PhD researcher profiles

Division: Primary Care and Health Services
Supervisors:  Matt Sutton, Alex Turner and Tarani Chandola

My research is in the area of determinants of health, and my PhD research specifically looks at the role of early-life non-cognitive skills in determining later-life health. My research also looks at how early-life environments, such as parental education, determine your non-cognitive skills. 

Non-cognitive skills, also known as “personality traits”, are the “relatively enduring patterns of thoughts, feelings, and behaviours that reflect the tendency to respond in certain ways under certain circumstances”. Evidence suggests that an individual’s non-cognitive skills are shaped by factors such as education, family income, parental investment, parenting style, life events, maltreatment and genetic diversity. However, many existing studies estimate only associations, as they fail to control for unmeasured predictors of both determinants and non-cognitive skills. My research aims to address this by understanding how parental education causally determines these skills.

Non-cognitive skills are increasingly becoming recognised for their importance in predicting later life outcomes, including health and health behaviours, labour market outcomes and educational outcomes. What is not yet understood is how the relationship between early-life non-cognitive skills and health varies along the health distribution. In particular, how these skills impact the extremes of the health distributions, which are of clinical and policy importance. I’m also interested in decomposing the relationship between these skills and health, by looking at the mediating factors in this relationship. Such a study would help shed light on the channels through which early-life non-cognitive skills impact later-life health. 

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Philip is undertaking a PhD in Health Economics funded by the Alumni Research Impact Scholarship. His research over the PhD will focus on the development of methods to identify and measure spillovers in the implementation of quality improvement programs.

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Division: Division of Informatics, Imaging and Data Sciences
Supervisors: Evangelos Kontopantelis, Darren Ashcroft, Rosa Parisi, Salwa saad m Zghebi

There is undeniable evidence that people living in different areas of the UK experience strikingly different health outcomes. Achieving health equality is one of the leading goals of the NHS. At the same time, there is an urgent need for more research and greater monitoring of prescribing of dependence forming medicines (DFM). Concerns have been raised regarding prescribing of opioids, benzodiazepines and gabapentinoids. Very few studies focused on the geographical variations in prescribing of these medications. Previous studies tend to focus on patterns in prescribing on a national scale but it is unclear if these patterns are distributed equally across the country. This PhD focuses on exploring the spatial and temporal trends in prescribing of opioids, gabapentinoids and benzodiazepines.

The main data used in the project is the NHS Digital practice level prescribing data. Prescriptions will be mapped to lower layer super output areas (LSOA) which is a spatial unit representing on average 1500 people. Although a few studies have previously explored spatial distribution of opioid prescribing, this has been done on much larger spatial units such as Clinical commissioning groups (CCGs). Using spatial statistics, I will explore the changes in spatial autocorrelation in prescribing as well as the correlation with spatial attributes, particularly socioeconomic deprivation. I will use local indicators of spatial association (LISA) to identify clusters of high and low prescribing levels and how these changed over time. Using spatial modelling, I will explore the potential explanations for existence of spatial and longitudinal patterns by looking at the population distribution, policy interventions and prescribing patterns.

Understanding the spatio-temporal patterns in prescribing of opioids, benzodiazepines and gabapentinoids can guide future policy development, evaluate previously implemented interventions and identify some of the factors leading the increase in DFM prescribing.

Division: Population Health, Health Services Research and Primary Care
Supervisors: Matt Sutton, Katherine Checkland, and Rachel Meacock

For several years English emergency departments have faced increasing attendance rates which have resulted in considerable pressure on these services. Crowded A&E departments and increasing unplanned hospital admissions are now two of the biggest challenges facing the NHS and despite the implementation of a number of programmes aimed at reducing A&E attendances and emergency admissions the numbers continue to grow year on year. It is often reported that a large proportion of emergency care utilisation could be avoided through effective management and treatment in primary care. For example this could relate to admissions that could have been potentially prevented by timely and effective primary care services, or divertible attendances at A&E departments who did not require the specialist services of A&E and could have been treated by their GP.

This PhD will first review and clarify the concept of avoidable emergency care use. Recognising that there are different types of undesirable utilisation which vary by underlying causes and potential solutions will aid policy makers in identifying areas where policies targeting reductions in emergency department attendances would best be directed.  I will then utilise a newly available and underutilised administrative dataset of all A&E attendances in England to examine the relationship between the volume and composition of avoidable A&E attendances and emergency admissions, and the accessibility and quality of primary care services.

