Karina Kinsella

Aims: The contribution that lay people can make to the public health agenda is being increasingly recognised in research and policy literature. This paper examines the role of lay workers (referred to as 'community health champions') involved in community projects delivered by Altogether Better across Yorkshire and Humber. The aim of the paper is to describe key features of the community health champion approach and to examine the evidence that this type of intervention can have an impact on health. Methods: A qualitative approach was taken to the evaluation, with two strands to gathering evidence: interviews conducted with different stakeholder groups including project leads, key partners from community and statutory sectors and community workers, plus two participatory workshops to gather the views of community health champions. Seven projects (from a possible 12) were identified to be involved in the evaluation. Those projects that allowed the evaluation team to explore fully the champion role (training, infrastructure, etc.) and how that works in practice as a mechanism for empowerment were selected. In total, 29 semi-structured interviews were conducted with project staff and partners, and 30 champions, varying in terms of age, gender, ethnicity and disability, took part in the workshops. Results: Becoming a community health champion has health benefits such as increased self-esteem and confidence and improved well-being. For some champions, this was the start of a journey to other opportunities such as education or paid employment. There were many examples of the influence of champions extending to the wider community of family, friends and neighbours, including helping to support people to take part in community life. Champions recognised the value of connecting people through social networks, group activities, and linking people into services and the impact that that had on health and well-being. Project staff and partners also recognised that champions were promoting social cohesiveness and helping to integrate people into their community. Conclusions: The recent public health White Paper suggested that the Altogether Better programme is improving individual and community health as well as increasing social capital, voluntary activity and wider civic participation. This evaluation supports this statement and suggests that the community health champion role can be a catalyst for change for both individuals and communities.

Abstract

Community environments have the potential to alleviate loneliness and social isolation as they offer opportunity for sociality and to expand personal social network connections. Implementing a social network intervention in community environments to connect people to who are at risk of loneliness or social isolation could help alleviate these concerns. However, implementing interventions in community environments is made difficult by the interplay between the community context and intervention. Thus, to support implementation a detailed understanding of the types of community contexts is required. To examine the optimal factors that promote the implementation of a social network designed to alleviate loneliness and social isolation intervention in the community observations, interviews and documentary analysis were conducted. The Consolidated Framework for Implementation Research and a typology of community contexts were used to inform the data analysis and interpret the findings. Key factors were found to affect the implementation of the intervention in the different community contexts. These inter-related factors operated across three domains. Service User Needs affected intervention take up as its suitability varied. The stability of the workforce and nature of everyday work also impacted on implementation. Finally, the fluctuating capacity of organisations and the organisational culture were also influential. No single community environment was found to have all of the optimal factors required for implementation and sustainably. The UK policy agenda of austerity had negatively affected community environments’ capacity to deliver such intervention through increasing service user needs and reducing available resources.

Background Loneliness and social isolation are associated with adverse mental and physical health outcomes in adults. However, there is a lack of existing research on effective interventions and the contexts in which these could be implemented. Primary objective To assess the clinical and cost-effectiveness of a social network intervention compared to usual care among at-risk populations. Design A pragmatic, community-based, cluster randomised controlled trial with embedded health economic evaluation, process evaluation and qualitative study. Outcome assessments were conducted at baseline and at 3 and 6 months. Setting The study was conducted in collaboration with 44 community-based organisations in two regions in England. Participants Adults aged ≥ 18 years at risk of loneliness and social isolation. Intervention A facilitated social network tool (‘project about loneliness and social networks’; PALS) designed to link people to opportunities for social involvement. First, participants map and reflect on personal social networks. Second, identification of local resources based on individual preferences, available support, and health and wellness needs. Main outcome measures The primary outcome was mental wellness at 6-month follow-up, measured by the Short Form questionnaire-12 items mental health component score (MCS). Secondary outcomes included the Short Form questionnaire-12 items Physical Health subscale, loneliness, social isolation, well-being and collective efficacy. Economic measures assessed the cost-effectiveness of the intervention in terms of costs, quality-adjusted life-years and net monetary benefits. Results We recruited 469 adults into the study, with 120 withdrawals (25.6%). The main trial results indicate little to no treatment effect of the intervention on either the primary or secondary outcomes compared to usual care. The within-trial economic evaluation found that PALS was inexpensive to deliver but there was no significant difference in quality-adjusted life-years, measures of well-being capability or costs, and the intervention did not lead to demonstrable cost-effectiveness in terms of net monetary benefits. The process evaluation found PALS to be acceptable to all types of community organisations, but low resource availability and capacity to sustain PALS was found across all community organisational contexts. Qualitative interviews (n = 20) highlighted that participants wanted to engage with meaningful social activities but barriers to doing so were psychological (i.e. confidence and competence) and practical (i.e. transport or cost). Limitations The timing of COVID-19 and associated restrictions (approximately splitting trial follow-up into thirds of pre-COVID, during the first lockdown, and following the trial reopening) meant its impact on the trial is difficult to assess. There were high levels of missing data (20–30% for most outcomes at 6 months), though methods to handle missing data did not change the conclusions of the trial. Conclusions Our findings do not provide strong evidence of the efficacy of the PALS social network intervention to address the complexities of loneliness and social isolation. Although the intervention was acceptable to participants and community organisations who hold the potential to deliver such an intervention, sustainability would require a networked approach between organisations to mitigate against the challenges found in each organisation. Future work Future interventions for loneliness would likely benefit from utilising a multistep approach providing tailored psychological, relational and social components. Trial registration This trial is registered as Current Controlled Trials ISRCTN19193075. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 16/08/41) and is published in full in Public Health Research; Vol. 13, No. 1. See the NIHR Funding and Awards website for further award information.

© 2015 John Wiley & Sons LtdAsset-based approaches seek to identify and mobilise the personal, social and organisational resources available to communities. Asset mapping is a recognised method of gathering an inventory of neighbourhood assets and is underpinned by a fundamentally different logic to traditional needs assessments. The aim of this paper is to explore how asset mapping might be used as a tool for health improvement. It reports on a qualitative evaluation of a pilot asset mapping project carried out in two economically disadvantaged neighbourhoods in Sheffield, UK. The project involved community health champions working with two community organisations to identify assets linked to the health and wellbeing of their neighbourhoods. The evaluation was undertaken in 2012 after mapping activities had been completed. A qualitative design, using theory of change methodology, was used to explore assumptions between activities, mechanisms and outcomes. Semi structured interviews were undertaken with a purposive sample of 11 stakeholders including champions, community staff and strategic partners. Thematic analysis was used and themes were identified on the process of asset mapping, the role of champions and the early outcomes for neighbourhoods and services. Findings showed that asset mapping was developmental and understandings grew as participatory activities were planned and implemented. The role of the champions was limited by numbers involved, nonetheless meaningful engagement occurred with residents which led to personal and social resources being identified. Most early outcomes were focused on the lead community organisations. There was less evidence of results feeding into wider planning processes because of the requirements for more quantifiable information. The paper discusses the importance of relational aspects of asset mapping both within communities and between communities and services. The conclusions are that it is insufficient to switch from the logic of needs to assets without building asset mapping as part of a broader planning process.

