Frome&Health&and&Well/being&project! A&research&project&by&Edventure:&Frome&in&collaboration&with&Frome&Medical& Practice&and&Frome&Town&Council.

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1 FromeHealthandWell/beingproject AresearchprojectbyEdventure:FromeincollaborationwithFromeMedical PracticeandFromeTownCouncil. December2014 Contents 1.0Introduction 1.1Background 1.2Theprojectteam 1.3Thepurposeofthisproject 1.4stakeholders 2.0Methodology 3.0Results 3.1Questionnairesreceived 3.2Question1 3.3Question2 3.4Question3 3.5Question4 3.6Question5 4.0Discussions 4.1Takinginsightsfurther 5.0Evaluation 5.1Limitationsofthestudy 5.2personallearning 5.3Futuresuggestions 6.0Conclusion 7.0Appendix 7.1Designprocessthinking 7.2Questionnaire

2 1.0Introduction Thisreportgivesanoverviewofthestepswetooktodesignandcarryoutthisresearchproject andtheresultsandinsightsthatwerediscovered. 1.1Background Frome Medical Practice(the Practice) is taking part in a survey for the NHS that will produce a national baseline of patient activation measure (PAM). The Practice was asked to canvass the opinionsofacrossusectionofthelocalpopulationinordertoassessthepamatlocallevel.this informationwillbefedintoanationaldatabase.aspecificsetofquestions,setoutbythenhs, wasusedinordertofulfilthesecriteria,whichmeetsscientificstandardsandwillprovidealevel ofvalidationatanationalscale. ThePracticewantedtotakethisasanopportunitytofindout,inadditiontotheabove,whatthe needsoflocalpeopleareinorderforthemtohavemoreownershipandagencywithregardsto theirhealthandwellbeing.bydoingthesetwoexercisesincombination,thepracticewillhavea validateddatasetonwhatpatientsneedsareregardingtheirhealthandwellubeing. ThisisthefirstsurveyofitskindinFromeandwillserveasabaselineforthedevelopmentofthis areabythepractice. 1.2Theprojectteam This project was undertaken by three apprentices, taking part in Edventure: Frome; A free nine monthtraininginsocialentrepreneurship;kylieconnell,oliviagoodeyandwillshipp. 1.3Purposeoftheproject Thepurposeofthisexerciseisthreefold: 1. To comply with NHS requirements to complete a patient activation measurement questionnaireinfrome. 2. TofindoutfromabroadcrossUsectionoftheFromepopulationwhattheyneedinorderto takeownershipandcontroloftheirhealthandwellubeing. 3. Toidentifylearning sonhowbesttoengagethelocalcommunityinhealthandwellubeing issues 1.4Stakeholders AfterourinitialmeetingwithDr.Kingstonwefeltitimportanttoapproachseveralstakeholders beforedesigningthequestionnaire,togainabroaderperspectiveonwhatwasneeded/wanted fromthedatawegathered.wespoketoanumberofpeoplefromdifferentgroupsofinterest, askingeachofthemasetofquestionsdesignedtoseewheretheirinterestslayandwhattheyfelt wouldbeofvaluefromsuchaquestionnaire.hereisalistofthestakeholdersweapproached: WithinFromeMedicalpractice: 1. HelenKingstontorepresenttheviewsoftheGeneralPractitioners. 2. Carestaffwithcommunityresponsibilities.Thisincludeddistrictnursesandthepractice manager. Furtherstakeholders: 1. FromeTownMayorandaFrometowncouncillor 2. ArepresentativeofSavetheNHSgroup 3. IndividualsfromtheKeyandBridgeCentres 4. CumulusResearch,statisticsspecialist

