Big Lottery Research Articles

Lessons learned from a gender-specific educational programme supporting young women with experience of domestic abuse

Background: Domestic abuse is a public health issue, and increasing evidence suggests that young women are more likely to suffer than older women, yet limited evidence exists in England about educational and intervention programmes for young women at risk. Study’s objectives: To evaluate a gender-specific (women-only) programme aimed at educating young women aged 13–25 years about abuse and staying safe in one English city. Setting: A third sector (charitable) organisation, aiming to improve women’s health in one English city delivered the programme over a 3-year period, funded by the Big Lottery Fund. Young women received both peer and one-to-one support, to educationally inform them, develop their skills and improve their capabilities in responding to abuse. Method: This qualitative evaluation captured the perspectives of young women accessing the programme ( n = 33), exploring the positive difference that it made to their lives. We also captured the views of internal stakeholders in 2018 ( n = 2), then followed up in 2020 ( n = 3), and external stakeholders referring young women to the programme ( n = 8). Results: The programme met its aims. Self-reported changes in young women’s lives included increased knowledge about staying safe and being happier. Some young women gained or retained custody of their children, and others exited harmful relationships. Young women identified a range of mechanisms of success including a non-judgemental approach from workers, peer support and a trusted space in which to meet and learn. The programme increased young women’s skills to stay safe while improving their mental wellbeing. Conclusion: The programme worked well for young women who accessed it. However, it could not reach all those in need, was only funded in the short-term and tended to individualise the responsibility for staying safe. Further research is needed in other community-based educational programmes to provide evidence of their effectiveness as well as transferrable models for workers in other contexts.

A partnership approach: supporting and empowering vulnerable women within one UK city

This paper draws upon a three-year longitudinal qualitative evaluation of a voluntary sector strategic partnership and delivery project involving eleven women-centred organisations. The consortium, funded by the Big Lottery (charity), worked together to support the most vulnerable women and girls across a city in the north of England 2017-2021. The partnership of eleven female led organisations delivered front-line services which aimed to enable women and girls to lead safer and healthier lives. Partners combined their expertise to support women with multiple needs including: mental health, domestic abuse, sexual violence and exploitation, experience of the criminal justice system, sex work, and substance misuse. The project aimed to achieve 3 outcomes: Outcome 1: Improved and extended access for vulnerable women and girls in Leeds to the services and support they want when they choose; Outcome 2: A holistic response to ensure that the needs of women and girls with multiple and complex issues are better supported; Outcome 3: Women and girls will be empowered to support their peers and influence service delivery, development and design across the city. Our evaluation placed the project staff, partners, stakeholders and service users at the centre of qualitative data collection, using a co-produced Theory of Change approach to data collection. Our sample of 34 service users, 35 professionals (19 interviewed twice) and monitoring data shows that the project successfully met its objectives and developed a model of practice that could be used in other contexts to support and empower vulnerable women.

Community Connectors (CCx): the strategies employed by peer to peer connectors to foster relationships with early years caregivers to improve universal early child health and development

Blackpool is one of the most deprived Local Authority (LA) areas in England; in April 2015 the Blackpool Better Start (BBS) Partnership was allocated £45 million over 10 years from the Big Lottery Fund (BLF) as one of five ‘A Better Start’ initiative areas in England. The aim of the ‘A Better Start’ initiative is to improve outcomes for children from conception to 3 years of age. Co-designed by professionals and the community, the Community Connector (CCx) programme employs residents to directly engage caregivers of children, in seven of Blackpool’s most socio-economically deprived wards. The CCx follow a socioecological framework which proposes that caregivers will be positively influenced to engage in early years activities because of connections to trained peers. Peer support models are commonly applied within targeted early years health settings (i.e., infant feeding support, literacy) yet their role to improve child outcomes at a universal level has received little attention. This paper focuses on caregiver-level evidence of the strategies employed by CCx - part of an early stage pilot study supported by Frontiers of Innovation, the Harvard Centre on the Developing Child’s Research and Development platform.The study collated attendance data from Children’s Centres, these are publically funded community centres providing information and activities for families with children 0–5 years of age. The study data included individual interactions between a CCx and caregiver over a 1 year period (1st April 2018 – 31st March 2019). A sampling frame was created from which a total of 22 interviews with caregivers were undertaken in early years community settings. The interview data was thematically analysed; the findings highlighted the mechanisms by which CCx served to mediate service and caregiver communication boundaries, negotiate access to spaces, and encouraged sustained engagement in longer term activities such as volunteering and training. Value was embedded by the CCx in their process of establishing and maintaining connections with caregivers through the ‘everyday’ conversations, their individualised approach and in demonstrating self-efficacy behaviours. Further research is required to review the impact of the CCx role in caregiver’s recall of early years information, nevertheless the study provided important learning for establishing formalised CCx programmes elsewhere, and has implications for community health and early years policy and practice.

