Leveraging Community Assets to
Tackle Social Isolation and Loneliness: A Needs Assessment of the London
Borough of Hammersmith & Fulham
Executive Summary
Dissertation by: Mr Hao Yang Pang, Master
of Public Health (MPH)
Co-Supervisors: Drs Marize Bakhet & Shamini
Gnani
Supervisor & Principal Investigator: Dr Austen El-Osta
(ICREC #19IC5385)
This
study is an investigation of factors that influence the routine adoption & diffusion of evidence-based asset-based community development (ABCD)
initiatives to tackle social isolation & loneliness (using LBH&F as a case study)
INTRODUCTION
·
Social
isolation may affect people of all ages, but it does not equate to loneliness
and vice versa. Although acknowledged to be different concepts, social
isolation and loneliness (SI&L) are often considered together.
·
SI&L
is a rising problem in society and has negative impacts to individual health as
well as wider economic and societal impacts. The public health implications of SI&L are well documented.
·
There
have been numerous attempts in the literature to identify predictors of loneliness,
but this subjective phenomenon remains difficult to measure, and its prevalence
is thought to be significantly under-represented.
·
Known
predictors of loneliness include living alone, living in rented accommodation (instead
of being a homeowner), having poor health or poor functional status etc.,
·
Successful
interventions aimed at combatting SI&L include befriending schemes, skill
development strategies and psychological therapies.
·
The
UK government published its first Loneliness Strategy in October 2018, signalling
the first important step in the DH’s long-term commitment to combat SI&L.
However, our pragmatic
review of the literature also revealed several knowledge gaps:
·
Little
is known about the suitability, effectiveness and sustainability of the
recommendations presented in the UK’s Loneliness Strategy
·
Little
is known about the prevalence and state of SI&L in localities within the UK
(beyond the modelling work undertaken by Age UK which only explored rates of
SI&L in the elderly population)
·
There
are various examples of how community assets could be used to combat SI&L,
but no recent enquiry as to how asset-based community development (ABCD)
interventions could be applied to reduce SI&L in the contemporary setting
·
We
did not find any studies that sought to understand the knowledge, attitude and
perceptions of key stakeholders from the social care, local authority, council
and third sector workforce as regards the drivers and barriers for the routine
adoption of ABCD interventions to combat SI&L
STUDY AIM
· Identify
extant barriers and drivers for the routine adoption and diffusion of
community-based interventions to combat social isolation and loneliness in the
contemporary setting.
· LBH&F
was used as a case study.
STUDY
DESIGN & METHODS
A mixed-methods
research approach was used to conduct a needs assessment of LBH&F in the
context of SI&L. This broadly involved 3 phases of investigation:
1. A
data-led evaluation of SI&L-relevant population statistics of
LBH&F and its sub-geographical regions (this involved determination of
loneliness predictors from the literature and synthesis of population
information from governmental sources)
2. Compilation
of physical community asset map within LBH&F (this was based on the widely used ABCD
methodology, and included the identification, characterisation and rating of
assets to determine their usefulness in interventions to combat SI&L)
3.
Semi-structured
qualitative interviews with
key stakeholders (including NHS,
LBH&F LA, council, community and social care & Imperial College London
staff) to capture perspectives and emergent themes concerning extant barriers
and drivers for the commissioning and implementation of ABCD initiatives to
combat SI&L. Ethical clearance from Imperial College Research Ethics
Committee (ICREC reference 19IC5385) was sought to enable collection of qualitative data form key stakeholders.
MAIN
FINDINGS (abridged)
Predictors of
loneliness in LBH&F
·
We
found 2 instances where LBH&F population demographics indicated a greater risk
of SI&L when compared to demographic data from Greater London: 1) higher
proportion of single, never-married people and non-elderly people who live
alone, and 2) a lower proportion of homeowners. Conversely, higher education
levels are associated with a lower risk of SI&L, and LBH&F had a higher
proportion of residents with Level 4 (university degree level or above)
qualifications
·
LBH&F
has 13 LSOAs that fall under the top 10% most deprived LSOAs in England for
Income (n=12), Employment (n=2) and Health and disability deprivation (n=4).
·
3
LSOAs in the borough fell under 2 or more SI&L-relevant deprivation domains
that placed them in the top 10% of the most deprived in England: College Park
and Royal Oak (001C) had 2 domains, whereas Shepherd’s Bush Green (004B) & Fulham Broadway
(015A) had 3 domains each.
