06 | Population Health and Training

Respiratory diseases and infections like asthma and COPD are among the leading causes of hospital admissions and health inequalities, yet they remain too often overlooked and under-prioritised. It’s time for a new approach. One that tackles the NHS’s most pressing challenges, from reducing unscheduled care demands and easing winter pressures to addressing entrenched respiratory health inequalities.

By uniting researchers, clinicians, industry leaders, and patient voices, we are committed to delivering tangible, scalable impact that improves lives, strengthens healthcare systems, and ensures that breakthroughs reach those who need them most - not just in theory, but in practice.

Co-designing research with local stakeholders improves relevance of findings and is especially pertinent to developing and evaluating complex interventions in low- and middle-income countries when technical expertise may lie with colleagues in high-income countries, but the experience and local knowledge is embedded in a low-resource setting.  Our experience in designing the PuRe trial during the RESPIRE programme illustrates some key steps and considerations.

Approach, challenges and opportunities

PuRe, a ‘Hybrid-1’ implementation trial testing low-resource pulmonary rehabilitation for people with chronic respiratory disease, will be conducted in four diverse settings in Bangladesh, India and Malaysia.

• Community engagement work conducted in the four centres, ensured the research question reflected the context and healthcare needs of the population, optimising the relevance of research to end-users.
• The research gap was identified by systematic reviews undertaken by the team.
• Feasibility studies in the four centres explored a range of approaches to delivering pulmonary rehabilitation and confirmed practicability, acceptability and potential utility in the proposed settings.
• The core components of pulmonary rehabilitation, systematically adapted from global guidelines by local colleagues, are being defined for the trial in a detailed manual.
• On-going discussions allow/encourage adaptations that will enable delivery in the diverse settings.
• A robust process evaluation will be needed to monitor fidelity and record local adaptations 

Progress

Following UK ethical approval, local ethical applications have been submitted. Initial on-line training will be followed by a face-to-face workshop in Khulna in October. We hope to recruit our first participants before the end of the year.

Exhibitor: Hilary Pinnock

Exposure to research for undergraduates and postgraduates may help build capacity and this is particulary important in disciplines such as primary care where academics are under represented.

Aim: To optimise the opportunities offered by a programme grant to involve students and build interest and capacity in applied health service research in primary care.

Throughout the IMP2ART programme grant we have sought opportunities to align student projects with our research.

Five years into the programme of work, a total of 22 students/trainees/registrars have been involved with, and contributed to the IMP2ART research. This includes twelve undergraduates (BMedSci/BSc/medical students), two MPH students, three Academic Clinical Fellows, and an international visiting PhD student who contributed to the developmental work, process evaluation data and qualitative work with patients. They have presented eight abstracts (four at international conferences) and contributed to eight papers (three as first authors).

In addition, three PhD students (funded by CSO/THIS/UoE) have explored supporting self-management in remote reviews, the role of facilitation, and asynchronous consulting, have presented 21 abstracts, and published three first author papers.

In addition, we are supporting IMP2ART early career researchers to apply for the newly-launched NIHR ‘mid-programme development grants (PDGs)’, for example on the challenges of reducing inequity in provision of supported self-management. 

On-going challenges: Global health grants typically include a budget for capacity building, enabling teams to allocate funded time for supervising student projects, develop on-line training modules, or supervise an aligned PhD student. This is rarely explicit within UK grants, limiting the contribution specific research projects can make to capacity building. The newly launched NIHR PDGs are a welcome move towards an approach that embraces capacity building as the norm within research.

• Visit IMP2ART's website

Exhibitors: Hilary Pinnock & Catherine MacLeod

The FRESHAIR4Life study selects and adapts air quality Interventions in five diverse settings.

Tobacco-use and air pollution are two most deadly risk factors for non-communicable diseases (NCDs), accounting for nearly 30% of the world’s non-communicable disease burden. Low- and middle-income countries (LMICs) are often disproportionately affected by the disease burden and risk factor exposure. Several interventions are recommended by the WHO for reducing these risk factors (WHO ‘best buys’) based on evidence of their effectiveness and cost-effectiveness. However, they are rarely implemented in LMICs, often due to a lack of resources and capacity to implement and poor 'fit' to the country's unique socio-economic, cultural and geo-political contexts. It is important that interventions and the strategies used in their delivery are selected and adapted carefully so that they can be effectively implemented in specific contexts. 

