The Social Relations of a Health Walk Group: An Ethnographic Study

Library based walking groups in Scotland: Exploring benefits, challenges and opportunities

Public libraries support a range of health and wellbeing activities, however little research has been done into the provision of library adult walking groups. This paper reports on a unique study exploring how widely adult walking groups are provided through Scottish public libraries, as well as library staff perceptions of the benefits, challenges and opportunities of these services. A rich qualitative research approach was used, involving Freedom of Information requests to the 32 Scottish local authority regions, an online questionnaire with 106 complete responses, and 8 follow-up interviews with Scottish public library staff, with and without walking group experience. Thematic analysis was used to identify key themes from collected data. Results show that adult walking groups are not widely provided through Scottish public libraries. However, respondents identified benefits for user groups, including but not limited to: improvements to participants’ health and social wellbeing; and increased engagement with library services. A range of opportunities for public libraries were highlighted, including staff interest, partnership working and a current focus on health and wellbeing. Challenges encompass resource restrictions, variations in partnership working and lack of effective networking. This original study provides valuable insights into the provision of public library walking groups in Scotland. It suggests that many factors can potentially influence the success of this library health and wellbeing service, with a range of different possible approaches. Results indicate that successful provision of a public library walking group may require close partnership working; adequate networking and information-sharing between public library staff; as well as sufficient resources; and staff interest. This exploratory study provides transferable insights and a basis for future research.

An international qualitative feasibility study to explore the process of using social innovation (co-production) strategies with older people: the SAIL project

Purpose

This paper aims to present the feasibility study findings from a four-year project funded by the European Union Commission (the SAIL project, Staying Active and Independent for Longer). The funding stream was Interreg 2Seas which offers opportunities for coastal areas on both sides of the English Channel to work together on complex practical issues. The project focused on enabling older people to stay active and independent for longer using social innovation (co-production) approaches.

Design/methodology/approach

Ten pilot projects were developed, and each of the pilots worked with an academic partner to undertake a feasibility study that included 10 pilots across the four countries involved, France, Belgium, Holland and England.

Findings

This paper presents barriers and facilitators (using logic models) to the social innovation process with older people, which has wider relevance in terms of social innovation and its application.

Research limitations/implications

The findings which inform this paper are extensive, and this is a longitudinal qualitative study with much of the data collection being done using an online wiki (complemented by interviews and documentary analysis) which is a relatively new method for data collection. However, the consistency of the findings when analysed by three researchers was clear and pragmatically this complex method was required to examine complexity in the process of implementing social innovation in practice.

Practical implications

This project has enabled greater understanding of how social innovation can be applied and has highlighted contextual issues that can undermine or enable attempts to adopt the approach.

Social implications

For the 10 pilot projects generated, there were obviously important cultural and geographical differences in terms of engagement and practical implementation of social innovation. Some of which, as mentioned in this paper, are very important for the successful implementation of social innovation in a particular setting and indeed may be a strength or a barrier in terms of engaging with local people and agencies.

Originality/value

The development of logic models is a useful approach when the topic under study is complex and likely to produce a diverse set of process outcomes. The logic model focuses upon the relationships between the resources that are used to create the intervention and what is produced in terms of outcomes. Ultimately, this enables the identification of the factors that contribute to a successful intervention. Thus, in relation to this study, logic models have helped to provide an evidence-based framework that can support decision-making regarding the most effective use of limited resources to support successful social innovation processes in the future. The logic model for each area of the findings presented here can in the future be used to help implement social innovation; also, to consider how it can be improved in future research.

