NIHR research prioritises the health and social care needs of the public, with a focus on under-served people and communities. It takes place in diverse regions and settings and includes a diverse participant base. Research findings are widely cited and available to all. They result in innovative products and services and evidence-led changes to policy and practice.
Executive summary
This report on the ‘Addressing Needs’ domain is the first of four. They form part of an initiative that aims to further our understanding of the outcomes and impact of our research and investments on improving the health and wealth of the nation, enabling us to learn from and continuously improve our work and to transparently track our progress.
This report is split into five sections, beginning with a description of the ways NIHR research has contributed to improvements in health, policy and practice. We work to achieve this by identifying and prioritising the most important research, which is then made accessible to participants across the country. The outcomes of the research we fund and support is then published and is made free to access so it can be taken up and widely used. At every step we include a specific focus on addressing health inequalities and the needs of people and communities under-served by research.
Improving Health, Policy and Practice
Three main areas of implementation identified from 660 reported examples from 2020/21 were:
- changes for patients and service users
- changes to health service delivery and practice
- developing the health and social care workforce
Prioritisation of research topics
- Four teams identified 492 research topics in 2020/21, approximately half were identified in partnership with 19 organisations, as well as individual clinicians, care workers, patients and members of the public.
Research Delivery
- 2021/22 participant recruitment in England was nearly double that in 2019/20.
- The Integrated Care System (ICS) with the highest participant recruitment rose from 35.78 per 1,000 population in 2019/20 to 103.67 in 2020/21 before declining to 70.92 in 2021/22.
- 100% of NHS trusts recruited one or more participants into a research study supported by us between 2018/19 and 2021/22.
- Around 50% of all GP practices recruited one or more participants into a research study supported by us between 2020/21 and 2021/22, up from 36% in 2019/20.
Research Outputs
- There were 10,483 publications from NIHR funded research in 2020.
- Our 2020 publications had 512,352 citations and an Relative Citation Ratio (RCR) of 4.65, meaning papers were almost five times more likely to be cited than comparable papers published the same year.
- There was year-on-year increase in publications and citations from 2016 to 2020.
- 32% of all infection publications in 2020 related to COVID-19.
- 96% of infection publications in 2020, with an RCR higher than 10.0, related to COVID-19.
- 4,505 policy documents cited our funded research from 2016 to 2020, and the number of policy documents citing our research has been increasing year-on-year.
- 92% of the research publications generated through our funded research from 2016 to 2020 were free to access, and just under three quarters of these have an associated reuse licence.
Under-served Communities and Inequalities
- Five change initiatives were implemented by our Under-served Communities Programme since March 2021, including building a research targeting tool and developing the NIHR INCLUDE framework.
- Our Research Ready Communities Programme has built relationships with 18 communities across 15 regions, trained 67 Community Champions, and is working in partnership with 36 local organisations.
- We have funded 285 awards with a focus on health inequalities since 2017.
Improving Health, Policy and Practice
We aim for the programmes we fund and the people, facilities and technology we invest in to drive innovation, enable delivery of new products and services, and advance changes in practice which benefit health and social care. To understand how successful we are at driving these changes, we have used researcher reports to analyse and draw out common themes and topics relating to the many different ways and contexts in which our research is shaping policy and practice.
The ways in which researchers report NIHR research being implemented to improve health, policy and practice
Thematic analysis of researchers’ annual report submissions from April 2020 to March 2021 identified that our research was implemented across ten themes which we synthesised into three broad areas. These were drawn from around 660 examples of research implementation provided by researchers as part of ResearchFish submissions through our research programmes and annual progress reports submitted to our infrastructure and global health research teams.
1. Changes for patients and service users
By transforming research into practice and implementing new and advanced diagnostic techniques, researchers reported improved health outcomes for patients.
These include:
- increased success of treatments
- better tolerated diagnostic tests and treatments
- reduced side effects
- increased survival rates and life expectancy
- lower incidence of disease and slower transmission
- fewer symptoms
- fewer hospital visits
- improved quality of life
Our research has improved understanding of treatments, care pathways and services. This has resulted in more informed decision-making, increased referrals, and improved health-seeking behaviours.
