Jane Wills

Purpose of Review Minority stroke survivors experience difficulties in access to rehabilitation due to a combination of systemic factors; lack of understanding of their cultural beliefs by health professionals; their colonial thinking and experiences; and they are underrepresented in social participation research. To address the disparity, this paper discusses how research on social participation of community dwelling minority stroke survivors could embrace decolonization. Recent Findings Decolonization of research in social participation can be achieved when minority stroke survivors are engaged in genuine trust and co-production of knowledge with social science researchers. Improvements in uptake and continuation of social participation are sustained when such reciprocal relationships take place. Summary There is a need for cultural competence and humility amongst healthcare professionals working in stroke rehabilitation with minority stroke survivors.

Aims: Encouraging leisure-time physical activity has proved to be a hard-to-solve complex problem. Underpinning this complexity is the range of determinants of sedentary behaviour. We report on a participatory actor mapping exercise which sought to understand the people and organisations in the local system in which a novel exercise referral scheme in a suburban/semi-rural region of England has been introduced. Methods: The participatory actor mapping exercise was conducted in two phases in September 2023. The first phase generated a draft actor map visually illustrating the key organisations and individuals (actors) that make up the local physical activity promotion system. The map was aligned to a socio-ecological model in which actors were positioned within a category of determinants. In the second phase, the draft actor map was refined during two workshops with participants ( n = 30) representing the key local organisations who sought to promote physical activity. Findings: The process of mapping revealed several factors influencing physical activity promotion: (1) differing views on the determinants of physical inactivity, and hence, a hesitancy towards addressing sedentary behaviour through a strategic systems approach; (2) an emerging system of actors with interdependent roles which sometimes act independently; (3) local commitment to encouraging increased leisure time activity but supported via a generalised approach to physical activity promotion; and (4) a peripheral role of the studied exercise referral scheme in the system for local physical activity provisions. Conclusion: The process of a participatory approach to actor mapping highlighted both opportunities and challenges for physical activity promotion. Although there were challenges around differing actors’ perspectives on sedentary behaviour and a lack of connection between actors, opportunities included an improved shared understanding of the complex issues of physical inactivity, and actor mapping provided a useful step towards adopting a systems approach with a common vision.

Background: Since 2013, local government in England has held statutory responsibility for public health and concurrently faced financial pressures and limited research capacity. The National Institute of Health and Care Research (NIHR) established Public Health Intervention Responsive Studies Teams (PHIRST) to bridge this gap, commissioning rapid, co‐produced evaluations of complex interventions. Main Body: Drawing on 5 years of PHIRST South Bank experience and ten diverse evaluations, this paper explores what supports and constrains collaborative evaluation in politically responsive, resource‐constrained local systems. Learnings from across evaluations include the dilemmas of balancing timeliness and rigour, the centrality of relationships and relational infrastructure, and the importance of building research and evaluation capacity in local government teams from the outset. We also consider the applicability and limits of existing evaluation frameworks for system‐level interventions. Conclusion: We argue that collaborative evaluation is both necessary and fragile: dependant on community engagement, adaptive design, balancing of demands, and building of intersectoral relationships.

Population Health Management uses available data to tailor services to identified and latent needs. It is advocated by the integrated care system in England, yet challenges remain regarding data availability, linkage, and application. This paper reports on the adoption of a population health management approach to design a complex programme aimed at improving young people’s mental health. In-depth qualitative interviews were conducted with local government public health professionals (PH) (n = 5), intervention leads (n = 3), and one focus group of young contributors to intervention design (n = 5) to explore how population health management informed programme design and was perceived by stakeholders. Data were analysed using Delve.io. Key learning for public health included: (i) Data analysis for the PHM approach was strengthened by a dedicated data scientist, though some regarded the PHM approach as not new; (ii) Routine data had limited capacity to fully identify need, and linking datasets across health, social care, and education remained difficult; (iii) Local insights and co-production with young people were critical in identifying target groups not visible in routine datasets. Routine health data capture only part of the picture, often reflecting those already in contact with services. PHM approaches in public health need to integrate qualitative insights and local intelligence alongside quantitative analysis to address inequalities effectively.

Introduction: Exercise referral schemes are a common intervention that seek to address physical inactivity. There is limited evidence on whether they can address the inequalities in inactivity associated with income, age, and gender. A novel intervention that sought to address barriers to the uptake of physical activity schemes including access, cost, and specific health and social needs of participants was evaluated in a mixed methods study.Methods: Serial qualitative interviews with participants were conducted across three time points over the six-month intervention and the routine outcome data collected by the delivery partner were statistically analysed after stratification for referral route, demographic and socioeconomic status and engagement. Data from non-participants in the intervention from the targeted community were collected through street intercept surveys. A descriptive cost analysis was undertaken to understand the cost of delivery.Results and discussion: The study found small improvements in health outcomes and engagement. The novel features of the intervention that aimed to address inequalities in the uptake of physical activity—personalised programme, extended time offer, free and subsidised offer, a dedicated health coach—all succeeded in acting as enablers to uptake although very few individuals met the recommended frequency for attendance.

