How can loneliness and social isolation be reduced among migrant and minority ethnic people? Systematic, participatory review of programme theories, system processes and outcomes

A person walking through a forest with a plastic bag that says bargains for life

Funded by NIHRFunded by the UK National Institute for Health Research under the Public Health Research Board (Reference number PHR 16/08/44) 

 What are the aims of this project?

The main aim of this project is to summarise the existing evidence on the causes of, and potential solutions to, unwanted social isolation and loneliness among people from migrant and minority ethnic backgrounds. The project takes a broad approach, viewing social isolation and loneliness as the products of the complex social settings within which people live.

 Why is this important?

Loneliness and social isolation are recognised as major public health issues. Both have been found to be associated with a range of physical and mental health problems. Recent research addressing the negative effects of loneliness and social isolation on the health and wellbeing of individuals has paid particular attention to the circumstances of older people, pregnant and postpartum women and adolescents.

While loneliness and social isolation affect people from all sections of society, migrants and people from minority ethnic backgrounds face particular risks of social isolation and loneliness. As the diversity of the UK population continues to grow in terms of the range of ethnic identities and the number of people seeing themselves as non-White British, it becomes important that public health evidence and practice reflects this diversity and addresses the needs of our multi-ethnic society.

 How will the research be carried out?

We will undertake a review of the existing literature and research evidence around loneliness and social isolation among migrant and minority ethnic groups. This desk-based work will take place alongside the use of a participatory approach, involving consultations with key stakeholders and members of some of our local migrant and minority ethnic communities within England.

Our literature review work will consist of an effectiveness review; and a theory-driven review. The effectiveness review will draw together earlier research that has looked at whether initiatives that have been introduced work to reduce levels of loneliness and social isolation among migrant and minority ethnic people. The theory-driven review, on the other hand, will go beyond more traditional review methods to understand the actual causal processes that may be linked to changes in levels of loneliness and social isolation among our populations of interest in varied settings. We will look beyond narrowly focused interventions aimed at individuals to explore the wider social processes that impact upon isolation and loneliness.

Timeframe:

October 2017 – March 2019

Who is undertaking the research?

Professor Sarah Salway, Dr Louise Preston, Dr Andrew Booth, Dr Liz Such, Dr Katie Powell, Dr Maria Zubair, Dr Jean Hamilton (University of Sheffield) &

Professor Raghu Raghavan (De Montfort University)

Professor Christina Victor (Brunel University London)

  How are stakeholders being engaged?

The project involves close collaboration between university researchers, community workers, lay experts from migrant and minority ethnic backgrounds and public health practitioners and policy makers. The community consultation aspect of the project, in particular, involves significant community engagement. This comprises three consultation panels being organised at three different sites within England, each focussing on different subgroups of migrants and minority ethnic people and taking place twice during the course of the project. Furthermore, a dissemination workshop will be arranged towards the end of the project for a diverse group of around 30 stakeholder participants in order to promote engagement with and testing out of the recommendations and conclusions from the project.

What will be the outputs from the study?

Presentations and papers from the project will be listed here.

How can loneliness and social isolation be reduced among migrant and minority ethnic people? Systematic, participatory review of programme theories, system processes and outcomes. Sarah Salway, Louise Preston, Maria Zubair, Elizabeth Such, Jean Hamilton, Andrew Booth, Raghu Raghavan, Christina Victor

PROSPERO 2017 CRD42017077378 Available from:

http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017077378


Evidence and Ethnicity in Commissioning

evidence and ethnicity

A multidisciplinary team of researchers and healthcare managers working to improve the commissioning and delivery of health services for multi-ethnic populations in England. We have a particular focus on improving the mobilisation of knowledge to identify, describe and understand ethnic inequalities in health and healthcare and to support evidence-informed interventions to reduce these inequalities. Sarah SalwayLynne Carter

View the team website.


Public Health Issues

Child Health
Communicable Diseases
Community Empowerment
Health Literacy
Health Policy and Systems
Healthy Eating
Mental Health
Physical Activity
Reproductive Health

Methods and Approches

Evaluation
Evidence Synthesis
Participatory Methods and Co-production
Qualitative, Case Studies and Ethnography
Survey Analysis

Community

Age:
Disability:
Gender:

Projects about Gender will be added soon.

Migration and Ethnicity:
Poverty and Deprivation:

Welfare with conditions can promote social division

Katie Powell, Sarah Milton and Stefanie Buckner

The UK benefits system is going through its biggest reform in 60 years. The revised system relies more heavily on welfare with conditions – that is to say, benefits allocated on the basis of assessments of individual financial or physical need. Whilst calls for introducing these sorts of conditions have been based on claims of fairness and equality, our research suggests that introducing more conditions has the potential to promote greater inequality and foster divisions both within the older population and between generations.