Examples reported by researchers:
- New interventions focused on preventing and treating diabetic foot problems reduced ulceration risk and foot ulcer incidence among people with diabetes.
- Community education work in Kenya and Nigeria resulted in a substantial rise in snakebite victims seeking hospital healthcare.
- Our research found that a chemotherapy combination of carboplatin and paclitaxel performed better overall than existing chemotherapy treatments, with anal cancer patients living seven months longer. These findings led to changes in clinical practice through recommendations in clinical guidelines.
Case study: Scarred Liver Project
The Scarred Liver Project has led research into detecting liver disease at a critical early stage to increase survival. Liver disease is the third highest cause of premature death in the UK. A new primary care pathway which identifies liver disease in high-risk patients with a non-invasive test Fibroscan demonstrated success in five primary care sites across the East Midlands. It was shown to increase detection of significant liver disease, have high satisfaction levels and be cost-effective. The diagnostic pathway is now available at more than 100 GP practices across south Nottinghamshire, serving a population of approximately 700,000 people.
2. Changes to health service delivery and practice
Our researchers reported that their research changed service delivery and management through the development of new health and social care services and the redesigning or decommissioning of existing services.
Our research contributed to the development of digital systems, tools and technology to improve the detection and management of disease and improve patient safety. Furthermore, changes to services, interventions and systems resulted in economic benefits through cost-savings and revenue generation from the sales of new products and services. The implementation of new, faster treatments resulted in staff time savings and subsequent NHS cost savings.
Our research contributed to the introduction of new diagnostics and interventions, most commonly including new treatments such as new drugs, therapies, diagnostic procedures, devices and technologies. This led to increased diagnosis of diseases and conditions and reduced hospital admissions and lengths of hospital stays. The results of our research also instigated the implementation of public health interventions such as public health campaigns and health management programmes.
Examples reported by researchers:
- The eRAPID approach to monitor lower gastrointestinal cancer ensured symptoms could be monitored online during the pandemic, improving the quality of remote service delivery.
- Using TARGET-IORT during breast cancer lumpectomies reduced the number of postoperative radiotherapy hospital admissions for patients.
- Football Fans in Training is a group-based weight management programme delivered through football clubs. It resulted in 10,000 men in 11 countries benefiting from healthy lifestyle programmes.
Case study: FAST-Forward trial
The FAST-Forward trial compared a one-week course of radiotherapy for women who had undergone surgery for early-stage breast cancer with the current standard of three weeks. Results published in 2020 demonstrated that the one week course was as safe and effective as the current standard. Due to pressures on NHS services during COVID-19, the recommended radiotherapy course was implemented rapidly to reduce the number of patient trips to hospital from 15 to five. In addition to UK adoption, the trial findings have influenced practice in Europe, the US and Australia.
3. Developing the health and social care workforce
Our researchers supported the development of the professional awareness, behaviours and skills of the health and social care workforce through generating training materials and sharing knowledge on research findings. This improved awareness of conditions and the understanding and effectiveness of treatment options, changing attitudes and behaviours when working with vulnerable groups. Our research also contributed to policy and practice guidelines, resulting in increased knowledge and skill levels among the workforce. Making electronic training materials helped extend access to more people, such as those in low and middle income countries (LMICs).
Examples reported by researchers:
- LMIC practitioners can better detect and confirm disease outbreaks in their countries due to successful knowledge transfer among NIHR researchers and practitioners.
- Our research informed professionals on what advice they should provide to women considering fasting during pregnancy and produced a leaflet to help patients make informed decisions.
- Our researchers developed a training model supporting the implementation of fetoscopic surgery, the first UK-commissioned foetal surgery programme for spina bifida.
Case study: Improving the recognition and referral of adults experiencing domestic violence and abuse
We have been funding research to improve the recognition and referral of adults experiencing domestic violence and abuse (DVA) in GP practices. Findings from two NIHR awards, PROVIDE and REPROVIDE, have been integrated in the IRISi social enterprise to train and support GP practice teams.
