 Felly, wrth gwrs, wrthych, wrth gwrs yw yng Nghymru, yng Nghymru, rwy'n fydd gafodol i'r gyfnod yma arall ac mae'n gweithio ar gyfer y sefyllol yma ar gyfer y sefyllol a'r gweithio ar y sefyllol yma ar gyfer y sefyllol yma ar gyfer y sefyllol. So we're used to doing it, so hopefully all will go well today, and we may return to face-to-face next year, depending on the situation, so we'll see. So on to the programme. So the morning session is 9.45 to 12.45 with a short comfort break for you to stretch your legs. So we're going to have our keynote speaker Laura Johnson first up, and that's a 45 minute session, a half hour session, sorry. And then we'll move on to three presentations from Natsen and Ipsos, who will give us updates on the cross-sectional surveys. Then after the break, we'll have three further presentations to give updates on the longitudinal data, and that will be from the Institute for Social and Economic Research, the Centre for Longitudinal Studies and Natsen. And then we'll break for lunch, and that will be 45 minute lunch, and then we'll move on to the parallel research paper sessions. So in the afternoon, there are two parallel research paper sessions with a comfort break in between. And then straight after the parallel research sessions, we'll have our final session, which is all about using and accessing health studies and training resources. So we have a session on the UK data service and what you can find on our website and YouTube channel to help you use the various health studies, a similar session from closer about longitudinal studies. There's also a session on data linkage and a session from NHS Digital on data access. So everything you need to know about using data in that session, so please do stay to the end. OK, so just a quick run through. We've got various chairs and facilitators throughout the day. So in the morning, there'll be me and Mary Toome Smith from Natsen who'll be chairing. And then in the afternoon, we will have three different chairs for each of the parallel sessions. So Jenny Mindell from UCL, Sally McManus from Natsen and me again. And then just to let you know that we have three behind the scenes facilitators who are making sure everything runs smoothly throughout the day. So Jill will be doing most of this throughout the day. And then in the parallel sessions, there will be Jill Gayle Howell and Ally Bloom. So you've got back up there if you need it. So we'll move on to Laura's keynote presentation now and she's going to be talking about are we there yet? Adjusting to the new normal in health research. So I am going to introduce Laura and Laura, if I stop sharing, do you want to get your slides at what I'm introducing? Yeah, sure. OK, so as director of the Centre for Health Research, Laura leads a team of 25 researchers using diverse research methods to investigate health and social care, including biomedical surveys and policy evaluation. Laura came to Natsen in 2022 after 10 years at the University of Bristol, where she remains an honorary associate professor in the Department of Population Health Sciences. In addition, she's a visiting researcher in the cardiovascular epidemiology unit at the University of Cambridge. Her research investigates diet disease associations using longitudinal cohorts and the biological, social and psychological factors that influence food intake and appetite control. Laura is a big fan of the UK Data Service, having used the National Diet and Nutrition Surveys that go back decades, providing a wealth of data to understand variation in the size, frequency, timing and quality of food intake between people, within people and over time. Laura also leads work on innovating passive dietary assessment methods, including wearable devices and biomarkers and is delighted to be sharing her insights on health research as we get used to living with the pandemic. Thank you for coming today and over to you. Thanks very much, Vanessa, and thank you everyone for logging in and joining us today. What looks like it's going to be a really exciting programme of different talks, so I'm excited to get started after this one. So, the title of the talk today is Are We There Yet? And really, it's just kind of the reflection on how it's really easy this year in the last few months to just think, oh yeah, no, it's post-pandemic now, it's all finished, and should we get back to normal? Is really this talk is meant to be a reflection on are we actually going to get back to normal? Are there things that we can do again that we were doing before? And are there things that actually we're never going to do those again because we've learned so much over the last few years? So, just to give you a bit of an overview, I'm going to be talking about where we are now in terms of the pandemic and what just happened in relation to health. Do we know what happened to health outside of COVID-19? And what happened to health research as well? How did that have to change and adapt? And I'll also, at the end, have a look at what's in store in the future. So, have a look at the promise of passive data measurement and some of the work I've been doing on that. So, where are we right now? So, this is the very helpful timeline from the Active Lives Survey. And it sort of gives us a reminder of exactly what has been happening over the last two years. It's been a very long two years and it's been featured by three national lockdowns as well as many periods of differing levels of restriction. But all restrictions now in the UK at least have been removed and so you'd be forgiven for believing that the pandemic is over. The latest stats on the Office for National Statistics website, however, tell a slightly different story. And as of yesterday, the rate of infections continues to increase at the moment. Hospital admissions are increasing. Thankfully, ICU admissions are staying low and while deaths are increasing, they are still low at the moment as well. About 98% of adults have antibodies, suggesting they've either been infected or vaccinated against COVID so far. But perhaps the most concerning aspect at the moment is that 3% of the populations, it's 2 million people, have symptoms of long COVID. So, that's symptoms beyond four weeks of first infection. So, it's a mixed picture in a sense in that infections certainly look bad, but the severity of disease definitely seems to be being controlled by vaccinations. But it's normal, not quite yet, I don't think. So, yeah, and the impact of all of this on health research has been huge and certainly those impacts are still being felt. So, what just happened? So, we know quite a lot about COVID and infections and what's happening there. But a lot of the other standard health markers that we track over time, we don't necessarily know as much about those if we'd hoped. The impact of the pandemic on the ability to do health research was massive. So, in-person data collection was impossible, and there are massive gaps in the kind of data that needs in-person data collection from 2020. But there has been massive adaptations, so there's been a shift to online. There was a real thirst for knowledge in 2020, and lots of online surveys were made. There were massive and impressive efforts, actually, by the longitudinal cohorts to try and harmonise the data that was being collected. But the nature of online data collection means that you have to be short and quick. And the vast majority of the plethora of surveys that happened in 2020 were cross-sectional and convenient samples. So, that reliable health data that we're used to having in the UK was really quite compromised. It did offer us an opportunity to test new methods, though, and the feasibility of doing online versions of data collection that used to be done in-person, and having a look to see what the effect of inviting people to nurse visits when they're doing the rest of the work online, when you're recruiting people online as well, has been a part of the work that Natsen have been doing with the Health Survey for England feasibility survey, obviously with collaborators. So, there have been really great opportunities that have been used to understand change. So, the main issue with the cross-sectional surveys that were mainly run throughout 2020 and 2021 is that they don't really tell you about change. So, often a lot of the questions that I saw in my field of interest, where I'm looking at what's happening to food intake, the questions were framed around people's perceptions of their own change. So, did you increase or decrease your snacking, for example, which gives you some information about what might be happening, but it doesn't allow you to actually quantify the change. So, they might have increased some, but actually how much and is it as big a problem as we think. So, really good innovation that was made was turning some existing cross-sectional data sets into longitudinal ones so that change could be measured and we could really understand what was happening. So, one of those data sets was the mental health in children and young people. And that work has been led by Natsen and it's really been the main source of information to understand the impact of the pandemic on mental health in children and young people. And it's not a pretty picture, sadly. So, overall, many children found that their mental health, as measured by the strengths and difficulties questionnaire, declined between 2017 and 2021 and that was equated to over half of young people. So, it's definitely been felt much greater in that age group. And it means that the number of children with a probable mental disorder is now one in six and for young people that's a quarter that have a probable mental disorder. And there's not really been much change between 2020 and 2021. And I think that possibly reflects the timing of the data collection, because both were during relatively restricted periods. But we're eagerly awaiting the results of the next follow-up to really understand, is this a temporary thing or will there be some kind of rebound? Whatever is happening is clearly very difficult. And I think the move to this kind of data collection has really enabled policymakers to look at the issues and think about policies head on. So, a lot of work has been commissioned around loneliness and connectedness, because that was highlighted as one of the key things that was co-occurring with poor mental health. And so, yeah, that was a key driver of keeping schools open. And there are lots of other initiatives that are being considered as well. Another major change that happened in the pandemic was to childhood obesity. So, the National Child Measurement Program managed to get back into schools and make measurements from March 2021. And when they did, there was quite a shock from the data that came back. So, this is the graph showing that basically there's been a 5% increase since 2019 in the prevalence of overweight and obesity in England. So, this data is for reception, but you see the same trends mirrored for the year six. And it's pretty similar in boys and girls. What's even more concerning is the increase in inequalities that's been observed. So, specifically, there are much bigger changes in the prevalence of overweight and obesity in non-white ethnic groups. And if you look at the socioeconomic measures, there's also much bigger inequalities emerging from the pandemic there as well. They were already there, of course, and I think this data just helps to reinforce the importance of having data on different ethnic groups and informative ethnic groups specifically. So, making sure that there's data on the individual rather than just a whole. Club together group. So, that's been part of then another opportunity that's been taken by researchers is in this time when we can't collect data. Actually, we can take some time to analyse the data that we've already got and the health survey for England have combined data over 10 years so that they could do a comprehensive analysis of ethnic differences in health using that data. And the fact that the data had to be combined over 10 years really did emphasise, I think, to government and commissioners that existing national surveys really do need to boost the recruitment of those different groups so that meaningful comparisons can be made. And, yeah, that's been a positive change and I know some national surveys that have had some ethnic boosts put in which I think shows that the pandemic has highlighted just with infection rates and mortality that ethnic groups are more vulnerable and the government really does need to invest in research that allows us to properly understand what's happening there. In terms of adults, there haven't been in-person measures that are published yet for adults in terms of obesity. So, but again, one of the opportunities that was used with the taking time to reflect was the health survey for England data on measured and self-reported weights was used to properly understand exactly how to correct self-reported weights so that the bias in them, the known bias in them is reduced. So, the Active Lives in Adults Survey gives us the best indication that we can get on the change in adult obesity prevalence and it's increased by 1%. So, there used to be 24% of adults that were obese and up till 2018. And then from the 2019-20 data through to 2021, the increase was 1%, which doesn't sound that much. Although it does mean that a quarter of adults are obese and that's been a problem for a long time. But just to put it in context, the last time there was a 1% increase in adult obesity prevalence, it was between 2015 and 2019. So, it's equivalent to a previous five-year increase all put together. So, we've definitely got a problem. We already had a problem with obesity in this country and it's just got a lot worse. So, we need to redouble efforts to implement policies and really understand what's happening so that interventions to help people prevent obesity and to also treat obesity can properly work. So, there's a lot