Centre. Beginning in 2017, the team ran workshops focused on six themes and trained 242 older adults with the result that ‘participants improved their online behaviours, in particular with regards to creating better passwords and being more vigilant online’ [ E3]. Following these, as part of a ‘CyberGuardians’ project commissioned via EPSRC’s Not-Equal Network Plus, Northumbria trained 14 cyber security ambassadors aged in their 50s, 60s, and 70s on how to interact with technology securely. As of September 2020, these ambassadors had cascaded key harm prevention information into their communities, helping approximately 820 people with become more cyber secure [ E3, p3].

4.2 Impact on public policy and practice

Northumbria’s team has made a substantial contribution to the thinking of UK and European bodies working on the human elements of cybersecurity, as few psychologists have been involved in this field from the outset. Paul Waller, Head of Research, NCSC Capability, noted: ‘Professors Briggs’ and Coventry’s sustained public insistence on relating sociotechnical security problems back to psychological theory has percolated the community and our thinking’ [ E4, p1]. The policy and practice community has benefitted through three types of policy impact: impact on new funding streams, impact on major campaigns to improve cyber security activity by the public, and impact on policy guidance.

Funding Streams: In early 2014, Briggs and Coventry were asked by the then UK Government Behavioural Insights Team to deliver a UK Government Office for Science report on ‘Using behavioural insights to improve the public’s use of cyber security best practice’ [ E5]. The report, published on 8 May 2014, highlighted the lack of reliable behavioural data on internet users’ understanding and use of cybersecurity measures. The report led to an EPSRC ‘Human Dimensions of Cybersecurity Workshop’ on 22 September 2014 (attended by Briggs) and a subsequent GBP5,000,000 EPSRC call on ‘Human Dimensions of Cybersecurity’, launched in 2016. Also in 2014, Coventry was asked to contribute a behavioural science/security perspective to the Blackett Review on the ‘Internet of Things [IoT]: Making the most of the second digital revolution’, which addressed issues of trust and public acceptance [ E6, p38]. The research agenda outlined in that report led directly to the establishment of the GBP14,000,000 National Centre of Excellence for IoT Systems Cybersecurity (PETRAS), with the GBP13,800,000 PETRAS 2 announced in 2019. PETRAS consists of 16 institutions (including Northumbria University) and ensures that the IoT technologies are safely and securely applied in consumer and business contexts [ E6, p41] .

Public campaigns: ‘Cyber Aware’ is the UK Government’s national campaign on cyber security and recent iterations have been influenced by Northumbria research. ‘Cyber Aware’ is led by NCSC and delivered in partnership with the Cabinet Office, Home Office, and the Department for Digital, Culture, Media & Sport (DCMS). The campaign has been running for six years, but was relaunched in April 2020 in the light of increasing online activity during the COVID-19 pandemic and received a major marketing push in December 2020 headed up by Penny Mordaunt, the Paymaster General, and Lindy Cameron, Chief Executive of the NCSC. This new approach to the Cyber Aware campaign focused on ideas of positive framing, coping strategies, and realistic action – making cyber security approachable for everyone – that come from the work of Briggs and Coventry [ E4, p3]. Other NCSC campaigns influenced by this work include ‘ You Shape Security’ and ‘ People are the Strongest Link’ [ E4, p3].

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Policy guidance: Policy has been influenced in Europe, with Briggs’ research using PMT used to assess the effectiveness of a range of cybersecurity nudges [R3]. This generated three European Commission technical reports for the Joint Research Centre, which provide evidence-based support to European policymaking. These reports covered effective privacy and security ‘nudges’ in warning messages and banners, with Briggs’ contributions explicitly acknowledged [E7, p4, p54 and p100 of the compiled document]. The digital identity research also fed into an EU policy guidance document ‘Cybersecurity in the European Digital Single Market’ which stated ‘the importance of sub-topics such as digital identity and the notion of "trust" emerged as central cross-cutting themes which aided the development of the opinion’ [E8, p53]. Briggs is cited as a contributor [E8, p84].

