Dr Joanne Trigwell

BACKGROUND: Smoking often starts in early adolescence and addiction can occur rapidly. For effective smoking prevention there is a need to identify at risk groups of preadolescent children and whether gender-specific intervention components are necessary. This study aimed to examine associations between mother, father, sibling and friend smoking and cognitive vulnerability to smoking among preadolescent children living in deprived neighbourhoods. METHODS: Cross-sectional data was collected from 9-10 year old children (n =1143; 50.7% girls; 85.6% White British) from 43 primary schools in Merseyside, England. Children completed a questionnaire that assessed their smoking-related behaviour, intentions, attitudes, and refusal self-efficacy, as well as parent, sibling and friend smoking. Data for boys and girls were analysed separately using multilevel linear and logistic regression models, adjusting for individual cognitions and school and deprivation level. RESULTS: Compared to girls, boys had lower non-smoking intentions (P = 0.02), refusal self-efficacy (P = 0.04) and were less likely to agree that smoking is 'definitely' bad for health (P < 0.01). Friend smoking was negatively associated with non-smoking intentions in girls (P < 0.01) and boys (P < 0.01), and with refusal self-efficacy in girls (P < 0.01). Sibling smoking was negatively associated with non-smoking intentions in girls (P < 0.01) but a positive association was found in boys (P = 0.02). Boys who had a smoking friend were less likely to 'definitely' believe that the smoke from other people's cigarettes is harmful (OR 0.57, 95% CI: 0.35 to 0.91, P = 0.02). Further, boys with a smoking friend (OR 0.38, 95% CI: 0.21 to 0.69, P < 0.01) or a smoking sibling (OR 0.45, 95% CI: 0.21 to 0.98) were less likely to 'definitely' believe that smoking is bad for health. CONCLUSION: This study indicates that sibling and friend smoking may represent important influences on 9-10 year old children's cognitive vulnerability toward smoking. Whilst some differential findings by gender were observed, these may not be sufficient to warrant separate prevention interventions. However, further research is needed.

BACKGROUND: Guidelines recommend children and young people participate in at least 60 min of physical activity (PA) every day, however, findings from UK studies show PA levels of children vary across ethnic groups. Since parents play an instrumental role in determining children's PA levels, this article aims to explore parental views of children's PA in a multi-ethnic sample living in a large city in the North-West of England. METHODS: Six single-ethnic focus groups were conducted with 36 parents of school-aged children (4 to 16 years) with a predominantly low socio-economic status (SES). Parents self-identified their ethnic background as Asian Bangladeshi (n = 5), Black African (n = 4), Black Somali (n = 7), Chinese (n = 6), White British (n = 8) and Yemeni (n = 6). Focus group topics included understanding of PA, awareness of PA guidelines, knowledge of benefits associated with PA and perceived influences on PA in childhood. Data were analysed thematically using QSR NVivo 9.0. RESULTS: Parents from all ethnic groups valued PA and were aware of its benefits, however they lacked awareness of PA recommendations, perceived school to be the main provider for children's PA, and reported challenges in motivating children to be active. At the environmental level, barriers to PA included safety concerns, adverse weather, lack of resources and lack of access. Additional barriers were noted for ethnic groups from cultures that prioritised educational attainment over PA (Asian Bangladeshi, Chinese, Yemeni) and with a Muslim faith (Asian Bangladeshi, Black Somali, Yemeni), who reported a lack of culturally appropriate PA opportunities for girls. CONCLUSION: Parents from multi-ethnic groups lacked awareness of children's PA recommendations and faced barriers to promoting children's PA out of school, with certain ethnic groups facing additional barriers due to cultural and religious factors. It is recommended children's PA interventions address influences at all socio-ecological levels, and account for differences between ethnic groups.

BACKGROUND: SmokeFree Sports (SFS) was a multi-component sport-for-health intervention aiming at preventing smoking among nine to ten year old primary school children from North West England. The purpose of this study was to evaluate the process and implementation of SFS, examining intervention reach, dose, fidelity, acceptability and sustainability, in order to understand the feasibility and challenges of delivering such interventions and inform interpretations of intervention effectiveness. METHODS: Process measures included: booking logs, 18 focus groups with children (n = 95), semi-structured interviews with teachers (n = 20) and SFS coaches (n = 7), intervention evaluation questionnaires (completed by children, n = 1097; teachers, n = 50), as well direct observations (by researchers, n = 50 observations) and self-evaluations (completed by teachers, n = 125) of intervention delivery (e.g. length of sessions, implementation of activities as intended, children's engagement and barriers). Descriptive statistics and thematic analysis were applied to quantitative and qualitative data, respectively. RESULTS: Overall, SFS reached 30.8% of eligible schools, with 1073 children participating in the intervention (across 32 schools). Thirty-one schools completed the intervention in full. Thirty-three teachers (55% female) and 11 SFS coaches (82% male) attended a bespoke SFS training workshop. Disparities in intervention duration (range = 126 to 201 days), uptake (only 25% of classes received optional intervention components in full), and the extent to which core (mean fidelity score of coaching sessions = 58%) and optional components (no adaptions made = 51% of sessions) were delivered as intended, were apparent. Barriers to intervention delivery included the school setting and children's behaviour and knowledge. SFS was viewed positively (85% and 82% of children and teachers, respectively, rated SFS five out of five) and recommendations to increase school engagement were provided. CONCLUSION: SFS was considered acceptable to children, teachers and coaches. Nevertheless, efforts to enhance intervention reach (at the school level), teachers' engagement and sustainability must be considered. Variations in dose and fidelity likely reflect challenges associated with complex intervention delivery within school settings and thus a flexible design may be necessary. This study adds to the limited scientific evidence base surrounding sport-for-health interventions and their implementation, and suggests that such interventions offer a promising tool for engaging children in activities which promote their health.

