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Community participation is a central concept for health promotion, covering a breadth of approaches, purposes and activities. This paper reports on a national knowledge translation project in England, UK, which resulted in a conceptual framework and typology of community-based approaches, published as national guidance. A key objective was to develop a conceptual framework linked to sources of evidence that could be used to support increased uptake of participatory methods across the health system. It was recognized that legitimacy of community participation was being undermined by a scattered evidence base, absence of a common terminology and low visibility of community practice. A scoping review, combined with stakeholder consultation, was undertaken and 168 review and conceptual publications were identified and a map produced. A 'family of community-centred approaches for health and wellbeing' was then produced as way of organizing the evidence and visually representing the range of intervention types. There are four main groups, with sub-categories: (i) strengthening communities, (ii) volunteer and peer roles, (iii) collaborations and partnerships and (iv) access to community resources. Each group is differentiated using key concepts and theoretical justifications around increasing equity, control and social connectedness. An open access bibliography is available to accompany the framework. The paper discusses the application of the family of community-centred approaches as a flexible planning tool for health promotion practice and its potential to be used as a framework for organizing and synthesizing evidence from a range of participatory methods. [ABSTRACT FROM AUTHOR]

Frailty represents an integrative prognostic marker of risk that associates with a myriad of age-related adverse outcomes in older adults. As a concept, frailty can help to target scarce resources and identify subgroups of vulnerable older adults that may benefit from interventions or changes in medical management, such as pursing less aggressive glycaemic targets for frail older adults with diabetes. In practice, however, there are several operational challenges to implementing frailty screening outside the confines of geriatric medicine. Electronic frailty indices (eFIs) based on the theory of deficit accumulation, derived from routine data housed in the electronic health record, have emerged as a rapid, feasible and valid approach to screen for frailty at scale. The goal of this paper is to describe the early experience of three diverse groups in developing, implementing and adopting eFIs (The English National Health Service, US Department of Veterans Affairs and Atrium Health—Wake Forest Baptist). These groups span different countries and organisational complexity, using eFIs for both research and clinical care, and represent different levels of progress with clinical implementation. Using an implementation science framework, we describe common elements of successful implementation in these settings and set an agenda for future research and expansion of eFI-informed initiatives. [ABSTRACT FROM AUTHOR]

Social workers in adult social care are at particular risk of job-related stress, although the contribution of different organisational and policy changes to this phenomenon is subject to debate. This paper explores a theoretical framework from the occupational psychology literature (the Job Demand/Control Model) to identify the characteristics of those most at risk of stress, in a sample of 249 social workers and other care managers working in English adult social services from the Individual Budget (IB) pilots. It finds that it is the particular combination of high work pressures, with a lack of control over decision making and resources needed to do the work, that are detrimental to job satisfaction. The study also finds that staff involved in delivering IBs were over twice as likely to be at risk of stress compared to those without any IB holders on their caseload. In-depth interviews with forty-eight care managers identified widespread complaints of additional pressures relating to IBs, but also the possibility that these may lessen as the policy evolves. The paper concludes that the Job Demand/Control Model is a helpful framework for evaluating the job-related impact of social work changes, particularly when part of a multi-methods approach. [ABSTRACT FROM AUTHOR]

Background The evidence on public health interventions has traditionally focussed on a limited number of costs and benefits, adopted inconsistent methods and is not always relevant to the UK context. This paper develops a multi-criteria decision analysis (MCDA) approach to overcome these challenges. Methods A document review and stakeholder consultation was used to identify interventions and the criteria against which they should be assessed. The interventions were measured against these criteria using literature reviews and decision models. Criteria weights were generated using a discrete choice experiment. Results Fourteen interventions were included in the final ranking. Taxation was ranked as the highest priority. Mass-media campaigns and brief interventions ranked in the top half of interventions. School-based educational interventions, statins and interventions to address mental health problems ranked in the bottom half of interventions. Conclusions This paper demonstrates that it is possible to incorporate criteria other than cost-effectiveness in the prioritization of public health investment using an MCDA approach. There are numerous approaches available that adopt the MCDA framework. Further research is required to determine the most appropriate approach in different settings. [ABSTRACT FROM AUTHOR]

