An Exploration of Rural–Urban Residence on Self-Reported Health Status with UK Cancer Survivors Following Treatment: A Brief Report

Objective: To explore the effect of rural–urban residence on the self-reported health status of UK cancer survivors following primary treatment. Design: A post-positivist approach utilizing a cross-sectional survey that collected data on demographics, postcode and self-reported health status. Methods: An independent samples t test was used to detect differences in health status between rural and urban respondents. Pearson’s χ2 was used to control for confounding variables and a multivariate analysis was conducted using Stepwise linear regression. Setting: East Midlands of England. Participants: Adult cancer survivors who had undergone primary treatment in the last five years. Participants were excluded if they had recurrence or metastatic spread, started active oncology treatment in the last twelve months, and/or were in receipt of palliative or end-of-life care. Main outcome: Residence was measured using the UK Office for National Statistics (ONS) RUC2011 Rural–Urban Classifications and Health Status via the UK ONS self-reported health status measure. Ethics: The study was reviewed and approved (Ref: 17/WS/0054) by an NHS Research Ethics Committee and the Health Research Authority (HRA) prior to recruitment and data collection taking place. Results: 227 respondents returned a questionnaire (response rate 27%). Forty-five percent (n = 103) were resident in a rural area and fifty-three percent (n = 120) in an urban area. Rural (4.11 ± 0.85) respondents had significantly (p < 0.001) higher self-reported health statuses compared to urban (3.65 ± 0.93) respondents (MD 0.47; 95% CI 0.23, 0.70). Conclusion: It is hoped that the results will stimulate further work in this area and that researchers will be encouraged to collect data on rural–urban residency where appropriate.


University of Lincoln, College of Social Science Research

David Nelson, University of Lincoln, Linvoln International Institute for Rural Health and Macmillan Cancer Support

Ian McGonagle, University of Lincoln, School of Health and Social Care

Christine Jackson, University of Lincoln, School of Health and Social Care

Ros Kane, University of Lincoln, School of Health and Social Care


 

An overview of research and scholarly activity – current studies and initiatives from the School of Health and Social Care

Mental Health, Health and Social Care Research Group (MH2aSC), Prof Ros Kane, Professor of Nursing and Public Health and Director of Research: Mental Health, Health and Social Care Research Group

 MH2aSC has evolved to encompass a broad range of research activity that involves social care and adult health, particularly cancer care through a partnership with Macmillan. The primary focus of this research group is to provide expert resources to government policy strategists, health, social, and education economies to create and drive innovation in health and social care settings. Key themes of our research include mental health, health and social care integration, valuesbased practice, workforce development, and service innovation and improvement.

Healthy Ageing Research Group (HARG), Prof Mo Ray, Professor of Health and Social Care: Healthy Ageing Research Group

 The Healthy Ageing Research Group (HARG) is allied with the Lincoln International Institute for Rural Health (LIIRH). Key areas of interest include experiences of ageing; healthy ageing; preventative and early intervention strategies in quality of later life through improved community and statutory provisions, including integration. Research in our group aims to support the challenges faced by an increasing global life expectancy and ageing populations. Our research aims to contribute to developing strategies which maximise the benefits of an ageing society as well as considering strategies to address the challenges.

Community and Health Research Unit (CaHRU), Prof Niro Siriwardena, Professor of Primary & Pre-Hospital Health Care and Director, Community and Health Research Unit

The Community and Health Research Unit (CaHRU) is a University recognised research centre. CaHRU’s mission is to increase people’s health and well-being by improving the quality,
performance, and systems of care across the health, social, and third sector care services through our world-leading interdisciplinary research. Our work promotes high-quality care to enhance the experience, safety, effectiveness, efficiency and equity of healthcare by examining and transforming the performance and function of health and social care practice, organisation and delivery.

Lincoln Clinical Trials Unit (LinCTU), Prof Graham Law, Professor in Medical Statistics and Co-Director of Lincoln Clinical Trials Unit

The Lincoln Clinical Trials Unit (LinCTU) was setup in 2020 at the University of Lincoln by the Community & Health Research Unit to support clinical trials. LinCTU is located in the newly established University of Lincoln Medical School and engages directly with the Medical School, the Lincoln International Institute for Rural Health(LIIRH), academic colleagues and the wider NHS community.

The international vision is to develop an identity which allows us to attract the type of trials and
studies where we have particular strengths and expertise.


