Fresh approaches to PPIE (patient and public involvement and engagement) in research are needed to ensure good quality research that is fit for purpose. NIHR Programme Grants for Applied Research (PGfAR) is seeking to increase opportunities for partnerships through our Programme Development Grant Scheme - Developing Innovative, Inclusive and Diverse Public Partnerships Call 2023 - now open for applications. Below is a case study of one of the successful applications from the first call, which took place in 2022.
Diverse and innovative research approaches are needed to tackle complex health and social care challenges. NIHR Programme Grants for Applied Research (PGfAR) is seeking to increase the diversity of study type and design submitted for funding. This case study outlines a novel and innovative research collaboration and research design to support people living with Severe Mental Illness (SMI), and who face food insecurity, to eat well.
Title – Increasing accessibility of affordable healthy food to adults living with Severe Mental Illness in Middlesbrough
Lead Researchers – Mr Joe Dunne, Mrs Jo Smith and Professor Amelia Lake
Institution – Tees, Esk and Wear Valleys NHS Foundation Trust, Middlesbrough Environment City and Teesside University
Funding - £143,161
Why we applied to this funding call
The NIHR PDG scheme presented a unique opportunity to research and test a novel intervention to address three separate significant public health challenges for people with SMI living in Middlesbrough. This unique opportunity also meant that three quite different organisations could work collaboratively to develop a new partnership and achieve shared goals, which will include using learning from the PDG to develop a PGfAR funding application to create and establish a larger scale model that can be replicated across a wider geographical area to improve diet quality of vulnerable groups.
Benefits to service users and NHS
A balanced diet is a very important part of health and can impact health outcomes throughout life. Food insecurity is defined as not having the financial resources needed to ensure that a person has reliable access to enough food to meet their dietary, nutritional and social needs. Food insecurity can make it more difficult for people to eat a balanced diet and causes considerable stress and anxiety. Stress and anxiety can exacerbate pre-existing mental illness, and severe mental illnesses can increase the risk of a person developing conditions like heart disease and diabetes; conditions which, in turn, can be exacerbated by poor diets.
Although a growing number of people in the UK are facing food insecurity, and the pandemic and related cost-of-living crisis have brought the pressure on UK food banks to the fore, about 1.3 billion meals-worth of high-quality fresh produce is wasted every year in the UK food system. In Middlesbrough alone, where this PDG is based, 57,000 people are in, or at risk of, food insecurity.
People living with SMI as well as food insecurity are particularly at risk of not meeting the recommended daily intake of fruit, vegetables, and protein-based foods, and report that while they would like to eat healthily, there are various barriers to them being able to do so. These barriers include not being able to find affordable, healthy meals, and not having the knowledge or skills to be able to cook them from scratch.
This collaboration between a mental health NHS Trust, a university, a community organisation, and people who live with SMI, expects to help people living with both SMI and food insecurity by developing, designing, and distributing a healthy, appetizing ready meal prepared with the surplus, fresh ingredients which would otherwise be wasted by the UK food system.
The new ready meal will be available in social supermarkets. Social supermarkets are not-for-profit initiatives which redistribute surplus food at significantly reduced prices to people living in, or at risk of, poverty. The 30+ social supermarkets in Middlesbrough form a strong network which provides surplus food, including fresh fruit and vegetables, to socially disadvantaged groups across the town.
Aims of the Programme
The aim of this award is to help people with mental illnesses to eat well. The new partnership of research collaborators aims to produce and test a new intervention for people living with SMI. The intervention is designed to improve the quality of their diets and start to mitigate the food insecurity they live with. To develop the intervention, the team will:
- Run 15 menu development workshops with people living with severe mental illness.
- Take the developed recipes to a university’s food processing lab to further develop one recipe into a ready meal, ready for distribution in three social supermarkets.
- Evaluate the project and the research partnerships with the longer-term aim of scaling the intervention to cover a broader geographic area and support more vulnerable groups.
This PDG has four phases of work which will build on each other through the award.
Phase 1: to co-produce a new intervention, get ethical and other approvals necessary, and to recruit people living with severe mental illness to the research team
- Five people will be recruited as participants and will have Occupational Therapy assessments with specialists and training to ensure they understand their roles in the project’s workshops, production, and evaluation.
- Health Cooking Advisors will also receive training by the Occupational Therapists to help them work effectively with the participants.
- The training and assessments will help the research collaborators to adjust the delivery of the workshops to meet everyone’s needs.
Phase 2: recipe development workshops to be held over a period of 15 weeks
- The workshop time will be used to develop recipes using surplus food. The meals produced will be feasible to produce at scale and acceptable to people living with severe mental illnesses.
- The workshops will follow a repeating format of sets after an initial introduction session.
- Four recipes will be developed. Each will have a development workshop, a cook and taste workshop, and one evaluation workshop.
- The penultimate workshop will be a discussion of all the recipes and aims to choose a final recipe product for Phase 3.
- The final workshop will be an evaluation focus group with the participants living with severe mental illnesses.
Phase 3: food processing trial and distribution through social supermarkets
- The finalised recipe from Phase 2 will then be developed into a chilled ready meal at the Teesside University food processing laboratory.
- The development will be influenced by the nutritional profile of the meal and its sensory attributes, as well as the cost of each meal and its environmental impact.
- The research partnership will form a sensory working group for the product development process and workshop participants from Phase 2 will be given the opportunity to participate in Phase 3 as well. Taking part in this will be a good experience for the participants if they want to be involved in the future planned PGfAR proposal.
- 30 frozen ready meals will be produced for community members to take home and will be distributed through three social supermarkets in Middlesbrough. Each social supermarket will be provided with the funds to purchase a fridge/ freezer through this grant to able to distribute the meals safely, adding more capacity to the network and community in the future. The people who receive the ready meals will be asked to complete a survey to evaluate the meal and will receive a £10 gift voucher for their time.
The evaluation of this PDG will be woven throughout its 12-month duration. The collaboration and trial outcomes will be evaluated as well as how feasible the intervention proved to be to produce and how feasible it would be to scale up production-wise. The evaluation process will also look at how well-received the ready meal was by people who developed and tested it.
This PDG’s findings will be shared and publicised through blogs, policy briefs, online meetings, peer reviewed journal articles, and the various institutions’ internal and external publications. The findings will also be shared through presentations and summary reports.