In the UK, the DCMS used the Blackett IoT report to create the Government guidance ‘Secure by Design: Improving the cyber security of consumer Internet of Things’ [ E9]. Coventry was invited onto the panel to create this document and the report referenced cSALSA [ R6] as the source of findings that helps government ‘to design more effective cyber security advice and educational materials that are tailored for different audiences’ [ E9, p27]. The digital identity research [ R5] led to an invitation for Briggs to join the All Party Parliamentary Group on Digital Identity. The findings from the IMPRINTS project then informed the House of Commons Science and Technology Committee Report on ‘Current and Future Uses of Biometric Data and Technologies’, where the challenge in establishing trust – especially around biometrics – was noted from IMPRINTS [ E10, p29, p43].

Ellis’ research has led to two main areas of impact, regarding: 1) improved clinical understanding, guidance, and skills for treating sleep issues and insomnia and 2) public understanding of sleep issues and ability to self-manage insomnia.

4.1 Improving clinical understanding of sleep issues and ways to treat insomnia for patient benefit

Ellis’ work has improved clinical understanding of insomnia and improved skills to effectively treat this condition. Since 2013, Ellis has delivered training on his brief, ‘one-shot’, CBT-I approach to over 580 healthcare professionals in the UK at locations including: NHS Aintree, the Edinburgh Sleep Service, Surrey & Borders NHS Foundation Trust, and NHS Scotland (Psychological Interventions team). Training has also been delivered by Ellis internationally to around 250 professionals from a wide range of countries, including the USA (n=>150), Holland (n=35), and Japan (n=5). Participation in this training, alongside engagement with Ellis’ broader research on insomnia, has been recognised to have a substantial effect on clinicians. Dr Renata Riha, a consultant in Sleep and Respiratory Medicine at Royal Infirmary of Edinburgh, states that it has ‘ helped me to deal more effectively with patient problems due to the speed of the intervention, on a day-to-day clinical basis’ [ E1]. In addition : ‘Professor Ellis’ research is seen as ground-breaking in the field of sleep, particularly his one-shot intervention… [his] work is valued very highly and seen as inspirational… I personally know individuals who have been inspired to change career after engaging with his work’ [ E1].

Similarly, Dr Richard Twaites, Consultant Clinical Psychologist at Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, invited Ellis to run a two-day sleep training course tailored to the First Step workforce (a service providing telephone-based therapy within Cumbria, Northumberland, Tyne and Wear, and Lancashire). Approximately 40 mental health practitioners were trained in how to deliver brief CBT-I practices, which have subsequently been rolled out in NHS clinical practice [ E2]. Twaites notes:

‘Staff were extremely receptive to this training and it has become clear since that this training has drastically boosted their understanding of and interest in brief CBT-I as a way to treat sleep issues. This training also provided [40+ members of] staff with the skills to be able to deliver CBT-I, using this approach, to patients who contact our service with sleep disorders’ [ E2].

Therapy services across the UK, including those specialising in treating sleep issues, have incorporated Ellis’ brief CBT-I intervention into their practice and are now using it to treat patients, including the Edinburgh Sleep Service [ E1], Berkshire Healthcare NHS Foundation Trust [ E3], and First Steps [ E2]. Accounts from clinicians using the brief CBT-I intervention clearly indicate that it is having a positive impact on patients sleep. Riha from the Edinburgh Sleep Clinic (which treats 2,000 patients a year) states that the intervention has improved practice across the department since it was incorporated into care protocols, by ‘ chang[ing] the way that we approach patient referrals for behavioural sleep issues [as] we are able to send the leaflet [Ellis’ aforementioned pamphlet] as an immediate intervention to the patient and their general practitioner allowing them to ‘get started’ and understand the process’ [ E1]. Riha notes that patients ‘ appear to find this approach very easy to follow and empowering, as it gives them a renewed sense of ownership over their future’ [ E1].

