Professor Jane South

Although ‘‘resilience’’ is now routinely invoked by modern public health policies, strategies, and frameworks, measuring and reporting on the concept, across culturally diverse populations in ways that are meaningful and engaging, is still a significant challenge. A coherent strategy to measure resilience is needed, in order to permit WHO to track progress of Member State implementation of Health 2020 and the Sustainable Development Goals (SDGs). Jane South presented the results of a rapid review conducted to identify quantitative and qualitative methods that can be used to measure health-related community resilience at a national level. Different measurement strategies like the development of (i) Frameworks giving a population profile of resilience factors , (ii) Mixed method assessment frameworks incorporating stakeholder views, and (iii) Qualitative and participatory approaches exploring resilience in specific contexts are introduced.

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

Africa has made great progress through the Millennium Development Goals (MDGs), however, it still faces challenges like high disease burdens, poverty, health inequalities and weak healthcare finances and systems. Improving health and well-being through the post-2015 development agenda cannot be an end but a means to addressing the causes of these health determinants and problems. The study uses the work of the Commission on Social Determinants of Health (2008) to expand healthcare financing in Ghana with the principles of equity, human rights and health needs. It places social determinants of health and health promotion in a historical, economic and social context.  The first stage involved a desk assessment to extract data from literature and policy documents. The assessment revealed that transportation, income, education, food security and nutrition, health status, assets, gender, age, employment and social position are the main determinants of NHIS. A second qualitative phase of study followed; gathering data from the field. Informed by social constructionism, nine focus group discussions were conducted in nine different communities within the Agogo Ashanti Akim North District of Ghana with seventy-two respondents. Nine key informants, including policy makers, heads of institutions and civil servants were also interviewed. The sampling approach tried to gain maximum variation so that a broad based understanding of NHIS could be obtained. The qualitative data of focus groups and the interviews of key informants were analysed using AttrideStirling’s (2001) thematic network framework. The qualitative data revealed that membership selection of the NHIS depends on ability to pay both the fees of the NHIS card and the premiums. However, an individual may also become a member of the scheme free of charge if exempted from payment on the grounds of age or through being accepted as core poor (indigent). The focus groups present a different perspective to inform policy makers in Ghana that the current official criteria for classifying the core poor are not appropriate. Despite the NHIS policy allowing free indigent registration, priority was also not given to reaching out to the indigents within the scheme's authority.Another key theme that emerged indicates that the poor struggles to manage the NHIS by sacrificing basic needs such as clothing and food or having to borrow to pay for health services out of pocket (OOP). There is therefore a gap between NHIS policy and real life.Insured and non-insured still pay OOP despite the generous benefits package. The FGDs find that the NHIS is progressive for formal sector employees, whose payments were by direct taxes and payments but regressive for the informal sector workers, whose payments were by premiums and other indirect payments.The results further noted lack of voice and lack of understanding as features limiting people from accessing the NHIS facilities. Understanding of equity as a key theme revealed: first, lack of stakeholder engagement and a lack of consultation or participation in the NHIS decision making process.Second, the NHIS displayed an overreliance on healthcare and an emphasis on a biomedical approach. Third, it was established that while the policy indicated a will to include all the core poor patients for an equitable NHIS, there is lack of willingness to implement this aim fully. Finally, health and local authorities are not sharing responsibility for tackling the unfairness inherent in the NHIS contributions.  The thesis argues that much more needs to be done to address the social determinants of NHIS by advancing concrete and meaningful Health Equity in All Policies for the post -2015 development agenda in Ghana. This entails improving the health of Ghanaians by coordinating action across health and non-health sectors to bridge the policy implementation gaps, increase access and reduce inequities that are not only unnecessary and avoidable but unfair. In conclusion, the research’s contribution to knowledge recommends clear directional philosophies that can help facilitate continued progress to improve health in the post-MDGs agenda and beyond.

Abstract

Background  Current UK policy has resulted in greater requirements for public and patient participation in health service planning and decision making. Organizations and services need to be able to monitor and evaluate the effectiveness and quality of their community involvement processes, but there are few appropriate evaluation tools or sets of indicators available. This paper reports on work within Bradford Health Action Zone to develop a self‐assessment tool for organizations on community involvement.

Methods  A multi‐agency working group developed the tool. A literature search was undertaken and evaluation resources were reviewed. A set of benchmarks for community involvement in regeneration was utilized in developing the assessment areas. A range of individuals with expertise on community involvement practice and performance management was consulted. The tool was then piloted in two primary care trusts prior to final modifications.

Results  The process resulted in the production of Well Connected – a self‐assessment tool on community involvement designed for organizations to assess their progress and identify areas for improvement. A scoring system assesses evidence of a strategic approach to community involvement, good practice throughout the organization, and a range of opportunities and support. Feedback from the pilots revealed that the tool had facilitated assessment of the strengths and weaknesses of organizational practices.

Conclusion  The paper discusses some of the methodological challenges pertaining to the measurement of community involvement. Notwithstanding those challenges, it is argued that Well Connected provides a robust and practical framework that health organizations and their partners can use to assess practice.

Local government and the NHS have important roles in building confident and connected communities as part of efforts to improve health and reduce inequalities. The project ‘Working with communities: empowerment evidence and learning’ was initiated jointly by PHE and NHS England to draw together and disseminate research and learning on community-centred approaches for health and wellbeing. This report presents the work undertaken in phase 1 of the project and provides a guide to the case for change, the concepts, the varieties of approach that have been tried and tested and sources of evidence.

This report forms the Year 3 annual report. Alongside documenting findings from Year 2 evaluation activities, this report also brings together findings from previous evaluation activities and gives wider consideration to the overall progress and outcomes of the programme so far. Section two explains the evaluation approach that has been adopted and details the activities that have been conducted and the methods used. Section 3 highlights the key themes and findings to emerge from the workshops undertaken with the Sure Start teams and provides a summary of the indepth evaluation conducted of the Family Support Team. Section 4 is entitled ‘Pulling it all together’ and considers the work and achievements of Sure Start Mellow Valley with particular regard to the five outcomes of Every Child Matters. A conclusion and brief summary of findings is found in Section 5 followed by a range of further information within the Section 6 Appendices.

The evaluation will try to reflect the particular issues arising at the various stages of programme implementation. For example, in the early stages we will focus on the way activities are being developed as well as identifying any early successes. As the programme matures there can be a gradual transition to assessing the achievement of objectives. In year 3, there is a requirement that we will formally report on progress towards meeting national targets.

Sure Start is a government programme which aims to make a difference to children 0-4 years and their families through supporting parents, increasing childcare availability and improving the health and social development of young children. Local Sure Start programmes seek to involve parents and other partners in their work. Sure Start principles are listed below. Sure Starts will be changing with the government’s commitment to build Children’s Centres in every community by 2010.

Sure Start Mellow Valley is a 6 th wave Sure Start programme, currently in its second year. The Children’s Society is the lead partner and accountable body. The programme was approved in April 2003. Since then the team has grown – for a full list of current Sure Start staff, please Appendix A. Sure Start Mellow Valley has established links with many other local initiatives that aim to improve the lives of families and children aged 04 years and promotes an inclusive approach to the development of working with local agencies, organisations and funders. Sure Start Mellow Valley is characterised by high levels of parental involvement. Indeed, parents in Little London & Woodhouse and in Meanwood were closely involved in forums/groups lobbying for a Sure Start programme. The Parents Forum groups are always well attended and parents are also represented on the management board. It is a requirement for all local Sure Start programmes to undergo a process of evaluation to determine whether the programme is meeting the needs and expressed wishes of the population it serves. The Centre for Health Promotion Research at Leeds Metropolitan University has been commissioned to evaluate Sure Start Mellow Valley. An initial Baseline User Satisfaction Survey formed the first stage of the evaluation. It was conducted in Summer 2004. This report details the methods used and findings from the survey.

Effective knowledge translation processes are critical for the development of evidence-based public health policy and practice. This paper reports on the design and implementation of an innovative approach to knowledge translation within a mixed methods study on lay involvement in public health programme delivery. The study design drew on scientific and experiential knowledge, and included iterative feedback loops to ensure that lay and professional perspectives shaped the research process and dissemination outputs. The paper concludes by discussing the application of this approach as a means to close the knowledge-practice gap in public health.

The 2013 WHO European review of social determinants and the health divide argues that actions to strengthen and empower disadvantaged communities should be central to a ‘whole-of-society’ approach to health. Participatory approaches can be particularly effective for engaging disadvantaged populations because they address the powerlessness associated with health inequalities. Although there are many well established models in England, evidence tends to be scattered around, terminology is confusing, and opportunities for sharing learning are often lost. This presentation will discuss why and how community-centred approaches are part of a strategic response to inequalities. A new map based on a ‘family’ of community interventions will be presented. This map identifies the range of options for local leaders, commissioners and practitioners and groups these into four categories: (1) Strengthening communities (2) Volunteer and peer roles (3) Collaborative approaches and (4) Access to community resources. This family of interventions emerges from an exciting national project, jointly funded by Public Health England and NHS England, that is aiming to draw together and disseminate existing evidence and learning on working with communities. The presentation will conclude that there is a coherent case for mainstreaming community-centred approaches as a building block for public health.

BACKGROUND AND AIMS: This paper explores contemporary issues around community-based health promotion in the light of international health policies reaffirming the central role of community action within broader efforts to achieve health equity. Adopting a system-level approach poses challenges for current health promotion practice and evaluation, particularly where there is a shift in emphasis from small-scale community health projects towards mainstream community programmes, capable of engaging widely across diverse populations. METHODS: Drawing on research with community members carried out by the Centre for Health Promotion Research, Leeds Metropolitan University, UK, the paper re-examines assumptions about the nature of interventions within community settings, and what participation means from a lay perspective. Key research issues for community-based health promotion are highlighted. CONCLUSIONS: The paper concludes by proposing that community-based interventions need to be reframed, if the dual challenges of citizen involvement and evidence based practice are to be met.

This evidence summary outlines the evidence base for community health champions. It has been produced for Altogether Better a five-year region wide collaborative programme funded through the BIG Lottery Well-being Fund that aims to empower people across the Yorkshire & Humber region to lead healthier lives. This evidence summary sets out the evidence base underpinning this approach for anyone involved in commissioning, planning, delivering and evaluating health programmes involving community health champions. A full report is also available on the results of the evidence review.

BACKGROUND: There is increasing cross-disciplinary research on the relationship between individuals' social, cultural and community engagement (SCCE) and mental health. SCCE includes engagement in the arts, culture and heritage, libraries and literature, sports and nature activities, volunteering, and community groups. Research has demonstrated the effects of these activities both on the prevention and management of mental illness. However, it remains unclear whether current research is focusing on the research questions that are of most immediate urgency and relevance to policy and practice. AIMS: The current project was funded as part of the UK Research and Innovation cross-disciplinary mental health network programme to develop and co-produce a new cross-disciplinary research agenda on SCCE and mental health. METHOD: Established processes and principles for developing health research agendas were followed, with a six-phase design including engagement with over 1000 key stakeholders, consultations, integration of findings and collective prioritisation of key questions. RESULTS: We identified four core themes: the mode of engagement, process of engagement, impact of engagement and infrastructure required to facilitate engagement. There were many points of agreement across all stakeholder groups on the priority questions within these themes, but also some specific questions of relevance to different sectors. CONCLUSIONS: This agenda is particularly timely given the extreme pressure on mental health services predicted to follow the current COVID-19 pandemic. It is important to identify how resources from other sectors can be mobilised, and what research questions are going to be most important to fund to support SCCE for mental health.

© The Author(s) 2019. The exemptions of the National Health Insurance Scheme (NHIS) for poor people in Ghana have not been sufficiently explored. Using a qualitative approach that involved gathering and analyzing viewpoints from the community, this article investigates the factors that are used to determine NHIS exemptions. Focus group discussions and interviews of key informants were conducted during the period (August 2015–August 2016) within the Ashanti and Greater Accra regions in Ghana. Nine focus group discussions were conducted in nine different communities with 72 respondents. Nine key informants including local and national policy makers, civil servants, and local community members were also interviewed. A sampling method was adopted to capture a range of understandings of community indicators of poverty for NHIS exemptions. Community perceptions of the indicators of poverty included interconnected themes of income, employment, education, assets, and social marginalization. The findings highlight contextual and community descriptions associated with exemptions, of which poverty is a predictor, and discovered that to identify the indigent for exemptions based only on income and quantitative measures is not enough. The results are significant for a number of reasons including poor fit with official measures and the neglect of lay perspectives. For practice implications, our findings show that communities should be principal stakeholders for describing the disadvantaged groups that require exemptions.

© 2018, The Author(s) 2018. This article aims to examine the National Health Insurance Scheme (NHIS) policy from the perspective of local communities. Qualitative data from 9 key informant interviews and 72 community respondents in 9 focus group discussions were analyzed using a thematic network approach. The focus-group discussions took place in seven different communities in seven regions of Ghana. The findings noted a disconnection between NHIS policy and community life. More so, the findings showed an explicit link between equity and access with its impacts on health outcomes. The qualitative results indicated lack of voice and understanding as the features limiting people from accessing the NHIS facilities. Understanding of equity as a key theme revealed, first, lack of stakeholder engagement and consultation or participation in the NHIS decision-making process. Second, it was established that while the policy indicated a will to include all the core poor for an equitable NHIS, there is lack of willingness to implement this aim fully. Finally, despite being a pro-poor intervention by name, practical management of the NHIS is transmitted down vertical silos from the national level, with the lack of joined-up government at the center undermining local partnerships. Thus, not only are national expectations being dashed locally, local expectations are dashed nationally. This article proposes that community viewpoints should be given higher priority given that NHIS has since its inception been associated with medical treatments and biomedical paradigm. Promoting community participation, understanding, and voices should be recognized to shape the future NHIS policy and practice.

This project sought to explore two key areas that are critical for moving to a more systematised approach to asset based action for health. These two areas are: 1. The need to develop further a Theory of Change for asset based approaches aligned to an asset model for health 2. The requirement to understand how to measure and illustrate impact and benefit from asset based approaches. Following work to develop an understanding of practice, through site visits, interviews and a think piece event, a new Theory of Change for asset-based working is presented. A rapid review of published and grey literature was also conducted to map and categorise evaluation approaches and measures used in asset-based programmes. The map of literature (33 studies) showed that a variety of methodologies and evaluation strategies are used in asset-based practice. Seven clusters were identified: Asset Based Community Development; Asset Mapping; Community-based evaluation; Conceptual frameworks for measurement; Resilience; Salutogenesis; Other.

As new organizations with responsibility for the health and health care of their local populations, primary care trusts (PCTs) need to engage with patients and the wider public. This paper identi. es the challenges faced by PCTs in implementing patient and public involvement and reports on a qualitative study of four PCTs in one health district. Findings from two pieces of data collection are reported on: an audit of community involvement activity and 16 semi-structured interviews with individuals working in the PCTs. The findings show that organizational capacity for undertaking patient and public involvement activities increased considerably over an 18 month period. The PCTs were found to be engaging with individuals and groups from the community and voluntary sector through a range of different structures and processes. Considerable commitment to patient and public involvement was reported but there were concerns over implementation. A number of influencing factors were identified including national policy, organizational factors, leadership, workload, access to experienced involvement workers and the pattern of local community activity. The paper discusses the implications for the development of patient and public involvement in PCTs including the importance of cultural change and the need for organizational development. The potential for PCTs to be involved in a range of participatory activities and to work with other partner organizations in localities is also discussed. The paper concludes that, despite challenges, progress can be made in implementing patient and public involvement as a mainstream activity in PCTs. © 2004, Arnold. All rights reserved.

The focus of this paper is on health inequalities at a local level and the implications for community-based practice. This paper describes the development of a small multi-agency project supporting families in a disadvantaged urban neighbourhood within the UK. A baseline assessment enabled primary and secondary data to be collected to inform project development and identify priorities for action. Findings revealed the scale of health need and helped focus the direction of the project. Several issues affecting implementation were identified, including the importance of good liaison between services and adopting a community development approach.This paper discusses the wider implications for the planning, delivery and evaluation of community-based initiatives addressing health inequalities. Despite the scale of need, there appears to be good potential for practitioners working in disadvantaged neighbourhoods to achieve some positive changes. Key points of learning are identified. © 2006, Arnold. All rights reserved.

This paper reports on a study undertaken with health promotion specialists working in the National Health Service in England. In-depth interviews were held with 25 people with the aim of investigating the place of research and evaluation in health promotion practice, the contextual factors that influenced such activity, and ideas about the place of research in future practice. Research for the purposes of evaluation was a core activity in specialist practice but research for other purposes was less often undertaken and while there was general interest to do more, it was not seen to be central to current roles. There was general awareness of the importance of evidence-based practice, of the debates surrounding appropriate evidence and methodologies to secure it, and commitment to evidence-based practice. At the same time it was acknowledged that most evaluation activity currently undertaken was insufficiently extensive or methodologically rigorous to have the potential to contribute to development of the evidence base. A variety of factors at the policy, health promotion unit and individual level served either to facilitate or to impede research and evaluation. The development of collaborative links with academic partners was seen to be an appropriate way of developing research in practice. Recommendations were made to build new and imaginative relationships between practice and academic institutions, and to develop collaborative research bids to secure resources which would increase resources available for evaluation. Some actions in response to findings from the project have already been put into place.

Health authorities' eligibility criteria for long-term care vary in scope. This small study suggests that while differences in access remain, they may be lessening. There is little evidence of radical changes in investment.

The 1995 guidance HSG(95)8 “NHS Responsibilities for Meeting Continuing Health Care Needs” required health authorities to develop local policies and eligibility criteria for a range of continuing care services. The role of criteria in defining health need, and the potential effect on open‐ended rights to NHS care, need to be considered in light of the prior erosion of rights associated with changes in continuing care provision. This paper examines whether the development of eligibility criteria has led to a loss of entitlements to NHS care. Analysis of empirical evidence from a study of the policies and criteria of six health authorities found that criteria for fully funded care were generally well defined and restricted access to those with very intense and specialist needs, thereby constituting a loss of rights. In contrast, the criteria for community‐based services left eligibility dependent on professional discretion but often failed to clarify the relationship between individual need and levels of service provision. The research found that resource limits are likely to remain a factor in the allocation of services and this will affect the status of the criteria as potential entitlements.

Considerable attention has been given in recent years to the merits of involving community members in the research process and the resulting benefits in terms of research outcomes. Far less is known about the experiences of individuals taking on the role of lay researchers within their own community. This research investigates the experiences of six young Asian women who, following training, undertook a community health needs assessment in a neighbourhood in Bradford. Semi-structured interviews were conducted. Findings indicated that participating was overall a positive experience, having an impact on the women in two main ways. Firstly, a positive change in perception relating to their own capabilities and influence, resulting in increased confidence, self-esteem, and a greater understanding of the research process. Secondly, the women developed greater awareness of and interest in issues affecting their community coupled with greater empathy towards fellow residents, inspiring a determination to work towards achieving positive changes. However, the women expressed concerns that the needs assessment had raised expectations within the community and they would be held responsible for delivering change. Further research is recommended into the experiences of lay researchers, particularly the longer term impact of being involved both to themselves individually and the wider community.

Community participation and leadership is a central tenet of public health policy and practice. Community engagement approaches are used in a variety of ways to facilitate participation, ranging from the more utilitarian, involving lay delivery of established health programmes, to more empowerment-oriented approaches. Evaluation methods within public health, adapted from clinical medicine, are most suited to evaluating community engagement as an 'intervention', in the utilitarian sense, focusing on the health impacts of professionally determined programmes. However, as communities are empowered and professional control is relinquished, it is likely to be harder to capture the full effects of an intervention and so the current evidence base is skewed away from knowledge about the utility of these approaches. The aim of this paper is to stimulate debate on the evaluation of community engagement. Building on current understandings of evaluation within complex systems, the paper argues that what is needed is a paradigm shift from viewing the involvement of communities as an errant form of public health action, to seeing communities as an essential part of the public health system. This means moving from evaluation being exclusively focused on the linear causal chain between the intervention and the target population, to seeking to build understanding of whether and how the lay contribution has impacted on the social determinants of health, including the system through which the intervention is delivered. The paper proposes some alternative principles for the evaluation of community engagement that reflect a broader conceptualisation of the lay contribution to public health.

Developing an evaluation plan . Ethical issues . Making the most of findings ..This book is the first in a series on current theories and concepts for those working within the wider field of public health.

It has been customary in health promotion courses to prepare students to complete masters level research based dissertations and to be able to undertake research and evaluation in the context of professional practice. Given the changing nature of health promotion practice and the place of research and evaluation within it, it is timely to review the preparation that courses offer. This paper examines current research education in the UK, drawing on a recent survey of postgraduate health promotion courses. Consideration is given to the question of whether current models of provision, although meeting academic requirements, offer insufficient preparation for the specifics of research and evaluation activity within current UK practice. The strengths and limitations of the traditional dissertation are discussed. In response to the challenges of incorporating collaborative and participatory research into masters level study and increasing dissemination of students' work, alternative models for the dissertation phase are presented. Overall the paper is designed to stimulate debate on the possibilities of a better fit between postgraduate research education and research practice.

This article looks at the different and sometimes conflicting policy drivers for a move towards greater community involvement in primary health care. In this context, research findings focusing on community involvement initiatives that have taken place within general practices, Primary Care Groups (PCGs) and Primary Care Trusts (PCTs) are explored and the key issues for implementation are appraised. Using an evaluation of a team set up to foster community involvement with the PCTs in Bradford, the utility of a social entrepreneurship approach is considered. It is argued that this form of approach can be employed as a means of utilizing the work of existing groups and operating in a 'joined up' way. It is further contended that an emphasis on process and on social entrepreneurship can foster the development of community involvement practices in Primary Care Trusts to meet the current and changing health needs of local communities. © 2005 Taylor & Francis Group Ltd.

This paper examines lay interpretations of lay health worker roles within three UK community-based health promotion projects. It argues that understanding lay health worker roles requires critical analysis of the complex interrelationships between professionals, lay workers and the communities receiving a programme. Findings are presented that are drawn from a qualitative study of lay engagement in public health programme delivery where a key objective was to examine the perspectives of community members with the experience of receiving services delivered by lay health workers. Interviews and focus groups were conducted with 46 programme recipients from three case study projects; a breastfeeding peer support service, a walking for health scheme and a neighbourhood health project. The results show how participants interpreted the function and responsibilities of lay health workers and how those roles provided personalized support and facilitated engagement in group activities. Further insights into community participation processes are provided revealing the potential for active engagement in both formal and informal roles. The paper concludes that social relationships are core to understanding lay health worker programmes and therefore analysis needs to take account of the capacity for community members to move within a spectrum of participation defined by increasing responsibility for others.

Hamara is a Healthy Living Centre which aims to improve health and well-being through providing a range of culturally appropriate activities and services. Hamara has a vision of 'bringing communities together' and since it was established in 2004, the Centre has provided a valuable community resource in South Leeds. Partnership work between Hamara and Leeds Met goes back to 2002. In 2007, the Centre for Health Promotion Research carried out an evaluation of Hamara in partnership with Hamara staff and Leeds Met Community Partnerships and Volunteering. This was followed by a highly successful community cohesion conference 'One Community' which was held at Hamara on 10th October 2008, and was supported through a Leeds Met public engagement grant. The event attracted over a hundred people from diverse communities and organisations across Leeds. A packed audience heard Hilary Benn, local MP and Patron of Hamara, talk about the importance of working in collaboration around community cohesion. Jane South, Centre for Health Promotion Research, presented the main evaluation results and set out the some challenges for the future. The proceedings concluded with the presentation of awards to a number of for local community champions who work to bring people together and make a real difference in the city of Leeds.

This thesis explores the changing role of public services in supporting active citizenship in the development of communities within an area of the north of England. The study was undertaken in the context of the Government’s ‘localism’ and ‘austerity’ agendas.  Literature was examined against themes of conceptualising, enabling and contextualising active citizenship. A conceptual framework was used associated with the rights and duties of citizenship.  Elements of a Grounded theory methodology provided an iterative approach to knowledge development with an action research method. Case studies of local groups involved focus groups and interviews with four community groups, Elected Members and public agencies. The data was analysed using Attride-Stirling’s (2001) thematic network approach. A range of tensions were revealed associated with interface between citizens, civil society and local authorities. Community spirit and social cohesion were seen to be weakening because of changing populations; ‘looser’ communities and historical adversity with need for a ‘transformation of civil society’. Citizen motivation for active citizenship is restrained by austerity with tensions around power imbalance between communities and the State. Integrated community leadership is required involving Elected Members although tensions exist because of political association and community group independence. ‘Rules in use’ enable citizens to engage with politics and are important in building confidence. Volunteering is significant with a need to facilitate local support and undertake further research around young people. Implications of findings are that active citizenship should be strategic priority and community resources better connected.  Knowledge has been advanced through better understanding from stakeholders and adapting a framework to measure local active citizenship. Findings have informed a ‘People with Public Service’ framework for local authorities to support active citizenship. The conclusions provide a better understanding of the complexity and tensions with the need to ‘reset’ the social contract between the community and the State.

© 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.

This article builds upon previous theoretical work on job loss as a status passage to help explain how people's experiences of involuntary unemployment affected their mental well-being during the 2009-2010 economic recession. It proposes a middle-range theory that interprets employment transitions as status passages and suggests that their health and well-being effects depend on the personal and social meanings that people give to them, which are called properties of the transitions. The analyses, which used a thematic approach, are based on the findings of a qualitative study undertaken in Bradford (North England) consisting of 73 people interviewed in 16 focus groups. The study found that the participants experienced their job losses as divestment passages characterised by three main properties: experiences of reduced agency, disruption of role-based identities, for example, personal identity crises, and experiences of 'spoiled identities', for example, experiences of stigma. The proposed middle-range theory allows us to federate these findings together in a coherent framework which makes a contribution to illuminating not just the intra-personal consequences of unemployment, that is, its impact on subjective well-being and common mental health problems, but also its inter-personal consequences, that is, the hidden and often overlooked social processes that affect unemployed people's social well-being. This article discusses how the study findings and the proposed middle-range theory can help to address the theoretical weaknesses and often contradictory empirical findings from studies that use alternative frameworks, for example, deprivation models and 'incentive theory' of unemployment.

Which coping strategies helped unemployed people in Bradford during times of recession? This research explores the mental health impacts of unemployment. Researchers spoke to 16 focus groups in Bradford that included 73 unemployed people to find out how job losses affected everyday well-being and which personal coping strategies and financial support opportunities were helpful. Participants revealed how financial losses could affect mental health and how aspects such as the loss of a previously valued social role and a lack of structure during the day also played a part. The study: - examines the impact of involuntary unemployment across different groups; - identifies the dangers to mental health associated with unemployment; and - presents the different coping strategies used by men and women and by different age groups. It identifies five main issues that require further policy attention to ensure that people who are unemployed do not also suffer from mental ill-health.

This review of existing research on local government and public health focuses on the leadership role of local government in developing local public health systems that are capable of addressing the wider determinants of health.

Background. This research aimed to explore how Friends Groups work with local authorities and other partners to ensure their local urban green spaces are a well maintained and utilised amenity for public health. Good quality green space, close to where people live, improves health and wellbeing yet, in deprived areas with worse health, there is less access to this health-promoting resource. Improving green space in these areas could help tackle health inequalities. Friends Groups, local people who act together to improve their local green space, are a growing phenomena. There is a lack of evidence however regarding how they develop and are sustained, especially in deprived areas, and whether relying on them contributes to or mitigates against inequality. Methods. This study utilised qualitative methodology, influenced by ethnography. Seven case studies, in disadvantaged neighbourhoods, participated: five established Friends Groups and two developing. Data collection included participant observation, interviews, focus groups, and ‘walk and talks’. Developing group data was collected longitudinally, over three years. Semi-structured interviews were conducted with local authority park staff. Analysis was initially by case to produce narrative accounts, and then cross-case to identify explanatory success factors. Results. A conceptual framework was developed that identifies four domains affecting the success, or otherwise, of Friends Groups: Place, People, Process and Power. Each domain identifies the most pertinent factors influencing group development and sustainability. Leaders play a key role. Commitment, perseverance and motivation are vital whilst being confident, capable, with authority and connections improves chances of success. Place also affected success. Groups operating in informal spaces found it harder to become established than those in traditional parks. Having formal structures, regular activities and in-built sociability helped groups succeed. The relationship between local authorities and Friends Groups was often challenging, with conflict and disagreement leading to frustration and stress. Different perceptions of participation and control contributed to tensions. Parks teams were often unaware of issues relating to inequality. Implications. This study raises concerns that, as the model currently operates, it could exacerbate green space inequalities. Deprived neighbourhoods are less likely to have leaders with the required qualities and connections for success, and parks teams show a preference for working with more capable groups, who are likely to be in more affluent areas. Recommendations centre on supporting Friends Groups in disadvantaged areas to strengthen capabilities and working with local authorities to encourage greater sharing of control.

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.

Background: The voluntary sector has long been recognised as making an important contribution to individual and community health. In the UK, however, the links between primary health care services and the voluntary and community sector are often underdeveloped. Social prescribing is an innovative approach, which aims to promote the use of the voluntary sector within primary health care. Social prescribing involves the creation of referral pathways that allow primary health care patients with non-clinical needs to be directed to local voluntary services and community groups. Such schemes typically use community development workers with local knowledge who are linked to primary health care settings. Social prescribing therefore has the potential to assist individual patients presenting with social needs to access health resources and social support outside of the National Health Service. Aim: The aim of this paper is to explore the concept of social prescribing and discuss its value as a public health initiative embedded within general practice. Methods: The rationale for social prescribing and existing evidence are briefly reviewed. The paper draws on a case study of a pilot social prescribing scheme based in general practice. Data collected during the development, implementation and evaluation of the scheme are used to illustrate the opportunities and limitations for development in UK primary health care. Findings: The potential for social prescribing to provide a mediating mechanism between different sectors and address social need is discussed. The paper argues that social prescribing can successfully extend the boundaries of traditional general practice through bridging the gap between primary health care and the voluntary sector. The potential for wider health gain is critically examined. The paper concludes that social prescribing not only provides a means to alternative support but also acts as a mechanism to strengthen community–professional partnerships. More research is needed on the benefits to patients and professionals.

This summary presents the main findings of a thematic evaluation on the community health champion role and empowerment, based on data collected from projects being delivered as part of the Altogether Better programme. The aim of this thematic evaluation was to understand how the Altogether Better projects involve community health champions to improve health and to provide robust evidence to inform the development of practice. This summary sets out the main findings from the thematic evaluation and concludes with some implications for policy and practice.

Abstract

This chapter concludes Part VII, with a focus on salutogenesis in prisons. In this chapter, the authors present and debate how prison health rhetoric, policy and practice are influenced by a pathogenic view of prisoner “health.” The authors comment that there is a growing recognition of a salutogenic approach to prison health policy and practice, to help tackle the root causes of health, criminality and inequality. This chapter emphasises that while the health of prisoners is influenced by material and social factors beyond their control, a salutogenic approach offers an alternative way of delivering public health and health promotion in prisons. The chapter concludes noting that the application of salutogenesis in prisons is in its infancy. They call for research, policy and practice framed by a salutogenic orientation, leading to sustained and effective measures to improve the health of people in criminal justice settings, and reducing health inequalities in prisons.

Background: Community-centred approaches to health and wellbeing seek to mobilise the assets within communities, promote equity and increase people’s control over their health. Public Health England (PHE) has evidenced a diverse range of models for use in public health practice. Scientific knowledge needs to be complemented by experiential learning because approaches are rarely standardised and should develop in response to community priorities. Problem: PHE identified a growing demand for examples of local implementation. A project was established (2015-6) to pilot a system for collecting public health practice examples to address this knowledge gap. The multi-disciplinary team comprised information specialists, topic experts and regional leads. One aim was to gather a set of community-centred practice examples in the North of England. Community projects completed a template covering context, project rationale, activities, outcomes and learning. Further work ensured each practice example met quality criteria. Feedback was collected at two workshops at a regional conference. Results: 16 community-centred practice examples were produced from local public health projects. Examples were mapped to the PHE framework of community-centred interventions and included community asset mapping, community involvement in health planning, peer support and community-based physical activity projects. Projects were working in disadvantaged neighbourhoods or with marginalised groups. Feedback from the workshops highlighted the value of practice examples to inform programme development and the need for contextual information. Lessons: There were some challenges in collecting information from practice and this required coordination and support. Overall the pilot confirmed the value of practice examples as a means to share learning not always captured in the formal evidence base. Results illustrate diverse ways to build resilient and healthier communities.

While research has shown links between income inequality and health, it is important to remember that employment is not universally healthy. For example, sole traders, those in precarious work and the unemployed fare worse than do workers in secure, protected and well-paid positions. Often lying somewhere between paid and unpaid, employee and volunteer, lay people in public health roles are in some what of a limbo. It is tempting, for example, to see such roles as simply offering the first step to a career in public health. Yet volunteer roles and any potential jobs will make demands on health. The consequence is a parallax, or alternative viewpoints, between enabling employment and making working lives healthier. The People in Public Health (PiPH) study combined site visits and interviews with commissioners, practitioners and lay people to build up detailed case studies of five health-promoting projects from across the UK. This poster will use these case studies to explore links between utilising lay people in public health roles and their health as potential or actual employees.

Professional support processes are critical for the establishment and maintenance of community health worker programmes. This paper reports on three public hearings held in England, UK, that were conducted as part of a national study into approaches to develop and support lay people in public health roles. Individuals with relevant theoretical or practical expertise, including lay activists, presented evidence in public as expert witnesses. Formal presentations, questions and plenary discussions were recorded and later analysed as qualitative data. This paper presents the results and critically examines emergent issues relating to the sustainability of lay health worker programmes. Consideration is given to the diversity of contemporary practice in England. Barriers seen to affect sustainability included organizational culture and onerous bureaucratic processes. Major themes emerging from the expert evidence included recruitment and training strategies, financial support and the need for a robust infrastructure. The expert hearings, in creating a public space for deliberation, opened up discussion on the levels and type of programme support required to foster lay health worker programmes. The paper concludes that professional support needs to be accompanied by a reorientation of public services to support lay engagement in programme delivery.

A summary of how asset-based methods contribute to community-centred public health. Discussion of the work of Public Health England to support community-centred approaches. Opportunities and challenges are discussed.

Health trainers work with disadvantaged groups in most parts of England to support people to make beneficial changes to their lifestyle. They are lay people who engage with communities rather than expect people to come to them and who provide a client-centred service where the individual decides when, what and how they want to change. Nurses work with health trainers to increase the support available to people with long-term conditions to self-manage and provide help to people found to be at risk following life checks or screening. Feedback from clients is positive, and health professionals are increasingly aware of how such trainers can complement their services. Managing a lay workforce presents challenges but this is an effective service for clients who struggle to change without support.

This report gives an account of a participatory evaluation conducted using photography within the Sure Start Mellow Valley area. Information about the current status of the Sure Start programme and the plans for the future are first provided. The report then describes the research that was undertaken and presents and discusses the findings.

Issue: Health 2020 envisions a critical role for civil society and volunteerism is an important facet of this. As well as the volunteer contribution to community health, volunteering is associated with intrinsic health benefits. This makes it a public health issue but little attention is given to the question of how volunteering intersects with health inequalities. Description of problem: This presentation reports on a UK project that is seeking to maximise the public health potential of volunteering and address barriers that result in unequal access. Because little is known about this issue beyond the variations that exist, the first stage was a rapid scoping review conducted in 2015-6. This involved reviewing key literature on health inequalities and volunteering across socio-economic status and the nine population groups protected by the UK Equality Act. Results: The scoping review identified 6,094 publications and after screening, 98 studies were reviewed; of these were 24 UK and 18 from elsewhere in Europe. Results confirmed that volunteering is associated with a social gradient, with disadvantaged groups less likely to volunteer. A web of factors were found to influence volunteering prevalence, however barriers varied between groups and across the lifecourse. The review also uncovered issues of stigma affecting people with disabilities. Lessons: The review provides a map of inequalities issues that affect volunteering, which given the focus of Europe 2020 will be of use to public health policy and practice. The next stage is to identify interventions that are able to widen participation and address social exclusion. Our conclusions are that volunteering should be recognised as a public health issue. More debate is needed on how public health systems can respond to the inequalities identified and enable those who face barriers to gain from the health and wellbeing benefits of volunteering. Main messages Volunteering needs to be considered as a public health issue, with more potential for addressing social exclusion and health inequalities Multiple factors influence inequalities in access to volunteering, with different population groups experiencing different barriers

This paper reviews how community wellbeing is defined and measured in relation to individual subjective wellbeing, the assumptions underlying the dominant approaches and what gets left out. An important distinction in approaches to community wellbeing concerns the primary purpose. The focus may be on community only in so far as community scale characteristics impact individual subjective wellbeing, or there may be a focus on community scale aspects of living together in which community wellbeing is more than the sum of the individual parts. Most existing frameworks for assessment of community wellbeing are premised on the centrality of an autonomous and independently acting or feeling individual and the primary interest is on how community aspects of life impact on individual wellbeing. Areas of life typically assessed notably omit attention to inequalities, intangible culture, settings and scale, sustainability and inter-generationality. However, social theory offers alternative understandings of individual experience as primarily relational which aligns with an interest in community and demands different ways of thinking about wellbeing and wellbeing assessments. Capturing subjective aspects of local life that are not simply individual but reflect the ways in which people feel and are well together is more challenging. Alternative forms of data collection are needed through deliberative processes or the analysis of narrative and other local culturally shared resources.

The current COVID-19 pandemic confines people to their homes, disrupting the fragile social fabric of deprived neighbourhoods and citizen’s participation options. In deprived neighbourhoods, community engagement is central in building community resilience, an important resource for health and a prerequisite for effective health promotion programmes. It provides access to vulnerable groups and helps understand experiences, assets, needs and problems of citizens. Most importantly, community activities, including social support, primary care or improving urban space, enhance health through empowerment, strengthened social networks, mutual respect and providing a sense of purpose and meaning. In the context of inequalities associated with COVID-19, these aspects are crucial for citizens of deprived neighbourhoods who often feel their needs and priorities are ignored. In this perspectives paper, illustrated by a varied overview of community actions in the UK and The Netherlands, we demonstrate how citizens, communities and organizations may build resilience and community power. Based on in-depth discussion among the authors we distilled six features of community actions: increase in mutual aid and neighbourhood ties, the central role of community-based organizations (CBOs), changing patterns of volunteering, use of digital media and health promotion opportunities. We argue that in order to enable and sustain resilient and confident, ‘disaster-proof’, communities, areas which merit investment include supporting active citizens, new (digital) ways of community engagement, transforming formal organizations, alignment with the (local) context and applying knowledge in the field of health promotion in new ways, focussing on learning and co-creation with citizen initiatives.

This presentation will reflect on the challenges encountered by the Communities Wellbeing Evidence Programme in assessing complex interventions delivered at the level of the community. We will present findings from our systematic review of community infrastructure to improve social relations and reflect on different approaches to assessing the validity of individual studies and the body of evidence across the whole review. We will discuss challenges of synthesising this diverse body of evidence, including a range of study designs with outcomes measured at individual or community levels. The use of the GRADE and CerQUAL tools for summarising the quantitative and qualitative findings of the review will be examined, as well as the potential usefulness of other validity assessment tools and frameworks that are new or in development.

Background There is a lack of research available that examines the diverse population of frequent users of Urgent and Emergency Healthcare services throughout England. The motivations and decision-making processes which frequent users take into consideration when selecting episodic treatment from: Out of Hours GPs; NHS111; Ambulance Services and Emergency Departments are not full examined. Most research explores this population by focusing on the patient’s demographics or preliminary diagnosis, rather than their unmet needs that has instigated the urgent and emergency contact. Subjective terminology and arbitrary thresholds are employed across these services to identify these individuals, with little standardisation or clinical justification to the reasons why they have been selected. Through understanding the unmet needs of this heterogenous population, improved individualised patient centred support and management options should be achieved. Aims The aim was to analyse the underlying reasons why frequent users of Urgent and Emergency Healthcare Services in England, select and request episodic instances of care, rather than the consistent approach provided within primary care. Methods A systematic mapping exercise was undertaken to create a comprehensive understanding of how these services are currently working with regard to frequent users. The search produced 5094 articles which were screened against the inclusion criteria, leaving 156 articles to be analysed. Data was extracted and a thematic synthesis was used to analyse this diverse population. From this analysis, a taxonomy of sub-groups of frequent users was formed and their underlying needs identified. Thirty-two clinical semi-structured interviews throughout these services were undertaken, to gain critical feedback on the robustness and viability of the taxonomy. A purposeful sampling method ensured that clinical practitioners that had substantial experience in supporting and managing these complex and vulnerable individuals participated within the research. The qualitative data received from clinicians with knowledge and skills of working with this population prompted adjustments to the original taxonomy. Results The taxonomy sub-divided the main heterogeneous group into 5 main groups: Elderly and Frail; Mental Health; Substance Misuse; Chronic Conditions; and Homeless and Vulnerably Housed. Within each sub-group, unmet needs were identified and further categorised. A hidden population of patients that were accessing urgent and emergency healthcare services due to unresolved pain emerged. This population was categorised into: persistent or chronic pain; acute episodes of severe pain (crisis) and addiction, opioid-induced hyperalgesia or tolerance factors. The reasons attributed to the patients’ frequent contacts were due to the breakdown of their relationship with their GP, polypharmacy issues, access to primary care treatments, perceptions and judgements from clinicians and lack of adequate clinical training around pain management both in primary and acute settings. These high intensity users of urgent and emergency healthcare services are often the most vulnerable and complex members of our society. Conclusion Repeated episodic instances of care, which are often given in urgent and emergency healthcare settings relating to pain management are not proactively allowing individuals to manage their long-term outcomes. Understanding the patients’ unmet needs and what has instigated their frequent contacts to services, could enable clinicians to signpost into other specialised services which will improve the patients’ quality of care. Furthermore, Improved pain management training in both the primary and acute services relating to high intensity users could diminish the negative experiences faced by these individuals and frustrations felt within day to day practice.

A theory to explain how changecan happen in communities to improve wellbeing, to inform the What Works Centre for Wellbeing community evidence programme. This Theory of Change describes ways in which community wellbeing can be built. It represents some of the possible pathways for improving community wellbeing and by doing so it simplifies some very complex issues and relationships. It should help to understand how and why interventions might work, what will happen in the short term and how long term change in communities can occur. This resource provides an accessible summary as an introduction to our Theory of Change. It will be used to inform how our researchers collect and interpret evidence during the three year project. As the evidence programme develops we will refine the Theory of Change to represent our growing understanding of what works for community wellbeing. The development of this Theory of Change was informed by some stakeholder engagement activities held across the UK between June and September 2015. This is summarised in a ‘Voice of the Users’ report.

Scope and rationale: This workshop will discuss contemporary issues around developing and sustaining community practice in health promotion in Europe. In 1986, the Ottawa Charter signified the importance of strengthening community action to health promotion. Health 2020 and many other international statements and reviews have since endorsed community empowerment as a core strategy for achieving better population health and reducing the health gap. Despite a shared vision, and an increasing evidence base to support practice, there are challenges for those wishing to build impactful community-centred approaches as an integral part of public health. If we are to sustain and empower resilient and healthy communities, then there is a need for honest reflection on what has been learnt so far, why we are some way from achieving genuinely people-centred health systems and where future directions lie. Objectives: The aim of this workshop is to stimulate discussion on the current ‘state of play’ of community-based health promotion practice in Europe. A key learning objective is for workshop participants to identify how health promotors can best work to support community-led action through planning, programme implementation and capacity building. A further objective is to set the first building blocks of a EUPHA network on the science of community engagement that would also collaborate with the Health Promotion section. Format: A skills building, interactive workshop with a focus on collaborative learning. Those attending will be encouraged to share learning about working within complex systems to build resilient and healthy communities and to reflect on practice within different contexts in Europe. Following an introduction and two brief presentations to stimulate thinking about the realities of community-centred prevention, delegates will be asked to consider key questions on programme theory, empowerment and evaluation: •How to deal with the nature of the properties of complex systems in our community practice and evaluation. •How to describe our actions in the field of community health and health promotion in ways that communicate programme theories and models to others and also that emancipate ourselves from a linear causality perspective. •How to ensure programmes are genuinely community-led and can support emerging community leaders. We will conclude with a summary of workshop themes and actions to take forward to strengthen community-based health promotion practice. An interactive workshop on contemporary issues for community-centred health promotion practice and evaluation Delegates will share learning on obstacles and solutions to building empowered and resilient communities and how to improve programme theory and evidence

Subject: There is a shared interest among public health researchers in tackling methodological issues surrounding community based research, and on moving beyond a focus on individual level change. As part of a project on community empowerment funded by the People’s Health Trust, we have conducted a feasibility study on quantitative and economic evaluation of complex community-based interventions. To understand different quantitative methods that can be used to evaluate community empowerment interventions, we have undertaken a methodological literature review that identified the following sets of challenges: Defining population of interest – interventions taking place at a community level are not specifically targeted at a well-defined group of individuals. Therefore it is challenging to even find those who are affected by an intervention. Diverse and un-prescribed effects – the effect of community empowerment interventions are likely broad, suggesting we need to measure multiple outcomes in order to detect change. This increases the likelihood of detecting spurious change and can require a lot of resource. Furthermore, in many cases these outcomes are not pre-defined by a programme (i.e. communities choose their own foci).

BACKGROUND: Previous research has examined individual-level and place characteristics as correlates of subjective wellbeing, with many studies concluding that individual factors (e.g. health, finances) are more strongly related to wellbeing. However, this 'dualistic' approach has been challenged, with some arguing that it is impossible to disentangle the effects of the two domains, and that wellbeing should be considered as part of a network of mutually reinforcing relationships between individual, community and place characteristics. We used network analysis to explore these complex associations. METHODS: Data were from a large sample of adults from a socioeconomically disadvantaged region of the United Kingdom (N = 4319). Wellbeing was assessed using the 7-item version of the Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). Mixed graphical networks were estimated including wellbeing, place and individual-characteristic variables as nodes. RESULTS: We found a densely connected network in which wellbeing was associated, both directly and indirectly, with all of the individual, community and place characteristics assessed. Wellbeing was most strongly connected with individual characteristics, in particular financial difficulty and subjective physical health. However, controlling for all other variables in the network model, wellbeing was positively associated with local greenspace usage, civic agency, and neighbourhood cohesion, and negatively associated with housing disrepair. Greater specificity in these associations was observed when the wellbeing construct was broken down into its constituent parts. CONCLUSIONS: These findings highlight the complex relationships that exist between individual, community and place characteristics in the context of subjective wellbeing, and that all domains need to be considered when developing population-level strategies to improve wellbeing. Further consideration needs to be given to how this might happen in practice, for example through a combination of consistent use of community engagement methodologies alongside Health in All Policy (HiAP) approaches.

The influence of place-based factors on the physical and mental health of residents is well established and acknowledged within the population health approach to addressing health and wellbeing inequalities. The COVID-19 pandemic brought to the fore the issues that global communities face. The current UK policy context of ‘levelling up’ represents these concerns and the need to address them. This research examines perceptions of community wellbeing and its determinants as collected within a city region of the North West Coast of England during COVID restrictions between June and August 2020. The paper aims to establish the structure, construct validity and reliability of a new measure of community wellbeing - the Wellbeing in Place Perceptions Scale. Further, it aims to examine how this measure of community wellbeing correlated with symptoms of common mental health as reported by residents of this relatively disadvantaged city region during this unprecedented time. Results indicate that the WIPPS has a reliable and valid structure, correlating significantly with another widely used measure of sense of community and with the Index of Multiple Deprivation. Its relationship to self-reported common mental distress is also clear. Though in need of replication and longitudinal testing, the findings reported here on this new measure remind us that individual and place-based factors combine to influence wellbeing and that community needs to have an increasingly influential role to sustainably prevent future mental health challenges.

AIM: This article describes the development and implementation of a virtual consensus development project to address current challenges in adult nursing care in the UK. DESIGN: This is a Consensus Development Project (CDP). METHODS: The five stages of this CDP were: develop questions (informed by PPI representatives and a documentary review), generate evidence reviews, recruit and orient the lay panel, host consensus seminars, and consult with panel members and stakeholders. RESULTS: To the best of our knowledge, a CDP has not previously been conducted in a UK nursing context, and this is the first of its kind to be hosted virtually. This article contributes a detailed outline of the consensus development methodology and constructive commentary to support future consensus development projects. Learning points include reflections on the impact of hosting this event virtually, the relationship between the project coordinator and chair, and the composition of the lay panel.

Abstract

The influence of place-based factors on the physical and mental health of residents is well established and acknowledged within the population health approach to addressing health and wellbeing inequalities. The COVID-19 pandemic brought to the fore the issues that global communities face. The current UK policy context of ‘levelling up’ represents these concerns and the need to address them. This research examines perceptions of community wellbeing and its determinants as collected within a city region of the North West Coast of England during COVID restrictions between June and August 2020. The paper aims to establish the structure, construct validity and reliability of a new measure of community wellbeing - the Wellbeing in Place Perceptions Scale. Further, it aims to examine how this measure of community wellbeing correlated with symptoms of common mental health as reported by residents of this relatively disadvantaged city region during this unprecedented time. Results indicate that the WIPPS has a reliable and valid structure, correlating significantly with another widely used measure of sense of community and with the Index of Multiple Deprivation. Its relationship to self-reported common mental distress is also clear. Though in need of replication and longitudinal testing, the findings reported here on this new measure remind us that individual and place-based factors combine to influence wellbeing and that community needs to have an increasingly influential role to sustainably prevent future mental health challenges.

People in Public Health is a national study that is looking at how volunteers and lay workers are involved in improving health in their communities. The study’s main aim is to improve understanding of how to support lay people in their many and varied public health roles. In June 2008, three expert hearings were held so that the research team could listen to the views of people with specialist knowledge or practical experience of working in this way. Fifteen experts were invited from around the country to talk about how and why lay people get involved in public health, why the work they do is important and what the main barriers are. Our experts included lay people active in their communities, university researchers, people working in the health service (NHS), local government and the voluntary sector. While some talked about their experience of specific projects, others made more general points about services and support. All the expert hearings were held in public and there were opportunities for discussion.

This article examines how and why members of the public should become involved in promoting health in the community. It draws on findings from People in Public Health (South et al 2010), which investigated approaches to developing and supporting lay people in public health roles. In practice, there are different approaches and health projects that can involve people in this way. Two case studies from the UK are used to illustrate different roles: one in which older people volunteered to spread health messages in their communities and another in which lay health workers delivered a community-based obesity management intervention for young people. The justifications for lay engagement in delivering health promotion are discussed, based on the findings from expert hearings on UK practice that were conducted as part of the study. There are many types of health project that can involve people in this way.

The Wakefield Metropolitan District Council (MDC) Area Working programme offers a radical and innovative approach to service improvement and redesign with the aim of better meeting community needs and addressing inequalities. Community participation is a core component of the Wakefield model, which is underpinned by the wider goals of encouraging active citizenship and community empowerment. There is an acknowledged need to evidence whether the Area Working approach leads to improved services, to what extent there is meaningful community engagement and ultimately to assess whether it makes a difference to people in their neighbourhoods. This literature review addresses a range of key questions that will usefully inform the development of an evaluation framework in relation to the deployment of Area Working within Wakefield. The aims of the literature review were to scope existing models of evaluation used to assess the deployment and impact of Area Working and to identify potential evaluation frameworks and benchmark indicators. A systematic literature search was undertaken to identify published and grey literature on Area Working and similar programmes and relevant literature was reviewed. This search was supplemented by key literature identified through previous research. This brief report presents a summary of findings and makes some recommendations for the development of an evaluation framework for Wakefield Area Working Programme.

BACKGROUND: Approaches that engage and support lay health workers in the delivery of health improvement activities have been widely applied across different health issues and populations. The lack of a common terminology, inconsistency in the use of role descriptors and poor indexing of lay health worker roles are all barriers to the development of a shared evidence base for lay health worker interventions. OBJECTIVES: The aim of the paper is to report results from a scoping study of approaches to involve lay people in public health roles and to present a framework for categorisation of the different dimensions of lay health worker programmes. METHODS: Our scoping study comprised a systematic scoping review to map the literature on lay health worker interventions and to identify role dimensions and common models. The review, which was limited to interventions relevant to UK public health priorities, covered a total of 224 publications. The scoping study also drew on experiential evidence from UK practice. RESULTS: Research-based and practice-based evidence confirmed the variety of role descriptors in use and the complexity of role dimensions. Five common models that define the primary role of the lay health worker were identified from the literature. A framework was later developed that grouped features of lay health worker programmes into four dimensions: intervention, role, professional support/service and the community. DISCUSSION AND CONCLUSION: More account needs to be taken of the variations that occur between lay health worker programmes. This framework, with the mapping of key categories of difference, may enable better description of lay health worker programmes, which will in turn assist in building a shared evidence base. More research is needed to examine the transferability of the framework within different contexts.

This article provides population norms for the Short Form Perceived Stress Scale (PSS-4) and investigates the relationship between PSS-4 scores and sociodemographic variables. The PSS-4 was administered to an English sample ( n = 1568) and was found to have acceptable psychometric properties. Sociodemographic variables explained 19.5% of variance in PSS-4 scores, and mean PSS-4 scores were significantly different from the mean scores reported in Cohen and Williamson’s original study. Greater levels of perceived health status, greater levels of social support, being male and being older were predictive of lower PSS-4 scores. Norm values for interpreting PSS-4 scores are presented.

While research has shown links between income inequality and health, it is important to remember that employment is not universally healthy. For example, sole traders, those in precarious work and the unemployed fare worse than do workers in secure, protected and well-paid positions. Often lying somewhere between paid and unpaid, employee and volunteer, lay people in public health roles are in somewhat of a limbo. It is tempting, for example, to see such roles as simply offering the first step to a career in public health. Yet, volunteer roles and any potential jobs will make demands on health. The consequence is a parallax, or alternative viewpoints, between enabling employment and making working lives healthier. The People in Public Health (PiPH) study combined site visits and interviews with commissioners, practitioners and lay people to build up detailed case studies of five health-promoting projects from across the UK. This presentation will use these case studies to explore links between utilising lay people in public health roles and their health as potential or actual employees.

This paper reports on the outcomes of the Community Health Apprentices Project, an intermediate labour market (ILM) project delivered in two neighbouring areas of Bradford, England. The project was illustrative of current UK policy in its attempt to both address unemployment and health inequalities. The aim of the paper is to improve understanding of the type and range of outcomes that can result from ILM projects based in the community health sector. A qualitative evaluation was undertaken and interviews were carried out with three groups of stakeholders: the community health apprentices, key informants in the placement organisations and the delivery partners. Findings show that both anticipated and unanticipated outcomes occurred in relation to increased skills for work, improved health and well-being and improved organisational capacity. While there are contextual factors which make this project unique, the findings illustrate the potential range of outcomes that can be achieved when social and emotional support is offered in tandem with work experience. The findings further highlight the organisational benefits of investing in local people to deliver community health work. The paper concludes that in order to build an evidence base for ILM approaches, a broader understanding of outcomes needs to be developed, taking into account social and health outcomes as well as economic indicators.

This paper brings together all the PHE outputs from a 10 year collaboration on Healthy Communities. This will help to retain the knowledge during organisational and government change.

Research and knowledge outputs to support the scaling of community-centred approaches and system working as part of action to reduce health inequalities, promote health and wellbeing and prevent illness; Originating from LBU’s Centre for Health Promotion Research and partnership with Public Health England and the Office for Health Improvement and Disparities, Department for Health and Social Care UK.

The ability of the public to remain psychologically resilient in the face of public health emergencies and disasters (such as the COVID-19 pandemic) is a key factor in the effectiveness of a national response to such events. Community resilience and social capital are often perceived as beneficial and ensuring that a community is socially and psychologically resilient may aid emergency response and recovery. This review presents a synthesis of literature which answers the following research questions: How are community resilience and social capital quantified in research?; What is the impact of community resilience on mental wellbeing?; What is the impact of infectious disease outbreaks, disasters and emergencies on community resilience and social capital?; and, What types of interventions enhance community resilience and social capital?A scoping review procedure was followed. Searches were run across Medline, PsycInfo, and EMBASE, with search terms covering both community resilience and social capital, public health emergencies, and mental health. 26 papers met the inclusion criteria.The majority of retained papers originated in the USA, used a survey methodology to collect data, and involved a natural disaster. There was no common method for measuring community resilience or social capital. The association between community resilience and social capital with mental health was regarded as positive in most cases. However, we found that community resilience, and social capital, were initially negatively impacted by public health emergencies and enhanced by social group activities.Several key recommendations are proposed based on the outcomes from the review, which include: the need for a standardised and validated approach to measuring both community resilience and social capital; that there should be enhanced effort to improve preparedness to public health emergencies in communities by gauging current levels of community resilience and social capital; that community resilience and social capital should be bolstered if areas are at risk of disasters or public health emergencies; the need to ensure that suitable short-term support is provided to communities with high resilience in the immediate aftermath of a public health emergency or disaster; the importance of conducting robust evaluation of community resilience initiatives deployed during the COVID-19 pandemic.

Introduction Volunteering is acknowledged to benefit individual, community, and population health and wellbeing. However, those who have the most to gain from volunteering are often least likely to take part. There are questions about how to ensure all groups, especially those who experience social exclusion, can benefit from volunteering. This presentation reports on a rapid review of volunteering, public health and inequalities, with a focus on the barriers to volunteering experienced by population groups with characteristics protected under the Equality Act 2010 (i.e. age, disability, gender, pregnancy/maternity, ethnicity, relationship status, religion, sexual orientation). Methods A rapid review of evidence describing barriers to volunteering experienced by each of the ‘protected characteristics’ was undertaken. After searching and screening, 98 relevant papers were identified across peer-reviewed and grey literature. Data were extracted and evidence synthesised across each of the groups. Results A varied number of papers were identified for each protected characteristic. ‘Age’ (n=23) and ‘sexual orientation’ (n=0) and ‘pregnancy/maternity’ (n=0) were the most and least common respectively. The greatest number of barriers were identified for ‘age’, ‘disability’, and ‘gender’, possibly due to limited research in other areas. There were some cross cutting barriers but also distinct barriers were identified in relation to specific groups. Conclusion Barriers to volunteering are not experienced homogenously within or across protected characteristic groups. The relationship between protected characteristics and barriers to volunteering is complex. The findings help identify appropriate processes promoting social inclusion to ensure all groups can benefit from volunteering. Funding was provided by Volunteering Matters.

This synthesis brings together insights formed across 12 community-university partnerships funded in Phase One of UKRI’s Mobilising Community Assets to Tackle Health Inequalities programme [1]. Projects began in January 2022, with Phase 1 of the programme funding twelve, 12-month pilot projects up to £180,000. These projects focussed on how to scale up small, local approaches with the view to addressing health inequalities. The research promoted people‑powered change, by amplifying lived experience voices and explored how collaborative community, cultural and nature-based activities could reduce health inequalities in the UK.

The rise in childhood obesity is a major public health challenge and a national priority for health action. Obesity is associated with many illnesses and is directly related to increased mortality and lower life expectancy. The Children’s Plan recognises child obesity as one of the most serious challenges for children and links it to a number of poor outcomes, physical, social and psychological (Department for Children, Schools and Families 2007). ‘Can’t wait to be healthy’- Leeds Childhood Obesity Prevention and Weight Management Strategy 2006-2016 is a comprehensive, city-wide strategy setting out actions to tackle the problem of childhood obesity for all children and young people 0-19 years. The strategy reviews the evidence around prevalence, causal factors and effective interventions. There is recognition of the complexity of the issue and the need for action on multiple levels and in different sectors, including health, education, environment and leisure services. The guiding principles are based on partnership working and local leadership, the active participation of parents, carers, children and young people, and the prioritisation of prevention and early intervention. ‘Can’t wait to be healthy’ was initiated by Leeds Primary Care Trust (PCT) and Children Leeds and its implementation is being overseen by a multi agency partnership. An initial action plan was agreed that gives an outline of proposed actions (2007-2010) grouped around strands of work. There are seven core objectives that are summarised in Box 1. A robust evaluation plan and reporting framework to measure progress and outcomes resulting from the strategy is required. This is supported by recent guidance for local areas indicating the importance of local evaluation and monitoring in tracking progress and informing commissioning (Cross Government Obesity Unit 2008a).The Centre for Health Promotion Research, Leeds Metropolitan University, was commissioned to work in collaboration with the Leeds Childhood Obesity Partnership to develop a strategic approach to evaluation. A series of workshops were held in Spring 2008 to enable stakeholders to engage with the planning process and to consider how evidence would be generated. The workshops used a ‘Theory of Change’ approach to develop understanding about how and why specific activities or combinations of activities work (Connell and Kubisch 1988). This resulted in a draft evaluation plan and recommendations for ongoing evaluation which are presented here. This briefing paper includes: • Summary of national guidance on indicators for childhood obesity • Evaluation planning process and approach • Theories of change and evaluation plans for each objective and for the overall strategy • Recommendations for evaluation of ‘Can’t wait to be healthy’ and priorities for data collection

Key messages and summary of the research on Leeds Community Champions programme 2021-23

This research has captured learning from the Leeds Community Champions programme and appraised options for embedding a sustainable Champion model in Leeds that builds community capacity and contributes to reducing health inequalities. The Leeds Community Champions programme has been effective at engaging with, and reaching into, diverse communities at risk of experiencing significant health inequalities. In neighbourhoods and communities, Community Champions became those trusted messengers, able to have informal conversations and connect with others. Community Champions also provided flexible additional capacity to support and complement local organisations and projects. A strong partnership approach between statutory services and Voluntary, Community and Social Enterprise (VCSE) organisations at all levels has been a major factor in the success of the programme. Overall, this flexible, responsive approach has helped services reach some of those communities with the greatest needs. Going forward, learning from the programme - on inclusive volunteering, on utilising the commitment and knowledge of Community Champions, on co-design and co-delivery - can be used to shape future action on health inequalities and help strengthen volunteering in the city.

Aims: Local authorities in England are responsible for public health and health promotion. This article sought to explore how research and decision-making co-exist in a local authority in England. Methods: An Embedded Researcher was based within the local authority and used qualitative methodology to address the research aim. Interviews and focus groups were employed to ascertain a range of stakeholder views in the local authority. All transcripts were coded on NVivo 12 by the Embedded Researcher and two members of the research team cross-checked a sample for coding accuracy. Data were analysed using framework analysis. Results: The data suggest several barriers to using research to inform decision-making in health promotion and public health. The study shows that research is valued in local authorities, but not always privileged – this is due to cultural factors and practical political reasons which often means that decisions need to be made expediently. Participants outlined a juxtaposition between academic credibility; timeliness to complete the research and the financial cost associated with it; against the independence and credibility that independent academics could bring. Conclusion: Policy formulation and delivery is an integral aspect of health promotion and critical to achieving improved population health and reductions in health inequalities. However, there exists tensions between gathering research evidence and making research-informed decisions. The article concludes by advocating the use of Embedded Researchers to fully understand how research is gathered and used to support public health and health promotion policymaking.

Background Local government has become a key constituent for addressing health inequalities and influencing the health of individuals and communities in England. Lauded as an effective approach to tackle the multiple determinants of health, there are concerns that generating and utilising research evidence to inform decision-making and action is a challenge. This research was conducted in a local authority situated in the north of England and addressed the research question – ‘What is the capacity to collaborate and deliver research?’. The study explored the assets that exist to foster a stronger research culture, identified barriers and opportunities for developing research capacity, and how a sustainable research system could be developed to impact on local residents’ health and reduce health inequalities. Methods This was a qualitative study utilising semi-structured interviews and focus groups. The study used an embedded researcher (ER) who was digitally embedded within the local authority for four months to conduct the data collection. Senior Managers were purposively sampled from across the local authority to take part in interviews. Three focus groups included representation from across the local authority. Framework analysis was conducted to develop the themes which were informed by the Research Capacity Development framework. Results Tensions between research led decision making and the political and cultural context of local government were identified as a barrier to developing research which addressed health inequalities. Research was not prioritised through an organisational strategy and was led sporadically by research active employees. A recognition across leaders that a culture shift to an organisation which used research evidence to develop policy and commission services was needed. Building relationships and infrastructure across local government, place-based collaborators and academic institutions was required. The embedded researcher approach is one method of developing these relationships. The study identifies the strengths and assets that are embedded in the organisational make-up and the potential areas for development. Conclusion Research leadership is required in local government to create a culture of evidence-based principles and policy. The embedded research model has high utility in gaining depth of information and recognising contextual and local factors which would support research capacity development.

This paper examines the development and impact of a national knowledge translation project aimed at improving access to evidence and learning on community-centred approaches for health and wellbeing. Structural changes in the English health system meant that knowledge on community engagement was becoming lost and a fragmented evidence base was seen to impact negatively on policy and practice. A partnership started between Public Health England, NHS England and Leeds Beckett University in 2014 to address these issues. Following a literature review and stakeholder consultation, evidence was published in a national guide to community-centred approaches. This was followed by a programme of work to translate the evidence into national strategy and local practice. The paper outlines the key features of the knowledge translation framework developed. Results include positive impacts on local practice and national policy, for example adoption within National Institute for Health and Care Evidence (NICE) guidance and Local Authority public health plans and utilisation as a tool for local audit of practice and commissioning. The framework was successful in its non-linear approach to knowledge translation across a range of inter-connected activity, built on national leadership, knowledge brokerage, coalition building and a strong collaboration between research institute and government agency.

There is a strong evidence-based rationale for community capacity building and community empowerment as part of a strategic response to reduce health inequalities. Within the current UK policy context, there are calls for increased public engagement in prevention and local decision-making in order to give people greater control over the conditions that determine health. With reference to the challenges and opportunities within the English public health system, this essay seeks to open debate about what is required to mainstream community-centred approaches and ensure that the public is central to public health. The essay sets out the case for a reorientation of public health practice in order to build impactful action with communities at scale leading to a reduction in the health gap. National frameworks that support local practice are described. Four areas of challenge that could potentially drive an implementation gap are discussed: (i) achieving integration and scale, (ii) effective community mobilization, (iii) evidencing impact and (iv) achieving a shift in power. The essay concludes with a call to action for developing a contemporary public health practice that is rooted in communities and offers local leadership to strengthen local assets, increase community control and reduce health inequalities.

Abstract

The ability of the public to remain psychologically resilient in the face of public health emergencies and disasters (such as the COVID-19 pandemic) is a key factor in the effectiveness of a national response to such events. Community resilience and social capital are often perceived as beneficial and ensuring that a community is socially and psychologically resilient may aid emergency response and recovery. This review presents a synthesis of literature which answers the following research questions: How are community resilience and social capital quantified in research?; What is the impact of community resilience on mental wellbeing?; What is the impact of infectious disease outbreaks, disasters and emergencies on community resilience and social capital?; and, What types of interventions enhance community resilience and social capital? A scoping review procedure was followed. Searches were run across Medline, PsycInfo, and EMBASE, with search terms covering community resilience or social capital, public health emergencies, and mental health. 26 papers met the inclusion criteria. The majority of retained papers originated in the USA, used a survey methodology to collect data, and involved a natural disaster. There was no common method of measuring community resilience or social capital. The association between community resilience and social capital with mental health was regarded as positive in most cases. However, we found that community resilience, and social capital, were initially negatively impacted by public health emergencies and enhanced by social group activities. Several key recommendations are proposed based on the outcomes from the review, which include: the need for a standardised and validated approach to measuring community resilience or social capital; that there should be enhanced effort to improve preparedness to public health emergencies in communities by gauging current levels of community resilience and social capital; that community resilience and social capital should be bolstered if areas are at risk of disasters or public health emergencies; the need to ensure that suitable short-term support is provided to communities with high resilience in the immediate aftermath of a public health emergency or disaster; the importance of conducting robust evaluation of community resilience initiatives deployed during the COVID-19 pandemic.

BACKGROUND: Valuable learning derived from public health practice can be captured through practice-based case studies, also known as practice examples. Practice examples of participatory interventions supplement the evidence base by providing information on the complexities of implementation in communities. This paper reports on a Public Health England project to build a bank of community-centered practice examples based on robust processes of collection and curation. METHODS: The multidisciplinary project had three phases: (i) development and piloting a process to collect practice examples, (ii) refining review processes and gathering further examples via national and regional teams (iii) maintenance of an accessible collection on the library platform. RESULTS: The project resulted in a searchable collection of 55 practice examples illustrating participatory approaches in public health practice. The collection shows diversity in terms of settings, population, focus and type of approach used to work with communities. A secondary outcome was the development of generic guidance and templates for further collections on public health topics. CONCLUSIONS: This project illustrates how information on the implementation of community-centered approaches in real-life contexts can be gathered and disseminated through a transferable process. Having collections of practice examples supports knowledge exchange in public health as learning is shared.

Objectives The aim of the study was to identify key elements of whole system approaches to building healthy communities and putting communities at the heart of public health with a focus on public health practice to reduce health inequalities. Design A mixed-method qualitative study was undertaken. The primary method was semi-structured interviews with 17 public health leaders from 12 local areas. This was supplemented by a rapid review of literature, a survey of 342 members of the public via Public Health England’s (PHE) People’s Panel and a round-table discussion with 23 stakeholders. Setting Local government in England. Results Eleven elements of community-centred public health practice that constitute taking a whole system approach were identified. These were grouped into the headings of involving, strengthening, scaling and sustaining. The elements were underpinned by a set of values and principles. Conclusion Local public health leaders are in a strong position to develop a whole system approach to reducing health inequalities that puts communities at its heart. The elements, values and principles summarise what a supportive infrastructure looks like and this could be further tested with other localities and communities as a framework for scaling community-centred public health.

The majority of prisoners are drawn from deprived circumstances with a range of health and social needs. The current focus within ‘prison health’ does not, and cannot, given its predominant medical model, adequately address the current health and well-being needs of offenders. Adopting a social model of health is more likely to address the wide range of health issues faced by offenders and thus lead to better rehabilitation outcomes. At the same time, broader action at governmental level is required to address the social determinants of health (poverty, unemployment and educational attainment) that marginalise populations and increase the likelihood of criminal activities. Within prison, there is more that can be done to promote prisoners’ health if a move away from a solely curative, medical model is facilitated, towards a preventive perspective designed to promote positive health. Here, we use the Ottawa Charter for health promotion to frame public health and health promotion within prisons and to set out a challenging agenda that would make health a priority for everyone, not just ‘health’ staff, within the prison setting. A series of outcomes under each of the five action areas of the Charter offers a plan of action, showing how each can improve health. We also go further than the Ottawa Charter, to comment on how the values of emancipatory health promotion need to permeate prison health discourse, along with the concept of salutogenesis.

The 'health-promoting prison' has been informed by a broader settings-based philosophy to health promotion which conceptualizes health as the responsibility for all social settings. Though in its relative infancy, the notion of a health-promoting prison has gained political backing from international organizations like the World Health Organization, but the implementation of the policy rhetoric has not translated across all prison environments. The aim of this paper is to consider how key elements of health promotion discourse-choice, control and implicitly, empowerment-can apply in the context of imprisonment. These concepts were examined in three category-C (secure) prisons in England, through interviews with 36 male prisoners and 19 prison staff conducted by the first author. Analysis showed that prisoners negotiated the norms, structures and strictures of prison life by both relinquishing control and also by taking control, showing resistance and exercising some element of choice. The paradox is that, as most prisoners are expected to be released at some point they need to exercise some agency, control and choice, but these learning experiences may be constrained whilst 'inside'. The paper argues that if a settings approach in prison is truly to move forward, both conceptually and practically, then health promoters should seek to embed the key values of health promotion within the prison setting.

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.

Through qualitative exploration with soon-to-be released men in three prisons in England, this article examines the difficulties that prisoners envisage on returning back to community settings, entering other settings such as workplaces, and the implications the transition may have for their health. Interviews and focus groups were conducted with 36 prisoners, some of whom were convicted of sexual offences and based on a vulnerable prisoner unit. While not all prisoners offered the information, approximately two-thirds of the sample had offended previously. The transition that individuals make from the prison setting to the community can be potentially complex and often detrimental to health. Accommodation issues were forecast as a major concern for those men without family ties. Temporarily residing with friends or living in hostel residences were viable options for many prisoners, but both had drawbacks which could increase the probability of engaging in substance misuse. Resettlement issues were perceived to be more difficult for sex-offenders; their ‘identity’ provided an additional burden which created further reintegration difficulties. Employment opportunities, for example, were predicted to be drastically reduced as the men had signed the sex-offenders’ register. This article suggests that opportunities for successful transition could be enhanced by a more ‘joined-up’ settings perspective and proposes that a settings-based approach to health promotion, which emphasises the synergy between social settings and addressing wider determinants of health, should be applied to prisons to reduce, rather than exacerbate, inequalities.

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.

Members of the public are becoming increasingly important in the delivery of public health programmes. The work they do varies. They might give out information about a health issue or tell people about a local service. They might help someone who is going to a health improvement activity for the first time or organise a group that encourages healthy living. Some are paid, others are volunteers. The People in Public Health research study wanted to find out more about these lay health workers. It wanted to discover what type of things they do in public health programmes, how they are recruited, trained and supported and what is needed to make these approaches work well.

Drawing on a study of lay engagement in public health and using case studies and real-life examples, this timely book provides a comprehensive and accessible overview of policy, practice, and research in this area.

Background There is a dearth of literature available that examines the characteristics of frequent users of urgent and emergency healthcare. Most research and literature explores this population by focusing within one clinical service rather than throughout the whole urgent and emergency healthcare system in England. The aim was to examine how frequent users of: Out of Hours General Practitioners; NHS 111; Ambulance Services; and Emergency Departments are defined, what thresholds are used to identify them and what approaches are used to manage this population. Method A systemic mapping exercise was undertaken to capture a wide range of data to gain a comprehensive understanding of how these services are currently working with regard to frequent users. The search provided 5094 articles which were screened against the inclusion criteria, leaving 156 articles to be analysed. Data was extracted and thematic synthesis created four main themes: typology with regard to definitions assigned; threshold variance; separation of the main population into subgroups; and case management approaches. Results The systematic mapping exercise revealed that diverse definitions and thresholds were being employed by all services; the language used to describe these individuals was often negative and subjective. A single definition of High Intensity User (HIUs) has been selected and advocated for standardisation within all services. This transposable terminology and identification process will aid in supporting and managing patients within all these services. A taxonomy of HIUs has been developed from this research to sub-divide the main heterogeneous group into 5 main classification groups. This meets a gap in current knowledge. Conclusions The standardised identification process and taxonomy will facilitate interoperability and clarity between clinicians, thus benefitting the patient and their outcome. The support and management of HIUs will become more comparable between all urgent and emergency services and within the research community.

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 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.

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.

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.

Aims: First proposed in the 2004 White Paper Choosing Health, health trainers are a new addition to the public health workforce. Health trainers are recruited from local communities and provide support to enable individuals to adopt healthy lifestyles. The aim of this paper is to examine the emerging role of the health trainer in the context of one of the twelve early adopter programmes. The paper describes the support and signposting model developed in Bradford.

Methods: An evaluation of the pilot scheme was undertaken using both quantitative and qualitative methods. The paper draws on two pieces of qualitative data from the evaluation. Two focus groups were held with 15 health trainers in their first months of practice. Telephone interviews were held with a sample of 16 key informants from community based placement organizations. Thematic analysis of the data was undertaken.

Results: The new health trainers were very clear about their role in listening and giving support. Clients presented with a diverse range of needs and often had complex problems. The health trainers perceived that a client-centred approach was of value but there were some issues about the boundaries of appropriate advice. Outreach and networking were considered important skills. In the telephone interviews, interviewees understood the health trainer role and identified potential benefits for service users. The significance of health trainers having local knowledge was highlighted, although some organizations were able to assist with networking. The health trainer programme was seen as an additional and distinct resource complementing existing provision.

Conclusion: The new role of health trainer is a significant development for the public health workforce. Health trainers can offer something quite distinctive and separate from professional advice, and there is potential to help individuals to access support and services in local communities. More research is needed on the relative value of different models of health trainer.

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.

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

Peer interventions delivered for prisoners by prisoners offer a means to improve health and reduce risk factors for this population. The variety of peer programs poses challenges for synthesizing evidence. This paper presents a typology developed as part of a systematic review of peer interventions in prison settings. Peer interventions are grouped into four modes: peer education, peer support, peer mentoring and bridging roles, with the addition of a number of specific interventions identified through the review process. The paper discusses the different modes of peer delivery with reference to a wider health promotion literature on the value of social influence and support. In conclusion, the typology offers a framework for developing the evidence base across a diverse field of practice in correctional health care.

AIMS: The role that members of the public (non-professional lay people) can play in improving health is being increasingly recognised in research and policy. This paper explores what contribution lay people employed as health trainers are making to addressing health inequalities in England. METHODS: Data from eight local evaluations of health trainer services were synthesised using a data-extraction framework to find out about client populations, any lifestyle changes made, health trainers' background and community engagement activities. These data were compared with national data to assess how findings relating to addressing inequalities compared with the national picture. RESULTS: Local data largely matched national data and showed that health trainers are reaching people living with disadvantage and enabling them to make lifestyle changes. The data suggest that they do this by engaging with communities and taking a person-centred approach. Being non-clinical peers is also important. However, no evidence was found that health trainers were impacting on health inequalities at a population level. CONCLUSION:Health trainers are contributing to addressing health inequalities but the services evaluated were small and had been operating for a limited time, so to expect reductions in inequalities at a population level within districts would be unrealistic. The findings of this synthesis present a challenge to primary care and public health to employ health trainers in order to engage marginalised communities as one element of plans to address health inequalities.

A report to reflect on learning from the Leeds URBACT Project, a project between partners in the NHS and Leeds City Council which looked at the relationship between health innovation and community engagement.

Despite volunteering being a feature of community life in the UK, differences as to who volunteers are evident. Reporting on a rapid review of the evidence on volunteering and inequalities, the aim of this paper is to provide an overview of the breadth and interconnectedness of barriers to volunteering for potentially disadvantaged groups. Sixty-seven articles were identified, to produce a map of factors affecting volunteer participation. Findings suggest that while different demographic groups experience specific barriers to volunteering, there are areas of commonality. Analysis shifts the onus of volunteering away from the level of individual choice (a dominant emphasis in policy and practical discussions around promoting volunteering) and towards the influence of structural factors related to broader exclusionary processes. Those who potentially have the most to gain from volunteering are the least likely to participate. Whilst the benefits of volunteering are increasingly documented by research and championed by policy, there are questions about the success of this approach given that the underlying social inequalities present substantive barriers to volunteering and must be address to promote greater access.

This article draws on the updated guidance on community engagement from the National Institute of Health and Care Excellence (NICE 2016), and the evidence that informed that guidance, to discuss the role and potential of engaging with the community in primary care, to improve health and wellbeing. In practice, there are several different ways of engaging with communities, and practitioners need to choose the way that is the best fit with their project, community and ways of working. A guide to community centred approaches recently published by Public Health England and NHS England, maps the range of evidence based options, and two examples from the UK are used to illustrate different approaches to community engagement: one in which lay people from the community delivered a diabetes education project, and one in which volunteers worked with a specialist nurse to provide a holistic arthritis support service.

Purpose Living in an area experiencing economic and social disadvantage is a known risk factor to poor mental health and well-being. This paper aims to understand how some communities experiencing disadvantage appear to be more resilient to the enduring challenges they face and display better mental health outcomes. Design/methodology/approach A qualitative case study approach was used. Semi-structured interviews (total = 74) were undertaken remotely with residents (n = 39) and voluntary, community and social enterprise groups, community leaders and other local stakeholders (n = 35) in four case study areas. Data analysis was cross-case, thematic analysis. Community analysis workshops (n = 4) and resilience mapping workshops (n = 4) in each site corroborated emerging insights. Findings Four overlapping and interacting themes support community resilience: community hubs and local voluntary, community and social enterprise (VCSE) networks; opportunities to participate and make connections within communities; open and supportive environments to talk about mental health and well-being; and community identities and collective narratives. Differences in access to these resources was a cross-cutting theme. Originality/value Community resilience can be understood in terms of the amount of resources – articulated in terms of capital – that communities can draw on in response to challenges, and how well these resources are mobilised. A thriving VCSE sector is important for community resilience in communities experiencing disadvantage as a mechanism for both sustainably building and mobilising community resources in the face of daily and enduring challenges.

INTRODUCTION Living in an area experiencing economic and social deprivation is a known risk factor to poor mental health and wellbeing. There is considerable need to prevent poor mental health outcomes through action on the social determinants of health. This paper is concerned with how some communities experiencing disadvantage appear to be more resilient to poor mental health and wellbeing (community resilience). METHODS A qualitative case study approach was used to carry out an in-depth exploration of what factors support community resilience in four communities experiencing disadvantage in the United Kingdom. 74 semi-structured interviews were undertaken remotely with 39 residents and 35 VCSE groups, community leaders and other local stakeholders. Interviews explored resilience narratives, assets and protective factors, and local challenges. Community analysis workshops and resilience mapping workshops in each site further explored insights from interviews. Data analysis was undertaken using cross-case, thematic analysis. RESULTS Communities experiencing disadvantage encounter a range of daily and enduring challenges to good mental health and wellbeing. Four overlapping and interacting themes support community resilience: (i) Community hubs and local VCSE networks enable a community to support one another and respond effectively to challenges; (ii) Opportunities to participate and make connections within communities strengthens social connections, builds local capacity and empowers people; (iii) Open and supportive environments to talk about mental health and wellbeing help reduce stigma and gives people the tools to help one another; and (iv) Community identities and collective narratives that establish a shared sense of belonging help people to feel secure and connected. DISCUSSION & CONCLUSION Community resilience can be understood in terms of the amount of resources – articulated in terms of capital (e.g. financial, social, cultural, human, natural, physical/built) – that communities can draw on in response to challenges and how well they are mobilised. VCSE organisations and networks play a significant role both building and mobilising different capitals in communities experiencing disadvantage. However, communities experiencing disadvantage face enduring challenges (e.g. poor housing, insecure employment, Covid-19). While VCSE organisations can directly support communities at a local level, their ability to affect structural change is limited to campaigning and advocacy. Responsibility for addressing these issues lie with local and national government. A thriving VCSE sector is important for community resilience in communities experiencing disadvantage as a mechanism for both sustainably building and mobilising community resources in the face of daily and enduring challenges.

This paper presents findings from our qualitative evaluation of one Third Sector response (grants programme) to Covid19 across Leeds, funded by the local city council. This partnership between statutory services and the Third Sector involved power sharing, and a delivery model based upon trust. The response aimed to reach into communities of interest who were vulnerable and most at risk for example, older people and people from deprived areas. Our paper outlines the delivery model, the project outputs across communities of interest, as well as lessons for a new way of working between state and voluntary sector partners on inequalities.

Involving members of the public in delivering public health programmes offers a way to utilise the knowledge, skills and resources within communities. Many health promotion projects involve volunteers or lay health workers; they carry out activities such as peer support and peer education, signposting to services and running community groups. Engaging citizens in co-producing health and wellbeing can help services tackle health inequalities by improving connections with less advantaged groups and by shaping provision to better meet community needs. This research briefing considers what active citizens can do for services and how services can best engage, support and sustain a community or volunteer workforce in order to improve health outcomes. It provides practical guidance on the steps that need to be taken to redesign services and maximise the long term benefits: • deciding what people can contribute to health improvement • choosing a service model • recruiting, training and supporting people in their roles • changing systems to support citizen engagement. This research briefing is based on the findings of the ‘People in Public Health’ study, independent research conducted by Leeds Metropolitan University and funded though the National Institute for Health Research Service Delivery and Organisation Programme. The research examined approaches to support members of the public who take on public health roles, with a focus on the Choosing Health priorities.

A pilot project, developed by Bradford and Airedale Teaching PCT was designed to identify patients within general practice with impaired glucose tolerance (IGT) and refer them to public health advisor who could provide support and individually tailored weight management programme over a period of one year. The aim of the IGT project was to prevent progression of IGT to the more serious condition of type 2 diabetes. Six general practices in Bradford and Airedale were involved in referring their clients into the pilot IGT project. This report details the methods and findings for an evaluation undertaken by the Centre for Health Promotion Research at Leeds Metropolitan University. A discussion of evidence and recommendations about the nature and future direction of the pilot project are made in the final sections 5 and 6 respectively.

This evidence review looks at the evidence base for community health champions and similar roles where community members, either as volunteers or paid community health workers, undertake health promotion activities within the neighbourhoods and communities where they live and work. The evidence review was commissioned as part of the evaluation of the Altogether Better programme, a five-year programme funded through the BIG Lottery that aims to empower people across the Yorkshire and Humber region to improve their own health and that of their families and their communities. The main purpose of this evidence review is to provide an overview of relevant evidence on community health champions and similar roles. It has been written to help inform those commissioning, managing and supporting programmes involving community health champions. It is hoped that the evaluation will help build a strong body of evidence for 21st century UK public health practice. The findings presented in this report are based on a rapid review of evidence on: • definitions of community health champions • types of role and activities • impact on the health & well-being of community health champions • impact on individuals and communities • key issues for programme implementation.

Health trainers are health workers who offer one-to-one support to help individuals make changes to improve their health. The government regards health trainers as being an important mechanism to help tackle health inequalities through improving access to health advice, support and services in disadvantaged communities (Department of Health, 2005). As one of the 12 early adopter sites of the national health trainer programme, Bradford was one of the first places in the country to have health trainers working out in local communities. The early adopter phase was evaluated in 2006 to provide feedback on the development and functioning of the programme and any early outcomes. The evaluation findings indicated that the health trainer role was successful at supporting people to make changes to improve their health. Since the initial evaluation one significant development has been the piloting of the senior health trainer role. Three senior health trainers were recruited in November 2006 and placed in three localities, all areas of disadvantage. Their role was to support the work of health trainers on the ground and to use community development skills to improve access to the health trainer programme. At the time of the second evaluation there were 32 health trainers and 3 senior health trainers working in Bradford providing support to those individuals and communities with greatest health needs.

Community resilience is the ability of communities and groups to adapt and thrive in response to external stressors. Building resilient communities as a strategy for population health requires assessment of personal and collective capacities alongside vulnerabilities. This report examines what quantitative and qualitative methods can be used to measure health-related community resilience at national and local levels. Evidence from a rapid review of 33 studies highlighted various methodological challenges. Measurement strategies, mostly drawn from the field of community disaster resilience, include population-level frameworks, mixed methods assessment tools, and qualitative and participatory case studies. The main conclusions are that measurement of health-related community resilience should cover multiple domains (economic, social, health, skills, political and environment) and consider local context and assets. Three stages of policy development are suggested: selection of a set of key indicators to collect data on community resilience, creation of a learning network to share knowledge and tools, and development of a comprehensive measurement framework.

Within the UK, there is growing recognition that individuals will need to take increased responsibility for managing their own health for there to be improvements in population health. The current evidence base on self care interventions reflects an interest in enhancing self care knowledge, skills and behaviour in relation to the management of long-term conditions. In contrast, this paper reports on a community-based self care initiative that was designed to promote self care approaches in the general population. The principal component was a self care skills training course delivered to groups of lay people in community and workplace settings. Self Care for People was piloted in three primary care trusts and a process evaluation was undertaken. The aim of this paper is to examine the feasibility, relevance and acceptability of the initiative. Qualitative interviews were conducted with a sample of stakeholders involved in implementation including coordinators, trainers and key informants from organisations hosting the course. In total 40 interviews and two focus groups were conducted from 2006 to 2008 and the data were analysed thematically. The evaluation found that implementation was relatively straightforward with few major barriers reported. Recruitment to the self care skills training course took place in both workplace and community group settings, including in organisations supporting socially excluded groups. The course was seen to provide a valuable space for contemplation on personal health, however, participation could raise sensitive issues that needed to be dealt with by skilled facilitators. Motivations for involvement differed markedly in host organisations and different strategies for marketing were adopted. The paper concludes by suggesting that while Self Care for People was both feasible and relevant to different stakeholder groups, there needs to be flexibility in responding to the needs of participants in different settings. © 2010 Blackwell Publishing Ltd.

Abstract

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

Practice-based case studies that describe learning from implementation are a useful source of evidence for policy makers, practitioners and researchers. Despite the value of narratives developed in context as a form of experiential or applied evidence, little is known about appropriate qualitative review and synthesis methods to deal with multiple practice-based case studies. This paper reports on a methodological study to develop and pilot a synthesis method using a sample of community wellbeing case studies focused on interventions to improve community infrastructure. The study was conducted in four interlinked phases: (i) literature review to scope synthesis methods (ii) piloting search and selection methods to identify a sample of relevant practice-based case studies that reported experiential learning (iii) undertaking cross case analysis and qualitative synthesis based on framework analysis methods (iv) review and reflection to produce a summative account of the method and agreed definition. The main output from the study was a staged approach to qualitative synthesis of practice-based case studies based on seven steps, which move from identification of a conceptual framework through to producing a narrative report. The potential transferability of this approach and its application in research and policy are critically discussed. Synthesis of case studies derived from community-based interventions could address knowledge gaps in the formal evidence base. While further methodological development is warranted, it is argued that study results form a credible qualitative framework for synthesising practice-based evidence.

Background Good quality green space, close to where people live, improves health and wellbeing. In deprived areas, where health is worse, there is less access to this health-promoting resource. Improving green space in these areas could help tackle health inequalities. Friends Groups consist of volunteers who act together to improve their local green space. Approximately 6000 such groups exist in the UK. This study aimed to explore how Friends Groups in deprived areas operate and whether relying on them to maintain green spaces, contributes to or mitigates against inequality. Methods This study utilised qualitative methodology, influenced by ethnography. Seven case-studies in disadvantaged neighbourhoods in England participated: five ‘established’ Friends Groups and two ‘developing’. Data collection took place over three years and included participant observation, interviews, focus groups and ‘walk and talks’. Semi-structured interviews were conducted with local authority park staff. Interviews / discussions were audio-recorded and transcribed verbatim, reflective field-notes were kept throughout. Data analysis was initially by case to produce narrative accounts and then cross-case to identify explanatory success factors. Results Successful Friends Groups were able to transform neglected, under-used green spaces into thriving community places, much used and appreciated by local people. A conceptual framework was developed that identified four domains affecting the success of groups: Place, People, Process and Power. Group leaders played a key role. Commitment, perseverance and motivation were vital, whilst being confident, capable, with authority and connections improved chances of success. The relationship between local authorities and Friends Groups was often challenging, with conflict and disagreement leading to frustration and stress. Different perceptions of participation and control contributed to tensions. Park teams were often unaware of issues relating to inequality. Conclusions The findings raise concerns that, as the model currently operates, it could exacerbate green space inequalities. Some of the identified success domains pattern with deprivation. Deprived neighbourhoods, for example, are less likely to have leaders with the required qualities, capacity and connections for success, and park teams show a preference to working with more capable groups, who are likely to be in more affluent areas. Recommendations include supporting Friend Groups in disadvantaged areas to strengthen their capabilities and capacity, and working with local authorities to encourage greater sharing of control with these potentially transformative community-based groups.

Abstract

Abstract

Stakeholder engagement for the What Works Centre for Wellbeing’s (WWCW) Community Wellbeing Evidence Programme identified ‘boosting social relations’ in communities as a priority policy-related topic. A scoping review of 34 reviews identified evidence gaps relating to social relations in the following areas: community infrastructure (places and spaces); interventions to reduce or prevent social isolation in adults <60 years; community engagement and volunteering; social network analyses. We developed ‘community infrastructure (places and spaces)’ as a systematic review, as this can be addressed at a local or regional level and has potential to produce immediate practical impact. We searched 11 bibliographic databases from 1997–2017, performed reference and citation checking, searched the websites of relevant organisations, and issued a call for evidence through the WWCW. We included studies which reported: interventions to improve or make alternative use of physical places and spaces at community or neighbourhood level; outcomes of social relations, community wellbeing and related concepts; quantitative, qualitative and mixed methods studies, and process evaluations. Two reviewers undertook study selection. One reviewer undertook data extraction and validity assessment, with a random 20% checked by a second reviewer. Validity of included studies was assessed using established checklists. Following thematic synthesis of qualitative data, a narrative synthesis was produced for each of eight intervention categories. The GRADE and CERQual approaches were used to rate the overall strength of evidence for each outcome. 51 studies, mostly of poor to moderate quality, were included. The better quality evidence was qualitative, and most of the review’s findings come from the thematic synthesis of qualitative evidence There was moderate evidence that Community hubs may promote social cohesion, increase social capital and build trust between people, widen social networks and increase interaction between people, and increase people’s knowledge or skills; Changes to neighbourhood design may positively affect sense of belonging and pride in a community; Green and blue space interventions that provide the opportunity to participate in activities or meetings improve social interactions, increase social networks, bonding and bridging social capital, physical activity and healthy eating, and improve people’s skills and knowledge. There were also common themes relating to facilitators and barriers to successful interventions. The review found moderate evidence that a range of intervention approaches to community infrastructure can boost social relations and community wellbeing. Future research should prioritise high quality evaluations using repeated measures and validated tools, with robust and credible qualitative evidence.

Resilience is a dynamic process of coping, adaptation and growth in response to threats and can be an attribute of individuals, communities or systems. ‘Creating resilient communities’ is a Health 2020 priority, reflecting the importance of the social environment as a determinant of population health. This is an emergent field for research, with questions of how best to define and measure this complex concept at a community level. This presentation reports on a rapid review and synthesis of measurement strategies conducted for WHO Europe Health Evidence Network (HEN). The review question was: ‘What quantitative and qualitative methods can be used to measure health-related community resilience at a national level?’ The rapid review used HEN Evidence Synthesis guidance. A systematic search of academic and grey literature databases and 73 websites combined key terms for community resilience and measurement. Included languages were English, French and German, and Russian (via an independent search). Study selection was in 2 phases, with an initial focus on Europe. Inclusion criteria were articles that reported outcomes involving measurement of health-related community resilience in all population groups, study designs and settings. Studies on individual/system resilience and those not specifying health and wellbeing measurement were excluded. Data extraction fields included theoretical framework, methods and indicators. Findings were summarised in tables and a narrative synthesis. In total, 3,753 publications were identified and following screening, 33 studies were included; 27 from WHO European Region. The map of literature showed various measurement frameworks in use, however most related to community disaster resilience. We grouped measurement strategies into: Frameworks providing population profiles of resilience factors, using quantitative data Mixed method assessments incorporating stakeholder views, used mostly for local planning & evaluation Qualitative and participatory approaches, which involved marginalised communities. There was a dearth of validated measures and insufficient evidence on national-level indicators, but socioeconomic measurement domains were categorised. Key methodological challenges were highlighted, including definitional issues, data aggregation and lack of attention to equity. Notwithstanding these challenges, the review identified some common principles for measuring community resilience. This review contributes to new understandings of health-related community resilience and its measurement. Using rapid review methods limited the scope of the search, and the focus was mainly on European literature. While there is learning from community disaster resilience methods, transferability to population health needs to be tested.Based on review gaps, recommendations are made for future research topics.

Purpose: Formalised support services for prisoners that rely on peer methods of delivery show promising health and social outcomes but there is also conjecture that negative effects, both at an individual and organisational level, can occur. Design/methodology/approach: Individuals with recognised professional expertise from various sectors (including ex-prisoners) were invited to contribute to an expert symposium to share their perceptions of the positive and negative effects of peer interventions in prison. Discussions and debate were audio recorded with the consent of all delegates and verbatim transcripts were analysed using Framework Analysis. Findings: According to the participants, peer interventions in the prison setting created both positive and negative impacts. It was clear from the evidence gathered that peer interventions in prisons can impact positively on health outcomes, but these effects were perceived to be more well-defined for peer deliverers. The notion that peer deliverers can be subjected to ‘burnout’ suggests that supervisory processes for peer workers need to be considered carefully in order to avoid the intervention from being counter-productive. Organizationally, one of the salient issues was the adverse effects that peer interventions cause to the security of the prison. Originality/value: To our knowledge, this is the first time an expert symposium has been conducted to specifically examine peer interventions in prison and to consider the effects, both positive and negative, of such schemes.

Epidemiological assessment of the prison population globally shows undeniable health need, with research evidence consistently demonstrating that the prevalence of ill health is higher than rates reported in the wider community. Since a meeting convened by the World Health Organisation in the mid-1990s, prisons have been regarded as legitimate settings for health promotion and a myriad of interventions have been adopted to address prisoners’ health and social need. Peer-based approaches have been a common health intervention used within the prison system, but despite their popularity little evidence exists on the approach. This paper presents findings from an expert symposium – part of a wider study which included a systematic review – designed to gather expert opinion on whether and how peer–based approaches work within prisons and if they can contribute to improving the health of prisoners. Experts were selected from various fields including the prison service, academic research and third sector organisations. Expert evidence suggested that the magnitude of success of peer interventions in prison settings is contingent on understanding the contextual environment and a recognition that peer interventions are co-constructed with prison staff at all levels of the organisation. Implications for developing peer-based interventions in prison are given which assist in developing the concept, theory and practice of the health promoting prison.

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.

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.

Lay involvement in public health programmes occurs through formalised lay health worker (LHW) and other volunteer roles. Whether such participation should be supported, or indeed rewarded, by payment is a critical question. With reference to policy in England, UK, this paper argues how framing citizen involvement in health only as time freely given does not account for the complexities of practice, nor intrinsic motivations. The paper reports results on payment drawn from a study of approaches to support lay people in public health roles, conducted in England, 2007-9. The first phase of the study comprised a scoping review of 224 publications, three public hearings and a register of projects. Findings revealed the diversity of approaches to payment, but also the contested nature of the topic. The second phase investigated programme support matters in five case studies of public health projects, which were selected primarily to reflect role types. All five projects involved volunteers, with two utilising forms of payment to support engagement. Interviews were conducted with a sample of project staff, LHWs (paid and unpaid), external partners and service users. Drawing on both lay and professional perspectives, the paper explores how payment relates to social context as well as various motivations for giving, receiving or declining financial support. The findings show that personal costs are not always absorbed, and that there is a potential conflict between financial support, whether sessional payment or expenses, and welfare benefits. In identifying some of the advantages and disadvantages of payment, the paper highlights the complexity of an issue often addressed only superficially. It concludes that, in order to support citizen involvement, fairness and value should be considered alongside pragmatic matters of programme management; however policy conflicts need to be resolved to ensure that employment and welfare rights are maintained.

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

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”.

The work was done to support the Yorkshire Dales National Park (YDNP) Authority’s Access & Engagement team in developing and refining their Theory of Change (ToC) and to produce an evaluation framework. This should enable the Authority to better understand and articulate the impact of their work and assist with the planning of their future delivery.

This evidence review looks at the evidence base for empowerment and health & wellbeing. It was commissioned as part of the evaluation of the Altogether Better programme, a five-year initiative funded through the BIG Lottery that aims to empower people across the Yorkshire and Humber region to lead healthier lives. The regional programme is made up of a learning network and 16 community and workplace projects, which are working to increase physical activity, improve healthy eating and promote better mental health & well-being. Altogether Better is based on a programme empowerment model. This model is based on three elements: building confidence, building capacity and system challenge.

There have been concerns about the decline of health promotion as a practice and discipline and alongside this, calls for a clearer articulation of health promotion research and what, if anything, makes it distinct. This discussion paper, based on a review of the literature; the authors’ own experiences in the field; and a workshop delivered by two of the authors at the 8th Nordic Health Promotion Conference, seeks to state the reasons why health promotion research is distinctive. While by no means exhaustive, the paper suggests four distinctive features. The paper hopes to be a catalyst to enable health promotion researchers to be explicit in their practice and to begin the process of developing an agreed set of research principles.

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

Background: Stakeholder engagement for the What Works Centre for Wellbeing’s (WWCW) Community Wellbeing Evidence Programme identified ‘boosting social relations’ in communities as a priority policy-related topic. A scoping review of 34 reviews identified evidence gaps relating to social relations in the following areas: community infrastructure (places and spaces); interventions to reduce or prevent social isolation in adults <60 years; community engagement and volunteering; social network analyses. We developed “community infrastructure (places and spaces)” as a systematic review, as this can be addressed at a local or regional level and has potential to produce immediate practical impact. Methods: We searched 11 bibliographic databases from 1997-2017, performed reference and citation checking, searched the websites of relevant organisations, and issued a call for evidence through the WWCW. We included studies which reported: interventions to improve or make alternative use of physical places and spaces at community or neighbourhood level; outcomes of social relations, community wellbeing and related concepts; quantitative, qualitative and mixed methods studies, and process evaluations. Two reviewers undertook study selection. One reviewer undertook data extraction and validity assessment, with a random 20% checked by a second reviewer. Validity of included studies was assessed using established checklists. Following thematic synthesis of qualitative data, a narrative synthesis was produced for each of eight intervention categories. The GRADE and CERQual approaches were used to rate the overall strength of evidence for each outcome. Results: 51 studies, mostly of poor to moderate quality, were included. The better quality evidence was qualitative, and most of the review’s findings come from the thematic synthesis of qualitative evidence There was moderate evidence that: (i) Community hubs may promote social cohesion, increase social capital and build trust between people, widen social networks and increase interaction between people, and increase people’s knowledge or skills; (ii) Changes to neighbourhood design may positively affect sense of belonging and pride in a community; (iii) Green and blue space interventions that provide the opportunity to participate in activities or meetings improve social interactions, increase social networks, bonding and bridging social capital, physical activity and healthy eating, and improve people’s skills and knowledge. There were also common themes relating to facilitators and barriers to successful interventions. Conclusions: The review found moderate evidence that a range of intervention approaches to community infrastructure can boost social relations and community wellbeing. Future research should prioritise high quality evaluations using repeated measures and validated tools, with robust and credible qualitative evidence.

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

This guidance provides a step by step approach to synthesising practice-based case study evidence. The rationale is the opportunity presented by combining case studies, in order to make the most of the data case studies contain, whilst also producing robust, potentially transferable findings. Findings from the synthesis of a number of individual cases may allow for translation to other settings and the generalisability of the findings from the synthesis of a number of practice-based case studies may also be increased by linking back to theory. This guide follows a full review of synthesis approaches that might be appropriate for practice-based case study evidence. The review included testing one approach, which has been used as the basis for this guide, to illustrate how synthesis can be done in practice.

Introduction: There are many scales and measures of individual wellbeing, but community wellbeing is less well defined. Indicators measuring a community’s wellbeing may not be described as such. To address this knowledge gap, the What Works Wellbeing Communities Evidence Programme conducted a rapid scoping review of indicators, frameworks and measures of community wellbeing used by UK agencies in the last 5 years. Methods: Five electronic databases were searched from 2010 – 2016, plus relevant organisations’ websites. We included policy documents, evaluations and research studies if they measured community wellbeing in the UK. Electronic search results were uploaded to systematic reviewing software, screened and data extracted by one of five reviewers, with a random 10% double checked. Results: 6,494 records were screened and 47 included, containing 43 indicators currently or recently in use in the UK. Governmental organisations were more likely to use indicator frameworks or sets; non-governmental or academic organisations were more likely to use conceptual frameworks. Academic organisations were the most likely to use validated measures or scales. A wide range of synonyms or proxy terms relating to community wellbeing were used; we have begun to map these against their included domains. Conclusion: This is the first iteration of a working document compiling and indexing UK community wellbeing indicators. The review is intended to grow throughout the life of the What Works Wellbeing Centre; as further measures are identified in systematic reviews or by stakeholder engagement, they will be added.

This briefing presents results from a synthesis and review of practice based case studies on how community hubs and green spaces can enhance wellbeing in a place. Case study evidence provides important and rich detail on these projects and activities, and how they are delivered. This research identified community wellbeing outcomes that support the findings from systematic review evidence, as well as describing additional and unforeseen outcomes, including those that arise from the benefits of more informal spaces that may not have been the subject of formal evaluations, as well as benefits to the organisations responsible for the delivery of the interventions.

Practice-based case studies are recognised as an important source of knowledge and learning and one that is complementary to research-based evidence. There is a knowledge gap about how to synthesise this evidence. This study addressed this knowledge gap by identifying the most robust methods to collate, review and synthesise practice-based case study evidence and by carrying out a pilot synthesis on practice-based community wellbeing case studies. The pilot focused on community-based interventions (projects, initiatives, services or programmes) that aimed to improve social relations and community wellbeing through better community infrastructure (places and spaces).

As part of the Communities of Place (CoP) Evidence Programme, at the What Works Centre for Wellbeing, we are conducting a scoping review and qualitative synthesis of the methods and approaches of community-based practices in supporting community wellbeing. This ‘Community Wellbeing Case Study Synthesis’ will have two areas of focus (i) development of a method to synthesise learning and outcomes from community-based wellbeing projects (ii) collection and review of a sample of projects that are focused on promoting wellbeing through a place or neighbourhood. There is considerable interest in the knowledge and learning that can be obtained from practice-based case studies, but no consensus on how to synthesise that evidence. This study will therefore aim to provide a ‘proof of concept’, laying the foundations for synthesising learning from community wellbeing practice. This protocol sets out the process that we will use to develop the methods and then apply them with a small set of community wellbeing case studies.

A synthesis of findings from social research on the District of Bradford. This report synthesises the findings from a wide range of social research undertaken on the District of Bradford, primarily between 1995 and 2005. The researchers reviewed almost 200 pieces of work. The key results are summarised under thematic headings: - The social, economic and institutional context - Community cohesion - Housing, neighbourhoods and regeneration - Business and enterprise - Health, disability and social care - Children and young people - Education, skills and the labour market - Crime and community safety It also identifies a future research agenda. The main purpose of the review was to provide the Joseph Rowntree Foundation and local organisations in Bradford with a firm basis upon which to build future work in the District.

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

This paper responds to challenges around how to generate robust evidence in keeping with the principles of an asset-based approach based on mobilization of community strengths. The design of a collaborative evaluation of a multi-site Asset Based Community Development program is described and emergent learning discussed. A qualitative mixed method design was used to capture changes at community and program level drawing on diverse sources of evidence. Shared principles on the conduct of the evaluation were developed with program leads and community practitioners and opportunities for shared learning were built in. The paper distils learning on evaluation into six design features including the asset-based model as a framework, understandings of evidence and outcomes, ethical conduct, and the centrality of a collaborative and developmental approach. The paper concludes that these features form a coherent approach to asset-based evaluation which can link the theory and practice of Asset Based Community Development.

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

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.

Community participation is a central concept for health promotion, covering a breadth of approaches, purposes and activities. This paper reports on a national knowledge translation project in England, UK, which resulted in a conceptual framework and typology of community-based approaches, published as national guidance. A key objective was to develop a conceptual framework linked to sources of evidence that could be used to support increased uptake of participatory methods across the health system. It was recognised that legitimacy of community participation was being undermined by a scattered evidence base, absence of a common terminology and low visibility of community practice. A scoping review, combined with stakeholder consultation, was undertaken and 168 review and conceptual publications were identified and a map produced. A ‘family of community-centred approaches for health and wellbeing’ was then produced as way of organising the evidence and visually representing the range of intervention types. There are four main groups, with sub-categories: (i) Strengthening communities (ii) Volunteer and peer roles (iii) Collaborations and partnerships and (iv) Access to community resources. Each group is differentiated using key concepts and theoretical justifications around increasing equity, control and social connectedness. An open access bibliography is available to accompany the framework. The paper discusses the application of the family of community-centred approaches as a flexible planning tool for health promotion practice and its potential to be used as a framework for organising and synthesising evidence from a range of participatory methods.

Background: Low rates of health service usage by men are commonly linked to masculine values and traditional male gender roles. However, not all men conform to these stereotypical notions of masculinity, with some men choosing to attend health services on a frequent basis, for a variety of different reasons. This study draws upon the accounts of male frequent attenders of the General Practitioner's (GP) surgery, examining their help-seeking preferences and their reasons for choosing services within general practice over other sources of support. Methods: The study extends thematic analysis of interview data from the Self Care in Primary Care study (SCinPC), a large scale multi-method evaluation study of a self care programme delivered to frequent attenders of general practice. Data were collected from 34 semi-structured interviews conducted with men prior to their exposure to the intervention. Results: The ages of interviewed men ranged from 16 to 72 years, and 91% of the sample (n= 31) stated that they had a current health condition. The thematic analysis exposed diverse perspectives within male help-seeking preferences and the decision-making behind men's choice of services. The study also draws attention to the large variation in men's knowledge of available health services, particularly alternatives to general practice. Furthermore, the data revealed some men's lack of confidence in existing alternatives to general practice. Conclusions: The study highlights the complex nature of male help-seeking preferences, and provides evidence that there should be no 'one size fits all' approach to male service provision. It also provides impetus for conducting further studies into this under researched area of interest. © 2011 WPMH GmbH.

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 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

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: 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 .

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.

To examine the effects of self-care training workshops for primary healthcare workers on frequently attending patients.

To determine the effects of a community-based training programme in self-care on the lay population.

‘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.

In 2012, I project managed a team of researchers who were commissioned to undertake an evaluation of the Sunderland Health Champions Programme. Evaluation is an activity that remains central to health promotion practice because it is concerned with assessing whether interventions are effective (Green and South 2006). Health Champions are a growing component within the British public health workforce and their roles are emphasised within the coalition’s Government’s public health strategy. However, there is the need for further exploration of the way in which Health Champions work and the effectiveness of programmes that use Health Champions as a mechanism to try to achieve positive health changes. Therefore Sunderland tPCT commissioned independent researchers, staff from the Centre for Health Promotion Research at Leeds Metropolitan University to evaluate their Health Champion Programme.

Health Champions are a growing component within the British public health workforce and their roles are now emphasised within the coalition’s Government’s public health strategy. However, there is the need for further exploration of the way in which Health Champions use interpersonal communication within their roles. This paper reports on the findings from a mixed method evaluation of one Health Champion programme in North East England. A key finding was the way in which Health Champions used circles of influence to communicate health knowledge and to try to achieve behaviour change, starting with themselves in the centre of their circle and then moving outwards to influence others such as family, friends and colleagues through their social networks. The paper argues that health champions act as healthy role models within their own circles of influence to successfully communicate health knowledge to those around them.

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

Health education has changed in numerous ways since the inception of this journal, with many developments moving the discipline forward in ways that perhaps were not envisaged 75 years ago. Whilst there have been reported concerns about the decline of the discipline of health promotion and therefore associated worries about education, the contemporary evidence base has grown (Woodall et al 2017 in press), which we argue supports the delivery of quality education and the development of capable, skilled practitioners. Pedagogy has further developed too, and technology now enables health education to have a broader global reach through online teaching, social media and open-access publications. Many global challenges remain, and the UK context is one in which both health education and indeed practice faces major trials despite the traditions and approaches to health education developed by those educated and trained in this setting over a period of many years. We argue that the broader UK policy environment remains a challenge to current health promotion education, research and practice.

An important consideration that needs adding to discussions of patient choice and whether or not men are reluctant to use primary care services is that many frequent attenders are male. The aim of this article is to explore how male frequent attenders construct decisions to use or not use health-care services. This is achieved through secondary analysis of baseline interviews with male frequent attenders from the Self Care in Primary Care study. As this was a complex study, a three-step analytic process was employed to incorporate the involvement of multiple researchers working together over a number of years. First, the interviewer summarised each interview and second, the summaries were read as a group to find themes across them. Subsequently, we returned to the interviews to add detail that would further illustrate or challenge the analysis. Participants talked of ‘engaging health and avoiding ill-health’, constructing themselves as embodied, health conscious and rational in a similar vein to constructions of feminine interactions with health. While participants talked of ‘choosing health services’ as if they were drawing upon a range of choices, the dominance of the image of the GP was such that seeing a GP was the only legitimate health choice.

Background: Stakeholder engagement for the What Works Centre for Wellbeing’s (WWCW) Community Wellbeing Evidence Programme identified ‘boosting social relations’ in communities as a priority policy-related topic. A scoping review of 34 reviews identified evidence gaps relating to social relations in the following areas: community infrastructure (places and spaces); interventions to reduce or prevent social isolation in adults <60 years; community engagement and volunteering; social network analyses. We developed “community infrastructure (places and spaces)” as a systematic review, as this can be addressed at a local or regional level and has potential to produce immediate practical impact. Methods: We searched 11 bibliographic databases from 1997-2017, performed reference and citation checking, searched the websites of relevant organisations, and issued a call for evidence through the WWCW. We included studies which reported: interventions to improve or make alternative use of physical places and spaces at community or neighbourhood level; outcomes of social relations, community wellbeing and related concepts; quantitative, qualitative and mixed methods studies, and process evaluations. Two reviewers undertook study selection. One reviewer undertook data extraction and validity assessment, with a random 20% checked by a second reviewer. Validity of included studies was assessed using established checklists. Following thematic synthesis of qualitative data, a narrative synthesis was produced for each of eight intervention categories. The GRADE and CERQual approaches were used to rate the overall strength of evidence for each outcome. Results: 51 studies, mostly of poor to moderate quality, were included. The better quality evidence was qualitative, and most of the review’s findings come from the thematic synthesis of qualitative evidence There was moderate evidence that: (i) Community hubs may promote social cohesion, increase social capital and build trust between people, widen social networks and increase interaction between people, and increase people’s knowledge or skills; (ii) Changes to neighbourhood design may positively affect sense of belonging and pride in a community; (iii) Green and blue space interventions that provide the opportunity to participate in activities or meetings improve social interactions, increase social networks, bonding and bridging social capital, physical activity and healthy eating, and improve people’s skills and knowledge. There were also common themes relating to facilitators and barriers to successful interventions. Conclusions: The review found moderate evidence that a range of intervention approaches to community infrastructure can boost social relations and community wellbeing. Future research should prioritise high quality evaluations using repeated measures and validated tools, with robust and credible qualitative evidence.

The aim of this systematic review is to synthesise the available evidence, and describe the quality of that evidence, in relation to interventions that improve or create the community infrastructure that impacts on social relations and/ or community wellbeing. For this review, we are defining community infrastructure as the physical places and spaces where people can come together, formally or informally, to interact and participate in the social life of the community. We intend to produce a synthesis which is accessible and will inform practice and future research in the area.

Background: Social relations are recognized as an important determinant of individual & community wellbeing. The UK What Works Wellbeing Centre chose “boosting social relations” as a priority topic for systematic review. First, a scoping review was undertaken to identify evidence gaps. Methods: We searched: Cochrane database of systematic reviews, DARE, Campbell Library, DoPHER (EPPI-Centre), Joanne Briggs Institute, MEDLINE, IDOX, CINAHL, PsycINFO, Social Policy & Practice, Social Care Online; relevant websites. Inclusion criteria: Population – communities in OECD countries; Intervention - Any community-based intervention, change in policy, organisation or environment that were designed to boost social relations within the community; Outcomes – social relations, community wellbeing or related synonyms; Study design – systematic & non-systematic reviews published between 2005 and 2016. Studies were selected & data extracted by 3 reviewers, and summarised narratively. Results: 11,257 titles and abstracts were screened, 182 obtained in full & 29 included. Existing evidence tells us: Targeted group interventions that foster social networks & provide meaningful roles can reduce social isolation and/ or loneliness in older people; Volunteering can improve physical & mental health & wellbeing in older people; Effective community engagement produces sustainable improvements in community health & individual wellbeing. Evidence gaps: Interventions for social isolation &/ or loneliness in adults aged up to 65 years; Volunteering in people aged up to 65 years; Social network analyses; Community infrastructure (places & spaces). Stakeholder consultations identified community infrastructure (places & spaces) as the most useful topic for systematic review. Conclusions: A systematic scoping review of reviews, with stakeholder consultation, identified community infrastructure (places & spaces) as an evidence gap. Early findings from the resulting systematic review will be presented.

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

This summary focuses on information from the Leeds Beckett ABCD evaluation about the effect of Covid-19 on the Leeds ABCD programme and how ABCD sites responded to the crisis.

A summary of the evidence on neighbourhood-based Asset Based Community Development (ABCD). It includes information from scientific journals and evaluation reports. The evidence review was done for Leeds City Council as part of Leeds Beckett University’s evaluation of the ABCD programme in the city.

This report reviews recent research on Asset Based Community Development (ABCD). ABCD is part of a broader group of asset-based approaches which have been applied in different types of community and settings. This report focuses on evidence about neighbourhood-based ABCD practice, which is the approach being taken in Leeds. Recent research studies are reviewed, building on previous reviews on asset-based approaches. The report summarises the evidence on key topics around ABCD theory, how the approaches work, implementation, evaluation and outcomes.

Background Despite growing interest in understanding complex systems and public health interventions, research methodologies that take account of system-wide action are relatively underdeveloped. Community-based participatory research (CBPR) is steered and conducted by people with lived experience of the issues being researched. This paper explores the value of CBPR in complex public health intervention evaluations. The ‘Local People’ and ‘Local Conversations’ programmes use a community empowerment approach in 50 communities across the UK experiencing social disadvantage to increase social connections and collective control, improve health and wellbeing, and reduce inequalities (linked to SDG 3 and 11). Methods Evaluation of the programmes followed a mixed-methods design, including qualitative case studies, longitudinal survey, process appraisal, and CBPR. Residents from 10 communities across the programmes each undertook 2 rounds of CBPR. These projects resulted in written reports, which were analysed thematically alongside other data sources. Results There was some variation in the scope and design of the 20 completed CBPR projects. Whilst projects did not generally extend beyond the scope of the overall evaluation, peer research provided information from residents that were inaccessible to other data collection streams. Gathering community (lay) knowledge improved understanding of local priorities and actions within the programmes. However, the utility of CBPR was less consistent for community-researchers and local communities, often failing to support project development. Some community-researchers felt unprepared for the activity despite support from the academic team. Conclusions Conducted appropriately, CBPR can elicit data that would be less accessible through externally led research. This study highlights the value of CBPR in complex programme evaluations, enabling a deeper understanding of social context in which interventions occur.

A summary presenting findings from Leeds Beckett University’s evaluation of an Asset Based Community Development programme in Leeds.

This report presents findings from the Leeds Asset Based Community Development (ABCD) programme evaluation. ABCD is a neighbourhood-based community building approach that uses community organising methods to identify, mobilise and strengthen the capacities or asset of individuals, families and communities (Kretzmann and McKnight, 1993). At the time of the evaluation. 12 ABCD pathfinder sites operated in Leeds neighbourhoods, the majority established in 2019. The model consists of: • Community Builders - paid workers hosted by Neighbourhood Organisations • Community Connectors - individuals living locally who may organise and support local activities • ‘Small Sparks’ grants - funds for groups and individuals to support local activity. Using mainly qualitative and participatory methods, this collaborative evaluation involved working with Leeds City Council and the Community Builders to gather evidence of what works and how. The findings show that the pioneering Leeds ABCD pathfinder model is still relatively new in its development and shifting to citizen-led activity takes time. Nonetheless the evaluation presents strong evidence on how ABCD works and the mechanisms of change thus demonstrating how a city-wide approach can be implemented. There is strong evidence for better social connections and the pathway to community change. Promising evidence for increased friendships, the social value of the pathfinder model, change in communities and other additional outcomes also exists. A series of recommendations and issues for consideration are presented to inform programme development.

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

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.

Aim: To undertake a service evaluation of the NHS East of England Supporting Self-Care in General Practice programme. Background: The number of people purported to live with long-term conditions continues to rise generating increasing policy emphasis on the importance of self-care. Previous work has highlighted barriers to implementing self-care interventions in general practice, including a lack of organisational approaches to providing self-care and limited engagement and training of healthcare professionals. In response to these barriers and policy drivers, NHS East of England Strategic Health Authority developed and commenced the Supporting Self-care in General Practice (SSCiGP) programme, which seeks to transform the relationships between people with long-term conditions and primary care practitioners. Methods: This was a mixed methods study, carried out over two phases, which included interviews, survey work and practice-based case studies. Results: This paper focuses on findings related to clinician and practice level change. Clinicians reported changes in their perceptions and in consultation practices following attendance on the SSCiGP programme. These changes were linked to empathy and patient-centredness that mirrored what patients valued in interactions with clinicians. There were qualitative and descriptive differences, but no statistically significant differences between clinicians who had and had not attended the SSCiGP programme. Time was recognised as a significant barrier to implementing, and sustaining skills learnt from the SSCiGP programme. Greater impact at practice level could be achieved when there was whole practice commitment to values that underpinned the SSCiGP programme. There was evidence that such approaches are being incorporated to change practice systems and structures to better facilitate self-care, particularly in practices who were early programme adopters. Conclusion: This evaluation demonstrates that training around clinician change can be effective in shifting service delivery when sat within a cultural framework that genuinely situates patients at the centre of consultations and practice activity.

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