The programme has been commissioned in 36 localities across England and Wales with around 850 GP practices now fully trained to increase signposting to domestic violence support. An NIHR Applied Research Collaboration evaluation of IRIS impact over four years found that the practices in which training had been implemented had increased identification of new cases and referrals to DVA workers. Researchers from the studies have chaired development groups of NICE domestic violence and mental health guidelines to implement their recommendations more widely.
Improving health, policy and practice: What will we do next?
Our qualitative analysis has improved our understanding of the many ways research is implemented by researchers during the course of their award funding. As a next step, we plan to build on this analysis to develop a searchable repository of examples of self-reported improvements to health policy and practice which we can then link to case study development. This will help us to provide further depth and detail on the impacts achieved after the awards are completed.
The identification and prioritisation of research topics
It is important that we prioritise the challenges and policy questions that could most benefit from research. We want to ensure we answer the most important research questions, bridging evidence gaps for health and social care decision-makers, and addressing topics that make the biggest difference to patients and the public.
Identification and prioritisation: How does this work?
Identification of topics
Topics can be identified by many stakeholders through a number of pathways, for example:
- We support the work of the James Lind Alliance (JLA) Priority Setting Partnerships (PSPs) which enable clinicians, patients and carers to work together to identify and prioritise research questions.
- We engage with individuals with lived experience, health and care practitioners and external organisations such as charities.
- We respond to topics named as priorities by the government, for example the Department of Health and Social Care (DHSC) Areas of Research Interest or through the DHSC Research and Development Committee.
- We consider recommendations arising from NHS demand signalling or work undertaken by the National Institute for Health and Care Excellence (NICE).
- We receive suggestions for research topics through our website.
- We identify topics through desk-based research, for example by mapping disease prevalence against our research activity.
- Researchers identify and propose topics and apply to a relevant NIHR programme, school or research unit for funding.
- Our Translational Research Collaborations facilitate the identification of areas of patient need through established networks between the UK’s leading universities, NHS trusts and research centres.
- Our committees and expert panels discuss and propose topics for research.
Prioritisation of topics
Some topics are prioritised for us by the DHSC’s Chief Scientific Advisor, or through engagement with charities. In most cases it falls to NIHR Committees, formed of professionals and public members, to prioritise the research we fund.
Funding research
We accept applications from researchers, academic institutions, local authorities, industry, charities, and social care organisations. Funding opportunities are advertised through either commissioned calls to answer specific research questions, researcher-led workstreams, or themed calls and highlight notices which provide funding opportunities in government high-priority areas. For example, in response to the publication of DHSC’s updated Areas of Research Interest, we advertised this year’s annual themed call on compound pressures. Applications are reviewed by programme teams who provide assessments to funding committees. NIHR Committees, formed of professionals and public members, agree on which applications should be recommended to DHSC, which makes the final decision on funding.
Evidence of identification of topics in partnership
Some of our research topics are identified in partnership with external stakeholders. To explore this partnership activity further, we analysed data collected from four areas between April 2020 and March 2021 to understand the number of challenges, policy questions and priority topics that were identified:
- 492 were identified by the NIHR Identification and Prioritisation team, the DHSC Research and Development Committee, the NIHR Research and Innovation for Global Health Transformation programme, and the JLA PSPs.
- 226 of the 492 topics were identified in partnership with 19 organisations, as well as individual clinicians, care workers, patients and members of the public.
Of the 226 priorities identified by organisations and individuals, 187 were identified in partnership with public sector organisations, 39 were identified with voluntary/charitable organisations, and 20 were identified through partnerships with members of the public.
The data shows that NIHR engages with a wide range of organisations, as well as members of the public, in identifying research topics. The initial analysis completed as part of this report gives us an insight into the scale of partnership working, and the high demand for evidence. This will form a strong starting point from which we can begin to track NIHR activity in future.
Identification and prioritisation: What will we do next?
Working in a variety of ways to identify and prioritise research topics with many partners makes consistent data collection challenging. Consistently tracking and analysing the process and our progress will promote transparency and improve our systems and processes. This will enable us to better understand how we prioritise the most important questions to meet the health and care needs of the public.
