Third-sector Organizations Research Articles

Targeted initiatives to tackle health inequalities, integrating the Leeds Health and Care Workforce

Abstract Deprivation and poor health are significant challenges in Leeds, with the poverty gap growing in parts of the city. The Leeds One Workforce approach to narrowing inequalities (NI) was co-designed in 2021 building on the innovative partnership approach already visible in the city. Its phased approach has seen interventions put in place to boost the opportunities for people from marginalised communities to develop their skills and remove barriers to careers in health and care and has global relevance for other localities experiencing high deprivation. The overall NI approach is supported by a long-term and wide-reaching evaluation plan which mobilises our partner organisations and intends to amplify best practice in getting people into careers and supporting this group to develop within the health and care workforce. We will present findings from embedded evaluations of initiatives across the city, and individual case studies, from those who have accessed NI interventions in Leeds. These will explore the relationships and contributions of partnership organisations and presence of any unexpected barriers or facilitators to these interventions. Linking with third-sector organisations and creating accessible pre-employment opportunities to develop core working skills is a vital part of the Leeds approach to recruiting people from priority wards. Additionally, supporting people into careers in health and care which suit their values, interests and personal circumstances, in addition to employing organisations with flexibility and openness towards their employees at their core is a strong factor in recruiting and retaining from areas of deprivation. Partnership working is essential to tackling health inequalities in places of high deprivation to address individual and systemic barriers to securing employment, ensure the best chance of success for community outreach programmes, and maximise efficiencies by combining the efforts of local organisations. Key messages • Leeds, UK is transforming approaches to narrowing health inequalities through partnership working across health and social care education and employment. • Current and future best practice will be explored to demonstrate transferable NI approaches.

Social prescribing for healthy ageing: insights from older people referral and uptake in Portugal

Abstract The population ageing presents multifaceted challenges for health systems, with implications for healthcare delivery and health and well-being outcomes. Innovative integrated-care approaches are needed to promote healthy aging and the quality of life of older people. Social Prescribing (SP) has emerged as a promising strategy to address the complex health and social needs of populations, including those older, offering non-medical interventions that encompass social, cultural, and community-based activities. SP has been implemented in Portugal since 2018 and currently target different subgroups, including elderly. This study aims to examine referral and uptake of older people to SP in Portugal. This cross-sectional study analysed sociodemographic, health condition, referral and uptake-related data from older patients (≥65 years) engaged in SP, collected through a survey and registries at primary healthcare units in Lisbon between 2018-2023. Of the 1060 patients referred to SP, 43.9% (n = 465) were aged 65 years or older. Within this age group, 38.1% were 71-80 years old and 36.1% were 81-90 years old; 67.5% were female. Around 48% were referred to SP for social isolation, 40% for social and financial support, and 32.5% for functional dependency. Two thirds had two or more chronic conditions, with cardiovascular disease (59,1%), mental health disorders (29,2%), and obesity (27,1%) being the most frequent. The SP consultations uptake rate was 59.1%, and patients were referred to a range of activities provided by third-sector organisations, as psychosocial support, home care, senior university classes, arts activities, and support in medicine management. The elderly population accounts for a large proportion of SP referrals. Further efforts are needed to identify the factors that influence patients’ acceptability and adherence and to promote the sustainability of SP and the well-being of the population. Key messages • Older people referred to SP initiative in Portugal have complex health-social needs, which reinforces the relevance of adopting a holistic centred-care approach to respond to the aging challenges. • Through SP older people have been integrated in community-based activities that promote their health and wellbeing, thus it is needed to develop tailored strategies to improve patient uptake.