about the kind of behaviours that might underpin obesity that raise questions in my mind. What was happening there is that there was a decrease in physical activity and certainly there is some evidence of that from self-reported data. There's also a small number of studies that have been done using objectively measured physical activity, looking at individual change, that again indicate that physical activity declined. Although perhaps not as much as one might think, maybe sort of five minutes when you measure it objectively in terms of moderate to vigorous, but there has been quite an increase in century time and screen time equivalent to about 20 or 30 minutes a day. But you kind of have to piece these bits of research together because there isn't any kind of nationally representative dataset that tells us. And that's kind of one of the reasons why I think investing in passive measurement is something that we really need to think about doing more of. So, this is data from the Office for National Statistics and it tells us a bit about mobility, which is one aspect of possibly of physical activity in terms of moving around. But it's an example of how there's data that's being collected on phones all the time that can be repurposed in an onomised way to understand how movements are changing. So this tells us about kind of visits to different locations on a map. But I remember early in the pandemic that there were publications coming out from Fitbit using the wealth of data that they had there to understand kind of how physical activity has measured by a wearable device like Fitbit changed at the onset of the pandemic. And you could see that, you know, with the imposition of lockdown restrictions in many countries, there was a massive decline in physical activity during lockdowns. And it's interesting to consider kind of how much that's maintained beyond that once restrictions are released, do we all kind of bounce back or not? Some data from Bristol suggests perhaps not so much yet, but the key thing here is that the Fitbit data is available to people that own Fitbits and that's not, it's nowhere near representative of the population. And so there are massive gaps in terms of understanding health behaviors at the moment that exist in really kind of harnessing the power of passive measurement. But I think that that example of using it showed that almost within a few weeks that data was published and we knew exactly what was happening. And, you know, there was clear policies around allowing physical activity in the UK that I think were kind of driven by that concern of the impact on physical activity. So in terms of thinking about, can we passively measure dietary intake? Because that would be useful for many different reasons, not least because it would have helped us really understand what happened during the pandemic and what continues to happen and how change is occurring. So I've been researching kind of different options for thinking about how to passively measure food intake and there's definitely an option of building in algorithms for wristworn devices, either smartwatchers or known research devices like activity, where you can detect the specific movement of eating with the rotation and the movement of the wrist. But there's a lot that you don't get, just you may be able to identify that someone's eating there, but you won't know what they're eating. And actually, the vast majority of the impacts on health is about what people are eating, not necessarily when or how often, although understanding that is definitely a good start. So the only way you could probably really passively measure diet is if you combine lots of different senses. So in this particular figure, which is in a paper that I published in 2020 led by Andy Skinner at the University of Bristol. So here you can see the integration of lots of different senses like a wristworn device, a wearable camera that we think if you could just activate that when someone was detecting eating, that could help make that a more feasible method avoiding the kind of privacy concerns and also the battery problems of having a camera taking photos like all the time. Here you've got skin based sensors that can look at the chemical composition of epithelial substance, and then also sensors that can go on teeth that give us an idea of the types of macronutrients that are being eaten. And there's lots of potential with wearable sensors now to get a sense of what the what food intake might be, but there's lots of work to be done. And yeah, so that's where I think we should be investing money is really in thinking how do we integrate all of these technologies and how do we bring them together to properly get an understanding of what people are eating over time. And because I think that would really help us plug some of the gaps that happened in terms of understanding diet during the pandemic. So yeah, that's there. Well, I have to say for now, I hope you will have a good day. As I said, the first half of the day is going to be updates on what has been going on on various cross-actional and longitude health related studies. There's been quite a lot of change development innovation on many of them. So we have some very interesting presentations in store. So the first session is about cross-actional studies. We have three presentations here and there is going to be about five minutes for questions after each of the presentations. So please type in your questions as we go along. The first presenter is Ann Connolly from Natsen and she's talking about the major health service during the second year of the pandemic. Hi Ann. So Ann is a research director at Natsen and she specialises in the delivery of complex large-scale health surveys with particular expertise in bi-social data collection methods. So over to you Ann. Thanks, Mari. Great. So as Mari said, Natsen carries out many population health surveys and the aim of this presentation is to give an overview of how they've adapted to the pandemic over the last couple of years and where we are now. So I'm going to talk about the surveys that you can see on the screen now. For each one, I'll give an overview of the methods and the content and then update on the latest surveys, data and reports. I'm not going to include any findings in this presentation or not many because there's not much time, but I will link to reports and websites where applicable. OK, so starting off with the health survey for England. The health survey for England or HSE is a nationally representative survey based on a random sample of households in England. It's a health examination survey, meaning that we collect both self-apported data from participants directly, but also we take physical measurements and biological data. Data is collected annually and it's been running for over 30 years now and this enables us to monitor trends of the trends over time. It's a cross-sectional survey, so we take a fresh sample of participants each year with around 8,000 adults and 2,000 child participants annually. Studies commissioned by NHS Digital and it's carried out by a collaborative team at Natsen and UCL. So this slide shows the core content of the interviewer and nurse stages of the health survey for England and it has various topics around health and health related behaviours. These aren't all asked every year, but they will rotate and be asked regularly. We also have additional content and this slide just shows some of the recent additional content where people have commissioned specific modules on particular topics. So going back to HSE 2020, when the pandemic hit, all-in-home interviewing and nurse field work was suspended as we weren't allowed to go into people's homes and it didn't resume for HSE 2020. We will archive the 4-1 data in due course, but as Laura mentioned, we used this opportunity to do some reporting of existing HSE data. So Laura already mentioned we published a report recently about health and ethnicity and in order to do this, we combined nine years of HSE data to make sure that we could look at specific ethnic groups without having to do it. We also planned to sort of lump together black and Asian and white just as big groups. We had more granularity to look at smaller ethnic groups and we do also plan to deposit that data with UKDS. We're also doing this piece of work looking at self-reported height and weight data, which has known self-reporting bias and our measured height and weight data, and so that we can establish ways of correcting for bias in self-reports. That report will be published at some point this year. Laura also mentioned our HSE feasibility study that was carried out in late 2020 and early 2021, and this was designed to test the suitability of transferring some key health survey content from the usual face-to-face interviewing to self-completion mode, so an online survey and a paper questionnaire for people who didn't complete online. The report from this study was published in November of last year, and I can't go into all the findings, but just very briefly, we did discover much lower response rates, both overall to the survey, but also to individual elements within the survey like consent to data linkage, consent for a follow-up nurse visit, and so on. We found that the sample of participants who responded to the feasibility study contained bias, so participants tended to be older, more likely to be from a white background, more likely to live in affluent areas, and so on. When we looked at the actual health survey estimates, we noticed that the feasibility study participants were less likely to have long-standing health conditions, less likely to smoke, less likely to eat five fruit and veg today, so we think we were getting a healthier group of people responding. We also found that many of the health survey questions that were designed as interviewer-led questions just weren't suitable for self-completion modes and couldn't be included. On to HSE 2021, so back at the start of last year, we still weren't able to go into people's homes, but we adapted a fieldwork model whereby we wrote to people, a random sample of households, and asked them to contact us with their contact details so that we could administer a telephone interview. By April, as restrictions started to ease, we changed this model to doing doorstep recruitment, so again, a random sample of participants, but our interviewers would go and make that doorstep contact where we have much more success at engaging participants and them agreeing to participate. However, the actual interviewing was still conducted by telephone. To facilitate this, we had to reduce the content of the interview significantly, so down to about half an hour, whereas usually it's about an hour. Of course, the nurse visits have to be face-to-face, so these won't be introduced until October 2021. Because of some of these changes, we've had to extend the 2021 fieldwork, so it ran until April 2022 for the interview stage and June of this year for the nurse stage. We're due to publish reports later this year and early next year with dates available next year. Finally, on HSC, we had a return to in-home interviewing at the start of this year. We still have a backup option of telephone interviewing where participants are uncomfortable or unable to participate face-to-face, but we're finding that the majority of fieldwork is now taking place in-home. Okay, that's HSC, so on to the next one, Scottish Health Survey. The Scottish Health Survey, like the Health Survey for England, is a national survey that is designed to be representative of people in Scotland. It was first carried out back in 1995 and then intermittently for a few years before it began being conducted annually from 2008 onwards. It's commissioned by the Scottish Government and it's carried out by our colleagues in Scotland, ONS and academic collaborators who you can see their logos on this slide, a whole range of academics. And the studies designed to estimate, analyse, compare and monitor health and health behaviours in Scotland. This is the content of the Scottish Health Survey, so these are the 2022 modules and these are modules that are asked every other year but aren't in the 2022 survey. So it covers a wide range of topics. And the survey process for shares in normal times would be the interviewer contacting sample addresses. Once someone agrees to participate, there's a household questionnaire that establishes the composition of the household and collects some household level data. Then there's individual questionnaires for up to 10 adults per household and up to two children per household. And each respondent is asked questions about aspects of their lifestyle that might affect their health. They're also asked to complete a paper questionnaire and participants age two and older have their height and weight measured. And we also ask their permission to be contacted for follow-up research in the future. So what's going on with shares 2022? The Scottish Government were a bit less, they were a bit stricter about letting researchers go back into participants' homes. So face-to-face field work only started in May of this year. Field work began in March with a similar approach to the Health Survey where interviewers would go to people's doorstep, recruit but carry out telephone interviewing. And then from May onwards, we've been in home with a telephone contingency. Because of the switch to telephone interviewing, it meant administering paper questionnaires was much more difficult. So we created online self-completion options and we'll carry that forward even with the return to in-home interviewing as an option. So there's an error here. Height and weight measurements returned in May 2022, not 2019. And the full biological module that includes waste measurements, blood pressure and saliva is to return from next month. Scottish Health Survey reports, so going back to 2019, when we did face-to-face days collection as usual, that report is available online. In 2020, they