Existing studies assessing the prevalence of avoidable attendances and their relationship with primary care are inconsistent, largely because no standardised definition exists. I will assess the sensitivity of different types of attendances at emergency department attendances in England, classified according to previously used definitions and criterion of ‘avoidable’ attendances, to indicators of primary care availability and quality, in order to validate the use of these definitions as a measure of primary care quality.

Secondly, the magnitude of clinically preventable A&E attendances in England is currently unknown since the usual methods of identifying preventable use, patients with ambulatory care sensitive conditions, are not able to be used as English A&E data reports A&E specific diagnosis codes rather than the ICD10 codes needed. I identified five NHS trusts in England which code their A&E attendance diagnosis using ICD10 codes. This provides a unique opportunity to assess the magnitude of preventable attendances in these trusts, and explore how they relate to primary care accessibility and quality measures.

I will also quantify the extent to which the change in the probability of being admitted with an avoidable condition (ambulatory care sensitive condition) from the emergency department between 2013 and 2017 is attributable to changes in distribution of determinants (including patient, attendance, area, general practice, and hospital characteristics) and to changes in the impact of these determinants over time. Finally, I aim to assess the effectiveness of an intervention that aims to improve primary care services, on avoidable emergency care use.  

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Division: Innovation, Management and Policy
Supervisors: Naomi Chambers and Ronnie Ramlogan

My research is concerned with the board’s role in the strategy process. I focus on the role of charity boards, particularly those that are involved in public health campaigns in Africa. I study the external social influences on these organisations and the board’s responses to these influences. As a consequence, my research is located within the organic strategy process perspective which deals with the structure and processes to administer strategy and the dialectic with stakeholders to embed the strategy, and the micro-perspective which is concerned with the strategizing practices underpinning this engagement.

I approach my research using realist methodology, an evaluation method for understanding programmes, interventions and policies. Realist methods help researchers uncover the mechanisms that underpin actions and outcomes in particular contexts. Using these methods, I have identified and tested four key mechanisms of the strategy process through realist review and validated them using realist interviews at charities involved in public health in Africa. The mechanisms identified are the reasoning mechanisms of social groups. There is room for further research to identify other constructs of mechanisms at different system levels and the relationships between these mechanisms.

I intend to make three contributions. The first is methodological as I extend realist methodology towards organisational strategy. The second is theoretical: a contribution to the concept of mission drift, which is the notion that organisations move from or focus on their missions under the influence of various resources. Thirdly, I hope to contribute to practice and provide boards with evidence-based guidance on the resources that risk or enhance their performance. My research may also have implications for policy makers, helping them understand the role and impact of charities involved in public health in Africa.

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I am interested in developing evidence that improves quality and safety in patient care, with a particular interest in reducing unwanted outcomes in complex healthcare settings. In my previous roles, I was actively involved in improving patient care in English NHS and worked in a number of different care delivery areas in NHS: planned/elective care : critical care; theatres; outpatient; blood transfusion.

My research investigates On The Day Surgery (OTDS) Cancellations in English NHS and funded by NIHR. When a planned care surgery is cancelled on the day of patient admission or the day of the surgery, it is defined as an OTDS cancellation. OTDS cancellation is a long-standing problem in healthcare faced by all over the world. OTDS represent a series of unwanted outcomes such as a significant loss of revenue and waste of resources; have significant psychological, social and financial implications for patients and their families.

My research focuses on the factors that influenced operation cancellations and consisted of three studies. Firstly, I am planning to conduct a realist synthesis to identify the mechanisms that influence OTDS cancellations and develop a Middle Range Theory (MRT) that explains cancellations and other unintended outcomes produced in complex organisational settings. Secondly, using a multi-centred study understand the variation in OTDS cancellations rates among NHS acute care providers. Thirdly, a comparative case study to identify the factors influencing OTDS cancellations rates. Finally, by linking the findings and insights from all of the parts, aims to contribute to improve the understanding of how variation can be managed to reduce unwanted outcomes in complex organisational setting. The study findings will also, potentially, be of great benefit to patients, healthcare provider organisations and the healthcare economy. The findings aim to contribute to the effective use of resources that can make substantial savings at an organisational level, which is vital for all NHS organisations in the current economic climate.

