Supporting Anticipatory Care and Ageing Well: The Anchor Project

“In the world of social innovation research it is more pertinent than ever to be attentive to change and adapt accordingly to emerging ideas and practices when presented. This has been the experience of the Social innovation Group and our current work on the ANCHOR project.” – Tom Bailey

The University of Exeter’s Social Innovation group (SIG) has now been working on place-based, person-centred issues within the health and social care sector to promote positive change for over 10 years. The primary focus of this multi-disciplinary research group in recent years has been the HAIRE project: Healthy Ageing through Innovation in Rural Europe, which is funded by the Interreg 2Seas European Regional Development Fund. Through the use of a co-designed Guided Conversation (GC) toolkit, HAIRE aimed to reduce loneliness, isolation and improve general wellbeing in the over 60 age group across rural communities in England, Belgium, France and The Netherlands. In terms of practical objectives, the project aimed to develop and test methods that empower and enable participants to:

  • Define what support is needed;
  • Participate in the design and delivery of services;
  • Develop solutions for the individual to reduce loneliness and improve quality of life, health and wellbeing, supported by the voluntary, private and public sectors.

HAIRE’s approach to achieving these objectives included the HAIRE toolkit, which was developed by the University of Exeter with support and consultation from the project partners in adapting the materials to cater to each location site. The toolkit is person-centred and allows for people to reflect on their own needs, interests, and aspirations in order for individualised care and support to be provided. The GC encourages a wide-ranging informal conversation that takes place between volunteers and participants. With the aid of visual and conversational prompts (see Figure 1), the GC fosters an honest and open dialogue between volunteer and participant to identify how the local area, community and the person themselves influence their wellbeing.

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Figure 1; A place-based visual prompt developed for Carnon Downs, Cornwall.

Due to the success of the HAIRE project across its eight pilot sites in Northern Europe, a new opportunity to use the same methodology in a wider area arose in Cornwall, England. This was named the ANCHOR project: Supporting Anticipatory Care and Ageing Well in Cornwall. This was funded by the NHS Cornwall Partnership Ageing Well/Urgent Care Response Programme Board as well as the Duchy Health Charity and a UKRI ESRC Impact Accelerator Award.

The aim of this project was to design and develop GCs to be implemented across the Coastal Primary Care Network (PCN) to support communities and anticipate undesired health outcomes. The ‘test and learn’ approach of the project was supported by the assumption that the toolkit would fit into existing work practices without adding to health practitioners’ workloads.

However, during the lifetime of the project there have been two significant innovations to service design and delivery in Cornwall which led the team to re-think how best the GC could fulfil the desired anticipatory care outcomes. These innovations were the emergence of the Community Hub model and a pilot scheme involving Community Health Workers (CHWs). These developments are part of the rapidly changing landscape of service design and delivery involving Cornwall’s voluntary sector (which we will deal with in another article). Understanding and adapting to these changes has been an important part of our work in ANCHOR.

While working in a practical capacity with both organisations and individuals to aid in the delivery of anticipatory care within the new innovation pathways we have also worked in a conceptual capacity to understand anticipatory care as both a philosophy and process of care. As a philosophy, anticipatory care speaks to the working assumption that care (provided by individuals, the community or health services) should enable people to maintain good health and wellbeing for longer. However, for those with chronic conditions, an Anticipatory Care Plan is necessary to precisely identify how an individual should be supported to prevent a deterioration in their condition and unwarranted health outcomes.

The ANCHOR project’s original aims – such as improving the management of long-term conditions, reducing loneliness and isolation, improving general wellbeing and reducing the demand on GP surgeries – are still important but can now be considered long term goals to be achieved while working in the emerging ecosystem of care including through Community Hubs and the CHW programme. Data will continue to be collected on these impacts, but the results will likely be published after the lifetime of the project.

The project is now essentially working to build capacity and skills in the sector that both supports the philosophy and process of anticipatory care. The ANCHOR project’s timeline serves to illustrate that flexibility, resilience and persistence required in the voluntary care sector and in research generally in order to succeed.

Article by Tom Bailey, Research Assistant on the Anchor Project

East Sussex Conference: Innovations in Healthy Ageing

View from the De Warr Pavilion

19th October 2022 saw our colleagues at Rother Voluntary Action and East Sussex County Council hold a Healthy Ageing social innovation workshop at the De Warr Pavilion in Bexhill-on-Sea. The conference brought the community up to speed on what the team has achieved so far through HAIRE. It was a thought provoking day, with our partners not only sharing innovations devised so far, but also brainstorming with the community about new place-based innovations for healthy ageing.

