Building Research by Communities to address Inequities through Expression (ReCITE) Consortium

文化和艺术有助于健康和福祉，并有助于将重点从疾病转移到以人为中心的更广泛的背景下看待健康。文化和艺术也有助于解决更复杂的保健公平问题，而解决这些问题的卫生保健解决办法很少。虽然利物浦拥有丰富的艺术和文化遗产，但它也是全国第三个最贫困的地方当局。尽管将健康的公平和社会决定因素放在了优先位置，但健康不平等现象已经扩大，新冠肺炎疫情加剧了这种不平等现象。这座城市最贫困和最贫困的地区之间的预期寿命相差超过12年。我们的目标是建立一个强有力的研究伙伴关系，其最终目标是通过将我们城市内丰富的创意遗产与社区健康联系起来，帮助减少健康方面的差距。我们将建立在基于社区的参与式研究模式的基础上，该模式最初是为解决肯尼亚社区的公平和医疗质量问题而开发的，最近进行了调整，以解决利物浦不公平的新冠肺炎疫苗接种问题。我们的模型表明，社区是自身健康方面的专家，社区合作研究人员可以收集、分析和使用数据来制定和实施解决方案，以解决当地的健康不平等问题，监测其进展情况，并评估其工作是否产生了积极影响。这项工作涉及叙事、故事板和摄影之声，但尚未正式纳入文化和艺术的干预方法，也没有探讨如何评估这样做的影响。我们的研究联盟将创造新的知识。我们将与现有的社区创新团队和利物浦市议会资助的一项倡议合作，该倡议由来自少数族裔和弱势社区的社区冠军组成，与通过利物浦NHS初级保健网络开展参与和外展工作的草根组织联系在一起。我们最初的重点将是讲故事，这是一种艺术形式，可以帮助弱势社区和人们表达、分享和验证他们的生活经历。讲故事可以用来收集和理解社区数据，加强个人和团体采取行动的机构，向政策制定者传达差距，提供健康信息，并通过团结和包容减少不平等的后果。在利物浦，讲故事的干预措施被成功地用来确定获得医疗保健的障碍，特别是在弱势或黑人和少数民族人口中，并被用来解决例如患有心理健康和慢性健康问题的问题(作为一种社会处方)。我们将寻求在利物浦内部利用现有的创意社区资产网络，并将参与范围扩大到其他参与者。我们将结合证据和理论，更好地理解艺术和文化、基于社区的研究和健康不平等之间的关系。我们的“变革理论”将帮助我们理解需要什么来扩大这项工作，衡量其影响并扩大其影响范围。因此，我们最初的调查领域将以理论和实践为基础，在以社区为基础的参与性行动研究中使用故事讲述来解决卫生不平等问题。我们预计，工作模式将可转移到其他文化或艺术干预和社区资产。该联盟将建立在现有合作的基础上，但也将扩大现有的合作，这些合作最适合于解决通过参与性进程商定的研究重点领域。这些群体之间的能力和思想的交叉交流将得到加强，从而能够设计出稳健的研究设计。在这一阶段的资助结束时，将建立一个新的准备进行研究的联合体。我们的联盟致力于在道德框架内进行“由社区为社区发展”的研究。

Culture and the arts contribute to health and wellbeing and can help shift the focus away from disease to viewing health in its broader context, focused around people. Culture and the arts can also contribute to addressing more complex health equity problems for which there are very few health care solutions. Whilst Liverpool has a rich heritage of arts and culture, it is also the third most deprived local authority in the country. Despite having prioritised equity and social determinants of health, health inequities have widened, exacerbated by the Covid-19 pandemic. Life expectancy differs by more than 12 years between the most and least deprived wards of the city. We aim to create a strong research partnership whose ultimate objective is to help reduce disparities in health through linking the rich creative heritage within our city to community health. We will build on a community based participatory research model, originally developed to tackle equity and health care quality for Kenyan communities and recently adapted to address inequitable COVID-19 vaccine uptake in Liverpool. Our model has demonstrated that communities are experts in their own health and that community co-researchers can collect, analyse and use data to develop and implement solutions to address local health inequities, monitor their progress and evaluate whether their work is having a positive impact. This work has involved narratives, storyboards and Photovoice but has not yet formally incorporated intervention approaches from culture and the arts, nor explored how to assess the impact of doing this. Our research consortium will be creating new knowledge. We will work with existing Community Innovation Teams and a funded initiative within Liverpool City Council of community champions from minority and disadvantaged communities, linked to grassroots organisations who have developed engagement and outreach work through Liverpool's NHS Primary Care Network. Our focus will initially be on storytelling as an art form that can help disadvantaged communities and people to express, share and validate their lived experiences. Storytelling can be used to collect and make sense of community data, strengthen agency of individuals and groups to take action, communicate disparities to policy makers, provide health messaging and reduce the consequences of inequities through solidarity and inclusion. Storytelling interventions have been successfully used in Liverpool to identify barriers to accessing healthcare, particularly amongst vulnerable or black and ethnic minority populations and used to address for example, living with mental health and chronic health conditions (as a type of social prescribing). We will seek to engage existing networks of creative community assets within Liverpool and extend engagement beyond these to other actors. We will combine evidence of what works with theory to better understand the relationships between arts and culture, community-based research and health inequities. Our "theory of change" will help us understand what is needed to scale-up this work, measure its impact and broaden its reach. Therefore, our initial area of inquiry will be based on both theory and practice for using storytelling in Community Based Participatory Action Research to tackle health inequities. We expect the model of working will be transferable to other cultural or artistic interventions and community assets. The consortium will build on, but also extend, existing collaborations which are best placed to address the research focal areas agreed through participatory processes. Capabilities and cross fertilisation of ideas across these groups will be strengthened allowing the design of robust research designs. At the end of this phase of funding a new research-ready consortium will have been built. Our consortium is all about research "developed by communities for communities" within an ethical framework.