Our new normal; still your RDS

I’m not entirely sure how to start this blog post. The global situation – the vast and far-reaching changes to our way of life – are almost inconceivable. Trying to find a way forward in the midst of all this uncertainty and change is difficult. I am very fortunate that, thus far, my family and friends remain safe and well. I am also so very thankful for the wonderful care and support of everyone in the NHS, health and social care, education, social services and a whole host of other vital services that are the very bedrock of our society.

Like many of my colleagues in the NIHR, I am now working from home. There is plenty of valuable advice and support available about how to do this successfully and we are all trying to get into a new routine in which we can all do our jobs. One of first things we implemented here at the Research Design Service in Sussex is a regular virtual coffee morning at 10.30 everyday for whomever is around and free at that time. I am already finding it a much-anticipated part of my morning routine!

We are a few weeks in now and I can say with certainty that the Research Design Service South East is very much still open for business. We have almost seamlessly transitioned from a face-to-face service – visiting researchers in person to discuss their research plans and offer methodological expertise – to an online consultation service. I am becoming adept at various software packages and teleconferencing services and find that these media take very little away from the relationships I am able to form with researchers and nothing from the quality of advice I am able to provide. Our group consultations and review panels are likewise just as effective over telephone, Zoom, Skype or Google Hangout as they are in person. We are even holding our first online webinar shortly – a resource I think will be a valuable addition to the range of support we offer researchers.

If this crisis has taught us anything, it is about the vital and life-saving importance of research. Science and the evidence it provides drives effective care; designing and conducting robust research is what allows for the development and implementation of evidence-based interventions that are crucial assets in any clinician or practitioners tool box.

The NIHR sits at the very forefront of applied health and social care research and now, as always, it reacts swiftly to issue funding calls to support projects that address topics of national priority. NIHR and UK Research and Innovation have already funded a £20 million coronavirus research rapid response initiative into active intervention development and diagnosing & understanding coronavirus which will hopefully deliver much needed evidence to fight this pandemic. We at the Research Design Service remain an important part of this process – offering our free and confidential methodological advice and support to health and social care researchers from across the NHS, social care and public health, academia and industry.

Do please reach out and let us help you, now and in the future. We remain your RDS.

#YourRDS

Social care research – a heated debate….?

I, along with my colleagues from the Research Design Service (RDS) South East and RDS South West, recently attended the 5th International Clinical Trials Methodology Conference, which was held this year in Brighton. In addition to attending various talks and sessions, we were involved in one of the conference’s debates – a new item on the programme. The debates were held to encourage discussion around potentially conflicting areas and the conference organisers were keen to play up the potentially antagonistic views held by the speakers on either side of the debate’s motion in a fun and playful way. For our debate, RDS SE Director Jörg Huber decided to focus one of the NIHR’s more recent research priorities – social care research – and to facilitate discussion on whether research in this area is ready to make use of the methodologies employed by clinical trials in health research. The debate was very good-natured and we purposely played up the potentially opposing points of view.

Helen Weatherly, from the Centre for Health Economics at the University of York, took the first position: that the social care evidence base could be enhanced by using the methodologies of clinical trials. She argued that reductions in public expenditure on social care amidst increasing costs meant that the area was ripe for robust research to identify effective and cost-effective interventions. This position is underlined by the work of funders such as NIHR in establishing social care research bodies such as the NIHR School for Social Care Research and funding streams such as the NIHR Research for Social Care call. Given this need for high-quality research, and provided investment is there for researchers and research infrastructure, is social care research really that different to health care research? Indeed there are many similarities – both cover broad-span, complex interventions for which guidance on research methodologies and design already exists – the MRC guidance, for example. Trial design offers technical and ethical advantages in demonstrating the effectiveness of interventions and the methods of trials have been developed in a culture that has been able to embed research in its practice. There are challenges, of course, and we do need to be mindful of the differences of the social care environment, the training and education needs of social care practitioners, and the need to raise awareness of the value of involvement in research. However, there remains value to utlilising the clinical health care research methods in social care research and this is something for which we should strive.

