HB2.21 - A review of the evidence base for modelling the costs of overweight,obesity and diet-related illness

A review of the evidence base for modelling the costs of overweight, obesity and diet-related illness for Scotland, and critical appraisal of the cost-effectiveness evidence base for population wide interventions to reduce overweight, obesity and diet-related illness

The specific objectives were to provide a review of the evidence base relating to the costs of overweight, obesity and diet-related illness for Scotland, and to review and critique the cost-effectiveness evidence base for population wide interventions affecting diet to reduce overweight, obesity and diet-related illness.

This research developed an improved understanding of the wider economic consequences of diet-related health, by describing and critiquing existing evidence of estimates of cost and cost-effectiveness developed to tackle overweight, obese and diet-related disease in Scotland.

Outcome and Translation

The international literature provides evidence for the cost-effectiveness of a range of population level interventions to improve diet and obesity.  However, these are modelling studies rather than evaluations of interventions post-implementation and specific estimates of the population impact for Scotland are lacking.  It is recommended that any future estimates for Scotland should be developed by reviewing evidence from effectiveness studies that have tracked longer term effects of interventions on weight change and health. 

HERU researchers involved in this project:  Paul McNamee, Anne Ludbrook, Patrícia Norwood, Aileen Neilson

External collaborator: Avenell, A. (HSRU, University of Aberdeen)

Publications

McNamee, P., Neilson, A.R., Norwood, P., Avenell, A. and Ludbrook, A. (2017) A review of the evidence base for modelling the costs of overweight, obesity and diet-related illness for Scotland, and critical appraisal of the cost-effectiveness evidence base for population wide interventions to reduce overweight, obesity and diet-related illness, Aberdeen: Food Standards Scotland. [Report]

Presentations

McNamee, P., Neilson, A.R., Norwood, P., Avenell, A. and Ludbrook, A. (2017) 'The cost-effectiveness evidence base for population level interventions to address diet and obesity in Scotland: results from a rapid review' [Poster], Public Health in Scotland: Transcending Boundaries, Aviemore, 2-3 November 2017.

McNamee, P., Neilson, A.R., Norwood, P., Avenell, A. and Ludbrook, A. (2017) 'The cost-effectiveness evidence base for population level interventions to address diet and obesity in Scotland: results from a rapid review', Scottish Government / Food Standards Scotland Seminar, Edinburgh, 7 September 2017.

McNamee, P., Avenell, A., Ludbrook, A., Neilson, A.R. and Norwood, P. (2018) 'Evidence review for Food Standards Scotland on population-wide interventions to prevent obesity', 12th European Conference on Health Economics (EuHEA), Maastricht, The Netherlands, 11-14 July 2018.

HBI1.9 - Analysis of choice behaviour and potential mechanisms of change

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This project reviewed the relevant economic literature to map out theoretical approaches and empirical examples for further analysis. Econometric analysis was then carried out using secondary data to investigate children’s diets and adult fruit and vegetable consumption. A discrete choice experiment (DCE) was undertaken to investigate the effect of introducing colour coding of calorie information within a traffic light food labelling system. The DCE incorporated eye-tracking technology in the pilot stage to help understand the effect of the additional information. A full-scale study was then conducted using an online panel.

Outcome and Translation

The secondary data analysis of children’s diets showed that household characteristics explain more of the variation than child characteristics, with adult healthy eating behaviour positively associated with children’s behaviour. The inclusion of both child and household effects reduces the amount of unexplained variation in children’s healthy eating although the unexplained variation remains substantial. The analysis of adult diet identified differences in determinants between fruit and vegetables and separate effects for income level and source of income.

In the food choice DCE, we found that saturated fat appears to be the attribute with largest impact on participants’ choices, followed by fat, with salt consistently ranked as least influential attribute. The willingness-to-pay (WTP) values are largely influenced by the number of sandwiches presented to the participants, with lower levels of WTP for a four sandwich choice. We also found that deciding to colour-code for calorific value has an important effect on the valuation of this attribute. Our results confirm that colour coding the nutritional information can significantly influence food choices.

 

HERU researchers involved in this research project: Anne Ludbrook, Shelley Farrar, Lynda McKenzie, Damilola Olajide, Patrícia Norwood, Nicolas Krucien and Mandy Ryan

External collaborators: P Morgan (Rowett Institute of Health and Nutrition (RIHN))

Publications

Bestwick, C.S., Douglas, F.C.G., Allan, J.L., Macdiarmid, J.I., Ludbrook, A. and Carlisle, S. (2013) 'A perspective on the strategic approach to the complexity and challenges of behaviour change in relation to dietary health', Nutrition Bulletin, 38(1), 50-56.

Presentations

Olajide, D., McKenzie, L. and Ludbrook, A. (2014) 'The role of income status or household main-source of income in the determinants of dietary inequalities', Health Economics in the Age of Longevity: a Joint iHEA & ECHE Congress, Trinity College, Dublin, 13-16 July 2014.

Olajide, D., McKenzie, L. and Ludbrook, A. (2014) 'Censored household demand for fruits and vegetable: evidence from the UK’s Living Costs and Food Survey', 35th Annual Nordic Health Economists’ Study Group Meeting, Reykjavik, Iceland, 20-22 August 2014.

Ludbrook, A. (2014) 'Prompting healthy food choices: what does economics tell us?', Promoting behaviour change in food and drink consumption and production. Identifying future priorities: what does the evidence tell us? A workshop for Scottish Government, Edinburgh, October 2014.

Norwood, P., Krucien, N., Ryan, M. and Ludbrook, A. (2014) 'Does calorie labelling need the green light? Findings from an eye tracking experiment', Annual Scottish Faculty of Public Health Conference - Health in a changing Scotland: the ball's in our court, Aviemore, 6 November 2014.

Norwood, P. (2015) 'Does calorie labelling need the green light? Findings from an eye tracking experiment', PechaKucha Aberdeen (Public engagement), Belmont Filmhouse, Aberdeen, 26 May 2015.

HBI2.18 - DEterminants of DIet and Physical ACtivity (DEDIPAC)

DEDIPAC was a Joint Programme Initiative Knowledge Hub to integrate and develop infrastructure for research across Europe.  

HERU co-ordinated the University of Aberdeen contribution within the Pathways to a Healthy Life strategic research theme.  HERU staff were involved in the development of a concept toolbox for evaluating policies addressing diet, physical activity and sedentary behaviours, with particular emphasis on economic evaluation.

Outcome and Translation

The overall DEDIPAC programme was successful in developing infrastructure and capacity for future research.  

More information on the DEDIPAC project is available at the DEDIPAC website.

HERU researchers involved in this research project: Anne Ludbrook and Aileen Neilson

DEDIPACExternal collaborators: J Allan (Health Psychology, University of Aberdeen); F Douglas and G McNeill ((The) University of Aberdeen Rowett Institute).  Researchers from 68 research institutes across 13 countries were involved in DEDIPAC.


Publications

Ludbrook, A., Campbell, J., Douglas, F., Michels, K., Müller, I., Furlong, B., De Craemer, M., Vuillemin, A. and Woods, C. (2015) Report on policy monitoring and evaluation based on literature search and rapid review., 3.2.1. DEDIPAC Consortium.

