Guided Conversations (GC) Part 2. Designing a GC

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.

Guided Conversations Part 1. What happened in HAIRE?

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.

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

Feock Parish Looks to the Future: HAIRE ‘Thank You’ Day

The following is a write up of Feock Parish’s ‘Thank You’ community event in February, 2023, held at Trelissick Gardens and organised by the Feock HAIRE team as the research project nears its end in March. Read on to find out what’s next for HAIRE in Feock.

A gentle thrum of chatter fills the Barn at Trelissick, which is twinkling with fairly lights and winter sun streaming through the windows. More than sixty people – including volunteers who have been involved with the HAIRE project in various ways – have gathered to hear what Feock Parish Council’s HAIRE team have to say about the project as it reaches its completion and to share in a discussion on its effect on the community and its legacy. They are also here for an almost-spring walk through the gardens with the National Trust team at this special estate on their doorstep.

The HAIRE team was led by Cllr Keith Hambly-Staite on behalf of Feock Parish Council and included Bex Rawbone, the Project Co-Ordinator and Cathy Whitmore, Project Administrator together with numerous volunteers who supported them. They all agree that HAIRE has impacted people’s lives by enabling older people to be listened to, and by supporting and developing a community directory of activities and services, improving connection and participation across the parish. Bex Rawbone created activities and events with very limited money and resources throughout a challenging time. These have had the effect of helping to empower people and improve their wellbeing. One new service put in place as a result of Covid restrictions has become an innovation the community cannot do without in the world after the pandemic: a telephone helpline.

A significant outcome of the project was the way Feock Parish Council re-examined its role regarding community support. It has determined to use the evidence of the project to continue with the services developed during the project. Cathy’s role as the helpful voice on the end of the telephone can’t be underestimated; throughout lockdown, it was Cathy who coordinated shopping and prescription collection for residents unable to leave their homes, and later, when supporting those living alone, she was not only coordinating services but forging connections with lonely residents. Feedback has been overwhelmingly positive from both service users as well as providers:

“HAIRE activity has helped people socially…and given them a new lease of life.”

“You have all done a wonderful job making things happen and providing a lot of help for a lot of people.”

“From an NHS point of view we appreciated everything that the team did for our patients – collecting scripts; helping wellbeing.”

Cathy’s role will be made permanent after the pilot stage of Project HAIRE ends, as it’s been recognised that people do so much better when they have a listening ear. Having time to talk and listen is one of the most important learning outcomes for Feock. When reflecting on the HAIRE outcomes, the team say it has engaged a whole new way of thinking about supporting the community – a two-way community engagement link whereby access to local information and resources is made easier. A community directory has been made available on a new community wellbeing website, MyFeock, and activities are advertised in numerous ways, using both traditional posters, word of mouth, and social media.

“It has connected people who would otherwise have stayed at home, often by themselves.”

“Sense of belonging and participation”

“Made life more interesting!”

The HAIRE approach means that throughout the pilot phase, the team were attentive to community-level interests, which can change over time. Some innovations have a life-cycle that is shaped by a community’s lived experiences: it’s useful for a time, then it can evolve into something new. What HAIRE provided – and will continue to provide – is dialogue with communities and understanding so that changes can be made as and when they are appropriate. The continued involvement of local volunteers and community members is vital as HAIRE moves beyond its pilot stage. As one of the local NHS service providers made clear to the volunteers: “We could not do it without you.”

If you would like to know further information about Feock’s wellbeing opportunities, help to support their services and to know what’s happening in Feock Parish, contact:

Telephone: 01872 863 333 (Monday – Friday, 9.30-12 noon)

Email:

Facebook: MyFeock Wellbeing

Website: www.myfeock.co.uk

Cross-border Learning: Belgian and UK partners exchange experiences

In early November, SIG‘s HAIRE team were delighted to welcome our Belgian partners Sofie Schepers and Katrien Serroyen who were visiting Cornwall from Laakdal. After a weekend of cultural and historical activities – taking in Guy Fawkes’ night and a tour of Falmouth’s Tudor castle, Pendennis – they spent a day exchanging experiences with Feock (one of our pilot sites) before travelling to East Sussex pilot sites and meeting our partners at Rother Voluntary Action and East Sussex County Council.

The East Sussex team were keen to give as broad a picture as possible of their locality and took our Belgian colleagues on a tour that took in the quaint beauty of Rye (cobbled streets and the fifteenth century Mermaid Inn), Tilling Green social housing estate, new housing in Winchelsea, and a relatively new community hub – The Hub on the Hill – which runs many classes and services for the community with an emphasis on older residents.

Katrien and Sofie are smiling, standing in front of Pendennis Castle in Falmouth, Cornwall

Katrien and Sofie at Pendennis Castle, Falmouth, Cornwall

The cultural exhange and sharing is important for Interreg2Seas funded projects. They promote cooperation between regions and countries to enhance economic and social development in our own countries and across borders. Our HAIRE 2Seas partners share the common challenge of supporting people to age well in rural areas, where loneliness and isolation and mobility problems are just some of the themes being tackled. Having had very few opportunities to meet due to restrictions brought about by the Covid pandemic, it was inspiring to share experiences and perspectives from nearly three years of HAIRE action and learning in our respective locations.