‘Fresh Air for Life’ aims to reduce adolescents’ exposure to tobacco and air pollution in five countries (Greece/Kyrgyzstan/Pakistan/Romania/Uganda) by optimising the implementation of evidence-based interventions selected from the 'best-buy palette'.  We present the work led by our team in Usher institute to assist the country teams in selecting and adapting interventions using the contextual understanding from an earlier situational analysis and extensive stakeholder involvement locally. 

In each country, the selection and adaptation process followed the steps below:

1. Identification of barriers and facilitators (B&Fs) to target behaviours from each country’s situational analysis and classification into individual, social and community, and context level.
2. A workshop with the country team to select the risk factors of concern, the behaviours to be targeted, relevant population and settings, and to generate a shortlist of interventions from the FA4Life palette along with potential implementation strategies.
3. A stakeholder workshop to elicit wide ranging views on intervention need, importance, likely reach and benefit, feasibility, and adaptation requirements, using qualitative/quantitative techniques.
4. Informed by the stakeholders’ input, country teams finalize selection of interventions and implementation strategies.

Exhibitor: Hilary Pinnock

UK asthma outcomes for children and adults are poor. Patients often miss review appointments and/or take their asthma preventer treatment infrequently. Little research has been published exploring the reasons of poor engagement with asthma services.

The overarching aim of the PACE programme is to improve asthma outcomes by designing and evaluating services that meet patients’ needs and preferences.

The study objectives were developed with patients.

WP1: Rapid realist review to derive the context and mechanisms that could improve engaging and accessible asthma care. We will establish patient and professional Expert Panels to support the iterative process.

WP2: Using routine primary care data from Clinical Practice Research Datalink Aurum linked with deprivation status and Hospital Episode Statistics (in England), we will describe factors associated with evidence of poor engagement with asthma services. Iteratively with the qualitative work, we will identify ‘markers’ that reflect engagement with healthcare services.

WP3a: From three demographically diverse UK areas (Leicester, Scottish Highlands, Swansea), we will recruit underserved and hard-to-reach adults, young people and parents of children with asthma. Interviews will explore barriers/enablers to engaging with asthma care.

WP3b: We will explore the perceptions of primary/secondary/tertiary healthcare professionals, and healthcare manager/commissioners on the challenges of providing patient-centred engaging asthma services.

WP4: In discussion with patient and professional panels, we will triangulate the findings from PDGs-1/2/3 to identify key components of an asthma care service that encourages engagement and improves accessibility.

The protocol has been submitted to the REC, study start date 1st May 2024 

On-going challenges:1. Underserved populations may be hard to engage in research.2. Small ethnic minorities may be hard to reach due to language barriers.3. Health care practitioners may be reluctant to explore reasons why services are not engaging.

Exhibitor: Hilary Pinnock

Launched in March 2023, the ERS CRC CONNECT aims to promote sustainable, equitable, connected implementation of digital healthcare in routine clinical respiratory practice within European/global healthcare systems. With 95 colleagues from 22 countries, a first objective was to build a global network of members willing to contribute to proposed projects.

After a video call in June, CONNECT recruited widely in August via the ERS Newsletter and Assembly emails. Further publicity/events were a meeting at the Congress in September, an ERJ editorial in October and a Monograph on Digital Respiratory Healthcare in December 2023.

Initial recruitment via Assemblies recruited 805 people from 79 countries, with a steady increase during the year. By February 2024 the network was 932 people from 83 countries.

Exhibitor: Hilary Pinnock

When we build machine learning (ML) models for healthcare, we usually judge how good they are using stats like accuracy or sensitivity. But here is the problem: just because a model looks great on paper does not mean it will work well in a real clinic. Hospitals and clinics deal with real-world limits (there might not be enough doctors, nurses, or appointment slots to follow up on every prediction a model makes).

That is why we created a new, practical way to test and use ML models that takes these everyday challenges into account. Instead of just asking, “How accurate is this model?” we ask, “Can we actually use it here, given our resources?” Our approach helps doctors, researchers, and healthcare managers see how a model would perform in their specific setting and adjust how they use it based on what’s actually possible.

We tried this out with an asthma prediction model in three different UK clinics. Each clinic had different numbers of patients and different levels of appointment availability. We will show how tweaking the model’s decision settings (model's threshold) could help each clinic use the same model in a way that fits their unique situation. It’s all about balancing risk with what the clinic can realistically handle.