Implementation evaluation of multiple complex early years interventions: an evaluation framework and study protocol

IntroductionImplementation evaluations are integral to understanding whether, how and why interventions work. However, unpicking the mechanisms of complex interventions is often challenging in usual service settings where multiple services are...

Schools address needs of young carers

Young carers face challenges in fully accessing education, so schools are being given the tools to better identify those in need of support PROJECT Young Carers in Schools Award PURPOSE To equip schools to support young carers and recognise good practice FUNDING The award scheme is part of the wider Young Carers in Schools programme, which was kickstarted by the Queen's Trust and the Big Lottery Fund. It is now funded by a range of businesses, charities and trusts

Using the Social Return on Investment Framework to Evaluate Behavior Changes of Individuals Living With Learning Difficulties

A number of scholars have raised concerns that many social marketers fail to consider the cost of their programs and its related savings. One solution is to use the social return on investment (SROI) framework, which is rooted in the theory of change. To demonstrate its possibilities, a single case study, focusing on a small social enterprise based in the north of England, was used. They apply social marketing (SM) principles to influence positive behavior changes in people living with learning difficulties. The study was limited to their Teens-n-Twenties program, which was designed to support individuals between the ages of 14 and 25 become more independent. The results demonstrate that the program had an SROI valued somewhere between 2.36:1 and 3.88:1 (i.e., for every pound invested, a value of between £2.36 and £3.88 was delivered in social worth). This evaluation was used as evidence of the program’s effectiveness in a continuing funding bid, and the organization was awarded just under £500 K from the United Kingdom’s Big Lottery Fund. The study contributes to the knowledge and practice of SM by presenting a possible solution to the domain’s concerns on how SM can be evaluated.

Language support gets families talking

Children and families get early support to live healthier lives, improve mental wellbeing and address emotional and communication issues PROJECT Let's Talk PURPOSE To improve the communication and language development of very young children and reduce referrals to the statutory speech and language therapy service FUNDING A Better Start Southend (ABSS) is part of the 10-year National Lottery-funded A Better Start programme set up by the Big Lottery Fund. In Southend, the programme is funded to the tune of £40m. Let's Talk has a £1.1m budget allocation, including staffing costs, from summer 2016 to summer 2019

Reframing "participation" and "inclusion" in public health policy and practice to address health inequalities: Evidence from a major resident-led neighbourhood improvement initiative.

There is a need for greater conceptual clarity in place-based initiatives that seek to give residents of disadvantaged neighbourhoods more control over action to address the social determinants of health inequalities at a local level. In this article, we address this issue as it relates to the concepts of participation and inclusion. We draw on qualitative data generated during the first phase of the Communities in Control Study, a longitudinal multisite independent evaluation of the impact of Big Local on the social determinants of health and health inequalities. Big Local is a resident-led area improvement initiative in England, funded by the UK Big Lottery Fund. Initiatives focused on community empowerment are increasingly prominent in public health policy and practice globally. Approaches emphasise the promotion of greater control over decisions and action among individuals, groups, and communities, particularly those living in disadvantaged circumstances. However, when it comes to participation and inclusion in taking action and making decisions, the field is characterised by conceptual confusion. This risks undermining the impact of these initiatives. While participation and inclusion are necessary conditions for empowerment and collective control, they are not necessarily sufficient. Sufficiency requires attention to the breadth of participation (i.e., to inclusion) and to the depth of participation (i.e., the extent to which it is experienced as empowering and ultimately enables the exercise of collective control over decisions and actions). In observing how different Big Local resident-led partnerships across England are tackling the day-to-day challenges of engaging with their communities, we reveal the potential for policy and practice of reframing, and therefore clarifying (to highlight the different roles they have) the concepts of participation and inclusion in terms of depth and breadth.

Better Start: The Blackpool universal health visiting service

Blackpool Better Start has invested £1 million into transforming the health visiting service across the town. The new service has been created with the help of Blackpool parents and health professionals, as part of Blackpool Better Start's 10-year programme to improve life chances for children aged 0–4, funded by the Big Lottery. The investment includes extensive consultation with parents, health-care practitioners and external consultants; the redesign of the service model; the training of all practitioners; and the review and creation of all assessment tools.

