Title: Understanding and addressing loneliness in people with chronic obstructive pulmonary disease
Funder: Economic and Social Research Council

Abstract: Within this fellowship I aim to use the findings of my PhD as a catalyst to develop new knowledge, skills and networks that will support my longer-term research career at the interface between psychological science and respiratory research. Within and beyond this fellowship, my ambition is to raise the profile of psychological science within respiratory research, and improve understanding of, and support for, people with chronic respiratory disease through psychologically-informed practice. To achieve this aim and progress towards my long-term term ambitions, I will move Division and Faculty to join the Health Psychology Section at King's College London, and work to achieve the following fellowship objectives: 1) Improve my knowledge and research skills to support a future research career at the interface of psychology and respiratory health Activities meeting this objective will include formal training about: theoretical approaches to behaviour change, patient reported outcome measures (including mental health assessment), techniques required for advanced statistical modelling, and how to build impact into research design. Additional activities include a visit to an internationally leading research organisation in Belgium, mentoring and support as a researcher based within the Health Psychology Section at King's College London, and engagement with MSc teaching and supervision. 2) Strengthen current and future impact opportunities through dissemination and networking with diverse stakeholders in respiratory psychology Key activities will focus on engaging with a range of different multi-disciplinary audiences and developing impact opportunities, including: submitting to and attending conferences spanning respiratory, psychological and social domains, submitting two academic publications (one from the final component of my PhD, one relating to the preliminary research conducted within the fellowship), and disseminating my findings to wider organisations, policy-influencers and the public via policy briefs, blogs and social media. 3) Conduct further limited research on the role of loneliness in the physical and mental health of people with chronic obstructive pulmonary disease (20% of the fellowship) Objective 3 focuses on carrying out further limited research to explore experiences of loneliness in people with chronic obstructive pulmonary disease, through a secondary analysis of interview data collected during my PhD. This work will progress an important topic that was raised by participants and service-user stakeholders throughout my PhD, but has yet to be addressed by respiratory research. 4) Develop a competitive funding proposal to progress research in this area Bringing together learning from Objectives 1-3, Objective 4 activities will focus on development of a funding proposal for future research. I will explore potentially useful datasets, lead stakeholder proposal development workshops and undergo mock peer-review processes to create a competitive proposal ready for submission to an ESRC New Investigator Grant call. Altogether, this fellowship will equip me with the knowledge and skills, pathways to impact, and preliminary evidence required to submit research proposals that address the psychosocial needs of people living and dying with chronic obstructive pulmonary disease.

Lay abstract: Chronic Obstructive Pulmonary Disease (COPD) is a common lung condition, affecting over three million people in the UK[1] and over 325 million people worldwide[2]. Common and disabling symptoms include breathlessness, cough and fatigue, which increasingly limit individuals' daily activities[3], and contribute to social isolation and loneliness[4]. Related to this, people with COPD are at increased risk of depression[5], and have almost twice the odds of dying by suicide than someone without the disease[6]. While medications, vaccinations, exercise- and self-management interventions can help people with COPD to manage their condition, the disease and its symptoms worsen over time there is currently no cure. Psychosocial support for people with COPD as they live and die with this disease is an essential clinical priority, yet there is still a lack of research in this area. Throughout my PhD project I worked with people with COPD and frailty, and loneliness was raised a common concern by both research participants and service user representatives. For example, when exploring experiences of frailty and rehabilitation services[7], participants emphasised feelings of loneliness as their declining health limited their day-to-day activities, and how they often missed the social aspects of group rehabilitation when their programme came to an end. As I collaborated with additional service users to design a new approach, they again highlighted the need to address, and measure, social outcomes. While these influences led to a heightened focus on loneliness within my PhD work about COPD and frailty, it was clear that dedicated research is needed to fully address this important unmet need. People with COPD have described feeling isolated and lonely in previous interview studies [7-10], and although population data is currently limited, it appears between 10-35% [11, 12] of people with COPD may be experiencing loneliness. People with chronic respiratory disease are likely at particular risk of loneliness: they face a shrinking social world due to the impacts of their symptoms on mobility. This is compounded by societal issues of stigma and shame due to perceptions of their illness as 'self-inflicted' and more recently negative public reactions to symptoms like cough due to associations with Covid-19[13]. Given evidence outside of lung disease showing that loneliness is associated with worse physical and psychological health, including putting people at higher risk of suicidal thoughts and behaviours[14], plus economic consequences due to lost productivity and increased healthcare utilisation[15], addressing these concerns is of upmost importance to society. Within this fellowship, I aim to use the findings of my PhD as a bridge to a new, essential programme of work around loneliness and the wider psychosocial health of people with COPD. To consolidate my PhD and strengthen potential impact of this future work, my first two objectives are to improve my knowledge and research skills to support a future research career at the interface of psychology and respiratory health (objective 1), and to strengthen current and future impact opportunities through dissemination and networking with diverse stakeholders in respiratory psychology (objective 2). Activities to support these objectives include: structured training courses in behavioural science and statistics, mentoring by a health psychologist, a visit to international respiratory psychology experts, academic dissemination and networking through publications and conferences, and creating outputs specifically for policy-makers and the public. Alongside this, I will conduct further limited research on the role of loneliness in the physical and mental health of people with COPD through a secondary analysis of my PhD interview data (objective 3), and develop a competitive funding proposal to progress research in this area (objective 4).

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: RESPIRATORY;MENTAL HEALTH