This paper describes an innovative systems methodology for evaluating child protection social work practice and improving organisational learning. It draws on learning in other high-risk areas where the importance of understanding performance in context has been recognised. Using a case study for illustration, the methodology is presented. This evaluative approach engages management, staff, service users and other stakeholders in assessing the factors that influence practice and outcomes. The data collection tools developed included surveys to reach staff, multi-agency professionals and service users, together with in-depth interviews to get a deep understanding of causal factors and their interactions. Data included organisational cultural factors that influence the effectiveness of decision making, improve patterns of interaction with families and other professionals, remove constraints on practice, help prioritisation and improve consistency of care. The paper discusses some of the practical implications of applying the instruments, such as avoiding bias and dealing with unresponsiveness. It also supports the gathering of feedback from vulnerable service users. [ABSTRACT FROM PUBLISHER]

This paper presents findings from a Department of Health-funded study into the emotional well-being of young people seeking asylum on their own in the UK. It discusses how young people accounted for only partly disclosing information about the circumstances surrounding their quest for asylum and subsequent aspects of their lives since arriving in the UK. Foucault's panoptic mechanism and its focus on the effects of power as dispersed through scrutiny are applied as a theoretical framework to contextualise these experiences. The paper shows that young people's decisions about how much of their current or past lives they share with others are more complex than indicated by earlier research. The paper argues that, for many young people, the predominant impetus for selective disclosure was a desire to retain a degree of agency as they navigated their way through immigration, asylum, social care, health and education systems and simultaneously sought to establish themselves in the social world. These findings have implications for how social care (and other) professionals engage and work with young people seeking asylum alone. [ABSTRACT FROM PUBLISHER]

This paper draws on an international comparative study of social work decision making in cases that are on the edge of care order proceedings, involving child protection workers from Finland, Norway, England and the USA (California). It focuses on workers' responses in an online questionnaire to questions about the use of independent experts to inform their decisions about whether or not to take a case to court. All the countries try to avoid taking cases to court if possible, but the ways they do this vary considerably. The findings show the different meanings and implications that the request for an independent assessment has in the different systems. Workers' views reflect the roles and tasks that independent experts have in the different countries; and these in turn reflect their distinctive child protection systems and wider child welfare approaches. The paper offers a starting point for reflection about one's own system, and suggests that the well-known distinction between family support and child protection models should not be seen as a simple binary categorisation, but rather as a complex, contingent and contested continuum. [ABSTRACT FROM AUTHOR]

This recruitment of international social workers (ISWs) in England has been primarily aimed at 'plugging the gaps' in the child protection services. This paper reports on one aspect of a qualitative research project investigating the post-arrival integration, professional practice and development of 'international social workers', namely those trained and qualified outside of the UK working in London and the Home Counties. Findings demonstrate that, as well as being a challenging professional and work experience, this form of labour mobility is a profound life event for most ISWs and, as with human migration in other fields and countries, entails a complex social, emotional and cultural transition. [ABSTRACT FROM AUTHOR]

Very few UK studies make use of longitudinal general population data to explore social service contact for children and young people. Those that do only look at specific interventions such as care placements. This paper seeks to address this gap by asking to what extent do structural, neighbourhood, familial and individual characteristics predict social service contact. We provide an empirical answer by analysing the Longitudinal Survey of Young People in England, which includes data on social service contact in connection with young people's behaviour. Our findings indicate that social class, gender, ethnicity, step-family status and special education needs are all significant predictors of social service contact. Difficult parent-child relationships, frequent arguments and parents' lack of engagement with school meetings also matter, as does young people's own risk-taking behaviour. We conclude with a discussion of the limitation of the data for social work research and the implications of the findings. [ABSTRACT FROM AUTHOR]

Background and Objectives Arts activities can improve social connectedness and foster reciprocity between people living with dementia and their caregivers. The extent to which the arts can help shape attitudes towards dementia remains unclear. This paper explores the impact of a 12-week visual arts program "Dementia and Imagination" on the attitudes of family and professional caregivers through a mixed-methods longitudinal investigation, underpinned by a conceptual framework of the arts in dementia care. Research Design and Methods One hundred and forty-six family and professional caregivers were recruited across three settings in England and Wales (residential care homes, a county hospital, and community venues). Quantitative and qualitative data on caregivers' attitudes and perceptions of the impact of the arts program were collected through interviews at three time points. Results Thematic analysis identified four themes shared across the caregivers: (1) Recognizing capabilities , (2) Social connectedness , (3) Improvements to well-being , and (4) Equality and personhood. Two further themes were distinct to family caregivers: (5) Duration of the effects of the art program , and (6) Enriched perspective. The final theme Inspiring professional development was distinct to the professional caregivers. The quantitative analysis found no effect for caregivers' attitude change over time. Family caregivers scored significantly lower than professional caregivers at each of the three time points. Discussion and Implications Art programs have the potential to make visible the capabilities of the people living with dementia, enabling caregivers to see the person behind the condition. This study highlights practice implications for future implementation, such as the role of the arts in dementia care education. [ABSTRACT FROM AUTHOR]