Kate Leyshon stands with two colleagues from RVA

HAIRE’s PI Catherine Leyshon with colleagues from Rother Voluntary Action

Collaboration between VCSOs, public and private sector and older people continues to lie at the heart of much-needed changes to the design and delivery of services, and it was exciting to see so many people present who were clearly committed to improving the lives of older people. From the start, there was a lot of energy in the room, and there was a very high level of interaction and ideation throughout.

Four key themes emerged from the HAIRE project’s Guided Conversations and form the basis for innovations in Rye and Robertsbridge and beyond: Loneliness and Isolation; Transitions and Life changes; Planning for the Future and Staying Active.

A tweet describing the Life Transitions service briefly and calling for volunteers

The Life Transitions Service pilot was launched in summer 2022

One result (that crosses multiple themes, in fact) is the team piloting a “Life Transitions Service.” This has, at its heart, the simple truth that the further ahead you can plan, the better the outcome. The Guided Conversations showed that sometimes, the decisions people make when moving to rural areas are not always ideal, as they can fail to take their ageing needs and later life changes into account – and end up encountering loneliness, isolation and other difficulties.

The aim of the service is to help people arrive in later life as prepared as they could be, and to provide a listening ear and a signposting service to help individuals make important decisions that can help make a positive impact on later life. Volunteers have been recruited and trained in using the approach as an example of a new model of service focused on prevention. The volunteer model for the Life Transitions service is being rolled out next year, and the team are considering ways to extend the service beyond their local area.

Designers were asked: How might we create joyful place-based opportunities for people across generations to improve planetary health?

Another innovation scheme in progress is the RSA/HAIRE Design Competition. The RSA – the royal society for arts, manufactures and commerce – is all about social impact, and the competition includes factors that go beyond personal, social and community issues. The partnership came up with a competition for design students to combine planetary health and ways to work intergenerationally to inspire healthier communities.

Winning designs will be tested in the summer of 2023, and included in the Age Friendly programme to ensure a long-lasting legacy. In parallel, there will be a community design competition, which was kicked off at the workshop: “How might we create fun opportunities in local communities for younger & older people to come together and improve each other’s health & the health of the planet?” All sorts of ideas were mooted: from Ready, Steady, Cook at the local food bank to a rickshaw club for greener, healthier, intergenerational transport.

Attendees all smiling as they write down their ideas for green healthy ageing initiatives

Kudos to product design student Jacob, who travelled down from Loughborough to hear all about HAIRE in order to better shape his design team’s submission.

Regarding strategic, system level innovation, East Sussex continues to develop a formal ‘age-friendly community’. The Guided Conversation analysis illustrated the multi-dimensional and interconnected dimensions of ageing well, which prompted the need for a holistic system response. The team (ESCC and RVA) worked with Rother District Council  – who are an official observer partner – to write an application to join the UK arm of the World Health Organisation’s Age Friendly Communities programme, as their approaches and domains of interest are well-aligned. The application was approved by the Rother District Council Cabinet and then by the Centre for Ageing Better, who run the UK AFC Network. The HAIRE Project collaborated with Rother District Council, local volunteers, and other stakeholders to develop the local AFC programme, holding a visioning workshop with key councillors and other local stakeholders to identify and agree priorities. These were presented and discussed at the conference, which finished on a futuristic note and a brainstorming session creating innovations 50 years into the future.

It was an inspiring day! 

Paul Bolton standing at the podium at the HAIRE conference

“It was great to bring aspects of the HAIRE partnership together and highlight the wider dimensions of the project. Our aim was to focus on the innovations to boost the momentum around Healthy Ageing going forwards and to set out the HAIRE legacy.” – Paul Bolton

 

Kate’s Grand Tour Part 4: Farewell Belgium

This last instalment of our PI Kate’s travel blog covers her last day in Belgium in April 2022, the final stop of a ‘grand tour’ in which Kate met members of the community through various meetings, lunches and gatherings. Sadly, the popular singer Kate mentions below – Juul Kabas – has since died unexpectedly. You can read a tribute to Juul here. 

On Wednesday it’s time to meet the Mayor of Laakdal, Tine Gielis, and Alderman Gerda Broeckx. Gerda has specific oversight of HAIRE and is keen to hear about progress and successes, of which there are many. We meet for lunch with a group of older people who gather regularly for a subsidised meal and conversation. The atmosphere is very convivial.

The Mayor, Alderman, Laakdal Team and I discuss the familiar issues of community engagement, encouraging younger volunteers and making sure that everyone’s voice is heard. We also explore how new models of service design and delivery can bring together the public sector and the local community groups and volunteers. I also meet Freddie, Laakdal’s Super Volunteer, who does a great deal in his community. He is part of HAIRE and has conducted several Guided Conversations. Stalwarts like Freddie can be found in every community, and are greatly valued.

