In part two of his blog, Shuks outlines key considerations for future users of the Guided Conversation tool.

This blog post builds on Guided Conversations Part 1. We outline key considerations for communities, organisations and individuals who may be interested in designing their own GC.

Although the topics that a GC aims to explore may be complex, such as wellbeing, three main principles can inform the design of a GC.

1. GC participants are given an open platform to talk about what is important to them.
2. Creative prompts are used as a starting point for conversation.
3. The creative prompts need to be relevant to an overarching open question, places that are of interest for a GC and the people who will interact with the GC.

The first principle, above, is a key ethical consideration for the study of subjective topics, like wellbeing. The open platform mentioned by the principle is not only linked to the way participants are asked questions, but to their comfort. Comfort is provided by relationship building and ensuring that participants feel at ease with the individuals who are conducting GCs and in the spaces that GCs are held. Therefore, the individuals who will conduct GCs really matter, as do the places that will be used to hold GCs.

If appropriate, GCs can be co-ordinated as a way of thinking within a community, as opposed to a sit-down, one-to-one method. The points listed below outline what individuals in a community can think about during their natural, informal conversations. The scenario links to a community space where members of the community, volunteers and health and social care professionals can meet, e.g. a Community Hub.

• Start with an easy, open question that will encourage someone to talk about their opinion of the local area – e.g. how do you find living here / where you live?
• When a problem comes up, we can ask individuals to talk about how they might be supported with an issue.
• There is not always a solution, sometimes people just want to talk and that’s fine.
• If you know of any recommendations that may help the individual, e.g. a club, social activity and/or charity that can help, feel free to tell them about it.
• For issues that require the involvement of a professional, you can fill in an Info Postcard and pass it on to a professional that deals with welfare issues. An explanation of an Info Postcard is provided in the paragraph below these points.
• An Info Postcard should only be filled in with the permission of the individual that it relates to and requires their approval, e.g. by signature.
• Respect the privacy of all individuals and do not pass on any details of your conversation to anyone else without their permission.

The approach outlined above can be appropriate for a drop-in help hub or social engagements that are organised for locals. In the case above, the Info Postcard refers to a simple piece of paper that can be given to a professional that is involved in the co-ordination of social and health care support. Example of an Info Postcard:

Interestingly, in the case above, there does not seem to be any creative conversational prompts – so, what happens with the GC’s second and third principles, which are all about creativity? Here, informal conversations are taking place between locals in their neighbourhoods and/or in a space that is part of a community. The surroundings become the conversation’s creative prompts and individuals can reflect on their neighbourhood’s influence by being there. An individual might think of a time when a certain building was their favourite grocers or memories of walking in the streets with friends. Like in HAIRE’s GC, the possibilities for sparking conversation are endless. Importantly, the prompts, i.e. being in the actual spaces, are still aligned with the GC’s overarching broad question: “how do you find living here?”

The example above does not intend to underplay the role of creativity in GCs. During group and/or one-to-one interactions, creative prompts can make the GC experience more engaging. Principles two and three, as listed in this blog’s opening paragraph, invite GC co-designers to think about what would be meaningful for their participants. In HAIRE, the spaces and cultural symbols in neighbourhoods and in people’s homes guided our co-design work. Hoiw However, in other cases, images that are more open to interpretation might be suitable. An example of this is the Talking Deck that was designed to talk about wellbeing in a support hub for individuals with experiences of homelessness. A blog about the Talking Deck can be seen here: Talking Deck Blog. In this case, the broad overarching starting point was to encourage individuals to talk about their day, or their week, form their own perspective.

Additionally, creative prompts do not necessarily have to be in graphic form. If interested in culture-led influences on wellbeing, it may be more appropriate to use physical objects that are well-recognised and valued by a certain culture. An interesting study, published in 2021, explored community-level opinions about Maori culture and belonging in New Zealand. Their toolkit used a selection of physical objects. The study authors reported the following:

“The aim of this [the physical objects] is to create a unique and shared experience, where the objects are used to assist participants in connecting with each other. Participants have an opportunity to comprehend and verbalise aspects of their and others’ identity and context. This experience aims to deepen their individual understanding of what belonging means to them and others.”

[Citation: Zino, I. et al. (2021) “things for thought – a creative toolkit to explore belonging,” Design for Health, 5(1), p.93. Available at: https://doi.org/10.1080/24735132.2021.1883822]

Written texts, stories and poems can spark memories, opinions and emotions in relation to a topic of interest. GC co-designers can use such resources as creative prompts too. In HAIRE, Kelly Stevens (University of Exeter) used a poetry workshop to explore the meaning of ageing and care with the project’s partners. A blog on this activity can be see here: Poetry, Caring and Ageing Blog. The session was structured around the following overarching question: “what does healthy ageing mean?” See below some of the poems and thoughts that were discussed at the workshop:

Therefore, when designing a GC, it is important to think about the creative skills that are present in the local community and/or the team that is co-ordinating the design of a GC. Creativity that is embedded in a community and amongst individuals who understand a GC’s topics of interest can be used to produce prompts that are relevant in particular settings. In fact, HAIRE’s work on the GC has highlighted the value of creativity when engaging communities with topics of interest that are loaded with meaning and, at times, influenced by uniqueness. The Social Innovation Group (SIG), University of Exeter, aims to build on its work in HAIRE and further develop understanding around the ways in which creativity can enhance inclusion and meanings around wellbeing.

