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- University of Worcester
- 4 - Psychology, Psychiatry and Neuroscience
- Submitting institution
- University of Worcester
- Unit of assessment
- 4 - Psychology, Psychiatry and Neuroscience
- Summary impact type
- Health
- Is this case study continued from a case study submitted in 2014?
- No
1. Summary of the impact
An exercise and lifestyle intervention for young people (aged 16-25) experiencing a first episode psychosis, developed in partnership between an interdisciplinary research team at the University of Worcester and Worcestershire Health and Care NHS Trust, has been shown to bring both economic benefits for service providers and significant health benefits for users. The intervention has been rolled out across Worcestershire by a dedicated team (and extended to all outpatient and inpatient mental health service users) but has also been adopted more widely in the UK and internationally thanks to a coordinated good practice dissemination programme.
2. Underpinning research
Smith has an established reputation in early intervention in psychosis for children and young people. Her research in this area has highlighted the economic value of EI services for children and adolescents (R1) and demonstrated the efficacy of specific interventions, for example a vocational rehabilitation intervention (R2).
In her joint role at the University and the Worcestershire Health and Care NHS Trust, Smith led on a successful bid to the Health Foundation (G1) in 2014 to develop, deliver and evaluate the first ‘real-world’ physical health intervention to young people with psychosis in the UK entitled SHAPE (Supporting Health and Promoting Exercise). The project brought together a multi-disciplinary team of exercise scientists (Griffiths), nutritionists (Bold) and health psychologists (Bradley).
Physical health problems are common in young people with psychosis who typically have a poorer quality of life with higher rates of premature cardiovascular disease and metabolic disorders (such as Type 2 diabetes) leading to a reduced life expectancy. The mortality gap compared to their non-psychotic peers is widening and this has been primarily due to a sedentary lifestyle, poor diet composition, higher rates of obesity and smoking. The team’s research has shown that those recently diagnosed with psychosis are at increased risk for cardiometabolic disorders (R3). Yet in many UK EI services, physical health monitoring is not systematic and care plans fail to address physical health risks.
The SHAPE intervention consisted of a 12-week programme, with weekly, 90-minute sessions comprising a healthy behaviour education session, followed by a facilitated exercise session. 27 participants were recruited to the pilot. Anthropometric data from participants was collected at baseline, 12 weeks, and 12 months post-intervention. Health behaviours and clinical measurements were assessed at baseline and 12 months.
Mean baseline data suggests participants were at an increased health risk on entry to the program, with elevated values in mean body mass index (BMI; 70% overweight/obese), waist circumference, resting heart rate, and triglycerides. 50% reported smoking daily, 64% ate less than 5 fruits/vegetables per day, and 52% of participants were prescribed highly obesogenic antipsychotic medications i.e., Olanzapine (R3). At 12 weeks and 12 months, contrary to expectations that these would be elevated, no changes were observed in mean BMI, waist circumference or any other clinical variable (p > 0.05). At 12 months, participants reported a positive impact on health behaviours including improved diet, increased physical activity levels, and cessation of substance use, alcohol use, and smoking. Focus groups captured participant experiences, engagement with and satisfaction with the program, including challenges/barriers to program adherence. Overall, the research showed that the programme supported participants to attenuate their physical health risk which was sustained at 12 months follow up (R4).
3. References to the research
McCrone, P., Singh, S.P., Knapp, M., Smith, J., Clark, M., Shiers, D. and Tiffin, P.A. (2013) The Economic Impact of Early Intervention in Psychosis Services for Children and Adolescents. Early Intervention in Psychiatry, 7 (4), pp. 368-373. https://doi.org/10.1111/eip.12024
Craig, T., Shepherd, G., Rinaldi, M., Smith, Jo, Carr, S., Preston, F. and Swaran, S. (2014) Vocational Rehabilitation in Early Psychosis: Cluster Randomised Trial. The British Journal of Psychiatry, 205 (2), pp. 145-150. https://doi.org/10.1192/bjp.bp.113.136283
Smith, J., Griffiths, L., Band, M. and Horne, D. (2020) Cardiometabolic Risk in First Episode Psychosis Patients. Frontiers in Endocrinology. https://doi.org/10.3389/fendo.2020.564240
Smith, J., Griffiths, L., Band, M., Hird-Smith, R., Williams, B., Bold, J., Bradley, E., Dilworth, R. and Horne, D. (2020) Early Intervention in Psychosis: Effectiveness and Implementation of a Combined Exercise and Health Behavior Intervention within Routine Care. Frontiers in Endocrinology. https://doi.org/10.3389/fendo.2020.577691
Grants
- Smith, J. (2014) SHAPE (Supporting Health and Promoting Exercise), Health Foundation, £70,493.
