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Exploring Public Health Research: My NIHR Undergraduate Internship

Written by Ellie Butterworth, NIHR Undergraduate Intern, Child Population Health, NIHR ARC Northwest London

This past summer, I had the opportunity to take part in an eight-week internship as an NIHR Undergraduate Intern, where I explored the world of public health research first hand. As a second-year Biology and Psychology student, the chance to intern within the Child Population Health theme of the NIHR Applied Research Collaboration North-West London was a unique and exciting opportunity to bridge my academic background with my growing interest in how research can drive real-world improvements in healthcare. This internship has allowed me to dive into key areas of public health, gain practical research experience, and develop skills that will shape my academic and professional journey. In this blog, I’ll share what I worked on, what I learned, and how the experience has influenced my long-term goals.

Highlights From My Summer in Research

This summer has been invaluable in deepening my understanding of public health research, as the eight weeks of my internship consisted of an incredible variety of experiences.

Day one began at Imperial College London’s School of Public Health on the White City campus, where I was immediately immersed into the world of research. I introduced myself to the child health team, before heading to the Centre for Paediatrics and Child Health’s Annual Science Day in South Kensington. I had lunch with the Editors of the Journal of Paediatrics, and the afternoon was filled with interesting talks, poster sessions, and networking opportunities with child health researchers, clinicians, and academics across the Faculty of Medicine at Imperial.

This set the tone for the summer to follow! Over eight weeks I contributed to research meetings with clinical and academic groups, participated in the development of funding bids, shadowed a Master of Public Health Student, and took part in learning and engagement events. Along the way, I refined essential research skills through peer-reviewing a study for BJGP Open, completing a course on critical appraisal, and working with administrative health data.

These skills all aided me in completing my main project – an exploration of the NHS service Hospital at Home.

Research Spotlight: Hospital at Home

My project looked specifically at Hospital at Home programmes for children – an NHS service that provides medical treatment in patients’ homes. While current research consists of many evaluations of these services, the outcomes they measure are inconsistent, making it difficult to compare findings or identify best practice.

We had two key objectives: to identify the outcomes used in evaluations of paediatric Hospital at Home services, and to compare these outcomes to an existing NHS evaluation framework. This framework was designed specifically for Hospital at Home services for adults, and so we aimed to assess its validity in a paediatric population.

To achieve this, I conducted an international literature review that identified all outcomes used in paediatric Hospital at Home evaluations. I then mapped the outcomes identified onto the NHS framework. Encouragingly, I found that many outcomes used in paediatric evaluations aligned with the framework. However, I identified several key differences, meaning the framework would need adaptation to ensure validity in a child population. One such adaptation I would recommend is including parental burden (e.g. time away from work and additional costs) in a paediatric framework, as this is something I identified from the paediatric literature that is not covered by the adult framework. I have submitted an abstract describing this work to the upcoming Royal College of Paediatrics and Child Health (RCPCH) Conference and it is currently under review!

I then had the exciting opportunity to share my project with parents and carers at the W12 Together festival, where I explored which potential outcomes of children’s hospital at home services are most important to them.

Whilst parents generally valued outcomes relating to their child’s experience and the quality of healthcare, outcomes related to parental burden were often ranked as the least important. I enjoyed engaging the public with my research in this way, and their insights will used in shaping the next phase of this project.

I presented my findings to our research group at Imperial and to the North-West London Hospital at Home clinical and evaluation team, gaining additional academic and clinical input into my findings. Interestingly, the clinical feedback contrasted the feedback from parents and carers, as the clinical team considered parental burden to be a key outcome to capture. Future work should explore this further, particularly with parents and carers who have direct experience with Hospital at Home programmes for children. My work will be utilised in a future study to gain consensus on which outcomes should be used in evaluations of paediatric Hospital at Home services.

Exploring Health Data in Practice

Alongside the literature review, I worked with ‘real world’ data on Hospital at Home services. I received ethical approval to access the local North-West London dataset, which contained (anonymised) information on all children accessing healthcare across North-West London and was linked to specific data about hospital at home use from the Paediatric Assessment and Treatment at Home (PATCH) programme.

The dataset we obtained had over 50,000 patients! My work supported a larger project which was looking at the association between referral to PATCH and readmission to hospital within 7 days for all children with respiratory tract infections. I wanted to examine whether the severity of infection was associated with the likelihood of a referral to PATCH, and separately, whether it was associated with readmission to hospital, as this would indicate it is an important confounder to consider in our analyses. I used statistical software to describe the amount of missing data, remove any duplicate entries, and filter to the relevant study period. With guidance from clinicians, I categorised clinical codes used to diagnose respiratory tract infections into levels of severity, by separating upper and lower respiratory tract infections. I then used these codes to categorise all children in the dataset.

My analysis showed that for children who initially attended A&E or urgent care with a respiratory tract infection, lower respiratory tract infections (which are typically more severe) were associated with both a referral to PATCH and with readmission to hospital. This suggests that severity of infection should therefore be accounted for as a confounder when examining the relationship between referral to PATCH and readmission to hospital. Interestingly, severity of infection was not associated with either referral to PATCH or readmission to hospital for children who were initially admitted to hospital. This contradicted what we thought, but it may be that all respiratory tract infections (both upper and lower) resulting in a hospital admission would meet a baseline threshold of severity, unlike children who present to A&E or urgent care with a respiratory infection and are ultimately not admitted to hospital. These results exposed me to the intricacies of working with administrative health data and reaffirmed the importance of considering all potential confounders when exploring relationships between variables. Applying my programming skills to a real-world problem has been a particularly exciting milestone!

Reflections and Takeaways

During my summer internship, I gained invaluable insight into how diverse, exciting, and meaningful a career in public health research would be. This summer was incredibly rewarding, as I not only developed key research skills, but I learnt how these skills can be applied to improving child health within local communities. I particularly enjoyed the collaborative nature of research, as I had the privilege of meeting with and learning from a wide range of experts, developing technical and professional skills that I will carry forward into my future career.

This internship has confirmed my ambition to pursue a career in Public Health research. I am grateful to my supervisor, Dr Kimberley Foley, who has guided and supported me throughout, to NIHR for this opportunity, and to the incredible team at Imperial College London for making this summer an unforgettable one.

Ellie Butterworth is an NIHR Undergraduate Internship Programme awardee supported by the National Institute for Health and Care Research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, NHS or the UK Department of Health and Social Care.

Associated Research Theme

This news story is related to our Child Population Health theme.

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