BACKGROUND: Smoking often starts in early adolescence and addiction can occur rapidly. For effective smoking prevention there is a need to identify at risk groups of preadolescent children and whether gender-specific intervention components are necessary. This study aimed to examine associations between mother, father, sibling and friend smoking and cognitive vulnerability to smoking among preadolescent children living in deprived neighbourhoods. METHODS: Cross-sectional data was collected from 9-10 year old children (n =1143; 50.7% girls; 85.6% White British) from 43 primary schools in Merseyside, England. Children completed a questionnaire that assessed their smoking-related behaviour, intentions, attitudes, and refusal self-efficacy, as well as parent, sibling and friend smoking. Data for boys and girls were analysed separately using multilevel linear and logistic regression models, adjusting for individual cognitions and school and deprivation level. RESULTS: Compared to girls, boys had lower non-smoking intentions (P = 0.02), refusal self-efficacy (P = 0.04) and were less likely to agree that smoking is 'definitely' bad for health (P < 0.01). Friend smoking was negatively associated with non-smoking intentions in girls (P < 0.01) and boys (P < 0.01), and with refusal self-efficacy in girls (P < 0.01). Sibling smoking was negatively associated with non-smoking intentions in girls (P < 0.01) but a positive association was found in boys (P = 0.02). Boys who had a smoking friend were less likely to 'definitely' believe that the smoke from other people's cigarettes is harmful (OR 0.57, 95% CI: 0.35 to 0.91, P = 0.02). Further, boys with a smoking friend (OR 0.38, 95% CI: 0.21 to 0.69, P < 0.01) or a smoking sibling (OR 0.45, 95% CI: 0.21 to 0.98) were less likely to 'definitely' believe that smoking is bad for health. CONCLUSION: This study indicates that sibling and friend smoking may represent important influences on 9-10 year old children's cognitive vulnerability toward smoking. Whilst some differential findings by gender were observed, these may not be sufficient to warrant separate prevention interventions. However, further research is needed.

BACKGROUND: Preventing children from smoking is a public health priority. This study evaluated the effects of a sport-for-health smoking prevention programme (SmokeFree Sports) on smoking-related intentions and cognitions among primary school children from deprived communities. METHODS: A non-randomised-controlled trial targeted 9-10 year old children from Merseyside, North-West England. 32 primary schools received a programme of sport-for-health activities over 7 months; 11 comparison schools followed usual routines. Data were collected pre-intervention (T0), and at 8 months (T1) and one year post-intervention (T2). Smoking-related intentions and cognitions were assessed using an online questionnaire. Intervention effects were analysed using multi-level modelling (school, student), adjusted for baseline values and potential confounders. Mixed-sex focus groups (n = 18) were conducted at T1. RESULTS: 961 children completed all assessments and were included in the final analyses. There were no significant differences between the two study groups for non-smoking intentions (T1: β = 0.02, 95 % CI = -0.08-0.12; T2: β = 0.08, 95 % CI = -0.02-0.17) or for cigarette refusal self-efficacy (T1: β = 0.28, 95 % CI = -0.11-0.67; T2: β = 0.23, 95 % CI = -0.07-0.52). At T1 there was a positive intervention effect for cigarette refusal self-efficacy in girls (β = 0.72, 95 % CI = 0.21-1.23). Intervention participants were more likely to 'definitely' believe that: 'it is not safe to smoke for a year or two as long as you quit after that' (RR = 1.19, 95 % CI = 1.07-1.33), 'it is difficult to quit smoking once started' (RR = 1.56, 95 % CI = 1.38-1.76), 'smoke from other peoples' cigarettes is harmful' (RR = 1.19, 95 % CI = 1.20-2.08), 'smoking affects sports performance' (RR = 1.73, 95 % CI = 1.59-1.88) and 'smoking makes 'no difference' to weight' (RR = 2.13, 95 % CI = 1.86-2.44). At T2, significant between-group differences remained just for 'smoking affects sports performance' (RR = 1.57, 95 % CI = 1.43-1.72). Focus groups showed that SFS made children determined to remain smoke free and that the interactive activities aided children's understanding of smoking harms. CONCLUSION: SFS demonstrated short-term positive effects on smoking attitudes among children, and cigarette refusal self-efficacy among girls. Although no effects were observed for non-smoking intentions, children said that SFS made them more determined not to smoke. Most children had strong intentions not to smoke; therefore, smoking prevention programmes should perhaps target early adolescents, who are closer to the age of smoking onset.

Objective: This study examined the relationship between ethnic background and parental views of healthy body size, concerns surrounding overweight and attitudes to perceived causes of overweight in childhood. Method: A self-report questionnaire was designed to explore parental attitudes towards childhood weight. Sampling deliberately over-represented the views of parents from minority ethnic groups. Eight-hundred-and-eight parents of school-aged children completed the questionnaire. Parental data from Asian British, Black African, Black Somali, Chinese, South Asian, White British and Yemeni groups were included in the analysis. Results: Data showed that ethnic background was significantly associated with parental beliefs that overweight children will grow out of being overweight (X2[12, n = 773] = 59.25, p 0.001) and that overweight children can still be healthy (X2[12, n = 780] = 25.17, p 0.05). In both cases, agreement with the statements was highest among Black Somali parents. While the majority of parents believed that both dietary behaviours and physical activity played a role in the development of overweight in childhood, Yemeni parents were more likely to attribute overweight in childhood to dietary but not physical activity causes. Conclusion: Ethnic differences in parental perceptions of weight in childhood must be considered in the design of, and recruitment to, childhood obesity interventions aimed at minority ethnic groups. © 2013 The Author(s).

