Prescribe Heritage Highland: Scaling Up Non-Pharmaceutical Interventions in Remote and Rural Areas

This project aims to establish the conditions for scalability of non-pharmaceutical cultural and natural heritage interventions in remote and rural areas. Exercise groups, outdoor activities, art therapies and peer support are increasingly being 'prescribed' to 'treat' both mental health conditions and address sedentary lifestyles. However, little has so far been done on how to deliver them at scale in remote and rural contexts. 17% of Scotland's population live in rural areas. Service providers face economic and logistical challenges delivering across large geographical areas with dispersed populations. Although rural communities can be perceived as tight-knit and resilient, the problems of mental ill-health, social isolation and deprivation can be hidden. However, rural areas have many natural and cultural assets on which non-pharmaceutical 'treatments' can be based to benefit a wide range of patients. Our study will focus on how to overcome challenges for service commissioners and planners; how to improve referral pathways to increase take up of non-pharmaceutical services; tackling delivery challenges faced by third sector providers; and identifying contextual factors determining the effective scaling up of non-pharmaceutical heritage interventions. We will identify the key conditions, mechanisms and contexts needed to scale up the prescription of these interventions so they can form part of mainstream health provision. To achieve this, we will explore scaling up from multi-stakeholder perspectives using qualitative research methods in conjunction with a scalability assessment. We will build our research around the 'Prescribe Culture' programme, developed by the University of Edinburgh, and use it as the basis to test scaling up in remote and rural areas. The cultural programme will be delivered both online and face to face with hands on workshops led by rural museums across the Highland region. Nature-based activities will also be led by countryside rangers. Focusing on this cultural and natural heritage intervention, we will look in detail at service planning/commissioning, referral, delivery, marketing and impact on providers, professionals and patients. Qualitative research methods such as interviewing will enable us to examine the challenges of scaling up from all angles along the social prescribing pathway. This mixed methods study will include a scalability assessment. A steering group of decision-makers, service planners and representatives from the voluntary sector will help inform the scalability assessment. Following a literature and policy review, we will interview or hold focus groups with steering group members, health professionals, community link workers, intervention facilitators and participants. In NHS Highland, Community Link Workers (CLWs) will be embedded in GPs practices in an attempt to reduce health inequalities. Located in areas of deprivation, CLWs will help patients to identify appropriate non-clinical activities or support. The heritage intervention will be delivered in areas where these CLWs are based. Outputs will include a final report, peer-reviewed publication, conference presentation, virtual exhibition of workshop material and a short film to raise awareness about social prescribing. A social prescribing 'fair' will be organised for the public and health professionals, so third sector providers can showcase a range of non-pharmaceutical interventions. Engagement with decision-makers and service providers is a key aspect and delivered via the steering group of representatives from NHS Highland, Highland Council and the third sector. We will develop a set of recommendations to help inform scaling up of services. We will disseminate findings through a range of organisations such as the NHS, Scottish Parliament Cross-party Working Group on Health Inequalities, Scottish Rural Health Partnership, Scottish Social Prescribing Network and Voluntary Health Scotland (VHS).