Purpose: This paper explores the conditions that create a ‘good’ prison visit, focusing on the role that a dedicated third-sector run prison visitors’ centre plays in creating a supportive environment. Design: This paper draws on a synthesis of empirical data gathering conducted over a decade at a voluntary sector managed prison visitors’ centre based at a male prison in Northern England. The paper draws specifically on qualitative data gathered through four independent evaluations of the centre over a ten-year period. Findings: An important point to emerge from the research is the unwavering importance of the prison visit in the life, well-being and regime of a prisoner. Prison visitors’ centre are shown to be an important part of creating positive visits experiences offering a space for composure and for support for families. Originality: Many voluntary sector organisations are unable to commission large research and evaluation studies, but are often able to fund smaller pieces of work. Pooling qualitative evidence from smaller studies is a viable way to potentially strengthen commissioning decisions in this sector.

Objective: The health of the prison population has become an increasing concern, given the disproportionate rates of ill health in this population. Moreover, the challenges faced by prisoners’ families and their children are also becoming more apparent, with prisoners’ children being more likely than other children to experience mental and emotional health problems and more likely to go to prison themselves. Prison visits are an integral part of institutional structures and are a key way by which families stay in contact and mitigate against the negative effects of family separation. This paper focuses particularly on the impact of prison play visits as an alternative to ‘standard’ visiting procedures. Design: Cross-sectional qualitative study. Setting: A male prison in Northern England. Method: Telephone interviews with six prison visitors who had regularly participated in a play visit, plus a focus group with five prisoners. Results: The paper identifies play visits as a useful way to maintain family well-being as they ‘mimic’, albeit temporarily, domestic life. This is reported to be beneficial for future family outcomes and in enabling children to adjust to parental incarceration. Play visits improve levels of intimacy, which is beneficial for the mental and emotional health both of prisoners and their children. Conclusion: The paper argues for a more holistic notion of prisoner health that sees family connections as a key part of supporting health and well-being.

Children can find the process of visiting a prison traumatic and as a result of parental incarceration may experience a range of adverse outcomes. When children stay in contact with their imprisoned parent through prison visiting, however, this seems to be a protective factor. This paper reports on a play visits service based at Her Majesty's Prison Leeds, UK. The service provides supervised play work provision for children visiting their father. Data were derived from prisoners and prisoners' families and were triangulated as a means of achieving a level of validity. The findings reveal that play visits do produce positive outcomes for children and play visits are effective in maintaining and strengthening family ties. These effects may be stronger when compared to standard prison visits, but further research is needed to confirm this.

Research has shown that prison visits have the potential to improve prisoners’ mental wellbeing, increase social support and reduce the inmate perceived stresses associated with imprisonment. Identifying effective ways to promote the health and well-being of prisoners is important because although they are not a homogeneous group, they often have unhealthy lifestyles and poorer health compared to the wider population. Fazel and Baillargeon suggest that prisoners bear a ‘substantial burden of physical and psychiatric disorders relative to the general population’. In particular, evidence suggests that prisoners experience higher rates of mental health issues including suicide. Improving the health of individuals in the criminal justice system is recognised to be a key element of the reducing reoffending and health inequalities agendas. The determinants of offending are similar to the determinants of health; poor housing, low levels of social capital, stress, substance misuse, low educational attainment. By adopting a social rather than medical model of health, it could be argued that increasing the health of an individual could also potentially be beneficial in terms of reducing re-offending and lead to better rehabilitation outcomes.

Objectives To present a typology of attributes associated with lay health worker (LHW) roles drawn from a qualitative study of lay roles in the delivery of public health programmes. Study design Qualitative research study of case studies of public health projects. Methods Five case studies of public health projects were undertaken, reflecting diverse roles, public health issues and populations. Semi-structured interviews and focus groups were carried out with a sample of 136 stakeholders, including commissioners, practitioners, LHWs and service users. Thematic analysis was conducted within and across cases. Results Findings on the pre-eminence of social skills associated with LHW roles were consistent across all five projects. Being approachable, non-judgemental and responsive to community needs were critical attributes that enabled LHWs to undertake outreach and communicate successfully with programme recipients. Experiential knowledge and cultural understanding were also important qualities. A typology of attributes associated with LHW roles is presented. Conclusions Social skills, the ability to connect with a community, and the ability to develop respectful relationships are fundamental qualities for LHW roles. Further research would be required to produce a comprehensive map of LHW skills; however, the paper questions assumptions that lay skills are necessarily of a lower order than the professional skill set.

Aims: To evaluate a local C-Card scheme from the perspectives of young people in order to determine how well it had worked in improving access to condoms and in providing young people with appropriate information to make healthier choices around safer sex. Methods: Secondary analysis of a year’s worth of existing registration and monitoring data routinely collected by the C-Card scheme, two focus group discussions with 14 young people (eight males and six females) and a short questionnaire-based survey of 55 young people. Results: The evidence suggested that the C-Card scheme is an effective tool for ensuring that young people know how to use a condom correctly. Ease of access and increased knowledge were key issues of effectiveness to emerge from the findings. The scheme also served as a mechanism for young people to be referred on to other sexual health services and the data appear to indicate that this was something that was taken up by young people. Conclusions: The young people who used C-Card generally viewed the scheme as an effective mechanism in terms of accessing condoms and the number of outlets available for acquiring condoms. In order for C-Card to become successful with young people, advertising needs to be improved to increase their awareness of the scheme.

