Exploring the health and sociodemographic characteristics of people seeking advice with claiming universal credit: a cross-sectional analysis of UK citizens advice data, 2017-2021.

BACKGROUND: The UK Department for Work and Pensions (DWP) administers Universal Credit (UC) - the main UK benefit for people in- and out-of-work. UC is being rolled out nationally from 2013 to 2024. Citizens Advice (CA) is an independent charity that provides advice and support to people making a claim for UC. The aim of this study is to understand who is seeking advice from CA when making a UC claim and how the types of people seeking advice are changing as the rollout of UC continues. METHODS: Co-developed with Citizens Advice Newcastle and Citizens Advice Northumberland we performed longitudinal analysis of national data from Citizens Advice for England and Wales on the health (mental health and limiting long term conditions) and socio-demographic of 1,003,411 observations for people seeking advice with claiming UC over four financial years (2017/18 to 2020/21). We summarised population characteristics and estimated the differences between the four financial years using population-weighted t-tests. Findings were discussed with three people with lived experience of seeking advice to claim UC to help frame our interpretation and policy recommendations. RESULTS: When comparing 2017/18 to 2018/19, there was a significantly higher proportion of people with limiting long term conditions seeking advice with claiming UC than those without (+ 2.40%, 95%CI: 1.31-3.50%). However, as the rollout continued between 2018/29 and 2019/20 (-6.75%, 95%CI: -9.62%--3.88%) and between 2019/20 and 2020/21 (-2.09%, 95%CI: -2.54%--1.64%), there were significantly higher proportions of those without a limiting long term condition seeking advice than with. When comparing 2018/19 to 2019/20 and 2019/20 to 2020/21, there was a significant increase in the proportion of self-employed compared to unemployed people seeking advice with claiming UC (5.64%, 95%CI: 3.79-7.49%) and (2.26%, 95%CI: 1.29-3.23%) respectively. CONCLUSION: As the rollout for UC continues, it is important to understand how changes in eligibility for UC may impact on those who need help with applying for UC. Ensuring that the advice process and application process is responsive to a range of people with different needs can help to reduce the likelihood that the process of claiming UC will exacerbate health inequalities.

Understanding the life experiences of people with multiple complex needs: peer research in a health needs assessment.

BACKGROUND: Multiple complex needs (MCN) describe a population experiencing a combination of homelessness, substance use, offending and/or mental ill-health. Using peer researchers, this study aimed to explore the perspectives of individuals with lived experience of MCN with regards to (i) issues leading to MCN and (ii) key intervention opportunities. METHODS: As part of a health needs assessment in Gateshead (North East England), trained peer researchers interviewed 27 adults (aged ≥18 years) with experience of MCN, identified using purposive sampling methods. Peer researchers designed a topic guide for interviews which were audio recorded and thematically analyzed. RESULTS: Interviewees reported adverse childhood experiences leading to MCN including abuse, bereavement, parental imprisonment, family break-up and inadequate support. Mental ill-health, substance use, poverty, early experiences of unstable housing and acute homelessness were identified as major precedents for adulthood experiences of MCN. Between 16 and 20 years, access to housing, social and mental health support was perceived as having the potential to prevent circumstances worsening. Individuals perceived removing barriers to mental health, housing and welfare and financial supports could help. CONCLUSIONS: This study highlights the perceived role austerity, adverse childhood events and current service provision have in current and future experiences of MCN. Individuals expressed a need for future interventions and support to be judgement free and provided by workers who are educated about MCN and related adversity. Involving peer researchers and individuals with experience of MCN in future research and service provision could ensure appropriate measures and supports are put in place.

Co-production in local government: process, codification and capacity building of new knowledge in collective reflection spaces. Workshops findings from a UK mixed methods study.

BACKGROUND: Co-production of research evidence is valued by local government to improve effective decision-making about public services in times of austerity. However, underlying structural issues of power (so-called 'dark shadows of co-production') challenge this ambition with limited evidence on how to embed research use sustainably. In this paper we reflect on mechanisms for increasing co-production in local government. METHODS: This paper presents findings from a Health Foundation funded research project that explored how a culture of evidence use to improve population health could be embedded in UK local government. Five linked work packages were undertaken using mixed methods. In this paper, we report the views of UK local authority staff who participated in four workshops (n = 54), informed by a rapid literature review and an online scoping survey. RESULTS: We identified five themes that facilitate public health evidence use in local government: (1) new governance arrangements to integrate national and local policies, (2) codifying research evidence through local system-wide approaches and (3) ongoing evaluation of programmes, and (4) overcoming political and cultural barriers by increasing absorptive capacity of Local Authorities to embed co-produced knowledge in their cognitive structures. This requires adaptive governance through relationship building between academic researchers and Local Authority staff and shared understanding of fragmented local policy making, which are supported by (5) collective spaces for reflection within local government. CONCLUSIONS: Creating collective spaces for reflection in between government departments allows for iterative, interactive processes of co-production with external partners that support emergence of new governance structures to socially action the co-produced knowledge in context and build capacity for sustained evidence use.

