The purpose of this study is to evaluate UCLP-Primrose and its implementation across several general practices in and around London, Bradford, and other sites subject to further rollout.
The objective of this evaluation is to explore the factors influencing the implementation and continuation of the UCLP-Primrose intervention based on service users and providers' experiences over a period of one year. Individual interviews will be conducted with service users who receive UCLP-Primrose to understand their experiences of the service and how it was delivered. Interviews with provider members (including general practitioners, nurses, peer coaches, health care assistants, and managers) will explore their experiences of providing and implementing UCLP-Primrose.
This study will support our understanding of the translation of a complex intervention to practice and inform decisions to adapt and implement the service.
Watch Professor David Osborn talk about why research in this area is important and how it is being used to improve the care for people with severe mental illness here: Improving physical healthcare for people with severe mental illness
Patient and Public Involvement
For the current patient and public involvement (PPI) we are working with Diamonds Voice and the Yorkshire Quality and Safety Research Group (quality and safety patient panel) which is part of the Bradford Institute for Healthcare Research.
Valuable and meaningful impact has already been provided, such as the need to further consider the accessibility and understandability of the project and the research, to review/define terminology in the patient facing research materials and use more creative methods when disseminating information and findings from our work.
A plan for more consistent and meaningful PPI through the project is being developed across the four multiple long-term condition research projects within the funding theme, this will be in the form of a shared public contributors' group with representatives from each project (two members of Diamonds Voice represent Primrose). The role of the public contributors will be mutually beneficial and co-developed, whilst ensuring time for feedback on governance and evaluation of the PPI in the projects.
Equality Impact Assessment
We completed an Equality Impact Assessment (EqIA) to ensure that research policies, practices, events, and decisions are fair, and barriers to participation of protected groups have been considered in the strategic and operational activities. This toolkit [https://arc-em.nihr.ac.uk/clahrcs-store/equality-impact-assessment-eqia-toolkit] is designed to encourage organisations to develop their own EqIA process, materials and information, using whatever is included in the toolkit as necessary. The Centre for Ethnic Health Research is keen to promote the template as a guide but also through use of the individual documents – tailored or otherwise.
Brief summaries of some of the equality related concerns highlighted in previous research, how our current research fits in with equality, and our action plan are provided below.
Concerns highlighted in previous research: Previous literature has demonstrated that people with SMIs face inequalities in health, and access to healthcare (Ali et al., 2020). The prevalence of SMIs across the implementation sites is higher than the average across England (Barker 2021), and there is also a higher prevalence of SMI in areas with high levels of deprivation (Barker 2019). In terms of the relationship between SMIs and physical health, literature suggests lower life expectancy for people with SMIs, increased risk for cardiovascular diseases (CVD) (Keenan et al., 2020; Osborn et al., 2016), and inadequate monitoring and management of physical health (Holt et al., 2010; Mitchell et al., 2012). Migrant and ethnic minority communities have a higher prevalence of SMI and research suggests the need for future interventions to monitor ethnicity to reduce health inequalities (Cantor-Graae & Selten, 2005; Kirkbride et al., 2012; Tortelli et al., 2015). Research studies have shown that sex can have an impact on factors such as symptom severity, side effects and stigmatisation, and that there may be need for sex specific clinical guidelines when considering SMIs (Seeman 2021; Fernando et al. 2020). Higher SMI prevalence has also been reported in LGBTQ+ populations (Chakraborty et al. 2011) along with lower levels of satisfaction with services (Kidd et al., 2016) and higher levels of stigma and discrimination (Smith et al., 2018).
UCLP-Primrose research and equality: The study is uniquely positioned to address the gap in research around the health inequalities faced by people with SMIs. The research design engages with the implementation leads at sites by providing them the opportunity to discuss barriers which may have a positive impact on quality. The results from the current implementation will be used to inform future scale up of the intervention and it is expected that some concerns related to inequalities will be identified and ameliorated in the process. The quantitative data collected as part of this research may help identify characteristics of service users who do not engage with the service and any inequalities can be identified and overcome.
Actions taken to support equality: The research team discussed the increased burden of taking part in the research for particular groups and concluded that this burden is considered balanced against the research benefits. Patient and Public Involvement (PPI) was integrated throughout the work to improve appropriateness and value of the research, limit the burden, and increase positive impact across equality characteristics. The researchers will be constantly reflective about the mental health and research participation burden for healthcare professionals. The researchers will remain in regular contact with the GPs/health care professionals participating in the research. This could add stress onto the healthcare professionals’ schedules. To ease some of this stress, they will be asked to specify a time and mode of their choice to connect with the researchers.
This research funded by the National Institute for Health Research ARC North Thames and ARC East Midlands.