Dr Sally Sj Brown

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.

Yoga originated in the Indian subcontinent 2.500 to 5,000 years ago (Mallinson & Singleton, 2017; Newcombe, 2009a). Increasingly popular in high-income countries, yoga offers multiple health and wellbeing benefits. However, yoga students and teachers in the United Kingdom (UK) are 91% white, 87% female and 71% university educated (Cartwright et al, 2020). The literature indicates that marginalised groups experience spirituality as a barrier to yoga access. However, a new, qualitative study of northern UK cities – the first to look at a broad, intersectional range of marginalised identities – identifies spirituality as an access enabler for these groups.

An evaluation of the Outreach activity conducted by YDNPA in Inner East Leeds.

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 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 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.