Asset Mapping
·
253
individual assets in LBH&F were compiled in the asset inventory. More than
half (52%, n=132) of these assets were determined to be both useful for
SI&L interventions and are readily accessible for mobilisation at little or
no cost.
·
Assets
were illustrated on a map of LBH&F, which was superimposed on LSOA map of the
borough. This analysis showed that the distribution of the of assets was uneven
across the borough.
· There
were large
differences between some wards’ asset number ranking and population density
ranking across the borough. For example, Addison Ward ranked 11th
(poor) in number of assets but had the second highest density of residents,
whereas Shepherd’s Bush Green ward had the highest (good) number of
SI&L-relevant community assets in LBH&F but ranked only 13th
(low) in population density.
· The
juxtaposition of assets in relation to LSOAs resulted in a heat map showing the
distribution of areas with higher risk of SI&L.
·
Paradoxically,
one of the most multi-deprived LSOAs that is most at risk of SI&L is
adjacent to Europe’s largest shopping centre (Westfield) and is co-terminus
with one of England’s most affluent boroughs (the Royal Borough of Kensington
& Chelsea)
Contextual
findings
·
A number of key emergent
themes were identified from interviews with a wide mix of stakeholders (n=19) in
LBH&F.
·
Participants were
well-informed of the public health and societal challenges associated SI&L,
the impact of deprivation, and the prevalence of vulnerable populations and
groups within the borough.
·
There was also a recognition
that measuring SI&L remains difficult, with most participants expressing a
lack of granular knowledge regarding prevalence of SI&L in LBH&F (as is
the case elsewhere).
·
Several practical
recommendations for future SI&L interventions were made, including
interventions using community assets.
·
The main barriers for the
commissioning and implementation of ABCD interventions to combat SI&L include:
(1) agencies working in silos, (2) fragmented budgets, (3) insufficient
funding, (4) interventions are one-time and not usually sustainable, (5)
competing interests between various stakeholder groups, (6) no
one-size-fits-all approach, and (7) SI&L could affect different age groups
and individuals from different ethnic backgrounds and different walks of life.
LIMITATIONS
The study has a
number of limitations including:
·
LBH&F
was considered in isolation without taking into account adjacent assets in
neighbouring boroughs,
·
The
asset map did not include all third sector/charities, or any corporations,
businesses, skilled individuals and informal social networks and organised
groups (the so-called the ‘gifts of individuals’ asset according to ABCD
methodology)
·
Limited
timeframe of the research (the qualitative arm of this study is still ongoing)
·
Did
not interview residents of the borough, but only stakeholders from the NHS, LA,
CCG, the local council, & academia.
RECOMMENDATIONS
·
LBH&F
has populations that are deemed at higher risk of SI&L when compared to
Greater London, and future intervention design should take these populations
into consideration.
·
Geographically
deprived areas, particularly LSOAs which are deprived in one or more SI&L-relevant
deprivation domains are areas of concern which necessitate a more granular
investigation to inform development of
interventions to combat rise in SI&L in the communities.
·
The
asset inventory and map can be used (as a starting point) for the planning of
SI&L interventions by leveraging these already available physical community
assets. Shortfalls in assets in certain wards can be addressed in future urban
development plans of the borough.
·
An
updated and comprehensive asset map of LBH&F is indicated which could form
the basis of a geographic information system (GIS) with added functionality.
The GIS may then be made available to residents to serve a variety of
functions.
·
Stakeholder
insights gleaned from this study are valuable and can inform new methods of
collaborative working and future intervention design.
·
A
unified, cross-departmental and collaborative borough-wide approach is required
to sustainably address SI&L in LBH&F. This requires the breakdown of
manifold ‘silos of activity’ coupled to a dedicated/pooled budget for
disbursement to realise strategic objectives over a longer period of time (3-5
years).
CONCLUSIONS
·
SI&L
is an important area of applied research, and this phenomenon will remain as
one of the world’s rising ‘wicked’ problems of society.
· Joined
up working and a borough/region-wide decision and strategy to combat SI&L
is indicated to ensure evidence-based interventions are sustainably introduced
to raise awareness, mitigate risks and combat SI&L in people of all ages
and from all walks of life.
· Existing
community assets could be leveraged to support a wide range of lifestyle,
social prescribing and other community interventions aimed at reducing
SI&L.
·
Further
applied research and collaboration could help identify suitable options for
mobilisation and deployment of ABCD to curb SI&L in LBH&F.
·
The
contextual findings of this study can be considered generalisable to a large
extent.
DATA SNAPSHOTS
End.
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