Public Health

Current awareness updates

Statistics on alcohol: England.
House of Commons Library; 2021.
[Research briefing. This note provides a summary of statistics on alcohol consumption among adults and children in England. Data on alcohol-related hospital admissions in England and alcohol-related deaths in
England, the UK and worldwide is also shown.]

Towards a dementia-inclusive society: WHO toolkit for dementia-friendly initiatives.
World Health Organization (WHO); 2021.
[This toolkit supports individuals, communities and countries in raising awareness of, and empowering people living with, dementia to remain in, and be a significant part of, their community. The toolkit provides practical guidance and tools that can support efforts, including planning and implementation activities, to create dementia-inclusive societies.]

Social isolation and loneliness among older people: advocacy brief.
World Health Organization (WHO); 2021.
[This brief highlights the growing public health and policy concern on these issues, made more salient by the COVID-19 pandemic. The brief summarises the scale, impact, and harms of social isolation and loneliness among older people and outlines what can be done to reduce them. It also describes several policy windows that offer opportunities for addressing social isolation and loneliness among older people and proposes a three-point global strategy for tackling these issues.]

WHO guideline on school health services.
World Health Organization (WHO); 2021.
[School health services are services provided by a health worker to students aged 5–19 in primary or secondary education, either within school premises or in a health service situated outside the school. Schools offer a unique opportunity to implement effective health services at scale for children and adolescents. Web Annexes found at the end of this summary link to intervention and implementation tools.]

WHO Guideline on the prevention of drowning through provision of day-care and basic swimming and water safety skills.
World Health Organization (WHO); 2021.
[This guideline addresses: provision of day-care for children under the age of 6 years and provision of basic swimming skills and water safety training to children aged 6 years and older. Developed following GRADE methodology, approved by the WHO Guideline Review Committee and intended for use by policy-makers and practitioners, the guideline issues strong recommendations in favour of both interventions for drowning prevention.]

Alcohol and drug misuse prevention and treatment guidance.
Public Health England (PHE); 2021.
[Information and other resources to support commissioners, service providers and others providing alcohol and drug interventions. 11 August 2021: Added new group: Opioid substitution treatment good practice resources.]

Supporting mental healthcare in a maternity and neonatal setting: good practice guide and case studies.
NHS England; 2021.
[This guide is for commissioners and staff involved in maternity and neonatal care. It describes the underpinning principles of and good practice for supporting good mental health and psychological wellbeing in maternity and neonatal settings. It also considers the role of specialist maternal mental health services (MMHS) in supporting this function.]

Improving non-emergency patient transport services.
NHS England; 2021.
[This report sets out a new national framework for non-emergency patient transport services to support them in becoming consistently more responsive, fair and sustainable.]

PCN winter planning tool.
Primary Care Commissioning (PCC); 2021.
[PCC has published a winter planning tool to support PCNs in preparing for the winter pressures that are anticipated. The tool is free to download and contains an introductory sheet with instructions for completion. We have also recorded a short video guide to using the tool.]

Responding to pandemics and other disease outbreaks in homeless populations: a review of the literature and content analysis.
Babando J. Health & Social Care in the Community 2021;-(6 April):13380.
[This review illustrates that the current breadth of academic literature on homeless populations has focused on tuberculosis rather than diseases that are more recent and closely related to COVID-19. Thematic content analysis revealed six themes that offer recommendations which include (1) education and outreach, (2) adapting structure of services, (3) screening and contract tracing, (4) transmission and prevention strategies, (5) shelter protocols and (6) treatment, adherence and vaccination.]

Government response to the independent review of drugs by Dame Carol Black.
Department of Health and Social Care (DHSC); 2021.
[Part 2 of Dame Carol Black’s review set out 32 recommendations for a whole system approach to tackling drug misuse. As a result, the government is developing a long-term strategy which will present a whole-of-government response to drive down drug supply and demand to be published by the end of the year. Immediate actions include a new cross government joint combating drugs unit and development of a national outcomes framework to set out measurable goals for the combating drugs programme.]

Restrictive eating disorders in higher weight persons: A systematic review of atypical anorexia nervosa prevalence and consecutive admission literature.[Abstract]
Harrop EN. International Journal of Eating Disorders 2021;54(8):1328-1357.
[Although atypical anorexia (AAN) appears to occur more frequently than AN in communities, fewer patients with AAN are being referred and admitted to eating disorder specific care, particularly in the United States. Given the significant medical and psychosocial consequences of AAN, and the importance of early intervention, this represents a crucial treatment gap.]