My last day in Belgium sees me attending the Seniors’ Party, a twice-yearly event which, pre-Covid, used to attract 600 older people from the municipality for entertainment, drinks and a sandwich lunch. About 250 people attend this lunch, seated at long tables set out in a sports hall decorated with fairy lights around the walls. There is a stage, lighting and an impressive sound system. Alderman Gerda Broeckx makes a speech about HAIRE. The entertainment is provided by Juul Kabas who sings popular sing-along classics and gets everyone clapping. Freddie is also volunteering at this event and tells me that Juul was badly affected during lock down, unable to do shows. Juul signs off his set with the phrase “If you lose your smile, you lose your heart”. The Seniors’ Party was a model of community action, with everyone working hard to create a joyous atmosphere.

I thoroughly enjoyed my trip to East Sussex and Belgium. I met people who I have only previously met over Teams, and I relished seeing them in action at the various events I attended. Everyone worked hard to make me welcome, which I really appreciated. There’s amazing work going on in our pilot sites and I am really looking forward to a few more trips before the project ends in March 2023. A huge THANK YOU to everyone involved in planning and making this trip a reality.

Extending the HAIRE toolkit: Guided Conversations with In The Mix Project

Over the past couple of months, a small team from the University of Exeter’s Social Innovation Group has been working on adapting HAIRE’s Guided Conversation tool for use in youth work. Two interns, Matilda Ferguson and Lewi Connor, have been involved in this process, and Matilda very kindly agreed to write a blog about it. Read on…

The HAIRE project aims to support older people in rural areas. One of the systems tested by the HAIRE project is Guided Conversations. These take the shape of a semi-structured discussion, prompted by images, general themes and talking points such as the local area, relationships, interests and community. Using the Guided Conversation tool, the HAIRE project has been able to explore the isolated situation of older people in rural areas, and identify their needs and desires. The Guided Conversations became not only part of a study into the rural isolation experienced by older people, but a tool for combatting it.

We have been working alongside In The Mix to explore implementing the Guided Conversations tool into youth work in rural areas. The In The Mix Project (ITMP) is based in the small town of Wiveliscombe, Taunton Deane. However, the charity provides youth and community services across Somerset. ITMP offers informal educational, activities and positive opportunities programmes to provide learning, skills and experiences, which supports young people’s personal, social, emotional and professional development, as well as boosting self-esteem and confidence. Their approach to youth work is flexible and based on issues and values prevalent to young people, their communities and their environment.

Image taken from In the Mix Project website

Working alongside the charity’s project manager John Hellier, we have tailored the prompts and structure of the HAIRE Guided Conversation to fit the focus of ITMP and context of youth work. Our version of the Guided Conversation covers three themes: place-based’, ‘people-centred’ and ‘empowerment’. We have also adapted the tool into a new format: an app. The app shows participants these themes, as well as some sub-topics, image prompts and radars which shows how positively they rate the topics discussed.

We hope that the Guided Conversations will help us to understand the situation of young people living in rural places in terms of the issues and relationships they have with their areas. This research will help youth work in rural areas to be responsive to young people’s needs. As well as this, we hope that like we have found in the HAIRE project, the Guided Conversations themselves will not just be research tools. The discussion provides opportunity for people to open up, share, connect and be heard. This itself will combat isolation and prompt discussion about solutions. The app also provides the opportunity for action through its ‘signposting’ feature, which will allow young people to find existing services to support them.

Over the last week, Lewi and Matilda went up to Exeter to meet with John to try it out. Our practice guided conversation lasted almost three hours and was a great way to understand how the tool would work in practice. After a few adjustments, the app is ready to be tested and we look forward to trying it out at ITMP sessions over the next couple of weeks.

Matilda Ferguson

Image taken from In The Mix Project website

 

 

 

 

Talking Deck to help people with life and health issues

The Talking Deck is a new resource that has been co-designed by researchers from the University of Exeter, staff and volunteers at CoLab Exeter’s wellbeing hub, people with lived experience of homelessness, and artist Hugh McCann. The project is aligned with Project HAIRE and is based on the Guided Conversation model, showing how the HAIRE toolkit can be customised for different target groups.

The Talking Deck aims to facilitate conversations that are led and shaped by individuals seeking support. Sometimes the purpose of a conversation is simply to allow individuals to share their experiences with staff and volunteers at CoLab Exeter. As seen below, the cards in the deck include a collection of symbols, words and place-based images. They are carefully curated to help people speak about the issues that are important to them.

A variety of Talking Deck cards are in the photo, e.g. a key, a heart, trainers, animals, pictures of Exeter and words such as 'yesterday', 'future' and 'fear'.

Over a series of workshops, staff, volunteers, researchers and people with lived experiences came together to co-design the Talking Deck pack.

