Title: Developing a Training Package for Link Workers in Wales using a Realist Approach.
Funder: Health and Care Research Wales (Welsh Government)

Abstract: Aims and objectives: The aim of this PhD studentship is to understand and develop theories to describe how training in social prescribing works, for whom and in what circumstances, with a view to develop a training package that is appropriate for the Welsh context. The key objectives will be: - To undertake a Rapid Realist Review of the literature (e.g., published literature, grey literature, training materials) in order to develop a programme theory of how existing link worker training works. This is a model of both causation and implementation and will allow the student to ascertain how and why training interventions work, for whom, to what extent, and within what circumstances. - To test and refine the study programme theory with a cohort of link workers, managers and commissioners in Wales. - To map the refined programme theory against existing relevant training modules and resources (e.g., social prescribing, behaviour change). - To build a training package that meets the needs of link workers operating within the Welsh context. - To refine the training package using a World Café workshop with link workers, managers, commissioners and members of the public. Design and method: Following the Realist methodology, data collection, synthesis, and theory building will follow an iterative process running across the three-year PhD studentship, and comprise of three cycles. An Advisory Group comprised of relevant stakeholders (practitioners, content experts, service commissioners) will be established. Pawson & Tilley (1997) classify stakeholders as ‘key informants’, this group will contribute significantly within all three cycles of the project. The Advisory Group will work closely with the student throughout the review and evaluation – co-productively developing search terms and inclusion/exclusion criteria and exploring the emerging Context-Mechanism-Outcome configurations (causal patterns). Cycle 1: Preparing and understanding the initial programme theory of how link worker training works (6-9 months). A Rapid Realist Review of the literature (e.g., published literature, grey literature, training materials) will be undertaken, using the Saul et al (2013) ‘Ten Step’ process. This will commence with an initial scoping review, in order to build familiarity with existing knowledge relating to link worker training. Whilst there is limited research upon such training, similar approaches that focus upon other health and social care employees may be particularly useful here. These would allow the student to detect demi-regularities (Lawson, 1997; Pawson, 2006) or similar patterns of behaviour that may be transferrable to the link worker context. The scoping review will also surface potential search terms, and document sources (including grey literature) that will be further interrogated and explored within the main Rapid Realist Review. The RAMESES Quality Standards for Realist Synthesis (Wong et al, 2013) will be applied throughout the review process in order to maintain methodological rigour, and the Advisory Group will also contribute to this process – critically considering the salience and coherence of the emerging themes. Ultimately the Context-Mechanism-Outcome configurations developed will facilitate the development of causal model or ‘programme theory’ explicating what forms of training work, how and why, for whom, to what extent, and within what circumstances (Pawson, 2006) Cycle 2: Building and further refining Context-Mechanism-Outcome configurations in order to develop a refined programme theory of ‘link worker training’ (18 months). A Realist Evaluation will test and further refine the programme theory developed within the review with a cohort of link workers (n=25) undertaking English social prescribing training in Wales, their managers and commissioners. The programme theory from Cycle 1 will be explored in greater depth within a series of focus groups and interviews – the interview schedules having been developed co-productively with the project Advisory Group. The focus group method is a qualitative semi-structured interview technique to collect data through group interaction. It provides participants and researcher with an opportunity to share knowledge and explore ideas, which lead to a broad understanding of aspects of evaluation topics (Stewart & Shamdasani, 2015). Therefore, the focus groups will precede the semi-structured interviews in this study so that more detail of ideas found may be later explored in confidence. The semi-structured interview, in which the researcher employs a series of pre-determined but open-ended questions in order to gather data is recognised as one of the most ubiquitous data collection techniques within qualitative research (Silverman, 2019). The approach has been selected here as the interview schedule may be structured by themes emerging from the focus groups, whilst retaining the flexibility to gather a richness of responses from the study participants. The data collected within this cycle will allow the Context-Mechanism-Outcome configurations and associated