Learning from a School Streets pilot in Sheffield: Creating healthy community spaces in a time of COVID-19? – Dr Amy Barnes

Sheffield Schools Carterknowle Junior and Holt House Infants released a community-led evaluation report on 8th October 2020 (Clean Air Day!) about their week-long ‘School Streets’ pilot in late 2019, which involved closing part of Bannerdale Road in the city. I worked with the school community on the pilot and we have learned a lot together.

‘School Streets’ have been trialled across the country. They involve restricting car access near schools during drop-off and pick-up to make streets healthier and safer for children. They often involve other local action too: encouraging active travel, ‘citizen science’ activities to get people involved in monitoring air quality or traffic flows, and organising events so that the community can celebrate and enjoy the space created. 

During the closure, we found that 4 out of 5 families opted for active travel, by walking, cycling or scooting to get to school. The report looks at changes in air quality and traffic volumes during the road closure. It also explores the views of parents, children and local residents.

By working together, we learned that School Streets can create a new local space for children and families: to play, interact, feel safe, be active and be independent. As a local resident, quoted in the report, said:

“There were some teething problems on the first day but once people who use the road were aware of the closure, there was a real difference around the peak hours. The road was not only quieter, but it also felt more open and calmer.”

Our report shows that there is a lot of support locally for more action to create School Streets. The pilot was not without its issues and these are also discussed in our report. For example, the impact of closing the road displaced some of the remaining commuter traffic onto nearby roads, increasing congestion there.

In terms of air quality, we worked with Dr Maria Val Martin, an atmospheric scientist at the University, who was involved with monitoring air quality during the closure. As Maria explained:

The results from the air quality sensors during the plot week were inconclusive. We’d need a much longer period of time to show if there’s a sustained impact on air pollution reductions. However, we know from NO2 readings during the 2020 lockdown that the reduced traffic resulted in consistently lower NO2 levels compared to the averages from 2016-19.”

In the midst of this global COVID-19 pandemic, perhaps now more than ever people need cleaner air to breathe and safer outdoor community spaces to help with physical distancing. ‘School Streets’ schemes could have a vital role to play here. We want all Sheffield and city communities to have the resources to take action to create safe and healthy School Streets as we deal with COVID-19. This will require bold city leadership but we are confident that Sheffield and other cities can seize the opportunity to make ‘School Streets’ schemes a reality.

If you agree, lets start a conversation about it…

Dr Amy Barnes, Lecturer in Public Health (Policy)

Email: a.barnes@sheffield.a.uk

Dr Maria Val Martin, University of Sheffield

Nikki Rees, Co-opted School Governor

For more information about the pilot, you can also Jenny Johnson, Parent Governor, Holt House & Carterknowle Schools Federation.

Email: jjohnson@holthouse.sheffield.sch.uk    

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Supporting ScHARR’s teaching for 2020-21

After the emergency responses needed for the continued delivery and assessment across our programmes since late March, responding to the COVID-19 pandemic lockdown, we are now busy preparing for the start of the 2020-21 academic year with some significant challenges and opportunities to keep us on our toes. We are all sad to see the departure of Rosalyn Ferguson, whose skilful leadership has shaped ScHARR’s vision for consolidation and redevelopment of our Masters-level courses in response to the University’s Programme Level Approach (PLA) initiative. A significant challenge will be to maintain momentum for our PLA developments and it is helpful that UEB has revised the PLA roadmap to allow more time for consideration of how better to embed employability, inclusivity and sustainability in our programmes at a time when we are all focusing on adapting our delivery of teaching and assessment for next semester. In the past few weeks, we have seen a number of changes in module leadership and a strong response from all quarters of ScHARR – academic, research, professional services and administrative staff alike. To ensure that we are well placed to respond flexibly to either a need for tighter restrictions on or more open access to campus-based teaching, essential for good student experience. While there is still some uncertainty about how our teaching will look across the semester, to help prepare for 2020 Luke Miller, Rosalyn Ferguson and Peter Grabowski are delivering a series of three ‘Bytesize’ sessions. Focusing on considerations for developing alternative assessments to replace timed invigilated exams, resources available for engaging students actively in synchronous and asynchronous delivery of learning outcomes, improving the accessibility of learning resources for students in line with recent changes in legislation, and keeping PLA priorities in mind as we go forward.

