Development and evaluation of innovative strategies for the prevention of chronic disease in primary care.

Lead Research Organisation: University of Cambridge
Department Name: Institute of Public Health

Abstract

We are investigating new ways of supporting people to change health-related behaviours through primary care and so reduce the burden of chronic disease in middle age.

Relevant health-related behaviours include food choice, sedentary activities, and not taking medication regularly as prescribed. These behaviours contribute to the burden of illness from for example obesity, cardiovascular disease and some cancers, at great cost to individuals and society.

This proposal brings together primary care researchers with behavioural scientists, epidemiologists and statisticians to develop new behavioural interventions and evaluate them in clinical trials.

A key challenge in this area is how to motivate and enable people who feel well to alter their behaviour to avoid future, uncertain risks. Simply telling people what to do has not proved very effective. We are investigating approaches based on the behavioural sciences which may help more. These focus for example on ideas of personal motivation and control and the effect of social pressure on behavioural choices.

There have been few systematic attempts to develop and evaluate interventions based on such approaches. Our work will help to understand better how to do this, with applications to specific behaviours among defined high risk groups. Beginning with groups at risk of diabetes, the work will clarify how, and how much behaviour change can be achieved by these strategies and so inform health policy in the prevention and management of chronic disease.

Technical Summary

This proposal addresses the prevention of chronic disease through research on modifiable behaviours. Three behaviours are strongly associated with the rising global burden of chronic disease. Sedentary living, excessive intake of foods high in saturated fat, and smoking tobacco are causally associated with cardiovascular disease, diabetes, osteoporosis, chronic respiratory disease and some cancers. Taking prescribed medication regularly conversely can significantly reduce disease risks.

Strategies to alter these behaviours may be most effective if aimed precisely at modifiable determinants on the causal pathway to disease. In the Department of Public Health and Primary Care at Cambridge, we have developed a multidisciplinary team linking psychology and primary care with epidemiology, health economics and statistics and committed to the development and evaluation of such strategies with an initial focus on diabetes. The MRC Biostatistics and Clinicial Trial Units have a strategic focus to develop complex trial design and analysis, and are committed to supporting trial capacity in primary care.

These groups are unusually well placed in the UK to cooperate in trials of prevention of diabetes and other chronic diseases in primary care. The collaboration will build on expertise in; selection and measurement of behaviours critical to disease incidence, theories and evidence of how to support behaviour change, and the design, conduct and analysis of complex trials in primary care.

We request core support for psychology, health economics and statistical capacity and a component grant to assess the psychological burden of screening for diabetes within an existing trial. Together, this support will add value to our current portfolio and underpin development of new studies.

Publications

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Campbell NC (2007) Designing and evaluating complex interventions to improve health care. in BMJ (Clinical research ed.)

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Charles M (2012) Cardiovascular risk reduction following diagnosis of diabetes by screening: 1-year results from the ADDITION-Cambridge trial cohort. in The British journal of general practice : the journal of the Royal College of General Practitioners

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Eccles MP (2009) An implementation research agenda. in Implementation science : IS

 
Description Diabetes QOF
Geographic Reach Europe 
Policy Influence Type Participation in advisory committee
Impact Finfings from the ADDITION trial informed the evidence for revision of the QOF guidelines
 
Guideline Title Developing and evaluating complex interventions: the new Medical Research Council guidance
Description case study
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in clinical guidelines
Impact The approach developed to develop and evaluate in trials designs complex behavioural interventions for supporting behaviour change has improved the execution of trials in this area and contributed to more reliable findings; the ProActive trial is cited in the new guidance and was an important part of the thinking leading to the original guidance
 
Description health trainers guidance
Geographic Reach National 
Policy Influence Type Citation in other policy documents
Impact Findings from the ProActive and ADDITION studies were used in the section on training health trainers.
 
