The Challenge

Four actionable factors – loneliness, service integration, sleep and social determinants of health (in alphabetical order) ­– have a massive impact on our health and wellbeing.

·       Loneliness is comparable with smoking and alcohol consumption as a risk factor for early death (Holt-Lunstad et al. 2010)

·       Service integration is needed to ensure joined-up patient centred care and minimise the problems of siloed services (Curry and Ham, 2010).

·       Poor sleep has serious negative effects on the immune system, memory and learning (Walker, 2018).

·       Social determinants of health and inequalities are strongly correlated with death and illness rates (Marmot, 2015).

We need methods to measure these alongside other variables, so that changes that impact one of these, or other variables, are not confounded by these factors. Testing new methods is complex and usually requires research-ethics approval and substantial grants.

The Idea

Our aim has been to develop a family of related measures for loneliness, service integration, sleep and social determinants of health.

Each new measure will have four question items with four response options each, using an agree-disagree format. The options will be colour-coded with emoji. This approach has been found to work well in other measures covering health status, well-being, health confidence and patient experience from a single service. These measures will be part of a larger family.

Candidate question items for each cover:

·       Loneliness: companionship, someone to confide in, people who can help, shared activities.

·       Service integration: service communication, knowledge about other services, repeat history-taking, service collaboration

·       Sleep: Going to sleep and waking up at the same time every day, refreshed on waking, sleeping well.

·       Social determinants of health: education, feeling valued, healthy environment, addiction issues.

The Process

Our proposal is to test four new measures collaboratively using the power of Q.

Any measurement development project typically has at least six stages:

1.     Literature research and understanding the problem

2.     Development of a new measure or survey

3.     Planning how to test it, including REC approval

4.     Data collection

5.     Analysis

6.     Writing up the results and publication

Over the past couple of years, we have undertaken stages 1 and 2. We are seeking Q Exchange support for the remaining four stages. We want help to refine the measures (stage 2) and to test them in a wide range of situations (stages 3 and 4). This needs the active engagement of other people in Q. We will test the new measures in quality improvement projects alongside existing gold-standard measures for each subject, where these are available.

The Deliverables

We wish to test these measures in the real world as part of existing QI projects. We will aim to obtain research ethics approval as quickly as possible.

A key objective will be to prepare a set of papers for submission to an open access peer-review journal, such as BMJ Open Quality. Measures which are not published in this way are essentially invisible to academics.

References:    

• Curry N, Ham C. Clinical and service integration. The route to improve outcomes. London: The Kings Fund. 2010.
• Holt-Lunstad J, Smith TB, Layton JB. Social Relationships and Mortality Risk: A Meta-analytic Review. PLoS Med 2010 7(7): e1000316. 
• Marmot M. The Health Gap: the challenge of an unequal world. Bloomsbury Publishing; 2015
• Walker M. Why we sleep: the new science of sleep and dreams. Penguin Books 2018