Background
The context
Live well Gateshead - the Gateshead integrated wellness service
Methods
Routinely collected monitoring data
Qualitative data collection
Method | Participants in total | Gender | |
---|---|---|---|
Female | Male | ||
Scoping and familiarisation meetings with staff in the Public Health Team, Community Capacity Building Team and Wellness Service, and with NHS Foundation Trust staff. Daily fieldwork notes were taken in these meetings. | 17 | Not recorded | |
1:1 in-depth, semi-structured interviews with individuals who use LWG services | 25 | 15 | 10 |
1:1 semi-structured interviews with LWG staff | 9 | 6 | 3 |
1× focus group with LWG Healthy Lifestyle group members | 4 | 4 | 0 |
2× focus groups with group members from 7 different groups in contact with CCBT members. | 10 | 7 | 3 |
2× focus groups with people not in contact with LWG services | 17 | 10 | 7 |
1× focus group with parents from a local primary school participating in a families programme | 7 | 5 | 2 |
Total number of participants | 72 | 47 | 25 |
Results
Access and assessment
Discussions with non-service users (NSUs) revealed questions about the training and professional qualifications of LWG staff, as shown in the following quote:Initial contact should be inclusive and motivating and straightforward and everything happens when it should happen, and you can feel confident in it (F, SU IV 11).
Non-service users suggested promoting the service through trusted GP practices, voluntary sector organisations, Citizens Advice Bureau, Council News, and social media, as well as through schools, nurseries and existing community networks. Cost was an important issue to address, especially for families during the school holidays, given the need for prevention and early intervention: You’ve got to get them young (F, NSUFG5).I think a lot of people might be slightly embarrassed having to ask for help. They’d rather suffer in silence I think. That’s the proud Geordies you see, don’t like asking for help (F, NSUFG4).
Reasons for contact
I’ve got what they call chronic depression, so it’s not going to go away. It’s about helping us manage it. And sometimes 12 weeks is not enough (M, SU IV3).
What difference do wellness services make for individuals and communities?
Factors influencing progress towards meeting goals
Individual level | Community level | Organisational level |
---|---|---|
Facilitators Holistic focus on mental and physical health and emotional wellbeing Clear communications and marketing of wellness offer Free / minimal cost Smooth, efficient, confidential access and assessment process Skills, knowledge and non-judgemental approach of wellness coaches Behaviour change techniques, including personal plan, goal setting, diary keeping, motivation, self reporting and feedback Choice of gender of coach Coaches who take time, do not push, or pressurise but offer informed, personalised, tailor-made advice and guidance Non-stigmatising, discrete services in safe, appropriate accessible local venues, available evenings and weekends Service promotes independence, builds confidence, self-esteem, self-efficacy and sense of purpose Service provides opportunities to grow and develop as individuals, and to progress Volunteering, buddying and mentoring opportunities are offered Support is offered to change old habits and overcome setbacks | Facilitators Resourcefulness and encouragement; finding out about local services, support to access different activities Informal, social interaction with peers in groups, making friends, reducing social isolation Meeting up and doing activities with partners and others in community Building strong, inclusive local networks and social connections with people Promoting inclusive, mutual support and assistance through caring positive relationships including with those facing additional barriers Sharing experiences, learning together and from one another Making plans collectively and as a community Feeling part of something Taking control, promoting local activism Developing new skills, trying new things Giving and sharing e.g. food, cooking skills, recipes, experiences Increasing resilience Support to access long term funding opportunities Good inter-organisational links, including with LA, voluntary organisations and primary health care staff in GP practices | Facilitators Shared understanding and acceptance of theory and ownership of principles underpinning integrated wellness model Senior level endorsement, strong, positive leadership Solid, mature, trusting working relationships Working environment which is secure, satisfying and rewarding for staff Commitment to genuine partnership and respectful collaboration Joined up connections between different elements of service Provision of funding and resources for VCS Clear data management and reporting systems Performance monitoring data used to inform service planning and delivery Robust systems in place for staff and service user feedback, which informs service developments Joint accountability and shared responsibility for outcomes Clear support and supervision structures and training opportunities in place for staff Successes celebrated and lessons learnt and shared |
What helped individuals’ progress?
