Chronic Disease

male having bloodpressure taken

The interdisciplinary chronic disease research team undertakes research to improve our understanding of disease aetiology, identify modifiable prognostic factors, and develop, evaluate and implement interventions that promote health through preventing the onset, early detection and management of chronic disease and related lifestyle factors, with a focus on tacking health inequalities

Aims of the research

This group is multidisciplinary in nature and focuses mainly on intervention development and evaluation, but includes epidemiological and policy work. Behavioural Medicine comprises the development and integration of environmental, behavioural and biomedical knowledge relevant to health and disease and the application of this knowledge to prevention, treatment and rehabilitation. In all of these areas, the focus of our work is on applied research. In particular, we aim to develop and test pragmatic interventions for use in primary care, but we are also engaged in explanatory trials and translational research.

Recent projects

  • Epidemiological study of childhood obesity correlates, impacting factors and control and prevention in Guangzhou city. Funder - Guangzhou Municipal Health Bureau and Guangzhou CDC 
  • A cluster randomised controlled trial of the effectiveness and cost-effectiveness of an obesity prevention intervention in primary school age children. Funder – NIHR HTA. 
  • Development of a culturally adapted weight management programme for children of Pakistani and Bangladeshi origin. Funder – NIHR HTA. 
  • Randomised controlled trial to test the effectiveness of a brief intervention for weight management for obese adults in primary care. Funder – NPRI (led by University of Oxford) 
  • Efficacy of water preloading before main meals as a weight loss intervention in obese patients. Funder – European Hydration Institute 
  • The feasibility and effectiveness of exercise a treatment for vasomotor menopausal symptoms. Funder -NIHR 
  • Patient self-management in primary care patients with COPD - a randomised controlled trial. Funder – National Schools for Primary Care Research 
  • Self weighing as a weight management intervention in primary care. Funder RSF/NIHR 
  • Effectiveness of exercise as a treatment for postnatal depression. Funder- National Schools for Primary Care Research 
  • Prevention of excessive weight gain during pregnancy. Funder- National Schools for Primary Care Research 
  • Evaluation of the Lighten-Up text message weight maintenance programme (Lighten Up Plus). Funder – Birmingham Public Health 
  • Efficacy of nicotine preloading for smoking cessation. Funder HTA. Led by University Oxford. 
  • Psychological wellbeing after smoking cessation. Funder RSF/NIHR 
  • Systematic review of self-management for COPD. Funder NIHR

Exercise as a treatment or intervention in chronic disease

 

ECHOES-Survive

The Echocardiographic Heart of England Screening (ECHOES) study, carried out between 1995 and 1999 in 16 general practices around the West Midlands region, established the prevalence of heart failure in the general population over the age of 45. Heart failure affects almost 1 million people in the United Kingdom and survival has not improved over time. The outcome for patients with screen-detected heart failure is currently unknown.

People with lung disease (COPD)

The PSM-COPD randomised controlled trial has recruited 577 participants with COPD that causes them to be mildly breathless. The trial has been testing a nurse delivered telephone coaching intervention to increase levels of physical activity and self-management of their condition.  The trial was funded by the NIHR School for primary Care Research and was a collaboration between the Universities of Birmingham, Manchester, Keele and Oxford. (PI Prof Kate Jolly).

Home-based cardiac rehabilitation for people with heart failure

The Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) programme of research studies is a collaboration between the Universities of Exeter, Birmingham, York, the Royal Cornwall NHS Trust, Leicester NHS Trust and Aneurin Bevin Health Board. The programme has developed a new, evidence-based self-help manual for people with heart failure and their caregivers, which is being evaluated by an RCT. The programme was funded by the NIHR Programme grants, led by Professors Hayes Dalal and Rod Taylor. (Local PIs Professor Kate Jolly and Dr Russell Davies). Find out more

Web-based cardiac rehabilitation for people who decline supervised centre-based cardiac rehabilitation

The WREN Feasibility Study  is a Web-Based Cardiac REhabilitatioN Alternative for Those Declining or Dropping Out Of Conventional Rehabilitation. It was funded by the NIHR RfPB and led by Professor Sally Singh, University Hospitals of Leicester NHS Trust. Local investigators Professors Kate Jolly and Tom Marshall.