The paper explores social work and work by using a theoretical optic neglected within the profession's academic literature—the Italian Marxist autonomist tradition. Key conceptual categories associated with the autonomists are discussed including the social factory, precariousness, the refusal of work and immaterial labour. It is maintained that a critical engagement with these interrelated concepts may help us think more deeply and politically about three dimensions: the changing content of the work; practitioners' focus, to differing degrees dependent on the national setting, on the work ‘readiness’ of clients; the ideologically pervasive work ethic within, what is termed, a ‘work society’. [ABSTRACT FROM PUBLISHER]

Clinical-academics are well established and expanding in English health settings. However, despite growing evidence that research-active organisations improve service quality and outputs, research by social work practitioners remains relatively rare in social work practice in England other than as part of qualifying or post-qualifying study. In this context, the National Institute for Health and Care Research developed new funding streams to support the development of 'practitioner–academics', as an equivalent to clinical-academics in health settings. As early career practitioner–academics, who undertake research whilst remaining employed in our social work organisations, we present a case for practitioner–academic research, via two small research projects within our teams based on creative methods and focus groups. These projects illustrate the benefits of practitioner–academics in the knowledge production process, improving access to hard-to-reach research areas, developing swift rapport, which facilitates the production of rich and reliable data, and providing a novel means to navigate ethical issues including researcher positionality and research sensitivity. We also highlight challenges around informed consent, employee roles and researcher bias, including where practitioners are critical of practice within their service areas or are exposed to criticism themselves. [ABSTRACT FROM AUTHOR]

The demand for social workers in England has been outstripping supply for more than a decade. As a result, social work continues to be on the UK Shortage Occupation List (2021; available online at: https://www.gov.uk/guidance/immigration-rules/immigration-rules-appendix-shortage-occupation-list (accessed May 26, 2021), ensuring the migration of social workers will continue. While several studies have examined the experiences of migrating social workers, these studies largely neglected the impact culture plays in this transition. This article will focus on the experiences of social workers who were trained in India and migrated to England. It is part of a much larger study that used a mixed method approach to explore the migration to England of social workers from eight different countries. Indian social workers highlighted the significant differences between the individualistic character of English culture and the much more collectivist Indian culture. This difference shaped a range of attitudes towards the family and parenting, as well as the distinctions between what is 'public' or 'communal' and what is 'private'. Other differences raised were regarding communication resulting from the more hierarchical tendencies of Indian society. In the final section, implications for practice are discussed and recommendations are made for the induction required to help future migrating social workers make a smoother transition. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic changed dramatically the ways social workers engaged with children and families. This article presents findings from our research into the effects of COVID-19 on social work and child protection in England during the first nine months of the pandemic. Our aim is to provide new knowledge to enable realistic expectations of what it was possible for social workers to achieve and particularly the limits to child protection. Such perspective has become more important than ever due to knowledge of children who died tragically from abuse despite social work involvement during the pandemic. Our research findings show how some practitioners got physically close to some children, whilst being distanced from others. We examine the dynamics that shaped closeness and distance and identify seven influences that created limits to child protection and the problem of 'the unheld child'. The article provides new understandings of child protection as embodied, multi-sensorial practices and the ways anxiety and experiences of bodily self-alienation limit practitioners' capacities to think about and get close to children. Whilst social workers creatively improvised to achieve their goals, coronavirus and social distancing imposed limits to child protection that no amount of innovative practice could overcome in all cases. [ABSTRACT FROM AUTHOR]

