community engagement to improve health fieldwork report - nice uk - 2008

8/14/2019 Community Engagement to Improve Health Fieldwork Report - NICE UK - 2008

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Findings from fieldwork on Draft Community

Engagement Guidance

Report

September 2007

Prepared for: National Institute for Health and Clinical Excellence

(NICE)

Prepared by: Claire McAlpine, Sue Clegg and Darren Bhattachary

BMRB

Telephone: 020 8433 4394

Email: [email protected]

Part of BMRB Limited (British Market Research Bureau)

BMRB / 45106553

BMRB is ISO9001:2000 and ISO 20252 accredited.

Copyright: findings and deliverables are normally intended for use within the Client's organisation or its

consultants and other associate organisations such as advertising agencies. Should the Client intend wider

circulation of the survey findings and deliverables, the Client should inform BMRB prior to such disclosure

and agree the form and content with BMRB. The client should acknowledge BMRB as the source of the

information with wording acceptable to BMRB.


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Table of Contents

Executive Summary ............................................................................................... 41 Introduction ....................................................................................................... 82 Research design ............................................................................................. 103 Views on the Guidance as a whole .......................................................... 184 Recommendations ......................................................................................... 265 Style and format of the guidance ............................................................ 406 Barriers to implementing the guidance ................................................ 467 Improving health and tackling health inequalities .......................... 528 Conclusions ...................................................................................................... 54Appendices .............................................................................................................. 58

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Acknowledgements

We would like to thank Lorraine Taylor, Amanda Killoran, Antony Morgan and the rest of

the research team at NICE for their help and support with this project.

We are also grateful to the BMRB Field Management Team who co-ordinated the

dedicated recruiters who worked on this project for their hard work and effort

throughout. Our thanks go to the remaining members of the research team: Eleanor

McDonald, Robert Fish and Glenys Davies.

Finally, we would like to express our gratitude to those who participated in the research

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Executive Summary

The Centre for Public Health Excellence at the National Institute for Clinical Excellence

developed a draft guidance on Community Engagement. BMRB Social Research were

commissioned to evaluate the draft guidance with those involved with comities and

vulnerable groups.

Research Design

The research involved qualitative interviews and group discussions and a small scale

survey. The qualitative work took place in the North East and South West, and the

survey across several geographical locations in England. The following took place:

40 interviews (a combination of face to face and telephone interviews)

4 group discussions (2 each in the North East and South West)

50 responses to the survey were received.

General views on the guidance

Overall the guidance was viewed positively. It was seen as highlighting NICEs support

for community engagement methods, and as reinforcing the need for strategic and

community organisations to engage with local communities. The guidance was felt to fit

well with other agendas such as Every Child Matters and Health Scrutiny Agendas.

The principles outlined in the guidance were familiar to respondents and were usually

working towards community engagement in their own organisations; however, this was a

key criticism of the guidance, with respondents feeling that it was not covering new

ground. It was acknowledged that for organisations less familiar with the concept of

community engagement the guidance would be a useful tool.

The guidance was seen as being useful as a blue print for organisations to check that

they were undertaking community engagement correctly, particularly those new to the

concept of community engagement.

Whilst the guidance was generally felt to be relevant to participants it was pointed out

that there was a gap in terms of childrens and young peoples organisations.

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It was felt that the guidance would benefit from being more directive, and from including

practical information for how to take forward community engagement.

The Recommendations

The recommendations section of the guidance was seen to be the most important part of

the document. Eight of the recommendations were thought to be of particular

importance:

Long term planning (recommendation 1)

Levels of engagement and power (recommendation 2)

Trust and respect (recommendation 3)

Avoiding pitfalls (recommendation 4)

Infrastructure (recommendation 5)

Partnership working (recommendation 8)

Training (recommendation 9)

Evaluation (recommendation 18)

Several suggestions were made for improving the recommendations overall, by:

Highlighting the importance of education in health improvement throughout the

recommendations

Emphasising the importance of honest feedback to the community regarding

decisions which had been made and the effectiveness of local initiatives

Providing advice on how to engage with vulnerable client groups

Including all communities of interest

Recognising the importance of volunteer workers

Reducing repetitiveness of the recommendations

Having consistency regarding who should take action

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Ensuring the recommendations do not imply community engagement should be

done to communities

Providing titles for all recommendations

A common request was that the recommendations should contain guidelines for how to

implement them.

Style and format of the guidance

Concerns were expressed about the style and format of the recommendations, withrespondents saying that they could negatively impact on how readers responded to the

guidance, and ultimately how effective it would be in improving health and reducing

health inequalities.

The language of the guidance was of particular concern, with participants expressing the

view that the document was not easy to read, and so could be off-putting for some

people, particularly those unused to using such documents, for whom the guidance was

thought to be of particular relevance.

The length of the guidance was also thought to be a barrier to use for some people, with

the intended audience not having time to read it.

Barriers to implementing the guidance

Lack of resources was perceived to be the major barrier to implementing the guidance.

Such lack of resources included both staff time and money to undertake work needed.

Other barriers were:

Lack of how to information

The length of the guidance and the language used

Promotion of the guidance this was highlighted as a potential barrier if the

guidance is not well promoted, however it was also seen as a key enabling factor

if done well

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Unwillingness to implement the guidance and recommendations on the part of

some local authorities

Lack of support from key bodies and organisations

Consultation apathy

Improving health and tackling health inequalities

There were mixed views about whether the guidance had the potential to improve health

and tackle health inequalities; in the main the recommendations were seen to have the

potential to do so, assuming the key barriers to implementation were tackled.

Conclusions

The guidance was seen as supporting and giving credibility to the concept of community

engagement, although some improvements to the recommendations were felt to be

needed if they were to be of use, and the barriers identified needed to be addressed.

A key consideration in reviewing the guidance was that respondents felt the need forconcrete suggestions for how each recommendation could be implemented.

Challenges faced during the research have been identified, and recommendations made

for overcoming them in the future.

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1 Introduction

1.1 Background to the research

The Centre for Public Heath Excellence (CPHE) at the National Institute for ClinicalExcellence (NICE) developed draft guidance on community development and engagement

methods and approaches for improving health and reducing health inequalities. The draft

guidance draws on a range of evidence of methods and approaches for involving

communities at the consultative and informing levels, as well as in the co-production of

activities and services, including devolving power and control, to ensure the greatest

impact on health outcomes. The draft guidance considers the effectiveness and cost

effectiveness of a range of engagement methods and approaches, together with cultural

and institutional factors affecting their adoption. The final guidance is due to be issued by

NICE in early 2008 to the NHS, Local Authorities and other community organisations.

1.2 Research aim and objectives

Aim

The aim of this project was to evaluate the draft community engagement guidance with

those involved in working with communities and vulnerable groups.