Description peer learning
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact A successful peer learning group was held over 3 years culminating in a publication contributing to method; Campbell N, Murray E, Darbyshire J, Emery J, Farmer A, Griffiths F, Guthrie B, Lester H, Wilson P, Kinmonth AL. Designing and evaluating complex interventions to improve health care. BMJ 2007; 334: 455-9 Participants now hold prestigious positions in academic primary care and their work impacts on health policy and educatiuon.; J Emery, A Farmer, H Lester and E Murray have partnered research within the co-op. The latter two are leading subsequent peer learning sets funded by the NIHR National School of Primary Care Research which has adopted the model
 
Description screening usa
Geographic Reach North America 
Policy Influence Type Citation in other policy documents
Impact ADDITION on follow-up. The work is included in the evidence to inform update of the US Preventive Services Task Force recommendations on screening for type 2 diabetes and prediabetes. [Norris SL et al. Screening adults for type 2 diabetes: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2008;148:855-868.]. We expect that the findings from our study will be considered when decisions are made on how the vascular risk screening programme will be implemented
 
Description MRC Project Grant
Amount £195,248 (GBP)
Funding ID G0200391 
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 12/2003 
End 12/2008
 
Description NHS Project
Amount £84,844 (GBP)
Organisation NHS England 
Sector Public
Country United Kingdom
Start  
 
Description NIHR CLAHRC for Cambridgeshire and Peterborough (shared with C Brayne)
Amount £5,000,000 (GBP)
Organisation National Institute for Health Research 
Department NIHR CLAHRC East of England
Sector Public
Country United Kingdom
Start 01/2009 
End 12/2013
 
Description NIHR Programme Grant
Amount £1,047,190 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start  
 
Description NIHR Programme Grant
Amount £1,501,930 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start  
 
Description NIHR Programme Grant
Amount £2,403,760 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start  
 
Description NIHR School of Primary Care Research (2007)
Amount £300,000 (GBP)
Organisation National Institute for Health Research 
Department School for Primary Care Research
Sector Academic/University
Country United Kingdom
Start 10/2007 
End 09/2012
 
Description Project
Amount £225,351 (GBP)
Organisation International Biometrics Society 
Sector Learned Society
Country United States
Start  
 
Description Project
Amount £143,471 (GBP)
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start  
 
Description RCGP Project
Amount £9,995 (GBP)
Organisation Royal College of General Practitioners 
Sector Academic/University
Country United Kingdom
Start  
 
Description UKCRC Public Health Research Centres of Excellence - The Centre for Diet and Activity Research (CEDAR) shared with S Griffin, K Ong, N Wareham
Amount £1,250,000 (GBP)
Organisation UK Clinical Research Collaboration 
Department UKCRC Public Health Research Centres of Excellence UKCRC PHRCoE)
Sector Academic/University
Country United Kingdom
Start 01/2008 
End 12/2012
 
Title INTERVENTION DEVELOPMENT 
Description CPNTRIBUTION TO UPDATE OF mrc GUIDANCE FOR DEVELOPMENT AND EVALUATION OF COMPLEX INTERVENTIONS 
Type Of Material Improvements to research infrastructure 
Year Produced 2008 
Provided To Others? Yes  
Impact IMPROVEMENT IN QUALITY OF INTERVENTION DESCRIPTION FOR EVALUATION IN TRIALS 
 
Title intervention delivery and QA 
Description 1 Intervention delivery and quality assurance (Hardeman, Kellar Michie) Little attention has been paid to assuring that the delivery of interventions is faithful to the underlying psychological theories and intervention protocols. We have developed approaches to assess and improve fidelity: a) training sessions and a detailed manuals linking the intervention to underlying theories; b) standardised intervention protocols; c) monitoring progress of participants in mastery of self-management skills; d) supervision aimed at promoting adherence to protocols and e) an independent assessment of use of specified behaviour change techniques by the intervention providers. In collaboration with Prof Michie, we demonstrated how transcripts from intervention sessions in ProActive could be used to assess whether the intervention had been delivered as planned, and how the intervention was received by the participants (see publications 
Type Of Material Data analysis technique 
Year Produced 2008 
Provided To Others? Yes  
Impact improvement in the development and evaluation of theory based behaviour change interventions and their reporting Michie S, Johnston M, Francis J, Hardeman W, Eccles M. (2008). From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Applied Psychology: An International Review, 57, 4, 660-680 
 