Rosemary Greenwood, from RDS South West and the University of Bristol, and Ann-Marie Towers, from RDS South East and the University of Kent, argued for the second position: that social care research is not yet ready to employ the methodologies of clinical health research. They argued that social care research is still at far too early a stage for such an approach; that even getting a PICO right for a social care research project is fraught with difficulty. How do you get an ‘unbiased’ group? How can you randomize care homes to interventions which *they* are going to have to pay for? This latter is a crucial point – who is going to pay for these novel social care interventions? Social care interventions require co-production, but the resources for this co-production simply hasn’t existed until very recently. We first need to concentrate on using the available research funding to develop such interventions before we even consider evaluating their effectiveness in randomised controlled trials. And, in the meantime, considerable work needs to be done to the social care sector as a whole – from workforce capacity and training to research management infrastructure and incentivisation – for delivering such trials. We also need to figure out the pathways to impact with social care research, especially given the multiple providers of social care and an ever-changing policy backdrop.

We had great engagement from the floor. Issues raised included highlighting that we need to figure out where children’s social care fits into this picture, as current NIHR funding initiatives focus solely on adult social care. And that we really need to be talking about ‘health *and* social care’, as they’re often indivisible from a clinical perspective. Points were also made about the challenges involved with engaging different providers from different sectors with different economic and finance models.

It was a fascinating debate with excellent points from all sides – thank you so much to our excellent speakers! Ultimately, I think we all really do agree that both opportunities and challenges exist as we design and fund social care research and that we must work through these issues together. Social care research is undoubtedly a priority for funding by the NIHR and rightly so. But, as with all NIHR-funded research, it must be of high quality and utilize appropriate research methods. Research questions need to be clearly defined and centred around service users, with outcomes leading to tangible changes to practice which will benefit both the care system itself and the lives and experiences of those who use it. The research methodologies employed to answer these research questions therefore need to be appropriate to producing the right kinds of data. It may very well be the case that these methods will be those already being employed successfully in health care research, but they equally may be entirely different. We need to be aware of, and sensitive to, the different professional and research environments and open to the potential need to adapt or develop new methodologies that may be better suited to the social care arena.

Social care research is here to stay. And your local Research Design Service is here to help you design your research study and apply for funding.

Research – a dizzying climb?

Preparing a research funding application can feel like an uphill struggle and our RDS SE graphic of support events depicts a researcher climbing a staircase towards the goal of funding application submission. It’s a nice metaphor – that planning a study, writing an application, and submitting to a funder takes hard work and dedication. It’s also one that highlights the need for help and support at each step – support which can come from your research team members, your mentors or supervisors, and from other sources such as RDS research advisers and our colleagues in the Clinical Research Networks and Clinical Trials Units.

However, it’s also a little two-dimensional. Research does not progress like a straight staircase and a graphic like this, even one that points out things that we can do to help you climb, can only ever be of limited use as an illustration of what it is really like to plan a study & submit its application for funding. The reality is more like some kind of strange, spiraling staircase, with different flights of steps forking from it a various, and often unexpected, junctions. Not something easy to render in graphical form! However, this is not to say that help is not available for these un-illustrated parts of the climb. Nor is it true that these alternative stairs are always unhelpful diversions. Often there is not a single ‘right’ set of steps to take.

I met with a researcher recently who came prepared with a list of questions. This can be helpful as it can direct a consultation quickly to the issues of greatest import, something especially useful with a submission deadline is fast approaching. However, as we were going through the list, it struck me that rarely was there a simple answer to the questions. Often there were multiple suggestions I could make, each that would send the researcher off to climb a slightly different set of steps. None of these possibilities were any more or less ‘right’ than the other, rather it was simply about the researcher deciding which flight was the one they wanted to climb at this point in time.

The possibility of alternative flights starts early – sometimes at the very first step. Is the NIHR the right funder for your research or should you consider a research council or charity funder? Do you want to apply for a research study from one of the NIHR funding programmes or to the NIHR Academy for a fellowship instead? When thinking about your research questions and outcome measures, is your primary going to be a clinical outcome or something more service-based? What happens when you’re holding a consultation meeting with service users and someone with lived experiences raises a point you hadn’t considered before?

