Evidence and Ethnicity in Commissioning

evidence and ethnicity

A multidisciplinary team of researchers and healthcare managers working to improve the commissioning and delivery of health services for multi-ethnic populations in England. We have a particular focus on improving the mobilisation of knowledge to identify, describe and understand ethnic inequalities in health and healthcare and to support evidence-informed interventions to reduce these inequalities. Sarah SalwayLynne Carter

View the team website.

Communities in Control

Big Local

What are the aims of this project?
This study aims to evaluate a Lottery-funded initiative – the Big Local – that aims to give residents in disadvantaged neighbourhoods a bigger say over what happens and how resources are used to improve their local area.  Big Local is run by Local Trust and is taking place in 150 communities across England over the next 15 years.

Why is this important?
Past research suggests that low control may be a fundamental cause of inequalities in health. However, we know little about how to support greater control, particularly at the level of communities. We also need to know more about how and why control impacts on health and its social determinants. The Big Local presents a great opportunity to learn more about effective ways to support greater control by communities.

How will the research be carried out?

There will be two phases. Phase one involves:

  1. Detailed case studies across 10 Big Local sites and analysis of quantitative data to describe the neighbourhood contexts and early experiences in different places.
  2. Interviews and document analysis at national level to describe how the Big Local intervention is expected to work.
  3. Design of methods to evaluate the impact of Big Local on health and wellbeing in the longer term (Phase two).

 Timeframe: January 2014-March 2017

Professor Jennie Popay of Lancaster University leads our team of researchers from LiLaC,  Cambridge, Exeter, London School of Hygiene and Tropical Medicine, FUSE and Sheffield.  Here in SPHR@Sheffield we are currently conducting case studies in two Big Local sites in Yorkshire.

How are stakeholders being engaged?
In case study sites residents are consulted on the conduct of the study and in some areas Community Researchers are directly engaged. Local advisory groups provide critical commentary and findings will be shared widely as they emerge. Local Trust guides and supports the work.

What will be the outputs from the study?
Resources for public health practitioners and local neighbourhoods will be produced, focusing on:

  • The links between collective control and health inequalities;
  • Factors influencing public health actions in low income neighbourhoods;
  • Lessons about community engagement/empowerment;
  • Small area monitoring systems;

Presentations and papers from the project will be listed here.

Find out more here

Young mothers’ negotiations of infant feeding. A qualitative study with ethnographic methods.

Funded by NIHR CLAHRC for South Yorkshire (Inequalities Theme)

What are the aims of this project?

This small study aims to enhance understanding of young mothers’ experiences of infant feeding. The objective is to examine why mothers under 20 have the lowest rate of breastfeeding in the UK. The study also aims to suggest changes to practice that may help support young mothers to breastfeed.

Why is this important?

Breastfeeding is known to have significant health benefits for mothers and babies and may help to ameliorate some health inequalities in deprived or marginalised groups such as young mothers.

How will the research be carried out?

Ten young mothers were followed on their journeys from pregnancy to weaning, by interviewing and observing them.


The data collection took place from January 2013 to November 2013. Analysis and write up will be completed by January 2016.

Who is undertaking the research?

Phoebe Pallotti for her doctoral research. Supervisors: Sarah Salway, Liddy Goyder.

How are stakeholders being engaged?

Young mothers and Teen Link midwives were consulted at each stage of the research.

What will be the outputs from the study?

A PhD Thesis.

A presentation was given at the UCLAN Maternal and Infant Nutrition and Nurture Unit (MAINN) 2015 conference.

Welfare and wellbeing at older age

ageing well

Funded by the NIHR School for Public Health Research as part of the Ageing Well Programme of research.

What were the aims of this project?

This project aimed to:

  • Look at the ways in which welfare benefits shape wellbeing at older age.
  • Assess the health impact of any potential changes to benefits for this age group.

How was the research carried out?

Interviews were conducted with 30 older people from three different areas of the UK, including people from a range of ethnic, socio-economic and older age groups. We asked people about their work and social histories, their current day-to-day activities and financial and social priorities as well as their views and experiences of welfare provision for older people.

Why is this important?

The continuation of universal welfare benefits for older people has been challenged at a national policy level. Calls for introducing further conditionality to benefits for older adults are often based on claims that this will increase fairness and equality but our findings indicate that introducing conditionality has the potential to promote inequality and foster differentiation and division among older people. Our findings drew attention to the material and psychosocial impact of welfare benefits, showing that universal benefits fostered self-worth and were seen as a reward for a lifetime of hard work and financial responsibility.  When talking about needs-tested benefits older people questioned the moral deservingness of recipients. People assessed deservingness according to class, age, ethnicity and nationality. Applying for conditional benefits meant dealing with the stigma that older people felt were attached to these benefits; some people described feeling shame and a sense that they were applying for something that was not theirs. These feelings caused anxiety and deterred some people from applying.


