Prescribe Heritage Highland: Scaling Up Non-Pharmaceutical Interventions in Remote and Rural Areas

该项目旨在为偏远和农村地区的非药物、文化和自然遗产干预措施的可扩张性创造条件。锻炼小组、户外活动、艺术疗法和同伴支持越来越多地被用来“治疗”心理健康问题和解决久坐不动的生活方式。然而，到目前为止，在如何在偏远和农村地区大规模提供这些服务方面，几乎没有采取什么行动。苏格兰17%的人口生活在农村地区。服务提供商面临着在人口分散的大片地理区域提供服务的经济和物流挑战。尽管农村社区可以被认为是紧密联系和有弹性的，但精神不健康、社会孤立和贫困的问题可能被隐藏起来。然而，农村地区有许多自然和文化资产，非药物“治疗”可以基于这些资产，使广泛的患者受益。我们的研究将侧重于如何克服服务专员和规划者面临的挑战；如何改进转诊途径，以增加对非医药服务的接受；解决第三部门提供者面临的提供挑战；以及确定决定有效扩大非医药遗产干预措施的背景因素。我们将确定扩大这些干预措施处方所需的关键条件、机制和背景，以便它们能够成为主流卫生服务的一部分。为了实现这一点，我们将探索从多个利益相关者的角度扩大规模，使用定性研究方法并结合可伸缩性评估。我们的研究将围绕爱丁堡大学开发的“处方文化”项目展开，并将其作为在偏远和农村地区测试扩大规模的基础。文化节目将在网上和面对面提供，由高地地区的农村博物馆领导的研讨会进行。基于自然的活动也将由乡村护林员领导。以文化和自然遗产干预为重点，我们将详细研究服务规划/启用、转介、交付、营销以及对提供者、专业人员和患者的影响。定性研究方法，如访谈，将使我们能够沿着社会处方路径，从各个角度审视扩大规模的挑战。这项混合方法研究将包括可伸缩性评估。由决策者、服务规划者和志愿部门代表组成的指导小组将帮助为可伸缩性评估提供信息。在文献和政策回顾之后，我们将与指导小组成员、卫生专业人员、社区联系工作者、干预促进者和参与者访谈或举行焦点小组。在NHS高地，社区链接工作者(CLW)将被嵌入全科医生的实践中，试图减少健康不平等。CLWS位于被剥夺的区域，将帮助患者确定适当的非临床活动或支持。遗产干预将在这些CLW所在的地区进行。产出将包括一份最终报告、同行评议的出版物、会议介绍、讲习班材料的虚拟展览和一部提高对社会处方认识的短片。将为公众和卫生专业人员组织一次社会处方“博览会”，以便第三部门提供者可以展示一系列非药物干预措施。与决策者和服务提供商的接触是一个关键方面，并通过来自NHS Highland、Highland Council和第三部门的代表指导小组进行。我们将制定一套建议，以帮助为扩大服务提供信息。我们将通过NHS、苏格兰议会健康不平等跨党派工作组、苏格兰农村健康伙伴关系、苏格兰社会描述网络和苏格兰自愿健康组织(VHS)等一系列组织传播调查结果。

This project aims to establish the conditions for scalability of non-pharmaceutical cultural and natural heritage interventions in remote and rural areas. Exercise groups, outdoor activities, art therapies and peer support are increasingly being 'prescribed' to 'treat' both mental health conditions and address sedentary lifestyles. However, little has so far been done on how to deliver them at scale in remote and rural contexts. 17% of Scotland's population live in rural areas. Service providers face economic and logistical challenges delivering across large geographical areas with dispersed populations. Although rural communities can be perceived as tight-knit and resilient, the problems of mental ill-health, social isolation and deprivation can be hidden. However, rural areas have many natural and cultural assets on which non-pharmaceutical 'treatments' can be based to benefit a wide range of patients. Our study will focus on how to overcome challenges for service commissioners and planners; how to improve referral pathways to increase take up of non-pharmaceutical services; tackling delivery challenges faced by third sector providers; and identifying contextual factors determining the effective scaling up of non-pharmaceutical heritage interventions. We will identify the key conditions, mechanisms and contexts needed to scale up the prescription of these interventions so they can form part of mainstream health provision. To achieve this, we will explore scaling up from multi-stakeholder perspectives using qualitative research methods in conjunction with a scalability assessment. We will build our research around the 'Prescribe Culture' programme, developed by the University of Edinburgh, and use it as the basis to test scaling up in remote and rural areas. The cultural programme will be delivered both online and face to face with hands on workshops led by rural museums across the Highland region. Nature-based activities will also be led by countryside rangers. Focusing on this cultural and natural heritage intervention, we will look in detail at service planning/commissioning, referral, delivery, marketing and impact on providers, professionals and patients. Qualitative research methods such as interviewing will enable us to examine the challenges of scaling up from all angles along the social prescribing pathway. This mixed methods study will include a scalability assessment. A steering group of decision-makers, service planners and representatives from the voluntary sector will help inform the scalability assessment. Following a literature and policy review, we will interview or hold focus groups with steering group members, health professionals, community link workers, intervention facilitators and participants. In NHS Highland, Community Link Workers (CLWs) will be embedded in GPs practices in an attempt to reduce health inequalities. Located in areas of deprivation, CLWs will help patients to identify appropriate non-clinical activities or support. The heritage intervention will be delivered in areas where these CLWs are based. Outputs will include a final report, peer-reviewed publication, conference presentation, virtual exhibition of workshop material and a short film to raise awareness about social prescribing. A social prescribing 'fair' will be organised for the public and health professionals, so third sector providers can showcase a range of non-pharmaceutical interventions. Engagement with decision-makers and service providers is a key aspect and delivered via the steering group of representatives from NHS Highland, Highland Council and the third sector. We will develop a set of recommendations to help inform scaling up of services. We will disseminate findings through a range of organisations such as the NHS, Scottish Parliament Cross-party Working Group on Health Inequalities, Scottish Rural Health Partnership, Scottish Social Prescribing Network and Voluntary Health Scotland (VHS).