Division: Population Health
Supervisors: Dr Maria Panagioti, Professor Evan Kontopantelis, Professor Darren Ashcroft

My research focuses on hearing health inequalities, which refer to the avoidable differences in people’s hearing health across different social and/or population groups. I examine the relationship between socioeconomic inequality and the development of hearing loss and the impact of hearing loss on the lives of older adults in England in terms of mental well-being, quality of life, social engagement and economic position, using longitudinal data from the English Longitudinal Study of Ageing (ELSA). The ELSA is a large representative data set with information on the health, social, wellbeing and economic circumstances of the English population aged 50 and older.

Theory development in the emerging research field of hearing health inequalities led to the construction of a conceptual framework, the “Model for Hearing Health Inequalities (HHI Model)”. The HHI Model depicts the modifiable factors for hearing loss during the life-course and the mechanisms between socioeconomic inequalities and hearing health. The HHI Model could be used as a tool for prevention, identification and management of hearing health inequalities and for policy formulation aimed at hearing loss risk reduction.

During my PhD project, we published the first study in hearing loss research that examines the effects of four different indicators of socioeconomic position (education, occupation, income, wealth), encompassing thus aspects of the life-course socioeconomic stratification, to the objectively measured hearing loss in older adults. In addition, that study was the first to explore how major lifestyle factors (such as high BMI, physical inactivity, tobacco consumption and alcohol intake above the low-risk-level guidelines) associated with hearing loss among older adults in England. We concluded that socioeconomic inequalities and modifiable lifestyle behaviours need to be targeted by the health policy strategies, as an important step in designing interventions for individuals that face hearing health inequalities.

Aim of the project is to inform and advance health policy strategies, to minimise socioeconomic risks for hearing loss and access to hearing health services and hearing aids use, in order to mitigate the adverse effects of hearing loss in older adults in England. Our work can also inform the harmonisation of measures with other seven global ageing surveys that include comparable physical and anthropometric measurements, allowing for accurate cross-country analyses on the role of hearing loss in healthy and active ageing.

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My PhD research focuses on understanding the issues with the measurement of informal (unpaid) care. Although no universal definition for informal care exists it mainly consists of help to those who cannot perform typical daily tasks (such as washing and dressing). Informal carers are an under-recognised contribution to the health and social care workforce. The demands on placed on carers are considerable and there is strong evidence that informal care has a profound effect on carers’ health and labour market participation. The methods used to measure the contribution of carers require development. Being aware of the measurement difficulties of informal care and how they impact upon the conclusion of empirical results is essential for future research and policy. 

My research first aims to review the available literature on informal care measurement issues. This is the first study to systematically identify measurement issues and recognise any possible gaps in the literature. Subsequent studies as part of my PhD are derived from the issues found in the review section and utilise household survey and time diary data. They include understanding whether obtaining informal care information from the recipient or provider of care results in discrepancy between the two. Further work explores how the allocation of time is different between carers and non-carers. The results of these studies will contribute to further understanding the measurement issues of informal care which is essential, for example, in obtaining a monetary valuation for caregiving. 

• View Sean’s full research profile here

Division: Division of Population Health
Supervisors: Matt Sutton, Luke Munford, Peter Bower

My research explores the effectiveness of community approaches at protecting and improving health and well-being and reducing inequalities.  The recent NHS Long term plan set ambitions to champion community approaches alongside formal healthcare, with the theory that peoples’ environment can effect social interactions and health outcomes. The two main approaches they are implementing are social prescribing, where individuals are prescribed community groups relating to their condition alongside formal healthcare, and community assets, which are collective resources that communities are available to use, for example leisure centres.

The research will evaluate these schemes at a national level using datasets like the General Practice Patient Survey and Community Life Survey. Particularly for community assets, assessment of inequality to access needs to be considered prior to evaluating their relationship with individuals’ health. There will be research evaluated at a local level of social prescribing programmes in Greater Manchester. The areas across Greater Manchester differ in socio-economic status; with some areas are some of the most deprived in the whole of England with others significantly more affluent. This will expose the use of social prescribing to assess how different areas can benefit from such intervention in means of dissimilarities in marginal benefits towards health and well-being and healthcare use. 

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