“Listening and co-production has been at the heart of this project. We’ve created these together with people from all sectors and walks of life. The cards are a way to facilitate conversations and help people find a way forward without getting to crisis point. People want to be listened to, first and foremost. To be seen and be validated.”  — CoLab Joint CEO Fiona Carden

The project was a partnership between researchers from the University of Exeter (Catherine Leyshon and Shukru Esmene from the Social Innovation Group‘s HAIRE team and Lorraine Hansford from the Wellcome Centre for Cultures and Environments of Health), CoLab Exeter and Devon Mind, funded through HAIRE and an ESRC Impact Accelerator Account (IAA) award. The IAA helped to translate the main principle of HAIRE’s Guided Conversation tool into a resource that suited CoLab Exeter’s working culture and the individuals who use their wellbeing hub. The principle here being the use of meaningfully co-designed visuals to facilitate wellbeing-related conversations.

“Seeing the Guided Conversation transform into the Talking Deck has been an incredibly exciting and rewarding process. Transferring our tools into new settings to help different groups and organisations always depends on successful co-design. We have worked alongside staff from CoLab and people with lived experience to produce something that can genuinely help people to have more in-depth, productive conversations about their needs, aspirations, hopes and fears.” — University of Exeter researcher Professor Catherine Leyshon

CoLab Exeter’s wellbeing hub hosts around 30 voluntary sector and statutory organisations who support people in Exeter with experiences of homelessness, addiction, the criminal justice system, the care system and domestic abuse. Over a series of workshops, staff, volunteers, researchers and people with lived experiences came together to co-design the Talking Deck pack. The packs are currently being trialled by staff and volunteers at CoLab and in other organisations, for example Julian House have experimented with using the Talking Deck in key worker support sessions with young adults in supported accommodation. So far, feedback from users of the Talking Deck has focused on how the cards help facilitate conversations that are led by the individual, rather than the staff member.

“It’s been really exciting to hear people’s reactions to the new cards. Support workers who have tried them out reported back that they were surprised how well such a simple tool opened up conversations, and helped people to talk about things that were important to them that they hadn’t raised before.” — University of Exeter researcher Lorraine Hansford

Workers commented that using the cards had given them more insight into people’s interests and concerns, and ‘opened different doors’ for people to talk about what is important to them, with issues sometimes emerging that would not necessarily come up in standard assessments used by the organisations:

“I was sceptical at first… I was quite surprised at how it was more powerful than I thought.”

“It’s another way of communicating with people, pictures have a connection to memories. For people who are vulnerable, talking can be intimidating, and it can bypass that in a gentle way.”

There is still work to be done, as the project does not intend to be prescriptive about how the resource is used. Ways of using the cards need to consider how some individuals may find engaging with the entire Talking Deck overwhelming and/or feel unsure about where to start. Continued exchanges between organisations that use the cards will be valuable in promoting the flexibility of the resource and in sharing new practices. Importantly, a Mental Health Alliance, including CoLab Exeter and Devon Mind, can potentially provide a platform for practice-led exchanges and skills sharing to take place. The Talking Deck’s launch will engage members of the Mental Health Alliance in scoping the coordination of such a platform.

Overall, the Talking Deck can be used informally in different settings to help guide conversations. The cards predominantly intend to give people choice about the topics that they wish to discuss, whilst helping to start conversations that may be difficult for people to raise.

After collating a last round of feedback, the finalised Talking Deck was launched at an event at CoLab Exeter on 3rd May 2022.

For more information, contact: Professor Catherine Leyshon (c.brace@exeter.ac.uk) or Lorraine Hansford ().

Picture of collaborators from MIND, CoLab and the University of Exeter

Left to Right: Tom Cox (Devon MIND), Fiona Carden (CoLab), Lorraine Hansford and Catherine Leyshon (University of Exeter)

 

 

Kate’s Grand Tour, Part 2 of 4: Arriving in Laakdal, Belgium

Professor Catherine (Kate) Leyshon, our Principal Investigator, was able to travel for the first time since our project launch in early 2020. She referred to her trip as the “Grand Tour”! We asked her to write about her journey to East Sussex and subsequent visit to Laakdal in Belgium, and give us a writerly flavour of what those places look and feel like, since we’ve been unable to visit. Here’s part two: her first glimpse of Laakdal. More to follow!

I arrive on the Eurostar in Brussels and pick up a hire car for the drive to Diest, the town where I am staying about 25 minutes away from the municipality of Laakdal, in the province of Antwerp. The municipality comprises the towns of Eindhout, Veerle, Vorst, Varendonk and Vorst-Meerlaar, all of which are involved with HAIRE. Diest is a pretty, well-kept town with narrow cobbled streets and new buildings tastefully blended into its historic town-centre. I take a walk up through a leafy park and back through the town square, lined with canopied restaurants where diners are enjoying the warm spring evening.