Shuks Esmene, the postdoctoral research fellow on HAIRE, reflects on the Guided Conversation, a key part of HAIRE’s toolkit, in a two part blog.

In this blog, we document how HAIRE’s Guided Conversation (GC) shaped the project’s insights into the wellbeing of the older adults in its pilot sites. We reflect on the attributes of the GC that enabled the project to explore the deep, changeable and sometimes unique aspects of wellbeing.

HAIRE’s Guided Conversation (GC) was co-designed by the project’s partners to support older adults in discussing their needs, knowledges and skills, and aspirations. In-depth, one-to-one dialogues in community settings helped HAIRE to understand how place-based, person-centred and structural influences combine to shape wellbeing at an individual level.

Broadly…

• …Place-based influences refer to the places and spaces that individuals use for socialising and during their daily routines. Places and spaces that have shaped a person’s life experiences, past and present, are important too.
• …Person-centred influences encompass the life experiences that shape a person’s self-esteem, confidence and how they relate to others. Such experiences guide what a person finds meaningful and values, which can change over time.
• …Structural influences are defined by the support that is available and accessible for a person – particularly in relation to how social and health care services are organised at a local and national level.

What is HAIRE’s GC and how did it help?

HAIRE’s GC combined creative conversational prompts and broad wellbeing-related topics that were of interest to the project’s partners. In brief, partners were interested in how a person’s local neighbourhood and living spaces influence their wellbeing. The creative prompts that we co-designed reflected these interests. Essentially, the creative prompts encouraged individuals to: i) think about their wellbeing in relation to their local area and ii) think about how their living spaces influence their wellbeing.

Example of a creative conversational prompt that relates to a local area (HAIRE’s pilot site in Goes, the Netherlands):

Example of a creative conversation prompt that relates to a living space (co-designed for HAIRE’s pilot sites in Department du Nord, France):

The collages shown above were co-designed via an iterative process. Input and feedback, collected during multiple points of the design process, was provided by the project partners and the groups, organisations and individuals that they worked with in HAIRE’s pilot sites. The collages do not intend to be representative of anyone or any place. Their main purpose is to help conversation.

Ultimately, HAIRE wanted to understand wellbeing as told by the project’s participants. To do so, broad questions were posed to the older adults that resided in the project’s pilot sites. For example: “how do you feel about living in your neighbourhood?” Responses to these types of questions can be difficult to articulate – particularly if individuals have not had the time to reflect on such matters. The creative prompts provided participants with a starting point for their thoughts. The streets and spaces in the collage can remind someone of a specific experience that they had in their neighbourhood, cultural symbols may spark thoughts about belonging (positive and negative), depictions of wildlife can induce conversations about someone’s fondness for nature, or a difficult time that they had with a wild goose. The possibilities are endless!

Importantly, the materials that are co-designed for a GC need to work in combination with active listening. Active listening’s six key skills are summarised below:

In terms of active listening, a person conducting a GC can focus on:

i) Taking an active interest in what a participant is saying (1. Pay Attention);

ii) Refraining from imposing their beliefs on someone’s opinions (2. Withold Judgement);

iii) Staying attentive to what can be asked next to understand a person’s experiences and opinions in relation to what a GC aims to explore (3. Reflect);

iv) Taking notes (if relevant) that are structured to summarise the key points of what is being said – usually, capturing positives, key issues, anything that can be done to address such issues (including actions that the individual can do) and any support that can be provided to address someone’s problems works well (4. Summarise);

v) Asking follow-up questions to understand points of conversation that seem unclear (e.g. “so, you mentioned that your relationship with the local area was ‘up and down’, what do you mean by that?”). This point is important for understanding certain issues and what can be done to support a person to navigate those issues (5. Clarity);

vi) Explaining to participants the key points that were captured from the conversation. This can be done via sharing any notes that were taken and/or explaining a summary of the conversation to the participant at a later date. Here, an opportunity is provided for a participant to confirm and reflect on what is important for them (6. Share).

The creative prompts in HAIRE’s GC and active listening helped to guide conversations with older adults towards the topics that were of specific interest to the project’s partners. In all, there were 20 topics (examples include facilities and amenities, social and cultural opportunities, mobility, identity and belonging, and inclusion). Not all topics had to be covered, but they provided opportunities to build on what a participant was saying about their wellbeing. A bit like a menu for conversation that can be picked from, based on what is important to a participant.  Although, the rich menu of 20 conversational options did come with its challenges. Conversations could last up to 4 hours and remembering all of the options while a conversation was ongoing proved to be tricky.