carried out telephone interviewing but with prior Scottish Health Survey participants and that's been published as experimental statistics. Then there's a forthcoming report from the 2021 survey where they did telephone interviewing but with a fresh sample and doorstep recruitment to be published later this year. And of course, Shares 2022 is a bit down the road in late 2023. Next up is MHCYP. So this is a major surveys series of the mental health of children and young people in England, which Laura mentioned in her presentation. So the first three iterations of this study were carried out in 1999, 2004 and then in 2017. And it's a probability sample of children and young people living in England who are registered with the GP. The 2017 data were collected from or about two to 19-year-olds and it included over 9,000 children and young people. And so data were collected from children and young people directly where they're old enough from parents and from teachers. And the data were analysed by clinical raters. And again, this study was commissioned by NHS Digital and conducted by a collaboration between nuts and ONS and academic collaborators at the University of Cambridge and the University of Exeter. And as Laura mentioned, in 2020, we carried out this follow-up study of the previous 2017 MHCYP participants who would agree to be re-contacted. And the aim of this was to measure mental health and wellbeing of children, young people in England, and to understand how they'd been affected by the pandemic. It involved a 20-minute web survey. And for people who didn't participate in the web survey, we phoned them to give them a little gentleness to try and encourage participation. And this report was published back in September 2020. And as you've already seen, it found that rates of probable mental disorder using the SDQ had increased from one in nine children and young people in 2017 to one in six children and young people in 2020. And that was using the same measure of mental disorder, but as Laura mentioned, different methodology in terms of face-to-face data collection versus an online survey. We then did a second follow-up of the same cohort of participants. The second follow-up, there was two options, either a web or a telephone survey with the same aims. And again, as Laura mentioned, we found that at this point, the rates of probable mental disorder had stabilised between 2020 and 2021. And then we did a third follow-up study again of the same cohort. By now, those children and young people that were aged two to 19 and now aged between seven and 24. It was another 20-minute web survey with similar aims, but also expanded to include some other issues that we know were affecting children and young people, particularly loneliness and disordered eating. Sorry, just quickly. The report for that won't be published until November of this year, so watch this space. And this slide shows the content of that third follow-up study. So there's loads of really interesting data that will be published on that. Okay, moving on to the National Diet and Nutrition Survey. So ending NS, this is a cross-sectional survey of diet and nutrition. It provides the only source of high quality nationally representative data on the types and quantities of food consumed by individuals. And we use that to estimate nutrient intake for the population. The survey runs continuously every year, and we aim to interview 1,000 people, 500 adults and 500 children annually. So for the first 11 years of this study, dietary data was collected using a food diary, an unwaid four-day food diary. But since year 12, which started in 2019, the dietary data has been obtained using an online dietary recall tool. So individuals are asked to complete four 24-hour recalls over two to seven weeks following the interview. So there's also information collected by an interviewer and during a nurse visit, including physical measurements and biological samples. The core funders of NDNS are the Office for Health Improvement and Disparities, or what used to be known as PHE, and the Food Standards Agency. That's in working partnership with MRC Epidemiology Unit at the University of Cambridge, and also NISRA carry out the field work in Northern Ireland. So what can you find in the data? There's quite a lot of different data files from NDNS, their group just follows. So we have household data that contains information on household composition, demographics. There's individual data that contains interview data, self-completion questionnaire data, physical measurements, biological sample analytes, and so on. And then we've got dietary level data, and this is actually in three different levels. So we've got personal level data. We've then got day level data, which is daily food consumption, and then a food level data file that has nutrient data at the food level. And then finally, there's this other UK nutrients data bank where nutrient information is provided per 100g of food. So an update on where NDNS is, the latest report was published back in 2020 and includes analyses of the first 11 years of the programme, so loads of interesting trend data in there. Year 12 of the study was paused in March 2020, and it didn't resume. Year 13 of the study was also paused due to the pandemic, but interviewer field work resumed in October of that year. And then year 14 launched as planned, but it needed a field work extension to October of this year. I just wanted also to mention the diet nutrition and activity during COVID study. So this was a piece of work we did during lockdown where we've recontacted participants from previous NDNS surveys and got them to complete an online survey, and that data was published back in September 21. Just a quick bit on how we adapted NDNS. So because of the pandemic, remote interviewing protocols were introduced so that households could still take part, either if they weren't comfortable with face-to-face interviewing or at the time the current restrictions prevented interviewing completely. In the end, all of year 13 interviewing took place by telephone. And when we did this telephone interviewing, we had to adapt the protocol for participants completing their dietary recall. Before COVID, interviewers would be in the home and they would support them through the completion of the first dietary recall, which is quite involved. Whereas once we switched to telephone, participants needed to do their first recall independently. Interviewers would phone back either later the same day or the next day to see how they go on and to give them any support if necessary. And we also offered the option of participants phoning interviewers to go through it with them over the phone. But only those who were able to do it independently were then invited to do the three subsequent recalls in the weeks that followed. We had to make other adaptations, so Python weight became self-reported. We had no biological samples. And then we had to create some socially distanced doorstep protocols for a couple of sub-studies. I'm not going to go into the sub-studies, but we have a doubly labelled water sub-study and a physical activity monitor sub-study, which also needed adaptation. And then year 14 fieldwork. It began just with the telephone-only model, but then in-home interviewing was reintroduced in September 21 and nurse fieldwork in November 21. And there I'm going. There's still the telephone option available when necessary. That's NDNS. So last but not least is the national surveys of sexual attitudes and lifestyles on that cell. So that cell is Britain's national probability sample survey of sexual health. And it's taken place every 10 years since 1990 and to date has interviewed over 45,000 people living in Britain and spans people born from the early 30s through to the start of the 21st century. So that cell was initiated in the mid 80s in response to the emergence of HIV and the realisation of a need for robust epidemiological data on sexual risk behaviours for HIV that didn't exist. But over the years it has evolved with each round to take a broader perspective on sexual health. So initially considering STIs more broadly than just HIV in the second that cell. And then considering sexual health in its broadest content, content, broadest content takes, sorry, sin in that cell three. And that cell four, which will be commencing in a couple of months time and will run through next year will continue to adopt this broader perspective of sexual health. But also considering sex and sexual health in Britain in 2022 major societal shifts that we've seen over the past decade, including greater recognition of gender fluidity and diversity more generally. But at the heart of that cell is really its unique ability to provide population perspective. In the jigsaw of evidence that's needed to design and evaluate sexual health services and interventions. So like many of our studies, that cell four got derailed a bit by COVID. Development work actually started back in 2019 and into 2020. And the intention was to pilot face to face field work in early 2020, but that got postponed. We then adapted the methodology to enable remote data collection, including remote biological sampling and data linkage consents and various aspects of the study. And we eventually piloted in June to August 2021 initially with a mixture of face to face telephone and video interviewing and then a second pilot in early 2022 with face to face and telephone interviewing. And the main stage is due to start in September of this year. I also just quickly wanted to mention the national COVID study, which isn't not involved in but the wider national team got very busy at the start of the pandemic and set up a rapid quota sample web panel surveys which were designed to understand the impact of COVID on the nation's sexual and reproductive health. And they did an initial wave in the summer of 2020 and a second wave in spring 2022. It contains loads of really interesting data about sexual behaviours, reproductive health, sexual health services, relationships, intimate partner violence. The wave one data is already available on UKDS website with wave two to be deposited shortly. So if you want any more information on any of the studies that I've talked about today, I've put the lead research director's names on this slide, and I'm sure they'd be happy to answer more detailed questions. But that's it from me, a whistle stop tour of our cross sectionals. So we have next presentation is from Katie Riddo. And from Natsyn and Katie will present about the preparations for the next adult psychiatric mobility survey or APMS. Katie is a senior researcher at Natsyn in the health and biomedical service team and has worked on a number of large scale population health surveys such as the Health Survey for England and is currently working on the APMS. So Katie, over to you. Thank you. Just a screen. There we go. Hope everyone can see that. So hi. So yeah, so I'm going to talk about us designing the next adult psychiatric mobility survey. So a little bit of background about sort of the survey series and then just sort of an overview of the development work that we've been doing for the 2023 survey as well. So APMS is the longest running mental health survey using consistent methods. And this is we've been running it since 1993 and it's been running sort of more or less every seven years. And the last one that was run was in 2014. And the next one that we'll be running is in 2023. So this is the one that we're currently in development for. So there have been other mental health surveys that are conducted on sort of more specific populations at certain times as well. So there's been some that have been conducted sort of on homelessness and those within institutions as well. But for APMS we have mostly it's been this wider it's been carried out within sort of a population level and going through and not necessarily within those levels of institutions. But for the 2023 survey we are using more specific population group within our sampling as well. So we're also going to be looking at deprived areas and ethnic minority groups as well. So the main aims of sort of the survey series in general is to be able to look at the prevalence of mental health conditions. So we asked lots of questions about different mental health conditions and it's finding out the population and prevalence for this. So it's a really important data source to be able to look into this where we've been conducting it since 1993 as well. We've been able to look at these changes over time. So we can look to see how any of these have been changing. We also allow us to look at some of the inequalities and prevalence as well from the extra information that we collect. And where we look at things in terms of sort of support and treatment that people have been using. We can find out the extent that people use those and have that support. And also we can look into those inequalities so we can use this data source to see where those needs are. And where we have so much information around sort of individuals. The lifestyles we can really have context onto some of these mental health conditions as well. And where we can collect collecting information about more than one mental health condition. We can look into some of those co-morbidities and see potentially where they lie. So for the 2023 service, this is the one we're in the development stage of. Obviously, as you can see here, it takes quite a long process in terms of from starting to when we actually go into field. So we started our development in April, March time in 2021. And first of all, we started off sort of with a consultation, which is talking to sort of stakeholders to really find out how this survey is used and what was really important to include on the survey this year. And from this consultation, we then took this into account and went into sort of developing the questionnaires and the content to understand what we needed to include. So we first of all carried