People aged 60 years and over in England are currently eligible to receive a range of State transfers of resources (‘benefits’). Some entitlements are based on age (such as the free bus pass for over 60s); others on financial contributions from earnings (such as the state pension); and others on evidence of financial need (such as housing benefit). Given the increasing numbers of people aged 60 years and over questions have been raised (in parliament and the media) about the ability of the State to provide benefits to an ageing population: the number of older adults living in Europe is expected to grow rapidly over the next 15 years, creating a number of new public health challenges. A generation once described as ‘deserving’ is now seen as an economic threat. Issues of ‘welfare deservingness were central to debates in the 2016 EU Referendum, raising questions about the ways in which people view welfare benefits and the consequences this might have for social cohesion.

For example, the ways in which benefits are delivered – and their conditional or universal basis – affects how people relate to one another. Older people that we interviewed in Sheffield, London and Cambridge talked about their experiences of managing financially as typical of their generation. ‘Our generation’ was characterised by our interviewees as having struggled to achieve independence and self-reliance. When we asked these people about welfare benefits, the receipt of universal age-related benefits (for themselves and other older people) was compatible with their view of ‘our generation’. Universal entitlement was experienced as social recognition: pensions, free travel and fuel subsidies are seen by older people as respect for hard work and resilience over a lifetime as a UK citizen. These welfare transfers were not seen as ‘benefits’ but, rather “something that we were entitled to automatically at 60”. The receipt of universal benefits facilitated a pride in getting older that might otherwise be threatened by other aspects of ageing. People talked about the ways in which the loss of working identities and increasing social and physical dependence on others threatened their sense of self; universal benefits helped some people to overcome this.

In contrast, conditional transfers provided on the basis of economic or physical need – such as pension credit – were more likely to be labelled as ‘benefits’ by the people that we spoke to. These benefits were negatively associated with dubious claims to entitlement and inappropriate use among an often unspecified group of ‘others’. In many interviews, people referred to class, generation, ethnic and national differences when discussing who should, and who should not, be eligible for benefits. Uptake of conditional benefits was also associated with vulnerability and seen as incompatible with ideas around purported levels of resilience of ‘our generation’.  In contrast with the respect associated with benefits provided to their whole generation, means or needs based conditional benefits highlighted the more difficult aspects of ageing: the decline in self-reliance, or the suggestion of a failure to manage (that is to say, to lack the resilience to cope). Others have shown that, in the context of increased welfare conditionality, there is often no legitimate way to be dependent on others – including the state – without shame. This might partly be because increased means testing individualises the need for welfare, casting social problems as personal problems. Universal benefits have the potential to establish claiming as a socially acceptable norm. Our study also showed that complicated claims processes could be fraught with shame, which stopped some older people from claiming conditional benefits. A substantial proportion of older people (estimated at between 27 and 38 per cent) do not claim their benefits entitlement (AGE UK, 2011). This means that people with a defined ‘need’ do not get their allowance.

Calls for introducing conditionality to benefits that are currently universal are often based on claims that this will create greater fairness and equality. In contrast, our findings suggest that introducing conditionality has the potential to promote inequality by creating barriers to uptake, and damaging the social solidarity that universal benefits has influenced.  Increasing conditionality may promote division within and between generations and this should be a central consideration in any further welfare reforms.

 

Acknowledgements

The research was funded by the NIHR School for Public Health Research (SPHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Acknowledgements are due to Judy Green, Sarah Salway and Suzanne Moffatt for their role in the research and their comments on an early draft of this blog.


Evaluating Co:Create (2016-2019)

Co Create

Project title

Evaluating Co:Create (2016-2019).

Funders

South Yorkshire Housing Association/Department of Health Innovation, Excellence and Strategic Development Fund.

Who is leading this research?

Amy Barnes and Janet Harris.

Project details

The Co:Create team at South Yorkshire Housing Association are working with commissioners in the health and social care field within South Yorkshire to change the way they commission services; redistributing power through a co-production process which seeks to ensure the voice of those receiving services, and particularly those who are seldom heard, are incorporated into commissioning. Janet and Amy are working with the Co:Create team to evaluate the Co:Create process, taking a developmental evaluation approach which seeks to produce real-time feedback to help adapt principles of practice.

While there is much interest and policy commitment to co-production across the countries of the UK, the evidence base on how co-production processes works, in what circumstances and with what outcomes is still limited. This project aims to add to the evidence base of what works in relation to co-production.

Timeframe

September 2016 – June 2019

Expected outputs

Outputs will be co-produced with the Co:Create team and local commissioners and service users throughout the process. We will be co-producing programme theories/systems models for a number of selected projects at the start of the process, and revisiting these and reflecting on successes, issues and ways forward throughout. We will also co-produce annual reports and a final report with the Co:Create team, commissioners and service users.

 

 


Good practice in the co-production of commissioned services within adult social care

Good Practice by Ron Mader https://www.flickr.com/photos/planeta/24569983877

Project title

Good practice in the co-production of commissioned services within adult social care

Funder

Skills for Care Workforce Development Innovation Fund

What are the aims of this project?

