Creating Change: A collaborative action inquiry approach for integrating creativity and community assets into ICS responses to Health Disparities

在卫生系统承受越来越大压力以及卫生差距的社会驱动因素日益得到认识的背景下，人们越来越认识到非医疗应对措施的价值，例如创造性、体力和基于自然的活动在支持健康和福祉方面的价值。有证据表明，三分之一的全科医生预约是为了解决与医疗无关的问题，许多有形的健康问题是由社会驱动因素引起的（例如，孤独、对财务或住房的焦虑、对身体形象的沮丧或失业）。因此，发展更广泛地使用以社区为基础的创造性办法来解决保健差距的潜力是巨大的。西约克郡在发展使用非医疗干预措施以促进健康和福祉方面处于领先地位。例如，屡获殊荣的慈善机构Creative Minds开发了一种创新的方法，通过120多个社区提供者的网络提供创意和户外活动；西约克郡是国家创新健康试点中心之一。然而，创造性和社区提供者依赖短期资金，并没有完全融入卫生保健系统，其结果是提供可能是临时的和不可持续的。该项目将以西约克郡的前沿发展为基础，通过将主要利益相关者（卫生信托、地方当局、创意/文化从业者、社区提供者和有生活经验的人）聚集在一起，创新思维，以便更好地将创意和社区反应纳入健康改善战略和系统，以解决健康差距。该项目将包括一种真正的共同生产方法，其中心是利用协作行动调查作为四个迭代阶段的变革学习的参与性过程。它将以有实际经验的人的故事为基础，加深对社区卫生问题的社会驱动因素和复杂性的了解，并从合作伙伴在实践中的挑战和成就中学习。此外，还将迅速审查关于社区保健提供的不同合作模式的证据，这些证据将共同为跨ics合作行动调查讲习班的初步方案理论的共同制定提供信息。在第二阶段，最初的方案理论将用于集中社区对创造性提供和伙伴关系的绘图，并在与社区团体和有实际经验的人的协商讲习班上进一步合作生产。随后将与主要利益攸关方进行进一步的协作行动调查，以完善关于如何将社区资产纳入应对卫生差距的方案理论，并逐步形成逻辑模型、原则和指导。然后，这些将在5个行动研究案例研究中进行测试，这些案例研究将涉及建立社区资产中心，每个ICS地方当局区域都有一个，以进一步完善跨ICS联盟模型，以整合社区资产。最后阶段将涉及第三个利益相关者行动调查讲习班，以回应从行动研究案例研究中吸取的教训，并进一步完善和最终确定该联盟的规划理论，并制定计划，扩大、嵌入和维持社区资产与卫生改善系统研究的整合。新的哈德斯菲尔德大学健康创新校园和福利学院将为这些发展提供一个环境，并承担支持、维持和进一步发展健康改善倡议所需的研究和开发功能。我们得到了所有主要卫生和地方当局参与者以及富有创意的社区提供者和有实际经验的人以及更广泛的社区代表的支持，他们将在整个项目中积极参与。

In a context where health systems are under increasing strain and the social drivers of health disparities are increasingly being recognised, there is a growing acknowledgement of the value of non-medical responses such as creative, physical and nature-based activities in supporting health and wellbeing. Evidence reveals that one third of GP appointments are for issues that are not medical and many tangible health problems arise as a result of social drivers (for example, loneliness, anxieties around finances or housing, depression about body image or being unemployed). The potential for developing the wider use of creative and community-based approaches to address health disparities is therefore substantial. West Yorkshire is leading the way in developing the use of non-medical interventions to promote health and well-being. For example, the award-winning charity Creative Minds has developed an innovative approach to providing creative and outdoor activities through a network of over 120 community providers; and West Yorkshire is one of the National Centre for Creative Health pilots. However, creative and community providers rely on short term funding and are not fully integrated into the health care system with the result that provision can be ad hoc and unsustainable. This project will build on leading edge developments across West Yorkshire in progressing the creative health agenda by bringing together key stakeholders (health trusts, local authorities, creative/cultural practitioners, community providers and people with lived experience) to innovate thinking in order to better integrate creative and community-based responses into health improvement strategies and systems to address health disparities. The project will encompass a truly coproductive approach centred around the use of collaborative action inquiry as a participatory process of learning for change in four iterative phases. It will build on stories from people with lived experience to provide a deeper understanding of the social drivers and complexities of health problems in communities, as well as learning from the challenges and achievements of partners in practice. These will be complemented by a rapid review of evidence about different collaborative models for community health provision which together will inform coproduction of an initial programme theory in a cross-ICS collaborative action inquiry workshop. The initial programme theory will be used to focus community mapping of creative provision and partnerships and further coproduction in consultation workshops with community groups and people with lived experience in phase 2. This will be followed by a further cycle of collaborative action inquiry with key stakeholders to refine the programme theory about how to integrate community assets into responses to health disparities and work up into a logic model, principles and guidance. These will then be tested in 5 action research case studies which will involve setting up community asset hubs, one in each of the ICS local authority areas to further refine the cross-ICS consortium model for integrating community assets. The final phase will involve a third stakeholder action inquiry workshop to respond to learning from the action research case studies and further refine and finalise the programme theory for the consortium and develop plans for scaling up, embedding and sustaining the integration of community assets into health improvement systems research. The new University of Huddersfield Health Innovation Campus and Wellbeing Academy will provide a context for hosting these developments and undertaking the research and development functions needed to support, sustain and further develop health improvement initiatives. We have support from all the key health and local authority players along with creative community providers and people with lived experience and wider community representatives who will be actively involved throughout the project.