out some cognitive testing as well. So for any of the new content we added in, just to make sure that we were asking questions that people understood and that we're really capturing the correct content as well. And then from that, we went on and have been developing the dress rehearsal. So we did a run of a trial run of the main stage to then see so we could look at any changes that we needed to make. And that's where we currently are. So we've just run our dress rehearsals. And we're looking at the findings from those and seeing potentially where we need to make those changes and adapt it. And then for the main stage, we're hoping to be starting that in September. And that's the fieldwork will run for about a year. So APMS in field is actually known as the National Study of Health and Well-Being. So we use a slightly different name, but we use a probability sample of private households in England. So this allows us to ask questions from participants that aren't just in contact with the health services as well, which is really important, especially when we're looking at those participants and we're looking at those who are using healthcare or those who aren't using healthcare services as well. So it's a cross-sectional survey and we ask of those adults age 16 plus. And we have it as a two-stage design. So we have the first stage, which we go into participants' homes and ask them questions with an interviewer. And then we have a second stage interview, which is a more clinical assessment and sort of validates the phase one interviews as well. And that's conducted with sort of a subsample of participants. And it's funded by the Department of Health and Social Care and NHS Digital. So a bit more information about sort of how we've been designing the 2023 survey and what's been going on in terms of what we're going to be doing. So as most years, we're going to be having our core sample of participants that we're going to be recruiting through private households that we're going to be randomly selecting. Now this year we've actually been having a focus, as I said, about those for deprived areas and for ethnic minority groups as well. So we're having a boost in our samples for this. And because of this, we've decided that we've designed it. So we're actually going to be conducting the survey with two separate samples. So we have our core sample, which is combined with the boost of deprived areas and our ethnic minority group boost as well. So we decided to have the deprived area boost as it was taken into consideration and it was sort of really important to have an extra understanding of those areas and sort of the mental health within those areas. And mental health is often found to be a lot higher within more deprived areas. So it means that for analysis wise, we can really look into the certain mental health conditions to further extent as well. For the ethnic minority groups, we are in this sample. We're really interested in looking, we've been looking at previous data to identify the groups that for mental health data and we really wanted to sort of have a further sample of. So for the ethnic minority groups, we're looking and we're sampling more individuals from those areas, from groups from the black African, black Caribbean, black mixed, Indian, Pakistani and Bangladeshi backgrounds. So we're going to be included in increasing that sample size. So the sample overall is a lot higher than it has been in previous years and even for the core sample, we've been increasing that, the sample size. So overall we have hoping samples of 8000 for the core sample and we're going to have about 739 in those deprived areas and 3000 for the ethnic minority boost. So we're really increasing those samples, which is meant in terms of the development work we've had to do, we've had to do a lot of work around how we're running the survey. So in terms of the fieldwork process, this sort of outlines how we contact and how the fieldwork runs. So we send out advanced letters to participants, so those that we've selected and then an interviewer will make contact with those participants and we'll carry out an adult selection. So we only have one adult from each household that is taking part so they'll have to carry out that selection. And then if they agree they'll have an interview and this interview is carried out in face-to-face moment and it's carried out with an interviewer asking them questions and it also has a self-completion element to it as well. Now the interview is normally supposed to take about 90 minutes but for some individuals obviously it can take slightly longer depending on their conditions that they might have as well and their experiences. And it is quite a sensitive topic, so it's really a lot of thought has to go into how these interviews are carried out and how the timing of those interviews are and to really understand, to reduce that burden from participants as well. So we try and do it so that we adapt the interview and so we make it so it's structured in a way that as it tails off to the end it becomes less sensitive and it's asked questions more about sort of their life and sort of their social media user and things like that. And we also ask them at the end if they're consent to being contacted to be able to carry out the phase two field work as well. And this year we're going to be asking for data linkage consent so we can link up data to their other records but that's still under discussions in terms of what data sources we'll be linking up with. So this outlines the proposed content for 2023. So when we have, there's a lot of content that we cover and this is the decision of what kind of goes in. There's a lot of thought that goes into what needs to be included as it's a really high demand data source. There's a lot of really important information that we want to be included in this. After looking at the previous content that's been included and having after the consultations, this is the proposed content that we had for the dress rehearsal. Now a lot of this is the same that's been included in previous years. This is so we can continue to have those and monitor those trends that we've had on previous years. Obviously where we've added in some modules which are some of the ones in red, we've also had to remove a couple of modules as well. But this year some of the main ones that we've included are problem gambling and self-rehorported height and weight as well. Now the interviews said earlier is about 90 minutes in length, the length we hope it to be. But because from the dress rehearsal we'd actually find that it was slightly longer than that. So some of this content will potentially be removed for the main stage. So in terms of the phase 2 survey, so they have their phase 1 interview and then we have the phase 2 survey. Now this is conducted by the University of Leicester and they're specially trained interviewers. This follows a more clinical assessment of the interview. The idea of it is to be able to validate and assess some of the serious mental health conditions. For phase 2, it's a sub-sample. So we have about 700 of the core sample is taken, about 65 from the deprived areas sample and 263 from the ethnic minority group sample. And we're also sampling those who screen for an eating disorder as well. So we're taking about 150 and sampling for those within phase 2. Now phase 2 covers psychosis, autism, ADHD in eating disorders this year. So eating disorders is a new content that's going to be in for phase 2. And it's a really interesting section of the interview. So some of the content of the priority areas that have been added in for this year. So one of them is eating disorders. So there's been a real interest from the Department of Health and Social Care around eating disorders where there's been an increase in referrals for eating disorders in England. Now we really want to understand if this is because of the, we really want to understand the current prevalence of eating disorders. So we really want to know whether or not this uptake in eating disorders is from those who, there's a high prevalence of the eating disorders or if it's just that there's sort of better access to care and services or there's just more understanding and knowledge about where those services are. So in previous years we've had SCOF included within APMS. But this doesn't really provide an understanding of prevalence of levels of eating disorders. It only really provides an understanding of possible eating problems. And it only contains five items in this assessment. So within the 2023 survey we have additionally added in the eating disorders examination questionnaire as well. And we've got the short questionnaire. So for those who screen positive for possible so eating disorder with the SCOF scale, we then ask them some more questions on the eating disorder examination scale as well. And then we've also included those eating disorders within phase two. So we're developing a scan ED, so an eating disorders scan. So this is going to be used to validate those who screen positive for having an eating disorder within phase one. So it's a really exciting piece of work that's going on for Lester in the phase two section of it as well. So the scan is supporting the DSM-5 and ICD-11 as well. And when you really need to, it's been tested to make sure that it's being validated against NHS clinical diagnosis as well. So they've been carrying out validation studies to make sure that that is there and comparing this between those who have been diagnosed from NHS patients as well and also looking at those who haven't to make sure that it is picking up the correct diagnosis. So another area that has been real interest this year is gambling that has been seen as something that we've been wanting to add in. The last time gambling was included was in 2007 on OPMS, and this was using the DSM questions. So where there was this need to ask these questions and this real interest around gambling, we've added those in. But when we were looking at the questions to include, instead of DSM questions, we're actually including the problem gambling and severity index. Now this is partly because if we're using DSM, we need to update the questions anyway, and that would be to the DSM-5, which would mean that we wouldn't really have that comparatability between the previous years anyway. And the PGSI is better at looking and looks at focuses on specific harms associated with gambling rather than the DSM-5, which really looks at diagnosis of gambling problems. So this allows us to identify people who are at potential risk of related harm as well. And also it has been asked on other surveys, such as HSE and Shares as well, and is a scale that's used more internationally. So hopefully we can then it can be compared between other surveys as well. And we've also added in a few questions on treatment use for gambling as well to see whether or not and who has been using those services. So a really important and really interesting part of the development of APMS has been us including the ethnic minority boost. So it's really important that APMS is representative of the diverse communities across the country. And as you may have seen earlier, the last time we had a focus on the ethnic minority boosts for mental health groups was actually in 2000. So it's been a really long time since we've managed to collect any of that data. So there's a really urgent need to have this sort of data updated. In previous studies where we use the random selection of addresses, this has meant that we don't actually collect enough information and have enough people taking part from certain ethnic minority backgrounds. To be able to go into more detail about these groups and their mental health as well. So to carry out the analysis on those. Even if we take data from two or three years of the surveys together, we still don't have enough to be able to sample to carry out those analysis. So it's really important that we have got this right and that we are increasing and making sure that we do have those taken part. So this year we have been, we've really been developing and trying to work at how we can implement this in the best way possible. So we've been reviewing sort of previous surveys that have included boosts, particularly sort of ethnic boosts as well. So surveys such as Evans and Selco and Imperic and just looking at sort of the processes that have involved and how they've carried those out and what we can apply in terms of for us as well. And we also looked at reviewing the content from our questionnaire and also those questionnaires, the previous questionnaires, to see what content we can sort of adapt to make sure that the questions we're asking are relevant and inclusive to everyone that we're asking them for as well. And after going through and looking at this, we have made some changes and adaptions to some of the questions such as religion, discrimination and ethnicity and migration modules as well. So we've updated these so that they're really capturing the information that we need to to these communities. We've also had a really exciting piece of work in terms of sort of trying to work at how we are increasing that participant engagement. See, we are sampling these participants but the really key thing is that they take part as well. So we've been really focusing and we've been talking to an immersive change agency as well and working with them in terms of how we can best get that message across and really how we can best carry out this research. So one thing that we did as well was changing the sort of the naming of and framing of it. So instead of the ethnic minority boost we were calling it representing ethnic minority groups to really get across to interviewers and to participants as well and sort of the importance of of this part of the survey and what impact this part of the survey is as well. We have a design and we have for this we are sampling random addresses as we do for the core but we are taking this