Community Health Worker Service: addressing the needs of Gypsy/Travellers in Scotland

Abstract Background Members of the Gypsy/Traveller community in the United Kingdom face significant health inequalities compared to the general population, including lower life expectancy, higher rates of morbidity and suicide and poorer infant and child outcomes. This study evaluated the implementation of community-based lay workers in Scotland - the Gypsy/Traveller Community Health Worker (CHW) service. Methods This multi-method qualitative study (December 2021 to August 2023) included 16 individual interviews, five focus groups, one workshop, two informal discussions, and one site visit. Participants were stakeholders, CHWs, and members of the Gypsy/Traveller community. Additionally, 116 documents were analysed. The framework method, Proctor’s implementation outcomes and thematic analysis were used for data analysis. Results CHWs reached approximately 1,000 individuals across six National Health Services (NHS) Boards. The implementation outcomes showed that the intervention was accepted and feasible. A third-sector organization (Black and Minority Ethnic Carers of People Project - MECOPP), played a crucial role in successfully delivering the CHW service. This innovative intervention employed members of the Gypsy/Traveller community as lay healthcare workers to break down barriers to accessing healthcare and other services (e.g., uptake of cervical screening, vaccination, housing, and sanitation). The CHWs were trusted, ensured healthcare information was culturally appropriate and successfully addressed discriminatory behaviours in health and social care. Limited resources pose challenges to the sustainability of the service. Conclusions The Gypsy/Traveller CHW service enhanced prevention, acted as a bridge between communities and health systems and addressed the wider determinants of health. The Gypsy/Traveller community still faces discriminatory, racist, and stigmatising behaviours, which further impede the quality, delivery, and accessibility of care. Key messages • The Community Health Worker service was acceptable and feasible in the Gypsy/Traveller community, acting as a bridge between community and health systems and increasing access to services. • Community Health Worker Service is an important strategy for delivering healthcare support through their sector organizations to address historical discrimination against minority ethnic groups.

Reflections on an Evidence Review Process to Inform the Co-Design of a Toolkit for Supporting End-of-Life Care Planning With People With Intellectual Disabilities.

There is growing recognition that healthcare inequalities faced by people with intellectual disabilities extend to their experiences at the end of life, resulting in calls for more inclusive research to help address these inequities. Our study aimed to address this through the co-design of a toolkit for supporting end-of-life care planning with people with intellectual disabilities. To inform the co-design process, we undertook an evidence review to identify existing tools, resources and approaches that were already being used in practice. Our evidence review comprised three components: (i) a rapid scoping review of the academic literature, (ii) a desk-based search of the grey literature and (iii) an online survey to capture unpublished resources that were distributed to services, professionals, third-sector organisations and family members. A longlist of existing materials was appraised using an adapted version of the AGREE II instrument, resulting in a shortlist that was shared with the co-design team. The evidence review played a critical role in the co-design of a new toolkit of end-of-life care resources for people with intellectual disabilities. However, AGREE II proved to be limited for our purposes. The survey was particularly useful in helping us identify resources, tools and approaches in current use. We identified evidence review processes that served to support co-design team activities and elements that were more problematic. We argue that evidence review practices might be enhanced to better aid co-design activities in health and care research, particularly for studies involving people with intellectual disabilities. This article reflects on an evidence review that was conducted as part of The Victoria and Stuart Project. People with intellectual disabilities were deeply involved at every stage of project design, delivery and dissemination. The project employed people with intellectual disabilities as members of the core research team. People with intellectual disabilities and family carers were members of the project co-design team and the project Advisory Group. The evidence review process itself was led by academic members of the research team with contributions from colleagues with intellectual disabilities via the Advisory Group and core research team. The findings from the evidence review were used by the co-design team to inform the development of an end-of-life care planning toolkit for people with intellectual disabilities.

Period poverty, menstrual health and menstrual (in)justice in the context of social work – in the opinions of students and graduates of social work

Menstruation, until recently treated as a purely biological phenomenon, is beginning to be perceived as a social phenomenon, becoming the subject of research, scientific theorizing and publications. Third-sector organizations are being formed to tackle period poverty, promote menstrual health and work for menstrual justice. Menstrual poverty and broadly understood menstrual inequalities are often experienced by socially vulnerable individuals, families, groups and communities, who become social welfare institutions and social work service users. The article presents selected results of a survey with participation of social work students (current and graduates) on their perception of the relationship between social work and the elimination of menstrual poverty, the promotion of menstrual health and the prevention of menstrual injustice.