Objectives

Specifically the projects objectives were to:

Evaluate the relevance and usefulness of the guidance to those working locally

with communities and vulnerable groups with regard to:

o Their current practice

o The potential to improve health and tackle health inequalities

Explore the views of communities on the usefulness, relevance and potential

impact of the guidance for improving health and tackling health inequalities

Explore factors which might help or hinder implementation and delivery of the

guidance, with specific reference to the roles and capacities of the statutory,

community and voluntary sectors.

1.3 Report outline

Following this introductory section, the report is divided into 7 further chapters. Chapter

2 discusses the design of the research; Chapter 3 considers views on the guidance as a

whole; Chapter 4 is concerned with the recommendations section of the guidance;

Chapter 5 considers the style of the guidance; Chapter 6 discusses barriers to

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implementing the guidance; Chapter 7 discusses the guidances potential to tackle health

inequalities; and conclusions are presented in Chapter 8.

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2 Research design

This chapter discusses the research design used for the study, including the methods

used for analysis of the data.

The challenge for this project was to develop an approach that could provide detailed

feedback on the guidance and test its feasibility for implementation, whilst being mindful

of views across the whole health gradient and spectrum of the population. To address

this, a two stage methodology consisting of qualitative fieldwork (depth interviews and

group discussions) and a small scale survey was used.

2.1.1 Qualitative fieldwork

The methods employed in the first stage of this research were qualitative in nature. Thisapproach was adopted to allow for individuals views and experiences to be explored in

detail. Qualitative methods neither seek, nor allow, data to be given on the numbers of

people holding a particular view nor having a particular set of experiences. The aim of

qualitative research is to define and describe the range of emergent issues and explore

linkages, rather than to measure their extent.

Geographical areas

Two English regions were chosen for this research: the North East and the South West.

These areas have marked inter and intra regional differences in health inequalities and

deprivation levels1 (please see below footnote for more information).

Numbers of interviews and groups

Forty depth interviews were conducted with representatives of community and strategic

organisations across the South West and North East of England (Please see Appendix A

for details of respondents). Interviews were either conducted face-to-face or on the

telephone, depending on the respondents preferences and the need to cluster face-to-

face interviews together to make them economically viable.

Four group discussions (of seven to eight respondents in each group) were also

conducted with members of community groups and strategic organisations (please see

1 For instance, for the period 1999-2003, 40 per cent of wards in the North East were in the 20 per cent of

wards in England and Wales with the lowest levels of life expectancy at birth, compared with only 7 per cent in

the South West [ONS (2006) New experimental life expectancy figures for small areas. Available at:http://www.statistics.gov.uk/pdfdir/lex0606.pdf]. Similarly, for the period 1998-2004, the North East also had

the lowest average household incomes per head in England [DTI (2006) Regional competitiveness and state of

the Regions. Available at: http://www.dtistats.net/sd/rcsor2006html/section1.htm].

10
http://www.statistics.gov.uk/pdfdir/lex0606.pdfhttp://www.dtistats.net/sd/rcsor2006html/section1.htmhttp://www.dtistats.net/sd/rcsor2006html/section1.htmhttp://www.statistics.gov.uk/pdfdir/lex0606.pdf


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appendix A for a details of respondents). Two of the groups were recruited and

conducted in the South West (Plymouth and Taunton) and two in the North East

(Sunderland and Northumberland).

Recruitment of participants

To recruit for the qualitative fieldwork, BMRB developed a sample of key individuals

across the South West and North East of England; this was done by internet searching

for organisations likely to be involved with, or working in the field of, community

engagement, and for individuals whose job roles were likely to give them insight into the

issues around community engagement.

A full briefing with field managers on the project and detailed recruitment instructions

ensured recruitment was carefully managed. A screening questionnaire was also

provided to enable the recruiter to screen for respondents eligibility to participate in the

research. All recruiters are members of the IQCS (Interviewers Quality Control Scheme).

One recruiter was used to recruit the respondents by telephone.

Each potential respondent was sent an invitation letter outlining details of the research

(please see Appendix B), which was followed up with a telephone call from one of BMRBs

specialist recruiters, to ask them to participate and to set up an interview date. All

respondents were emailed the draft guidance and an introductory letter (see appendix C)

following publication of the guidance on the 23rd August 2007.

Conduct of the interviews and group discussions

The in-depth interviews and group discussions were carried out by five experienced

qualitative researchers who have extensive experience of conducting qualitative fieldwork

and have been trained the use of non-directive techniques.

All members of the research team took part in a briefing to ensure the methodological

approach was consistent across the interviews and discussions.

Each interview and group discussion was exploratory in form so that questioning could be

responsive to the experiences and circumstances of the individuals involved. They were

based on a topic guide (see Appendix D) 2, which listed the key themes and sub topics to

2 It should be noted that the topic guide was amended after the groups and a few of the interviews had taken

place, as the researchers were finding it difficult to address all of the issues in the original topic guide. This

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be addressed and the specific issues for coverage within each. Although topic guides

help to ensure systematic coverage of key points across interviews and discussions, they

are used flexibly to allow issues of relevance for individual respondents to be covered

through detailed follow up questioning.

All interviews and group discussions were recorded and transcribed.

The analysis of qualitative material using M a t r i x M a p p in g

Material collected through qualitative methods is invariably unstructured and unwieldy.

Much of it is text based, consisting of verbatim transcriptions of interviews and

discussions. Moreover, the internal content of the material is usually detailed and in

micro-form (for example, accounts of experiences and inarticulate explanations). The

primary aim of any analytical method is to provide a means of exploring coherence and

structure within a cumbersome data set whilst retaining a hold on the original accounts

and observations from which it is derived.

Qualitative analysis is essentially about detection and exploration of the data, making

sense of the data by looking for coherence and structure within the data. Matrix Mapping

works from verbatim transcripts and involves a systematic process of sifting,

summarising and sorting the material according to key issues and themes. The process

begins with a familiarisation stage and includes a researchers review of the audio files

and/or transcripts. Based on the coverage of the topic guide, the researchersexperiences of conducting the fieldwork and their preliminary review of the data, a

thematic framework is constructed. The analysis then proceeds by summarising and

synthesising the data according to this thematic framework using a range of techniques

such as cognitive mapping and data matrices. When all the data have been sifted

according to the core themes the analyst begins to map the data and identify features

within the data: defining concepts, mapping the range and nature of phenomenon,

creating typologies, finding associations, and providing explanations.

The analyst reviews the summarised data; compares and contrasts the perceptions,

accounts, or experiences; searches for patterns or connections within the data and seeks

explanations internally within the data set. Piecing together the overall picture is not

simply aggregating patterns, it also involves a process of weighing up the salience and

dynamics of issues, and searching for structures within the data that have explanatory

power, rather than simply seeking a multiplicity of evidence.

amendment was undertaken at the suggestion of NICE staff that had observed three of the four groups

discussions, and was done in agreement with the NICE team. Such amendments are usual in qualitative

research, as the topic guides are not used as questionnaires, but as aides memoire.

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The use of qualitative data in this report

This report is mainly based on the themes and issues arising from the analysis of the

qualitative data from the interviews and group discussions. Verbatim quotations are

used throughout the report to illustrate points being made.