Attentional bias in eating disorders: A meta-review.[Abstract]
Stott N. International Journal of Eating Disorders 2021;54(8):1377-1399.
[There is evidence for attentional avoidance and vigilance in eating disorders depending on stimulus properties (low vs. high-calorie food; high-body mass vs. low-body mass index photos of others) and attentional avoidance of food stimuli in those with anorexia nervosa. Sad mood induction may generate attentional bias for food in those with binge-eating disorder. There may also be attentional bias to general threat in eating disorder samples.]

Lunch and Learn – August Reminder

A session around the Soundskills Project

This is just a reminder that the next Lunch and Learn session will be held via Teams on Wednesday 25th August between 12pm and 1pm.

This session will discuss:

  • The Soundskills project and visual arts based community development work
  • The principles of socially engaged practice
  • The health benefits of creative expression

Library Bulletin

Forensic Psychiatry

The current bulletin for Forensic Psychiatry, produced by Greater Manchester Mental Health Trust, is now available to view and download here

For support accessing any of the articles within the bulletin please contact: academic.library@lscft.nhs.uk

Public Health

Current awareness updates

Increasing COVID-19 vaccination rates amongst vulnerable groups: summary advice for GPs.
Royal College of General Practitioners (RCGP); 2021.
[GPs will be aware of the disparity in uptake of the COVID-19 vaccine between different population groups; often, the groups most at risk from infection and serious illness are those least represented at vaccination centres. We continue to collect examples, case studies or evidence on what works in addressing this issue.]

Vaccination of people working or deployed in care homes: operational guidance.
Department of Health and Social Care (DHSC); 2021.
[From 11 November 2021, anyone working or volunteering in a care home will need to be fully vaccinated against coronavirus (COVID-19), unless exempt.]

JCVI statement, August 2021: COVID-19 vaccination of children and young people aged 12 to 17 years.
Department of Health and Social Care (DHSC); 2021.
[This statement sets out JCVI’s latest considerations and advice regarding the potential extension of the COVID-19 vaccination programme to children and young people.]

JCVI issues updated advice on COVID-19 vaccination of young people aged 16 to 17.
Public Health England (PHE); 2021.
[The Joint Committee on Vaccination and Immunisation (JCVI) is today advising that all 16 and 17 year olds receive their first dose of the Pfizer-BioNTech vaccine.]

COVID-19 vaccination: resources for children and young people.
Public Health England (PHE); 2021.
[Information for eligible children and young people on COVID-19 vaccination.]

PHE women’s reproductive health programme 2020 to 2021.
Public Health England (PHE); 2021.
[Progress update on the PHE reproductive health programme, including a new return on investment tool and the next steps for 2021 to 2022. ‘Extending PHE’s contraception return on investment tool: maternity and primary care settings’ outlines a new return on investment (ROI) model for contraception in maternity and the provision of long-acting reversible contraceptives (LARC) in primary care, building on the existing contraception ROI tool published in 2018.]

BHIVA guidance for virtual consultations for people with HIV: May 2021.
British HIV Association (BHIVA); 2021.
[This guidance was released in May 2021 in response to the increased proportion of consultations carried out remotely due to COVID-19. The guidance highlights issues important for safe and effective consultation, including awareness of the limitations of remote consultation.]

Expanding access to naloxone.
Department of Health and Social Care (DHSC); 2021.
[Naloxone is a drug that reverses the effects of an opioid overdose and can help to prevent overdose deaths. We are seeking responses to this consultation to assess the viability of proposals to widen access to naloxone by expanding the list of services and individuals that can give it out without a prescription or other written instruction.]

Quality indicators in lung cancer: a review and analysis. [Abstract]
Chiew KL. BMJ Open Quality 2021;10(3):DOI: 10.1136/bmjoq-2020-001268.
[Conclusions: We found a large number of published QIs in lung cancer but they focused on relatively few areas not reflective of patterns of contemporary practice. We identified gaps in lung cancer QIs especially for systemic therapies, radiotherapy, palliative care and patient-reported outcomes. In order to comprehensively assess the care of patients with lung cancer, future efforts should focus on developing readily measurable QIs in these areas…]

Now or never: A systemic investment review of mental health care in England.
Centre for Mental Health; 2021.
[This report, commissioned by the NHS Confederation’s Mental Health Network, sets out ten key areas where strategic investment could solve systemic issues in the mental health system, with significant benefits to the lives of people with mental health difficulties and their experiences of support.]