NHS Bradford & Airedale Provider Services (formerly Bradford & Airedale Community Health Service) have established a district-wide C-Card (condom card) scheme to provide improved accessed to condoms and sexual health advice for young people. An existing condom distribution scheme currently distributes over 400,000 condoms per year through GP surgeries and other agencies in contact with young people. The C-Card scheme is initially being piloted over an 18 month period, alongside the existing scheme, to assess its feasibility. Prior to the C-Card pilot project a condom distribution scheme existed across the Bradford and Airedale district sexual health service. This condom distribution scheme was evaluated and, through this process, the staff involved in this scheme indicated that there needed to be a more rigorous system in place to keep track of what had taken place with young people. At the end of January 2010 funds became available to support a pilot project of the C-Card scheme, intended to eventually replace the old ‘ad hoc’ system of distributing condoms to young people.

Walking for Health is a national programme of volunteer-led health walks, coordinated through Natural England and endorsed by the NHS as a means of promoting physical activity in the sedentary population. Walking for Wellness is a pilot project that has sought to widen access to Walking for Health in Northumberland and to pilot a new befriender role supporting the engagement of people with mental health needs in health walks. The pilot project, which started in April 2010, has been delivered by North Country Leisure and Blyth Valley Arts and Leisure, in partnership with Natural England. Northumberland County Council provided funding through the Communities for Health programme. The report presents findings from an evaluation of the Walking for Wellness project, conducted by Centre for Health Promotion Research, Leeds Metropolitan University. It presents evidence about engagement in walking groups and the social and health outcomes that can result from participation.

‘I am My Community’ is an asset mapping exercise led by Altogether Better that has explored a model by which trained Community Health Champions (CHCs) are used to undertake an inventory of the physical and social assets linked to the health and well-being of their communities and neighbourhoods. The project, which started in 2011 and was completed in April 2012, was undertaken in two communities in Sheffield, Sharrow and Firth Park, by two delivery organisations, ShipShape and SOAR. A steering group including Altogether Better, the Department of Health, Sheffield Well-Being Consortium, Sheffield City Council, ShipShape staff and CHCs, SOAR staff and CHCs, and South Yorkshire Police has overseen the delivery and development of the project and work. This report presents findings from an evaluation of the ‘I am My Community’ asset mapping, conducted by the Centre for Health Promotion Research, Institute for Health and Wellbeing at Leeds Metropolitan University. It presents evidence about the engagement of CHCs in asset mapping and offers recommendations regarding their involvement in future projects.

The aim of this paper is to critically examine the rationale for citizen engagement in the delivery of public health programmes through exploring perspectives on volunteer roles in two case studies: a neighbourhood health project based in a disadvantaged housing estate and a sexual health outreach project working with men who have sex with men. Interviews were conducted with stakeholders, including managers, practitioners, volunteers and service users. Volunteers were found to perform a bridging function, connecting disadvantaged communities to welfare provision, and they were engaged in social networks beyond their immediate role. The paper concludes by arguing that citizen engagement in public health is not a superficial response to welfare deficits, but should be framed as an appropriate strategy to address health inequalities at community level, within a citizenship framework.

This article reports the findings of a mixed methods evaluation study on the impact of a national fund to support volunteering as a mechanism to achieve health and social goals, within the Department of Health’s Volunteering Fund Programme (HSCVF). This paper adds understanding of the mechanisms through which government organisations can build VSCE organisational capacity to support volunteers. Firstly, the programme increased capacity via resource mobilisation to enhance volunteer recruitment, secondly it strengthened voluntary, community and social enterprise (VCSE) organisations through linkages and finally the programme supported development and learning. The HSCVF impacted upon both volunteering projects and host organisations to produce a range of positive outcomes that were particularly marked in smaller organisations: ‘small project, big difference’. Successful community capacity building can result from programmes such as HSCVF, with this paper contributing to the evidence base by detailing the processes through which this occurred.

The aim of this evidence review is to capture the impact that community health champion work, and that of those in similar roles, has for older people. This includes older people who become community health champions and older people in communities (programme beneficiaries) who are supported by community health champions. The evidence for older people working in lay public health roles presented in this report is derived from three primary sources: *A rapid review of the evidence in relation to older people and lay public health roles; *A summary of key themes emerging from the data collected with older people during a thematic evaluation of community health champions in Yorkshire and Humberside produced for Altogether Better; *Analysis and synthesis of monitoring and evaluation data produced by Altogether Better’s older people’s projects.

The winter of 2012/13 was longer and colder than usual; whilst temperatures were average in December, it was colder than usual from January through to May. March was the coldest it has been for 50 years (Met Office, 2013). This evaluation focuses on the organisations funded by the Winter Warmth campaign to deliver services to Leeds residents. The overriding aim of the evaluation was to inform the operation of possible future schemes, with good practices and any issues identified. The views of organisations on the need for the funds and how the campaign was organised were ascertained. How they delivered the services, reached clients and worked with other stakeholders is explored and their suggestions for improvements described. This report should be read alongside the overall campaign report, by Leeds City Council, and the beneficiary report.

The ‘Building Sustainability: Extended Support Package’ aimed to increase the capacity and sustainability of 94 local projects - all were Voluntary, Community and Social Enterprise (VCSE) organisations funded by the Health and Social Care Volunteering Fund (HSCVF). The bursary scheme, as it became known, was managed by Ecorys as the lead partner alongside Eastside Primetimers, CSV and Attend as the three delivery partners. Projects chose from a menu of over 50 offers including mentoring, coaching, on-site support, training and ‘other’. A Support Consultant, allocated to each project, helped them assess their needs, choose the most appropriate offers and submit the application. The scheme was introduced in 2012 with all offers utilised by May 2013. It was funded by the Department of Health. This report presents the findings from an evaluation undertaken by the Institute for Health & Wellbeing at Leeds Metropolitan University.

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.

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.

This paper examines the value of participatory approaches within interventions aimed at promoting mental health and wellbeing in the workplace. Specifically the paper explores data from the thematic evaluation of the Mental Health and Employment project strand within the Altogether Better programme being implemented in England in the Yorkshire and Humber region, which was funded through the BIG Lottery and aimed to empower people across the region to lead better lives. The evaluation combined a systematic evidence review with semi-structured interviews across mental health and employment projects. Drawing on both evaluation elements, the paper examines the potential of workplace-based 'business champions' to facilitate organizational culture change within enterprises within a deprived regional socio-economic environment. First, the paper identifies key policy drivers for interventions around mental health and employment, summarizes evidence review findings and describes the range of activities within three projects. The role of the 'business champion' emerged as crucial to these interventions and therefore, secondly, the paper examines how champions' potential to make a difference depends on the work settings and their existing roles, skills and motivation. In particular, champions can proactively coordinate project strands, embed the project, encourage participation, raise awareness, encourage changes to work procedures and strengthen networks and partnerships. The paper explores how these processes can facilitate changes in organizational culture. Challenges of implementation are identified, including achieving leverage with senior management, handover of ownership to fellow employees, assessing impact and sustainability. Finally, implications for policy and practice are discussed, and conclusions drawn concerning the roles of champions within different workplace environments.