2.1.2 Small scale survey

An electronic survey explored the views of individuals across various geographic areas,

service providers and communities of interest.

This survey consisted of six attitudinal statements (please see Appendix E or below) on

which respondents rated their agreement/disagreement, and six open ended questions to

explore negative responses.

Survey sample

BMRB developed a sample of 517 individuals whose work included engaging with local

communities on health promotion initiatives or initiatives that addressed the social

determinants of health. Again, this sample was achieved by internet searching, and, in

some cases, by recommendations from NICEs PDG and staff .

Conduct of the survey

Each potential respondent was emailed the same invitation letter as the depth/focus

group respondents (Appendix B)which was followed up by an email including the draft

guidance, an information sheet (Appendix F) and the short questionnaire on the 23rd

August 2007. Respondents were sent a reminder email two days before the deadline

(3rd September 2007), and those who had not completed the questionnaire after this

deadline were sent an email extending the deadline until the 7th September 2007.

The survey questions

The six altitudinal questions in the survey were all designed to be answered with one only

of the following responses:

Agree strongly

Agree

Disagree

Disagree strongly

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The omission of a middle ground option for answering was purposeful, to eliminate the

possibility of respondents merely ticking the middle-most answer (which could have

been, for example, neither agree not disagree).

The survey questions were as follows:

Q.1 The language used within the guidance and the recommendations is easy to

understand

Q.2 The guidance and the recommendations are very relevant to my current

practice and the organisation/s which I work with

Q.3 The organisation/s which I work with have adequate resources to implement

the guidance and recommendations

Q.4 I am satisfied that the guidance and the recommendations are relevant to the

needs of all communities

Q.5 The guidance and the recommendations are useful for organisations working

with communities to improve health and tackle health inequalities

Q.6 I do not imagine that there will be any barriers to implementing this guidanceand the recommendations within the organisation/s I work with

Each question was followed by an open ended question, for clarification of negative

responses:

If you ticked disagree or disagree strongly please use the space below to

explain your answer

Data was also collected on respondents, to classify answers according to type of

organisation.

Please see Appendix E for a copy of the survey questionnaire.

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Responses to the survey

From the sample of 517 individuals 50 responses to the survey were received. Although

this is a small number of responses the spread of organisation type and location was

relatively good. Forty nine of the fifty respondents gave information about the type of

service they represented, as follows:

Service type (or role) Number

Councillor 2

Disadvantaged & vulnerable group service 6

Neighbourhood based management and/or community empowerment programme 15

Other* 18

PCT or LA with community involvement function 8

Total 49

Table 1: Service type of survey respondents

*In the table above Other represents groups which did not fit into the existing

categories. Eleven the Other grouping represented general communities of interest, 3

older people, 3 BME groups and 1 a general group.

The regions represented by the survey participants were:

Region Number

East Midlands 4

East of England 4

London 10

North East 7

North West 7

South East 4

South West 4

West Midlands 4

Yorkshire & Humber 6

Total 50

Table 2: Regions represented in survey

Thirty six of the respondents represented organisations working mainly in urban areasand nine represented organisations working mainly in rural areas (five respondents did

not answer this question).

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The communities of interest represented by survey respondents were:

Community of interest Number

BME groups 5

Disability groups 2

General 30

Older people 6

Other 5

Women 2

Total 50

Table 3: Communities of interest represented in the survey

Analysis of the survey data

The data from the survey was entered into an Excel spreadsheet, developed for this

research, and was then analysed by producing pivot tables to give cross tabulations ofanswers to questions by organisation type. The data from the open ended questions was

analysed by putting comments into a matrix, and looking for commonalities and

differences between answer types.

The use of quantitative data in this report

Graphs showing responses to the survey questions appear throughout this report. Data

from the open ended questions in the survey are included alongside the qualitative data,

and are identified as being survey answers.

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3 Views on the Guidance as a whole

This section considers respondents views of the draft community engagement guidance

as a whole document. Where respondents have raised points around the usefulness and

relevance of specific recommendations, these are discussed in section 4.

3.1 Usefulness of the draft community engagement guidance

The guidance was seen as a document which highlighted NICEs support for community

engagement methods, which in turn would serve to reinforce the need for strategic and

community organisations to engage with local communities. By creating a community

engagement guidance, NICE was seen as giving credibility and importance to the idea of

community engagement.

Overall, respondents agreed with the issues and recommendations made, and felt very

familiar with the principles portrayed within the document. However, this was one of the

key criticisms of the draft community engagement guidance in that the guidance was not

perceived as covering new ground. There were respondents who felt their organisations

were currently working towards the recommendations with their own plans and policies

and questioned the need and usefulness of the guidance.

It doesn't contradict anything else Ive seen but why reinvent the wheel

and do another document. Why not use resources already available?

Group Discussion 4, South West; Somerset

On the other hand, there were respondents at both strategic level and from community

groups who felt that whilst they were familiar with all that the guidance recommended, it

provided them with an opportunity to check they were doing it right. The guidance was

also considered useful to those new to the concept of community engagement (concerns

were raised around the style of the language for those new to community engagement

this is discussed further within section 5.2).

I think they will be useful for some people, you know, perhaps newer

people in this area of work or you know as a start point for this sort of

approachbut there wasnt much that was new to me.

Manager, SureStart

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The glossary was found to be helpful, and thought to be particularly useful for those new

to the concept of community engagement. However, specific concerns were raised

around the definitions of Community Engagement and Community Development in the

glossary. The first concern was that the guidance did not adequately explain what these

terms mean, so people new to the concept would not be able to understand them. The

second critique was that the guidance did not adequately address debates around the

distinction between these two terms, which could result in the terms being used

interchangeably.

Although there is a brief reference to the distinctiveness of community

engagement and community development they are in the vast majority of

references in the report linked in an umbilical way to the extent that many

will see them as interchangeable

Womens Organisation - Survey response3

The potential for lack of distinction between Community Engagement and Community

Development led to respondents suggesting that the guidance would benefit from

explicitly stating NICEs standpoint on these two terms and stating that it is recognised

that debate currently exists around the definitions.

When you talk with some groups theyll see a very distinct delineation

between community engagements and community development, and there

are a lot of very detailed conversations and discussions and arguments

that people will have about the difference between the two(the guidance

needs to be) something that really just expressly lays out the way that this

document views it, in that it is encompassing, it recognises that it

encompasses a very wide range of differing perspectives, differing

definitions, and that I think will help it to be better viewed by some

organisations

Head of Public Health, Healthy Community Organisation

Respondents felt that the guidance would be useful to use as a blueprint for best

practice, but suggested that it provided very little practical advice. A key critique of the

guidance was that it stated what should be done, without explaining how it could be

3 Whilst the survey asked specific questions, there were respondents who chose to include additional comments

in a separate document. These have been highlighted and included throughout the report where appropriate.

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done. It was felt that the guidance assumed that readers would know how to implement

the recommendations; for example one respondent stated that the idea of community

engagement is laudable but that in practice it is very difficult.