Localising and tailoring research evidence helps public health decision making.

BACKGROUND: Published research evidence is typically not readily applicable to practice but needs to be actively mobilised. OBJECTIVES: This paper explores the mechanisms used by information professionals with a specific knowledge mobilisation role to make evidence useful for local decision making and planning of public health interventions. METHODS: Data are drawn from a NIHR project that studied how, when, where and by whom published research evidence is used in commissioning and planning across two sites (one in England and one in Scotland). Data included 11 in-depth interviews with information professionals, observations at meetings and documentary analysis. RESULTS: Published research evidence is made fit for local commissioning and planning purposes by information professionals through two mechanisms. They localise evidence (relate evidence to local context and needs) and tailor it (present actionable messages). DISCUSSION: Knowledge mobilisation roles of information professionals are not recognised and researched. Information professionals contribute to the 'inform' and 'relational' functions of knowledge mobilisation; however, they are less involved in improving the institutional environment for sustainable knowledge sharing. CONCLUSION: Information professionals are instrumental in shaping what evidence enters local decision making processes. Identifying and supporting knowledge mobilisation roles within health libraries should be the focus of future research and training.

"You're sort of building community in a bigger way": exploring the potential of creative, nature-based activities to facilitate community connections.

BACKGROUND: This paper explores the opportunities that creative, nature-based activities offer for mobilising social connections via community-centred approaches to improve individual and collective wellbeing. METHODS: The study involved ethnographic methods and data was gathered from a nature for wellbeing project implemented in a rural village in North East England. RESULTS: The findings indicate creative, nature-based activities delivered within an environment marked by an ethic of care and kindness enabled the project to engage with participants at individual and collective levels simultaneously, which enhanced the project's ability to mobilise community skills and assets, and affect connectedness, equity and control within social groups facing significant disadvantages. CONCLUSION: Creative, nature-based activities, delivered with an ethic of care, present an opportunity to recognise and engage complex and, at times, opposing undercurrents inherent in social connections between individuals and social groups.

Involving young people in health service delivery.

Young people are entitled to be involved in decisions about their health care, yet many are not engaged in any meaningful way. This article outlines the approach taken by Newcastle Upon Tyne Hospitals NHS Foundation Trust and partners to implement quality criteria for young people-friendly health services. It describes the opportunities and challenges of actively involving young people in their care. Several approaches that have been applied in diverse healthcare settings are illustrated. Recommendations on how to engage young people are provided from the authors' experiences.

Leading co-production in five UK collaborative research partnerships (2008-2018): responses to four tensions from senior leaders using auto-ethnography.

BACKGROUND: Despite growing enthusiasm for co-production in healthcare services and research, research on co-production practices is lacking. Multiple frameworks, guidelines and principles are available but little empirical research is conducted on 'how to do' co-production of research to improve healthcare services. This paper brings together insights from UK-based collaborative research partnerships on leading co-production. Its aim is to inform practical guidance for new partnerships planning to facilitate the co-production of applied health research in the future. METHODS: Using an auto-ethnographic approach, experiential evidence was elicited through collective sense making from recorded conversations between the research team and senior leaders of five UK-based collaborative research partnerships. This approach applies a cultural analysis and interpretation of the leaders' behaviours, thoughts and experiences of co-production taking place in 2008-2018 and involving academics, health practitioners, policy makers and representatives of third sector organisations. RESULTS: The findings highlight a variety of practices across CLAHRCs, whereby the intersection between the senior leaders' vision and local organisational context in which co-production occurs largely determines the nature of co-production process and outcomes. We identified four tensions in doing co-production: (1) idealistic, tokenistic vs realistic narratives, (2) power differences and (lack of) reciprocity, (3) excluding vs including language and communication, (4) individual motivation vs structural issues. CONCLUSIONS: The tensions were productive in helping collaborative research partnerships to tailor co-production practices to their local needs and opportunities. Resulting variation in co-production practices across partnerships can therefore be seen as highly advantageous creative adaptation, which makes us question the utility of seeking a unified 'gold standard' of co-production. Strategic leadership is an important starting point for finding context-tailored solutions; however, development of more distributed forms of leadership over time is needed to facilitate co-production practices between partners. Facilitating structures for co-production can enable power sharing and boost capacity and capability building, resulting in more inclusive language and communication and, ultimately, more credible practices of co-production in research. We provide recommendations for creating more realistic narratives around co-production and facilitating power sharing between partners.