from areas where there is a higher percentage of ethnic density higher ethnic density areas. So we've been using the census data to help us identify that as well. So for the first quarter we're going to be using the 2011 census to be able to find out areas where we have those higher percentage and then hopefully for the further quarters we'll be able to use the most recent census data to then be able to have a more accurate analysis of that. So for the where we're sampling these areas when we go to those participants households obviously potentially although it's a higher proportion of those in that area there's still potential that no one in that household will be living there any of the groups that we are selecting. So we are going to be carrying out a screening process to understand eligibility of that household. And we're hoping of achieving 500 interviews with each of the selected groups. So where we're having this screening section to start off with actually decided to split this into two phases. So we're having a screening phase and an interviewing phase. This is a really new piece of work that we are doing. So we're really looking into how we can carry out this in a really appropriate way and in a way that we can get the most engagement out of it as well. So there's a lot of participants that we're having to go, households we have to go to for the screening process. We've actually decided to have a specialist screening panel that we're recruiting separately as well. Now this allows us to sort of developing how we can best carry this out. So one thing we have been looking into is trying to make sure that we are including people from those communities within the screening panel as well. Just to try and have that so when they're making contact we have the familiarity and hopefully the understanding and sort of they can really get across the idea of the importance of the research as well. We're going to be training these participants as well and we've been using another agency as well to help us with that and in terms of how they're selling the interview on the doorstep and just how they're approaching it as well. We're also going to be providing translations for the interviews so we're going to be providing translations in Erdur as well. So hopefully some of those participants that we otherwise wouldn't be able to take an interview with because they don't speak English we can then capture them within this as well. As I said we now have just finished the ethnic minority boost dress rehearsal so we are really in the stage of looking into what we can learn from that stage of the survey and how we can apply this for the main stage. So we had some really positive feedback from the dress rehearsal which was really promising and they really especially liked having the splits between the screening and the interviewing stage as well and they thought that worked really well but this is just some of the key things that we came out that we need to consider that we're going to try and develop further to then try and improve for the main stage. So one of the things was the interview was too long so it was found that it was a lot longer than 90 minutes so we really need to reduce the level of that content whereas it is a very sensitive interview obviously that is quite burdensome for participants if that is quite long. The ability to reallocate interviews to different interviewers so this was something that came up within certain communities where a female was the adult who was selected and it was felt that they weren't comfortable with a male taking part in the interview. So we really need to have the ability to be able to reallocate to a female interviewer if that need is there as well. Now for having a follow up letter between the screening and the interviewing stage so we had where we had the two stages there wasn't any contact really between those two stages so providing them with a letter between those stages to then to sort of as a reminder of the research was felt to be something that was quite important as well. There was also they found it that within some households it was quite hard to have difficulty accessing sort of buildings especially where there were telecoms that weren't working and how so they couldn't actually make any contact so really looking into how we can get around this as well especially within the areas within the ethnic minority beast areas and there's potentially and the deprived areas as well this is potentially going to impact the survey a little bit more than it would otherwise as well. We really want to try and define a little bit more the black mixed group definition as well to really get a better definition and sort of understanding of what we are sampling for so that we can define this better to participants as well. And some of the interviewers we really sort of found out where is quite a sensitive interview we really do need to try and provide support for interviewers as well in terms of how they can handle handle those interviews. So we have the previous versions of the report and the last version of the report was 2014 is available to have a look at on NHS Digital's website as well but yes we are in the general stage for the main stage and hopefully we can start carrying that out in September. All right thank you very much Katie and we are now going to move on to Eileen Irving from Ipsos who is presenting on understanding patient experience and introduction to the CHP patient survey and NHS patient survey programme. So Eileen is an associate director at Ipsos she sits within the Ipsos health team and survey research method centre focusing on developing, sharing and implementing methodological learning she specialises in high quality large-scale mixed method surveys working on projects with results that are used as official statistics and in national assessment frameworks. So Eileen, hope that you. Thank you and hopefully you can see my slides and not my notes and I think that's started so fantastic. So thank you for listening today today I'm going to be introducing you to a couple of surveys so the GP patient survey and the NHS patient survey programme and I think they're both long-running self-complete survey programmes which have really come into their own during the pandemic as they have long running trends to analyse and don't need to change method due to the pandemic so you can really measure those differences. I'm also aware it's going to be a bit of a whistle stop tour so the slides are available and they do include links for more information but obviously I'm happy to answer questions at the end. So we're going to talk through what do we mean by patient experience surveys, what are the surveys and a bit about the method, the data and how we can use it and then a bit about where the data is accessible. So what do we mean by patient experience? So when we talk about patient experience surveys we're talking about people's entire journey through health services including some self-reported outcomes that mainly focus on what happened during the engagements with health services which can have a real impact on what happens next. The Beryl Institute finds patient experience as the sum of all interactions shaped by an organisation's culture that influence patient perceptions across the continuum of care. So what are the surveys? Well the GP patient survey it covers engagement with primary care in England and it's been running since 2007. The main thing to draw attention in both these surveys is the scale. So it takes place annually and we get 750,000 participants each year and I think last year it was 850,000 so there's a lot of data and you can do a lot of analysis there and GPPS is designed to provide data for every eligible practice in England which is quite a scale. The programme is commissioned by NHS England and is used for a variety of activities including service improvement evaluation of health inequalities, regulation and policy measurement and development. The other surveys I'm going to be talking about are the NHS patient survey programme which is managed by the Care Quality Commission and it allows patients and the public to feedback on experiences of secondary care delivery and it covers NHS trusts so it covers adult inpatient services, maternity community mental health, pediatric care and urgent emergency care and those surveys take place either annually or every other year. Because we've got limited time I'm going to focus today on the maternity survey which has been running since 2007 and covers the entire journey of maternity care and the first engagement with the health professional about pregnancy to postnatal care received in the community but obviously happy to answer questions about any of the other surveys if they are included. So what is the method? So both surveys use a robust and high quality sampling design, GPPS uses a stratified random probability sampling design and maternity is a census of all mothers who give birth in NHS trusts in February both cover anyone over the age of 16 sorry 16 or over and GPPS you just have to be registered with your GP practice for the last six months just so you've had enough time to have engaged with the practice itself. In terms of mailing strategy the surveys have both changed over the last few years to encourage participants to take part online which is more cost effective and results in cleaner data. So all changes to the methods were heavily piloted to ensure we understand the impact on the change in contact strategy on how people respond, how many people respond and who responds and I can talk more about that if people are interested but the NHS patient survey programmes in particular those pilot reports are all available online. The surveys now both use a push to web approach with a combination of login details provided in letters and paper questionnaires maternity withholds the paper questionnaire until the third mailing or GPPS provides the paper alongside the login detail at every contact and that's just to make sure we're getting that spread of people and not just those who are online. Because the samples are drawn from health records we're also able to address all contacts to a named individual and send SMS reminders which included directly to the survey and from this GPPS has a response rate of 36% with 37% taking part online as of last year and the maternity survey has an adjusted response rate of 52% up from 39% in 2019 with 89% taking part online and that big jump was due to the change in mode to encourage people to take part online. In terms of materials we try and use a very similar approach so both surveys have paper questionnaires covering letters with links to the online survey and text messages and we try and make sure those feel like a case of contact strategy so people recognise that they're being contacted about the same survey. For maternity it's a very similar picture using that same style of design. The maternity survey also uses posters to tell people about the survey before it happens so in maternity wards during the sampling months posters are put up with details about the survey and mothers aged 16 and 17 are given a specific leaflet to give them a bit more information about the survey and allow them to opt out before being contacted. We also offer the surveys in a variety of accessibility formats particularly because of the scale of the surveys we are even when a small proportion of people respond using additional languages actually because of the scale we're still talking thousands of people. Both surveys are offered in additional languages online 9 for maternity and 14 for GPPS as well as via a telephone helpline which also offers language options. GPPS is also offered online in BSL videos. Both surveys can be requested in braille and large print and maternity can be requested in easy read. The online survey also has accessibility options including adjustable font size, background colours and screen reader compatibility and that's something we continue to work on and those accessibility options are advertised in the maternity survey in a separate little piece of paper that goes into all of the mailing packs and GPPS is on the back of the letters with notes in the languages that are being offered. That's just what the adjustable online tool looks like. What can the data tell us? Will GPPS cover a range of experiences of primary care making appointments, experience of appointments out of hours dentistry as well, use of digital tools and long-term conditions, frailty and support and a wide range of demographics. Deprivation, age, ethnicity gender, sex and trans status, disability, working status all of those things are available so you can really look at those health inequalities and the maternity survey covers that full range right through from antenatal care through to the early stages of infant feeding and again a wide range of demographics including sort of the demographics of the mother but also things like whether they've had a baby before whether or not they were induced and what the mode of labour was. How can we use this data? There are three main ways we use the data. One is understanding change over time. They have very long time series for many of their questions. We do really aim to maintain trends but obviously we do keep them up to date to ensure they reflect policy so for example with the pandemic new questions were added to reflect things like remote appointments. In terms of health inequalities there's a large range of demographics, local areas statistics, detailed sample information survey programme so there's lots of information that can be drawn on and look at those differences and looking at different organisations they're both designed so that you can look either at individual trust experience or individual practice experience and then build that up to for example ICS areas. I'm going to take you through a few studies very quickly. You have two minutes. Looking at metanty data over time what it told us was