Ive got a scribbled note here involve resident members of the communityfrom the outset well Ive got a question mark, how?its alright stating

these things in what you want done but sometimes its very difficultI

keep coming back with a question mark. Fine, weve heard it all before,

but how are we going to do it?

Chair, Patient and Public Involvement Forum

Further concerns were raised as to how useful the guidance would be used in current

practice. It was suggested that community engagement as a concept is nebulous and

this itself would cause problems implementing the guidance, for example identifying

target populations.

The bit, it keeps repeating whos the target population and who should

take actionand its like well what does that actually mean because, yes

its just, I think that bits very nebulous.

Drug Action Team Coordinator

It was suggested that the guidance would greatly benefit from being more directive and

including practical advice such as;

o A how to section listing best practice techniques

o Advice on where to go for tools

o Templates and tools4

o Specific information on who should have training and where from

o A directory of key people and organisations to contact

4 It should be noted that the draft version of the community engagement guidance did not contain a tool kit.

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Whilst the lack of how to and specific details in the guidance was, overall, perceived to

be a weakness, there were respondents working in more strategically based

organisations who perceived this to be a strength. Not including specific details within

the guidance and recommendations helped the guidance to be open to interpretation and

therefore applicable to a wider audience.

A further point which was considered to be useful about the guidance was that it was

perceived to fit in well with other agendas such as Every Child Matters and Health

Scrutiny Agendas.

3.2 Relevance of the draft community engagement guidance

On the whole, the guidance was considered by respondents to cover a subject area that

was very relevant to the organisations they worked with. This is also reflected in the

results from the small scale survey for question 2 (The guidance and the

recommendations are very relevant to my current practice and the organisation/s which I

work with). As shown in graph 1, all but one of the respondents either agreed or agreed

strongly that the guidance and recommendations were very relevant to their current

practice.

Q2 - Relevant to current practice

0

1

2

34

5

6

7

8

9

10

agree agree

strongly

disagree

strongly

count

Councillor

Disadvantaged & vulnerable group

service

Neighbourhood based management

and/or community empowerment

programme

PCT or LA with community involvementfunction

Other

Graph 1 Responses to Survey Question 2 The guidance and the recommendations are

very relevant to my current practice and the organisation/ s which I work w ith.

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(Note: In this graph, Other represents the following communities of interest: Agree 2 BME

groups, 6 general groups and 1 group representing older people; Agree Strongly 4 general

groups, 2 older peoples groups and 1 other group; Disagree Strongly 1 BME group)

In probing respondents in more detail during the depths and group discussions the

responses that were given suggested that although the topics of health inequality and

community engagement itself was considered relevant, respondents called into question

the relevance of specifics of the guidance, such as the language used and individual

recommendations. The format and language of the guidance was felt to be more

relevant to those in strategic organisations compared with those who work directly with

communities. Additionally, the relevance of the guidance came into question when

respondents considered the usefulness of the guidance, particularly because there were

respondents who were already working towards the implementation of similar

recommendations through other guidance/policies. Those respondents who had similar

guidance or policy in their organisation felt they would not use the guidance as they

would prefer to use their own guidance, which was often locally orientated.

It is relevant to me...but weve got Community Engagement Guidelines

ourselves within the Councilyes, the Government guidelines on

consultation (and) community engagement, so if I was looking for

guidance on something thats probably where Id go, I dont think I would

go to this (NICE draft community engagement guidance)

Community Engagement Officer, Local Authority

On an individual level, respondents who felt familiar with the concept of community

engagement, despite feeling that the guidance was relevant, doubted if they would use

it. This was in part due to respondents feeling that a large amount of other information

regarding community engagement was also available.

So would I have read it if it had come on my desk? I dont know. Theres

sometimes a lot about on community engagement, isn't there

Manager, Youth Offending Team

It was felt that the guidance would be particularly relevant, as well as useful, to those

less familiar with, or new to, community engagement.

In judging the relevance of the guidance to themselves and the organisations they

worked with, community organisations in particular would look to see who the target

population was for each recommendation and who should take action. As a result, there

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were respondents from community groups and in strategic roles who felt only parts of

the guidance were relevant to them, namely the recommendations which mentioned

either their client group as a target population or them as a group who should take

action. In particular, childrens and young peoples organisations highlighted that

children and education were rarely mentioned in the guidance and recommendations,

and therefore suggested that the guidance may not be relevant to their organisations.

The target population doesnt seem to outline vulnerable young people,

and you always look for your own areas. It talks about the target

population a number of times but I dont think it actually mentions young

people. When I didnt see young people, I thought this was very much

aimed at adult health issues

Manager, Youth Offending Team

Survey respondents were also asked whether they considered the guidance to be

relevant to the needs of all communities. As can be seen from the graph below, there

were mixed responses to this question, with almost a quarter of respondents

disagreeing:

Q4 - Relevant to needs of all communities

01

2

3

4

5

6

7

8

910

agree agree strongly disagree

count

Councillor


service



programme

PCT or LA with community

involvement function

Other

Graph 2 Responses to Survey Question 4 I am satisfied that the guidance and the

recommendations are relevant to the needs of all communities


groups, 5 general groups and 1 group representing older people; Agree Strongly 1 group

representing older people, 1 general group and 1 other group; Disagree 1 BME group, 4 general

groups and 1 group representing older people)

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The reasons given for negative responses included views that there were gaps in the

guidance for specific groups, for example one respondent wrote:

Although BME, elderly and disabled groups are mentioned, there are other

vulnerable groups which need including such as, children, travellers,

refugees and asylum seekers and carers. More emphasis is needed on the

differing needs of vulnerable groups and vulnerable communities regarding

engagement and participation.

Respondent representing an in the North of England (Urban), with a wide

remit including refugees and asylum seekers, travellers, and carers.

However, most respondents who elucidated their answers raised concerns about the

resources needed to implement the guidance, and felt that there would be some groups

who would not be able to work with them due to lack of resources, thus making the

guidance of limited relevance to them. One respondent wrote:

Pardon me for sounding cynical, but this report and recommendations

will do very well - thank you - in middle class suburbia, but, will fail in the

poorer parts of town if not adequately funded and resourced for longer

term input than 2-3 years. I feel funders/decision makers underestimate

the time it takes to build confidence and capacity in deprived communities

Respondent representing an group in the Midlands (Urban), in anouter-city deprived housing estate.

The lack of resources related not only to money, but also to people within groups who

could understand, and work with the guidance:

Whilst the ethos of the recommendations certainly seems to be inclusive,

the length, structure and language may make it inaccessible for some

communities.

Respondent representing a neighbourhood based management

and/or community empowerment programme in London (Urban).

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3.3 Views on the Public Health Need and Practice and

Considerations sections 5

The main focus of the interviews and the group discussions was the Recommendations

section of the guidance, however there were some views expressed about the Public

Health Need and Practice and Considerations sections of the document.