Conceptual frameworks for school-based, preventive interventions recognise that educators' capacity is, in part, dependent on school-level characteristics. This study aimed to (i) examine the factor structure and internal consistency of the Mental Health Literacy and Capacity Survey for Educators (MHLCSE); (ii) assess responses in relation to supporting students' mental health; (iii) describe schools' mental health provision in terms of designated roles, training offered, and perceived barriers; (iv) investigate variance in MHLCSE outcomes explained by schools; and, (v) explore school-level predictors of educators' perceived MHL and capacity after controlling for individual-level characteristics. A multi-level, cross-sectional design involving 710 educators across 248 schools in England was used, and secondary analyses of baseline data collected as part of the Education for Wellbeing Programme were conducted. Mental health provision data was available for 206 schools, of which 95% offered training to some staff, and 71% had a designated mental health lead. Secondary schools offered significantly more training than primary schools. Significant barriers included lack of capacity in Child and Adolescent Mental Health Services (CAMHS) and within school, and communication challenges between agencies. The amount of training offered by schools significantly predicted educators' awareness and knowledge of mental health issues, treatments and services, legislation and processes for supporting students' mental health and comfort providing active support, with increased training predicting higher scores. However, little variance was explained by schools (1.7–12.1%) and school-level variables (0.7–1.2%). Results are discussed in relation to current mental health and education policy in England. [ABSTRACT FROM AUTHOR]

Background Findings are presented from the evaluation of Public Health England's (PHE) Prioritization Framework (PF) aimed to assist local authority commissioners with their public health investment and disinvestment decisions. The study explored the take up of the PF in three early adopter local authority settings. Methods Semi-structured interviews (n  = 30) across three local authorities supplemented by participant observation of workshops. Results Participants acknowledged that the PF provided a systematic means of guiding priority-setting and one that encouraged transparency over investment and disinvestment decisions. The role performed by PHE and its regional teams in facilitating the process was especially welcomed and considered critical to the adoption process. However, uptake of the PF required a significant investment of time and commitment from public health teams at a time when resources were stretched. The impact of the political environment in the local government was a major factor determining the likely uptake of the PF. Ensuring committed leadership and engagement from senior politicians and officers was regarded as critical to success. Conclusions The study assessed the value and impact of PHE's PF tool in three early adopter local authorities. Further research could explore the value of the tool in aiding investment and disinvestment decisions and its impact on spending. [ABSTRACT FROM AUTHOR]

Signs of Safety (SoS) is a comprehensive assessment framework (AF) used in some form in most English children's service departments as well as in many other countries. The Framework for the Assessment of Children in Need and their Families (AF) was introduced nearly twenty years ago to address identified failures to adopt a holistic approach to assessments of families where there were concerns that children were in need of protection or support. The AF is not only a statutory requirement in England but it has influenced the development of approaches to assessment globally. An evaluation of SoS in pilot local authorities in England provided opportunities to examine the extent to which the two frameworks were being used together. Findings from interviews, case record analysis and a survey indicate that while recording processes were aligned with the AF, it was not central to many of the assessments conducted and it proved difficult to detect its influence on their content. It appears timely to examine the extent to which the AF is used across England, to assess its relevance to current practice and the extent to which frameworks such as SoS have supplemented or replaced it. [ABSTRACT FROM AUTHOR]

Background With the aim of decreasing immigration, the British government extended charging for healthcare in England for certain migrants in 2017. There is concern these policies amplify the barriers to healthcare already faced by asylum seekers and refugees (ASRs). Awareness has been shown to be fundamental to access. This article jointly explores (i) health care professionals' (HCPs) awareness of migrants' eligibility for healthcare, and (ii) ASRs' awareness of health services. Methods Mixed methods were used. Quantitative survey data explored HCPs' awareness of migrants' eligibility to healthcare after the extension of charging regulations. Qualitative data from semi-structured interviews with ASRs were analyzed thematically using Saurman's domains of awareness as a framework. Results In total 514 HCPs responded to the survey. Significant gaps in HCPs' awareness of definitions, entitlements and charging regulations were identified. 80% of HCP respondents were not confident defining the immigration categories upon which eligibility for care rests. Only a small minority (6%) reported both awareness and understanding of the charging regulations. In parallel, the 18 ASRs interviewed had poor awareness of their eligibility for free National Health Service care and suitability for particular services. This was compounded by language difficulties, social isolation, frequent asylum dispersal accommodation moves, and poverty. Conclusion This study identifies significant confusion amongst both HCP and ASR concerning eligibility and healthcare access. The consequent negative impact on health is concerning given the contemporary political climate, where eligibility for healthcare depends on immigration status. [ABSTRACT FROM AUTHOR]

Objective To propose an empirically derived and theoretically-informed mechanism to explain how Community Health Workers (CHWs) bring about health gain in clients in England. Methods We undertook in-depth interviews (n = 43) with CHWs and service staff working in four case studies selected using maximum variation sampling. Interviewees were encouraged to talk about the service, how they had become involved with the service, the CHW role and relationship with clients. Findings We identified the provision of social support to be central to the mechanism of CHW-mediated health gain. Appropriate social support provision comprised three inter-related elements; needs assessment, social support delivery and client engagement. This mechanism is dependent on the personal characteristics of CHWs and of the roles they are employed or volunteer to carry out. Conclusion A range of CHW characteristics can influence the social support process, but these are context-dependent and move beyond simple notions of CHW similarity to the client. This finding has important policy implications for the development and implementation of CHW services in high income countries with super-diverse populations. [ABSTRACT FROM AUTHOR]