Learning and Teaching Publication

Rosario E, Grabowski P, Evans M. (2020). How do spaces for learning and teaching impact upon the achievement of small group learning outcomes? A student perspective at the University of Sheffield, UK. Student Engagement in Higher Education Journal. 3(1):157-166

In this project, funded by the Student Engagement team at the University of Sheffield, a group of six Student Ambassadors for Learning and Teaching (SALT), drawn from across the Faculty of Medicine Dentistry and Health, developed a questionnaire to assess student views of the appropriateness of current teaching and learning spaces for achieving target learning outcomes across small group learning activities. In follow-up focus groups, they further explored how a range of teaching spaces might impact upon the achievement of learning outcomes. Drawing also from the literature, they looked beyond environmental factors (lighting, heating, noise etc) to identify three key recommendations that could be easily adopted, for Faculty to consider when planning the reconfiguration of learning spaces; easily configurable rooms for the flexibility to work in different group sizes, multiple visual aids to encourage better engagement and more innovative spaces with dynamic layouts that help regulate the power balances among teachers and learners and that encourage participation. Impacting beyond the Faculty, the University’s central Learning, Infrastructure and Space Management Group endorsed the SALT recommendations, agreed that they should inform the University’s current refurbishment programme for learning and teaching spaces and agreed that student views should be included in refurbishment planning going forward. The paper includes reflections on the project from the SALT Lead (ER), the academic supervisor (PG) and the L&T Professional Services supervisor (ME) and it demonstrates effective empowerment of students’ voice across the Faculty.

(Peter Grabowski is a Senior University Teacher in ScHARR and is Programme Lead for the MSc in Human Nutrition. He collaboratively developed the above project during a secondment as a Faculty Officer for Learning and Teaching.)

M.Ed. Graduation

In January, Emma Hock graduated from the School of Education with an MEd in Teaching and Learning in Higher education. For her dissertation, she examined the impact of a new problem-based learning (PBL) module on the integration of teaching and research in a research-led department at a research-based institution, through interviews with staff and students on the module. Her findings revealed that the module gave students an insight into the research undertaken in the department, and further steps could be taken to make research-teaching integration more complete. In broad terms, participants highlighted a need to make research-teaching integration integral to both teaching and research, potentially involving a ‘win-win’ solution that respects the workloads of staff while also getting students more involved. She has presented her findings at the Learning and Teaching Scholarship Showcase at the University of Sheffield in November 2019 and June 2020.

(Emma Hock is a Senior Research Fellow in ScHARR. She leads on two MPH modules and is Deputy Programme Lead for the MSc International Health Technology Assessment, Pricing and Reimbursement.)

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Public Health Practice and Research Collaborative (PaRC) – Dr Annette Haywood, School of Health and Related Research (ScHARR)

A HaywoodDr Annette Haywood, Manager for the Public Health Practice and Research Collaborative (PaRC) (Yorkshire & Humber) recently blogged about her journey to becoming PaRC Manager.

You can read more here:

From CLAHRC to PaRC my journey so far

See our short animation here:

https://youtu.be/yQs6uMRvENc

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Experiencing MD Viva during lock-down and thinking about racism by Alicia Vedio

I am a postgraduate research student for a Doctorate of Medicine in Public Health, and a physician in the NHS. I started part time PGR studies in 2014 in the School of Health and Related Research (ScHARR) at The University of Sheffield, studying the role that healthcare practitioners have in access to healthcare and submitted my thesis early in January 2020.

My viva was initially planned for March 2020, but the university workers’ strikes, and later COVID 19, delayed this. It was finally arranged for the end of April during the lockdown in the UK. Having a viva during lockdown meant this had to be online and I did not know how would this affect the experience. I had a mock viva using Blackboard Collaborate with both my supervisors that was really useful but I noticed my connection was not strong due to being far from the modem at home. I made sure that on the day of the viva I was in my dining room where the modem is and asked everyone at home to find something to do so, as not to be interrupted – not an easy task during lock-down but it worked well, and I felt more relaxed!

It was a relief that the experience was enjoyable mainly because both my examiners were as interested in the subject of inequalities in access to health care as I am and I was pleased to receive some useful and also complimentary feedback. But of course, it was not all positive. Before the viva, I knew there was a significant gap in my thesis and I wanted to draw attention to it by naming it here. The gap was a lack of discussion of racism theory. I had been made aware of this and had been expecting to receive comments about this in the viva feedback. I did. It was not easy to realise that I had such a serious blind spot and that perhaps I, even if unwittingly, had avoided entering into a deeper analysis and discussion of the subject of racialisation and racism within health care. I really hope and expect that my experience will resonate with other researchers. The many discussions and meetings I attended that reflected the work of the Health Equity and Inclusion theme team made it easier to direct the work I needed to do.