We will implement new fields into our data collection on research prioritisation that will ensure the same types of information are being collected across NIHR teams. Once we have baseline data, we will gain a better understanding of the inclusiveness of our decision-making processes, and if we need to improve our ways of working. Putting these foundations in place will allow us to further develop indicators that will meaningfully demonstrate how we are doing across this wide-ranging area of work.
Research delivery
We know that research active settings have better patient outcomes. Examples of this can be found on our Embedding a research culture page. We need to support our research community to maximise opportunities for individuals to participate in research. Effective clinical and applied research should address health and social care needs and increasingly aim to include people and communities under-served by research.
We support the delivery of research across various types of health and care settings and within wider communities and populations. To understand how taking part in research varies geographically across the nation, we analysed recruitment activity data from NHS trusts and GP practices. We used these research sites as the majority of our supported research currently takes place within these settings. Our interactive dashboard visualises this research activity and can be used to compare the location of higher rates of certain diseases or conditions.
Proportion of participants in clinical and applied research studies funded or supported by NIHR delivered across geographic regions
We have chosen to use integrated care systems (ICSs) to map the information for these indicators. ICSs are partnerships of organisations that come together to plan and deliver joined-up health and care services, to improve the lives of people who live and work in their area. ICSs were established on a statutory basis on 1 July 2022. There are 42 ICSs in England. ICSs have populations of approximately 1 million to 3 million people.
The figures in Table 1 reflect the NIHR Clinical Research Network supported recruitment within organisations in the current ICS geographical boundaries. This indicator, and the related interactive dashboard, enable comparison across the recently established ICSs.
Key finding:
- The ICS with the highest recruitment per 1,000 population rose considerably from 2019/20 to 2020/21 due to increased research participation during the COVID-19 pandemic (see Table 1). Although this number fell in 2021/22, it remained nearly double the 2019/20 number.
Table 1: Highest, average (mean) and lowest ICS recruitment per 1,000 population to NIHR Clinical Research Network supported research
| 2018/19 | 2019/20 | 2020/21 | 2021/22 | |
|---|---|---|---|---|
| Highest recruitment by an ICS region per 1,000 population | 32.94 | 35.78 | 103.67 | 72.92 |
| Average (mean) recruitment by an ICS region per 1,000 population | 13.26 | 11.81 | 30.23 | 20.19 |
| Lowest recruitment by an ICS region per 1,000 population | 3.24 | 4.26 | 4.45 | 4.58 |
View the geographical distribution of participant recruitment (weighted by ICS population) into NIHR-funded or supported research studies in 2018/19, mapped to ICSs region. The intensity of the colours on the map indicate the number of participants recruited by region. The darker the colour, the greater this number, and the paler the colour, the lower this number.
We will continue to make it easier for participants to take part in research, such as through our Be Part of Research website. On this website, people can search for studies that are taking place in their area and on particular health conditions that they are interested in. People can also find opportunities to take part in studies from home.
Proportion of NHS trusts and GP practices active in research supported by NIHR
To understand more about the opportunities we offer for the public to take part in NIHR Clinical Research Network supported research, we have explored two health settings where a significant proportion of our health research takes place. Understanding where NHS trusts and GP practices recruit people into research studies, provides an indication that the public are being offered opportunities to participate in research as part of the care they receive.
Table 2 shows the proportion of NHS trusts and GP practices which have recruited one or more people into a research study supported by the NIHR Clinical Research Network, per reporting year. All NHS trusts between 2018/19 and 2021/22 recruited one or more people into a research study supported by us. In GP practices there was a rise in 2020/21 and 2021/22, with half of all GP practices recruiting one or more people into a research study we supported.
Table 2: Proportion of NHS trusts and GP practices active in research supported by the NIHR Clinical Research Network
| 2018/19 | 2019/20 | 2020/21 | 2021/22 | |
|---|---|---|---|---|
| Proportion of NHS trusts | 230/230 (100%) | 226/226 (100%) | 221/221 (100%) | 216/216 (100%) |
| Proportion of GP practices | 2,721/7,253 (38%) | 2,492/6,975 (36%) | 3,422/6,854 (50%) | 3,397/6,640 (51%) |
View our interactive dashboard which shows variations in research activity between sites, between different types of site, and between the same type of site in different geographic regions. For the linked maps, the intensity of the colours on the map indicate the proportion of studies that sites have recruited into. The darker the colour, the greater this proportion, and the paler the colour, the lower this proportion.