The HAIRE teams from East Sussex and Belgium are looking over a vista of housing and fields near Rye

Steve, Sue and Naomi from East Sussex taking the Belgians on a tour of their locality

At the initial meeting in Devoran, the village in Feock parish where the council offices are located, the difference between locations felt quite stark to our Belgian colleagues: Laakdal is a municipality with a population of around 16,000, whereas the population in Feock Parish numbers around 3,700. The larger East Sussex pilot sites felt more familar to the Belgian team. Yet one of the most difficult challenges for all locations has been reaching members of the community who may be in need, or may benefit from HAIRE’s activities, but who are almost “hidden.”

The extended HAIRE team pictured in the "warm space" at Feock parish council

The extended HAIRE team pictured in a community space at Feock parish council

However, as a result of the emphasis the HAIRE toolkit placed on listening to residents, the needs of the older population as a whole can be better taken into account. Now that HAIRE and its ethos of co-creation and listening is familiar to each department and area of responsibility, the views, opinions, needs and ideas of residents are being heard, and this has led to subtle changes in the system. Different methods to listen and co-create products and services have been introduced in all of our pilot sites to ensure their older residents are included in important decisions.

Feock now has an information and help line, originating out of the Covid pandemic, but which has become a staple of the parish. A legacy of HAIRE is that parish-based decisions take into account any impact on the older population in a way that they may not have been so obviously before. It is the same in Laakdal: the planning department, for example, is aware of the way its decisions impact the elderly – and they are now prepared to consult the HAIRE team for information about how they might best move forward with their works.

East Sussex partners have done an excellent job by instigating local and national design innovations after working with the RSA, the royal society for arts, manufactures and commerce (“committed to a world that is resilient, rebalanced and regenerative, where everyone can fulfil their potential.”) Their Hastings and Rother Ageing Network meets monthly to network with local organisations, groups and individuals with a focus on how they can work together to make Rother and Hastings healthy and supportive places to grow older in.

From a longer term, strategic standpoint, Feock has made the decision to work with partners to develop a formal age-friendly community as our partners in East Sussex have done. The Guided Conversations in pilot sites illustrated the multiple dimensions of ageing well, which prompted the need for a holistic system response, and the UK arm of the World Health Organisation’s Age Friendly Communities programme is well aligned with the aims of the HAIRE project.

As Katrien and Sofie pointed out, the pilot site comparisons were useful, showing commonalities and differences and making them reflect on what went well in their own communities – and how “HAIRE thinking” could be built into longer term planning.

“Feock felt very isolated in comparison to Laakdal. The lack of public transport, the lack of shops, the very rural environment, the huge amount of second homes … I would think that building the community would be very difficult. Yet they succeed to organise meetings where 80 people attend and they make the most of small things (the red phone booths made into small libraries). Well done Feock! Rye felt more like Laakdal. What stood out was that both pilot sites are much more in contact with the church. In Belgium the church doesn’t organise much and in our pilot site the church isn’t involved. What was also different is the health part. I think that in the UK the health partners and health “input” is bigger than in Belgium. In Laakdal it’s more community building and well being than health. What I think both pilot sites did very well is thinking about life after HAIRE right from the beginning of the project. I believe that that will make it possible to continue and embed HAIRE better.”

The Belgian team are pictured with people from Feock and the University of Exeter - and the HAIRE mascot, a Corgi called Treacle

The Belgian team with Feock and the University of Exeter – and the HAIRE mascot, Treacle

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.

Kate’s Grand Tour Part 3: Training in Adjacent Areas

One of the objectives of our project is to extend the use of the HAIRE toolkit beyond the borders of our pilot areas. Kate’s visit to Laakdal (one of our pilot sites) included training new volunteers in the village of Bergom in the neighbouring municipality of Herselt. This region is a good example of how the toolkit can be customised to suit the community it is used in. Assisted dying is legal in Belgium, and the toolkit needed to include training volunteers in conversations about end of life. This is the third of four short blogs about Kate’s visit to Belgium in April, 2022.

On my second full day in Belgium, myself and the local project team (Katien, Sophie and Severine) train Jill Van der Auwera from the neighbouring municipality of Herselt, which comprises the villages of Herselt proper, Ramsel, Blauberg, Bergom and Varenwinkel. The sat nav takes me to an empty field about 5k from our meeting point. Thank goodness for Google Maps.  

We meet in a community hall in a small village surrounded by farmland and forests. This area feels more remote than Vorst, with more small, scattered settlements. The team in Laakdal – including the volunteers – will help to train professionals and volunteers in Herselt in the next few weeks. The issues that face their older community – especially the rising cost of living – are very familiar. We incorporate the insights from Laakdal’s volunteers into the session, which really helps with the practical aspects of applying the HAIRE toolkit elsewhere. After our session, we walk through the quiet, neat village to the magnificent Catholic Church with its lofty, modern interior and high, vaulted wooden ceiling.  In the evening, I drive to Bergom to attend the training of volunteers in conversations about end of life. This is a particular focus for Herselt and an issue for which they have adapted their Guided Conversations. Although the training is in Flemish, I keep up with the slides by putting a few key phrases from each into Google Translate. The training covers why and how we should talk about and prepare for the end of life along with useful case studies. Assisted dying is legal in Belgium, so some of the training is about that. A new model of palliative care is presented which introduces elements of palliative care alongside continuing treatment in a more gradual way. This breaks down the cure/care dualism in which only when the search for a cure ends does palliative care begins. Instead, this model seeks to open up the conversation about the journey towards the end of life more gradually and in a supportive and empathic way. It is a moving and very productive session.

 

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)