How you deal with these alternatives can help define what your final application will look like and there is plenty of support there to help you make your choice and support you on your way. It can seem daunting, but it is important to remember that there probably isn’t one right choice – there is no guarantee of funding success simply because you picked one flight of steps over another. It is also worth remembering that you can also change your mind and take the other path at any point on your climb toward that goal of application submission.

Contacting your local NIHR Research Design Service can help – with taking that first step and with each one that follows, no matter whether your climb is progressing smoothly upward or spiraling around, down and up again. I have no doubt you’ll make it to the top and get to enjoy the view!

Your RDS adviser – a steadfast travelling companion

When I first started this blog, I wanted to use it to share the research design advice that I give health and social care researchers on a regular basis. Through it, I’ve written about a range of research topics – study design, team formation, fellowship applications, funding feedback and even why researchers should use the RDS in the first place. I’ve also used it to reflect upon my own experiences as an adviser – talking about issues that I’ve encountered and sharing the expertise of my colleagues. But what I haven’t written about is what you, the researcher, can expect from us when you first get in touch with your local NIHR Research Design Service. This is an oversight because we exist purely to support you.

RDS advisers have a wide variety of experiences, areas of expertise and funder insight that we want to share with you. We offer advice in a variety of different ways – in meetings, on teleconferences, during workshops and seminars – but our goal is always the same: we want to improve the quality of your research funding application. This means that we can help you with a wide range of issues because behind your funding application lies pretty much everything related to your research.

The journey to submitting your research application has many stages, some of which may be unexpected. We are here to be your steadfast companion on this journey.

Your application actually starts with the very topic of the research you intend to conduct. From this it flows to the research questions you’re asking and then on to your study design, data collection and analysis plans. And, from here, onward still to the dissemination of your results and your future plans. Your RDS adviser can help with every part of this journey – bringing their own expertise to bear on your plans along with that of other methodologists and service users as needed.

But even once you have this part completed, you still have yet to reach your journey’s end: there is then the matter of the funding application itself. Applications are very different from research plans or protocols despite many of the details being the same. Where the earlier stages of your journey are concerned with putting forward what you are going to do, the process of writing your funding application means that you have to sell these plans, along with yourself and your team, to your research funder. Again, your RDS adviser is there to support you – using our expertise of reviewing for funders and observing panels to offer advice on how to put forward your arguments most effectively and identifying potential pitfalls in your way. We can also offer you detailed peer and lay reviews of your application, allowing you a trial run of this part of your journey.

Yet, even once you have your final stage application submitted, the journey is often not yet over. Panels frequently require detailed responses to comments, even if they decide to provisionally fund your application. You may also be required to attend an interview as a final hurdle. Your RDS adviser can offer their support and advice, seeing you through these last, final stages of your journey.

So although the journey to submitting your research application is long and often unexpectedly meandering, your RDS adviser will be with you every step of the way.

Minding your Ps and Qs

Tactics are important when writing a funding application and knowing what a given funder is looking for can often give one research application the edge over another. Funding panel meetings have packed agendas where many applications are considered by busy people. Knowing how to write for this audience – how to clearly demonstrate why your research application should be funded – is therefore an important skill. One of my main roles as an NIHR Research Design Service adviser is to help researchers pull together their funding applications – to mould their research ideas into a fundable project and to put this across in what are often stark and word-limited application forms.

If you’re applying to the NIHR for funding, there are two important things to keep in mind when starting to write your application: First, is the need to demonstrate the PRIORITY of your research topic and the second, closely related, is to have a clearly defined research QUESTION which your study will directly address and answer through appropriate design and methods.

The first thing that any NIHR funding panel will do is assess the priority of your research topic and question to service users and the NHS. Therefore, it is imperative that you demonstrate this from the outset. The exception to this rule is when you’re applying to a specific commissioned call, where the job of identifying and prioritizing topics has already been done by NIHR panels convened specifically for this purpose. Still, even here, it is worth addressing why your team’s particular take on the requirements of the commissioning brief are a particular priority for service users.