- Geographical distribution of NHS trust research activity mapped to ICSs in 2018/19
- Geographical distribution of GP practice research activity mapped to ICSs in 2018/19
The evidence shows consistently high levels of research activity among NHS trusts across the country. It also shows that while the number of research-active GP practices has increased in recent years, there is still work to be done. We've detailed our commitment to expanding research activity in primary care settings in the NIHR Clinical Research Network Primary Care Strategy.
Research delivery: What will we do next?
The research delivery indicators provide an insight into participation in our supported studies. By linking to routinely collected health data, we hope that the interactive dashboard may also be able to map the partial postcode and characteristics, such as ethnicity, gender and age of participants, providing more granular insights. When available, we will work to incorporate such information into the interactive dashboard, which may inform future reporting. When the data to map the smaller geographies of ICSs (places and neighbourhoods) becomes available, we will also add it to the dashboard. Using this tool, we will be able to track our progress against this outcome to widen participation in research and make research more accessible.
Research outputs
It is crucial that our funded research teams and centres are producing high-quality outputs that can be shared rapidly, openly and in relevant and accessible formats to maximise the use of evidence in health and social care. We are committed to supporting open access to research data and the publication of peer-reviewed research findings. We track how often and in what ways our research is cited in scientific and policy contexts, to help us understand how and where our research is being used and how useful the research is.
Citation of NIHR-funded research in publications, policy outputs and guidelines
A citation refers to the reference of NIHR-funded published research in other publications, such as the scientific literature, policy and guidelines. Citation data helps us to understand how timely and influential our research is. For a more robust understanding, we must also analyse the relative citation ratio (RCR), which indicates the usefulness and influence of our research and whether it benefits the wider health and social care system. For example, an RCR of 3.0 means that, on average, papers were three times more likely to be cited than comparable papers published within the same year.
Key findings:
- From 2016 to 2020, publications and citations increased year-on-year, whereas RCR remained relatively steady until a large jump in 2020 (Table 3).
Table 3: NIHR publications, citation counts, and RCR (2016 - 2020)
| Year | Publications (total) | Citations | RCR (mean) |
|---|---|---|---|
| 2016 | 6,334 | 196,581 | 2.61 |
| 2017 | 6,940 | 249,956 | 2.75 |
| 2018 | 7,642 | 300,699 | 2.47 |
| 2019 | 8,730 | 365,675 | 2.51 |
| 2020 | 10,483 | 512,352 | 4.65 |
| Total | 40,129 | 1,625,263 | 3.00 |
Figure 1: NIHR Publication and RCR trends (2016 - 2020)
- The top six disease areas in which we published most are listed in Table 4. For papers published in the infection category during 2020, 32% of all papers and 96% of papers with an RCR higher than 10.0 related to COVID-19, emphasising our role in producing useful and timely COVID-19 pandemic research.
Table 4: Top Health Research Classification System (HRCS) health categories by volume of publications (2016 - 2020)
| HRCS health category | Number of publications | Citations | RCR (mean) |
|---|---|---|---|
| Cancer | 4,841 | 187,792 | 2.68 |
| Mental health | 4,096 | 127,607 | 3.12 |
| Cardiovascular | 3,774 | 123,896 | 2.57 |
| Generic health relevance | 3,697 | 121,918 | 3.05 |
| Neurological | 3,550 | 119,825 | 2.93 |
| Infection | 2,908 | 127,628 | 4.26 |
Citation of NIHR-funded research in policy and practice guidance
There were 4,505 policy documents from 2016 to 2020 which cited our funded research (published from 2012 onwards). These ranged from strategies, committee and consultation papers to clinical guidelines. The data suggest that the number of policy documents citing our research has been increasing year on year (Figure 2). Future analysis will help us to understand whether this increase is reflective of a trend or is due to our improved ability to identify citation of our research.
