By Dr Cathy Williams
DECIPHer Affiliate and Reader in Paediatric Opthalmology at the School of Social and Community Medicine, University of Bristol
As a hospital-based consultant interested in neuroscience and visual development in children, I never thought I would be attending a course developed for Public Health researchers – but I did in 2014 and it changed my life!
I had been working for years to try and develop a service for children with brain-related vision problems (known as cerebral visual impairment or CVI) – many of whom have complex neurological and medical problems. I had come to the depressing conclusion that the clever vision tests and customised advice to patients that we painstakingly recommended, were totally dependent on the families and teachers out in the “real world” for their success or failure. Often it was as if we had done nothing if the families or teachers were unable or unwilling to act on our recommendations. But how to tackle this? With such variation between individual children’s need, families’ and schools attitudes and resources and variations in local service provisions?
I was planning an application to NIHR for a Senior Research Fellowship to buy out some of my sessions as a Consultant Paediatric Ophthalmologist, in order to try and develop my research. On their website the report from the Interview panel of the previous year’s applications for SRFs- which had all been unsuccessful – said that candidates had not properly understood Complex Interventions and that was in part why their applications had been turned down. So as well as studying the MRC guidance I looked for courses and saw that DECIPHer had courses on Developing Complex Interventions and Evaluating Complex Interventions. Despite advice from colleagues that this “wasn’t for me” as it would be aimed at Public Health research questions like smoking in schools etc- I signed up as at it least I could say I had been to a course on Complex Interventions.
The courses themselves were a revelation. Firstly it was great to have an introduction to the “ecological model” and I realised I also had not previously understood that Complex Interventions work on different levels eg personal and societal. It really helped to be introduced to a vocabulary and way of conceptualising how Complex Interventions might work by using Logic Models. It made me realise that the problems I was slowly and painfully recognising in my own clinical work were in fact well described and being tackled head-on in Public Health. So the NIHR were right!
I used the content from the courses to design a programme of work to refine then evaluate my own complex intervention – including a feasibility randomised controlled trial with Process Evaluation. My application to NIHR was successful and I am now an NIHR Senior Research Fellow, carrying out the studies I designed using the courses. Now that we are up and running with the preliminary work, DECIPHer have adopted the feasibility RCT so that my team and I can benefit further from the advice, perspectives and experience of all the other researchers and academics that comprise this partnership.
Overall it was great to discover that I was not alone in all the problems I had encountered with getting better outcomes for my patients and that there was a whole methodology to help. I would recommend the courses to any hospital clinicians trying to improve their service design and approach to improving outcomes – and they are a way to meet some great people doing interesting work!
Attached is a talk given to the CVI society about this research and our Twitter page is @thecviproject