Presentations

Ludbrook, A., Campbell, J., Douglas, F., Michels, K., Müller, I., Furlong, B., De Craemer, M., Vuillemin, A. and Woods, C. (2014) 'Rapid review on policy monitoring and evaluation', DEDIPAC Consortium Meeting, Amsterdam, 15 May 2014.

Ludbrook, A., Campbell, J., Douglas, F., Michels, K., Müller, I., Furlong, B., De Craemer, M., Vuillemin, A. and Woods, C. (2014) 'Rapid review on policy monitoring and evaluation', International Society for Behavioural Nutrition and Physical Activity (ISBNPA) 2015 Edinburgh, 3-6 June 2015.

HBI2.11 - Economic aspects of alcohol policy

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Various approaches to alcohol pricing have been proposed, including minimum pricing per unit of alcohol, increases in current duty rates and restrictions on below cost selling. This project considered the economic impacts and equity effects of alternative approaches and also considered the comparative effectiveness of non-financial interventions.

Outcome and Translation

Legislation on minimum pricing for alcohol has been passed by the Scottish Parliament and deemed legal by the UK Supreme Court. Evidence relating to the effectiveness of minimum pricing was presented to the Health and Sport Committee of the Scottish Parliament during the legislative process and has been used in the Scottish Government’s submission in the legal case.

In this YouTube video Professor Anne Ludbrook discusses the introduction of a minimum price on alcohol policy in Scotland during a roundtable discussion at the AMPHORA Conference in Stockholm, October 2012.

 

HERU researchers involved in this research project: Anne Ludbrook, Lynda McKenzie and Ourega-Zoé Ejebu.

External collaborators: D Petrie (University of Melbourne).

Publications

Ludbrook, A. 'Asking the right questions about substitution and complementerity: a comment on Moore's paper', Alcohol and Alcoholism. 2010; 45(5): 412-413.

Ludbrook, A., Petrie, D., McKenzie, L. and Farrar, S. (2012) 'Tackling alcohol misuse: purchasing patterns affected by minimum pricing for alcohol', Applied Health Economics and Health Policy, 10(1), 51-63.

Johnston, M.C., Ludbrook, A. and Jaffray, M.A. (2012) 'Inequalities in the distribution of the costs of alcohol misuse in Scotland: a cost of illness study', Alcohol and Alcoholism, 47(6), 725-731.

Alcohol Health Alliance Strategy Group (2013) Health first: an evidence-based alcohol stratgey for the UK, Stirling: University of Stirling. (Ludbrook, A., member of AHAS Group).

Ludbrook, A., Holmes, J. and Stockwell, T. (2014) 'Gender differences in alcohol demand: a systematic review of the role of prices and taxes. Comment on conclusions by Nelson', Health Economics, 23(10), 1281-1283.

Ludbrook, A. (2015) 'Special focus III: How does minimum unit pricing for alcohol affect different types of drinkers?', in Sassi, F. (ed.) Tackling Harmful Alcohol Use. Paris: OECD Publishing. [pdf]

Ludbrook, A. and Griffith, R. (2015) Drinkaware latest viewpoints series: should minimum unit pricing be introduced in the UK? Drinkaware. [Webpage].

Ludbrook, A. (2016) 'Fairness and efficiency: addressing the harms of excessive drinking', HERU Policy Brief, January 2016, University of Aberdeen.

Ludbrook, A. (2017) 'Commentary: Cost of alcohol: better data will be justified if it is put to better use', Addiction, 112(4), 566.

Presentations

Ludbrook, A. (2012) 'Why is action on alcohol so needed? Round table discussion', AMPHORA Conference, Stockholm, October 2012.

Ejebu, O. (2014) 'Minimum Unit Pricing for alcohol and the 'moderate drinker of moderate means': an analysis of household scanner data', Annual Scottish Faculty of Public Health Conference: Health in a Changing Scotland: the Ball's in Our Court, Aviemore, 6 November 2014.

Ejebu, O.. (2014) 'Minimum unit pricing (MUP) for alcohol: who are the predominant purchasers of cheap alcohol in Scotland?', PechaKucha Aberdeen (public engagement), Belmont Filmhouse, Aberdeen, 2 December 2014.

Ludbrook, A. (2016) 'Today's student, tomorrow's heavy drinker', Café Variété (Public engagement), University of Aberdeen, Aberdeen, 3 November 2016.

HB1.22 - The effects of economic insecurity on physical and mental health (HERU Post-Doctoral Fellowship - Elizabeth Russell Career Development Fellowship)

Insecure employment has consistently been shown to have a significant adverse effect on mental health, particularly for males. Using data from the British Household Panel Survey (BHPS), we  examined the mental health effects of this anticipating entry or prolonged exposure to insecure employment. By estimating the monetary value of health-utility decrements resulting from exposure and anticipation of exposure, we assessed the likely benefits of policies which are effective in reducing insecure employment.

Outcome and Translation

We show that there are valuable individual and population health benefits which could be gained through effective polices to reduce exposure to insecure employment. These benefits will be experienced by males over an anticipation period and an exposure period. For females only the contemporaneous benefits are significant.

HERU researchers involved in this project:  Daniel Kopasker, Marjon van der Pol, Diane Skåtun, Paul McNamee

Publications

Kopasker, D., Montagna, C. and Bender, K.A. (2019) Insecure lock-in: the mental health effects of anticipating insecure employment, Discussion Papers in Economics and Finance, 19:7.

HBI3.6A - A feasibility study for Walk With Ease UK - a community-based walking programme for adults with arthritis and musculoskeletal conditions

This feasibility study had three main aims – 1) to identify and make cultural adaptations to ensure the relevance and adoption of an existing physical activity intervention, “Walk With Ease” (WWE) in a UK setting; 2) to examine aspects of recruitment, randomisation, compliance to assessments, extent of data variation, and adherence to activity to inform the design of a future RCT of WWE-UK; and 3) to explore the perceptions and experiences of WWE among participants and community partners to identify processes implicit in integrating a community-based walking programme for individuals with arthritis/MSK conditions into current care.

Participants were recruited across three study group formats: WWE instructor-led, WWE self-directed and non-walking. Participants completed a self-report survey and physical performance assessment at baseline and six-weeks, with mailed survey at three-months. Participant observation, biographical narratives and semi-structured interviews explored the implementation processes and experiences of WWE.

Outcome and Translation

In total, 149 participants were allocated to the WWE programme: 52 chose instructor-led; 45 chose self-directed, and a further 52 were participants were randomised to usual care. Participants were mostly women (70%) and aged ≥60 years (77%), with the majority reporting osteoarthritis (58%) and/or back pain (53%). Statistically significant differences in pain were observed amongst respondents who undertook the programme using the self-directed rather than instructor-led format.  Loss to follow-up among WWE program participants was approximately 20% at 6-weeks. Nearly all (99%) would recommend WWE to family or friends and 81% reported they were satisfied with the programme. At 6 weeks, about half reported that their health was at least moderately better, with noticeable improvement in physical health (47%) and emotional well-being (53%).  These findings indicate that WWE is a relevant, acceptable and feasible walking program when delivered in the UK. Wider implementation of this evidence-based program may benefit the physical health and well-being of people with arthritis.