Reference 4 is included in the output submission for UoA3.
4. Details of the impact
The evaluation of the SHAPE programme (Source A) showed the clear clinical benefits of the intervention. The programme:
effectively supported weight maintenance
reduced harmful lifestyle behaviours such as tobacco and alcohol use
increased physical activity levels.
An economic evaluation of the programme (Source B) highlighted a wide range of potential costs savings derived from:
improved clinical outcomes for users
improved “quality of life years” for users (QALY)
Following the success of the pilot programme, in 2017 Worcestershire Clinical Commissioning Group extended the delivery of the SHAPE intervention to all outpatient mental health service users in the county and introduced three new permanent job roles (Physical Health Lead, Physical Activity Health Coordinator, Physical Activity Support Worker) to oversee, deliver and support the delivery of the SHAPE intervention across Worcestershire at a cost of £70,000 (Source C). The introduction of the programme, with associated referral processes, has enabled the Trust to improve their collection of physical and mental health data, with associated benefits for service users, but also Trust performance against nationally identified performance measures, e.g. CQUINs, and national initiatives, e.g. Making Every Contact Count; Don’t just screen, intervene (Source C).
The ongoing delivery of the programme was supported by the SHAPE project team through:
the development of a new clinical health assessment form to standardise screening, now used as part of the standard clinical assessment process in Worcestershire.
the design and delivery of a one day training course entitled ‘Physical Health Training for Mental Health Nurses’ which provides an overview of the NHS Commissioning for Quality and Innovation (CQUIN) responsibilities and training for physical health assessments (blood pressure, body mass index, waist circumference) for mental health care professionals to assess and monitor patient physical health (Source D).
The SHAPE team received an additional £30,000 funding from a Health Foundation Spreading Improvement grant to disseminate further the findings of the project and the resources developed. This supported the development of a ‘mySHAPE’ website to provide patients, carers, providers and commissioners online access to physical health care information for individuals with psychosis and to give healthcare providers free access to all SHAPE intervention programme materials, allowing them to deliver the SHAPE programme in their region.
The SHAPE team adopted a wider dissemination programme which saw them deliver to both academic and practitioner audiences regionally, nationally and internationally. This included: NHS National Learning Network (April 2015); Health Services Journal (HSJ) Value in Healthcare Congress (May 2016); American College of Sports Medicine Annual Meeting, Boston, USA (June 2016); IEPA 10th International Conference on Early Intervention in Mental Health, Milan, Italy (October 2017); West Midlands Early Intervention Psychiatry regional network (March 2017); NICE Shared Learning Awards (June 2017).
The SHAPE intervention has been recognised in the NICE Shared Learning Database which underlines how the intervention addresses recent NICE guidance and quality standards -NICE CG178, NICE CG155, NICE QS80, NICE QS102 (Source E). The intervention is also highlighted in the King’s Fund learning network for Integrated Physical and Mental Health (Source F). Further, the intervention was identified as a key area of evidence in the British Association for Psychopharmacology (BAP) Guidelines (co-authored by Jo Smith) on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment (Source G).
The SHAPE programme has now been delivered (and continues to be delivered, including online during the Covid pandemic) in a number of NHS trusts across the Midlands:
North and South Worcestershire (Worcester, Malvern, Evesham, Kidderminster, Redditch, Bromsgrove)
Dudley and Walsall
Hereford (in partnership with a local fitness centre provider (Halo) and offered to service users from a range of different adult mental health services (not restricted to the FEP / EI service)
Coventry and Warwickshire Partnership NHS Trust
The SHAPE programme has thus been delivered to 38 groups of service users across 4 NHS trusts in the West Midlands.
SHAPE has also informed the development of a similar programmes nationally, e.g. in the Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, and internationally, in Australia and Portugal. This wider impact on the SHAPE programme is articulated by Dr David Shiers, lead for the National Early Intervention in Psychosis Programme (2004-2010), who states: “the SHAPE programme continues to play an important role in influencing other healthcare professionals within EIP services, [and] made a compelling case for how services can help tackle this health inequality by addressing health risks in the critical first few years of psychosis and its treatment” (Source H).
