International Festival of Public Health

LT 1 - Transdisciplinarity in Public Health

A realist evaluation of community (health) development projects in Wales

Presenter: Andrew Rogers (University of Manchester)

Other Author(s): Paul Brocklehurst, Glynne Roberts, Lynne Williams, Gail Findlay, Joanna Charles

Abstract Text:

Community development for health and wellbeing is back in fashion across Wales. Renewed interest in governance at the community level, building local resilience and empowering people to make the most of their wellbeing assets is influencing a wide range of projects. The Well-Being of Future Generations (Wales) Act (2015) [1] provides a further impetus to this through requiring all public bodies to work together to make an impact upon sustainable development by driving them, through better collaboration and joint action, to build wellbeing within communities.
However, this very faddism brings inherent problems as the history of community development is vast, draws from many disciplines and ideologies yet these are often hidden in implementation ([2]. The result is that projects borrow approaches uncritically and consequently in application in local circumstances the initiatives don’t quite ‘fit’.
Each community development trend has brought theories, values and principles, even toolkits, but on the whole these suggest what works not how projects work, for which communities, and in which specific types of circumstance (contexts) the mechanisms operating within projects will ‘fire’ to make an impact and produce wellbeing outcomes [3].
Using realist evaluation methodologies [4] this research attempts to ‘unpack the black box’ of community health development.
Realist methodology is a theory driven approach to programme evaluation and is suited to this study as it helps to penetrate the complexities of interventions, unpacking what is really working in such projects to enable a more granular learning to be applied and uniquely reconstructed in other contexts. Often communities look at programmes and interventions successful elsewhere and try to replicate them within in their own different local contexts but with limited results. This research provides them with the tools to build their own success not merely patents to copy.
Phase 1 has explored with community stakeholders what is working in practice, what myriad theories of change are driving the actors and actions in these projects and how the two are related.
Concept mapping was undertaken alongside stakeholder workshops in four place-based community projects (Isolation/Loneliness in Anglesey, Youth Sheds in Denbigh, The Holway Housing Estate, and, Wrexham Homelessness). Soft systems methodology [5] was used to facilitate stakeholders to express through rich pictures “what makes a good community (health) development project?”
In realist research this stage aims to develop candidate theories, or ‘context- mechanism – outcome’ (CMO) configurations [2]. Four initial propositions emerged from the first phase to test further in a realist review:
1. Appreciate and build identity between members of a community
2. Develop individual and community coherence
3. Provide physical and personal space
4. Reframing from ‘what is wrong’ to ‘what is strong’
These four emerging propositions will now be further developed into CMO configurations and a purposive search for and appraisal of the evidence to support them will be undertaken in Phase 2 of the research.

Collaboration for quality improvement across public health, health and social care

Presenter: Becky Cook (National Institute for Health and Care Excellence)

Other Author(s): -

Abstract Text:

Collaborative working is not prescriptive. It is about relationships and conversations, not just about structures and budgets. Collaboration isn’t new, we all know that public health, health, and social care should work together with communities for the people they support. Sometimes our focus on the practicalities of integration distracts us from the value of collaboration. This presentation offers 3 questions to inspire conference delegates to take their next step in their collaborative journey. These questions form part of a wider online collaboration resource Unlocking Capacity: Smarter Together developed by England’s Quality Matters partner organisations including NICE (National Institute for Health and Care Excellence), NHS England, LGA (Local government association) and TLAP (Think Local Act Personal). The Unlocking Capacity: Smarter Together resource seeks to improve people’s experience of seamless services by encouraging greater inter-sector working. The presentation will also introduce the resources for quality improvement through collaboration which are available on the Unlocking Capacity: Smarter Together resource. The resource features an animation which explains how collaboration between a range of partners can add value, collaboration case studies and signposts to additional resources, ideas and information. The aim of the presentation is to affirm the importance of collaborative working between the public health, health, and social care sectors and communities, to introduce the resource, and to inspire conference delegates to develop their own collaborative working journey by using the 3 questions. (Link to the resource: http://qualitymatters.nice.org.uk/unlocking-capacity-smarter-together/index.html)

Discourses on the interpreter’s role within the NHS England

Presenter: Fabio Serrato Radigonda (The University of Manchester)

Other Author(s): -

Abstract Text:

National commitments establish that the NHS England must offer equitable and effective services based on the patients’ needs. These needs tend to be greatly varied in terms of language due to the diverse U.K. population. In order to attend the healthcare needs of non-English speakers, the U.K. government provides medical interpreting services through the National Health Service (NHS). In England, the government recently published the “Guidance for commissioners: Interpreting and Translation Services in Primary Care” This presentation seeks to explore how discourses about the provision of interpretation services in the Guidance shape the interpreter’s role. In order to analyse these discourses, I have applied the Foucauldian Discourse Analysis (FDA) approach developed by Willig (2013). The method focuses on the relationships among discourses, subjectivity, feelings and practices. Some conclusions are that the Guidance was produced mainly taking into account primary care, although secondary care uses medical interpreters in more complex scenarios. The document provides contradictory and unclear pieces of advice about the interpreter’s role, sometimes suggesting a conversation reproduction, sometimes demanding further professional relationship with patients. However, there is no clear and practical information on how to play these roles. The interpreter’s role is also considered beyond communication purposes, as in the case of ensuring a secure place. In general, the Guidance provides an over-responsabilisation on the interpreter, and the NHS is just a background where the interaction/relationship takes place. Ultimately, the Guidance perhaps contributes to publicly demonstrate the supposed NHS concern on the provision of medical interpretation services. The Guidance leaves such services to the rules of market competition, betting that, in the cases where the service is provided by interpreting agencies, neoliberalism results in cheaper prices and better quality. However, what may happen is that the customers-patients need to use the services that are available to them within the agency providers that are interested in profits and are not obligated to comply with the specific standards (at least in the context of the document analysed). The support that the Guidance provides may be more symbolic (empowered by the existence of the document) than effective.

Bibliography: Willig, Carla. (2013) Introducing Qualitative Research in Psychology: adventures in theory and method (2nd edition) Buckingham: Open University Press.

GIT: Interdisciplinary, intercultural working group; our answer in reducing inequalities in migrant's health

Presenter: Luca Carlo Sala (ASL Biella)

Other Author(s): D. Brioschi, S. Barbera

Abstract Text:

Migrants arrive in Europe with a very complexity of clinical situation for phisycal and psycological health status. Complexity is connected with theyr needs of assistential and curative nature such as personality disturb, hospital access, social emergency. We are giving them our answer with an health intercultural, interdisciplinary group of specialist and with NGOs support.

Wait Marketing vs Social Wait Marketing

Presenter: Luca Carlo Sala (ASL Biella)

Other Author(s): F. Chiastellaro, F. Ferraris, M. Valenti, A. Rosazza, N. Bovanrith, G. Graziola, M. Bacchi, S. Barbera, A. Grillo, L. Felisari, R. Sella, D. Brioschi, S. Barbera

Abstract Text:

Mass media are powerfull and unavoidable for large consumer brands. But if your budget is limited, innovative media and promotion activities are very interesting options. Italian consumers are exsposed to several hundred advertisments a day. In social Marketing promotion it is crucial to comunicate at the right moment at the right place: contestual advertising. As largely reported by the sector lecterature, waiting times is the perfect opportunity to comunicate in an affective, affordable way and the waiting room of our Dipartiment in wich people wait for beeng vaccinated, or for a visit to be admited to sport activity, or to have information about the possibility to open a restaurant or a milk farmer or how to go to the sea side with their pet is a good plece to do it. When waiting half of the consumers attend to various occupations, while the other half simply waits and is receptive to health promotion messages. Our strenght point is the very helpful aid that volunteers of ONG's organization gives, giving information to people about the acess and our performance.