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.
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.
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.
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.
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 (firstname.lastname@example.org) or Lorraine Hansford ().
Left to Right: Tom Cox (Devon MIND), Fiona Carden (CoLab), Lorraine Hansford and Catherine Leyshon (University of Exeter)
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.
Jo Little, Shuks Esmene, Catherine Leyshon and Michael Leyshon, researchers at the University of Exeter, have been working on a new paper about loneliness which we introduce below. It’s one of the key issues for the rural ageing population in our study, and it’s particularly on our minds as we post, as it was recently Mental Health Awareness Week in the UK, and loneliness was the theme. For some practical tips on coping with loneliness in later life, the Mental Health Foundation has created a toolkit which you can access here.
Over recent years there has been growing recognition from government, policy makers, academics and the public of the significance of loneliness within contemporary society and with the associated deep and enduring negative consequences for wellbeing and quality of life. For example, a recent study characterises loneliness’s societal impact as follows: “Social isolation and loneliness has been classed as a major public health concern due to its negative physical and mental health implications, and living in a remote or rural area is a prominent contributing risk factor”. Loneliness has been referred to by the UK Minister for Loneliness as one of the greatest challenges of our time.
While the visibility of loneliness has increased substantially, and more understanding exists concerning its links to health, there are still important gaps in current research which we will explain and develop in our paper. We aim to develop critical scholarly understandings of loneliness that go beyond measurable indicators and risk factors (such as living in rural settings and mobility issues). While such indicators and risk factors are important in producing an overview of loneliness’s causes and impacts, loneliness is increasingly seen as not simply an individual problem and an issue that manifests due to a combination of risk factors, but as more inherently social, cultural and relational. As Geographers we are mindful of the difference that space and place make in both conceptual understandings of loneliness and its manifestation as a lived experience.
As we write, we begin with a review of the study of loneliness, summarizing some of the findings of what have been perhaps more traditional attempts to identify and measure experiences of loneliness. This provides an understanding of key trends but acts more as a springboard for the next part of the paper in which we, first, provide an improved conceptual understanding of loneliness as a dynamic part of the human condition, the definition of which derives from a set of cultural expectations as much as a lived experience which is embodied and performed in everyday life. We ask what is the connection between the apparent ‘epidemic’ of loneliness and the human condition in a world characterised by endless connection?
Second, and in a linked point, we call for more work on the multiple, shifting ways in which loneliness forms part of the lived experience. Much research implies a somewhat uncritical view of loneliness as a binary condition of being or not being lonely. This has implications for the sorts of solutions that are provided by governments, charities, communities, and individuals, which sometimes tackle ‘aloneness’ rather than ‘loneliness’. Loneliness has temporal and spatial dimensions, it comes and goes, can be experienced in a crowded place or when alone, has causes that are both identifiable and elusive, is linked to a sense of self and the place of the self in the community and wider society. Ultimately, loneliness should be understood as a profoundly subjective experience. Building on and developing Franklin’s 2009 paper, ‘On Loneliness’, we provide a critical examination of the key ‘taken for granted’ characteristics of loneliness. This will explore how loneliness is felt and experienced in contemporary society – and in particular how it relates to social bonds.
Our paper argues that a focus on space is a critical part of the complex jigsaw of loneliness – not simply that loneliness occurs more in some places than others – rather, that place can be central to the ways in which loneliness ‘sticks’ to identity. To explore these issues, we take as our focus rural spaces and the particular relationship between the constructions and contradictions of rurality and loneliness as part of its lived reality.
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.
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.
As part of the HAIRE project, the University of Plymouth is undertaking a systematic review on the impact of social networks on loneliness among older people living in rural areas. In this month’s blog, Basharat Hussain and Mahrukh Mirza, from the University of Plymouth, explain the process and findings to date.
Healthcare related decisions are critical and therefore need to be based on high quality scientific evidence. The scientific evidence on a topic is generated through individual studies. However, evidence from a single study may not offer confidence to policy makers and practitioners to change an existing practice or adopt a new intervention. This requires an acceptable method to pool all the relevant evidence on a topic and to make the information accessible to busy policy makers and practitioners.
Systematic review is a well-recognised method of identifying, evaluating and summarising evidence from all relevant individual studies, thereby making the available evidence readily accessible to decisionmakers. In a systematic review, all studies published on a topic (in our case, healthy ageing) are searched through online bibliographic databases (e.g., MEDLINE). The online searching of databases is undertaken using a comprehensive, reproducible, and predefined search strategy. This search can result in few hundreds to thousands of studies published on the topic globally or a geographical region of interest (e.g., Europe). The searched studies are screened using strict and narrow inclusion and exclusion criteria. These criteria can consist of research participants (e.g., age over 60 years), setting (e.g., rural areas) and phenomenon of interest (e.g., impact of social network on loneliness). All studies meeting the inclusion criteria are thoroughly read, quality assessed, and their findings synthesised. The final product is a summary of findings on a topic of interest and identification of any gaps for further research in that area.
The review started in January 2022 and will be completed by April 2022. A comprehensive search strategy has been developed to search five main healthcare related databases on the topic. The search has identified over 38,000 published studies on the topic globally, starting from 1954 to January 2022. Screening of the published studies is underway. An interesting finding struck during the screening process is an acute lack of research on social networks and loneliness among older people in rural areas of Europe.
The findings from this review will be helpful not only for the HAIRE project, but also for policy makers, practitioners and researchers who have an interest in the topic. If you are interested in knowing more about this systematic review or would like to have copy once the findings are published, please get in touch with Dr Basharat Hussain, Research Fellow in Health Innovation, University of Plymouth (Basharat.email@example.com), OR Dr Mahrukh Mirza, Lecturer in Clinical Education, University of Plymouth (Mahrukh.firstname.lastname@example.org).
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.”
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:
Season’s Greetings! After nearly two years of working together throughout the Covid pandemic, the team has still not managed to meet up in person since the project launch in early 2020. At the end of 2021, plans for our first face to face gathering were once again thwarted by the emergence of Omicron, but we are still finding ways to connect with each other on a personal level despite everything. To celebrate the season, the HAIRE team got together virtually to share their favourite family recipes from each of our four countries: the UK, France, Belgium and the Netherlands. Such was the response we decided to make our own HAIRE recipe book, featuring tasty dips and snacks, desserts and treats from across the 2Seas region. Below are a few highlights …bon appetit!