There were three types of views expressed about the type of information contained in

these sections, with respondents from across organisation types expressing all three

viewpoints:

That the information was useful, and more signposting backwards and forwards

from the Recommendations section would have been welcomed

For these respondents, the information contained in these sections was of greatinterest and they would have welcomed, for example, footnote explanations of

other documents referenced throughout guidance or hyperlinks between the

recommendations and the Considerations or background evidence relating to

them.

That the sections seemed very academic, and therefore off-putting

Respondents expressing this view tended to think that the academic language and

the evidence presented made the guidance a difficult document to use.

There is a lot of gumf to get through before getting to the main meat of

the document. In particular some of the considerations could perhaps be

condensed and some of the evaluation and limitations section put in

appendix

Programme Manager, New Deal for Communities

That more rigour was needed

There were some respondents who felt that the guidance, and particularly the

Considerations section, should be more cautious in the language it used. They

felt that NICE should be applying same level of academic rigour to the production

of this guidance as they would when considering whether, for example, a certain

drug should or should not be used, for example 'is there any evidence that you're

going to make any progress?'. For these respondents the Considerations section

did not seem to give enough evidence of academic rigour.

5It should be noted that the emphasis of the interviews was on the Recommendations section of the guidance,and not all respondents discussed the two sections discussed here.

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4 Recommendations

This section discusses views of the recommendations as a whole and identifies the

recommendations which were felt to be most important. The section concludes with a

detailed look at each recommendation and the key changes which were suggested to

improve each recommendation.

4.1 Views on recommendations as a whole

The recommendations were considered to cover the key areas and issues involved in

community engagement and health, and was felt to be the most important and useful

section of the draft community engagement guidance. Indeed, there were suggestions

that the recommendations could be a stand alone document in itself (this is discussed

further within section 5.3).

4.1.1 Most important recommendations

Individual recommendations were identified by respondents as being particularly

important, with the majority (recommendations 1, 2, 3, 4, 5) of these being

recommendations identified as essential conditions required if community

engagement/development activities are to be undertaken in the guidance (in the order in

which they appear in the guidance):

o Long term Planning (Recommendation 1)

o Levels of engagement and power (Recommendation 2)

o Trust and Respect (Recommendation 3)

o Avoiding pitfalls (Recommendation 4)

o Infrastructure (Recommendation 5)

o Partnership Working (Recommendation 8)

o Training (Recommendation 9)

o Evaluation (Recommendation 18)

The above recommendations were also usually those which respondents identified as the

most useful and relevant. These recommendations (and those not listed above) are

discussed in more detail in section 4.2. These recommendations were considered to be

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the most important to implement and to have a large role in effective community

engagement. For example, there were respondents from both strategic and community

organisations who felt that recommendations 1-5, and for one respondent

recommendations 1-3, covered a good proportion of the issues involved.

I think the first threejust because I think they are pretty overwhelming

and if they get that right they will be halfway there


A key finding to emerge was that by numbering the recommendations 1-18 there was a

suggestion of hierarchy of importance. There were respondents from all types and levels

of organisation who suggested that important recommendations should be placed at the

beginning of the recommendation sections; Infrastructure, Evaluation and Partnership

working were specifically identified. If NICE had not intended any recommendation to be

perceived as more important than another, it was felt important that this was explicitly

stated within the guidance. One respondent felt this could be represented visually within

a circle showing each recommendation to have equal weight.

If they are intended to be of equal or have an equal value, then

presenting them as a narrative list automatically starts a hierarchy because

the first one you read is going to be the most important one that you might

think about, so if they were presented as, I dont know, some sort of

model, circle, like pie diagram of equal size, you know the wedges are

equal size on the pie diagram, so that the reader is under no illusion that

these are all the ingredients that you would need to have for a robust

community development intervention.

Public Health Consultant, Primary Care Trust

There were also respondents, both at strategic and community level, who felt that this

section of the guidance should indicate and highlight how each recommendation was

related to others (for example, trust and long term planning see section 4.2).

4.1.2 Suggestions for improvement to recommendations as a w hole

Suggestions for improvement were made which relate generally to all recommendations.

These are discussed here, with suggestions for improvement relating to specific

recommendations discussed in section 4.2.

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Nine key improvements were suggested;

1. Highlight the importance of education in health improvement throughout the

recommendations

2. Emphasise the importance of honest feedback to the community on decisions

that have been made, why decisions have been made and the effectiveness of

local initiatives

3. Provide advice on how to engage with vulnerable client groups, for example,

drug users

4. Ensure readers are not excluded by mentioning all communities of interest,

particularly children and young people. If this list of communities is not

comprehensive, balance this by ensuring that the target populations are not

too specific so that recommendations will be considered relevant to a wide

range of organisations

5. Recognise the importance of volunteer workers throughout the

recommendations

6. Reduce repetitiveness of the recommendations particularly who is target

population, who should take action and what action should they take

7. Have consistency across the recommendations regarding who should take

action for example, Sure Start are specifically mentioned in some

recommendations but not others

I am sort of a little bit confused - reading through Sure Start appeared

(in some section but) it wasnt appearing in some other sections and I

wasnt clear what the rational was for thatI wasnt totally sure why

Sure Start had been put in at one section but not others.

Manager, SureStart

8. Ensure that recommendations (and guidance) do not imply community

engagement should be done to communities for example;

o Target population it was suggested that this term gave the

impressions that engagement was being done to communities ratherthan with them

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I said earlier on about it being about feeling as if people were

being done unto a little bit, the use of a target population term

sort of seems to add to that kind of thing that I didnt like around

the overall approach to the wording, so you know, who can get

involved? Who can benefit? The target population makes it sound

as if we are directing something at people, not working to improve

and engage.


9. Provide titles for all recommendations (for example, recommendations 10-12

and 14-17)

4.2 Views on specific recommendations

o Long term P lanning (Recommendation 1)

This recommendation was considered particularly key by respondents, and in

terms of the structure of the guidance a sensible place at which to start the

recommendations. Respondents highlighted that long term planning was

important to ensure project sustainability, which in turn can help to develop the

other guidance recommendations such as trust and respect (recommendation 3).

In discussing planning, the value of long term funding was raised to help ensure

organisations are given the means to make a real difference in the local

community.

We operate on very short term contracts or short term funding, which can

be a year, 2 years to 3 years funding. Thats not very good when youre

trying to keep a project sustainable or you know youre trying to have a

long term future where the project can actually make a real difference to

local people youve got to have that sustainability otherwise youre just

raising peoples (expectations)

Assistant Director Community Partnership Organisation

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Suggestions for improvement:

o State HOW to implement long term planning as with much of the

guidance, this recommendation was criticised for not stating how to

implement long term planning

o Highlight importance of time required to set up projects

o Include that it is important to have mechanisms that monitor and allow

organisation to intervene in projects which are not currently delivering, to

enable further help to be provided.

o Important that long term planning engages with local priorities, such as

Local Area Agreements (LAA). This can also help to ensure projects are

not duplicated and funding is used effectively.

o Levels of engagement and power (Recommendation 2)

Involving relevant members of the community was considered key and stressed

that it should be done from the outset of a project. As suggested in the guidance,

the need for feedback mechanisms was also highlighted as being of particular

importance in engaging groups. Respondents agreed with the recommendation to

engage with people from a wide variety of backgrounds and felt that sharedpower was an important issue to address.

