BACKGROUND:Research has been criticised for its extractive nature, often neglecting to reciprocate benefits to the communities involved. Addressing this, Patient and Public Involvement and Engagement (PPIE) has emerged as a crucial approach, engaging community members as research partners rather than subjects of research. However, it is important that PPIE is carried out in a meaningful way to avoid tokenism and extraction from communities. This paper reflects on the learning from the PPIE approach of the CommonHealth Assets (CHA) project, which partnered with 14 community-led organisations (CLOs) across the UK to evaluate their impact on health and wellbeing in their communities. MAIN BODY:The CHA Lived Experience Panel (LEP), comprised of around 13 individuals from the project-partnered CLOs, played a pivotal role in informing and influencing the research process to enhance the relevance and impact of the CHA project. Following community engagement resources, we aimed to create a supportive and inclusive environment for meaningful PPIE. Through the evaluation of the CHA LEP, this paper reports on its successes and limitations to offer recommendations on creating the conditions for meaningful and effective PPIE in community-based public health research. From our evaluation, we found that adequately resourcing PPIE is crucial to its success. PPIE activities require a dedicated facilitator with expertise in working with diverse stakeholders to advocate for the sustained integration of PPIE into the research team, and to support contributors in their engagement. Being adaptive and responsive in your approach, utilising continuous evaluation and accountability in the process is also key. For contributors to have a meaningful impact, they must be engaged from the funding application stage and throughout the early stages of the project. Contributors must work closely with members of the research team at all levels, with researchers committing to facilitating authentic involvement of contributors, accessing training to work with diverse communication needs where required. CONCLUSION:Our findings demonstrate that meaningful and effective PPIE requires a strong, sustained commitment to valuing and integrating patient/public perspectives in research. We add to the knowledge base in this area by offering a practical example of implementing PPIE in community-based research settings.
This paper presents an economic evaluation of community-led and -owned organisations that deliver activities to support health and wellbeing. Because community-led organisations (CLOs) are a vital part of the social and solidarity economy, they increasingly feature in public health policies targeting disadvantaged populations. However, little is known about the value CLOs generate as few economic evaluations of them exist and those available focus on isolated activities (such as exercise classes) and/or specific populations (e.g., men-only collectives). The novelty of our work lies in the inclusion of multiple CLOs, comprehensive coverage of their activities, breadth of participants studied, and control group methodology applied in creating new knowledge of the health and wellbeing outcomes of CLOs and resources consumed to achieve them. We conducted cost-effectiveness and cost-consequence analyses of data collected via a 12-month longitudinal study. We compared 331 CLO participants in 14 UK-based CLOs to a 'do nothing' synthetic control group (n = 100). Health and wellbeing were measured using the ICECAP-A capability measure for adults, EuroQol EQ-5D-5L, Short-form Warwick Edinburgh Mental Wellbeing Scale and the Revised Social Connectedness Scale. Resource use data included health, social care, and other community sector resources. Data collection occurred at four-points over the study period supported by publicly available accounts and data provided by each CLO. We found an incremental cost per year in full capability of £35,813 and an incremental cost per quality adjusted life year of £29,827. Statistically significant improvement in both social connectedness, and mental wellbeing were observed over the 12 month follow up. This work supports CLOs as an intervention to improve health and wellbeing in disadvantaged communities and identifies challenges for traditional evaluation methodology with regards to costing and comparator groups.
Background The UK Government’s ‘welfare reform’ programme included reductions to social security payments, phased in over the financial years 2011/2012–2015/2016. Previous studies of social security cuts and health outcomes have been restricted to analysing single UK countries or single payment types (eg, housing benefit). We examined the association between all social security cuts fully implemented by 2016 and life expectancy, for local authorities in England, Scotland and Wales. Methods Our unit of analysis was 201 upper tier local authorities (unitary authorities and county councils: 147 in England, 32 in Scotland, 22 in Wales). Our exposure was estimated social security loss per head of the working age population per year for each local authority, calculated against the baseline in 2010/2011. The primary outcome was annual life expectancy at birth between the calendar years 2012 and 2016 (year lagged following exposure). We used a panel regression approach with fixed effects. Results Social security cuts implemented by 2016 were estimated to be £475 per head of the working age population in England, £390 in Scotland and £490 in Wales since 2010/2011. During the study period, there was either no improvement or only marginal increases in national life expectancy. Social security loss and life expectancy were significantly associated: an estimated £100 decrease in social security per head of working age population was associated with a 1-month reduction in life expectancy. Conclusions Social security cuts, at the UK local authority level, were associated with lower life expectancy. Further research should examine causality.