© 2016 Taylor & Francis Group, LLC. This study evaluated the impact and acceptability of a three-hour bespoke training workshop for sports coaches and teachers to subsequently deliver a sport-for-health smoking prevention intervention in primary schools. Questionnaires were completed pre- and post-training by both teachers (N = 24) and coaches (N = 8), and post-intervention by teachers. Interviews were also conducted with coaches (N = 7) and teachers (N = 12). Both groups displayed a significant increase in intervention knowledge and delivery self-efficacy from pre- to post-training, which was maintained at post-intervention for teachers. Data suggest that a brief training workshop is acceptable to practitioners and fosters confidence to implement a sport-for-health smoking prevention program.

A critical assessment of health trainer activity, with particular reference to the most deprived social groups, and a focus on mental health and wellbeing.

One You Leeds provides the maternal stop smoking service across the city of Leeds. Staff from the Centre for Health Promotion Research were commissioned to evaluate the service, between March 2018-June 2019.

The Making Advice Work Project (MAW) was set up in 2013 to facilitate advice agencies in Calderdale to work together, and to improve advice and support through partnership. The project was delivered by a group of 4 organisations; Citizens Advice Calderdale Bureau (CACB), Age UK Calderdale and Kirklees, WomenCentre Calderdale and Kirklees and Calderdale Disability Advice Resource (DART). This report presents the findings from an evaluation of MAW conducted by the Centre for Health Promotion Research, Leeds Beckett University. It presents evidence about the project’s journey, the project outcomes and the overall learning from the project.

Existing evidence shows that many Roma communities have received little attention in relation to their health requirements. Evidence illustrates how Roma communities suffer from poorer health and unhealthier living conditions when compared to majority populations, with their poor health closely linked to wider social determinants. This study explored the health status and associated health needs of the Leeds Roma migrant community, a hard to reach and under-explored group across Europe. Questionnaires (n = 70) and focus groups (n = 43) with Roma community members as well as interviews with health professionals (n = 5) working with them were used. The study found language was a key barrier to accessing health care and understanding health messages. Furthermore, participant’s understandings of the health system were hindered by their different experiences within their countries of origin. Self-reports illustrated low mental well-being, high levels of stress and unhealthy lifestyles as common issues. The research also highlighted several wider determinants of health as key concerns within the Roma community including housing, employment opportunities and money. The findings of this study contribute to increasing understandings of this community’s health needs, their support requirements and the barriers faced by them. These need to be considered to inform strategies and ways of working as mechanisms to tackle health inequalities and promote health within this community.

This report illustrates the findings from a piece of health-related research carried out within the Roma community in Leeds in 2012. The research aimed to explore Roma community member’s health status and associated health needs. Based upon data gathered from questionnaires and focus groups with Roma community members and interview data from health professionals working with them, this report presents evidence from the data gathered. The findings reported here relate to the migrant population of Roma resident within the UK, not the indigenous Gypsy and Traveller population of the UK. UK and Irish Travellers, despite sharing common experiences to the Roma in terms of discrimination and exclusion, are a distinct community and are not of Roma origin and thus are not the focus of this report.

This short report explores the key findings from a review1of information on health trainers in 2013/2014 which had a particular focus on mental health and wellbeing. After summarising the key findings of the review, it focuses on mental health, briefly exploring the links between mental and physical health before discussing what differences engagement with a health trainer made to people’s sense of self-efficacy and wellbeing.

Health trainers are a non-clinical workforce introduced in 2004,2who receive training in competencies to enable them to support people in disadvantaged communities to improve their health.3The population groups or settings that health trainers focus on varies from service to service, but all work one-to-one, most spending at least an hour with a client at their first appointment, supporting and enabling them to decide what they want to do. The emphasis is on the client determining their own priorities and how to achieve them. Generally, health trainers see clients for a total of six sessions, where how to achieve goals and progress towards them is discussed.

The Data Collection and Reporting System (DCRS) is used by approximately 60% of Health Trainer Services to record monitoring data. Around 90% of Health Trainer Services using DCRS record ethnographic data on health trainers and clients, plus the issues clients worked on and the progress they made. There is also a wide range of other data which can be recorded, including before and after mental health and wellbeing scores. We were given access to aggregate data in order to conduct an analysis. Descriptive statistics were generated to calculate percentage change pre- to post-intervention.

A total of 1,377 (= 919 full time equivalents) health trainers were recorded in the DCRS system as working with 97,248 clients in England during 2013/2014. The health trainer model embodies the principle of lay support,4and services aim to recruit a high proportion of their staff from similar backgrounds to their clients. They have been reasonably successful with 32% of health trainers coming from the most deprived areas (Quintile 1),iwith a further 20% from Quintile 2. In all, 40% percent of health trainers lived in the same areas as their clients.