Integrating physical activity into the treatment of depression in adults: A qualitative enquiry

Around 246 million people globally suffer from depression. Physical activity (PA) can reduce the risk of depression by 30% and is recognised as an effective treatment for mild-to-moderate depression (MMD). However, a high proportion of patients with MMD are currently inactive and the implementation of PA as an adherent treatment for MMD is not well understood. This study contributes to a growing body of research exploring how to support people who are experiencing MMD to increase their PA levels (i.e. initiation and maintenance). It investigated which factors individuals with MMD perceived to be important for integrating PA into the treatment of depression in adults. In-depth interviews were carried out with individuals with MMD (N = 6), and data were analysed using thematic analysis. Two main theories of social capital that of Bourdieu and Putnam informed the discussion of findings. The initiation and maintenance of PA were linked to individual factors including health (i.e. nature of depression; comorbidities); abilities and tastes; socioeconomic status (e.g. financial position) and positive encouragement. In addition, maintenance emerged as dependent upon the choice, enjoyment, and meaningfulness of PA itself, and, for those who engaged in group PA, on social capital. PA interventions need to be personalised. This goes beyond a simple exercise prescription based on functional ability, but instead takes into account the needs, desires and capabilities of the whole person. The nature of MMD, the wider physical and socio-economic context and the social capital that is available to the individual also need to be harnessed.

Mobility-A Bridge to Sense of Coherence in Everyday Life: Older Patients' Experiences of Participation in an Exercise Program During the First 3 Weeks After Hip Fracture Surgery

Our aim with this article was to explore the experiences of older people who participated in the evidence-based High-Intensity Functional Exercise (HIFE) Program during the first 3 weeks of rehabilitation after hip fracture surgery. Nineteen older people participated in the study. Data were analyzed using systematic text condensation. One overarching theme "Exercise is the key for regaining mobility and a sense of coherence (SOC) in everyday life" emerged from the analysis in addition to these five themes: (a) understanding the existential importance of mobility; (b) maintaining a positive self-image by regaining mobility; (c) regaining one's old life and independence in everyday living; (d) maintaining interpersonal relationships through mobility; and (e) creating positive emotions by being able to move. The findings highlight the importance of exercise as a strategy for regaining mobility, illustrated by the essential role it played in the participants' lives after suffering a hip fracture.

Functional and recreational dog walking practices in the UK

Dog walking is a popular everyday activity known to contribute considerably to human health through motivating substantial additional physical activity. However, despite recognition that walking with a dog is substantially different from walking without a dog, little is known sociologically about the practices of dog walking. This study used in-depth interviews with 38 dog owners, combined with autoethnographical observation of dog walking. The aim was to investigate the types of dog walks that occur and the implications of this for the promotion of dog walking to increase human and animal wellbeing. Two distinct types of dog walking were found that had differing influencers and resulting experiences. Functional walks were purposed through feelings of guilt to provide the dog with a convenient form of exercise but were less pleasurable for the owner. In contrast, recreational walks provided significant owner stress-relief and were longer, typically during pleasant weather and at weekends, in less urban environments, and involved more members of the household. Limitations on time availability, conducive weather or accessibility of desirable physical environments for dog walking, generated functional rather than recreational dog walks. These findings have implications for interventions aiming to promote dog walking and for policy relating to the availability of safe and suitable green spaces for encouraging dog walking.

The geographies of digital health - Digital therapeutic landscapes and mobilities

Digital technologies have long impacted the field of health, causing fundamental changes for the geographies of the production, movement, and consumption of health. Despite this, there is limited health geography engagement with digital health, and an understanding of how digital health affects the spatialities of health remains underdeveloped. Here, using autoethnography, I reflect on personal encounters with digital health in the UK to initiate analytical attention into the geographies of digital health. I demonstrate that digital health technologies are interconnected and increasingly structure access to health, impacting the equality of health; and that digital health disrupts existing, and creates new, therapeutic landscapes and mobilities.

The application of social innovation as it relates to older people and the implications for future policymaking: a scoping review

Purpose

Social innovation has received increasing attention in recent decades (Agostini et al., 2017). This study aims to consider how the concept has been applied to the issue of ageing and what can be learnt about effective policy responses.

Design/methodology/approach

The acknowledged lack of understanding generally about the concept makes it timely to undertake a scoping review of the current evidence from social innovation projects associated with older people. A scoping review is considered appropriate where there is a need to “identify and analyse knowledge gaps” (Munn et al., 2018, p. 2).

Findings

Findings from the scoping review indicate that, as yet, the concept of social innovation is not fully defined. However, it has widespread appeal across a diverse range of disciplines and has the potential to generate innovative policy responses.