Ten years on from Morgan and Ziglio’s call to revitalise the evidence base for public health through an asset model, there are still gaps in understanding about how best to evaluate asset-based approaches. The demand for better evidence poses some challenges as asset-based working emerges from radically different traditions from the mainstream deficit model in public health. This paper will present findings from a rapid evidence review on the measurement of asset-based approaches. The rapid review aimed to improve understanding of categories of measurement in the evaluation of asset-based approaches for health and wellbeing and to identify indicators and frameworks that can used in practice. The review was part of a project to develop an asset-based theory of change in health, care and wellbeing, funded by the Health Foundation. Rapid Evidence Assessment techniques were used to produce a map of evaluation approaches and measures. The search strategy used strings of common terms (eg Salutogensis, Asset Based Community Development) combined with synonyms of measurement/evaluation. Academic databases were searched from 2005 along with relevant websites. Additionally, the results of a previous search were screened and reference lists mined. Publications were included if they explicitly discussed the asset model and measurement. Data were then extracted across various fields including population, conceptual framework, measurement type and application. Findings were summarised in tables, with some additional thematic analysis. 8689 publications were identified and 91 full text articles assessed for eligibility. In total, 33 publications were included in the review. Many of these flagged up the challenges of evaluation and the need for better outcome measurement. Reported research strategies varied considerably from the practical to the theoretical. Also the purpose, level and specificity of measurement ranged from validated indicators through to broad domain frameworks. Seven clusters were identified: Asset Based Community Development; Asset Mapping; Community-based evaluation; Conceptual frameworks for measurement; Resilience; Salutogensis; Other. One key theme was the importance of communities being involved in the assessment of assets. The review provides an overview of research strategies and measures with application and purpose described. Producing a map of how asset-based approaches are evaluated and articulating key methodological differences helps researchers and practitioners select appropriate evaluation methods. There are a number of limitations, including the use of rapid review methods which may have missed other relevant evaluation approaches. Further methodological development is needed in this field and we welcome debate about ways to evaluate asset-based approaches.

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.

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.

Objectives: There has been an increased focus in policy discourse on individuals with severe, multiple and complex needs. This paper seeks to understand how best to enable these individuals to take greater control of their health. Design: Qualitative, user-led, peer research Setting: Large urban UK city. Method: Trained peer researchers with previous experience of severe and multiple disadvantage gathered data using a snowball sampling approach from 21 individuals engaged in a service specifically designed to provide for their needs. Results: The study identified enabling factors that create conditions for individuals with severe and multiple disadvantage to take greater control of factors impacting on their health and social situations. These included working holistically with individuals, understanding the interconnected issues impacting on health, developing trusting relationships with professionals and working within a positive framework that fosters self-belief and is focused on salutogenesis rather than pathogenesis. Conclusion: There exists a set of enabling factors that may support individuals facing particular challenges in their lives. While derived from within a specific geographical context, findings have relevance to other settings in relation to ways of working. Peer research demonstrates itself to be a research approach well suited to understanding lived experiences.

Background Peer interventions involving prisoners in delivering peer education and peer support in a prison setting can address health need and add capacity for health services operating in this setting. This paper reports on a qualitative synthesis conducted as part of a systematic review of prison-based peer interventions. One of the review questions aimed to investigate the positive and negative impacts of delivering peer interventions within prison settings. This covered organisational and process issues relating to peer interventions, including prisoner and staff views. Methods A qualitative synthesis of qualitative and mixed method studies was undertaken. The overall study design comprised a systematic review involving searching, study selection, data extraction and validity assessment. Studies reporting interventions with prisoners or ex-prisoners delivering education or support to prisoners resident in any type of prison or young offender institution, all ages, male and female, were included. A thematic synthesis was undertaken with a subset of studies reporting qualitative data (n=33). This involved free coding of text reporting qualitative findings to develop a set of codes, which were then grouped into thematic categories and mapped back to the review question. Results Themes on process issues and wider impacts were grouped into four thematic categories: peer recruitment training and support; organisational support; prisoner relationships; prison life. There was consistent qualitative evidence on the need for organisational support within the prison to ensure smooth implementation and on managing security risks when prisoners were involved in service delivery. A suite of factors affecting the delivery of peer interventions and the wider organisation of prison life were identified. Alongside reported benefits of peer delivery, some reasons for non-utilisation of services by other prisoners were found. There was weak qualitative evidence on wider impacts on the prison system, including better communication between staff and prisoners. Gaps in evidence were identified. Conclusions The quality of included studies limited the strength of the conclusions. The main conclusion is that peer interventions cannot be seen as independent of prison life and health services need to work in partnership with prison services to deliver peer interventions. More research is needed on long-term impacts.

This research aimed to find out how Voluntary and Community Organisations (VCOs) can help improve the mental health and wellbeing of Black women born outside of the UK. Factors that can help improve mental health and wellbeing and those that affect it negatively were explored. People were asked what barriers there were to accessing mental health services and what support VCOs can give. Key messages and recommendations are included in an executive summary.

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”.

Volunteer engagement is crucial to the effective delivery of mega-sporting events. While evidence points to reported motivations and wellbeing benefits for individual participants during and post event, there is less evidence on how this type of civic participation relates to the social context in which it occurs and the wider social determinants of health. This qualitative study sought to understand impacts on wellbeing and the determinants of health resulting from the experience of volunteering at the Glasgow 2014 Commonwealth Games. Focus groups and interviews were conducted one-year post-Games to gather the perspectives of 46 volunteers and 7 unsuccessful applicants on their experiences. Participants provided insight into the volunteer journey, contributions and associated outcomes. Wider social impacts were also reported including a renewed sense of pride in the city. The qualitative analysis suggested an important non-linear relationship between volunteer contributions, impacts and rewards, and the outcome of enhanced social connections. The emergent ‘people and place’ framework identifies some critical factors around city life and volunteer assets that planners could consider in developing and evaluating sustainable volunteering and its wider impacts beyond a mega-event.