HERU researchers involved in this research project:  Paul McNamee

External Collaborators: Martin, K. (Institute of Applied Health Sciences, University of Aberdeen); MacFarlane, G. (Epidemiology, University of Aberdeen); Morrison, Z., Rae, R. (AURIS Business Centre, University of Aberdeen); Smith, T. (University of East Anglia) and Neilson, A. (University of Edinburgh)

Presentations

Martin, K.R., Smith, T.O., Gaihre, S., Macfarlane, G., Neilson, A.R., McNamee, P., Rae, R. and Morrison, Z.J. (2018) 'A mixed-methods feasibility study exploring the cultural adaptation of Walk With Ease to the United Kingdom', American College of Rheumatology / Association of Rheumatology Health Professionals Annual Meeting, Chicago, USA, 19-24 October 2018.

Martin, K.R., Stelfox, K., Morrison, Z.J., McNamee, P., Smith, T.O. on behalf of the Walk with Ease Research Study Team (2019) 'The more I go out and the more I walk it eases up, the pain: a mixed-methods approach to exploring participants’ pain symptoms and their experience of the Walk With Ease programme', Scottish Pain Research Community Annual Scientific Meeting, West Park Conference Centre, Dundee, 29 March 2019.

HBI3.2 - Obese men, SMS and weight loss incentives

Feasibility study of how to best engage obese men in narrative SMS (short message system) and incentive interventions for weight loss, to inform a future effectiveness and cost-effectiveness trial

Being obese causes 5% of deaths worldwide and puts people at greater risk of diseases like diabetes or some cancers. In 2013, 26% of UK men were obese, but men rarely participate in weight loss programmes.

This project was a two-phase feasibility study.

Phase 1 (i) built on an existing narrative SMS intervention with embedded behaviour change techniques for men using qualitative co-design, and (ii) developed an endowment incentive drawing on insights from behavioural economics, existing evidence and men’s preferences for delivery based on survey/DCE evidence. An iterative mixed-methods approach was used including a systematic review of the evidence, theory and learning from recent UK behaviour change trials to refine the interventions through PPI and user testing.

Phase 2 was a 12-month feasibility RCT with three arms: SMS only; SMS and incentive; usual practice with waiting list for SMS intervention. Iterative mixed-method data collection and analysis helped to refine the intervention parameters, design and processes in preparation for a potential, full, pragmatic effectiveness and cost-effectiveness RCT.

Outcome and Translation

The developed interventions were shown to be feasible.  An application has been submitted to progress to a full trial.

HERU researchers involved in this research project: Marjon van der Pol and Hannah Collacott

External Collaborators: P. Hoddinott, B. Williams, S. Dombrowski, M. Grindle (University of Stirling); A. Avenell (HSRU, University of Aberdeen); C. Gray (University of Glasgow); F. Kee, M. McKinley (The Queen's University of Belfast); C. Jones (University of Dundee); A. Elders (Glasgow Caledonian University) and P. Carroll (Waterfood Institute of Technology).

Publications

Dombrowski, S.U., McDonald, M., Pol, M. van der, Grindle, M., Avenell, A., Carroll, P., Calveley, E., Elders, A., Glennie, N., Gray, C.M., Harris, F.M., Hapca, A., Jones, C., Kee, F., McKinley, M.C., Skinner, R., Tod, M. and Hoddinott, P. (2020) 'Game of Stones: feasibility randomised controlled trial of how to engage men with obesity in text message and incentive interventions for weight loss', BMJ Open, 10(2), e032653.

Dombrowski, S. U., McDonald, M., Pol, M. van der, Grindle, M., Avenell, A., Carroll, P., Calveley, E., Elders, A., Glennie, N., Gray, C. M., Harris, F. M., Hapca, A., Jones, C., Kee, F., McKinley, M. C., Skinner, R., Tod, M. and Hoddinott, P. (2020) 'Text messaging and financial incentives to encourage weight loss in men with obesity: the Game of Stones feasibility RCT', Public Health Research, 8(11).

Presentations

Pol, M. van der (2017) 'Designing financial incentives for weight loss: the role of behavioural economics and preference elicitation', London School of Economics and Political Science, Health and Social Care Seminar, LSE, London, 10 May 2017.

Pol, M. van der (2018) 'Designing financial incentives for weight loss: the role of behavioural economics and preference elicitation', Workshop on the Economics of Health Behaviours and Health Information, University of Bath in London, London, 15-16 March 2018.

HBI2.17 - Implementation of a psychosocial programme of support and training for people with dementia and their family care givers

International research has shown that a psychosocial programme to improve self-management skills is effective at maintaining health-related quality of life and well-being amongst caregivers of people with dementia. There is however a lack of UK studies, and limited economic information. This study was conducted to build the evidence base in these areas, and to inform the design of a future, larger, controlled study.

Outcome and Translation

The programme was feasible to implement, and acceptable to participants. The data on health-related quality of life, well-being and costs were used to design a larger controlled study. There is also potential for the intervention to be rolled out and tested amongst other unpaid carers of people with dementia in other areas of Scotland.

HERU researchers involved in this research project: Paul McNamee

External collaborators: M Milders (Heriot-Watt University); A Lorimer, S Bell (NHS Grampian)

Publications

Milders, M., Bell, S., Lorimer, A., Jackson, H. and McNamee, P. (2019) 'Improving access to a multi-component intervention for caregivers and people with dementia', Dementia, 18(1), 347-359.


Archived

HBI1.11 - The nature and extent of food poverty/insecurity in Scotland

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Using existing sources of information to develop further the evidence base in relation to the experience of food poverty among particular vulnerable groups of the population (not covered by other studies) e.g. older people, people in rural and remote rural areas, those facing destitution. Consider ways in which community food initiatives are currently responding to this situation and what they could or might do to mitigate it.

Outcome and Translation

This research has identified key recommendations that require policy, practitioner and research attention, including more research and information about household food insecurity (HFI), coming from the care sector itself. Medium- to longer-term policy interventions are recommended that address the root/basic causes of poverty, e.g. to generate/increase income sufficiency and bring more certainty of income to more households in Scotland is fundamentally required to address HFI in this country. There needs to be better understanding of the impact of short- and longer-term HFI on health, including the relationship with obesity and malnutrition (which can co-exist).

HERU researchers involved in this research project: Lynda McKenzie, Anne Ludbrook and Ourega-Zoé Ejebu

External collaborators: F Douglas (University of Aberdeen Rowett Institute)

Publications

Douglas, F., Ejebu, O., Garcia, A., MacKenzie, F., Whybrow, S., McKenzie, L., Ludbrook, A. and Dowler, E. (2015) The nature and extent of food poverty. NHS Health Scotland.

Douglas, F., MacKenzie, F., Ejebu, O., Whybrow, S., Garcia, A.L., McKenzie, L., Ludbrook, A. and Dowler, E. (2018) 'A lot of people are struggling privately. They don’t know where to go or they’re not sure of what to do: frontline service provider perspectives of the nature of household food insecurity in Scotland', International Journal of Environmental Research and Public Health, 15(12), 2738.

Ejebu, O., Whybrow, S., McKenzie, L., Dowler, E., Garcia, A.L., Ludbrook, A., Barton, K.L., Wrieden, W.L. and Douglas, F. (2019) 'What can secondary data tell us about household food insecurity in a high-income country context?', International Journal of Environmental Research and Public Health, 16(1), 82.