3 WealsoattemptedtocontactFromeCitizenAdviceBureauandActiveandInTouchbutwere unabletoreachthem. Oncewehaddesignedthequestionsweforwardedthequestionnairetofurtherstakeholdersto makethemawareofthequestionnaireandtoinvolvethemintheprocessofsharingtheonline formatforittoreachawideraudience.theseincluded: 1. SomersetCCG 2. MedicalPracticestaff 3. SomersetPartnership 2.Methodology TheapproachthatwechoseforthisqualitativestudyisbasedonDesignThinking:anintentional process to develop new, relevant solutions that create a positive impact. This approach places creativity at the centre and provides a process for transforming difficult challenges into opportunitiesfordesign.wechosethismethodologybecause: 1. It's humanucentred: it stems from deep empathy and understanding of needs and motivationsofpeople 2. It scollaborative:itbenefitsfromtheviewsofmultipleperspectives 3. It'soptimisticaboutthepossibilityofcreatingpositivechange 4. It'sexperimental:itallowsforlearningfrommistakesduetoitsiterativenature. Intheappendix8.1showsthefivephasesinvolvedinthedesignthinkingprocess.Duetothetime constraintsofthisproject,wefocussedontheinitialtwophases: Discovery: Understanding how to approach the challenge: We met with Peter and Helen to discuss the purpose of the PAM questionnaire and the motivations behind creating another questionnaire. Wecontactedotherstakeholderstofindoutadviceonwritingaquestionnaire. Preparingthequestionnaire:InresponsetomeetingHelenandPeteranddiscussionswithother stakeholdersweseparatedtheadviceintopotentialquestionsandprocess.fromthisinformation weputtogetherfivequestions.wealsotookadvicefromastatisticianandalteredthequestions accordingly. Gathering the data: We contacted various community groups and venues suggested to us by stakeholders and from our knowledge of being in Frome and took the questionnaires to them. Withsomegroupsweleftquestionnairesforthemtofilloutintheirowntimeandotherpeople weconnectedwithfacetoface,writingtheiranswersforthemifnecessary.wealsocreatedan online version on Google forms and distributed this as widely as possible amongst peers and stakeholders. Interpretation:ToFindmeaninginthedata,wetriedtoseparatetheanswersinto3categories. We attempted this with one question and decided that it was not a true representation of the data as our views on how to categorise were very subjective. We then decided to use a word count, to see which words were mentioned the most. We used an online programme called Wordle togiveavisualrepresentationofthewordfrequency.thenwefoundthetop10words andcreatedapiechart.wethenpickedthe2mostmentionedwordsperquestion,wentthrough thedataandfoundoutinwhatcontexteachwordwasmentioned,thiswasturnedintoamind map.

4 3.Results 3.1Questionnairesreceived This list shows the groups or places in which the questionnaires were filled out and how many werecompleted. OnlineU65 MedicalpractisepatientsU22 AcornpharmacyU21 LunchclubU20 RossettihouseU18 SportscentreU12 MaturemoversTalkingclubU12 WImarketU11 FromeWholefoodsU8 StanderwickmarketU8 RuralyouthU8 FriendsandfamilyU7 LegclubU7 StartupinspireU6 EdventureU6 FootballclubstaffU2 BridgecentreU2 PoetryclassU1 TheWelshmillhubU1 MenshedU1 FrometowncouncilU1

5 3.2Question1 Whatthingsdoyoureallyenjoydoinginyourlife? Visualrepresentationofwordfrequency: Piechartofthe10mostcommonlymentionedwords:

6 Thetwomostcommonlymentionedwordsandthecategoriesinwhichtheywerementioned: Family: Walking:

7 3.3Question2 Whatdoyoudowhenyou refeelingloworunwelltofeelbetter? Visualrepresentationofwordfrequency: Piechartofthe10mostcommonlymentionedwords:

8 Thetwomostcommonlymentionedwordsandthecategoriesinwhichtheywerementioned: Friends: Talking:

9 3.4Question3 Whatdoyoufindchallengingaboutlookingafteryourself? Visualrepresentationofwordfrequency: Piechartofthe10mostcommonlymentionedwords:

10 Thetwomostcommonlymentionedwordsandthecategoriesinwhichtheywerementioned: Time: Motivation:

11 3.5 Question 4 Howwouldyoufindouthowtohelpyourselfwhenyournot feelinggood? Visualrepresentationofwordfrequency: Piechartofthe10mostcommonlymentionedwords:

12 Thetwomostcommonlymentionedwordsandthecategoriesinwhichtheywerementioned: Doctor: Internet:

13 3.6Question5 Howwouldyoufindouthowtohelpyourselfwhenyou renot feelinggood? Visualrepresentationofwordfrequency: Piechartofthe10mostcommonlymentionedwords:

14 Thetwomostcommonlymentionedwordsandthecategoriesinwhichtheywerementioned: Time: Exercise:

15 4.0Discussion WeinvitedHelenandPetertolookatthevisualdatawithus,toseewhatinsightswecoulddraw fromittogetherasagroup. Wedrewtheseinsightsfromthedata;thefurtherthoughtsareourownpersonalinterpretations anddiscussionsthatfollowedfromtheseinsights. Insight1 People most commonly rely on their doctor and the internet as go to places for information whennotfeelinggood. Furtherthoughts: 1. Use of the internet was high amongst people who completed the questionnaire, even thoughnoteveryonehasaccesstoitorknowshowtouseit.ifmorepeoplehadinternet accessandtheskillstouseit,thenperhapsagreaternumberofpeoplewouldutiliseitasa sourceofinformationwhennotfeelinggood. 2. Whetherusingtheinternetasasourceofinformationisagoodthingisupfordebate.It couldbearguedthatadownsideofusingtheinternettofindoutinformationabouthealth and wellbeing issues is that in some cases the information could be unreliable or misinterpretedwhichmightleaveapersonfeelingworse. 3. Fewer people mention their pharmacist or nurse as sources of help when they need it. ThesemedicalprofessionalsmaybeunderutilisedpotentiallyputtingstrainonGPservices. Insight2 Exercise was the second most frequently occurring word in the responses to question 5, which couldbeviewedasapredominantlyphysicalwaythatpeoplecanlookafterthemselvesbetter. Furtherthoughts: 1. Wecannotdeterminewhypeopleexerciseandrecognisethatitcouldbefortheindirect social,mentalandemotionalhealthbenefits. 2. In our culture, physical health tends to be easier to talk about; it is an accepted custom. When it comes to mental and emotional health there is more reticence to discuss this openly. 3. People may not see the connection between their mental and their physical health, therefore when they feel unwell they may focus mainly on strategies linked to their physicalhealthsuchasexercising. Insight3 TalkingtootherpeopleUnamely,friendsandfamilyUandbeingsociableissomethingthatmost peoplesaidtheyenjoydoingintheirlivesanduseasstrategiestofeelbetterwhenfeelinglowor unwell. Furtherthoughts: 1. Social activity as a health and wellbeing strategy and the benefits of socialising may be perceivedashavinglessimpactthan,forinstance,physicalactivitybuttheresponsesshow thattalkingandbeingwithfriendsandfamilyarethemostcommonwaysinwhichpeople dealwithfeelingloworunwell. Insight4 People face a variety of different challenges in looking after themselves: some cite their circumstancessuchasspecifichealthproblems,familypressuresorworkastheirmainchallenge; othersmentiondifficultieswithtimeumanagementandmotivation.