Figure 2: Policy documents published citing NIHR research by year (2016-2020)
Level of openly accessible and reusable NIHR-funded research outputs
To ensure greater uptake and use of research evidence, our outputs must be accessible and reusable by health and social care practitioners, patients, people who use social care services, and members of the public.
One way in which we seek to understand whether our research is accessible and reusable is by measuring the open access (OA) status of our publications. Under the NIHR Open Access policy (2022), for articles to be considered OA, they must be immediately, freely and openly accessible to all with an open licence allowing reuse. This report measures the number of articles that are free to access on any platform at the time of analysis, as well as the associated reuse licence attached to those publications.
Key findings:
- From 2016 to 2020, 92% of the primary research publications generated through our funded research were freely accessible at the time of the analysis, however these publications displayed variable levels of reusability depending on OA model and licence type.
- It is important to note that this time period is prior to the introduction of the new NIHR Open Access policy in 2022, which requires all peer-reviewed research papers from our funded studies to be made immediately and freely accessible and reusable. This will increase the number of NIHR-funded articles published immediately OA. For this analysis, the level of our funding or support was not analysed and all publications were included, rather than limiting the analysis to only papers in the scope of the new policy.
Table 5: OA publication trends between 2016 and 2020
| Year | Total free to access publications | % of total publications that are free to access |
|---|---|---|
| 2016 | 5,712 | 90% |
| 2017 | 6,511 | 94% |
| 2018 | 7,172 | 94% |
| 2019 | 8,074 | 93% |
| 2020 | 9,632 | 92% |
| Total | 37,101 | 92%* |
*shows mean figure
Just under three quarters of these free to read publications have an associated reuse licence, hence are OA (see Table 6).
Table 6: Percentage of free to read publications with a reuse licence
| Year | Free to access publications with associated reuse licence | Total free to access publications | % total publications with reuse licence |
|---|---|---|---|
| 2016 | 3,911 | 5,712 | 68% |
| 2017 | 4,459 | 6,522 | 68% |
| 2018 | 4,946 | 7,172 | 69% |
| 2019 | 5,883 | 8,074 | 73% |
| 2020 | 7,320 | 9,632 | 76% |
| Total | 26,519 | 37,101 | 71% |
Since May 2020 we have produced 100 plain English, accessible summaries of our funded research annually. These are available on the NIHR Evidence website, helping to improve the general accessibility of research evidence.
Research outputs: What will we do next?
We can see from the baseline evidence presented here that the volume of our research has increased year on year since 2016, with the largest yearly increase attributable to the COVID-19 pandemic. However, the number of publications alone does not tell us about how impactful our research has been. For this we can consider the RCR and the number of policy documents our research has been cited in, both of which have also seen an increase since 2016. We consider this to be a good result, one which we will continue to track to understand what the future trajectory of research articles will be post-pandemic. We will also continue to monitor the percentage of our publications with Open Access trends, noting that levels have seen modest fluctuation but remain trending in a positive direction.
Highlight on under-served communities and health inequalities
To address the health and social care needs of the public, our research must contribute to reducing health inequalities. We seek to fund and deliver research studies where the need is greatest, including people from under-served communities at every stage of the research pathway, so that our research is of most benefit. This is identified as an area of strategic focus in Best Research for Best Health: The Next Chapter.
To tackle this priority area, we are embedding a culture of considering under-served people and communities in all the research we fund and support. Since March 2021, our Under-served Communities Programme has implemented five change initiatives to ensure that everyone has an equal opportunity to participate in research. We also piloted approaches to working more collaboratively and effectively through the Research Ready Communities Programme.
We adapted research processes to ensure the appropriate data is being collected to tackle health inequalities through our funded awards. We have funded 285 awards which focus on health inequalities since 2017. Many of these initiatives are new, which means we don’t yet have a complete picture of their outcomes. However, there are many areas where we have already been successful in driving positive change:
Developing resources to support research design and delivery
- Our Under-served Communities Programme built a new research targeting tool. The tool was designed to help identify areas under-served by research, so that those applying for our funding and funding panels, or aiming to choose the most relevant research sites, can better understand and locate these under-served areas and populations. The tool is an online dashboard and was developed in partnership with the intended users, including researchers and the public. To access the research targeting tool, contact inforequest@nihr.ac.uk
- The NIHR INCLUDE framework and guidance aims to increase the number of people from under-served groups included across the entire life cycle of research projects. It was also converted into an e-learning package accessible by the NHS, UK universities, and other publicly funded organisations conducting and supporting clinical research.