Since my viva, I have learnt a lot about racism theory, and not only about academic work in relation to health care related to my viva feedback. A month after my viva, George Floyd was brutally murdered in the US because he was black – one of a long line of shocking murders of people of colour that has been happening for centuries – and that it was made globally public due to being shared widely within social networks. It sparked a strong worldwide response and has also highlighted some really important resources on the work white people need to do to build a society that is fair to people of colour by dismantling racism. Systemic and structural/organisational racism are useful concepts that help to research and discuss barriers of access to health care services. Understanding structural racism is important but I (we) also need to work on our own blind spots to generate real changes in our lives and where we work. Most importantly, personal realisations are hard to confront. Knowing that I grew up in a white-dominated society with racist structures, organisations, and daily messages and education makes clear why I failed to name such an important issue but is deeply uncomfortable. My only consolation is that I am one of millions of white people in this society with the same problem to tackle. Intent and impact comes to mind, and impact is what we need to focus on. These two concepts refer to how we need to look at the effects of our actions and of the society structures. Intent may be positive but this is not relevant to the detrimental impact it has.

In conclusion, I have learnt that we can only work towards anti-racism and, for me, incorporating this in my thesis is only one of many steps. However, seeing racism and naming racism, is essential for in-depth change and this is why I wanted to tell my story here. Like everyone, my identity is an important part of my life. I am white, despite being of mixed indigenous, Black and Jewish descent, but I am mostly from white-mixed European descent, and I am myself a migrant descending from migrants. My own life experience and that of my ancestors impacted who I am today.

I now realise that the deconstruction required to eliminate racism is life-long work regardless of age and it is essential. In my study and work I look into addressing the role practitioners have in facilitating or hindering access to healthcare for a particular population. I explored the impact myself and other practitioners have, approaching it with an inequalities lens trying to address the imbalance of power between practitioner and individuals. My work now is to link societal, structural and personal racism to understand its role in creating barriers, in influencing personal development and in impacting the work of the NHS.

I also wanted to share some of the excellent resources I have encountered in my search for understanding.

The Great Unlearn” and “Do the Work” by Rachel Cargle provides many examples of how white supremacy and white privilege work and gives frameworks that help examine how organisations can respond to this problem.

Me and White Supremacy” by Layla Saad names many of the barriers to dismantling racism and these are well structured and clearly explained. You can also find her in YouTube describing her book in four steps.

I particularly found “Mindful of Race” a book by Ruth King (2018) helpful- this is a journey through an understanding of racism with a mindfulness framework and helps understand this oppression more clearly. Ruth King uses Buddhist concepts and shares her own experiences in helping organisations become more inclusive, diverse and anti-racist.

There are many more anti-racist resources available; these are some of the ones that have helped me greatly. I would encourage you to explore these or other resources to ensure that, together, we have a collective impact on dismantling societal and structural racism.

Alicia Vedio

Infectious Diseases Physician, Postgraduate Researcher Public Health, School of Health and Related Research, The University of Sheffield – abvedio1@sheffield.ac.uk

Publications:

https://onlinelibrary.wiley.com/doi/full/10.1111/jvh.12673

https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017- 4796-4

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How to conduct a stakeholder workshop virtually during a global health crisis by Naomi Gibbs

 

Background: I am a ScHARR PhD student, approaching my final year. My academic background is in economics and health economics, but I also have 10 years work experience in the third sector. Alcohol poses a significant public health problem in South Africa and there is real interest in effective policy solutions. I am trying to GH June 20contribute evidence via building a health economic model of a minimum unit price, with a focus on how the policy might affect groups of people differently, for example rich vs poor.  A minimum unit price basically removes the cheapest alcohol from the market, such as the wine pictured here which is £1.16 per litre (although this is far from the cheapest alcohol available). Stakeholder engagement is key to make sure the modelling fits with the context. It has allowed me to see the problem through a new lens and given me the opportunity to listen to diverse voices; something I really enjoy.