Recommendation two is important as well, because within our project

there's no hierarchy within the groups, you might have someone whos a

pharmacist, you might have someone whos a nurse, you might have

someone who has been unemployed for 15 year and was a skilled manual

worker, it doesnt make any differenceit's not about professionals driving

us forward, because although people might come from very different

backgrounds they have a very good skill mix within, you know, from those

backgrounds, so it's very, very important to get the right mix and to make

sure that all the power implications are taken away


To one respondent, shared power did not just mean those in power supporting

those without power, but actually giving power away, which would help to build

up trust and respect. There were those who felt that this recommendation made

helpful tips as to what actions should be taken, but in the main the view was held

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that further advice on how to implement this recommendation would be greatly

beneficial.


o State HOW to identify and engage relevant community members

o Highlight outset in the first bullet point to stress the importance of

this point

o Include a definition of partnership engagement through

partnerships may not necessarily be equal, but rather junior and

senior partners

o Trust and Respect (Recommendation 3)

Trust and respect was also identified as a key recommendation and was

understood to link closely to other recommendations such as long term planning

(rec 1) and levels of engagement and power (rec 2). Honesty and truth were felt

to be key factors in building trust and respect with communities, with trust and

respect being paramount to effective community engagement.

I think if you're trying to engage any kind of community at any level you

must attain high trust and respect from that community. Without that, no

intervention that you try to get into the community will work. So I think

thats paramount really in terms of engaging communities.



o State HOW to build trust and respect with communities

respondents felt this would be a difficult recommendation to

implement; suggestions of how to build trust were provided:

the importance of providing honest information about the

effectiveness of local services e.g. local hospitals.

the importance of regular communication with partners

and target groups was also highlighted

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o Clarify what the appropriate methods to involve and reach out

to under-represented community groups are

o State HOW to feedback to communities there were

respondents from community groups whose attempts tofeedback to communities through newsletters and meetings had

been unsuccessful.

other respondents suggested building and networking

from existing relationships to help with feedback

o Avoiding pitfalls (Recommendation 4)

The coverage of pitfalls was felt to be useful and an important element of the

guidance. There were concerns raised regarding bullet point 1 Recognise that a

short-term focus on projects and initiatives can undermine efforts to secure long

term and effective community participation in that funding on projects could be

short term, for example one year. Respondents suggested that they had to make

the best of the current situation, which could be projects with a shorter term

focus.

Recognising short term focuses on projects and initiatives can undermine

efforts - I think that is all very well getting that type of guidance at a

local level but when a lot of the resources we have are only short term

resourceseveryone can recognise that the environment that you are

working in is short term, and some grants are only lasting a year. I mean

you do the best you can with what you have got



o Highlight this particular recommendation could increase emphasis

by placing this recommendation higher up (see section 4.1.1 or a

discussion on how the numbering of the recommendations was

perceived by respondents as relative importance)

o State HOW to deal with consultation fatigue

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There was a suggestion that using joined up consultation

could help overcome consultation fatigue. This was

described as identifying the joint consultation needs within

the local area to conduct consultations which serve the

needs of multiple organisations and reduce the amount of

overlapping consultations.

o Consider the risk of consulting with a loud minority and

misrepresenting the views of the quiet majority

o Clarify what adequate support is required to ensure individual

community group members are not overburdened.

o Infrastructure (Recommendation 5)

Training for those working with communities was considered to be very important,

but it was also stressed the resources need to be available for this training. There

were also concerns, particularly from those working at more strategic levels that

groups would not know who to contact for this training nor appreciate the time

involved in finding trainers.

If you take recommendation five; infrastructure - Provide training for

those working in the communities including community organisations and

there are a whole set of things. Now I happen to know where we might

commission that from, luckily enough, because we have been doing this for

a long time.but there is nothing there which says this is not something

that you could just do in a half day, there are a range of specialist training

providers who could work alongside you to do this, it just says provide it

Director, Public Health Organisation


o State HOW to identify funding streams for training

o Provide information about where training can be commissioned from

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o Cultural Shift (Recommendation 6)

This was a recommendation which respondents particularly felt they were already

working towards in their organisations and was considered standard policy. It

was felt that in the main, most people who work within this remit are aware of thedangers and consequences of stereotyping, as stereotyping target groups can

reduce the effectiveness of initiatives and result in targets not being met.

My general experience is probably 80 maybe 90 percent of the people who

work in the communities in one way or another are usually fairly sensitive

to the dangers of stereotyping, because they know that if they over-

stereotype or they overdo the sort of target group recognition they won't

be able to achieve their objectives

Chief Executive, Housing and Homelessness Organisation

On the other hand, there were respondents who felt that there was a thin line

between identifying the needs of specific communities and stereotyping that

community. For these respondents, further advice was requested as to how

stereotyping can be avoided.


o State HOW to not stereotype members of the target community.

Respondents suggested the following ways to help reduce stereotyping of

target communities;

provide diversity training

engage directly with community groups to increase cultural

awareness

ensure any consultation is wide enough to accurately reflect

the range of views of a whole community

utilise the expertise of voluntary organisations who are often

experts in specific communities

encourage target communities to engage with local strategy

boards to ensure a wide variety of views are represented

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o Policy Development (Recommendation 7)

In the main, the principle of this recommendation was agreed with, but there

were respondents who worked for community organisations who felt that this was

not relevant to them. As stated within the guidance, this recommendation wasfelt to be something which was of a higher level to them to be dealt with by

decision makers and decision making bodies.


o Clarify what polices are being referred to by the recommendation

o Partnership Working (Recommendation 8)

This recommendation was considered to be very relevant, but an area that

organisations were currently working towards through their own guidance and

polices. The importance of partnership working was consistently highlighted by

respondents and the benefits highly praised, with the idea of a formal agreement

considered to be useful in forming and maintaining partnerships.

Thats quite useful in terms of say developing formal statement people

like having a compact with community groups and I think thats quite

useful


There were respondents from community groups and at strategic level who

expressed concerns as to how members of the community could be engaged in

partnerships.


o Provide templates for setting up partnerships, particularly with Local

Authorities

o State HOW to engage community members in partnerships

o Include a definition of partnership engagement through partnerships

may not necessarily be equal, but rather junior and senior partners

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o PCT could help to raise profile of local groups to encourage partnerships

o Recognise that partnerships are more complex than just forming

compacts.

o Training (Recommendation 9)

Training was a recommendation considered to be particularly key to community

engagement. Respondents highlighted the mutual benefits of using community

representatives to train those in local organisations. The importance of building

and developing the skills and capacity of community representatives was agreed

with, but concerns were raised regarding funds for this training.

and the fact that you do need to give people training, and there does

have to be funding and there does have to be back-up - it's amazing how

much it can cost people to be involved with things

Chair, Patient and Public Involvement Forum

Training was also felt to be important to the forthcoming LINKS 6. There were

respondents who felt there were important overlaps between this

recommendation and recommendation 5 Infrastructure, with a suggestion

that the training recommendation simply repeated recommendation 5.


o State HOW to identify funding streams for training

o Provide information to help identify those in need of training and

training providers

o Highlight importance of tailoring training to the needs of your

audience

6 The Local Government and Public Involvement in Health Bill currently going through Parliament includesplans to replace Patient Forums with Local Involvement Networks (LINks), which areexpected to become

operational from 1st April 2008.

