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In this chapter, we will critically examine the role of social prescribing in addressing health inequalities. We will define what is meant by the term health inequalities and discuss assumptions around how social prescribing can tackle such inequalities. Drawing on examples from research and practice, we will reflect on how far social prescribing has contributed to addressing social determinants of health and what challenges may exist. We will explore questions such as are those most in need accessing social prescribing and how is its impact on health inequalities being evidenced? We will consider barriers that may be faced when referring people to social prescribing link workers and issues arising at the point of connecting people to community assets. We will conclude with considerations for how data collection and evidence can be better captured to evidence the impact of social prescribing on health inequalities.

Background Social prescribing (SP) is part of universal personalised care and available to everyone in the UK National Health Service. However, emerging evidence suggests access disparities in social prescribing. This study aimed to investigate the feasibility of accessing and analysing data on social prescribing from primary care records. Our secondary aim was to examine exposure to social prescribing and compare characteristics of patients who decline/accept social prescribing referrals to explore possible health inequalities in access to social prescribing. Methods Patient records (n=3086) were extracted from 11 GP practices across Northwest England for accepted, offered and declined social prescribing referrals. Patient demographics collected included sex, age, ethnicity, mental and physical health diagnoses. Patient characteristics in social prescribing referrals were compared to the overall practice population (practice information from Public Health England). Decline and acceptance rates were compared by group (e.g. male/female decline rates). Results GP referral data showed inconsistent recording of wider determinants of health and variations in referral patterns on a practice-to-practice basis. Some variables had very poor rates of recording and did not yield useful information. Patient age, sex and mental and physical health conditions were consistently recorded. Other variables such as disability and housing status showed sporadic GP recording across our dataset. Our preliminary findings identified underrepresentation of younger age groups and Asians, and higher declined referrals among individuals with physical health diagnoses. Conclusions The differing referral patterns between practices and recording discrepancies meant that many patient factors could not be used to assess trends in social prescribing referrals and declines. Preliminary results suggest that some patient groups may be underrepresented in referral data, however this needs further resear

OBJECTIVES: During the COVID-19 pandemic, the UK government and public health leaders advocated for community level responses to support vulnerable people. This activity could be planned and co-ordinated, however much was informal and developed organically. The effects on the individuals who were involved in providing and receiving informal support and implications for their communities have not been widely explored. The aim of this study was therefore to document and explore the nature, potential effects and longevity of community responses to the COVID-19 pandemic. PARTICIPANTS: We asked 15 individuals in North West England to keep a diary during the first UK COVID-19 lockdown. Over 8 weeks, diaries were completed and supported with weekly calls with researchers. A community capacity building framework was used to explore reported community responses to the COVID-19 pandemic. RESULTS: Diarists described community characteristics that enabled and hindered helpful responses in the lockdown context. Diarists frequently described informal approaches with residents acting alone or with near neighbours, although there were examples of community networks and residents recommencing formal volunteering activities. Diarists reported communities providing practical help and social support to vulnerable people. Participants perceived a greater sense of community, increased contact between residents and new networks during the period covered. CONCLUSION: The diaries provided valuable insights and the framework was a useful tool to explore the COVID-19 lockdown context. The findings indicate that organic capacity building took place, primarily via individual agency, highlighting the risk of communities being 'left behind' if there were not individuals or community networks available with resources to plug gaps in organisational support. Recommendations to sustain helpful responses to the pandemic include further consideration of ongoing community mobilisation, empowerment and c

Introduction The social and economic consequences of COVID-19 have the potential to affect individuals and populations through different pathways (e.g., bereavement, loss of social interaction). Objective This study adopted a solicited diary method to understand how mental health was affected during England's first lockdown. We also considered the experiences of diary keeping during a pandemic from the perspective of public participants. Methods Fifteen adults older than 18 years of age were recruited from northwest England. Diarists completed semistructured online diaries for 8 weeks, which was combined with weekly calls. A focus group captured participants' experiences of diary keeping. Findings Four key factors influenced mental health, which fluctuated over time and in relation to diarists' situations. These concerned navigating virus risk, loss of social connections and control and constrictions of the domestic space. Diarists also enacted a range of strategies to cope with the pandemic. This included support from social networks, engagement with natural environments, establishing normality, finding meaning and taking affirmative action. Conclusion Use of diary methods provided insights into the lived experiences of the early months of a global pandemic. As well as contributing evidence on its mental health effects, diarists' accounts illuminated considerable resourcefulness and strategies of coping with positive effects for well-being. While diary keeping can also have therapeutic benefits during adversity, ethical and practical issues need to be considered, which include the emotional nature of diary keeping. Public Contribution Members of the public were involved in interpretation of data as well as critiquing the overall diary method used in the study.

