Building Research by Communities to address Inequities through Expression (ReCITE) Consortium

Lead Research Organisation: Liverpool School of Tropical Medicine
Department Name: International Public Health


Culture and the arts contribute to health and wellbeing and can help shift the focus away from disease to viewing health in its broader context, focused around people. Culture and the arts can also contribute to addressing more complex health equity problems for which there are very few health care solutions. Whilst Liverpool has a rich heritage of arts and culture, it is also the third most deprived local authority in the country. Despite having prioritised equity and social determinants of health, health inequities have widened, exacerbated by the Covid-19 pandemic. Life expectancy differs by more than 12 years between the most and least deprived wards of the city. We aim to create a strong research partnership whose ultimate objective is to help reduce disparities in health through linking the rich creative heritage within our city to community health. We will build on a community based participatory research model, originally developed to tackle equity and health care quality for Kenyan communities and recently adapted to address inequitable COVID-19 vaccine uptake in Liverpool. Our model has demonstrated that communities are experts in their own health and that community co-researchers can collect, analyse and use data to develop and implement solutions to address local health inequities, monitor their progress and evaluate whether their work is having a positive impact. This work has involved narratives, storyboards and Photovoice but has not yet formally incorporated intervention approaches from culture and the arts, nor explored how to assess the impact of doing this. Our research consortium will be creating new knowledge. We will work with existing Community Innovation Teams and a funded initiative within Liverpool City Council of community champions from minority and disadvantaged communities, linked to grassroots organisations who have developed engagement and outreach work through Liverpool's NHS Primary Care Network. Our focus will initially be on storytelling as an art form that can help disadvantaged communities and people to express, share and validate their lived experiences. Storytelling can be used to collect and make sense of community data, strengthen agency of individuals and groups to take action, communicate disparities to policy makers, provide health messaging and reduce the consequences of inequities through solidarity and inclusion. Storytelling interventions have been successfully used in Liverpool to identify barriers to accessing healthcare, particularly amongst vulnerable or black and ethnic minority populations and used to address for example, living with mental health and chronic health conditions (as a type of social prescribing). We will seek to engage existing networks of creative community assets within Liverpool and extend engagement beyond these to other actors. We will combine evidence of what works with theory to better understand the relationships between arts and culture, community-based research and health inequities. Our "theory of change" will help us understand what is needed to scale-up this work, measure its impact and broaden its reach. Therefore, our initial area of inquiry will be based on both theory and practice for using storytelling in Community Based Participatory Action Research to tackle health inequities. We expect the model of working will be transferable to other cultural or artistic interventions and community assets. The consortium will build on, but also extend, existing collaborations which are best placed to address the research focal areas agreed through participatory processes. Capabilities and cross fertilisation of ideas across these groups will be strengthened allowing the design of robust research designs. At the end of this phase of funding a new research-ready consortium will have been built. Our consortium is all about research "developed by communities for communities" within an ethical framework.


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