The Chief Medical Officers have recently announced updates to the national alcohol guidelines reflecting new scientific evidence that risks of alcohol on health are dose-dependent, and there is no 'safe' level of alcohol consumption. There is now a need to increase public awareness of this recent evidence to all types of alcohol consumers, whether light or heavy drinkers, in order to reduce alcohol intake across the whole population. There is relatively little research as to whether providing alcohol brief interventions for moderate drinkers (who are still at increased risk of cancer including breast cancer) is either acceptable or feasible. Evidence tends to show that patients and the wider public are both more receptive to health improvement advice and more open to make positive changes in their lifestyle when facing significant health events, for instance pregnancy or a visit to an Emergency Department, this has been described as 'readiness to change'. Many opportunistic brief interventions use these health service encounters to increase the effectiveness of public health advice. We propose an early phase study to determine the information about alcohol needed by women attending these clinics, how tailored and supportive feedback can be provided, and what tools may help develop this into a long-term intrinsic motivation to reduce alcohol consumption. We propose to explore the acceptability and feasibility of an opportunistic alcohol brief intervention (ABI) delivered electronically to women during health care attendances related to breast cancer, when women maybe particularly alert to breast health initiatives. Every year, approximately 275,000 women in England are referred urgently to clinics for suspected breast cancer, and a further 4.4 million women take up a mammography as part of the NHS Breast Screening Programme. Our recent Cancer Research UK-funded pilot study found that less than 20% of women attending these appointments identified alcohol as a risk factor for breast cancer, despite now well-established evidence that this is the case. The proposed formative work is driven by what women in clinics would find most useful and acceptable. It aims to identify the most appropriate means to empower women to better understand their own alcohol consumption, and the benefits of reduction, capitalising on the heightened receptivity provided by the context of breast clinic waiting areas. We will do this using a range of research methods (survey, semi structured interviews, and focus groups), the results of which will feed into each other to give us the most appropriate format to share alcohol risk information and health improvement advice that addresses women referred to these clinics information needs in a positive and empowering way. We will also explore the acceptability of spreading the ABI to the family and friends of participants, where appropriate. Finally, we will test the prototype intervention with clinic attendees. Results will show whether enough patients engage with the intervention, accept and understand the advice, and ultimately feel a determination to act upon it. All these would confirm sufficient potential to justify a future main study assessing the efficacy of the intervention on alcohol reduction.

As the world goes through one of the most turbulent periods in its recent history, the health, social & economic consequences associated with 'post-conflict disability' arising through major limb loss (MLL) has gained importance as a significant public health issue. Our preliminary observations and community engagement activities in two post-conflict societies - the Sub-Acholi Region in Northern Uganda and Northern/Eastern provinces in Sri Lanka, have demonstrated this to be an under-appreciated complex and multi-faceted problem characterised by: a: Lack of suitable services capable of addressing the complex needs of the affected populations b:Inability of the affected population to access the existing services due to poor transport links, poverty and ignorance. c: Ad-hoc service development using non-sustainable funding sources at the time (or the immediate aftermath) of the conflict with inadequate characterisation of the needs of the local population. d: Social-cultural factors and belief systems that adversely affect the day-to-day experiences of the victims and prevent their reintegration into the society. Influencing and engaging with future policy making in this field therefore requires an integrated approach involving multi-disciplinary teams. This proposal aims to bring together the 'Humanitarian and Conflict Response Institute (HCRI)' - an institution specialising in global health and 'In Place of War (IPOW)'- an organisation with expertise in conducting cultural programmes in post conflict settings, to focus on the multi-faceted problem of disability associated with MLL in two post-conflict societies - Uganda and Sri Lanka. The project will link HCRI and IPOW with Gulu Medical Faculty (GMF)-established specifically to address the health needs of Northern Uganda, the 'Gulu Referral Orthopaedic Workshop (GROW)' - the only centre providing prosthetic limb services in Gulu district in Northern Uganda, and 'Meththa Foundation UK' (MF)-a charity that pioneered prosthetic services in post-war Sri Lanka using recycled components from the UK and an innovative outreach model for service delivery. The involvement of Geographical Information Scientists (GIS) from University of Manchester (UOM), surgeons/public health officials from Northern