It is likely that nursing homes in the UK will become clusters in their communities for the worst clinical manifestations of COVID-19. Since all nursing home residents are at substantial risk, nursing home care staff need to know what residents would want to happen should they become infected with COVID-19. The aim of this project is to develop and evaluate an online advance care planning (ACP) COVID-centric intervention for nursing homes during a COVID-19 outbreak to improve care at the end of life. Findings from a rapid review of available resources will be used to develop an online ACP COVID-centric intervention for training nursing home staff and providing an information resource to family carers. Nine nursing homes will participate in the project with three nursing homes located in Northern Ireland, England, and Scotland. We will collect data from up to 54 family carers and 45 nursing home staff. Expected outcomes: (a) enhanced knowledge of conducting end of life discussions during COVID distancing measures; (b) improved ability for staff to assess resident needs and respond more appropriately in relation to ACP; (c) enhanced decision making among family members regarding resident care; (d) improved communication between staff and family carers regarding their relatives health care needs; (e) increased evidence of completed ACPs; (f) development of open source online ACP COVID-centric resources for use by nursing homes.

Background: Children consume a third of their food at school, providing an opportunity to promote healthy diets and reduce levels of obesity. The World Health Organisation and UK government recommend that schools adopt approaches across the whole school day that support children to make healthy food choices, offering consistency in the quality of foods provided, eating culture, education about diet, and use of food to learn. In reality, uptake is poor, partly due to lack of direction on how to use such an approach, but also because schools work in highly complex environments with multiple competing demands, and influences from wider factors like national policy, cultural beliefs, population characteristics, costs and catering requirements. Methods: We will design a practical and acceptable intervention to help primary schools adopt whole school approaches to food. This will be done in partnership with key people (stakeholders) including head teachers, teachers, staff, children, parents, school governors, local businesses, and local and national government, by: 1. Hosting stakeholders workshops in Bradford, Leeds, Newcastle and Belfast to discuss factors influencing what children eat during the school day. We will ask people to consider potential influencing factors at school (e.g. space needed to provide lunch), in the community (e.g. cultural influences on eating practices) and from wider society (e.g. government policies on free-school meals). We will encourage discussion on how these factors relate to each other and use this information to build a picture called a 'systems map', providing a richer understanding of the local and wider influences on children's food choice. The map may also help to identify parts of the system most likely to respond to intervention and whether adding an intervention in one part (e.g. a packed lunch policy) is likely to cause positive or negative adaptations in others (food eaten at home). 2. Inviting stakeholders to take part in designing an intervention. This will involve consideration of the factors identified in our system maps. Based on existing discussion with people who work in schools, we do not expect the intervention to involve excess paperwork or expense for schools. Instead, it might include visual resources (like websites or videos) to support schools to include children in decision making, and to improve the food environment. It could also consider changes to catering decisions or specific activities such as embedding catering staff more across the school, growing food in schools, teaching with food, avoiding using food as reward/or punishment, and consistent food messages. To ensure the intervention supports schools without excessive burden, acceptability and potential barriers will be a key consideration during development. Importantly, we will focus on developing an intervention that has the best chance of supporting those in greatest need. 3. Seeking feedback about our draft intervention ideas from our wider stakeholder group. We will share the draft with stakeholders and ask them to rate its acceptability and how easily they can be used by schools. A form will also be used for stakeholders to consider which parts of the intervention they feel can be applied across all schools and which may be less transferable. We will then make any required improvements before fully developing the intervention and its resources. Impact and dissemination: The intervention has the potential to improve dietary options extending beyond the school day. It is important that it is evaluated so that, if successful, it can become standard practice. We will therefore engage with key decision makers and advocates, including Public Health England, School Food Matters (a national organisation supporting schools) and the Department of Education. We will share our findings widely, including with schools, children and parents, and will develop plans to test its impact on food choice.

UK ENABLE Consortium vision, aims and objectives: Local government is uniquely placed to shape the environmental and social factors which fundamentally influence non-communicable diseases (NCDs) and thus our health and wellbeing. Our vision is for local government to consider the health of local populations in all policy and practice decisions and to have the best possible scientific evidence to support those decisions. We will test our vision by working with five different local authority (LA) based public health systems across the UK, learning what works best, and what can be useful for all LAs across the UK. Our consortium brings together academics, practitioners, policy makers and other stakeholders from across the UK in five centres in NE and SW England, Scotland, Northern Ireland and Wales; each with different models of public health delivery. We will develop and test a process that embeds research capacity and expertise in LAs. Working closely with our partners in each LA, we will identify a current priority for improving the health and wellbeing and reducing inequalities of people living in that area. By building relationships between academics, practitioners and policy makers we will enable the LA to access and create new evidence that is relevant for decision making about the priority issue. Scientific rationale for the proposed research: Evidence-informed policy-making aims to improve decision making by using the best available research. Organisational and cultural barriers within the current system have made this approach difficult to achieve. New methods and approaches are needed which bring together researchers, practitioners and policy makers in local government, where evidence is only one contributing factor to decision-making. Embedded researchers and knowledge brokers can help to ensure evidence is used by building understanding of the context, accessing existing, and co-producing new evidence. Intervention(s) of interest and the potential applications and anticipated benefits of the work: By the end of the project we will: 1. Increase research capacity and 'no how' in each LA, focusing on a local NCD priority issue, enabling access to evidence to inform local decision-making. We will develop and share learning which is generalisable across the UK 2. Build and support new partnerships for active and effective research use with practitioners, policy makers, and academia 3. Build knowledge and skills in local government and universities to maximise use of different kinds of evidence for policy, practice and public decision-making 4. Co-create evidence that addresses local government priorities, with a focus on prevention, by working across sectors and disciplines, utilising novel methodological approaches, including complex systems models 5. Develop a range of health and system interventions that have been co-produced and tested across LA areas 6. Create sustained change in research culture in LAs and academia so that evidence use is embedded across local government 7. Evaluate this new approach and methods to see if we made a difference to the health of people living in each area, related to their priority topic, and whether/how this approach could be rolled out across the UK We anticipate that this work will improve population health and wellbeing and increase the use of scientific research. It aims to improve quality, efficiency and effectiveness of public health interventions and services, reduce waste, and improve staff morale and retention. Consortium management: Our across-UK academic leadership brings together experience of applied translational research in prevention from four of the UKCRC funded Centres of Excellence in Public Health. Senior leaders in local government public health, bring practical experience of putting evidence into action. Other members have expertise in systems thinking, embedded research, knowledge brokerage and other skills essential to our success.