The role of epigenetics in psychological resilience. [Abstract]
Smeeth D. The Lancet Psychiatry 2021;8(7):620-629.
[In this Review, we propose a new conceptual model for the different functions of epigenetic mechanisms in psychological resilience. After reviewing empirical evidence for the various components of the model, we identify research that should be prioritised and discuss practical implications of the proposed model for epigenetic research on resilience.]

Effect of telehealth interventions on quality of life in cancer survivors: A systematic review and meta-analysis of randomized controlled trials.
Li J. International Journal of Nursing Studies 2021;122:103970 .
[Telehealth interventions are effective and alternative methods for improving quality of life among cancer survivors. The most effective approach was application-based intervention, the most common approach was website-based intervention, and in terms of intervention durations, the short-term telehealth intervention was the most effective. Most telehealth interventions included breast cancer survivors.]

Podcast

Louise Minchin and Annie Emmerson talk to sailor Tracy Edwards MBE

Source: Her Spirit

BBC Breakfast presenter Louise Minchin and BBC Triathlon presenter Annie Emmerson host series 2 and 3 of the Her Spirit podcasts. Their mission is to inspire women everywhere to live a healthier, happier life. In their podcasts you will hear from phenomenal women in the world of sport and business talking about their desires, vulnerabilities and spirited ways.

In this episode Louise and Annie talk to sailor Tracy Edwards MBE about her skippering the first all-female crew in the Whitbread Round the World Yacht Race, life growing up and her passion for change.

Listen to the podcast here.

Covid 19

Current awareness updates

Daily Insight: Covid can’t peak too soon.
HSJ: Health Service Journal (Daily Insight) 2021;:7030598.
[Confirmed covid cases in the community fell again on Tuesday, offering further hope that the current wave could have peaked. Most experts are highly cautious about saying so – there is likely to be further growth following ‘freedom day’. Also: In the Cheshire and Merseyside ICS, the nine local authorities have issued a series of “red lines” and pre-conditions to health service leaders. 28 July.]

Daily Insight: Covid puts one in 10 beds to sleep.
HSJ: Health Service Journal (Daily Insight) 2021;:7030631.
[A major hospital trust has made its highest number of bed closures “for many years” due to covid staffing pressures. Newcastle upon Tyne Hospitals Trust lost 933 bed days in the first week of June due to staff testing positive for covid or being required to isolate. Also: Latest figures show just 3 per cent of A&E attendances nationally are ‘booked’ through the 111 First service. And Healthwatch England says the NHS has not done enough to publicise this new service. 3 August.]

New study into COVID-19 vaccine dose interval for pregnant women.
Department of Health and Social Care (DHSC); 2021.
[The Preg-CoV clinical trial has been launched to help determine optimal gap between doses as well as explore potential side-effects in more detail. Research shows pregnant women more likely to become seriously ill from COVID-19 and 98% of those in hospital due to COVID-19 are unvaccinated.]

Coronavirus: the consequences for mental health.
Mind; 2021.
[This research with almost 12,000 people found that those with mental health problems report an increase in the severity of challenges they’re facing now and concerns about the future. The authors call for services to be ready for the increase in severity of people’s mental health problems, and to take into account the trauma that people have experienced over the past year and how this might affect the support they need.]

Coronavirus: Adult social care key issues and sources.
House of Commons Library; 2021.
[House of Commons Library research Briefing updated 23 July 2021. An overview of key issues facing the adult social care sector during the coronavirus (Covid-19) outbreak, with links to some of the key official guidance for the sector.]

Coronavirus and the social impacts of ‘long COVID’ on people’s lives in Great Britain: 7 April to 13 June 2021.
Office for National Statistics (ONS); 2021.
[Indicators from the Opinions and Lifestyle Survey covering the period 7 April to 13 June 2021 to understand the impact of the coronavirus (COVID-19) pandemic on people by their self-reported long COVID-19.]