Title statistical correlations 
Description Statistical; allowing for correlations between correlations in random-effects meta analysis of correlation matrices. We identified, extended, and programmed, methods of meta-analysis which allow multiple associated outcome-related quantities to be pooled at once. The focus was on the Theory of Planned Behaviour in particular on assessing the strength of the associative links between determinants and between determinants and the behavioural outcome (physical activity) by pooling the correlation coefficients that are attached to links in the hypothesised causal chain 
Type Of Material Data analysis technique 
Year Produced 2007 
Provided To Others? Yes  
Impact Prevost AT, Mason D, Griffin S, Kinmonth AL, Sutton S, Spiegelhalter D. Allowing for correlations between correlations in random-effects meta analysis of correlation matrices. Psychol Methods 2007; 12 (4): 434-50. 
 
Description Emery 
Organisation University of Perth
Country Australia 
Sector Academic/University 
PI Contribution definition of questions scientific collaboration
Collaborator Contribution *Emery/General Practice/ Perth Australia/scientific/5y/complex intervention trial methodology/extension to cancer, early diagnosis and referral behaviours
Impact *Emery/General Practice/ Perth Australia/scientific/5y/complex intervention trial methodology/extension to cancer, early diagnosis and referral behaviours
 
Description Leicester ADDITION 
Organisation University of Leicester
Department Leicester Medical School
Country United Kingdom 
Sector Academic/University 
PI Contribution extensive sharing of approaches and methods
Collaborator Contribution exetnds ADDITION study to Asian population
Impact Davies /Diabetes and Endocrinology, Leicester/ scientific/3y/ extension of Addition to Leicester and Asian population
Start Year 2006
 
Description MRC epidemiology unit 
Organisation University of Cambridge
Department MRC Epidemiology Unit
Country United Kingdom 
Sector Multiple 
PI Contribution intellectual partnership; grant raising; fieldwork; interpretation and analyses
Collaborator Contribution Wareham/Griffin/MRC Epidemiology Unit, Cambridge/Co-Is; scientific/5y/measurement of physical activity; selection of target groups; epidemiology and trial design and analyses. Ekelund/MRC Epidemiology Unit/scientific/5y/active components of physical activity
Impact Wareham/Griffin/MRC Epidemiology Unit, Cambridge/Co-Is; scientific/5y/measurement of physical activity; selection of target groups; epidemiology and trial design and analyses.
 
Description MRC trials unit 
Organisation Medical Research Council (MRC)
Department MRC Clinical Trials Unit
Country United Kingdom 
Sector Public 
PI Contribution methodological/hosting/mentoring
Collaborator Contribution Darbyshire/MRC Clinical Trials Unit, London/Co-I; scientific/ 5y/mentoring/academic capacity development in primary care /trial design/CTU support.
Impact all peer learning group participants now leading primary care research;Campbell NC, Murray E, Darbyshire J, Emery J, Farmer A, Griffiths F, Guthrie B, Lester H, Wilson P, Kinmonth AL. Designing and evaluating complex interventions to improve health care. BMJ 2007; 334 (7591): 455-9
Start Year 2006
 
Description Marteau 
Organisation King's College London
Country United Kingdom 
Sector Academic/University 
PI Contribution scientific collaboration primary care questions and applications
Collaborator Contribution /psychological theory of behaviour; extension of work to study predictors of attendance at screening
Impact Marteau/Psychology and Genetics KCT London/scientific/5y/psychological theory of behaviour; extension of work to study predictors of attendance at screening
 