"I think people have been in survival mode": a qualitative study of community connectivity in a neighbourhood of North East England before and during COVID-19.

OBJECTIVES: The aim of the study was to examine whether and how community-centred approaches facilitate community connectivity by exploring changes that matter to communities. DESIGN: Qualitative study comprising ethnographic methods, participant observation and interviews.Setting Economically deprived neighbourhood of North East England. PARTICIPANTS: Interviews with community members (n=14) and staff and stakeholders (n=14) involved in a National Lottery Community-funded initiative and 567 hours of participatory observation were undertaken between September 2019 and July 2020. Data were thematically analysed using a community-centred public health framework. RESULTS: Communities experiencing disadvantage approached the pandemic adversely affected by stigma, austerity and reductions in public sector funding. Community members' priorities centred on the environment, housing, activities for children and young people, crime, community safety and area reputation. Multiagency efforts to promote connectivity, led by voluntary and community sector organisations, were prerequisites in community-centred approaches to public health. Stakeholders reported that these approaches can help alleviate some of the health, social and financial burdens facing communities that are marginalised. Findings suggest community-centred responses were facilitated by trusting relationships, visionary leadership and lived experience of adversity among staff. Issues which appeared to hamper progress included interorganisational power dynamics and attempts to impose solutions. The strength of stakeholders' connections to the area and to people living there contributed to laying the foundations for local responses to the COVID-19 pandemic. Relational, values-informed work with communities provided a platform to mobilise recovery assets. CONCLUSIONS: Whole-system approaches, codesigned with communities most affected, can help address the long-term consequences of COVID-19 and its negative effects on health and social inequalities. Further comparative implementation research is needed to examine the partnerships, values and principles that drive success and inclusion.

Evaluation of the mental health impacts of Universal Credit: protocol for a mixed methods study.

INTRODUCTION: The UK social security system is being transformed by the implementation of Universal Credit (UC), which combines six existing benefits and tax credits into a single payment for low-income households. Despite extensive reports of hardship associated with the introduction of UC, no previous studies have comprehensively evaluated its impact on mental health. Because payments are targeted at low-income households, impacts on mental health will have important consequences for health inequalities. METHODS AND ANALYSIS: We will conduct a mixed methods study. Work package (WP) 1 will compare health outcomes for new recipients of UC with outcomes for legacy benefit recipients in two large population surveys, using the phased rollout of UC as a natural experiment. We will also analyse the relationship between the proportion of UC claimants in small areas and a composite measure of mental health. WP2 will use data collected by Citizen's Advice to explore the sociodemographic and health characteristics of people who seek advice when claiming UC and identify features of the claim process that prompt advice-seeking. WP3 will conduct longitudinal in-depth interviews with up to 80 UC claimants in England and Scotland to explore reasons for claiming and experiences of the claim process. Up to 30 staff supporting claimants will also be interviewed. WP4 will use a dynamic microsimulation model to simulate the long-term health impacts of different implementation scenarios. WP5 will undertake cost-consequence analysis of the potential costs and outcomes of introducing UC and cost-benefit analyses of mitigating actions. ETHICS AND DISSEMINATION: We obtained ethical approval for the primary data gathering from the University of Glasgow, College of Social Sciences Research Ethics Committee, application number 400200244. We will use our networks to actively disseminate findings to UC claimants, the public, practitioners and policy-makers, using a range of methods and formats. TRIAL REGISTRATION NUMBER: The study is registered with the Research Registry: researchregistry6697.

Impact of Universal Credit in North East England: a qualitative study of claimants and support staff.