My stakeholders began with scoping interviews in August 2019 and then, last November, I went to South Africa to deliver the first of three planned workshops. In this initial workshop I asked stakeholders to complete a mapping exercise of alcohol harm in South Africa. I then asked them to choose the specific pricing policy they would like modelled, for example a change to taxation levels or structure, minimum prices, ban on discounting or any other pricing policy. They chose minimum pricing. They then highlighted subgroups of interest (women, poor, heavy drinkers, different age groups) and health outcomes they wanted included in the model. Because of this workshop I discovered that violence and HIV were critical to include in the alcohol model. My second workshop aimed to inform them of my progress so far and seek feedback on assumptions and critical modelling decisions, for example do we expect drinkers to switch to home brewing when facing a price increase and if so, to what extent. I also wanted to use it to present some preliminary results and discuss communication strategies. I was ready to go to deliver the workshop face to face in Cape Town, South Africa in May 2020 when Covid-19 hit. Since I had a space saved in everyone’s diaries, and with no possible way of knowing when I, or my stakeholders, would be able to travel and meet again, I decided to deliver the workshop online. This involved a significant rewrite of the workshop material, it had to be shorter and clearer. I had to think about how I would gather stakeholder feedback in an online context. I also needed to learn about the software as I didn’t want incompetence with the technology to be a distraction.

I was pleased with the outcome of my online workshop; it was well attended, I received positive feedback on the content and format and, crucially, I got what I needed to shape the next stage of my research including suggestions for data sources, choice of assumptions, direction for what other health outcomes should be included in the model, advice on how to present results and a collective communication strategy for the final results. Part of my success was due to circumstance; the sale of alcohol had been banned entirely during lockdown in South Africa, making it a hot policy topic, and encouraging attendance. Additionally, people were far more used to, and competent at, online meetings as they had all been forced into it by Covid-19 restrictions. Nevertheless, I spent a lot of time and effort carefully preparing and planning the webinar which was critical to the smooth running on the day.

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Despite the success I would like to mention one pitfall from running the workshop online. My experience was that community groups found it harder to engage than policy makers and academics. They had the worst internet connections and computers and sometimes couldn’t even find a physical space to facilitate their participation. This was a loss and although I have tried to follow it up with them individually, I have struggled to get the level of engagement I got when I was in a room with them in November. For my final workshop/webinar I will ask these specific stakeholders if there is anything I can do to facilitate their engagement, perhaps sending hard copies of materials in advance with stamped addressed envelopes for feedback, I don’t know but I will ask. If you are reading this and have an idea please let me know. It is important to the research to make it as inclusive as possible.

I also benefited massively from the input of lots of different people. The support is there if you ask. Learning Technologists, information governance, ethics committees, supervisors, peers, family and friends. Don’t think you have to do it all by yourself. I am very grateful to the six peers who sacrificed two hours of their time to go through all the material and provide such useful advice, it would not have been half as good without them! So I thought I would share with you a list of simple tasks that helped me organise my webinar, maybe it will help you in conducting your own online workshop. I hope so.

On that note if you want any further help or advice please do feel free to get in touch.

Naomi Gibbs

n.gibbs@sheffield.ac.uk

Instructions:

  • Consult your institution’s information governance team about data management before you choose your platform and submit your ethics application.
  • Consult a learning technologist within your institution and ask them to teach you how to use the software (I used blackboard collaborate and enjoyed it as it felt like a very controlled environment, the slides are uploaded in advance, the live polls and chat box are very simple).
  • Rewrite your consent forms online (I used google forms as this complied with information governance rules).
  • On receipt of ethical approval invite your recipients to your event. Provide them with a link to the online consent form and the participant information sheet. Tell participants they will not receive a link to the event until they have completed the consent form.
  • Plan your material, make it as short as possible (2 hours maximum) and make it interactive. Blackboard collaborate allows you to use live polls. Although these are a bit clunky, as you can’t pre-load them, they are invaluable at making you feel connected to your stakeholders and keeping their attention away from their inbox.
  • Use online short questionnaires to gather written feedback throughout the online workshop. You can post the link into the chatbox and participants can simply click through. Split the material into 10 minute chunks.  This will break the session up nicely for participants between listening and providing feedback.
  • Schedule a tea break for half way. This is really important for you but also for your participants.
  • Pilot your material a lot. Test it with anybody who will listen, family or friends first, then upgrade to peers. Make sure you also complete a technical run-through with your least technologically competent stakeholders (if you know who they are).
  • Give time at the beginning to let people introduce themselves and say what their interest in the topic is. At the end, give people an opportunity to offer one key point about the research, however also give them the option to pass. Sometimes the comments you get during this period are as important as all the written feedback. I ensured this ran smoothly by naming people one by one and asking them to un-mute themselves. Being a clear facilitator is important here.
  • Remember to record your webinar so you can listen to it again.

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Foraging by Laura von Nordheim

What does nature have in store for you this month?