Co-producing and co-assessing a new service solution for enhancing health and social care integration: a participatory research protocol

BackgroundThis paper describes a study protocol for co-producing and co-assessing a new sustainable and scalable service solution that enhances health and social integration by involving providers and volunteers delivering services for elderly people in the province of Cremona (Italy), where the elderly population will reach 27% in 2023.MethodsThis upcoming study involves mixed-method participatory research and is structured in three study phases and related objectives. First, it will co-produce a new, accessible and sustainable service solution using an iterative design and management method, Plan-Do-Check-Act by involving professionals and volunteers of a heterogeneous group of health, social and third sector organizations located in the city of Cremona (Italy). Second, the study protocol will co-assess the outcomes of the new service solution using a mixed-method approach for measuring the outcomes on: professionals and volunteers (micro level) and their health, social and third sector organizations (meso level). Third, this study will co-investigate the scalability of the new solution promoting health and social integration in other similar urban areas of the Province of Cremona via the Intervention Scalability Assessment Tool (macro level). The data will be collected through the analysis of official documents, websites, policies and participatory workshops.DiscussionThis protocol proposes an innovative intervention, a novel participatory approach, and an unexplored scalability assessment tool in the context of health and social care integration. This study aims to support professionals from health and social care service providers and volunteers from third-sector organizations to collaborate and integrate each other’s resources. In doing so, the participatory approach will facilitate the co-creation of an effective response to the need of health and social integration, and the development of trustful relationships between health and social care service providers. Moreover, the adoption of Plan-Do-Check-Act and Intervention Scalability Assessment Tool will ensure the quality, scalability and sustainability of the new service solution in other settings.

Unravelling the multi-level governance of Ukrainian refugee reception in Italy: a focus on small and medium-sized cities

ABSTRACT The article suggests a shift in the understanding of the established concepts of battleground, local turn and governance decoupling, all of which have strongly influenced the framework of immigrant integration scholarship. It does so by looking at the puzzle of the reception of Ukrainians in Italy from the perspective of multi-level governance (MLG), which made it possible to identify the activism of small and medium-sized cities in contrast to the inefficiencies of the central government. Previous research has not adequately examined grassroots responses within the MLG framework, leaving a gap in understanding the interplay between local mobilisation and national policies. Despite the (seemingly) cooperative multi-level response to Ukrainian refugees, there have been numerous delays and poor performance in reception, resulting in smaller localities bearing the brunt of the challenges of the refugee influx. This research draws on 40 semi-structured interviews with representatives of third-sector organisations, local authorities and national agencies.

A qualitative study exploring how vocational rehabilitation for people with multiple sclerosis can be integrated within existing healthcare services in the United Kingdom

BackgroundTo explore how a vocational rehabilitation (VR) intervention can be integrated within existing healthcare services for people with multiple sclerosis (MS) in the United Kingdom (UK) National Health Service (NHS).MethodsData from 37 semi-structured interviews with 22 people with MS, eight employers, and seven healthcare professionals were analysed using a framework method informed by the Consolidated Framework for Implementation Research and an intervention logic model.ResultsFour themes were identified relating to the structure of current NHS services, how to improve access to and awareness of VR services, the collaboration between internal and external networks, and the benefits of integrating VR within the NHS services. Participants identified several implementation barriers such as poor links with external organisations, staffing issues, and lack of funding. To overcome these barriers, participants suggested enablers such as technology (e.g., apps or online assessments) and collaboration with third-sector organisations to reduce the pressure on the NHS.ConclusionSignificant organisational changes are required to ensure a successful implementation of a VR intervention within current NHS services. Despite this, the NHS was seen as a trustworthy organisation to offer support that can optimise the health and professional lives of people with MS.