There are many ways to demonstrate the priority of your research topic & associated questions. Your literature review should demonstrate the knowledge gap that your research question is addressing. Your description of the current care pathway can illustrate how and where the problem caused by this gap manifests itself in clinical practice. Your consultation with service users can help demonstrate the burden of this problem on patients and their families. You can look further afield here as well – for example, speak to any relevant charities and check to see whether the James Lind Alliance has set research priorities for your topic. Talk about what will change in clinical practice as a result of answering your research questions. All of these things will help demonstrate that your research is a priority of funding.

In many ways, these are all fairly obvious and are all probably things you are already doing. However, it is worth bearing in mind that the reason you are writing about the literature, your service user consultations, and the problems with current service provision is to prove to the funding panel why they simply must fund your research:

By so doing, there will be direct benefit to service users and the wider NHS once your study completes.

So, when it comes to your NIHR funding application, you really do need to mind your Ps & Qs. And your local RDS can help you do just that.

Research by Design – but which design is right?

One of the tag lines I’ve seen used in the past by the NIHR Research Design Service is ‘research by design’. Appropriate design is obviously central to any research project and describing it vital to the success of any funding application. The involvement of relevant methodologists in your research team is also something on which your funding application will be judged. But, what design is the right one for your study?

One of the things I’ve found it important to remember as an RDS adviser is that there are a myriad of possible designs for researchers to consider when first putting together a study, each with its own advantages over another. Indeed, I often meet researchers who find it hard to decide how best to proceed with designing their study – and this difficulty inevitably leads me to ask to a larger, more basic, underlying question: what is your study really about?

In terms of applied health and social care research, your research study should begin with a problem. This problem could be about anything you encounter in your clinical practice – something to do with the treatments you deliver or the way in which you deliver them, it could be a way they could be delivered differently or to explore an intervention that you’re not delivering but that you could. The list goes on and the NIHR’s wide array of funding programmes offer funding for pretty much any of these kinds of questions. At the heart of it, any of these problems represent something that, once resolved, could benefit patients. It is this last – bringing about benefit to patients – in which many funders, including the NIHR, are interested. They are also problems which research can address, but where different designs are required.

So, when it comes to design, start with the problem you are trying to solve and from here the rest of the research should flow. From the problem, form the questions; from the questions, decide upon the outcomes that will answer them; from these outcomes, decide upon the design that will best produce them.

It is easy to get caught up in the pressure to apply for research funds and there is certainly a desire to immediately begin to fill in application forms. However, in my experience, you are far better served by holding back and considering what the research is really about. This understanding can often help illuminate other issues that will arise later on in the design and planning of the research. All of which will ultimately culminate right back where the research started – by solving the problem in such a way as to benefit patients.
So, yes, design is vital, but it is not where research starts, nor where it ends. It’s the bit in the middle and, although I’ve oversimplified things for the purposes of this blog, it is the bit with which the RDS can help.

If you’re an applied health or social care researcher applying for peer-reviewed funding in England, contact your local RDS and we can help you design your study.

Stop, collaborate and listen

I’ve taken part in a number of RDS and research events recently – speaking at conferences, holding teaching sessions, and participating in advising forums – all of which have given me the opportunity to focus on the benefits of talking through your research in larger groups. There is something unique about having to explain and justify your research topic and design to a group of experienced researchers who are unfamiliar with your specific project.

As I’ve written about before, the strength of your case for the priority of your research topic is one of the very first things any funder of health and social care research will assesses when considering research applications. Nevertheless, in my experience, elucidating the priority of their topic can be something of a struggle for many researchers. It’s easy to become so close to your own area of research that it’s importance becomes self-evident. It is vital to remember that the need for your research may not be so obvious to others.

I’ve spoken before about what I see as one of the strengths of RDS advisers – our outsider’s perspective on the specific topic under investigation alongside our grasp of research design, methodology, and the requirements of various health and social care research funders. Participating in various events in recent weeks has reinforced to me how helpful it can be for researchers to engage with RDS advisers as they design and write their research applications.