Foraging for wild food is a great incentive to get outdoors, soak up the sun, get to know your local flora and tap into all the goodness that nature has to offer. May is abundant with wild herbs such as sorrel, dandelion, hawthorn, lambs’ tongue, mustard garlic, wild garlic, and ground elder.

How to identify wild herbs.

Get yourself a guide on wild herbs – in print or online. Wild herbs are relatively easy to identify when you learn to take leaves, flowers, roots and surrounding area as well as time of year into account. Familiarise yourself with look-alikes to ensure you are picking what you were looking for. The woodland trust has an excellent month-by-month foraging guide: www.woodlandtrust.org.uk/visiting-woods/things-to-do/foraging and you can make a donation to help UK’s largest woodland conservation charity.

How to use wild herbs.

Only pick what you need! Wash wild herbs thoroughly and use raw in salads. Some herbs like wild garlic or ground elder can be cooked like spinach, encased in puff pastry to make a delicious Borek, or added to curries and soups. Wild herbs make beautiful garnishes on any dish.

How to preserve wild herbs.

To preserve wild herbs, preserve in oil, freeze or dry. For freezing, chop finely, mix with a little bit of oil and pop in the freezer in small portions to use in your cooking all year around. An ice-cube tray is perfect for freezing small herb portions. Drying herbs loses much of their flavor, but you might want to experiment with hanging small bunches over a radiator and drying them out completely before storing in pretty glass jars. Alternatively, preserve in jars as deliciously healthy wild herb pesto and use with pasta, spread on bread, dip with veggies or add to stews and soup.

How to make wild herb pesto.

Wash wild herbs like sorrel, dandelion, hawthorn, lamb‘s tongue, mustard garlic, wild garlic and ground elder thoroughly. Use a blender to blend nuts such as walnuts, almonds, cashews, pine nuts and seeds like pumpkin, sesame, sunflower seeds. Add wild herbs and a good quality olive oil. Season with salt, pepper, chilli. Wild herbs such as dandelion and lamb’s tongue can be bitter, so experiment with adding honey. The Sheffield Honey company offers local honey: www.sheffield-honey.co.uk

If you do not have access to an electrical blender, use a knife to chop nuts, seeds and herbs finely, mix with oil and season to taste.

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Take these easy steps to avoid your lovely pesto from spoiling.

Before filling your pesto into jars, make sure your jars are 100% clean. Clean thoroughly with hot water and soap, do not dry. Sterilise open jars and lids in an oven for 15 mins at 160-180°C.

When filling your jars, leave an inch space at the top to fill up with olive oil, covering the top layer of pesto. Wipe smears away with a clean paper towel. Avoid air bubbles in the pesto by gentle knocking the jar on a table covered with a tablecloth.

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How are wild herbs so healthy?

Wild herbs contain high amounts of amazingly healthy vitamins, minerals and nutrients, because they get to live in an intact ecosystem filled with other plants, trees and animals. Wild herbs get to soak up nutrients from healthy soil instead of being raised in large greenhouses or mono cultures that require fertiliser to cope with depleted soil. In contrast to store-bought herbs, vegetables and fruit loose much of their nutrients due to early picking, time-consuming transport, and long storage in warehouses and supermarket shelves, wild herbs are freshly picked, and retain micro- and macro-nutrients.

Good for you, good for the planet.

Foraged foods require no packaging and no transport. Did you notice? Our wild herb pesto is vegan! Plant-based diets help to improve soil, animal welfare and human health.

Roszak et al (1995) wrote an excellent book on the importance of (re-) connecting to nature, as a mutual healing process between the planet and its people. Use this month to connect to nature and the hunter-gatherer that lives in all of us. Don’t be greedy. Pick in areas that are abundant and be mindful to share with other animals and foragers. ‘Take some, leave some’.

How to find wild herbs.

In Sheffield, Rivelin Valley near Walkley and Porter Brook near Endcliffe Park are great foraging spots. You will find sorrel, dandelion and lamb’s tongue in the meadows and fields. Ground elder and wild garlic prefer shade and proximity to a stream. Mustard garlic likes to grow near paths, with some shade and some sun. Hawthorn can easily be foraged in a park, as the bushy tree allows you to pick leaves higher up than a dog can pee.

Who am I?

Laura von Nordheim is a PhD researcher at UoS. As part of her research, Laura designs healthy food advertising to investigate the effects of healthy food cues on children’s eating behavior. Before her PhD, Laura worked as a cooking instructor and vegan chef in London and taught healthy eating workshops at nurseries, schools and colleges.