Abstract

Background Interventions that engage communities have been shown to improve health and wellbeing in disadvantaged groups internationally, but there is little evidence on current community-led practice, particularly in relation to the process of community engagement. This paper presents a qualitative cross-case analysis of barriers & facilitators in six UK community engagement projects, using different models of community engagement. Methods The primary sampling criteria was the type of approach to community engagement, using a conceptual framework with four main groups: Strengthening communities; Volunteer and peer roles; Collaborations and partnerships; Connecting to community resources. Qualitative interview-based methods (semi-structured interviews and focus groups) explored community and professional perspectives in depth. Thematic analysis was used to analyse the data, building within-case studies before comparing findings and using an iterative process to build explanations in a cross-case analysis. Results Fifty-five people took part in the research. Prominent themes included barriers and facilitators to community engagement. Key themes related to successful community engagement were: trust within the community and between community members and service providers; respect for community members’ expertise; allowing sufficient time for relationships to establish and for outcomes to be seen; commitment of key people; and Flexibility. Conclusions This qualitative case study research found that in successful community engagement projects, community expertise is respected and valued, allowing community members to be fully involved and take ownership of the projects. Sufficient time should be allowed for this process. Flexibility and adaptation of project materials, protocols and role descriptions is important in overcoming barriers to community engagement.

Background: Evidence of the effectiveness of social prescribing is inconclusive causing commissioning challenges. This research focusses on a social prescribing scheme in Northern England which deploys ‘Wellbeing Coordinators’ who offer support to individuals, providing advice on local groups and services in their community. The research sought to understand the outcomes of the service and, in addition, the processes which supported delivery. Methods: Quantitative data was gathered from service users at the point they entered the service and also at the point they exited. Qualitative interviews were also undertaken with service users to gather further understanding of the service and any positive or negative outcomes achieved. In addition, a focus group discussion was also conducted with members of social prescribing staff to ascertain their perspectives of the service both from an operational and strategic perspective. Results: In total, 342 participants provided complete wellbeing data at baseline and post stage and 26 semi-structured qualitative interviews were carried out. Improvements in participants’ well-being, and perceived levels of health and social connectedness as well as reductions in anxiety was demonstrated. In many cases, the social prescribing service had enabled individuals to have a more positive and optimistic view of their life often through offering opportunities to engage in a range of hobbies and activities in the local community. The data on reductions in future access to primary care was inconclusive. Some evidence was found to show that men may have greater benefit from social prescribing than women. Some of the processes which increased the likelihood of success on the social prescribing scheme included the sustained and flexible relationship between the service user and the Wellbeing Coordinator and a strong and vibrant voluntary and community sector. Conclusions: Social prescribing has the potential to address the health and social needs of individuals and communities. This research has shown a range of positive outcomes as a result of service users engaging with the service. Social prescribing should be conceptualised as one way to support primary care and tackle unmet needs.

Purpose: A proportion of the working age population in the UK experience mental health conditions, with this group often facing significant challenges to retain their employment. As part of a broader political commitment to health and well-being at work, the use of job retention services have become part of a suite of interventions designed to support both employers and employees. While rigorous assessment of job retention programmes are lacking, this paper examines the success of, and distils learning from, a job retention service in England. Design/methodology/approach A qualitative methodology was adopted for this research with semi-structured interviews considered an appropriate method to illuminate key issues. Twenty eight individuals were interviewed, including current and former service users, referrers, employers and job retention staff. Findings Without the support of the job retention service, employees with mental health conditions were reported to have been unlikely to have maintained their employment status. Additional benefits were also reported, including improved mental health outcomes and impacts on individuals’ personal life. Employers also reported positive benefits in engaging with the job retention service, including feeling better able to offer appropriate solutions that were mutually accepted to the employee and the organisation. Originality/value Job retention programmes are under researched and little is known about their effectiveness and the mechanisms that support individuals at work with mental health conditions. This study adds to the existing evidence and suggests that such interventions are promising in supporting employees and employers.

Abstract

Yoga offers multiple health and wellbeing benefits and is socially prescribed by clinicians in the NHS as part of health promotion measures in the United Kingdom (UK). However, socially marginalised groups are under-represented and yoga participants, or practitioners, are predominantly white, higher educated women. This research contributes to the knowledge by exploring, for the first time, the yoga access experiences of people with a broad range of marginalised identities in a UK context. It was prompted by my experiences of teaching yoga to diverse groups in a northern British city neighbourhood amongst the 10% most deprived in the country. Purposive sampling was employed to recruit 17 people from four northern UK cities who had practised, or participated in, yoga in the previous six months, but did not consider themselves to be yoga insiders, and who self-identified with one or more of seven marginalised identities, namely: Black, Brown or other people of colour; disabled; older (later life); LGBTQIA+; of a larger body type; from a religious faith or background; or on a low income. Data was collected via 1-1 teleconferencing software interviews during COVID-19 pandemic restrictions and analysed initially using thematic analysis and, subsequently, using a critical theory-based approach. Nine barriers to yoga access were initially identified using thematic analysis: cost, place, discomfort, physicality, appearance, behaviour, people, potential distress, and alien-ness. These were intersectional in impact and experienced across the range of identities studied. Additionally, nine areas of barrier effect were identified using a critical theory-based approach, these were: Inclusion and access; Whiteness/ableism; Postcolonialism and cultural/religious appropriation; Commercialisation/neoliberalism; Unaware of/don’t see; I was lucky; Belief in loveliness; and Power/challenge. These areas arose from practices and norms within the social institution of UK Yoga and could be associated with emerging criticisms in the literature. Findings were that a range of barriers to yoga access were experienced, some of which could be attributed to practices and norms within the social institution of UK Yoga. These barriers could be seen to contribute to the health inequalities faced by marginalised groups and could be associated with the social determinants of health. Recommendations are for appraisal and revision of delivery of yoga in the UK including: teacher training; pedagogy and language; tailored approaches; examination of privilege; and sharing of power. Further research is indicated with yoga ‘insiders’ with marginalised identities.

