Why NIHR has made inclusion a key condition of our funding

NIHR Executive Directors Lisa Cotterill, Lynn Kerridge and David King reflect on why we have introduced changes to our funding conditions, and how we will support the research community to deliver more inclusive research addressing existing inequalities in health and social care.  

Our milestone decision requiring applicants to demonstrate how their research will address existing inequalities in health and social care as a condition of funding will be pivotal for NIHR research.

The condition places a renewed emphasis on the need to consider health inequalities when designing research. This will ensure research is generalisable, reproducible, and benefits all members of society and contributes to the wider mission of reducing the burden on our NHS and social care. We know inclusive research is scientifically more robust.

This change builds on a wealth of existing work we have undertaken in recent years. We have engaged with communities previously seen as under-served by research. Examples include targeted funding calls, in areas of Liver Disease, Chronic Obstructive Pulmonary Disease, and Palliative Care. In the area of patient and public involvement and engagement, the Research Ready Communities project has aimed to build trusting and trusted relationships with under-served communities, by listening to and understanding people’s needs. Local teams have trained over 100 Community Champions across the country. This includes working with rural communities in Lincolnshire, older age people in two towns near Manchester, and Goan and Muslim communities in Swindon.

Reaching diverse communities

However, we know research has not always been conducted in the areas of the highest need. Or with the populations who need it the most. The Chief Medical Officer’s Annual Report in 2023 (.PDF) noted that increases in people living longer, means that our population is ageing. With that, comes a need to ensure that research activity does not fail to include them. Research which has not considered differential application or outcomes for different populations has been shown to have real implications in terms of the effectiveness or performance of interventions when applied in clinical practice. For example, in the last few years it has become clear that pulse oximetry may overestimate oxygen levels when used in Black patients (.PDF). The clinical significance of this remains unknown. But more inclusive testing in diverse populations could have ensured that such differences were identified earlier or avoided entirely.  We hope our new requirements for funding will address this and that the need to justify why your target population is the appropriate population to participate in your research will reduce the occurrences of unknown differences.

We are working to bolster data availability. This will support you to find the most appropriate sites or locations to undertake research. In addition to the existing Research Targeting Tool, we are working to add population demographic data alongside information about condition prevalence into a new Scoping Locations for Research Tool. These resources such as these can help inform thinking about where health and social care need may be greatest and research activity the most sparse.

Building on innovative projects

We know many researchers are already working with communities to devise inclusive research activity. A research project based on priority setting work with South Asian women found a lack of resources to support discussions about the menopause. A diverse team of researchers trained women in the local community as peer-researchers for the project. The team were then able to conduct interviews in a range of languages. An animation that has been created is also voiced over in a number of South Asian languages. This has ensured the research is inclusive of the population it was designed to benefit. This is exactly the kind of research we hope this new change will encourage.

We encourage you to think innovatively about your research design and delivery. We urge you to draw on widely available data to inform your sampling. You should consider whether your eligibility criteria might inadvertently exclude groups where there is a need to make concerted efforts to include.

We are excited by this change.  We know that this will take time to become embedded in research activity. This key condition of funding is initially for domestic awards. Global health and infrastructure awards will follow in the next 18 months. But we firmly believe that more inclusive research is key to our overarching aim of improving the health and wealth of the whole nation. This contributes to the wider mission of building a fairer Britain.

To learn more about the specific requirements for your funding application, and for links to further resources you might draw upon to aid you, we encourage you to read through our new guidance.