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You can find out more via https://www.facebook.com/TurningEarth, https://www.instagram.com/turningearthfood www.TurningEarth.co.uk and on Youtube via Turning Earth Fun with Food.

Laura von Nordheim Lvonnordheim1@sheffield.ac.uk

BSc Psychology

MSc Health Psychology

PhD Developmental Psychology (IP)

https://www.youtube.com/channel/UC1CvY-OBKGd-SpPUyetQ7Tg

 

 

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Introducing the Yorkshire and Humber Practice and Research Collaborative (PaRC YH) – Dr Annette Haywood

The follow up report from the Academy of Medical Sciences focusing on improving the health of the public by 2040 (https://acmedsci.ac.uk/policy/policy-projects/health-of-the-public-in-2040) called for the establishment of regional “hubs of engagement” which would build on existing infrastructure to support engagement between public health academic researchers and practitioners working in local authority settings.

In response to this, and utilising legacy funding from the Collaboration for Leadership in Applied Research and Care Yorkshire and Humber (CLAHRC YH) we have established a regional hub, known as the ‘Yorkshire & Humber Public Health Practice and Research Collaborative’ (PaRC YH). The aim of this collaborative is to bring public health practitioners and researchers together to identify opportunities to generate locally relevant research to improve and protect the health of the public and translate that research into practice.

The collaborative is gaining momentum across the region and from its inception in June 2019 we have secured support for the PaRC from the majority of academic institutions across the Yorkshire and Humber region. These have joined our active network of regional local authority colleagues who form the Local Authority Research Link or LARK network. The LARK network was established within the Public Health and Inequalities theme of the CLAHRC YH through its ‘Identifying and fulfilling priority evidence needs for Local Authorities’ work stream.

We have developed an animation to show how the PaRC fits into existing infrastructure (https://youtu.be/yQs6uMRvENc) and are planning a number of research and evidence translation events to bring together practitioners and academic colleagues across Yorkshire and Humber to identify local priorities and opportunities for collaboration. In addition, we will develop a suite of training and resources designed to enable the public health workforce to develop skills in research and evaluation.

The collaborative is supported by Public Health England Yorkshire & Humber, NIHR Clinical Research Network (CRN), Yorkshire & Humber Applied Research Consortium (ARC) and the regional Association of Directors of Public Health (ADPH).

For further information, please contact Dr Annette Haywood (PaRC Manager) a.haywood@sheffield.ac.uk or Professor Liddy Goyder (PaRC Academic Lead) e.goyder@sheffield.ac.uk

PaRC launch event held 21st June 2019

 

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Finding the art of public health research in the Gambia – Anny Yuanfei Huang (@doctopus_anny)

Everyone has their favourite sayings. One of my previous bosses loved to keep telling me that healthcare was both a science and an art. He loved to emphasise the “art” part of the statement by demonstrating different ways to phrase a question, or how he read between the lines, or how he persuaded somebody to do something.

Here in the Gambia, I’ve discovered that the “art” component of the equation can be much more literal. As a researcher, I’ve benefitted from many doors being opened simply as a result of showing some creative skills. Apparently, they’re not just useless hobbies, after all.

I’ve been working on a qualitative research project on infertility here, representing the University of Sheffield at the Medical Research Council Unit. My supervisor is none other than the ever-encouraging and energetic Julie Balen, who provides me with all the guidance that I need, remotely from Sheffield. She gives me the freedom to follow any leads that I think could be useful to the project. Some of these have been fascinating.

The first unexpected connection through art had occurred at the end of a tiring week. I needed to recharge, and I knew that the best way to do this would be through feeding my creative side. The Gambia, unfortunately, does not have a national art gallery. And so I made the long and arduous journey, via five shared taxis, to the home and private art gallery of one of the local artists here. The trip gave me everything that I needed, and more. Not only did I feel replenished afterwards, but I was able to meet and chat with the artist herself. It turns out that she runs several other projects from her art gallery space. One of these was an infertility awareness project. Another was to engage local traditional herbalists who provided treatments for infertility. Suddenly, the dots started connecting between my research work and creative pastimes. I was able to form some new connections for our research.

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The ‘waiting room’ of a Gambian herbalist

In the end, though, I’m much more of a musician than a painter. The art gallery was a great start, but I needed music in my life. This need became so persistent that it drove me to search social media on a daily basis, until I finally tracked down a music teacher. I started taking lessons in playing the ‘Balafon’, a traditional Gambian instrument that was one of the precursors to the orchestral xylophone (more details on my personal blog). My classes take place at my teacher’s home, a typical Gambian compound with multiple dwellings belonging to the same family. Many of his family members sit in the central courtyard listening while I play. They’ve started to teach me Mandinka, one of the local languages, and invited me over to attend a ceremony.