Background The prisoner population has poorer health and worse health inequalities than the general population. Peer-based interventions may be an effective way of reaching this vulnerable group. Methods The systematic review aimed to answer the following questions: 1. What are the effects of peer interventions on prisoner health and its determinants? 2. What are the positive and negative impacts of delivering peer interventions on health services in prisons? 3. How do the effects of peer approaches compare to those of professionally led approaches? 4. What is the cost effectiveness of peer interventions in prisons? In addition to grey literature identified and searches of websites, 19 electronic databases were searched from 1985 to present. Quantitative, qualitative and mixed method evaluations were included. Results 57 studies were included in the effectiveness review; most were of poor methodological quality. Evidence suggested that peer education interventions are effective at reducing risky behaviours, and that peer support services are acceptable within the prison environment, have a positive effect on deliverers and recipients and can impact positively on the prison as an organisation. There was only one study on cost-effectiveness of peer-based interventions. Conclusions Being a peer worker is associated with positive health; peer support services are also an acceptable source of help within the prison environment and can have a positive effect on recipients, although research into cost-effectiveness is sparse. Peer-based interventions can be considered a valuable mechanism to maintain or improve health and wellbeing in the prison setting. Funding: NIHR HS&DR programme Project 10/2002/13

Background The prisoner population has a higher prevalence of poor health and health inequalities compared to the general population. Peer based interventions may be an effective way of reaching this vulnerable group. Methods Review questions: 1. What are the effects of peer interventions on prisoner health and its determinants? 2. What are the positive and negative impacts of delivering peer interventions on health services in prison settings? 3. How do the effects of peer approaches compare to those of professionally led approaches? 4. What is the cost effectiveness of peer interventions in prison settings? 19 electronic databases were searched from 1985 to present, plus relevant websites. Inclusion criteria: prisoners, or children in Young Offender Institutions; delivering or receiving peer-based interventions; outcomes relating to health or its determinants, organisational or process outcomes; Quantitative, qualitative and mixed method evaluations. Results 58 studies were included in the review; most were methodologically poor. Evidence suggested that peer education interventions are effective at reducing risky behaviours, and peer support services are acceptable within the prison environment, having a positive effect on recipients. Consistent evidence from many studies, suggested that being a peer deliverer was associated with positive effects. There was little evidence on cost-effectiveness of peer-based interventions. Conclusions There is consistent evidence from a large number of studies that being a peer worker is associated with positive health; peer support services are also an acceptable source of help within the prison environment and can have a positive effect on recipients. Research into cost-effectiveness is sparse.

Background The prisoner population has a higher prevalence of poor health and health inequalities compared to the general population. Peer based interventions may be an effective way of reaching this vulnerable group, but to date the evidence has not been systematically reviewed. Methods The systematic review aimed to answer the following questions: 1. What are the effects of peer interventions on prisoner health and its determinants? 2. What are the positive and negative impacts of delivering peer interventions on health services in prison settings? 3. How do the effects of peer approaches compare to those of professionally led approaches? 4. What is the cost effectiveness of peer interventions in prison settings? In addition to grey literature identified and searches of websites, 19 electronic databases were searched from 1985 to present. Two reviewers selected studies using the following criteria: prisoners resident in adult prisons or children resident in Young Offender Institutions; delivering or receiving peer-based interventions; outcomes relating to prisoner health or its determinants, organisational or process outcomes or views of prison populations. Quantitative, qualitative and mixed method evaluations were included. Results 57 studies were included in the effectiveness review and one study in the cost-effectiveness review; most were of poor methodological quality. Evidence suggested that peer education interventions are effective at reducing risky behaviours, and that peer support services are acceptable within the prison environment and have a positive effect on recipients. Consistent evidence from many, predominantly qualitative, studies, suggested that being a peer deliverer was associated with positive effects. There was little evidence on cost-effectiveness of peer-based interventions. Conclusions There is consistent evidence from a large number of studies that being a peer worker is associated with positive health; peer support services are also an acceptable source of help within the prison environment and can have a positive effect on recipients. Research into cost-effectiveness is sparse. Main messages This comprehensive systematic review of peer interventions in prisons found positive effects for peer deliverers and recipients, particularly in mental health and reducing risky behaviours.

Background: In 2020, NHS England commissioned independent commercial service providers to deliver a Low Calorie Diet Programme pilot, offering Total Diet Replacement alongside behavioural support. Methods: This paper presents participant experiences of the programme using both quantitative and qualitative data derived from four cross-sectional surveys, and examines differences by sociodemographics, delivery model and provider. Results: The majority of participants reported a positive experience with the referral process, with a small proportion feeling that insufficient information was provided and that they did not feel respected or listened to by their healthcare professional. Participants’ relationship with their coach was generally positive throughout each phase of the programme, and highlights the importance of coach-participant relationships. The relationship with the coach via digital delivery was less favourable compared to other delivery models, as was the perceived adequacy of support provided. Conclusions: The experience of the referral from general practice and the relationship with the coach are key elements of the participant experience. They demonstrate the importance of, and need for, person-centred care.

Background: Obesity and type 2 diabetes can both profoundly impact health and wellbeing, and their prevalence largely follows a social gradient. The National Health Service Low Calorie Diet programme in England, aims to support people to achieve type 2 diabetes remission, while also reducing health inequalities. We aimed to explore the experiences of local health service leads and identify barriers and facilitators in relation to the equitable mobilisation of the Low Calorie Diet programme. Methods: Twenty semi-structured interviews were completed with 24 locality leads across the first two years of the Low Calorie Diet programme. Interviewees were purposively sampled from the ten localities who undertook the Low Calorie Diet programme pilot. Each interview explored a number of topics of interest including referrals, training, communication, incentivisation, governance and engagement, before being subjected to a thematic analysis. Results: From the data, seven core themes were identified: Covid-19 and primary care capacity and engagement, methods of communication, approaches to training, approaches to incentivisation, approaches to Referrals, barriers to referrals and the importance of collaboration. Covid-19 presented a specific challenge to the mobilisation and delivery of the Low Calorie Diet programme; however, our findings demonstrate the large variation and differences in the approaches taken when delivering the programme across ten geographically and demographically distinct pilot sites. We also identified a lack of a recognised approach or strategy to mobilisation and delivery support for the Low Calorie Diet programme, such as proportionate universalism, which is a social policy response to tackling health inequalities by ensuring service delivery is equitable. Conclusions: Health inequalities remain a significant challenge, and health service leads have the potential to adopt an equity perspective from the start of programme mobilisation. In doing so resources at their disposal can be managed equitably and can therefore contribute to efforts to reduce the potential occurrence of intervention generated inequalities.