To sum up, the research described in section 2 has had the following impacts on health and wellbeing:
the development of a new lifestyle intervention trialled with users which demonstrated a positive outcome for users and healthcare providers alike
informed decisions taken by a health service and improved provision of health services
influenced the content of CPD for health professionals
raised awareness of the importance of exercise in the treatment of mental health and early cardio-metabolic risk for young people with FEP
5. Sources to corroborate the impact
Letter from Chris Burton, Physical Health Activity Co-ordinator, Herefordshire and Worcestershire Health and Care NHS Trust
Physical Activity Nurse Clinical Champions - PHE clinical training to improve local outcomes
Letter from Dr David Shiers, Honorary Reader in Early Psychosis, University of Manchester
- Submitting institution
- University of Worcester
- Unit of assessment
- 4 - Psychology, Psychiatry and Neuroscience
- Summary impact type
- Health
- Is this case study continued from a case study submitted in 2014?
- No
1. Summary of the impact
Severe allergies are common amongst adults in the UK. Effective treatment relies on patient and health professional’s education. The team’s research and consultancy with an allergy treatment global leader challenged thinking about treatment and has been used to improve the company’s allergy education materials, now translated into 17 languages. Impacts contributed to significant growth in the company’s market share and informed their strapline “committed to patient support”. Working with patients, families, health professionals, industry and third sector stakeholders, the research has raised the profile of the psychological aspects of treatment, influencing approaches to support.
2. Underpinning research
The research focused on the effects of severe allergy on adult patients and their families. It identified unique self-care issues faced by these patients, challenging accepted thinking that mere provision of medical instructions will lead these patients to be effective self-carers. The research identified that severely allergic adults are active self-carers whose health beliefs and experiences can be barriers to their self-care. The research has provided new patient-focused perspectives on the treatment of these patients, raising the profile of severely allergic adults support needs which have been relatively overlooked in academic research, healthcare design and delivery.
The research was conducted in collaboration with the Allergy Service at Worcestershire Acute Hospitals NHS Trust. It includes one of the first UK based qualitative studies on the experiences of individuals living with adult-onset severe allergy, the perspectives of their families and allergy service healthcare staff (Reference 1). Patient and family insights identified lengthy referral times, limited patient-focused treatment, patients struggling to self-care and healthcare staff unaware that psychological factors influence what it is like living with severe allergy for these patients. It found that self-care for severely allergic adults has unique and overlooked challenges.
The work advanced further through industry sponsorship from ALK-Abelló, a global pharmaceutical company specialising in allergy and allergic asthma. This led to the development of a unique psychologically-informed training programme, delivered across Worcestershire to healthcare staff who train severely allergic patients to use an adrenaline auto-injector, the NICE recommended treatment for severe allergic reactions or anaphylaxis (Reference 2). Longitudinal evaluation of the training programme showed it had a transformational impact on staff understanding of severely allergic adults’ self-care as a process with psychological and not purely physical dimensions, altering their communication with patient groups (Reference 3). The research challenged accepted notions of severely allergic adults as “easy” adherent self-carers compared to younger patients and equipped healthcare staff with knowledge and skills they reported applying confidently in a range of clinical contexts.
The research was widely disseminated to practitioner audiences:
Summary findings were published in Outlook the Anaphylaxis Campaign flagship magazine in 2016 and The Psychologist the British Psychological Society’s flagship professional publication in 2019, extending the reach to diverse health and allied professionals, third sector organisations and members of the public interested in severe allergy.
Anaphylaxis in adulthood: exploring the psychological experience and patient-centred care, British Society for Allergy and Clinical Immunology Annual Conference, 2015.
Putting the patient first - a patient focused approach to allergy treatment (ALK-Abelló Ltd sponsored symposium), British Society of Allergy and Clinical Immunology Annual Conference, 2018.
Nonadherence to carrying and using adrenaline pens in adults with anaphylaxis: the impact of a theoretically informed training intervention on staff knowledge and beliefs, European Academy of Allergy and Clinical Immunology Annual Conference, 2020.
3. References to the research
Walklet, E., Taylor, C., Bradley, E., Mahoney, B., Scurlock-Evans, L., & O’ Hickey, S. (2016). “Because it kind of falls in between, doesn’t it? Like an acute thing and a chronic”: the psychological experience of anaphylaxis in adulthood". Journal of Health Psychology, 23 (12): 1579-1589. DOI: 10.1177/1359105316664130.