The next day, I drive to Vorst in Laakdal. Initially my car’s sat nav wants to take me to Vorst near Brussels but I realise this is in completely the wrong direction! I drive out of Diest and I’m quickly into the flat, farmed landscape of this part of Belgium. The road is straight and quiet. As I reach Vorst, I notice how quiet and tidy it is. We are meeting in the fantastic Gemeentehuis. Recently constructed and serving the whole municipality, it contains the library, a post office, meeting rooms, the only bank machine in town and some local council functions.

I meet four volunteers who have some fascinating insights into their experience of using the HAIRE toolkit. They are very generous with their knowledge, and – with a retired Alderman amongst their number – we have an in-depth discussion about new models of service design and delivery. The issues in this part of rural Belgium are familiar across the project: people growing older sometimes become less confident and stop going out as much. They become isolated and suffer some consequences to their overall wellbeing. The Guided Conversation has helped to reconnect them to the community. The partners are especially looking forward to taking ownership of a new minibus; transport here is very limited – it’s no surprise that getting around is a problem in all our pilot sites.

Kate’s Grand Tour Part One: A Visit to Rother

Professor Catherine Leyshon, our Principal Investigator, was able to travel for the first time since our project launch in early 2020. She referred to her trip as the “Grand Tour”! We asked her to write about her journey to East Sussex and subsequent visit to Laakdal in Belgium, and give us a writerly flavour of what those places look and feel like, since we’ve been unable to visit. Here’s part one, starting in Rye, East Sussex. More posts to follow!

I arrive at Rye station in afternoon spring sunshine opposite Jempsons, which looks to be a well-stocked grocery store/deli with attractive displays. It’s a short walk to the Ship Inn through the historic redbrick town centre. It’s rush-hour in Rye, with children eagerly getting on the train home from school. The offices of the Bluebird care agency remind me that Rye has an aging population, many of whom suffer from isolation and loneliness. This is why Rye is part of HAIRE, along with the nearby town of Robertsbridge, both in the county of East Sussex.

I turn off the delightfully named Wish Street onto Wish Ward in the direction of a disused factory, a piece of industrial heritage referencing the area’s past. A former bakery, it now houses a pottery. I walk past picturesque redbrick and half shingle houses. The pretty townhouse along a cobbled street with a new Jaguar parked outside tells a story that I’m only too familiar with from Cornwall where the picturesque rural setting can hide great disparities in wealth. Mermaid Street, with its ancient, rounded cobbles, opens up to my left. The Ship Inn – my destination after 7 hours traveling from Cornwall, sits in an attractive riverside location. After dumping my bags, I go for a run along a levee between the river and a nature reserve. It’s a lovely part of the world – startlingly flat compared to Cornwall.

The next day, I meet four volunteers from HAIRE and the team from East Sussex County Council, Rother Voluntary Action, and Lorna Ford, the new Deptuty CEO from Rother District Council. We all feel thrilled to be able to meet up after two years on Teams. In that time, 16 volunteers have been recruited and trained, 76 Guided Conversations have been held and more than 200 hours of information about health and wellbeing have been used in the research analysis. Key themes prioritised through the innovation process are loneliness, accessing information, life transitions, and staying active.

We have a great meeting, discussing the volunteer experience of using the HAIRE toolkit – especially the Guided Conversation – and the legacy of HAIRE which will be felt through the pilot projects in Age Friendly Rother, now officially a part of the World Health Organisation’s Age Friendly Community programme.

The eight domains of Age Friendly Communities are illustrated. They are: Communication and Information, Community and Healthcare, Transportation, Housing, Civic Participation and Employment, Outdoor Spaces and Buildings, and Respect and Social Inclusion. 

Above: the eight domains are Communication and Information, Community and Healthcare, Transportation, Housing, Civic Participation and Employment, Outdoor Spaces and Buildings, and Respect and Social Inclusion. 

 

 

The Latest News from Poperinge

The following article, translated from the Dutch, appeared in the local publication, Stadskrant (“the City Newspaper”), in Poperinge, Belgium in February, 2022, informing local citizens of the work undertaken so far by Poperinge’s HAIRE team.

Poperinge is a partner in the HAIRE project, which stands for Healthy Ageing through Innovation in Rural Europe. The project aims to improve the wellbeing of seniors in Poperinge and its sub-municipalities, and to break through isolation and loneliness in the countryside. Numerous volunteers and professionals in healthcare have been involved in the project.

75 people over sixty were interviewed in Poperinge and smaller surrounding areas. The interviews mapped out the wellbeing of each participant, and allowed the drawing up of an individual action plan. The interviews are also part of a developing ‘community report’, with suggestions for all kinds of areas for improvement for the neighbourhood. Wellbeing is a word that is important in everyone’s life and at every age; meaningful and fun activities for the elderly help create a positive community atmosphere.