16 Furtherthoughts: 1. Peoplewhoarestrugglingwiththeircircumstancesmaybedoingbetterwithlookingafter theirhealthandwellubeingthantheygivethemselvescreditfor.somerecognitionforwhat theyaredoingalreadymayhelpthemseethisandappreciateit. 2. Sometimespeopledon'tallowthemselvespermissiontofeellow,ortonotmeetgoalsor expectationsthattheyhavesetforthemselves.peoplemaybenefitfrombeingaccepting ofthesesituationsandunderstandingthemasnormalandok. 3. PeoplewhostrugglewithtimeUmanagementorwithhowtoprioritisetheirhealthandwellU beingmayneedsomesupportandeducationtoknowwheretoresorttoforhelp. Insight5 The most common challenge that people mention in looking after themselves is not having enoughtime.thisisfollowedbyalackofmotivation. Furtherthoughts: 1. Itmaybethattheissuesoftimeandmotivationarelinked:alackofmotivationmaybea biggerchallengethannothavingenoughtimetoaddresswellubeingissues. Insight6 Inanswertoquestions1and2peoplehaveidentifiedawiderangeofstrategiestheyhaveinplace to help look after their wellbeing, mentioning many different groups and services available in Frome. Furtherthoughts: U This is something we can appreciate from the data as positive and encouraging for the following reasons: Frome has plenty to offer people in terms of facilities, groups and servicestoservepeople swellbeing;peopleinthecommunityaretakingpositiveactionin lookingafterthemselves. 4.1Takinginsightsfurther Following our analysis of the data, together with Dr. Kingston and Mayor Peter Macfadyen, we havedevelopeda howmightwe questionwhichfeltinteresting: 1. Howmightweacknowledgethestrategiesthatpeoplealreadyhaveinplacetolookafter themselves? 2. Howmightwepromotethosestrategiesandstructuresthatareworkingforpeople,sothat otherscanbeinspiredorsupportedtoimprovetheirhealthandwellubeing? 5.0Evaluation 5.1Limitationsofthestudy: 1.Timeconstraintswefounditdifficulttoanalysequalitativedatainonlyafewdays.Wealsofelt wewereunabletogetthedepthandrichnesswewantedfromthedatainthisshorttime. 2. Examples: we wrote examples under the questions in the questionnaire, to us the examples were obvious answers to the questions. Some of the examples we used were mentioned most frequently in the questionnaire, this could have been because we wrote them as examples or

17 becausetheyarecommon.writingexamplesmayhaveskewedthedata. 3. Demographic: we did not reach a wide enough demographic to represent the population of Frome,somedemographicswereunderoroverrepresented.Peopledidn talwaysleaveageetcso wewereunabletomatchtheirdatatoademographic. 4. Subjectivity: we all have our own individual opinions on health and wellbeing, and different things we wanted to get out of the questionnaire, consciously or unconsciously we may have adaptedthequestionnairetomeetourownneeds. 5.Knowledge:weallhavelimitedknowledgeonworkingwithquestionnairesandqualitativedata. 6.Qualitativedata:wefounditdifficulttodrawinsightsfromsuchabroadrangeofqualitative data. 7. Reactions: we discovered that people were generally mistrusting of questionnaires and were reluctanttofillthemin. 5.2Personallearning: 1.Peoplefilledinquestionnairesinmuchgreaterdepthwhendoingitonline,attheirownleisure andchoice,ratherthanbeinghandeditandaskedtofillitin. 2.WehadnoideahowmanyexistinggroupsthereareinFrome,andhowtheyarehelpingpeople tomanagetheirhealthandwellbeing,itwasinspirationaltodiscoverthesegroupsandmeetthe peoplethattakepartinandrunthem. 3.Wehavelearntmanyskillstoworkwithinatighttimescaleandthededicationandfocusthis requires. 4.Itwasdifficulttogetthemessageacrosstopeopleaboutwhatweweredoingandwhywewere doingit.peopleweren talwayswillingtoreadinformationandpreferredtogetonwithwriting thequestionnaire. 5.3Futuresuggestions: 1.Makemoreefforttoreachayoungerdemographic. 2.Haveafocusgrouptodothequestionnairewithpeoplewhowanttofillitout,togetmorein depthanswers. 3.Findoutmoreinformationfromthosewhoworkwithspecificgroupsonhowtoapproachthose groups. 4.Createagecategoriestofindoutthespecificnumberofpeoplefromeachdemographicrelative tothepopulation. 6.0Conclusion We have learnt a lot about the people in Frome and their health and wellbeing, the challenges theyfaceandthewaysinwhichpeopleusedifferentstrategiestofeelhappyandhealthy.wefeel that Frome already provides for peoples health and wellbeing through various groups and services. Hearing that people face challenges and can identify the things that would help them look after themselves better tells us that there is more work to be done in terms of connecting peoplewithsolutionsforimprovingtheirqualityoflife;someofthesesolutionsalreadyexistand