Organisational settings such as schools, workplaces and hospitals are well recognised as key environments for health promotion. Whilst there is extensive literature on specific types of settings, little empirical research has investigated the transfer of frameworks between sectors. This study analyses Food for Life, an England-wide healthy and sustainable food programme that evolved in schools and is being adapted for children's centres, universities, care homes, and hospital settings. Following a case study design, we interviewed 85 stakeholders in nine settings. Food for Life's systemic framework of 'food education, skills and experience' 'food and catering quality', 'community and partnerships' and 'leadership' carried salience in all types of settings. These were perceived to act both as principles and operational priorities for driving systemic change. However, each setting type differed in terms of the mix of facilitating factors and appropriate indicators for change. Barriers in common included the level of culture-shift required, cost perceptions and organisational complexity. For settings based health promotion practice, this study points to the importance of 'frame-working' (the systematic activity of scoping and categorising the field of change) alongside the development and application of benchmarks to stimulate change. These processes are critical in the transfer of learning from between sectors in a form that balances commonality with sufficient flexibility to adapt to specific settings. Synergy between types of settings is an under-recognised, but critical, part of action to address complex issues such as those emerging from the intersection between food, health and sustainability. [ABSTRACT FROM AUTHOR]

Background Community pharmacies are now commissioned nationally in England to provide a seasonal influenza vaccination service. However, there is little evidence about the effectiveness of a pharmacy-based immunization service in improving uptake. Methods The Donabedian framework was used to evaluate a community pharmacy service in the West Midlands from a commissioning perspective. A mixed methods approach was adopted, including provider and patient surveys, data from the national influenza vaccination returns and an electronic pharmacy data recording system. Results Patient satisfaction with the service was high. There was no increase in uptake rates. Impact on reaching new patients was limited. The service had an appropriate information system to record activity. Promotion and signposting for the service was weak. Poor engagement with stakeholders led to dissatisfaction and General Practitioner complaints. Commissioners responded to emerging issues to ensure the pharmacies’ set up was compliant with the Service Level Agreement. Conclusions Improvements in convenience and choice for patients did not result in an increase in uptake rates. With a national pharmacy influenza programme, local arrangements to optimize the service may be limited. Clear arrangements for activity transfer and recording, partnership working and a good communications strategy are crucial in achieving a positive outcome. [ABSTRACT FROM AUTHOR]

The research reported on here examined the utility of a multidimensional model for operationalising the findings from a research-informed approach known as Resilient Therapy (RT). The approach is designed to support practitioners, carers, parents and young people in contexts of multiple disadvantages. Seven kinship carers and six children were involved in collaborative action research. Kinship carers met together, on eighteen occasions over a period of fifteen months, to learn about RT and explore how they might draw on the approach to inform their care of children. Children were interviewed on two occasions. Learning arising from the research suggests the importance of introducing RT as a collaborative model that builds opportunities for reflection and action. Carers are supported to find their own solutions, based on an understanding of their relationships with children, children's relationships with them and with others in their network. It is an approach which is attentive to what families do and views family practices as emerging in complex ecological systems. The study is located in an inequalities-informed conceptualisation of resilience research. Findings reinforce the importance of understanding resilience building as a process which parents/ carers/practitioners and young people can facilitate, but also one that must be attentive to the socio-economic systems around families. [ABSTRACT FROM AUTHOR]

