Methods to advance health equity and social justice in healthcare: Protocol for a scoping review on the utilisation of routinely collected data.

BACKGROUND: Many areas of healthcare are impacted by a paucity of research that is translatable to clinical practice. Research utilising real-world data, such as routinely collected patient data, may be one option to efficiently create evidence to inform practice and service delivery. Such studies are also valuable for exploring (in)equity of services and outcomes, and benefit from using non-selected samples representing the diversity of the populations served in the 'real world'. This scoping review aims to identify and map the published research which utilises routinely collected clinical healthcare data. A secondary aim is to explore the extent to which this literature supports the pursuit of social justice in health, including health inequities and intersectional approaches. METHOD: This review utilises Arksey and O'Malley's methodological framework for scoping reviews and draws on the recommended enhancements of this framework to promote a team-based and mixed methods approach. This includes searching electronic databases and screening papers based on a pre-specified inclusion and exclusion criteria. Data relevant to the research aims will be extracted from included papers, including the clinical/professional area of the topic, the source of data that was used, and whether it addresses elements of social justice. All screening and reviewing will be collaborative and iterative, drawing on strengths of the research team and responsive changes to challenges will be made. Quantitative data will be analysed descriptively, and conceptual content analysis will be utilised to understand qualitative data. These will be collectively synthesised in alignment to the research aims. CONCLUSION: Our findings will highlight the extent to which such research is being conducted and published, including gaps and make recommendations for future endeavours for real-world data studies. The findings from this scoping review will be relevant for practitioners and researchers, as well as health service managers, commissioners, and research funders.

Tackling physical inactivity and inequalities: implementing a whole systems approach to transform community provision for disabled people and people with long-term health conditions.

BACKGROUND: Physical inactivity is a global public health priority. There are known health and well-being consequences of being inactive, and the benefits of being physically active are well established. However, there are persistent inequalities when it comes to how physically active people are, with disabled people, people living with long-term health conditions, and people residing in areas of socio-economic deprivation being particularly affected. Methods such as whole system approaches (WSAs), which are dynamic, multifaceted, and engage all relevant stakeholders, have gained momentum as an approach to address such complex public health problems. However, evidence relating to the implementation of WSAs to address physical inactivity is lacking. The aim of the Prevention and Enablement Model (PEM) was to take a whole system approach in Essex to encourage and support disabled people and/or individuals living with long-term health conditions to be more active, happier, and to live more independently. METHODS: The aim of this study was to explore the enablers, challenges, and reflections associated with the process of designing and implementing the PEM. Semi-structured interviews (n = 12) were used to collect data from people involved in the PEM's design, implementation and/or delivery. Data was analysed using Braun and Clarke's reflexive thematic analysis. RESULTS: Four themes were identified: (1) Working collaboratively: Specific enablers of time and space were identified as important in the planning and implementation of a WSA (2) Leadership and planning: Distributed and flexible leadership was identified as central to successful implementation (3) Re-orientating practice: Highlighted the transformative potential of a whole system approach and how it contrasts with conventional work practices, and (4) Reflection and learning: Informing ongoing refinements and further implementation of successful system change. CONCLUSIONS: These findings highlight the challenge and complexity of implementing a WSA that involves diverse stakeholders from across adult social care, the NHS, and the third sector. Several important enablers are identified, such as leadership and planning, and the challenges and discomfort that can arise whilst changing systems. Ongoing efforts are required to ensure that different elements of the system collaborate effectively to address inequalities in physical activity participation, through the implementation of a WSA.

Levelling the playing field: Exploring inequalities and exclusions with a community-based football league for people with experience of mental distress.

INTRODUCTION: Sport workforce strategy in the United Kingdom (UK) has identified the occupational therapy profession as being ideally positioned to contribute to public health agendas relating to tackling physical inactivity amongst marginalised populations, such as disabled people and people with experience of mental distress. However, a robust understanding of the enablers, restrictions, and exclusions such groups encounter when seeking to participate in sport and physical activity is currently lacking. METHODS: This study aimed to gain an in-depth understanding of the different ways people with experience of mental distress talked about their participation in a community-based football league in England, in the UK. Nine people took part in this strand of a larger participatory action research (PAR) study, which used go-along interviews as the method of data collection. In alignment with PAR seeking to address power imbalances, the data from the go-along interviews were analysed through a Foucauldian lens using a collaboratively produced analytic framework. FINDINGS: Participants constructed the community-based football league as fostering feelings of purpose and belonging, against a backdrop of them describing experiencing stigma and exclusion when seeking to be active in their wider communities. They used the concept of occupational marginalisation to further interpret their situation. CONCLUSION: Understanding why and how people participate in football extends beyond seeing it as an individual exercise to shared social lives and occupations. With this perspective, occupational therapists could address occupational marginalisation in partnership with community sports organisations, collaborating for wider social change beyond specialist services.