Commenting on a desire to address a range of ‘self-destructive behaviours’ and change all his ‘bad habits’ together, another interviewee commented:I think the thing I was impressed with is that she realised it wasn’t just about my diet and losing weight, it was the whole picture. It was around how I felt mentally. It’s about my depression as well (F, SU IV15).
Coaches recognition that health and social issues were inter-related appeared to help service users to address them. Interventions worked when services users could engage in ways that related to how they lived their lives. Some participants with long term conditions described feeling nervous and anxious about exercising, embarrassed about needing help and fearful about approaching services. Wellness coaches facilitated access to social, leisure and exercise opportunities for individuals, and their partners, friends and family, demonstrating the interconnected nature of people’s health related decision-making.It seemed to be a way of rolling all that in to one. There’s several other changes I’m making to my life, so the more they come under one umbrella, the more chance I’ve got of actually seeing them through (M, SU IV19).
Some participants mentioned how the service had improved their confidence to move back in to education, training and employment, and helped them to stay in work. One participant reflected on changes she made at work after identifying the cause of her stress levels and reported improvements in her diet, reductions in alcohol use and increased activities with her partner:A lot of older men, they’ll not sort of mix, but you get them in a garden situation and they’re talking about their garden (M, SU FG2).
Interventions worked on multiple interconnected levels, and often had several beneficial effects. The mental health benefits of physical activity and exercise were identified by many people, alongside reduced social isolation and feeling part of the community. Asked what would be lost if the service was not available, one participant commented:When you’re less stressed, you don’t go home and drink a glass of wine… it’s made me open my eyes in a way to what I’ve been doing. I mean it’s not easy to change your habits, but I think it’s been really positive (F, SU IV 5).
Other participants described feeling motivated to ‘take control and make changes’ (F, SU IV15) suggesting integrated wellness services had a role in promoting self-efficacy and supporting self-management. Overall, the qualitative data indicated a combination of physical, social, emotional, nutritional and educational benefits for participants, their partners and families. The wellness service offered support for participants, opportunities to reflect on their lives, talk about personal issues, ‘offload’, a chance to share experiences with others facing similar challenges, activities to look forward to, a reason for getting out, reducing social isolation and loneliness, promoting social networks, mental health and confidence, creating positive peer relationships, which in turn enabled health related lifestyle changes. These benefits were less clear in the routine quantitative data collected.I wouldn’t be exercising 2-3 times a week. I wouldn’t have had the confidence to go. I think people would be struggling more on their own, and probably feeling isolated, overwhelmed. I would feel a bit lonelier, not part of the community. I feel part of the community doing this (F, SU IV20).
What helped communities?
Participants described ways in which the team initiate, develop, support and sustain groups, help to navigate bureaucratic systems and ‘covers all aspects including health, finance, housing and employment’, to connect and build links between groups, using local knowledge:You’ve got a vision in your head but it’s quite hard to know what to do, where to go, and (CCBT staff member) helped us make things happen (F, SU FG3).
Activities were offered which promoted interaction between generations, people living with and without disabilities, and mental health concerns, challenging negative stereotypes. ‘Making connections and working together’ (F, SU FG3) encouraged understanding among participants of different life experiences, and raised awareness of the issues facing those living in poverty, refugee and asylum seeker communities, homeless people and young parents. There were examples of diverse community groups coming together to address holiday hunger, offer arts and sporting activities. Overall, participants valued the practical and emotional support they received from the CCBT, contributing to a sense of community cohesion and belonging:It’s all about them doing their homework, knowing what’s going on in the local area and physically bringing people together, being prepared to make face to face contact (M, SU FG2)
We’ve lost our community spirit and we need to bring it back. Live Well Gateshead is helping to bring it back (F, SU FG2).