Family Attitudes, Actions, Decisions and Experiences Following Implementation of Deemed Consent and the Human Transplantation Act (Wales) 2013

Family Attitudes, Actions, Decisions and Experiences Following Implementation of Deemed Consent and the Human Transplantation Act (Wales) 2013

Development of an alcohol liaison midwifery service in a health Trust in Northern Ireland

Background Consumption of alcohol is integrated into the social fabric of UK society and the guidelines for drinking alcohol during pregnancy have only recently been updated in the UK to a zero approach. There is clear evidence that alcohol may have an impact on both the ongoing pregnancy and the developing fetus. Aim To identify and support pregnant women with a history of alcohol misuse. Methods In 2013, one health Trust in Northern Ireland received support from the Big Lottery Fund to set up an Alcohol Liaison Midwifery service. This article provides an overview of the effect of maternal alcohol consumption during pregnancy and the development of a new alcohol liaison midwifery service. Findings The aims of the service were achieved and due to the legacy from the educational programme some may be continued by midwives. Conclusion The support required by the ongoing complex caseload of women with a history of alcohol misuse is dependent on a close working relationship between addiction and maternity services which requires a key central role to continue.

Pilot trial and process evaluation of a multilevel smoking prevention intervention in further education settings

Background Preventing smoking uptake among young people is a public health priority. Further education (FE) settings provide access to the majority of 16- to 18-year-olds, but few evaluations of smoking prevention interventions have been reported in this context to date. Objectives To evaluate the feasibility and acceptability of implementing and trialling a new multilevel smoking prevention intervention in FE settings. Design Pilot cluster randomised controlled trial and process evaluation. Setting Six UK FE institutions. Participants FE students aged 16–18 years. Intervention ‘The Filter FE’ intervention. Staff working on Action on Smoking and Health Wales’ ‘The Filter’ youth project applied existing staff training, social media and youth work resources in three intervention settings, compared with three control sites with usual practice. The intervention aimed to prevent smoking uptake by restricting the sale of tobacco to under-18s in local shops, implementing tobacco-free campus policies, training FE staff to deliver smoke-free messages, publicising The Filter youth project’s online advice and support services, and providing educational youth work activities. Main outcome measures (1) The primary outcome assessed was the feasibility and acceptability of delivering and trialling the intervention. (2) Qualitative process data were analysed to explore student, staff and intervention team experiences of implementing and trialling the intervention. (3) Primary, secondary and intermediate (process) outcomes and economic evaluation methods were piloted. Data sources New students at participating FE settings were surveyed in September 2014 and followed up in September 2015. Qualitative process data were collected via interviews with FE college managers (n = 5) and the intervention team (n = 6); focus groups with students (n = 11) and staff (n = 5); and observations of intervention settings. Other data sources were semistructured observations of intervention delivery, intervention team records, ‘mystery shopper’ audits of local shops and college policy documents. Results The intervention was not delivered as planned at any of the three intervention settings, with no implementation of some community- and college-level components, and low fidelity of the social media component across sites. Staff training reached 28 staff and youth work activities were attended by 190 students across the three sites (< 10% of all eligible staff and students), with low levels of acceptability reported. Implementation was limited by various factors, such as uncertainty about the value of smoking prevention activities in FE colleges, intervention management weaknesses and high turnover of intervention staff. It was feasible to recruit, randomise and retain FE settings. Prevalence of weekly smoking at baseline was 20.6% and was 17.2% at follow-up, with low levels of missing data for all pilot outcomes. Limitations Only 17% of eligible students participated in baseline and follow-up surveys; the representativeness of student and staff focus groups is uncertain. Conclusions In this study, FE settings were not a supportive environment for smoking prevention activities because of their non-interventionist institutional cultures promoting personal responsibility. Weaknesses in intervention management and staff turnover also limited implementation. Managers accept randomisation but methodological work is required to improve student recruitment and retention rates if trials are to be conducted in FE settings. Trial registration Current Controlled Trials ISRCTN19563136. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 5, No. 8. See the NIHR Journals Library website for further project information. It was also funded by the Big Lottery Fund.

A better start for Bradford?