‘People in Public Health’ is a study about approaches to develop and support lay people in public health roles. The use of participatory approaches in public health programmes, both in national and international contexts, is well established and seen as necessary to deliver sustainable improvements in public health (Bracht and Tsouros, 1990; Rifkin et al., 2000; World Health Organization, 2002). Indeed a central argument in the Wanless reviews was that a ‘fully engaged scenario’ with high levels of public engagement in health would result in lower levels of public expenditure and better health outcomes (Wanless, 2002; Wanless, 2004). Government policy supports greater community engagement in health as a means of addressing public health priorities and tackling health inequalities (Department of Health, 2003). The health agenda on community involvement resonates with arguments for citizen empowerment and greater democratisation of services, not only in the NHS but across the public sector, in national agencies and local authorities (Campbell et al., 2008). Recent national guidance on community engagement noted the wide variety of approaches, indicating that those approaches based on higher levels of participation and greater community control were more likely to lead to increased health and social outcomes1 (National Institute for Health and Clinical Effectiveness, 2008). There was a recommendation to recruit what were termed ‘agents of change’ in communities who become involved ‘to plan, design and deliver health promotion activities and to help address the wider social determinants of health’ by taking on roles such as peer educators, health champions or neighbourhood wardens (National Institute for Health and Clinical Effectiveness, 2008:28). The concept of empowerment, the process of individuals and communities being enabled to undertake local action to effect change, is seen as core to health promotion (Tones and Tilford, 2001; World Health Organization, 1986; Wallerstein, 2006). Government policy on community empowerment advocates increased citizen involvement in planning and running services (Secretary of State for Communities and Local Government, 2008) and this agenda is linked to the personalisation of health and social services and patient and public involvement (Department of Health, 2005b; Department of Health, 2006; Secretary of State for Health, 2006). More evidence is required, however, about effective mechanisms for lay engagement and how public services can best enhance, support and sustain community involvement.

The Health and Social Care Volunteering Fund (HSCVF) is an innovative programme that was established in 2009 by the Department of Health (DH) to build organisational and community capacity for volunteering through a national and local grant scheme. The HSCVF has offered both funds and tailored support to health and social care projects delivered by Voluntary, Community and Social Enterprise (VCSE) organisations. The HSCVF is managed by a partnership led by Ecorys and with expertise from leading national voluntary sector organisations: Attend, Community Service Volunteers (CSV) and Primetimers. To date the HSCVF has funded a total of 157 local and national projects, of which 114 are currently live. This report presents findings from an evaluation of the HSCVF with a specific focus on the 2010/2011 national and local projects, conducted by a team from the Institute for Health & Wellbeing at Leeds Metropolitan University. It presents evidence on the extent to which, how and in what ways the HSCVF programme has built organisational and community capacity across the national and local HSCVF projects, as well as on the health and social outcomes that resulted.

Background: Offender health is deemed a priority issue by the Department of Health. Peer support is an established feature of prison life in England and Wales; however, more needs to be known about the effectiveness of peer-based interventions to maintain and improve health in prison settings. Objectives: The study aimed to synthesise the evidence on peer-based interventions in prison settings by carrying out a systematic review and holding an expert symposium. Review questions were (1) what are the effects of peer-based interventions on prisoner health and the determinants of prisoner health?, (2) what are the positive and negative impacts on health services within prison settings of delivering peer-based interventions?, (3) how do the effects of peer-based approaches compare with those of professionally led approaches? and (4) what are the costs and cost-effectiveness of peer-based interventions in prison settings? Data sources: For the systematic review, 20 electronic databases including MEDLINE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature and EMBASE were searched from 1985. Grey literature and relevant websites were also searched. To supplement the review findings 58 delegates, representing a variety of organisations, attended an expert symposium, which provided contextual information. Review methods: Two reviewers independently selected studies using the following inclusion criteria: population – prisoners resident in prisons and young offender institutions; intervention – peer-based interventions; comparators: review questions 3 and 4 compared peer-led and professionally led approaches; outcomes – prisoner health or determinants of health, organisational/process outcomes or views of prison populations; study design: quantitative, qualitative and mixed-methods evaluations. Two reviewers extracted data and assessed validity using piloted electronic forms and validity assessment criteria based on published checklists. Results from quantitative studies were combined using narrative summary and meta-analysis when appropriate; results from qualitative studies were combined using thematic synthesis. Results: A total of 15,320 potentially relevant papers were identified of which 57 studies were included in the effectiveness review and one study was included in the cost-effectiveness review; most were of poor methodological quality. A typology of peer-based interventions was developed. Evidence suggested that peer education interventions are effective at reducing risky behaviours and that peer support services provide an acceptable source of help within the prison environment and have a positive effect on recipients; the strongest evidence came from the Listener scheme. Consistent evidence from many predominantly qualitative studies suggested that being a peer deliverer was associated with positive effects across all intervention types. There was limited evidence about recruitment of peer deliverers. Recurring themes were the importance of prison managerial and staff support for schemes to operate successfully, and risk management. There was little evidence on the cost-effectiveness of peer-based interventions. An economic model, developed from the results of the effectiveness review, although based on data of variable quality and a number of assumptions, showed the cost-effectiveness of peer-led over professionally led education in prison for the prevention of human immunodeficiency virus (HIV) infection. Limitations: The 58 included studies were, on the whole, of poor methodological quality. Conclusions: There is consistent evidence from a large number of studies that being a peer worker is associated with positive health. Peer support services can also provide an acceptable source of help within the prison environment and can have a positive effect on recipients. This was confirmed by expert evidence. Research into cost-effectiveness is sparse but a limited HIV-specific economic model, although based on a number of assumptions and evidence of variable quality, showed that peer interventions were cost-effective compared with professionally led interventions. Well-designed intervention studies are needed to provide robust evidence including assessing outcomes for the target population, economic analysis of cost-effectiveness and impacts on prison health services. More research is needed to examine issues of reach, utilisation and acceptability from the perspective of recipients and those who choose not to receive peer support. Study registration: This study was registered as PROSPERO CRD42012002349. Funding: The National Institute for Health Research Health Services and Delivery Research programme.