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The ‘training Balafon’ that my teacher had reserved for my use

The most satisfying experience so far has been on a field visit to a village called Janneh Kunda, about three hours away by road. I was there to observe a women’s group, in order to help with planning a similar event for our own project. Out of the 20 women in the group, there were 5 kanyalengs, who are a special group of women in the Gambia and Senegal. They are essentially women who have struggled with infertility, repeated miscarriages or neonatal deaths, and they form a local support group for each other. What is culturally unique about these support groups throughout the country is that the members learn to be performers, and they are often invited to ceremonies to sing, dance and entertain the audience with their jokes and antics. These antics are meant to be a little bit ridiculous, and at times subvert social norms. This is so that they can attract the attention of God, who might then see their self-shaming actions and pity them enough to give them a child who survives. And so while the kanyalengs were, for the most part, attentive and engaged members of the women’s group, at various times they started crowing like roosters, or danced around, much to the amusement of everyone else in attendance.

This particular women’s group was structured around a two-day workshop. On the first day, the participants were given homework. I was not quite sure how this was going to go. After all, these women were busy farmers with families to look after. The homework was to come up with a short play to illustrate one of the concepts that had been discussed. These plays were then to be performed on the second day.

I had not prepared myself to be so pleasantly surprised. The women came to the second day armed with props and costumes. The kanyalengs, who were the seasoned performers, led each performance, but the other women joined in as well. Enthusiastically, in fact. The final group to present had a play that was in two parts. The first part was a story about a man learning how important it was for his teenage daughter to stay in school. Then, to transition to the second part, one of the kanyalengs started singing a song that they had composed especially for this play, and another woman started drumming on a plastic chair. The rest of the performing group started clapping along with a particular rhythmic pattern.

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The empty school classroom that was transformed by the theatre performances of the women’s group

Standing in the corner of the room, I started clapping along too. One of the kanyalengs saw that I understood the rhythm, and pulled me out into the middle of the room to dance. And so I became part of this performance, as a random dancing foreigner who happened to be passing by and crash the apartment of this man, his wife, and their teenage daughter. Seeing that I was dancing was enough for everyone else to get up and join in as well, and so there ended up being an unscripted apartment party. The “off-script” aspect of my participation probably applied to my research objectives as well, but I am sure that this will be one of the indelible memories of this stint in the Gambia that I will take home.

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Thinking out of the box: Improving Health Literacy through a Radio Programme by Dr Parveen Ali

Parveen

Health care professionals are responsible for providing appropriate health care services to patients to help them overcome an illness in a clinical setting. They also promote health by engaging in health education and health promotion activities. They can play an important role in improving health literacy among the general population to help them adapt a healthier lifestyle to reduce the likelihood of future health problems. One way this can be addressed, as I will describe below, is through using local radio stations.

Promoting health literacy among the general population, and migrant populations in particular, is important as well as challenging. With an increase in the internal and external migration and mobility of people from/to different parts of the world, the likelihood of experiencing language barriers while providing and receiving care has increased. Language barriers can contribute to health inequalities that people from minority ethnic groups experience. These groups may already be subjected to health inequalities due to gender, socioeconomic status, education, sexual orientation or disability. Language barriers may worsen the situation for these already marginalised groups by adversely affecting their ability to communicate effectively. This manifests itself through public health issues such as impaired health seeking behaviour, low uptake of physical and mental health services, late presentation of serious illnesses, low uptake of health screening (e.g. cervical screening, or health checks) and poor management of long-term conditions such as diabetes. Language barriers also impact on individuals’ ability to explain their symptoms and experiences to health care providers and ask appropriate questions about their health condition when seeking health care services. However, the impact of this can be reduced if the information is provided by healthcare professionals to these populations in their own language and in a simple, jargon free and non-threatening way.

Current advances in health, technology and communication mean that there are a wide variety of mechanisms through which health promotion and health education strategies can be developed and delivered. Radio and television programmes can be used effectively to provide health information. This is exactly what I am doing using my language skills and using the medium of radio to disseminate health information in an easy to understand format for the South Asian population who can communicate in Urdu. I conduct a weekly radio programme called ‘Health Show’ on Link FM 96.7 radio station which offers a local service to inform, educate and entertain listeners and provides a voice to local communities. Health Show was initiated, recognising the needs in Sheffield’s South Asian population to promote awareness of various health conditions and public health issues. The programme also aims to increase awareness about public health issues and dispel myths by ensuring that information is provided by Registered Nurses and specialist healthcare professionals. Every week one health condition is explained in Urdu. Specialist health care professionals (cardiologists, stroke consultants, nephrologists etc) are also invited on to the programme. Care is taken to ensure that they can communicate in Urdu as much as possible.