Background: Interventions that engage communities have been shown to improve health and wellbeing in disadvantaged groups internationally, but there is little evidence on current community-led practice, particularly in relation to the process of community engagement. This paper presents a qualitative cross-case analysis of barriers & facilitators in six UK community engagement projects, using different models of community engagement. Methods: The primary sampling criteria was the type of approach to community engagement, using a conceptual framework with four main groups: Strengthening communities; Volunteer and peer roles; Collaborations and partnerships; Connecting to community resources. Qualitative interview-based methods (semi-structured interviews and focus groups) explored community and professional perspectives in depth. Thematic analysis was used to analyse the data, building within-case studies before comparing findings and using an iterative process to build explanations in a cross-case analysis. Results: Fifty-five people (28 community stakeholders and 27 professional stakeholders) from six selected case study projects took part in the research. Key themes related to successful community engagement were: trust within the community and between community members and service providers; respect for community members’ expertise; allowing sufficient time for relationships to establish and for outcomes to be seen; commitment of key people; and flexibility. Conclusions: This qualitative case study research found that in successful community engagement projects, community expertise is respected and valued, allowing community members to be fully involved and take ownership of the projects. Sufficient time should be allowed for this process. Flexibility and adaptation of project materials, protocols and role descriptions is important in overcoming barriers to community engagement. Keywords: Community engagement, health and wellbeing, cross-case analysis, health equity, health inequalities, public health, health promotion, qualitative research

Background The National Institute for Health and Care Excellence (NICE) in the UK commissioned a mapping review of current and emerging UK community engagement practice to inform their updated guidance. Methods Given the difficulties of identifying studies via traditional electronic database searches we focused on: Specialised research registers and websites; search results and forwards and backwards citations from recent relevant systematic reviews; website searches of relevant organisations; and direct calls for evidence via networks of contacts with community practitioners and groups. Records were screened independently by more than one reviewer, and included if published after 2000, relevant to the UK and evaluated or described community engagement in public health. Included records were coded for type, level and extent of community engagement, indicators of disadvantage, health issues and outcomes. Results 316 articles (227 research/ evaluation studies) were included. Evidence was dominated by: qualitative and mixed methods studies; initiatives targeting health inequalities via socioeconomically deprived areas and groups, and via “hard to reach” groups. Community level outcomes (e.g. improved housing) and wellbeing outcomes (e.g. improved self-esteem) were most commonly addressed, and community mobilisation/ action and community partnerships/ coalitions were the types of community engagement most commonly employed. Community engagement initiatives for “hard to reach” populations were most likely to use targeted and/ or peer or volunteer approaches. Conclusions Community engagement initiatives in the UK include a substantial proportion who are at risk of health inequalities but who are not routinely fully represented in health equity profiles/ audits. Consideration should continue to be given to these “marginalised” groups, in terms of both initial engagement and measurement of impact. Key messages: Community engagement initiatives in the UK go beyond targeting the most obvious indicators of inequality and seek to engage some of the most marginalised, disadvantaged or excluded population groups Different approaches are used for different health issues and population groups e.g. peer involvement for individual behaviour change; community mobilisation for community level outcomes © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

A recent systematic review found that initiatives with high levels of community engagement may produce more positive health outcomes than those with lower engagement. Systematic reviews in this area risk publication bias because (i) literature on community based health initiatives is widely dispersed and poorly indexed; and (ii) professionally-led (top down) interventions are more likely than community-led (bottom up) interventions to be formally evaluated and published. An opportunity to examine the gap between research and practice arose in a systematic scoping review commissioned by the UK National Institute of Health and Care Excellence (NICE), of current practice in community engagement. We searched specialised research registers and websites; literature searches and citations from recent relevant systematic reviews; and direct calls for evidence via networks of community practitioners and groups. Records were screened independently by more than one reviewer, and included if published after 2000, relevant to the UK and evaluated or described community engagement in public health. Included records were coded for type, level and extent of community engagement, indicators of disadvantage, issues and outcomes. 316 articles were included, 72% were research or evaluation studies (7% were randomised controlled trials; most were mixed methods or qualitative studies). 26% were found through website searches and the calls for evidence. The issues addressed most frequently were social capital or social cohesion (41%) and community wellbeing (35%). Indicators of health inequality observed most frequently were socioeconomic (39%) and “other” (39%), including people with disabilities; refugees and asylum seekers; mental health service users. Only 33 initiatives reported a high extent of community engagement; a comparatively high proportion were in the non-research literature (20% of non-research articles, compared to 8% of research articles). This may indicate a gap between organisations which usually write and publish research articles, and organisations which fully involve community members, and/or may indicate challenges in the evaluation or publication process of high community engagement initiatives. Using conventional systematic review methods to examine community based approaches risks overlooking community-led “bottom up” initiatives, which may have the highest potential to reduce health inequalities. Reviewers should therefore make every effort to find reports of such initiatives, and consider broadening their definition of “evidence”.