Exhibitor: Arif Budiarto

This display will showcase findings from recent research on preventing gambling and nicotine-related harm among children and young people. It combines evidence from two separate projects in which we conducted extensive consultations with school staff, students, parents/carers, and stakeholders from policy and practice. Our aim is to deepen our understanding of the risk factors and develop school-based interventions focusing on peer support and social networks.

Exhibitor: Fiona Dobbie

This poster presents the Cancer in Primary Care Group, based in the Centre for Population Health Sciences. The poster showcases the varied projects that are ongoing within the group as well as some of the recently completed studies.

Our projects cover: Lung cancer screening; cervical cancer screening; Cancer and multimorbidity; 2nd primary cancers; pancreatic cancer; HPV vaccine uptake; patients who are lost to follow-up after abnormal results; breast cancer survivorship; and the ethnography of cervical cancer survivorship.

Our work highlights issues of equity in service provision and healthcare access including rurality; ethnicity and people with experience of homelessness, transactional sex, prison, and addiction. In addition to our work in Scotland and the UK, we have ongoing and recent projects in Kenya, Malawi, Pakistan, and Botswana. The poster illustrates the impact our projects have had and introduces the staff and students involved.

Exhibitors: Mia Closs, Christine Campbell, Debbie Cavers and Laia Ventura-Garcia

This poster will describe highlights from thirteen years of partnership working with many colleagues in Malawi and Scotland and alongside the Ministry of Health to strengthen health care for women in rural areas of Malawi, specifically through provision of cervical cancer screening.

Malawi has very high rates of cervical cancer, and the highest global mortality rate. The poster will describe (through a mix of text, figures and pictures) some key features of the programme including:

• implementing screening provision in under-served rural areas, reaching over 100,000 women;
• empowerment of women through development of accessible education and awareness materials;
• increasing clinical skills of nurse providers through iterative and experiential training;
• strengthening health facilities through refurbishment and equipping of screening clinics;
• adoption of an inclusion health perspective, ensuring vulnerable and excluded women have the opportunity to access the service; and
• supporting development of national Safeguarding and mentoring policies and practice.

Exhibitor: Christine Campbell

This poster will offers an overview of the study, its aims, and a brief summary of the work packages, along with how these may influence the future of the national bowel screening programme.

How can we best use digital and data to transform the delivery of health and social care and achieve better outcomes for the people of Scotland? This new leadership programme is a key part of the answer, as outlined in Scotland’s Digital Health and Care Strategy and the Care in the Digital Age Delivery Plan.

Funded by the Scottish Government and COSLA, and designed and delivered by The University of Edinburgh in collaboration with NHS Education Scotland, the aim is to equip a new generation of leaders with the knowledge, skills and connections to drive forward transformation across health, social care and housing services.

The programme draws on expertise within the Usher Institute and our partners to deliver courses at Postgraduate Certificate (PGCert), Postraduate Diploma (PGDip) and Masters (MSc) level tailored to the needs of current and future digital leaders. With the first cohort about to start their final year of study, evidence of impact is now emerging. Come and view the poster and chat to our programme team to gain an insight into this innovative and collaborative learning journey and how it is making a difference to the design and delivery of health and social care across the country.

Exhibitor: Elaine Mowat

In Edinburgh, we are proud to be pioneers in the development of community-based primary health care, starting with the creation of the Royal Public Dispensary of Edinburgh in 1783, which ultimately led to the first Department of General Practice, and in 1963, the first Chair of General Practice in the world.

The Master of Family Medicine builds upon this strong tradition, providing an innovative online distance learning programme for international students who may otherwise find it hard to access high-quality postgraduate education in Family Medicine. Our programme directly delivers to the World Health Organisation's goals in strengthening Primary Health Care towards the achievement of Universal Health Coverage (as included in Sustainable Development Goal 3).

We aim to empower and equip individuals to provide and promote compassionate, values-based and academic family medicine for the benefit of communities around the world.  Look out for the Master of Family Medicine programme pop-up banner.  Programme team members will be available to chat, answer questions and share our passion for this work.

Exhibitors: Robin Ramsay and Lin Watson

Our postgraduate programmes aim to transform health in society by working with people, populations and data. We offer lifelong learning opportunities in epidemiology, public health, family medicine, data science for health and social care and clinical trials to international students from a wide variety of sectors.

Our posters provide an overview of our teaching offerings, our highlights, a map of where our graduates are from over the last four years, and beautiful photos of our students and staff.

Exhibitor: Michelle Evans