BACKGROUND: Prisoners experience significantly worse health than the general population. This review examines the effectiveness and cost-effectiveness of peer interventions in prison settings. METHODS: A mixed methods systematic review of effectiveness and cost-effectiveness studies, including qualitative and quantitative synthesis was conducted. In addition to grey literature identified and searches of websites, nineteen electronic databases were searched from 1985 to 2012. Study selection criteria were: Population: Prisoners resident in adult prisons and children resident in Young Offender Institutions (YOIs). INTERVENTION: Peer-based interventions Comparators: Review questions 3 and 4 compared peer and professionally led approaches. OUTCOMES: Prisoner health or determinants of health; organisational/ process outcomes; views of prison populations. STUDY DESIGNS: Quantitative, qualitative and mixed method evaluations. RESULTS: Fifty-seven studies were included in the effectiveness review and one study in the cost-effectiveness review; most were of poor methodological quality. Evidence suggested that peer education interventions are effective at reducing risky behaviours, and that peer support services are acceptable within the prison environment and have a positive effect on recipients, practically or emotionally. Consistent evidence from many, predominantly qualitative, studies, suggested that being a peer deliverer was associated with positive effects. There was little evidence on cost-effectiveness of peer-based interventions. CONCLUSIONS: There is consistent evidence from a large number of studies that being a peer worker is associated with positive health; peer support services are also an acceptable source of help within the prison environment and can have a positive effect on recipients. Research into cost-effectiveness is sparse. SYSTEMATIC REVIEW REGISTRATION: PROSPERO ref: CRD42012002349 .

Lay-led walking group interventions to increase physical activity often use community engagement methods to ensure intervention reach and to address the determinants of neighbourhood walking. More needs to be known about how social factors support engagement and maintenance of group activity. This paper presents results from qualitative research on a pilot project in the North of England, UK that sought to increase participation in lay-led walking groups run as part of the national Walking for Health scheme. The ‘Walking for Wellness’ project included the introduction of a befriending role as a support mechanism. Focus groups and individual interviews were used to examine social processes within lay-led walking groups and how these processes facilitated participation and led to wellbeing outcomes. The sample comprised walkers attending six health walks, befrienders and professional stakeholders. In total 92 people were interviewed, including 77 walkers. Thematic data analysis identified six major themes: pathways to involvement; factors influencing involvement; widening access; befriender role; benefits from participation; and strengthening communities. There was strong qualitative evidence that social factors, which included mutual aid, strengthening of social networks and social support to facilitate participation for those having mild difficulties, facilitated engagement in group-based walking. Walk participants did not see social benefits as an unanticipated outcome but as integral to the processes of engagement and maintenance of activity. In contrast the introduction of a formal befriending role was seen to lack relevance and raised issues around the stigma associated with poor mental health. The paper concludes that understanding social processes and how they link to health outcomes has implications for the design and evaluation of lay-led walking group interventions.

Introduction: The National Health Service (NHS) Low Calorie Diet (LCD) pilot programme aimed to support people with type 2 diabetes (T2DM) to lose weight, reduce glycaemia and potentially achieve T2DM remission using total diet replacement alongside behaviour change support. The Re:Mission study seeks to provide an enhanced understanding of the long-term cost-effectiveness of the programme and its implementation, equity, transferability and normalisation across broad and diverse populations. This article presents an overview of the methods used in the Re:Mission study. Methods and analysis: A mixed method approach was used to draw together service user insights from across longitudinal and cross-sectional online surveys and semi-structured interviews supported by a modified photovoice technique. Insights were captured from active service users across the three phases of the programme (total diet replacement, food reintroduction and maintenance) in addition to those discharged prematurely. Survey data were analysed using descriptive statistics and qualitative data were thematically analysed and interpreted through a realist informed lens to understand which aspects of the service work and do not work, for whom, in what context and why. Results: Results from the study are presented elsewhere, with recommendations for policy practice and research.

The Centre for Health Promotion at Leeds Beckett University were commissioned to review existing literature on the impacts of mega-sporting event volunteering and to undertake a qualitative study to investigate the experiences of volunteers at the Glasgow 2014 Commonwealth Games (known as ‘clyde-siders’). The study also set out to explore the experiences of those who applied to be a clyde-sider but were not successful with their application (referred to as non-clyde-siders). The literature review identified process issues as significant factors in the delivery of a mega-sporting event that results in a positive experience for volunteers. The review also found that mega-sporting event volunteering yields health and social outcomes both for individual volunteers and the host community. The weight of evidence in this review suggests that the process of mega-sporting event volunteering is relatively well understood. However, gaps remain with regard to the longer-term outcomes of mega-sporting event volunteering for individual volunteers (and those who apply but do not go on to become volunteers) and for communities. Qualitative exploration with clyde-siders and non-clyde-siders identified important assets that they brought to the Glasgow 2014 Commonwealth Games. Existing skills and experiences from their professional life or other volunteering roles; a personal touch reflecting commitment and approachability; and local knowledge of the city were important attributes that were highlighted. The research highlighted that while volunteers added to the success of the Games and its delivery, they were also able to draw on the event for their own personal benefit. Positive outcomes included increased confidence and knowledge, and the development of skills for future employment. These outcomes were often more pronounced in clyde-siders than non-clyde-siders, but this was not always the case as some non-clyde-siders drew benefits from applying for the role. The development of friendships and the value that people placed on meeting new people was a particularly prominent finding for both clyde-sider and non-clyde-siders. This included ‘bridging’ with others across social and cultural boundaries. The link between place, participation and the social impacts of volunteering at the Glasgow 2014 Commonwealth Games is a distinctive finding from the research. For clyde-siders, benefits were derived from the formal volunteering role and from being part of the collective experience in the city during the Games. These benefits could not be solely attributed to being a volunteer, as non-clyde-siders also reported gaining from being part of the friendly atmosphere generated by hosting the Games. Implications for strategic planning for mega-sporting events are outlined in the report.

Summary Obesity and Type 2 Diabetes Mellitus (T2DM) are chronic conditions with significant personal, societal, and economic impacts. Expanding on existing trial evidence, the NHS piloted a 52‐week low‐calorie diet programme for T2DM, delivered by private providers using total diet replacement products and behaviour change support. This study aimed to determine the extent to which providers and coaches adhered to the service specification outlined by NHS England. An observational qualitative study was conducted to examine the delivery of both one‐to‐one and group‐based delivery of programme sessions. Observations of 122 sessions across eight programme delivery samples and two service providers were completed. Adherence to the service specification was stronger for those outcomes that were easily measurable, such as weight and blood glucose, while less tangible elements of the specification, such as empowering service users, and person‐centred delivery were less consistently observed. One‐to‐one sessions were more successful in their person‐centred delivery, and the skills of the coaches delivering the sessions had a strong impact on adherence to the specification. Overall, the results show that there was variability by provider and delivery mode in the extent to which sessions of the NHS Low‐Calorie Diet Programme reflected the intended service specification. In subsequent programmes it is recommended that one‐to‐one sessions are used, with accompanying peer support, and that providers improve standardised training and quality assurance to ensure specification adherence.