initial programme theory generated within Cycle 1 to be further confirmed, refined, or refuted (Pawson, 2006) – resulting in the development of a refined programme theory of Social Prescribing link worker training. Cycle 3: Using the refined programme theory to develop a Link Worker training package (9 months). During this cycle, the focus will be upon mapping the refined programme theory developed against existing social prescribing training modules (or other relevant modules e.g., behaviour change) in order to build a course that meets the needs of link workers operating within the Wales context. To conclude Cycle 3, the student will conduct a World Café style workshop (MacFarlane et al, 2017) with social prescribing link workers, managers, commissioners and members of the public. The aim of this World Café will be to gather feedback on the training package from stakeholders, generate consensus about the delivery of the training package (e.g. duration, module formation, content detail) and ensure that the training package is truly fit-for-purpose in the Welsh social prescribing context, as intended. Following any amendments from the World Café workshop, the student will finalise the training package for dissemination and delivery across Wales. We anticipate this project having widespread impact for practitioners and their service users. Social Prescribers in Wales have expressed a need for training (Wallace et al, 2020) and the project outputs will directly address this, concluding with either identification of appropriate learning materials, or a bespoke training package. This will enhance service provision and may subsequently impact on the health and well-being of the individuals receiving the social prescription. Planning and use of resources: The PhD candidate will be supported by a supervision team made up of academics with expertise in Realist Review and Evaluation (MD, CW, SC, SR) and its application to social prescribing (CW, SR), education (MD) and practice (SC, SR). The student will meet with the Co-Directors of Studies (MD, CW) once a week. The whole supervision team will meet monthly and will be serviced by the student. An Advisory Group will include link workers, lay members/service user engagement/patient public involvement, local commissioning groups, WCVA, WSSPR, representatives from UHBs and Welsh Government. The purpose of the Advisory Group is to advise on the development of the Realist Review and Evaluation, the findings, and the dissemination plan and products. This will bring the findings closer to practice, policy and the public. The supervisory team have been allocated MD (5%), CW (2%), This is a joint co-lead application to develop MD’s supervision skills. MD is an expert in education and since passing his PhD is developing his research portfolio. The PhD candidate will have full access to USW post-graduate support via the Graduate School and Faculty Library services. All relevant external permissions will be sought for data access and storage as appropriate. The PhD candidate will have designated desk space in the post-graduate research student facility and be allocated USW resources for Microsoft Office 365 including email and cloud storage. Access will be available to USW software for quantitative and qualitative data analysis i.e., QBIS, STATA and NVivo, and audio recording and transcribing equipment. The student will be required to use the University’s PhD Manager which records all supervision notes, student reviews and all student processes. A laptop to support remote and USW working when permissible has also been factored into the bid. Costs have been included for the student to undertake Realist Review and Evaluation (RRE) training at Oxford University with Dr Geoff Wong. This is the Centre of Excellence for RRE training, and both MD and CW have attended RRE training there. The University of South Wales is currently building its expertise in this methodology with an RRE group led by MD and supported by CW. The student will register for the 20-credit module at Oxford University. Costs have also been included to support travel for interviews where possible (COVID-19 permitting), and thank you vouchers in the form of a prize draw for participants. Method of analysis: Cycle 1: The student will use the Saul et al (2013) ‘Ten Step’ adaption of Pawson and Tilley’s (1997) Realist Review process to review/analyse the literature and develop a theory-driven framework for link worker training, to establish what forms of training work, how and why, for whom, to what extent, and within what circumstances (Pawson, 2006). Cycle 2: The data will be analysed using the Papoutsi et al (2017) process and reported using the RAMESES Reporting Standards for Realist Evaluation (Wong et al, 2016). Cycle 3: The training package will be iteratively developed based on the programme theory from cycles 1 and 2, in partnership with the Advisory Group. Analysis of the World Café is iterative during the workshop and findings will be triangulated within the Realist Evaluation. Expected outputs and outcomes: Outputs from this PhD studentship will include, but are not limited to: - Realist Review report and peer reviewed publication. - Realist Evaluation