OBJECTIVES: To understand the impact of the roll-out of Universal Credit (UC) from the perspectives of claimants and staff supporting them in North East England. DESIGN: Qualitative study comprising interviews and focus groups. SETTING: Gateshead and Newcastle, two localities in North East England characterised by high levels of socioeconomic deprivation, where the roll-out of UC started in 2017 as a new way to deliver welfare benefits for the UK working age population. PARTICIPANTS: 33 UC claimants with complex needs, disabilities and health conditions and 37 staff from local government, housing, voluntary and community sector organisations. RESULTS: Participants' accounts of the UC claims process and the consequences of managing on UC are reported; UC negatively impacts on material wellbeing, physical and mental health, social and family lives. UC claimants described the digital claims process as complicated, disorientating, impersonal, hostile and demeaning. Claimants reported being pushed into debt, rent arrears, housing insecurity, fuel and food poverty through UC. System failures, indifference and delays in receipt of UC entitlements exacerbated the difficulties of managing on a low income. The threat of punitive sanctions for failing to meet the enhanced conditionality requirements under UC added to claimant's vulnerabilities and distress. Staff reported concerns for claimants and additional pressures on health services, local government and voluntary and community sector organisations as a result of UC. CONCLUSIONS: The findings add considerable detail to emerging evidence of the deleterious effects of UC on vulnerable claimants' health and wellbeing. Our evidence suggests that UC is undermining vulnerable claimants' mental health, increasing the risk of poverty, hardship, destitution and suicidality. Major, evidence-informed revisions are required to improve the design and implementation of UC to prevent further adverse effects before large numbers of people move on to UC, as planned by the UK government.

Children and young people's perceptions of energy drinks: A qualitative study.

BACKGROUND: Consumption of soft drinks is declining in many countries, yet energy drink sales continue to increase, particularly amongst young consumers. Little is currently known about the drivers behind these trends. Energy drinks are high in sugar and caffeine, and evidence indicates that regular or heavy use by under 18s is likely to be detrimental to health. This study aimed to explore children and young people's attitudes and perceptions in relation to energy drinks in a UK context. METHODS: Eight focus groups were conducted with pupils aged 10-11 years (n = 20) and 13-14 years (n = 17) from four schools in northern England. A sub-sample also took part in a mapping exercise to generate further insights. Data were analysed using the constant comparative approach. RESULTS: Energy drinks were reportedly consumed in a variety of public and private places, generally linked to social activities, sports and computer gaming (particularly amongst boys). Participants demonstrated strong brand awareness and preferences that were linked to taste and perceived value for money. The relatively low price of energy drinks and their widespread availability were identified as key factors, along with gendered branding and marketing. Some participants demonstrated a critical approach to manufacturers' claims and many were keen to become better informed, often through school- or peer-based interventions. Other potential interventions included age restrictions, voluntary schemes involving retailers and improved labelling. CONCLUSIONS: The lack of a single dominant factor in participants' consumption choices suggests that there is unlikely to be a 'silver bullet' in attempting to address this issue. However, the findings provide support for policy-level interventions that seek to change the behaviours of manufacturers and retailers as well as consumers, and actively involve children and young people where possible.

Consumption of energy drinks by children and young people: a rapid review examining evidence of physical effects and consumer attitudes.

OBJECTIVE: To examine patterns of energy drink consumption by children and young people, attitudes towards these drinks, and any associations with health or other outcomes. DESIGN: Rapid evidence assessment and narrative synthesis. DATA SOURCES: 9 electronic bibliographic databases, reference lists of relevant studies and searches of the internet. RESULTS: A total of 410 studies were located, with 46 meeting the inclusion criteria. The majority employed a cross-sectional design, involved participants aged 11-18 years, and were conducted in North America or Europe. Consumption of energy drinks by children and young people was found to be patterned by gender, with boys consuming more than girls, and also by activity levels, with the highest consumption observed in the most and least sedentary individuals. Several studies identified a strong, positive association between the use of energy drinks and higher odds of health-damaging behaviours, as well as physical health symptoms such as headaches, stomach aches, hyperactivity and insomnia. There was some evidence of a dose-response effect. 2 experimental studies involving small numbers of junior athletes demonstrated a positive impact on limited aspects of sports performance. 3 themes emerged from the qualitative studies: reasons for use; influences on use; and perceived efficacy and impact. Taste and energy-seeking were identified as key drivers, and branding and marketing were highlighted as major influences on young people's consumption choices. Awareness of possible negative effects was low. CONCLUSIONS: There is growing evidence that consumption of energy drinks is associated with a range of adverse outcomes and risk behaviours in terms of children's health and well-being. However, taste, brand loyalty and perceived positive effects combine to ensure their popularity with young consumers. More research is needed to explore the short-term and long-term impacts in all spheres, including health, behaviour and education. TRIAL REGISTRATION NUMBER: CRD42014010192.