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o Agents of Change (Recommendations 10-12)

There was a level of unfamiliarity with the term agents of change, but for those

who were familiar this set of recommendations was perceived as helping to bring

agents of change to the fore, and highlighting the importance of key individuals indriving initiatives forward in communities. Concerns were raised around

maintaining the motivation of these agents of change as respondents had

experienced volunteer agents, particularly those in poorer communities, losing

enthusiasm.

Its much better, particularly in poor communities, if you really are

considering having agents of change that they are paid agents of change

Group Discussion 3, North East


o Provide a definition and introduction of what agents of change are

o Consider incentivisation for community agents, for example paid time

o Ensure agents of change are monitored to help assess resource and

motivational needs of these agents

o Housing (Recommendation 13)

This recommendation was considered to be particularly important for those

working at ground level and especially for those respondents who worked in

housing and homelessness. This recommendation was seen to tap into a

particularly vulnerable group of people through housing tenure acting as a proxy

for health inequalities.

Housing tenure can be a really good proxy for some health inequalities so

it was good to see that

Head of Public Health, Healthy Communities Organisation


o

Increase priority of this recommendation, as housing is key to the basis ofcommunity engagement (see section 4.1.1 for a discussion on how the

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numbering of the recommendations was perceived by respondents as

relative importance)

o Highlight role of Local Authorities in this recommendation

o Area Based Initiatives (Recommendations 14-17)

Respondents agreed that area based initiatives are important and beneficial to

draw on the skill set of the local community. However, concerns were raised that

by being area based, this could exclude some communities and produce

neighbourhood inequality.

they dont talk about the area based initiatives and they tend to create

further inequalities, it seemed to puzzle me. They have a community in

one area, then those in that area are going to get the intervention but

those outside are not, and automatically you create neighbourhood

inequality. This is not mentioned as a thorny issue to deal with

Public Health Consultant, Primary Care Trust

There were also concerns that this recommendation could reinvent the wheel

as it was perceived that Local Authorities already had responsibility for

developing area based initiatives. There were respondents who, as they did

not work for Local Authorities, felt that this recommendation was not relevant

to them.


o Provide example of effective area based initiatives

o Discuss the possibility of creating neighbourhood inequality

o Do not use abbreviation LSP as whilst the acronym is explained in

recommendation 15, it should be also be written in full in all

recommendations.

o Evaluation (Recommendation 18)

Evaluation and monitoring was perceived to be key recommendation and relevant

to all groups and organisations. Respondents felt that groups should prove the

effectiveness of their initiatives through close monitoring and evaluation of

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performance. This was also stated with the caveat that effective initiatives can

take time before change is produced, and this should be taken into consideration

in evaluations. There were some questions as to what methods of evaluation

should be used and that good practice examples would benefit this

recommendation.

It's the whole evaluation and value for money aspect of it and I felt there

was not a huge amount of information in this document around that. And

while I certainly wouldn't expect the document to come up with all of the

answersit might also be useful to include a series of good practice

guidelines around evaluation and assessing impact.

Community Manager, Community Action Project

The key criticism is that there was not enough evidence provided around what

good evaluation methods are, with the concern that poor methods will not identify

those initiatives that are working effectively/ineffectively. The guidance should

help to identify which tools are necessary to conduct good evaluation.


o Provide good practice examples of monitoring and evaluation

o Highlight that important to focus on quality of engagement in

evaluation as well as success in reducing health inequalities

o PCTs should take a lead in identifying areas where evaluation is

important

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5 Style and format of the gu idance

The content of the guidance and in particular the key areas covered by the

recommendations were in the main positively received. The area around which the

suggestions for improvement particularly centred was the style and format of the

guidance. Concerns were expressed that the layout and style of the guidance could

negatively impact on how readers responded to the guidance and ultimately how

effective it would be in improving health and reducing health inequalities. Issues that

were raised were focused around three areas, the intended audience, the layout of the

guidance and the language used within the guidance.

5.1 Intended Audience

Concerns were raised that the intended audience may be too broad for the current

version of the guidance. A key theme to emerge was that the guidance had been written

in an academic style which could prevent readers less familiar with such guidance from

digesting and making use of it. Respondents who were accustomed to receiving such

documents, such as those in strategic roles, did not show any particular difficulty but

suggested that community groups could struggle with the language and layout of the

guidance.

I think, I suppose it depends who the audience is because it comes

across as quite academic, quite dry, its not very engaging in terms of, I

cant imagine many of our community groups sitting down unless theyve

got a particular health interest or remit I dont think they would be sitting

down poring through it so to speak.

Assistant Director, Community Partnership Organisation

Consistent with these concerns, there were respondents at all levels who found the

guidance difficult to engage with. Particular issues around the language and the layout

of the guidance were raised and are discussed in more detail in the following sections.

5.2 Language

The guidance was not considered to be a document that was easy to read, and there

were respondents at all but the highest strategic levels who reported needing to use

dictionaries to understand some words and needing to refer back through the document

to understand what acronyms represented. The language used in the guidance was felt

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to be belong to a specialist field and as such made the guidance feel like a specialist

document. This is important to note, as the content of the guidance was considered to

be particularly useful to those new to the concept of health inequalities and/or

community engagement, but the style of the language was thought to be a particular

barrier for these people. Similarly, there was also concern that this language could

exclude those members from community groups who are a key target for this guidance.

I mean it seemed to me from the beginning that it looks as if it's been

written as guidance for people who are about to be or are already

engaged in these (areas) and people who would have a health service

language or a medical languagebut if it was someone who hadnt got

sort of youth work training or educational background somebody who

was actually running a fitness suite, who would have all sorts of

opportunities for creating these types of interventions, I think the

language might need a little bit of modification, it would need

explanation.

Chief Executive, Housing and Homelessness Organisation

The key concerns raised in reference to the language used in the guidance were:

o Use of technical or specialist language this made the guidance feel as

though it was aimed at professionals or specialists. This was true across

the whole guidance, but heterogeneity and social capital caused

particular comment. It was suggested that an alternative version of the

guidance could be made available using only plain English. This version

should be specifically tailored to community groups and those individuals

who might be less familiar with the terms associated with health

inequalities and community engagement.

o Use of uninteresting language throughout the guidance - it was felt that

the language would not engage readers to try and implement the

recommendations in their organisation

o Language used can be confusing or waffley

I think it could be summarised a lot easier because it just repeats

itself over and over againIts very waffley.