Weight management

Preventing weight gain over the Christmas holidays

Studies show that Christmas holidays are a very high risk period for weight gain that is not later compensated and retention therefore occurs.  Holiday periods are a high risk time for weight gain because they typically involve consumption of high fat energy dense food, increased snacking, reduced physical activity, increased alcohol consumption, longer eating durations and easy access to food.

People often feel holiday periods are a time where they can eat what they chose. There is a need therefore to investigate the effectiveness of simple, low cost interventions that can be delivered to prevent the public from gaining weight.  With funding from the University of Birmingham for a PhD studentship we will assess the effectiveness of a brief intervention to prevent weight gain over the Christmas holidays.  This study will start in September 2016 and run for three years. (PhD supervisors:  Drs Amanda Daley and Helen Parretti, Professor Sheila Greenfield).

Preventing weight regain after weight loss (LIMIT Study)

Typically people who try to lose weight will regain, most, if not all of this weight over time. With funding from the NIHR Public Health Research Programme we conducted a randomised controlled trial (n=583) "The effectiveness and cost effectiveness of a brief behavioural intervention to promote regular self weighing to prevent weight regain after weight loss." This study was a collaboration between the Universities of Birmingham and Oxford.  (PI: Dr Amanda Daley). Study publications

Preventing weight gain after kidney transplantation

We are investigating the feasibility of an intervention to prevent weight gain in renal transplant recipients.  Previous studies have shown that renal transplant recipients gain weight post transplant and that obesity and weight gain lead to poorer outcomes with regards to mortality and morbidity including graft function and failure. This study involves an intervention that is embedded into existing outpatient contacts and so could be relatively easily implemented by the NHS if effective.  We are investigating the feasibility of a behavioural change intervention that includes a weight management consultation from a dietitian with regular monitoring and feedback on an individual’s weight. NIHR CLAHRC-West Midlands are also part funding this study.  (PI: Dr Helen Parretti). 

Preventing excessive weight gain during pregnancy (POPS and POPS2)

Many women gain excessive weight during pregnancy and this can cause complications for the mother and the baby.  We conducted a feasibility trial followed by an RCT to examine the effectiveness of regular weighing and feedback by community midwives in preventing excessive weight gain in pregnant women. The NIHR School for Primary Care Research, NIHR CLAHRC-Oxford and NIHR CLAHRC-West Midlands funded the study.  Study publications

Healthy dads, Healthy Kids UK

This study took a healthy lifestyles programme developed in Australia by Professor Phil Morgan and colleagues for fathers and their primary school aged children and adapted and tested it in the multi-ethnic UK context. This study was a collaboration between the Universities of Birmingham and Newcastle, New South Wales and the Fatherhood Institute.  It was funded by the NIHR Public Health Research programme. (PI: Prof Kate Jolly).  Find out more

Prevention and management of obesity in children

A number of studies are led by Professor Peymane Adab and Dr Miranda Pallan 

FUEL-study 

The aim of the FUEL study is to compare secondary schools legally required to meet the School Food Standards with those that are not legally required to meet the standards. We will explore what food is provided and how healthy eating is supported in these two groups of schools. 

BEACHeS Study

The development of a childhood obesity prevention intervention focused on South Asian children. 

 

WAVES Trial

This is one of the largest childhood obesity prevention studies undertaken to date, set in a diverse socioeconomic and multi-ethnic population and addressing the main limitations identified in previous research. 

 

CHANGE study

The design and development of a child weight management programme that is culturally relevant to minority ethnic groups. 

 

Chirpy Dragon Study

Development and evaluation of a childhood obesity prevention intervention targeting children, as well as their parents, grandparents and school teachers through primary schools in Guangzhou, China. 

 

Childhood obesity determinants in China Study

This collaborative study with Guangzhou CDC, aims to examine modifiable risk factors for childhood obesity among urban Chinese children.

  

Effectiveness of monetary incentives on child nutritional status and development among left-behind children in rural China

This cluster randomised controlled trial is a collaboration between our research team and researchers in Central South University, Changsha, China, and aims to tackle the important health problem of children affected by rural-urban migration in China.