that feeding support really dropped during the pandemic both during pregnancy which you can see on this slide but particularly during antenatal care and what we saw was a reduction in exclusive breast milk feeding in the first few days so obviously a key health policy. With GPPS we also looked at people experiencing isolation and what we found was that varied quite drastically between groups as well as increasing during the pandemic so younger groups who'd always experienced more isolation were also more likely to report increasing. Also those who were young carers, people with long-term conditions particularly mental health, autism and learning disability and you can also look at different trusts. So in terms of accessing the data top level data is available on the website and the GPPS survey also has an analysis tool where you can play with data online and new data the new year's data is coming out later this week so worth checking that out but if you want to do more details analysis the respondent level data is available via the UK data catalogue or if you request it. Thank you. Thank you very much. Very interesting presentation and clearly a really useful important datasets as well. All right let's make a start of our second session so this session focuses on the updates to the longitudinal studies covering understanding society, British cohort studies and also ELSA. We have three presentations coming up and we're doing the questions slightly different this time so all the presenters will go first and then we'll have 15 minutes for combined Q&A at the end. Without further ado we'll make a start with Mina Kamari from the Institute for Social and Economic Research talking about understanding society what has been going on in the past year. Mina is a professor of biological and social epidemiology she is a leading expert in biomarkers and genetics and has worked to apply insights from these areas to better understand aging cardiovascular disease and health inequalities using Whitehall to go ahead study of British Reservants Mina is the topic champion for health and biomarker content and research and understanding society and leads research on the biological interface and genetic epidemiology as an investigator for the study. So over to you Mina. So I'm going to talk to you about understanding society I will do an overview of the study for those of you that might not know it and then I'll talk a little bit about what we did during the pandemic and then if there's time a little bit on next steps might not be understanding society is one of ESRC's key investments it's a survey of individuals and it's representative of the UK population it's a household panel study so we started with a randomly selected sample of households it's a cluster certified population sample and we interview everybody in the home it's kind of similar to a number of household panel studies internationally there's equivalence in the US in Germany, Australia and New Zealand the sample is actually composed of four or five different subgroups really so we've got a general population sample and we've got an ethnic minority boost sample 26,000 people from the general population 4,000 households with at least one individual from an ethnic minority background we started in 2009 and that was our wave one and we incorporated the British House panel survey which was a similar study that started in 1991 so incorporated participants from that survey from wave two and then we have a set of people that we use for methodological innovation and then recently 2015 and 16 we added a new immigrant and ethnic minority boost so that's people born outside of the UK not just the established ethnic minority boost ethnic minority people but also Eastern European and other ethnic minority groups we, as I said, we interview we collect information from everybody in the household so we interview people aged 16 and over we also collect self-completion from children aged between 10 and 15 and then information about children and under the age of 10 from parents and guardians so we've got lots of current information there's some retrospective elements to the information that we collect from the participants in terms of health and well-being we interview people we ask lots of different types of information so every year we ask about chronic conditions we ask about health conditions we collect mental health information from our participants every year so we have annual information collected on things like the general health questionnaire which is a measure of psychological distress or mental health functioning we've got SF-12 and people every year so there's some information that we collect every single year health smoking for example is collected every single year and then early in the survey we collected some objective data so we interviewed our participants and then asked them if a nurse could come and visit them and then we collected we did a nurse visit on 20,000, approximately 20,000 participants so we've height and weight lung function got the strength we collected a blood sample and with that we measured 21 different analytes we've got a few more online coming soon using up the blood samples that were collected and then we extracted DNA we've got a genetic resource that's available for if you want to use it in terms of there's been a lot of talk today about mental health and well-being so these are the sorts of information that we collect with respect to that as I said we interviewed the participants every year and we collect the general health questionnaire every year from them we have lots of information about satisfaction in different domains and then we do this positive well-being scale and we collect that intermittently for the children we collect information about happiness in different aspects of their life every year and we do collect the strength and difficulties questionnaire earlier on there was some mentioned that there isn't a continuous measure of mental health in children but we do have the strength and difficulties questionnaire asked every other year the children as they move through from 10 to 10 to 15 and so we do have that information from before the pandemic we are extending the content in the survey so we are doing developing lots of work in terms of harvesting information and linking with other data sources we consent the participants to link to other types of data so HMRC we have consent to the participants to link to health records we do things like scraping websites that we've got we can get an idea of house value and that sort of thing from Zyplen we're sort of working on adding or supplementing the data that we've got in addition to the questionnaire and other information that we collect from our participants we keep a long call, longitudinal kind of consistency we sort of have to stay the same as one of the features of doing a longitudinal surveys that you have to think about keeping these the same so that we can monitor how things are changing in people's lives as the world is changing but we do think about adapting the content to making sure that it remains relevant so over the period since 2019 we've added content around things like gig working or the use of mobile devices so we now know who has devices who has smartphones there's kinds of things we've added or done some work on adding questions on food security we think about environmental interaction so there is a constant sort of keeping up or trying to maintain relevant in the survey while keeping the longitudinal consistency we have been thinking about doing lots of innovative work on new ways of collecting data so we ran the IP in the IP 12 in one of the innovation panel years we did some work on how we could have people collect bi-measures themselves and we're working on trying to get that rolled out into the main survey subject to funding and their study and what served us really well before going into the pandemic is that the innovation team had done quite a lot of work on thinking about what we would do in terms of if an event happened how we could adapt the survey in the face of that event and modify content and think about how to make things happen so that we could do that work one of the features of understanding societies that we started off as a face to face survey and over time we've become more web based and so we already had quite loving knowledge about how to sort of do that and who would be open to web survey and so that stood us in good stead when the pandemic happened in that we could we were kind of ready and able to adapt the way that understanding society was working and add lots of information to the survey to help us to really understand what we could do in terms of asking what was happening to participants during the pandemic so we did that we have administered a COVID survey we started in April 2020 and we went monthly until July 2020 and then bi-monthly from September 2020 to March 2021 and then we did a final interview in September 2021 so that means that you can draw on the information that all of that information that we had collected before the pandemic and use it to examine change the first interview sample eligibility conditions you can see them the participants we interviewed every participant who were aged 16 and older and the people who had taken part in one of the last two ways of the survey and then as the survey developed we adapted eligibility criteria so we actually conducted nine interviews altogether from the fifth interview onward for example people have had to have completed a partial interview in the previous web survey as I said earlier it was suggested that there isn't a continuous collection of mental health measures in children but in fact we conducted three we collected SDQ the strength and difficulties questionnaire three times during this period from our children so we did it in July in November and we did it in July November and again in March I think yes in March 2021 so we have changed from before the pandemic and what was happening to children during the pandemic if you want to have a look at those data in the study right here you go so this is the sample size and response rates for the first two ways so we collected in April and May to start off with and as you can see it was mentioned earlier on that you'd expect in a web survey response rates to be about 25% and we got a 40% response rate which is what you I think you might take which is a little bit higher but I think it was similar to all of the surveys that were being collected at the time and so we did well and as we went through we started off with about about 17,000 participants and that sort of 13,000 12,000 number maintained all the way through with these web surveys what we did in the first interview was that we started up with a telephone survey for some of our participants just to see if we could fill back where there might be people who couldn't do the web survey or weren't willing to and you can see that you can see that the content in April that we administered by telephone does, we did get slightly different profile of participants who did the telephone interview than did the web interview what we've done is provided you with these data and provided with weight to help you kind of get back to population and have an inference with the study and so there's a way of doing that and we've provided a longer team of weights and you can go to our website and get guidance on how to do all of that analysis I'll just draw it out for you here in terms of if you're interested in the main study we carried on with the main study while doing these web content COVID content with the participants so the if you're interested in the main survey the wave that doesn't overlap at all with the pandemic period is wave 9 in the final few months of wave 10 we kind of hit the pandemic period and wave 11 and wave 12 were collected during the pandemic period we're still in the pandemic period really but this is sort of how it looks if you're thinking about the pandemic what we did we normally sorry you only have a minute or two left okay I've only got a couple of exercise so what we did was we provided people with a 2019 file so if you want to compare to the year before kind of the pandemic there is a 2019 file available to you in the in the archive so you can go and get that but it doesn't have everything because we take slightly longer than a year or two years to collect from all of our participants and we've made available on our website this sort of dashboard where you can see what happened to various different variables during this collection and in the part of this set of data so these data are treatment data so Covid symptoms I'm not going to go over these at all but just to say that there was the data have been used extensively there's lots and lots of outputs from the file and you can go to our website and find what has been done with the different all of the different types of data that were collected during the pandemic we're also part of the LLC consortium and I won't go into that because I'm running out of time but these are the websites and various other things that you can other places you can go to to find out more information about the data or you can email me so I'm going to finish now sorry It's okay it really interesting presentation and thank you so much for talking about the children's mental health data so I will definitely be looking at that as well next we have a presentation from Richard Silverford from the Centre for Longitudinal Studies on the British cohort studies Richard is an associate professor of statistics and chief statistician at the UCL Centre for Longitudinal Studies his applied research is mainly within the context of health in particular the causes and consequences of non-communicable diseases often taking a life course perspective he also has a mathematical interest including approaches for handling missing data the analysis of linked survey and administrative data and making causal inferences