Four volunteers from Nestor services, the Local Service Center De Bres, WZC Huize Proventier and the Social Service went out with an extensive questionnaire asking about general well-being, what seniors think of their neighbourhood, what activities can be organized to help them age better and how everyone can benefit from this. A number of questions about the individual’s social network were also discussed.

The interviews lasted one and a half to two hours. The interviewee could choose from telephone or face to face sessions in person to complete the survey. Of course, all safety measures regarding coronavirus were observed during personal visits. Participation was entirely without obligation and participants were able to choose between a thank you gift voucher of 20 euros or two free meals delivered to the home by WZC Huize Proventier.

“Although I was armed with a mouth mask, safety screen and hand sanitiser, I was warmly welcomed everywhere by the fifteen interviewees despite Covid,” says Luc, who is 68 years old and volunteers at Local Services Center De Bres and WZC Huize Proventier. “Many older people found it a pity that services such as banks, post offices and shops are disappearing from their local areas. It’s vital for them that the city invests in basic services like neighbourhood salons or shops, which then become the beating heart of the village.”

MEANINGFUL ACTIVITIES

The person-centred topics in the survey addressed the emotional well-being of the seniors. It emerged that they need a listening ear for emotional problems and for things that are not going well in the specific care of older people. An effort is needed to enable more people to grow old with good mental health and well-being. Luc clarifies: “Participation in meaningful activities such as volunteering, culture promotion, computer education and in some cases staying longer at work are here clearly reflected in the answers.” Concerns about caring for later, dementia and early care planning were also discussed. Many seniors want to age actively. “Local cooperation is of great importance. It is important to gain insight into loneliness in all its aspects. Everything starts with making contacts. As a result, all of a senior citizens’ associations, including community workers, the police and the postman, are of great importance,” said Luc.

TO STAY INFORMED

Regular contacts with neighbours, friends, family and caregivers are crucial. Luc concludes: “On average, we noticed an increase in the number of relatives in the social network of seniors, but at the same time a decrease in the number of non-relatives. As you get older, your world becomes smaller. People around you die or become less mobile, so that they disappear from your social network. It is important that the seniors are provided with resources so they can stay informed and be involved in the world around them.”

You can read the article in its original language below:

CREATE Juin 2021 – Réflexion (French translation)

Our French intern, Valentine, has again translated this month’s blog for us into French.  It is a research reflection by Shuks Esmene, our postdoctoral research fellow. To read the original English language version, click here.

A l’occasion des ateliers CREATE, les partenaires du projet HAIRE se sont rassemblés pour discuter de leurs premières idées d’innovations destinées à améliorer le bien-être des séniors dans les sites pilotes. Les outils de recherche utilisés dans le cadre du projet représentent un aspect essentiel de l’apprentissage HAIRE. En particulier, les expériences et les idées de tous les partenaires, y compris des bénévoles et des participants, sont aussi importantes que ces outils le sont pour identifier des actions axées sur la personne et adaptées au milieu qui soient pertinentes à échelle locale.

Notre atelier de poésie a montré que les partenaires de prestation et les équipes de recherche du projet HAIRE sont parvenus à élaborer un environnement favorable à la discussion – même en ces temps troublés ! Les souvenirs de ces personnes âgées avec qui nous avons des liens privilégiés, par exemple des parents, des grands-parents, d’autres membres de la famille et des amis, ont inspiré une séance riche en émotions. Un de nos partenaires a fait remarquer :

« Ce ne sont pas des larmes de tristesse ! »

La remarque ci-dessus concernait un grand-parent défunt et résume la façon dont nos liens avec les personnes qui comptent pour nous s’étendent au-delà de leur présence physique auprès de nous. Bien qu’elles ne fussent qu’une parenthèse parmi les autres activités du projet, les réflexions que nous tirons de telles expériences peuvent aider HAIRE à amorcer des conversations relatives à l’intégration des soins dans nos communautés. Des soins plus approfondis. Des soins qui surpassent les besoins fonctionnels des individus. Ces besoins sont extrêmement importants, bien sûr. Cependant, le bien-être ne se limite pas à la somme des besoins fonctionnels d’un individu.

Les Conversations Guidées du projet HAIRE ont révélé que les activités et les passions qui importent aux participants (marcher, tricoter, lire et se rendre à des marchés locaux, entre autres) leur ont apporté de la joie et, malheureusement, de la tristesse lorsqu’ils n’ont pu s’y adonner pendant la pandémie. Ces conclusions ne sont en aucune façon propres au projet HAIRE, mais elles lui offrent plusieurs possibilités. Le réseau HAIRE, constitué de personnes soudées et attentionnées, va nous permettre de réfléchir différemment à notre façon de procéder face à ces conclusions. Certes, il est important de faire une liste des activités et des passions présentes dans une région, et de s’assurer que ces activités sont proposées à ses habitants, mais il faudrait aussi offrir l’opportunité aux séniors de développer de nouveaux centres d’intérêts et de nouvelles passions – ce serait une façon d’ajouter de la capacité à un lieu donné. La variété des activités et les activités extracurriculaires sont considérées comme une partie fondamentale du développement de l’enfant (1).