This impact is not restricted to the UK. Brief CBT-I has been incorporated into clinical practice in other countries, including the USA, Australia, and Iceland. One example demonstrating how far this intervention has been adopted is its use in the Republic of Korea. Dr Chan-Young Kwon, Specialist in Neuropsychiatry of Korean Medicine, highlights that he has been using the brief CBT-I intervention with his patients since opening his clinic in May 2020, with positive results:

‘Incorporating Prof. Ellis’ one-shot CBT-I approach into my practice has given my patients more choice over their treatment and I believe it has improved the sense of self-efficacy among patients and their engagement with the treatment process…I often meet patients who feel that keeping a diary (to organise the previous day), as recommended by Prof. Ellis’s pamphlet, has improved their sleep. From this I believe this practice can help the sleep onset, by reducing excessive ruminant thoughts’ [ E4].

Ellis’ own evaluative work demonstrates the effective and efficacious nature of the brief CBT-I intervention, including a 73% remission status at three months post-treatment [ E5]. The patient benefit of brief CBT-I has also been confirmed by an independent evaluative study conducted in 2018 by the University of Reading [ E6], which applied the intervention in adolescent depression and identified ‘ positive improvements in sleep but also an indication of improvements in depressive symptoms’ [ E3]. Dr Faith Orchard, a psychologist who worked on this evaluation, confirmed that since the completion of this work in 2018, Berkshire Healthcare NHS Foundation Trust have continued to offer the intervention to young people referred to the Child and Adolescent Mental Health Service for difficulties with anxiety and depression. In addition, it has been adapted into a workshop series that was tested for feasibility and acceptability with three local schools. This involved a total of 41 secondary school students, 96% of whom reported that they found the sessions ‘useful’, particularly because of their ‘calm’ and ‘non-judgmental’ nature [ E3].

Ellis’ brief CBT-I intervention has also been recognised in guidance on the management of sleep problems, including the European Guidelines for the Assessment and Management of Insomnia [ E7] – a reference document for all clinicians involved in the stepped-care management of insomnia – and a response to managing sleep in the context of COVID-19 published by the Society for Behavioural Sleep Medicine, which acknowledges that the three D’s (detect, detach, distract) can assist patients with managing new-onset (acute) insomnia [ E8, p3].

4.2 Improving public understanding, and supporting self-management, of insomnia

In addition to the development of an intervention for use by professionals Ellis has also published a self-help book targeted at members of the public entitled The One-Week Insomnia Cure (2017), which has sold more than 10,000 copies around the world. The book presents techniques informed by Ellis’ research to address sleep issues including CBT-I, and, as the title suggests, includes a 7-day course that readers can follow to improve their sleep. The content of this book has been approved by clinicians working in the field; Surrey Hospital Insomnia Unit, for example, recommend the book as an appropriate form of self-help for individuals living with insomnia [ E9, p4].

The book has received substantial media interest and following its publication Ellis was invited to appear on television shows to discuss his research, including This Morning [ E10] (around 1,000,000 viewers a day). The Daily Mail (readership: 1,511,357 – Audit Bureau of Circulations) published a serialisation based on the book in February 2017 – comprised of 6 articles which have since been shared online over 2,250 times [ E10]. Louise Atkinson, the freelance journalist involved in producing this serialisation, acknowledges it was ‘ very well received by the editors and readers alike […particularly because] it offered a ‘new’ solution (sleep restriction) with advice and guidance from a respected expert’ [ E11]. Indeed, Atkinson notes that the Daily Mail were so impressed with the series that they ‘invested in a TV advert, which attracted new readers and helped boost newspaper circulation for that period – the ultimate measure of success in newspaper land!’ [ E11].

Through the publication of the book, and subsequent media engagement, Ellis has worked to make his research accessible to the public, to support individuals to identify and self-manage their sleep issues in an effective way. Case studies denoting people’s experience of following Ellis’ approach, published within the Daily Mail serialisation, highlight the benefit on their sleep:

‘I’ve seen a dramatic improvement in my sleep quality and I’m delighted […the solutions] were simple, but effective… I’m thrilled I’ve been able to sleep properly for the first time in nearly two years’ [ E10, p2-3].