from observational data so over to Richard Thank you very much for the introduction sorry let me just share my slides okay hopefully you've got that so thanks very much for inviting me to speak about the health data that we have in the CLS cohort studies so I'm going to try and speak about seven different studies here so that's four ongoing core CLS cohort studies plus briefly mention another three studies that we're just setting up and so I've only got 15 minutes I'm afraid I'm going to have to be quite brief on a lot of areas and not go into any detail but I've tried to signpost where there's other resources available to find out more and obviously happy to answer any questions either here or later on so first of all just briefly what do we do at CLS so we're an ESRC funded resource centre based within the UCL social research institute we run currently four major national longitudinal studies so each of these are following thousands of people across life and then we observe them at regular points in time collecting extensive and rich data part of our role is also to provide data to the research community and this is often via the UK data service so we prepare our data, deposit it make it available then provide extensive documentation guidance and also training for using the data appropriately we also welcome researcher inputs onto the data that we collect so in advance of each wave of data collection within each study we'll run consultations usually in person and online to try and find out the sorts of data that it will be useful for researchers to collect we also conduct our own research and this is really multidisciplinary so there's people from all sorts of disciplines across health and social research and both substantive and methodological so because we're collecting the data ourselves we're interested in survey methodological research to optimise what we're doing and then because we're analysing the data ourselves and advising others on doing so we're interested in statistical methodological research too so the four cohorts main cohorts that we run all contain at least 16,000 individuals at initiation so the national child development study at the top is a nationally representative study including all children born in one single week in 1958 across all of Great Britain the British birth cohort study similarly all births in one week in 1970 across Great Britain next steps was only recruited when they were age 14 in 2004 so they correspond to births between 1989 and 1990 and then the millennium cohort study and sorry next steps only covers England and then the millennium cohort study is births or sorry a sample of births between 2000 and 2002 across all of the UK and we also work closely with colleagues at the MRC unit for lifelong health and aging at UCL where the national survey for health and development at the 1946 birth cohort is based so this plot here are quite like it shows us where we've made data collections on each of these studies so we can see maybe looking at next steps first that we don't have any of these dots representing data collection in the first 14 years of life because they were only recruited at that age then they were observed every year for the next few years and then less regularly after age 20 across all the other studies the other three we observed them from birth of fairly regular intervals throughout their life and we can see the sort of ages that they're at at the moment so NCDS are now into their 60s so really they're I guess working towards retirement or thinking about extending their working life BCS 70 into their 50s so I guess into later midlife next steps in their 30s so really thinking about topics such as career trajectories and starting families and probably home ownership and MCS in their 20s so really continuing education starting out on their careers and probably leaving home so this is the typical information that we tend to cover in each of these cohort studies so that we can see what's going on and what's going on and what's going on and what's going on and when it's not then we've got some ongoing programmes of data harmonisation where we try and identify where data being collected similarly across cohorts and make it more similar if that's possible so I won't dwell on this because really the focus is on health today in childhood we're interested about the home environment education, what's going on in school what's going on outside of school and then transitions into adulthood to educational employment transitions once they're into adulthood partnership formations starting families employment and then there's some common threads all the way through we're thinking about health cognition, mental health as well as physical health at many points in time often using similar sorts of instruments which allow us to construct more longitudinal trajectories I suppose here's just a few examples of the many different analyses that have been undertaken using data from across the CLS cohorts so I think maybe one or two would just be using cross-sectional data but in the majority of cases people would be using the longitudinal nature of these cohorts at least to answer their questions sometimes as I say in a second ago they're using the repeated measures that we have to construct life course trajectories and then most of these I think are single cohort analyses but increasingly we're seeing more cross cohort work so it allows you to try and investigate how things are changing across time and between cohorts so how the levels of things or the associations between things change over time. So what's the current state of play in terms of our data collections so starting from the bottom in NCDS age 62 in inverted commas sweep of data collection actually started pre-pandemic in 2020 had to be suspended due to the pandemic restart here towards the end of last year and we're hoping to finish that early next year next steps has just started recently and again hopefully finishing early next year so we can see it's a very busy time at the moment for our for our survey team because we've got three of these big studies out in the field MCS have got their next data in the field so we can see it's a very busy time at the moment for our survey team because we've got three of these big studies out in the field MCS have got their next data collection which should be starting next year completing the following year so the majority of the waves of data collection across the CLS studies are undertaken using a standard survey approaches a lot of the time in person or increasingly for some sweeps we're getting more online or telephone modes of data collection a few specific biomedical data collections we're trying specifically to capture information within this area so there's two in NCDS including the one that's currently out in the field and one in BCS at age 46 which we'll look at in a bit more detail on the next slide so there's lots of opportunities perhaps not always realised given the number of opportunities that are available using these biomedical data both single cohort analyses and in cross cohort analyses thinking about trends in health and trends in the determinants and consequences of health so this is the BCS 70 age 46 biomedical sweep the other biomedical data connections are broadly similar so there's some questionnaire data collection around household composition relationships finances and employment and then the focus is really on here the health wellbeing and cognition section within the questionnaire as well as additional nurse measures that were taken in person so there's lots of information on physical and mental health mental wellbeing medical care medication health behaviours and then some cognitive function tests trying to tap into immediate and delayed memory executive function and concentration and attention to detail the nurse measures standard measures of anthropometry and some physical function measures around grip and balance blood pressure taking blood samples for later assaying and then accelerometry data over a seven day period with an online diet questionnaire as well so there's lots of rich data here that you can imagine being used in a variety of different ways and in fact have been used across many different analysis we also have now really a lot of this has happened over the last couple of years an extensive selection of linked administrative data in the cohort so both health data set out here and other linked administrative data sets so in England we have linked all of our studies apart from MCS although you see at the bottom that that's coming soon into hospital episode statistics which come in in four separate files I won't go into the details of each of these but they're all available they're available over different periods of time which is one thing that you need to be aware of and that also differs by the study as well as the HES data set these are available via the SecureLab at UKDS in Scotland we've got all of the studies linked into the Scottish medical records so recall I hopefully said that next steps was England only so you won't see that included in the Scotland and Wales linked health admin data so SMR we've got some of these modules of records are linked into all the studies and then others are only linked into those where relevant again these are available at UKDS and in Wales we've got some MCS linkage either available from the sale data bank or also some hospitalisation and diagnosis from ICD-10 chapter codes available from UKDS and there's some upcoming so the moment the HES data are only available up to 2017 but there's an upcoming refresh of that bringing it more up to date and that will include COVID-19 data for the cohort members we also have lots of genetic data increasingly available so I think currently available for NCDS and MCS MCS because it's a study which also includes data collection on other family members we often have genetic data available on the cohort member the mother and the father which I understand allows you to do some interesting things with genetic analyses BCS-70 genotyping underway at the moment so those data should be available soon and in next steps we're collecting saliva samples as part of the current sweep of data collection so looking for funding to extract DNA and genotype those soon a couple of projects in this area currently underway there we're working on a single quality control data set for the NCDS genetic data should be available soon so people don't have to undertake that work themselves each time and also a program of work generating polygenic risk scores for multiple phenotypes I think probably starting in NCDS but then across the studies and again those should be available soon we've recently changed the system for applying to access the genetic data so it should be a quicker response with a simple form so hopefully if you're interested then the link is there if you're interested in that we've also undertook COVID-19 surveys so when the pandemic struck obviously we've got these ongoing cohort studies we realised quickly that if we collected additional COVID-19 data then this would provide a very useful resource for the research community so it's across the four CLS cohorts I've been talking about plus the 1946 both cohort as well so these are a wide range of ages at the start of the pandemic so it provides a lot of information across a broad range of the population three waves of data collection between 2020 and 2021 with the sorts of topics that you might imagine from a kind of COVID-focused survey thinking about people's home life their employment, their health their experience of the pandemic particularly around mental health again these data are available and then as part of this we've also been contributing to the national core studies so kind of harmonised analyses across a large number of nationally representative or UK longitudinal studies we've also collected some serology data so participants in the COVID surveys were invited to provide samples by return of males we've got antibody results from those tests for over 10,000 blood samples that were returned in early 2021 and then I'm going to try and very quickly do one slide on each of these studies sorry I'm ambitious as these are three new cohorts that CLS are involved into kind of varying degrees first one of these is the early life cohort feasibility study so this has started last year I think we're yet to recruit testing the feasibility of a new UK wide birth cohort study recruiting several thousand babies at this stage collecting information about their families and their development and really the feasibility part here is because we're looking at quite innovative methods of sample frame definition recruitment and data collection so we're looking to see if we can improve in some of these areas with the hope that it will be rolled out more broadly in the next couple of years and so the study co-directors include Alyssa and Lisa from CLS as well as Pascofiaron children of the 2020s is another nationally representative birth cohort this one commissioned by the DFE so the questions are probably more as you would expect aligned to their interests around family early education childcare determinants of early school success and I think this sample is partially or fully drawn now in the way suggested there five waves I think one and three are face to face the remaining ones are sequential mixed mode and some again some innovative methods to data collection including using apps that parents would use to record childhood milestones and other things in kind of real time so Pascofiaron is leading on that again and then finally Cosmo the COVID social mobility and opportunities survey this is recruiting older students so 12000 of them those who are in year 11 in their last academic year so those who've been really badly affected by school closures and other restrictions over that over the previous two years so this is answering some important questions about who's been particularly