Tackling inequities in health and wellbeing with Lincolnshire’s east coast communities

The health and well-being of coastal communities in England was highlighted as an important and enduring challenge in the Chief Medical Officers 2021 annual report. Like rural communities, coastal communities exhibit significant variation in historic, physical, economic and social makeup. It is these characteristics of coastal places that can make them vulnerable to changes in socio-demographics and the broader economic and fiscal policy climate. Some coastal communities have experienced major shifts in economies and industries resulting in damaging social change while others have been insulated by large core populations or have been able to diversify and adapt. Lincolnshire’s coastal communities, particularly the towns of Mablethorpe and Skegness in the district of East Lindsey, are amongst the most deprived neighbourhoods in the country and its citizens experience high levels of ill health and social disadvantage. Conversely people who live there have good access to green and blue spaces and there are examples of local innovations to support the wellbeing of local people.

The Lincoln International Institute for Rural Health (LIIRH) has established partnerships with local health, social care and third sector organisations to develop 1) a shared understanding of the placebased drivers of health and wellbeing and 2) mobilise networks and local resources to develop solutions that address community priorities. This presentation will briefly discuss our mixed-methods approach to this work and highlight the critical importance of establishing genuine local partnerships.


Prof. Mark Gussy, Lincoln International Institute for Rural Health, University of Lincoln
Dr David Nelson, Lincoln International Institute for Rural Health, University of Lincoln
Dr Maxime Inghels, Lincoln International Institute for Rural Health, University of Lincoln
Dr Simon Lowe, First Coastal Primary Care Network
Kim Barr, Lincolnshire Community Health Services NHS Trust
Dr Joanna Blackwell, School of Health and Social Care, University of Lincoln
Roxanne Warrick, East Lindsey District Council
Janet Farr, Community Learning in Partnership – CLIP

LISTEN and learn: the long and short of COVID-19

The COVID-19 pandemic has led to rapid realignment of research priorities towards the shortterm effects of Covid, the national response to the pandemic and long Covid. The Community and Health Research Unit (CaHRU) has been working with collaborators at the University of Lincoln and other institutions on a number of pandemic studies including a major study of long Covid, the LISTEN (Long Covid Personalised Self-managemenT support- co-design and EvaluatioN) study with Kingston, Cardiff, Swansea Universities and Kings College London. The study aims to work in partnership with individuals living with long Covid to design and evaluate a package of self-management support personalised to their needs. The presentation will discuss the LISTEN study and also touch on other pandemic studies in progress or completed.


Prof Niro Siriwardena, School of Health and Social Care, University of Lincoln
Prof Graham Law, School of Health and Social Care, University of Lincoln
Ms Despina Laparidou, School of Health and Social Care, University of Lincoln
Members of the Community and Health Research Unit (CaHRU)


 

Rural Health in a changing world: An overview of the Lincoln International Institute for Rural Health

The Lincoln International Institute for Rural Health (LIIRH) conducts interdisciplinary research to address the most important health issues facing rural communities locally, nationally, and internationally. The institute aims to ‘shine a light’ on the unacceptable health inequities that exist across the rural-urban divide and to find innovative ways of reducing or ideally eliminating that inequality. The institute brings together world-leading specialists, conducting research across a range of rural health related concerns, ranging from infectious disease epidemiology, HIV, oral health, and emergent response analysis through to sustainable remote health care delivery solutions, metagovernance approaches, and m-health technological innovation. LIIRH is supported by generous grants from the Wolfson Foundation, and the Greater Lincolnshire Local Enterprise Partnership. Our research benefits from strong links with members of CAHRU, the School of Psychology, the School of Health and Social Care, the School of Computer Science and research groups within Life Sciences, particularly the Diabetes Research Group. Nationally, the institute has strong links to researchers at University College London and is a key partner of the National Centre for Rural Health and Care. LIIRH’s strong global health portfolio of research is supported by a network of academic partners located in Germany, Canada, Burkina Faso, Tanzania, South Africa, Malaysia, Bangladesh, and Australia.