Presentations

Douglas, F., Ejebu, O, Garcia, A. L., Whybrow, S., McKenzie, L., MacKenzie, F., Ludbrook, A. and Dowler, E. (2015) 'The nature and extent of food poverty/insecurity in Scotland: a preliminary study', British Sociological Association (BSA) Food Study Group – Sheffield Political Economy Research Institute (SPERI). Food, Poverty and Policy: Evidence Base and Knowledge Gap, University of Sheffield, 30 June 2015.

Ejebu, O., Douglas, F., Garcia, A., MacKenzie, F., Whybrow, S., McKenzie, L., Ludbrook, A. and Dowler, E. (2015) 'The nature and extent of food poverty/insecurity in Scotland: preliminary results', 12th Federation of European Nutrition Societies (FENS) Congress, Berlin, Germany, 20-23 October 2015.

Ejebu, O., Douglas, F., Garcia, A., MacKenzie, F., Whybrow, S., McKenzie, L., Ludbrook, A. and Dowler, E. (2015) 'Food poverty in Scotland: a preliminary study of prevalence and nature using secondary data', Faculty of Public Health, Scottish Conference: Securing Scotland's Health, Peebles Hydro, Peebles, 5-6 November 2015.

Douglas, F., Ejebu, O., Garcia, A., MacKenzie, F., Whybrow, S., McKenzie, L., Ludbrook, A. and Dowler, E. (2015) 'Looking beyond food banks: a qualitative study of food poverty in Scotland', Faculty of Public Health, Scottish Conference: Securing Scotland's Health, Peebles Hydro, Peebles, 5-6 November 2015.

HBI1.15 - PhD: Applying economic methods to optimise self-management

Chronic conditions are illnesses that have no cure and for which current care can only control symptoms. In Scotland, it is estimated that nearly 40% of the population lives with at least one chronic condition. Self-management of chronic conditions occurs when the patient acts as the primary decision-maker in the treatment of her/his condition.

This PhD thesis uses econometric analysis of secondary data to investigate the effect of preferences and personality on self-management of chronic conditions. From an economic perspective, the decision to self-manage can be described as an investment in health because it incurs immediate costs to produce future health.

A key economic factor that affects an individual’s intertemporal decision-making is time preference, which describes an individual’s propensity for immediate benefits over delayed ones. Furthermore, future health is inherently uncertain, and individuals’ risk preference may also be an important factor affecting the type and quantity of self-management activities adopted. Beyond classic economic models, this thesis also explores the effect of health on individuals’ time preference, which is often assumed to be exogenous. 

Outcome and Translation

This thesis produced several important novel findings. First, it was found that the time discount rate was associated with maintained physical activity participation but not healthy eating or low-risk alcohol consumption. Second, economic insecurity, defined as the anxiety produced from an unsafe financial future, was associated with smoking in women and physical activity in men. Finally, to investigate whether health itself may influence perceptions of the future, the effect of a lagged health shock was modelled as a proxy for the time discount rate. It was found that a health shock led women to become more future-oriented whilst the opposite occurred amongst men. Overall, it is concluded that the findings of this thesis could be used in the development of policy and interventions to support uptake and adherence of self-management regimes for people with long-term conditions.

Student: Laura Dysart

Supervisors: Paul McNamee and Marjon van der Pol (HERU)

Publications

Dysart, L. (2018) 'Health over time: an investigation into the relationship between the future and health behaviours for people with long-term conditions', PhD Thesis, HERU, University of Aberdeen.

Presentations

Dysart, L., McNamee, P. and Pol, M. van der (2015) 'Exploration of the effect of time preference on change in self-management behaviours in older adults with at least one chronic health condition [poster]', 2nd European Health Economics Association (EuHEA) PhD Student - Supervisor Conference, Paris-Dauphine University, Paris, France, 2-4 September 2015.

Dysart, L., McNamee, P. and Pol, M. van der (2016) 'The role of time preference on healthy lifestyle choices in older adults living with chronic health conditions', European Health Economics Association Conference, 'Know the Ropes - Balancing Costs and Quality in Health Care', Universität Hamburg, Germany 13-16 July 2016.

Dysart, L., McNamee, P. and Pol, M. van der (2016) 'Health shocks and endogenous time discounting', 3rd European Health Economics Association (EuHEA) PhD Student-Supervisor and Early Career Researcher Conference, Universitat Internacional de Catalunya, Barcelona, Spain, 7-9 September 2016.

Dysart, L., McNamee, P. and Pol, M. van der (2017) 'Health shocks and endogenous time discounting', Institute of Applied Health Sciences (IAHS) Postgraduate Research Symposium, University of Aberdeen, Aberdeen, 17 February 2017.

Dysart, L., McNamee, P. and Pol, M. van der (2018) 'Economic insecurity and health behaviours in older adults', 39th Nordic Health Economists’ Study Group (NHESG) Meeting, University of Tromsø, Norway, 22-24 August 2018.

HBI1.12 - PhD: Economic aspects of food choice and its association with health inequalities in Scotland and the UK

This PhD project focused on non-price determinants of food choices with the aim of improving individuals’ diet. These non-price determinants included perceptions of food and time preference. Negative externalities provided an economic rationale for intervention as over-consumption of food results in additional costs to the health service. Many factors affecting food choices. The first empirical chapter used the Scottish Health Survey to investigate how perceived barriers towards healthy eating influence food choices. Primary data collection allowed the association between time preference and food choices to be explored. A discrete choice experiment and field experiemnt was undertaken to investigate whether the impact of a food tax is affected by displaying the tax rate.

Outcome and translation

Overall, this PhD project has added to the understanding of non-price determinants of food choice by investigating perceived barriers, time preference, signposting tax rates, and how these were associated with food choices. Empirical results, for example specific perceived barriers to healthy eating or the rate of time preference, can be used to inform the development of policy interventions to improve individual food choices. The project has highlighted a number of potential avenues of future research including potential methods to implement a tax on foods. 

PhD Student: Liam Mc Morrow

Supervisors: Anne Ludbrook and J Macdiarmid, (Rowett Institute of Nutrition and Health (RINH)).

Publications

Mc Morrow, L., Ludbrook, A., Macdiarmid, J. I. and Olajide, D. (2017) 'Perceived barriers towards healthy eating and their association with fruit and vegetable consumption', Journal of Public Health, 39(2), 330-338.

Mc Morrow, L. (2018) 'Economic analysis of the non-price determinants of food choices', PhD Thesis, HERU, University of Aberdeen.

 

Presentations

Mc Morrow, L., Ludbrook, A., Macdiarmid, J. I. and Olajide, D. (2013) 'Economic aspects of food choice and health inequalities', SGPE Residential Methodology Conference, Crieff, January 2013.

McMorrow, L., Ludbrook, A., Macdiarmid, J. I. and Olajide, D. (2013) 'Determinants of fruit and vegetable consumption in Scotland', Institute of Applied Health Sciences (IAHS) summer symposium, University of Aberdeen, Aberdeen, 17 June 2013.

Mc Morrow, L., Ludbrook, A., Macdiarmid, J. I. and Olajide, D. (2013) 'Determinants of fruit and vegetable consumption in Scotland', Irish Society for New Economists, Maynooth, Ireland, September 2013.