Public Health

Current awareness updates

Tick bite risks and prevention of Lyme disease: resources.
Public Health England (PHE); 2021.
[Toolkit and resources for local authorities and other stakeholders to raise awareness of the potential risks created by ticks and tick-borne disease in England. You can choose to co-brand leaflets and posters with PHE by adding your logo to the Word files or simply download the PDFs.]

Holiday activities and food programme 2021.
Department for Education (DfE); 2021.
[This document provides information for local authorities delivering the holiday activities and food programme in 2021. In 2020 the government announced that the holiday activities and food programme, that covers the Easter, summer and Christmas holidays, will be expanded across the whole of England in 2021. There will be up to £220 million available to local authorities to coordinate free holiday provision, including healthy food and enriching activities.]

New cross-government unit to tackle drug misuse following major independent review.
Department of Health and Social Care (DHSC), Home Office, and Public Health England (PHE); 2021.
[The new unit aims to end illegal drug-related illness and deaths. The rise in drug misuse poisoning deaths has been driven by increases in heroin deaths which have doubled in this time and other substances such as cocaine have seen notable recent increases. The proportion of 11 to 15-year-olds who use drugs has increased in recent years with one in three 15-year-olds saying they took drugs in the last year.]

Tackling obesity: the role of the NHS in a whole-system approach.
The King’s Fund; 2021.
[Rates of obesity in England are high and rising, with a strong systemic relationship between obesity and deprivation. Rates are also higher in women than in men, and in some ethnic minority groups compared to the white British group. This briefing explores the role of the NHS in tackling obesity, focusing on how the NHS can work with local partners and engage with communities to deliver targeted interventions to treat and prevent obesity.]

Effectiveness of complementary therapies in cancer patients: a systematic review.
Guerra-Martin MD. International Journal of Environmental Research & Public Health 2021;18(3):1017.
[The findings reveal some effective complementary therapies: auriculotherapy and acupuncture, laser moxibustion, hypnosis, Ayurveda, electroacupuncture, progressive muscle relaxation and guided imagery, yoga, phytotherapy, music therapy and traditional Chinese medicine. On the other hand, electroacupuncture, laser moxibustion and traditional Chinese medicine presented adverse effects, and kinesiology did not show effectiveness.]

Wellbeing toolkit for Alcohol Related Brain Damage (ARBD).
Penumbra; 2021.
[As well as providing important medical information about ARBD and alcohol use, the toolkit covers key practical and holistic information on recovery – including information on reducing stress, improving memory, coping with challenging emotions without using alcohol, nutrition and exercise, connecting with others and the community, along with guidance on improving digital skills, budgeting and knowing your rights. It includes a podcast of relaxation exercises.]

What support do young people with sickle cell disease need when moving into adult services?.
NIHR Evidence; 2021.
[This research suggests that non-specialist healthcare services are failing young people with sickle cell disorder. This is a critical period in their development when they are learning to live as adults. It is difficult to manage conflicting demands, such as wanting to work hard at school but needing to rest to avoid pain. Researchers suggest healthcare professionals shouuld work with schools to create supportive services that can help young people to achieve their life goals.]

Loneliness is strongly linked to depression in older adults in a large, long-term study.
NIHR Evidence; 2021.
[Depression is a major public health problem that is growing worldwide. The causes are complex and vary from person to person. However, new research estimates that up to one in five cases of depression among older adults could be prevented by reducing loneliness. The study therefore has important public health implications, highlighting the need for comprehensive action across society to combat loneliness.]

HIV infection and AIDS.
Clinical Knowledge Summary (CKS); 2021.
[This CKS topic has been updated.]

Could a decision support tool help to guide mental health treatment in primary care?
The Mental Elf; 2021.
[Linda Gask reviews a recent randomised controlled trial on the clinical efficacy of a Decision Support Tool (Link-me) to “guide the intensity of mental health care in primary practice”.]

Improving the care of patients discharged following a pulmonary embolism, in line with NICE Guidelines (NG158).
[Shared learning from Nottingham Universities Hospitals Trust. Project started out as audit looking into how to improve discharge process for patients following a PE, however upon understanding limitations of care provided on discharge, practice was changed in line with NICE guidelines to ensure safest possible discharge for these patients.]

Risk factors for LGBTQ+ youth self-harm and suicide.
The Mental Elf; 2021.
[In her debut blog, Hazel Marzetti reviews a recent systematic review and meta-analysis on victimisation and mental illness prevalence among LGBTQ+ young people with experiences of self-harm and suicide.]

