Chronic Care, Chronic Disease, and Disadvantaged Populations

Addressing Health Inequalities

This theme addresses gaps in health outcomes, wellbeing, and participation in health and social care systems for people living in rural remote and coastal communities. Four substantive areas of work fall under this theme: mental health, oral health, diabetes, and chronic pulmonary and cardiac diseases.

Mental health and wellbeing are a major focus across all three themes of the institute. Previous work in mental health undertaken by the former Lincoln Institute for Health (LIH) will be consolidated and expanded within the LIIRH, including PGR projects on vulnerability and resilience and child and youth mental health and new workstreams investigating mental wellbeing of rural populations and service providers.

The LIIRH is formalising a strategic partnership with the Lincolnshire Partnership NHS Foundation Trust and work has commenced on a programme of mutually beneficial research. Collaborative, groundbreaking research is studying the experience of moral injury and psychological distress among care home workers and the use of e-health service delivery in high prevalence/low severity mental disorders in rural service users.

International work is underway in innovative peer-led community interventions for improving mental health of refugee populations in Bangladesh.

Diabetes, chronic pulmonary and cardiac conditions represent a large proportion of poor health burden in rural populations in developed high and middle-income countries. Ongoing work in COPD includes the MonitorMe study, assessing the utility of a mobile app for remote monitoring of COPD to improve patient outcomes and prevent emergency service presentations.

Several coastal communities within the county of Lincolnshire (Mablethorpe and Skegness) have been identified as national outliers in diabetes experience and in known risk factors for this condition (smoking, overweight/obesity, and inactivity). These communities will be prioritised for the LIIRH’s work on diabetes prevention and management research. Funded first-stage research has commenced in Mablethorpe to explore mechanisms for effective engagement with so called ‘difficult to reach’ groups who are at elevated risk.

This novel coproduction research involving community-based partnership organisations and health and social care support services will inform future large-scale projects including an ambitious longitudinal coastal community cohort study.

In the area of oral health, two studies to reduce inequities in oral health in rural populations will add significant new knowledge to the field. The first project asks how oral health, one of the most complex, multi-causal issues of social inequity, can be improved for vulnerable, rural, older people who are severely disadvantaged by both rurality and age.

This study will use the highly innovative Triple Helix and Integrated Knowledge Translation (iKT) methods. Health practitioners, policy makers, leaders, and consumers will actively engage in addressing poor oral health as a primary health system issue. Strategies and outcomes directly impacting rural communities, practice, and policy will be co-produced through area-based action and rapid translation of evidence.

The second project focuses on the broader community, using co-design to systematically design, implement and evaluate the feasibility and acceptability of a rural pharmacist model to address poor oral health outcomes. Further research into innovative co-design service solutions in rural workforces will include international partners.