North of England Alcohol Team (NEAT) research partnership: barriers and opportunities to deliver research into alcohol related liver disease in the north of England

Alcohol, Liver disease, Patient and public involvement, Research infrastructure ALL Metrics - Views Downloads How to cite this article Parker R, Abouda G, Harrison L et al. North of England Alcohol Team (NEAT) research partnership: barriers and opportunities to deliver research into alcohol related liver disease in the north of England [version 1; peer review: 2 approved with reservations]. NIHR Open Res 2025, 5:101 (https://doi.org/10.3310/nihropenres.13946.1) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente Select a format first ▬ ✚ Research Article [version 1; peer review: 2 approved with reservations] Richard Parker https://orcid.org/0000-0003-4888-8670 1,2, George Abouda3, Laura Harrison https://orcid.org/0000-0001-5516-4764 4, [...] Steven Masson5, Paul Richardson6, Judith Cohen7, Laura Goodwin8, Thomas Phillips https://orcid.org/0000-0001-8020-4510 9, Eileen Kaner https://orcid.org/0000-0002-7169-9344 10, Amy O'Donnell https://orcid.org/0000-0003-4071-9434 10, Sam Finnikin11, Ian Rowe https://orcid.org/0000-0003-1288-0749 1,2, Roya Vazirir12, John Holmes13Richard Parker https://orcid.org/0000-0003-4888-8670 1,2, George Abouda3, [...] Laura Harrison https://orcid.org/0000-0001-5516-4764 4, Steven Masson5, Paul Richardson6, Judith Cohen7, Laura Goodwin8, Thomas Phillips https://orcid.org/0000-0001-8020-4510 9, Eileen Kaner https://orcid.org/0000-0002-7169-9344 10, Amy O'Donnell https://orcid.org/0000-0003-4071-9434 10, Sam Finnikin11, Ian Rowe https://orcid.org/0000-0003-1288-0749 1,2, Roya Vazirir12, John Holmes13 PUBLISHED 16 Oct 2025 Author details Author details 1 Leeds Liver Unit, Leeds Teaching Hospitals NHS Trust, Leeds, England, UK 2 University of Leeds Leeds Institute of Medical Research at St James's, Leeds, England, UK 3 Gastroenterology and hepatology, Hull University Teaching Hospitals NHS Trust, Hull, England, UK 4 Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England, UK 5 Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, England, UK 6 NHS University Hospitals of Liverpool Group, Liverpool, England, UK 7 University of Hull Faculty of Health Sciences, Hull, England, UK 8 Lancaster University Faculty of Health and Medicine, Lancaster, England, UK 9 Centre for Addiction and Mental Health Research, University of Hull, Hull, England, UK 10 Population Health Sciences Institute, The University of Newcastle, England, UK 11 University of Birmingham Birmingham Medical School, Birmingham, England, UK 12 Executive Medical Director, Waythrough, Humankind, Durham, England, UK 13 The University of Sheffield School of Health and Related Research, Sheffield, England, UK 2 University of Leeds Leeds Institute of Medical Research at St James's, Leeds, England, UK 3 Gastroenterology and hepatology, Hull University Teaching Hospitals NHS Trust, Hull, England, UK 4 Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England, UK 5 Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, England, UK 6 NHS University Hospitals of Liverpool Group, Liverpool, England, UK 7 University of Hull Faculty of Health Sciences, Hull, England, UK 8 Lancaster University Faculty of Health and Medicine, Lancaster, England, UK 9 Centre for Addiction and Mental Health Research, University of Hull, Hull, England, UK 10 Population Health Sciences Institute, The University of Newcastle, England, UK 11 University of Birmingham Birmingham Medical School, Birmingham, England, UK 12 Executive Medical Director, Waythrough, Humankind, Durham, England, UK 13 The University of Sheffield School of Health and Related Research, Sheffield, England, UK Richard Parker Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing George Abouda Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing Laura Harrison Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing Steven Masson Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing Paul Richardson Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing Judith Cohen Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing Laura Goodwin Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing Thomas Phillips Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing Eileen Kaner Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing Amy O'Donnell Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing Sam Finnikin Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing Ian Rowe Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing Roya Vazirir Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing John Holmes Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing OPEN PEER REVIEW REVIEWER STATUS Alcohol-related liver disease is a common cause of premature death, with higher incidence in the north of England and particularly in areas of high deprivation. Despite this burden of disease, research into liver disease has historically been delivered in other areas of the United Kingdom. THe North of England Alcohol Team (NEAT) research partnership was funded by the NIHR to improve the infrastructure for research into ArLD and in the north of england. NEAT used a variety of methods to bring together stakeholders in ArLD to face-to-face and virtual meetings to identify current barriers to research, possible solutions and research priorities in ArLD. A dedicated public and patient involvement and engagement (PPIE) group was established to support NEAT and future research. An online educational resource was developed. Finally, online workshops including all relevant stakeholders delivered applications for further research funding for specific projects. NEAT used a variety of workstreams to achieve its aims. Regional meetings allowed face to face discussion as well as online conversations to identify current barriers to research in ArLD and potential measures to overcome them. Research priorities were confirmed and means to address research barriers were discussed. A PPIE group was convened, and terms of engagement agreed. A virtual research training pack was developed. Research questions were developed, discussed and prepared for future funding applications. We plan to investigate the value of community clinics to improve engagement with liver medicine. NEAT brought together a wide range of stakeholders with an interest in improving access to research for people living with alcohol related liver injury. Infrastructure for research was developed including training resources and a PPIE group. This will underpin future research into ArLD in the north of England and more widely. Severe liver disease is most commonly caused by alcohol. Alcohol-related liver disease causes more hospital admissions and more deaths than any other cause of liver disease. Rates of ArLD are not even across the UK: there is a much higher rate in the north of England. However, research into liver disease tends to be done elsewhere in the UK, and tends not to be focussed on alcohol . We can’t reduce rates of liver disease or improve how we look after people without research. The north of England alcohol team (NEAT) is a project to allow more research to be done in ArLD in the North. The north of England Alcohol Team brings together a range of people to address low rates of research in alcohol related liver disease in the north. We have identified barriers to research and areas where research is most needed. We held a series of meetings across the north to discuss current barriers to research, how we could address these and which research questions were thought to be most important. We set up a group of patients, carers and the public to advise on research and plans for research projects. We developed a training pack to help people without experience of clinical research to get involved. The activities of NEAT has helped us to create more infrastructure to support future research to address the high numbers of people who have liver disease in our region. Alcohol, Liver disease, Patient and public involvement, Research infrastructure Corresponding Author(s) Richard Parker ([email protected]) Grant information: This project is funded by the National Institute for Health Research (NIHR) under its [‘Research for Patient Benefit (RfPB) Programme’ (Grant Reference Number: NIHR155041]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2025 Parker R et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Parker R, Abouda G, Harrison L et al. North of England Alcohol Team (NEAT) research partnership: barriers and opportunities to deliver research into alcohol related liver disease in the north of England [version 1; peer review: 2 approved with reservations]. NIHR Open Res 2025, 5:101 (https://doi.org/10.3310/nihropenres.13946.1) First published: 16 Oct 2025, 5:101 (https://doi.org/10.3310/nihropenres.13946.1) Latest published: 16 Oct 2025, 5:101 (https://doi.org/10.3310/nihropenres.13946.1) The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Alcohol related liver disease (ALD) is the commonest cause of liver-related deaths in the UK. ALD causes a significant burden of premature mortality, particularly in areas of greater deprivation1. ALD affects around 3% of the general population2 but is much more common in people who drink hazardously. This means that the burden of ArLD is not evenly distributed across the UK, but is concentrated in some areas1. The north of England has higher than average rates of hospital admissions and deaths due to ArLD; however these same areas have lower rates of liver research3. This discrepancy means that many people with ArLD are unable to access research, and that progress in the prevention, understanding and management of ArLD improves more slowly. The North of England Alcohol Team is an NIHR-funded research partnership, designed with the intention of being the first step to improving outcomes in ArLD through research, and improving access to research in areas of high disease prevalence in the north of England. A region-wide survey of experience, training and confidence in research was done online using a google form. This survey was shared widely amongst all practitioners working with people with alcohol excess and/or ArLD. A further survey aimed specifically at hepatologists who are most likely to act as chief investigators or principal investigators was done in tandem with another NIHR funded research partnership, ALPINE. These surveys were anonymous and response was voluntary. Respondents were asked to indicate their professional background but no identifying information was recorded Face-to-face meetings were held across the north of England in Manchester, Leeds and Middlesbrough and a further meeting held online where barriers to research were explored in more detail. These meetings were facilitated by an independent meeting leader to ensure that all attendees had the opportunity to present their opinions. Views of barriers to research were captured with free text and photographs. Potential solutions to perceived research barriers were discussed. Free text was recorded and themes identified with word frequency analysis to produce word clouds. No identifiable information about participants was recorded. Areas of research into ArLD that should be a priority for research attention were discussed and meeting attendees invited to record these with free text. The NEAT project included funding to support the development of a dedicated patient and public involvement and engagement (PPIE) group. A liver charity group, LiverNorth, was engaged from the outset of the project and acted as co-applicants for the initial application. The outcome of meetings to discuss research was summarised using text analyses to identify common themes, including generation of word frequency and visualised with word cloud images. We did not seek ethical approval for this work as no sensitive data were collected regarding for example gender, age, ethnicity or sexual orientation. All reponses to online surveys or in meetings were voluntary and anonymous and are reported as simple aggregate data. In view of this, and the hybrid nature of meetings (i.e. a combination of virtual and face to face events) we sought verbal consent to make notes of the words that people put onto post-it notes. Training, education and experience. Seventy-five respondents completed an online survey to report their experience of medical research. This included 28 nurses, doctors and 12 additional workers. There was a marked spread of experience, confidence and training in research (Figure 1). Overall a minority of respondents (43%) reported some or lots of experience of research, 27% reported being fairly confident or very confident doing research and 27% of respondents reported receiving some or lots of research training (Figure 1). Experience, confidence and training in research differed by professional background. Respondents who considered themselves academic reported very high levels of each metric as did medical doctors, whereas alcohol and addiction practitioners and nursing staff reported lower levels of experience (supplementary table)4. Perceived barriers to research. Face to face meetings were held across the north of England (in Manchester, Middlesbrough and Leeds) and online. At each meeting attendees considered current barriers to research in alcohol related liver disease. Common barriers identified were stigma around ArLD, a lack of practitioners’ time for research, and a lack of training and experience (Figure 2). Sorting these barriers into themes showed that practical problems, in particular time, were the biggest barriers to research in ArLD, as well as stigma, training and funding. Further to this, in collaboration with another NIHR funded research partnership (ALPINE) we undertook another survey of the medical workforce in gastroenterology or hepatology to explore current time available for research. Of twenty respondents, 8 reported that they had protected research time in their job plan but overall the average time available for research was low - a median of 1 session per week and there was scepticism that doing research was feasible with current arrangements: only 6 of the respondents considered that research was feasible with current demands on their time. Potential solutions to the identified barriers were discussed. Similar thematic analysis of attendees’ responses showed a need for increased opportunities for research and greater experience as common themes in improving research. Further categorisation of the proposed solutions to improve rates of research prioritisation showed that the NEAT group considered improving access to research for participants, and improving education and training for practitioners as the most important factors. In light of the findings of the online survey and the discussions in meetings, we developed a training package for allied health professionals that addressed basic foundations of research and put this in the context of liver disease. This has been developed to be delivered as an online course to increase its accessibility. The NEAT group considered future research into ALD, and the research questions that should be answered. Common themes that were considered important were broadly grouped as research into natural history (How do metabolic or psychological cofactors influence the development of ALD?), interventional (How can we prevent progression of ALD), structural (How can we improve engagement with medical services? How does the built environment influence ALD?). Further research into palliative care was considered important, and moving research into primary care or community settings was also identified as a priority. Themes for future research are summarised in Figure 3. We developed a dedicated PPIE group to support the activities of NEAT. We recruited to the PPIE group through direct approaches to people with lived experience of disease in clinical services, and invitations to those with an interest in PPIE through established connections with the NEAT team. We held a series of virtual meetings initially to discuss the terms of reference for the group, and to discuss NEAT activities and future plans. In light of the work of the NEAT group to identify barriers to research and future research priorities, potential research studies were developed and discussed. Online meetings were held with the NEAT co applicants, the NEAT PPI group and finally a combined meeting of both groups. Overall the groups felt that a research study that explored new ways of delivering specialist care to people with advanced disease, by providing community liver clinics would address many of the important issues that were identified. The LOCAL study (LOcally delivered Care in people at high risk of liver Outcomes) will explore if providing liver clinics in communities where people live, rather than providing clinics in hospitals in the traditional model, improves outcomes through better engagement of care. This will be delivered in several sites across the north of England, in areas of high prevalence of disease and with historically lower rates of research participation. Alcohol related liver disease is a common but preventable cause of premature mortality in the north of England1. Despite the prevalence of ALD, there has been a marked discrepancy with research resources where ALD is less likely to be the focus of research spending or activity. The North of England Alcohol Team was developed to review research activity and provide infrastructure for future research. NEAT achieved its aims through online meetings, educational resources, PPIE groups and by developing new research proposals that will increase access to research opportunities for people living with ALD and their carers in the north of England. NEAT has documented the lack of current infrastructure for research into ALD in the north of England showing a lack of training, experience and confidence in many groups of practitioners, especially marked amongst groups who probably spend the most amount of time interacting with potential trial recruits. This may be both cause and effect of the historic lower levels of research activity in the north of England. Even amongst research trained and active clinicians, time available for research was minimal and there was not much optimism that delivering research was possible. When considering solutions to the current barriers to research, improving experience and training were both identified as means to improve research activity. The NEAT project brought together a wide range of stakeholders, many of whom met for the first time through NEAT despite working in similar fields. The groups were able to discuss common experiences and based on this background, identified current problems that need to be addressed to facilitate research, and important research questions that will improve care for people living with ALD. Facilitating this interaction, whilst not one of the major objectives of the NEAT partnership, was nevertheless very valuable and allowed connections to be made between individuals. In addition to exploring current barriers to research, the NEAT project was intended to create an infrastructure that would allow greater research activity in ALD. This has been achieved through supporting training via an online course and a PPI group. THese resources will underpin the research projects that have been developed based on the work of the NEAT group as we move towards delivering research to previously underserved populations. https://doi.org/10.5281/zenodo.166311924 This project contains the following underlying data: Data are available under the terms of the Creative Commons Zero "No rights reserved" data waiver (CC0 1.0 Public domain dedication) Faculty Opinions recommendedReferences - 1. Public Health England: The 2nd atlas of variation in risk factors and healthcare for liver disease in England. 2017. Reference Source - 2. Amonker S, Houshmand A, Hinkson A, et al.: Prevalence of alcohol-associated liver disease: a systematic review and meta-analysis. Hepatol Commun. 2023; 7(5): e0133. PubMed Abstract | Publisher Full Text | Free Full Text - 3. NIHR: NIHR support and services. Reference Source - 4. Parker R: North of England Alcohol Team [Data set]. In: NIHR Open. Zenodo. 2025. http://www.doi.org/10.5281/zenodo.16631192 Author details Author details 1 Leeds Liver Unit, Leeds Teaching Hospitals NHS Trust, Leeds, England, UK 2 University of Leeds Leeds Institute of Medical Research at St James's, Leeds, England, UK 3 Gastroenterology and hepatology, Hull University Teaching Hospitals NHS Trust, Hull, England, UK 4 Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England, UK 5 Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, England, UK 6 NHS University Hospitals of Liverpool Group, Liverpool, England, UK 7 University of Hull Faculty of Health Sciences, Hull, England, UK 8 Lancaster University Faculty of Health and Medicine, Lancaster, England, UK 9 Centre for Addiction and Mental Health Research, University of Hull, Hull, England, UK 10 Population Health Sciences Institute, The University of Newcastle, England, UK 11 University of Birmingham Birmingham Medical School, Birmingham, England, UK 12 Executive Medical Director, Waythrough, Humankind, Durham, England, UK 13 The University of Sheffield School of Health and Related Research, Sheffield, England, UK 2 University of Leeds Leeds Institute of Medical Research at St James's, Leeds, England, UK 3 Gastroenterology and hepatology, Hull University Teaching Hospitals NHS Trust, Hull, England, UK 4 Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England, UK 5 Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, England, UK 6 NHS University Hospitals of Liverpool Group, Liverpool, England, UK 7 University of Hull Faculty of Health Sciences, Hull, England, UK 8 Lancaster University Faculty of Health and Medicine, Lancaster, England, UK 9 Centre for Addiction and Mental Health Research, University of Hull, Hull, England, UK 10 Population Health Sciences Institute, The University of Newcastle, England, UK 11 University of Birmingham Birmingham Medical School, Birmingham, England, UK 12 Executive Medical Director, Waythrough, Humankind, Durham, England, UK 13 The University of Sheffield School of Health and Related Research, Sheffield, England, UK Richard Parker Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing George Abouda Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing Laura Harrison Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing Steven Masson Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing Paul Richardson Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing Judith Cohen Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing Laura Goodwin Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing Thomas Phillips Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing Eileen Kaner Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing Amy O'Donnell Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing Sam Finnikin Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing Ian Rowe Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing Roya Vazirir Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing John Holmes Roles: Conceptualization, Writing – Review & Editing Roles: Conceptualization, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information This project is funded by the National Institute for Health Research (NIHR) under its [‘Research for Patient Benefit (RfPB) Programme’ (Grant Reference Number: NIHR155041]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright © 2025 Parker R et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. metrics VIEWS $counts.viewCount downloads Citations CITE how to cite this article Parker R, Abouda G, Harrison L et al. North of England Alcohol Team (NEAT) research partnership: barriers and opportunities to deliver research into alcohol related liver disease in the north of England [version 1; peer review: 2 approved with reservations]. NIHR Open Res 2025, 5:101 (https://doi.org/10.3310/nihropenres.13946.1) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. track receive updates on this article Track an article to receive email alerts on any updates to this article. Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 16 Oct 2025 Views 0 How to cite this report: Schölin L. Reviewer Report For: North of England Alcohol Team (NEAT) research partnership: barriers and opportunities to deliver research into alcohol related liver disease in the north of England [version 1; peer review: 2 approved with reservations]. NIHR Open Res 2025, 5:101 (https://doi.org/10.3310/nihropenres.15155.r38740) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/5-101/v1#referee-response-38740 https://openresearch.nihr.ac.uk/articles/5-101/v1#referee-response-38740 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Reviewer Report 08 Jan 2026 Approved with Reservations VIEWS 0 Thank you for inviting me to review this article on research priorities for alcohol-related liver disease research in the North of England. The article outlines information from a variety of sources showing what the barriers to undertaking research into ArLD ... Continue reading I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close Thank you for inviting me to review this article on research priorities for alcohol-related liver disease research in the North of England. The article outlines information from a variety of sources showing what the barriers to undertaking research into ArLD in North of England and setting research priorities for future research, with support of people with lived experience. I think the article adds value in demonstrating how the gap in research in an area of high need can be filled. I think the article requires some revision, which mainly comes down to lack of details on methodological aspects, presentation of the findings, and to some extent anchoring in the wider literature.

Introduction - The introduction and is very short and ArLD is not my specific area of expertise so I don’t know for sure what literature should reasonably be covered here but there appears to be a JLA priority setting exercise done for ArLD (https://www.jla.nihr.ac.uk/priority-setting-partnerships/alcohol-related-liver-disease#tab-top-10-priorities) and there are some articles around this https://www.thelancet.com/journals/langas/article/PIIS2468-1253(24)00009-8/abstract. I’d suggest fleshing the introduction out a bit further at least to acknowledge other priority setting activities and how that links (or doesn’t link) to the current article and associated research. - The other research partnership (ALPINE) should be described to the reader, including spelling out the acronym if it is indeed a project name acronym. - There is a lack of detail around recruitment for the survey participants. How many services was the survey sent to or what was the process for sending this out? Whilst it may not be possible to comment on the potential population of relevant responders, further detail on the overall population it was sent to should be added including how this was done (e.g. is there an established email list for all practitioners). In addition, the article speaks to two different surveys, may there be overlap between the hepatologist survey and the broader survey? Worth noting that it might have some of the same responders if they were recruited from the same services. - Meetings – is it correct that there were a total of four meetings (three in-person and one online)? Clarification of number of meetings, number and overall characteristics (understand no identifiable information was recorded but if there is some record of job roles for example) of participants, length of meetings, and how people were invited to these meetings should be added. - More detail should be added to the PPIE section – how many people form part of this group? Authors note they have been engaged from the outset but don’t specify how. In addition, adding detail here on their input on the current article would be useful as well. - The authors note that responses were analysed according to themes and ‘word frequency’. Was there any methodological framework for this analysis? It reads a little thin without any form of structured analysis which probably was the case but may not have been described. Some further detail/clarification here would be useful. - Was there any overlap between meetings and survey? I.e. were people who attended the meetings also invited to respond to the survey? - The results talk about perceived barriers - The first sentence refers to number of respondents to the survey, which states it “includes 28 nurses, doctors and 12 additional workers”. This is unclear – state the breakdown of all respondents as this leaves gaps: of the n=75, 28 were nurses, x(?) were doctors, and 12 were ‘additional workers’? i.e. does this mean n=40 were professionals (depending if the number of doctors have been included or not here) and the remaining 35 were who? Also, ‘additional workers’ is very unclear so please provide clarification of what types of roles these individuals had. - Authors note differences in experience, confidence and training based on professional background and cite a supplementary table. When reviewing the supplementary files, the only table I can find is a raw data file. As the authors are drawing conclusions on aggregated data it would make sense to provide these findings (even if supplementary) rather than the reader having to analyse the raw data to find the findings that the authors are presenting. I’d suggest re-writing this paragraph to actually summarise the findings with numbers and/or percentages. - The first sentence in the sub section perceived barriers repeat what’s already in the methods and I suggest removing. - I am not convinced a word cloud is the best way to present these findings – is the focus here to show the prominence of stigma as a perceived barrier relative to other barriers? The paragraph talks about the themes that they have been sorted into and for the reader I think it’s more relevant to see these themes rather than individual words in a word cloud. - The findings from the ‘additional survey’ only focused on time available for research it only looked at one very specific barrier (rather than ‘perceived barriers’ which is broader)? Might need further contextualising. - The research priority section is only presented as a word cloud which seems to miss important detail. Since there was work to categorise these in themes I would suggest outlining these findings relating to the themes developed as in my opinion the word cloud doesn’t give the reader an idea of the overall findings. - ‘PPIE group’ – is this section describing something different to the section in the methods? If so, how did the exiting PPIE group influence the establishment of a PPIE group, as described in the results section? - While I understand the article is dealing with outlining the barriers and future directions in a particular region of England, it may be interesting to situate this against the broader literature. If there is any literature on this, are these barriers seen elsewhere i.e. similar in other locations? Also, is the proposed study, developed from the findings and priorities, unique or has this been done elsewhere? I.e. will be useful to show the broader picture and implications of the work, and its link to the broader literature (as there is hardly any literature cited), or whether it is all unique and local barriers/issues and solutions or there is a broader picture to be discussed. - As mentioned in the introduction, discussion in relation to existing priorities at a broader level would be useful to show how it aligns/differ from other work and priorities. - Is the work clearly and accurately presented and does it cite the current literature? Partly - Is the study design appropriate and is the work technically sound? Yes - Are sufficient details of methods and analysis provided to allow replication by others? Partly - If applicable, is the statistical analysis and its interpretation appropriate? Not applicable - Are all the source data underlying the results available to ensure full reproducibility? Yes - Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Substance use and mental health, public health - not an expert on ArLD specifically but have experience of alcohol-related research and activaties around setting research priorities CITE HOW TO CITE THIS REPORT Schölin L. Reviewer Report For: North of England Alcohol Team (NEAT) research partnership: barriers and opportunities to deliver research into alcohol related liver disease in the north of England [version 1; peer review: 2 approved with reservations]. NIHR Open Res 2025, 5:101 (https://doi.org/10.3310/nihropenres.15155.r38740) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/5-101/v1#referee-response-38740 https://openresearch.nihr.ac.uk/articles/5-101/v1#referee-response-38740 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. Views 0 How to cite this report: Shah N. Reviewer Report For: North of England Alcohol Team (NEAT) research partnership: barriers and opportunities to deliver research into alcohol related liver disease in the north of England [version 1; peer review: 2 approved with reservations]. NIHR Open Res 2025, 5:101 (https://doi.org/10.3310/nihropenres.15155.r38216) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/5-101/v1#referee-response-38216 https://openresearch.nihr.ac.uk/articles/5-101/v1#referee-response-38216 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Reviewer Report 25 Nov 2025 Approved with Reservations VIEWS 0 Thank you for the opportunity to review this valuable manuscript. This paper highlights a significant gap between the disease burden and research activity. The manuscript reflects an impressive engagement work bringing all the stakeholders together to address an important ... Continue reading I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close Thank you for the opportunity to review this valuable manuscript. This paper highlights a significant gap between the disease burden and research activity. The manuscript reflects an impressive engagement work bringing all the stakeholders together to address an important issue. Overall, this manuscript is all encompassing and covers all the pertinent issues. However, additional information/clarification would be helpful to make it robust. Major Comments 1. Methods The manuscript outlines surveys, meetings, and qualitative summaries, detailed information would be helpful for the readers to understand the robustness of the findings The data encompasses a wide range of barriers (e.g., stigma, IT systems, organisational boundaries, political factors) and solutions (e.g., community screening, transport support, flexible appointments). Incorporating these in the results section, would highlight the contributions of the stake holders. 3. Research priorities could be elaborated a bit mote The research ideas dataset includes a very broad set of priorities from prevention to palliative care, early detection, trauma-informed care, gender differences, and data infrastructure. Presenting a summary of these priorities (rather than a simplified list) would better reflect the depth of participant input. 4. It would help to clarify the PPIE section -How many PPI members were involved -How their views influenced decisions or priorities -Any reflections on how the group will be sustained Minor Comments Overall Assessment This work clearly addresses a major unmet need. An additional information on the methods and highlighting the detailed information from the stakeholders in the manuscript will make a valuable contribution to the literature on research capacity building in underserved regions. I look forward to seeing the revised version. Top of Form Bottom of Form Overall, this manuscript is all encompassing and covers all the pertinent issues. However, additional information/clarification would be helpful to make it robust. Major Comments 1. Methods The manuscript outlines surveys, meetings, and qualitative summaries, detailed information would be helpful for the readers to understand the robustness of the findings - How survey participants were recruited and the response rate. - How meeting data were analysed i.e coding approach, how themes were generated). - Numbers and types of participants attending meetings and PPIE sessions. The data encompasses a wide range of barriers (e.g., stigma, IT systems, organisational boundaries, political factors) and solutions (e.g., community screening, transport support, flexible appointments). Incorporating these in the results section, would highlight the contributions of the stake holders. 3. Research priorities could be elaborated a bit mote The research ideas dataset includes a very broad set of priorities from prevention to palliative care, early detection, trauma-informed care, gender differences, and data infrastructure. Presenting a summary of these priorities (rather than a simplified list) would better reflect the depth of participant input. 4. It would help to clarify the PPIE section -How many PPI members were involved -How their views influenced decisions or priorities -Any reflections on how the group will be sustained Minor Comments - A few typos - Standardise ArLD terminology. Overall Assessment This work clearly addresses a major unmet need. An additional information on the methods and highlighting the detailed information from the stakeholders in the manuscript will make a valuable contribution to the literature on research capacity building in underserved regions. I look forward to seeing the revised version. Top of Form Bottom of Form - Is the work clearly and accurately presented and does it cite the current literature? Yes - Is the study design appropriate and is the work technically sound? Yes - Are sufficient details of methods and analysis provided to allow replication by others? Partly - If applicable, is the statistical analysis and its interpretation appropriate? Yes - Are all the source data underlying the results available to ensure full reproducibility? Yes - Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Alcohol related liver disease and finding treatment options to help them achieve abstinence CITE HOW TO CITE THIS REPORT Shah N. Reviewer Report For: North of England Alcohol Team (NEAT) research partnership: barriers and opportunities to deliver research into alcohol related liver disease in the north of England [version 1; peer review: 2 approved with reservations]. NIHR Open Res 2025, 5:101 (https://doi.org/10.3310/nihropenres.15155.r38216) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/5-101/v1#referee-response-38216 https://openresearch.nihr.ac.uk/articles/5-101/v1#referee-response-38216 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. Alongside their report, reviewers assign a status to the article: - Approved - Approved with reservations - Not approved | Invited Reviewers | || |---|---|---| | 1 | 2 | | | Version 1 16 Oct 25 | read | read | Sign up for content alerts You are now signed up to receive this alert Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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