Je pense souvent à cette façon que nous avons d’essayer de trouver et de doser un assortiment d’activités spécifiques dont la population adulte puisse bénéficier – plutôt que de nous appliquer à mieux comprendre les modalités du bien-être de chaque individu. Comme nous l’avons dit durant nos discussions sur l’innovation au deuxième jour des ateliers CREATE, cela peut faire la différence d’« être prêt à commencer modestement » afin de produire des innovations qui restent ouvertes aux contributions des habitants – particulièrement si les opinions et points de vue reçoivent une réponse et ne sont pas perdus au fil des démarches administratives. A ce titre, les solutions numériques contribuent largement à améliorer la sensibilisation, mais c’était aussi encourageant de voir des idées se développer lors des ateliers autour des activités en face à face et de la notion d’« aller vers les gens ».

Dans leurs réponses aux Conversations Guidées, les participants ont communiqué l’importance qu’ils attachent aux interactions en face à face et aux évènements de rassemblement convivial. De plus, même si nous l’avons appris par le biais d’anecdotes, nous ne pouvons oublier que les commerçants et les docteurs étaient bien plus profondément intégrés dans les quartiers ruraux par le passé. Les services avaient plus souvent lieu en face à face, et ces expériences doivent être prises en compte lorsque l’on réunit des personnes âgées.

Par ailleurs, des préoccupations primordiales vis-à-vis du profil des participants recrutés jusqu’ici ont été soulevées lors des ateliers CREATE. On considère souvent qu’une méthode de communication qui attire et inclus les groupes vulnérables et marginalisés représente un défi (2). Les communautés inclusives doivent s’assurer que tout le monde sent qu’il ou elle fait partie du lieu dans lequel il ou elle vit, et que l’opportunité d’exprimer ses opinions leur soit donnée de façon à ce que tout le monde puisse contribuer à façonner l’avenir du lieu en question. Parvenir à une compréhension plus inclusive du bien-être représentera un défi important pour le projet HAIRE, et la démarche consistant à « être prêt à commencer modestement » pourra nous être bénéfique dans cette mesure également. La recherche a parfois tendance à se focaliser sur des chiffres et des objectifs à accomplir, tous les deux générés par des groupes larges et soi-disant représentatifs. Toutefois, si nous nous posons des questions essentielles sur les points de vue variés que nous avons recueillis pendant les Conversations Guidées, nous pouvons commencer modestement. Des questions telles que : comment se fait-il que quelqu’un qui s’est occupé des autres, et qui a travaillé dur dans un secteur qui n’est pas généreux économiquement, peut se retrouver dans une position financière précaire plus tard dans sa vie ?, et, que pouvons-nous faire pour impliquer quelqu’un à échelle locale quand cette personne n’a pas pu développer et/ou approfondir des centres d’intérêt à cause d’une enfance ou d’un début de vie d’adulte mouvementés ?

Enfin, la question qui selon moi ressort le plus de nos séances CREATE est :

« Pourquoi sommes-nous, en tant que société, si mauvais à cela ? »

La réponse se trouve peut-être dans une nouvelle conception des soins, une conception selon laquelle les soins seraient reçus et donnés par des individus dans leurs communautés, et ne seraient pas simplement un service dédié à répondre aux besoins fonctionnels des personnes âgées. Fait encourageant, nous avons parfois accompli cela au sein de projet HAIRE – que ce soit entre les chercheurs et les équipes de prestation, entre les équipes de prestation et les bénévoles, et/ou entre les bénévoles et les participants. Notre prochain défi sera de trouver des façons d’impliquer les donneurs de soins dans le projet, sur tous les sites pilotes, plus étroitement encore. J’ai hâte d’affronter ce défi.

Footnotes

1. Metsäpelto, R., & Pulkkinen, L. (2012). Socioemotional Behavior and School Achievement in Relation to Extracurricular Activity Participation in Middle Childhood. Scandinavian Journal Of Educational Research, 56(2), 167-182. doi: 10.1080/00313831.2011.581681

2. Meyer, C., Evans, D., Soucat, A., Dkhimi, F., Akweongo, P., & Kessy, F. et al. (2018). Leaving no one behind? Reaching the informal sector, poor people and marginalised groups with Social Health Protection. Journal Of Poverty And Social Justice. doi: 10.1332/175982718x1536143686739

CREATE Research Reflection: Caring

This month’s blog post is a research reflection penned by Shuks Esmene, our doctoral research fellow.