Background: The food reintroduction phase of the NHS Low Calorie Diet (LCD) programme aims to support service users to reintroduce food gradually back into their diet. Understanding experiences of food reintroduction from a broad and diverse range of service users is critical in helping to improve service delivery and commissioning and equity in care. Methods: This was a co-produced qualitative study underpinned by a realist informed approach, using interviews and photovoice techniques. Service users (n=43) of the NHS LCD Programme were recruited from three delivery models across 21 pilot sites in England. Data were analysed using a thematic approach. Results: The food introduction phase required control and planning that challenged the behaviours of participants. Around a third of participants continued use of Total Diet Replacement products, or considered doing so, for convenience and to maintain calorie control. The coach–service user relationship was important to understanding of session content and translation into behaviour change. Physical activity increased during this phase, which contributed to positive health outcomes. Conclusions: The paper reports insights from the food reintroduction phase of the LCD programme. Key messages include the need for increased frequency of support and the need for tailored and culturally representative education.

Background: The National Health Service (NHS) Low Calorie Diet (LCD) programme in England aims to support people with type 2 diabetes (T2DM) to lose weight, improve glycaemic parameters and potentially achieve diabetes remission. The programme pilot launched in 2020 using three different delivery models: one-to-one, group and digital via an App. Service users begin the programme with 12 weeks of Total Diet Replacement (TDR). This study aims to understand the experience of this TDR phase from the service user perspective. Methods: This was a co-produced qualitative longitudinal and cross-sectional study, underpinned by a realist informed approach using semi-structured interviews and photovoice techniques. Service users (n=45) from the NHS LCD programme were recruited across the three delivery models and 21 pilot sites in England. Data were analysed using a thematic approach. Results: Participant demographics were representative of the overall LCD pilot population sample and included experiences from a mix of delivery models and providers. Three themes were presented chronologically. 1) life pre-LCD: the LCD programme was viewed as an opportunity to reset eating behaviours and improve quality of life; 2) experience of TDR: flexibility in allowing supplementary non-starchy vegetables and adapting the flavour and texture of TDR products supported adherence; 3) looking ahead to food reintroduction: at the end of the TDR phase, weight and glycaemia had reduced, while subjective energy levels and mobility improved. Some participants were concerned about progressing to the food reintroduction phase and the possibility of weight regain. Conclusions: The paper reports insight from the TDR phase of the LCD programme. The co-production of this work has resulted in several recommendations for policy and practice which have informed the national roll out of the programme.

Background: The weight maintenance phase of the NHS Low CalorieaDiet (LCD) programme focuses on embedding long- term dietary and physical activity changes. Understanding individual experiences of this phase is crucial to exploring long- term effectiveness and equity of the intervention approach. Methods: This was a coproduced qualitative study underpinned by a realist informed approach, using interviews and photovoice techniques. Service users (n=25) of the NHS LCD programme were recruited from three delivery models, across 21 sites in England. Data were analysed using a thematic approach. Results: The experiences reported were largely positive, with many participants reporting changes in their diet and physical activity. Some service users expressed a need for additional support and there appeared variation in their experiences of the service providers and the wider available support network. Fear of weight regain and its glycaemic consequences was expressed by many; various mitigations were employed, including participating in other weight loss services and continuing use of Total Diet Replacement products. Conclusions: The NHS LCD programme has been life-changing for some people. However, service user insights suggest that a stronger person-centred focus might further improve effectiveness and service user experience.

Background National Health Service England piloted a low-calorie diet programme, delivered through total diet replacement and behaviour change support via 1 : 1, group or digital delivery, to improve type 2 diabetes in adults with excess weight. Aim To coproduce a qualitative and economic evaluation of the National Health Service low-calorie diet pilot, integrated with National Health Service data to provide an enhanced understanding of the long-term cost-effectiveness, implementation, equity and transferability across broad and diverse populations. Research questions What are the theoretical principles, behaviour change components, content and mode of delivery of the programme, and is it delivered with fidelity to National Health Service specifications? What are the service provider, user and National Health Service staff experiences of the programme? Do sociodemographics influence programme access, uptake, compliance and success? What aspects of the service work and what do not work, for whom, in what context and why? Can the programme be improved to enhance patient experience and address inequities? What are the programme delivery costs, and policy implications for wide-spread adoption? Methods A mixed-methods study underpinned by a realist-informed approach was delivered across five work packages, involving: semistructured interviews with service users (n = 67), National Health Service staff (n = 55), service providers (n = 9); 13 service provider focus groups; and service user surveys (n = 719). Findings were triangulated with clinical data from the National Health Service England’s first cohort analysis (n = 7540). Results Fifty-five per cent of service users who started total diet replacement completed the programme and lost an average of 10.3 kg; 32% of those with data available to measure remission achieved it. Examination of programme mobilisation identified barriers around referral equality and the impact of COVID-19, while effective cross-stakeholder working and communication were key facilitators. Service delivery and fidelity assessments identified a drift in implementation fidelity, alongside variation in the behaviour change content across providers. Perceived barriers to programme uptake and engagement aligned across service providers and users, resulting in key learning on: the importance of person-centred care, service user support needs, improvements to total diet replacement and the social and cultural impact of the programme. Early National Health Service quantitative analyses suggest some socioeconomic variation in programme uptake, completion and outcomes. Insights from the evaluation and National Health Service data were combined to develop the programme theory and underpinning context, mechanisms and outcomes. These were used to develop a list of recommendations to improve the cultural competency of programme delivery, total diet replacement delivery, peer support and address psychological support needs. Cost-effectiveness analyses using short-term follow-up data indicated there is potential for the programme to be cost-effective, but not cost saving. Conclusions The National Health Service low-calorie diet can provide a clinically effective and potentially cost-effective programme to support weight loss and glycaemic control in adults with type 2 diabetes. However, this evaluation identified areas for improvement in referral equity, uptake and completion, and fidelity of delivery, which have informed the development of the programme, which has now been rolled out nationally. Ongoing programme monitoring and long-term follow-up are now required. Future work and limitations The real-world setting limited some data collection and analysis. Future work will focus on the analysis of long-term clinical and cost-effectiveness, and addressing inequalities. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR132075.