HEU led research highlights

Funding: Wellcome Trust investigator award in Social Science and Humanities (Hareth Al-Janabi) - (2021-2025) 

Schools and workplaces command significant resources for supporting mental wellbeing and have an increasing expectation of responsibility to their students and employees.  However current methods for improving resource allocation are not clearly linked to how such organisation work.

In this Wellcome Trust funded research project, HEU researchers are investigating how schools and workplaces invest in mental wellbeing.  The study aims to make an intellectual step change in studying mental wellbeing investment in schools and workplaces. The programme of work focuses on studying how and why organisations invest in mental health and wellbeing – ultimately as a new way to support such organisations with resource allocation decision-making. The WISE study has work packages related to the processes of investment in mental health promotion in schools and workplaces, the use of evidence, and stakeholders’ attitudes to mental health investment in these settings.

The work is taking a broad view of wellbeing investment, including financial, human, and space-based investments. Case study methods will be used to study wellbeing investment in school networks and large employers.  Process-tracing will establish causal processes behind resource allocation. Cognitive interviews will be used to understand how decisions are influenced by different types of evidence. Q-methodology will be used to establish stakeholder viewpoints on wellbeing investments. 

HEU researchers are working with schools and workplaces who are investing in the wellbeing of their students and employees.  This project is being supported by collaboration from experts from within the University of Birmingham and externally.  Ultimately this project will promote disciplinary advance within the field of Health Economics (resource allocation, supporting decision makers), methodological advance (process tracing, think-aloud interviews, Q-methodology), lessons for policy and practice and capacity building.

Research team: Hareth Al-Janabi, Rebecca Johnson, Camille Allard, Luke Henstock, Yusuf Ozdmir, Sally O’Loughlin 

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Funding: NIHR career development award (Hareth Al-Janabi) - (2015-2019) 

Family carers are vital in supporting patients and the wider health service but many suffer health, financial, and relationship problems as a result of their caring. Carers’ quality of life is very rarely considered in economic evaluation, despite the potential for many healthcare interventions to have positive and negative impacts on carers’ lives. 

In this NIHR funded research project, HEU researchers are developing methods to include carers in economic evaluation. The specific objectives are to identify: (i) which patient interventions are likely to have a ‘spillover’ impact on carers’ lives; (ii)  how best to measure carer quality of life; (iii) the social value of improving carer quality of life; and (iv) how, in practice, carer quality of life can be included alongside patient quality of life in economic evaluations. 

The work is being conducted in projects that match the four research objectives. The methods comprise: a Delphi survey of carers, care professionals and key researchers; longitudinal surveys and cognitive interviews with carers to explore quality of life measurement techniques; preference elicitation studies with carers and the general public; and a re-worked economic evaluation that simultaneously considers patient and carer quality of life impacts. 

HEU researchers are principally working with carers and care professionals in dementia, stroke and long-term mental illness to address these issues. A ‘lived experience’ panel including five family carers is supporting the research project, with collaboration from experts from within University of Birmingham and externally. Ultimately the project will help extend economic evaluation methods to include family carers, which will hopefully help to ‘carer-proof’ health care funding and policy decisions. 

Researchers: Hareth Al-Janabi, Carol McLoughlin 

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Funding: NIHR career development award (Emma Frew) (2015-2019) 

Local authorities are now responsible for commissioning a wide range of public health functions and at a time of unprecedented financial pressures, are faced with making difficult resource allocation decisions.  Economic evaluation can assist decision making by expressing the costs and benefits of alternative uses of money, and whilst there is evidence of these methods being used at the national level, there is little evidence of them being used at the local organisational level.  The key aim of this NIHR funded research project is to work closely with local authority decision makers, to understand what economic evidence would be most useful to support decision making at this level, and to refine the methods accordingly. 

This will be done using childhood obesity services within the City of Birmingham as a case study.  Rising levels of obesity presents a major challenge for public health due to the complex, multi-casual, systemic nature of the problem.  The prevalence of childhood obesity in the UK has markedly increased and in Birmingham, 24% of children are overweight or obese in reception, rising to 40% when children are 10-11 years. 