Prof Frank Tanser, Global Professor in Rural Health and Social Care

 

Recovery of Health and Wellbeing in Rural Cancer Survivors Following Primary Treatment: Analysis of UK Qualitative Interview Data

Purpose: Rural cancer survivors have poorer experiences and health outcomes compared to their urban counterparts. There is limited research on the post-treatment experiences of UK cancer survivors residing in rural areas. This study aimed to provide an understanding of the specific challenges and opportunities faced by rural cancer survivors and to provide insight into how rurality influences experiences post-primary treatment, ultimately to inform service provision. Methods: A secondary analysis of in-depth interview transcripts (n = 16) from a wider study on self-management in cancer survivors was conducted. An adapted version of Foster and Fenlon’s recovery of health and wellbeing in cancer survivorship framework informed the data coding. Results: Health and wellbeing were interrupted by a variety of problem incidents, and the subsequent steps to recovery were influenced by pre-existing, personal, environmental, and healthcare factors. A prominent theme was support, both from local communities and family as well as from healthcare professionals, with many survivors feeling that their rural setting had a positive influence on their health and wellbeing. Close relationships with local GPs were seen as fundamental to supporting recovery. Access to healthcare was frequently mentioned as a challenge with an emphasis on lengthy travel times and limited bespoke support in rural areas. Conclusions: This study is novel in that it applied a well-established theoretical framework to a rich qualitative dataset on the lived experiences of rural cancer survivors. Rural residency influenced recovery from cancer both positively and negatively. Implications for Cancer Survivors: Future practitioners and policy makers should consider working with local communities to tailor interventions to the specific characteristics of the rural environment.


University of Lincoln, College of Social Science Research

Florence Graham, Universities of Nottingham and Lincoln, Lincoln Medical School

Ros Kane, University of Lincoln, School of Health and Social Care

Mark Gussy, University of Lincoln, Lincoln International Institute for Rural Health

David Nelson, University of Lincoln, Lincoln International Institute for Rural Health and Macmillan Cancer Support

Ethnicity and risk for SARS-CoV-2 infection among the healthcare workforce: Results of a retrospective cohort study in rural United Kingdom

The reason why Black and South Asian healthcare workers are at a higher risk for SARS-CoV-2 infection remain unclear. We aimed to quantify the risk for SARS-CoV-2 infection among healthcare staff who belong to the ethnic minority and elucidate pathways of infection.

A one-year follow-up retrospective cohort study has been conducted among National Health Service employees who were working at 123 facilities in Lincolnshire, UK.

Overall, 13,366 professionals were included. SARS-CoV-2 incidence per person-year was 5.2% (95% CI: 3.6–7.6%) during the first COVID-19 wave (January–August 2020) and 17.2% (13.5–22.0%) during the second wave (September 2020–February 2021). Compared with White staff, Black and South Asian employees were at higher risk for SARS-CoV-2 infection during both the first wave (hazard ratio, HR 1.58 [0.91–2.75] and 1.69 [1.07–2.66], respectively) and the second wave (HR 2.09 [1.57–2.76] and 1.46 [1.24–1.71]). Higher risk for SARS-CoV-2 infection persisted even after controlling for age, sex, pay grade, residence environment, type of work, and time exposure at work. Higher adjusted risk for SARS-CoV-2 infection were also found among lower-paid health professionals.

Black and South Asian health workers continue to be at higher risk for SARS-CoV-2 infection than their White counterparts. Urgent interventions are required to reduce SARS-CoV-2 infection in these ethnic groups.


University of Lincoln, College of Social Science Research

Maxime Inghels, University of Lincoln, Lincoln International Institute for Rural Health
Ros Kane, University of Lincoln, School of Health and Social Care
Priya Lall, University of Lincoln, Lincoln International Institute for Rural Health
David Nelson, University of Lincoln, Lincoln International Institute for Rural Health
Agnes Nanyonjo, University of Lincoln, Lincoln International Institute for Rural Health
Zahid Asghar, University of Lincoln, School of Health and Social Care
Derek Ward, Lincolnshire County Council
Tracy McCranor, Lincolnshire Partnership NHS Foundation Trust
Tony Kavanagh, Lincolnshire Partnership NHS Foundation Trust
Todd Hogue, University of Lincoln, School of Psychology
Jaspreet Phull, Lincolnshire Partnership NHS Foundation Trust
Frank Tanser, University of Lincoln, Lincoln International Institute for Rural Health


 

Impact of the COVID-19 pandemic on public attitudes to cardiopulmonary resuscitation and publicly accessible defibrillator use in the UK

Members of the public have an essential role to play in the out-of-hospital cardiac arrest (OHCA) chain of survival by acting to call Emergency Medical Services (EMS), start cardiopulmonary resuscitation (CPR) and use a Public Access Defibrillator (PAD) to help save lives.1.2.3.4.5. In recent years, there has been a rise in bystander CPR rates across many worldwide EMS systems (Denmark,6.7. United States,8 Japan,9 Canada,10 South Korea.11) In England, the percentage of people sustaining an OHCA that was either unwitnessed or witnessed by a bystander and who received bystander CPR has risen from 55.2% in 2014 to 69.8% in 2019.12.13. In Scotland, this increased from 39.4% in 2011–2012 to 64.0% in 2018–2019.14

In the UK, as in many other countries, there has been a parallel rise in the proportion of people reporting they have trained in resuscitation skills. In 2014, 47% of people reported formal CPR skills training and by 2019 it was 62.2%.15.16. National initiatives are associated with increases in the numbers of people trained, which in turn is associated with increased bystander CPR rates and improved survival outcomes.6.17.

