NIHR Dr Hannah Young has been awarded an NIHR Advanced Fellowship, which supports individuals on their trajectory to becoming future leaders in health and social care NIHR research. The experienced research physiotherapist - whose work will focus on creating an adaptable and holistic exercise programme to support vulnerable people with multiple long term health conditions - talks about her work, the Fellowship process, and shares her advice for Fellowship hopefuls in this interview.
First of all, congratulations about your NIHR Fellowship! Before we get stuck into that, can you tell us a little bit about yourself and how you became a Specialist Research Physiotherapist?
I suppose it was by accident really! When I first started in research, I was working as a physiotherapist in the Oncology department at Leicester Royal Infirmary and noticed that there were a group of researchers who were using our gym for their project. They had come in talk about the research they were conducting, which involved people with kidney disease and the impact of exercise on their quality of life and symptoms. This really resonated with me because I had seen people with high-symptom burden within my oncology patients and was starting to introduce them to exercise programmes. I decided to meet the person who was leading the talk, Professor Alice Smith, and mention my interest. Professor Smith mentioned that her team were looking for somebody to deliver exercise on dialysis. I was able to take up the post, which involved working with Professor Smith to deliver a cycling programme for patients on dialysis, and Professor Sally Singh to conduct research around pulmonary rehabilitation. I really loved having patient contact and discovering new things. I have always enjoyed learning and doing new things, so it was a really exciting opportunity!
This progressed as many of the patients I was seeing were really frail. They were really keen on continuing the exercise programme; however they struggled with symptoms and had periods where they felt really unwell. I began to wonder if there was a better way of looking after these patients, and that became the subject of my PhD, which has now moved into me looking at multi-morbidity alongside frailty, which is how this project in my Fellowship came about.
So, now onto the Fellowship, are you able to tell us a little bit about your research application topic?
It is well-known that the number of people living with multiple long term conditions (two or more long-term conditions) is increasing. There are currently around five million people living with multiple long-term conditions, which is predicted to increase by 86% by 2035. We are starting to see it more in younger people and through my interest in frailty, we know that these two factors are interlinked. For example, if a person is frail, they are more likely to have multiple long-term conditions and, vice versa, a person with multiple-long term conditions is more likely to become frail.
What I found whilst working on my PhD was that a lot of what people with frailty and multiple long-term conditions were able to do was dependent on the care and support they received. Maintaining independence was very important to these people, but they were struggling to engage with the services available to them as the majority of services were single-condition focused. These services were also often delivered on-site in hospitals, which can be difficult for patients to access regularly, and thus patients desired home or online-based programmes which were adapted to their circumstances. We as an organisation are very good at progressing people’s physical activity as they become better, but quite often if people have setbacks, they do not have an alternative exercise programme that can be adapted. We also found that carer support was incredibly important to these patients, as they relied on their carers for support with their programme; however this had not been factored into the programmes currently available.
So through my project, I want to create a physical activity programme to involve carers and consider patients’ symptoms and periods of ill health, and test this approach to see if it is acceptable and feasible. Supporting carers to be physically active will have important benefits for their health and wellbeing, which can often be missed in existing programmes. Finally, The Personal and Public Involvement (PPI) group I worked with whilst developing this project emphasised the importance of linking people in with local community groups and services to make the programme sustainable. As a result of this, we are going to involve social prescribers in the programme to help patients move onto physical activity community groups. Many people want to keep going to activity groups because they meet new people, and they form friendships and a sense of community which encourage them to keep going back, sustaining the benefits of the physical activity programme for longer.
Are you able to tell us a little bit about the Fellowship process? And what advice would you give to anyone considering the Fellowship?
I've been incredibly fortunate that I have had three Fellowships from the NIHR, so I have been able to learn through the process. The application itself took around a year, from development to write-up.
In terms of advice, I found it really helpful to get support from people who had already been through the process. I had some amazing mentorship from Professor Melanie Davies, Professor Laura Grey, and Dr Sharlene Greenwood, a consultant physiotherapist at King’s College Hospital. I also made sure to involve my PPI group throughout the process, which was key to the development of the programme and I received a lot of support from the Centre for Ethnic Health Research. I also made sure to align my work to key drivers for healthcare policy, such as the NHS Long-term plan, National Institute for Health and Care Excellence’s (NICE) multi-morbidity guidance and kept research priorities for this patient group at the fore-front of my plans.
There are also some fantastic opportunities being offered by the doctoral training programme (https://le.ac.uk/study/research-degrees/healthcare-inequalities) and the Leicester Biomedical Research Centre (BRC) (http://le.ac.uk/study/research-degrees/funded-opportunities/brc).
One of the things that can be quite nerve-wracking about an NIHR Fellowship is the interview. The interview consists of a panel of 20 individuals, and I was really lucky to have mock interviews with panels from the RDS (NIHR Research Design Service), our Diabetes Centre and the University, which really helped me to prepare.
We'd love to see more Allied Health Professionals (AHPs) get involved in research. What advice do you have for someone wanting to take their first steps?
For me, this project feels really exciting because the field of multi-morbidity research is an emerging area. I believe AHPs have a huge amount to offer because we have transferable skills that work beyond a single-disease specialism. Part of my fellowship includes collaborating with researchers in Newcastle Biomedical Research Centre, so I believe this project will be a great way fostering collaborations and learning about their work.
While it is becoming much better for Allied Health Professionals (AHPs) to get into a research career, I still think that there are a few challenges. While undertaking a PhD feels like a huge step, I found that there are other things that can be explored before taking that step to see whether it is a career to invest in. For me, I found it helpful to reach out to groups or people working in that field to see if there are any opportunities to shadow them or perhaps get involved in projects they might be running. I also looked out for publications or opportunities to write which gave me a feel for academic writing and hone my writing skills. It doesn't have to be a huge piece of work; it could be a case study or a short review.
One of the challenges for allied health professionals is that career routes are not always clearly-defined for clinical academics, which means you do have to take a bit of a risk, such as taking a sideways move into a slightly different field. Looking for any kind of opportunities where you could develop and looking out for others who have been through the process to talk to you about the pros and cons, and give advice can be beneficial.
Why do you think it is so important for people to participate in research trials?
I think participating in research is the only way that we are able to demonstrate what works, particularly for AHPs, where the evidence base is not available or as strong as it could be. By building a group of AHPs who work in research this can also create an evidence base for their area of expertise. For me, this is the only way we have to show the impact we are making on patient care and outcomes, as well as improving patient experiences.
