Title: Evidencing the Social Return on Investment of Age-Friendly Community Initiatives
Funder: Department of Health and Social Care

Abstract: People are living longer. But many will experience poor health, and miss out on the good things a longer life can bring. Across the world, cities and communities aim to become ‘age-friendly’. This means they are trying to become places that help older people stay well and active, and enjoy fulfilling lives. They might focus on improving public transport and access to social activities, and many other things. It is important to understand how well such age-friendly programmes work, and whether investing in them is worthwhile. While we know a bit about their value, we need to understand this better._x000D_ _x000D_ We want to study what difference age-friendly programmes make to older people’s health. In other words, we want to find out what their effect is on “health outcomes” such as wellbeing and quality of life. We also want to measure older people’s preferences to understand what health outcomes they value the most – the so-called ‘social value’ of age-friendly work. And we want to know how much age-friendly work costs._x000D_ _x000D_ First, we will examine what other studies have learned about the social value of age-friendly programmes, and create a list of the outcomes from these programmes. We will then carry out research in four sites in England – a city (Liverpool), a county (Suffolk), and two rural parishes (Kelsall in Cheshire; Buckden in Huntingdonshire). In each, we will look at up to three age-friendly areas of work (e.g. housing; transport, leisure) that are considered important locally. Through discussions, we will find out what local residents and professionals expect to gain from work in these areas, and we will measure the outcomes from this work. We will check what we find in the four sites with experts across the country._x000D_ _x000D_ We will invite local residents and professionals to choose what outcomes from age-friendly work they would like to see most in their community. We will use a method that allows us to rank their chosen outcomes, and to assign a worth in £ to each outcome._x000D_ _x000D_ We will select a total of two to three specific activities within the age-friendly areas of work across the four sites (e.g. an age-friendly housing development). For each activity, we will describe the resources invested in £. We will compare these against the £ value of all its outcomes. This way, we can estimate how much is gained from investing in each activity. These findings will be presented simply as a resource that everybody can access on the internet._x000D_ _x000D_ To achieve all this, we will interview professionals and residents in each site, run workshops, carry out surveys, and analyse documents. All this will be done in line with relevant Covid-19 rules and guidance. We will adjust our approach if these change. We while pay particular attention to the fact that the study involves older and potentially vulnerable adults._x000D_ _x000D_ Members of the public have shaped this study. They have confirmed that our planned study is important, advised on our research plan, and helped clarify the approach. The Cambridge Positive Ageing Patient and Public Involvement will be consulted throughout the study, as will members of the public in each research site. Two members of the public will be on the study Advisory Group and offered training to work along-side the research team._x000D_ _x000D_ The findings will be published in public health and economics journals, and presented at conferences. They will also be presented via reports, press releases, social media, events, and a video. The study will conclude with a final event. The research will help us to better understand the health outcomes of age-friendly programmes and their social value. This will be used in decisions on whether, and how much, to invest in age-friendly work.

Lay abstract: People are living longer. Yet for many, the opportunities of a longer life are lost due to poor health and difficulty remaining involved in society. Many places across the UK aim to be ‘age-friendly’ through improved housing, transport and access to social activities to help older people to stay well and enjoy fulfilling lives. Understanding how such initiatives work, and whether investing in them is worthwhile is essential for their success and sustainability. Currently, we know little of their effect on health and even less of their value to communities. This project will assess Age-friendly City and Community (AFCC) projects using a Social Return on Investment (SROI) framework across four selected sites in England: Liverpool, Suffolk, Kelsall and Buckden. We will measure the social, economic and environmental values they generate – the social value – and compare this with their monetary costs._x000D_ _x000D_ SROI comprises several steps, each represented, in our study, by six complementary work packages (WP). We will systematically review what previous studies have found about AFCCs, and list the health and wellbeing outcomes used to measure their impact (WP1). In each site (WP2), we will identify two to three priority age-friendly areas of work (e.g. transport, leisure), and select two to three specific interventions across all sites to evaluate. We will identify the health and wellbeing outcomes prioritised by each community, and decide how to measure these. This will be achieved with document analysis, community surveys, interviews and consensus methods with practice stakeholders and members of the public, with further validation with national stakeholders._x000D_ _x000D_ The social value of priority outcomes (in £) will be calculated using a Discrete Choice Experiment (WP3). A representative panel of older adults will be presented hypothetical communities and asked to state their preferences. These will be recorded in a ‘social value bank’. We will also calculate the cost of the selected two to three interventions across the sites (WP4). This, and the total value of their outcomes, will serve to estimate their SROI (WP5). A final consultation (WP6) will help design a resource for practice stakeholders to assess the SROI of AFCC initiatives._x000D_ _x000D_ All data collection and meetings will be conducted in adherence with relevant Covid-19 rules and guidance. We will adjust our approach where necessary as these changes over time, and pay particular attention to the fact that the study involves older and potentially vulnerable adults._x000D_ _x000D_ This proposal was informed by extensive consultation with PPI contributors who advised on the research direction from inception. They will be consulted throughout, as will members of the public in the research sites. Two members of the public will be on the study Advisory Group, and offered training and involvement in dissemination activities._x000D_ _x000D_ Findings will be published in journals and presented at conferences. Reports for each study site, briefing papers, social media, public engagement events, and a video will be used to reach target audiences through our practitioner-focused, academic and public facing networks._x000D_ _x000D_ This study will provide evidence of the health-related outcomes and social value of AFCC initiatives through site specific evaluations; support decision making with an accessible bank of social values, and provide a stepped approach to assess the SROI of AFCC initiatives. Case studies will exemplify how the public and practice-based stakeholders shape AFC initiatives. It will make a robust methodological contribution to evidencing the social value of AFCC initiatives, as well as public health interventions generally. These outputs will address important evidence gaps, build capacity for evaluation and inform policy and practice designed to support ageing well.

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