When the COVID-19 pandemic began and the first national lockdown started in England, my next-door neighbour was an older woman, who was instructed to shield and not leave her home. I called her after a few days, worrying about how she’s getting shopping and food, and she told me that her daughter had set up Meals on Wheels for her, and that she’s getting her meals every day. I am an Associate Professor in Public Health Nutrition, so I had heard of Meals on Wheels, but never really paid much attention, and thought it was a service from the past. In this blog, I share my journey, from a place where I knew nothing about a research topic, to doing research that slowly builds impact to hopefully change policy and practice. The journey is ongoing and will be long, but here are some lessons learnt so far:

1. When you find a topic you are interested in, take time to read: I blocked my calendar for a few days, and searched, and read about Meals on Wheels. And then I read some more. Evidence came mostly from the USA, Australia, and Canada, but all suggested that Meals on Wheels is a lifeline to adults with care and support needs; not only because the service provides a meal to those who are not able to get the ingredients and prepare one, but also because they get to say hello to a friendly face (every day when the service delivers daily), and someone gets to check that everything is okay. The research from England was limited to none, mostly on the satisfaction with, and evaluation of local services.

2. There is no need to pretend you know everything – build the research and professional team collaborators: I don’t have a background in social care and I didn’t know much about social care in England. So I talked to colleagues with expertise in social care and gerontology in the School for Policy Studies, where I’m based, about my readings. I also asked to meet with colleagues from the USA, to learn from their experience. One of them had just published a qualitative study among Meals on Wheels service providers; I asked if I could replicate this in England - one year later, our first paper on Meals on Wheels was published, co-authored with the US team. I still work together with the colleagues we first discussed Meals on Wheels with; it is really important to build a team of people you share common goals with, and bring the right expertise to a body of work.

It’s at that time that I also contacted my University’s Division of Research, Enterprise and Innovation, which includes, among others, a dedicated Impact Development Team, and PolicyBristol, who work specifically on identifying ways to enhance the impact of research on policy and practice. Every University should have similar teams, and I cannot recommend starting discussions with them early on, as they give you important pointers to shape your research so that it leads to impact (and tell you what impact might look like!). PolicyBristol also provided guidance on how to write policy briefings (short documents that help translate research findings into clear recommendations to shape policy), making them an essential tool to engage with policymakers. I had written one before for another project, but I was reminded of the importance of timing the briefing’s publication with an event, governmental announcement or similar type of consultation. Three years forward, we launched our policy briefing in a webinar during the National Meals on Wheels Week 2023 (see lesson 8). Following my first study on Meals on Wheels (see lesson 5), PolicyBristol also pointed me to the Public Accounts Committee’s enquiry on COVID-19 (Supporting the vulnerable during lockdown), and with its help I submitted written evidence based on our findings. Both professional service teams’ insights have been invaluable since day 1 of my journey. 

3. Establish the need for research, and change in policy and practice, in your setting: The number of people in England who live with care and support needs, and could benefit from Meals on Wheels, exceeds 15 million. This includes people living with functional limitations, cognitive decline, disabilities and comorbidities. But in 2018 (the last available data we had at the time), only 36% of Councils in England provided Meals on Wheels – down from 43% in 2016. This was puzzling, because just a few years back, the Care Act 2014 highlighted the need for social care services that prevent and/or delay the need for residential care. Surely, Meals on Wheels was such a service? Apparently, no – currently local authorities have no statutory requirement to provide Meals on Wheels. So clearly something needed to change. Meals on Wheels could relieve financial pressures to healthcare and social care budgets; US research estimated that if ‘all states had increased the number of adults aged ≥65 years who received home-delivered meals in 2009 by 1%, total annual savings to states’ Medicaid programmes could have exceeded $109 million’ – savings that primarily reflected the decreased need for an adult with care and support needs to require nursing home care. Instead, these adults would be able to continue living in their homes and communities for longer, just by receiving Meals on Wheels. Policymakers in England, but also the devolved nations, might value such evidence to make the service statutory, but such evidence doesn’t yet exist in this country. 

4. Don’t rush it: I followed the advice of a wise mentor of mine. When I joined academia, he told me that if I wanted my research to benefit people and create impact to change policy and practice, I would need to start small and build my story (i.e. the evidence). I would also need to talk to people on the ground, understand their needs, and find common visions and goals (i.e. public engagement). And then I would need to find the people who influence policy in the field and talk to them (i.e. policy engagement). But I’d need to remember that when it comes to policy engagement, its relatively rare for impact to happen overnight, or even in a short space of time outside of extraordinary circumstances. Taking time to build up a knowledge base, relationships, and networks can be fundamental to impact happening at all.

5. Start small (i.e. do some exploratory research that doesn’t cost millions): Right then at the beginning of the pandemic, we started by interviewing employees of Meals on Wheels services in two local authorities in England. We found out that the benefits outlined in the international literature apply in England too (e.g. identifying and addressing isolation, promoting independence, the importance of a nutritious meal, carrying out wellbeing checks and helping with household chores). I also found out that I wasn’t alone in not being aware of the service. A participating driver who delivers meals told us they didn’t know either that Meals on Wheels existed before they started working for the service, nor that the service offers support that goes beyond the meal. Our participants perceived that awareness-raising activities are needed if we want more people to benefit from the service. We also heard providers’ concerns about the future of the service; they perceived that more financial support is needed from the local and national government for the service to keep on running. 