In 2013, the local authority in Birmingham implemented a school based obesity strategy, a multi-faceted package made up of cooking workshops, nutritional advice, staff training as well as physical activity programmes.  Using established as well as novel methods within economic evaluation, this project will conduct an in-depth evaluation of the cost effectiveness of these services.  At the same time, a formal assessment of the usefulness of economic evaluation from the decision maker perspective will be carried out focusing on how the costs and benefits are measured and presented.  This will be done using a checklist developed with the decision makers at the outset. 

The research will determine the barriers to the uptake and use of economic evaluation for decision making within local authorities.  It will conduct an in-depth economic evaluation of Birmingham school-based childhood obesity services by applying both established and novel methods which take account of the ‘natural experiment’ setting which are common in the public health context.  It will produce a formal checklist that can be used by decision makers to feedback on the usefulness of the different component parts of economic evaluation, which can then be used to further refine methods that fit with local decision making needs. 

Researchers: Emma Frew, Katie Breheny 

Funding: Sexually Transmitted Infection Research Foundation (STIRF) and Queen Elizabeth Hospital Birmingham Charity 

STIs have important impacts on sexual and reproductive health and young people continue to experience the greatest burden of STI infection. STI screening has changed fundamentally over the last few years with the introduction of screening in a wider range of settings such as GP surgeries, community based pharmacies, and via the internet. 

This research project aims to find out how changes in screening services for sexually transmitted infections (STIs) influence young people’s choices about whether to screen and where to screen. Very few studies have been conducted which are concerned with measuring people's preferences for STI screening and testing. The research evidence which does exist has mainly been carried out with people who already use sexual health services and has not fully incorporated ethnic minority groups. This research project aims to include the views of a range of ethnic groups and those who do not currently access screening services. 

The research will involve both qualitative and quantitative techniques. Firstly, in-depth interviews and focus group discussion will be carried out with around 40 young people in community, primary care and specialist settings to identify the factors that are particularly important to young people. This will be followed by a questionnaire survey involving around 1000 young people to measure their screening preferences. 

The results will help to improve our understanding of young people’s preferences for screening in different settings. This research will contribute to the development of Birmingham’s new sexual health system and will also have national and international application. 

Researchers: Louise Jackson (PI). Co-applicants: Tracy Roberts, Hareth Al-Janabi and Jonathan Ross (University Hospitals Birmingham NHS Foundation Trust).  

• Find out more about the STEPS Study

Funding: Medical Research Council New Investigator Grant (Philip Kinghorn) (2016-2019) 

Constrained resources and growing demand result in significant pressures for the NHS and social care.  Institutions such as the National Institute for Health and Care Excellence (NICE) seek to promote an efficient use of resources in the NHS, informed in part by cost-utility analysis (CUA), a form of economic evaluation involving the maximisation of health functioning.  In 2013 NICE extended its remit to include social care.  Rather than adopting the same CUA framework as used for health, NICE have acknowledged that people using social care services and the workforce providing them have different priorities and needs. 

NICE has recommended the use of a small number of instruments to assess social care, which includes the ICECAP-A, a capability based measure for use with the general adult population.  ICECAP measures are being used across the world in studies where reliance on CUA is likely to provide a partial view of the effects of public health and social care interventions. However, when using capability measures such as ICECAP-A, the lack of a clear decision-rule and related monetary threshold limits the ability of researchers to present the results of trials in a way that is easily accessible and meaningful for decision-makers. 

Because the capability approach as an overarching conceptual framework is underspecified, researchers have to make decisions based on broad principles from Sen’s writings.  Sen advocates tackling some of the more practical steps in operationalising the capability approach (such as establishing the value of particular capabilities) via reasoned consensus, involving public discussion and democracy.  A related and potentially useful methodology from the political and philosophical literatures is public deliberation. 

Two phases of public deliberation will be used to establish: a sufficient level of capability and a monetary threshold for an improvement in wellbeing, equivalent to a year of sufficient capability. A level of sufficient capability is essentially a ‘poverty line’, below which an individual would be prioritised for state funded support.  There will be comparison of the deliberative societal value elicited from the public with (i) a deliberative societal value elicited from policy-makers; and (ii) an aggregated monetary value based upon individual (non-deliberative) values from an online survey. The resulting monetary threshold will be applied to a number of case studies from social care and public health. 

Researcher: Philip Kinghorn (PI)