Social Intervention That Facilitates Recovery from Gender-Based Violence: Dialogic Reconstruction of Memory

Services for victims of gender-based violence are an interdisciplinary work space where the recovery of women and, thus, preventing their social exclusion are among the main objectives. Although previous scientific literature provides some indicators of the social impact of these services, that is, the improvements in the lives of these women, and allow them to advance in their recovery, it is necessary to deepen and broaden this knowledge. One of the objectives of the SOLNET R&D research was to more comprehensively identify the indicators of the social impact of these interventions. This objective was achieved by carrying out 8 case studies and a total of 56 interviews—32 of which involved women who were victims of violence—in third-sector organisations that tend to women victims in 7 different regions of Spain. The results of our research show that the dialogical reconstruction of the memory of violence contributes to overcoming one of the main barriers to women’s recovery: emotional dependency. To achieve this impact, the dialogic reconstruction of memory should focus on changing the image these women have of the abuser and the conceptions of love associated with violence. These results have important implications for the design and evaluation of interventions carried out in services for women victims of gender-based violence. The application of these results can help these women successfully leave the situation of violence and build a violence-free future.

Resilience and Adaptation of Third-Sector Organisations (TSOs): Insights from a Developing Economy

Resilience and Adaptation of Third-Sector Organisations (TSOs): Insights from a Developing Economy

The Third Sector in Integrated Care: Partner, Provider, or Both?

Third-sector organizations (TSOs) are recognized for having a unique and essential role in designing and delivering community-centred, sustainable health and well-being services. A World Café workshop at the 2023 International Conference on Integrated Care to explore perspectives on the questions explored the question: How do we characterize the role of the Third Sector in Integrated Care Systems? Are they Partners, Service Providers, Both or Neither? Attendees from Canada, England, Scotland, Wales, Ireland, Belgium, Denmark, and the Netherlands shared perspectives regarding facilitators and barriers to engaging TSOs in integrated care systems, drawing on experiences and practices from their communities and health systems. Building from participant perspectives, we posit that while cross-sectoral alliances between government and voluntary organizations are possible, and this engagement can contribute substantial health-promoting value to society, much work remains to be done. Meaningful collaboration requires attitudinal shifts, new working methods, rebalancing power within the relationships, and sufficient resources to support the collaboration. Creative approaches to facilitating positive engagement of TSOs within integrated care systems can address long-standing barriers and misunderstandings. Sharing and learning through research, evaluations, and networks is essential to achieve integrated care systems based on trust and committed collaboration.

Supporting migrant inclusion: the role of linguistic diversity in community-led organisations

ABSTRACT This empirical study explores migrant inclusion in the linguistically diverse city of Glasgow. The particular focus is on the minoritisation of emergent speakers of English, who can find it especially difficult to access support. The research involved in-depth interviews with professionals at third-sector organisations supporting people with a refugee or migrant background. Interviewees gave examples of flexible communicative practices that support migrant inclusion. Such communicative practices can be understood in terms of translanguaging: the way that speakers fluidly draw on their full linguistic repertoires to make meaning. The analysis indicates that language minoritisation can be reduced when services better reflect the linguistic diversity of community members who access them. The examples given show how organisations can embrace linguistic diversity in ways that appear to enable inclusion, valuing the linguistic and cultural resources of recently arrived and settled community members. The article concludes that organisations which are more community led and linguistically diverse can better support the inclusion of language-minoritised migrants.

Resilience and adaptation of third sector organizations (TSOs) during crisis situations: Insights from a West African economy

Resilience and adaptation of third sector organizations (TSOs) during crisis situations: Insights from a West African economy

Harm reduction strategies for cannabis-related problems: a literature review and typology.

Measures that seek to minimise the health and social consequences of substance use are an integral part of national drug strategies in many European countries. Against the backdrop of a high prevalence of cannabis use in the economically advanced countries, and increasing demand for treatment for cannabis-related problems, a range of harm reduction measures have been implemented by peers, statutory bodies and third-sector organisations. Based on a systematic review of the literature, the author describes these different forms of intervention, identifies innovative strategies and presents a simple typology that can be used when exploring existing measures or seeking to develop new policies. This typology covers different kinds of legal, socio-organisational and health-related interventions. All study designs were eligible for inclusion, with the exception of case reports, non-systematic reviews, editorials and news stories. Studies had to be published between 2011 and 2022, in English, and they had to refer to Europe, the Americas, Australia or New Zealand. A two-concept search was implemented using Embase.com and a number of other databases, combined with citation searches and manual website searching to improve coverage of research reports and advocacy documents. A total of 35 documents were deemed eligible, many of which rely on qualitative research methods.