Originality/value

A key argument identified is the need to change the public’s perceptions of ageing and devise public policies that encourage and nurture age-friendly communities. In summation, although social innovation has the potential to act as a policy driver, but to be effective, it is necessary to devise robust strategies to ensure full user-engagement and active involvement of communities. Therefore, it is the process of delivery that needs urgent attention in any future research into social innovation.

Beyond adherence to social prescriptions: How places, social acquaintances and stories help walking group members to thrive

Social prescribing (SP) is an increasingly popular means of enabling medical professionals to refer people to social activities. However, how individuals accommodate activity groups into their routines has been neglected by studies exploring SP. This paper uses qualitative approaches to explore how place and sociability influence the experiences of individuals with type-2 diabetes in a social prescription walking group. Using in-situ conversations and in-depth interviews, we demonstrate how place and sociability extends beyond a group via storytelling, and allows individuals to become part of a group. Understanding place, sociability and storytelling is critical in characterising the benefits of social prescription.

Communal therapeutic mobility in group walking: A meta-ethnography

Increased attention to links between walking, health and wellbeing have contributed to a growth in the number of walking groups meeting on a regular basis to offer short, social walks. Walking group interventions are known to increase physical activity and to have wide-ranging health benefits, and there is evidence that drop out is generally low. The aim of this paper is to synthesise qualitative research on experiences and perceptions of group walking in order to develop a new conceptual understanding of the group walking experience. We conducted a systematic search of the literature and identified 22 such studies which we synthesised using meta-ethnography. Included studies were conducted in the UK, USA, Australia and Ireland. Most reported research was undertaken with outdoor walking groups, some of which catered specifically for people who shared a disease experience or a disability. A smaller number of studies examined indoor mall walking groups, while two looked at perceptions of non-participants of group walking as a potential activity. From the original constructs identified in the papers we derived five higher order constructs: seeking and enjoying health and fitness, attachment to walking, providing purpose and confidence, mobile companionship and a peaceful and contemplative shared respite from everyday life. We argue that participating in a walking group provides a set of experiences that together constitute a specific form of shared or communal therapeutic mobility that is not simply the accumulation of the constructs we have outlined. Rather, we suggest that an initial instrumental and disciplinary focus on health and fitness is transformed through the experience of group walking into a shared meaningful and enjoyable practice; an emergent communal therapeutic mobility, which recruits and retains large numbers of group walkers. However, this communal therapeutic mobility is not equally accessible to all.

Doing more with movement: constituting healthy publics in movement volunteering programmes

The recent phenomenon of movement volunteering programmes is a form of 'fitness philanthropy' that combines exercise with volunteering in order for physical activity to generate a more widely shared set of benefits. These newest practices of fitness philanthropy radically rework both exercise and volunteering through the ways in which these come together and take place outdoors and in the everyday spaces of the street or community. The paper explores these new practices through the movement volunteering programme 'GoodGym', in relation to the concept of 'healthy publics'. Fieldwork comprised ethnography, including participant observation, interviews, go-along interviews, conversations, photography and an end of fieldwork discussion workshop. We focus on the experiences of three different constituencies in GoodGym: the volunteers; the participants and passers-by; the space and atmosphere. The formation of these dynamic, multiple and shifting healthy publics emerge through the complex intersections of several processes. We draw particular attention to the centrality in the new fitness philanthropy practices of visibility and spectacle, sociality and merging mobilities in constituting healthy publics.

Inequities and inequalities in outdoor walking groups: a scoping review

Background

Outdoor walking groups are widely-used programmes aimed at improving physical activity and health outcomes. Despite being promoted as accessible and inclusive, emerging work highlights participation biases based on gender, age and socioeconomic status, for example. To explicate the impact of outdoor walking groups on physical activity inequities, we conducted a scoping review of published outdoor walking group literatures. Specifically, we critically examined: (a) equity integration strategies; (b) intervention reach; (c) effectiveness; and (d) potential social determinants of engagement relating to the World Health Organization’s conceptual framework.