Engaging with under-served communities
An evaluation of the Research Ready Communities pilot in Blackpool, Brixton and Doncaster showed that communities were more aware of and had improved perceptions of health research. The evaluation showed that the researchers had improved their understanding and capacity to engage under-served communities.
Since April 2022, we have built relationships with 18 communities across 15 regions of the country, including:
- in rural Lincolnshire, Herefordshire and Worcestershire
- with ethnic minority women’s groups in Newcastle, Brixton and North Thames
- with low-income communities in Blackpool, Whitley and on the North West Coast of England
We have trained 67 Community Champions and are working in partnership with 36 local organisations across England through the programme.
We are now transforming the programme materials into a resource that can be used to improve engagement with under-served communities.
Considering research applications with a health inequalities lens
In 2022, the NIHR Policy Research Programme introduced a new strategic focus on health inequalities. Researchers applying to the programme are now asked to identify whether their proposed research is relevant to, or includes a health inequalities component. They are asked to detail if they will be able to collect a core set of data relating to health inequalities through their research design. Developing guidance on this is an iterative process, with input from experts and users needed for updates and improvements to ensure it remains fit for purpose. A webinar, NIHR Policy Research Programme Health Inequalities, was hosted to support researchers to understand and implement this guidance. The Policy Research Programme plans to evaluate the impact of this initiative, with the potential to expand the guidelines and data collection requirement to our other programmes.
Funding research on health inequalities and under-served people and communities
Working with partners such as local authorities, both our School for Public Health Research and our Public Health Programme fund research focusing on health inequalities and the wider determinants of health. This enables evaluation of the impact of interventions aimed at improving health and reducing the health inequalities of local populations. A collection of case studies have been developed to demonstrate the impact of this work.
For example, we funded researchers from the London School of Hygiene and Tropical Medicine, University College London and the University of Leeds to evaluate the impact of free bus travel for young people in London. They found that making such journeys improved the safety and activity levels of young people and highlighted how universal free travel reduced social stigma among young people. Free bus travel had a major impact on equity, largely removing travel poverty as a barrier to social inclusion. This initiative has since informed UK and international public health guidance on promoting healthier travel.
What will we do next?
While we have made significant strides in putting in place the programmes and tools needed to begin addressing health inequalities and the needs of people and communities under-served by research, we know we still have a long way to go. Our work to date on developing indicators of our progress has taught us that the impacts of these programmes and initiatives will take time to be fully realised.
We must work in partnership with organisations across the health and social care sector to achieve our shared outcomes. This means it is challenging to isolate and measure our specific contributions to population-level change. To address these challenges, the approach to developing evidence of our progress will need to include an understanding of how we work across the wider health and social care system to deliver.
Conclusion
The NIHR Outcomes Framework serves as a valuable tool for documenting the medium- and long-term contributions of our activities to the scientific knowledge base, patients, people who use social care services, carers, the public, and the health and social care system. It allows us to track the outcomes of our investment and programmes over time, providing a broader and more systemic view of how we shape research infrastructure, culture and capacity and contribute to improving the health and wealth of the nation. It is, however, important to acknowledge the limitations of the framework. It only captures a subset of our activity and may not fully capture the complexity and breadth of our impact.
The evidence presented in this report serves as a starting point from which we will continue to evolve and continuously improve the data we collect and the analytic methods we use. Through our co-development approach, we have gained valuable insights into our processes and engaged with the communities who actively shape and contribute to our work. This ongoing engagement has been instrumental in identifying our current desired outcomes and helping to formulate our ambitions for the future. We recognise the challenge in balancing the need to track our progress towards our goals with the need to ensure the indicators we develop remain relevant within a dynamic and evolving landscape. Continued engagement with our many stakeholders and communities will help to ensure this continued relevance, and will support greater transparency and accountability, which we welcome.
