Rural Co-Design and Collaboration: Maximising Rural Community Assets to Reduce Place-Based Health Inequalities

该项目将以第一阶段资助的“处方遗产高地”（prescription Heritage Highland， PHH）工作的结果为基础，该工作审查了文化和自然遗产干预措施的实施挑战和可扩展性条件，以促进农村精神健康和福祉。非临床干预的价值日益得到卫生和社会保健服务规划人员和专业人员的认可。以社区为基础的服务，如锻炼小组、户外活动、艺术疗法和同伴支持，正在被“处方”以“治疗”心理健康状况，解决久坐不动的生活方式，并减少健康不平等。尽管人们对潜在益处的认识正在提高，但这些干预措施并非普遍可用或可获得，特别是对那些来自贫困农村地区的人（Morton和Bradley， 2020）。虽然农村社区可以被认为是紧密团结和具有复原力的，但社会孤立和贫困的程度仍然是隐蔽的。由于人口密度低，农村数据稀缺，农村剥夺很难使用苏格兰多重剥夺指数（SIMD）等传统工具来衡量（RSE, 2023）。然而，“农村溢价”是显而易见的，生活成本普遍高于城市地区（RSE 2023）。由于人口分散的广大地理区域面临经济和后勤方面的挑战，农村地区为提供服务提供了独特的挑战，特别是在规模上。根据公共卫生研究所的研究结果，该项目将开发一种可复制的农村模式，以采用共同设计方法开展协作社区工作。合作的目的是最大限度地利用现有的社区资产（如博物馆、档案中心、图书馆和绿地），并开发将其与主流医疗保健相结合的新方法，以便为服务调试提供信息，改善服务，增强社区复原力，减少农村卫生不平等。合作模式将在六个农村大陆和岛屿社区通过由有实际经验的社区成员、保健专业人员和第三部门组织组成的当地利益攸关方团体制定。这些小组将得到研究小组的支持，他们在社区参与和合作生产方面具有专业知识。这些小组将分享他们的经验，为面临类似后勤和卫生公平挑战的其他农村地区开发一个工具包。该工具包将对农村社区、服务规划人员和决策者有价值。该项目将为合作生产、社区参与、服务设计和社区资产价值提供更多证据，并为农村政策提供新的见解。该项目将：建立一个区域咨询小组，由有实际经验的人士和第三部门代表（包括遗产、卫生和农村贫困）、国民保健制度和地方当局组成。让社区研究人员参与资产测绘工作，以确定关键的当地资源、保健需求和农村数据方面的差距，建立并支持社区共同设计小组开发新的方法，最大限度地发挥现有资产和设施的价值，根据收集的数据满足当地需求4。进行政策/文献回顾和数据映射。通过从每个成员的角度研究障碍和推动因素，开发可复制的合作模式，并为农村社区、服务规划人员和政策制定者开发工具包。执行一项明确的沟通、传播和影响战略，涉及一系列创造性和可获得的产出。

The project will build on the findings of the Prescribe Heritage Highland (PHH) work, funded under Phase 1, which examined delivery challenges and conditions for scalability of a cultural and natural heritage intervention to promote rural mental health and well-being. The value of non-clinical interventions is increasingly recognised by health and social care service planners and professionals. Community-based services like exercise groups, outdoor activities, art therapies and peer support are being 'prescribed' to 'treat' mental health conditions, address sedentary lifestyles and reduce health inequalities. Although awareness is increasing about potential benefits, such interventions are not universally available or accessible, particularly to those from disadvantaged rural areas (Morton and Bradley, 2020). Although rural communities can be perceived as tight-knit and resilient, the extent of social isolation and deprivation can remain hidden. Rural deprivation is hard to measure using conventional tools such as the Scottish Index of Multiple Deprivation (SIMD) due to low population densities and rural data is scarce (RSE, 2023). However, a "rural premium" is evident, with living costs generally higher than in urban areas (RSE 2023). Rural areas provide unique challenges for service delivery, particularly at scale, due to the economic and logistical challenges in large geographical areas with dispersed populations.Drawing on PHH findings, the project will develop a replicable rural model for collaborative community working using a co-design approach. The collaboration's aim is to maximise the use of existing community assets (e.g. museums, archive centres, libraries and green spaces) and develop new ways of integrating them with mainstream healthcare in order to inform service commissioning, improve services, increase community resilience and reduce rural health inequalities. The collaborative model will be developed through local stakeholder groups comprising community members with lived experience, healthcare professionals and third sector organisations in six rural mainland and island communities. The groups will be supported by the research team, who have expertise in community engagement and co-production. The groups will share their learning to develop a toolkit for other rural regions experiencing similar logistical and health equity challenges. The toolkit will be of value to rural communities, service planners and policy makers. The project will add to evidence on co-production, community engagement, service design and the value of community assets as well as offer new insights for rural policy.The project will:establish a regional advisory group comprising people with lived experience and third sector representatives (encompassing heritage, health and rural poverty), NHS and Local Authorities.engage community researchers in asset mapping to identify key local resources, health needs and gaps in rural dataestablish and support community co-design groups to develop new ways to maximise the value of existing assets and facilities to address local needs based on data gathered4. conduct a policy/literature reviews and data mapping5. develop a replicable collaborative model by researching barriers and enablers from each member perspective and develop a toolkit for rural communities, service planners and policy makers6. implement a clear communication, dissemination and impact strategy involving a range of creative and accessible outputs.