Walklet, E., Mahoney, B., Bradley, E., & O' Hickey, S. (2019) Application of Health Psychology: Development of a Practitioner Training Intervention in Anaphylaxis. Journal of Continuing Education in the Health Professions, 39 (2): 130-35. DOI: 10.1097/CEH.0000000000000254.
Mahoney, B., Walklet, E., Bradley, E., & O' Hickey, S. (2019). Improving Adrenaline Auto-injector Adherence: a Psychologically-informed Training for Healthcare Professionals. Immunity, Inflammation and Disease, 7 (3): 214-28. DOI: 10.1002/iid3.264.
All outputs were reviewed as part of the processes set out in the University’s REF Code of Practice and were identified as at least 2*.
4. Details of the impact
New processes have been adopted in organisations leading to improvement in their services
The research team has worked closely with ALK-Abelló since 2016 providing expert advice to the company on patient education (Source A) and developing and evaluating training materials for healthcare staff in the use of the company’s adrenaline auto-injector (Source B). This provision has led to the following improvements in ALK-Abelló services and innovations as outlined in testimonials from the company (Sources C and D):
Informed a complete overhaul of the adult patient section of the Jext® (adrenaline auto-injector) website in July 2018 ( https://adults.jext.co.uk/)
Implementation of a more structured online training tool for healthcare professionals ( https://hcp.jext.co.uk/training/)
Design and development of a more patient friendly administration route for adrenaline
Professional ideas influenced by research via training
The unique psychologically-informed training developed by the team, was delivered to healthcare staff in Worcestershire Acute Hospitals NHS Trust. It influenced the reported knowledge, understanding and practice of attendees (Sources B and G). The training used health psychology principles to develop the communication techniques healthcare staff could use to explore the perceptions and beliefs of severely allergic adults about their condition, and to influence their injector use and other self-care behaviours. Longitudinal evaluation of the training showed it influenced: attendees’ professional ideas about and practice with severely allergic adults and other patient groups; and ideas and practices they intended sharing with their professional colleagues. The training led to “a completely different view of how to approach patients now” and increased confidence that they now had the techniques and supporting materials to enable effective changes to their practice. The training was reported as useful for enhancing the experiences of severely allergic adults by encouraging them to be more effective self-carers: “giving them the tools to think about how they’re going to get over those problems”.
Research challenged conventional wisdom and stimulated debate among stakeholders
The team’s research has challenged conventional thinking and stimulated debate among industry providers of allergy treatment (Sources C and D) and healthcare professionals (B and G) about how to encourage severely allergic adults to be effective self-carers. For *ALK-*Abelló, the team’s research findings and ongoing partnership have “been instrumental in shaping ALK’s communication to healthcare professionals and patients”.
Further, the team have stimulated debate in the wider “allergy community”. The CEO of the Anaphylaxis campaign, the UKs leading charity supporting the needs of individuals living with severe allergy, sat on the steering group that oversaw the overarching project. Mahoney and Walklet were the invited chairs for the ALK-Abelló sponsored Symposium Putting the Patient First at the British Society of Allergy and Clinical Immunology Annual Conference in 2018, the major forum for researchers and practitioners in allergy services.
Further, the team are also developing a collaboration with world-leading providers of specialist allergy care and largest adult allergy service in the UK exploring the impact of severe allergy on adults at the Department of Allergy at Guy's and St Thomas' Hospital, London, a European Academy of Allergy and Clinical Immunology and World Allergy Organisation Centre of Excellence (Source F).
5. Sources to corroborate the impact
Consultancy contract with ALK-Abelló for Mahoney and Walklet.
Mahoney, Berenice, Walklet, Elaine, Bradley, Eleanor and O'Hickey, Stephen (2019) Improving Adrenaline Auto-injector Adherence: a Psychologically-informed Training for Healthcare Professionals. Immunity, Inflammation and Disease. ISSN Online: 2050-4527.
Testimony from National Projects Manager, ALK-Abelló
Testimony from Allergology Laboratory Kopenhagen, ALK-Abelló
BSACI 2018 slides
Email from Consultant Allergist and Clinical Lead for Adult Allergy, Department of Allergy at Guy's and St Thomas' Hospital, London
Testimonial from Consultant Respiratory Medicine, Worcestershire Acute Hospitals NHS Trust