Co-Creating Asset and Place-Based Approaches to Tackling Refugee and Migrant Health Exclusion
Lead Research Organisation:
Anglia Ruskin University
Department Name: Fac of Health, Educ, Med & Social Care
Abstract
Refugees, asylum seekers and migrants (R/AS/Ms) are varyingly yet systematically disadvantaged (EHRC, 2016) throughout their migration and resettlement journeys, as well as (typically) across the post-migration life-course (Allsopp, Sigona and Phillimore, 2014; BMA, 2021; Kemmak, Nargesi and Saniee, 2021). Inequitable access to health-care (physical and mental) and the ability to meaningfully access NHS/integrated care services, whilst fundamental to counteracting health disadvantage, is but one element in relation to improving wellbeing outcomes for these populations.
Poor health experienced by the above groups result from inequitable access to services and opportunities across the social determinants of health (SDOH) including: language barriers, accommodation, employment, education, frequent (often enforced) movement, poverty, and discrimination (Castañeda et al., 2015; Davies, 2006; Marmot et al., 2020). So deep are these exclusions that experience of multiple disadvantage is common, and has been found to persist across the life-course, worsening exponentially for some individuals at particular life-stages, or resulting from possession of 'protected characteristics' (Aldridge et al., 2018; Borhade and Dey, 2018; Dagilyte et al., 2022; The Migration Observatory, 2020)
Against this backdrop, our innovative co-created interdisciplinary research proposal which draws together expertise from a broad range of stakeholders from academia, policy professions, community development, healthcare (front-line practitioners, public health commissioners and Integrated Care Systems [ICS]), statutory and local government sectors, civil society agencies and creatives; has been designed.
The key research aim (framed through understanding the experiences of R/AS/M migrant communities in relation to how diverse SDOHs impact wellbeing, and which by extension is transferable to wider populations) is: to generate an evidence-based conceptual framework for transdisciplinary interventions in health care that allow community assets to be efficiently integrated; in turn supporting cost-efficient, accessible, scalable services, delivered locally and regionally by ICSs and their key partners.
Poor health experienced by the above groups result from inequitable access to services and opportunities across the social determinants of health (SDOH) including: language barriers, accommodation, employment, education, frequent (often enforced) movement, poverty, and discrimination (Castañeda et al., 2015; Davies, 2006; Marmot et al., 2020). So deep are these exclusions that experience of multiple disadvantage is common, and has been found to persist across the life-course, worsening exponentially for some individuals at particular life-stages, or resulting from possession of 'protected characteristics' (Aldridge et al., 2018; Borhade and Dey, 2018; Dagilyte et al., 2022; The Migration Observatory, 2020)
Against this backdrop, our innovative co-created interdisciplinary research proposal which draws together expertise from a broad range of stakeholders from academia, policy professions, community development, healthcare (front-line practitioners, public health commissioners and Integrated Care Systems [ICS]), statutory and local government sectors, civil society agencies and creatives; has been designed.
The key research aim (framed through understanding the experiences of R/AS/M migrant communities in relation to how diverse SDOHs impact wellbeing, and which by extension is transferable to wider populations) is: to generate an evidence-based conceptual framework for transdisciplinary interventions in health care that allow community assets to be efficiently integrated; in turn supporting cost-efficient, accessible, scalable services, delivered locally and regionally by ICSs and their key partners.
| Description | Methodshop training on participatory arts-based and visual methods in mental health for Medicine Sans Frontiers |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | At the end of the training, participants had to present and receive feedback on how they can apply these methods to their current or upcoming work in the field. |
| Description | Training of peer-researchers on participatory and creative methodologies |
| Geographic Reach | National |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | Most of the peer/community researchers had no previous research experience and none of them had prior knowledge of ethical and methodological aspects of participatory and creative methods. At the successful completion of the training, including the home practice, the ECRs received a certificate. |
| Title | Digital Mapping of Community Assets in field-site locations |
| Description | Working with our community participants, CCRs and wider stakeholders, we are near completion of the first iteration of the 'community asset map' which will go live later in 2025. This map contains details of a range of community assets identified by all of the above groups in the diverse field-sites. In the second iteration to follow - as we gather more data - we will then populate this with assets identified by Community Forum participants which will be available to view, and incorporate audio, visual and other sources of creative data gathered through our research, in addition to the phase one pin-drop map which shows a range of assets such as health centres, law centres, community groups, foodbanks etc. |
| Type Of Material | Improvements to research infrastructure |
| Year Produced | 2025 |
| Provided To Others? | No |
| Impact | This map is under development and will go live in late Spring/early Summer 2025 - we are in discussion with stakeholders and community over what assets should be made public and which are potentially 'sensitive' assets which might subject users to risk - eg migrant/refugee community meeting locations in private premises or community clubs. Once this is decided upon, the map will be accessible to the public via the project website |
| Title | Training of Community Researchers in multi-method and creative arts data gathering |
