PHA led Cross-Border Research (CHITIN) and COVID-19

By Dr Rhonda Campbell, CHITIN Programme Manager, HSC Research & Development Division, PHA

Evidence shows that healthcare organisations engaging in research provide better outcomes for their patients. Health research is a global endeavour, generating substantial return on investment.

CHITIN graphic

The Department of Health (DoH) in Northern Ireland’s R&D Strategy, Research for Better Health and Social Care (HSC) 2016-2025, aims to support research that brings health and prosperity to the population of Northern Ireland. The HSC R&D Division of the Public Health Agency (PHA) is the organisation providing strategic leadership and support for a range of R&D infrastructure across the HSC R&D landscape in Northern Ireland.

The HSC R&D Division’s counterpart in the Republic of Ireland (RoI), the Health Research Board (HRB), the state agency that supports research, recently launched their Strategy 2021-2025, Health research – making an impact. Research. Evidence. Action.

The Cross-border Healthcare Intervention Trials in Ireland Network (CHITIN) programme, launched in September 2018 and led by HSC R&D Division in a unique partnership with the Health Research Board, is supported by €10.6m of INTERRREG V EU funding (managed by the Special EU Programmes Body (SEUPB)), and aims to develop infrastructure and deliver cross-border area health intervention trials for novel but unproven health interventions to prevent and cure illness and to provide specialist training and development programmes for cross-border area HSC providers. The CHITIN ethos is one of enhanced opportunity of involvement in health research.

A Health Intervention Trial (HIT) can: investigate if a new intervention is safe; determine if it is better than current practice; or direct resources to improve and protect people’s health and reduce health inequality. The HITs within CHITIN include;

  • walking to improve the physical health and wellbeing of people with serious mental illness

  • peer-led walking to address increased physical inactivity in adolescent girls

  • a web-based intervention to alleviate the symptoms of anxiety and depression and to increase help-seeking among students with mental health problems

  • Mirror Box Therapy for upper limb rehabilitation in stroke patients

  • inhaler compliance assessment for symptomatic uncontrolled asthma patients

  • pragmatic pregnancy and post pregnancy lifestyle interventions for women who are considered to have overweight or obesity in pregnancy and pregnant women with gestational diabetes

  • medicines management and anticipatory care planning for older people on multiple medicines and/or at risk of functional decline

  • a practical lifestyle intervention for healthy neurocognitive ageing in diabetes. 

There have been many direct and indirect impacts of the COVID-19 pandemic on health and wellbeing, often exacerbating existing inequalities. The health research effort is an integral and frontline component of addressing the COVID-19 pandemic, the impact of which on the HSC in NI and Health Service Executive (HSE) in RoI has been severe.

Nevertheless with limited resource, the research community has proudly played a part in delivering the vital research that has set the world on course for recovery from the pandemic, but now turns its attention to enabling recovery, resilience and growth of all health research, alongside that needed for COVID-19.

From March 2020, as the research community channelled considerable effort to addressing COVID-19, CHITIN research activity experienced a significant downturn with many of the participant recruitment sites residing within the hardest hit sectors of health and education (e.g. General Practices, secondary care clinics, university campuses and post-primary schools) which were experiencing new and challenging pressures as a result of the pandemic.

Many of our trial participants were amongst those most vulnerable to the direct and indirect impacts of COVID-19 on health and wellbeing (e.g. the elderly, often with additional underlying health conditions, others who are vulnerable due to underlying health conditions such as Type II or gestational diabetes, asthma or mental health disorders).

To recover, the 11 CHITIN trial delivery teams, supported by HSC R&D Division, HRB and SEUPB, have demonstrated considerable resilience, to innovate, to adapt and to modify the approach taken to deliver the research in a COVID-secure way, ensuring the safety of all involved, and where possible newly incorporating within, a means to assess specifically the impact of the COVID-19 pandemic on study participants.

To date just over 2200 participants have been recruited onto CHITIN trials, with 184 recruited during or since the COVID-19 pandemic. Also, a programme of specialist training and development activity to train a further 1500 Allied Health Professionals (AHPs) from across Northern Ireland and RoI, commences in summer to support person centred care, to respond to the needs of an aging population with stroke, to support role development and quality of care, and to develop capacity and capability in health service leadership and clinically relevant research methods knowledge and skills.

It is so encouraging that the research and associated training prevails and that all 11 CHITIN studies are persevering and progressing in a COVID-secure way, thanks to the resolute commitment and dedication of the CHITIN network and the invaluable contribution of all our trial participants.

To explore our HIT activity in further detail, please view our case study examples or follow us on Twitter at: @CHITINProject @RhondaCHITIN @WishStudy @WORTHwalking @BRAINDiabetes @Paige2Trial @INCA_team @ACP_Study @spit_project @REfLECTS_Study twitter handles

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