Issue: Strengthening community action, as proposed in the Ottawa Charter, is key to achieving public health goals within a whole-of society approach to health. Community engagement is not a simple intervention as it is shaped by community contexts and policy agendas that can either constrain or enable local action. This has implications for developing an evidence base. Description of problem: Changes in UK policy and programme funding have led to a fragmented evidence base and many participatory models not achieving sustainability. To inform an update of public heath guidance, the National Institute for Health and Care Excellence commissioned an independent, systematic scoping review to understand UK community engagement policy and practice. This paper presents findings from the documentary analysis of policy themes and concepts. Results: After systematic searching and screening, 40 policy and 30 conceptual publications were included and extracted data then mapped onto a matrix. We found that UK policy interest in community engagement in health threads through multiple sectors including health, local government and volunteering. Policy focus was not static; new concepts (eg social action) have emerged since 2000, while others (eg health inequalities) have less prominence. Local government was identified as a key policy actor. Community empowerment was a common theme but concepts were not used consistently. Lessons: Community engagement in health has policy significance but can lack visibility because it is applied across multiple policy areas and is cross referenced to different concepts. This is important for promoting intersectoral action involving communities and for building healthy public policy. Our conclusions are that community engagement is best used as a broad organising concept as it covers a range of policy areas and terms. This needs to be accounted for in building an evidence base for participatory methods within and between countries. Message 1 A mapping of UK policy since 2000 shows that community engagement in health can be promoted through a range of policy initiatives and sectors; however there is change through policy cycles Message 2 The evidence base on community engagement can appear fragmented, results from this policy analysis help identify related concepts and terms.

The RNIB Eye Health Champion project, funded by the Department for Health’s Health & Social Care Volunteering Fund (HSCVF), aimed to reduce the rates of sight loss caused by diabetic eye disease. The Centre for Health Promotion Research (CHPR) at Leeds Beckett University (LBU) was commissioned to evaluate the project, starting in January 2015. This is the final report, covering the context of the project, the intervention, the evaluation methodology and findings reported thematically. The project ended in November 2017.

Introduction Public Health England (PHE) carried out a consultation exercise with its People’s Panel, a group of approximately 1000 lay members who regularly participate in engagement exercises with the organisation. The aim of the consultation was to find out what members of the public think the public health system can do to put communities at the heart of public health. Method An online survey was designed by PHE. Questions covered demographics and five open questions. Members of the People’s Panel were invited to complete the survey. Data were coded and analysed thematically by Leeds Beckett University. Results In total, 342 respondents completed the survey (female, 70.5%; 55 years or over, 66.6%). Three quarters (75.7%) of respondents were members or part of social/ neighbourhood/ sports/ volunteer/ political/ faith-based/ community groups. Respondents reported that public sector organisations could best support communities and encourage involvement by: understanding local needs and priorities; raising awareness of existing provision as well as providing inclusive activities and better infrastructure. Factors considered to get in the way of or weaken community strengths and vitality included: austerity; disengagement; social isolation; political will; no ‘heart’ to the community; poor communication; and crime and anti-social behaviour. Suggestions for improvement were provided. Conclusion For the health system to put communities at the heart of public health, lay members feel more ‘local thinking’ surrounding co-production and shared decision making is needed. Improvements to communication/ information sharing within the health system as well as the promotion of the social model of health are suggested. Funders This work was funded by Public Health England

During Spring/Summer 2025, the Centre for Health Promotion Research are leading a series of discussions for local and national partners about the voluntary sector, learning disabilities, and digital inequalities. These discussions are for academics, community and civil society organisations, local authorities, and service users to discuss current research and priorities for the future. The first event was a webinar on Wednesday 21st May 2025, 12:00-13:00. Kris Southby, Anne-Marie Bagnall, Danielle Varley, and Jo Trigwell will share the results of an NIHR School for Social Care study about how community organisations can effectively use digital technology to delivery services to adults with learning disabilities and/or autism. The webinar was attended by 44 people from universities, local and national government, the voluntary sector, and NHS

A mixed methods evaluation of a Leeds youth organisation. Methods included; qualitative interviews, a survey of young people attending plus an SROI.

The report shows the impact of the community project since its inception in 2017, during its early growth, through the pandemic and looking to the future. By consulting with the local community, partners and co-workers this report shows the project’s impact on local people’s health and wellbeing, the growth of strong partnership working and the solid financial footing The Old Fire Station demonstrates. The trustees intend that this report shows the clear advantages of the investment made, the return given and the power of partnership working.

Background A community empowerment programme in the UK aims to enable people to have greater collective control over area-based decision making, improved health and wellbeing and reduce health inequalities, by providing small grants to support residents of deprived neighbourhoods and communities of interest to come together to take action on issues of importance to them. Methods A survey was conducted at 4 6-month intervals as part of a mixed methods evaluation, to collect data about participant demographics, level of involvement, opinions of the project, and impacts. The survey was self-completed online or on paper, and distributed by local project leads. Outcome questions were adapted from the UK Government Community Life Survey to facilitate comparison with national statistics. Data were analysed using SPSS to produce descriptive statistics, supported by inferential statistical tests where appropriate. Regression analysis using multi-level modelling was used to estimate the conditional correlation between health outcome and Local People project participation. Results 1053 people from 29 local areas responded to the survey over the 4 time points; only 93 responded more than once. 43% took part in project activities, 36% were local project committee members and 19% were volunteers. The analysis found positive impacts on confidence, control, friendships, skills, happiness, life satisfaction, feelings of worth (p < 0.05), and that greater length and degree of involvement in the projects were associated with greater positive impacts on all of these outcomes. Conclusions The survey provides tentative evidence that participation in a community empowerment initiative may result in improved wellbeing, feelings of power and control, sense of belonging and trust. People who are involved for longer or more deeply involved are more likely to see these impacts. More community-based survey research is needed to gather people's views on neighbourhood initiatives. Key messages An evaluation of a community empowerment programme found positive impacts on control, wellbeing, belonging and trust. Greater length or degree of involvement were associated with greater impact.

