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

本项目旨在为偏远和农村地区非药物文化和自然遗产干预的可扩展性创造条件。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”心理健康状况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做得很少。苏格兰17%的人口生活在农村地区。服务提供商在人口分散的大地理区域提供服务面临着经济和后勤方面的挑战。虽然农村社区可以被认为是紧密团结和具有复原力的，但精神疾病、社会孤立和贫困等问题可能是隐藏的。然而，农村地区拥有许多自然和文化资产，非药物“治疗”可以基于这些资产，从而使广泛的患者受益。我们的研究将集中在服务专员和规划者如何克服挑战；如何改善转诊途径以提高非药物服务的使用率；解决第三部门供应商面临的交付挑战；并确定决定有效扩大非药物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，使其成为主流卫生服务的一部分。为了实现这一目标，我们将利用定性研究方法结合可扩展性评估，从多方利益相关者的角度探索扩大规模。我们将围绕爱丁堡大学开发的“处方文化”项目开展研究，并将其作为测试在偏远和农村地区扩大规模的基础。该文化项目将通过网络和面对面的方式进行，由高地地区的乡村博物馆组织的工作坊将亲自参与。以自然为基础的活动也将由乡村护林员领导。以这种文化和自然遗产干预为重点，我们将详细研究服务规划/委托、转诊、交付、营销以及对提供者、专业人员和患者的影响。访谈等定性研究方法将使我们能够沿着社会处方途径从各个角度检查扩大规模的挑战。这种混合方法的研究将包括可伸缩性评估。一个由决策者、服务规划人员和志愿部门代表组成的指导小组将帮助为可扩展性评估提供信息。在文献和政策审查之后，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面谈或举行焦点小组。在NHS高地，社区联系工作者（clw）将嵌入全科医生的做法，试图减少健康不平等。clw位于贫困地区，将帮助患者确定适当的非临床活动或支持。文物保育介入会在这些文物保育中心所在的地区进行。产出将包括一份最后报告、同行评议出版物、会议发言、讲习班材料的虚拟展览和一部短片，以提高对社会处方的认识。将为公众和卫生专业人员组织一个社会处方“公平”，因此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者的接触是一个关键方面，并通过NHS高地、高地委员会和第三部门的代表指导小组交付。我们将制定一套建议，帮助为扩大服务提供信息。我们将通过诸如NHS、苏格兰议会健康不平等问题跨党派工作组、苏格兰农村健康伙伴关系、苏格兰社会处方网络和苏格兰自愿健康（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).