Introduction The social and economic consequences of COVID-19 have the potential to affect individuals and populations through different pathways (e.g., bereavement, loss of social interaction). Objective This study adopted a solicited diary method to understand how mental health was affected during England's first lockdown. We also considered the experiences of diary keeping during a pandemic from the perspective of public participants. Methods Fifteen adults older than 18 years of age were recruited from northwest England. Diarists completed semistructured online diaries for 8 weeks, which was combined with weekly calls. A focus group captured participants' experiences of diary keeping. Findings Four key factors influenced mental health, which fluctuated over time and in relation to diarists' situations. These concerned navigating virus risk, loss of social connections and control and constrictions of the domestic space. Diarists also enacted a range of strategies to cope with the pandemic. This included support from social networks, engagement with natural environments, establishing normality, finding meaning and taking affirmative action. Conclusion Use of diary methods provided insights into the lived experiences of the early months of a global pandemic. As well as contributing evidence on its mental health effects, diarists' accounts illuminated considerable resourcefulness and strategies of coping with positive effects for well-being. While diary keeping can also have therapeutic benefits during adversity, ethical and practical issues need to be considered, which include the emotional nature of diary keeping. Public Contribution Members of the public were involved in interpretation of data as well as critiquing the overall diary method used in the study.

Purpose: Strengthening research capacity (RC) amongst health professionals has both organisational and individual benefits. It can increase the quality of research and support the transfer of evidence into practice and policy. However there is little evidence on what works to develop and strengthen RC. This paper contributes to the evidence base by reporting findings from an evaluation of a programme that aimed to build capacity to use and do research amongst NHS and local authority organisations and their staff in a large english research partnership organisation. Methods: The evaluation used multiple qualitative methods including semi-structured interviews, focus groups and workshops (n=131 respondents including public advisers, university, NHS, and local government partners). Results: The RC building programme provided a range of development opportunities for NHS and local authority staff resulting in increased confidence and skills to undertake, participate in, and use research. Additionally, positive influences on organisational practice and collaborative working were reported. Conversely, challenges to developing research capacity were also identified as were the importance of resources, senior level buy-in, and the relevance of research topic to practice in facilitating participation in the programme. Conclusion: Collaboration for Leadership in Applied Health Research and Care North West Coast’s (CLAHRC-NWC) RC building programme differed from convential approaches giving less emphasis to formal teaching and more to experiental learning and focusing on both individual capacities and supporting organisations to integrate RC building into staff development programmes. The findings demonstrate that providing opportunities for staff in NHS and local authority organisations to develop research knowledge and skills alongside an infrastructure that supports and encourages their participation in research can have positive impacts on research capacity and organisation

Background: There is a strong national drive within the UK government and NHS for social prescribing. Previous research studies have mainly focused on service user perspectives and evaluating their experiences. There is limited evidence on how the general public perceive and understand what social prescribing is and how these views could influence service planning and delivery. This paper seeks to understand perceptions of social prescribing within the wider community. Methods: Semi-structured focus groups were conducted with 37 members of the public in four areas in north-west England. We explored public awareness and understanding of social prescribing. Results: Limited knowledge of the term social prescribing was found amongst participants as well as limited involvement in community discussions of the topic. Concerns were raised about the short-term nature of activities and the need for adequate resourcing to support continuity of service provision. The social prescribing link worker was considered to be important in supporting engagement with services and it was preferred this role was undertaken by people with local knowledge. Conclusions: The findings provide evidence of public perspectives on social prescribing and highlight how wider community perceptions can supplement service user feedback to support social prescribing service planning, commissioning and delivery.

Purpose: Strengthening research capacity (RC) amongst health professionals has both organisational and individual benefits. It can increase the quality of research and support the transfer of evidence into practice and policy. However there is little evidence on what works to develop and strengthen RC. This paper contributes to the evidence base by reporting findings from an evaluation of a programme that aimed to build capacity to use and do research amongst NHS and local authority organisations and their staff in a large English research partnership organisation. Methods: The evaluation used multiple qualitative methods including semi-structured interviews, focus groups and workshops (n=131 respondents including public advisers, university, NHS, and local government partners). Results: The RC building programme provided a range of development opportunities for NHS and local authority staff resulting in increased confidence and skills to undertake, participate in, and use research. Additionally, positive influences on organisational practice and collaborative working were reported. Conversely, challenges to developing research capacity were also identified as were the importance of resources, senior level buy-in, and the relevance of research topic to practice in facilitating participation in the programme. Conclusion: Collaboration for Leadership in Applied Health Research and Care North West Coast’s (CLAHRC-NWC) RC building programme differed from conventional approaches giving less emphasis to formal teaching and more to experiential learning and focusing on both individual capacities and supporting organisations to integrate RC building into staff development programmes. The findings demonstrate that providing opportunities for staff in NHS and local authority organisations to develop research knowledge and skills alongside an infrastructure that supports and encourages their participation in research can have positive impacts on research capacity and organisat