Background During the Covid-19 pandemic there was a significant rise in health and care services delivering services remotely, including by voluntary and community sector organisations (VCSOs) to adults with learning disabilities and/or autistic people. However, there was not enough research evidence of how different technologies are used, what works well or not well, for whom, and in what circumstances to support the diverse needs of adults with learning disabilities and/or autistic people. To address this evidence gap, Leeds Beckett University carried out a participatory realist review in partnership with 100% Digital Leeds, Pyramid and the Autism and Learning Disabilities Digital Inclusion Network (ALaDDIN) to explore how VCSOs can appropriately use digital technologies alongside or instead of in-person activity (hybrid delivery) to provide social care services to different adults with learning disabilities and/or autistic people. Methods This briefing is based on the findings of the participatory realist review. The research involved: • Five workshop and focus group discussions with people with learning disabilities and/or autistic people and representatives from VCSOs who worked with them, • A comprehensive review of relevant published research, guidance and policy, and • A deliberative hearing event to bring together findings from research and lived experience Results Everyone has the right to choose how they engage with the digital world! The workshop discussions and preliminary literature review produced 13 areas of interest that we explored in the realist review. The review included 141 articles in total and, following our discussions of the findings with service deliverers and users at the deliberative hearing event, led to six top tips for VCSOs using digital technology for delivering services to people with learning disabilities and/or autistic people.

Background aims Community organisations started using technology like video conferencing and social media more during the Covid-19 pandemic to keep doing activities with adults with learning disabilities and autism. They are now trying to figure out the best ways to combine technology and face-to-face activities. We wanted to find out the different ways that these community organisations combine technology and face-to-face activities and what works well. Methods We looked at published research about how community organisations use technology to provide services for adults with learning disabilities and autism. We held an event for community organisations and adults with learning disabilities and autism. We talked about what we had found out and heard peoples’ experiences of using technology. Results There is lots of research that includes community organisations using technology. Having a choice about whether to use technology is really important. Using technology can make it easier for people with learning disabilities and autism to join in if they have the right equipment, skills, and support. But there is no information about what community organisations need to use technology to delivery services for adults with learning disabilities and autism. Conclusion Supporting people with learning disabilities and autism to use technology can improve their independence and life skills. But there is not a lot of information for community groups to help them do this. We have applied for funding to do more research about this.

Background Delivery of health and care services using a combination of remote and/or in-person channels and digital and/or traditional tools (Hybrid Service Delivery, HSD) is increasingly seen as a way of improving quality and affordability, improving access, personalisation and sustainability, and reducing inequalities. Across the voluntary, community and social enterprise sector (VCSE), using a combination of remote and/or in-person channels and digital and/or traditional tools (HSD) has enabled the essential provision of services for people who have learning disabilities and/or autistic (LDA). However, it is unclear how different tools and channels have been used, what worked well or not well, for whom, and in what circumstances. The aim of this realist review is to explore how VCSE organisations can effectively use digital technologies alongside or instead of in-person activity to provide social care services to adults with learning disabilities and/or autism. This review protocol is presented in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P). Methods We will conduct a participatory realist review. Following realist review methodology, and involving people with LDA and organisations who deliver services to them, we will define the scope of the review/theory development, search for and appraise evidence, extract and synthesise findings, and develop the narrative. Using a developed strategy, electronic databases (Academic Search Complete, CINAHL, MEDLINE, PsycInfo, SCOPUS, Social Science Citation Index and Social Policy and Practice) will be searched. A data extraction table will be used to assist in sifting, sorting and organising relevant information from identified studies. For each proposition statement, relevant data from the identified literature will be synthesised and compared with the proposed theory to develop an understanding of how, why and when hybrid delivery works in different settings with different populations. Discussion This review aims to collate and synthesise evidence relating to hybrid service delivery in VCSE organisations to provide social care services to LDA adults. By conducting a participatory realist review, we anticipate that the findings will lead to a greater understanding of contextual factors and therefore more relevant recommendations.

Background Community organisations started using technology like video conferencing and social media more during the Covid-19 pandemic to keep doing activities with adults with learning disabilities and autism. They are now trying to figure out the best ways to combine technology and face-to-face activities. We wanted to find out the different ways that these community organisations combine technology and face-to-face activities and what works well. Methods We looked at published research about how community organisations use technology to provide services for adults with learning disabilities and autism. We held an event for community organisations and adults with learning disabilities and autism. We talked about what we had found out and heard peoples’ experiences of using technology. Results There is lots of research that includes community organisations using technology. Having a choice about whether to use technology is really important. Using technology can make it easier for people with learning disabilities and autism to join in if they have the right equipment, skills, and support. But there is no information about what community organisations need to use technology to delivery services for adults with learning disabilities and autism. Conclusion Supporting people with learning disabilities and autism to use technology can improve their independence and life skills. But there is not a lot of information for community groups to help them do this. We have applied for funding to do more research about this.