But it is not only engagement with RDS advisers that can be helpful. It was with pleasure that I observed, at a recent RDS SE research writing day, how much peer discussion enhances proposals. This is a phenomenon I have observed before – at events such as the National RDS Writing Retreat and RDCS’s Research Retreat. At all of these events, different research teams tended not to view each other as competitors for the same pot of funders money, but rather as fellows researchers all of whom are striving to design and carry out the highest quality research for the benefit of all. Ultimately, we are all part of the same community and are generally delighted to share our experiences, expertise and knowledge with others.

It is considered good practice for research projects to set up a steering group comprising experienced individuals who are external to the research group. The remit of such a group is to oversee the project as it is running and members can be called upon to offer advice when things don’t go according to plan. In some ways, I think such a group could be helpful when designing a study – ensuring that researchers can justify their choices of topic, research question and design, offering advice and expertise to deal with difficult or sensitive issues, and presenting different and external viewpoints that might not otherwise be considered.

This type of informal and ‘pre-award’ steering group is a role that we, as RDS advisers, can, and often do, play. I also think it a valuable role that we should encourage other researchers to adopt and one that we should facilitate whenever possible.

This is one way that I believe we can strengthen our community and the quality of our research design, plans and output.

Home again

So, the first RDS National Grant Writing Retreat is over and the delegates and Research Design Service (RDS) staff have returned home. Everyone is once again juggling their research with their day jobs.

The week was a full on affair, with every team working incredibly hard. There were a huge array of topics covered: in my own cluster of teams we had projects on mental health, diabetes, and dementia, with outcomes ranging from disease prevention and symptom reduction right through to optimising health service organisation and the delivery of care. As I found from my time at a similar Retreat in Wales, the work of advising these teams was both challenging and satisfying. Four projects, all at different stages of development and aimed at different funding programmes, is quite a lot to keep in your head at once. Often, a discussion with one team would finish only for a different one with another team to start. Yet it was this constant progression of ideas and plans that made the week so productive. With nothing else to distract them from their research plans, teams could take onboard one set of advice, think and act on it immediately, and then be ready to discuss the next set of ideas a couple of hours later.

Interestingly, we found that it was this discussion, dissection and then re-assembly of research plans and ideas that took up most of the week. Research planning is iterative by nature: you end up designing and re-designing all aspects of your project – from the argument you make for it’s priority to the methods you’ll be using to the analyses you’ll be carrying out – many times over before you have a project ready to submit for funding. For many of the teams, it was on this part of the process that the Retreat focused. Drafting an NIHR funding application which adequately addresses the myriad of issues required to obtain funding is something of an art form. One of the unique selling points of the Research Design Service, which I’ve written about at greater length here, is our collective experience of literally hundreds of NIHR applications. This experience was something we could use to help teams plan their research and so make a start on their applications in a strong position.

I have no doubt that the progress teams made over the course of the week will be invaluable to them. As I’ve said in previous posts, the week itself represents many months of advising work in the ‘real world’. The challenge now will be for teams to keep up the momentum gained during the Retreat. I look forward to hearing what happens to each team’s research applications. Hopefully most, if not all, will be submitted to one of the NIHR funding programmes. And, of these, some will be successful.

Regardless of the final outcome of any one particular project, the lessons learned and experiences gained by the researchers on the Retreat are something which will help them plan every project of their research careers. And, ultimately, this is what will be of most use – knowledge gained, shared and used by researchers of the future.

The first National RDS Grant Writing Retreat

Today is the start of the NIHR Research Design Service’s (RDS) first national Grant Writing Retreat. It’s a week dedicated to helping research teams who are pulling together a research application, with a crack team of RDS methodologists on hand to offer advice and support. The idea is that, over the course of the week, a research idea which was in the early stages of development would be fleshed out, focussed, and take the form of a completed application near-ready for submission to a funding body.

I’ve been fortunate in the past to attend a similar event, held in South East Wales and hosted by their wonderful Research Design and Conduct Service. I wrote about my experiences here and my most striking memory was how far the research teams progressed over the course of just 3 days.