The fieldwork was carried out between December 2013 and July 2014. The findings were published at the start of 2015.

Who undertook the research?

This was carried out by the following researchers at the national School for Public Health Research:  Judith Green (Project Lead),  London School of Hygiene and Tropical Medicine; Stefanie Buckner,  Cambridge Institute of Public Health; Sarah Milton, London School of Hygiene and Tropical Medicine; Suzanne Moffatt,  Fuse The Centre for Translational Research in Public Health, Newcastle University; Sarah Salway, School of Health and Related Research (ScHARR), University of Sheffield; Katie Powell, School of Health and Related Research (ScHARR), University of Sheffield. Thanks are due to Roy Darlison, Sheffield 50+ and the Sheffield Palliative Care Studies Advisory Group for their advice and to Mubarak Ismail, Sadique Bhanbro, Lerleen Willis for their contribution to data generation.

How were stakeholders engaged?

  • We sought feedback on project aims and design through informal conversations with practitioners working to support older people in the field of welfare
  • We sought feedback on project aims, design and recruitment methods and emerging findings through more formal and structured face-to-face focus groups with older people: an engagement event was organised in Sheffield with lay people, commissioners, voluntary sector organisations and public health officers working with older people to discuss ways in which the findings might be used to inform practice.

What are the outputs from the study?

A lay summary was prepared and shared with stakeholders locally and nationally.

A paper has been published:

Milton A, Buckner S, Salway S, Powell K, Moffatt S, Green J. Understanding welfare conditionality in the context of a generational habitus: A qualitative study of older citizens in England. (2015) Journal of Ageing Studies, 34, 113-122

Presentations have been given at a number of regional and national conferences.

Cascading genetic information within families

Funded by Sheffield Children’s Hospital Charity 

 What are the aims of this project?

This research aims to understand in detail patients’ and providers’ perspectives on the issue of cascading genetic information and services within families.

 Why is this important?

The inherited nature of genetic health conditions makes them a family concern. When one person is diagnosed with a genetic condition, this raises questions about the risk of illness for related individuals, including children yet to be born. However, sharing information among family members may not be straightforward, raising a host of personal, ethical and practical issues. This is particularly so for conditions where individuals can be healthy carriers, living life unaware of the genetic risk that they carry. As genetic technologies develop and testing for even very rare conditions expands, there is a growing need to develop effective and appropriate approaches to offering genetic services to wider family members. Furthermore, increasing ethnic and religious diversity of the population makes it important that such approaches are adequately responsive to diverse patient needs. Indeed, advances in genetic services must be made as accessible to all groups of people as possible. Currently we know little about the factors that encourage or discourage genetics service users – particularly those from minority ethnic groups – from sharing information with other family members (we call this ‘cascading’). This gap in understanding makes it difficult for service providers to know how to approach this issue effectively.

This project links to our wider programme of work on developing an appropriate service response to genetic risk associated with customary consanguineous marriage.

 How will the research be carried out?

We will carry out detailed interviews with service users from a range of ethnic and religious backgrounds, and also with genetic counsellors working within the Regional Genetics Service at Sheffield Children’s Hospital. Initial findings will be shared in a participatory workshop with stakeholders to explore possible modifications to current practice.


March 2014 – December 2016

Who is undertaking the research?

Professor Sarah Salway, Dr Oliver Quarrell (Sheffield Children’s Hospital), Dr Parveen Ali.

 How are stakeholders being engaged?

The project involves close collaboration between university researchers, clinicians and healthcare professionals and Sheffield Children’s Hospital. An advisory group has been convened to provide critical commentary on the research, involving lay and professional members.

What will be the outputs from the study?

Findings will be used to inform the development of improved approaches to cascading with the aim of testing in a follow on study.

Presentations and papers will be prepared for both professional and lay audiences.

CATH-B Study

CATH-B Study (Chinese community Access to Treatment for Hepatitis-B). Identifying and addressing barriers to healthcare access for Hepatitis B in UK Chinese populations.


Policy Research Programme, Department of Health – (NIHR adopted)

What are the aims of this project?

This study aims to identify drivers for the gap in healthcare access and provision for Chinese residents living in the UK by discussions with both the community and health professionals serving them.

Why is this important?

Migrant Chinese communities’ prevalence of Hepatitis B infection approaches 10%. South Yorkshire Chinese residents constitute 0.2-1.3% of the population. UK and international studies demonstrate low access to local health systems and many cases of late diagnosis.