Mc Morrow, L., Ludbrook, A., Macdiarmid, J. I. and Olajide, D. (2013) 'The determinants of fruit and vegetable consumption: a focus on individual attitudes', Scottish Faculty of Public Health Conference, Dunblane, 7-8 November 2013.

Mc Morrow, L., Ludbrook, A., Macdiarmid, J. I. and Olajide, D. (2014) 'Attitudes towards healthy eating, fruit and vegetable consumption, and health outcomes in Scotland', Health Economists' Study Group, Sheffield, 8-10 January 2014.

McMorrow, L., Ludbrook, A., Macdiarmid, J. I. and Olajide, D. (2014) 'The determinants of fruit and vegetable consumption: a focus on individual attitudes', NHS Grampian CDP Session, Aberdeen, January 2014.

Mc Morrow, L., Ludbrook, A., Macdiarmid, J. I. and Olajide, D.(2014) 'Nudging consumers towards a healthy food choice: a pilot discrete choice experiment', Aberdeen Centre for Energy Regulation and Obesity (ACERO) Symposium, Rowett Institute of Nutrition and Health, Aberdeen, 24 April 2014.

Mc Morrow, L., Ludbrook, A., Macdiarmid, J. I. and Olajide, D. (2014) 'The determinants of fruit and vegetable consumption: a focus on individual attitudes', Health Surveys User Conference, University College London, 15 July 2014.

Mc Morrow, L., Ludbrook, A., Macdiarmid, J. I. and Olajide, D. (2014) 'Nudging consumers towards a healthy food choice: a pilot discrete choice experiment', European Health Economics Association (EuHEA) PhD Student-Supervisor and Early Career Researcher Conference, Manchester Centre for Health Economics, 1-3 September 2014.

Mc Morrow, L., Ludbrook, A., Macdiarmid, J. I. and Olajide, D. (2015) 'The role of perceptions when taxing food', Cuthbertson Prize Lecture, [poster] Rowett Institute for Nutrition and Health, University of Aberdeen, 15 April 2015.

McMorrow, L., Ludbrook, A., Macdiarmid, J. I. and Olajide, D. (2015) 'The non-price determinants of food choice: a focus on the role of perceptions', Cuthbertson Prize Lecture, Rowett Institute for Nutrition and Health, University of Aberdeen, 15 April 2015.

Mc Morrow, L. (2015) ‘Nudging people to make better decisions: is it ethical?’ PechaKucha Aberdeen (Public engagement), Belmont Filmhouse, Aberdeen, 17 November 2015.

Mc Morrow, L., Ludbrook, A. and Macdiarmid, J. I. (2016) 'Can time preference help explain variations in diet quality?', Health Economists' Study Group (HESG) Meeting, University of Manchester, Manchester, England, 6-8 January 2016.

Mc Morrow, L., Ludbrook, A. and Macdiarmid, J. I. (2016) 'Food taxes: is it possible to influence snack food choices by using tax as a signal?', Scottish Faculty of Public Health Conference, Dunblane Hydro Hotel, Dunblane, 27-28 October 2016.

HBI1.14 - PhD: The role of time preference in the medical decision making context

The aim of the thesis is to examine patient and physician time preferences and investigate how these relate to treatment adherence.

The existing health economics literature focussed largely on time preference of individuals, especially in regard to health behaviours (smoking, alcohol consumption and obesity). Adherence to medical advice has only been explored in a few small studies. More importantly, such research has largely ignored the role that the doctor plays in guiding the patient through the diagnosis and treatment choices and whether this process is affected by the preferences of the provider as well as those of the patient.

This research investigates this link, and its interaction with patient time preferences. A key hypothesis is that, while doctors may prescribe treatments that exhibit exponential discounting and provide the best ‘whole-life’ outcome for the patient (pre-treatment), if the time preference embodied in treatment is sufficiently different from that of the patient adherence is likely to be low and lead to a poorer outcome (post-treatment) than if the doctor had initially prescribed a treatment more closely matching the patient’s time preference.

The first paper compared Scottish GPs’ professional time preferences (for the patient) and private time preferences (for the self). GPs had similar time preferences for themselves and their patients. We also found a large proportion of ’increasingly impatient’ doctors.

The second project is a theoretical model exploring time inconsistency with paternalistic doctors. Doctors face an economic screening problem when they can’t tell in advance whether a patient is present-biased. This is extended to an experiment for the final project. Students in the doctor role made treatment recommendations to patients could observe adherence. Present-bias patients will not adhere to the ‘best’ treatment. Participants adapted to non-adherence as predicted by the model, and a performance payment led to stronger adaptation.

Outcome and Translation

Scottish GPs were found to have the same time preferences for themselves as for their patients in a between-sample design. We also found a large proportion of increasingly-impatient doctors, implying they were less willing to wait for treatment benefits as these are moved into the future. The theory model provided the first examination of non-adherence as an outcome of hidden present-bias time preferences, and showed that responding to this non-adherence depends on the welfare effects and probability that a person is present-biased. Finally, the experiment demonstrated that students in the doctor role did not need direct financial incentives to adapt to non-adherence. The adaptation was as predicted by the model. While a performance payment increased the adaptation, it would not be feasible to implement such strong incentives in reality. The experiment showed that providing doctors with information about adherence was sufficient for them to adapt optimally to non-adherence.

PhD Student: Alastair Irvine

Supervisors: Marjon van der Pol (HERU); Euan Phimister (Economics, University of Aberdeen Business School (UABS))

Publications

Irvine, A. (2018) 'Time preferences and the patient-doctor interaction', PhD Thesis, HERU, University of Aberdeen.

Irvine, A., Pol, M. van der and Phimister, E. (2019) 'A comparison of professional and private time preferences of General Practitioners', Social Science & Medicine, 222, 256-264.


Presentations

Irvine, A., Pol, M. van der and Phimister, E. (2015) 'The role of time preference in the medical decision making context: a research plan', Scottish Graduate Programme in Economics (SGPE) Residential Methodology Conference, Crieff, 8-9 January 2015.

Irvine, A., Pol, M. van der and Phimister, E. (2015) 'The role of time preference in the medical decision making context', Institute of Applied Health Sciences (IAHS) Summer Symposium Aberdeen University, 25 June 2015.

Irvine, A., Pol, M. van der and Phimister, E. (2016) 'Paternalistic patient-doctor interaction and time inconsistency', Scottish Graduate Programme in Economic's (SGPE) Residential Methodology Conference, Crieff Hydro, Crieff, 6-7 January 2016.

Irvine, A., Pol, M. van der and Phimister, E. (2016) 'Professional and private time preferences of Scottish General Practitioners', Stirling Behavioural Science Centre Annual PhD Student Conference in Behavioural Science, Stirling University, Stirling, 9 June 2016.

Irvine, A., Phimister, E. and Pol, M. van der (2016) 'Professional and private time preferences of Scottish general practitioners', European Health Economics Association Conference, 'Know the Ropes - Balancing Costs and Quality in Health Care', Universität Hamburg, Germany 13-16 July 2016.

Irvine, A., Pol, M. van der and Phimister, E. (2016) 'Time inconsistency and paternalistic patient-doctor interaction', Nordic Health Economists' Study Group Meeting, Centre of Health Economics Research (COHERE), University of Southern Denmark, Odense, Denmark, 17-19 August 2016.