| Description | We have developed a training package, delivered across 3 sequential training sessions (2 face to face full day events across multiple field sites (one on-line and additional 'home-work' and practice walking interviews) for our community co-researchers (CCRs). In total 23 CCRs have received the training. 13 academics and community partners also undertook the training. We are intending to write-up the training more fully subject to agreement with the authors (academic CIs) and consider making this available more widely. All training materials are accessible to CCRs and confidential to research team at present behind a password protected element of the migrefhealth website. |
| Type Of Material | Improvements to research infrastructure |
| Year Produced | 2024 |
| Provided To Others? | No |
| Impact | CCRs and community collaborators/academics have given very positive feedback on the training package which has supported the first stage qualitative data-gathering activities through 'walking interviews' (76 undertaken so far across 11 field-sites - nb: Weathersfield Camp is being treated in a different manner given it is a first destination extremely large asylum holding centre so we are mapping asset use and interviewing there rather than undertaking local walking interviews with the residents given high numbers there - in the region of 900 men- and short duration of their residence which is for a maximum of 9 months which does not align to the duration of the project). |
| Description | Collaboration with Universita' Milano-Bicocca for a visual/digital methodologies laboratory |
| Organisation | University of Milano-Bicocca |
| Country | Italy |
| Sector | Academic/University |
| PI Contribution | This institution has requested to share learnings on the use of visual methodologies to their postgraduate students through a series of laboratories, currently under development. |
| Collaborator Contribution | provided funding and the logistic organization of the laboratories and film screening |
| Impact | in progress |
| Start Year | 2024 |
| Description | Collaborative working with NHS Norfolk and Waveney |
| Organisation | NHS Norfolk and Waveney ICB |
| Country | United Kingdom |
| Sector | Public |
| PI Contribution | We have provided direct advice to members of the above ICB in relation to their improving lives activities with regard to engagement with communities, and costings for supporting commnity groups/people with lived experience into collaborative research roles |
| Collaborator Contribution | Sharing networking opportunities, inviting us to present on our project (two of our field-sites are within this ICB), and join with their community walks. This supports networking and publicity about our project and has assisted in identifying potential participants and community researchers |
| Impact | n/a |
| Start Year | 2024 |
| Description | Community Forums across 12 field sites |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Study participants or study members |
| Results and Impact | The first community forum was the launch event in each of the 12 sites. During these meetings the teams presented the project to community leaders, potential participants from the core nationalities and stakeholders. These events were also used to identify key individuals who were suited to the role of a community co-researcher, and subsequently invited to apply. In total approximately 235 people attended the 12 launch events. These were key networking opportunities for the stakeholders and project team. The second community forum held in each of the 12 field sites were initial data collection focus groups with the core nationalities plus the specific EU and Non-EU nationality groups that the community partners had established contacts with. The purpose of the focus group was to discover asset use of known assets, validate asset information and gain information of unknown assets and their use based on lived experience. Three physical maps were produced, and drawn, to generate discussion and answers to a series of focus group questions, in this world cafe style session. In total approximately 160 participants contributed across the 12 field sites. |
| Year(s) Of Engagement Activity | 2024,2025 |
| URL | https://migrefhealth.co.uk/ |
| Description | Featured on ARU - short video about research activities - flagging up aspects of this current project |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Media (as a channel to the public) |
| Results and Impact | Short Film on research being undertaken at ARU - Greenfields featuring in this production speaking about the current project. Release date 12th March - url to follow - will be distributed widely through university channels and to international academic recruiters |
| Year(s) Of Engagement Activity | 2025 |
| Description | Participation in DHSC working group July 2024 and follow-up meeting 19 November 2024 to draft a response and guidance to questions raised in that meeting |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Participating by invitation - via Theme Leader - Prof Helen Chatterjee in DHSC working group and discussion on language use/barriers in health and other settings. Subsequently invited to smaller working group drafting a response to questions arising from the meeting submitted to DHSC and other Ministries and aligned to developing Government strategies across multiple areas including health/social care/education/employment and security. |
| Year(s) Of Engagement Activity | 2024 |
| Description | Presentation - East of England Local Government Association and Roundtable participation |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Presentation on our project, anticipated outcomes and activities to date to audience of approximately 100 people, representatives from health services, local authorities and voluntary sector organisations working across the East of England in our field-sites and beyond. |
| Year(s) Of Engagement Activity | 2024 |
| URL | https://www.eelga.gov.uk/events/eelga-roundtable-discussion-improving-outcomes-for-asylum-seekers-re... |
| Description | Presentation to East of England health professional network conference including information and updates on this project |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | Invited to introduce the current project as part of a presentation at the inaugural EPIIC in June 2024 and again to update on activities in March 2025 to a specialist audience including NHS England, ICB representatives, clinicians, local authority representatives and community groups EPIIC Conference [Eastern Partnership for Innovations in Integrated Care (EPIIC)]. |
| Year(s) Of Engagement Activity | 2024,2025 |