European Surveillance of Antimicrobial Consumption Network (ESAC-Net).
World Health Organization (WHO); 2021.
[The report found some differences in the use of antibiotics between two sets of countries, the ECDC’s European Surveillance of Antimicrobial Consumption Network (ESAC-Net) and WHO/Europe’s Antimicrobial Medicines Consumption (AMC) Network. Findings show a significant decrease in the consumption of antibacterials in eight ESAC-Net countries including the United Kingdom. However, figures for the AMC Network were less clear, reflecting the more complicated nature of data collection.]

Transition to adulthood and transfer to adult care of adolescents with congenital heart disease: a global consensus statement.
Moons P. European Heart Journal 2021;:ehab388.
[This consensus document describes issues and practices of transition and transfer of adolescents with CHD. Transitional care ought to be provided to all adolescents with CHD, taking into consideration the available resources. When reaching adulthood, patients ought to be transferred to adult care facilities capable of managing their needs, and systems have to be in place to ensure continuity of high-quality care.]

Children and young people’s mental health – policy, CAMHS services, funding and education.
House of Commons Library; 2021.
[Research briefing on children and young people’s mental health policy, June 2021.]

Community mental health and wellbeing : what does gold standard look like?
Digital Health & Care Innovation Centre, Scotland; 2021.
[Following interviews and meetings with key stakeholders a range of tools were developed to support collaborative discussion around gold standard community mental health and wellbeing, key relationships and challenges to implementation. This report presents findings of the resulting workshop.]

Emerging lessons from the commissioning and delivery of a gambling treatment service.
Woodall J. Public Health 2021;196:69-73.
[This article offers a unique contribution to understanding more about the provision of gambling treatment services. This is crucial, given that a greater number of people face challenges as a consequence of gambling harms, and such services should be seen part of forming a coherent public health response.]

PHE women’s reproductive health programme 2020 to 2021.
Public Health England (PHE); 2021.
[Progress update on the PHE reproductive health programme, including a new return on investment tool and the next steps for 2021 to 2022. Use these documents and tools to understand how this programme integrates with the upcoming women’s and sexual and reproductive health strategies. Links to new tools, publications and examples of best practice can also be used as a reference point for colleagues across the healthcare system, to inform prioritisation and planning.]

National flu immunisation programme plan.
Department of Health and Social Care (DHSC); 2021.
[The annual flu letter for 2021 to 2022 describes the national flu immunisation programme and outlines which groups are eligible for flu vaccination.]

Life Sciences Vision.
Department for Business, Energy & Industrial Strategy; 2021.
[This document outlines the government’s and the life science sector’s ambitions for the sector over the next decade. It sets out the government’s plans to stimulate a thriving UK life sciences sector. It also focuses on how the sector can address some of the UK’s most significant health care challenges, including cancer, dementia and obesity.]

Alcohol consumption and harm during the COVID-19 pandemic.
Public Health England (PHE); 2021.
[A report collating data on alcohol consumption and alcohol-related harm in England during the COVID-19 pandemic and comparing it to data from previous years. The report improves our understanding of how alcohol consumption and harm changed in England while physical and social restrictions to prevent and control coronavirus were in place. The findings help to understand whether pandemic-related changes have affected rates of alcohol hospital admissions and deaths as well as health inequalities.]

Early evaluation of the Children and Young People’s Mental Health Trailblazer programme.
University of Birmingham; 2021.
[The programme was launched in December 2018 to improve the prevention of mental health problems and early intervention for children and young people with mild to moderate mental health problems. The early evaluation is following the experiences of the initial group of mental health support teams, which are based in 25 areas across England (called Trailblazers) and work with more than 1,000 schools and colleges.]

Covid 19


Current awareness updates

The impact of COVID-19 restrictions in the United Kingdom on the positive behavioural support of people with an intellectual disability
Murray G. British Journal of Learning Disabilities 2021;49(2):138-144.
[It has been suggested that COVID-19 and the associated restrictions are likely to have a negative impact on the provision of positive behavioural support (PBS) to people with an intellectual disability. Participants reported a neutral or somewhat positive impact on all the areas measured and the learning from their PBS programme as helping them cope with COVID-19. Many staff developed creative solutions that allowed them to provide PBS despite COVID-19 restrictions.]