Irvine, A., Pol, M. van der and Phimister, E. (2016) 'Paternalistic patient-doctor interaction and time inconsistency', 4th Workshop in Behavioral and Experimental Health Economics University of Cologne, Cologne, Germany, 8-9 December 2016.

Irvine, A., Pol, M. van der and Phimister, E. (2017) 'A comparison of professional and private time preferences of Scottish GPs', Institute of Applied Health Sciences (IAHS) Postgraduate Research Symposium, University of Aberdeen, Aberdeen, 17 February 2017.

Irvine, A., Pol, M. van der and Phimister, E. (2017) 'Time inconsistency and altruism in the patient-doctor interaction', 4th European Health Economics Association PhD Student-Supervisor and Early Career Researcher Conference, Lausanne, Switzerland, 6-8 September 2017.

Irvine, A., Pol, M. van der and Phimister, E. (2017) 'Improving adherence with an economic model – so what?', School of Medicine, Medical Sciences and Nutrition Postgraduate Research Conference, University of Aberdeen, Aberdeen, 29 November 2017.

Irvine, A. (2018) 'The role of time preference in the medical decision making context', Aberdeen (Uni's) Got Talent, May Festival, (Public Engagement), University of Aberdeen, 25 May 2018.

Irvine, A., Phimister, E. and Pol, M. van der (2018) 'Adaptation to time inconsistent patients – an experiment', 12th European Conference on Health Economics (EuHEA), Maastricht, The Netherlands, 11-14 July 2018.

HBI3.4 - REBALANCE: REview of Behaviour And Lifestyle interventions for severe obesity: AN evidenCE synthesis

Adults with severe obesity (body mass index, BMI ≥35kg/m2) have an increased risk of comorbidities, and psychological, social and economic consequences. Systematic review (SR) evidence and economic evaluations on weight management programmes (WMPs) for adults with severe obesity are limited.

The overall aim of this study was to systematically review the evidence for bariatric surgery, lifestyle WMPs and orlistat pharmacotherapy for severe obesity, and evaluate their feasibility, acceptability, effectiveness, and cost-effectiveness.

The health economic objectives were 1) to review the current evidence base on cost-effectiveness and 2) to determine the long term cost-effectiveness of different strategies from an NHS perspective.

Outcome and Translation

N=46 studies were included in the review of cost-effectiveness. Many evaluations were of short duration or did not include extrapolations of input data, failing to fully capture the long term implications of obesity related disease. Modelling assumptions regarding weight regain after the period of weight loss were poorly described, and their impact on long term cost-effectiveness was rarely tested in sensitivity analyses. There was a distinct lack of high quality, long term data on the cost-effectiveness of VLCDs in a UK setting.

Data on the cost-effectiveness of orlistat had mixed results. When compared with WMPs, surgery was found to be cost-effective. When compared with no treatment, surgery was sometimes cost-saving with the savings from reduced obesity related comorbidities found to offset the surgery costs. However, the cost-effectiveness of surgery depended on the quality of the model input data, which were rarely sufficient to fully capture the costs of preparation, delivery, complications and most importantly long term follow-up subsequent to bariatric surgery. None of the studies included any quality of life decrements for surgery related complications, which might over-state the cost-effectiveness case for surgery.

The micro-simulation model was used to address gaps in the current evidence base. The model results show that WMPs were generally cost-effective compared to a baseline ‘do nothing’ approach (ICER <£20,000/QALY). However, the addition of VLCDs to WMPs was not cost-effective. The Look AHEAD programme was borderline cost-effective, with an improved case for cost-effectiveness under more realistic, longer term weight regain assumptions. Roux-en-Y bariatric surgery was the most cost-effective strategy in the base case analysis, over a 30 year time horizon, though the model did not replicate long term cost savings for surgery suggested by some studies in our SR. The economic model results were sensitive to assumptions about weight regain, model time horizon and discount rate for costs and QALYs.

This review is registered with PROSPERO International prospective register of systematic reviews (PROSPERO 2016:CRD42016040190).

HERU researchers involved in this research project: Dwayne Boyers and Elisabet Jacobsen

External collaborators: Avenell, A., Skea, Z., De Bruin, M., MacLennan, G. (HSRU, University of Aberdeen); Aveyard, P. (University of Oxford) and Webber, L (UK Health Forum).

Publications

Avenell, A., Robertson, C., Ske, Z., Jacobsen, E., Boyers, D., Cooper, D., Aceves-Martins, M., Retat, L., Fraser, C., Aveyard, P., Stewart, F., MacLennan, G., Webber, L., Corbould, E., Xu, B., Jaccard, A., Boyle, B., Duncan, E., Shimonovich, M. and de Bruin, M. (2018) REview of Behaviour And Lifestyle interventions for severe obesity: AN evidenCE synthesis (REBALANCE). Systematic reviews and economic evaluations. Final report submitted to NIHR Health Technology Assessment Programme (Project number: 15/09/04).

Avenell, A., Robertson, C., Skea, Z., Jacobsen, E., Boyers, D., Cooper, D., Aceves-Martins, M., Retat, L., Fraser, C., Aveyard, P., Stewart, F., MacLennan, G., Webber, L., Corbould, E., Xu, B., Jaccard, A., Boyle, B., Duncan, E., Shimonovich, M. and Bruin, M. (2018) 'Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation', Health Technology Assessment, 22(68).

Jacobsen, E.Boyers, D. and Avenell, A. (2020) 'Challenges of systematic reviews of economic evaluations: a review of recent reviews and an obesity case study', PharmacoEconomics, 38, 259-267.

Presentations

Jacobsen, E. and Boyers, D. (2018) 'Challenges of cost-effectiveness systematic reviews: REBALANCE study', HTAi Annual Meeting, Vancouver, Canada, 1-5 June 2018.

Boyers, D., Retat, L., Corbould, E., Jacobsen, E., Avenell, A., Xu, B., Jaccard, A., Cooper, D., Robertson, C., Webber, L. and the Rebalance Study Team (2018) 'Economic evaluation of Roux-en-Y bariatric surgery for adults with severe obesity: results from the REBALANCE Project' [poster], 5th UK Congress on Obesity, Newcastle University, Newcastle, England, 6-7 September 2018.

Boyers, D., Retat, L., Corbould, E., Jacobsen, E., Avenell, A., Xu, B., Jaccard, A., Cooper, D., Robertson, C., Webber, L. and the Rebalance Study Team (2018) 'Economic evaluation of weight management for adults with severe obesity: results from the NIHR HTA funded REBALANCE Project', 5th UK Congress on Obesity, Newcastle University, Newcastle, England, 6-7 September 2018.

Jacobsen, E., Boyers, D., Avenell, A., Fraser, C. and the Rebalance Study Team (2018) 'Cost-effective interventions for adults with severe obesity: findings from the REBALANCE systematic review' [poster], 5th UK Congress on Obesity, Newcastle University, Newcastle, England, 6-7 September 2018.

Retat, L., Corbould, E., Boyers, D., Jacobsen, E., Xu, B., Webber, L., Jaccard, A., Avenell, A., Cooper, D., Robertson, C. and the Rebalance Study Team (2018) 'Modelling the epidemiological impact and cost-effectiveness of Look AHEAD in the UK healthcare system: results from the NIHR HTA funded REBALANCE Project' [poster], 5th UK Congress on Obesity, Newcastle University, Newcastle, England, 6-7 September 2018.