Uganda and the Uganda-UK Health Alliance (UUHA) - the official intergovernmental body with a mandate to create sustainable partnerships between the two countries, will strengthen the proposed network. Research output from this network will: a. Evaluate the impact of arts and social theatre in challenging entrenched cultural views and bias associated with MLL b: Highlight the harm caused by ad-hoc service development in conflict environments c: Provide the forum, pilot data, policy options and critical appraisals of delivery systems in low-middle income countries to deal with the rising tide of MLL cost-effectively d: Fabricate and deliver 50 prosthetic limbs using an outreach service delivery model (successfully implemented in post-war Sri Lanka) and assess its suitability, acceptability and cost effectiveness in Northern Uganda. The partnership will also create a quality assured environment where UK based professionals and students will be able to undertake short/long term volunteering and student placements with mutual benefits to both countries. The involvement of UUHA and Health Education England (HEE) as project partners creates a window of opportunity to champion the cause of disabled people in the region (and the UK) by influencing training, research, policy making and funding priorities. We submit that the policy documents, particularly those in relation to the feasibility/desirability of outreach prosthetic services in LMICs, will have wider applications in service planning in many other post-conflict societies in Asia, the Middle east, and Africa

Understanding human behaviour and how it shapes organisations, communities and societies is needed to address global challenges such as the environmental, economic and health crises that we face now and in the future. Currently, behavioural research is not well coordinated in the UK. It also doesn't always ask the right research questions, involve people with the best skills, make good use of existing data, take advantage of innovative research methods or produce findings that can be used to make positive changes. The Behavioural Research UK Leadership Hub (BR-UK) will change this. BR-UK brings together a team from England, Scotland, Wales and Northern Ireland that includes experienced researchers from many different backgrounds and partners from government, the wider public sector, charities and businesses. We will work with communities to better understand behaviour and conduct research to improve lives and livelihoods. BR-UK will deliver a detailed work programme for the first 18 months. At the same time, we will expand our initial plans for the longer term to be reviewed by the funder, the Economic and Social Research Council (ESRC). In the first 18 months, we will: - Carry out a scoping study to look at needs, priorities and opportunities for behavioural research and set up a national network of researchers and research users - Determine how behavioural research can be more sustainable to make the best use of available funding - Identify (with our international advisory board) under-used global evidence as well as methods and theories to improve behavioural research excellence - Conduct 'demonstration projects' to show how the team can work together to use existing data and speed up the application of models and frameworks to provide rapid results. Topics include how behavioural advice was used during the Covid-19 pandemic, how we address some current issues like speeding on our roads, how to combine large amounts of data more efficiently and how well public support for different policies to help tackle climate change can be transferred between countries - Set up & test a responsive-mode consultancy service where organisations can ask questions about how behavioural research could help them with their policies or practices, and be matched to team members with relevant expertise. Looking ahead, BR-UK will organise our work around four Work Packages (WPs) and Themes (T). Work Packages are about HOW we will do things, and our Themes are about WHAT we will focus on. These are: WP1: Capability Building; WP2: Data and Technology; WP3: Methods and Evidence Synthesis; WP4: Engagement and Involvement; T1: Environment and Sustainability; T2: Health and Wellbeing; T3: Resilient Communities: and T4: Organisations, Markets and the Economy. We will conduct new studies across WPs and Themes. Examples of research questions to illustrate the range are: how to better use mobile phone technologies to engage people long-term to stop smoking or reduce their alcohol consumption; how to help regulators and the police keep children safer online and tackle internet crime; how to help people and organisations shift to transport that is better for the environment; how best to work with local and national governments to better understand the needs of their local communities when making policy decisions. As a Leadership 'Hub', BR-UK will work with other parts of the programme ('spokes' including a centre to train students and early career researchers as they develop. We will be flexible, and reserve part of the funding that could lead to new studies when sudden events like a new threat, emergency or event occur. We are well positioned to carry out rapid reviews of existing research to help governments and organisations know what behavioural evidence exists to inform decisions, and to identify evidence gaps. We will be ready to adapt and bring in new members with skills and experience that are most needed as BR-UK evolves.

The communities and neighbourhoods where we grow up have a lifelong influence on the illnesses we get and how long we live. Health is about avoiding disease and having a long life, but is also about feeling well in mind and body, feeling safe, being part of a community and having things to look forward to. Many aspects of the world around us influence our health directly or influence health related behaviours. These so called "broader" determinants of health include the houses and flats we live in, the design of our roads and high streets, the availability and quality of parks, green spaces, libraries, galleries, museums, sports and recreational facilities, entertainment opportunities, places and events to connect with others, the shops and businesses around us, pollution levels, learning opportunities, the jobs available to us and whether we have enough money to make ends meet and to participate in social activities. Attempts to change health related behaviours such as unhealthy eating, drinking, smoking and lack of exercise, have met with important but limited success. For example, increased awareness of links between childhood obesity and ill health and the importance of exercise and healthy diet will have limited success if broader determinants are not also tackled. These broader determinants include, but are not limited to, the many fast food outlets that children may walk past, lack of access to high quality play and recreational facilities, sell off of school playing fields, streets that are not safe for children to walk or cycle to school, lack of high quality green spaces for exercise, shops with poor choice of healthy foods, increased screen time replacing physical activity, poor quality of school food, and, for some, insufficient income to buy healthy food. Our ActEarly approach focuses on improving the health of children in two contrasting areas with high levels of child poverty, Bradford in Yorkshire and Tower Hamlets in London. In preparation for this work we have worked with local communities, local authorities and other local organisations and have established shared priority areas for research: Healthy Places, Healthy Learning and Healthy Livelihoods. We have brought together experts in these themes with local community and local authority representatives to begin to develop a range of approaches to improving child health across these areas. For example, within our Healthy Places theme we will work together to: map local community assets and to understand how they can be improved and used by more people; develop a Healthy Streets approach and improve green space quality. In our Healthy Learning theme we will work together to develop local "Evidence Active Networks" of pre-school, school and community learning venues. These networks will help develop and evaluate a wide range of approaches to improve child health. In our Healthy Livelihoods theme we will work together on approaches such as relocation of welfare advice services to improve access, enabling parental leave, ensuring a minimum basic income in school leavers, providing life skills training and involving local communities in decisions on how to spend local authority budgets. To understand the effect of these approaches on child health we will develop strong data resources that bring together existing information from across our localities to measure changes in the local environment, health related behaviours and health outcomes. Teams of researchers will use this data and work with local communities to understand how successful our initiatives have been. We describe our emphasis on early life interventions, our highly collaborative approach and development of local data sources to enable evaluation of multiple initiatives, as the "ActEarly Collaboratory". We hope the approach will promote a fairer and healthier future for children and a global example of how to work with communities to improve health.

The Northern Health Futures (NortHFutures) hub aims to create a world-leading healthcare technology (health-tech) development ecosystem. This will address unmet health needs and inequalities by supporting: inclusive digital skills training and sharing; research, innovation and entrepreneurship, enabled by digital design. Based in the North East and North Cumbria (NENC), with national and global reach, NortHFutures will support underserved communities, as it is known that national disparity of investment in NENC negatively impacts population health and wellbeing, and that a 'levelling up' of investment is needed to stimulate socio-economic and cultural growth for all, to encourage living and ageing well. NortHFutures builds upon the joined-up NENC approach to people-powered digital health innovation, as our regional Integrated Care Board (ICB) uniquely involves local authorities, communities, and citizens. Academic team members have a research track record that is stakeholder-involved and civic- and community-engaged. They are world-leading on understanding (i) health inequalities from medical, social, and design perspectives, and (ii) the opportunities for enrichment and enablement related to ageing well, connecting rural and urban populations, and pioneering applications of data science. In the pilot phase, we draw on this specialist expertise to address evidenced unmet health needs in NENC, (which have national and global importance): children and young people's health and nutrition; mental health and wellbeing; development of digital surgical pathways (for monitoring patient journeys beyond the hospital); living well with multiple long-term conditions. We combine the strengths and resources of 6 universities (Newcastle, Cumbria, Durham, Northumbria, Sunderland and Teesside), bringing regional investment in NIHR services, facilities and Applied Research Collaborations, plus National Innovation Centres for Ageing (NICA), Data (NICD) and Rural Enterprise (NICRE), National Horizons Centre (NHC), EPSRC Digital Economy programmes in data and digital citizens, and Health Data Research UK, the UK's national institute for health data science. NortHFutures supports new planned Centres, including Northumbria's Centre for Health & Social Equity and Cumbria's new campus and medical school. These University offers combine with an extensive partner network, including: ICB-NENC, 7 NHS Trusts, NHS Business Services Authority, Department of Health and Social Care, Health Education England; VCSE organisations delivering community-based services; industry partners - from SMEs to global tech giants; civic bodies such as Local and Combined Authorities; existing health research networks (e.g. AHSN-NENC, Newcastle Health Innovation Partnership); and innovation accelerators (e.g. Innovation SuperNetwork). Through an integrated, regional approach uniting this consortium for the first time, NortHFutures ambitiously aims to establish global leadership in Digital Health. To deliver this we will develop a supportive community infrastructure. We will co-design a digital brokerage service to connect and amplify partners' work, to offer and consume expertise, services and facilities (supporting acceleration of health-tech companies at differing tech-readiness levels). We will pioneer a Live Digital Health Databank, to explore, and train for, advanced healthcare data analytics, combining live data flows with care records (e.g. Great North Care Record). This will support personalised health diagnostics and interventions, giving our hub a unique value proposition to companies wishing to explore advanced data technologies. We will invest in Extended Reality pilots, to open up possibilities for clinical practice and service delivery. Our approaches will embed Responsible Research and Innovation (RRI), and Patient and Public Engagement (PPIE) throughout, to deliver health-tech that supports care beyond the hospital and is co-designed with end-users.