18 perhapssomeneedtobefound.perhapswithamoreindepthlookatthedata,furtherinsights couldbegainedandsomeofthesesolutionscouldbefound 7.0Appendix 7.1Designthinkingmethodology:process

19 7.2Questionnaire Health and Wellbeing questionnaire Introduction We are working with Frome Medical Practice, Beckington Family Practice, Mendip Country Practice and Frome Town Council to find out what things in the town help people to stay healthy, happy and improve their quality of life, so that they can understand people's needs better. Being healthy and happy means different things to different people: we would be really grateful if you could answer the questions below to tell us what it means for you. The information you give us will help contribute to improving services in Frome. Your personal data will not be shared publicly. If you would like any more information please contact us at THIS QUESTIONNAIRE MUST BE COMPLETED BY SUNDAY 30 TH NOV. Please place the filled in questionnaire in the brown envelope provided Consent This questionnaire is being carried out by Frome Medical Practice, Frome Town Council and Edventure: Frome. Information from the first six questions will be used only by the organisations in Frome mentioned above to inform the development of services in Frome. The information gathered from the 13 patient activation measure questions will be inputted into a national database and used by the NHS for research purposes. Your personal information will be added to the NHS database, if you choose to provide it at the end of the questionnaire. All data you provide is protected under the data protection act If you want to remain anonymous please do not leave your name, address or date of birth I understand the above. Signature Date

20 Please keep this page for personal reference. Your health and wellbeing 1. What things do you really enjoy doing in your life? E.g. Hobbies, spending time with family etc. 2. What do you do when you re feeling low or unwell to feel better? E.g. Talking to a friend, exercise etc. 3. What do you find challenging about looking after yourself? E.g. Time, motivation, health issue etc. 4. How would you find out how to help yourself when you re not feeling good? E.g. Internet search, asking your doctor etc. 5. What one thing would help you to look after yourself better? 6. Are you interested in setting up a group or service in Frome to help others? (Please circle) YES NO

21 If yes, what would this be? NHS patient activation questions Please answer the following 13 questions: circle the answer that best represents how you feel. (Strongly Disagree, Disagree, Agree, Agree Strongly, N/A). If the statement does not apply to you, circle N/A. 1. When all is said and done, I am the person who is responsible for taking care of my health. 2. Taking an active role in my own health care is the most important thing that affects my health. 3. I am confident I can help prevent or reduce problems associated with my health. 4. I know what each of my prescribed medications do. 5. I am confident that I can tell whether I need to go to the doctor or whether I can take care of a health problem myself. 6. I am confident that I can tell a doctor concerns I have even when he or she does not ask. 7. I am confident that I can follow through on medical treatments I may need to do at home. 8. I understand my health problems and what causes them.

22 9. I know what treatments are available for my health problems. 10. I have been able to maintain (keep up with) lifestyle changes, like eating right or exercising. 11. I know how to prevent problems with my health. 12. I am confident I can figure out solutions when new problems arise with my health. 13. I am confident that I can maintain lifestyle changes, like eating right and exercising, even during times of stress.

23 Personal information If you want to remain anonymous please do not fill in this section. Name: Date of birth: Gender: (please circle) Male / Female Signature: If you would like to receive the results of the questionnaire please leave your address: