Dr Andrew Passey

Background: UK local authorities are developing and implementing Whole Systems Approaches to childhood obesity to tackle persistent and complex health inequalities. However, there is a lack of research on the practical application of these approaches. This paper reports on findings of a study into the initial implementation of this approach in Dundee, Scotland. Study design/methods: We applied a mixed methods research design: 1) semi-structured interviews (n = 9) with partnership members; 2) training members as peer researchers to interview their wider networks; n = 17); 3) an online survey among wider stakeholders (n = 27); and 4) two action learning sets with decision makers. Interview data was analysed using thematic framework analysis and survey data was analysed using descriptive statistics. Results: Dundee stakeholders stated that they had good knowledge of childhood obesity prevention efforts, but their engagement with working groups around identified priority themes was still limited, due to a lack of awareness about existing structures and knowledge about sustainable, impactful strategies, which were not always well-aligned between key organisations. Conclusions: Our findings extend current literature on facilitators for Whole Systems Approaches in public health by highlighting that understanding of strategies and wider structures are crucial to build capacity and maintain engagement to address inequalities. We identified an ongoing need for targeted communication and diverse involvement opportunities for different stakeholder groups.

Background During the COVID-19 pandemic, United Kingdom (UK) stop smoking services had to shift to remote delivery models due to social distancing regulations, later reintroducing face-to-face provision. The “Living Well Smokefree” service in North Yorkshire County Council adopted a hybrid model offering face-to-face, remote, or a mix of both. This evaluation aimed to assess the hybrid approach’s strengths and weaknesses and explore potential improvements. Methods Conducted from September 2022 to February 2023, the evaluation consisted of three components. First, qualitative interviews involved 11 staff and 16 service users, analysed thematically. Second, quantitative data from the QuitManager system that monitored the numbers and proportions of individuals selecting and successfully completing a 4-week quit via each service option. Third, face-to-face service expenses data was used to estimate the value for money of additional face-to-face provision. The qualitative findings were used to give context to the quantitative data via an “expansion” approach and complementary analysis. Results Overall, a hybrid model was seen to provide convenience and flexible options for support. In the evaluation, 733 individuals accessed the service, with 91.3% selecting remote support, 6.1% face-to-face, and 2.6% mixed provision. Remote support was valued by service users and staff for promoting openness, privacy, and reducing stigma, and was noted as removing access barriers and improving service availability. However, the absence of carbon monoxide monitoring in remote support raised accountability concerns. The trade-off in “quantity vs. quality” of quits was debated, as remote support reached more users but produced fewer carbon monoxide-validated quits. Primarily offering remote support could lead to substantial workloads, as staff often extend their roles to include social/mental health support, which was sometimes emotionally challenging. Offering service users a choice of support options was considered more important than the “cost-per-quit”. Improved dissemination of information to support service users in understanding their options for support was suggested. Conclusions The hybrid approach allows smoking cessation services to evaluate which groups benefit from remote, face-to-face, or mixed options and allocate resources accordingly. Providing choice, flexible provision, non-judgmental support, and clear information about available options could improve engagement and match support to individual needs, enhancing outcomes.

This article enhances our understanding of institutional work, through a study of professional health commissioners in the English National Health Service. Using a case study of mental health policy implementation, commissioners are conceptualised as institutional agents involved in shaping the organisational field and its boundary. Health service commissioners face a series of challenges as institutional agents. Commissioning is a relatively new health profession. It lacks a strong professional association and has predominantly been externally professionalised. Commissioners have limited direct organisational strategic management control. In the case study, commissioners were charged with leading implementation of the policy, which required them to address fragmentation in the field. Using existing typologies as an analytical frame, activities by commissioners in the case study are identified and explored as different modes of institutional work. Commissioners created a new normative network and instigated specific processes to embed and routinise cross-organisation working. They undertook boundary-spanning cognitive institutional work, creating new knowledge by commissioning education of school staff in the basics of children’s mental health. Their institutional work involved challenging existing working practices, both in the health field and in the contiguous education field. The article elucidates connections between different modes of institutional work, and attends to boundary work by commissioners in parallel with institutional work in the field. It also outlines how a profession seemingly lacking many of the ingredients of institutional power, might pursue its own professional project through institutional work. Findings have resonance in other geographical and policy areas, and fields.

This paper provides a novel application of Bourdieu’s theory to the implementation of public policy in the mental health field, by deploying two of his lesser-used concepts (doxa and illusio). Framing a local case study as a Bourdieusian game, we demonstrate how these concepts have explanatory power within the field and how national policy discourses at once influenced and constrained by neoliberalism have real and long-lasting effects when it comes to the implementation of public policy. We found three key themes in the case study: doxa as a narrative device (‘mental health is everybody’s business’); the linking of this doxa with the game’s illusio in a shared view that the policy should address the problem of a high rate of ‘inappropriate referrals’ into specialist services; and the consequences of the dynamic between the game’s doxa and illusio for the organisational hierarchy in the mental health services field. We do not evaluate the success of the policy, but instead apply and explore the potential of Bourdieu’s concepts to provide explanatory power to the processes and interactions evident in the implementation programme. This paper highlights the potential of such a theoretically based analytical approach, which could be applied in other contexts and to other health fields and policy domains.

Objectives Although local politicians (councillors) in England are key decision-makers in relation to local services, little is known about how they use evidence in making decisions pertaining to the wider determinants of health. The setting-up of 30 Health Determinants Research Collaborations (HDRCs), commissioned to increase the capability and capacity of local authorities to use research and other evidence, provides an opportunity to plug this knowledge gap. Study design A qualitative reflection on our initial experiences of working with councillors in one HDRC. Methods We critically reflect on these interactions to extract wider learning that will be of interest to researchers and practitioners in local authorities and potentially research funders. We develop a continuum of interactions with councillors in the HDRC based on our experiences. Results Organisational positionality plays a crucial role in shaping research interactions and outcomes. By focusing on existing practices, preferences, and strengths, researchers can move beyond the deficit models that often dominate academic discourse. Engaging with councillors is rarely a linear process; it demands parallel approaches and a high degree of adaptability. Researchers must also remain attentive to both the challenges and opportunities presented by organisational structures and electoral cycles. In this context, mixed-methods research demonstrates resilience, accommodating the varied levels of engagement and involvement among councillors. Conclusions We conclude from these experiences that research with councillors and building their capability to use research evidence in their work requires sustained, flexible, and relational approaches that are responsive to the political and organisational realities of local government.

This report explores the relationship between volunteering and wellbeing during the pandemic in Wales by analysing practice-based case studies of volunteering.

Background: Local authorities in England are ideally placed to address the social determinants of health in the communities they serve. An evidence-led approach to developing programmes and policies to tackle determinants of health is critical to ensuring outcomes are attained and resources are used appropriately. Previous studies though suggest that local authorities do not always use evidence consistently in their decision-making processes. This paper seeks therefore to explore perceived research capability and capacity across one local authority in northern England to understand how research influences policy and practice. Methods: A qualitative exploration of 29 leaders and managers across the local authority, representing the four directorates of the organisation, was obtained to gain an overall understanding of research capacity and capability. Data were analysed thematically with eight overarching thematic categories derived. Results: The capacity and capability for research across the local authority directorates varied. Some participants described departments within directorates as being research active where research was part of their core business. Conversely, some departments were engaged in front-line service delivery where research was not prioritised. In these areas there was a disconnect between daily working practices and research. Staff in these departments generally lacked skills and training in research, whereas those in research active areas often had professional training where research was incorporated. There was rarely a shared definition of research by participants and ambiguity in what constituted research was common. The local authority was perceived to gather lots of data, but this was often used very functionally to fulfil reporting obligations. Curiosity to explore data was often minimised due to work pressures. Links from local authority staff to democratically elected officials varied and research and evidence was not always routinely presented. The majority of participants recognised that reforming ways of working and developing a clear training offer around research would be beneficial to addressing health outcomes. Conclusions: Data demonstrated variance between research practice, partnerships and culture in departments where space for intellectual curiosity was tempered by service demands. There were exceptions to this, where departmental views of research were positive and leaders valued the research-informed culture.

Growing policymaker interest in community wellbeing puts a premium on knowledge about existing community-level challenges and possible policy responses. If evidence-based policy and practice is foregrounded in these developments, there is a risk that lived experience is seen to lack validity in policy-making decisions and that knowledge from and about underrepresented groups is underemphasised. In consequence, the best available evidence on which to make policy decisions affecting these groups might be missed, thus potentially increasing health inequalities. This paper extends debate on this dilemma in this journal by using the lens of ‘pragmatic complexity’ as an alternative view on what works as evidence for policy and practice in community wellbeing. We present an empirical analysis of two expert hearings about community wellbeing. The events used a deliberative approach, allowing participants to probe evidence and consider from multiple perspectives ideas of how to address identified issues. Two overarching themes from the hearings - a perceived gap between the rhetoric and reality of wellbeing evidence, and proposals on ‘what works’ in the (co)-production of knowledge about wellbeing – are articulated and explored. We develop specific features emerging from the hearings that have wider resonance for community wellbeing research and suggest potential responses: what counts as ‘good’ or good-enough evidence about community wellbeing; system responses requiring thinking and engaging with complexity; reflections on the collective and collaborative process of an expert hearing approach. The combination of analysis of knowledge generated deliberatively through an expert hearing approach and a pragmatic complexity lens, delimits our contribution.

BACKGROUND: Community-based volunteering supports outbreak management by extending reach into at-risk communities. This paper examines the application of a 'community champions' model in England, UK, during the COVID-19 pandemic. Evidence pre-pandemic shows that community champion interventions tap into social networks to strengthen connections with disadvantaged communities. During the pandemic, the UK government set up a COVID community champions funding award scheme for local authorities to develop local programmes that addressed emerging inequalities. The study aim was to identify transferable learning on community engagement in the pandemic by undertaking a secondary qualitative synthesis of practice-based case studies of local COVID community champion programmes. METHODS: A systematic staged approach for synthesis of practice-based case studies was used. In total, 16 COVID community champion case studies, which were written by practitioners involved in local programme implementation and published by the Local Government Association, were included. Case studies covered aims, programme development and delivery, examples of activities and a discussion of learning. Framework qualitative analysis methods were used to code and organise data prior to cross case analysis. The final stage produced an overarching thematic framework that best represented descriptive and interpretive themes. RESULTS: The results provide an overview of common features of COVID community champion programmes and emergent learning. All local programmes aimed to reduce health inequalities by involving at-risk communities in local prevention efforts, adapting the approach to local priorities. Two levels of community engagement were volunteer mobilisation and subsequent community-based outreach activities. Elements of capacity building, such as training and creation of networks, were common. The synthesis of practice-based learning found that stronger relationships with communities were regarded as a key mechanism to support more equitable prevention strategies. Other learning themes related to champion roles, community engagement strategies and programme implementation. CONCLUSIONS: By focusing on how community champion approaches were applied by local authorities in England during the COVID-19 pandemic, this study contributes to knowledge on volunteer mobilisation as a mechanism to improve public health communication and outreach. Notwithstanding the limitations of experiential evidence, the synthesis of practice-based learning highlights potentially transferable community engagement strategies for health protection and health improvement.

Community champions (also known as health champions) are community members who volunteer to promote health and wellbeing or improve conditions in their local community. Champions use their social networks and life experience to address barriers to engagement and improve connections between services and disadvantaged communities. Findings from this rapid review show that community champion approaches have high relevance to reducing health inequalities, whether the context is one of an emergency, or of longer term prevention. Community champions can be key connectors in communities but these roles do not operate in isolation and need to be embedded in effective community engagement strategies. As public health interventions, community champion approaches can be applied flexibly dependent on local needs and community assets. This review identifies different models and ways of building champion programmes