Diversified Workforce and Employees' Performance: Moderating Effect of Bureaucratic Leadership in Third Sector

With the global workforce undergoing unprecedented diversification, organizations in the Third Sector are compelled to scrutinize the intricate relationship between a diverse workforce and employees' performance. This paper delves into the nuanced dynamics within the Third Sector, focusing on the moderating effect of bureaucratic leadership on the link between workforce diversity and performance. The unique challenges and opportunities faced by non-profit organizations, NGOs, and social enterprises underscore the significance of this study. The research employs quantitative surveys to offer a holistic understanding of the complex interplay among workforce diversity, bureaucratic leadership, and employee performance. The study aims to identify patterns, correlations, and moderating influences that may provide valuable insights for organizations within the Third Sector. The key variables under investigation include workforce diversity, assessed through established scales regarding age, gender, ethnicity, and educational background diversity; employees' performance and bureaucratic leadership were also measured through established scales. Data was collected from diverse employees across various levels and departments within Lahore's third-sector organizations. The analysis employed statistical tools like regression analysis for quantitative data. This research seeks to contribute to the academic understanding of the subject and provide practical implications for organizational leaders in the Third Sector. The findings aim to guide effective decision-making, foster inclusive leadership practices, and enhance organizational performance in a diverse workforce.

Policy-makers and Population Ageing in Bangladesh: A Dearth of Attention

AbstractPolicy responses to population ageing have seldom been studied in Bangladesh. This article contributes to this research stream by asking to what extent policy-makers in Bangladesh are aware of the rapidly growing older population and care needs in the country and how this awareness is reflected in their policy initiatives. The concept of inattention is introduced to investigate phenomena from a public policy perspective. Data were collected via open-ended interviews with key policy-makers in Bangladesh’s government and other local stakeholders. Their responses were transcribed and coded for thematic content analysis. The findings show that policy-makers in Bangladesh have paid very little attention to the rapidly growing older population and their care needs. Without considering social, economic and demographic circumstances, the government has left full responsibility for old-age care to family members. No specific health or social care facilities have been built for older adults. Instead, limited coverage pension schemes for government employees and the Old Age Allowance (OAA) for financially vulnerable older adults remain the only measures taken thus far. However, these means-tested OAAs are very limited in terms of both their level and coverage. The lack of policy attention to older adults’ needs has led to a situation in which many older persons, especially in rural areas, are left without any support or care from their family, the government or third-sector organisations. More research is needed to guide the government and other organisations in developing adequate policies to support older adults in Bangladesh.

The slings and arrows of outrageous fortune: Exploring resilience in the third sector

AbstractThis Special Issue is based on a selection of papers initially presented at the conference on “Resilience and the Third Sector” (Institute of Public Sector Accounting Research, University of Edinburgh, November 2022). The third sector is pervasive in most societies and makes a distinctive and widely‐recognized contribution to the public good by building social capital, frequently affording a foundation for social cohesiveness. However, it is a fragile sector that is significantly affected by crises (the slings and arrows of outrageous fortune). These have the potential to curtail the capacity of third‐sector organizations (TSOs) to deliver societal benefits and, in the most extreme cases, even threaten their survival. Given this, the resilience of TSOs (albeit this term has multiple layers and manifold meanings) is critical. This paper explores a range of connotations linked to third‐sector resilience and explores contemporary evidence (including the papers in this Special Issue) as to how the sector identifies, manages, and learns from crises. In addition, it provides a brief outline research agenda as a basis for encouraging researchers to focus on resilience in TSOs and enhance knowledge. It is argued that more rigorous, evidence‐based research of this nature has the potential to positively influence practice in the sector, as well as policy formulation by government and others who steer TSOs.

Moving beyond the 'PPG': co-production and inclusion health.

