Abstract

EXECUTIVE SUMMARY
Background:
A regional integrated database could serve as a rich data source for in-depth analysis in research studies across key Public Health lifestyle areas in the East Midlands. This could inform Public Health policy, service delivery and commissioning decisions. Unfortunately, existing datasets are poorly aligned across the four key Public Health lifestyle areas examined in this study: physical activity, smoking cessation, reduction in alcohol consumption, and diet and weight management. This feasibility study was therefore commissioned by the East Midlands Directors of Public Health Group chaired by Professor Derek Ward, Director of Public Health in Lincolnshire, with funding from the NIHR East Midlands Clinical Research Network and the College of Social Science, University of Lincoln. Public Health researchers in the Mental Health, Health and Social Care Research Group (MH2aSC) at the University of Lincoln were invited to carry out the study to explore the feasibility of developing and implementing an integrated lifestyle database across the East Midlands Region.

Methods:
A scoping review for available evidence was conducted to inform decisions about feasibility of the proposed integrated lifestyle database. This was followed by a consultation exercise with 18 stakeholders, predominantly in the East Midlands, from September 2020 to February 2021. The consultation exercise sought to gather the views of stakeholders, purposively invited to take part due to their role in public health, about the potential feasibility of an integrated database. Stakeholders were identified and invited by email to participate in the consultation meetings which took place via Microsoft Teams. A topic guide, designed specifically for this study, was used to guide the discussion. The meetings were recorded, transcribed, and analysed thematically.

Results:
The scoping literature review revealed potential benefits but also barriers to the development of an integrated lifestyle dataset, and highlighted the need to consider local factors which need to be better understood prior to implementation. These findings from the literature were supported by rustults from the subsequent consultation exercise.

Stakeholders for the most part, welcomed the idea of an integrated East Midlands lifestyle database because of its potential benefits for research and to produce evidence to inform service development and commissioning decisions.
However, concerns were expressed by some providers including anxieties around revealing their business strategies to rival organisations also involved in the provision of lifestyles services, the cost of setting up and running the proposed integrated database, and the complexities involved in information sharing and governance arrangements which would need to be established.

Conclusion:
In view of the findings the following options should be explored while taking into consideration the barriers and facilitators expressed by stakeholders:
1. A fully integrated individual level lifestyle dataset across the whole East Midlands covering all four lifestyle areas, with governance and access controlled by one institution (possibly a Local Authority or a university) that will house and maintain the database.
2. A fully integrated individual level dataset for all four lifestyle areas, within just one geographical area to start with, which is owned by the service provider. There is a need to consider how to make this available more widely, as the providers only report collated data back to the commissioners.
3. A fully integrated individual level dataset initially starting with one health area (possibly smoking which already has a standardised Key Performance Indicators (KPI) across the whole region, (to be rolled out later subject to success), with governance and access controlled by the institution (either a Local Authority or a local university) that will house the database.
4. An integrated aggregated level dataset covering all four lifestyle areas (reporting similar KPIs as is done currently by service providers who report back to their commissioners), across the whole East Midlands, with governance and access controlled by one institution (possibly a Local Authority or a university) that will house and maintain the database.
5. A fully integrated aggregated level dataset for all four lifestyle areas, within just one geographical area to start with, as we have in Lincolnshire, which is owned by the service provider. There is a need to consider how to make this more widely available, as the providers only report collated data back to the commissioners. This is the model already used in Lincolnshire.
6. An integrated aggregated level dataset initially starting with one health area (possibly smoking which already has a standardised KPI) across the whole region, (to be rolled out later subject to success), with governance and access controlled by the institution (either a Local Authority or a local university) that will house the database.