Methods and caveats
Improving health, policy and practice
Methods
- Qualitative analysis was conducted on relevant ResearchFish entries (1773 entries representing 468 awards), Infrastructure annual reports (93 annual reports from across seven schemes), and Global Health Research (GHR) annual reports (14 annual reports from one programme). ResearchFish is a platform used for tracking the outputs, outcomes and impacts of our research.
- Data was deductively coded in NVivo using themes identified in the previous year of indicator analysis. New codes were inductively created, and codes were removed and merged upon completion of the analysis where appropriate.
- A sample of the coded data and the coded evidence within each theme was cross-checked by a second analyst.
Caveats
- Variations in the way questions were framed across data sources may have skewed the data to include more outcomes, or a greater variety of outcomes, reported via certain reporting mechanisms when compared to others.
- Data used for this indicator are self-reported and unvalidated and may be subject to reporting bias.
- When using NIHR’s annual reporting mechanisms as a data source, there is a lack of time lag for the implementation of our research to have occurred.
- Validated case studies included as examples are relevant to the theme but not drawn from the analysis.
Research delivery
Methods
- Proportion of participants in clinical and applied research studies funded or supported by NIHR delivered across geographic regions data were filtered by reporting year, then NHS trusts (including Acute, Ambulance, Mental Health, and Care trusts) and primary care sites were grouped by ICS. The recruitment activity for each NHS trust and primary care site grouped by ICS was combined then weighted by the respective ICS population.
- Proportion of NHS trusts and GP practices active in research supported by NIHR data was filtered by reporting year and then grouped into NHS trusts (which include Acute, Ambulance, Mental Health, and Care trusts) or GP practices. The proportion was calculated as the number of organisations of a given type (e.g. NHS trusts) that recruited to one or more studies relative to the total number of organisations of that type existing in the respective year.
- The data for both indicators is drawn from NIHR Clinical Research Network’s Central Portfolio Management System (CPMS) and reflects only NIHR Clinical Research Netowrk supported studies. The data is visualised as an interactive dashboard built using Qlik Sense.
Caveats
- We weighted participant recruitment by ICS population and defined ‘research active’ as an NHS trust or GP practice recruiting one or more participants into an NIHR-supported study.
- Studies which do not require participant informed consent are excluded from the data. Certain study designs can recruit many participants in a short time which may result in notable changes in recruitment regionally and/or nationally when comparing across time and may be misinterpreted without context.
- In recent years, the proportion of GP practices active in NIHR-supported research reflects one or more large studies.
- The current method is limited by mapping participation by recruitment site rather than by participants' addresses.
- The method and reported key findings do not reflect data such as the identification and referral of participants. Therefore, when considering research activity by region, it is possible that participants may be identified in one region and recruited in another.
Research outputs
Methods
- We conducted publication citation, RCR, HRCS and OA analysis via the Dimensions data platform, covering 2016 to 2020.
- We further analysed papers published in 2020 within the category ‘Infection’, searching for ‘covid-19; coronavirus; SARS-CoV-2; covid’ within the title and abstract of each paper to identify the number of papers related to COVID-19. We then sorted the papers by RCR (from high to low) to identify how many of the highest RCR papers were related to COVID-19.
- An explanation of how the RCR score is calculated can be found on the Dimensions webpage.
- Overton was searched for policy outputs where our research was cited. We randomly selected the twenty policy outputs for qualitative analysis.
- OA status and RCR were determined using the Dimensions dataset and the Unpaywall database was used to review a particular publication’s licence type. There may be further reuse licences than reported.
- An explanation of the Health Research Classification System (HRCS) can be found on the HRCS website.
Caveats
- Outputs are defined as publications and do not include other research outputs such as datasets.
- The Dimensions dataset has gaps due to incomplete or improperly formatted metadata.
- HRCS codes are automatically assigned by a machine-learning, continuously optimising algorithm, resulting in the absence of weightings related to the proportion of an award associated with a particular topic.
- Data accurately reflect OA status, publication and citation figures when the data was extracted. As this data is routinely updated, figures for the same period may change over time.
- Only peer-reviewed publications were reviewed.