How will the research be carried out?

The project methodology combines inductive qualitative research methods with knowledge translation approaches to (i) generate new insight into the barriers and supports to appropriate healthcare access for Hepatitis B among high prevalence groups and (ii) apply this evidence to the development of potential interventional strategies at policy and practice level. Qualitative methods will comprise: Focus group discussions (FGDs) with members of the Chinese community; Key informant interviews with members of the Chinese community; Individual interviews with healthcare professionals involved in key areas of care and policy formulation.


Due to be completed by the end of 2015

Who is undertaking the research?

Sheffield Teaching Hospitals NHS Foundation Trust

Lead Investigator: Alicia Vedio
Co-investigators: Ben Stone, Steve Green

School of Health and Related Research, University of Sheffield

Principal Investigator: Andrew Lee
Co-investigators: Eva Liu, Sarah Salway, Jason Horsley, Elizabeth Goyder

How are stakeholders being engaged?

Study design and recruitment advice via public consultation and appointment panel for Research Fellow – Sheffield Chinese Community Centre
Research Advisory Group – Two members belonging to UK Chinese Community Groups.
Design of Information Sheet and Consent Form via STH Research Patient and Public Involvement Group – Two members of such panel of Far East origin

What will be the outputs from the study?

Identifying common themes both in the community and professionals will inform efforts to design and evaluate support tools for the community and professionals involved, and help to formulate policy to address service gaps.

Find out more here:








Tailoring physical activity interventions to meet the needs of minority ethnic groups in England

This project is supported by CLAHRC YH

Aims of this project

  1. To establish the characteristics of physical activity interventions/programmes that prioritise minority ethnic community participation in England
  2. To identify the characteristics of ‘tailoring’ of interventions that account for minority ethnic population needs

Why is this important?

Adapted public health interventions have widespread support as a means of challenging health inequity. Minority ethnic populations in the UK and across the Global North continue to display disadvantage in several health domains such as cardio-vascular disease and diabetes (Bhopal 2009). Physical activity interventions can play a positive role in reducing the risk of such conditions. Rates of participation in physical activity among minority ethnic populations are, however, low relative to the White British population in the UK. This research uses an existing national database to examine the characteristics of physical activity interventions intended for diverse populations. It is an opportunity to assess the current ‘state of the field’ and areas of emergent practice.

How will the research be carried out?

Analysis of an English database of physical activity interventions has been used to identify and analyse adaptations for minority ethnic participation. From this, case studies have been built to demonstrate good practice.

Timeframe: November 2014-December 2015

Who is undertaking the research?

Liz Such

How are stakeholders being engaged?

Stakeholders are being consulted in the identification and exploration of case studies and in ‘sense checking’ of the findings on adaptation.

What will be the outputs from the study?

A case study summary will be produced for consultation with community based organisations and other local partners. A peer reviewed journal paper.

Image: Riccardo Romano, The Blue Dress, Attribution-NonCommercial-NoDerivs 2.0 Generic (CC BY-NC-ND 2.0), https://www.flickr.com/photos/pixx0ne/4270662379

Identifying promising innovations to enhance equity and efficiency in care for new migrant populations

Funder: Sheffield Clinical Commissioning Group

Aims of this project

  1. To undertake a mapping and formative evaluation of innovative practice at the primary care-community interface related to meeting the needs of new migrant populations
  2. To identify a promising package of innovation that warrants further refinement and testing
  3. To develop research capacity among primary care colleagues and strengthen research-practice linkages to support knowledge translation.

Why is this important?

Access to primary care has been identified as one of the key means through which health inequity can be reduced (Browne et al 2012). New migrant populations may be marginalised from the process of service access for several reasons. Service response to new migrant population growth at the local, primary care level often requires innovation, transgression from standard models of service delivery and commissioning and service responsiveness, including new ways of engaging with under-served populations. The purpose of the research is to map these innovations and provide case studies of promising practice.

How will the research be carried out?

The formative review will include a broad scoping exercise in the first instance followed by an in-depth case study approach to mapping innovation. It will be carried out in partnership with primary care and community based organisations to develop a Local Innovation Partnership. Principles of co-production and participatory methods will be adopted.


September 2015-March 2016

Who is undertaking the research?

Liz Such, Liz Walton, Sarah Salway, Janet Harris and Brigette Colwell

How are stakeholders being engaged?

In local case study sites, local practitioners will be engaged in a Local Innovation Partnership. Local residents will consulted about service provision through Patient and Public Engagement activities.

What will be the outputs from the study?

A Summary and Mini Casebook will be produced to demonstrate how and why local innovations can enhance new migrants’ access to primary care.