Developing a conversation about identifying community needs to embrace wellbeing through social prescribing interventions: a qualitative study

Background
Previous evidence suggests that co-production and co-design are effective approaches to engage stakeholders in the development and implementation of social prescribing (SP) interventions within community settings. SP initiatives can be enhanced from the outset, by drawing on stakeholder knowledge to design services that improve health and wellbeing outcomes for community members. The aim of this qualitative study was to engage with the residents of the Nantlle Valley, a rural community in North West Wales, UK, to gather perceptions regarding the need for co-design, co-produced SP interventions to meet the wellbeing needs and requirements of the community. In line with the Well-being of Future Generations Act (Wales) 2015, the current study also aimed to gather knowledge that would shape the sustainable development of SP interventions creating positive wellbeing outcomes for the future.

Methods
A purposeful, convenience sample (n=16 in total; 12 identified as female and four identified as male) of community members (white British) who were residents of the Nantlle Valley were recruited by various means including emails and Facebook notices, and data were collected using focus groups. Drawing from the principles of citizen assembly deliberations and future design in developing sustainable strategies, a novel approach was applied to the focus groups. This included conducting two focus groups, the “Today Group” deliberated on the wellbeing of the community today, and the “Legacy Group” deliberated on the wellbeing of future generations in developing SP interventions. Ethical approval for this study was granted by Bangor University's Healthcare and Medical Sciences Academic Ethics Committee (2020–16850) on 11th January 2021. Due to the COVID-19 pandemic restrictions, the participants were sent an electronic consent form to return before the focus group and their verbal consent were also recorded at the beginning of each focus group.

Findings
The focus groups were conducted online between Feb 22, and Feb 25, 2021, due to social restrictions because of the COVID-19 pandemic. The results of the focus groups indicated a need for additional SP interventions. The Today Group discussions identified concerns such as a sense of self-enforced social exclusion among less economically privileged individuals living in the community, which has remained unaddressed for generations The Legacy Group participants expressed views that community projects would be essential to sustaining communities for future generationsin the Nantlle Valley. It was clear that unaddressed social and economic needs influencing the determinants of health had been made worse by a weakened economy due to the effects of the COVID-19 pandemic.

Interpretation
Having a co-produced design approach might empower community members to take ownership of their own community in terms of generating solidarity by having health and social services together in one wellbeing hub. The long-term thinking approach could lead community members to feel they are the guardians of the future and are responsible for instilling a desire to preserve communal endeavours for sustainable, inclusive, and cohesive communities in the NV