Aims: This co-inquiry project aimed to develop a qualitatively informed model of professionally led stop smoking outreach. It involved 13 staff from a Stop Smoking Service (SSS) which operates across three Local Authorities in England (Central Bedfordshire, Bedford Borough and Milton Keynes). Staff’s outreach sought to engage people from the most deprived areas who smoked but were not engaging with the service. Methods: The co-inquiry comprised six reflection sessions and ethnographic research which aimed to explicate and examine staff’s assumptions about how outreach works, conducted over 12 months. Data included 32 diary entries, eight observations of staff’s outreach events, 10 interviews with staff and eight interviews with members of the communities being targeted. Data were reflected on to develop a ‘real-world’ logic model and summarised using thematic analysis. Results: Professionally led outreach can raise awareness of service offers, remove access barriers and generate referrals. A non-judgemental, person-centred approach is vital through which staff carefully initiate conversations with community members about smoking, and tailor information to community members’ needs and preferences. Such an approach, in combination with an e-cigarette support option, can generate interest in SSS and challenge negative perceptions. However, outreach is time-consuming for busy frontline staff, unpredictable and best implemented via effective community partnerships. Conclusions: Our findings suggest that stop smoking advisors’ outreach can contribute substantially to national ambition to create a ‘smoke free generation’ provided that sufficient investment is provided. Professionally led outreach, delivered in partnership with community organisations, can generate referrals among people who are disconnected from health services. Such non-traditional referral routes are likely to become more significant as smoking prevalence further declines in the general population.

Background: Understanding psychosocial factors which impact responses to emerging infectious diseases (EIDs) is vital in managing epidemics and pandemics. Two under-researched areas in this field are the interactive roles of optimistic bias (underestimation of the likelihood of negative events occurring to the self, relative to others) and group membership (a factor observed to be psychologically protective, but infection risk enhancing). Aims: The current study aimed to test the relationships between optimistic bias and membership of multiple groups upon EID-related emotional and psychological responses and behavioral intentions. Methods: Participants from the UK and US ( N = 360) rated how they would evaluate and respond to a fictitious EID immediately before the 2020 COVID-19 lockdowns in a correlational study. Results: Negative relationships were observed between optimistic bias and perceived infection vulnerability, infection prevention strategies, and perceived EID severity. Multiple group membership correlated negatively with germ avoidance, but positively with emotional responses such as disgust and increased perceived vulnerability to infection – factors linked to avoiding infection. Multiple group memberships and optimistic bias were unrelated. Limitations: The study focussed on a fictitious disease and relies on cross-sectional data and behavioral intentions. Conclusions: These findings build upon the small evidence base on the role of optimistic bias in EID management and suggest that multiple group membership is unlikely to increase optimistic bias. The theoretical and practical implications of the findings for EID management are discussed.

Despite the volume and breadth of health literacy research related to children, children’s involvement in that research is rare. Research with children is challenging, but the principles of involvement and engagement underpin all health promotion work, including health literacy. This commentary reflects on the process of setting up a Children’s Advisory Group to consult on an institutional ethnography study of health literacy work from children’s standpoint. The Children’s Advisory Group contributed feedback on the study ethics and design and piloted methods for rapport-building and data collection, including livestreamed draw-and-describe and modified Interview to the Double. Consulting with the Children’s Advisory Group highlighted the importance of listening to children and recognizing and valuing children’s imaginative contributions to methods for involving children in health literacy research. Insights from this commentary can be used to foreground equity-focused approaches to future research and practice with children in the field of health literacy.

Critical health literacy enables individuals to use cognitive and social resources for informed action on the wider determinants of health. Promoting critical health literacy early in the life-course may contribute to improved health outcomes in the long term, but children’s opportunities to develop critical health literacy are limited and tend to be school-based. This study applies a settings-based approach to analyse the potential of public libraries in England to be supportive environments for children’s development of critical health literacy. The study adopted institutional ethnography as a framework to explore the public library as an everyday setting for children. A children’s advisory group informed the study design. Thirteen children and 19 public library staff and community stakeholders were interviewed. The study results indicated that the public library was not seen by children, staff, or community stakeholders as a setting for health. Its policies and structure purport to develop health literacy, but the political nature of critical health literacy was seen as outside its remit. A supersetting approach in which children’s everyday settings work together is proposed and a conceptual model of the public library role is presented.