Methods

Arksey and O’Malley’s scoping review protocol was used to develop a comprehensive search strategy and identify relevant academic and grey literatures, which were screened using pre-defined inclusion and exclusion criteria. Data were organised by Cochrane PROGRESS-Plus equity characteristics and a narrative summary was presented for each thematic area.

Findings

Sixty-two publications were included. Key findings were: (a) some evidence of targeted intervention trials. Large-scale national programmes were tailored to regional activity and health needs, which may contribute toward addressing inequities. However, participant demographics seldom informed reported analyses; (b) participation was more likely among white, more socioeconomically advantaged, middle-to-older aged, female and able-bodied adults; (c) positive physical and psychological outcomes were unlikely to extend along social gradients; and (d) interventions primarily addressed intermediary determinants (e.g. psychosocial barriers; material resource). Social capital (e.g. friend-making) was identified as potentially important for addressing physical activity inequalities.

Conclusions

The published literature on outdoor walking groups leaves unanswered questions regarding participation inequalities, with implications for future physical activity promotion. Currently, participation in outdoor walking groups is typically more prevalent among advantaged subpopulations. We make recommendations for research and practice to address these issues, as well as aid the translation of existing knowledge into practice. We advocate increased focus on the social determinants of engagement. A more consistent approach to collecting and analysing participant socio-demographic data is required. Our findings also support recommendations that appropriate tailoring of universal programmes to community needs and embedding strategies to increase social cohesion are important in developing equitable programmes.

Pursuing Well-Being Among Rural-Dwelling Adults With Disabilities

Through this constructivist grounded theory study, it was our purpose to create a substantive theory to explain how rural-dwelling, working-age adults with disabilities define and pursue well-being. Twelve rural-dwelling participants were interviewed up to 3 times to understand the processes involved in defining and pursuing well-being. From this exploration, we suggest that well-being is not a set state to be achieved and then enjoyed, rather well-being results from establishing and maintaining membership in the rural community. Membership facilitated access to the array of material and psychological supports needed for a sense of well-being. Findings support the assumption that urban models of care are insufficient for rural areas. This study also provides an understanding of how individuals in this population mobilize resources to overcome functional limitations and environmental barriers to establish group membership and create a sense of well-being. Implications for health care practice and policy are discussed.

Perceived Environmental, Individual and Social Factors of Long-Distance Collective Walking in Cities

Long-distance collective walking is a popular activity in cities across China. However, related research is limited, creating a research gap to explore participants' dynamic experience and related influential factors. Therapeutic mobilities theory explores the relationships among walking, health, and well-being from a qualitative perspective. Based on therapeutic mobilities theory, following a systematic process, this study develops a scale to quantitatively estimate the perceived environmental, personal, and social factors that may influence health and well-being. By applying construal level theory, this paper further hypothesizes that personality traits and familiarity moderate environmental, personal, and social perceptions. Data were collected with a paper survey (n = 926) from the "Shenzhen 100 km Walking" event. The findings highlight that long-distance collective walkers have comparatively greater experiences of health and well-being in three aspects: positive social interaction, individual development, and environmental understanding. Personality traits, familiarity, and gender moderate this well-being experience. Theoretical and managerial implications are discussed.

Navigating Nuances of Language and Meaning: Challenges of Cross-Language Ethnography Involving Shona Speakers Living With Schizophrenia

For people living with schizophrenia, their experience is personal and culturally bound. Focused ethnography enables researchers to understand people's experiences in-context, a prerequisite to providing person-centered care. Data are gathered through observational fieldwork and in-depth interviews with cultural informants. Regardless of the culture, ethnographic research involves resolving issues of language, communication, and meaning. This article discusses the challenges faced by a bilingual, primary mental health nurse researcher when investigating the experiences of people living with schizophrenia in Zimbabwe. Bilingual understanding influenced the research questions, translation of a validated survey instrument and interview transcripts, analysis of the nuances of dialect and local idioms, and confirmation of cultural understanding. When the researcher is a bilingual cultural insider, the insights gained can be more nuanced and culturally enriched. In cross-language research, translation issues are especially challenging when it involves people with a mental illness and requires researcher experience, ethical sensitivity, and cultural awareness.