Description NIHR School for primary care resarch 
Organisation National Institute for Health Research
Department School for Primary Care Research
Country United Kingdom 
Sector Academic/University 
PI Contribution research partners in prevention of diabetes and cardiovascular disease and its consequences
Collaborator Contribution research partners in prevention of diabetes and cardiovascular disease and consequences
Impact followup to 5 years of ProActive trial (MRC) andADDITION-Plus(MRC)
Start Year 2006
 
Description Rutten 
Organisation Utrecht University
Country Netherlands 
Sector Academic/University 
PI Contribution methodological collaboration
Collaborator Contribution Rutten/General Practice/Utrecht Netherlands/scientific/4y/complex intervention trial methodology/extension to different theories
Impact Rutten/General Practice/Utrecht Netherlands/scientific/4y/complex intervention trial methodology/extension to different theories
Start Year 2006
 
Description mrc biostatistics unit 
Organisation University of Cambridge
Department MRC Biostatistics Unit
Country United Kingdom 
Sector Public 
PI Contribution interdisciplinary clinical/statistical interface
Collaborator Contribution Thompson/Spiegelhalter /MRC Biostatistics Centre, Cambridge/Co-I; scientific/5y/statistical methods; supervision
Impact Thompson/Spiegelhalter /MRC Biostatistics Centre, Cambridge/Co-I; scientific/5y/statistical methods; supervision White/ MRC Biostatistics Unit/Cambridge/ 5y/scientific/ handling missing outcome data in smoking cessation trials
 
Description smoking London 
Organisation University College London
Department Research Department of Primary Care & Population Health
Country United Kingdom 
Sector Academic/University 
PI Contribution research partnering in smoking cesation studies
Collaborator Contribution Gilbert & Nazareth /Department of Primary Care and Population Sciences, Royal Free and UCL/ scientific/5y/ distance interventions for smoking cessation.
Impact Gilbert & Nazareth /Department of Primary Care and Population Sciences, Royal Free and UCL/ scientific/5y/ distance interventions for smoking cessation.
 
Description smoking york 
Organisation University of York
Department Centre for Health Economics (CHE)
Country United Kingdom 
Sector Academic/University 
PI Contribution smoking data
Collaborator Contribution economic analyses
Impact Godfrey/ Dept Health Economics /York/ 3y/ scientific/ economics of smoking cessation
 
Title multi-diab ADD 
Description multilevel practice based intervenion to intesify treatment for people with screen detected diabetes 
Type Management of Diseases and Conditions
Current Stage Of Development Late clinical evaluation
Year Development Stage Completed 2007
Development Status Under active development/distribution
Impact Advice re QOF in diabetes; advice re vascular scrrening programme;Eborall HC, Griffin SJ, Prevost AT, Kinmonth AL, French DP, Sutton S: Putting prevention first. In Vascular checks: risk assessment and management. London: Central Office of Information; 2007. Return to text 
 
Title phys act 
Description intervention to promote physical activity in groups at risk of diabetes 
Type Preventative Intervention - Behavioural risk modification
Current Stage Of Development Late clinical evaluation
Year Development Stage Completed 2006
Development Status Under active development/distribution
Impact brief advice technique as effective as more intensive approaches; contribution to helath trainers handbook 
 
Title sams 
Description BRIEF INTERVENTION TO SUPPORT MEDICATION TAKING ;EFFICACY SUPPORTED IN PROOF F PRINCIPLE TRIAL 
Type Therapeutic Intervention - Psychological/Behavioural
Current Stage Of Development Refinement. Non-clinical
Year Development Stage Completed 2010
Development Status Under active development/distribution
Impact NONE YET 
 
Description patient particpants 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Participants in your research and patient groups
Results and Impact Regular newsletters and summaries of findings; policy makers ;

contribution to high recruitment and retention rates
Year(s) Of Engagement Activity 2006,2007,2008,2009