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Lizzie Ingram

SPHR - ARC North Thames PhD student

Health Inequalities theme, Efficient and equitable health systems theme

University College London (UCL)

e.ingram.17@ucl.ac.uk

Lizzie's PhD reflections

My choice to pursue a PhD, funded by the NIHR SPHR and CLAHRC (now ARC) North Thames, was one of the best decisions I have ever made. It kickstarted my career and has helped me figure out what type of research I want to pursue in my future work.

My PhD research investigated whether knowledge generated from the analysis of linked health and council data could advance our understanding of the social determinants of multimorbidity (where someone has co-occurring multiple long-term conditions) and inform strategic and equitable decision making. Ultimately, my work demonstrated how linked health and council data can be used to provide novel and actionable population health insights for concerns like multimorbidity. However, my work also challenged some of the policy assumptions behind the creation of such linked data, namely that knowledge generated from linked data will improve decision-making, care, and the equity of health and care services. My findings suggest that without efforts to address the wider relational and organisational barriers to analytics access and use, building linked data systems will not lead to substantial changes in the equity of health and care provision for populations such as those with, or at risk of, multimorbidity.

As part of my work, I learnt a huge amount – spanning quantitative and qualitative data skills to softer communication and teamwork skills. I worked collaboratively with key leaders of health and care organisations in North London, which helped ensure my research findings were disseminated locally to support local health and care systems. I also worked with a panel of patients and members of the public to ensure my research was relevant to patients and the public. I have loved working with such knowledgeable and passionate colleagues, and I look forward to working with them in the future.

I really valued the networking events that enabled me to meet other SPHR PhD students. I think I’ve made connections that will last throughout my career.

Lizzie's Q&A

  • What has been your career journey so far?

    Prior to starting my PhD, I completed a Clinical Mental Health Sciences MSc at UCL (2018) and a Neuroscience (BA) at the University of Oxford (2016). Whilst studying, I worked as a Research Assistant on various projects implementing interventions to improve mental health and educational outcomes.

  • Why did you choose to do a PhD in public health research?

    I have always been interested in public health research, in particular understanding how we can better prevent the development of ill-health and its complications. A PhD with the NIHR School for Public Health Research was a natural fit for me.

  • What is your research focused on?

    My research focuses on understanding how we can use linked health and Local Authority resident records to examine how multimorbidity (the co-occurrence of multiple long-term conditions) clusters within households and how people’s social circumstances are associated with multimorbidity. My research also focuses on how we can better use these kinds of data to inform service provision.

  • Why is it important?

    Multimorbidity is a major public health challenge. Despite this, many typically consider multimorbidity in a biomedical sense even though social factors greatly influencing its extent and nature. Local Authorities hold an array of information describing the social circumstances of their residents. Linking these data to health information could help senior decision makers better understand multimorbidity in their area and plan services accordingly.

  • What do you like about being a part of the NIHR School for Public Health Research?

    I enjoy the opportunities to collaborate with public health researchers from across the UK, to learn about the breadth of research being conducted across the school and I enjoy the support the school offers early career researchers like myself.

  • What skills have you learnt and/or are hoping to learn as part of your PhD?

    As part of my PhD I have learnt how to conduct mixed methods research, in particular how to conduct semi-structured qualitative interviews, and I have learnt how to analyse large datasets. I have also improved my ability to communicate research findings to a range of audiences through disseminating my findings at various conferences and events.

  • What do you hope to do after completing your PhD?

    I hope to continue using large, linked datasets to improve our understanding of the social determinants of multimorbidity. I hope to continue working with health and Local Authority partners on this work. I would also like to extend this to examine social factors influencing care provision for those with multimorbidity.

Publications

Ingram E, Gomes M, Hogarth S, McDonald HI, Osborn D, Sheringham J. Household Tenure and Its Associations with Multiple Long-Term Conditions amongst Working-Age Adults in East London: A Cross-Sectional Analysis Using Linked Primary Care and Local Government Records. International Journal of Environmental Research and Public Health. 2022; 19(7):4155. https://doi.org/10.3390/ijerph19074155

Ingram, E. Ledden, S. Beardon, S. Gomes, M. Hogarth, S. McDonald, H. Osborn, D P. Sheringham, J. (2020) Household and area-level social determinants of multimorbidity: a systematic review. Journal of Epidemology & Community Health.

Ingram E, Cooper S, Beardon S, et al Barriers and facilitators of use of analytics for strategic health and care decision-making: a qualitative study of senior health and care leaders’ perspectives BMJ Open 2022;12:e055504. doi: 10.1136/bmjopen-2021-055504

Beardon, S., Woodhead, C., Cooper, S., Ingram, E., Genn, H., & Raine, R. (2021). International Evidence on the Impact of Health-Justice Partnerships: A Systematic Scoping Review. Public Health Reviews, 42, 6. https://www.ssph-journal.org/articles/10.3389/phrs.2021.1603976/full
Lut, I., Woodman, J., Armitage, A., Ingram, E., Harron, K., & Hardelid, P. (2021). Health outcomes, healthcare use and development in children born into or growing up in single-parent households: a systematic review study protocol. BMJ open, 11(2), e043361. https://pubmed.ncbi.nlm.nih.gov/33574152/

Conferences

Poster presentation at the Society for Social Medicine & Population Health Annual Scientific Meeting (2020) titled “Household and area level social determinants of multimorbidity: a systematic review of observational studies.

Presentation: QHRN Conference 2021. The role of trust in senior leaders’ experiences of using analytics to inform strategic health and care decisions.

Presentation: HSRUK Conference 2021. Senior leaders’ experiences of using analytics to inform strategic decision making with implications across health and care.

Awards and Recognitions

Vice Chair of SPHR Researcher’s Network (ResNet) between 2020-2021

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