Background Technology is seen as a way to improve quality and reduce the cost of social care services. Voluntary and community sector organisations (VCSOs) are also becoming more involved in delivering social care services to adults with intellectual disabilities and/or autism. However, there is not enough information to help VCSOs use technology in the best way to deliver services. The aim of this research is to explore how VCSOs can appropriately use digital technologies alongside or instead of in-person activity (hybrid delivery) to provide services to different adults with intellectual disabilities and/or autism. Methods We conducted a participatory realist review. Workshops were held with service users and VCSOs to refine the scope of the review and develop preliminary theories. A systematic search of academic and grey literature was then carried out, including academic databases, website searches, and a call for evidence. Following screening, extraction, and synthesise, a deliberative hearing was held with service users and VCSOs to discuss emergent findings, refine theories, and develop conclusions. Results 141 papers were included in the review, although very few were specifically about how VCSOs use technology as part of their service delivery with people with learning disabilities and/or autism. Different technologies can have specific benefits for adults with learning disabilities and/or autism in different contexts. ‘Good’ hybrid service delivery requires co-production of services between users and VCSOs, and support that goes beyond just providing access to equipment. Conclusions VCSOs can use technology in a myriad of ways but there is limited guidance about how to do this appropriately with adults with learning disabilities and/or autism. We propose six ‘top tips’ as a starting point to help VCSOs.

Background Hybrid service delivery (HSD), involving the utilisation of both in-person and remote delivery for service provision, has been noted as a way of improving quality and affordability, increasing access and reducing inequalities. While HSD has facilitated the provision of services for people with learning disabilities and/or autism across the voluntary, community and social enterprise sector (VCSE), it is not apparent how HSD has been used, what worked well or not well, for whom, and in what circumstances. This study aimed to explore how VCSE organisations could effectively use digital technologies alongside or instead of in-person activity to provide social care services to adults with learning disabilities and/or autism. Methods A participatory realist review methodology was utilised. Programme theories and propositions about the phenomenon and related concepts were identified utilising preliminary literature searches and co-production workshops with service providers and service users. The developed statements were used to guide the database and the identification of evidence. This evidence was used to test and refine the statements. Results 141 records were used to produce 13 areas of interest. While there was strong evidence supporting the use of digital technology to improve social connections and independence, this was only the case when the technology was used correctly, implemented in a suitable setting and ‘fit’ the person using it. Evidence indicated that the development or adaptation of technology which were co-produced with adults with learning disabilities and/or autism were associated with better service delivery. Conclusions Supporting adults with learning disabilities and autism to use technology can improve their independence and life skills. However, the technology needs to be implemented in the right setting, as well as co-production being used to ensure the technology and the delivery is suitable and accessible. Key messages • There is evidence that digital technologies can be used to support people with learning disabilities and autistic people, but only if it is used correctly and in the right setting. • Utilise co-production to shape tech-enabled services. Consider language use, visuals and technology delivery. Listen to their ideas, so the technology delivers what they want and need.

Background The ‘Local People’ programme operates in 29 UK communities experiencing disadvantage and economic stressors that impact on population wellbeing. The programme uses a community empowerment approach to increase social connections, and collective control, improve health, and reduce inequalities. This links to SDGs 3 and 11. Mechanisms include a decision-making group led by residents, a project lead, funding, and support from a national charity. Methods A mixed method evaluation was conducted (2017-19) to identify processes and assess outcomes and impacts. This presentation outlines the findings from five in-depth qualitative case studies (c140 interviews) with emphasis on one post-industrial UK town suffering from the effects of industrial decline. A within case and cross case qualitative analysis was undertaken using a thematic framework. Results Priorities set by local areas focused on increasing community involvement and connections between people. A wide range of activities took place including regular classes and community events. The five case studies found strong qualitative evidence of increased social connectedness, community spirit and a sense of purpose, along with the area becoming a better place to live. People involved in project delivery gained confidence and skills, improved their wellbeing and gained a sense of control. There is, as yet, limited evidence that increased involvement has influenced the wider determinants of health. In the post-industrial town, people’s social networks expanded, enriching their lives and providing missed companionship. Participants in the programme reported improved mental and physical health, as well as increased confidence and skills. Involvement gave a voice to marginalised older people in the area. Conclusion Empowering communities and putting residents in control can lead to improvements in connectedness and some aspects of health and wellbeing, even in post-industrial towns facing considerable and complex challenges.

Community empowerment interventions, which aim to build greater individual and community control over health, are shaped by the community systems in which they are implemented. Drawing on complex systems thinking in public health research, this paper discusses the evaluation approach used for a UK community empowerment programme focused on disadvantaged neighbourhoods. It explores design choices and the tension between the overall enquiry questions, which were based on a programme theory of change, and the varied dynamic socio-cultural contexts in intervention communities. The paper concludes that the complexity of community systems needs to be accounted for through in-depth case studies that incorporate community perspectives.

Issues presented by COVID-19 to community resilience are located at individual, community and system level. In this paper, we reflect on WHO Europe propositions on what makes resilient communities, and explore how communities and systems with varying capacity have responded to the pandemic by absorbing and adapting to challenges. In our research we are seeing local responses at all three levels, which challenge current assumptions about the respective roles of citizen, local voluntary sector and state. This paper presents opportunities and challenges to translating this reactive social movement into proactive resilience-transforming change in how local systems work in the future.