The COVID-19 pandemic appears to have increased the incidence of OHCA cases.18.19.20.21. In some places bystander CPR rates also appear to be reduced.18.19. National and international organisations have developed revised guidelines for performing CPR as safely as possible on OHCA patients during the pandemic to reduce the risk of the rescuer catching COVID-19 during a resuscitation attempt (such as favouring compression-only CPR with a cloth over the patients mouth rather than CPR with rescue breaths).22.23. However, little is known about the public’s knowledge of this guidance, how their attitudes to performing different resuscitation actions may have changed and reasons for any reluctance to do so during the pandemic. Public health messaging on social distancing may have contributed to increased fear about helping OHCA patients.24

Research to understand whether concerns about the COVID-19 pandemic have adversely affected gains in bystander CPR rates, including any changes in public attitudes to performing CPR is needed. It will inform stakeholders’ strategies to support recovery in the public’s confidence and likelihood of helping people who sustain an OHCA.

We conducted 4 short surveys of adults during the first wave of the pandemic in the UK (April – July 2020) and a longer survey in November 2020 to assess the UK public’s knowledge of revised resuscitation guidance and the impact of the COVID-19 pandemic on their attitudes to CPR and defibrillator use.


University of Lincoln, College of Social Science Research

Claire A. Hawkes, University of Warwick, Warwick Medical School

Inès Kander, University of Warwick, Warwick Medical School

Abraham Contreras, University of Warwick, Warwick Medical School

Chen Ji, University of Warwick, Warwick Medical School

Terry P. Brown, University of Warwick, Warwick Medical School

Scott Booth, University of Warwick, Warwick Medical School

A. Niroshan Siriwardena, University of Lincoln, School of Health and Social Care

Rachael T. Fothergill, London Ambulance Service NHS Trust

Julia Williams, South East Coast Ambulance Service NHS Foundation Trust

Nigel Rees, Swansea University, Institute of Life Science

Estelle Stephenson, British Heart Foundation

Gavin D. Perkins, University of Warwick, Warwick Medical School and University Hospitals Birmingham, Heartlands Hospital

The effectiveness of primary care streaming in emergency departments on decision-making and patient flow and safety – A realist evaluation

Primary care streaming was implemented in UK Emergency Departments (EDs) to manage an increasing demand for urgent care. We aimed to explore its effectiveness in EDs with different primary care models and identify contexts and mechanisms that influenced outcomes: streaming patients to the most appropriate clinician or service, ED flow and patient safety.

We observed streaming and interviewed ED and primary care staff during case study visits to 10 EDs in England. We used realist methodology, synthesising a middle-range theory with our qualitative data to refine and create a set of theories that explain relationships between contexts, mechanisms and outcomes.

Mechanisms contributing to the effectiveness of primary care streaming were: quality of decision-making, patient flow, redeploying staff, managing patients across streams, the implementation of governance protocols, guidance, training, service evaluation and quality improvement efforts. Experienced nurses and good teamworking and strategic and operational management were key contextual factors.


Michelle Edwards, Cardiff University, Division of Population Medicine

Alison Cooper, Cardiff University, Division of Population Medicine

Thomas Hughes, John Radcliffe Hospital, Emergency Department

Freya Davies, Cardiff University, Division of Population Medicine

Delyth Price, Cardiff University, Division of Population Medicine

Pippa Anderson, Swansea University, Swansea Centre for Health Economics

Bridie Evans, Swansea University, Swansea University Medical School

Andrew Carson-Stevens, Cardiff University, Division of Population Medicine

Jeremy Dale, Warwick University, Academic Primary Care

Peter Hibbert, Macquarie University, Centre for Healthcare Resilience and Implementation Science

Barbara Harrington, Cardiff University, Division of Population Medicine

Julie Hepburn, Cardiff University, Division of Population Medicine

Aloysius Niroshan Siriwardena, University of Lincoln, Community and Health Research Unit

Helen Snooks, Swansea University, Swansea University Medical School

Adrian Edwards, Cardiff University, Division of Population Medicine