The programme was initiated more than a year ago and to date more than 60 programmes have been delivered. The programme is also broadcasted via Facebook live meaning that listeners not only from Sheffield but other parts of the world such as Pakistan, India, UAE and Saudi Arabia can listen and participate. The programme is valued by local health care professionals and organisations who struggle to engage with hard to reach communities due to linguistic and other issues.

Conducting a radio programme is a big commitment and is daunting, however, my nursing background, language skills, and teaching ability helps me to live up to this challenge every week. My aim is to use this programme to disseminate information, promote health and improve health literacy among the local population. I always look forward to speaking to colleagues to help them disseminate health messages coming from their research. So please get in touch if you think you have a message to deliver to the South Asian community in Sheffield.

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Project improves access to basic healthcare in low resource communities in Bangalore, India

By Luc de Witte (Global Health Theme member, HSR section, School of Health and Related Research)

Access to healthcare seems natural to most people, but there are many situations in which healthcare is not easily accessible. Access to healthcare has several dimensions: availability (presence of services), accessibility (distance, opening hours, physical barriers), affordability (direct, indirect and opportunity costs) and acceptability (cultural, perceived effectiveness, language, ethnicity and other barriers that may discourage use). In rural areas and urban slums in India all these dimensions play a role. A large part of the Indian population lives in such areas where health services are scarce, travel is complicated and poverty is widespread. In the large cities, most of which are fast growing, a substantial number of people (estimates vary between 15-25%) live in slums, characterised by migratory populations, poor living circumstances, poor hygiene and extreme poverty. In such settings access to healthcare is very limited for a variety of reasons but with one effect: most people will only seek healthcare in a very late stage, when preventative approaches are no longer relevant and treatment is often too late.

This is the kind of setting in which we are working on an innovate model to provide basic healthcare to these communities. Over the past few years a consortium of the Baptist Hospital in Bangalore, three local companies, Zuyd University of Applied Sciences in the Netherlands and the University of Sheffield have worked on this model. It is built upon four pillars: a) local women are trained to become ‘health navigators’, executing health screening in their communities and acting as linking pin to hospitals and health centres; b) these health navigators are provided with a mobile screening toolkit that allows them to screen for the most common health conditions in an easy way; c) the data they collect is automatically uploaded onto an electronic patient record that is, of course only with proper patient consent, accessibly for health professionals in the collaborating healthcare facilities; d) when the screening tests indicate the possible presence of a health condition that requires treatment, people are referred to the collaborating health facility and followed-up by the health navigator.

This model has been developed in close collaboration with professionals of the Bangalore Baptist Hospital that has a large community health programme, health and social workers who work in urban slums and rural villages served by the above mentioned programme, people living in these slums and villages and experts from collaborating universities and local companies specialised in healthcare technology. Elements of the model have been extensively tested: the mobile toolkit was used in a large survey among 3,300 people and proved to be usable and result in good and relevant data; in a separate project training materials and assessment protocols for training the health navigators were developed and tested; in two communities the whole model was then implemented with 9 health navigators to evaluate its feasibility. In one month time they screened more than 1,500 people for non-communicable diseases and other basic health issues. They found serious health issues in about one third of the adult population. These people are referred for treatment and will be followed up by the health navigators. The 9 health navigators have been able to generate a little bit of additional income, because people pay 40 Indian Rupee to be screened. In this way the project directly impacts on the health of the people screened, but also indirectly on the lives of the health navigators and their families.

The results so far offer strong support for the potential of this model. We very recently obtained some funding to further develop the training material into a digital course and to work on an assessment protocol to evaluate whether a health navigator has the necessary skills to safely and effectively perform this role. With that extra money we will also train a few more women to become health navigators. In parallel we will prepare a large-scale evaluation study in a few regions in India. Potentially this new care model may be applicable in many other low-resource settings. That is why the partners have established a not-for-profit society – Samarthya Arogyam – to disseminate the screening toolkits, offer the training for health navigators and support for organisations that want to implement the model in their region.

Left: Health screening in practice and Right: A health navigator along the route

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