In principle, the GC is all about allowing for deep and far-reaching conversations to take place. However, in many circumstances, other time constraints mean that conversations need to, at least, have a rough estimated duration. Such circumstances can benefit from limiting the number of specific topics in a GC and/or ensuring that a conversation is spread across multiple interactions, at different times, with a participant. In our next blog, HAIRE’s learning will be drawn on to provide an overview of key considerations for designing a GC.

The Rother (East Sussex, UK) Voluntary Association AGM took place on 19th October 2021 and included the first RVA Volunteer Award ceremony. The award for Outstanding Volunteers was presented by The Lord Lieutenant of East Sussex, Mr Andrew Blackman, and received on behalf of the team by volunteer Hans and Councillor Sue Prochak. The nomination for the award is printed below as it sums up beautifully the work of the volunteers. It was written by Steve Broome, HAIRE Project Manager, Policy & Strategic Development Team, Adult Social Care and Health at ESCC.

The Healthy Ageing and Innovation in Rural Europe (HAIRE) project is an Interreg-funded initiative led by the University of Exeter that works with a wide range of partners across England, France, Belgium, and the Netherlands. At the centre of the project is the importance of understanding the lived experience of ageing in multiple ways – in terms of physical health, mental and emotional wellbeing, loneliness, social relationships, connections to local organisations and services, transport, finances, and what people perceive their future might hold.

In 2020, just as the pandemic was beginning, the HAIRE project began advertising for volunteers who cared about the above issues in their Rye or Robertsbridge communities. Even in the midst of the challenges brought about by Covid, the HAIRE project was very lucky and grateful to have received interest from such an individually and collectively talented group of local people. The volunteers brought a range of professional experiences relevant to healthy ageing, and rich personal experiences of local community life and issues connected to ageing and wellbeing. All our volunteers live in the Rother area, and many have numerous voluntary and activist roles in their communities to improve wellbeing and community life in a diversity of ways.

The HAIRE volunteer team have supported the project for some 16 months and counting. The task of volunteers has been wide and complex and required flexibility.  Firstly, they undertook multiple training sessions that covered: healthy ageing theories, data, and attitudes; reflection on their own attitudes and experiences of ageing; active listening and interviewing skills; safeguarding; loneliness and mental wellbeing; understanding social networks; and action planning.

Following the training, volunteers had to put all these skills and knowledge together in conducting Guided Conversations with people aged 60+ who lived in the Rye and Robertsbridge areas. These conversations were very wide ranging, covering all the aspects of healthy ageing described above, and typically lasted 2-3 hours each. They required volunteers to build rapport and trust with others and be able to support and empathise with difficult experiences and topics, while also recording relevant information in written notes. The team have completed more than 200 hours of guided conversations, and are now repeating the exercise in going back to our 80 or so participants and seeing how things have changed for them six months on.

Beyond this, the volunteers have formed local steering groups in each of our pilot sites, meeting regularly to help guide the project, interpret data, make strategic decisions and co-produce community events. Most recently, they have helped to design and deliver events in the community with a wide range of resident and organisational stakeholders, which have resulted in innovative ideas to take forward over the remaining 18 months of HAIRE.

The volunteers have managed to do all this in the context of the COVID-19 pandemic.  This has meant having to adapt to digital ways of working, despite many volunteers not having a high degree of familiarity with the technologies we have needed to use to run many aspects of the project virtually.

To date, the HAIRE project has engaged approximately 80 local people aged 60+ and taken the time to understand their experience and situation, to reflect on it, and help identify actions and sources of support that can improve their lives and age well in place. Volunteers have helped to identify the most important themes around healthy ageing in their communities and have been a key part in designing social innovations that will meet the challenges and opportunities of ageing faced by local people.

Throughout their volunteering, they have been very generous with their time, ideas, passions and personal experience. Not only has this been key to growing a team (rather than a set of individual volunteers) and to supporting each other in the multiple and challenging tasks they have undertaken, it has directly expressed the values of the HAIRE project in a way that has been ‘socially contagious’ – because they have been passionate, committed, open, kind, and generous, others have responded similarly and felt included in the project. They have set, and continue to set, the tone of the project in a way that makes more ambitious, transformative change possible.

The project, and everything that will stem from and be influenced by it, would not have been possible without the individual and collective contributions of the HAIRE volunteers. The wide range of people involved in the HAIRE project in East Sussex and beyond are extremely grateful for their involvement in the HAIRE project and look forward to continuing to improve the lives of local people with them.

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If you have any questions about HAIRE, please contact HAIRE@exeter.ac.uk

Videos, posts and more information coming soon!

Best wishes from

The HAIRE project team