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Understanding, addressing, and meeting the complex needs of people living with long term physical and mental health conditions: a qualitative study

Complexity represented by dandelion seed

Lead applicant: Prof Mari Carmen Portillo and Dr Leire Ambrosio

Co-applicants: Prof David Baldwin, Dr Lindsey Cherry, Dr Kate Lippiett, Dr Pritti Aggarwal, Mr William Barnaby Jones, Dr Sara McKelvie

What problem will the research address and what evidence do you have this is a major concern for the public and health and care providers of Wessex?

People with long term physical conditions are 2-3 times more likely to have mental health problems than the general population: at least 30% of adults with such conditions also have mental health problems (like anxiety and depression). People living with physical and mental long term conditions experience hardships relating to health, and have complex psychosocial, environmental, financial, and spiritual needs. Healthcare professionals find it difficult to provide fully integrated care for these populations, due to systematic barriers and fragmentation of services. The NHS has incorporated an initiative involving Social Prescribing Link Workers (SPLW) in response to these complex needs. SPLWs connect people to community local services to meet needs through a comprehensive person-centred approach. However, the way in which this initiative occurs in different areas and services is variable, and there is unclear guidance for primary care services about how to integrate this novel workforce into wider efforts to address and meet the complex needs of people living with long term physical and mental conditions.

Where will the research take place and who will you involve?

The project will be undertaken in primary care practices in Hampshire, the Isle of Wight and Oxfordshire, and with a range of local third sector organizations (e.g., Anxiety UK, Mind).

Semi-structured interviews will be undertaken with people living with long term physical and mental health conditions. Subsequent focus groups will explore the range of care provider perspectives (e.g., social prescribing link workers, GPs, nurses, practice managers). We expect to interview 20-25 individuals and conduct 4-6 focus groups with 6-8 participants per group. Maximum variation sampling will focus on sociodemographic characteristics (age, sex, ethnicity, socioeconomic background), with a sharp focus on disadvantage and deprivation.

Overall aim: To determine the barriers and facilitators to successful implementation of the SPLW role in primary care for individuals living with long term physical and mental conditions.

Specific objectives.

  1. Identify the range of health and social needs of people living with long term physical and mental conditions.
  2. Explore provider perspectives about social prescribing link workers role implementation and effectiveness for people living with long term physical and mental conditions.
  3. Explore user perspectives about social prescribing link workers role implementation and effectiveness
  4. Explore how, SPLW implementation methods can be adapted to better meet the needs of culturally diverse populations including those living within deprived areas.
  5. Explore potential limitations of SPLW model for people living with long term physical and mental conditions.
  6. Co-produce recommendations to enable effective implementation of social prescribing link workers to address health and social needs of people living with long term physical and mental conditions.

A qualitative design, utilising semi-structured interviews and focus groups will be conducted. Patients and the public will contribute to all aspects of the research process.

How will the findings inform improvements in population health and patient care.

Following this study, a comprehensive tailored programme will be developed to address the complex needs of people with long term physical and mental conditions including those living in deprived areas. Plans for its implementation will be explored involving key stakeholders from and integrated Care System (ICS), Primary care Networks (PCNs), Local Authorities and any other organizations/sectors that may benefit from the findings.