‘Now I am getting at least three more hours of sleep every night. I can’t believe the vast improvement and I no longer dread going to sleep’ [ E10, p19].

58% of reviewers on Amazon gave the book 5 stars, with several stating it ‘worked’ and ‘really help[ed]’ [ E12]. One individual stated ‘by the 3^rd night I was sleeping more deeply… I am falling asleep as soon as I go to bed now and sleeping deeply, waking only rarely now… I’ve broken the addiction to my phone and checking the bedroom clock… I am confident things will go on improving’ [ E12, p1].

As part of the Daily Mail serialisation, readers were provided with a 32-page sleep diary to use alongside the articles to develop a personalised plan to address their specific sleep issue. Readers were encouraged to send completed diaries to Ellis for analysis. Of the 347 diaries returned, 213 contained sufficient data for analysis [ E13]. Results revealed a statistically significant improvement in sleep, with regards to reductions in time to sleep onset (p=.001), waking after sleep onset (p=.002), and number of awakenings (p=.002) [ E13].

BPNRC’s research on the effects of dietary components has had impact in three distinct areas, in relation to (1) bringing to market new dietary supplements, including [text removed for publication], (2) improving dose recommendations for Neuravena, and (3) supporting the international marketing initiatives of one of Europe’s biggest-selling supplements.

4.1 Bringing new supplements to market

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4.2 Improving dose recommendations for Neuravena® ( Avena Sativa)

IFF Health – a division of International Flavours and Fragrances Inc. – is a leading global natural health and nutrition ingredient manufacturer. IFF Inc. had sales of USD5,100,000,000 in 2019. Northumbria research was used to inform a new lower dose of IFF’s Avena sativa extract product, Neuravena. The research provided new insights by demonstrating that 800mg was sufficient to have a positive effect [ R4]. IFF Health states that ‘this dose is lower than what was previously used (1250mg), and current dose recommendations are based on the study results’ [ E8]. This discovery is also important for consumers as ‘a dose of 800mg is more economically viable as well as user friendly (one capsule instead of two, for example)’ [ E8]. This further benefitted the company, as it supports ‘promoting the ingredient to new markets and new users’ [ E8]. In addition, using COMPASS in this study ‘enabled us to check for many attributes of the extract at the same time, and is regarded by many in the market as an advanced method for checking effects on cognition’ [ E8]. The results revealed improved speed of performance across all the cognitive tasks and these data were used to develop a new concept showing how to use Neuravena in products targeting consumers involved with video games [ E8, E9]. Finally, the research supports the company to meet regulatory requirements around the world:

‘the study is integral for establishing the efficacy and safety of the extract with regards regulatory processes. Especially in the USA and EU, where we mainly operate and have many customers, the sale of nutraceutical products is governed by strict rules and standards, so the research is very important so that we can meet those requirements’ [ E8].

4.3 Supporting international marketing initiatives

Bayer Consumer Care AG (Basel) has used Northumbria’s research [ R1, R2] to promote its products and recognises the commercial value of the research findings. Bayer states that ‘these studies help differentiate the products in the marketplace via the development of more distinctive claims’ and ‘play a substantial role in their commercial success’ [ E10]. For example, Supradyn^TM – which is marketed in Europe, Latin America, Africa, and Asia Pacific, and is worth more than EUR200,000,000 in annual sales – ‘continues to gain further market share since 2 years, proving its stronger equity and execution vs. its competitors in the market; the brand grew globally +7%, vs. the category growth of 4%’ [ E10]. In order to achieve this, Northumbria research was used to produce new marketing materials that have been used ‘to support claims about product effectiveness (i.e., works from the first intake, clinically/scientifically tested/proven) ’ [ E10, E11]. The research has also been used ‘to train the Bayer medical staff in the company’s affiliates around the world, to train the sales forces (targeting pharmacies) and consequently the pharmacy staff’ [ E10]. Additionally, the publications are used as ‘references in documents submitted to health authorities for claims substantiation’ [ E10]. In summary Bayer stated the collaboration with Northumbria University ‘is crucial for the continued success of our products’ [ E10].