Background. There is no consensus regarding the effectiveness of transcutaneous electrical nerve stimulation (TENS) for management of chronic musculoskeletal pain or chronic low back pain. A recent review of previous trial methodology identified significant problems with low treatment fidelity. There is little information available to guide selection of patient-reported outcome measures appropriate for TENS evaluation. Objectives. The purpose of this study was to explore the experiences of patients at a secondary care pain clinic who successfully used TENS to help manage chronic musculoskeletal pain. These key informants were selected because they had the potential to generate knowledge that could inform research design and clinical practice. Design. A qualitative method using individual semistructured interviews with open questions was selected for its capacity to generate rich data. Methods. A mini focus group informed the development of a discussion guide for semistructured interviews with 9 patients (6 women, 3 men). Thematic analysis was used as the primary data analysis method, and this analysis was enhanced by a case-level analysis of the context and processes of TENS use of each individual. Results. Data analysis indicated that distraction from pain and a reduction in the sensations associated with muscle tension or spasm should be considered as separate outcomes from pain relief. These direct benefits led to a wide range of indirect benefits dependent on patient decision making, including medication reduction, enhanced function, psychological benefits, and enhanced ability to rest. Conclusions. The findings indicate that evaluating TENS using a unidimensional pain scale is likely to overlook potential benefits. The complex pattern of TENS usage, as well as multiple direct and indirect outcomes, indicates that TENS could be considered as a complex intervention. [ABSTRACT FROM AUTHOR]

The Strengthening Families (SF) child protection conference model attempts to address some of the weaknesses of traditional conferences by helping families participate more easily and by enhancing risk assessment. This study examined the impact and feasibility of implementing the SF model across one local authority. A mixed-methods design was adopted. Data collection included: semi-structured interviews with professionals and parents; non-participant observation of SF and traditional conferences; and anonymised child protection plans. Interviews and observation data were analysed thematically using NVivo8 software. Study findings indicated problems with the roll-out of training for the SF approach, yet model fidelity was largely adhered to during SF conferences. Most professionals reported initial child protection conferences (ICPCs) to be working well and they were perceived as constructive places for addressing child protection issues. While the majority of parents described their pre-conference preparation as good, many still felt disempowered by the child protection process. Thought is needed about how to tackle the perception amongst families that they are judged and that they are powerless during the ICPC process, particularly as our observations of SF conferences revealed that parents were active in their contributions to meetings. [ABSTRACT FROM AUTHOR]

Aims: Provision of effective treatment for dependent drinkers has been identified as a priority in England yet evidence suggests that access is problematic and there are low levels of retention. This qualitative study explores how the alcohol treatment system is experienced by service users, identifying barriers and facilitators that influence treatment outcomes. Methods: A total of 20 semi-structured face-to-face interviews were conducted with patients from community alcohol treatment services in three London boroughs in 2012. Interviews were undertaken one year after initially entering treatment. A thematic analysis was conducted, with the results further abstracted to relate them to specific aspects of the treatment journey. Results: Patients journeys were characterized by a perceived lack of control leading to help-seeking, with treatment outcomes influenced by an individuals’ self-efficacy and the capabilities and skills of staff in actively engaging and supporting patients on the journey. A focus of services on the detoxification process and fragmented care pathways impacted negatively on engagement. Conclusions: Current alcohol care pathways require significant levels of motivation and self-efficacy to navigate that few patients possess. Pathways need to better reflect the capacity and capabilities of patients to be successful in supporting recovery. [ABSTRACT FROM AUTHOR]

This article deals with the engagement of social workers in the policy arena. It offers a conceptual framework for the examination of why social workers engage in policy practice and how they actually do so. Drawing upon examples from a cross-national study comprising eight countries, the Policy Practice Engagement (PPE) conceptual framework presented in the article comprises three legs--Opportunity, Facilitation and Motivation. It is asserted that social worker involvement in the policy arena and the form that this takes will depend upon the degree to which political institutions are accessible to social workers and the degree to which the organisational culture of theirw orkplace facilitates this type of activity. It will also be related to the degree to which social workers are motivated to engage in policy practice. This will be linked to the professional socialisation process as well as to individual characteristics and values. [ABSTRACT FROM AUTHOR]

Background Persistent health inequalities encourage researchers to identify new ways of understanding the policy process. Informal relationships are implicated in finding evidence and making decisions for public health policy (PHP), but few studies use specialized methods to identify key actors in the policy process. Methods We combined network and qualitative data to identify the most influential individuals in PHP in a UK conurbation and describe their strategies to influence policy. Network data were collected by asking for nominations of powerful and influential people in PHP (n = 152, response rate 80%), and 23 semi-structured interviews were analysed using a framework approach. Results The most influential PHP makers in this conurbation were mid-level managers in the National Health Service and local government, characterized by managerial skills: controlling policy processes through gate keeping key organizations, providing policy content and managing selected experts and executives to lead on policies. Public health professionals and academics are indirectly connected to policy via managers. Conclusions The most powerful individuals in public health are managers, not usually considered targets for research. As we show, they are highly influential through all stages of the policy process. This study shows the importance of understanding the daily activities of influential policy individuals. [ABSTRACT FROM AUTHOR]