Many researchers, especially those applying to one of the NIHR’s funding programmes are busy clinicians with heavy clinical loads. Once you’ve had a research idea, finding the time and energy to dedicate to crafting a research proposal can be a challenge. Yet this ‘Time to Write’ is essential if you’re to pull together a research proposal that has any chance of being funded. Anyone who has filled in an NIHR research application knows they are lengthy forms, with sections that seem to spring into being, hydra-like, just as you think you’ve completed the final one. Time is, therefore, an essential aspect, not just to come up with the idea for your study and its design, but of ‘Telling your Research Story’ in your application in a way that will convince a funding panel it is research worth supporting.

Yet, time isn’t the only issue. You also need to have ‘the right team’ of people around you. Often I review research applications that address an important area, but which lack clarity because they have been cobbled together by various contributors with no time spent ensuring the over-arching message is coherent. Similarly, I also see applications where it is clear that there has only been a single author and, as such, important aspects are missing because that person, quite understandably, lacks the expertise needed to cover all the issues. This is where the RDS comes in – providing not only our own expertise in a wide range of methodologies, but also in match-making between researchers. And, now, there is also the chance to have a whole week with your research team members dedicated to completing that all-important application, with freely-available RDS adviser input.

From an RDS perspective, I’m excited to be participating as an adviser. As the Retreat is a national initiative, it is being staffed by advisers from across England. We tend to be very regional in our outlook – I’m an adviser for the RDS South East and, under normal circumstances, have little contact with my fellow advisers in other regions. That said, I have managed to visit both RDS London (which you can read about here) and RDS East Midlands (which you can read about here) and have found the opportunity to observe other RDSs in action, and meet with other advisers, has helped me tremendously as well as boosting my enthusiasm for a job I love. I now have another opportunity to meet and work alongside my colleagues in other RDSs.

All in all, at the start of the first RDS National Grant Writing Retreat, I find myself feeling positive. I’ve read all the research plan summaries for the teams attending and am excited by the prospect of helping bring these important projects to their full potential.

Stay tuned for more thoughts as the week progresses. And, if you’re at the Retreat in any capacity, do please comment and tweet about your experiences.

Telling a research story

I, like many of my RDS colleagues, spend a lot of time with clinicians who are making their first forays into both research and the processes involved with obtaining research funding. In my experience, the two are often very different things, although obviously, and often inextricably, linked.

Research always begins with a question and, as far as NIHR funding is concerned, that question often originates from an observed problems in, or frustrations with, clinical practice. From these research questions flow the stages of the scientific method – the appropriate methodologies, outcome measures, and analysis plans. All are essential steps and, as such, are vitally important aspects of any research proposal vying for competitive funding. However, the process of securing such funding requires more than a good question being addressed in the most appropriate way. As far as the NIHR is concerned, there is a need to demonstrate the priority of your specific topic of research.

Demonstrating priority is not always an easy task, especially for someone who is intimately familiar with their own specific topic. We all know the importance of our own chosen field; to us it is self-evident. However, this will not necessarily be the case for a funding panel full of experts in fields other than our own.

The NIHR is a funder that puts users of the NHS in the spotlight. Consultation and involvement with service users is expected throughout the research process – from the very inception of the research idea right the way through to the dissemination of research results and into clinical practice. There is a fairly underwhelming diagram which the NIHR uses to explain its structure – you can find it here, if you are so inspired. I use it, on occasions, to highlight the fact that patients and the public are at the very centre. And this is the way to demonstrate the priority of your research application – you need to put the patients and the public at the centre.

It sounds obvious – after all, what else is health research about if not patients? – but it is something far too often missed. It’s easy to get tied up in the clinical/methodological/statistical/whatever-ical detail when writing a research application and, amongst all this, the patient can get lost.

When talking to researcher about their applications, I often talk about the need to tell a story. A good research application is a story in which the patients are the lead characters who have a shot at their happy endings.

A good story has a protagonist, some obstacle they need to overcome, and a way in which they do so. To simply tell a story of how something is done is not all that interesting, but hearing about how someone achieves something makes for a captivating tale.

And captivating tales are the ones that funding panels are going to want to read, and fund, right to the very end.