HAIRE’s CREATE workshops (held June 2021) brought together the partnership to discuss our initial ideas for innovations to improve the wellbeing of local older adults in our pilot sites. The research tools being used in HAIRE are a key part of the
project’s learning. Notably, the experiences and ideas of all project partners,
including volunteers and participants, are as important as these tools in
identifying person-centred and place-based actions that are locally relevant.

Our poetry workshop demonstrated that HAIRE’s delivery partners and
research teams have been able to build a comfortable environment for
discussion – even in these challenging times! Memories of older adults that we
hold special connections to, including parents, grandparents, other family
members and friends, filled the session with emotion. One of our partners
simply remarked, “These are not sad tears!”

Some of the poetry about ageing shared at our CREATE session

The remark above related to a late grandparent and sums up how connections to
people that we value go beyond being in their physical presence. Although a
small moment in HAIRE’s activities, reflections from such experiences can help
HAIRE start conversations around embedding care into communities. A deeper
care. Care that surpasses the functional needs of people. These needs are, of
course, extremely important. However, wellbeing is much more than the sum of
someone’s functional needs.

HAIRE’s Guided Conversations showed how valued activities and passions (walking, knitting, reading and going to local markets, to name a few) provided participants with joy and, unfortunately, sadness due to missing these activities and passions during the pandemic. These findings are in no way unique to HAIRE, but they do present the project with opportunities. The close-knit, caring network of people that HAIRE has engaged can help us to think differently about how we can act on these findings. A record of valued activities and passions in an area, and trying to ensure these activities are offered to locals is important, but opportunities to develop new interests and passions can be seen as a way of adding capacity to a place. Variety and extracurricular activities are regarded as a fundamental part of development in children (1).

I often reflect on why we try to find and measure a set of specific activities that show
benefit when adults are considered – rather than addressing how we can best
understand wellbeing priorities at an individual level. As stated during our
discussions about innovation on the second day of our CREATE workshops,
“…being willing to start small” to achieve innovations that stay open to input
from locals can make a difference – particularly if voices and perspectives are
responded to and not lost in bureaucratic processes. As such, digital solutions
are important in improving outreach, but it was encouraging to see ideas
develop around face-to-face activities and “going to people”.

A French Guided Conversation in action

Face-to-face interactions and events that bring people together were certainly
valued in responses to HAIRE’s Guided Conversations. Additionally, even if
revealed through anecdotes, we cannot overlook how local shop owners and
doctors used to be more deeply embedded in rural neighbourhoods. Services
were more face-to-face and such experiences need to be considered when
bringing older adults together.

Importantly, concerns around the participant profiles engaged by HAIRE so far
were raised at CREATE. Outreach that engages and is inclusive of vulnerable and marginalised groups is often referred to as challenging (2). Inclusive
communities ensure that everyone can feel part of where they live and, through
being able to voice and discuss their opinions, individuals can contribute to
shaping the future of a place. How we achieve more inclusive understandings of
wellbeing will be an important challenge for HAIRE and “…being willing to
start small” can benefit the project here too. Research can tend to focus on
numbers and achieving outcomes that are generated by large, so-called
representative groups. However, if we ask critical questions of the differing
perspectives that we have been able to gather through HAIRE’s Guided
Conversation, we can start small. Questions such as: why can someone that has
cared for others and worked hard in a sector that is not economically
generous end up in a financially precarious position in later life?, and, what
can we do to involve someone locally that has not been able to develop and/or
pursue interests due to a turbulent childhood and early adult life?

Finally, the question that stands out for me the most from our CREATE sessions
was: “Why, as a society, are we so rubbish at this?” The answer may lie in re-thinking care, where care is received and given by individuals in communities and not simply a service that aims to meet the functional needs of older adults. Encouragingly, we have examples in HAIRE where this has been achieved – whether it be between the researchers and delivery teams, between the delivery teams and the volunteers and/or between the volunteers and participants. Our next challenge is to find ways to engage the caring people on the project, across all sites, more closely. I look forward to
working on that challenge.

Footnotes

1. Metsäpelto, R., & Pulkkinen, L. (2012). Socioemotional Behavior and School Achievement in Relation to Extracurricular Activity Participation in Middle Childhood. Scandinavian Journal
 Of Educational Research, 56(2), 167-182. doi: 10.1080/00313831.2011.581681

2. Meyer, C., Evans, D., Soucat, A., Dkhimi, F., Akweongo, P., & Kessy, F. et al. (2018). Leaving no one behind? Reaching the informal sector, poor people and marginalised groups with
 Social Health Protection. Journal Of Poverty And Social Justice. doi: 10.1332/175982718x1536143686739

Shukru Esmene, s.esmene@exeter.ac.uk, University of Exeter