affected by this disruption what inequalities are there how long term are those inequalities wave one data already collected and will actually be available quite soon the second wave coming up in the near future lots of different individuals and bodies involved in this one with the PI being Jake Anders from the UCL centre for education policy and equalising opportunities lots more information on those three studies available on either the CLS website or in this case the UCL website thank you very much thank you very much Richard and really interesting and so much going on as well so yeah really a challenge to fit it in the 50 minutes isn't it I'm now going to hand over to Alexandra Lee who's going to tell us about ELSA wave 10 changes and adaptations Alexandra is a researcher in the longitudinal service team at NATSEN where she predominantly works on the ELSA which follows the lives of people in England age 50 and over and prior to joining NATSEN she worked as a research assistant at the University of Manchester on a mixed earth project exploring international education policy and outcomes so over to Alexandra Thanks Mary I'm just going to share my screen so yeah as Mary said thank you for introducing me and thank you for allowing me to speak today I'm going to be talking to you today about the English longitudinal study of the agent or ELSA and the changes and adaptations that were made to the 10th wave of field work so today I'll start by giving you a brief background of the study and then I'll talk to you about COVID-19 and the impact of it and how we adopted computer assisted video interview or CAVI as the mode to enable data collection during the pandemic and then I'll speak to you about the adaptations that were made to wave 10 of ELSA followed by the approach to coding prescribed medicines and also the accelerometry module where respondents where activity monitors to record physical activity levels so the English longitudinal study of agent or ELSA is a study of people aged 50 and over and their partners and we know it is ELSA but it's also known on the doorstep and in the logo as ELSA 50 plus health and life and the study began in 2002 and it aims to interview the same group of people every two years to explore the health, lifestyles and financial situations of people as they grow older and every four years we also have a nurse visit and the aim is to create a picture of what it means to age in England and to understand the reasons behind any changes in people's lives and ELSA is modelled on the health and retirement study or HRS which is run in the US and it's carried out well ELSA is carried out by NATSEN in collaboration with University College London the Institute for Physical Studies the University of Manchester and the University of East Anglia and we're currently undertaking field work at Wave 10 and the Wave 10 ELSA Cappy interview so this is the face to face and the video interview and there's been a few module changes that I'll talk to you about a bit later on but these are the different modules that we have within the interview and the content is similar to previous waves but there have been some tweaks to different modules just due to the pandemic such as the health module for instance where we've added questions on COVID-19 and vaccinations for example and also in the work and pensions modules where we've added fellow questions for example and the self-completion questionnaire so you can see this on the bottom right of the screen so the last module that's mentioned here and this is actually a paper questionnaire that is completed by the respondent separately to their interview with an interviewer and this just allows privacy for some more personal questions rather than being asked in the interview so Wave 10 field work was due to launch in April 2020 but face to face field work was put on hold due to the pandemic and as a result we explored alternative modes of data collection on ELSA and historically ELSA has adopted a face to face or Cappy so computer assisted personal interview approach however this was not possible during the pandemic as there was an increased use of video calling tools developed and made accessible during the pandemic this made computer assisted video interviewing or Cappy more accessible so we could conduct video interviews and the 1970 British cohort study also known as BCS 70 which Richard has spoken about already today so which is run by the Center for Longitudinal Studies or CLS and this successfully adopted a Cappy approach in its pilot where it had a response rate of 76% sorry and as such we adopted a Cappy approach on ELSA as well in the Wave 10 pilot which just allowed us to make progress during the pandemic where we wouldn't have otherwise been able to make any progress and here we had a response rate of 31% and we received really positive feedback from interviewers in the approach and incorporated their feedback into the main stage Cappy tranches and these Cappy these Cappy interviews finished in March 2022 and we had a 32% response rate for main stage but due to our sample consisting of people aged 50 plus many of whom don't have access to or aren't comfortable with the technology required for Cappy interviews we also offered respondents the option to opt in for a face-to-face interview at a later date where we expect to achieve a response rate of 83% overall among existing sample members and after we started Cappy fieldwork in October 2021 we were able to move back to face-to-face interviewing again earlier this year in March and we are currently three of the fifths of the way through fieldwork now however respondents do still have the option to have a video interview if that is what they would prefer and some adaptations were made to the Wave 10 interview content to ensure that all questions were applicable to a Cappy interview and as such show cards were shown to the participant using screenshed during the video interview which include additional information such the list of categories for example for sensitive questions where the interviewer or the respondent may not feel comfortable with the questions or answers being read out loud or also consent information that the participant can read through during the interview in their own time rather than having it read to them and this just ensures that the participant still had access to all of the information that they needed for the interview and in addition to this the paper self-completion questioners that I spoke about at the beginning were sent in advance and sent back to the respondent before the interview where previously they were provided during the interview by the interviewer and then finally the consent to data linkage process was also amended so previously we obtained written consent through forms and this process was amended for video interviews to incorporate the questions into the interview where the respondent could then consent or refuse consent during the interview and that's recorded as a question and it's now recorded verbally and their response is recorded in the interview and fed forward to future waves so that we can check this in the future and this process has worked really well and has been continued in face-to-face interviews in wave 10 and in future waves and we found that on also video interviews are technically feasible however it was important to amend certain parts of the interview as mentioned previously just to ensure that certain aspects weren't lost and some components of the interview worked really well despite the concerns such as the cognitive function module where the respondent is asked a series of interactive questions to assess their mental capacity however other modules were not possible such as the measurements module for example where weight is taken and a timed walk is carried out and we found that in also response rates were lower in video interviews than in face-to-face interviews from previous waves was predicted due to the sample of people aged 50 plus however it did allow us to make progress when it would not have otherwise been possible and we have gone back to a face-to-face approach now that the pandemic permits us to do so so it's just worth bearing that in mind as well and interviewers also require technical training before commencing video interviews however we also received really positive feedback from some respondents and interviewers who preferred the convenience of video interviews and we also discovered that concurrent interviews are possible using CAVI where respondents are interviewed both at the same time using the same device and one of the main changes to the Wave 10 interview content is the prescribed medicine coding aspect which is a module of questions about prescribed medications and over-the-counter statins previously this information was coded by nurses using a paper booklet as part of the nurse visit however the nurse visit in Wave 10 was postponed to Wave 11 just due to the pandemic so as such this part of the study was moved into the main interview that's conducted by an interviewer so currently interviewers record medications using a look-up table in the CAVI questionnaire and the interviewer uses a look-up table to type in the name of the medication the dosage and the medication type so whether it's a tablet, a caplet and so forth and then they select from a list to assign the BNF code to the British National Formulary Code and previously nurses only collected this information from core members however this change allows the module to be asked of both core members and their partners and this is the first study that has adopted this approach of interviewers coding medications using a look-up table during the interview and the approach is being developed and adopted for other studies with similar modules and the module was designed in collaboration with the Nuts and Biomedical Centre alongside the ELSA collaborators both of whom have expertise in this area and we also received positive feedback from interviewers from their experiences during the pilot and there were no changes needed for the main stage interviewer as it worked really well and out of approximately 13,000 possible medicines that can be coded as of this week only 79 medicines were not coded using the look-up and instead were recorded using a free text response and of these 79 responses 34 could be back coded using the coding frame and 29 need further clarification on from collaborators but we should still be able to code this clarification and the remaining 16 of these 79 were entered incorrectly or did not have sufficient information for us to be able to backcode them so far this shows that the changes are working really well as so few medicines have not been able to be coded using the look-up and then the activity monitor module or accelerometry module is a new addition to Wave 10 and this aims to measure the physical activity levels of participants using activity monitors that are a bit like a watch and they're worn for eight consecutive days and nights and those who are eligible and willing to participate will be sent an activity monitor and a wrist strap along with the instructions on how to wear and return the monitor and respondents receive an incentive of £5 for taking part once the monitor has been returned to the office and they're also sent their results and 75% of households are eligible for this module where data are collected from both core members and their partners and measuring physical activity is really challenging because self-reported information tends to be inaccurate so activity monitors allow us to objectively measure participants physical activity levels and it's important to measure physical activity and the research has shown that lifestyle factors such as the amount of time people spend being active or the time spent being inactive and the types of activity that they do have an important impact on their health and we've added a question to the interview to determine whether the respondent is happy to participate in this module and if they agree they're sent a monitor a wrist strap, a leaflet and a free post envelope from the office and this pack also includes a postcard and here the respondent can note down the start time and date from when the monitor was worn and so far we have a response rate of 82% of respondents who are willing and able to wear a monitor but please do note that this is not the final figure as we're currently three-fifths of the way through field work and therefore this response rate is subject to change and respondents are sent feedback plots of their activity levels over the week and an example of this feedback plot is on the screen on the right hand side and here we can see the different types of activity that the participant has done over the eight days so we can see that yellow signifies imputed data and this is before the monitor was worn and this is why that card where the participant drops down the time and date started wearing the monitor is really important and then the green is moderate to vigorous physical activity where red is sedentary so where the respondent is resting or just sitting down for example and then blue shows sleep and the black line signifies acceleration and orange is light activity so alongside this feedback plot respondents are also sent a summary letter of their average time per type of activity over the eight days so for example summarising that they may sleep for an average of eight hours per night and this is in addition to the feedback plot but as you can see this is really rich data and it will be available with the survey data upon the completion of way 10 field work so thank you for listening to this presentation I really appreciate your time and you can find my contact details on the screen so please don't hesitate to ask me any questions either in the chat or feel free to get in touch with me using these contact details Excellent, thank you very much Alexandra, I'm fairly a lot of interesting stuff going on Elsa as well