 

Tobacco control and harm reduction

Parental use of electronic cigarettes in the home

This mixed-methods study, a first in the UK, explored parents’ perceptions and experiences of using electronic cigarettes in homes with children. The results from this early exploratory study will be used to help develop novel interventions to support families to change their home smoking behaviours.  It was funded by Cancer Research UK [grant number C50276/A21555]. (PI: Dr Laura Jones).

Delivering secondhand smoke harm reduction messages to families in primary care

Currently there is only limited, outdated and conflicting evidence as to whether and how healthcare professionals deliver harm reduction advice to smoking parents in primary care. There is a need to further explore, using mixed-methods, how healthcare professionals currently address the issue of secondhand smoke and harm reduction advice with smoking families and whether there is scope and support for developing interventions, in particular around training for healthcare professionals, to address secondhand smoke exposure risk in primary care. This mixed-methods study will explore if primary care is an appropriate setting for delivering secondhand smoke harm reduction messages to parents and carers who cannot or will not stop smoking. This studentship, funded by the College of Medical and Dental Sciences, started in October 2015 and will be completed in September 2019. (PI and lead supervisor: Dr Laura Jones, co-supervisors Prof Kate Jolly and Dr Amanda Farley).

Protecting children and non-smokers from secondhand smoke in disadvantaged homes

This work is a collaboration between the University of Birmingham (Dr Laura Jones) and the University Centre for Rural Health North Coast, University of Sydney (Dr Megan Passey and Dr Jo Longman). The group (with support from collaborators from the University of Liverpool – Prof Jude Robinson and the University of Newcastle, Australia – Prof John Wiggers) recently published a qualitative systematic review and synthesis of the motivators and barriers to creating smoke-free homes.

Based on the findings of this review, a new two phase longitudinal qualitative study has been established to explore the views, behaviours and experiences of pregnant women living in smoking households in disadvantaged areas of rural Australia. Recruitment started in March 2016 with the study expected to run for at least 18 months. The study is supported by funding from the New South Wales Cancer Institute and the National Health and Medical Research Council of Australia. (PI: Dr Megan Passey, local collaborator: Dr Laura Jones)

Changing professional behaviour

Professional health care provider behaviour change

Clinical handover is the cornerstone of patient safety, patient centred care, and continuation of care. Effective clinical handover is particularly important for conditions where care extends beyond one service provider such as chronic diseases. We have established a programme of work investigating clinical handover in LMIC and developing interventions based on health care provider behaviour change supported by organisational and systems change models. Such multi-dimensional intervention packages are complex to implement and evaluate. UOB was a collaborator on the European Commission funded FP7 HANDOVER project ended 2012, as the evaluation and health economic expert partner. Currently, our work extend to India, Mongolia, and Nigeria, and Europe.

Acute Ambulatory Care

Led by Professor Dan Lasserson, the first UK Professor of Ambulatory Care, this group undertakes mixed methods research to understand how we can deliver more acute medical care whilst reducing our reliance on hospital beds and hospital based assessment. Clinical and academic multi-disciplinarity is embedded within the PhD students (including a physiotherapist, acute physician trainee and a consultant) and post-doctoral researchers (an NIHR ACL in Acute Internal Medicine and a social scientist).

Professor Lasserson leads the Society for Acute Medicine (SAM) Benchmarking Audit, giving the group access to a UK wide analysis of variation in organisation and delivery of acute medical care at acute hospital level, as well as data from successive ‘day of care’ surveys of acute medicine. He was also the NHS England Acute Kidney Injury Programme Measurement co-lead and is part of the team analysing the national master patient index of all NHS episodes of AKI held at the Renal Registry. Lasserson was in the working party that wrote the national Ambulatory Emergency Care Guidelines (SAM/Royal College of Physicians of Edinburgh) and was a member of the NICE Guideline Committee for Urgent and Emergency Medical Care in >16s (NG94).

Two NIHR infrastructure Themes are based in this group (NIHR West Midlands ARC – Acute Care Interfaces; NIHR Community Healthcare MIC – Acute Ambulatory Care and The Future Hospital) and Lasserson is part of the Birmingham Acute Care Research Group (BACR). Professor Lasserson also leads the Birmingham Health Partners Health and Well-being research pillar (focussed on acute care service change at the mental/physical health interface) and the IGI Ageing, Frailty and Resilience Theme.