Boyers, D., Retat, L., Jacobsen, E., Avenell, A., Corbould, E., Webber, L., De Bruin, M., Robertson, C., Aceves-Martins, M., Cooper, D. and the REBALANCE Study Team. (2019) 'Cost-effectiveness of interventions for the management of severe obesity (findings from the REBALANCE study)' [poster], Public Health Research and Science Conference, University of Manchester, 9-10 April 2019.

Jacobsen, E. and Boyers, D. on behalf of the REBALANCE study team (2019) 'REview of Behaviour And Lifestyle interventions for severe obesity: AN evidenCE synththesis', 7th Annual Research Symposium: Evidence for Value in an Era of Realistic Medicine, COSLA Conference Centre, Edinburgh, 25 April 2019.

Retat, L., Boyers, D.Jacobsen, E., Corbould, E., Webber, L. and Avenell, A. (2019) 'The cost-effectiveness of Very Low Calorie Diets for severe obesity: modelling study in the UK' [poster], 26th European Congress on Obesity, Scottish Event Campus, Glasgow, 28 April - 1 May 2019.

HBI1.13 - SanteMed: Measurement and determinants of inequalities in health and well-being in the Middle-Eastern and North African region

Recent empirical research, including that carried out by some of the research teams participating in this project (SESSTIM-UMR912 and GREQAM-UMR 7316), has shown that the conventional methods that have been used to assess inequalities in health and well-being in developed countries cannot straightforwardly be applied to developing countries owing to their underlying assumptions, which are far from being consistent with the realities in the developing countries. Consequently, more refined approaches to the measurement of inequalities are called for.

Building on previous experiences of the research teams involved and the lessons learned from a recently completed research project that was supported by the French National Agency of Research (ANR-INEGSANTE 2010–2014), this new project seeks to improve the measurement and explanations of various aspects of inequality in health and healthcare within a broader perspective of well-being. Thanks to previous collaboration, this project will benefit from micro-data sets, recently made available, providing detailed information on different aspects of health and well-being in 13 countries in the MENA region.

Outcome and Translation

This project has provided researchers with innovative methodologies to compare distributions of health outcomes in the developing country context in terms of equity and well-being, and has developed statistical inference tools in order to test hypotheses regarding distributional change.

This project is supported by the A*MIDEX project (n° ANR-11-IDEX-0001-02) funded by the  Investissements d’Avenir French Government program, managed by the French National Research Agency (ANR).

HERU researchers involved in this research project:  Ramses Abul Naga

External collaborators: Y Arrighi (Lille); M Abu-Zaineh, B Ventelou, M.E Woode (Marseille); I Ayadi (University of Tunis); A Boutayeb (University Mohammed Premier, Morocco); A Mataria (World Health Organization, Regional Office for the Eastern Mediterranean); S Abdulrahim (American University of Beirut); N Salti (American University of Beirut)

Publications

Abul Naga, R.H. and Stapenhurst, C. (2015) 'Estimation of inequality indices of the cumulative distribution function', Economics Letters, 130(May), 109-112.

Abul Naga, R. H., Shen, Y. and Yoo, H. I. (2016) 'Joint hypothesis tests for multidimensional inequality indices', Economics Letters, 141, 138-142.

Abul Naga, R. H., Shen, Y. and Yoo, H. I. (2016) Joint hypothesis tests for multidimensional inequality indices, Discussion Paper in Economics, 16-3, University of Aberdeen Business School.

Presentations

Abul Naga, R.H. and Shen, Y. (2014) 'Joint hypotheses tests for multidimensional inequality indices with application on income and health in the context of Egypt', Socio-economic Inequality and Health in the Middle East and North African Countries: a Multidisciplinary Perspective, Aix Marseille School of Economics - Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale (AMSE-SESSTIM) 2nd Scientific Symposium on Health Economics, Marseille, France, 3 April 2014.

Abul Naga, R.H. and Shen, Y. (2015) 'Joint hypotheses tests for multidimensional inequality indices (with Egyptian data applications)', Business School Seminar, University of Durham, 11 March 2015.

Abul Naga, R.H. and Abu-Zaineh, M. (2016) 'Bread and social justice: measuring social welfare and inequality using anthropometrics', Scottish Development Economics Workshop, University of Edinburgh, Edinburgh, 26 May 2016.

Abu-Zaineh, M. and Abul Naga, R. H. (2016) 'Bread and social justice: measuring social welfare and inequality using anthropometrics', Applied Health, Equity and Development Research Network, 3rd Scientific Symposium, Marseille, France, 9-10 June 2016.

Abul Naga, R. (2017) 'Discrete data and the measurement of inequality: progressive transfers and the limits to redistribution', New Challenges in the Measurement of Economic Inequalities and Injustices, Aix-Marseille School of Economics, Aix-Marseille University, Marseille, France, 14-15 June 2017.

HBI1.10 - The socio-economic status and integration of immigrants in the UK: the role of language skills and education

ARCHIVED


The project aims to analyse how English language skills and education affect the integration and the socio-economic status of first- and second-generation immigrants in the United Kingdom (UK). The ultimate goal of the project is to explore the policies that might be effective in mitigating health and socio-economic disparities of immigrants by examining the role of a potential source of the disparities, English language proficiency and education.

To identify the causal effect of English language skills, the Instrumental Variable estimation technique is used where age at arrival to the UK is exploited to construct an instrument for English language proficiency.

Outcome and translation

Our results suggest that the education, fertility and extent of deprivation of immigrants are influenced by their ability to speak English. Precisely, better English language skills significantly raise the likelihood of having academic degrees and reduce that of having no qualifications. Regarding fertility and health outcomes, a better proficiency in English significantly delays the age at which an immigrant woman has her first child, lowers the likelihood of becoming a teenage mother, decreases the number of children a woman has, but has little effect on self-reported adult health and no effect on child health measured by birthweight. The results for deprivation outcomes indicate that better English skills lead immigrants to live in an area where residents are less deprived in terms of income, employment and health, although the effect on health deprivation is not statistically significant.

HERU researcher involved in this research project: Yu Aoki

External collaborators: L Santiago (Office for National Statistics)

Publications

Aoki, Y. and Santiago, L. (2015) 'Fertility, health and education of UK immigrants: the role of English language skills', CINCH Working Paper Series, Essen, Germany: CINCH.

Aoki, Y. and Santiago, L. (2015) Education, health and fertility of UK immigrants: the role of English language skills, Discussion Paper in Economics, 15-12, Aberdeen: University of Aberdeen Business School.

Aoki, Y. and Santiago, L. (2016) English language skills and socioeconomic segregation of UK immigrants, Discussion Paper in Economics, 16-7, Aberdeen: University of Aberdeen Business School.

Aoki, Y. and Santiago, L. (2016) 'Speak well, do well - English language proficiency and health and social outcomes of UK immigrants', HERU Policy Brief, August 2016, University of Aberdeen.

Aoki, Y. and Santiago, L. (2018) Deprivation, segregation, and socioeconomic class of UK immigrants: does English proficiency matter? IZA Discussion Paper No. 11368, Bonn, Germany: Institute for the Study of Labor (IZA).