Background: Action to address the structural determinants of health inequalities is prioritised in high level initiatives such as the UN Sustainable Development Goals and many national health strategies. Yet, the focus of much local policy and practice is on behaviour change. Research shows that whilst lifestyle approaches can improve population health, at best they fail to reduce health inequalities because they fail to address upstream structural determinants of behaviour and health outcomes. In health research most efforts have been directed at three streams of work: understanding causal pathways; evaluating the equity impact of national policy; and developing and evaluating lifestyle/behavioural approaches to health improvement. As a result, there is a dearth of research on effective interventions to reduce health inequalities that can be developed and implemented at a local level. Objective: To describe an initiative that aimed to mainstream a focus on health equity in a large scale research collaboration in the UK and to assess the impact on organisational culture, research processes and individual research practice. Methods: The study used multiple qualitative methods including semi-structured interviews, focus groups and workshops (n=131 respondents including Public Advisers, university, NHS and local and document review.. Results: Utilising Extended Normalisation Process Theory (ENPT) and Gender Mainstreaming theory the evaluation illuminated: (i) the processes developed by CLAHRC NWC to integrate ways of thinking and acting to tackle the upstream social determinants of health inequities (i.e. to mainstream a health equity focus) and, (ii) the factors that promoted or frustrated these efforts. Conclusions: Findings highlight the role of contextual factors and processes aimed at developing and implementing a robust strategy for mainstreaming health equity as building blocks for transformative change in applied health research.

Introduction There is an extensive literature on public involvement (PI) in research, but this has focused primarily on experiences for researchers and public contributors and factors enabling or restricting successful involvement in specific projects. There has been less consideration of a ‘whole system’ approach to embedding PI across an organization from governance structures through to research projects. Objective To investigate how a combination of two theoretical frameworks, one focused on mainstreaming and the other conceptualizing quality, can illuminate the embedding of positive and influential PI throughout a research organization. Methods The study used data from the evaluation of a large UK research collaboration. Primary data were collected from 131 respondents (including Public Advisers, university, NHS and local government staff) via individual and group interviews/workshops. Secondary sources included monitoring data and internal documents. Findings CLAHRC‐NWC made real progress in mainstreaming PI. An organizational vision and infrastructure to embed PI at all levels were created, and the number and range of opportunities increased; PI roles became more clearly defined and increasingly public contributors felt able to influence decisions. However, the aspiration to mainstream PI throughout the collaboration was not fully achieved: a lack of staff ‘buy‐in’ meant that in some areas, it was not experienced as positively or was absent. Conclusion The two theoretical frameworks brought a novel perspective, facilitating the investigation of the quality of PI in structures and processes across the whole organization. We propose that combining these frameworks can assist the evaluation of PI research.

Introduction There is an extensive literature on public involvement (PI) in research, but this has focused primarily on experiences for researchers and public contributors and factors enabling or restricting successful involvement in specific projects. There has been less consideration of a ‘whole system’ approach to embedding PI across an organization from governance structures through to research projects. Objective To investigate how a combination of two theoretical frameworks, one focused on mainstreaming and the other conceptualizing quality, can illuminate the embedding of positive and influential PI throughout a research organization. Methods The study used data from the evaluation of a large UK research collaboration. Primary data were collected from 131 respondents (including Public Advisers, university, NHS and local government staff) via individual and group interviews/workshops. Secondary sources included monitoring data and internal documents. Findings CLAHRC‐NWC made real progress in mainstreaming PI. An organizational vision and infrastructure to embed PI at all levels were created, and the number and range of opportunities increased; PI roles became more clearly defined and increasingly public contributors felt able to influence decisions. However, the aspiration to mainstream PI throughout the collaboration was not fully achieved: a lack of staff ‘buy‐in’ meant that in some areas, it was not experienced as positively or was absent. Conclusion The two theoretical frameworks brought a novel perspective, facilitating the investigation of the quality of PI in structures and processes across the whole organization. We propose that combining these frameworks can assist the evaluation of PI research.