report and peer reviewed publication. - World Café report and peer reviewed publication. - A training package for link workers in Wales. - Lay summaries co-produced with members of the public. - Conference presentations (oral and poster). - PhD thesis. These outputs will be published on the Wales School for Social Prescribing Research (WSSPR) website and will be disseminated through WSSPR, the Wales Social Prescribing Research Network and Communities of Practice. Outcome: A bespoke training package will be developed for link workers, which is fit-for-purpose and suitable for the Welsh policy, legislative and practice context. This will influence the quality-of-service delivery across Wales. The purpose is to develop the skillset and capabilities of link workers in Wales, to ensure that they can provide high quality, accessible and co-produced social prescribing services. This aligns with the Health & Social Care Workforce Strategy (HEIW & SCW, 2020) which aspires to have a ‘motivated, engaged and valued, health and social care workforce, with the capacity, competence and confidence to meet the needs of the people of Wales’. Dissemination: The dissemination plan will be agreed between the PhD student, the supervisory team, the study stakeholder group and members of the public. We anticipate that it will include the following: Training materials/programme outputs Impact: Dissemination of training package to policy makers, workforce and commissioners to increase workforce motivation, sense of value, increase ‘competence and confidence to meet the needs of the people of Wales' (HEIW & SCW, 2020) Timescales: 36 months Social media updates & dissemination across the Wales Social Prescribing Research Network Impact: Updates in real time to WSSPR and stakeholders Timescales: Ongoing throughout study Thesis Impact: Provision of a training package which complies with the Health and Social Care workforce strategy (HEIW & SCW, 2020). Contributes to the social prescribing workforce development of knowledge and skills. Timescales: 36 months Submission of peer reviewed articles Impact: Increases the visibility and usability of study findings. Ensures credibility of the study and its findings. Academic impact through gold standard publication in high impact journal i.e., Health and Social Care in the Community will increase visibility and credibility. Timescales:18-36 months Conference attendance and presentations Impact: Contributes to academic, national and international social prescribing networks and audiences, policy impact through professional and government networks such as HEIW, Primary Care clusters, Welsh Government Social prescribing Task and Finish group, WCVA leads, Public Health Wales. Timescales: 24-36 months. Impact: Short term Raising awareness of the learning and training needs of link workers, identifying training provision and resources which are relevant to the Welsh context. Medium term Enabling link workers in Wales to receive relevant and appropriate training to support their professional development and service delivery in the community. Providing an evidence-based, trustworthy training package for commissioners which is fit-for-purpose. Long term Creating a consistent, high-quality social prescribing workforce who can meet the needs of Welsh citizens. This social prescribing workforce will form a key component of the Health and Social Care workforce of Wales.

Lay abstract: Many people in Wales aren’t able to get help when they have longer term health problems, or issues with their well-being. Social prescribing is a service where these people can have a conversation with a person known as a link worker. During this conversation, the link work finds out more about the person, and can connect them up with activities or services within their own community that can help them. In Wales, lots of these services are ran by voluntary organisations. The link worker job is very complicated, and at the moment there isn’t any training for those who are doing it in Wales. Within this project, the student will first look at all the publications, documents, websites and other sources that provide information about training for link workers. Doing this will help them to come up with some idea about what sorts of approaches to training might work best. The student will then speak to people who are link workers and going to be doing a social prescribing training course from England, their managers and social prescribing commissioners. They will ask them about their experiences and tell them about the things they found out when they looked at the publications. This will allow them to develop a good understanding of the type of training that link workers need. Finally, they will use all the information they have found to make a new link worker training package. At the end of the PhD, the student will run a series of workshop with link workers, their managers, commissioners and people who use social prescribing services, to check that the training package is suitable and add detail about the delivery of the package. The training package will then be shared across Wales.

Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING
Health categories: GENERIC HEALTH RELEVANCE