Title: Identifying the facilitators and barriers to implementing the routine use of outcome measures in third sector wellbeing organisations
Funder: Department of Health and Social Care

Abstract: Title Identifying the facilitators and barriers to implementing the routine use of outcome measures in third sector wellbeing organisations. Background The statutory sector including the NHS spends over 1.86 billion annually on health services provided by the third sector [3] and the role of the third sector in service delivery is increasing [4]. However the evidence base on whether such services improve patients' (service-users') health and wellbeing is limited. Both service-providers and commissioners need this understanding to enable them to make evidence-based decisions concerning which services to invest in. One type of health activity the third sector delivers is health and wellbeing improvement activities (wellbeing activities). These promote social inclusion and increase people's sense of empowerment and self-efficacy e.g. lunch clubs and community allotment projects. Increasing peoples' wellbeing is important because of the impact it has on mental and physical health. People with higher self-reported levels of wellbeing have better health outcomes. For example their life expectancy can be 4-10 years higher compared to people with lower levels of wellbeing [5], and people can feel more empowered to make health behaviour changes. There are no statistics available on the numbers of people engaged in wellbeing activities nationally, but in Sheffield alone there were 21,528 service-users involved annually in just one wellbeing programme [6]. If this figure was extrapolated, this would equate to over 2.5 million service-users in the UK. One approach to understanding the impact of third sector wellbeing activities is using standardised outcome measures in routine practice (similar to the NHS Patient Reported Outcome Measures programme). However little is known about how best to implement outcome measures in third sector organisations. There may be specific implementation issues, for example organisational culture. This proposal explores the facilitators and barriers to implementing outcome measures routinely in the third sector. Aim To identify barriers to implementing the routine use of outcome measures in third sector wellbeing organisations and to determine facilitators that make their use acceptable to service-users, service-providers and commissioners. Plan of investigation Phase 1- Systematic review of existing reviews on using outcome measures to identify implementation issues relevant to the third sector. Phase 2- To explore the perspectives of a range of stakeholder groups, up to forty semi-structured interviews will be conducted with service-users, third sector front-line workers, managers and commissioners. Topics will include participants' views on potential facilitators and barriers to the routine use of outcome measures in third sector wellbeing organisations. The interviews will be analysed using framework analysis. Phase 3- Sixty service-users from two third sector wellbeing organisations will be asked to complete outcome measures at 3 time points to explore what issues arise in practice when using outcome measures. Data will be collected through service-user satisfaction surveys, undertaking analyses of the outcome measures such as completion rates and interviewing service-users, front-line workers and managers. Phase 4- The findings from the different phases will be integrated, using a triangulation protocol' approach to explore convergence, complementarity and discrepancy between findings from the different components. Guidance will be developed on implementing the routine use of outcome measures in third sector organisations. Potential benefits The research will provide commissioners and service-providers information on how to implement routine outcome measures in the third sector. Longer-term, this will enable stakeholders to identify the impact of third sector services, enabling informed decisions to be made on which services are benefiting service-users and thus should be funded and delivered. This research will potentially benefit other types of health services by developing the knowledge base on the implementation of outcome measures in routine practice.

Lay abstract: The NHS and Local Authorities spend over 1.86 billion a year funding third sector organisations e.g. charities and community groups to deliver health related services. This includes health and wellbeing improvement activities (wellbeing activities), for example befriending services, community allotment projects and craft groups. Wellbeing activities seek to improve patients' (service-users') health by initially increasing their wellbeing. This means improving a person's social relationships and helping them to feel more valued, content and happy with their life. For example a person may attend a lunch club because they were lonely or help out at a charity to improve their confidence. Increasing people's wellbeing is important because it enables them to live a healthier and longer life. Over 2.5 million people attend wellbeing activities in the UK. Service-users report they find the activities helpful. But funders such as the NHS do not know which activities do improve service-users' wellbeing. Funders need to find ways of measuring this, to help them decide which wellbeing activities to fund. One way of doing this is through the use of outcome measure questionnaires. Outcome measures are questionnaires which ask standardised questions about a person's health and wellbeing. For example asking people how happy they have been in the last week. If a person completes an outcome measure at different points in time, their answers can be compared to see how their health and wellbeing has changed. People have been asked to complete outcome measures in some NHS services, for example when they have a knee replacement operation. However service-users have not usually been asked to complete outcome measures when they attend third sector wellbeing activities. If outcome measures are to be used in third sector wellbeing activities, it is important to understand how they can be used in ways which are both suitable and useful. For example: Which outcome measures service-users and organisations prefer. How and when service-users want to complete the outcome measures, for example electronically or on paper. Service-users' concerns about completing the outcome measures. How organisations and funders use the information collected. This research will explore these issues. There are many types of outcome measures. This research will only focus on outcome measures which measure changes in a person's wellbeing. This is because wellbeing activities in the short-term seek to improve a person's wellbeing. However as this research is considering how to use outcome measures, the findings will be useful for other outcome measures. Aim The aim of the research is to understand how to use outcome measures in third sector wellbeing activities in ways which are suitable and useful for service-users, funders and third sector organisations. This research will benefit service-users because it will ensure outcome measures are collected in ways which reflect their needs. Longer-term, it will enable the NHS and other funders to direct funding at the third sector wellbeing activities which provide the greatest benefits to service-users. Design and Methods The research will have four phases over a three year period. Phase 1- I will review existing literature reviews on using outcome measures to understand what lessons for implementing outcome measures may be relevant for the third sector. Phase 2- Interviews will be conducted with 30-40 service-users, front-line workers, managers and funders about their views of using outcome measures. Phase 3- Outcome measures will be tested in two third sector wellbeing organisations. This is to understand what issues arise in practice when using outcome measures. Sixty service-users will be asked to complete outcome measures three times. The service-users will be asked to complete a survey about their experiences. I will analyse the outcome measures such as completion rates. I will also interview service-users and workers about their experiences. Phase 4- The findings from the different phases will be combined including holding a stakeholder event to discuss the findings. Patient and Public Involvement Over 30 service-users and members of the general public have been involved in developing the design of the research. Two service-users will be actively involved in the research including being on the advisory panel and being consulted about the emerging findings. During phase 4, at least 10 service-users will be invited to attend an event to discuss the findings and their implications. Dissemination In conjunction with the service-users, guidance will be developed to give information to third sector organisations and funders on how to use outcome measures. Training events will be held to explain the guidance. The research will also be published in journals and discussed at conferences.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: GENERIC HEALTH RELEVANCE