We frequently fail to meaningfully incorporate patient voice in the development of health services, in particular the voices of those who are most disadvantaged. To share learning from a co-production project to improve primary care experience for those with multiple disadvantage and lived experience of trauma. We formed a collective of women (Bridging Gaps). Group members had lived experience of poverty, mental health challenges, addictions, homelessness, and sexual exploitation. Other members were researchers, GPs, and members of a third-sector organisation. We worked alongside local GPs to change how services were delivered. We collected interviews (n = 9), ethnographic data from group meetings (n = 3), and reflective notes from group members (n = 19). Data on our process were analysed using a framework approach drawn from the principles of trauma-informed care. We highlight the challenges for those with multiple disadvantages and trauma experience to meaningfully and safely engage in traditional Patient Participation Group (PPG) models. True co-production of services requires adequate resources and close collaborative working with local community organisations. Groups must be facilitated by those with relevant experience and the ability to both notice and manage power dynamics within the room. With sufficient support, co-production models have potential to empower group participants and improve health services. Partnership working between GPs, the third sector, and other organisations is vital. This can allow GPs to benefit from the expertise of those with relevant lived experience in tackling health inequalities.

Educational trajectories for residential care experienced young people are complex. A lived experience perspective from a PhD study in Scotland

PurposeResearch highlights that residential care experienced children and young people in Scotland have poorer educational outcomes than their peers within the wider population. Despite this, poor educational attainment is not inevitable, and further research is needed to increase the understanding of long-term trajectories. This paper aims to address a gap in contemporary literature that is of benefit to practitioners, academics and policymakers. Despite experiencing adversity, attachment, separation and loss, school attainment data on leaving care only reflects part of the educational journey.Design/methodology/approachUsing a mixed methodology and social constructionist theoretical framework, a practitioner-led PhD study gathered data from questionnaires and qualitative information from 13 semi-structured interviews with young people who had experienced residential care in Scotland. Recruitment was through a gatekeeper within a national third-sector organisation. The educational trajectories for young people with experience of residential care in Scotland are complex. A lived experience perspective from a PhD study illustrates that statistical data only captures part of the journey and the author needs to reconsider how success is measured.FindingsOf the 13 participants in the study, 12 achieved success educationally, although for the majority of those interviewed, attainment continued after leaving compulsory education. Barriers to greater success included placement uncertainty and movement, stigma, low expectations, pressure to not become a statistic, procedural obstacles and inconsistency or poor relationships.Research limitations/implicationsSupportive relationships and stable placements can create circumstances conducive to effective learning, but evidence reflects that support is necessary throughout the life course if children, young people and adults with care experience are to reach their full academic potential.Originality/valueResearch into the educational outcomes for those with experience of residential care in Scotland is limited. This paper, from a PhD, provides lived experience accounts from a practitioner-led study.

Community integration, quality of life, thriving, and mental health among refugees and asylum seekers. A London service provider perspective.

This article explores how systemic injustices and social inequalities affect refugee and asylum seeker integration, thriving, and mental health in London. This is pertinent as the United Kingdom currently operates a 'broken' asylum system with unfair policies and a 'tough' immigration rhetoric which makes it extraordinarily difficult for asylum seekers and refugees to achieve community integration, have a good quality of life, be able to thrive, and have good health including mental health. Paradoxically, the United Kingdom Home Office also features an Indicators for Integration Framework to provide practical ways to design more effective strategies, monitor services and evaluated integration interventions. This study employed a qualitative research design including semi-structured interviews with 19 mental health and psychosocial support service providers working in third-sector organizations in London. The study results show that the current asylum system severely undermines efforts to support asylum seekers and refugees with their integration. All participants highlighted that asylum seekers and refugees lacked experienced poor quality of life and faced structural challenges to build meaningful social connections; to have access education, fair employment and good work; to achieve good mental health and wellbeing; and to be able to thrive. To improve community integration, quality of life, thriving, and mental health for asylum seekers and refugees in London and, beyond, the United Kingdom, four recommendations are made on structural and service-levels: (1) reform of the current asylum system by centering human rights; (2) implement and carry out needs assessments among asylum seekers and refugees focussing on key social determinants; (3) ensure asylum seekers and refugees benefit from the NHS Inclusion Health framework; and (4) extend the NHS Patient and Carer Race Equality framework beyond England. To be effective, all four initiatives need to be grounded in a participatory approach that meaningfully involves diverse groups of stakeholders including asylum seekers and refugees.