Bradford was one of five areas across the UK successful in a bid for funding from the Big Lottery Fund's A Better Start initiative. The £49 million funding that Bradford won is being used to further develop 22 projects to improve the social and emotional development, communication and language development, and health and nutrition of children aged 0–3 years. One of these projects is a 3-year pilot of a personalised midwifery care team. Using a ‘buddy’ system, the midwifery team aims for the named midwife or buddy to provide 90% of all antenatal and postnatal midwifery care. Each midwife has a maximum caseload of 60 women and is, therefore, able to offer an enhanced care package, individualised to each woman's needs. The pilot began in October 2015 and the learning from this model of care is being fed into the local discussions about the National Maternity Review.

Evaluation of the impact on audiences of Inside Out of Mind, research-based theatre for dementia carers

Background: A play about dementia care was taken on tour, funded by the Big Lottery through Arts Council England, to six cities. This paper explores its impact, mainly on professional carers.Methods: Mixed methods were applied; semi-structured self-completion questionnaires and subsequent telephone interviews to a stratified sample of respondents. Framework analysis was used, paying particular attention to critical comments.Results: Post-show questionnaires were submitted by 1035 (19%) and 64 people were later interviewed. Audience members expressed heightened awareness of the needs of people with dementia, with greater appreciation of the care process itself and of the challenges faced by professional dementia carers in hospitals and other long-term settings.Conclusions: This production of Inside Out of Mind afforded an effective medium for knowledge transfer. It engaged audiences with key issues – including dignity, identity and loss – and enabled them to reflect on these issues, while encouraging appropriate practical responses.

Putting context centre stage: evidence from a systems evaluation of an area based empowerment initiative in England

It is now widely accepted that context matters in evaluations of the health inequalities impact of community-based social initiatives. Systems thinking offers a lens for uncovering the dynamic relationship between such initiatives and their social contexts. However, there are very few examples that show how a systems approach can be applied in practice and what kinds of evidence are produced when this happens. In this paper, we use data from ethnographic fieldwork embedded within a multi-site mixed method evaluation to demonstrate how a systems approach can be applied in practice to evaluate the early stages of an area-based empowerment initiative – Big Local (funded by the Big Lottery Fund and delivered by Local Trust). Taking place in 150 different local areas in England and underpinned by an ethos of resident-led collective action, Big Local offers an illustration of the applicability of a systems approach to better understand the change processes that emerge as social initiatives embed and co-evolve within a series of local contexts. Findings reveal which parts of the social system are likely to be changed, by what mechanisms, and with what implications. They also raise some salient considerations for knowledge generation and methods development in public health evaluation, particularly for the evaluation of social initiatives where change does not necessarily happen in linear or predictable ways. We suggest future evaluations of such initiatives require the use of more flexible designs, encompassing qualitative approaches capable of capturing the complexity of relational systems processes, alongside more traditional quantitative methods.

Evaluating the delivery, impact, costs and benefits of an active lives programme for older people living in the community.

The World Health Organisation recommends older people should be able to achieve physical, social and mental well-being throughout their lives, and that international, national and local policies should be developed to support older adults, promote their independence and well-being, and encourage physical exercise. Consequently, the West Lancashire programme was to establish preventative community support for older people to assist in improving their well-being and physical and mental health, particularly those isolated due to age-related illness or disability. It was to provide interventions not available from local social care providers. A mixed methods approach was adopted, with the qualitative evaluation utilising focus groups to establish people's experiences, identify impacts on their health and well-being, and suggestions for services development. This paper describes the quantitative evaluation, which involved three surveys and a costs analysis. The surveys were scheduled to give timely feedback to management about programme delivery and content, and overall benefits of participation. Findings The active lives programme and groups offered a wide range of flexible and local activities that provided benefits for older people in terms of health and well-being, social well-being and quality of life, and reducing social isolation. There was interconnectivity between these benefits. The programme was delivered in an affordable and flexible manner. Such programmes should be made more widely available.

Born in Bradford's Better Start: an experimental birth cohort study to evaluate the impact of early life interventions.

