“It was the whole picture” a mixed methods study of successful components in an integrated wellness service in North East England

Abstract

BackgroundA growing number of Local Authorities (LAs) have introduced integrated wellness services as part of efforts to deliver cost effective, preventive services that address the social determinants of health. This study examined which elements of an integrated wellness service in the north east of England were effective in improving health and wellbeing (HWB).MethodsThe study used a mixed-methods approach. In-depth semi-structured interviews (IVs) were conducted with integrated wellness service users (n = 25) and focus groups (FGs) with group based service users (n = 14) and non-service users (n = 23) to gather the views of stakeholders. Findings are presented here alongside analysis of routine monitoring data. The different data were compared to examine what each data source revealed about the effectiveness of the service.ResultsFindings suggest that integrated wellness services work by addressing the social determinants of health and respond to multiple complex health and social concerns rather than single issues. The paper identifies examples of ‘active ingredients’ at the heart of the programme, such as sustained relationships, peer support and confidence building, as well as the activities through which changes take place, such as sports and leisure opportunities which in turn encourage social interaction. Wider wellbeing outcomes, including reduced social isolation and increased self-efficacy are also reported.Practical and motivational support helped build community capacity by encouraging community groups to access funding, helped navigate bureaucratic systems, and promoted understanding of marginalised communities. Fully integrated wellness services could support progression opportunities through volunteering and mentoring.ConclusionsAn integrated wellness service that offers a holistic approach was valued by service users and allowed them to address complex issues simultaneously. Few of the reported health gains were captured in routine data. Quantitative and qualitative data each offered a partial view of how effectively services were working.

Exploring how and why social prescribing evaluations work: a realist review

“…Overall, 83 documents were included in this realist review (see figure 1). 1 2 5 8 9 21–24 26–29 32 47–114 Documents were split by methodology into four subcases, with representation from both the published and grey literature, although the majority of grey literature documents employed mixed methods (table 3). Generally, studies lacked in-depth descriptions of the evaluation processes and methods.…”

“…Twenty-five documents provided evidence for this mechanism 8 9 22 27–29 32 52 55–57 60 62 64 65 67 68 71 76 81 87 105 110 113. In designing a social prescribing evaluation, the research team must develop a comprehensive understanding of the intervention and how it may be working.…”

“…Fifteen documents contributed to this CMOC 2 26 27 32 51 53–56 60 62 68 82 88 97. Evaluations were rarely implemented alongside services and were more commonly commissioned and designed after service implementation.…”

“…This theme was heavily supported; forty-two documents contributed to its’ development and it is split into two CMOCs 2 5 9 21–27 32 52–54 56 60–62 66 68 69 71 73 76 79–81 85–87 95 100–103 105–108 110 113 114…”

“…Mixed-methods approaches were optimal for gaining a nuanced, in-depth understanding of the social prescribing intervention under evaluation, particularly when used sequentially and findings were integrated. Often this integration was missing from the evaluation documents, resulting in a partial view of how services were working 56. Even where each component of the mixed-methods study was reported separately, the depth and nuances were lacking.…”