The Northern Ireland Longitudinal Study (NILS) is an important element in the ESRC data infrastructure for population and public health research in Northern Ireland and across the constituent countries of the UK. It has strategic relationships with the other UKCenLSs and, within Northern Ireland, with the Northern Ireland Statistics and Research Agency (NISRA), the Public Health Agency (PHA), and the Honest Broker Service (HBS). Its 28% sample, which combines census data with administrative data from the healthcard register, social care, and housing, will span the period 1981-2021 when the link to the 2021 Census is completed. This enables the description and analysis of changing populations in changing places, individual fortunes over the life course, household contexts, as well as progress between successive generations. The grant will fund, until 2025, the NILS Research Support Unit (NILS-RSU) which has the functions of maintaining a secure data laboratory for users to work on these data safely, of supporting users from project application to publication, of promoting NILS-based research to policymakers and the public, of seeking new users through the promotion of the NILS, and of encouraging research for the public benefit. A major highlight of our work programme will be testing, using and developing research around the 2021 Census link. The NILS-RSU will also seek to widen the social and educational base of the NILS in Northern Ireland through engaging with new stakeholders and growing its contribution to education. It will also encourage research using the NILS and the other UK longitudinal studies to contribute to national and international research agendas whilst developing new research partnerships in Northern Ireland.

The number of people worldwide living with dementia and cognitive impairment is increasing, mainly due to people living longer, so we want to figure out how where we live affects dementia and brain health as we get older. Some research suggests that where we live might influence our brain health. For example, poor air quality in towns and cities, can lead to a decline in brain health. As more of us now live in towns and cities, it is important that the environment where we live is scientifically designed and improved to maximise our brain health. The complex social and physical environments where we live make some people more vulnerable than others to developing cognitive impairment. In other words, the factors that account for who is most likely to develop cognitive ill-health due to the environment has less to do with 'how' we live and more to do with 'where' we live. We do not know how these factors interact to make urban environments a problem for brain health, nor which are the best policies and interventions for promoting healthy ageing and brain health for our poorest communities. Our project will provide evidence for policies and practices that provide supportive urban environments to promote healthy ageing, including promoting brain health. This could include using creative urban designs to support people to adopt and maintain healthier lifestyles such as being more active. However, this needs a strong evidence base with expert community advocates who can articulate how supportive urban environments can improve brain health. Our research has the following steps: 1. First, with the help of stakeholders, including those from business, industry, and local government, and a review of existing research, we will represent the relationships between our biology, our lifestyles and our environment in a diagram illustrating how they likely interact to affect brain health, because visual thinking can help stakeholders better identify possible intervention sweet-spots to improve brain health. 2. By analysing data from over 8,000 older people in Northern Ireland, and linking this to information about where they live, such as the amount of air pollution, the toxins in soil, or how walkable their neighbourhoods are, we will explore how different environmental factors relate to brain health. 3. Next, we will collect new data on a subgroup of 1,000 older people including more in-depth measures of brain health and better measures of physical activity, using GPS devices worn around the waist that monitor our locations. This will allow us to explore how the urban environment influences our brain health. 4. Then, we will explore how aspects of our biology play a role in how the urban environment affects our brain health. 5. We will host workshops with local citizens to 'sense-check' our findings and co-develop promising prevention approaches. In these, we will explore the acceptability, affordability, feasibility and sustainability of new initiatives to improve the environmental influences on brain health. This might include, for example, policies on: expanding the car-free areas of the city to reduce air pollution; increasing the number of footpaths and cycle paths to encourage walking and cycling; improving public transport to reduce car use. As a result of our research we will produce: 1. A map of the system in which our genes, lifestyle behaviours and urban environments interact to affect brain health, to help guide stakeholders towards policies and programmes that can improve brain health. 2. An evidence base exploring how where we live affects our brain health. 3. A suite of potential policies and interventions to improve brain health and promote healthy ageing 'tested' (in terms of acceptability and feasibility) with older people, business, industry, policymakers and other stakeholders.