BackgroundEarly interventions are recognised as key to improving life chances for children and reducing inequalities in health and well-being, however there is a paucity of high quality research into the effectiveness of interventions to address childhood health and development outcomes. Planning and implementing standalone RCTs for multiple, individual interventions would be slow, cumbersome and expensive. This paper describes the protocol for an innovative experimental birth cohort: Born in Bradford’s Better Start (BiBBS) that will simultaneously evaluate the impact of multiple early life interventions using efficient study designs. Better Start Bradford (BSB) has been allocated £49 million from the Big Lottery Fund to implement 22 interventions to improve outcomes for children aged 0–3 in three key areas: social and emotional development; communication and language development; and nutrition and obesity. The interventions will be implemented in three deprived and ethnically diverse inner city areas of Bradford.MethodThe BiBBS study aims to recruit 5000 babies, their mothers and their mothers’ partners over 5 years from January 2016-December 2020. Demographic and socioeconomic information, physical and mental health, lifestyle factors and biological samples will be collected during pregnancy. Parents and children will be linked to their routine health and local authority (including education) data throughout the children’s lives. Their participation in BSB interventions will also be tracked. BiBBS will test interventions using the Trials within Cohorts (TwiCs) approach and other quasi-experimental designs where TwiCs are neither feasible nor ethical, to evaluate these early life interventions. The effects of single interventions, and the cumulative effects of stacked (multiple) interventions on health and social outcomes during the critical early years will be measured.DiscussionThe focus of the BiBBS cohort is on intervention impact rather than observation. As far as we are aware BiBBS is the world’s first such experimental birth cohort study. While some risk factors for adverse health and social outcomes are increasingly well described, the solutions to tackling them remain elusive. The novel design of BiBBS can contribute much needed evidence to inform policy makers and practitioners about effective approaches to improve health and well-being for future generations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3318-0) contains supplementary material, which is available to authorized users.

Applying the lessons of VSA to new psychoactive substances

Purpose– The purpose of this paper is to explore whether there are ways in which the preventive strategies used to tackle volatile substance abuse (VSA) can be usefully applied to today’s new psychoactive substances (NPS).Design/methodology/approach– In 2010-2013, with funding from the Big Lottery, Re-Solv, in partnership with St George’s, University of London, andeducari, commissioned a re-analysis of both the mortality data relating to VSA and of the legislative and preventative measures taken that may have played a part in the steady downward trend in VSA mortality since. This paper is informed by Re-Solv’s research findings and the papers resulting from it, namely, Ives (2013) and Butlandet al.(2013).Findings– Efforts to reduce the harm from NPS could benefit from a re-examination of preventive approaches to VSA, which have resulted in a downward trend in mortality over the past two decades.Social implications– There is evidence from past prevention practice which could be relevant and applied to present day concerns about drugs and substances not previously available or used.Originality/value– This is the first paper to explore how learning from VSA might be applied to NPS and the “legal highs” of today.

The role of communities in sustainable land and forest management: The case of Nyanga, Zvimba and Guruve districts of Zimbabwe.

Forest benefit analysis is vital in ensuring sustainable community-based natural resources management. Forest depletion and degradation are key issues in rural Zimbabwe and strategies to enhance sustainable forest management are continually sought. This study was carried out to assess the impact of forests on communities from Nyanga, Guruve and Zvimba districts of Zimbabwe. It is based on a Big Lottery Fund project implemented by Progressio-UK and Environment Africa. It focuses on identifying replicable community forest and land management strategies and the level of benefits accruing to the community. Analysis of change was based on the Income and Food Security and Forest benefits, which also constitutes the tools used during the research. The study confirms the high rate of deforestation and the increased realisation by communities to initiate practical measures aimed at protecting and sustaining forest and land resources from which they derive economic and social benefits. The results highlight the value of community structures (Farmer Field Schools and Environmental Action Groups) as conduits for natural resource management. The interconnectivity among forests, agricultural systems and the integral role of people are recognised as key to climate change adaptation.

Peer-to-peer mental health: a community evaluation case study

Purpose– The purpose of this paper is to report the findings of a third-sector community review into peer-to-peer best practices in mental health service provision in Sussex. This community initiative was funded by the Big Lottery to explore the benefits of the peer-led approach on individual and public health outcomes and identify avenues for partnership working.Design/methodology/approach– A total of 131 participants who had engaged with peer-to-peer services both as receivers and providers of support were invited to share knowledge and best-practice expertise via a survey, focus groups and a public consultation day.Findings– This case study review suggests peer-to-peer support services as an innovative approach to reducing suicide, self-harm, reliance on public health services (GPs, hospital stays, etc.) and engaging with drugs, alcohol and criminal activity. In addition to offering a holistic and social approach to mental health, it further identifies that engagement in peer-to-peer activities potentially provide long-term benefits by reducing the stigma associated with mental health conditions and treatment. This review highlights the importance of third-sector groups in providing peer-to-peer mental health support services. It recommends a network of Peer-to-Peer services to share best practices and improve partnership working.Originality/value– Conducted by and for people with personal or family experiences with mental health challenges, this review captures the often inaccessible ideas of a highly marginalised group. It communicates how they would prefer to work in partnership with academic institutions, public and statutory service to improve individual and community health outcomes.