6. Do some more exploratory work (nobody will give you those millions just yet): Then we interviewed recipients of Meals on Wheels, and people who referred a family member to the service, this time recruited from four service providers in England. These participants highlighted how the service never fails them, and the benefits of: having a meal every day, the wellbeing checks carried out, how the service helps them continue living in their home, and how it reduces social isolation and offers peace of mind to family members (who could not visit users of the service during the pandemic). Participants also perceived the Meals on Wheels team to be ‘very much part of the care team’, and called for the service to become an essential part of the care package that adults with care and support receive. Again, we found some participants had not heard of Meals on Wheels before starting the service, while others had, but ‘until you need to use the service you don’t register any information’. 

7. Start building a story (i.e. the evidence that could lead to impact), but be realistic: These two small-scale studies helped us start building a case: that there is a need for Meals on Wheels to become a statutory service, and that we need to raise awareness of the service and its benefits. The former would take longer to establish, and needs more robust evidence, for example on cost savings, to influence policy, which we are trying to obtain through ongoing research and grant applications. So we continued with the latter. 

8. Work with people who have lived experience of what you are researching (i.e. public engagement): We knew that to raise awareness of Meals on Wheels, we needed to consult with people who have lived experience of the service. So we ‘recruited’ a group of six Meals on Wheels recipients and people who referred a family member to the service, because our research showed that the latter are most likely to set up Meals on Wheels for an adult with care and support needs. We worked together with this group (our ‘PPI’ group, patient and public involvement, to use the academic term) throughout the summer of 2023, and we co-produced the content and design of two infographics, and a film, from the results of our research. We chose these two methods of knowledge translation because they can be easily disseminated via print and social media (therefore contributing to greater reach and enhancing the possibility of impact). Also, infographics have been suggested to make research easier to communicate and understand, and more accessible, by both experts and non-experts, making them a useful decision aid for policymakers.  

The process of co-production is not easy, and I’m not an expert in it, but it is hugely rewarding. I found that if you approach it as a human being, and not as a ‘tick-box’ exercise, with a genuine interest to listen to what people have to say, only good things can come out of it. We listened, and asked questions, and probed gently to explore the reasoning behind people’s views. And kept notes; many notes. We received such helpful advice, from the colours that should be used, to the need for the images to be diverse (it’s not only older adults who could use Meals on Wheels), to the fact that not everyone might be technology-literate and we need to provide various options of how someone can find out more about the service (from calling their local authority to scanning a QR code that would take them to a relevant website). The group advised us about how, and to whom, we should disseminate these resources. We were also told that a film that contains only academic voices would likely not be well-received; if we want to raise awareness, it’s important for the people who have actual experience of Meals on Wheels to tell their story. We wouldn’t have known all this if we had set out to develop these resources from our own academic silos. 

We launched the resources last month, during National Meals on Wheels Week 2023. The resources are free to download and re-use, after reviewing a licence agreement and answering a few questions, from this website: https://express-licences.bristol.ac.uk/product/meals-on-wheels-awareness-raising-aids . 

The film can be found here:  https://www.youtube.com/watch?v=mO3GtnPO4E4& ;t=5s 

We also published a policy briefing that outlines the research and recommendations for policy and practice. 

9. Talk with more people and build a stronger case (public and policy engagement): If we want to reach the stage where our research changes policy and practice, we need to identify the right stakeholders. Since we started our Meals on Wheels body of research in 2020, I have been emailing service providers, organisations advocating for Meals on Wheels, and public bodies, at every available opportunity, but without pestering. Not everyone replies, but I have built some excellent relationships, with fantastic people, along the way. I got to hear about the incredible work that service providers do, and the challenges they face. Charities, non-profit organisations, and public service associations have invited me to present and discuss our research, which has led to developing a network of stakeholders supporting our work. I note the questions stakeholders need answers to, and I’m trying to build our research around those. Slowly, my network is expanding to people who are influencing policy. Our research has placed me to attend the launch of the National Meals on Wheels Week 2022 in the house of Lords, where I discussed our findings and advocated for the service with Members of the House. With the help of my School's Research Impact Director, I contacted a Chief Officer of a Ministerial Department, to let them know of our co-produced resources and policy briefing. It sparked their interest, they attended the launch in November 2023, and then emailed me to thank me for the work. It's a small step into policy engagement - simply by saying yes to the right opportunities, and developing respectful relationships. 

10. Build in time to take stock. In a presentation on how to build impact from research, we were shown a graph that I remember to this day: it could take 10 years or longer to achieve impact. We know the journey is long, and hopefully it will have some wins along the way (some providers have already told us that the infographics are helping them to keep their services running). During the journey, nurturing relationships and connections will be important, and expanding networks might open up new roads. Finding time to take stock of everything is essential. Bumps along the way will also be inevitable. But it is all worth it to help achieve our ultimate aim: bringing Meals on Wheels on the social care policy agenda, for the benefit of the millions of adults who live with care and support needs, and their carers.

Dr Angeliki Papadaki (angeliki.papadaki@bristol.ac.uk) is an Associate Professor in Public Health Nutrition at the School for Policy Studies, University of Bristol.