Aoki, Y. and Santiago, L. (2018) 'Speak better, do better? Education and health of migrants in the UK', Labour Economics, 52(June), 1-17.

Presentations

Santiago, L. and Aoki, Y. (2015) 'Fertility, health and education of UK immigrants: the role of English languages skills', Office for National Statistics (ONS) Social and Analysis Directorate Seminar : Research, Evidence and Impact for Policy - Examples of using the ONS Longitudinal Study, Titchfield, 12 May 2015.

Aoki, Y. and Santiago, L. (2015) 'Fertility, health and education of UK immigrants: the role of English languages skills', Essen Health Conference: Health. Skills. Education. New Economic Perspectives on the Health-Education Nexus, Essen, Germany, 29-31 May 2015.

Aoki, Y. and Santiago, L. (2015) 'Fertility, health and education of UK immigrants: the role of English languages skills', CPB Netherlands Bureau for Economic Policy Analysis, The Hague, Netherlands, 9 June 2015.

Aoki, Y. and Santiago, L. (2015) 'Fertility, health and education of UK immigrants: the role of English languages skills', 6th International Workshop on Applied Economics of Education, Catanzaro, Italy, 14-16 June 2015.

Santiago, L. and Aoki, Y. (2015) 'Fertility, health and education of UK immigrants: the role of English languages skills', European Society for Population Economics (ESPE) 29th Annual Conference, Izmer, Turkey, 17-20 June 2015.

Aoki, Y. and Santiago, L. (2015) 'Fertility, health and education of UK immigrants: the role of English languages skills', 4th SOLE-EALE (Society of Labor Economists / European Association of Labour Economists) World Conference, Montreal, Canada, 26-28 June 2015.

Santiago, L. and Aoki, Y. (2015) 'Fertility, health and education of UK immigrants: the role of English languages skills', Understanding Society Scientific Conference 2015, University of Essex, Colchester, 21-23 July 2015.

Santiago, L. and Aoki, Y. (2015) 'Fertility, health and education of UK immigrants: the role of English languages skills', British Society for Population Studies (BSPS) Annual Conference, University of Leeds, Leeds, 7-9 September 2015.

Aoki, Y. (2015) 'Fertility, health and education of UK immigrants: the role of English languages skills', Theory & Applied Micro-Health Workshop, Alicante University, Spain, 19-20 October 2015.

Aoki, Y. and Santiago, L. (2016) 'Education health and fertility of UK immigrants: the role of language skills', Institute for the Study of Labor (IZA) 13th Annual Migration Meeting, Bonn, Germany, 27-28 May 2016.

Aoki, Y. and Santiago, L. (2016) 'Education, health and fertility of UK immigrants: the role of English language skills', International Association for Applied Econometrics Annual Conference, University of Milano-Bicocca, Milan, Italy, 22-25 June 2016.

Aoki, Y. and Santiago, L. (2016) 'Education health and fertility of UK immigrants: the role of language skills', 25th European Workshop on Econometrics and Health Economics, Department of Business and Economics, Econometrics Group and COHERE, University of Southern Denmark, Nyborg, Denmark, 31 August-3 September 2016.

Aoki, Y. (2017) 'Speak better, do better? Education and health of migrants in the UK', Economics Department Seminar, University of Dundee, Dundee, 8 February 2017.

Aoki, Y. (2017) 'Speak better, do better? Education and health of migrants in the UK', Society of Labor Economists (SOLE), Raleigh, North Carolina, USA, 5-6 May 2017.

Aoki, Y. (2017) 'Speak better, do better? Education and health of migrants in the UK', Second Workshop on Immigration, Health and Well-Being, University of Oxford, Oxford, England, 7 June 2017.

Aoki, Y. (2017) 'Speak well, do well? English proficiency and health and social integration of UK immigrants', 31st Annual Conference of the European Society for Population Economics (ESPE), Strathclyde Business School, University of Strathclyde, Glasgow, 14-17 June 2017.

Aoki, Y. (2017) 'Deprivation, enclaves, and socioeconomic classes of UK immigrants. Does English proficiency matter?', 32nd Annual Congress of the European Economic Association (EEA), jointly held with the 70th European Meeting of the Econometric Society (ESEM), Lisbon, Portugal, 21-25 August 2017.

Aoki, Y. and Santiago, L. (2018) 'Deprivation, enclaves, and socioeconomic classes of UK immigrants. Does English proficiency matter?', Scottish Economic Society Annual Conference, Perth, 15-17 April 2018.

Aoki, Y. and Santiago, L. (2018) 'Speak better, do better? Education and health of migrants in the UK', Workshop on Health Challenges, University of Glasgow, Glasgow, 4-5 June 2018.

Aoki, Y. and Santiago, L. (2018) 'Deprivation, enclaves, and socioeconomic classes of UK immigrants. Does English proficiency matter?', International Association for Applied Econometrics Annual Conference, Université du Québec à Montréal (UQAM) and Université de Montréal (UdeM), Montréal, Canada, 26-29 June 2018.

Aoki, Y. and Santiago, L. (2018) 'Deprivation, segregation and socioeconomic class of UK immigrants. Does English proficiency matter?', EEA-ESEM 2018. 33rd Annual Congress of the European Economic Association - 71st European Meeting of the Econometric Society, University of Cologne, Cologne, Germany, 27-31 August 2018.

HBI1.8 - TOPS: Technologies to support Older People at home: maximising personal and Social interaction

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The role of new technologies in health and social care for older people is attracting increasing interest as part of government agendas for modernising public services across the UK. However, there is concern that such technology, if used to substitute for social care provision, will lead to detrimental effects due to loss of personal and social interaction with nurses and other community-based service providers.

This study determined the extent and nature of personal and social interaction between health and social care professionals and older adults with chronic pain, explored the impact of telecare and telehealth technologies on these personal and social interactions for older adults experiencing chronic pain, and integrated understanding of social and personal interactions into the design and application of technologies for the management of chronic pain.

The economic analysis, using a discrete choice experiment study, indicated that there was a preference for having less waiting time, more than one in-person home visit and less telecare. The additional waiting time that respondents were prepared to accept in order to receive fewer video calls suggests that, relative to in-person home visits, this mode of delivery is less preferred. We also found that respondents with chronic pain had less negative perceptions of ICT than respondents living without chronic pain.

Outcome and Translation

This study can inform the future development of telecare and telehealth technologies amongst people with chronic pain.

HERU researchers involved in this research project: Paul McNamee

External collaborators: L Philip, P Wilson, P Edwards, J Farrington (Other Applied Health Sciences, University of Aberdeen); G Rodger (UHIMI Centre for Rural Health); F Williams (Institute of Rural Health, Wales); V Hanson (University of Dundee); P Oliver and P Wright (University of Newcastle); P Schofield (University of Greenwich)

Presentations

Mort, A., McNamee, P., Philip, L., Schofield, P., Hanson, V. and Rodger, G. (2011)'TOPS: designing digital tools for personal and social interaction', Digital Engagement 2011 Conference, Newcastle, 2011.

McNamee, P. (2015) 'Attitudes and preferences for telecare in remote and rural areas: a discrete choice experiment study', Digital Health and Care Congress 2015, King's Fund, London, 16-17 June 2015.