Coproducing change community involvement in research and action

Co-producing change: community involvement in research and action to address low birth-weight in an East London borough Susanna Rance [1], Angela Harden [1], Gail Findlay [1], Patrick Tobi [1], Dilisha Patel [2], Gulnar Ali [1] Asmat Syed [1], Jin Tong [1], Judith Stephenson [2] [1] Institute for Health and Human Development, University of East London [2] Institute for Women’s Health, University College London Faculty of Public Health EXPO & Annual Conference 2017 – Telford, 20 th -21 st June

Low birth-weight: an issue of local concern Ø In 2014 -16, 9. 7% of babies born to women living in the London borough of Newham had low birth-weight (<2. 5 kg). Ø Nearly four in ten women living in the borough (37. 4%) were at risk of having low birth-weight babies. Ø Preventing low birth-weight and its adverse consequences is a priority for Newham’s Clinical Commissioning Group. Ø The locally-funded project “Low Birth-Weight in Newham: Definitions, Antecedents and Consequences” aims to: - understand factors influencing low birth-weight identify community assets that could help to address the issues involve stakeholders in co-producing preventive action.

Using elements of the CEAD model for community and stakeholder engagement in co-production of a local programme Findlay G, Tobi P (2017). Well Communities. Perspectives in Public Health; 137(1): 17 -20

Low Birth-Weight project stages and stakeholder involvement Patient and Public Involvement group Stakeholder prioritisation workshop RESEARCH Hospital data analysis ENGAGEMENT Community asset mapping Community Interviews with consultation parents & PPI group professionals ACTION Stakeholder consultations & feedback Prioritisation Workshop Intervention co-design Pilot actions & evaluation

Results of the co-design process Appreciative Enquiry workshops, with discussion and voting on priority proposals, brought initially divergent stakeholder positions closer together: Ø Common interests 1 -to-1 and group support for parents Women’s pre-pregnancy care Healthy infant feeding Ø Shared concerns Professionals’ conflicting messages Involving partners and family members Addressing language barriers

Co-designed Action 1: Piloting and evaluation of pre-pregnancy service delivered by “health buddies” in primary care Women planning a pregnancy, recruited via their GP practice, are offered “Healthy Conversations” with trained volunteer health buddies. Tinati T, Lawrence W et al. Implementation of new Healthy Conversation Skills to support lifestyle changes – what helps and what hinders? Experiences of Sure Start Children’s Centre staff. Heath & Social Care in the Community 2012; 20(4): 430– 437

Co-designed Action 2: Case studies and video for public dissemination showcasing local healthy infant feeding initiatives Antenatal, postnatal and community-based drop-in breastfeeding support sessions; community baby & toddler group and

Current step: co-designing an improvement model Evaluation of prepregnancy “health buddy” service delivered in two local GP practices UEL Knowledge Exchange Internship: “Partnership work translating research into action: taking key messages from the Low Birth-Weight in Newham study into healthy infant feeding initiatives” Empowering relationships and Healthy Conversations Partnership working and reflective practice Dissemination of evidence-based “missing messages”

Topics in tension: challenges identified in the co-design process Expectations of “health buddies” Involving women’s partners Gaps in breastfeeding support Not/talking about formula feeding Avoiding rapid “catch-up” growth of babies born small