Background Despite active travel investment increasing, evidence of benefit is often limited to selected health outcomes and a short follow-up period, and cyclists and pedestrians are often analysed together. We aimed to examine prospective associations with multiple health outcomes over 18 years for pedestrians and cyclists separately.Methods The Scottish Longitudinal Study is based on census data, from which we selected 82 297 individuals aged 16–74 years. Individuals were followed-up between 2001 and 2018 through linkage to hospitalisation, death and prescription records. Cox proportional hazard models were used to compare cyclist and pedestrian commuters with non-active commuters for a range of health outcomes, controlling for pre-existing health conditions, and demographic and socioeconomic characteristics.Results Compared with non-active commuting, cyclist commuting was associated with lower all-cause mortality risk (HR 0.53, 95% CI 0.38 to 0.73), lower risk of any hospitalisation (HR 0.90, 95% CI 0.84 to 0.97), lower risk of cardiovascular disease (CVD) hospitalisation (HR 0.76, 95% CI 0.64 to 0.91) and of having a CVD prescription (HR 0.70, 95% CI 0.63 to 0.78), lower risk of cancer mortality (HR 0.49, 95% CI 0.30 to 0.82) and cancer hospitalisation (HR 0.76, 95% CI 0.59 to 0.98), and lower risk of having a prescription for mental health problems (HR 0.80, 95% CI 0.73 to 0.89). Pedestrian commuting was associated with lower risk of any hospitalisation (HR 0.91, 95% CI 0.88 to 0.93), lower risk of CVD hospitalisation (HR 0.90, 95% CI 0.84 to 0.96) and of having a CVD prescription (HR 0.90, 95% CI 0.87 to 0.93), and lower risk of a mental health prescription (HR 0.93, 95% CI 0.90 to 0.97).Conclusion Active commuters were less likely to suffer from a range of negative physical and mental health outcomes than non-active commuters. These findings strengthen the evidence for the health benefits of active commuting.
Background: Vaccination is a fundamental tenet of public and population health. Several barriers to vaccine uptake exist, exacerbated post-COVID-19, including misconceptions about vaccine efficacy and safety, vaccine hesitancy, vaccine inequity, costs, religious beliefs, and insufficient education and guidance for healthcare professionals. Vaccine uptake may be aided using microarray patches (MAPs) due to reduced pain, no hypodermic needle, enhanced thermostability, and potential for self and lay administration. Objectives: This protocol outlines the development of a scale that aims to accurately measure the perceived safety, usability, and acceptability of MAPs for vaccination among laypeople, MAP recipients, clinicians, and parents or guardians of children. Methods and analysis: This study will follow three phases of scale development and validation, including (1) item development, (2) scale development, and (3) scale evaluation. Inductive (interviews) and deductive methods (literature searches) will be used to develop scale items, which experts from target populations will assess through an online survey. Cognitive interviews will be conducted to observe their processes of answering the draft survey. Thematic analysis will be conducted to analyse qualitative data. Lastly, four surveys will be administered online to our target populations over two time points to determine their repeatability. Exploratory and confirmatory factor analyses, Cronbach’s alpha, and construct validity will be performed. Ethics: This study was approved by Metro South Health (HREC/2021/QMS/81653) and Western Sydney Local Health District (2023/ETH00705) Human Research Ethics Committees. Discussion: The scale will support a standardised approach to assessing the social and behavioural aspects of MAP vaccines, enabling comparison of outcomes across studies. Once validated, this scale will assist vaccination programmes in developing effective strategies for integrating MAPs and overcoming barriers to vaccination. This includes improving vaccine equity and accessibility, especially in lower- and middle-income countries and rural or remote locations.