VacciNation: Exploring vaccine confidence.
Healthwatch England; 2021.
[Our new research explores vaccine confidence amongst people from African, Bangladeshi, Caribbean, and Pakistani backgrounds. We want to understand these barriers to ensure key lessons are taken forward for future public health campaigns.]

Lateral flow device performance data.
Department of Health and Social Care (DHSC); 2021.
[Analysis confirms lateral flow devices (LFDs) are successful at identifying infectious cases of coronavirus (COVID-19) and real-world data shows Innova LFDs are capable of detecting the Delta variant.]

COVID-19 surveillance and immunity studies.
Department of Health and Social Care (DHSC); 2021.
[Updated 01 July 21: Added link to Schools Infection Survey research findings – round 5.]

JCVI issues interim advice on COVID-19 booster vaccination.
Public Health England (PHE); 2021.
[The Joint Committee on Vaccination and Immunisation (JCVI) has been asked to consider the options for a potential coronavirus (COVID-19) booster programme.]

COVID-19 and adult congenital heart disease services: impact on support and advice from nurse specialists.
Anthony J. British Journal of Nursing 2021;30(12):730-732.
[Although the focus on service provision in response to the COVID-19 pandemic has mainly been on acute and particularly intensive care, it is important to consider other services that are still needed. This is especially the case for vulnerable patients with long-term conditions, such as those under the care of an adult congenital heart disease (ACHD) service.]

Use of Telehealth in Mental Health (MH) Services During and After COVID-19.
Molfenter T. Community Mental Health Journal 2021;:Online ahead of print.
[COVID-19 social distancing guidelines caused a rapid transition to telephone and video technologies for the delivery of mental health (MH) services. The study examined: (a) adoption of these technologies across the MH service continuum; (b) acceptance of these technologies; and (c) intention of providers to use these technologies following the pandemic based on a sample of 327 MH organizations from 22 states during May-August 2020.]

Persistent symptoms following SARS-CoV-2 infection in a random community sample of 508,707 people.
Imperial College London; 2021.
[Random samples of the population between September 2020 and February 2021 found that nearly 27,000 (around 6%) reported experiencing at least one of 29 symptoms linked with COVID-19 for 12 weeks or more.]

Potential Coronavirus (COVID-19) symptoms reported through NHS Pathways and 111 online (18 Mar 2020-30 Jun 2021).
NHS Digital; 2021.
[Data published on potential COVID-19 symptoms reported through NHS Pathways and 111 online Dashboard shows the total number of NHS Pathways triages through 111 and 999, and online assessments in 111 online which have received a potential COVID-19 final disposition. This data is based on potential COVID-19 symptoms reported by members of the public to NHS Pathways through NHS 111 or 999 and 111 online, and is not based on the outcomes of tests for coronavirus. This is not a count of people.]


Coronavirus Shielded Patient List Summary Totals, England – as at 01 July 2021.
NHS Digital; 2021.
[Snapshot on 22 Jun 2021 – England only.]

Primary Care Workforce in Alternative Settings – General Practitioners in the Covid Clinical Assessment Service.
NHS Digital; 2021.
[28 Mar 2020 to 31 Mar 2021.The COVID-19 Clinical Assessment Service was operative from 28 March 2020 to May 2021 and there were fluctuations in the demand for patient appointments during this period according to the COVID-19 infection rates. Recruitment to the service ceased in January 2021 and all GPs were onboarded by March this year.]

Remote home monitoring (virtual wards) for confirmed or suspected COVID-19 patients: a rapid systematic review.
Vindrola-Padros C. EClinicalMedicine 2021;37:Vindrola-Padros.
[A rapid systematic review on models led by primary and secondary care across seven countries (US, Australia, Canada, The Netherlands, Ireland, China, UK) identified 27 articles. Monitoring was carried out via online platforms, paper-based systems with telephone calls or (less frequently) through wearable sensors. No substantive conclusions regarding patient safety and the identification of early deterioration due to lack of standardized reporting and missing data.]

Bridging the uptake gap – COVID-19 vaccination toolkit for Black African and Black African Caribbean communities.
NHS England; 2021.
[Evidence-based good practice for increasing vaccination confidence and uptake among Black African and Black African Caribbean populations.]