Integrating care: the importance of community support and links with health and social care services for health and wellbeing
Dr Lou Henderson discusses her research into the experiences of people within the community who were accessing and providing Health and Social Care (HSC) services at home, to find out what they thought about their care, or the care they were providing, and how it influenced wellbeing.
My name is Lou, it is really good to be connected with all those reading this. I am a nurse and researcher by background. I have been newly appointed to the role of Managing Director for Bon Accord Care, a Health and Social Care (HSC) provider in Aberdeen City. In my roles as a nurse, researcher and leader, I am passionate about community-led health, and I would like to share my experiences and PhD work with you.
My research explored the experiences of people within the community who were accessing and providing HSC at home. It included those who accessed services for support and those who supported them at home, including informal carers (often a family member) and HSC workers. I wanted to find out what they thought about their care or the care they were providing and how it influenced their wellbeing.
Understanding different points of view
In integrated HSC the aim is to meet the health and wellbeing needs of the individual, using sustainable care that puts the individual at the centre. However, there is not currently much research looking into the experiences of the people who use these services and so my research study was designed with people who use services and those who support them, to explore perceptions of wellbeing and experiences of HSC at home.
I interviewed 14 people, including service users, informal carers and HSC staff, and analysed their perceptions to better understand people’s experiences when using HSC services from different points of view. Findings from the study highlighted that people who accessed and provided HSC in the community felt that HSC services were not always working in integrated ways. They highlighted the significant role that interpersonal connections and supportive relationships played in helping people to feel able to cope with their changing HSC needs and roles. Connections between individuals, their communities and HSC services and systems were of key importance in helping people to feel reassured, share information and reduce anxiety. Moreover, when these connections were lacking, it negatively impacted upon experiences of HSC.
Communities have a significant impact
For me, one of the key findings of this study was around the significant impact that communities had in helping people to maintain their health and wellbeing at home. They talked about factors in community support that enhanced their wellbeing, and factors that hindered their ability to access support from individuals and groups in their communities.
HSC staff, were largely unaware of the significant part that communities played in helping the people they support to maintain their health and wellbeing. People who used HSC services and their informal carers explained what ‘integrated care’ looked and felt like to them; they focused strongly on the importance of support from their communities, instead of the support from HSC organisations. For them, it was about integrating with the community and building up prior knowledge and a supportive relationship with individuals, not specifically with HSC provider services or systems. For example, Barney (pseudonym) explained:
Quote in blue text on a white background: “People that support me, are often people who are integrated into the local community so, people know them, erm, and they kind of know me, so, that’s quite important to me, like… they know what I need and they, they know that I can’t walk too far so if, for example… I’d went and got some very heavy shopping; they would pick it up and put it in the car for me.”
Barney went on to tell me that building supportive relationships with people in his community helped him to maintain his own health and wellbeing; being able to do that was important to him. He, along with other participants, told me that they felt supported by their communities. Participants highlighted a need for HSC services to work closely with local communities to provide and compliment support for individuals. Furthermore, offering communities an opportunity to build up their knowledge about others and their circumstances, including those who might need support, was also important.
Community support affected by changes to the local area
However, this type of community support is vulnerable and can be affected by other changes happening in the local area. Grant (pseudonym) shared his perception that housing changes in his local area had led to reduced access to community support. He perceived a reduced level of community members’ knowledge about him and his needs, attributing this to the increased size and changing demographic of their community. This led to a reduced resource of people to support him with practical tasks, particularly when his daughter and informal carer, Gail, was away on holiday:
Quote in blue text on a white background: “The village is expanded so much, everybody before knew who I was and knew who the kids were but, no… you don’t know all the people now, you see, and there isn’t that contact, village contact, if you like…
…I think people are so much tied up in their own lives, very often you see nowadays, husband and wife both work, even the family's, after a few years, the kids go to creches and that and right back at work. So, I don't think they've the time now to devote much… I don't think it's that open, er, neighbourly kind of care then that used to be. The people probably are more dependent on, er, trained professional people.”
It is clear that community support is an important part of improving wellbeing. Promoting connections and supportive relationships between people who access HSC and their communities, can help care to be more people-centred, relationship-based, and improve people’s experiences of healthcare systems.
If you would like to read more, you can access a recent academic journal article in the International Journal of Integrated Care.
If you’d like more information on this research and the work of Bon Accord Care, you can email Lou.