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o Need for careful definitions in the glossary as a whole, the glossary was

considered very useful, but it was suggested that key terms such as

Community Engagement and Community Development needed to be

carefully defined so as to include recognition of the current debates around

these terms.

o Language should be more cautious there was a suggestion that the

guidance would benefit from being more cautious and should include more

caveats as the evidence base for the recommendations was not

considered to be conclusive by all.

The results of survey question 1 were:

Q1. Language easy to understand

0

2

4

6

8

10

12

14

agree agree strongly disagree

count

Councillor

Disadvantaged &

vulnerable group service

Neighbourhood based

management and/or

community

empowerment

programme

PCT or LA with

community involvement

function

Other

Graph 3 - Responses to Survey Question 1 The language used within the guidance and

the recommendations is easy to understand.

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group, 9 general groups, 2 groups representing older people and 1 other group; Agree Strongly

1 BME group; Disagree 1 BME group, 1 general group and 1 group representing older people)

At first viewing the results do not appear to reflect the above opinion. The majority of

respondents (with 43 out of 49 answering agree strongly or agree) felt that the

language in the guidance was easy to understand. However, it is important to consider

two key factors:

Firstly, it is likely that respondents would have been answering this question based on

their views of the language used in the guidance. In the interviews and groups those

familiar with documents similar to the guidance found the language easy to understand

themselves, but expressed concerns that other people might have difficulties, particularly

community based organisations.

Secondly, it is possible that if respondents had found the language in the guidance

difficult to understand, they might have been less likely to read through the guidance and

complete the survey, and therefore their views may not have been reflected in the

survey.

5.3 Layout of the guidance

The layout of the guidance was felt to be characteristic of other types of guidance that

respondents had received. Respondents had general suggestions for improving the

layout, and in particular the length and presentation of the draft community engagement

guidance. The key issues raised reflect the recognition that this is a document

encouraging action from its readers. These are discussed further below:

o Length

A key concern that emerged was in relation to the length of the guidance. It was

suggested that the guidance was too long, and the intended audience for this

guidance would generally not have the time to allocate for reading the guidance. The

length of the guidance was also considered to be daunting (at 78 pages including the

appendix, and possibly longer in the final version) and it was considered that readers,

particularly community groups, may choose not to read the guidance simply based on

this. The length of the actual guidance and particularly the recommendations was

seen to be adequately long. However, the length and inclusion of the appendix and

glossary made the guidance seem overly long.

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I think any document which purports to be about taking forward

something quite practical, which has 37 pages of text and the rest of it

are appendix, I think doesnt kind of sit right. It does make it feel much

more academic rather than something which is going to help take

forward organisations approaches to community development and

community engagement.

Director, Public Health Organisation

Respondents stressed the importance of the guidance being a useable document, to

encourage readers to take action.

[The] recommendations could usefully be presented in more punchy

concise fashion. it reads very much as an academic paper (which of

course it is) [respondents own parenthesis] rather than a practicalguidance checklist for organisations in the field to use

Programme Manager, New Deal for Communities

Suggestions to improve the usability and length of the guidance were focused around

the presentation of the guidance and are discussed in more detail below.

o Presentation

As stated above, respondents placed emphasis on the guidance being a usable

document which encouraged readers to implement the recommendations. It was felt

that the current presentation of the guidance could prove to be a barrier to this, and

suggestions were made to develop the presentation. 8 recommendations were made:

o Include more visuals and diagrams to illustrate the recommendations being

made

o Start each recommendation on a new page to help readers identify specific

recommendations

o Have a title for each recommendation (for example recommendations 10-

12 and 14-17 which do not have individual titles)

o Include a table at the beginning of the guidance listing the

recommendations

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6 Barriers to implementing the guidance

The majority of respondents in the small scale survey (28 out of 50 responses) felt that

there would be barriers to implementing the guidance and the recommendations in the

organisations they worked with. This was in response to question 6 I do not imagine

that there will be any barriers to implementing this guidance and the recommendations

within the organisation/s I work with.

Q6 - There will be no barriers to implementation

0

2

4

6

8

10

12

agree agree

strongly

disagree disagree

strongly

numbers

Councillor


service



programme

PCT or LA with community involvement

function

Other

Graph 4 - Responses to Survey Question 6 I do not imagine that there will be any

barriers to implementing the guidance and the recommendations within the

organisation/ s I w ork with

(Note: In this graph, Other represents the following communities of interest: Agree 1 BME group

and 1 group representing older people; Agree Strongly 1 group representing older people and 1

general group; Disagree 2 BME groups and 8 general groups; Disagree Strongly 2 general

groups, 1 group representing older people and 1 other group)

Similarly, respondents in the depth interviews and group discussions identified a number

of potential barriers to implementing the community engagement guidance. These are

discussed below in combination with the open ended responses from the small scale

survey.

7 key barriers were identified and are discussed in more detail below.

1. Resources

Availability of resources was of key concern to respondents. Engagement and

consultation were considered to be highly demanding of both funds and time and so it

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was suggested that specific funding should be made available to help implement the

recommendations.

It was felt that this funding needs to come from the top. A particular need for

funding was in order to address the training needs identified in the guidance.

There were respondents, particularly those from community groups, who felt that

community engagement initiatives would be in direct competition for resources in

their organisation (for example, providing services for clients). These respondents

felt that the aims of the guidance were laudable, but that they were unsure that they

would choose to expend resources on implementing the guidance recommendations

rather than providing the services of their organisation.

In considering the results from the small scale survey for question 3 The

organisation/s which I work with have adequate resources to implement the guidance

and recommendations, mixed results were shown. A split was indicated between

agreeing and disagreeing with this statement, with 26 respondents marking agree

strongly/agree and 23 marking disagree strongly/disagree.

Q3 - Adequate resources to implement

0

1

2

3

4

5

6

7

89

agree agree

strongly

disagree disagree

strongly

count

Councillor


service



programme

PCT or LA with community involvement

function

Other

Graph 5 - Responses to Survey Question 3 The organisation/ s which I w orth with

have adequate resources to implement the guidance and recommendations.


group, 4 general groups and 1 group representing older people; Agree Strongly 1 general

group, 1 group representing older people and 1 other group; Disagree 1 BME group and 6

general groups; Disagree Strongly 1 BME group and 1 group representing older people)

47


51/78


52/78


53/78

manipulate the aims of Community Development initiatives in order to pass these

initiatives through their Local Authority.

There are barriers to implementing this work both internally and

externally to our organisation. The local authority are very slow atacknowledging a community development approach to work and we have

had to wrap all community development up in the engagement banner

to implement community development 'by stealth' in the district.

Primary Care Trust Manager Survey Response

6. Support of key bodies and organisations

For the guidance to be effectively implemented, support from organisations such as

PCTs (in particular the Chief Executives) and PPI forums was considered to be key.

This e

community engagement to improve health fieldwork report - nice uk - 2008

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