The aim is to evaluate whether the involvement of stakeholders in review and co-design of a modified Direct Payment Support Service for Disability informs changes in the design of the service and removes barriers to accessing payment.

How will the research be carried out?

Developmental evaluation is being used, which produces real-time or close to real-time feedback, allowing stakeholders to use the learning within the lifespan of the initiative to adapt principles of practice (Quinn Patton 2015). We will collect information to inform the approach to co-production, the ability of co-production to identify issues with the existing service, and the creation of a Direct Payment Support Service (DPSS) model that contains solutions to enabling people to feel more in control of direct payment.

Timeframe:

Due to be completed in April 2017.

Who is undertaking the research?

Disability Sheffield Centre for Independent Living

Project Lead: Emily Morton

http://www.disabilitysheffield.org.uk/

School of Health & Related Research

Lead Evaluator: Janet Harris

http://www.sheffield.ac.uk/scharr

How are stakeholders being engaged?

Disability Sheffield Centre for Independent Living is a membership and user led organisation, run and controlled by disabled people. Service users, workers, managers and commissioners will be engaged in identifying barriers to using the payment scheme and generating solutions together. Participatory approaches are being used to involve everyone in reflecting on the process of co-production, including

  • Ability to create a level playing field, where the voice of different types of stakeholders is represented
  • Ability to facilitate dialogue and reflection across diverse people and groups
  • Transparency in collecting information and showing people how it is going to be used
  • Involvement of stakeholders in decisions about how to use information to inform service development
  • Ability to negotiate conflict and resolve issues

What will be the outputs from the study?

A model for the service which enables people to be more in control of managing their payments.

A good practice guide on using co-production to inform user-centred commissioning.


Communities in Control

Big Local

What are the aims of this project?
This study aims to evaluate a Lottery-funded initiative – the Big Local – that aims to give residents in disadvantaged neighbourhoods a bigger say over what happens and how resources are used to improve their local area.  Big Local is run by Local Trust and is taking place in 150 communities across England over the next 15 years.

Why is this important?
Past research suggests that low control may be a fundamental cause of inequalities in health. However, we know little about how to support greater control, particularly at the level of communities. We also need to know more about how and why control impacts on health and its social determinants. The Big Local presents a great opportunity to learn more about effective ways to support greater control by communities.

How will the research be carried out?

There will be two phases. Phase one involves:

  1. Detailed case studies across 10 Big Local sites and analysis of quantitative data to describe the neighbourhood contexts and early experiences in different places.
  2. Interviews and document analysis at national level to describe how the Big Local intervention is expected to work.
  3. Design of methods to evaluate the impact of Big Local on health and wellbeing in the longer term (Phase two).

 Timeframe: January 2014-March 2017

Professor Jennie Popay of Lancaster University leads our team of researchers from LiLaC,  Cambridge, Exeter, London School of Hygiene and Tropical Medicine, FUSE and Sheffield.  Here in SPHR@Sheffield we are currently conducting case studies in two Big Local sites in Yorkshire.

How are stakeholders being engaged?
In case study sites residents are consulted on the conduct of the study and in some areas Community Researchers are directly engaged. Local advisory groups provide critical commentary and findings will be shared widely as they emerge. Local Trust guides and supports the work.

What will be the outputs from the study?
Resources for public health practitioners and local neighbourhoods will be produced, focusing on:

  • The links between collective control and health inequalities;
  • Factors influencing public health actions in low income neighbourhoods;
  • Lessons about community engagement/empowerment;
  • Small area monitoring systems;

Presentations and papers from the project will be listed here.

Find out more here


Race, ethnicity and child development

 Funded by University of Sheffield Economics Department 

 What are the aims of this project?

This research aims to explore the effects of racism, experienced directly or indirectly, on child development and childhood outcomes.

 Why is this important?

From an early age, children interact with other children and adults within and outside of the family environment, and the outcomes of these interactions may shape child development and wellbeing. In addition, the interactions of parents with wider society may also play a role in shaping child outcomes if children witness these interactions or if these interactions influence the parenting received by the child. To date, there is very little evidence on the extent to which child and parental interactions with wider society matter for child development and wellbeing. We will address this issue by looking specifically at the effect of racism, which children may experience directly or vicariously through the experiences of parents, on children’s outcomes.

How will the research be carried out?

We will undertake a literature review to examine measures of racism and ways of exploring the relationships between racism and child outcomes. We will analyse secondary survey and cohort data to examine relationships between experience of racism and racist incidents and indicators of child development.

Timeframe:

February 2015 – March  2016

Who is undertaking the research?

Dr Ana Nuevo-Chiqeuro (Economics), Dr Anita Ratcliffe (Economics), Dr Gurleen Popli (Economics), Professor Sarah Salway (ScHARR)

How are stakeholders being engaged?

The project will engage with stakeholders including members of the public and policy and practice communities via a one day conference to be held in January 2016.

What will be the outputs from the study?

Findings will be used to inform the development of a more detailed, follow on research study. Findings will also be shared through presentations and academic papers.